The Promise and Challenge of Practice-Research Collaborations: Guiding Principles and Strategies for Initiating, Designing, and Implementing Program Evaluation Research

ERIC Educational Resources Information Center

Secret, Mary; Abell, Melissa L.; Berlin, Trey

2011-01-01

The authors present a set of guiding principles and strategies to facilitate the collaborative efforts of social work researchers and practitioners as they initiate, design, and implement outcome evaluations of human service interventions and programs. Beginning with an exploration of the interpersonal barriers to practice-research collaborations,…

Evaluations of the conformational search accuracy of CAMDAS using experimental three-dimensional structures of protein-ligand complexes

NASA Astrophysics Data System (ADS)

Oda, A.; Yamaotsu, N.; Hirono, S.; Takano, Y.; Fukuyoshi, S.; Nakagaki, R.; Takahashi, O.

2013-08-01

CAMDAS is a conformational search program, through which high temperature molecular dynamics (MD) calculations are carried out. In this study, the conformational search ability of CAMDAS was evaluated using structurally known 281 protein-ligand complexes as a test set. For the test, the influences of initial settings and initial conformations on search results were validated. By using the CAMDAS program, reasonable conformations whose root mean square deviations (RMSDs) in comparison with crystal structures were less than 2.0 Å could be obtained from 96% of the test set even though the worst initial settings were used. The success rate was comparable to those of OMEGA, and the errors of CAMDAS were less than those of OMEGA. Based on the results obtained using CAMDAS, the worst RMSD was around 2.5 Å, although the worst value obtained was around 4.0 Å using OMEGA. The results indicated that CAMDAS is a robust and versatile conformational search method and that it can be used for a wide variety of small molecules. In addition, the accuracy of a conformational search in relation to this study was improved by longer MD calculations and multiple MD simulations.

Development and Use of a Goal Setting/Attainment Process Designed To Measure a Teacher's Ability To Engage in Professional Growth and Leadership Initiatives.

ERIC Educational Resources Information Center

Minix, Nancy; And Others

The process used to evaluate progress in identifying the goals to be used in evaluating teacher performance under the Kentucky Career Ladder Program is described. The process pertains to two areas of teacher development: (1) professional growth and development, and (2) professional leadership and initiative. A total of 1,650 individuals were asked…

Evaluation of Stratospheric Transport in New 3D Models Using the Global Modeling Initiative Grading Criteria

NASA Technical Reports Server (NTRS)

Strahan, Susan E.; Douglass, Anne R.; Einaudi, Franco (Technical Monitor)

2001-01-01

The Global Modeling Initiative (GMI) Team developed objective criteria for model evaluation in order to identify the best representation of the stratosphere. This work created a method to quantitatively and objectively discriminate between different models. In the original GMI study, 3 different meteorological data sets were used to run an offline chemistry and transport model (CTM). Observationally-based grading criteria were derived and applied to these simulations and various aspects of stratospheric transport were evaluated; grades were assigned. Here we report on the application of the GMI evaluation criteria to CTM simulations integrated with a new assimilated wind data set and a new general circulation model (GCM) wind data set. The Finite Volume Community Climate Model (FV-CCM) is a new GCM developed at Goddard which uses the NCAR CCM physics and the Lin and Rood advection scheme. The FV-Data Assimilation System (FV-DAS) is a new data assimilation system which uses the FV-CCM as its core model. One year CTM simulations of 2.5 degrees longitude by 2 degrees latitude resolution were run for each wind data set. We present the evaluation of temperature and annual transport cycles in the lower and middle stratosphere in the two new CTM simulations. We include an evaluation of high latitude transport which was not part of the original GMI criteria. Grades for the new simulations will be compared with those assigned during the original GMT evaluations and areas of improvement will be identified.

Physiotherapy in rheumatoid arthritis: development of a practice guideline.

PubMed

Hurkmans, E J; van der Giesen, F J; Bloo, H; Boonman, D C; van der Esch, M; Fluit, M; Hilberdink, W K; Peter, W F; van der Stegen, H P; Veerman, E A; Verhoef, J; Vermeulen, H M; Hendriks, H M; Schoones, J W; Vliet Vlieland, T P

2011-01-01

To improve the quality of the physiotherapy management in patients with rheumatoid arthritis (RA) a Dutch practice guideline, based on current scientific evidence and best practice, was developed. This guideline comprised all elements of a structured approach (assessment, treatment and evaluation) and was based on the Internatio-nal Classification of Functioning, disability and Health (ICF) and the ICF core sets for RA. A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence was graded (1-4). For the initial assessment and evaluation mainly review papers and textbooks were used. Based on evidence and expert opinion, recommendations were formulated. A first draft of the guideline was reviewed by 10 experts from different professional backgrounds resulting in the final guideline. In total 7 topics were selected. For the initial assessment, three recommendations were made. Based on the ICF core sets for RA a list of health problems relevant for the physiotherapist was made and completed with red flags and points of attention. Concerning treatment, three recommendations were formulated; both exercise therapy and education on physiotherapy were recommended, whereas passive interventions (delivery of heat or cold, mechanical, electric and electromagnetic energy, massage, passive mobilization/manipulation and balneotherapy) were neither recommended nor discouraged. For treatment evaluation at the level of activities and participation, the Health Assessment Questionnaire was recommended. For evaluating specific body structures and functions the handheld dynamometer, 6-minute walk test or Ästrand bicycle test (including Borg-scale for rating the perceived exertion), Escola Paulista de Medicina Range of Motion Scale and a Visual Analog Scale for pain and morning stiffness were recommended. This physiotherapy practice guideline for RA included seven recommendations on the initial assessment, treatment and evaluation, which were all based on the ICF and the ICF Core Set for RA. The implementation of the guideline in clinical practice needs further evaluation.

Thiol-Ene functionalized siloxanes for use as elastomeric dental impression materials

PubMed Central

Cole, Megan A.; Jankousky, Katherine C.; Bowman, Christopher N.

2014-01-01

Objectives Thiol- and allyl-functionalized siloxane oligomers are synthesized and evaluated for use as a radical-mediated, rapid set elastomeric dental impression material. Thiol-ene siloxane formulations are crosslinked using a redox-initiated polymerization scheme, and the mechanical properties of the thiol-ene network are manipulated through the incorporation of varying degrees of plasticizer and kaolin filler. Formulations with medium and light body consistencies are further evaluated for their ability to accurately replicate features on both the gross and microscopic levels. We hypothesize that thiol-ene functionalized siloxane systems will exhibit faster setting times and greater detail reproduction than commercially available polyvinylsiloxane (PVS) materials of comparable consistencies. Methods Thiol-ene functionalized siloxane mixtures formulated with varying levels of redox initiators, plasticizer, and kaolin filler are made and evaluated for their polymerization speed (FTIR), consistency (ISO4823.9.2), and surface energy (goniometer). Feature replication is evaluated quantitatively by SEM. The Tg, storage modulus, and creep behavior are determined by DMA. Results Increasing redox initiation rate increases the polymerization rate but at high levels also limits working time. Combining 0.86 wt% oxidizing agent with up to 5 wt% plasticizer gave a working time of 3 min and a setting time of 2 min. The selected medium and light body thiol-ene formulations also achieved greater qualitative detail reproduction than the commercial material and reproduced micrometer patterns with 98% accuracy. Significance Improving detail reproduction and setting speed is a primary focus of dental impression material design and synthesis. Radical-mediated polymerizations, particularly thiol-ene reactions, are recognized for their speed, reduced shrinkage, and ‘click’ nature. PMID:24553250

Pilot study of pharmacist-assisted delivery of pharmacogenetic testing in a primary care setting.

PubMed

Haga, Susanne B; LaPointe, Nancy M Allen; Cho, Alex; Reed, Shelby D; Mills, Rachel; Moaddeb, Jivan; Ginsburg, Geoffrey S

2014-09-01

To describe the rationale and design of a pilot program to implement and evaluate pharmacogenetic (PGx) testing in a primary care setting. Several factors have impeded the uptake of PGx testing, including lack of provider knowledge and challenges with operationalizing PGx testing in a clinical practice setting. We plan to compare two strategies for the implementation of PGx testing: a pharmacist-initiated testing arm compared with a physician-initiated PGx testing arm. Providers in both groups will be required to attend an introduction to PGx seminar. Anticipated results: We anticipate that providers in the pharmacist-initiated group will be more likely to order PGx testing than providers in the physician-initiated group. Overall, we aim to generate data that will inform an effective delivery model for PGx testing and to facilitate a seamless integration of PGx testing in primary care practices.

Evaluation of various LandFlux evapotranspiration algorithms using the LandFlux-EVAL synthesis benchmark products and observational data

NASA Astrophysics Data System (ADS)

Michel, Dominik; Hirschi, Martin; Jimenez, Carlos; McCabe, Mathew; Miralles, Diego; Wood, Eric; Seneviratne, Sonia

2014-05-01

Research on climate variations and the development of predictive capabilities largely rely on globally available reference data series of the different components of the energy and water cycles. Several efforts aimed at producing large-scale and long-term reference data sets of these components, e.g. based on in situ observations and remote sensing, in order to allow for diagnostic analyses of the drivers of temporal variations in the climate system. Evapotranspiration (ET) is an essential component of the energy and water cycle, which can not be monitored directly on a global scale by remote sensing techniques. In recent years, several global multi-year ET data sets have been derived from remote sensing-based estimates, observation-driven land surface model simulations or atmospheric reanalyses. The LandFlux-EVAL initiative presented an ensemble-evaluation of these data sets over the time periods 1989-1995 and 1989-2005 (Mueller et al. 2013). Currently, a multi-decadal global reference heat flux data set for ET at the land surface is being developed within the LandFlux initiative of the Global Energy and Water Cycle Experiment (GEWEX). This LandFlux v0 ET data set comprises four ET algorithms forced with a common radiation and surface meteorology. In order to estimate the agreement of this LandFlux v0 ET data with existing data sets, it is compared to the recently available LandFlux-EVAL synthesis benchmark product. Additional evaluation of the LandFlux v0 ET data set is based on a comparison to in situ observations of a weighing lysimeter from the hydrological research site Rietholzbach in Switzerland. These analyses serve as a test bed for similar evaluation procedures that are envisaged for ESA's WACMOS-ET initiative (http://wacmoset.estellus.eu). Reference: Mueller, B., Hirschi, M., Jimenez, C., Ciais, P., Dirmeyer, P. A., Dolman, A. J., Fisher, J. B., Jung, M., Ludwig, F., Maignan, F., Miralles, D. G., McCabe, M. F., Reichstein, M., Sheffield, J., Wang, K., Wood, E. F., Zhang, Y., and Seneviratne, S. I. (2013). Benchmark products for land evapotranspiration: LandFlux-EVAL multi-data set synthesis. Hydrology and Earth System Sciences, 17(10): 3707-3720.

Using evaluation theory in priority setting and resource allocation.

PubMed

Smith, Neale; Mitton, Craig; Cornelissen, Evelyn; Gibson, Jennifer; Peacock, Stuart

2012-01-01

Public sector interest in methods for priority setting and program or policy evaluation has grown considerably over the last several decades, given increased expectations for accountable and efficient use of resources and emphasis on evidence-based decision making as a component of good management practice. While there has been some occasional effort to conduct evaluation of priority setting projects, the literatures around priority setting and evaluation have largely evolved separately. In this paper, the aim is to bring them together. The contention is that evaluation theory is a means by which evaluators reflect upon what it is they are doing when they do evaluation work. Theories help to organize thinking, sort out relevant from irrelevant information, provide transparent grounds for particular implementation choices, and can help resolve problematic issues which may arise in the conduct of an evaluation project. A detailed review of three major branches of evaluation theory--methods, utilization, and valuing--identifies how such theories can guide the development of efforts to evaluate priority setting and resource allocation initiatives. Evaluation theories differ in terms of their guiding question, anticipated setting or context, evaluation foci, perspective from which benefits are calculated, and typical methods endorsed. Choosing a particular theoretical approach will structure the way in which any priority setting process is evaluated. The paper suggests that explicitly considering evaluation theory makes key aspects of the evaluation process more visible to all stakeholders, and can assist in the design of effective evaluation of priority setting processes; this should iteratively serve to improve the understanding of priority setting practices themselves.

Development and Formative Evaluation of Computer Simulated College Chemistry Experiments.

ERIC Educational Resources Information Center

Cavin, Claudia S.; Cavin, E. D.

1978-01-01

This article describes the design, preparation, and initial evaluation of a set of computer-simulated chemistry experiments. The experiments entailed the use of an atomic emission spectroscope and a single-beam visible absorption spectrophometer. (Author/IRT)

Initial Results of an MDO Method Evaluation Study

NASA Technical Reports Server (NTRS)

Alexandrov, Natalia M.; Kodiyalam, Srinivas

1998-01-01

The NASA Langley MDO method evaluation study seeks to arrive at a set of guidelines for using promising MDO methods by accumulating and analyzing computational data for such methods. The data are collected by conducting a series of re- producible experiments. In the first phase of the study, three MDO methods were implemented in the SIGHT: framework and used to solve a set of ten relatively simple problems. In this paper, we comment on the general considerations for conducting method evaluation studies and report some initial results obtained to date. In particular, although the results are not conclusive because of the small initial test set, other formulations, optimality conditions, and sensitivity of solutions to various perturbations. Optimization algorithms are used to solve a particular MDO formulation. It is then appropriate to speak of local convergence rates and of global convergence properties of an optimization algorithm applied to a specific formulation. An analogous distinction exists in the field of partial differential equations. On the one hand, equations are analyzed in terms of regularity, well-posedness, and the existence and unique- ness of solutions. On the other, one considers numerous algorithms for solving differential equations. The area of MDO methods studies MDO formulations combined with optimization algorithms, although at times the distinction is blurred. It is important to

2006 Bethesda International Consensus recommendations on the immunophenotypic analysis of hematolymphoid neoplasia by flow cytometry: optimal reagents and reporting for the flow cytometric diagnosis of hematopoietic neoplasia.

PubMed

Wood, Brent L; Arroz, Maria; Barnett, David; DiGiuseppe, Joseph; Greig, Bruce; Kussick, Steven J; Oldaker, Teri; Shenkin, Mark; Stone, Elizabeth; Wallace, Paul

2007-01-01

Immunophenotyping by flow cytometry has become standard practice in the evaluation and monitoring of patients with hematopoietic neoplasia. However, despite its widespread use, considerable variability continues to exist in the reagents used for evaluation and the format in which results are reported. As part of the 2006 Bethesda Consensus conference, a committee was formed to attempt to define a consensus set of reagents suitable for general use in the diagnosis and monitoring of hematopoietic neoplasms. The committee included laboratory professionals from private, public, and university hospitals as well as large reference laboratories that routinely operate clinical flow cytometry laboratories with an emphasis on lymphoma and leukemia immunophenotyping. A survey of participants successfully identified the cell lineage(s) to be evaluated for each of a variety of specific medical indications and defined a set of consensus reagents suitable for the initial evaluation of each cell lineage. Elements to be included in the reporting of clinical flow cytometric results for leukemia and lymphoma evaluation were also refined and are comprehensively listed. The 2006 Bethesda Consensus conference represents the first successful attempt to define a set of consensus reagents suitable for the initial evaluation of hematopoietic neoplasia. Copyright 2007 Clinical Cytometry Society.

Systemic characterization and evaluation of particle packings as initial sets for discrete element simulations

NASA Astrophysics Data System (ADS)

Morfa, Carlos Recarey; Cortés, Lucía Argüelles; Farias, Márcio Muniz de; Morales, Irvin Pablo Pérez; Valera, Roberto Roselló; Oñate, Eugenio

2018-07-01

A methodology that comprises several characterization properties for particle packings is proposed in this paper. The methodology takes into account factors such as dimension and shape of particles, space occupation, homogeneity, connectivity and isotropy, among others. This classification and integration of several properties allows to carry out a characterization process to systemically evaluate the particle packings in order to guarantee the quality of the initial meshes in discrete element simulations, in both the micro- and the macroscales. Several new properties were created, and improvements in existing ones are presented. Properties from other disciplines were adapted to be used in the evaluation of particle systems. The methodology allows to easily characterize media at the level of the microscale (continuous geometries—steels, rocks microstructures, etc., and discrete geometries) and the macroscale. A global, systemic and integral system for characterizing and evaluating particle sets, based on fuzzy logic, is presented. Such system allows researchers to have a unique evaluation criterion based on the aim of their research. Examples of applications are shown.

Systemic characterization and evaluation of particle packings as initial sets for discrete element simulations

NASA Astrophysics Data System (ADS)

Morfa, Carlos Recarey; Cortés, Lucía Argüelles; Farias, Márcio Muniz de; Morales, Irvin Pablo Pérez; Valera, Roberto Roselló; Oñate, Eugenio

2017-10-01

A methodology that comprises several characterization properties for particle packings is proposed in this paper. The methodology takes into account factors such as dimension and shape of particles, space occupation, homogeneity, connectivity and isotropy, among others. This classification and integration of several properties allows to carry out a characterization process to systemically evaluate the particle packings in order to guarantee the quality of the initial meshes in discrete element simulations, in both the micro- and the macroscales. Several new properties were created, and improvements in existing ones are presented. Properties from other disciplines were adapted to be used in the evaluation of particle systems. The methodology allows to easily characterize media at the level of the microscale (continuous geometries—steels, rocks microstructures, etc., and discrete geometries) and the macroscale. A global, systemic and integral system for characterizing and evaluating particle sets, based on fuzzy logic, is presented. Such system allows researchers to have a unique evaluation criterion based on the aim of their research. Examples of applications are shown.

Evaluating a Satellite-derived Time Series of Inundation Dynamics

NASA Astrophysics Data System (ADS)

Matthews, E.; Papa, F.; Prigent, C.; McDonald, K.

2006-12-01

A new data set of inundation dynamics derived from a suite of satellites (Prigent et al.; Papa et al.) provides the first global, multi-year observations of monthly inundation extent. Initial global and regional evaluation of the data set using data on wetland/vegetation distributions from traditional and remote-sensing sources, GCPC rainfall, and altimeter-derived river heights indicates reasonable spatial distributions and seasonality. We extend the evaluation of this new data set - using independent multi-date, high-resolution satellite observations of inundated ecosystems and freeze-thaw dynamics, as well as climate data - focusing on a variety of boreal and tropical ecosystems representative of global wetlands. The goal is to investigate the strengths of the new data set, and develop strategies for improving weaknesses where identified.

Research-IQ: Development and Evaluation of an Ontology-anchored Integrative Query Tool

PubMed Central

Borlawsky, Tara B.; Lele, Omkar; Payne, Philip R. O.

2011-01-01

Investigators in the translational research and systems medicine domains require highly usable, efficient and integrative tools and methods that allow for the navigation of and reasoning over emerging large-scale data sets. Such resources must cover a spectrum of granularity from bio-molecules to population phenotypes. Given such information needs, we report upon the initial design and evaluation of an ontology-anchored integrative query tool, Research-IQ, which employs a combination of conceptual knowledge engineering and information retrieval techniques to enable the intuitive and rapid construction of queries, in terms of semi-structured textual propositions, that can subsequently be applied to integrative data sets. Our initial results, based upon both quantitative and qualitative evaluations of the efficacy and usability of Research-IQ, demonstrate its potential to increase clinical and translational research throughput. PMID:21821150

Intervening to promote early initiation of breastfeeding in the LDR.

PubMed

Komara, Carol; Simpson, Diana; Teasdale, Carla; Whalen, Gaye; Bell, Shay; Giovanetto, Laurie

2007-01-01

To evaluate the effectiveness of an interventional protocol for the early initiation of breastfeeding that would remove barriers in the labor, delivery, recovery (LDR) unit. Descriptive design using 100 postpartum mothers who were interviewed before discharge at a large university hospital in the south-central United States. Descriptive statistics were used for analysis. The protocol was effective for initiating breastfeeding, and breastfeeding increased from 53% to 66%. When barriers to breastfeeding are reduced in the LDR setting, women will breastfeed. It is possible that reducing hospital barriers to breastfeeding in the LDR can also set the stage for sustained breastfeeding during hospitalization and for less supplementation with formula.

Activities for Engaging Schools in Health Promotion

ERIC Educational Resources Information Center

Bardi, Mohammad; Burbank, Andrea; Choi, Wayne; Chow, Lawrence; Jang, Wesley; Roccamatisi, Dawn; Timberley-Berg, Tonia; Sanghera, Mandeep; Zhang, Margaret; Macnab, Andrew J.

2014-01-01

Purpose: The purpose of this paper is to describe activities used to initiate health promotion in the school setting. Design/Methodology/Approach: Description of successful pilot Health Promoting School (HPS) initiatives in Canada and Uganda and the validated measures central to each program. Evaluation methodologies: quantitative data from the…

ICF-CY code set for infants with early delay and disabilities (EDD Code Set) for interdisciplinary assessment: a global experts survey.

PubMed

Pan, Yi-Ling; Hwang, Ai-Wen; Simeonsson, Rune J; Lu, Lu; Liao, Hua-Fang

2015-01-01

Comprehensive description of functioning is important in providing early intervention services for infants with developmental delay/disabilities (DD). A code set of the International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY) could facilitate the practical use of the ICF-CY in team evaluation. The purpose of this study was to derive an ICF-CY code set for infants under three years of age with early delay and disabilities (EDD Code Set) for initial team evaluation. The EDD Code Set based on the ICF-CY was developed on the basis of a Delphi survey of international professionals experienced in implementing the ICF-CY and professionals in early intervention service system in Taiwan. Twenty-five professionals completed the Delphi survey. A total of 82 ICF-CY second-level categories were identified for the EDD Code Set, including 28 categories from the domain Activities and Participation, 29 from body functions, 10 from body structures and 15 from environmental factors. The EDD Code Set of 82 ICF-CY categories could be useful in multidisciplinary team evaluations to describe functioning of infants younger than three years of age with DD, in a holistic manner. Future validation of the EDD Code Set and examination of its clinical utility are needed. The EDD Code Set with 82 essential ICF-CY categories could be useful in the initial team evaluation as a common language to describe functioning of infants less than three years of age with developmental delay/disabilities, with a more holistic view. The EDD Code Set including essential categories in activities and participation, body functions, body structures and environmental factors could be used to create a functional profile for each infant with special needs and to clarify the interaction of child and environment accounting for the child's functioning.

An Evaluation of a Community Living Initiative in Ireland

ERIC Educational Resources Information Center

Sheerin, Fintan; Griffiths, Colin; de Vries, Jan; Keenan, Paul

2015-01-01

One of the central principles underpinning Irish intellectual disability policy is that of decongregation. Allied to this is the belief that life in community settings offers greater opportunities and richer experiences than does life in institutional settings. This study explores the experiences of a group of adults with intellectual disabilities…

Evaluation of a deidentification (De-Id) software engine to share pathology reports and clinical documents for research.

PubMed

Gupta, Dilip; Saul, Melissa; Gilbertson, John

2004-02-01

We evaluated a comprehensive deidentification engine at the University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, that uses a complex set of rules, dictionaries, pattern-matching algorithms, and the Unified Medical Language System to identify and replace identifying text in clinical reports while preserving medical information for sharing in research. In our initial data set of 967 surgical pathology reports, the software did not suppress outside (103), UPMC (47), and non-UPMC (56) accession numbers; dates (7); names (9) or initials (25) of case pathologists; or hospital or laboratory names (46). In 150 reports, some clinical information was suppressed inadvertently (overmarking). The engine retained eponymic patient names, eg, Barrett and Gleason. In the second evaluation (1,000 reports), the software did not suppress outside (90) or UPMC (6) accession numbers or names (4) or initials (2) of case pathologists. In the third evaluation, the software removed names of patients, hospitals (297/300), pathologists (297/300), transcriptionists, residents and physicians, dates of procedures, and accession numbers (298/300). By the end of the evaluation, the system was reliably and specifically removing safe-harbor identifiers and producing highly readable deidentified text without removing important clinical information. Collaboration between pathology domain experts and system developers and continuous quality assurance are needed to optimize ongoing deidentification processes.

Development of a core outcome set for clinical trials in facial aging: study protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey.

PubMed

Schlessinger, Daniel I; Iyengar, Sanjana; Yanes, Arianna F; Henley, Jill K; Ashchyan, Hovik J; Kurta, Anastasia O; Patel, Payal M; Sheikh, Umar A; Franklin, Matthew J; Hanna, Courtney C; Chen, Brian R; Chiren, Sarah G; Schmitt, Jochen; Deckert, Stefanie; Furlan, Karina C; Poon, Emily; Maher, Ian A; Cartee, Todd V; Sobanko, Joseph F; Alam, Murad

2017-08-01

Facial aging is a concern for many patients. Wrinkles, loss of volume, and discoloration are common physical manifestations of aging skin. Genetic heritage, prior ultraviolet light exposure, and Fitzpatrick skin type may be associated with the rate and type of facial aging. Although many clinical trials assess the correlates of skin aging, there is heterogeneity in the outcomes assessed, which limits the quality of evaluation and comparison of treatment modalities. To address the inconsistency in outcomes, in this project we will develop a core set of outcomes that are to be evaluated in all clinical trials relevant to facial aging. A long list of measureable outcomes will be created from four sources: (1) systematic medical literature review, (2) patient interviews, (3) other published sources, and (4) stakeholder involvement. Two rounds of Delphi processes with homogeneous groups of physicians and patients will be performed to prioritize and condense the list. At a consensus meeting attended by physicians, patients, and stakeholders, outcomes will be further condensed on the basis of participant scores. By the end of the meeting, members will vote and decide on a final recommended set of core outcomes. Subsequent to this, specific measures will be selected or created to assess these outcomes. The aim of this study is to develop a core outcome set and relevant measures for clinical trials relevant to facial aging. We hope to improve the reliability and consistency of outcome reporting of skin aging, thereby enabling improved evaluation of treatment efficacy and patient satisfaction. Core Outcome Measures in Effectiveness Trials (COMET) Initiative, accessible at http://www.comet-initiative.org/studies/details/737 . Core Outcomes Set Initiative, (CSG-COUSIN) accessible at https://www.uniklinikum-dresden.de/de/das-klinikum/universitaetscentren/zegv/cousin/meet-the-teams/project-groups/core-outcome-set-for-the-appearance-of-facial-aging . Protocol version date is 28 July 2016.

New telemedicine techniques in dermatology - evaluation with reflectance confocal microscopy via cloud-based platform.

PubMed

Łudzik, Joanna; Witkowski, Alexander Michael; Roterman-Konieczna, Irena

Dermoscopically equivocal skin lesions may present a diagnostic challenge in daily clinical practice and are regularly sent for second expert opinion. We present a new approach to handling these cases in a consultation referral system that enables communication between the initial doctor at the image upload site and dermatology experts at a distance via cloud-based telemedicine. In our study we retrospectively evaluated 100 equivocal cases with complete digital dermoscopy-reflectance confocal microscopy image sets and compared suggested management of the initial doctor to a second expert confocal reader. We evaluated the effect of reader concordance on final management of these lesions resulting in a single reader overall sensitivity of 89% and specificity of 66% and double reader concordance method sensitivity of 98% and specificity of 54%. In conclusion, we found that application of double reader evaluation of these image sets with automatic referral of lesions for removal in the case of discordant diagnosis between two doctors improved the sensitivity of diagnosis in this subset of lesions and may increase the safety threshold of management choice reducing potential misdiagnosis in telemedicine settings. This paper concerns the application of telemedicine in practical medicine.

Using the Nine Common Themes of Good Practice checklist as a tool for evaluating the research priority setting process of a provincial research and program evaluation program.

PubMed

Mador, Rebecca L; Kornas, Kathy; Simard, Anne; Haroun, Vinita

2016-03-23

Given the context-specific nature of health research prioritization and the obligation to effectively allocate resources to initiatives that will achieve the greatest impact, evaluation of priority setting processes can refine and strengthen such exercises and their outcomes. However, guidance is needed on evaluation tools that can be applied to research priority setting. This paper describes the adaption and application of a conceptual framework to evaluate a research priority setting exercise operating within the public health sector in Ontario, Canada. The Nine Common Themes of Good Practice checklist, described by Viergever et al. (Health Res Policy Syst 8:36, 2010) was used as the conceptual framework to evaluate the research priority setting process developed for the Locally Driven Collaborative Projects (LDCP) program in Ontario, Canada. Multiple data sources were used to inform the evaluation, including a review of selected priority setting approaches, surveys with priority setting participants, document review, and consultation with the program advisory committee. The evaluation assisted in identifying improvements to six elements of the LDCP priority setting process. The modifications were aimed at improving inclusiveness, information gathering practices, planning for project implementation, and evaluation. In addition, the findings identified that the timing of priority setting activities and level of control over the process were key factors that influenced the ability to effectively implement changes. The findings demonstrate the novel adaptation and application of the 'Nine Common Themes of Good Practice checklist' as a tool for evaluating a research priority setting exercise. The tool can guide the development of evaluation questions and enables the assessment of key constructs related to the design and delivery of a research priority setting process.

Lean and leadership practices: development of an initial realist program theory.

PubMed

Goodridge, Donna; Westhorp, Gill; Rotter, Thomas; Dobson, Roy; Bath, Brenna

2015-09-07

Lean as a management system has been increasingly adopted in health care settings in an effort to enhance quality, capacity and safety, while simultaneously containing or reducing costs. The Ministry of Health in the province of Saskatchewan, Canada has made a multi-million dollar investment in Lean initiatives to create "better health, better value, better care, and better teams", affording a unique opportunity to advance our understanding of the way in which Lean philosophy, principles and tools work in health care. In order to address the questions, "What changes in leadership practices are associated with the implementation of Lean?" and "When leadership practices change, how do the changed practices contribute to subsequent outcomes?", we used a qualitative, multi-stage approach to work towards developing an initial realist program theory. We describe the implications of realist assumptions for evaluation of this Lean initiative. Formal theories including Normalization Process Theory, Theories of Double Loop and Organization Leaning and the Theory of Cognitive Dissonance help understand this initial rough program theory. Data collection included: key informant consultation; a stakeholder workshop; documentary review; 26 audiotaped and transcribed interviews with health region personnel; and team discussions. A set of seven initial hypotheses regarding the manner in which Lean changes leadership practices were developed from our data. We hypothesized that Lean, as implemented in this particular setting, changes leadership practices in the following ways. Lean: a) aligns the aims and objectives of health regions; b) authorizes attention and resources to quality improvement and change management c) provides an integrated set of tools for particular tasks; d) changes leaders' attitudes or beliefs about appropriate leadership and management styles and behaviors; e) demands increased levels of expertise, accountability and commitment from leaders; f) measures and uses data effectively to identify actual and relevant local problems and the root causes of those problems; and g) creates or supports a 'learning organization' culture. This study has generated initial hypotheses and realist program theory that can form the basis for future evaluation of Lean initiatives. Developing leadership capacity and culture is theorized to be a necessary precursor to other systemic and observable changes arising from Lean initiatives.

Implementation of an evidence-based order set to impact initial antibiotic time intervals in adult febrile neutropenia.

PubMed

Best, Janie T; Frith, Karen; Anderson, Faye; Rapp, Carla Gene; Rioux, Lisa; Ciccarello, Christina

2011-11-01

To evaluate the impact of the implementation of a standardized order set on the time interval in initiation of antibiotic therapy for adult patients with cancer and febrile neutropenia. Practice change. The oncology unit of an urban hospital in the south-eastern United States. Adult patients with cancer and febrile neutropenia admitted six months prior to (n = 30) or during the three months following (n = 23) implementation of the order set. Literature regarding febrile neutropenia, use of order sets, and change process was reviewed. In addition, a retrospective and concurrent chart review was conducted for adult patients admitted with febrile neutropenia. Time intervals were analyzed using SPSS® software, version 18. Initial antibiotic times, order-set use, and length of stay. An overall reduction in time intervals for initiation of antibiotic therapy was observed for presentation (t = 2.25; degrees of freedom [df] = 37; p = 0.031) and order (t = 2.67; df = 40.17; p = 0.012) to antibiotic administration, with an order-set usage of 31% in the inpatient unit and 71% in the emergency department. Findings in the presence of low order-set usage suggest that staff education and placement of the order-set antibiotics in unit-based medication dispensing machines helped reduce time intervals for initial antibiotic therapy. The use of an evidence-based approach to nursing care is essential to achieving the best outcomes for patients with febrile neutropenia. Incorporation of current evidence into an order set to guide clinical practice and comprehensive nurse, pharmacy, and physician education are needed for the successful implementation of evidence-based practice changes.

Development of the Joint Committee Standards for Evaluations of Educational Programs, Projects, and Materials.

ERIC Educational Resources Information Center

Diamond, Esther E.

The growing demand for program evaluation in the 1970s gave rise to a need for a comprehensive, carefully developed, objective set of guiding principles for the evaluation process, from initial planning to final report. The Joint Committee on Standards for Education Evaluation was established to meet this need. This broad-based group, representing…

Evaluating the Theory of Executive Dysfunction in Autism

ERIC Educational Resources Information Center

Hill, Elisabeth L.

2004-01-01

In this paper studies of executive function in autism spectrum disorder are reviewed. Executive function is an umbrella term for functions such as planning, working memory, impulse control, inhibition, and shifting set, as well as for the initiation and monitoring of action. In this review, the focus will be on planning, inhibition, shifting set,…

How Are Health Research Priorities Set in Low and Middle Income Countries? A Systematic Review of Published Reports

PubMed Central

McGregor, Skye; Henderson, Klara J.; Kaldor, John M.

2014-01-01

Background Priority setting is increasingly recognised as essential for directing finite resources to support research that maximizes public health benefits and drives health equity. Priority setting processes have been undertaken in a number of low- and middle-income country (LMIC) settings, using a variety of methods. We undertook a critical review of reports of these processes. Methods and Findings We searched electronic databases and online for peer reviewed and non-peer reviewed literature. We found 91 initiatives that met inclusion criteria. The majority took place at the global level (46%). For regional or national initiatives, most focused on Sub Saharan Africa (49%), followed by East Asia and Pacific (20%) and Latin America and the Caribbean (18%). A quarter of initiatives aimed to cover all areas of health research, with a further 20% covering communicable diseases. The most frequently used process was a conference or workshop to determine priorities (24%), followed by the Child Health and Nutrition Initiative (CHNRI) method (18%). The majority were initiated by an international organization or collaboration (46%). Researchers and government were the most frequently represented stakeholders. There was limited evidence of any implementation or follow-up strategies. Challenges in priority setting included engagement with stakeholders, data availability, and capacity constraints. Conclusions Health research priority setting (HRPS) has been undertaken in a variety of LMIC settings. While not consistently used, the application of established methods provides a means of identifying health research priorities in a repeatable and transparent manner. In the absence of published information on implementation or evaluation, it is not possible to assess what the impact and effectiveness of health research priority setting may have been. PMID:25275315

INTEGRATION OF SPATIAL DATA: EVALUATION OF METHODS BASED ON DATA ISSUES AND ASSESSMENT QUESTIONS

EPA Science Inventory

EPA's Regional Vulnerability Assessment (ReVA) Program has focused initially on the synthesis of existing data. We have used the same set of spatial data and synthesized these data using a total of 11 existing and newly developed integration methods. These methods were evaluated ...

The use of Benford's law for evaluation of quality of occupational hygiene data.

PubMed

De Vocht, Frank; Kromhout, Hans

2013-04-01

Benford's law is the contra-intuitive empirical observation that the digits 1-9 are not equally likely to appear as the initial digit in numbers resulting from the same phenomenon. Manipulated, unrelated, or created numbers usually do not follow Benford's law, and as such this law has been used in the investigation of fraudulent data in, for example, accounting and to identify errors in data sets due to, for example, data transfer. We describe the use of Benford's law to screen occupational hygiene measurement data sets using exposure data from the European rubber manufacturing industry as an illustration. Two rubber process dust measurement data sets added to the European Union ExAsRub project but initially collected by the UK Health and Safety Executive (HSE) and British Rubber Manufacturers' Association (BRMA) and one pre- and one post-treatment n-nitrosamines data set collated in the German MEGA database and also added to the ExAsRub database were compared with the expected first-digit (1BL) and second-digit (2BL) Benford distributions. Evaluation indicated only small deviations from the expected 1BL and 2BL distributions for the data sets collated by the UK HSE and industry (BRMA), respectively, while for the MEGA data larger deviations were observed. To a large extent the latter could be attributed to imputation and replacement by a constant of n-nitrosamine measurements below the limit of detection, but further evaluation of these data to determine why other deviations from 1BL and 2BL expected distributions exist may be beneficial. Benford's law is a straightforward and easy-to-implement analytical tool to evaluate the quality of occupational hygiene data sets, and as such can be used to detect potential problems in large data sets that may be caused by malcontent a priori or a posteriori manipulation of data sets and by issues like treatment of observations below the limit of detection, rounding and transfer of data.

Biocompatibility and setting time of CPM-MTA and white Portland cement clinker with or without calcium sulfate.

PubMed

Bramante, Clovis Monteiro; Kato, Marcia Magro; Assis, Gerson Francisco de; Duarte, Marco Antonio Hungaro; Bernardineli, Norberti; Moraes, Ivaldo Gomes de; Garcia, Roberto Brandão; Ordinola-Zapata, Ronald; Bramante, Alexandre Silva

2013-01-01

To evaluate the biocompatibility and the setting time of Portland cement clinker with or without 2% or 5% calcium sulfate and MTA-CPM. Twenty-four mice (Rattus norvegicus) received subcutaneously polyethylene tubes filled with Portland cement clinker with or without 2% or 5% calcium sulfate and MTA. After 15, 30 and 60 days of implantation, the animals were killed and specimens were prepared for microscopic analysis. For evaluation of the setting time, each material was analyzed using Gilmore needles weighing 113.5 g and 456.5 g, according to the ASTM specification Number C266-08 guideline. Data were analyzed by ANOVA and Tukey's test for setting time and Kruskal-Wallis and Dunn test for biocompatibility at 5% significance level. Histologic observation showed no statistically significant difference of biocompatibility (p>0.05) among the materials in the subcutaneous tissues. For the setting time, clinker without calcium sulfate showed the shortest initial and final setting times (6.18 s/21.48 s), followed by clinker with 2% calcium sulfate (9.22 s/25.33 s), clinker with 5% calcium sulfate (10.06 s/42.46 s) and MTA (15.01 s/42.46 s). All the tested materials showed biocompatibility and the calcium sulfate absence shortened the initial and final setting times of the white Portland cement clinker.

Development of a Goal Setting Process and Instrumentation for Teachers and Principals.

ERIC Educational Resources Information Center

Minix, Nancy; And Others

A pilot program, the Career Ladder Plan, was developed in Kentucky to evaluate a teacher's performance in terms of professional growth and development and professional leadership/initiative based on that teacher's performance on a setting/goal attainment process. Goals jointly selected by the teacher and his/her principal must contribute to school…

Video Self-Modeling: A Job Skills Intervention with Individuals with Intellectual Disability in Employment Settings

ERIC Educational Resources Information Center

Goh, Ailsa E.; Bambara, Linda M.

2013-01-01

The purpose of this study was to explore the effectiveness of video self-modeling (VSM) to teach chained job tasks to individuals with intellectual disability in community-based employment settings. Initial empirical evaluations have demonstrated that VSM when used in combination with other instructional strategies, are effective methods to teach…

Evaluating a Small-Group Counseling Program--A Model for Program Planning and Improvement in the Elementary Setting

ERIC Educational Resources Information Center

Bostick, Dee; Anderson, Ron

2009-01-01

School counselors are under increasing pressure to evaluate their programs in a manner consistent with teachers and other educators. A small-group counseling intervention was used by a school counselor as part of a three-level program planning initiative that illustrated best research practices to evaluate program outcomes. Forty-nine third-grade…

The Wisconsin Early Childhood Obesity Prevention Initiative: An Example of Statewide Collective Impact.

PubMed

Meinen, Amy; Hilgendorf, Amy; Korth, Amy L; Christens, Brian D; Breuer, Catherine; Joyner, Hilary; Polzin, Molle; Adams, Alexandra; Wolfe, Daithi; Braun, Abbe; Hoiting, Jill; Paulson, Jeanette; Cullen, Bridget; Stader, Kelli

2016-11-01

The Wisconsin Early Childhood Obesity Prevention Initiative (Initiative), established in 2007, seeks to address and prevent obesity in the early care and education system through nutrition and physical activity environmental and policy changes. The collaborative includes professionals from 3 state of Wisconsin Departments, the University of Wisconsin-Extension, the University of Wisconsin-Madison, and public health and early care and education organizations. This paper explores the efforts of the Initiative to advance our understanding of collective impact in practice and its value to health promotion efforts. Evaluators conducted a mixed methods case study to evaluate the application of collective impact principles by the Initiative. This included a survey of Initiative partners, review of archival documents, and qualitative interviews with Initiative leaders. Initiative partners noted progress in establishing the conditions for collective impact. Archival documents and interviews describe both formal and informal practices that helped set a common agenda, align and coordinate partner activities, and promote communication among Initiative leaders. Results also detail the important current and potential roles of “backbone” staff from healthTIDE to support the Initiative. Additionally, results suggest particularly challenging aspects of the Initiative’s impact model related to shared measurement and broader stakeholder communication. While the Initiative is still setting in place the conditions for collective impact, it has achieved significant policy, systems, and environment changes since its formation. Inclusion of nutrition and physical activity criteria in the state’s quality rating improvement system for child care centers is one of its outcomes. This case study offers several important insights about the application of collective impact in health promotion efforts, particularly in relation to the transition from previous collaborative activities, the value of establishing a clear common agenda among partners, the roles of backbone staff, and time and partner relationships in collective impact.

Effects of a Multimedia Social Skills Program in Increasing Social Responses and Initiations of Children with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Block, Heidi M.; Radley, Keith C.; Jenson, William R.; Clark, Elaine; O'Neill, Robert E.

2015-01-01

The current study evaluated the effectiveness of Superheroes Social Skills, a multimedia social skills package, in improving social responsiveness and social initiation behaviors of four elementary school children with an autism spectrum disorder (ASD). The program was implemented in a public school setting in the southwestern United States for…

Attention please: evaluative priming effects in a valent/non-valent categorisation task (reply to Werner & Rothermund, 2013).

PubMed

Spruyt, Adriaan

2014-04-01

It has previously been argued (a) that automatic evaluative stimulus processing is dependent upon feature-specific attention allocation (FSAA) and (b) that evaluative priming effects can arise in the absence of dimensional overlap between the prime set and the response set. In opposition to these claims, Werner and Rothermund (2013) recently reported that they were unable to replicate the evaluative priming effect in a valent/non-valent categorisation task. In this manuscript, I report the results of a conceptual replication of the studies by Werner and Rothermund (2013). A clear-cut evaluative priming effect was found, thus supporting the initial claims about FSAA and dimensional overlap. An explanation for these divergent findings is discussed.

Stratification and sample selection for multicrop experiments. [Arkansas, Kentucky, Michigan, Missouri, Mississippi, Ohio, Wisconsin, Illinois, Indiana, Minnesota, Iowa, Louisiana, Nebraska, South Dakota, and North Dakota

NASA Technical Reports Server (NTRS)

Landgrebe, D. A. (Principal Investigator); Hixson, M. M.; Davis, B. J.; Bauer, M. E.

1978-01-01

The author has identified the following significant results. A stratification was performed and sample segments were selected for an initial investigation of multicrop problems in order to support development and evaluation of procedures for using LACIE and other technologies for the classification of corn and soybeans, to identify factors likely to affect classification performance, and to evaluate problems encountered and techniques which are applicable to the crop estimation problem in foreign countries. Two types of samples, low density and high density, supporting these requirements were selected as research data set for an initial evaluation of technical issues. Looking at the geographic location of the strata, the system appears to be logical and the various segments seem to represent different conditions. This result is supportive not only of the variables and the methodology employed in the stratification, but also of the validity of the data sets employed.

Lower energy and pulse stacking. A safer alternative for skin tightening using fractional CO2 laser.

PubMed

Motta, Marcos Matias; Stelini, Rafael Fantelli; Calderoni, Davi Reis; Gilioli, Rovilson; Kharmandayan, Paulo

2016-01-01

To evaluate the effect of different energies and stacking in skin shrinkage. Three decreasing settings of a fractional CO2 laser were applied to the abdomen of Twenty five Wistar rats divided into three groups. Group I (n=5) was histologically evaluated for microthermal zones dimensions. Groups II and III (n=10 each) were macroscopic evaluated with freeware ImageJ for area contraction immediately and after 30 and 60 days. No statistical significance was found within microthermal zone histological dimensions (Group I) in all settings studied. (Ablation depth: 76.90 to 97.18µm; Coagulation depth: 186.01 to 219.84 µm). In Group II, macroscopic evaluation showed that all settings cause significant immediate skin contraction. The highest setting cause significant more intense tightening effect initially, contracting skin area from 258.65 to 179.09 mm2. The same pattern was observed in Group III. At 30 and 60 days, the lowest setting significantly sustained contraction. Lower fractional CO2 laser energies associated to pulse stacking could cause consistent and long lasting tissue contraction in rats.

Pragmatic Applications of RE-AIM for Health Care Initiatives in Community and Clinical Settings

PubMed Central

Estabrooks, Paul E.

2018-01-01

The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) planning and evaluation framework has been applied broadly, but users often have difficulty in applying the model because of data collection needs across multiple domains and sources. Questions in the more common “who, what, where, how, when, and why” format may be an effective guide to ensure that individual participants, organization staff, and the perspectives of the setting are considered in planning and evaluation. Such a format can also help users in typical community and clinical settings to identify which outcomes are most valued and to focus limited measurement resources. Translations of RE-AIM that are easy to understand and apply are needed for application in real-world community and clinical settings where research and evaluation resources are limited. The purpose of this article is to provide simplified, pragmatic, user-centered and stakeholder-centered recommendations to increase the use of RE-AIM in community and clinical settings and in translational research. PMID:29300695

Evaluation criteria for commercially oriented materials processing in space proposals

NASA Technical Reports Server (NTRS)

Moore, W. F.; Mcdowell, J. R.

1979-01-01

An approach and criteria for evaluating NASA funded experiments and demonstrations which have commercial potential were developed. Methods for insuring quick initial screening of commercial proposals are presented. Recommendations are given for modifying the current evaluation approach. New criteria for evaluating commercially orientated materials processing in space (MPS) proposals are introduced. The process for selection of qualified individuals to evaluate the phases of this approach and criteria is considered and guidelines are set for its implementation.

Evaluating online diagnostic decision support tools for the clinical setting.

PubMed

Pryor, Marie; White, David; Potter, Bronwyn; Traill, Roger

2012-01-01

Clinical decision support tools available at the point of care are an effective adjunct to support clinicians to make clinical decisions and improve patient outcomes. We developed a methodology and applied it to evaluate commercially available online clinical diagnostic decision support (DDS) tools for use at the point of care. We identified 11 commercially available DDS tools and assessed these against an evaluation instrument that included 6 categories; general information, content, quality control, search, clinical results and other features. We developed diagnostically challenging clinical case scenarios based on real patient experience that were commonly missed by junior medical staff. The evaluation was divided into 2 phases; an initial evaluation of all identified and accessible DDS tools conducted by the Clinical Information Access Portal (CIAP) team and a second phase that further assessed the top 3 tools identified in the initial evaluation phase. An evaluation panel consisting of senior and junior medical clinicians from NSW Health conducted the second phase. Of the eleven tools that were assessed against the evaluation instrument only 4 tools completely met the DDS definition that was adopted for this evaluation and were able to produce a differential diagnosis. From the initial phase of the evaluation 4 DDS tools scored 70% or more (maximum score 96%) for the content category, 8 tools scored 65% or more (maximum 100%) for the quality control category, 5 tools scored 65% or more (maximum 94%) for the search category, and 4 tools score 70% or more (maximum 81%) for the clinical results category. The second phase of the evaluation was focused on assessing diagnostic accuracy for the top 3 tools identified in the initial phase. Best Practice ranked highest overall against the 6 clinical case scenarios used. Overall the differentiating factor between the top 3 DDS tools was determined by diagnostic accuracy ranking, ease of use and the confidence and credibility of the clinical information. The evaluation methodology used here to assess the quality and comprehensiveness of clinical DDS tools was effective in identifying the most appropriate tool for the clinical setting. The use of clinical case scenarios is fundamental in determining the diagnostic accuracy and usability of the tools.

Impact of integrated upper limb spasticity management including botulinum toxin A on patient-centred goal attainment: rationale and protocol for an international prospective, longitudinal cohort study (ULIS-III)

PubMed Central

Turner-Stokes, Lynne; Ashford, Stephen; Jacinto, Jorge; Maisonobe, Pascal; Balcaitiene, Jovita; Fheodoroff, Klemens

2016-01-01

Objectives Describe the rationale and protocol for the Upper Limb International Spasticity (ULIS)-III study, which aims to evaluate the impact of integrated spasticity management, involving multiple botulinum toxin A (BoNT-A) injection cycles and concomitant therapies, on patient-centred goal attainment. Outline novel outcome assessment methods for ULIS-III and report initial evaluation data from goal setting in early stages of the study. Design Large international longitudinal cohort study of integrated upper limb spasticity management, including BoNT-A. Participants and setting ULIS-III is a 2-year study expected to enrol >1000 participants at 58 study centres across 14 countries. Interventions The study design is non-interventional and intended to reflect real-life clinical practice. It will describe injection practices and additional treatment strategies, and record clinical decision-making in a serial approach to long-term spasticity management. Outcome measures ULIS-III will use a goal-directed approach to selection of targeted standardised measures to capture the diversity of presentation, goals and outcomes. ULIS-III will implement the Upper Limb Spasticity Index, a battery of assessments including a structured approach to goal attainment scaling (Goal Attainment Scaling—Evaluation of Outcomes for Upper Limb Spasticity tool), alongside a limited set of standardised measures, chosen according to patients' selected goal areas. Concomitant therapy inputs, patient satisfaction with engagement in goal setting, health economic end points and health-related quality of life data will also be captured. Results of initial evaluation of goal quality Recruitment started in January 2015. By June 2015, 58 sites had been identified and initial data collected for 79 patients across 13 sites in 3 countries. Goal setting data were quality-checked and centres rated on the basis of function-related and Specific, Measurable, Achievable, Realistic, Timed (SMART) characteristics of goal statements. Overall, 11/13 centres achieved the highest rating (A++). Conclusions ULIS-III will provide valuable information regarding treatment of and outcomes from real-life upper limb spasticity management worldwide. Trial registration number NCT02454803; Pre-results. PMID:27315835

A Hybrid Method for Pancreas Extraction from CT Image Based on Level Set Methods

PubMed Central

Tan, Hanqing; Fujita, Hiroshi

2013-01-01

This paper proposes a novel semiautomatic method to extract the pancreas from abdominal CT images. Traditional level set and region growing methods that request locating initial contour near the final boundary of object have problem of leakage to nearby tissues of pancreas region. The proposed method consists of a customized fast-marching level set method which generates an optimal initial pancreas region to solve the problem that the level set method is sensitive to the initial contour location and a modified distance regularized level set method which extracts accurate pancreas. The novelty in our method is the proper selection and combination of level set methods, furthermore an energy-decrement algorithm and an energy-tune algorithm are proposed to reduce the negative impact of bonding force caused by connected tissue whose intensity is similar with pancreas. As a result, our method overcomes the shortages of oversegmentation at weak boundary and can accurately extract pancreas from CT images. The proposed method is compared to other five state-of-the-art medical image segmentation methods based on a CT image dataset which contains abdominal images from 10 patients. The evaluated results demonstrate that our method outperforms other methods by achieving higher accuracy and making less false segmentation in pancreas extraction. PMID:24066016

Evaluating the Outcomes and Implementation of a TaMHS (Targeting Mental Health in Schools) Project in Four West Midlands (UK) Schools Using Activity Theory

ERIC Educational Resources Information Center

Cane, Fiona Eloise; Oland, Louise

2015-01-01

Government guidance in 2008 endorsed the "Targeting Mental Health in Schools" (TaMHS) agenda, which sets out to promote mental health in schools through the delivery of universal and targeted interventions. This paper initially defines mental health and outlines the TaMHS initiative. It then offers empirical findings from four focus…

Changing How High Schools Serve Black and Latino Young Men: A Report on NYC's Expanded Success Initiative. Technical Appendices

ERIC Educational Resources Information Center

Villavincencio, Adriana; Klevan, Sarah; Kang, David

2015-01-01

These appendices describe the matching process used to identify an appropriate set of comparison schools for use in the report evaluating Year 2 of the Expanded Success Initiative, "Changing How High Schools Serve Black and Latino Young Men." As described in Chapter 2 of the report, selecting schools similar to ESI schools to serve as a…

Results of the Greenland ice sheet model initialisation experiments: ISMIP6 - initMIP-Greenland

NASA Astrophysics Data System (ADS)

Goelzer, Heiko; Nowicki, Sophie; Edwards, Tamsin; Beckley, Matthew

2017-04-01

Ice sheet model initialisation has a large effect on projected future sea-level contributions and gives rise to important uncertainties. The goal of this intercomparison exercise for the continental-scale Greenland ice sheet is therefore to compare, evaluate and improve the initialisation techniques used in the ice sheet modelling community. The initMIP-Greenland project is the first in a series of ice sheet model intercomparison activities within ISMIP6 (Ice Sheet Model Intercomparison Project for CMIP6). The experimental set-up has been designed to allow comparison of the initial present-day state of the Greenland ice sheet between participating models and against observations. Furthermore, the initial states are tested with two schematic forward experiments to evaluate the initialisation in terms of model drift (forward run without any forcing) and response to a large perturbation (prescribed surface mass balance anomaly). We present and discuss results that highlight the wide diversity of data sets, boundary conditions and initialisation techniques used in the community to generate initial states of the Greenland ice sheet.

Recommendations for a mixed methods approach to evaluating the patient-centered medical home.

PubMed

Goldman, Roberta E; Parker, Donna R; Brown, Joanna; Walker, Judith; Eaton, Charles B; Borkan, Jeffrey M

2015-03-01

There is a strong push in the United States to evaluate whether the patient-centered medical home (PCMH) model produces desired results. The explanatory and contextually based questions of how and why PCMH succeeds in different practice settings are often neglected. We report the development of a comprehensive, mixed qualitative-quantitative evaluation set for researchers, policy makers, and clinician groups. To develop an evaluation set, the Brown Primary Care Transformation Initiative convened a multidisciplinary group of PCMH experts, reviewed the PCMH literature and evaluation strategies, developed key domains for evaluation, and selected or created methods and measures for inclusion. The measures and methods in the evaluation set (survey instruments, PCMH meta-measures, patient outcomes, quality measures, qualitative interviews, participant observation, and process evaluation) are meant to be used together. PCMH evaluation must be sufficiently comprehensive to assess and explain both the context of transformation in different primary care practices and the experiences of diverse stakeholders. In addition to commonly assessed patient outcomes, quality, and cost, it is critical to include PCMH components integral to practice culture transformation: patient and family centeredness, authentic patient activation, mutual trust among practice employees and patients, and transparency, joy, and collaboration in delivering and receiving care in a changing environment. This evaluation set offers a comprehensive methodology to enable understanding of how PCMH transformation occurs in different practice settings. This approach can foster insights about how transformation affects critical outcomes to achieve meaningful, patient-centered, high-quality, and cost-effective sustainable change among diverse primary care practices. © 2015 Annals of Family Medicine, Inc.

An Evaluation of a Community Health Intervention Programme Aimed at Improving Health and Wellbeing

ERIC Educational Resources Information Center

Strachan, G.; Wright, G. D.; Hancock, E.

2007-01-01

Objective: The objective of this evaluation was to examine the extent to which participants in the Tailor Made Leisure Package programme experienced any improvement in their health and wellbeing. Design: A quantitative survey. Setting: The Healthy Living Centre initiative is an example of a community-based intervention which was formalized as part…

Evaluative Thinking: Using Results-Oriented Reasoning to Strengthen Collaboration

ERIC Educational Resources Information Center

Malloy, Courtney L.; Lee, Janet S.; Cawthon, Stephanie W.

2016-01-01

In today's world, much of what used to be individual work has become collaborative. Moreover, complex change initiatives often require individuals within and across organizations to team up to set and achieve meaningful goals. The role of researchers and evaluators is to offer support that can be used to strengthen the work of organizations and…

Self Evaluation: A Case Study of a School in Dar Es Salaam, Tanzania

ERIC Educational Resources Information Center

Kokeyo, Carolyne Adhiambo; Oluoch, John

2015-01-01

External evaluation of schools purpose to monitor delivery of education with a view to ensuring adherence to stipulated curriculum and set standards as well as efficient and effective quality education. However, school improvement scholars in developed economies now argue that schools must take their own initiative to assess the extent to which…

The Evaluation Life Cycle: A Retrospective Assessment of Stages and Phases of the Circles of Care Initiative

ERIC Educational Resources Information Center

Bess, Gary; Allen, James; Deters, Pamela B.

2004-01-01

A life cycle metaphor characterizes the evolving relationship between the evaluator and program staff. This framework suggests that common developmental dynamics occur in roughly the same order across groups and settings. There are stage-specific dynamics that begin with Pre-History, which characterize the relationship between the grantees and…

Evaluation of selected properties of a new root repair cement containing surface pre-reacted glass ionomer fillers.

PubMed

Yassen, Ghaeth H; Huang, Ruijie; Al-Zain, Afnan; Yoshida, Takamitsu; Gregory, Richard L; Platt, Jeffrey A

2016-11-01

This study evaluated selected properties of a prototype root repair cement containing surface pre-reacted glass ionomer fillers (S-PRG) in comparison to mineral trioxide aggregate (MTA) and intermediate restorative material (IRM). The antibacterial effect of S-PRG, MTA, and IRM cements was tested against Porphyromonas gingivalis and Enterococcus faecalis after 1 and 3 days of aging of the cements. The set cements were immersed in distilled water for 4 h to 28 days, and ion-releasing ability was evaluated. Initial and final setting times of all cements were evaluated using Gilmore needles. The push-out bond strength between radicular dentin and all cements was tested at different levels of the roots. S-PRG and IRM cements, but not MTA cement, demonstrated significant antibacterial effect against P. gingivalis. All types of cements exhibited significant antibacterial effect against E. faecalis without being able to eliminate the bacterium. S-PRG cement provided continuous release of fluoride, strontium, boron, sodium, aluminum, and zinc throughout all tested time points. Both initial and final setting times were significantly shorter for S-PRG and IRM cements in comparison to MTA. The push-out bond strength was significantly lower for S-PRG cement in comparison to MTA and IRM at coronal and middle levels of the roots. S-PRG cement demonstrated significant antibacterial effects against endodontic pathogens, multiple ion-releasing ability, relatively short setting time, and low bonding strength. S-PRG cement can be used as a one-visit root repair material with promising antibacterial properties and ion-releasing capacity.

On the Automaticity of the Evaluative Priming Effect in the Valent/Non-Valent Categorization Task

PubMed Central

Spruyt, Adriaan; Tibboel, Helen

2015-01-01

It has previously been argued (a) that automatic evaluative stimulus processing is critically dependent upon feature-specific attention allocation and (b) that evaluative priming effects can arise in the absence of dimensional overlap between the prime set and the response set. In line with both claims, research conducted at our lab revealed that the evaluative priming effect replicates in the valent/non-valent categorization task. This research was criticized, however, because non-automatic, strategic processes may have contributed to the emergence of this effect. We now report the results of a replication study in which the operation of non-automatic, strategic processes was controlled for. A clear-cut evaluative priming effect emerged, thus supporting initial claims concerning feature-specific attention allocation and dimensional overlap. PMID:25803444

On the automaticity of the evaluative priming effect in the valent/non-valent categorization task.

PubMed

Spruyt, Adriaan; Tibboel, Helen

2015-01-01

It has previously been argued (a) that automatic evaluative stimulus processing is critically dependent upon feature-specific attention allocation and (b) that evaluative priming effects can arise in the absence of dimensional overlap between the prime set and the response set. In line with both claims, research conducted at our lab revealed that the evaluative priming effect replicates in the valent/non-valent categorization task. This research was criticized, however, because non-automatic, strategic processes may have contributed to the emergence of this effect. We now report the results of a replication study in which the operation of non-automatic, strategic processes was controlled for. A clear-cut evaluative priming effect emerged, thus supporting initial claims concerning feature-specific attention allocation and dimensional overlap.

An Evaluation of an Algorithm for Linear Inequalities and Its Applications

NASA Technical Reports Server (NTRS)

Jurgensen, J.

1973-01-01

An algorithm is presented for obtaining a solution alpha to a set of inequalities (A alpha) 0 where A is an N x m-matrix and alpha is an m-vector. If the set of inequalities is consistant, then the algorithm is guaranteed to arrive at a solution in a finite number of steps. Also, if in the iteration, a negative vector is obtained, then the initial set of inequalities is inconsistant, and the iteration is terminated.

A Novel Enuresis Alarm for Toilet Training Students with Intellectual Disability: An Initial Evaluation in a School Setting

ERIC Educational Resources Information Center

Mruzek, Daniel W.; McAleavey, Stephen; Engel, Suzanne; Smith, Tristram

2016-01-01

In this study, a novel enuresis alarm device using a miniaturized radio frequency module and disposable sensors made with inexpensive conductive ink was used to teach toilet use for urination with three participants with severe intellectual disability (two males and one female; aged 7-15 years) in a private special education school setting. At…

Electrocardiographic repolarization-related variables as predictors of coronary heart disease death in the women's health initiative study.

PubMed

Rautaharju, Pentti M; Zhang, Zhu-Ming; Vitolins, Mara; Perez, Marco; Allison, Matthew A; Greenland, Philip; Soliman, Elsayed Z

2014-07-28

We evaluated 25 repolarization-related ECG variables for the risk of coronary heart disease (CHD) death in 52 994 postmenopausal women from the Women's Health Initiative study. Hazard ratios from Cox regression were computed for subgroups of women with and without cardiovascular disease (CVD). During the average follow-up of 16.9 years, 941 CHD deaths occurred. Based on electrophysiological considerations, 2 sets of ECG variables with low correlations were considered as candidates for independent predictors of CHD death: Set 1, Ѳ(Tp|Tref), the spatial angle between T peak (Tp) and normal T reference (Tref) vectors; Ѳ(Tinit|Tterm), the angle between the initial and terminal T vectors; STJ depression in V6 and rate-adjusted QTp interval (QTpa); and Set 2, TaVR and TV1 amplitudes, heart rate, and QRS duration. Strong independent predictors with over 2-fold increased risk for CHD death in women with and without CVD were Ѳ(Tp|Tref) >42° from Set 1 and TaVR amplitude >-100 μV from Set 2. The risk for these CHD death predictors remained significant after multivariable adjustment for demographic/clinical factors. Other significant predictors for CHD death in fully adjusted risk models were Ѳ(Tinit|Tterm) >30°, TV1 >175 μV, and QRS duration >100 ms. Ѳ(Tp|Tref) angle and TaVR amplitude are associated with CHD mortality in postmenopausal women. The use of these measures to identify high-risk women for further diagnostic evaluation or more intense preventive intervention warrants further study. http://www.clinicaltrials.gov. Unique identifier: NCT00000611. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Evaluating quality of patient care communication in integrated care settings: a mixed method approach.

PubMed

Gulmans, J; Vollenbroek-Hutten, M M R; Van Gemert-Pijnen, J E W C; Van Harten, W H

2007-10-01

Owing to the involvement of multiple professionals from various institutions, integrated care settings are prone to suboptimal patient care communication. To assure continuity, communication gaps should be identified for targeted improvement initiatives. However, available assessment methods are often one-sided evaluations not appropriate for integrated care settings. We developed an evaluation approach that takes into account the multiple communication links and evaluation perspectives inherent to these settings. In this study, we describe this approach, using the integrated care setting of Cerebral Palsy as illustration. The approach follows a three-step mixed design in which the results of each step are used to mark out the subsequent step's focus. The first step patient questionnaire aims to identify quality gaps experienced by patients, comparing their expectancies and experiences with respect to patient-professional and inter-professional communication. Resulting gaps form the input of in-depth interviews with a subset of patients to evaluate underlying factors of ineffective communication. Resulting factors form the input of the final step's focus group meetings with professionals to corroborate and complete the findings. By combining methods, the presented approach aims to minimize limitations inherent to the application of single methods. The comprehensiveness of the approach enables its applicability in various integrated care settings. Its sequential design allows for in-depth evaluation of relevant quality gaps. Further research is needed to evaluate the approach's feasibility in practice. In our subsequent study, we present the results of the approach in the integrated care setting of children with Cerebral Palsy in three Dutch care regions.

Initial data sets for the Schwarzschild spacetime

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

Gomez-Lobo, Alfonso Garcia-Parrado; Kroon, Juan A. Valiente; School of Mathematical Sciences, Queen Mary, University of London, Mile End Road, London E1 4NS

2007-01-15

A characterization of initial data sets for the Schwarzschild spacetime is provided. This characterization is obtained by performing a 3+1 decomposition of a certain invariant characterization of the Schwarzschild spacetime given in terms of concomitants of the Weyl tensor. This procedure renders a set of necessary conditions--which can be written in terms of the electric and magnetic parts of the Weyl tensor and their concomitants--for an initial data set to be a Schwarzschild initial data set. Our approach also provides a formula for a static Killing initial data set candidate--a KID candidate. Sufficient conditions for an initial data set tomore » be a Schwarzschild initial data set are obtained by supplementing the necessary conditions with the requirement that the initial data set possesses a stationary Killing initial data set of the form given by our KID candidate. Thus, we obtain an algorithmic procedure of checking whether a given initial data set is Schwarzschildean or not.« less

Every antibiotic, every day: Maximizing the impact of prospective audit and feedback on total antibiotic use.

PubMed

Campbell, Tonya J; Decloe, Melissa; Gill, Suzanne; Ho, Grace; McCready, Janine; Powis, Jeff

2017-01-01

The success of antimicrobial stewardship is dependent on how often it is completed and which antimicrobials are targeted. We evaluated the impact of an antimicrobial stewardship program (ASP) in three non-ICU settings where all systemic antibiotics, regardless of spectrum, were targeted on the first weekday after initiation. Prospective audit and feedback (PAAF) was initiated on the surgical, respiratory, and medical wards of a community hospital on July 1, 2010, October 1, 2010, and April 1, 2012, respectively. We evaluated rates of total antibiotic use, measured in days on therapy (DOTs), among all patients admitted to the wards before and after PAAF initiation using an interrupted time series analysis. Changes in antibiotic costs, rates of C. difficile infection (CDI), mortality, readmission, and length of stay were evaluated using univariate analyses. Time series modelling demonstrated that total antibiotic use decreased (± standard error) by 100 ± 51 DOTs/1,000 patient-days on the surgical wards (p = 0.049), 100 ± 46 DOTs/1,000 patient-days on the respiratory ward (p = 0.029), and 91 ± 33 DOTs/1,000 patient-days on the medical wards (p = 0.006) immediately following PAAF initiation. Reductions in antibiotic use were sustained up to 50 months after intervention initiation, and were accompanied by decreases in antibiotic costs. There were no significant changes to patient outcomes on the surgical and respiratory wards following intervention initiation. On the medical wards, however, readmission increased from 4.6 to 5.6 per 1,000 patient-days (p = 0.043), while mortality decreased from 7.4 to 5.0 per 1,000 patient-days (p = 0.001). CDI rates showed a non-significant declining trend after PAAF initiation. ASPs can lead to cost-effective, sustained reductions in total antibiotic use when interventions are conducted early in the course of therapy and target all antibiotics. Shifting to such a model may help strengthen the effectiveness of ASPs in non-ICU settings.

Patient-reported outcomes to initiate a provider-patient dialog for the management of hip and knee osteoarthritis.

PubMed

Golightly, Yvonne M; Allen, Kelli D; Nyrop, Kirsten A; Nelson, Amanda E; Callahan, Leigh F; Jordan, Joanne M

2015-10-01

Although many treatment guidelines exist for hip and knee osteoarthritis (OA), uptake in clinical practice is typically low. Valid patient-reported outcome measures (PROs) that can be easily used in the clinic could aid implementation and evaluation of treatment recommendations, and the tracking of symptoms and function over time. This project responded to a 2012 Call to Action of the Chronic Osteoarthritis Management Initiative of the United States Bone and Joint Initiative; we aimed to develop a tiered list of recommended PROs that could be feasibly applied in common clinical settings, across four domains of pain, function, fatigue, and sleep. PROs were identified through a focused literature review. Clinicians and researchers with OA expertise evaluated each measure' feasibility for use in routine clinical practice, followed by meaningfulness in assessing OA outcomes. Eligible PROs were categorized by domain and ranked into Tiers One (very brief measures for initial use in clinical settings), Two (brief measures with more in-depth assessment), and Three (most detailed assessment). Total PROs identified were 172 for pain, 160 for function, 55 for fatigue, and 60 for sleep. Of these, 9 pain, 7 function, 7 fatigue, and 8 sleep PROs were ranked into one of three tiers. This three-tiered list of recommended PROs provides a basis for tools to systematically track outcomes, facilitate provider-patient dialog, and guide treatment for hip or knee OA. Research is needed to test the utility and feasibility of systematic implementation of these measures in primary care and specialty clinical settings. Copyright © 2015 Elsevier Inc. All rights reserved.

The 1982-83 Promotional Gates Program: Mid-Year Assessment and Analysis of August, 1982 and January, 1983 Test Results. O.E.E. Evaluation Report.

ERIC Educational Resources Information Center

Opperman, Prudence; And Others

The Promotional Gates Program was initiated in the New York City Public Schools in order to set and maintain citywide curriculum and performance standards, identify students unable to meet the minimum standards, and provide remedial instruction. Under this program, the promotional policy sets "gates" at grades 4 and 7; students unable to…

Shake, Rattle and Roll--Can Music Be Used by Parents and Practitioners to Support Communication, Language and Literacy within a Pre-School Setting?

ERIC Educational Resources Information Center

Harris, Deborah Jayne

2011-01-01

The aim of this small-scale study was to evaluate whether music could support communication, language and literacy development within a pre-school setting. The research focused on a music specialist who provided a range of musical activities that engaged both parents and children over a 20-week period. Initial interviews with parents indicated…

[Evaluation of the influence of humidity and temperature on the drug stability by initial average rate experiment].

PubMed

He, Ning; Sun, Hechun; Dai, Miaomiao

2014-05-01

To evaluate the influence of temperature and humidity on the drug stability by initial average rate experiment, and to obtained the kinetic parameters. The effect of concentration error, drug degradation extent, humidity and temperature numbers, humidity and temperature range, and average humidity and temperature on the accuracy and precision of kinetic parameters in the initial average rate experiment was explored. The stability of vitamin C, as a solid state model, was investigated by an initial average rate experiment. Under the same experimental conditions, the kinetic parameters obtained from this proposed method were comparable to those from classical isothermal experiment at constant humidity. The estimates were more accurate and precise by controlling the extent of drug degradation, changing humidity and temperature range, or by setting the average temperature closer to room temperature. Compared with isothermal experiments at constant humidity, our proposed method saves time, labor, and materials.

The healthy learner model for student chronic condition management--part II: the asthma initiative.

PubMed

Erickson, Cecelia DuPlessis; Splett, Patricia L; Mullett, Sara Stoltzfus; Jensen, Charlotte; Belseth, Stephanie Bisson

2006-12-01

The Healthy Learner Asthma Initiative (HLAI) was designed as a comprehensive, school-community initiative to improve asthma management and produce healthy learners. National asthma guidelines were translated into components of asthma management in the school setting that defined performance expectations and lead to greater quality and consistency of asthma care. The HLAI incorporated evidence-based practice and introduced the role of the asthma resource nurse. Leadership, capacity building, and strong partnerships among school nurses, students, families, and health care providers were essential to the implementation and sustainability of the HLAI. Professional school nursing and evaluation were defined as key requisites to a successful initiative. Evaluation results indicated positive effects on nursing practice, fewer asthma visits to the health office, and better attendance among students who received asthma care in the school health office. The HLAI provided the basis for development of the Healthy Learner Model for Student Chronic Condition Management.

Trait and state anxiety across academic evaluative contexts: development and validation of the MTEA-12 and MSEA-12 scales.

PubMed

Sotardi, Valerie A

2018-05-01

Educational measures of anxiety focus heavily on students' experiences with tests yet overlook other assessment contexts. In this research, two brief multiscale questionnaires were developed and validated to measure trait evaluation anxiety (MTEA-12) and state evaluation anxiety (MSEA-12) for use in various assessment contexts in non-clinical, educational settings. The research included a cross-sectional analysis of self-report data using authentic assessment settings in which evaluation anxiety was measured. Instruments were tested using a validation sample of 241 first-year university students in New Zealand. Scale development included component structures for state and trait scales based on existing theoretical frameworks. Analyses using confirmatory factor analysis and descriptive statistics indicate that the scales are reliable and structurally valid. Multivariate general linear modeling using subscales from the MTEA-12, MSEA-12, and student grades suggest adequate criterion-related validity. Initial predictive validity in which one relevant MTEA-12 factor explained between 21% and 54% of the variance in three MSEA-12 factors. Results document MTEA-12 and MSEA-12 as reliable measures of trait and state dimensions of evaluation anxiety for test and writing contexts. Initial estimates suggest the scales as having promising validity, and recommendations for further validation are outlined.

The Childhood Obesity Declines Project: Implications for Research and Evaluation Approaches.

PubMed

Young-Hyman, Deborah; Morris, Kathryn; Kettel Khan, Laura; Dawkins-Lyn, Nicola; Dooyema, Carrie; Harris, Carole; Jernigan, Jan; Ottley, Phyllis; Kauh, Tina

2018-03-01

Childhood obesity remains prevalent and is increasing in some disadvantaged populations. Numerous research, policy and community initiatives are undertaken to impact this pandemic. Understudied are natural experiments. The need to learn from these efforts is paramount. Resulting evidence may not be readily available to inform future research, community initiatives, and policy development/implementation. We discuss the implications of using an adaptation of the Systematic Screening and Assessment (SSA) method to evaluate the Childhood Obesity Declines (COBD) project. The project examined successful initiatives, programs and policies in four diverse communities which were concurrent with significant declines in child obesity. In the context of other research designs and evaluation schemas, rationale for use of SSA is presented. Evidence generated by this method is highlighted and guidance suggested for evaluation of future studies of community-based childhood obesity prevention initiatives. Support for the role of stakeholder collaboratives, in particular the National Collaborative on Childhood Obesity Research, as a synergistic vehicle to accelerate research on childhood obesity is discussed. SSA mapped active processes and provided contextual understanding of multi-level/component simultaneous efforts to reduce rates of childhood obesity in community settings. Initiatives, programs and policies were not necessarily coordinated. And although direct attribution of intervention/initiative/policy components could not be made, the what, by who, how, to whom was temporally associated with statistically significant reductions in childhood obesity. SSA provides evidence for context and processes which are not often evaluated in other data analytic methods. SSA provides an additional tool to layer with other evaluation approaches.

Means, Variability and Trends of Precipitation in the Global Climate as Determined by the 25-year GEWEWGPCP Data Set

NASA Technical Reports Server (NTRS)

Adler, R. F.; Gu, G.; Curtis, S.; Huffman, G. J.

2004-01-01

The Global Precipitation Climatology Project (GPCP) 25-year precipitation data set is used as a basis to evaluate the mean state, variability and trends (or inter-decadal changes) of global and regional scales of precipitation. The uncertainties of these characteristics of the data set are evaluated by examination of other, parallel data sets and examination of shorter periods with higher quality data (e.g., TRMM). The global and regional means are assessed for uncertainty by comparing with other satellite and gauge data sets, both globally and regionally. The GPCP global mean of 2.6 mdday is divided into values of ocean and land and major latitude bands (Tropics, mid-latitudes, etc.). Seasonal variations globally and by region are shown and uncertainties estimated. The variability of precipitation year-to-year is shown to be related to ENS0 variations and volcanoes and is evaluated in relation to the overall lack of a significant global trend. The GPCP data set necessarily has a heterogeneous time series of input data sources, so part of the assessment described above is to test the initial results for potential influence by major data boundaries in the record.

Measuring Reading Performance Informally.

ERIC Educational Resources Information Center

Powell, William R.

To improve the accuracy of the informal reading inventory (IRI), a differential set of criteria is necessary for both word recognition and comprehension scores for different levels and reading conditions. In initial evaluation, word recognition scores should reflect only errors of insertions, omissions, mispronunciations, substitiutions, unkown…

40 CFR 1066.275 - Daily dynamometer readiness verification.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) AIR POLLUTION CONTROLS VEHICLE-TESTING PROCEDURES Dynamometer Specifications § 1066.275 Daily... automated process for this verification procedure, perform this evaluation by setting the initial speed and... your dynamometer does not perform this verification with an automated process: (1) With the dynamometer...

Cold Blooded: Evaluating Brain Temperature by MRI During Surface Cooling of Human Subjects.

PubMed

Curran, Eric J; Wolfson, Daniel L; Watts, Richard; Freeman, Kalev

2017-10-01

Targeted temperature management (TTM) confers neurological and survival benefits for post-cardiac arrest patients with return of spontaneous circulation (ROSC) who remain comatose. Specialized equipment for induction of hypothermia is not available in the prehospital setting, and there are no reliable methods for emergency medical services personnel to initiate TTM. We hypothesized that the application of surface cooling elements to the neck will decrease brain temperature and act as initiators of TTM. Magnetic resonance (MR) spectroscopy was used to evaluate the effect of a carotid surface cooling element on brain temperature in healthy adults. Six individuals completed this study. We measured a temperature drop of 0.69 ± 0.38 °C (95% CI) in the cortex of the brain following the application of the cooling element. Application of a room temperature element also caused a measurable decrease in brain temperature of 0.66 ± 0.41 °C (95% CI) which may be attributable to baroreceptor activation. The application of surface cooling elements to the neck decreased brain temperature and may serve as a method to initiate TTM in the prehospital setting.

Practical Approaches to Evaluating Progress and Outcomes in Community-Wide Teen Pregnancy Prevention Initiatives.

PubMed

Tevendale, Heather D; Condron, D Susanne; Garraza, Lucas Godoy; House, L Duane; Romero, Lisa M; Brooks, Megan A M; Walrath, Christine

2017-03-01

This paper presents an overview of the key evaluation components for a set of community-wide teen pregnancy prevention initiatives. We first describe the performance measures selected to assess progress toward meeting short-term objectives on the reach and quality of implementation of evidence-based teen pregnancy prevention interventions and adolescent reproductive health services. Next, we describe an evaluation that will compare teen birth rates in intervention communities relative to synthetic control communities. Synthetic controls are developed via a data-driven technique that constructs control communities by combining information from a pool of communities that are similar to the intervention community. Finally, we share lessons learned thus far in the evaluation of the project, with a focus on those lessons that may be valuable for local communities evaluating efforts to reduce teen pregnancy. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

The STAR Data Reporting Guidelines for Clinical High Altitude Research.

PubMed

Brodmann Maeder, Monika; Brugger, Hermann; Pun, Matiram; Strapazzon, Giacomo; Dal Cappello, Tomas; Maggiorini, Marco; Hackett, Peter; Bärtsch, Peter; Swenson, Erik R; Zafren, Ken

2018-03-01

Brodmann Maeder, Monika, Hermann Brugger, Matiram Pun, Giacomo Strapazzon, Tomas Dal Cappello, Marco Maggiorini, Peter Hackett, Peter Baärtsch, Erik R. Swenson, Ken Zafren (STAR Core Group), and the STAR Delphi Expert Group. The STARdata reporting guidelines for clinical high altitude research. High AltMedBiol. 19:7-14, 2018. The goal of the STAR (STrengthening Altitude Research) initiative was to produce a uniform set of key elements for research and reporting in clinical high-altitude (HA) medicine. The STAR initiative was inspired by research on treatment of cardiac arrest, in which the establishment of the Utstein Style, a uniform data reporting protocol, substantially contributed to improving data reporting and subsequently the quality of scientific evidence. The STAR core group used the Delphi method, in which a group of experts reaches a consensus over multiple rounds using a formal method. We selected experts in the field of clinical HA medicine based on their scientific credentials and identified an initial set of parameters for evaluation by the experts. Of 51 experts in HA research who were identified initially, 21 experts completed both rounds. The experts identified 42 key parameters in 5 categories (setting, individual factors, acute mountain sickness and HA cerebral edema, HA pulmonary edema, and treatment) that were considered essential for research and reporting in clinical HA research. An additional 47 supplemental parameters were identified that should be reported depending on the nature of the research. The STAR initiative, using the Delphi method, identified a set of key parameters essential for research and reporting in clinical HA medicine.

USL/DBMS NASA/PC R and D project system design standards

NASA Technical Reports Server (NTRS)

Dominick, Wayne D. (Editor); Moreau, Dennis R.

1984-01-01

A set of system design standards intended to assure the completeness and quality of designs developed for PC research and development projects is established. The standards presented address the areas of problem definition, initial design plan, design specification, and re-evaluation.

Characterizing the Diversity and Biological Relevance of the MLPCN Assay Manifold and Screening Set

PubMed Central

Zhang, Jintao; Lushington, Gerald H.; Huan, Jun

2011-01-01

The NIH Molecular Libraries Initiative (MLI), launched in 2004 with initial goals of identifying chemical probes for characterizing gene function and druggability, has produced PubChem, a chemical genomics knowledgebase for fostering translation of basic research into new therapeutic strategies. This paper assesses progress toward these goals by evaluating MLI target novelty and propensity for undergoing biochemically or therapeutically relevant modulations and the degree of chemical diversity and biogenic bias inherent in the MLI screening set. Our analyses suggest that while MLI target selection has not yet been fully optimized for biochemical diversity, it covers biologically interesting pathway space that complements established drug targets. We find the MLI screening set to be chemically diverse and to have greater biogenic bias than comparable collections of commercially available compounds. Biogenic enhancements such as incorporation of more metabolite-like chemotypes are suggested. PMID:21568288

Evaluation of SLAR and thematic mapper MSS data for forest cover mapping using computer-aided analysis techniques

NASA Technical Reports Server (NTRS)

Hoffer, R. M. (Principal Investigator)

1980-01-01

The column normalizing technique was used to adjust the data for variations in the amplitude of the signal due to look angle effects with respect to solar zenith angle along the scan lines (i.e., across columns). Evaluation of the data set containing the geometric and radiometric adjustments, indicates that the data set should be satisfactory for further processing and analysis. Software was developed for degrading the spatial resolution of the aircraft data to produce a total of four data sets for further analysis. The quality of LANDSAT 2 CCT data for the test site is good for channels four, five, and six. Channel seven was not present on the tape. The data received were reformatted and analysis of the test site area was initiated.

Multidisciplinary perspectives: Application of the Consolidated Framework for Implementation Research to evaluate a health coaching initiative.

PubMed

Brook, Judy; McGraw, Caroline

2018-05-01

Long-term conditions are a leading cause of mortality and morbidity. Their management is founded on a combination of approaches involving government policy, better integration between health and care systems, and individual responsibility for self-care. Health coaching has emerged as an approach to encouraging individual responsibility and enhancing the self-management of long-term conditions. This paper focuses on the evaluation of a workforce initiative in a diverse and socially deprived community. The initiative sought both to improve integration between health and care services for people with long-term conditions, and equip practitioners with health coaching skills. The aim of the study was to contribute an empirical understanding of what practitioners perceive to be the contextual factors that impact on the adoption of health coaching in community settings. These factors were conceptualised using the Consolidated Framework for Implementation Research (CFIR). A stratified purposive sample of 22 health and care practitioners took part in semi-structured telephone interviews. Data were analysed using the CFIR as an analytical framework. The perceptions of trainees mapped onto the major domains of the CFIR: characteristics of the intervention, outer setting, inner setting, characteristics of individuals involved and process of implementation. Individual patient expectations, comorbidities and social context were central to the extent to which practitioners and patients engaged with health coaching. Structural constraints within provider services and the wider NHS were also reported as discouraging initiatives that focused on long-term rewards rather than short-term wins. The authors recommend further research is undertaken both to understand the role of health coaching in disadvantaged communities and ensure the service user voice is heard. © 2018 John Wiley & Sons Ltd.

Performance on a strategy set shifting task during adolescence in a genetic model of attention deficit/hyperactivity disorder: Methylphenidate vs. atomoxetine treatments

PubMed Central

Harvey, Roxann C; Jordan, Chloe J; Tassin, David H; Moody, Kayla R; Dwoskin, Linda P; Kantak, Kathleen M

2013-01-01

Research examining medication effects on set shifting in teens with attention deficit/hyperactivity disorder (ADHD) is lacking. An animal model of ADHD may be useful for exploring this gap. The Spontaneously Hypertensive Rat (SHR) is a commonly used animal model of ADHD. SHR and two comparator strains, Wistar-Kyoto (WKY) and Wistar (WIS), were evaluated during adolescence in a strategy set shifting task under conditions of a 0-sec or 15-sec delay to reinforcer delivery. The task had three phases: initial discrimination, set shift and reversal learning. Under 0-sec delays, SHR performed as well as or better than WKY and WIS. Treatment with 0.3 mg/kg/day atomoxetine had little effect, other than to modestly increase trials to criterion during set shifting in all strains. Under 15-sec delays, SHR had longer lever press reaction times, longer latencies to criterion and more trial omissions than WKY during set shifting and reversal learning. These deficits were not reduced systematically by 1.5 mg/kg/day methylphenidate or 0.3 mg/kg/day atomoxetine. Regarding learning in SHR, methylphenidate improved initial discrimination, whereas atomoxetine improved set shifting but disrupted initial discrimination. During reversal learning, both drugs were ineffective in SHR, and atomoxetine made reaction time and trial omissions greater in WKY. Overall, WIS performance differed from SHR or WKY, depending on phase. Collectively, a genetic model of ADHD in adolescent rats revealed that neither methylphenidate nor atomoxetine mitigated all deficits in SHR during the set shifting task. Thus, methylphenidate or atomoxetine monotherapy may not mitigate all set shift task-related deficits in teens with ADHD. PMID:23376704

Evaluation of psychological support for victims of sexual violence in a conflict setting: results from Brazzaville, Congo

PubMed Central

Hustache, Sarah; Moro, Marie-Rose; Roptin, Jacky; Souza, Renato; Gansou, Grégoire Magloire; Mbemba, Alain; Roederer, Thomas; Grais, Rebecca F; Gaboulaud, Valérie; Baubet, Thierry

2009-01-01

Background Little is known about the impact of psychological support in war and transcultural contexts and in particular, whether there are lasting benefits. Here, we present an evaluation of the late effect of post-rape psychological support provided to women in Brazzaville, Republic of Congo. Methods Women who attended the Médecins Sans Frontières program for sexual violence in Brazzaville during the conflict were selected to evaluate the psychological consequences of rape and the late effect of post-rape psychological support. A total of 178 patients met the eligibility criteria: 1) Women aged more than 15 years; 2) raped by unknown person(s) wearing military clothes; 3) admitted to the program between the 1/1/2002 and the 30/4/2003; and 4) living in Brazzaville. Results The initial diagnosis according to DSM criteria showed a predominance of anxious disorders (54.1%) and acute stress disorders (24.6%). One to two years after the initial psychological care, 64 women were evaluated using the Trauma Screening Questionnaire (TSQ), the Global Assessment of Functioning scale (GAF) and an assessment scale to address medico-psychological care in emergencies (EUMP). Two patients (3.1%) met the needed criteria for PTSD diagnosis from the TSQ. Among the 56 women evaluated using GAF both as pre and post-test, global functioning was significantly improved by initial post-rape support (50 women (89.3%) had extreme or medium impairment at first post-rape evaluation, and 16 (28.6%) after psychological care; p = 0.04). When interviewed one to two years later, the benefit was fully maintained (16 women (28.6%) presenting extreme or medium impairment). Conclusion We found the benefits of post-rape psychological support to be present and lasting in this conflict situation. However, we were unable to evaluate all women for the long-term impact, underscoring the difficulty of leading evaluation studies in unstable contexts. Future research is needed to validate these findings in other settings. PMID:19338671

Choosing Meteorological Input for the Global Modeling Initiative Assessment of High Speed Aircraft

NASA Technical Reports Server (NTRS)

Douglas, A. R.; Prather, M. P.; Hall, T. M.; Strahan, S. E.; Rasch, P. J.; Sparling, L. C.; Coy, L.; Rodriquez, J. M.

1998-01-01

The Global Modeling Initiative (GMI) science team is developing a three dimensional chemistry and transport model (CTM) to be used in assessment of the atmospheric effects of aviation. Requirements are that this model be documented, be validated against observations, use a realistic atmospheric circulation, and contain numerical transport and photochemical modules representing atmospheric processes. The model must also retain computational efficiency to be tractable to use for multiple scenarios and sensitivity studies. To meet these requirements, a facility model concept was developed in which the different components of the CTM are evaluated separately. The first use of the GMI model will be to evaluate the impact of the exhaust of supersonic aircraft on the stratosphere. The assessment calculations will depend strongly on the wind and temperature fields used by the CTM. Three meteorological data sets for the stratosphere are available to GMI: the National Center for Atmospheric Research Community Climate Model (CCM2), the Goddard Earth Observing System Data Assimilation System (GEOS DAS), and the Goddard Institute for Space Studies general circulation model (GISS). Objective criteria were established by the GMI team to identify the data set which provides the best representation of the stratosphere. Simulations of gases with simple chemical control were chosen to test various aspects of model transport. The three meteorological data sets were evaluated and graded based on their ability to simulate these aspects of stratospheric measurements. This paper describes the criteria used in grading the meteorological fields. The meteorological data set which has the highest score and therefore was selected for GMI is CCM2. This type of objective model evaluation establishes a physical basis for interpretation of differences between models and observations. Further, the method provides a quantitative basis for defining model errors, for discriminating between different models, and for ready re-evaluation of improved models. These in turn will lead to a higher level of confidence in assessment calculations.

Decreased rates of hypoglycemia following implementation of a comprehensive computerized insulin order set and titration algorithm in the inpatient setting.

PubMed

Sinha Gregory, Naina; Seley, Jane Jeffrie; Gerber, Linda M; Tang, Chin; Brillon, David

2016-12-01

More than one-third of hospitalized patients have hyperglycemia. Despite evidence that improving glycemic control leads to better outcomes, achieving recognized targets remains a challenge. The objective of this study was to evaluate the implementation of a computerized insulin order set and titration algorithm on rates of hypoglycemia and overall inpatient glycemic control. A prospective observational study evaluating the impact of a glycemic order set and titration algorithm in an academic medical center in non-critical care medical and surgical inpatients. The initial intervention was hospital-wide implementation of a comprehensive insulin order set. The secondary intervention was initiation of an insulin titration algorithm in two pilot medicine inpatient units. Point of care testing blood glucose reports were analyzed. These reports included rates of hypoglycemia (BG < 70 mg/dL) and hyperglycemia (BG >200 mg/dL in phase 1, BG > 180 mg/dL in phase 2). In the first phase of the study, implementation of the insulin order set was associated with decreased rates of hypoglycemia (1.92% vs 1.61%; p < 0.001) and increased rates of hyperglycemia (24.02% vs 27.27%; p < 0.001) from 2010 to 2011. In the second phase, addition of a titration algorithm was associated with decreased rates of hypoglycemia (2.57% vs 1.82%; p = 0.039) and increased rates of hyperglycemia (31.76% vs 41.33%; p < 0.001) from 2012 to 2013. A comprehensive computerized insulin order set and titration algorithm significantly decreased rates of hypoglycemia. This significant reduction in hypoglycemia was associated with increased rates of hyperglycemia. Hardwiring the algorithm into the electronic medical record may foster adoption.

Developing Leaders: The Importance--and the Challenges--of Evaluating Principal Preparation Programs

ERIC Educational Resources Information Center

George W. Bush Institute, Education Reform Initiative, 2016

2016-01-01

Research on school leadership shows that principals can significantly impact student achievement by influencing classroom instruction, organizational conditions, community support and setting the teaching and learning conditions in schools. Moreover, strong principals provide a multiplier effect that enables improvement initiatives to succeed. The…

Front-end Electronics for Unattended Measurement (FEUM). Prototype Test Plan

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

Conrad, Ryan C.; Morris, Scott J.; Smith, Leon E.

2015-09-16

The IAEA has requested that PNNL perform an initial set of tests on front-end electronics for unattended measurement (FEUM) prototypes. The FEUM prototype test plan details the tests to be performed, the criteria for evaluation, and the procedures used to execute the tests.

History and evaluation of national-scale geochemical data sets for the United States

USGS Publications Warehouse

Smith, David B.; Smith, Steven M.; Horton, John D.

2013-01-01

Six national-scale, or near national-scale, geochemical data sets for soils or stream sediments exist for the United States. The earliest of these, here termed the ‘Shacklette’ data set, was generated by a U.S. Geological Survey (USGS) project conducted from 1961 to 1975. This project used soil collected from a depth of about 20 cm as the sampling medium at 1323 sites throughout the conterminous U.S. The National Uranium Resource Evaluation Hydrogeochemical and Stream Sediment Reconnaissance (NURE-HSSR) Program of the U.S. Department of Energy was conducted from 1975 to 1984 and collected either stream sediments, lake sediments, or soils at more than 378,000 sites in both the conterminous U.S. and Alaska. The sampled area represented about 65% of the nation. The Natural Resources Conservation Service (NRCS), from 1978 to 1982, collected samples from multiple soil horizons at sites within the major crop-growing regions of the conterminous U.S. This data set contains analyses of more than 3000 samples. The National Geochemical Survey, a USGS project conducted from 1997 to 2009, used a subset of the NURE-HSSR archival samples as its starting point and then collected primarily stream sediments, with occasional soils, in the parts of the U.S. not covered by the NURE-HSSR Program. This data set contains chemical analyses for more than 70,000 samples. The USGS, in collaboration with the Mexican Geological Survey and the Geological Survey of Canada, initiated soil sampling for the North American Soil Geochemical Landscapes Project in 2007. Sampling of three horizons or depths at more than 4800 sites in the U.S. was completed in 2010, and chemical analyses are currently ongoing. The NRCS initiated a project in the 1990s to analyze the various soil horizons from selected pedons throughout the U.S. This data set currently contains data from more than 1400 sites. This paper (1) discusses each data set in terms of its purpose, sample collection protocols, and analytical methods; and (2) evaluates each data set in terms of its appropriateness as a national-scale geochemical database and its usefulness for national-scale geochemical mapping.

Goal setting: an integral component of effective diabetes care.

PubMed

Miller, Carla K; Bauman, Jennifer

2014-08-01

Goal setting is a widely used behavior change tool in diabetes education and training. Prior research found specific relatively difficult but attainable goals set within a specific timeframe improved performance in sports and at the workplace. However, the impact of goal setting in diabetes self-care has not received extensive attention. This review examined the mechanisms underlying behavioral change according to goal setting theory and evaluated the impact of goal setting in diabetes intervention studies. Eight studies were identified, which incorporated goal setting as the primary strategy to promote behavioral change in individual, group-based, and primary care settings among patients with type 2 diabetes. Improvements in diabetes-related self-efficacy, dietary intake, physical activity, and A1c were observed in some but not all studies. More systematic research is needed to determine the conditions and behaviors for which goal setting is most effective. Initial recommendations for using goal setting in diabetes patient encounters are offered.

Differentiating osteomyelitis from bone infarction in sickle cell disease.

PubMed

Wong, A L; Sakamoto, K M; Johnson, E E

2001-02-01

This brief review discusses one possible approach to evaluating the sickle cell patient with bone pain. The major differential diagnoses include osteomyelitis and bone infarction. Based on previous studies, we provide an approach to assessing and treating patients with the possible diagnosis of osteomyelitis. An algorithm has been provided, which emphasizes the importance of the initial history and physical examination. Specific radiographic studies are recommended to aid in making the initial assessment and to determine whether the patient has an infarct or osteomyelitis. Differentiating osteomyelitis from infarction in sickle cell patients remains a challenge for the pediatrician. This algorithm can be used as a guide for physicians who evaluate such patients in the acute care setting.

Initial assessment of hearing loss using a mobile application for audiological evaluation.

PubMed

Derin, S; Cam, O H; Beydilli, H; Acar, E; Elicora, S S; Sahan, M

2016-03-01

This study aimed to compare an Apple iOS mobile operating system application for audiological evaluation with conventional audiometry, and to determine its accuracy and reliability in the initial evaluation of hearing loss. The study comprised 32 patients (16 females) diagnosed with hearing loss. The patients were first evaluated with conventional audiometry and the degree of hearing loss was recorded. Then they underwent a smartphone-based hearing test and the data were compared using Cohen's kappa analysis. Patients' mean age was 53.59 ± 18.01 years (range, 19-85 years). The mobile phone audiometry results for 39 of the 64 ears were fully compatible with the conventional audiometry results. There was a statistically significant concordant relationship between the two sets of audiometry results (p < 0.05). Ear Trumpet version 1.0.2 is a compact and simple mobile application on the Apple iPhone 5 that can measure hearing loss with reliable results.

Team Leader: An Approach to Mixed-Initiative Agent Team Management and Evaluation

DTIC Science & Technology

2003-03-01

defined on top of Jini (Arnold, et al., 1999). 5.1 MIXED-INITIATIVE MANAGEMENT OF A JOINT TASK FORCE Our simulation of the US Military’s disaster...coalition military operations. Binni is set in the year 2012 and involves three imaginary countries in Africa – Binni, Gao , and Agadez. Due to a...peacekeeping force. For example, the US, UK, and Australia have a high degree of mutual trust whereas Gao , which is also a member of the coalition, is trusted

A technique for increasing the accuracy of the numerical inversion of the Laplace transform with applications

NASA Technical Reports Server (NTRS)

Berger, B. S.; Duangudom, S.

1973-01-01

A technique is introduced which extends the range of useful approximation of numerical inversion techniques to many cycles of an oscillatory function without requiring either the evaluation of the image function for many values of s or the computation of higher-order terms. The technique consists in reducing a given initial value problem defined over some interval into a sequence of initial value problems defined over a set of subintervals. Several numerical examples demonstrate the utility of the method.

Initial retrieval sequence and blending strategy

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

Pemwell, D.L.; Grenard, C.E.

1996-09-01

This report documents the initial retrieval sequence and the methodology used to select it. Waste retrieval, storage, pretreatment and vitrification were modeled for candidate single-shell tank retrieval sequences. Performance of the sequences was measured by a set of metrics (for example,high-level waste glass volume, relative risk and schedule).Computer models were used to evaluate estimated glass volumes,process rates, retrieval dates, and blending strategy effects.The models were based on estimates of component inventories and concentrations, sludge wash factors and timing, retrieval annex limitations, etc.

A reference case for economic evaluations in osteoarthritis: an expert consensus article from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).

PubMed

Hiligsmann, Mickaël; Cooper, Cyrus; Guillemin, Francis; Hochberg, Marc C; Tugwell, Peter; Arden, Nigel; Berenbaum, Francis; Boers, Maarten; Boonen, Annelies; Branco, Jaime C; Maria-Luisa, Brandi; Bruyère, Olivier; Gasparik, Andrea; Kanis, John A; Kvien, Tore K; Martel-Pelletier, Johanne; Pelletier, Jean-Pierre; Pinedo-Villanueva, Rafael; Pinto, Daniel; Reiter-Niesert, Susanne; Rizzoli, René; Rovati, Lucio C; Severens, Johan L; Silverman, Stuart; Reginster, Jean-Yves

2014-12-01

General recommendations for a reference case for economic studies in rheumatic diseases were published in 2002 in an initiative to improve the comparability of cost-effectiveness studies in the field. Since then, economic evaluations in osteoarthritis (OA) continue to show considerable heterogeneity in methodological approach. To develop a reference case specific for economic studies in OA, including the standard optimal care, with which to judge new pharmacologic and non-pharmacologic interventions. Four subgroups of an ESCEO expert working group on economic assessments (13 experts representing diverse aspects of clinical research and/or economic evaluations) were charged with producing lists of recommendations that would potentially improve the comparability of economic analyses in OA: outcome measures, comparators, costs and methodology. These proposals were discussed and refined during a face-to-face meeting in 2013. They are presented here in the format of the recommendations of the recently published Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, so that an initiative on economic analysis methodology might be consolidated with an initiative on reporting standards. Overall, three distinct reference cases are proposed, one for each hand, knee and hip OA; with diagnostic variations in the first two, giving rise to different treatment options: interphalangeal or thumb-based disease for hand OA and the presence or absence of joint malalignment for knee OA. A set of management strategies is proposed, which should be further evaluated to help establish a consensus on the "standard optimal care" in each proposed reference case. The recommendations on outcome measures, cost itemisation and methodological approaches are also provided. The ESCEO group proposes a set of disease-specific recommendations on the conduct and reporting of economic evaluations in OA that could help the standardisation and comparability of studies that evaluate therapeutic strategies of OA in terms of costs and effectiveness. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Design and fabrication of forward-swept counterrotation blade configuration for wind tunnel testing

NASA Technical Reports Server (NTRS)

Nichols, G. H.

1994-01-01

Work performed by GE Aircraft on advanced counterrotation blade configuration concepts for high speed turboprop system is described. Primary emphasis was placed on theoretically and experimentally evaluating the aerodynamic, aeromechanical, and acoustic performance of GE-defined counterrotating blade concepts. Several blade design concepts were considered. Feasibility studies were conducted to evaluate a forward-swept versus an aft-swept blade application and how the given blade design would affect interaction between rotors. Two blade designs were initially selected. Both designs involved in-depth aerodynamic, aeromechanical, mechanical, and acoustic analyses followed by the fabrication of forward-swept, forward rotor blade sets to be wind tunnel tested with an aft-swept, aft rotor blade set. A third blade set was later produced from a NASA design that was based on wind tunnel test results from the first two blade sets. This blade set had a stiffer outer ply material added to the original blade design, in order to reach the design point operating line. Detailed analyses, feasibility studies, and fabrication procedures for all blade sets are presented.

Every antibiotic, every day: Maximizing the impact of prospective audit and feedback on total antibiotic use

PubMed Central

Decloe, Melissa; Gill, Suzanne; Ho, Grace; McCready, Janine; Powis, Jeff

2017-01-01

Background The success of antimicrobial stewardship is dependent on how often it is completed and which antimicrobials are targeted. We evaluated the impact of an antimicrobial stewardship program (ASP) in three non-ICU settings where all systemic antibiotics, regardless of spectrum, were targeted on the first weekday after initiation. Methods Prospective audit and feedback (PAAF) was initiated on the surgical, respiratory, and medical wards of a community hospital on July 1, 2010, October 1, 2010, and April 1, 2012, respectively. We evaluated rates of total antibiotic use, measured in days on therapy (DOTs), among all patients admitted to the wards before and after PAAF initiation using an interrupted time series analysis. Changes in antibiotic costs, rates of C. difficile infection (CDI), mortality, readmission, and length of stay were evaluated using univariate analyses. Results Time series modelling demonstrated that total antibiotic use decreased (± standard error) by 100 ± 51 DOTs/1,000 patient-days on the surgical wards (p = 0.049), 100 ± 46 DOTs/1,000 patient-days on the respiratory ward (p = 0.029), and 91 ± 33 DOTs/1,000 patient-days on the medical wards (p = 0.006) immediately following PAAF initiation. Reductions in antibiotic use were sustained up to 50 months after intervention initiation, and were accompanied by decreases in antibiotic costs. There were no significant changes to patient outcomes on the surgical and respiratory wards following intervention initiation. On the medical wards, however, readmission increased from 4.6 to 5.6 per 1,000 patient-days (p = 0.043), while mortality decreased from 7.4 to 5.0 per 1,000 patient-days (p = 0.001). CDI rates showed a non-significant declining trend after PAAF initiation. Conclusions ASPs can lead to cost-effective, sustained reductions in total antibiotic use when interventions are conducted early in the course of therapy and target all antibiotics. Shifting to such a model may help strengthen the effectiveness of ASPs in non-ICU settings. PMID:28562638

From Initiation to Evaluation: Developing Primary Care Perceptorships.

ERIC Educational Resources Information Center

Quenk, Naomi; Smith, Sandra

The use of preceptorships in medical education is examined in this guide from the AMSA Foundation. It reflects the insight of medical faculty, preceptors, administrators, and student participants, with major emphasis on ambulatory patient care settings, such as physician's offices. The issues and areas covered also apply to the development of…

A Preliminary Analysis of a Strategic Staffing Initiative

ERIC Educational Resources Information Center

Pulliam, Cheryl L.; LaCaria, Lynne; Schoeneberger, Jason; Algozzine, Bob

2014-01-01

The authors evaluated a reform program known as "Strategic Staffing" in which principals were given increased autonomy to modify the delivery of instruction without compromising academic content. The program's central feature was reassignment of school leaders and key staff members from settings in which they were successful to schools…

[Ethics and methodology: the importance of promoting, evaluating and implementing education and humanities research in health].

PubMed

Consejo-Y Chapela, Carolina; González-Martínez, José Francisco

2017-01-01

In this editorial we initially expose the agreements that have set the mechanisms to guarantee safety and fair treatment to human subjects in research. Later on, we offer alternatives from translational and multidisciplinary research to promote education and humanities research in health.

Axis I Screens and Suicide Risk in Jails: A Comparative Analysis

ERIC Educational Resources Information Center

Harrison, Kimberly S.; Rogers, Richard

2007-01-01

Mental health professionals conducting screenings in jail settings face formidable challenges in identifying inmates at risk for major depression and suicide. Psychologists often rely on correctional staff to provide initial appraisals of those inmates requiring further evaluation. In a sample of 100 jail detainees, the effectiveness of two…

When Curriculum Does Not Match Readiness.

ERIC Educational Resources Information Center

Jaworski, Anne Porter; Riley, Stephanie Mueller

To evaluate the long term impact of developmental placement, a longitudinal study was initiated with over 500 subjects from a variety of school settings across the state of Michigan. Three groups of subjects were selected: (1) children recommended for a "growth year" before entering kindergarten who followed the recommendation, thus…

Xpert®MTB/RIF for the Diagnosis of Tuberculosis in a Remote Arctic Setting: Impact on Cost and Time to Treatment Initiation.

PubMed

Oxlade, Olivia; Sugarman, Jordan; Alvarez, Gonzalo G; Pai, Madhukar; Schwartzman, Kevin

2016-01-01

Tuberculosis (TB) remains a significant health problem in the Canadian Arctic. Substantial health system delays in TB diagnosis can occur, in part due to the lack of capacity for onsite microbiologic testing. A study recently evaluated the yield and impact of a rapid automated PCR test (Xpert®MTB/RIF) for the diagnosis of TB in Iqaluit (Nunavut). We conducted an economic analysis to evaluate the expected cost relative to the expected reduction in time to treatment initiation, with the addition of Xpert®MTB/RIF to the current diagnostic and treatment algorithms used in this setting. A decision analysis model compared current microbiologic testing to a scenario where Xpert®MTB/RIF was added to the current diagnostic algorithm for active TB, and incorporated costs and clinical endpoints from the Iqaluit study. Several sensitivity analyses that considered alternative use were also considered. We estimated days to TB diagnosis and treatment initiation, health system costs, and the incremental cost per treatment day gained for each individual evaluated for possible TB. With the addition of Xpert®MTB/RIF, costs increased while days to TB treatment initiation were reduced. The incremental cost per treatment day gained (per individual investigated for TB) was $164 (95% uncertainty range $85, $452). In a sensitivity analysis that considered hospital discharge after a single negative Xpert®MTB/RIF, the Xpert®MTB/RIF scenario was cost saving. Adding Xpert®MTB/RIF to the current diagnostic algorithm for TB in Nunavut appears to reduce time to diagnosis and treatment at reasonable cost. It may be especially well suited to overcome some of the other logistical barriers that are unique to this and other remote communities.

Evaluation of Algorithms for a Miles-in-Trail Decision Support Tool

NASA Technical Reports Server (NTRS)

Bloem, Michael; Hattaway, David; Bambos, Nicholas

2012-01-01

Four machine learning algorithms were prototyped and evaluated for use in a proposed decision support tool that would assist air traffic managers as they set Miles-in-Trail restrictions. The tool would display probabilities that each possible Miles-in-Trail value should be used in a given situation. The algorithms were evaluated with an expected Miles-in-Trail cost that assumes traffic managers set restrictions based on the tool-suggested probabilities. Basic Support Vector Machine, random forest, and decision tree algorithms were evaluated, as was a softmax regression algorithm that was modified to explicitly reduce the expected Miles-in-Trail cost. The algorithms were evaluated with data from the summer of 2011 for air traffic flows bound to the Newark Liberty International Airport (EWR) over the ARD, PENNS, and SHAFF fixes. The algorithms were provided with 18 input features that describe the weather at EWR, the runway configuration at EWR, the scheduled traffic demand at EWR and the fixes, and other traffic management initiatives in place at EWR. Features describing other traffic management initiatives at EWR and the weather at EWR achieved relatively high information gain scores, indicating that they are the most useful for estimating Miles-in-Trail. In spite of a high variance or over-fitting problem, the decision tree algorithm achieved the lowest expected Miles-in-Trail costs when the algorithms were evaluated using 10-fold cross validation with the summer 2011 data for these air traffic flows.

A survey of critical care nurses' practices and perceptions surrounding early intravenous antibiotic initiation during septic shock.

PubMed

Roberts, Russel J; Alhammad, Abdullah M; Crossley, Lindsay; Anketell, Eric; Wood, LeeAnn; Schumaker, Greg; Garpestad, Erik; Devlin, John W

2017-08-01

Delays in antibiotic administration after severe sepsis recognition increases mortality. While physician and pharmacy-related barriers to early antibiotic initiation have been well evaluated, those factors that affect the speed by which critical care nurses working in either the emergency department or the intensive care unit setting initiate antibiotic therapy remains poorly characterized. To evaluate the knowledge, practices and perceptions of critical care nurses regarding antibiotic initiation in patients with newly recognised septic shock. A validated survey was distributed to 122 critical care nurses at one 320-bed academic institution with a sepsis protocol advocating intravenous(IV) antibiotic initiation within 1hour of shock recognition. Among 100 (82%) critical care nurses responding, nearly all (98%) knew of the existence of the sepsis protocol. However, many critical care nurses stated they would optimise blood pressure [with either fluid (38%) or both fluid and a vasopressor (23%)] before antibiotic initiation. Communicated barriers to rapid antibiotic initiation included: excessive patient workload (74%), lack of awareness IV antibiotic(s) ordered (57%) or delivered (69%), need for administration of multiple non-antibiotic IV medications (54%) and no IV access (51%). Multiple nurse-related factors influence IV antibiotic(s) initiation speed and should be incorporated into sepsis quality improvement efforts. Copyright © 2017 Elsevier Ltd. All rights reserved.

Integrating TeamSTEPPS® into ambulatory reproductive health care: Early successes and lessons learned.

PubMed

Paul, Maureen E; Dodge, Laura E; Intondi, Evelyn; Ozcelik, Guzey; Plitt, Ken; Hacker, Michele R

2017-04-01

Most medical teamwork improvement interventions have occurred in hospitals, and more efforts are needed to integrate them into ambulatory care settings. In 2014, Affiliates Risk Management Services, Inc. (ARMS), the risk management services organization for a large network of reproductive health care organizations in the United States, launched a voluntary 5-year initiative to implement a medical teamwork system in this network using the TeamSTEPPS model. This article describes the ARMS initiative and progress made during the first 2 years, including lessons learned. The ARMS TeamSTEPPS program consists of the following components: preparation of participating organizations, TeamSTEPPS master training, implementation of teamwork improvement programs, and evaluation. We used self-administered questionnaires to assess satisfaction with the ARMS program and with the master training course. In the first 2 years, 20 organizations enrolled. Participants found the preparation phase valuable and were highly satisfied with the master training course. Although most attendees felt that the course imparted the knowledge and tools critical for TeamSTEPPS implementation, they identified time restraints and competing initiatives as potential barriers. The project team has learned valuable lessons about obtaining buy-in, consolidating the change teams, making the curriculum relevant, and evaluation. Ambulatory care settings require innovative approaches to integration of teamwork improvement systems. Evaluating and sharing lessons learned will help to hone best practices as we navigate this new frontier in the field of patient safety. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

The AcCell series 2000 as a support system for training and evaluation in educational and clinical settings.

PubMed

Greening, S E; Grohs, D H; Guidos, B J

1997-01-01

Providing effective training, retraining and evaluation programs, including proficiency testing programs, for cytoprofessionals is a challenge shared by many academic and clinical educators internationally. In cytopathology the quality of training has immediately transferable and critically important impacts on satisfactory performance in the clinical setting. Well-designed interactive computer-assisted instruction and testing programs have been shown to enhance initial learning and to reinforce factual and conceptual knowledge. Computer systems designed not only to promote diagnostic accuracy but to integrate and streamline work flow in clinical service settings are candidates for educational adaptation. The AcCell 2000 system, designed as a diagnostic screening support system, offers technology that is adaptable to educational needs during basic and in-service training as well as testing of screening proficiency in both locator and identification skills. We describe the considerations, approaches and applications of the AcCell 2000 system in education programs for both training and evaluation of gynecologic diagnostic screening proficiency.

A mixed-methods impact evaluation of the feasibility of an initiative in small rural stores to improve access to fruit and vegetables.

PubMed

Palermo, Claire; Gardiner, Breeana; Gee, Carena; Charaktis, Stella; Blake, Miranda

2016-02-01

Retail stores are a promising setting for improving access to nutritious food. This study opportunistically evaluated an initiative that supported stores in small rural Victorian towns to sell fresh fruit and vegetables. It aimed to measure whether the initiative showed a trend towards improved access to fruit and vegetables in these rural communities. A mixed-methods, pre-post evaluation was employed to measure the range and price of 39 fruits and 45 vegetables, together with 15 interviews with stakeholders 2.5 years after the commencement of the initiative. Twenty-one of 35 eligible stores took up the initiative. Analysis of qualitative and quantitative data showed that the initiative improved the availability of and access to fruit and vegetables, and that stores have a role in improving access to fruit and vegetables. The overall range of fruit and vegetables increased over 18 months from a median of 10 varieties (n=10) to 17 varieties (n=15) (P=0.028) and the prices decreased over 12 months in five out of seven stores where data was available. The capacity to influence availability of fruit and vegetables was affected by time, human resources and community support. Sustaining change to fruit and vegetables access is challenging. Using stores for health promotion may be an effective strategy for improving rural populations' fruit and vegetable intake.

Evaluation of Suitability of Selected Set of Department of Defense Military Bases and Department of Energy Facilities for Siting a Small Modular Reactor

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

Poore III, Willis P; Belles, Randy; Mays, Gary T

This report summarizes the approach that ORNL developed for screening a sample set of US Department of Defense (DOD) military base sites and DOE sites for possible powering with an SMR; the methodology employed, including spatial modeling; and initial results for several sample sites. The objective in conducting this type of siting evaluation is demonstrate the capability to characterize specific DOD and DOE sites to identify any particular issues associated with powering the sites with an SMR using OR-SAGE; it is not intended to be a definitive assessment per se as to the absolute suitability of any particular site.

Lessons learned from the application of a participatory evaluation methodology to healthy municipalities, cities and communities initiatives in selected countries of the Americas.

PubMed

Rice, Marilyn; Franceschini, Maria Cristina

2007-01-01

Health promotion has made significant strides in the past few decades in the Americas. Creating a healthy and supportive setting, also known as the settings approach, continues to be one of the most widely used health promotion strategies. Interest in evaluating the effectiveness of these strategies has been increasing greatly in the past few years. Participatory evaluation holds great promise for helping to generate this evidence and promote understanding of the factors that affect, positively or negatively, the advances of health promotion in the Region. During 2004-2006, a Participatory Evaluation methodology was introduced into several countries in the Americas through formal trainings conducted by the Pan American Health Organization (PAHO) in collaboration with country partners. This article summarizes the main lessons learned from the application of the participatory evaluation methodology in various countries in Latin America and the Caribbean. Factors affecting the evaluation of the initiatives were identified at multiple levels (individual, community, organizational, political, economic, etc.). Specific issues that were addressed included the political context, turnover of personnel in key institutions, concerns related to the effectiveness of participatory processes, and the existence of strong and sustained leadership at the country level. These factors are intertwined and affect each other in very complex ways, a fact that was reflected in the municipalities' experiences with participatory evaluation. Challenges included the ability to secure resources for the evaluation, the time needed to conclude the process, and working in an intersectoral manner. However, participating municipalities reported that the process of implementing a participatory evaluation and working with various stakeholders had an empowering effect: communities and stakeholders were more willing and interested in participating in health promotion initiatives in a sustained manner; alliances and intersectoral collaboration were strengthened; communication channels were opened; and municipalities were stimulated to review their planning and implementation processes in order to more appropriately incorporate health promotion principles. The article concludes with recommendations to improve the planning and implementation process of participatory evaluation efforts.

Audiologist-driven versus patient-driven fine tuning of hearing instruments.

PubMed

Boymans, Monique; Dreschler, Wouter A

2012-03-01

Two methods of fine tuning the initial settings of hearing aids were compared: An audiologist-driven approach--using real ear measurements and a patient-driven fine-tuning approach--using feedback from real-life situations. The patient-driven fine tuning was conducted by employing the Amplifit(®) II system using audiovideo clips. The audiologist-driven fine tuning was based on the NAL-NL1 prescription rule. Both settings were compared using the same hearing aids in two 6-week trial periods following a randomized blinded cross-over design. After each trial period, the settings were evaluated by insertion-gain measurements. Performance was evaluated by speech tests in quiet, in noise, and in time-reversed speech, presented at 0° and with spatially separated sound sources. Subjective results were evaluated using extensive questionnaires and audiovisual video clips. A total of 73 participants were included. On average, higher gain values were found for the audiologist-driven settings than for the patient-driven settings, especially at 1000 and 2000 Hz. Better objective performance was obtained for the audiologist-driven settings for speech perception in quiet and in time-reversed speech. This was supported by better scores on a number of subjective judgments and in the subjective ratings of video clips. The perception of loud sounds scored higher than when patient-driven, but the overall preference was in favor of the audiologist-driven settings for 67% of the participants.

Effect of addition of nano-hydroxyapatite on physico-chemical and antibiofilm properties of calcium silicate cements.

PubMed

Guerreiro-Tanomaru, Juliane Maria; Vázquez-García, Fernando Antonio; Bosso-Martelo, Roberta; Bernardi, Maria Inês Basso; Faria, Gisele; Tanomaru, Mario

2016-01-01

Mineral Trioxide Aggregate (MTA) is a calcium silicate cement composed of Portland cement (PC) and bismuth oxide. Hydroxyapatite has been incorporated to enhance mechanical and biological properties of dental materials. This study evaluated physicochemical and mechanical properties and antibiofilm activity of MTA and PC associated with zirconium oxide (ZrO2) and hydroxyapatite nanoparticles (HAn). White MTA (Angelus, Brazil); PC (70%)+ZrO2 (30%); PC (60%)+ZrO2 (30%)+HAn (10%); PC (50%)+ZrO2 (30%)+HAn (20%) were evaluated. The pH was assessed by a digital pH-meter and solubility by mass loss. Setting time was evaluated by using Gilmore needles. Compressive strength was analyzed by mechanical test. Samples were radiographed alongside an aluminum step wedge to evaluate radiopacity. For the antibiofilm evaluation, materials were placed in direct contact with E. faecalis biofilm induced on dentine blocks. The number of colony-forming units (CFU mL-1) in the remaining biolfilm was evaluated. The results were submitted to ANOVA and the Tukey test, with 5% significance. There was no difference in pH levels of PC+ZrO2, PC+ZrO2+HAn (10%) and PC+ZrO2+HAn (20%) (p>0.05) and these cements presented higher pH levels than MTA (p<0.05). The highest solubility was observed in PC+ZrO2+HAn (10%) and PC+ZrO2+HAn (20%) (p<0.05). MTA had the shortest initial setting time (p<0.05). All the materials showed radiopacity higher than 3 mmAl. PC+ZrO2 and MTA had the highest compressive strength (p<0.05). Materials did not completely neutralize the bacterial biofilm, but the association with HAn provided greater bacterial reduction than MTA and PC+ZrO2 (p<0.05) after the post-manipulation period of 2 days. The addition of HAn to PC associated with ZrO2 harmed the compressive strength and solubility. On the other hand, HAn did not change the pH and the initial setting time, but improved the radiopacity (HAn 10%), the final setting time and the E. faecalis antibiofilm activity of the cement.

Sexual history taking and sexually transmitted infection screening in patients initiating erectile dysfunction medication therapy.

PubMed

Holman, Katherine M; Carr, James Andrew; Baddley, John W; Hook, Edward W

2013-11-01

Erectile dysfunction medications are being prescribed frequently; however, little is known about the amount of sexual health screening occurring in this setting. A retrospective cohort study evaluating sexual health and sexually transmitted infection screening occurring in veterans receiving initial erectile dysfunction medication prescription was conducted. A total of 252 patients received initial erectile dysfunction medication prescriptions between October 1, 2009, and December 31, 2009; had at least 1 health care provider visit 12 months before the date of initial prescription; and had no documentation of previous erectile dysfunction medication use. Approximately 3% of these patients had any aspect of a sexual history recorded in the 24 months surrounding initial erectile dysfunction medication prescription. Sexually transmitted infection screening was 9.9% for syphilis, 4.8% for HIV, and 4.3% for gonorrhea/chlamydia before prescription, with only a slight increase in HIV screening after prescription. Minimal sexual health assessment is being performed during the time surrounding initial prescription of erectile dysfunction medication. Further work needs to evaluate patient and provider barriers to basic elements of sexual health care, such as taking sexual histories or screening for sexually transmitted infections.

Dain’s invariant on non-time symmetric initial data sets

NASA Astrophysics Data System (ADS)

Valiente Kroon, J. A.; Williams, J. L.

2017-06-01

We extend Dain’s construction of a geometric invariant characterising static initial data sets for the vacuum Einstein field equations to situations with a non-vanishing extrinsic curvature. This invariant gives a measure of how much an initial data set with non-vanishing ADM 4-momentum deviates from stationarity. In particular, it vanishes if and only if the initial data set is stationary. Thus, the invariant provides a quantification of the amount of gravitational radiation contained in the initial data set.

Mass functional for initial data in 4 +1 -dimensional spacetime

NASA Astrophysics Data System (ADS)

Alaee, Aghil; Kunduri, Hari K.

2014-12-01

We consider a broad class of asymptotically flat, maximal initial data sets satisfying the vacuum constraint equations, admitting two commuting rotational symmetries. We construct a mass functional for "t -ϕi"-symmetric data which evaluates to the Arnowitt-Deser-Misner mass. We then show that R ×U (1 )2 -invariant solutions of the vacuum Einstein equations are critical points of this functional amongst this class of data. We demonstrate the positivity of this functional for a class of rod structures which include the Myers-Perry initial data. The construction is a natural extension of Dain's mass functional to D =5 , although several new features arise.

Geometric constraints in semiclassical initial value representation calculations in Cartesian coordinates: accurate reduction in zero-point energy.

PubMed

Issack, Bilkiss B; Roy, Pierre-Nicholas

2005-08-22

An approach for the inclusion of geometric constraints in semiclassical initial value representation calculations is introduced. An important aspect of the approach is that Cartesian coordinates are used throughout. We devised an algorithm for the constrained sampling of initial conditions through the use of multivariate Gaussian distribution based on a projected Hessian. We also propose an approach for the constrained evaluation of the so-called Herman-Kluk prefactor in its exact log-derivative form. Sample calculations are performed for free and constrained rare-gas trimers. The results show that the proposed approach provides an accurate evaluation of the reduction in zero-point energy. Exact basis set calculations are used to assess the accuracy of the semiclassical results. Since Cartesian coordinates are used, the approach is general and applicable to a variety of molecular and atomic systems.

Electrosurgical skin resurfacing: a new bipolar instrument.

PubMed

Burns, R L; Carruthers, A; Langtry, J A; Trotter, M J

1999-07-01

Numerous modalities may be used for skin resurfacing, including chemical peels, dermabrasion, and lasers. Each of these methods is associated with significant disadvantages. The purpose of these initial studies was to determine the efficacy and safety of a new electrosurgical resurfacing system. Depth of cutaneous injury was also evaluated. Postoperative scar resurfacing was performed on six patients in the initial feasibility study. Patients were evaluated with questionnaires, physician observations, and photographs. The histologic investigation evaluated depth of injury after resurfacing at various power settings and number of passes. Appearance of postoperative scars in all 6 patients was improved by electrosurgical resurfacing. The overall injury, residual thermal damage plus ablation, for all power levels and passes was 114.1 micrometer (mean) with a standard deviation of 60.7 micrometer. Electrosurgical resurfacing may become an effective and safe alternative to current resurfacing modalities.

Iterative integral parameter identification of a respiratory mechanics model.

PubMed

Schranz, Christoph; Docherty, Paul D; Chiew, Yeong Shiong; Möller, Knut; Chase, J Geoffrey

2012-07-18

Patient-specific respiratory mechanics models can support the evaluation of optimal lung protective ventilator settings during ventilation therapy. Clinical application requires that the individual's model parameter values must be identified with information available at the bedside. Multiple linear regression or gradient-based parameter identification methods are highly sensitive to noise and initial parameter estimates. Thus, they are difficult to apply at the bedside to support therapeutic decisions. An iterative integral parameter identification method is applied to a second order respiratory mechanics model. The method is compared to the commonly used regression methods and error-mapping approaches using simulated and clinical data. The clinical potential of the method was evaluated on data from 13 Acute Respiratory Distress Syndrome (ARDS) patients. The iterative integral method converged to error minima 350 times faster than the Simplex Search Method using simulation data sets and 50 times faster using clinical data sets. Established regression methods reported erroneous results due to sensitivity to noise. In contrast, the iterative integral method was effective independent of initial parameter estimations, and converged successfully in each case tested. These investigations reveal that the iterative integral method is beneficial with respect to computing time, operator independence and robustness, and thus applicable at the bedside for this clinical application.

A Core Outcome Set for Evaluation of Interventions to Prevent Preterm Birth.

PubMed

van ʼt Hooft, Janneke; Duffy, James M N; Daly, Mandy; Williamson, Paula R; Meher, Shireen; Thom, Elizabeth; Saade, George R; Alfirevic, Zarko; Mol, Ben Willem J; Khan, Khalid S

2016-01-01

To develop a consensus on a set of key clinical outcomes for the evaluation of preventive interventions for preterm birth in asymptomatic pregnant women. A two-stage web-based Delphi survey and a face-to-face meeting of key stakeholders were used to develop a consensus on a set of critical and important outcomes. We approached five stakeholder groups (parents, midwives, obstetricians, neonatologists, and researchers) from middle- and high-income countries. Outcomes subjected to the Delphi survey were identified by systematic literature review and stakeholder input. Survey participants scored each outcome on a 9-point Likert scale anchored between 1 (limited importance) and 9 (critical importance). They had the opportunity to reflect on total and stakeholder subgroup feedback between survey stages. For consensus, defined a priori, outcomes required at least 70% of participants of each stakeholder group to score them as "critical" and less than 15% as "limited." A total of 228 participants from five stakeholder groups from three lower middle-income countries, seven upper middle-income countries, and 17 high-income countries were asked to score 31 outcomes. Of these participants, 195 completed the first survey and 174 the second. Consensus was reached on 13 core outcomes: four were related to pregnant women: maternal mortality, maternal infection or inflammation, prelabor rupture of membranes, and harm to mother from intervention. Nine were related to offspring: gestational age at birth, offspring mortality, birth weight, early neurodevelopmental morbidity, late neurodevelopmental morbidity, gastrointestinal morbidity, infection, respiratory morbidity, and harm to offspring from intervention. This core outcome set for studies that evaluate prevention of preterm birth developed with an international multidisciplinary perspective will ensure that data from trials that assess prevention of preterm birth can be compared and combined. COMET Initiative, http://www.comet-initiative.org/studies/details/603, REGISTRATION NUMBER: 603.

Computer program documentation: ISOCLS iterative self-organizing clustering program, program C094

NASA Technical Reports Server (NTRS)

Minter, R. T. (Principal Investigator)

1972-01-01

The author has identified the following significant results. This program implements an algorithm which, ideally, sorts a given set of multivariate data points into similar groups or clusters. The program is intended for use in the evaluation of multispectral scanner data; however, the algorithm could be used for other data types as well. The user may specify a set of initial estimated cluster means to begin the procedure, or he may begin with the assumption that all the data belongs to one cluster. The procedure is initiatized by assigning each data point to the nearest (in absolute distance) cluster mean. If no initial cluster means were input, all of the data is assigned to cluster 1. The means and standard deviations are calculated for each cluster.

The evaluation life cycle: a retrospective assessment of stages and phases of the circles of care initiative.

PubMed

Bess, Gary; Allen, James; Deters, Pamela B

2004-08-12

A life cycle metaphor characterizes the evolving relationship between the evaluator and program staff. This framework suggests that common developmental dynamics occur in roughly the same order across groups and settings. There are stage-specific dynamics that begin with Pre-History, which characterize the relationship between the grantees and evaluator. The stages are: (a) Pre-History, (b) Process, (c) Development, (d) Action, (e) Findings-Compilation, and (f) Transition. The common dynamics, expectations, and activities for each stage are discussed.

Comparative Initial and Sustained Engagement in Web-based Training by Behavioral Healthcare Providers in New York State.

PubMed

Talley, Rachel; Chiang, I-Chin; Covell, Nancy H; Dixon, Lisa

2018-06-01

Improved dissemination is critical to implementation of evidence-based practice in community behavioral healthcare settings. Web-based training modalities are a promising strategy for dissemination of evidence-based practice in community behavioral health settings. Initial and sustained engagement of these modalities in large, multidisciplinary community provider samples is not well understood. This study evaluates comparative engagement and user preferences by provider type in a web-based training platform in a large, multidisciplinary community sample of behavioral health staff in New York State. Workforce make-up among platform registrants was compared to the general NYS behavioral health workforce. Training completion by functional job type was compared to characterize user engagement and preferences. Frequently completed modules were classified by credit and requirement incentives. High initial training engagement across professional role was demonstrated, with significant differences in initial and sustained engagement by professional role. The most frequently completed modules across functional job types contained credit or requirement incentives. The analysis demonstrated that high engagement of a web-based training in a multidisciplinary provider audience can be achieved without tailoring content to specific professional roles. Overlap between frequently completed modules and incentives suggests a role for incentives in promoting engagement of web-based training. These findings further the understanding of strategies to promote large-scale dissemination of evidence-based practice in community behavioral health settings.

Initiating a Standardized Regional Referral and Counter-Referral System in Guatemala: A Mixed-Methods Study.

PubMed

Kapoor, Rupa; Avendaño, Leslie; Sandoval, Maria Antonieta; Cruz, Andrea T; Sampayo, Esther M; Soto, Miguel A; Camp, Elizabeth A; Crouse, Heather L

2017-01-01

Background: Few data exist for referral processes in resource-limited settings. We utilized mixed-methods to evaluate the impact of a standardized algorithm and training module developed for locally identified needs in referral/counter-referral procedures between primary health centers (PHCs) and a Guatemalan referral hospital. Methods : PHC personnel and hospital physicians participated in surveys and focus groups pre-implementation and 3, 6, and 12 months post-implementation to evaluate providers' experience with the system. Referred patient records were reviewed to evaluate system effectiveness. Results : A total of 111 initial focus group participants included 96 (86.5%) from PHCs and 15 from the hospital. Of these participants, 53 PHC physicians and nurses and 15 hospital physicians initially completed written surveys. Convenience samples participated in follow-up. Eighteen focus groups achieved thematic saturation. Four themes emerged: effective communication; provision of timely, quality patient care with adequate resources; educational opportunities; and development of empowerment and relationships. Pre- and post-implementation surveys demonstrated significant improvement at the PHCs ( P < .001) and the hospital ( P = .02). Chart review included 435 referrals, 98 (22.5%) pre-implementation and 337 (77.5%) post-implementation. There was a trend toward an increased percentage of appropriately referred patients requiring medical intervention (30% vs 40%, P = .08) and of patients requiring intervention who received it prior to transport (55% vs 73%, P = .06). Conclusions : Standardizing a referral/counter-referral system improved communication, education, and trust across different levels of pediatric health care delivery. This model may be used for extension throughout Guatemala or be modified for use in other countries. Mixed-methods research design can evaluate complex systems in resource-limited settings.

Initiating Self-Assessment Strategies in Novice Physiotherapy Students: A Method Case Study

ERIC Educational Resources Information Center

Young, Catherine

2013-01-01

Student self- and peer-assessment strategies ideally are instigated early in programmes for health professionals. This study presents an innovative method of stimulating critical evaluation of clinical skills learned in the practical class setting for first year physiotherapy students. Twice in the semester (beginning and end) students assessed…

The Development of Instruments to Measure Motivational Interviewing Skill Acquisition for School-Based Personnel

ERIC Educational Resources Information Center

Small, Jason W.; Lee, Jon; Frey, Andy J.; Seeley, John R.; Walker, Hill M.

2014-01-01

As specialized instructional support personnel begin learning and using motivational interviewing (MI) techniques in school-based settings, there is growing need for context-specific measures to assess initial MI skill development. In this article, we describe the iterative development and preliminary evaluation of two measures of MI skill adapted…

Synchronous Online CPD: Empirical Support for the Value of Webinars in Career Settings

ERIC Educational Resources Information Center

Yates, Julia

2014-01-01

The careers profession in England is facing unprecedented challenges. Initiatives to improve service delivery while keeping costs low are attractive and online training holds the promise of high impact at low cost. The present study employs a qualitative methodology to evaluate a series of online "webinars" conducted with 15 careers…

Adolescent Weight Status and Receptivity to Food TV Advertisements

ERIC Educational Resources Information Center

Adachi-Mejia, Anna M.; Sutherland, Lisa A.; Longacre, Meghan R.; Beach, Michael L.; Titus-Ernstoff, Linda; Gibson, Jennifer J.; Dalton, Madeline A.

2011-01-01

Objective: This study examined the relationship between adolescent weight status and food advertisement receptivity. Design: Survey-based evaluation with data collected at baseline (initial and at 2 months), and at follow-up (11 months). Setting: New Hampshire and Vermont. Participants: Students (n = 2,281) aged 10-13 in 2002-2005. Main Outcome…

ICT Integration in Turkey: Evaluation of English Language E-Content of the FATIH Project

ERIC Educational Resources Information Center

Kizilet, Esra; Özmen, Kemal Sinan

2017-01-01

A nationwide technology integration movement, FATIH Project, was initiated by Ministry of National Education. FATIH Project whose main objective is to provide equal opportunities to the learners during compulsory education is made up of many components: Hardware supply, procurement of software and e-content, infrastructure set up, and teacher…

Applying the Quality Matters (QM)™ Rubric to Improve Online Business Course Materials

ERIC Educational Resources Information Center

Woods, Dexter R., Jr.

2014-01-01

Online classes, hybrid or blended classes, and web-facilitated classes all employ online materials, which instructors and students are using at ever-increasing rates. Accordingly, instructors should continuously evaluate the effectiveness of such online materials. This paper sets forth the author's initial attempts to analyze a business course…

An Exploratory Analysis of Student-Community Interactions in Urban Agriculture

ERIC Educational Resources Information Center

Grossman, Julie; Sherard, Maximilian; Prohn, Seb M.; Bradley, Lucy; Goodell, L. Suzanne; Andrew, Katherine

2012-01-01

Urban agriculture initiatives are on the rise, providing healthy food while teaching a land ethic to youth. In parallel, increasing numbers of university graduates are obtaining Extension work requiring the effective communication of science in a diverse, urban, low-income setting. This study evaluates a pilot service-learning program, the…

Evidence Summary for H&R Block College Financial Aid Application Assistance. Top Tier Evidence Initiative

ERIC Educational Resources Information Center

Coalition for Evidence-Based Policy, 2012

2012-01-01

U.S. social programs, set up to address important problems, often fall short by funding specific models/strategies ("interventions") that are not effective. When evaluated in scientifically-rigorous studies, social interventions in K-12 education, job training, crime prevention, and other areas are frequently found ineffective or…

Evidence Summary for New York City's Small Schools of Choice. Top Tier Evidence Initiative

ERIC Educational Resources Information Center

Coalition for Evidence-Based Policy, 2015

2015-01-01

U.S. social programs, set up to address important problems, often fall short by funding specific models/strategies ("interventions") that are not effective. When evaluated in scientifically-rigorous studies, social interventions in K-12 education, job training, crime prevention, and other areas are frequently found ineffective or…

75 FR 39934 - The Effects of Mountaintop Mines and Valley Fills on Aquatic Ecosystems of the Central...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-13

... additional time to evaluate the data used to derive a benchmark for conductivity. The original Federal... below, reviewers may download the initial data and EPA's derivative data sets that were used to... and other surface coal mining projects, in coordination with federal and state regulatory agencies...

"Inspired and Assisted", or "Berated and Destroyed"? Research Leadership, Management and Performativity in Troubled Times

ERIC Educational Resources Information Center

Saltmarsh, Sue; Sutherland-Smith, Wendy; Randell-Moon, Holly

2011-01-01

Research leadership in Australian universities takes place against a backdrop of policy reforms concerned with measurement and comparison of institutional research performance. In particular, the Excellence in Research in Australian initiative undertaken by the Australian Research Council sets out to evaluate research quality in Australian…

Evaluation of NU-WRF Rainfall Forecasts for IFloodS

NASA Technical Reports Server (NTRS)

Wu, Di; Peters-Lidard, Christa; Tao, Wei-Kuo; Petersen, Walter

2016-01-01

The Iowa Flood Studies (IFloodS) campaign was conducted in eastern Iowa as a pre- GPM-launch campaign from 1 May to 15 June 2013. During the campaign period, real time forecasts are conducted utilizing NASA-Unified Weather Research and Forecasting (NU-WRF) model to support the everyday weather briefing. In this study, two sets of the NU-WRF rainfall forecasts are evaluated with Stage IV and Multi-Radar Multi-Sensor (MRMS) Quantitative Precipitation Estimation (QPE), with the objective to understand the impact of Land Surface initialization on the predicted precipitation. NU-WRF is also compared with North American Mesoscale Forecast System (NAM) 12 kilometer forecast. In general, NU-WRF did a good job at capturing individual precipitation events. NU-WRF is also able to replicate a better rainfall spatial distribution compare with NAM. Further sensitivity tests show that the high-resolution makes a positive impact on rainfall forecast. The two sets of NU-WRF simulations produce very close rainfall characteristics. The Land surface initialization do not show significant impact on short term rainfall forecast, and it is largely due to the soil conditions during the field campaign period.

Initial Flight Test Evaluation of the F-15 ACTIVE Axisymmetric Vectoring Nozzle Performance

NASA Technical Reports Server (NTRS)

Orme, John S.; Hathaway, Ross; Ferguson, Michael D.

1998-01-01

A full envelope database of a thrust-vectoring axisymmetric nozzle performance for the Pratt & Whitney Pitch/Yaw Balance Beam Nozzle (P/YBBN) is being developed using the F-15 Advanced Control Technology for Integrated Vehicles (ACTIVE) aircraft. At this time, flight research has been completed for steady-state pitch vector angles up to 20' at an altitude of 30,000 ft from low power settings to maximum afterburner power. The nozzle performance database includes vector forces, internal nozzle pressures, and temperatures all of which can be used for regression analysis modeling. The database was used to substantiate a set of nozzle performance data from wind tunnel testing and computational fluid dynamic analyses. Findings from initial flight research at Mach 0.9 and 1.2 are presented in this paper. The results show that vector efficiency is strongly influenced by power setting. A significant discrepancy in nozzle performance has been discovered between predicted and measured results during vectoring.

Evaluation of ERDA-sponsored coal feed system development

NASA Technical Reports Server (NTRS)

Phen, R. L.; Luckow, W. K.; Mattson, L.; Otth, D.; Tsou, P.

1977-01-01

Coal feeders were evaluated based upon criteria such as technical feasibility, performance (i.e. ability to meet process requirements), projected life cycle costs, and projected development cost. An initial set of feeders was selected based on the feeders' cost savings potential compared with baseline lockhopper systems. Additional feeders were considered for selection based on: (1) increasing the probability of successful feeder development; (2) application to specific processes; and (3) technical merit. A coal feeder development program is outlined.

Selecting Meteorological Input for the Global Modeling Initiative Assessments

NASA Technical Reports Server (NTRS)

Strahan, Susan; Douglass, Anne; Prather, Michael; Coy, Larry; Hall, Tim; Rasch, Phil; Sparling, Lynn

1999-01-01

The Global Modeling Initiative (GMI) science team has developed a three dimensional chemistry and transport model (CTM) to evaluate the impact of the exhaust of supersonic aircraft on the stratosphere. An important goal of the GMI is to test modules for numerical transport, photochemical integration, and model dynamics within a common framework. This work is focussed on the dependence of the overall assessment on the wind and temperature fields used by the CTM. Three meteorological data sets for the stratosphere were available to GMI: the National Center for Atmospheric Research Community Climate Model (CCM2), the Goddard Earth Observing System Data Assimilation System (GEOS-DAS), and the Goddard Institute for Space Studies general circulation model (GISS-2'). Objective criteria were established by the GMI team to evaluate which of these three data sets provided the best representation of trace gases in the stratosphere today. Tracer experiments were devised to test various aspects of model transport. Stratospheric measurements of long-lived trace gases were selected as a test of the CTM transport. This presentation describes the criteria used in grading the meteorological fields and the resulting choice of wind fields to be used in the GMI assessment. This type of objective model evaluation will lead to a higher level of confidence in these assessments. We suggest that the diagnostic tests shown here be used to augment traditional general circulation model evaluation methods.

Evaluating the Credibility of Transport Processes in the Global Modeling Initiative 3D Model Simulations of Ozone Recovery

NASA Technical Reports Server (NTRS)

Strahan, Susan E.; Douglass, Anne R.

2003-01-01

The Global Modeling Initiative has integrated two 35-year simulations of an ozone recovery scenario with an offline chemistry and transport model using two different meteorological inputs. Physically based diagnostics, derived from satellite and aircraft data sets, are described and then used to evaluate the realism of temperature and transport processes in the simulations. Processes evaluated include barrier formation in the subtropics and polar regions, and extratropical wave-driven transport. Some diagnostics are especially relevant to simulation of lower stratospheric ozone, but most are applicable to any stratospheric simulation. The temperature evaluation, which is relevant to gas phase chemical reactions, showed that both sets of meteorological fields have near climatological values at all latitudes and seasons at 30 hPa and below. Both simulations showed weakness in upper stratospheric wave driving. The simulation using input from a general circulation model (GMI(sub GCM)) showed a very good residual circulation in the tropics and northern hemisphere. The simulation with input from a data assimilation system (GMI(sub DAS)) performed better in the midlatitudes than at high latitudes. Neither simulation forms a realistic barrier at the vortex edge, leading to uncertainty in the fate of ozone-depleted vortex air. Overall, tracer transport in the offline GMI(sub GCM) has greater fidelity throughout the stratosphere than the GMI(sub DAS).

Comparison of surface freshwater fluxes from different climate forecasts produced through different ensemble generation schemes.

NASA Astrophysics Data System (ADS)

Romanova, Vanya; Hense, Andreas; Wahl, Sabrina; Brune, Sebastian; Baehr, Johanna

2016-04-01

The decadal variability and its predictability of the surface net freshwater fluxes is compared in a set of retrospective predictions, all using the same model setup, and only differing in the implemented ocean initialisation method and ensemble generation method. The basic aim is to deduce the differences between the initialization/ensemble generation methods in view of the uncertainty of the verifying observational data sets. The analysis will give an approximation of the uncertainties of the net freshwater fluxes, which up to now appear to be one of the most uncertain products in observational data and model outputs. All ensemble generation methods are implemented into the MPI-ESM earth system model in the framework of the ongoing MiKlip project (www.fona-miklip.de). Hindcast experiments are initialised annually between 2000-2004, and from each start year 10 ensemble members are initialized for 5 years each. Four different ensemble generation methods are compared: (i) a method based on the Anomaly Transform method (Romanova and Hense, 2015) in which the initial oceanic perturbations represent orthogonal and balanced anomaly structures in space and time and between the variables taken from a control run, (ii) one-day-lagged ocean states from the MPI-ESM-LR baseline system (iii) one-day-lagged of ocean and atmospheric states with preceding full-field nudging to re-analysis in both the atmospheric and the oceanic component of the system - the baseline one MPI-ESM-LR system, (iv) an Ensemble Kalman Filter (EnKF) implemented into oceanic part of MPI-ESM (Brune et al. 2015), assimilating monthly subsurface oceanic temperature and salinity (EN3) using the Parallel Data Assimilation Framework (PDAF). The hindcasts are evaluated probabilistically using fresh water flux data sets from four different reanalysis data sets: MERRA, NCEP-R1, GFDL ocean reanalysis and GECCO2. The assessments show no clear differences in the evaluations scores on regional scales. However, on the global scale the physically motivated methods (i) and (iv) provide probabilistic hindcasts with a consistently higher reliability than the lagged initialization methods (ii)/(iii) despite the large uncertainties in the verifying observations and in the simulations.

Extreme throat initial data set and horizon area-angular momentum inequality for axisymmetric black holes

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

Dain, Sergio; Max Planck Institute for Gravitational Physics

2010-11-15

We present a formula that relates the variations of the area of extreme throat initial data with the variation of an appropriate defined mass functional. From this expression we deduce that the first variation, with fixed angular momentum, of the area is zero and the second variation is positive definite evaluated at the extreme Kerr throat initial data. This indicates that the area of the extreme Kerr throat initial data is a minimum among this class of data. And hence the area of generic throat initial data is bounded from below by the angular momentum. Also, this result strongly suggestsmore » that the inequality between area and angular momentum holds for generic asymptotically flat axially symmetric black holes. As an application, we prove this inequality in the nontrivial family of spinning Bowen-York initial data.« less

Making a success of providing NHS Health Checks in community pharmacies across the Tees Valley: a qualitative study

PubMed Central

2011-01-01

Background In England and Wales, the Department of Health introduced a primary prevention programme, NHS Health Checks, to provide screening for cardiovascular risk amongst people aged 40-74. The aim of this programme is to offer treatment and advice to those identified with an increased risk of cardiovascular diseases (CVD). The North East of England has some of the highest rates of CVD in the UK and prevention is therefore a priority. NHS Tees funded this programme of work under the local branding of Healthy Heart Checks (HHC). These were initially implemented principally through GP practices from October 2008 but, in order to mitigate the possibility that some hard to reach communities would be reluctant to engage with some primary care settings, plans were also developed to deliver the programme through workplace settings and through community pharmacies. This paper reports specifically on the findings from the evaluation in respect of the setting up of HHCs in community pharmacies and aims to offer some lessons for other service settings where this option is seen as a way of providing low threshold services which will minimise inequalities in intervention uptake. Methods In assessing the community pharmacy component of HHCs, a selection of staff having direct involvement in the process was invited to take part in the evaluation. Interviews were carried out with representatives from community pharmacy, staff members from the commissioning Primary Care Trusts and with Local Pharmaceutical Committee members. Results Evaluation and analysis identified challenges which should be anticipated and addressed in initiating HHC in community pharmacies. These have been categorised into four main themes for discussion in this paper: (1) establishing and maintaining pharmacy Healthy Heart Checks, (2) overcoming IT barriers, (3) developing confident, competent staff and (4) ensuring volume and through flow in pharmacy. Conclusions Delivering NHS health checks through community pharmacies can be a complex process, requiring meticulous planning, and may incur higher than expected costs. Findings from our evaluation provide insight into possible barriers to setting up services in pharmacies which may help other commissioning bodies when considering community pharmacy as a location for primary prevention interventions in future. PMID:21929809

The LSST metrics analysis framework (MAF)

NASA Astrophysics Data System (ADS)

Jones, R. L.; Yoachim, Peter; Chandrasekharan, Srinivasan; Connolly, Andrew J.; Cook, Kem H.; Ivezic, Željko; Krughoff, K. S.; Petry, Catherine; Ridgway, Stephen T.

2014-07-01

We describe the Metrics Analysis Framework (MAF), an open-source python framework developed to provide a user-friendly, customizable, easily-extensible set of tools for analyzing data sets. MAF is part of the Large Synoptic Survey Telescope (LSST) Simulations effort. Its initial goal is to provide a tool to evaluate LSST Operations Simulation (OpSim) simulated surveys to help understand the effects of telescope scheduling on survey performance, however MAF can be applied to a much wider range of datasets. The building blocks of the framework are Metrics (algorithms to analyze a given quantity of data), Slicers (subdividing the overall data set into smaller data slices as relevant for each Metric), and Database classes (to access the dataset and read data into memory). We describe how these building blocks work together, and provide an example of using MAF to evaluate different dithering strategies. We also outline how users can write their own custom Metrics and use these within the framework.

Evaluations of reproductive health programs in humanitarian settings: a systematic review

PubMed Central

2015-01-01

Provision of reproductive health (RH) services is a minimum standard of health care in humanitarian settings; however access to these services is often limited. This systematic review, one component of a global evaluation of RH in humanitarian settings, sought to explore the evidence regarding RH services provided in humanitarian settings and to determine if programs are being evaluated. In addition, the review explored which RH services receive more attention based on program evaluations and descriptive data. Peer-reviewed papers published between 2004 and 2013 were identified via the Ovid MEDLINE database, followed by a PubMed search. Papers on quantitative evaluations of RH programs, including experimental and non-experimental designs that reported outcome data, implemented in conflict and natural disaster settings, were included. Of 5,669 papers identified in the initial search, 36 papers describing 30 programs met inclusion criteria. Twenty-five papers described programs in sub-Saharan Africa, six in Asia, two in Haiti and three reported data from multiple countries. Some RH technical areas were better represented than others: seven papers reported on maternal and newborn health (including two that also covered family planning), six on family planning, three on sexual violence, 20 on HIV and other sexually transmitted infections and two on general RH topics. In comparison to the program evaluation papers identified, three times as many papers were found that reported RH descriptive or prevalence data in humanitarian settings. While data demonstrating the magnitude of the problem are crucial and were previously lacking, the need for RH services and for evaluations to measure their effectiveness is clear. Program evaluation and implementation science should be incorporated into more programs to determine the best ways to serve the RH needs of people affected by conflict or natural disaster. Standard program design should include rigorous program evaluation, and the results must be shared. The papers demonstrated both that RH programs can be implemented in these challenging settings, and that women and men will use RH services when they are of reasonable quality. PMID:25685183

Redesign of a university hospital preanesthesia evaluation clinic using a queuing theory approach.

PubMed

Zonderland, Maartje E; Boer, Fredrik; Boucherie, Richard J; de Roode, Annemiek; van Kleef, Jack W

2009-11-01

Changes in patient length of stay (the duration of 1 clinic visit) as a result of the introduction of an electronic patient file system forced an anesthesia department to change its outpatient clinic organization. In this study, we sought to demonstrate how the involvement of essential employees combined with mathematical techniques to support the decision-making process resulted in a successful intervention. The setting is the preanesthesia evaluation clinic (PAC) of a university hospital, where patients consult several medical professionals, either by walk-in or appointment. Queuing theory was used to model the initial set-up of the clinic, and later to model possible alternative designs. With the queuing model, possible improvements in efficiency could be investigated. Inputs to the model were patient arrival rates and expected service times with clinic employees, collected from the clinic's logging system and by observation. The performance measures calculated with the model were patient length of stay and employee utilization rate. Supported by the model outcomes, a working group consisting of representatives of all clinic employees decided whether the initial design should be maintained or an intervention was needed. The queuing model predicted that 3 of the proposed alternatives would result in better performance. Key points in the intervention were the rescheduling of appointments and the reallocation of tasks. The intervention resulted in a shortening of the time the anesthesiologist needed to decide upon approving the patient for surgery. Patient arrivals increased sharply over 1 yr by more than 16%; however, patient length of stay at the clinic remained essentially unchanged. If the initial set-up of the clinic would have been maintained, the patient length of stay would have increased dramatically. Queuing theory provides robust methods to evaluate alternative designs for the organization of PACs. In this article, we show that queuing modeling is an adequate approach for redesigning processes in PACs.

The Soldier-Athlete Initiative: Program Evaluation of the Effectiveness of Athletic Trainers Compared to Musculoskeletal Action Teams in Initial Entry Training, Fort Leonard Wood, June 2010 - December 2011

DTIC Science & Technology

2012-10-01

skills and injury prevention methods applied by ATs in sports and exercise situations may also be applicable to recruits in IET. In late 2009, the...able to assure that physical training exercises are carried out in a manner to optimize mission readiness and minimize the incidence of injury. In...facility with a 21-piece Nautilus set and aerobic exercise equipment. Money spent on the equipment/facility was recouped within 10 months and there was

Evaluation of quality improvement initiative in pediatric oncology: implementation of aggressive hydration protocol.

PubMed

Fratino, Lisa M; Daniel, Denise A; Cohen, Kenneth J; Chen, Allen R

2009-01-01

Our goal was to improve the efficiency of chemotherapy administration for pediatric oncology patients. We identified prechemotherapy hydration as the process that most often delayed chemotherapy administration. An aggressive hydration protocol, supported by fluid order sets, was developed for patients receiving planned chemotherapy. The mean interval from admission to achieving adequate hydration status was reduced significantly from 4.9 to 1.4 hours with a minor reduction in the time to initiate chemotherapy from 9.6 to 8.6 hours. Chemotherapy availability became the new rate-limiting process.

Evaluation of the effect of torsemide on warfarin dosage requirements.

PubMed

Lai, Sophia; Momper, Jeremiah D; Yam, Felix K

2017-08-01

Background According to drug interaction databases, torsemide may potentiate the effects of warfarin. Evidence for this drug-drug interaction, however, is conflicting and the clinical significance is unknown. Objective The aim of this study is to evaluate the impact of torsemide initiation on warfarin dosage requirements. Setting This study was conducted at the Veterans Affairs Healthcare System in San Diego, California. Method A retrospective cohort study was conducted using Veterans Affairs data from patients who were converted from bumetanide to torsemide between March 2014 and July 2014. Patients were also prescribed and taking warfarin during the observation period. Warfarin dosage requirements were evaluated to determine if any changes occurred within the first 3 months of starting torsemide. Main outcome measure The primary outcome was the average weekly warfarin dose before and after torsemide initiation. Results Eighteen patients met study inclusion criteria. The weekly warfarin dose before and after initiation of torsemide was not significantly different (34 ± 15 and 34 ± 13 mg, p > 0.05). Of those eighteen patients, only two experienced elevations in INR that required a decrease in warfarin dosage after torsemide initiation. Between those two patients, dosage reductions ranged from 5.3 to 18%. Conclusion These results indicated that most patients did not require any warfarin dosage adjustments after torsemide was initiated. The potential for interaction, however, still exists. While empiric warfarin dosage adjustments are not recommended when initiating torsemide, increased monitoring is warranted to minimize the risk of adverse effects.

Empirical evaluation demonstrated importance of validating biomarkers for early detection of cancer in screening settings to limit the number of false-positive findings.

PubMed

Chen, Hongda; Knebel, Phillip; Brenner, Hermann

2016-07-01

Search for biomarkers for early detection of cancer is a very active area of research, but most studies are done in clinical rather than screening settings. We aimed to empirically evaluate the role of study setting for early detection marker identification and validation. A panel of 92 candidate cancer protein markers was measured in 35 clinically identified colorectal cancer patients and 35 colorectal cancer patients identified at screening colonoscopy. For each case group, we selected 38 controls without colorectal neoplasms at screening colonoscopy. Single-, two- and three-marker combinations discriminating cases and controls were identified in each setting and subsequently validated in the alternative setting. In all scenarios, a higher number of predictive biomarkers were initially detected in the clinical setting, but a substantially lower proportion of identified biomarkers could subsequently be confirmed in the screening setting. Confirmation rates were 50.0%, 84.5%, and 74.2% for one-, two-, and three-marker algorithms identified in the screening setting and were 42.9%, 18.6%, and 25.7% for algorithms identified in the clinical setting. Validation of early detection markers of cancer in a true screening setting is important to limit the number of false-positive findings. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Application of quality improvement analytic methodology in emergency medicine research: A comparative evaluation.

PubMed

Harries, Bruce; Filiatrault, Lyne; Abu-Laban, Riyad B

2018-05-30

Quality improvement (QI) analytic methodology is rarely encountered in the emergency medicine literature. We sought to comparatively apply QI design and analysis techniques to an existing data set, and discuss these techniques as an alternative to standard research methodology for evaluating a change in a process of care. We used data from a previously published randomized controlled trial on triage-nurse initiated radiography using the Ottawa ankle rules (OAR). QI analytic tools were applied to the data set from this study and evaluated comparatively against the original standard research methodology. The original study concluded that triage nurse-initiated radiographs led to a statistically significant decrease in mean emergency department length of stay. Using QI analytic methodology, we applied control charts and interpreted the results using established methods that preserved the time sequence of the data. This analysis found a compelling signal of a positive treatment effect that would have been identified after the enrolment of 58% of the original study sample, and in the 6th month of this 11-month study. Our comparative analysis demonstrates some of the potential benefits of QI analytic methodology. We found that had this approach been used in the original study, insights regarding the benefits of nurse-initiated radiography using the OAR would have been achieved earlier, and thus potentially at a lower cost. In situations where the overarching aim is to accelerate implementation of practice improvement to benefit future patients, we believe that increased consideration should be given to the use of QI analytic methodology.

An improved initialization center k-means clustering algorithm based on distance and density

NASA Astrophysics Data System (ADS)

Duan, Yanling; Liu, Qun; Xia, Shuyin

2018-04-01

Aiming at the problem of the random initial clustering center of k means algorithm that the clustering results are influenced by outlier data sample and are unstable in multiple clustering, a method of central point initialization method based on larger distance and higher density is proposed. The reciprocal of the weighted average of distance is used to represent the sample density, and the data sample with the larger distance and the higher density are selected as the initial clustering centers to optimize the clustering results. Then, a clustering evaluation method based on distance and density is designed to verify the feasibility of the algorithm and the practicality, the experimental results on UCI data sets show that the algorithm has a certain stability and practicality.

Mobile Landing Platform with Core Capability Set (MLP w/CCS): Combined Initial Operational Test and Evaluation and Live Fire Test and Evaluation Report

DTIC Science & Technology

2015-07-01

annex.   iii Self-defense testing was limited to structural test firing from each machine gun mount and an ammunition resupply drill. Robust self...provided in the classified annex. Self-   8 defense testing was limited to structural test firing from each machine gun mount and a single...Caliber Machine Gun Mount Structural Test Fire November 2014 San Diego, Offshore Ship Weapons Range Operating Independently       9 Section Three

Towards environment and health promoting South African schools.

PubMed

Mathee, A; Byrne, J

1996-03-01

This article describes the activities of the Greater Johannesburg Healthy Schools Program of the World Health Organization's (WHO) Healthy Cities Project in South Africa. Healthy Cities projects emphasize community participation, intersectoral action, supportive environments for health, and a settings approach. Children in South Africa, are exposed to environmental and health hazards in the school setting including poor building design, poor equipment, and understaffing. The Healthy Schools initiative in Greater Johannesburg, is a pilot for enhancing environmental quality, health, and well-being among students. Schools include those in an informal settlement in an industrial area, an inner city district, and in a suburban area. The initiative includes research, establishment of environmental and health committees, development of an action plan, and evaluation and feedback. The plan aims to promote environmental and health sustainability, to empower children to become full participants in the community, and to support teachers and parents in the promotion of health-enhancing school environments. The program builds upon the lessons learned from several local school initiatives. Initiatives include an anti-smoking poster competition involving over 10,000 students, special environmental and health awareness days, consciousness raising among high school students about air pollution, and local efforts to engage students in environmental clean-up days.

Vacuum packing: a model system for laboratory-scale silage fermentations.

PubMed

Johnson, H E; Merry, R J; Davies, D R; Kell, D B; Theodorou, M K; Griffith, G W

2005-01-01

To determine the utility of vacuum-packed polythene bags as a convenient, flexible and cost-effective alternative to fixed volume glass vessels for lab-scale silage studies. Using perennial ryegrass or red clover forage, similar fermentations (as assessed by pH measurement) occurred in glass tube and vacuum-packed silos over a 35-day period. As vacuum-packing devices allow modification of initial packing density, the effect of four different settings (initial packing densities of 0.397, 0.435, 0.492 and 0.534 g cm(-3)) on the silage fermentation over 16 days was examined. Significant differences in pH decline and lactate accumulation were observed at different vacuum settings. Gas accumulation was apparent within all bags and changes in bag volume with time was observed to vary according to initial packing density. Vacuum-packed silos do provide a realistic model system for lab-scale silage fermentations. Use of vacuum-packed silos holds potential for lab-scale evaluations of silage fermentations, allowing higher throughput of samples, more consistent packing as well as the possibility of investigating the effects of different initial packing densities and use of different wrapping materials.

The upper bound of abutment scour defined by selected laboratory and field data

USGS Publications Warehouse

Benedict, Stephen; Caldwell, Andral W.

2015-01-01

The U.S. Geological Survey, in cooperation with the South Carolina Department of Transportation, conducted a field investigation of abutment scour in South Carolina and used that data to develop envelope curves defining the upper bound of abutment scour. To expand upon this previous work, an additional cooperative investigation was initiated to combine the South Carolina data with abutment-scour data from other sources and evaluate the upper bound of abutment scour with the larger data set. To facilitate this analysis, a literature review was made to identify potential sources of published abutment-scour data, and selected data, consisting of 446 laboratory and 331 field measurements, were compiled for the analysis. These data encompassed a wide range of laboratory and field conditions and represent field data from 6 states within the United States. The data set was used to evaluate the South Carolina abutment-scour envelope curves. Additionally, the data were used to evaluate a dimensionless abutment-scour envelope curve developed by Melville (1992), highlighting the distinct difference in the upper bound for laboratory and field data. The envelope curves evaluated in this investigation provide simple but useful tools for assessing the potential maximum abutment-scour depth in the field setting.

Community-based interventions to promote increased physical activity: a primer.

PubMed

Bopp, Melissa; Fallon, Elizabeth

2008-01-01

Current recommendations, based on an abundance of empirical data documenting the impact of physical activity (PA) on preventing morbidity and mortality associated with common chronic diseases, indicate that adults should accumulate 30 minutes of moderate-intensity PA > or =5 days per week. However, worldwide rates of PA remain low, indicating a great need for large-scale implementation of evidence-based PA interventions. We briefly present practical aspects of intervention planning, implementation and evaluation within common community settings. The first stage of intervention planning is formative research, which allows for a better understanding of the elements needed for a successful intervention. Partnering with community settings (schools, worksites, faith-based organizations and healthcare organizations) offers many benefits and the opportunity to reach specific populations. Setting-based approaches allow for multilevel strategies, ranging from individual-based programmes and educational initiatives to physical and social environmental changes. Various settings such as healthcare, worksite, and school- and community-based settings are discussed. Intervention delivery methods and strategies can range, depending on the population and setting targeted, from small-group approaches to mediated methods (e.g. print, telephone, electronic). The final phase of intervention planning and implementation is evaluation. Several objective and subjective methods of PA assessment are available to determine the effectiveness of the intervention. We have highlighted the need for process evaluation of intervention implementation to provide valuable information for the dissemination and sustainability of successful interventions. Although there are numerous considerations for the design, implementation, assessment and evaluation of PA interventions, the potential for positive impact on the overall health of the public indicates the necessity for programmes designed to increase PA.

C-reactive protein as a marker of melanoma progression.

PubMed

Fang, Shenying; Wang, Yuling; Sui, Dawen; Liu, Huey; Ross, Merrick I; Gershenwald, Jeffrey E; Cormier, Janice N; Royal, Richard E; Lucci, Anthony; Schacherer, Christopher W; Gardner, Julie M; Reveille, John D; Bassett, Roland L; Wang, Li-E; Wei, Qingyi; Amos, Christopher I; Lee, Jeffrey E

2015-04-20

To investigate the association between blood levels of C-reactive protein (CRP) in patients with melanoma and overall survival (OS), melanoma-specific survival (MSS), and disease-free survival. Two independent sets of plasma samples from a total of 1,144 patients with melanoma (587 initial and 557 confirmatory) were available for CRP determination. Kaplan-Meier method and Cox regression were used to evaluate the relationship between CRP and clinical outcome. Among 115 patients who underwent sequential blood draws, we evaluated the relationship between change in disease status and change in CRP using nonparametric tests. Elevated CRP level was associated with poorer OS and MSS in the initial, confirmatory, and combined data sets (combined data set: OS hazard ratio, 1.44 per unit increase of logarithmic CRP; 95% CI, 1.30 to 1.59; P < .001; MSS hazard ratio, 1.51 per unit increase of logarithmic CRP; 95% CI, 1.36 to 1.68; P < .001). These findings persisted after multivariable adjustment. As compared with CRP < 10 mg/L, CRP ≥ 10 mg/L conferred poorer OS in patients with any-stage, stage I/II, or stage III/IV disease and poorer disease-free survival in those with stage I/II disease. In patients who underwent sequential evaluation of CRP, an association was identified between an increase in CRP and melanoma disease progression. CRP is an independent prognostic marker in patients with melanoma. CRP measurement should be considered for incorporation into prospective studies of outcome in patients with melanoma and clinical trials of systemic therapies for those with melanoma. © 2015 by American Society of Clinical Oncology.

C-Reactive Protein As a Marker of Melanoma Progression

PubMed Central

Fang, Shenying; Wang, Yuling; Sui, Dawen; Liu, Huey; Ross, Merrick I.; Gershenwald, Jeffrey E.; Cormier, Janice N.; Royal, Richard E.; Lucci, Anthony; Schacherer, Christopher W.; Gardner, Julie M.; Reveille, John D.; Bassett, Roland L.; Wang, Li-E; Wei, Qingyi; Amos, Christopher I.; Lee, Jeffrey E.

2015-01-01

Purpose To investigate the association between blood levels of C-reactive protein (CRP) in patients with melanoma and overall survival (OS), melanoma-specific survival (MSS), and disease-free survival. Patients and Methods Two independent sets of plasma samples from a total of 1,144 patients with melanoma (587 initial and 557 confirmatory) were available for CRP determination. Kaplan-Meier method and Cox regression were used to evaluate the relationship between CRP and clinical outcome. Among 115 patients who underwent sequential blood draws, we evaluated the relationship between change in disease status and change in CRP using nonparametric tests. Results Elevated CRP level was associated with poorer OS and MSS in the initial, confirmatory, and combined data sets (combined data set: OS hazard ratio, 1.44 per unit increase of logarithmic CRP; 95% CI, 1.30 to 1.59; P < .001; MSS hazard ratio, 1.51 per unit increase of logarithmic CRP; 95% CI, 1.36 to 1.68; P < .001). These findings persisted after multivariable adjustment. As compared with CRP < 10 mg/L, CRP ≥ 10 mg/L conferred poorer OS in patients with any-stage, stage I/II, or stage III/IV disease and poorer disease-free survival in those with stage I/II disease. In patients who underwent sequential evaluation of CRP, an association was identified between an increase in CRP and melanoma disease progression. Conclusion CRP is an independent prognostic marker in patients with melanoma. CRP measurement should be considered for incorporation into prospective studies of outcome in patients with melanoma and clinical trials of systemic therapies for those with melanoma. PMID:25779565

Evidence Summary for First-Grade Classroom Prevention Program (Good Behavior Game Plus Enhanced Academic Curriculum). Top Tier Evidence Initiative

ERIC Educational Resources Information Center

Coalition for Evidence-Based Policy, 2010

2010-01-01

U.S. social programs, set up to address important problems, often fall short by funding specific models/strategies ("interventions") that are not effective. When evaluated in scientifically-rigorous studies, social interventions in K-12 education, job training, crime prevention, and other areas are frequently found ineffective or…

Validation and Estimation of Additive Genetic Variation Associated with DNA Tests for Quantitative Beef Cattle Traits

USDA-ARS?s Scientific Manuscript database

The U.S. National Beef Cattle Evaluation Consortium (NBCEC) has been involved in the validation of commercial DNA tests for quantitative beef quality traits since their first appearance on the U.S. market in the early 2000s. The NBCEC Advisory Council initially requested that the NBCEC set up a syst...

THE DEVELOPMENT AND TEST OF A SPECIAL PURPOSE FOREIGN LANGUAGE TRAINING CONCEPT.

ERIC Educational Resources Information Center

ROCKLYN, EUGENE H.

THIS ARTICLE TRACES THE ORIGIN AND EVALUATION OF A SPECIAL FOREIGN LANGUAGE TRAINING CONCEPT THAT EVOLVED OUT OF A SPECIFIC MILITARY NEED TO INTERROGATE NEWLY CAPTURED PRISONERS OF WAR TO ACQUIRE IMMEDIATE TACTICAL INFORMATION. THROUGH AN INITIAL FEASIBILITY STUDY, A REASONABLE SET OF VERBAL MATERIALS WAS SELECTED AS COURSE CONTENT, AND A…

Behavioral Intervention to Treat Selective Mutism across Multiple Social Situations and Community Settings

ERIC Educational Resources Information Center

Lang, Russell; Regester, April; Mulloy, Austin; Rispoli, Mandy; Botout, Amanda

2011-01-01

We evaluated a behavioral intervention for a 9-year-old girl with selective mutism. The intervention consisted of role play and video self-modeling. The frequency of spoken initiations, responses to questions, and communication breakdowns was measured during three social situations (i.e., ordering in a restaurant, meeting new adults, and playing…

75 FR 51058 - The Effects of Mountaintop Mines and Valley Fills on Aquatic Ecosystems of the Central...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-18

... the public additional time to evaluate the data used to derive a benchmark for conductivity. The... FR 18499). By following the link below, reviewers may download the initial data and EPA's derivative data sets that were used to calculate the conductivity benchmark. These reports were developed by the...

75 FR 30393 - The Effects of Mountaintop Mines and Valley Fills on Aquatic Ecosystems of the Central...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-01

... opportunity to evaluate the data used to derive a benchmark for conductivity. By following the link below, reviewers may download the initial data and EPA's derivative data sets that were used to calculate the... surface coal mining projects, in coordination with Federal and State regulatory agencies ( http://www.epa...

Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia: a prospective cohort study

PubMed Central

2014-01-01

Background Initial management of chemotherapy-induced febrile neutropaenia (FN) comprises empirical therapy with a broad-spectrum antimicrobial. Currently, there is sufficient evidence to indicate which antibiotic regimen should be administered initially. However, no randomized trial has evaluated whether adherence to an antimicrobial stewardship program (ASP) results in lower rates of mortality in this setting. The present study sought to assess the association between adherence to an ASP and mortality among hospitalised cancer patients with FN. Methods We conducted a prospective cohort study in a single tertiary hospital from October 2009 to August 2011. All adult patients who were admitted to the haematology ward with cancer and FN were followed up for 28 days. ASP adherence to the initial antimicrobial prescription was determined. The mortality rates of patients who were treated with antibiotics according to the ASP protocol were compared with those of patients treated with other antibiotic regimens. The multivariate Cox proportional hazards model and propensity score were used to estimate 28-day mortality risk. Results A total of 307 FN episodes in 169 subjects were evaluated. The rate of adherence to the ASP was 53%. In a Cox regression analysis, adjusted for propensity scores and other potential confounding factors, ASP adherence was independently associated with lower mortality (hazard ratio, 0.36; 95% confidence interval, 0.14–0.92). Conclusions Antimicrobial selection is important for the initial management of patients with FN, and adherence to the ASP, which calls for the rational use of antibiotics, was associated with lower mortality rates in this setting. PMID:24884397

Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia: a prospective cohort study.

PubMed

Rosa, Regis G; Goldani, Luciano Z; dos Santos, Rodrigo P

2014-05-23

Initial management of chemotherapy-induced febrile neutropaenia (FN) comprises empirical therapy with a broad-spectrum antimicrobial. Currently, there is sufficient evidence to indicate which antibiotic regimen should be administered initially. However, no randomized trial has evaluated whether adherence to an antimicrobial stewardship program (ASP) results in lower rates of mortality in this setting. The present study sought to assess the association between adherence to an ASP and mortality among hospitalised cancer patients with FN. We conducted a prospective cohort study in a single tertiary hospital from October 2009 to August 2011. All adult patients who were admitted to the haematology ward with cancer and FN were followed up for 28 days. ASP adherence to the initial antimicrobial prescription was determined. The mortality rates of patients who were treated with antibiotics according to the ASP protocol were compared with those of patients treated with other antibiotic regimens. The multivariate Cox proportional hazards model and propensity score were used to estimate 28-day mortality risk. A total of 307 FN episodes in 169 subjects were evaluated. The rate of adherence to the ASP was 53%. In a Cox regression analysis, adjusted for propensity scores and other potential confounding factors, ASP adherence was independently associated with lower mortality (hazard ratio, 0.36; 95% confidence interval, 0.14-0.92). Antimicrobial selection is important for the initial management of patients with FN, and adherence to the ASP, which calls for the rational use of antibiotics, was associated with lower mortality rates in this setting.

System diagnostic builder

NASA Technical Reports Server (NTRS)

Nieten, Joseph L.; Burke, Roger

1992-01-01

The System Diagnostic Builder (SDB) is an automated software verification and validation tool using state-of-the-art Artificial Intelligence (AI) technologies. The SDB is used extensively by project BURKE at NASA-JSC as one component of a software re-engineering toolkit. The SDB is applicable to any government or commercial organization which performs verification and validation tasks. The SDB has an X-window interface, which allows the user to 'train' a set of rules for use in a rule-based evaluator. The interface has a window that allows the user to plot up to five data parameters (attributes) at a time. Using these plots and a mouse, the user can identify and classify a particular behavior of the subject software. Once the user has identified the general behavior patterns of the software, he can train a set of rules to represent his knowledge of that behavior. The training process builds rules and fuzzy sets to use in the evaluator. The fuzzy sets classify those data points not clearly identified as a particular classification. Once an initial set of rules is trained, each additional data set given to the SDB will be used by a machine learning mechanism to refine the rules and fuzzy sets. This is a passive process and, therefore, it does not require any additional operator time. The evaluation component of the SDB can be used to validate a single software system using some number of different data sets, such as a simulator. Moreover, it can be used to validate software systems which have been re-engineered from one language and design methodology to a totally new implementation.

Implementing priority setting frameworks: Insights from leading researchers.

PubMed

Angell, Blake; Pares, Jennie; Mooney, Gavin

2016-12-01

In spite of a substantial literature developing frameworks for policymakers to use in resource allocation decisions in healthcare, there remains limited published work reporting on the implementation or evaluation of such frameworks in practice. This paper presents findings of a targeted survey of 18 leading researchers around the implementation and evaluation of priority-setting exercises. Approximately one third of respondents knew of situations where recommendations of priority-setting exercises had been implemented, one third knew that recommendations had not been implemented and the final third responded that they did not know whether recommendations had been adopted. The lack of evidence linking the implementation of priority-setting recommendations to equity and efficiency outcomes was highlighted by all respondents. Features identified as facilitating successful implementation of priority-setting recommendations included having a climate ready to accept priority-setting, good leadership or a 'champion' for the priority-setting process and having a health economist to guide the process. Successful disinvestment was very uncommon in the experience of the researchers surveyed. Recommendations emerging from Program Budgeting and Marginal Analysis exercises appeared to be more widely implemented than those coming from alternative processes. Identifying if the process was repeated following the initial process was suggested as a means to measure success. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Times They Are a Changin': Neuropsychology and Integrated Care Teams.

PubMed

Kubu, Cynthia S; Ready, Rebecca E; Festa, Joanne R; Roper, Brad L; Pliskin, Neil H

2016-01-01

To gather illustrative data from clinical neuropsychologists who are working in integrated care settings in order to provide an initial blueprint for moving forward in this new era of health care. A survey was designed to illustrate the ways in which neuropsychologists are participating in integrated care teams and distributed on major neuropsychology listservs. The survey evaluated the settings, roles, services provided, practice issues, remuneration, and impact of neuropsychologists' participation in integrated care teams with respect to patient care and health outcomes. Frequencies were used to summarize the findings as well as qualitative coding of narrative responses. There were 412 respondents to the survey and 261 of those indicated that they worked in at least one integrated care setting. Neuropsychologists work in a variety of integrated care settings and provide diverse services which contribute to improved patient care and outcomes. Three primary themes emerge from the findings with regard to the engagement and teams: advocacy, collaboration, and communication. We argue for the need for more easily accessible outcome studies illustrating the clinical benefits and cost-savings associated with inclusion of neuropsychologists in integrated care teams. In addition, educational and training initiatives are needed to better equip current and future clinical neuropsychologists to function effectively in integrated care settings.

Replacing maladaptive speech with verbal labeling responses: an analysis of generalized responding.

PubMed Central

Foxx, R M; Faw, G D; McMorrow, M J; Kyle, M S; Bittle, R G

1988-01-01

We taught three mentally handicapped students to answer questions with verbal labels and evaluated the generalized effects of this training on their maladaptive speech (e.g., echolalia) and correct responding to untrained questions. The students received cues-pause-point training on an initial question set followed by generalization assessments on a different set in another setting. Probes were conducted on novel questions in three other settings to determine the strength and spread of the generalization effect. A multiple baseline across subjects design revealed that maladaptive speech was replaced with correct labels (answers) to questions in the training and all generalization settings. These results replicate and extend previous research that suggested that cues-pause-point procedures may be useful in replacing maladaptive speech patterns by teaching students to use their verbal labeling repertoires. PMID:3225258

Operational and Clinical Strategies to Address Drug Cost Containment in the Acute Care Setting.

PubMed

McConnell, Karen J; Guzman, Oscar E; Pherwani, Nisha; Spencer, Dustin D; Van Cura, Jennifer D; Shea, Katherine M

2017-01-01

To provide clinical and operational strategies to generate drug cost savings in the hospital setting. A search of the PubMed database was performed with no time limit through July 2016. All original prospective and retrospective studies, peer-reviewed guidelines, consensus statements, review articles, and accompanying references were evaluated for inclusion. Only articles published in the English language were included. Investigators reviewed 937 abstracts. The review of the literature showed that acute care hospitals are under increasing financial pressures, and the pharmacy is often responsible for opportunities to manage drug costs. The literature also indicated that cost-containment strategies in the acute care setting range from pharmacy-directed activities to initiatives requiring interdisciplinary collaboration and strategic planning. Hospital pharmacies should consider establishing an interdisciplinary team that is responsible for systematically reviewing drug cost implications and leading any initiatives that are deemed necessary. Acute care settings can use various operational and clinical strategies to lower their expenditures on high-cost drugs. Operational strategies include various activities that pharmacy staff implement related to contracting, purchasing, and inventory management. Clinical strategies utilize clinical pharmacists working with interdisciplinary teams to develop and maintain a formulary, implement established-use criteria for select drugs, use dose optimization, and implement other clinical tactics aimed at cost containment. After initiatives are implemented, assessing the outcomes of the initiatives is important to determine how successful they were at lowering costs safely and effectively. Acute care hospitals can use various operational and clinical strategies to lower overall drug costs. A systematic stepwise approach is recommended to ensure relevant drugs are regularly reviewed and addressed as needed. © 2016 Pharmacotherapy Publications, Inc.

A common evaluation framework for the African Health Initiative.

PubMed

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

2013-01-01

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

Identification of Arbitrary Zonation in Groundwater Parameters using the Level Set Method and a Parallel Genetic Algorithm

NASA Astrophysics Data System (ADS)

Lei, H.; Lu, Z.; Vesselinov, V. V.; Ye, M.

2017-12-01

Simultaneous identification of both the zonation structure of aquifer heterogeneity and the hydrogeological parameters associated with these zones is challenging, especially for complex subsurface heterogeneity fields. In this study, a new approach, based on the combination of the level set method and a parallel genetic algorithm is proposed. Starting with an initial guess for the zonation field (including both zonation structure and the hydraulic properties of each zone), the level set method ensures that material interfaces are evolved through the inverse process such that the total residual between the simulated and observed state variables (hydraulic head) always decreases, which means that the inversion result depends on the initial guess field and the minimization process might fail if it encounters a local minimum. To find the global minimum, the genetic algorithm (GA) is utilized to explore the parameters that define initial guess fields, and the minimal total residual corresponding to each initial guess field is considered as the fitness function value in the GA. Due to the expensive evaluation of the fitness function, a parallel GA is adapted in combination with a simulated annealing algorithm. The new approach has been applied to several synthetic cases in both steady-state and transient flow fields, including a case with real flow conditions at the chromium contaminant site at the Los Alamos National Laboratory. The results show that this approach is capable of identifying the arbitrary zonation structures of aquifer heterogeneity and the hydrogeological parameters associated with these zones effectively.

Clinical Management of ADHD in a Family Medicine Residency Program: Comparison with AAP Guidelines.

PubMed

Skelley, Jessica W; Carpenter, P Chase; Morehead, M Shawn; Murphy, Patrick L

2016-06-01

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder. Research has shown that even with the growing incidence of children diagnosed as having ADHD, physicians may find providing optimal care to these patients challenging. Our objective was to contrast existing clinical management of ADHD in a family medicine setting with published American Academy of Pediatrics guidelines and review the literature pertinent to differences. A report was generated for all visits with "ADHD" or "ADD" (attention-deficit disorder) as a current or past medical problem that had been addressed at the family medicine clinic from July 2012 to June 2014. A total of 60 pediatric patients were identified. A retrospective chart review of clinical practice and management patterns for these patients was completed using a standardized data collection form based on the 2011 ADHD treatment guidelines set by the American Academy of Pediatrics. Fifty-seven (95%) patients had documentation of at least one core symptom of ADHD, and 27 (45%) patients had documentation of these symptoms in more than one setting (clinic/school/home). Only 30 (50%) patients were assessed at the initial ADHD visit for coexisting conditions. Coexisting conditions were found to be present in 20 (33.3%) patients. Of these 20 patients, coexisting conditions were not addressed during the visit in 12 (60%) patients before drug therapy for ADHD was initially prescribed. Behavioral therapy was initiated as first-line monotherapy in one of the nine preschool-age patients (4-5 years old). Fifty-two (86.7%) patients received a preferred initial medication as identified by guidelines, and 41 (78.8%) of those patients received an appropriate initial dose. Fifty-one (85%) patients were assessed for improvement of symptoms, and 39 (65%) were assessed for adverse events. Of 62 documented medication adjustments, 54 (87.1%) adjustments coincided with current practice guidelines. Sixteen (26.7%) patients were referred to mental health specialists. This retrospective review identified areas of strength and weakness for attending physicians and medical residents in the diagnosis, evaluation, and treatment of children with ADHD. A significant need was identified for more physician-focused education on the evaluation of coexisting conditions and long-term management associated with ADHD therapy. Further training in the initiation of behavioral therapy as a first-line treatment above drug therapy and proper medication selection in children aged 4 to 5 years also are recommended.

Review of economic evaluations of mask and respirator use for protection against respiratory infection transmission.

PubMed

Mukerji, Shohini; MacIntyre, C Raina; Newall, Anthony T

2015-10-13

There has been increasing debate surrounding mask and respirator interventions to control respiratory infection transmission in both healthcare and community settings. As decision makers are considering the recommendations they should evaluate how to provide the most efficient protection strategies with minimum costs. The aim of this review is to identify and evaluate the existing economic evaluation literature in this area and to offer advice on how future evaluations on this topic should be conducted. We searched the Scopus database for all literature on economic evaluation of mask or respirator use to control respiratory infection transmission. Reference lists from the identified studies were also manually searched. Seven studies met our inclusion criteria from the initial 806 studies identified by the search strategy and our manual search. Five studies considered interventions for seasonal and/or pandemic influenza, with one also considering SARS (Severe Acute Respiratory Syndrome). The other two studies focussed on tuberculosis transmission control interventions. The settings and methodologies of the studies varied greatly. No low-middle income settings were identified. Only one of the reviewed studies cited clinical evidence to inform their mask/respirator intervention effectiveness parameters. Mask and respirator interventions were generally reported by the study authors to be cost saving or cost-effective when compared to no intervention or other control measures, however the evaluations had important limitations. Given the large cost differential between masks and respirators, there is a need for more comprehensive economic evaluations to compare the relative costs and benefits of these interventions in situations and settings where alternative options are potentially applicable. There are at present insufficient well conducted cost-effectiveness studies to inform decision-makers on the value for money of alternative mask/respirator options.

Evaluating success criteria and project monitoring in river enhancement within an adaptive management framework

USGS Publications Warehouse

O'Donnell, T. K.; Galat, D.L.

2008-01-01

Objective setting, performance measures, and accountability are important components of an adaptive-management approach to river-enhancement programs. Few lessons learned by river-enhancement practitioners in the United States have been documented and disseminated relative to the number of projects implemented. We conducted scripted telephone surveys with river-enhancement project managers and practitioners within the Upper Mississippi River Basin (UMRB) to determine the extent of setting project success criteria, monitoring, evaluation of monitoring data, and data dissemination. Investigation of these elements enabled a determination of those that inhibited adaptive management. Seventy river enhancement projects were surveyed. Only 34% of projects surveyed incorporated a quantified measure of project success. Managers most often relied on geophysical attributes of rivers when setting project success criteria, followed by biological communities. Ninety-one percent of projects that performed monitoring included biologic variables, but the lack of data collection before and after project completion and lack of field-based reference or control sites will make future assessments of ecologic success difficult. Twenty percent of projects that performed monitoring evaluated ???1 variable but did not disseminate their evaluations outside their organization. Results suggest greater incentives may be required to advance the science of river enhancement. Future river-enhancement programs within the UMRB and elsewhere can increase knowledge gained from individual projects by offering better guidance on setting success criteria before project initiation and evaluation through established monitoring protocols. ?? 2007 Springer Science+Business Media, LLC.

Quality measures for nurse practitioner practice evaluation.

PubMed

Kleinpell, Ruth; Kapu, April N

2017-08-01

Evaluating the impact of nurse practitioner (NP) practice has become a priority area of focus for demonstrating outcomes. A number of quality measures are available to enable practice-specific evaluation of NP roles and initiatives. This article reviews sources of quality measures that can be used to facilitate quantifying the outcomes of NP practice as part of an overall evaluation agenda. National resources and published literature on NP quality measures were reviewed. Various resources and toolkits exist to assist NPs in identifying outcomes of practice using quality measures. The need to demonstrate outcomes of NP practice remains an ongoing priority area regardless of the clinical practice setting. A variety of sources of quality measures exist that can be used to showcase the effect of NP care. The use of quality measures can be effectively integrated into evaluation of NP role and NP-directed initiatives to demonstrate impact, and enhance the conduct of an NP outcomes assessment. The use of organizational, NP-specific, and national-related quality measures can help to showcase how NP care improves the quality, safety, and costs of health care. ©2017 American Association of Nurse Practitioners.

Systematic review: handwashing behaviour in low- to middle-income countries: outcome measures and behaviour maintenance.

PubMed

Vindigni, Stephen M; Riley, Patricia L; Jhung, Michael

2011-04-01

To describe global approaches to handwashing research in low- and middle-income communities, schools and health care settings using behavioural outcome measurement and temporal study design. Peer-reviewed and grey literature was screened for handwashing studies that evaluated behaviour change. Relevant articles were assessed by their research approach, including the investigator's selected outcome measure and time frame of various study components (e.g., formative research, intervention and evaluation). The initial search yielded 527 relevant articles. After application of exclusion criteria, we identified 27 unique studies (30 total articles). Of the 27 articles, most were focused in the community setting. Fifteen (56%) documented observed handwashing behaviour, while 18 (67%) used proxy measures (e.g., soap presence, diarrhoea) and 14 (52%) used self-reported behaviour. Several studies used multiple outcome measures. While all studies had an evaluation of behaviour change, there was a dearth of studies that evaluated long-term maintenance of behaviour change after the intervention's conclusion. While the literature is replete with a variety of handwashing studies in community, school and health care settings, none have been able to definitively document long-term behaviour change, thereby challenging the sustainability of various interventions. Additionally, there is a need to better understand which research approach is most effective in promoting long-term behaviour compliance in global low- and middle-income settings. © 2011 Blackwell Publishing Ltd.

Planning an organizational wellness initiative at a multi-state social service agency.

PubMed

Miller, J Jay; Grise-Owens, Erlene; Addison, Donia; Marshall, Midaya; Trabue, Donna; Escobar-Ratliff, Laura

2016-06-01

Increasingly, organizations in general, and social service organizations, specifically, are recognizing the importance of planning and evaluating organizational wellness initiatives. Yet, few participatory models for carrying out these aims exist. For this study, researchers utilized concept mapping (CM) to explicate a conceptual framework for planning, and subsequently evaluating, a wellness initiative at a multi-state social service organization. CM is a participatory approach that analyzes qualitative data via multi-dimensional scaling and hierarchical cluster analyses. Outputs include a number of visual depictions that allow researchers to explore complex relationships among sets of the data. Results from this study indicated that participants (N=64), all of whom were employees of the agency, conceptualized organizational wellness via an eight-cluster solution, or Concept Map. Priority areas of this framework, specifically importance and feasibility, were also explored. After a brief review of pertinent literature, this article explicates the CM methodology utilized in this study, describes results, discusses lessons learned, and identifies apt areas for future research. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of addition of nano-hydroxyapatite on physico-chemical and antibiofilm properties of calcium silicate cements

PubMed Central

GUERREIRO-TANOMARU, Juliane Maria; VÁZQUEZ-GARCÍA, Fernando Antonio; BOSSO-MARTELO, Roberta; BERNARDI, Maria Inês Basso; FARIA, Gisele; TANOMARU, Mario

2016-01-01

ABSTRACT Objective Mineral Trioxide Aggregate (MTA) is a calcium silicate cement composed of Portland cement (PC) and bismuth oxide. Hydroxyapatite has been incorporated to enhance mechanical and biological properties of dental materials. This study evaluated physicochemical and mechanical properties and antibiofilm activity of MTA and PC associated with zirconium oxide (ZrO2) and hydroxyapatite nanoparticles (HAn). Material and Methods White MTA (Angelus, Brazil); PC (70%)+ZrO2 (30%); PC (60%)+ZrO2 (30%)+HAn (10%); PC (50%)+ZrO2 (30%)+HAn (20%) were evaluated. The pH was assessed by a digital pH-meter and solubility by mass loss. Setting time was evaluated by using Gilmore needles. Compressive strength was analyzed by mechanical test. Samples were radiographed alongside an aluminum step wedge to evaluate radiopacity. For the antibiofilm evaluation, materials were placed in direct contact with E. faecalis biofilm induced on dentine blocks. The number of colony-forming units (CFU mL-1) in the remaining biolfilm was evaluated. The results were submitted to ANOVA and the Tukey test, with 5% significance. Results There was no difference in pH levels of PC+ZrO2, PC+ZrO2+HAn (10%) and PC+ZrO2+HAn (20%) (p>0.05) and these cements presented higher pH levels than MTA (p<0.05). The highest solubility was observed in PC+ZrO2+HAn (10%) and PC+ZrO2+HAn (20%) (p<0.05). MTA had the shortest initial setting time (p<0.05). All the materials showed radiopacity higher than 3 mmAl. PC+ZrO2 and MTA had the highest compressive strength (p<0.05). Materials did not completely neutralize the bacterial biofilm, but the association with HAn provided greater bacterial reduction than MTA and PC+ZrO2 (p<0.05) after the post-manipulation period of 2 days. Conclusions The addition of HAn to PC associated with ZrO2 harmed the compressive strength and solubility. On the other hand, HAn did not change the pH and the initial setting time, but improved the radiopacity (HAn 10%), the final setting time and the E. faecalis antibiofilm activity of the cement. PMID:27383700

Evaluating the Credibility of Transport Processes in Simulations of Ozone Recovery using the Global Modeling Initiative Three-dimensional Model

NASA Technical Reports Server (NTRS)

Strahan, Susan E.; Douglass, Anne R.

2004-01-01

The Global Modeling Initiative (GMI) has integrated two 36-year simulations of an ozone recovery scenario with an offline chemistry and tra nsport model using two different meteorological inputs. Physically ba sed diagnostics, derived from satellite and aircraft data sets, are d escribed and then used to evaluate the realism of temperature and transport processes in the simulations. Processes evaluated include barri er formation in the subtropics and polar regions, and extratropical w ave-driven transport. Some diagnostics are especially relevant to sim ulation of lower stratospheric ozone, but most are applicable to any stratospheric simulation. The global temperature evaluation, which is relevant to gas phase chemical reactions, showed that both sets of me teorological fields have near climatological values at all latitudes and seasons at 30 hPa and below. Both simulations showed weakness in upper stratospheric wave driving. The simulation using input from a g eneral circulation model (GMI(GCM)) showed a very good residual circulation in the tropics and Northern Hemisphere. The simulation with inp ut from a data assimilation system (GMI(DAS)) performed better in the midlatitudes than it did at high latitudes. Neither simulation forms a realistic barrier at the vortex edge, leading to uncertainty in the fate of ozone-depleted vortex air. Overall, tracer transport in the offline GML(GCM) has greater fidelity throughout the stratosphere tha n it does in the GMI(DAS)

In Vitro Cytotoxicity and Setting Time Assessment of Calcium-Enriched Mixture Cement, Retro Mineral Trioxide Aggregate and Mineral Trioxide Aggregate

PubMed Central

Pornamazeh, Tahereh; Yadegari, Zahra; Ghasemi, Amir; Sheykh-al-Eslamian, Seyedeh Mahsa; Shojaeian, Shiva

2017-01-01

Introduction: The present study sought to evaluate and compare biocompatibility and setting time of Retro mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) and Angelus MTA. Methods and Materials: CEM cement, Angelus MTA and Retro MTA were assessed in set and fresh states. Extracts transformed to each cavity of three 24-well plates in which 1×104 cell were seeded into each well 24 h earlier. All specimens were incubated in a humidified incubator with 5% CO2 at 37°C. Mosmann’s tetrazolium toxicity (MTT) assay was used to determine in vitro cytotoxicity on L929 mouse fibroblast cell line. Cell viability was determined at 1, 24, and 72 h after exposure. The initial setting time was measured by 113.4 g Gilmore needle testing. Then, final setting times were assessed by the 456.5 g Gilmore needle. Data comparisons were performed using the analysis of variance (ANOVA) and Tukey's post hoc test (α=0.05). Results: All groups in both forms indicated higher cell vitality compared to positive control group (P<0.001). After 24 h, the set Retro MTA showed better biocompatibility compared to set CEM and set Angelus MTA (P<0.001). Retro MTA showed significantly lower initial and final setting time compared to CEM and Angelus MTA (P<0.001). Conclusion: Our results indicated the good cell viability values of Retro MTA and relatively short period of setting time. It seems a promising alternative material in clinical situations where accelerated setting is required. However, more clinical and in vivo investigations are needed for a clear decision making. PMID:29225646

Evaluation of Potential Evapotranspiration from a Hydrologic Model on a National Scale

NASA Astrophysics Data System (ADS)

Hakala, K. A.; Hay, L.; Markstrom, S. L.

2014-12-01

The US Geological Survey has developed a National Hydrologic Model (NHM) to support coordinated, comprehensive and consistent hydrologic model development and facilitate the application of simulations on the scale of the continental US. The NHM has a consistent geospatial fabric for modeling, consisting of over 100,000 hydrologic response units (HRUs). Each HRU requires accurate parameter estimates, some of which are attained from automated calibration. However, improved calibration can be achieved by initially utilizing as many parameters as possible from national data sets. This presentation investigates the effectiveness of calculating potential evapotranspiration (PET) parameters based on mean monthly values from the NOAA PET Atlas. Additional PET products are then used to evaluate the PET parameters. Effectively utilizing existing national-scale data sets can simplify the effort in establishing a robust NHM.

High quality garbage: A neural network plastic sorter in hardware and software

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

Stanton, S.L.; Alam, M.K.; Hebner, G.A.

1993-09-01

In order to produce pure polymer streams from post-consumer waste plastics, a quick, accurate and relatively inexpensive method of sorting needs to be implemented. This technology has been demonstrated by using near-infrared spectroscopy reflectance data and neural network classification techniques. Backpropagation neural network routines have been developed to run real-time sortings in the lab, using a laboratory-grade spectrometer. In addition, a new reflectance spectrometer has been developed which is fast enough for commercial use. Initial training and test sets taken with the laboratory instrument show that a network is capable of learning 100% when classifying 5 groups of plastic (HDPEmore » and LDPE combined), and up to 100% when classifying 6 groups. Initial data sets from the new instrument have classified plastics into all seven groups with varying degrees of success. One of the initial networks has been implemented in hardware, for high speed computations, and thus rapid classification. Two neural accelerator systems have been evaluated, one based on the Intel 8017ONX chip, and another on the AT&T ANNA chip.« less

Sector activities and lessons learned around initial implementation of the United States national physical activity plan.

PubMed

Evenson, Kelly R; Satinsky, Sara B

2014-08-01

National plans are increasingly common but infrequently evaluated. The 2010 United States National Physical Activity Plan (NPAP) provided strategies to increase population levels of physical activity. This paper describes (i) the initial accomplishments of the NPAP sector teams, and (ii) results from a process evaluation to determine how the sectors operated, their cross-sector collaboration, challenges encountered, and positive experiences. During 2011, a quarterly reporting system was developed to capture sector-level activities. A year-end interview derived more detailed information. Interviews with 12 sector leads were recorded, transcribed verbatim, and analyzed for common themes. The 6 sectors worked on goals from the implementation plan that focused broadly on education, promotion, intervention, policy, collaboration, and evaluation. Through year-end interviews, themes were generated around operations, goal setting, and cross-sector collaboration. Challenges to the NPAP work included lack of funding and time, the need for marketing and promotion, and organizational support. Positive experiences included collaboration, efficiency of work, enhanced community dynamic, and accomplishments toward NPAP goals. These initial results on the NPAP sector teams can be used as a baseline assessment for future monitoring. The lessons learned may be useful to other practitioners developing evaluations around state- or national-level plans.

Sector Activities and Lessons Learned Around Initial Implementation of the United States National Physical Activity Plan

PubMed Central

Evenson, Kelly R.; Satinsky, Sara B.

2016-01-01

Background National plans are increasingly common but infrequently evaluated. The 2010 United States National Physical Activity Plan (NPAP) provided strategies to increase population levels of physical activity. This paper describes (i) the initial accomplishments of the NPAP sector teams, and (ii) results from a process evaluation to determine how the sectors operated, their cross-sector collaboration, challenges encountered, and positive experiences. Methods During 2011, a quarterly reporting system was developed to capture sector-level activities. A year-end interview derived more detailed information. Interviews with 12 sector leads were recorded, transcribed verbatim, and analyzed for common themes. Results The 6 sectors worked on goals from the implementation plan that focused broadly on education, promotion, intervention, policy, collaboration, and evaluation. Through year-end interviews, themes were generated around operations, goal setting, and cross-sector collaboration. Challenges to the NPAP work included lack of funding and time, the need for marketing and promotion, and organizational support. Positive experiences included collaboration, efficiency of work, enhanced community dynamic, and accomplishments toward NPAP goals. Conclusions These initial results on the NPAP sector teams can be used as a baseline assessment for future monitoring. The lessons learned may be useful to other practitioners developing evaluations around state- or national-level plans. PMID:24176800

The Preparation for and Execution of Engineering Operations for the Mars Curiosity Rover Mission

NASA Technical Reports Server (NTRS)

Samuels, Jessica A.

2013-01-01

The Mars Science Laboratory Curiosity Rover mission is the most complex and scientifically packed rover that has ever been operated on the surface of Mars. The preparation leading up to the surface mission involved various tests, contingency planning and integration of plans between various teams and scientists for determining how operation of the spacecraft (s/c) would be facilitated. In addition, a focused set of initial set of health checks needed to be defined and created in order to ensure successful operation of rover subsystems before embarking on a two year science journey. This paper will define the role and responsibilities of the Engineering Operations team, the process involved in preparing the team for rover surface operations, the predefined engineering activities performed during the early portion of the mission, and the evaluation process used for initial and day to day spacecraft operational assessment.

Sustainability Tools Inventory - Initial Gaps Analysis | Science ...

EPA Pesticide Factsheets

This report identifies a suite of tools that address a comprehensive set of community sustainability concerns. The objective is to discover whether "gaps" exist in the tool suite’s analytic capabilities. These tools address activities that significantly influence resource consumption, waste generation, and hazard generation including air pollution and greenhouse gases. In addition, the tools have been evaluated using four screening criteria: relevance to community decision making, tools in an appropriate developmental stage, tools that may be transferrable to situations useful for communities, and tools with requiring skill levels appropriate to communities. This document provides an initial gap analysis in the area of community sustainability decision support tools. It provides a reference to communities for existing decision support tools, and a set of gaps for those wishing to develop additional needed tools to help communities to achieve sustainability. It contributes to SHC 1.61.4

Teaching severely multihandicapped students to put on their own hearing aids.

PubMed Central

Tucker, D J; Berry, G W

1980-01-01

Two experiments were conducted with six severely multihandicapped students with hearing impairments to: (a) train the six students to put on their own hearing aids independently, and (b) provide an empirical evaluation of a comprehensive instructional program for putting on a hearing aid by assessing acquisition, maintenance, and generalization of that skill across environments. All six students acquired the skill rapidly, with two students requiring remedial training on one step of the program. Because for two of the original three students the newly learned skill failed initially to generalize to other environments, a second experiment was initiated to assess generalization across environments as well as to replicate the efficiency of the acquisition program. When a variation of the multiple-probe baseline technique was used, the behavior of three additional students generalized to other settings without direct training in those settings. PMID:6444931

An empirical study of the influence of demographic variable on the choice criteria for assisted living facilities.

PubMed

O'Bryan, D; Clow, K E; O'Bryan, J; Kurtz, D

1996-01-01

Despite the growth and prevalence of assisted-living facilities, empirical marketing research for these facilities is scarce. The objectives of this study were to determine the relative importance of three sets of evaluation criteria in the initial selection of an assisted-living facility, and determine whether the relative importance of these three sets of criteria differed by gender, marital status, level of household, age, or income of the consumer. Survey responses from 279 households indicates that primary service criteria are relatively more important than facilities amenities or organized social activities in the initial selection of an assisted-living facility. The relative importance of the choice criteria differed markedly by gender of the consumer, but marital status, level of household income, and age of the consumer did not have as great an impact on consumers' choice criteria.

The OECD Handbook for Innovative Learning Environments. Educational Research and Innovation

ERIC Educational Resources Information Center

OECD Publishing, 2017

2017-01-01

How might we know whether our schools or system are set up to optimise learning? How can we find out whether we are getting the most from technology? How can we evaluate our innovation or think through whether our change initiative will bring about its desired results? Teachers and educational leaders who grapple with such questions will find this…

Implementing Problem-Solving Techniques in an Urban Central Office Department by Establishing Teams and Infusing TQM Concepts.

ERIC Educational Resources Information Center

Smith, Jewell R.

This practicum is designed to assist central office personnel in evaluating the work environment for better coordination to accomplish work, plan for a change effort, and implement a participatory change initiative. The work setting involved a K-12 urban school district (193 schools) containing 431 central-office administrators and more than…

Using an iPad Application to Promote Early Literacy Development in Young Children with Disabilities

ERIC Educational Resources Information Center

Chai, Zhen; Vail, Cynthia O.; Ayres, Kevin M.

2015-01-01

This investigation evaluated the effects of using an iPad application to teach young children with developmental delays to receptively identify initial phonemes through 0- to 5-s constant time delay procedures in the context of a multiple-probe design across three sets of behaviors and replicated across three students. The dependent variable was…

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

PubMed

Stacy, Kathleen M

2015-01-01

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

An Evaluation of Flash Cells Used in Critical Applications

NASA Technical Reports Server (NTRS)

Katz, Rich; Flowers, David; Bergevin, Keith

2016-01-01

Due to the common use of Flash technology in many commercial and industrial Programmable Logic Devices (PLDs) such as FPGAs and mixed-signal microcontrollers, flash technology is being utilized in fuzed munition applications. This presents a long-term reliability issue for both DoD and NASA safety- and mission-critical applications. A thorough understanding of the data retention failure modes and statistics associated with Flash data retention is of vital concern to the fuze safety community. A key retention parameter for a flash cell is the threshold voltage (VTH), which is an indirect indicator of the amount of charge stored on the cells floating gate. Initial test results based on a study of charge loss in flash cells in an FPGA device is presented. Statistical data taken from a small sample set indicates quantifiable charge loss for devices stored at both room temperature and 150 C. Initial evaluation of the distribution of threshold voltage in a large sample set (800 devices) is presented. The magnitude of charge loss from exposure to electrostatic discharge and electromagnetic fields is measured and presented. Simulated data (and measured data as available) resultant from harsh-environment testing (neutron, heavy ion, EMP) is presented.

Using Eye Trackers for Usability Evaluation of Health Information Technology: A Systematic Literature Review

PubMed Central

Yang, Yushi

2015-01-01

Background Eye-tracking technology has been used to measure human cognitive processes and has the potential to improve the usability of health information technology (HIT). However, it is still unclear how the eye-tracking method can be integrated with other traditional usability methodologies to achieve its full potential. Objective The objective of this study was to report on HIT evaluation studies that have used eye-tracker technology, and to envision the potential use of eye-tracking technology in future research. Methods We used four reference databases to initially identify 5248 related papers, which resulted in only 9 articles that met our inclusion criteria. Results Eye-tracking technology was useful in finding usability problems in many ways, but is still in its infancy for HIT usability evaluation. Limited types of HITs have been evaluated by eye trackers, and there has been a lack of evaluation research in natural settings. Conclusions More research should be done in natural settings to discover the real contextual-based usability problems of clinical and mobile HITs using eye-tracking technology with more standardized methodologies and guidance. PMID:27026079

Mental health promotion in the health care setting: collaboration and engagement in the development of a mental health promotion capacity-building initiative.

PubMed

Horn, Michelle A; Rauscher, Alana B; Ardiles, Paola A; Griffin, Shannon L

2014-01-01

Health Compass is an innovative, multiphased project that aims to transform health care practice and shift organizational culture by building the capacity of Provincial Health Services Authority (PHSA) health care providers to further promote the mental health and well-being of patients and families accessing PHSA's health care services. Health Compass was developed within a health promotion framework, which involved collaboration and engagement with stakeholders across all partnering PHSA agencies. This approach led to the development of an educational and training resource that contributes to increased capacity for mental health promotion within the health care setting. Based on interviews with Health Compass' internal Project Team and findings from a Stakeholder Engagement Evaluation Report, this article outlines the participatory approach taken to develop the Health Compass Mental Health Promotion Resource and E-Learning Tool. A number of key facilitators for collaboration and engagement are discussed, which may be particularly applicable to the implementation of a mental health promotion program or initiative within a complex health care setting.

Estimating initial contaminant mass based on fitting mass-depletion functions to contaminant mass discharge data: Testing method efficacy with SVE operations data

NASA Astrophysics Data System (ADS)

Mainhagu, J.; Brusseau, M. L.

2016-09-01

The mass of contaminant present at a site, particularly in the source zones, is one of the key parameters for assessing the risk posed by contaminated sites, and for setting and evaluating remediation goals and objectives. This quantity is rarely known and is challenging to estimate accurately. This work investigated the efficacy of fitting mass-depletion functions to temporal contaminant mass discharge (CMD) data as a means of estimating initial mass. Two common mass-depletion functions, exponential and power functions, were applied to historic soil vapor extraction (SVE) CMD data collected from 11 contaminated sites for which the SVE operations are considered to be at or close to essentially complete mass removal. The functions were applied to the entire available data set for each site, as well as to the early-time data (the initial 1/3 of the data available). Additionally, a complete differential-time analysis was conducted. The latter two analyses were conducted to investigate the impact of limited data on method performance, given that the primary mode of application would be to use the method during the early stages of a remediation effort. The estimated initial masses were compared to the total masses removed for the SVE operations. The mass estimates obtained from application to the full data sets were reasonably similar to the measured masses removed for both functions (13 and 15% mean error). The use of the early-time data resulted in a minimally higher variation for the exponential function (17%) but a much higher error (51%) for the power function. These results suggest that the method can produce reasonable estimates of initial mass useful for planning and assessing remediation efforts.

Clustering Categorical Data Using Community Detection Techniques

PubMed Central

2017-01-01

With the advent of the k-modes algorithm, the toolbox for clustering categorical data has an efficient tool that scales linearly in the number of data items. However, random initialization of cluster centers in k-modes makes it hard to reach a good clustering without resorting to many trials. Recently proposed methods for better initialization are deterministic and reduce the clustering cost considerably. A variety of initialization methods differ in how the heuristics chooses the set of initial centers. In this paper, we address the clustering problem for categorical data from the perspective of community detection. Instead of initializing k modes and running several iterations, our scheme, CD-Clustering, builds an unweighted graph and detects highly cohesive groups of nodes using a fast community detection technique. The top-k detected communities by size will define the k modes. Evaluation on ten real categorical datasets shows that our method outperforms the existing initialization methods for k-modes in terms of accuracy, precision, and recall in most of the cases. PMID:29430249

Novel priming and crosslinking systems for use with isocyanatomethacrylate dental adhesives.

PubMed

Chappelow, C C; Power, M D; Bowles, C Q; Miller, R G; Pinzino, C S; Eick, J D

2000-11-01

(a) to design, formulate and evaluate prototype primers and a crosslinking agent for use with isocyanatomethacrylate-based comonomer adhesives and (b) to establish correlations between bond strength and solubility parameter differences between the adhesives and etched dentin, and the permeability coefficients of the adhesives. Equimolar mixtures of 2-isocyanatoethyl methacrylate (IEM) and a methacrylate comonomer were formulated with tri-n-butyl borane oxide (TBBO) as the free radical initiator to have cure times of 6-10 min. Shear bond strengths to dentin were determined for each adhesive mixture (n = 7) using standard testing protocols. Shear bond strengths for the three systems were also determined after application of "reactive primers" to the dentin surface. The "reactive primers" contained 10-20 parts by weight of the respective comonomer mixture and 3.5 parts by weight TBBO in acetone. Solubility parameters difference values (delta delta) and permeability coefficients (P) were approximated for each adhesive system and correlated with shear bond strength values. Additionally, a crosslinking agent was prepared by bulk reaction of an equimolar mixture containing IEM and a methacrylate comonomer. The effects of crosslinker addition on: (a) the setting time of IEM; and (b) the setting times and initiator requirements of selected IEM/comonomer mixtures were determined. Shear bond strength values (MPa): IEM/HEMA 13.6 +/- 2.0 (no primer), 20.1 +/- 2.0 (with primer); IEM/HETMA 9.3 +/- 3.3 (no primer), 20.8 +/- 8.1 (with primer); IEM/AAEMA 13.6 +/- 1.9 (no primer), 17.3 +/- 3.2 (with primer). Also, approximated permeability coefficients showed a significant correlation (r = +0.867, p < 0.001) with shear bond strength values. Crosslinker addition studies with IEM/4-META: (a) at 5-9 mol% reduced the setting time of IEM polymerization by 79%; and (b) at 6 mol% reduced initiator level requirements 60-70% to achieve a comparable setting time, and decreased setting times by ca. 75% for a given initiator level with selected IEM/methacrylate adhesive systems. The shear bond strengths of isocyanatomethacrylate-based dental adhesives can be enhanced by using reactive primers; their setting times and initiator requirements can be improved using a dimethacrylate crosslinker. Approximated permeability coefficients may be useful as indicators of bonding performance for dentin adhesive systems.

Follow-up of cancer in primary care versus secondary care: systematic review

PubMed Central

Lewis, Ruth A; Neal, Richard D; Williams, Nefyn H; France, Barbara; Hendry, Maggie; Russell, Daphne; Hughes, Dyfrig A; Russell, Ian; Stuart, Nicholas SA; Weller, David; Wilkinson, Clare

2009-01-01

Background Cancer follow-up has traditionally been undertaken in secondary care, but there are increasing calls to deliver it in primary care. Aim To compare the effectiveness and cost-effectiveness of primary versus secondary care follow-up of cancer patients, determine the effectiveness of the integration of primary care in routine hospital follow-up, and evaluate the impact of patient-initiated follow-up on primary care. Design of study Systematic review. Setting Primary and secondary care settings. Method A search was carried out of 19 electronic databases, online trial registries, conference proceedings, and bibliographies of included studies. The review included comparative studies or economic evaluations of primary versus secondary care follow-up, hospital follow-up with formal primary care involvement versus conventional hospital follow-up, and hospital follow-up versus patient-initiated or minimal follow-up if the study reported the impact on primary care. Results There was no statistically significant difference for patient wellbeing, recurrence rate, survival, recurrence-related serious clinical events, diagnostic delay, or patient satisfaction. GP-led breast cancer follow-up was cheaper than hospital follow-up. Intensified primary health care resulted in increased home-care nurse contact, and improved discharge summary led to increased GP contact. Evaluation of patient-initiated or minimal follow-up found no statistically significant impact on the number of GP consultations or cancer-related referrals. Conclusion Weak evidence suggests that breast cancer follow-up in primary care is effective. Interventions improving communication between primary and secondary care could lead to greater GP involvement. Discontinuation of formal follow-up may not increase GP workload. However, the quality of the data in general was poor, and no firm conclusions can be reached. PMID:19566990

Evaluating Uncertainty of Runoff Simulation using SWAT model of the Feilaixia Watershed in China Based on the GLUE Method

NASA Astrophysics Data System (ADS)

Chen, X.; Huang, G.

2017-12-01

In recent years, distributed hydrological models have been widely used in storm water management, water resources protection and so on. Therefore, how to evaluate the uncertainty of the model reasonably and efficiently becomes a hot topic today. In this paper, the soil and water assessment tool (SWAT) model is constructed for the study area of China's Feilaixia watershed, and the uncertainty of the runoff simulation is analyzed by GLUE method deeply. Taking the initial parameter range of GLUE method as the research core, the influence of different initial parameter ranges on model uncertainty is studied. In this paper, two sets of parameter ranges are chosen as the object of study, the first one (range 1) is recommended by SWAT-CUP and the second one (range 2) is calibrated by SUFI-2. The results showed that under the same number of simulations (10,000 times), the overall uncertainty obtained by the range 2 is less than the range 1. Specifically, the "behavioral" parameter sets for the range 2 is 10000 and for the range 1 is 4448. In the calibration and the validation, the ratio of P-factor to R-factor for range 1 is 1.387 and 1.391, and for range 2 is 1.405 and 1.462 respectively. In addition, the simulation result of range 2 is better with the NS and R2 slightly higher than range 1. Therefore, it can be concluded that using the parameter range calibrated by SUFI-2 as the initial parameter range for the GLUE is a way to effectively capture and evaluate the simulation uncertainty.

Superensemble Climate Simulations for attribution of 2013-15 Western US drought

NASA Astrophysics Data System (ADS)

Mote, P.; Rupp, D. E.; Otto, F. E. L.; Uhe, P.; Allen, M. R.

2015-12-01

As of summer 2015, California is in its fourth year of drought, Oregon in its second year, and Washington in its first, with serious economic and ecological consequences. Scientists are using various approaches to evaluate the rarity, severity, and causes of this drought. This talk describes one approach to evaluating the influences of various causal factors. Using a framework for generating a superensemble of regional climate simulations called climateprediction.net, created by scientists at University of Oxford, we have generated tens of thousands of simulations of the period November 2013 to May 2015, to focus on the most acute period of drought in these three states. One set used observed sea surface temperatures (SSTs), one used average SSTs from 2000-2010, and one "natural" set used the observed SSTs but with the anthropogenic warming component subtracted and greenhouse gas concentrations set to pre-industrial values. Within the three sets, the simulations differ only in the atmospheric initial conditions used. Distinctly different likelihoods of drought emerge in the Pacific states in the three sets of simulations. This talk will describe differences in temperature, precipitation, snow water equivalent, atmospheric flow, and energy and water balance terms in the various sets of simulations, and how they differ from California to Washington.

Variability and Extremes of Precipitation in the Global Climate as Determined by the 25-Year GEWEX/GPCP Data Set

NASA Technical Reports Server (NTRS)

Adler, R. F.; Gu, G.; Curtis, S.; Huffman, G. J.; Bolvin, D. T.; Nelkin, E. J.

2005-01-01

The Global Precipitation Climatology Project (GPCP) 25-year precipitation data set is used to evaluate the variability and extremes on global and regional scales. The variability of precipitation year-to-year is evaluated in relation to the overall lack of a significant global trend and to climate events such as ENSO and volcanic eruptions. The validity of conclusions and limitations of the data set are checked by comparison with independent data sets (e.g., TRMM). The GPCP data set necessarily has a heterogeneous time series of input data sources, so part of the assessment described above is to test the initial results for potential influence by major data boundaries in the record. Regional trends, or inter-decadal changes, are also analyzed to determine validity and correlation with other long-term data sets related to the hydrological cycle (e.g., clouds and ocean surface fluxes). Statistics of extremes (both wet and dry) are analyzed at the monthly time scale for the 25 years. A preliminary result of increasing frequency of extreme monthly values will be a focus to determine validity. Daily values for an eight-year are also examined for variation in extremes and compared to the longer monthly-based study.

The effect of mixing method on tricalcium silicate-based cement.

PubMed

Duque, J A; Fernandes, S L; Bubola, J P; Duarte, M A H; Camilleri, J; Marciano, M A

2018-01-01

To evaluate the effect of three methods of mixing on the physical and chemical properties of tricalcium silicate-based cements. The materials evaluated were MTA Angelus and Portland cement with 20% zirconium oxide (PC-20-Zr). The cements were mixed using a 3 : 1 powder-to-liquid ratio. The mixing methods were manual (m), trituration (tr) and ultrasonic (us) activation. The materials were characterized by means of scanning electron microscope (SEM) and energy dispersive X-ray spectroscopy. Flowability was analysed according to ANSI/ADA 57/2012. Initial and final setting times were assessed following ASTM C266/08. Volume change was evaluated using a micro-CT volumetric method. Solubility was analysed according to ADA 57/2012. pH and calcium ion release were measured after 3, 24, 72 and 168 h. Statistical analysis was performed using two-way analysis of variance. The level of significance was set at P = 0.05. The SEM analysis revealed that ultrasonic activation was associated with a homogeneous distribution of particles. Flowability, volume change and initial setting time were not influenced by the mixing method (P > 0.05). Solubility was influenced by the mixing method (P < 0.05). For pH, at 168 h, significant differences were found between MTA-m and PC-20-Zr-m (P < 0.05). For calcium ion release, PC-20-Zr-tr had higher values than MTA-m at 3 h, and MTA-tr had higher values than PC-20-Zr-m at 168 h (P < 0.05). The ultrasonic and trituration methods led to higher calcium ion release and pH compared with manual mixing for all cements, whilst the ultrasonic method produced smaller particles for the PC-20-Zr cement. Flow, setting times and volume change were not influenced by the mixing method used; however, it did have an impact on solubility. © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Early initiation of night-time NIV in an outpatient setting: a randomized non-inferiority study in ALS patients.

PubMed

Bertella, Enrica; Banfi, Paolo; Paneroni, Mara; Grilli, Silvia; Bianchi, Luca; Volpato, Eleonora; Vitacca, Michele

2017-12-01

In patients with amyotrophic lateral sclerosis (ALS), non-invasive ventilation (NIV) is usually initiated in an in-hospital regime. We investigated if NIV initiated in an outpatient setting can be as effective in terms of patients' acceptance/adherence. We also evaluated factors predicting NIV acceptance and adherence and disease progression. Prospective randomized study. Outpatient versus inpatient rehabilitation. ALS patients. ALS patients were randomized to two groups for NIV initiation: outpatients versus inpatients. At baseline (T0), end of NIV trial program (T1) and after 3 months from T1 (T2), respiratory function tests, blood gas analysis, and sleep study were performed. At T1, we assessed: NIV acceptance (>4 h/night), and dyspnea symptoms (day/night) by Visual analogue scale (VAS), staff and patients' experience (how difficult NIV was to accept, how difficult ventilator was to manage, satisfaction); at T2: NIV adherence (>120 h/month) and patients' experience. Fifty patients participated. There were no differences in acceptance failure (P=0.733) or adherence failure (P=0.529). At T1, outpatients had longer hours of nocturnal ventilation (P<0.02), at T2 this was similar (P=0.34). Female gender and spinal onset of the disease were predictors for NIV acceptance/adherence failure. There were no between-group differences in progression of respiratory impairment, symptoms and sleep quality. Early outpatient initiation of NIV in ALS is as effective as inpatient initiation.

Technical note: Coordination and harmonization of the multi-scale, multi-model activities HTAP2, AQMEII3, and MICS-Asia3: simulations, emission inventories, boundary conditions, and model output formats.

PubMed

Galmarini, Stefano; Koffi, Brigitte; Solazzo, Efisio; Keating, Terry; Hogrefe, Christian; Schulz, Michael; Benedictow, Anna; Griesfeller, Jan Jurgen; Janssens-Maenhout, Greet; Carmichael, Greg; Fu, Joshua; Dentener, Frank

2017-01-31

We present an overview of the coordinated global numerical modelling experiments performed during 2012-2016 by the Task Force on Hemispheric Transport of Air Pollution (TF HTAP), the regional experiments by the Air Quality Model Evaluation International Initiative (AQMEII) over Europe and North America, and the Model Intercomparison Study for Asia (MICS-Asia). To improve model estimates of the impacts of intercontinental transport of air pollution on climate, ecosystems, and human health and to answer a set of policy-relevant questions, these three initiatives performed emission perturbation modelling experiments consistent across the global, hemispheric, and continental/regional scales. In all three initiatives, model results are extensively compared against monitoring data for a range of variables (meteorological, trace gas concentrations, and aerosol mass and composition) from different measurement platforms (ground measurements, vertical profiles, airborne measurements) collected from a number of sources. Approximately 10 to 25 modelling groups have contributed to each initiative, and model results have been managed centrally through three data hubs maintained by each initiative. Given the organizational complexity of bringing together these three initiatives to address a common set of policy-relevant questions, this publication provides the motivation for the modelling activity, the rationale for specific choices made in the model experiments, and an overview of the organizational structures for both the modelling and the measurements used and analysed in a number of modelling studies in this special issue.

Technical note: Coordination and harmonization of the multi-scale, multi-model activities HTAP2, AQMEII3, and MICS-Asia3: simulations, emission inventories, boundary conditions, and model output formats

NASA Astrophysics Data System (ADS)

Galmarini, Stefano; Koffi, Brigitte; Solazzo, Efisio; Keating, Terry; Hogrefe, Christian; Schulz, Michael; Benedictow, Anna; Griesfeller, Jan Jurgen; Janssens-Maenhout, Greet; Carmichael, Greg; Fu, Joshua; Dentener, Frank

2017-01-01

We present an overview of the coordinated global numerical modelling experiments performed during 2012-2016 by the Task Force on Hemispheric Transport of Air Pollution (TF HTAP), the regional experiments by the Air Quality Model Evaluation International Initiative (AQMEII) over Europe and North America, and the Model Intercomparison Study for Asia (MICS-Asia). To improve model estimates of the impacts of intercontinental transport of air pollution on climate, ecosystems, and human health and to answer a set of policy-relevant questions, these three initiatives performed emission perturbation modelling experiments consistent across the global, hemispheric, and continental/regional scales. In all three initiatives, model results are extensively compared against monitoring data for a range of variables (meteorological, trace gas concentrations, and aerosol mass and composition) from different measurement platforms (ground measurements, vertical profiles, airborne measurements) collected from a number of sources. Approximately 10 to 25 modelling groups have contributed to each initiative, and model results have been managed centrally through three data hubs maintained by each initiative. Given the organizational complexity of bringing together these three initiatives to address a common set of policy-relevant questions, this publication provides the motivation for the modelling activity, the rationale for specific choices made in the model experiments, and an overview of the organizational structures for both the modelling and the measurements used and analysed in a number of modelling studies in this special issue.

Technical note: Coordination and harmonization of the multi-scale, multi-model activities HTAP2, AQMEII3, and MICS-Asia3: simulations, emission inventories, boundary conditions, and model output formats

PubMed Central

Galmarini, Stefano; Koffi, Brigitte; Solazzo, Efisio; Keating, Terry; Hogrefe, Christian; Schulz, Michael; Benedictow, Anna; Griesfeller, Jan Jurgen; Janssens-Maenhout, Greet; Carmichael, Greg; Fu, Joshua; Dentener, Frank

2018-01-01

We present an overview of the coordinated global numerical modelling experiments performed during 2012–2016 by the Task Force on Hemispheric Transport of Air Pollution (TF HTAP), the regional experiments by the Air Quality Model Evaluation International Initiative (AQMEII) over Europe and North America, and the Model Intercomparison Study for Asia (MICS-Asia). To improve model estimates of the impacts of intercontinental transport of air pollution on climate, ecosystems, and human health and to answer a set of policy-relevant questions, these three initiatives performed emission perturbation modelling experiments consistent across the global, hemispheric, and continental/regional scales. In all three initiatives, model results are extensively compared against monitoring data for a range of variables (meteorological, trace gas concentrations, and aerosol mass and composition) from different measurement platforms (ground measurements, vertical profiles, airborne measurements) collected from a number of sources. Approximately 10 to 25 modelling groups have contributed to each initiative, and model results have been managed centrally through three data hubs maintained by each initiative. Given the organizational complexity of bringing together these three initiatives to address a common set of policy-relevant questions, this publication provides the motivation for the modelling activity, the rationale for specific choices made in the model experiments, and an overview of the organizational structures for both the modelling and the measurements used and analysed in a number of modelling studies in this special issue. PMID:29541091

[The Danish debate on priority setting in medicine - characteristics and results].

PubMed

Pornak, S; Meyer, T; Raspe, H

2011-10-01

Priority setting in medicine helps to achieve a fair and transparent distribution of health-care resources. The German discussion about priority setting is still in its infancy and may benefit from other countries' experiences. This paper aims to analyse the Danish priority setting debate in order to stimulate the German discussion. The methods used are a literature analysis and a document analysis as well as expert interviews. The Danish debate about priority setting in medicine began in the 1970s, when a government committee was constituted to evaluate health-care priorities at the national level. In the 1980s a broader debate arose in politics, ethics, medicine and health economy. The discussions reached a climax in the 1990s, when many local activities - always involving the public - were initiated. Some Danish counties tried to implement priority setting in the daily routine of health care. The Council of Ethics was a major player in the debate of the 1990s and published a detailed statement on priority setting in 1996. With the new century the debate about priority setting seemed to have come to an end, but in 2006 the Technology Council and the Danish Regions resumed the discussion. In 2009 the Medical Association called for a broad debate in order to achieve equity among all patients. The long lasting Danish debate on priority setting has entailed only very little practical consequences on health care. The main problems seem to have been the missing effort to bundle the various local initiatives on a national level and the lack of powerful players to put results of the discussion into practice. Nevertheless, today the attitude towards priority setting is predominantly positive and even politicians talk freely about it. © Georg Thieme Verlag KG Stuttgart · New York.

Breast Reference Set Application: Karen Abbott- University of Arkansas (2013) — EDRN Public Portal

Cancer.gov

We are evaluating whether detection of a tumor-specific N-linked glycosylation known as B 1,6 branched N-glycan present on the glycoprotein periostin in breast cancer will be useful as a new biomarker for the detection of breast cancer in patient plasma and serum. We have completed an initial study using samples with known inavasive ductal breast carcinoma diagnosis and the results look very promising. Therefore, we would like to proceed with our analysis of this potential biomarker for breast cancer diagnosis by analyzing the blinded samples in breast reference set 1.

Training instructional skills with paraprofessional service providers at a community-based habilitation setting.

PubMed

Wood, Amanda L; Luiselli, James K; Harchik, Alan E

2007-11-01

The present study evaluates a training program with paraprofessional service providers at a community-based habilitation setting. Four staff were taught to implement alternative and augmentative communication instruction with an adult who had autism and mental retardation through a combination of instruction, demonstration, behavior rehearsal, and performance feedback. Training was conducted under natural conditions at the adult's group home residence. Three of the four staff were able to maintain near-100% instructional accuracy following initial training. The results add to the limited research literature concerning community-based training of direct-care personnel.

GN&C Engineering Best Practices for Human-Rated Spacecraft Systems

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.; Lebsock, Kenneth; West, John

2007-01-01

The NASA Engineering and Safety Center (NESC) recently completed an in-depth assessment to identify a comprehensive set of engineering considerations for the Design, Development, Test and Evaluation (DDT&E) of safe and reliable human-rated spacecraft systems. Reliability subject matter experts, discipline experts, and systems engineering experts were brought together to synthesize the current "best practices" both at the spacecraft system and subsystems levels. The objective of this paper is to summarize, for the larger Community of Practice, the initial set of Guidance, Navigation and Control (GN&C) engineering Best Practices as identified by this NESC assessment process.

GN&C Engineering Best Practices for Human-Rated Spacecraft System

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.; Lebsock, Kenneth; West, John

2008-01-01

The NASA Engineering and Safety Center (NESC) recently completed an in-depth assessment to identify a comprehensive set of engineering considerations for the Design, Development, Test and Evaluation (DDT&E) of safe and reliable human-rated spacecraft systems. Reliability subject matter experts, discipline experts, and systems engineering experts were brought together to synthesize the current "best practices" both at the spacecraft system and subsystems levels. The objective of this paper is to summarize, for the larger Community of Practice, the initial set of Guidance, Navigation and Control (GN&C) engineering Best Practices as identified by this NESC assessment process.

GN&C Engineering Best Practices For Human-Rated Spacecraft Systems

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.; Lebsock, Kenneth; West, John

2007-01-01

The NASA Engineering and Safety Center (NESC) recently completed an in-depth assessment to identify a comprehensive set of engineering considerations for the Design, Development, Test and Evaluation (DDT&E) of safe and reliable human-rated spacecraft systems. Reliability subject matter experts, discipline experts, and systems engineering experts were brought together to synthesize the current "best practices" both at the spacecraft system and subsystems levels. The objective of this paper is to summarize, for the larger Community of Practice, the initial set of Guidance, Navigation and Control (GN&C) engineering Best Practices as identified by this NESC assessment process.

The promise and challenge of practice-research collaborations: Guiding principles and strategies for initiating, designing, and implementing program evaluation research.

PubMed

Secret, Mary; Abell, Melissa L; Berlin, Trey

2011-01-01

The authors present a set of guiding principles and strategies to facilitate the collaborative efforts of social work researchers and practitioners as they initiate, design, and implement outcome evaluations of human service interventions and programs. Beginning with an exploration of the interpersonal barriers to practice-research collaborations, and building on their experiences in successfully completing a community-based research evaluation, the authors identify specific relationship-focused principles and strategies and illustrate how these approaches can guide practice-research teams through the various sequential activities of the evaluation research process. In particular, it is suggested that practice-research collaborations can be formed, strengthened, and sustained by emphasis on a spirit of discovery and shared leadership at the start of the relationship, use of a comprehensive evaluation model to clarify and frame the evaluation and program goals, beginning where the client is when selecting research methodology and measurement tools, commitment to keeping the program first and recording everything during the implementation and data-collection stages, discussion of emerging findings and presentation of findings in graphic format at the data-analysis stage, and a total team approach at the dissemination stage.

Terahertz NDE of Stressed Composite Overwrapped Pressure Vessels - Initial Testing

NASA Technical Reports Server (NTRS)

Madaras, Eric I.; Seebo, Jeffrey P.; Anatasi, Robert F.

2009-01-01

Terahertz radiation nondestructive evaluation was applied to a set of Kevlar composite overwrapped pressure vessel bottles that had undergone a series of thermal and pressure tests to simulate stress rupture effects. The bottles in these nondestructive evaluation tests were bottles that had not ruptured but had survived various times at the elevated load and temperature levels. Some of the bottles showed evidence of minor composite failures. The terahertz radiation did detect visible surface flaws, but did not detect any internal chemical or material degradation of the thin overwraps.

FAST TRACK COMMUNICATION Initial data for the relativistic gravitational N-body problem

NASA Astrophysics Data System (ADS)

Chruściel, Piotr T.; Corvino, Justin; Isenberg, James

2010-11-01

In general relativity, an initial data set for an isolated gravitational system takes the form of a solution of the Einstein constraint equations which is asymptotically Euclidean on a specified end. Given a collection of N such data sets with a subregion of interest (bounded away from the specified end) chosen in each, we show that there exists a family of new initial data sets, each of which contains exact copies of each of the N chosen subregions, positioned in a chosen array in a single asymptotic end. These composite initial data sets model isolated, relativistic gravitational systems containing N chosen bodies in specified initial configurations.

Aspirin for acute stroke of unknown etiology in resource-limited settings: a decision analysis.

PubMed

Berkowitz, Aaron L; Westover, M Brandon; Bianchi, Matt T; Chou, Sherry H-Y

2014-08-26

To analyze the potential impact of aspirin on outcome at hospital discharge after acute stroke in resource-limited settings without access to neuroimaging to distinguish ischemic stroke from intracerebral hemorrhage (ICH). A decision analysis was conducted to evaluate aspirin use in all patients with acute stroke of unknown type for the duration of initial hospitalization. Data were obtained from the International Stroke Trial and Chinese Acute Stroke Trial. Predicted in-hospital mortality and stroke recurrence risk were determined across the worldwide reported range of the proportion of strokes caused by ICH. Sensitivity analyses were performed on aspirin-associated relative risks in patients with ICH. At the highest reported proportion of strokes due to ICH from a large epidemiologic study (34% in sub-Saharan Africa), aspirin initiation after acute stroke of undetermined etiology is predicted to reduce in-hospital mortality (from 85/1,000 without treatment to 81/1,000 with treatment), in-hospital stroke recurrence (58/1,000 to 50/1,000), and combined risk of in-hospital mortality or stroke recurrence (127/1,000 to 114/1,000). Benefits of aspirin therapy remained in sensitivity analyses across a range of plausible parameter estimates for relative risks associated with aspirin initiation after ICH. Aspirin treatment for the period of initial hospitalization after acute stroke of undetermined etiology is predicted to decrease acute stroke-related mortality and in-hospital stroke recurrence even at the highest reported proportion of acute strokes due to ICH. In the absence of clinical trials to test this approach empirically, clinical decisions require patient-specific evaluation of risks and benefits of aspirin in this context. © 2014 American Academy of Neurology.

Ultrasound Vein and Artery Mapping by General Surgery Residents During Initial Consult Can Decrease Time to Dialysis Access Creation.

PubMed

Gray, Kelsey; Korn, Abraham; Zane, Joshua; Gonzalez, Gabriel; Kaji, Amy; Bowens, Nina; de Virgilio, Christian

2018-05-01

Formal preoperative ultrasound (US) mapping of vascular anatomy by radiology is recommended before hemodialysis access surgery. We hypothesized that US performed by general surgery residents in place of formal US would decrease the time from initial consult to creation of dialysis access without affecting patient outcomes. This is a retrospective review of all patients who underwent dialysis access surgery from November 2014 to July 2016 and received preoperative upper extremity US vein and artery evaluation by either radiology or general surgery residents. The primary endpoints were days from initial consult to dialysis access creation, rate of arteriovenous fistula (AVF) creation, fistula maturation, and 1-year primary assisted patency. Of 242 patients, 167 (69%) had formal US, and 75 (31%) had only a resident US. The resident US group had 100% AVF creation compared with the formal US group with 92.2% AVF creation (P = 0.01). There was no difference between the groups in rate of fistula maturation (P = 0.1) and 1-year assisted patency (P = 0.9). Of the resident US 90.7% occurred in the outpatient setting. On multivariable analysis controlling for outpatient consult, the average time to the operating room was 13.7 days longer for the formal US group in the outpatient setting (P = 0.0006). Ultrasound vein and artery evaluation at the time of the initial consult by general surgery residents can decrease the time to dialysis access creation by bypassing the need for formal US with a higher rate of AVF creation and no difference in fistula maturation or 1-year primary assisted patency. Copyright © 2018 Elsevier Inc. All rights reserved.

Large-scale road safety programmes in low- and middle-income countries: an opportunity to generate evidence.

PubMed

Hyder, Adnan A; Allen, Katharine A; Peters, David H; Chandran, Aruna; Bishai, David

2013-01-01

The growing burden of road traffic injuries, which kill over 1.2 million people yearly, falls mostly on low- and middle-income countries (LMICs). Despite this, evidence generation on the effectiveness of road safety interventions in LMIC settings remains scarce. This paper explores a scientific approach for evaluating road safety programmes in LMICs and introduces such a road safety multi-country initiative, the Road Safety in 10 Countries Project (RS-10). By building on existing evaluation frameworks, we develop a scientific approach for evaluating large-scale road safety programmes in LMIC settings. This also draws on '13 lessons' of large-scale programme evaluation: defining the evaluation scope; selecting study sites; maintaining objectivity; developing an impact model; utilising multiple data sources; using multiple analytic techniques; maximising external validity; ensuring an appropriate time frame; the importance of flexibility and a stepwise approach; continuous monitoring; providing feedback to implementers, policy-makers; promoting the uptake of evaluation results; and understanding evaluation costs. The use of relatively new approaches for evaluation of real-world programmes allows for the production of relevant knowledge. The RS-10 project affords an important opportunity to scientifically test these approaches for a real-world, large-scale road safety evaluation and generate new knowledge for the field of road safety.

Physicians' accounts of frontline tensions when implementing pilot projects to improve primary care.

PubMed

Mansfield, Elizabeth; Bhattacharyya, Onil; Christian, Jennifer; Naglie, Gary; Steriopoulos, Vicky; Webster, Fiona

2018-03-19

Purpose Canada's primary care system has been described as "a culture of pilot projects" with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach. Design/methodology/approach Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information. Findings While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations. Originality/value Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

A common evaluation framework for the African Health Initiative

PubMed Central

2013-01-01

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

Perceived Utility of the RE-AIM Framework for Health Promotion/Disease Prevention Initiatives for Older Adults: A Case Study from the U.S. Evidence-Based Disease Prevention Initiative.

PubMed

Ory, Marcia G; Altpeter, Mary; Belza, Basia; Helduser, Janet; Zhang, Chen; Smith, Matthew Lee

2014-01-01

Dissemination and implementation (D&I) frameworks are increasingly being promoted in public health research. However, less is known about their uptake in the field, especially for diverse sets of programs. Limited questionnaires exist to assess the ways that frameworks can be utilized in program planning and evaluation. We present a case study from the United States that describes the implementation of the RE-AIM framework by state aging services providers and public health partners and a questionnaire that can be used to assess the utility of such frameworks in practice. An online questionnaire was developed to capture community perspectives about the utility of the RE-AIM framework. Distributed to project leads in 27 funded states in an evidence-based disease prevention initiative for older adults, 40 key stakeholders responded representing a 100% state-participation rate among the 27 funded states. Findings suggest that there is perceived utility in using the RE-AIM framework when evaluating grand-scale initiatives for older adults. The RE-AIM framework was seen as useful for planning, implementation, and evaluation with relevance for evaluators, providers, community leaders, and policy makers. Yet, the uptake was not universal, and some respondents reported difficulties in use, especially adopting the framework as a whole. This questionnaire can serve as the basis to assess ways the RE-AIM framework can be utilized by practitioners in state-wide D&I efforts. Maximal benefit can be derived from examining the assessment of RE-AIM-related knowledge and confidence as part of a continual quality assurance process. We recommend such an assessment be performed before the implementation of new funding initiatives and throughout their course to assess RE-AIM uptake and to identify areas for technical assistance.

An Evaluation Framework for Lossy Compression of Genome Sequencing Quality Values.

PubMed

Alberti, Claudio; Daniels, Noah; Hernaez, Mikel; Voges, Jan; Goldfeder, Rachel L; Hernandez-Lopez, Ana A; Mattavelli, Marco; Berger, Bonnie

2016-01-01

This paper provides the specification and an initial validation of an evaluation framework for the comparison of lossy compressors of genome sequencing quality values. The goal is to define reference data, test sets, tools and metrics that shall be used to evaluate the impact of lossy compression of quality values on human genome variant calling. The functionality of the framework is validated referring to two state-of-the-art genomic compressors. This work has been spurred by the current activity within the ISO/IEC SC29/WG11 technical committee (a.k.a. MPEG), which is investigating the possibility of starting a standardization activity for genomic information representation.

An Initial Investigation of the Generalization of a School-Based Social Competence Intervention for Youth with High-Functioning Autism

PubMed Central

Schmidt, Carla; Stichter, Janine P.; Lierheimer, Kristin; McGhee, Stephanie; O'Connor, Karen V.

2011-01-01

This study evaluated the impact of generalization of the Social Competence Intervention-Adolescent (SCI-A) curriculum in a school setting for individuals with high-functioning autism or Asperger's Syndrome (N = 6). This study examined to what degree the generalization of the SCI-A curriculum could be measured when delivered in a school setting. Across the six participants preliminary results suggest improvement on teacher reports of social skills and executive functioning. Some improvements were also evident in direct measures of facial-expression recognition. Data collected in the nonintervention settings indicated that some generalization of social interaction skills may have occurred for all six participants. Future research directions are discussed. PMID:22937252

Evaluation of Offline Models Used to Simulate Components of the Permafrost Carbon Feedback: Experience from the Permafrost Carbon Network Model Integration Group

NASA Astrophysics Data System (ADS)

McGuire, A. D.

2016-12-01

The Model Integration Group of the Permafrost Carbon Network (see http://www.permafrostcarbon.org/) has conducted studies to evaluate the sensitivity of offline terrestrial permafrost and carbon models to both historical and projected climate change. These studies indicate that there is a wide range of (1) initial states permafrost extend and carbon stocks simulated by these models and (2) responses of permafrost extent and carbon stocks to both historical and projected climate change. In this study, we synthesize what has been learned about the variability in initial states among models and the driving factors that contribute to variability in the sensitivity of responses. We conclude the talk with a discussion of efforts needed by (1) the modeling community to standardize structural representation of permafrost and carbon dynamics among models that are used to evaluate the permafrost carbon feedback and (2) the modeling and observational communities to jointly develop data sets and methodologies to more effectively benchmark models.

Questionnaires for eliciting evaluation data from users of interactive question answering

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

Kelly, Diane; Kantor, Paul B.; Morse, Emile

Evaluating interactive question answering (QA) systems with real users can be challenging because traditional evaluation measures based on the relevance of items returned are difficult to employ since relevance judgments can be unstable in multi-user evaluations. The work reported in this paper evaluates, in distinguishing among a set of interactive QA systems, the effectiveness of three questionnaires: a Cognitive Workload Questionnaire (NASA TLX), and Task and System Questionnaires customized to a specific interactive QA application. These Questionnaires were evaluated with four systems, seven analysts, and eight scenarios during a 2-week workshop. Overall, results demonstrate that all three Questionnaires are effectivemore » at distinguishing among systems, with the Task Questionnaire being the most sensitive. Results also provide initial support for the validity and reliability of the Questionnaires.« less

Improving geriatric prescribing in the ED: a qualitative study of facilitators and barriers to clinical decision support tool use.

PubMed

Vandenberg, Ann E; Vaughan, Camille P; Stevens, Melissa; Hastings, Susan N; Powers, James; Markland, Alayne; Hwang, Ula; Hung, William; Echt, Katharina V

2017-02-01

Clinical decision support (CDS) may improve prescribing for older adults in the Emergency Department (ED) if adopted by providers. Existing prescribing order entry processes were mapped at an initial Veterans Administration Medical Center site, demonstrating cognitive burden, effort and safety concerns. Geriatric order sets incorporating 2012 Beers guidelines and including geriatric prescribing advice and prepopulated order options were developed. Geriatric order sets were implemented at two sites as part of the multicomponent 'Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department' quality improvement initiative. Facilitators and barriers to order sets use at the two sites were evaluated. Phone interviews were conducted with two provider groups (n = 20), those 'EQUiPPED' with the interventions (n = 10, 5 at each site) and Comparison providers who were only exposed to order sets through a clickable option on the ED order menu within the patient's medical record (n = 10, 5 at each site). All providers were asked about order set 'use' and 'usefulness'. Users (n = 11) were asked about 'usability'. Order set adopters described 'usefulness' in terms of 'safety' and 'efficiency', whereas order set consultants and order set non-users described 'usefulness' in terms of 'information' or 'training'. Provider 'autonomy', 'comfort' level with existing tools, and 'learning curve' were stated as barriers to use. Quantifying efficiency advantages and communicating safety benefit over preexisting practices and tools may improve adoption of CDS in ED and in other settings of care. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Performance and Perception in the Flipped Learning Model: An Initial Approach to Evaluate the Effectiveness of a New Teaching Methodology in a General Science Classroom

ERIC Educational Resources Information Center

González-Gómez, David; Jeong, Jin Su; Airado Rodríguez, Diego; Cañada-Cañada, Florentina

2016-01-01

"Flipped classroom" teaching methodology is a type of blended learning in which the traditional class setting is inverted. Lecture is shifted outside of class, while the classroom time is employed to solve problems or doing practical works through the discussion/peer collaboration of students and instructors. This relatively new…

Initial Field Deployment Results of Green PCB Removal from Sediment Systems (GPRSS)

NASA Technical Reports Server (NTRS)

Devor, Robert; Captain, James; Weis, Kyle; Maloney, Phillip; Booth, Greg; Quinn, Jacqueline

2014-01-01

Purpose of Study: (a) Develop/optimize technology capable of removing PCBs from contaminated sediments; (b) Develop design for functional GPRSS unit; (c) Produce and prove functionality of prototype units in a laboratory settings; (d) Produce fully-functional GPRSS units for testing at a demonstration site in Altavista, VA; and (e) Evaluate efficacy of GPRSS technology for the remediation of PCB-contaminated sediments.

The Relationship of Emotional Competencies to Transformational Leadership: Using a Corporate Model to Assess the Dispositions of Educational Leaders

ERIC Educational Resources Information Center

Hackett, Paul T.; Hortman, J. William

2008-01-01

The work of Goleman (1998) in the area of Emotional Intelligence offers promise for the assessment and evaluation of leader behaviors not related to a technical skill set such as those related to finance, data analysis, curriculum alignment, law or strategic planning. Researchers at a West Central Georgia University initiated a project that…

Bookbabies, Their Parents and the Library: An Evaluation of a Flemish Reading Programme in Families with Young Children

ERIC Educational Resources Information Center

Vanobbergen, Bruno; Daems, Marie; Van Tilburg, Sarah

2009-01-01

Bookbabies, an initiative from the Flemish Reading Association and the Flemish Centre for Public Libraries, is a pilot project organised in 10 Flemish cities where local public libraries worked together with 82 couples with young babies for two years to set up a programme called "having fun with books". The objectives of the research…

An Empirical Assessment of Administration and Planning Activity and Their Impact on the Realization of Sustainability-Related Initiatives and Programs in Higher Education

ERIC Educational Resources Information Center

Semeraro, Elizabeth; Boyd, Neil M.

2017-01-01

Purpose: Administrators in higher-education settings routinely create planning documents that help steer the organization in mission-centric ways. In the area of sustainability planning, strategic plans, sustainability plans and climate action plans are the most common methods used. The purpose of this study is to evaluate if specific forms of…

Web 2.0 and Education: Not Just Another Case of Hype, Hope and Disappointment?

ERIC Educational Resources Information Center

Gouseti, Anastasia

2010-01-01

It could be said that in the fast-changing field of education technology the initial excitement for a tool or application usually fades away as the next technology emerges on the horizon--leaving little or no room for critical evaluation of how it may best be used in educational settings. Some critics have identified this endless "pursuit of the…

Improved Diagnostic Accuracy of Alzheimer's Disease by Combining Regional Cortical Thickness and Default Mode Network Functional Connectivity: Validated in the Alzheimer's Disease Neuroimaging Initiative Set.

PubMed

Park, Ji Eun; Park, Bumwoo; Kim, Sang Joon; Kim, Ho Sung; Choi, Choong Gon; Jung, Seung Chai; Oh, Joo Young; Lee, Jae-Hong; Roh, Jee Hoon; Shim, Woo Hyun

2017-01-01

To identify potential imaging biomarkers of Alzheimer's disease by combining brain cortical thickness (CThk) and functional connectivity and to validate this model's diagnostic accuracy in a validation set. Data from 98 subjects was retrospectively reviewed, including a study set (n = 63) and a validation set from the Alzheimer's Disease Neuroimaging Initiative (n = 35). From each subject, data for CThk and functional connectivity of the default mode network was extracted from structural T1-weighted and resting-state functional magnetic resonance imaging. Cortical regions with significant differences between patients and healthy controls in the correlation of CThk and functional connectivity were identified in the study set. The diagnostic accuracy of functional connectivity measures combined with CThk in the identified regions was evaluated against that in the medial temporal lobes using the validation set and application of a support vector machine. Group-wise differences in the correlation of CThk and default mode network functional connectivity were identified in the superior temporal ( p < 0.001) and supramarginal gyrus ( p = 0.007) of the left cerebral hemisphere. Default mode network functional connectivity combined with the CThk of those two regions were more accurate than that combined with the CThk of both medial temporal lobes (91.7% vs. 75%). Combining functional information with CThk of the superior temporal and supramarginal gyri in the left cerebral hemisphere improves diagnostic accuracy, making it a potential imaging biomarker for Alzheimer's disease.

Assessing effects of variation in global climate data sets on spatial predictions from climate envelope models

USGS Publications Warehouse

Romañach, Stephanie; Watling, James I.; Fletcher, Robert J.; Speroterra, Carolina; Bucklin, David N.; Brandt, Laura A.; Pearlstine, Leonard G.; Escribano, Yesenia; Mazzotti, Frank J.

2014-01-01

Climate change poses new challenges for natural resource managers. Predictive modeling of species–environment relationships using climate envelope models can enhance our understanding of climate change effects on biodiversity, assist in assessment of invasion risk by exotic organisms, and inform life-history understanding of individual species. While increasing interest has focused on the role of uncertainty in future conditions on model predictions, models also may be sensitive to the initial conditions on which they are trained. Although climate envelope models are usually trained using data on contemporary climate, we lack systematic comparisons of model performance and predictions across alternative climate data sets available for model training. Here, we seek to fill that gap by comparing variability in predictions between two contemporary climate data sets to variability in spatial predictions among three alternative projections of future climate. Overall, correlations between monthly temperature and precipitation variables were very high for both contemporary and future data. Model performance varied across algorithms, but not between two alternative contemporary climate data sets. Spatial predictions varied more among alternative general-circulation models describing future climate conditions than between contemporary climate data sets. However, we did find that climate envelope models with low Cohen's kappa scores made more discrepant spatial predictions between climate data sets for the contemporary period than did models with high Cohen's kappa scores. We suggest conservation planners evaluate multiple performance metrics and be aware of the importance of differences in initial conditions for spatial predictions from climate envelope models.

International validation of quality indicators for evaluating priority setting in low income countries: process and key lessons.

PubMed

Kapiriri, Lydia

2017-06-19

While there have been efforts to develop frameworks to guide healthcare priority setting; there has been limited focus on evaluation frameworks. Moreover, while the few frameworks identify quality indicators for successful priority setting, they do not provide the users with strategies to verify these indicators. Kapiriri and Martin (Health Care Anal 18:129-147, 2010) developed a framework for evaluating priority setting in low and middle income countries. This framework provides BOTH parameters for successful priority setting and proposes means of their verification. Before its use in real life contexts, this paper presents results from a validation process of the framework. The framework validation involved 53 policy makers and priority setting researchers at the global, national and sub-national levels (in Uganda). They were requested to indicate the relative importance of the proposed parameters as well as the feasibility of obtaining the related information. We also pilot tested the proposed means of verification. Almost all the respondents evaluated all the parameters, including the contextual factors, as 'very important'. However, some respondents at the global level thought 'presence of incentives to comply', 'reduced disagreements', 'increased public understanding,' 'improved institutional accountability' and 'meeting the ministry of health objectives', which could be a reflection of their levels of decision making. All the proposed means of verification were assessed as feasible with the exception of meeting observations which would require an insider. These findings results were consistent with those obtained from the pilot testing. These findings are relevant to policy makers and researchers involved in priority setting in low and middle income countries. To the best of our knowledge, this is one of the few initiatives that has involved potential users of a framework (at the global and in a Low Income Country) in its validation. The favorable validation of all the parameters at the national and sub-national levels implies that the framework has potential usefulness at those levels, as is. The parameters that were disputed at the global level necessitate further discussion when using the framework at that level. The next step is to use the validated framework in evaluating actual priority setting at the different levels.

Evaluation of Potential Evapotranspiration from a Hydrologic Model on a National Scale

NASA Astrophysics Data System (ADS)

Hakala, Kirsti; Markstrom, Steven; Hay, Lauren

2015-04-01

The U.S. Geological Survey has developed a National Hydrologic Model (NHM) to support coordinated, comprehensive and consistent hydrologic model development and facilitate the application of simulations on the scale of the continental U.S. The NHM has a consistent geospatial fabric for modeling, consisting of over 100,000 hydrologic response units HRUs). Each HRU requires accurate parameter estimates, some of which are attained from automated calibration. However, improved calibration can be achieved by initially utilizing as many parameters as possible from national data sets. This presentation investigates the effectiveness of calculating potential evapotranspiration (PET) parameters based on mean monthly values from the NOAA PET Atlas. Additional PET products are then used to evaluate the PET parameters. Effectively utilizing existing national-scale data sets can simplify the effort in establishing a robust NHM.

Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems

PubMed Central

2012-01-01

Background A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments’ healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. Methods Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England’s National Health Service’s Care Records Service (NHS CRS). Results/discussion We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. Summary New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and reflecting a constantly changing milieu of policies, strategies and software, with constant interactions across such boundaries. PMID:22545646

Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems.

PubMed

Takian, Amirhossein; Petrakaki, Dimitra; Cornford, Tony; Sheikh, Aziz; Barber, Nicholas

2012-04-30

A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments' healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England's National Health Service's Care Records Service (NHS CRS). We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and reflecting a constantly changing milieu of policies, strategies and software, with constant interactions across such boundaries.

Initialized Fractional Calculus

NASA Technical Reports Server (NTRS)

Lorenzo, Carl F.; Hartley, Tom T.

2000-01-01

This paper demonstrates the need for a nonconstant initialization for the fractional calculus and establishes a basic definition set for the initialized fractional differintegral. This definition set allows the formalization of an initialized fractional calculus. Two basis calculi are considered; the Riemann-Liouville and the Grunwald fractional calculi. Two forms of initialization, terminal and side are developed.

T-cell acute lymphoblastic leukemia associated with complex karyotype and SET-NUP214 rearrangement: a case study and review of the literature.

PubMed

Lee, Sang-Guk; Park, Tae Sung; Cho, Sun Young; Lim, Gayoung; Park, Gwang Jin; Oh, Seung Hwan; Cho, Eun Hae; Chong, So Young; Huh, Ji Young

2011-01-01

SET-NUP214 rearrangements have been rarely reported in T-cell acute lymphoblastic leukemia (T-ALL), acute undifferentiated leukemia, and acute myeloid leukemia, and most documented cases have been associated with normal karyotypes in conventional cytogenetic analyses. Here, we describe a novel case of T-ALL associated with a mediastinal mass and a SET-NUP214 rearrangement, which was masked by a complex karyotype at the time of initial diagnosis. Using multiplex reverse transcriptase-polymerase chain reaction analysis, we detected a cryptic SET-NUP214 rearrangement in our patient. As only 11 cases (including the present study) of T-ALL with SET-NUP214 rearrangement have been reported, the clinical features and treatment outcomes have not been fully determined. Further studies are necessary to evaluate the incidence of SET-NUP214 rearrangement in T-ALL patients and the treatment responses as well as prognosis of these patients.

Selective Laser Sintering of Nano Al2O3 Infused Polyamide

PubMed Central

Warnakula, Anthony; Singamneni, Sarat

2017-01-01

Nano Al2O3 polyamide composites are evaluated for processing by selective laser sintering. A thermal characterization of the polymer composite powders allowed us to establish the possible initial settings. Initial experiments are conducted to identify the most suitable combinations of process parameters. Based on the results of the initial trials, more promising ranges of different process parameters could be identified. The post sintering characterization showed evidence of sufficient inter-particle sintering and intra-layer coalescence. While the inter-particle coalescence gradually improved, the porosity levels slightly decreased with increasing laser power. The nano-filler particles tend to agglomerate around the beads along the solid tracks, possibly due to Van der Walls forces. The tensile stress results showed an almost linear increase with increasing nano-filler content. PMID:28773220

Evaluating detection limits of next-generation sequencing for the surveillance and monitoring of international marine pests.

PubMed

Pochon, Xavier; Bott, Nathan J; Smith, Kirsty F; Wood, Susanna A

2013-01-01

Most surveillance programmes for marine invasive species (MIS) require considerable taxonomic expertise, are laborious, and are unable to identify species at larval or juvenile stages. Therefore, marine pests may go undetected at the initial stages of incursions when population densities are low. In this study, we evaluated the ability of the benchtop GS Junior™ 454 pyrosequencing system to detect the presence of MIS in complex sample matrices. An initial in-silico evaluation of the mitochondrial cytochrome c oxidase subunit I (COI) and the nuclear small subunit ribosomal DNA (SSU) genes, found that multiple primer sets (targeting a ca. 400 base pair region) would be required to obtain species level identification within the COI gene. In contrast a single universal primer set was designed to target the V1-V3 region of SSU, allowing simultaneous PCR amplification of a wide taxonomic range of MIS. To evaluate the limits of detection of this method, artificial contrived communities (10 species from 5 taxonomic groups) were created using varying concentrations of known DNA samples and PCR products. Environmental samples (water and sediment) spiked with one or five 160 hr old Asterias amurensis larvae were also examined. Pyrosequencing was able to recover DNA/PCR products of individual species present at greater than 0.64% abundance from all tested contrived communities. Additionally, single A. amurensis larvae were detected from both water and sediment samples despite the co-occurrence of a large array of environmental eukaryotes, indicating an equivalent sensitivity to quantitative PCR. NGS technology has tremendous potential for the early detection of marine invasive species worldwide.

Development of an Evaluation Methodology for Triple Bottom Line Reports Using International Standards on Reporting

NASA Astrophysics Data System (ADS)

Skouloudis, Antonis; Evangelinos, Konstantinos; Kourmousis, Fotis

2009-08-01

The purpose of this article is twofold. First, evaluation scoring systems for triple bottom line (TBL) reports to date are examined and potential methodological weaknesses and problems are highlighted. In this context, a new assessment methodology is presented based explicitly on the most widely acknowledged standard on non-financial reporting worldwide, the Global Reporting Initiative (GRI) guidelines. The set of GRI topics and performance indicators was converted into scoring criteria while the generic scoring devise was set from 0 to 4 points. Secondly, the proposed benchmark tool was applied to the TBL reports published by Greek companies. Results reveal major gaps in reporting practices, stressing the need for the further development of internal systems and processes in order to collect essential non-financial performance data. A critical overview of the structure and rationale of the evaluation tool in conjunction with the Greek case study is discussed while recommendations for future research on the field of this relatively new form of reporting are suggested.

Development of an evaluation methodology for triple bottom line reports using international standards on reporting.

PubMed

Skouloudis, Antonis; Evangelinos, Konstantinos; Kourmousis, Fotis

2009-08-01

The purpose of this article is twofold. First, evaluation scoring systems for triple bottom line (TBL) reports to date are examined and potential methodological weaknesses and problems are highlighted. In this context, a new assessment methodology is presented based explicitly on the most widely acknowledged standard on non-financial reporting worldwide, the Global Reporting Initiative (GRI) guidelines. The set of GRI topics and performance indicators was converted into scoring criteria while the generic scoring devise was set from 0 to 4 points. Secondly, the proposed benchmark tool was applied to the TBL reports published by Greek companies. Results reveal major gaps in reporting practices, stressing the need for the further development of internal systems and processes in order to collect essential non-financial performance data. A critical overview of the structure and rationale of the evaluation tool in conjunction with the Greek case study is discussed while recommendations for future research on the field of this relatively new form of reporting are suggested.

Evaluating Sleep Disturbance: A Review of Methods

NASA Technical Reports Server (NTRS)

Smith, Roy M.; Oyung, R.; Gregory, K.; Miller, D.; Rosekind, M.; Rosekind, Mark R. (Technical Monitor)

1996-01-01

There are three general approaches to evaluating sleep disturbance in regards to noise: subjective, behavioral, and physiological. Subjective methods range from standardized questionnaires and scales to self-report measures designed for specific research questions. There are two behavioral methods that provide useful sleep disturbance data. One behavioral method is actigraphy, a motion detector that provides an empirical estimate of sleep quantity and quality. An actigraph, worn on the non-dominant wrist, provides a 24-hr estimate of the rest/activity cycle. The other method involves a behavioral response, either to a specific probe or stimuli or subject initiated (e.g., indicating wakefulness). The classic, gold standard for evaluating sleep disturbance is continuous physiological monitoring of brain, eye, and muscle activity. This allows detailed distinctions of the states and stages of sleep, awakenings, and sleep continuity. Physiological delta can be obtained in controlled laboratory settings and in natural environments. Current ambulatory physiological recording equipment allows evaluation in home and work settings. These approaches will be described and the relative strengths and limitations of each method will be discussed.

Analysis to Inform CA Grid Integration Rules for PV: Final Report on Inverter Settings for Transmission and Distribution System Performance

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

Smith, Jeff; Rylander, Matthew; Boemer, Jens

The fourth solicitation of the California Solar Initiative (CSI) Research, Development, Demonstration and Deployment (RD&D) Program established by the California Public Utilities Commission (CPUC) supported the Electric Power Research Institute (EPRI), National Renewable Energy Laboratory (NREL), and Sandia National Laboratories (SNL) with data provided from Pacific Gas and Electric (PG&E), Southern California Edison (SCE), and San Diego Gas and Electric (SDG&E) conducted research to determine optimal default settings for distributed energy resource advanced inverter controls. The inverter functions studied are aligned with those developed by the California Smart Inverter Working Group (SIWG) and those being considered by the IEEE 1547more » Working Group. The advanced inverter controls examined to improve the distribution system response included power factor, volt-var, and volt-watt. The advanced inverter controls examined to improve the transmission system response included frequency and voltage ride-through as well as Dynamic Voltage Support. This CSI RD&D project accomplished the task of developing methods to derive distribution focused advanced inverter control settings, selecting a diverse set of feeders to evaluate the methods through detailed analysis, and evaluating the effectiveness of each method developed. Inverter settings focused on the transmission system performance were also evaluated and verified. Based on the findings of this work, the suggested advanced inverter settings and methods to determine settings can be used to improve the accommodation of distributed energy resources (PV specifically). The voltage impact from PV can be mitigated using power factor, volt-var, or volt-watt control, while the bulk system impact can be improved with frequency/voltage ride-through.« less

The acceptability of TV-based game platforms as an instrument to support the cognitive evaluation of senior adults at home.

PubMed

Rivas Costa, Carlos; Fernández Iglesias, Manuel José; Anido Rifón, Luis Eulogio; Gómez Carballa, Miguel; Valladares Rodríguez, Sonia

2017-01-01

The computing capabilities of state-of-the-art television sets and media centres may facilitate the introduction of computer-assisted evaluation at home. This approach would help to overcome the drawbacks of traditional pen-and-paper evaluations administered in clinical facilities, as they could be performed in a more comfortable environment, the subject's home, and they would be more flexible for designing complex environments for the evaluation of neuropsychological constructs that are difficult to assess through traditional testing. The objective of this work was to obtain some initial evidence about the technical acceptance by senior adults of serious games played at home on the TV set and therefore about the convenience of further investigating such an approach to cognitive assesment. We developed a collection of games to be deployed on a TV environment. These games were tried by a group of senior adults at their homes. The Technology Acceptance Model (TAM) was used to validate this approach. Surveys were performed to study the perceived usefulness and perceived ease of use of such technical setting as an instrument for their cognitive evaluation; that is, its technical acceptance. Subjective information collected from participants was correlated with actual interaction data captured. An additional survey was performed 36 months after pilot testing to have an indication about the long-term perceptions about usefulness and ease of use. More than 90% of participating subjects perceived cognitive games on TV as useful or very useful. The majority of participants selected the TV set as their preferred option to interact with serious games at home, when compared to other devices such as smartphones, tablets or PCs. This result correlates with the number of participants perceiving them as easily usable or very easy to use, and also with automatically captured interaction data. Three out of four seniors expressed their interest in keeping the system at home after the pilot. Besides, these perceptions are fairly stable in time as shown by the survey performed 36 months after pilot testing. Although participating users are a representative sample of the Galician population, which in turn is comparable to the population of most rural areas in Europe, a larger and more diverse user sample would be needed to obtain significant results for a wider population profile. The study confirmed the technical acceptance, that is, the perceived usefulness and perceived ease of use, of the TV-based home technical setting introduced as a means of cognitive evaluation. This study provides initial evidence on the viability of a TV-based serious games approach for cognitive longitudinal screening at home with little intervention of clinical professionals, thus contributing to the early detection of cognitive impairments in the senior population.

A Validated Set of MIDAS V5 Task Network Model Scenarios to Evaluate Nextgen Closely Spaced Parallel Operations Concepts

NASA Technical Reports Server (NTRS)

Gore, Brian Francis; Hooey, Becky Lee; Haan, Nancy; Socash, Connie; Mahlstedt, Eric; Foyle, David C.

2013-01-01

The Closely Spaced Parallel Operations (CSPO) scenario is a complex, human performance model scenario that tested alternate operator roles and responsibilities to a series of off-nominal operations on approach and landing (see Gore, Hooey, Mahlstedt, Foyle, 2013). The model links together the procedures, equipment, crewstation, and external environment to produce predictions of operator performance in response to Next Generation system designs, like those expected in the National Airspaces NextGen concepts. The task analysis that is contained in the present report comes from the task analysis window in the MIDAS software. These tasks link definitions and states for equipment components, environmental features as well as operational contexts. The current task analysis culminated in 3300 tasks that included over 1000 Subject Matter Expert (SME)-vetted, re-usable procedural sets for three critical phases of flight; the Descent, Approach, and Land procedural sets (see Gore et al., 2011 for a description of the development of the tasks included in the model; Gore, Hooey, Mahlstedt, Foyle, 2013 for a description of the model, and its results; Hooey, Gore, Mahlstedt, Foyle, 2013 for a description of the guidelines that were generated from the models results; Gore, Hooey, Foyle, 2012 for a description of the models implementation and its settings). The rollout, after landing checks, taxi to gate and arrive at gate illustrated in Figure 1 were not used in the approach and divert scenarios exercised. The other networks in Figure 1 set up appropriate context settings for the flight deck.The current report presents the models task decomposition from the tophighest level and decomposes it to finer-grained levels. The first task that is completed by the model is to set all of the initial settings for the scenario runs included in the model (network 75 in Figure 1). This initialization process also resets the CAD graphic files contained with MIDAS, as well as the embedded operator models that comprise MIDAS. Following the initial settings, the model progresses to begin the first tasks required of the two flight deck operators, the Captain (CA) and the First Officer (FO). The task sets will initialize operator specific settings prior to loading all of the alerts, probes, and other events that occur in the scenario. As a note, the CA and FO were terms used in developing this model but the CA can also be thought of as the Pilot Flying (PF), while the FO can be considered the Pilot-Not-Flying (PNF)or Pilot Monitoring (PM). As such, the document refers to the operators as PFCA and PNFFO respectively.

EnOI-IAU Initialization Scheme Designed for Decadal Climate Prediction System IAP-DecPreS

NASA Astrophysics Data System (ADS)

Wu, Bo; Zhou, Tianjun; Zheng, Fei

2018-02-01

A decadal climate prediction system named as IAP-DecPreS was constructed in the Institute of Atmospheric Physics (IAP), Chinese Academy of Sciences, based on a fully coupled model FGOALS-s2 and a newly developed initialization scheme, referred to as EnOI-IAU. In this paper, we introduce the design of the EnOI-IAU scheme, assess the accuracies of initialization integrations using the EnOI-IAU and preliminarily evaluate hindcast skill of the IAP-DecPreS. The EnOI-IAU scheme integrates two conventional assimilation approaches, ensemble optimal interpolation (EnOI) and incremental analysis update (IAU). The EnOI and IAU were applied to calculate analysis increments and incorporate them into the model, respectively. Three continuous initialization (INIT) runs were conducted for the period of 1950-2015, in which observational sea surface temperature (SST) from the HadISST1.1 and subsurface ocean temperature profiles from the EN4.1.1 data set were assimilated. Then nine-member 10 year long hindcast runs initiated from the INIT runs were conducted for each year in the period of 1960-2005. The accuracies of the INIT runs are evaluated from the following three aspects: upper 700 m ocean temperature, temporal evolution of SST anomalies, and dominant interdecadal variability modes, Pacific Decadal Oscillation (PDO) and Atlantic Multidecadal Oscillation (AMO). Finally, preliminary evaluation of the ensemble mean of the hindcast runs suggests that the IAP-DecPreS has skill in the prediction of the PDO-related SST anomalies in the midlatitude North Pacific and AMO-related SST anomalies in the tropical North Atlantic.

A social preference valuations set for EQ-5D health states in Flanders, Belgium.

PubMed

Cleemput, Irina

2010-04-01

This study aimed at deriving a preference valuation set for EQ-5D health states from the general Flemish public in Belgium. A EuroQol valuation instrument with 16 health states to be valued on a visual analogue scale was sent to a random sample of 2,754 adults. The initial response rate was 35%. Eventually, 548 (20%) respondents provided useable valuations for modeling. Valuations for 245 health states were modeled using a random effects model. The selection of the model was based on two criteria: health state valuations must be consistent, and the difference with the directly observed valuations must be small. A model including a value decrement if any health dimension of the EQ-5D is on the worst level was selected to construct the social health state valuation set. A comparison with health state valuations from other countries showed similarities, especially with those from New Zealand. The use of a single preference valuation set across different health economic evaluations within a country is highly preferable to increase their usability for policy makers. This study contributes to the standardization of outcome measurement in economic evaluations in Belgium.

Evaluation of a setting reaction pathway in the novel composite TiHA-CSD bone cement by FT-Raman and FT-IR spectroscopy

NASA Astrophysics Data System (ADS)

Paluszkiewicz, Czesława; Czechowska, Joanna; Ślósarczyk, Anna; Paszkiewicz, Zofia

2013-02-01

The aim of this study was to determine a setting reaction pathway in a novel, surgically handy implant material, based on calcium sulfate hemihydrate (CSH) and titanium doped hydroxyapatite (TiHA). The previous studies confirmed superior biological properties of TiHA in comparison to the undoped hydroxyapatite (HA) what makes it highly attractive for future medical applications. In this study the three types of titanium modified HA powders: untreated, calcined at 800 °C, sintered at 1250 °C and CSH were used to produce bone cements. The Fourier Transform-InfraRed (FT-IR) spectroscopy and Raman spectroscopy were applied to evaluate processes taking place during the setting of the studied materials. Our results undoubtedly confirmed that the reaction pathways and the phase compositions differed significantly for set cements and were dependent on the initial heat treatment of TiHA powder. Final materials were multiphase composites consisting of calcium sulfate dihydrate, bassanite, tricalcium phosphate, hydroxyapatite and calcium titanate (perovskite). The FT-IR and Scanning Electron Microscopy (SEM) measurements performed after the incubation of the cement samples in the simulated body fluid (SBF), indicate on high bioactive potential of the obtained bone cements.

The core learning objectives education model: an approach to the teaching of core concepts in the clinical clerkship.

PubMed

Rapp, David E; Lyon, Mark B; Orvieto, Marcelo A; Zagaja, Gregory P

2005-10-01

The classical approach to the undergraduate medical clerkship has several limitations, including variability of clinical exposure and method of examination. As a result, the clerkship experience does not ensure exposure to and reinforcement of the fundamental concepts of a given specialty. This article reviews the classic approach to clerkship education within the undergraduate medical education. Specific attention is placed on clinical exposure and clerkship examination. We describe the introduction of the Core Learning Objective (CLO) educational model at the University of Chicago Section of Urology. This model is designed to provide an efficient exposure to and evaluation of core clerkship learning objectives. The CLO model has been successfully initiated, focusing on both technical and clinical skill sets. The proposed model has been introduced with positive initial results and should allow for an efficient approach to the teaching and evaluation of core objectives in clerkship education.

A frequency-domain approach to improve ANNs generalization quality via proper initialization.

PubMed

Chaari, Majdi; Fekih, Afef; Seibi, Abdennour C; Hmida, Jalel Ben

2018-08-01

The ability to train a network without memorizing the input/output data, thereby allowing a good predictive performance when applied to unseen data, is paramount in ANN applications. In this paper, we propose a frequency-domain approach to evaluate the network initialization in terms of quality of training, i.e., generalization capabilities. As an alternative to the conventional time-domain methods, the proposed approach eliminates the approximate nature of network validation using an excess of unseen data. The benefits of the proposed approach are demonstrated using two numerical examples, where two trained networks performed similarly on the training and the validation data sets, yet they revealed a significant difference in prediction accuracy when tested using a different data set. This observation is of utmost importance in modeling applications requiring a high degree of accuracy. The efficiency of the proposed approach is further demonstrated on a real-world problem, where unlike other initialization methods, a more conclusive assessment of generalization is achieved. On the practical front, subtle methodological and implementational facets are addressed to ensure reproducibility and pinpoint the limitations of the proposed approach. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Nurse-led in Primary Health Care setting: a well-timed and promising organizational innovation].

PubMed

Torres-Ricarte, Marc; Crusat-Abelló, Ernest; Peñuelas-Rodríguez, Silvia; Zabaleta-del-Olmo, Edurne

2015-01-01

At present, the severe economic crisis along with the increasing prevalence of chronic diseases is leading to different countries to consider updating their Primary Health Care (PHC) services in order to make them more efficient and reduce health inequalities. To that end, various initiatives are being carried out, such as the provision of Nurse-led services and interventions. The purpose of this article is to present the available knowledge, controversies and opportunities for Nurse-led initiatives in the setting of PHC. Nurse- led interventions or health services in PHC have proven to be equal or more effective than usual care in disease prevention, the routine follow-up of patients with chronic conditions, and first contact care for people with minor illness. However, as there are only a few health economic evaluation studies published their efficiency is still potential. In conclusion, the Nurse-led care could be an innovative organizational initiative with the potential to provide an adequate response to the contemporary health needs of the population, as well as an opportunity for the nursing profession and for PHC and health systems in general. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Development of a group-based self-management programme for individuals with chronic fatigue syndrome: a pilot study.

PubMed

Pinxsterhuis, Irma; Hellum, Live Lange; Aannestad, Hilde Hassum; Sveen, Unni

2015-03-01

The aim of the study was to develop a group-based self-management programme for individuals with chronic fatigue syndrome (CFS) by using the participants' experiences with the initial version of the programme, which intends to promote coping with the illness in a primary healthcare setting. An initial programme was developed, based on self-efficacy theory and the concepts of client-centred practice and empowerment. Subsequently, the programme was tested and further developed by drawing on the participants' experiences with the programme. Focus-group interviews were applied. The interviews were analysed using thematic analysis. The initial programme was found to be feasible, although several modifications regarding the content and practical organization of the programme were proposed. In line with the participants' experiences, the final self-management programme was developed, which includes short presentations of eight topics, exchange of experiences among participants, goal-setting, construction of action plans, and relaxation exercises, in addition to a meeting for relatives. The programme will be provided in eight biweekly sessions and be led by juxtaposed peer counsellors and occupational therapists. The effects of the final programme will be evaluated in a randomized controlled trial.

Psychiatric Evaluation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychiatric Evaluation Workgroup

PubMed Central

Stowell, Keith R; Florence, Peter; Harman, Herbert J; Glick, Rachel L

2012-01-01

It is difficult to fully assess an agitated patient, and the complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. Nonetheless, emergency clinicians must perform an initial mental status screening to begin this process as soon as the agitated patient presents to an emergency setting. For this reason, the psychiatric evaluation of the agitated patient can be thought of as a 2-step process. First, a brief evaluation must be aimed at determining the most likely cause of agitation, so as to guide preliminary interventions to calm the patient. Once the patient is calmed, more extensive psychiatric assessment can be completed. The goal of the emergency assessment of the psychiatric patient is not necessarily to obtain a definitive diagnosis. Rather, ascertaining a differential diagnosis, determining safety, and developing an appropriate treatment and disposition plan are the goals of the assessment. This article will summarize what components of the psychiatric assessment can and should be done at the time the agitated patient presents to the emergency setting. The complete psychiatric evaluation of the patient whose agitation has been treated successfully is beyond the scope of this article and Project BETA (Best practices in Evaluation and Treatment of Agitation), but will be outlined briefly to give the reader an understanding of what a full psychiatric assessment would entail. Other issues related to the assessment of the agitated patient in the emergency setting will also be discussed. PMID:22461916

Comparing Pain and Depressive Symptoms of Chronic Opioid Therapy Patients Receiving Dose Reduction and Risk Mitigation Initiatives With Usual Care.

PubMed

Thakral, Manu; Walker, Rod L; Saunders, Kathleen; Shortreed, Susan M; Parchman, Michael; Hansen, Ryan N; Ludman, Evette; Sherman, Karen J; Dublin, Sascha; Von Korff, Michael

2018-01-01

Dose reduction and risk mitigation initiatives have been recommended to reduce opioid-related risks among patients receiving chronic opioid therapy (COT), but questions remain over whether these initiatives worsen pain control and quality of life. In 2014 to 2015, we interviewed 1,588 adult COT patients within a health care system in Washington State and compared those who received dose reduction and risk mitigation initiatives in primary care clinics (intervention) with patients in comparable health care settings without initiatives (control). The primary outcomes were pain assessed using the pain, enjoyment, and general activity (PEG) scale, a 3-item scale to assess global pain intensity and interference, with secondary measures including depression (Patient Health Questionnaire-8 scale). Generalized estimating equations for linear regression models were used to estimate differences in mean scores between intervention and control sites. Estimated differences, adjusted for patient characteristics and weighted for nonresponse, between patients at intervention and control clinics were not clinically significant for the PEG (-.03, 95% confidence interval = -.25 to .19) or Patient Health Questionnaire-8 (-.64, 95% confidence interval = -1.19 to -.08). We found no evidence that COT patients in clinics with dose reduction and risk mitigation initiatives had clinically meaningful differences in pain intensity, interference with activities and enjoyment of life, or depressive symptoms compared with control health care settings. This article evaluates the effect of dose reduction and risk mitigation initiatives, such as those recently recommended by the Centers for Disease Control and Prevention, to reduce risks associated with COT on global pain and interference, depressive symptoms, and perceived pain relief and bothersomeness of side effects. Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

On the Lulejian-I Combat Model

DTIC Science & Technology

1976-08-01

possible initial massing of the attacking side’s resources, the model tries to represent in a game -theoretic context the adversary nature of the...sequential game , as outlined in [A]. In principle, it is necessary to run the combat simulation once for each possible set of sequentially chosen...sequential game , in which the evaluative portion of the model (i.e., the combat assessment) serves to compute intermediate and terminal payoffs for the

Physiological, Biomechanical, and Maximal Performance Evaluation of Medium Rucksack Prototypes

DTIC Science & Technology

2013-07-01

injuries that limit the ROM about the shoulder, hip, knee , or ankle joint, were excluded from participation. Volunteers abstained from heavy and...time histories of running strides differ among individuals. Individuals who make initial contact with their heels ( heel - strike runners) show a...and a relatively large force. In the current data set, not all volunteers displayed the impact peak that is typical of heel - strike running. The

An Outbreak of Plasmodium falciparum Malaria in U.S. Marines Deployed to Liberia

DTIC Science & Technology

2010-01-01

rapid diagnosis of malaria in an outbreak setting, the NOW ICT Malaria P.f/P.v test (Binax, Inc...kits offer speed and accuracy when compared with traditional microscopy, these tests are critical in making a timely diagnosis of malaria in resource...Providers should use rapid diagnostic tests (e.g., NOW ICT test ) and have a low threshold to initiate empiric treatment of malaria when evaluating

Development and initial evaluation of the SCI-FI/AT

PubMed Central

Jette, Alan M.; Slavin, Mary D.; Ni, Pengsheng; Kisala, Pamela A.; Tulsky, David S.; Heinemann, Allen W.; Charlifue, Susie; Tate, Denise G.; Fyffe, Denise; Morse, Leslie; Marino, Ralph; Smith, Ian; Williams, Steve

2015-01-01

Objectives To describe the domain structure and calibration of the Spinal Cord Injury Functional Index for samples using Assistive Technology (SCI-FI/AT) and report the initial psychometric properties of each domain. Design Cross sectional survey followed by computerized adaptive test (CAT) simulations. Setting Inpatient and community settings. Participants A sample of 460 adults with traumatic spinal cord injury (SCI) stratified by level of injury, completeness of injury, and time since injury. Interventions None Main outcome measure SCI-FI/AT Results Confirmatory factor analysis (CFA) and Item response theory (IRT) analyses identified 4 unidimensional SCI-FI/AT domains: Basic Mobility (41 items) Self-care (71 items), Fine Motor Function (35 items), and Ambulation (29 items). High correlations of full item banks with 10-item simulated CATs indicated high accuracy of each CAT in estimating a person's function, and there was high measurement reliability for the simulated CAT scales compared with the full item bank. SCI-FI/AT item difficulties in the domains of Self-care, Fine Motor Function, and Ambulation were less difficult than the same items in the original SCI-FI item banks. Conclusion With the development of the SCI-FI/AT, clinicians and investigators have available multidimensional assessment scales that evaluate function for users of AT to complement the scales available in the original SCI-FI. PMID:26010975

Evaluating the safety impact of adaptive cruise control in traffic oscillations on freeways.

PubMed

Li, Ye; Li, Zhibin; Wang, Hao; Wang, Wei; Xing, Lu

2017-07-01

Adaptive cruise control (ACC) has been considered one of the critical components of automated driving. ACC adjusts vehicle speeds automatically by measuring the status of the ego-vehicle and leading vehicle. Current commercial ACCs are designed to be comfortable and convenient driving systems. Little attention is paid to the safety impacts of ACC, especially in traffic oscillations when crash risks are the highest. The primary objective of this study was to evaluate the impacts of ACC parameter settings on rear-end collisions on freeways. First, the occurrence of a rear-end collision in a stop-and-go wave was analyzed. A car-following model in an integrated ACC was developed for a simulation analysis. The time-to-collision based factors were calculated as surrogate safety measures of the collision risk. We also evaluated different market penetration rates considering that the application of ACC will be a gradual process. The results showed that the safety impacts of ACC were largely affected by the parameters. Smaller time delays and larger time gaps improved safety performance, but inappropriate parameter settings increased the collision risks and caused traffic disturbances. A higher reduction of the collision risk was achieved as the ACC vehicle penetration rate increased, especially in the initial stage with penetration rates of less than 30%. This study also showed that in the initial stage, the combination of ACC and a variable speed limit achieved better safety improvements on congested freeways than each single technique. Copyright © 2017 Elsevier Ltd. All rights reserved.

Concept dictionary creation and maintenance under resource constraints: lessons from the AMPATH Medical Record System.

PubMed

Were, Martin C; Mamlin, Burke W; Tierney, William M; Wolfe, Ben; Biondich, Paul G

2007-10-11

The challenges of creating and maintaining concept dictionaries are compounded in resource-limited settings. Approaches to alleviate this burden need to be based on information derived in these settings. We created a concept dictionary and evaluated new concept proposals for an open source EMR in a resource-limited setting. Overall, 87% of the concepts in the initial dictionary were used. There were 5137 new concepts proposed, with 77% of these proposed only once. Further characterization of new concept proposals revealed that 41% were due to deficiency in the existing dictionary, and 19% were synonyms to existing concepts. 25% of the requests contained misspellings, 41% were complex terms, and 17% were ambiguous. Given the resource-intensive nature of dictionary creation and maintenance, there should be considerations for centralizing the concept dictionary service, using standards, prioritizing concept proposals, and redesigning the user-interface to reduce this burden in settings with limited resources.

Concept Dictionary Creation and Maintenance Under Resource Constraints: Lessons from the AMPATH Medical Record System

PubMed Central

Were, Martin C.; Mamlin, Burke W.; Tierney, William M.; Wolfe, Ben; Biondich, Paul G.

2007-01-01

The challenges of creating and maintaining concept dictionaries are compounded in resource-limited settings. Approaches to alleviate this burden need to be based on information derived in these settings. We created a concept dictionary and evaluated new concept proposals for an open source EMR in a resource-limited setting. Overall, 87% of the concepts in the initial dictionary were used. There were 5137 new concepts proposed, with 77% of these proposed only once. Further characterization of new concept proposals revealed that 41% were due to deficiency in the existing dictionary, and 19% were synonyms to existing concepts. 25% of the requests contained misspellings, 41% were complex terms, and 17% were ambiguous. Given the resource-intensive nature of dictionary creation and maintenance, there should be considerations for centralizing the concept dictionary service, using standards, prioritizing concept proposals, and redesigning the user-interface to reduce this burden in settings with limited resources. PMID:18693945

Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries

PubMed Central

Staton, Catherine; Vissoci, Joao; Gong, Enying; Toomey, Nicole; Wafula, Rebeccah; Abdelgadir, Jihad; Zhou, Yi; Liu, Chen; Pei, Fengdi; Zick, Brittany; Ratliff, Camille D.; Rotich, Claire; Jadue, Nicole; de Andrade, Luciano; von Isenburg, Megan; Hocker, Michael

2016-01-01

Background Road traffic injuries (RTIs) are a growing but neglected global health crisis, requiring effective prevention to promote sustainable safety. Low- and middle-income countries (LMICs) share a disproportionately high burden with 90% of the world’s road traffic deaths, and where RTIs are escalating due to rapid urbanization and motorization. Although several studies have assessed the effectiveness of a specific intervention, no systematic reviews have been conducted summarizing the effectiveness of RTI prevention initiatives specifically performed in LMIC settings; this study will help fill this gap. Methods In accordance with PRISMA guidelines we searched the electronic databases MEDLINE, EMBASE, Scopus, Web of Science, TRID, Lilacs, Scielo and Global Health. Articles were eligible if they considered RTI prevention in LMICs by evaluating a prevention-related intervention with outcome measures of crash, RTI, or death. In addition, a reference and citation analysis was conducted as well as a data quality assessment. A qualitative metasummary approach was used for data analysis and effect sizes were calculated to quantify the magnitude of emerging themes. Results Of the 8560 articles from the literature search, 18 articles from 11 LMICs fit the eligibility and inclusion criteria. Of these studies, four were from Sub-Saharan Africa, ten from Latin America and the Caribbean, one from the Middle East, and three from Asia. Half of the studies focused specifically on legislation, while the others focused on speed control measures, educational interventions, enforcement, road improvement, community programs, or a multifaceted intervention. Conclusion Legislation was the most common intervention evaluated with the best outcomes when combined with strong enforcement initiatives or as part of a multifaceted approach. Because speed control is crucial to crash and injury prevention, road improvement interventions in LMIC settings should carefully consider how the impact of improvements will affect speed and traffic flow. Further road traffic injury prevention interventions should be performed in LMICs with patient-centered outcomes in order to guide injury prevention in these complex settings. PMID:26735918

Evaluation of Shear Strength of RC Beams with Multiple Interfaces Formed before Initial Setting Using 3D Printing Technology

PubMed Central

Kim, Kyeongjin; Park, Sangmin; Jeong, Yoseok; Lee, Jaeha

2017-01-01

With the recent development of 3D printing technology, concrete materials are sometimes used in 3D printing. Concrete structures based on 3D printing have been characterized to have the form of multiple layer build-up. Unlike general concrete structures, therefore, the 3D-printed concrete can be regarded as an orthotropic material. The material property of the 3D-printed concrete’s interface between layers is expected to be far different from that of general concrete bodies since there are no aggregate interlocks and weak chemical bonding. Such a difference finally affects the structural performance of concrete structures even though the interfaces are formed before initial setting of the concrete. The current study mainly reviewed the changes in fracture energy (toughness) with respect to various environmental conditions of such interface. Changes in fracture energies of interfaces between concrete layers were measured using low-speed Crack Mouth Opening Displacement (CMOD) closed loop concrete fracture test. The experimental results indicated reduction in fracture energy as well as tensile strengths. To improve the tensile strength of interfaces, the use of bridging materials is suggested. Since it was assumed that reduction in fracture energy could be a cause of shear strength, to evaluate the reduced structural performance of concrete structure constructed with multiple interfaces by 3D printing technology, the shear strength of RC beam by 3D printing technology was predicted and compared with that of plain RC beam. Based on the fracture energy measured in this study, Modified Compression Field Theory (MCFT) theory-applied Vector 2 program was employed to predict the degree of reduction in shear strength without considering stirrups. Reduction factors were presented based on the obtained results to predict the reduction in shear strength due to interfaces before initial setting of the concrete.

An evaluation plan of bus architectures and protocols using the NASA Ames intelligent redundant actuation system

NASA Technical Reports Server (NTRS)

Defeo, P.; Chen, M.

1987-01-01

Means for evaluating data bus architectures and protocols for highly integrated flight control system applications are needed. Described are the criteria and plans to do this by using the NASA/Ames Intelligent Redundant Actuation System (IRAS) experimental set-up. Candidate bus architectures differ from one another in terms of: topology, access control, message transfer schemes, message characteristics, initialization. data flow control, transmission rates, fault tolerance, and time synchronization. The evaluation criteria are developed relative to these features. A preliminary, analytical evaluation of four candidate busses (MIL-STD-1553B, DATAC, Ethernet, and HSIS) is described. A bus must be exercised in a real-time environment to evaluate its dynamic characteristics. A plan for real-time evaluation of these four busses using a combination of hardware and simulation techniques is presented.

How good are publicly available web services that predict bioactivity profiles for drug repurposing?

PubMed

Murtazalieva, K A; Druzhilovskiy, D S; Goel, R K; Sastry, G N; Poroikov, V V

2017-10-01

Drug repurposing provides a non-laborious and less expensive way for finding new human medicines. Computational assessment of bioactivity profiles shed light on the hidden pharmacological potential of the launched drugs. Currently, several freely available computational tools are available via the Internet, which predict multitarget profiles of drug-like compounds. They are based on chemical similarity assessment (ChemProt, SuperPred, SEA, SwissTargetPrediction and TargetHunter) or machine learning methods (ChemProt and PASS). To compare their performance, this study has created two evaluation sets, consisting of (1) 50 well-known repositioned drugs and (2) 12 drugs recently patented for new indications. In the first set, sensitivity values varied from 0.64 (TarPred) to 1.00 (PASS Online) for the initial indications and from 0.64 (TarPred) to 0.98 (PASS Online) for the repurposed indications. In the second set, sensitivity values varied from 0.08 (SuperPred) to 1.00 (PASS Online) for the initial indications and from 0.00 (SuperPred) to 1.00 (PASS Online) for the repurposed indications. Thus, this analysis demonstrated that the performance of machine learning methods surpassed those of chemical similarity assessments, particularly in the case of novel repurposed indications.

A Testbed for Evaluating Lunar Habitat Autonomy Architectures

NASA Technical Reports Server (NTRS)

Lawler, Dennis G.

2008-01-01

A lunar outpost will involve a habitat with an integrated set of hardware and software that will maintain a safe environment for human activities. There is a desire for a paradigm shift whereby crew will be the primary mission operators, not ground controllers. There will also be significant periods when the outpost is uncrewed. This will require that significant automation software be resident in the habitat to maintain all system functions and respond to faults. JSC is developing a testbed to allow for early testing and evaluation of different autonomy architectures. This will allow evaluation of different software configurations in order to: 1) understand different operational concepts; 2) assess the impact of failures and perturbations on the system; and 3) mitigate software and hardware integration risks. The testbed will provide an environment in which habitat hardware simulations can interact with autonomous control software. Faults can be injected into the simulations and different mission scenarios can be scripted. The testbed allows for logging, replaying and re-initializing mission scenarios. An initial testbed configuration has been developed by combining an existing life support simulation and an existing simulation of the space station power distribution system. Results from this initial configuration will be presented along with suggested requirements and designs for the incremental development of a more sophisticated lunar habitat testbed.

Palonosetron versus other 5-HT₃ receptor antagonists for prevention of chemotherapy-induced nausea and vomiting in patients with hematologic malignancies treated with emetogenic chemotherapy in a hospital outpatient setting in the United States.

PubMed

Craver, Chris; Gayle, Julie; Balu, Sanjeev; Buchner, Deborah

2011-01-01

This study evaluated the rate of uncontrolled chemotherapy-induced nausea and vomiting (CINV) after initiating antiemetic prophylaxis with palonosetron versus other 5-HT₃ receptor antagonists (RAs) in patients diagnosed with hematologic malignancies (lymphoma and leukemia) and receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC) in a hospital outpatient setting. Patients aged ≥ 18 years and diagnosed with hematologic malignancies initiating HEC or MEC and antiemetic prophylaxis with palonosetron (Group 1) and other 5-HT₃ RAs (Group 2) for the first time in a hospital outpatient setting between 4/1/2007 and 3/31/2009 were identified from the Premier Perspective Database. Within each cycle, CINV events were identified (in the hospital outpatient, inpatient, and emergency room settings) through ICD-9 codes for nausea, vomiting, and/or volume depletion (from each CT administration day 1 until the end of the CT cycle), or use of rescue medications (day 2 until the end of the CT cycle). Negative binomial distribution generalized linear multivariate regression model estimating the CINV event rate on CT, specific CT cycles, and cancer diagnosis (leukemia/lymphoma)-matched groups in the follow-up period (first of 8 cycles or 6 months) was developed. Of 971 identified patients, 211 initiated palonosetron (Group 1). Group 1 patients comprised of more females [50.2 vs. 41.4%; p = 0.0226], Whites [74.4 vs. 70.4%, and Hispanics [7.6 vs. 6.3%; all races p = 0.0105], received more HEC treatments [89.6 vs. 84.2%; all CT types p = 0.0129], and had more lymphoma diagnosed patients [89.6 vs. 76.3%; all cancer types p = 0.0033] at baseline. After controlling for differences in several demographic and clinical variables, the regression model predicted a 20.4% decrease in CINV event rate per CT cycle for Group 1 versus Group 2 patients. Study limitations include potential lack of generalizability, absence of data on certain confounders including alcohol consumption and prior history of motion sickness, potential underestimation of incidence of uncontrolled CINV, and inability to draw conclusions pertaining to cause and effect relationship. In this retrospective hospital study, patients with hematologic malignancies treated with HEC or MEC and initiated on antiemetic prophylaxis with palonosetron in the hospital outpatient setting were more likely to experience significantly lower CINV event rates (in the hospital outpatient, inpatient, and emergency room settings) versus patients initiated on other 5-HT₃ RAs.

Effect of early statin therapy after acute coronary syndromes: a concise review of the recent data.

PubMed

Bybee, Kevin A; Wright, R Scott; Kopecky, Stephen L

2002-01-01

HMG Co-A reductase inhibitors(statins) have been shown, in three large randomized trials, to decrease adverse cardiac events in patients with clinically evident coronary artery disease. All of these trials have excluded patients with an acute coronary syndrome within the three months prior to enrollment. Statin therapy is thought to stabilize coronary plaque and decrease the risk of plaque rupture. Statins have been shown to quickly reduce levels of LDL-C in addition to altering systemic inflammatory responses, improving endothelial function, and reducing platelet aggregation and activation. These mechanisms are potentially beneficial in the setting of acute coronary syndromes, a time of profound plaque instability. There is a growing body of evidence supporting the early initiation of statin therapy in the setting of acute coronary syndromes. This paper reviews the available data from randomized-controlled trials and observational studies evaluating the effect of early statin initiation during, or soon following, an acute coronary syndrome.

An analytical-numerical approach for parameter determination of a five-parameter single-diode model of photovoltaic cells and modules

NASA Astrophysics Data System (ADS)

Hejri, Mohammad; Mokhtari, Hossein; Azizian, Mohammad Reza; Söder, Lennart

2016-04-01

Parameter extraction of the five-parameter single-diode model of solar cells and modules from experimental data is a challenging problem. These parameters are evaluated from a set of nonlinear equations that cannot be solved analytically. On the other hand, a numerical solution of such equations needs a suitable initial guess to converge to a solution. This paper presents a new set of approximate analytical solutions for the parameters of a five-parameter single-diode model of photovoltaic (PV) cells and modules. The proposed solutions provide a good initial point which guarantees numerical analysis convergence. The proposed technique needs only a few data from the PV current-voltage characteristics, i.e. open circuit voltage Voc, short circuit current Isc and maximum power point current and voltage Im; Vm making it a fast and low cost parameter determination technique. The accuracy of the presented theoretical I-V curves is verified by experimental data.

Web-based triage in a college health setting.

PubMed

Sole, Mary Lou; Stuart, Patricia L; Deichen, Michael

2006-01-01

The authors describe the initiation and use of a Web-based triage system in a college health setting. During the first 4 months of implementation, the system recorded 1,290 encounters. More women accessed the system (70%); the average age was 21.8 years. The Web-based triage system advised the majority of students to seek care within 24 hours; however, it recommended self-care management in 22.7% of encounters. Sore throat was the most frequent chief complaint (14.2%). A subset of 59 students received treatment at student health services after requesting an appointment via e-mail. The authors used kappa statistics to compare congruence between chief complaint and 24/7 WebMed classification (kappa = .94), between chief complaint and student health center diagnosis (kappa = .91), and between 24/7 WebMed classification and student health center diagnosis (kappa = .89). Initial evaluation showed high use and good accuracy of Web-based triage. This service provides education and advice to students about their health care concerns.

Fault-free behavior of reliable multiprocessor systems: FTMP experiments in AIRLAB

NASA Technical Reports Server (NTRS)

Clune, E.; Segall, Z.; Siewiorek, D.

1985-01-01

This report describes a set of experiments which were implemented on the Fault tolerant Multi-Processor (FTMP) at NASA/Langley's AIRLAB facility. These experiments are part of an effort to formulate and evaluate validation methodologies for fault-tolerant computers. This report deals with the measurement of single parameters (baselines) of a fault free system. The initial set of baseline experiments lead to the following conclusions: (1) The system clock is constant and independent of workload in the tested cases; (2) the instruction execution times are constant; (3) the R4 frame size is 40mS with some variation; (4) the frame stretching mechanism has some flaws in its implementation that allow the possibility of an infinite stretching of frame duration. Future experiments are planned. Some will broaden the results of these initial experiments. Others will measure the system more dynamically. The implementation of a synthetic workload generation mechanism for FTMP is planned to enhance the experimental environment of the system.

Upper bound of abutment scour in laboratory and field data

USGS Publications Warehouse

Benedict, Stephen

2016-01-01

The U.S. Geological Survey, in cooperation with the South Carolina Department of Transportation, conducted a field investigation of abutment scour in South Carolina and used those data to develop envelope curves that define the upper bound of abutment scour. To expand on this previous work, an additional cooperative investigation was initiated to combine the South Carolina data with abutment scour data from other sources and evaluate upper bound patterns with this larger data set. To facilitate this analysis, 446 laboratory and 331 field measurements of abutment scour were compiled into a digital database. This extensive database was used to evaluate the South Carolina abutment scour envelope curves and to develop additional envelope curves that reflected the upper bound of abutment scour depth for the laboratory and field data. The envelope curves provide simple but useful supplementary tools for assessing the potential maximum abutment scour depth in the field setting.

Pressure ulcer risk assessment and prevention: what difference does a risk scale make? A comparison between Norway and Ireland.

PubMed

Johansen, E; Moore, Z; van Etten, M; Strapp, H

2014-07-01

To explore similarities and differences in nurses' views on risk assessment practices and preventive care activities in a context where patients' risk of developing pressure ulcers is assessed using clinical judgment (Norway) and a context where patients' risk of developing pressure ulcers is assessed using a formal structured risk assessment combined with clinical judgement (Ireland). A descriptive, qualitative design was employed across two different care settings with a total of 14 health care workers, nine from Norway and five from Ireland. Regardless of whether risk assessment was undertaken using clinical judgment or formal structured risk assessment, identified risk factors, at risk patients and appropriate preventive initiatives discussed by participant were similar across care settings. Furthermore, risk assessment did not necessarily result in the planning and implementation of appropriate pressure ulcer prevention initiatives. Thus, in this instance, use of a formal risk assessment tool does not seem to make any difference to the planning, initiation and evaluation of pressure ulcer prevention strategies. Regardless of the method of risk assessment, patients at risk of developing pressure ulcers are detected, suggesting that the practice of risk assessment should be re-evaluated. Moreover, appropriate preventive interventions were described. However, the missing link between risk assessment and documented care planning is of concern and barriers to appropriate pressure ulcer documentation should be explored further. This work is partly funded by a research grant from the Norwegian Nurses Organisation (NNO) (Norsk Sykepleierforbund NSF) in 2012. The authors have no conflict of interest to declare.

Leveraging Citizen Science for Healthier Food Environments: A Pilot Study to Evaluate Corner Stores in Camden, New Jersey.

PubMed

Chrisinger, Benjamin W; Ramos, Ana; Shaykis, Fred; Martinez, Tanya; Banchoff, Ann W; Winter, Sandra J; King, Abby C

2018-01-01

Over the last 6 years, a coordinated "healthy corner store" network has helped an increasing number of local storeowners stock healthy, affordable foods in Camden, New Jersey, a city with high rates of poverty and unemployment, and where most residents have little or no access to large food retailers. The initiative's funders and stakeholders wanted to directly engage Camden residents in evaluating this effort to increase healthy food access. In a departure from traditional survey- or focus group-based evaluations, we used an evidence-based community-engaged citizen science research model (called Our Voice ) that has been deployed in a variety of neighborhood settings to assess how different features of the built environment both affect community health and wellbeing, and empower participants to create change. Employing the Our Voice model, participants documented neighborhood features in and around Camden corner stores through geo-located photos and audio narratives. Eight adult participants who lived and/or worked in a predefined neighborhood of Camden were recruited by convenience sample and visited two corner stores participating in the healthy corner store initiative (one highly-engaged in the initiative and the other less-engaged), as well as an optional third corner store of their choosing. Facilitators then helped participants use their collected data (in total, 134 images and 96 audio recordings) to identify and prioritize issues as a group, and brainstorm and advocate for potential solutions. Three priority themes were selected by participants from the full theme list ( n  = 9) based on perceived importance and feasibility: healthy product selection and display, store environment, and store outdoor appearance and cleanliness. Participants devised and presented a set of action steps to community leaders, and stakeholders have begun to incorporate these ideas into plans for the future of the healthy corner store network. Key elements of healthy corner stores were identified as positive, and other priorities, such as improvements to safety, exterior facades, and physical accessibility, may find common ground with other community development initiatives in Camden. Ultimately, this pilot study demonstrated the potential of citizen science to provide a systematic and data-driven process for public health stakeholders to authentically engage community residents in program evaluation.

The current state of funded NIH grants in implementation science in genomic medicine: a portfolio analysis.

PubMed

Roberts, Megan C; Clyne, Mindy; Kennedy, Amy E; Chambers, David A; Khoury, Muin J

2017-10-26

PurposeImplementation science offers methods to evaluate the translation of genomic medicine research into practice. The extent to which the National Institutes of Health (NIH) human genomics grant portfolio includes implementation science is unknown. This brief report's objective is to describe recently funded implementation science studies in genomic medicine in the NIH grant portfolio, and identify remaining gaps.MethodsWe identified investigator-initiated NIH research grants on implementation science in genomic medicine (funding initiated 2012-2016). A codebook was adapted from the literature, three authors coded grants, and descriptive statistics were calculated for each code.ResultsForty-two grants fit the inclusion criteria (~1.75% of investigator-initiated genomics grants). The majority of included grants proposed qualitative and/or quantitative methods with cross-sectional study designs, and described clinical settings and primarily white, non-Hispanic study populations. Most grants were in oncology and examined genetic testing for risk assessment. Finally, grants lacked the use of implementation science frameworks, and most examined uptake of genomic medicine and/or assessed patient-centeredness.ConclusionWe identified large gaps in implementation science studies in genomic medicine in the funded NIH portfolio over the past 5 years. To move the genomics field forward, investigator-initiated research grants should employ rigorous implementation science methods within diverse settings and populations.Genetics in Medicine advance online publication, 26 October 2017; doi:10.1038/gim.2017.180.

Design of Economic Evaluations of Mindfulness-Based Interventions: Ten Methodological Questions of Which to Be Mindful.

PubMed

Edwards, Rhiannon Tudor; Bryning, Lucy; Crane, Rebecca

Mindfulness-based interventions (MBIs) are being increasingly applied in a variety of settings. A growing body of evidence to support the effectiveness of these interventions exists and there are a few published cost-effectiveness studies. With limited resources available within public sectors (health care, social care, and education), it is necessary to build in concurrent economic evaluations alongside trials in order to inform service commissioning and policy. If future research studies are well-designed, they have strong potential to investigate the economic impact of MBIs. The particular challenge to the health economist is how best to capture the ways that MBIs help people adjust to or build resilience to difficult life circumstances, and to disseminate effectively to enable policy makers to judge the value of the contribution that MBIs can make within the context of the limited resourcing of public services. In anticipation of more research worldwide evaluating MBIs in various settings, this article suggests ten health economics methodological design questions that researchers may want to consider prior to conducting MBI research. These questions draw on both published standards of good methodological practice in economic evaluation of medical interventions, and on the authors' knowledge and experience of mindfulness-based practice. We argue that it is helpful to view MBIs as both complex interventions and as public health prevention initiatives. Our suggestions for well-designed economic evaluations of MBIs in health and other settings, mirror current thinking on the challenges and opportunities of public health economics.

In Flight Evaluation of Active Inceptor Force-Feel Characteristics and Handling Qualities

NASA Technical Reports Server (NTRS)

Lusardi, Jeff A.; Blanken, Chris L.; Ott, Carl Raymond; Malpica, Carlos A.; von Gruenhagen, Wolfgang

2012-01-01

The effect of inceptor feel-system characteristics on piloted handling qualities has been a research topic of interest for many years. Most of the research efforts have focused on advanced fly-by-wire fixed-wing aircraft with only a few studies investigating the effects on rotorcraft. Consequently, only limited guidance is available on how cyclic force-feel characteristics should be set to obtain optimal handling qualities for rotorcraft. To study this effect, the U.S. Army Aeroflightdynamics Directorate working with the DLR Institute of Flight Systems in Germany under Task X of the U.S. German Memorandum of Understanding have been conducting flight test evaluations. In the U.S., five experimental test pilots have completed evaluations of two Mission Task Elements (MTEs) from ADS-33E-PRF and two command/response types for a matrix of center-stick cyclic force-feel characteristics at Moffett Field. In Germany, three experimental test Pilots have conducted initial evaluations of the two MTEs with two command/response types for a parallel matrix of side-stick cyclic force-feel characteristics at WTD-61 in Manching. The resulting data set is used to correlate the effect of changes in natural frequency and damping ratio of the cyclic inceptor on the piloted handling qualities. Existing criteria in ADS-33E and a proposed Handling Qualities Sensitivity Function that includes the effects of the cyclic force-feel characteristics are also evaluated against the data set and discussed.

Using Perceptual and Neuromuscular Responses to Estimate Mechanical Changes During Continuous Sets in the Bench Press.

PubMed

Chapman, Mark; Larumbe-Zabala, Eneko; Gosss-Sampson, Mark; Triplett, N Travis; Naclerio, Fernando

2018-02-22

The present study analyzed the effectiveness of the OMNI-RES (0-10) and the electromyographic signal for monitoring changes in the movement velocity during a set to muscular failure performed with different relative loads in the bench press exercise (BP). Ten males (30.8 ± 5.7 years) were evaluated on eight separate days with 48 hours of rest between sessions. After determining the 1RM value, participants performed seven sets to failure with the following relative loads ranges: 30<40%; 40<50%, 50<60%, 60%<70%, 70<80%, 80<90% and >90%. The mean accelerative velocity (MAV), the Rating of Perceived Exertion (RPE) and the normalized root mean square (N-RMS) signal from the anterior deltoids were measured for every repetition of each set. The RPE expressed after the first repetition and when the maximum value of MAV was achieved over the sets was lower (p <0.001, d >0.80) than the RPE associated with a 10% drop in MAV and at failure. Furthermore, the initial RPE was useful to distinguish different loading zones between the light relative loads (30<40% vs. 40<50% vs. 50<60%) and from these three zones to the higher relative load ranges (60 to >90%). Similar, but less clear, differences were observed for the N-RMS. In conclusion, apart from differentiating between relative loads, the RPE and in some cases N-RMS can both reflect changes associated with the initial, maximal, 10% drop in movement velocity and muscular failure during a continuous set in the BP.

Improved Diagnostic Accuracy of Alzheimer's Disease by Combining Regional Cortical Thickness and Default Mode Network Functional Connectivity: Validated in the Alzheimer's Disease Neuroimaging Initiative Set

PubMed Central

Park, Ji Eun; Park, Bumwoo; Kim, Ho Sung; Choi, Choong Gon; Jung, Seung Chai; Oh, Joo Young; Lee, Jae-Hong; Roh, Jee Hoon; Shim, Woo Hyun

2017-01-01

Objective To identify potential imaging biomarkers of Alzheimer's disease by combining brain cortical thickness (CThk) and functional connectivity and to validate this model's diagnostic accuracy in a validation set. Materials and Methods Data from 98 subjects was retrospectively reviewed, including a study set (n = 63) and a validation set from the Alzheimer's Disease Neuroimaging Initiative (n = 35). From each subject, data for CThk and functional connectivity of the default mode network was extracted from structural T1-weighted and resting-state functional magnetic resonance imaging. Cortical regions with significant differences between patients and healthy controls in the correlation of CThk and functional connectivity were identified in the study set. The diagnostic accuracy of functional connectivity measures combined with CThk in the identified regions was evaluated against that in the medial temporal lobes using the validation set and application of a support vector machine. Results Group-wise differences in the correlation of CThk and default mode network functional connectivity were identified in the superior temporal (p < 0.001) and supramarginal gyrus (p = 0.007) of the left cerebral hemisphere. Default mode network functional connectivity combined with the CThk of those two regions were more accurate than that combined with the CThk of both medial temporal lobes (91.7% vs. 75%). Conclusion Combining functional information with CThk of the superior temporal and supramarginal gyri in the left cerebral hemisphere improves diagnostic accuracy, making it a potential imaging biomarker for Alzheimer's disease. PMID:29089831

R & D GTDS SST: Code Flowcharts and Input

DTIC Science & Technology

1995-01-01

trajectory from a given set of initial conditions Typical output is in the form of a printer le of Cartesian coordinates and Keplerian orbital ... orbiting the Earth The input data specied for an EPHEM run are i Initial elements and epoch ii Orbit generator selection iii Conversion of osculating...discussed ELEMENT sets coordinate system reference central body and rst components of initial state ELEMENT sets the second

A mixed methods approach to adapting and evaluating the functional assessment of HIV infection (FAHI), Swahili version, for use with low literacy populations.

PubMed

Nyongesa, Moses K; Sigilai, Antipa; Hassan, Amin S; Thoya, Janet; Odhiambo, Rachael; Van de Vijver, Fons J R; Newton, Charles R J C; Abubakar, Amina

2017-01-01

Despite bearing the largest HIV-related burden, little is known of the Health-Related Quality of Life (HRQoL) among people living with HIV in sub-Saharan Africa. One of the factors contributing to this gap in knowledge is the lack of culturally adapted and validated measures of HRQoL that are relevant for this setting. We set out to adapt the Functional Assessment of HIV Infection (FAHI) Questionnaire, an HIV-specific measure of HRQoL, and evaluate its internal consistency and validity. The three phase mixed-methods study took place in a rural setting at the Kenyan Coast. Phase one involved a scoping review to describe the evidence base of the reliability and validity of FAHI as well as the geographical contexts in which it has been administered. Phase two involved in-depth interviews (n = 38) to explore the content validity, and initial piloting for face validation of the adapted FAHI. Phase three was quantitative (n = 103) and evaluated the internal consistency, convergent and construct validities of the adapted interviewer-administered questionnaire. In the first phase of the study, we identified 16 studies that have used the FAHI. Most (82%) were conducted in North America. Only seven (44%) of the reviewed studies reported on the psychometric properties of the FAHI. In the second phase, most of the participants (37 out of 38) reported satisfaction with word clarity and content coverage whereas 34 (89%) reported satisfaction with relevance of the items, confirming the face validity of the adapted questionnaire during initial piloting. Our participants indicated that HIV impacted on their physical, functional, emotional, and social wellbeing. Their responses overlapped with items in four of the five subscales of the FAHI Questionnaire establishing its content validity. In the third phase, the internal consistency of the scale was found to be satisfactory with subscale Cronbach's α ranging from 0.55 to 0.78. The construct and convergent validity of the tool were supported by acceptable factor loadings for most of the items on the respective sub-scales and confirmation of expected significant correlations of the FAHI subscale scores with scores of a measure of common mental disorders. The adapted interviewer-administered Swahili version of FAHI questionnaire showed initial strong evidence of good psychometric properties with satisfactory internal consistency and acceptable validity (content, face, and convergent validity). It gives impetus for further validation work, especially construct validity, in similar settings before it can be used for research and clinical purposes in the entire East African region.

A comparison of the diagnostic accuracy of magnetic resonance imaging to axillary ultrasound in the detection of axillary nodal metastases in newly diagnosed breast cancer.

PubMed

Assing, Matthew A; Patel, Bhavika K; Karamsadkar, Neel; Weinfurtner, Jared; Usmani, Omar; Kiluk, John V; Drukteinis, Jennifer S

2017-11-01

Patients with a diagnosis of invasive breast cancer are increasingly undergoing breast magnetic resonance imaging (MRI) for preoperative staging including evaluation of axillary lymph node metastases (ALNM). This retrospective study aims to evaluate the utility of adding axillary ultrasound (AUS) in the preoperative setting when an MRI is planned or has already been performed. This IRB approved, HIPAA compliant study reviewed a total of 271 patients with a new diagnosis of invasive breast cancer at a single institution, between June 1, 2010 and June 30, 2013. The study included patients who received both AUS and MRI for preoperative staging. Data were divided into two cohorts, patients who underwent MRI prior to AUS and those who underwent AUS prior to MRI. AUS and MRI reports were categorized according to BI-RADS criteria as "suspicious" or "not suspicious" for ALNM. In the setting of a negative MRI and subsequent positive AUS, only one out of 25 cases (4%) were positive for metastases after correlating with histologic pathology. MRI detected metastatic disease in four out of 27 (15%) patients who had false-negative AUS performed prior to MRI. Our results indicate the addition of AUS after preoperative MRI does not contribute significantly to increased detection of missed disease. MRI could serve as the initial staging imaging method of the axilla in the setting that AUS is not initially performed and may be valuable in identification of lymph nodes not identified on AUS. © 2017 Wiley Periodicals, Inc.

Bench Test Evaluation of Adaptive Servoventilation Devices for Sleep Apnea Treatment

PubMed Central

Zhu, Kaixian; Kharboutly, Haissam; Ma, Jianting; Bouzit, Mourad; Escourrou, Pierre

2013-01-01

Rationale: Adaptive servoventilation devices are marketed to overcome sleep disordered breathing with apneas and hypopneas of both central and obstructive mechanisms often experienced by patients with chronic heart failure. The clinical efficacy of these devices is still questioned. Study Objectives: This study challenged the detection and treatment capabilities of the three commercially available adaptive servoventilation devices in response to sleep disordered breathing events reproduced on an innovative bench test. Methods: The bench test consisted of a computer-controlled piston and a Starling resistor. The three devices were subjected to a flow sequence composed of central and obstructive apneas and hypopneas including Cheyne-Stokes respiration derived from a patient. The responses of the devices were separately evaluated with the maximum and the clinical settings (titrated expiratory positive airway pressure), and the detected events were compared to the bench-scored values. Results: The three devices responded similarly to central events, by increasing pressure support to raise airflow. All central apneas were eliminated, whereas hypopneas remained. The three devices responded differently to the obstructive events with the maximum settings. These obstructive events could be normalized with clinical settings. The residual events of all the devices were scored lower than bench test values with the maximum settings, but were in agreement with the clinical settings. However, their mechanisms were misclassified. Conclusion: The tested devices reacted as expected to the disordered breathing events, but not sufficiently to normalize the breathing flow. The device-scored results should be used with caution to judge efficacy, as their validity depends upon the initial settings. Citation: Zhu K; Kharboutly H; Ma J; Bouzit M; Escourrou P. Bench test evaluation of adaptive servoventilation devices for sleep apnea treatment. J Clin Sleep Med 2013;9(9):861-871. PMID:23997698

Predicting inpatient clinical order patterns with probabilistic topic models vs conventional order sets.

PubMed

Chen, Jonathan H; Goldstein, Mary K; Asch, Steven M; Mackey, Lester; Altman, Russ B

2017-05-01

Build probabilistic topic model representations of hospital admissions processes and compare the ability of such models to predict clinical order patterns as compared to preconstructed order sets. The authors evaluated the first 24 hours of structured electronic health record data for > 10 K inpatients. Drawing an analogy between structured items (e.g., clinical orders) to words in a text document, the authors performed latent Dirichlet allocation probabilistic topic modeling. These topic models use initial clinical information to predict clinical orders for a separate validation set of > 4 K patients. The authors evaluated these topic model-based predictions vs existing human-authored order sets by area under the receiver operating characteristic curve, precision, and recall for subsequent clinical orders. Existing order sets predict clinical orders used within 24 hours with area under the receiver operating characteristic curve 0.81, precision 16%, and recall 35%. This can be improved to 0.90, 24%, and 47% ( P  < 10 -20 ) by using probabilistic topic models to summarize clinical data into up to 32 topics. Many of these latent topics yield natural clinical interpretations (e.g., "critical care," "pneumonia," "neurologic evaluation"). Existing order sets tend to provide nonspecific, process-oriented aid, with usability limitations impairing more precise, patient-focused support. Algorithmic summarization has the potential to breach this usability barrier by automatically inferring patient context, but with potential tradeoffs in interpretability. Probabilistic topic modeling provides an automated approach to detect thematic trends in patient care and generate decision support content. A potential use case finds related clinical orders for decision support. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Reflective practice groups for nurses: a consultation liaison psychiatry nursing initiative: part 2--the evaluation.

PubMed

Dawber, Chris

2013-06-01

This paper outlines an evaluation of reflective practice groups (RPG) involving nurses and midwives from three clinical nursing specialties at Redcliffe and Caboolture Hospitals, Queensland, Australia. The groups were facilitated by the consultation liaison psychiatry nurse and author using a process-focused, whole-of-group approach to explore clinical narrative in a supportive group setting. This was a preliminary evaluation utilizing a recently-developed tool, the Clinical Supervision Evaluation Questionnaire, along with externally-facilitated focus groups. Nurses and midwives responded favourably to RPG, reporting a positive impact on clinical practice, self-awareness, and resilience. The majority of participants considered RPG had positive implications for team functioning. The focus groups identified the importance of facilitation style and the need to address aspects of workplace culture to enable group development and enhance the capacity for reflection. Evaluation of the data indicates this style of RPG can improve reflective thinking, promote team cohesion, and provide support for nurses and midwives working in clinical settings. Following on from this study, a second phase of research has commenced, providing more detailed, longitudinal evaluation across a larger, more diverse group of nurses. © 2012 The Author; International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

Three-dimensional shear wave elastography for differentiation of breast lesions: An initial study with quantitative analysis using three orthogonal planes.

PubMed

Wang, Qiao

2018-05-25

To prospectively evaluate the diagnostic performance of three-dimensional (3D) shear wave elastography (SWE) for breast lesions with quantitative stiffness information from transverse, sagittal and coronal planes. Conventional ultrasound (US), two-dimensional (2D)-SWE and 3D-SWE were performed for 122 consecutive patients with 122 breast lesions before biopsy or surgical excision. Maximum elasticity values of Young's modulus (Emax) were recorded on 2D-SWE and three planes of 3D-SWE. Area under the receiver operating characteristic curve (AUC), sensitivity and specificity of US, 2D-SWE and 3D-SWE were evaluated. Two combined sets (i.e., BI-RADS and 2D-SWE; BI-RADS and 3D-SWE) were compared in AUC. Observer consistency was also evaluated. On 3D-SWE, the AUC and sensitivity of sagittal plane were significantly higher than those of transverse and coronal planes (both P < 0.05). Compared with BI-RADS alone, both combined sets had significantly (P < 0.05) higher AUCs and specificities, whereas, the two combined sets showed no significant difference in AUC (P > 0.05). However, the combined set of BI-RADS and sagittal plane of 3D-SWE had significantly higher sensitivity than the combined set of BI-RADS and 2D-SWE. The sagittal plane shows the best diagnostic performance among 3D-SWE. The combination of BI-RADS and 3D-SWE is a useful tool for predicting breast malignant lesions in comparison with BI-RADS alone.

Which Triple Aim related measures are being used to evaluate population management initiatives? An international comparative analysis.

PubMed

Hendrikx, Roy J P; Drewes, Hanneke W; Spreeuwenberg, Marieke; Ruwaard, Dirk; Struijs, Jeroen N; Baan, Caroline A

2016-05-01

Population management (PM) initiatives are introduced in order to create sustainable health care systems. These initiatives should focus on the continuum of health and well-being of a population by introducing interventions that integrate various services. To be successful they should pursue the Triple Aim, i.e. simultaneously improve population health and quality of care while reducing costs per capita. This study explores how PM initiatives measure the Triple Aim in practice. An exploratory search was combined with expert consultations to identify relevant PM initiatives. These were analyzed based on general characteristics, utilized measures and related selection criteria. In total 865 measures were used by 20 PM initiatives. All quality of care domains were included by at least 11 PM initiatives, while most domains of population health and costs were included by less than 7 PM initiatives. Although their goals showed substantial overlap, the measures applied showed few similarities between PM initiatives and were predominantly selected based on local priority areas and data availability. Most PM initiatives do not measure the full scope of the Triple Aim. Additionally, variety between measures limits comparability between PM initiatives. Consensus on the coverage of Triple Aim domains and a set of standardized measures could further both the inclusion of the various domains as well as the comparability between PM initiatives. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Surveillance and Monitoring Program Full-Scale Experiments to Evaluate the Potential for Corrosion in 3013 Containers

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

Narlesky, Joshua Edward; Berg, John M.; Duque, Juan

A set of six long-term, full-scale experiments were initiated to determine the type and extent of corrosion that occurs in 3013 containers packaged with chloride-bearing plutonium oxide materials. The materials were exposed to a high relative humidity environment representative of actual packaging conditions for the materials in storage. The materials were sealed in instrumented, inner 3013 containers with corrosion specimens designed to test the corrosiveness of the environment inside the containers under various conditions. This report focuses on initial loading conditions that are used to establish a baseline to show how the conditions change throughout the storage lifetime of themore » containers.« less

The West Virginia Occupational Safety and Health Initiative: practicum training for a new marketplace.

PubMed

Meyer, J D; Becker, P E; Stockdale, T; Ducatman, A M

1999-05-01

Occupational medicine practice has experienced a shift from larger corporate medical departments to organizations providing services for a variety of industries. Specific training needs will accompany this shift in practice patterns; these may differ from those developed in the traditional industrial or corporate medical department setting. The West Virginia Occupational Health and Safety Initiative involves occupational medicine residents in consultation to a variety of small industries and businesses. It uses the expertise of occupational physicians, health and safety extension faculty, and faculty in engineering and industrial hygiene. Residents participate in multidisciplinary evaluations of worksites, and develop competencies in team-building, workplace health and safety evaluation, and occupational medical consulting. Specific competencies that address requirements for practicum training are used to measure the trainee's acquisition of knowledge and skills. Particular attention is paid to the acquisition of group problem-solving expertise, skills relevant to the current market in practice opportunities, and the specific career interests of the resident physician. Preliminary evaluation indicates the usefulness of training in evaluation of diverse industries and worksites. We offer this program as a training model that can prepare residents for the challenges of a changing marketplace for occupational health and safety services.

Physiological studies of fruit set in strawberry (Fragaria x ananassa Duch. )

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

Darnell, R.L.

1986-01-01

The present study was initiated to test the hypothesis that hormones control fruit set by controlling the amount of assimilate transport and accumulation in fruit tissues. The objectives were to compare assimilate mobilization and accumulation in two treatments which induced fruit set; i.e. pollination and exogenous hormone application, versus a non-pollinated treatment which did not induce fruit set. Initial experiments revealed that several auxins which induce parthenocarpic set in June-bearing strawberries did not induce set in the day-neutral cultivar used in this study. The only auxin found which induced set with a single application was indoleacetic acid ethyl ester (Et-IAA).more » Subsequently, /sup 14/C-Et-IAA was synthesized and the translocation and metabolism of this auxin was examined and correlated with fruit set and initial growth. Et-IAA transport out of the receptacle was not required for induction of set and growth.« less

Strength and stiffness of small glued-laminated beams with different qualities of tension laminations

Treesearch

Catherine M. Marx; Russell C. Moody

1981-01-01

A total of 180 small Douglas Fir–Larch (DF-L) or Southern Pine (SP) glued-laminated beams were evaluated to determine the tension lamination quality necessary to obtain desired design stresses. The test beams had either the regular laminating grades of L1 DF-L/No. 1D SP or the special 302-24 laminating grade as tension laminations. Because an initial set of SP beams...

Tier One Performance Screen Initial Operational Test and Evaluation: 2012 Interim Report

DTIC Science & Technology

2013-12-01

are known to predict outcomes in work settings. Because the TAPAS uses item response theory (IRT) methods to construct and score items, it can be...Qualification Test (AFQT), to select new Soldiers. Although the AFQT is useful for selecting new Soldiers, other personal attributes are important to...to be and will continue to serve as a useful metric for selecting new Soldiers, other personal attributes, in particular non-cognitive attributes

Development of a Novel Alginate-Based Pleural Sealant

DTIC Science & Technology

2017-09-01

and will be the subject of ongoing studies . Figure 20: Experimental set-up for endobronchial administration of sealants in the ex vivo pig lung...toxicity. In the studies to date, we have done extensive materials characterization not just of modified alginates but now a number of other biologic...pig) ex vivo lung models and have performed initial in vivo evaluations of several compounds in a non-survival surgery rat lung injury model. The

Evaluating Detection Limits of Next-Generation Sequencing for the Surveillance and Monitoring of International Marine Pests

PubMed Central

Pochon, Xavier; Bott, Nathan J.; Smith, Kirsty F.; Wood, Susanna A.

2013-01-01

Most surveillance programmes for marine invasive species (MIS) require considerable taxonomic expertise, are laborious, and are unable to identify species at larval or juvenile stages. Therefore, marine pests may go undetected at the initial stages of incursions when population densities are low. In this study, we evaluated the ability of the benchtop GS Junior™ 454 pyrosequencing system to detect the presence of MIS in complex sample matrices. An initial in-silico evaluation of the mitochondrial cytochrome c oxidase subunit I (COI) and the nuclear small subunit ribosomal DNA (SSU) genes, found that multiple primer sets (targeting a ca. 400 base pair region) would be required to obtain species level identification within the COI gene. In contrast a single universal primer set was designed to target the V1–V3 region of SSU, allowing simultaneous PCR amplification of a wide taxonomic range of MIS. To evaluate the limits of detection of this method, artificial contrived communities (10 species from 5 taxonomic groups) were created using varying concentrations of known DNA samples and PCR products. Environmental samples (water and sediment) spiked with one or five 160 hr old Asterias amurensis larvae were also examined. Pyrosequencing was able to recover DNA/PCR products of individual species present at greater than 0.64% abundance from all tested contrived communities. Additionally, single A. amurensis larvae were detected from both water and sediment samples despite the co-occurrence of a large array of environmental eukaryotes, indicating an equivalent sensitivity to quantitative PCR. NGS technology has tremendous potential for the early detection of marine invasive species worldwide. PMID:24023913

The use of Goal Attainment Scaling in a community health promotion initiative with seniors.

PubMed

Kloseck, Marita

2007-07-03

Evaluating collaborative community health promotion initiatives presents unique challenges, including engaging community members and other stakeholders in the evaluation process, and measuring the attainment of goals at the collective community level. Goal Attainment Scaling (GAS) is a versatile, under-utilized evaluation tool adaptable to a wide range of situations. GAS actively involves all partners in the evaluation process and has many benefits when used in community health settings. The purpose of this paper is to describe the use of GAS as a potential means of measuring progress and outcomes in community health promotion and community development projects. GAS methodology was used in a local community of seniors (n = 2500; mean age = 76 +/- 8.06 SD; 77% female, 23% male) to a) collaboratively set health promotion and community partnership goals and b) objectively measure the degree of achievement, over- or under-achievement of the established health promotion goals. Goal attainment was measured in a variety of areas including operationalizing a health promotion centre in a local mall, developing a sustainable mechanism for recruiting and training volunteers to operate the health promotion centre, and developing and implementing community health education programs. Goal attainment was evaluated at 3 monthly intervals for one year, then re-evaluated again at year 2. GAS was found to be a feasible and responsive method of measuring community health promotion and community development progress. All project goals were achieved at one year or sooner. The overall GAS score for the total health promotion project increased from 16.02 at baseline (sum of scale scores = -30, average scale score = -2) to 54.53 at one year (sum of scale scores = +4, average scale score = +0.27) showing project goals were achieved above the expected level. With GAS methodology an amalgamated score of 50 represents the achievement of goals at the expected level. GAS provides a "participatory", flexible evaluation approach that involves community members, research partners and other stakeholders in the evaluation process. GAS was found to be "user-friendly" and readily understandable by seniors and other community partners not familiar with program evaluation.

Evaluation of COSMO-ART in the Framework of the Air Quality Model Evaluation International Initiative (AQMEII)

NASA Astrophysics Data System (ADS)

Giordano, Lea; Brunner, Dominik; Im, Ulas; Galmarini, Stefano

2014-05-01

The Air Quality Model Evaluation International Initiative (AQMEII) coordinated by the EC-JRC and US-EPA, promotes since 2008 research on regional air quality model evaluation across the atmospheric modelling communities of Europe and North America. AQMEII has now reached its Phase 2 that is dedicated to the evaluation of on-line coupled chemistry-meteorology models as opposed to Phase 1 where only off-line models were considered. At European level, AQMEII collaborates with the COST Action "European framework for on-line integrated air quality and meteorology modelling" (EuMetChem). All European groups participating in AQMEII performed simulations over the same spatial domain (Europe at a resolution of about 20 km) and using the same simulation strategy (e.g. no nudging allowed) and the same input data as much as possible. The initial and boundary conditions (IC/BC) were shared between all groups. Emissions were provided by the TNO-MACC database for anthropogenic emissions and the FMI database for biomass burning emissions. Chemical IC/BC data were taken from IFS-MOZART output, and meteorological IC/BC from the ECWMF global model. Evaluation data sets were collected by the Joint Research Center (JRC) and include measurements from surface in situ networks (AirBase and EMEP), vertical profiles from ozone sondes and aircraft (MOZAIC), and remote sensing (AERONET, satellites). Since Phase 2 focuses on on-line coupled models, a special effort is devoted to the detailed speciation of particulate matter components, with the goal of studying feedback processes. For the AQMEII exercise, COSMO-ART has been run with 40 levels of vertical resolution, and a chemical scheme that includes the SCAV module of Knote and Brunner (ACP 2013) for wet-phase chemistry and the SOA treatment according to VBS (volatility basis set) approach (Athanasopoulou et al., ACP 2013). The COSMO-ART evaluation shows that, next to a good performance in the meteorology, the gas phase chemistry is well captured throughout the year; the few cases showing a systematic underestimation of chemical concentrations arise as a consequence of the boundary conditions. Through this exercise we have identified the main critical issues in the COSMO-ART performance: sea salt and dust particulate matter components. The AQMEII exercise has provided an excellent platform to evaluate the COSMO-ART performance against both measurement data and other European regional on-line coupled models. From the analysis we have been able to identify specific model deficiencies and situations where the model cannot satisfactorily reproduce the data. Our future work will be focused on improving their modelling.

Probation as a setting for building well-being through integrated service provision: evaluating an Offender Health Trainer service.

PubMed

Dooris, Mark; McArt, Dervla; Hurley, Margaret A; Baybutt, Michelle

2013-07-01

The NHS Health Trainer Programme was launched in England and Wales in 2005 with the aim of tackling health inequalities. While initially focusing on geographical communities, the initiative has extended its reach to particular population groups, such as offenders and their families, who experience high levels of physical and mental health needs and wider social exclusion. This paper reports on the evaluation of the Offender Health Trainer service delivered in probation settings in Bury, Rochdale and Oldham (Greater Manchester). This service has sought to improve the health of offenders, improve their access to mainstream services, and help reduce health inequalities - as well as facilitate rehabilitation and improve job prospects for ex-offenders through employment as health trainers. This evaluative research study aimed to explore the delivery of the Offender Health Trainer service and examine its impact on service users. The study design and limited time frame meant that the research was focused on the journeys of service users rather than on long-term outcomes. The evaluation used a mixed-methods approach, comprising two key elements: the interrogation and analysis of routinely collected quantitative data extracted from the National Health Trainer Data Collection Recording System (DCRS); and in-depth qualitative research using interviews and focus groups with clients and health trainers. The evaluation points to the overall success of the service in meeting its aims and impacting positively on the lives of offenders. It reveals promising trends in behaviour change and self-perceived health and well-being, articulating a rich narrative detailing how the service has helped probation clients tackle multiple interwoven problems and build hope and self-belief. Of particular importance was the health trainers' experience of the criminal justice system, which resonated with and inspired clients, developing trust and motivation to change. While the research inevitably had limitations, this study suggests that the health trainer model can be effectively implemented within the probation setting, making a valuable contribution to the improvement of offenders' health and well-being by working in ways that acknowledge the connections between personal lifestyle and wider determinants of health. Within the context of forthcoming probation reforms, it will be increasingly important to develop services that highlight these links and to invest in appropriate evaluation that can generate further learning about 'what works and why'.

Evaluative reports on medical malpractice policies in obstetrics: a rapid scoping review.

PubMed

Cardoso, Roberta; Zarin, Wasifa; Nincic, Vera; Barber, Sarah Louise; Gulmezoglu, Ahmet Metin; Wilson, Charlotte; Wilson, Katherine; McDonald, Heather; Kenny, Meghan; Warren, Rachel; Straus, Sharon E; Tricco, Andrea C

2017-09-06

The clinical specialty of obstetrics is under particular scrutiny with increasing litigation costs and unnecessary tests and procedures done in attempts to prevent litigation. We aimed to identify reports evaluating or comparing the effectiveness of medical liability reforms and quality improvement strategies in improving litigation-related outcomes in obstetrics. We conducted a rapid scoping review with a 6-week timeline. MEDLINE, EMBASE, LexisNexis Academic, the Legal Scholarship Network, Justis, LegalTrac, QuickLaw, and HeinOnline were searched for publications in English from 2004 until June 2015. The selection criteria for screening were established a priori and pilot-tested. We included reports comparing or evaluating the impact of obstetrics-related medical liability reforms and quality improvement strategies on cost containment and litigation settlement across all countries. All levels of screening were done by two reviewers independently, and discrepancies were resolved by a third reviewer. In addition, two reviewers independently extracted relevant data using a pre-tested form, and discrepancies were resolved by a third reviewer. The results were summarized descriptively. The search resulted in 2729 citations, of which 14 reports met our eligibility criteria. Several initiatives for improving the medical malpractice litigation system were found, including no-fault approaches, patient safety policy initiatives, communication and resolution, caps on compensation and attorney fees, alternative payment system and liabilities, and limitations on litigation. Only a few litigation policies in obstetrics were evaluated or compared. Included documents showed that initiatives to reduce medical malpractice litigation could be associated with a decrease in adverse and malpractice events. However, due to heterogeneous settings (e.g., economic structure, healthcare system) and variation in the outcomes reported, the advantages and disadvantages of initiatives may vary.

Ethnoracial Differences in the Clinical Characteristics of Alzheimer Disease at Initial Presentation at an Urban Alzheimer’s Disease Center

PubMed Central

Livney, Melissa Gartenberg; Clark, Christopher M.; Karlawish, Jason H.; Cartmell, Su; Negrón, Mirna; Nuñez-Lopez, Jessica; Xie, Sharon X.; Entenza-Cabrera, Fernando; Vega, Irving E.; Arnold, Steven E.

2010-01-01

Objective To compare presentation of Alzheimer disease (AD) at the time of initial evaluation at a university specialty clinic across three ethnoracial groups in order to understand similarities and differences in the demographic, clinical, cognitive, psychiatric, and biologic features. Design Cross-sectional study. Participants A total of 1,341 self-identified African American, Latino (primarily of Caribbean origin), and white non-Hispanic (“WNH”) subjects were recruited from primary care sites or by referral by primary care physicians. Measurements Demographic variables and age of onset of AD, as well as cognitive, functional, and mood impairments at the time of initial presentation and frequencies of apolipoprotein E genotypes, were compared across groups. Results Differences among ethnoracial groups were found for nearly all variables of interest. In particular, the largely immigrant Puerto Rican Latino group had an earlier age of onset of AD, more cognitive impairment, and greater severity of cognitive impairment at the time of initial evaluation in the setting of low average education and socioeconomic status. There was more depression in the Latinos compared with African Americans and WNHs. Greater severity of symptoms was not accounted for by a difference in lag time between onset of symptoms and initial evaluation. The apolipoprotein E-4 genotype was not associated with AD in the Latino cohort. Conclusions Minority groups in Philadelphia, especially Latinos, exhibit a more severe profile of AD at the time of presentation than WNHs. Important potential confounds need to be considered and future research comparing immigrant and nonimmigrant Latino groups will be necessary to elucidate the highly significant differences reported. PMID:21522051

Relative contributions of set-asides and tree retention to the long-term availability of key forest biodiversity structures at the landscape scale.

PubMed

Roberge, Jean-Michel; Lämås, Tomas; Lundmark, Tomas; Ranius, Thomas; Felton, Adam; Nordin, Annika

2015-05-01

Over previous decades new environmental measures have been implemented in forestry. In Fennoscandia, forest management practices were modified to set aside conservation areas and to retain trees at final felling. In this study we simulated the long-term effects of set-aside establishment and tree retention practices on the future availability of large trees and dead wood, two forest structures of documented importance to biodiversity conservation. Using a forest decision support system (Heureka), we projected the amounts of these structures over 200 years in two managed north Swedish landscapes, under management scenarios with and without set-asides and tree retention. In line with common best practice, we simulated set-asides covering 5% of the productive area with priority to older stands, as well as ∼5% green-tree retention (solitary trees and forest patches) including high-stump creation at final felling. We found that only tree retention contributed to substantial increases in the future density of large (DBH ≥35 cm) deciduous trees, while both measures made significant contributions to the availability of large conifers. It took more than half a century to observe stronger increases in the densities of large deciduous trees as an effect of tree retention. The mean landscape-scale volumes of hard dead wood fluctuated widely, but the conservation measures yielded values which were, on average over the entire simulation period, about 2.5 times as high as for scenarios without these measures. While the density of large conifers increased with time in the landscape initially dominated by younger forest, best practice conservation measures did not avert a long-term decrease in large conifer density in the landscape initially comprised of more old forest. Our results highlight the needs to adopt a long temporal perspective and to consider initial landscape conditions when evaluating the large-scale effects of conservation measures on forest biodiversity. Copyright © 2015 Elsevier Ltd. All rights reserved.

Decadal climate prediction in the large ensemble limit

NASA Astrophysics Data System (ADS)

Yeager, S. G.; Rosenbloom, N. A.; Strand, G.; Lindsay, K. T.; Danabasoglu, G.; Karspeck, A. R.; Bates, S. C.; Meehl, G. A.

2017-12-01

In order to quantify the benefits of initialization for climate prediction on decadal timescales, two parallel sets of historical simulations are required: one "initialized" ensemble that incorporates observations of past climate states and one "uninitialized" ensemble whose internal climate variations evolve freely and without synchronicity. In the large ensemble limit, ensemble averaging isolates potentially predictable forced and internal variance components in the "initialized" set, but only the forced variance remains after averaging the "uninitialized" set. The ensemble size needed to achieve this variance decomposition, and to robustly distinguish initialized from uninitialized decadal predictions, remains poorly constrained. We examine a large ensemble (LE) of initialized decadal prediction (DP) experiments carried out using the Community Earth System Model (CESM). This 40-member CESM-DP-LE set of experiments represents the "initialized" complement to the CESM large ensemble of 20th century runs (CESM-LE) documented in Kay et al. (2015). Both simulation sets share the same model configuration, historical radiative forcings, and large ensemble sizes. The twin experiments afford an unprecedented opportunity to explore the sensitivity of DP skill assessment, and in particular the skill enhancement associated with initialization, to ensemble size. This talk will highlight the benefits of a large ensemble size for initialized predictions of seasonal climate over land in the Atlantic sector as well as predictions of shifts in the likelihood of climate extremes that have large societal impact.

Lessons Learned from Comprehensive Energy and Water Evaluations at U.S. Army Campus Installations

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

Woodward, James C.; Dahowski, Robert T.

The U.S. Department of Energy’s Pacific Northwest National Laboratory has engaged in a multi-year collaboration with the U.S. Army to support comprehensive energy and water evaluations at large Army campus installations. Initiated to help the Army achieve compliance with facility evaluation requirements dictated by the Energy Independence and Security Act of 2007, this effort has resulted in the evaluation of 530 buildings at 14 installations across the U.S., and the identification of annual savings potential of over 212 billion Btu of energy and 29 million gallons of water. This paper highlights the nature of the evaluation process applied at thesemore » Army installations and discusses a number of key findings that can be considered for ongoing and future evaluations at Army and other federal agency facilities, particularly those buildings within campus settings.« less

Photoinitiation chemistry affects light transmission and degree of conversion of curing experimental dental resin composites.

PubMed

Ogunyinka, A; Palin, W M; Shortall, A C; Marquis, P M

2007-07-01

The effect of photoinitiator and co-initiator chemistry on the setting reaction and degree of conversion of dental resin-based composites (RBCs) has rarely been determined explicitly. This work examines the effect of type and concentration of photoinitiator and co-initiator on the rate of change of light transmission throughout polymerisation and degree of conversion of model RBC formulations. Bisphenol-A diglycidyl ether dimethacrylate (bis-GMA) and triethylene glycol dimethacrylate (TEGDMA) (6:4 molar ratio) resins filled with silanized glass filler (74wt.%) and containing various photoinitiators (camphorquinone; CQ, 1-phenyl-1,2-propanedione; PPD, benzil; BZ), co-initiator types (N,N-dimethyl-p-amino benzoic acid ethyl ester; DABE, N,N-cyanoethyl methylaniline; CEMA, N,N-diethanol-p-toluidine; DEPT) and concentration (0.0-0.3% DABE) were polymerised using a halogen or LED light curing-unit (LCU) for 10, 20 and 40s. The setting reaction was monitored in real-time by measuring the light transmittance through the curing specimen and bulk degree of conversion (DC) evaluated using Fourier transform infra-red spectroscopy. Specimens containing CQ and PPD cured with the halogen LCU did not have a significant effect on DC or changes in light transmission, although a significant increase in DC was observed for CQ compared with PPD specimens cured with the LED LCU. DABE and CEMA were more effective co-initiators than DEPT. Although DC was not limited by co-initiator concentration, the absence of a co-initiator resulted in marked differences in light transmission and decreased DC throughout 40s irradiation with each LCU type. The spectral range emitted from different types of LCU and absorption characteristics of the photoinitiator chemistry of light-activated resin-based composites play a critical role in the efficiency of polymerisation.

The Future of the Space Age or how to Evaluate Innovative Ideas

NASA Astrophysics Data System (ADS)

Vollerthun, A.; Fricke, E.

2002-05-01

Based on an initiative of the German Aerospace Industry Association to foster a more transparent and structured funding of German commercial-oriented space projects a three-phased approach is suggested in this paper, to stepwise improve and evaluate proposed concepts for space-related innovations. The objective of this concept was to develop a transparent, structured, and reproducible process to select the right innovative project in terms of political, economical, and technical objectives for funding by e.g. a governmental agency. A stepwise process and related methods, that cover technical as well as economical aspects (and related sensitivities) are proposed. Based on the special needs and requirements of space industry the proposals are compared to a set of predefined top level objectives/requirements. Using an initial trades analysis with the criteria company, technology, product, and market, an initial business case is analyzed. The alternative innovative concepts are in the third process step subject to a very detailed analysis. The full economical and technical scale of the projects is evaluated and metrics for e.g. the 'Return on Investment' or 'Break Even Point' are determined, to compare the various innovations. Risks related to time, cost, and quality are considered, when performing sensitivity analysis by varying the most important factors of the project. Before discussing critical aspects of the proposed process, space-related examples will be presented to show how the process could be applied, and how different concepts should be evaluated.

Evaluating an HIV and AIDS Community Training Partnership Program in five diamond mining communities in South Africa.

PubMed

Rispel, L C; Peltzer, K; Nkomo, N; Molomo, B

2010-11-01

In 2006, De Beers Consolidated Diamond Mines in South Africa entered into a partnership with the Soul City Institute for Health and Development Communications to implement an HIV and AIDS Community Training Partnership Program (CTPP), initially in five diamond mining areas in three provinces of South Africa. The aim of CTPP was to improve HIV knowledge and to contribute to positive behavior changes in the targeted populations. This paper describes the evaluation of the CTPP, one year after implementation. The evaluation combined qualitative interviews with key informants and trainers and a post-intervention survey of 142 community members. The successes of the CTPP included capacity building of trainers through an innovative training approach and HIV and AIDS knowledge transfer to community trainers and targeted communities in remote mining towns. The Soul City edutainment brand is popular and emerged as a major reason for success. Challenges included insufficient attention paid to contextual factors, resource constraints and the lack of a monitoring and evaluation framework. Independent evaluations are useful to strengthen program implementation. In remote areas and resource constraint settings, partnerships between non-governmental organisations and corporations may be required for successful community HIV and AIDS initiatives. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Free breakfasts in schools: design and conduct of a cluster randomised controlled trial of the Primary School Free Breakfast Initiative in Wales [ISRCTN18336527

PubMed Central

Moore, Laurence; Moore, Graham F; Tapper, Katy; Lynch, Rebecca; Desousa, Carol; Hale, Janine; Roberts, Chris; Murphy, Simon

2007-01-01

Background School-based breakfast provision is increasingly being seen as a means of improving educational performance and dietary behaviour amongst children. Furthermore, recognition is growing that breakfast provision offers potential as a means of addressing social inequalities in these outcomes. At present however, the evidence base on the effectiveness of breakfast provision in bringing about these improvements is limited. Methods/Design This paper describes the research design of a large scale evaluation of the effectiveness of the Welsh Assembly Government's Primary School Free Breakfast Initiative. A cluster randomised trial, with school as the unit of randomisation was used for the outcome evaluation, with a nested qualitative process evaluation. Quantitative outcome measures included dietary habits, attitudes, cognitive function, classroom behaviour, and school attendance. The study recruited 111 primary schools in Wales, of which 56 were randomly assigned to control condition and 55 to intervention. Participants were Year 5 and 6 students (aged 9–11 years) in these schools. Data were collected for all 111 schools at each of three time points: baseline, 4 month and 12 month follow-up. This was achieved through a repeated cross-sectional survey of approximately 4350 students on each of these occasions. Of those students in Year 5 at baseline, 1975 provided data at one or both of the follow-ups, forming a nested cohort. The evaluation also included a nested process evaluation, using questionnaires, semi-structured interviews and case studies with students, school staff, and local authority scheme coordinators as key informants. Discussion An overview of the methods used for the evaluation is presented, providing an example of the feasibility of conducting robust evaluations of policy initiatives using a randomised trial design with nested process evaluation. Details are provided of response rates and the flow of participants. Reflection is offered on methodological issues encountered at various stages through the course of the study, focusing upon issues associated with conducting a randomised trial of a government policy initiative, and with conducting research in school settings. Trial registration Current Controlled Trials ISRCTN18336527 PMID:17888158

Free breakfasts in schools: design and conduct of a cluster randomised controlled trial of the Primary School Free Breakfast Initiative in Wales [ISRCTN18336527].

PubMed

Moore, Laurence; Moore, Graham F; Tapper, Katy; Lynch, Rebecca; Desousa, Carol; Hale, Janine; Roberts, Chris; Murphy, Simon

2007-09-21

School-based breakfast provision is increasingly being seen as a means of improving educational performance and dietary behaviour amongst children. Furthermore, recognition is growing that breakfast provision offers potential as a means of addressing social inequalities in these outcomes. At present however, the evidence base on the effectiveness of breakfast provision in bringing about these improvements is limited. This paper describes the research design of a large scale evaluation of the effectiveness of the Welsh Assembly Government's Primary School Free Breakfast Initiative. A cluster randomised trial, with school as the unit of randomisation was used for the outcome evaluation, with a nested qualitative process evaluation. Quantitative outcome measures included dietary habits, attitudes, cognitive function, classroom behaviour, and school attendance. The study recruited 111 primary schools in Wales, of which 56 were randomly assigned to control condition and 55 to intervention. Participants were Year 5 and 6 students (aged 9-11 years) in these schools. Data were collected for all 111 schools at each of three time points: baseline, 4 month and 12 month follow-up. This was achieved through a repeated cross-sectional survey of approximately 4350 students on each of these occasions. Of those students in Year 5 at baseline, 1975 provided data at one or both of the follow-ups, forming a nested cohort. The evaluation also included a nested process evaluation, using questionnaires, semi-structured interviews and case studies with students, school staff, and local authority scheme coordinators as key informants. An overview of the methods used for the evaluation is presented, providing an example of the feasibility of conducting robust evaluations of policy initiatives using a randomised trial design with nested process evaluation. Details are provided of response rates and the flow of participants. Reflection is offered on methodological issues encountered at various stages through the course of the study, focusing upon issues associated with conducting a randomised trial of a government policy initiative, and with conducting research in school settings.

Quality Improvement Initiatives in Inflammatory Bowel Disease.

PubMed

Berry, Sameer K; Siegel, Corey A; Melmed, Gil Y

2017-08-01

This article serves as an overview of several quality improvement initiatives in inflammatory bowel disease (IBD). IBD is associated with significant variation in care, suggesting poor quality of care. There have been several efforts to improve the quality of care for patients with IBD. Quality improvement (QI) initiatives in IBD are intended to be patient-centric, improve outcomes for individuals and populations, and reduce costs-all consistent with "the triple aim" put forth by the Institute for Healthcare Improvement (IHI). Current QI initiatives include the development of quality measure sets to standardize processes and outcomes, learning health systems to foster collaborative improvement, and patient-centered medical homes specific to patients with IBD in shared risk models of care. Some of these programs have demonstrated early success in improving patient outcomes, reducing costs, improving patient satisfaction, and facilitating patient engagement. However, further studies are needed to evaluate and compare the effects of these programs over time on clinical outcomes in order to demonstrate long-term value and sustainability.

Addiction treatment-related Employment barriers: the impact of methadone maintenance

PubMed Central

Richardson, Lindsey; Wood, Evan; Montaner, Julio; Kerr, Thomas

2012-01-01

Employment is commonly upheld as an important outcome of addiction treatment. To explore this attribution we assessed whether treatment enrolment predicts employment initiation among participants enrolled in a community-recruited Canadian cohort of people who inject drugs (IDU) (n=1579). Survival analysis initially found no association between addiction treatment enrolment and employment initiation. However, when methadone maintenance therapy (MMT) was separated from other treatment modalities, non-MMT treatment positively predicted employment transitions, while MMT was negatively associated with employment initiation. Sub-analyses examining transitions into temporary, informal and under-the-table income generation echo these results. Findings suggest that individual factors impacting employment transitions may systematically apply to MMT clients, and that, in this setting, the impact of treatment on employment outcomes is contingent on treatment type and design. Treatment-specific differences underscore the need to expand low-threshold MMT, explore MMT alternatives and evaluate the impact of treatment design on the social and economic activity of IDU. PMID:22301085

Fuzzy pharmacology: theory and applications.

PubMed

Sproule, Beth A; Naranjo, Claudio A; Türksen, I Burhan

2002-09-01

Fuzzy pharmacology is a term coined to represent the application of fuzzy logic and fuzzy set theory to pharmacological problems. Fuzzy logic is the science of reasoning, thinking and inference that recognizes and uses the real world phenomenon that everything is a matter of degree. It is an extension of binary logic that is able to deal with complex systems because it does not require crisp definitions and distinctions for the system components. In pharmacology, fuzzy modeling has been used for the mechanical control of drug delivery in surgical settings, and work has begun evaluating its use in other pharmacokinetic and pharmacodynamic applications. Fuzzy pharmacology is an emerging field that, based on these initial explorations, warrants further investigation.

Method and apparatus for determining and utilizing a time-expanded decision network

NASA Technical Reports Server (NTRS)

de Weck, Olivier (Inventor); Silver, Matthew (Inventor)

2012-01-01

A method, apparatus and computer program for determining and utilizing a time-expanded decision network is presented. A set of potential system configurations is defined. Next, switching costs are quantified to create a "static network" that captures the difficulty of switching among these configurations. A time-expanded decision network is provided by expanding the static network in time, including chance and decision nodes. Minimum cost paths through the network are evaluated under plausible operating scenarios. The set of initial design configurations are iteratively modified to exploit high-leverage switches and the process is repeated to convergence. Time-expanded decision networks are applicable, but not limited to, the design of systems, products, services and contracts.

Guidelines for Initiating a Research Agenda: Topic Selection and Evidence of Impact.

PubMed

Delost, Maria E; Nadder, Teresa S

2014-01-01

The focus on scholarly productivity as an outcome measure for performance evaluations of personnel and/or units and benchmarking purposes is increasing in both the academic and clinical settings. This article presents avenues for identifying achievable research projects in both the academic and clinical settings. Factors for consideration when selecting a project include its significance or impact on the profession, feasibility for implementing the project, and ethical issues related to human subjects protection. A review of the literature is essential for identifying gaps in knowledge and for constructing the hypothesis or research question. Decisions concerning IRB submission, budget allocation, and collection of data must also be considered before implementation of the research design.

Caring for homeless persons with serious mental illness in general hospitals.

PubMed

Bauer, Leah K; Baggett, Travis P; Stern, Theodore A; O'Connell, Jim J; Shtasel, Derri

2013-01-01

The care of homeless persons with serious mental illness remains a common and challenging problem in general hospital settings. This article aims to review data on homelessness and its psychiatric comorbidities, and to expand the skills of providers who encounter homeless individuals in general hospital settings. Literature review reveals patient, provider, and systems factors that contribute to suboptimal health outcomes in homeless individuals. Diagnostic rigor, integrated medical and psychiatric care, trauma-informed interventions, special considerations in capacity evaluations, and health care reform initiatives can improve the treatment of homeless persons with serious mental illness. Copyright © 2013 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Image-guided regularization level set evolution for MR image segmentation and bias field correction.

PubMed

Wang, Lingfeng; Pan, Chunhong

2014-01-01

Magnetic resonance (MR) image segmentation is a crucial step in surgical and treatment planning. In this paper, we propose a level-set-based segmentation method for MR images with intensity inhomogeneous problem. To tackle the initialization sensitivity problem, we propose a new image-guided regularization to restrict the level set function. The maximum a posteriori inference is adopted to unify segmentation and bias field correction within a single framework. Under this framework, both the contour prior and the bias field prior are fully used. As a result, the image intensity inhomogeneity can be well solved. Extensive experiments are provided to evaluate the proposed method, showing significant improvements in both segmentation and bias field correction accuracies as compared with other state-of-the-art approaches. Copyright © 2014 Elsevier Inc. All rights reserved.

Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative

PubMed Central

Thomas-Gibson, Siwan; Bugajski, Marek; Bretthauer, Michael; Rees, Colin J; Dekker, Evelien; Hoff, Geir; Jover, Rodrigo; Suchanek, Stepan; Ferlitsch, Monika; Anderson, John; Roesch, Thomas; Hultcranz, Rolf; Racz, Istvan; Kuipers, Ernst J; Garborg, Kjetil; East, James E; Rupinski, Maciej; Seip, Birgitte; Bennett, Cathy; Senore, Carlo; Minozzi, Silvia; Bisschops, Raf; Domagk, Dirk; Valori, Roland; Spada, Cristiano; Hassan, Cesare; Dinis-Ribeiro, Mario; Rutter, Matthew D

2017-01-01

The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for lower gastrointestinal endoscopy. We recommend that endoscopy services across Europe adopt the following seven key performance measures for lower gastrointestinal endoscopy for measurement and evaluation in daily practice at a center and endoscopist level: 1 rate of adequate bowel preparation (minimum standard 90%); 2 cecal intubation rate (minimum standard 90%); 3 adenoma detection rate (minimum standard 25%); 4 appropriate polypectomy technique (minimum standard 80%); 5 complication rate (minimum standard not set); 6 patient experience (minimum standard not set); 7 appropriate post-polypectomy surveillance recommendations (minimum standard not set). Other identified performance measures have been listed as less relevant based on an assessment of their importance, scientific acceptability, feasibility, usability, and comparison to competing measures. PMID:28507745

Perceived Utility of the RE-AIM Framework for Health Promotion/Disease Prevention Initiatives for Older Adults: A Case Study from the U.S. Evidence-Based Disease Prevention Initiative

PubMed Central

Ory, Marcia G.; Altpeter, Mary; Belza, Basia; Helduser, Janet; Zhang, Chen; Smith, Matthew Lee

2015-01-01

Dissemination and implementation (D&I) frameworks are increasingly being promoted in public health research. However, less is known about their uptake in the field, especially for diverse sets of programs. Limited questionnaires exist to assess the ways that frameworks can be utilized in program planning and evaluation. We present a case study from the United States that describes the implementation of the RE-AIM framework by state aging services providers and public health partners and a questionnaire that can be used to assess the utility of such frameworks in practice. An online questionnaire was developed to capture community perspectives about the utility of the RE-AIM framework. Distributed to project leads in 27 funded states in an evidence-based disease prevention initiative for older adults, 40 key stakeholders responded representing a 100% state-participation rate among the 27 funded states. Findings suggest that there is perceived utility in using the RE-AIM framework when evaluating grand-scale initiatives for older adults. The RE-AIM framework was seen as useful for planning, implementation, and evaluation with relevance for evaluators, providers, community leaders, and policy makers. Yet, the uptake was not universal, and some respondents reported difficulties in use, especially adopting the framework as a whole. This questionnaire can serve as the basis to assess ways the RE-AIM framework can be utilized by practitioners in state-wide D&I efforts. Maximal benefit can be derived from examining the assessment of RE-AIM-related knowledge and confidence as part of a continual quality assurance process. We recommend such an assessment be performed before the implementation of new funding initiatives and throughout their course to assess RE-AIM uptake and to identify areas for technical assistance. PMID:25964897

Pain management in home hospice patients: A retrospective descriptive study.

PubMed

Campbell, Cathy L; Kelly, Meghan; Rovnyak, Virginia

2017-09-01

The development and evaluation of evidence-based, safe, and effective home-based pain management models for caregivers implementation is receiving greater attention in the literature because of international initiatives intended to increase the number of people who receive end-of-life care in home-based settings. The purpose of this "retrospective descriptive design" study was to describe pharmacological pain management and outcomes for 40 cancer and non-cancer patients receiving hospice care at home. While the median pain score was higher at admission in the cancer group than in the hospice care at home group, the difference was not significant at or within 48 hour of admission. Overall, there was a significant decrease in pain from the first measurement to the second. Within the last seven days of life, the majority of participants were not able to provide a pain severity score when asked to evaluate the effectiveness of pain management, thus their caregiver provided a proxy evaluation. Pain management was effective in the home setting. More research is needed on the best methods to teach lay caregivers to assess pain and evaluate the effectiveness of pharmacological modalities to manage pain. © 2017 John Wiley & Sons Australia, Ltd.

Developing Guidelines for Assessing Visual Analytics Environments

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

Scholtz, Jean

2011-07-01

In this paper, we develop guidelines for evaluating visual analytic environments based on a synthesis of reviews for the entries to the 2009 Visual Analytics Science and Technology (VAST) Symposium Challenge and from a user study with professional intelligence analysts. By analyzing the 2009 VAST Challenge reviews we gained a better understanding of what is important to our reviewers, both visualization researchers and professional analysts. We also report on a small user study with professional analysts to determine the important factors that they use in evaluating visual analysis systems. We then looked at guidelines developed by researchers in various domainsmore » and synthesized these into an initial set for use by others in the community. In a second part of the user study, we looked at guidelines for a new aspect of visual analytic systems – the generation of reports. Future visual analytic systems have been challenged to help analysts generate their reports. In our study we worked with analysts to understand the criteria they used to evaluate the quality of analytic reports. We propose that this knowledge will be useful as researchers look at systems to automate some of the report generation.1 Based on these efforts, we produced some initial guidelines for evaluating visual analytic environment and for evaluation of analytic reports. It is important to understand that these guidelines are initial drafts and are limited in scope because of the type of tasks for which the visual analytic systems used in the studies in this paper were designed. More research and refinement is needed by the Visual Analytics Community to provide additional evaluation guidelines for different types of visual analytic environments.« less

A Round Robin evaluation of AMSR-E soil moisture retrievals

NASA Astrophysics Data System (ADS)

Mittelbach, Heidi; Hirschi, Martin; Nicolai-Shaw, Nadine; Gruber, Alexander; Dorigo, Wouter; de Jeu, Richard; Parinussa, Robert; Jones, Lucas A.; Wagner, Wolfgang; Seneviratne, Sonia I.

2014-05-01

Large-scale and long-term soil moisture observations based on remote sensing are promising data sets to investigate and understand various processes of the climate system including the water and biochemical cycles. Currently, the ESA Climate Change Initiative for soil moisture develops and evaluates a consistent global long-term soil moisture data set, which is based on merging passive and active remotely sensed soil moisture. Within this project an inter-comparison of algorithms for AMSR-E and ASCAT Level 2 products was conducted separately to assess the performance of different retrieval algorithms. Here we present the inter-comparison of AMSR-E Level 2 soil moisture products. These include the public data sets from University of Montana (UMT), Japan Aerospace and Space Exploration Agency (JAXA), VU University of Amsterdam (VUA; two algorithms) and National Aeronautics and Space Administration (NASA). All participating algorithms are applied to the same AMSR-E Level 1 data set. Ascending and descending paths of scaled surface soil moisture are considered and evaluated separately in daily and monthly resolution over the 2007-2011 time period. Absolute values of soil moisture as well as their long-term anomalies (i.e. removing the mean seasonal cycle) and short-term anomalies (i.e. removing a five weeks moving average) are evaluated. The evaluation is based on conventional measures like correlation and unbiased root-mean-square differences as well as on the application of the triple collocation method. As reference data set, surface soil moisture of 75 quality controlled soil moisture sites from the International Soil Moisture Network (ISMN) are used, which cover a wide range of vegetation density and climate conditions. For the application of the triple collocation method, surface soil moisture estimates from the Global Land Data Assimilation System are used as third independent data set. We find that the participating algorithms generally display a better performance for the descending compared to the ascending paths. A first classification of the sites defined by geographical locations show that the algorithms have a very similar average performance. Further classifications of the sites by land cover types and climate regions will be conducted which might result in a more diverse performance of the algorithms.

Bench test evaluation of adaptive servoventilation devices for sleep apnea treatment.

PubMed

Zhu, Kaixian; Kharboutly, Haissam; Ma, Jianting; Bouzit, Mourad; Escourrou, Pierre

2013-09-15

Adaptive servoventilation devices are marketed to overcome sleep disordered breathing with apneas and hypopneas of both central and obstructive mechanisms often experienced by patients with chronic heart failure. The clinical efficacy of these devices is still questioned. This study challenged the detection and treatment capabilities of the three commercially available adaptive servoventilation devices in response to sleep disordered breathing events reproduced on an innovative bench test. The bench test consisted of a computer-controlled piston and a Starling resistor. The three devices were subjected to a flow sequence composed of central and obstructive apneas and hypopneas including Cheyne-Stokes respiration derived from a patient. The responses of the devices were separately evaluated with the maximum and the clinical settings (titrated expiratory positive airway pressure), and the detected events were compared to the bench-scored values. The three devices responded similarly to central events, by increasing pressure support to raise airflow. All central apneas were eliminated, whereas hypopneas remained. The three devices responded differently to the obstructive events with the maximum settings. These obstructive events could be normalized with clinical settings. The residual events of all the devices were scored lower than bench test values with the maximum settings, but were in agreement with the clinical settings. However, their mechanisms were misclassified. The tested devices reacted as expected to the disordered breathing events, but not sufficiently to normalize the breathing flow. The device-scored results should be used with caution to judge efficacy, as their validity depends upon the initial settings.

The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians.

PubMed

Peikes, Deborah; Dale, Stacy; Ghosh, Arkadipta; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Day, Timothy J; Duda, Nancy; Singh, Pragya; Anglin, Grace; Sessums, Laura L; Brown, Randall S

2018-06-01

The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions. The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures. As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care.

Genetic variation in telomere maintenance genes, telomere length and breast cancer risk.

PubMed

Shen, Jing; Terry, Mary Beth; Liao, Yuyan; Gurvich, Irina; Wang, Qiao; Senie, Ruby T; Santella, Regina M

2012-01-01

Telomeres at the ends of eukaryotic chromosomes play a critical role in maintaining the integrity and stability of the genome and participate in the initiation of DNA damage/repair responses. We performed a case-control study to evaluate the role of three SNPs (TERT-07, TERT-54 and POT1-03) in telomere maintenance genes previously found to be significantly associated with breast cancer risk. We used sister-sets obtained from the New York site of the Breast Cancer Family Registry (BCFR). Among the 313 sister-sets, there were 333 breast cancer cases and 409 unaffected sisters who were evaluated in the current study. We separately applied conditional logistic regression and generalized estimating equations (GEE) models to evaluate associations between the three SNPs and breast cancer risk within sister-sets. We examined the associations between genotype, covariates and telomere length among unaffected sisters using a GEE model. We found no significant associations between the three SNPs in telomere maintenance genes and breast cancer risk by both conditional logistic regression and GEE models, nor were these SNPs significantly related to telomere length. Among unaffected sisters, shortened telomeres were statistically significantly correlated with never hormone replacement therapy (HRT) use. Increased duration of HRT use was significantly associated with reduced telomere length. The means of telomere length were 0.77 (SD = 0.35) for never HRT use, 0.67 (SD = 0.29) for HRT use < 5 yrs and 0.59 (SD = 0.24) for HRT use ≥ 5 yrs after adjusting for age of blood donation and race and ethnicity. We found that exogenous hormonal exposure was inversely associated with telomere length. No significant associations between genetic variants and telomere length or breast cancer risk were observed. These findings provide initial evidence to understand hormonal exposure in the regulation of telomere length and breast cancer risk but need replication in prospective studies.

Using probabilistic record linkage methods to identify Australian Indigenous women on the Queensland Pap Smear Register: the National Indigenous Cervical Screening Project

PubMed Central

Diaz, Abbey; Baade, Peter; Garvey, Gail; Cunningham, Joan; Brotherton, Julia M L; Canfell, Karen; Valery, Patricia C; O'Connell, Dianne L; Taylor, Catherine; Moore, Suzanne P; Condon, John R

2016-01-01

Objective To evaluate the feasibility and reliability of record linkage of existing population-based data sets to determine Indigenous status among women receiving Pap smears. This method may allow for the first ever population measure of Australian Indigenous women's cervical screening participation rates. Setting/participants A linked data set of women aged 20–69 in the Queensland Pap Smear Register (PSR; 1999–2011) and Queensland Cancer Registry (QCR; 1997–2010) formed the Initial Study Cohort. Two extracts (1995–2011) were taken from Queensland public hospitals data (Queensland Hospital Admitted Patient Data Collection, QHAPDC) for women, aged 20–69, who had ever been identified as Indigenous (extract 1) and had a diagnosis or procedure code relating to cervical cancer (extract 2). The Initial Study Cohort was linked to extract 1, and women with cervical cancer in the initial cohort were linked to extract 2. Outcome measures The proportion of women in the Initial Cohort who linked with the extracts (true -pairs) is reported, as well as the proportion of potential pairs that required clerical review. After assigning Indigenous status from QHAPDC to the PSR, the proportion of women identified as Indigenous was calculated using 4 algorithms, and compared. Results There were 28 872 women (2.1%) from the Initial Study Cohort who matched to an ever Indigenous record in extract 1 (n=76 831). Women with cervical cancer in the Initial Study Cohort linked to 1385 (71%) records in extract 2. The proportion of Indigenous women ranged from 2.00% to 2.08% when using different algorithms to define Indigenous status. The Final Study Cohort included 1 372 823 women (PSR n=1 374 401; QCR n=1955), and 5 062 118 records. Conclusions Indigenous status in Queensland cervical screening data was successfully ascertained through record linkage, allowing for the crucial assessment of the current cervical screening programme for Indigenous women. Our study highlights the need to include Indigenous status on Pap smear request and report forms in any renewed and redesigned cervical screening programme in Australia. PMID:26873047

The acceptability of TV-based game platforms as an instrument to support the cognitive evaluation of senior adults at home

PubMed Central

Rivas Costa, Carlos; Anido Rifón, Luis Eulogio; Gómez Carballa, Miguel; Valladares Rodríguez, Sonia

2017-01-01

Introduction The computing capabilities of state-of-the-art television sets and media centres may facilitate the introduction of computer-assisted evaluation at home. This approach would help to overcome the drawbacks of traditional pen-and-paper evaluations administered in clinical facilities, as they could be performed in a more comfortable environment, the subject’s home, and they would be more flexible for designing complex environments for the evaluation of neuropsychological constructs that are difficult to assess through traditional testing. The objective of this work was to obtain some initial evidence about the technical acceptance by senior adults of serious games played at home on the TV set and therefore about the convenience of further investigating such an approach to cognitive assesment. Materials and Methods We developed a collection of games to be deployed on a TV environment. These games were tried by a group of senior adults at their homes. The Technology Acceptance Model (TAM) was used to validate this approach. Surveys were performed to study the perceived usefulness and perceived ease of use of such technical setting as an instrument for their cognitive evaluation; that is, its technical acceptance. Subjective information collected from participants was correlated with actual interaction data captured. An additional survey was performed 36 months after pilot testing to have an indication about the long-term perceptions about usefulness and ease of use. Results More than 90% of participating subjects perceived cognitive games on TV as useful or very useful. The majority of participants selected the TV set as their preferred option to interact with serious games at home, when compared to other devices such as smartphones, tablets or PCs. This result correlates with the number of participants perceiving them as easily usable or very easy to use, and also with automatically captured interaction data. Three out of four seniors expressed their interest in keeping the system at home after the pilot. Besides, these perceptions are fairly stable in time as shown by the survey performed 36 months after pilot testing. Limitations Although participating users are a representative sample of the Galician population, which in turn is comparable to the population of most rural areas in Europe, a larger and more diverse user sample would be needed to obtain significant results for a wider population profile. Conclusion The study confirmed the technical acceptance, that is, the perceived usefulness and perceived ease of use, of the TV-based home technical setting introduced as a means of cognitive evaluation. This study provides initial evidence on the viability of a TV-based serious games approach for cognitive longitudinal screening at home with little intervention of clinical professionals, thus contributing to the early detection of cognitive impairments in the senior population. PMID:28070464

Injuries of the globe: what can the radiologist offer?

PubMed

Sung, Edward K; Nadgir, Rohini N; Fujita, Akifumi; Siegel, Cory; Ghafouri, Roya H; Traband, Anastasia; Sakai, Osamu

2014-01-01

Traumatic ocular injuries are a significant cause of blindness and visual deficits. In the setting of acute orbital trauma, urgent ophthalmologic evaluation and intervention are critical in preserving vision. However, in the acute trauma setting, clinical evaluation of the globe may be difficult in the presence of surrounding periorbital soft-tissue swelling and other associated injuries, and patient cooperation may be limited because of unresponsiveness, altered mentation, or sedation. Often, rapid access to imaging is part of the initial diagnostic evaluation, and radiologists may be the first to identify traumatic injuries of the globe. Because of this, radiologists should be familiar with normal orbital and globe anatomy at various imaging modalities and have a thorough understanding of the various patterns of ocular injury and their imaging appearances. Radiologists should also be familiar with the various mimics of ocular injury, including congenital and acquired conditions that may alter the shape of the globe, various types of ocular calcifications, and the different types of material used to treat retinal detachment. Such knowledge may help radiologists make accurate diagnoses, which facilitates prompt and appropriate patient care. RSNA, 2014

Comparison of the inertial properties and forces required to initiate movement for three gait trainers.

PubMed

Paleg, Ginny; Huang, Morris; Vasquez Gabela, Stephanie C; Sprigle, Stephen; Livingstone, Roslyn

2016-01-01

The purpose of this study was to evaluate the inertial properties and forces required to initiate movement on two different surfaces in a sample of three commonly prescribed gait trainers. Tests were conducted in a laboratory setting to compare the Prime Engineering KidWalk, Rifton Pacer, and Snug Seat Mustang with and without a weighted anthropometric test dummy configured to the weight and proportions of a 4-year-old child. The Pacer was the lightest and the KidWalk the heaviest while footprints of the three gait trainers were similar. Weight was borne fairly evenly on the four casters of the Pacer and Mustang while 85% of the weight was borne on the large wheels of the mid-wheel drive KidWalk. These differences in frame style, wheel, and caster style and overall mass impact inertial properties and forces required to initiate movement. Test results suggest that initiation forces on tile were equivalent for the Pacer and KidWalk while the Mustang had the highest initiation force. Initiation forces on carpet were lowest for the KidWalk and highest for the Mustang. This initial study of inertia and movement initiation forces may provide added information for clinicians to consider when selecting a gait trainer for their clients.

Development and implementation of a laboratory spray device and rainfall simulator for retention research using small amounts of agroformulations.

PubMed

Zwertvaegher, Ingrid Ka; Van Daele, Inge; Verheesen, Peter; Peferoen, Marnix; Nuyttens, David

2017-01-01

Rainfall greatly affects the retention of foliar-applied agroformulations. Improving their resistance to wash-off is therefore of great importance in spray applications. When developing such formulations, small-scale laboratory assays are generally required. A set-up for retention studies using only small amounts of agroformulations (<0.5 L) was developed. The set-up consists of a spray device and a rainfall simulator. The effect of rain quantity (1, 3, 6 mm) on the spray retention of agroformulations was evaluated using this set-up. The data showed that uniform and repeatable spraying was achieved with the small-scale spray device (coefficient of variation 23.4%) on potato pot plants (Solanum tuberosum L.). Rain quantity significantly affected the spray retention. Approximately 40% of the initial deposition was lost after 1 mm of rain at an intensity of 25 mm h -1 . Additional losses decreased with increasing volumes of rain (65 and 80% loss after 3 and 6 mm of rain respectively). Future studies could implement the set-up to evaluate the effect of different rainfall characteristics and formulations on spray retention in order to improve the rainfastness of agroformulations. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Developing the Translational Research Workforce: A Pilot Study of Common Metrics for Evaluating the Clinical and Translational Award KL2 Program

PubMed Central

Guerrero, Lourdes; Jones, Lisa B.; Tong, Greg; Ireland, Christine; Dumbauld, Jill; Rainwater, Julie

2015-01-01

Abstract Purpose This pilot study describes the career development programs (i.e., NIH KL2 awards) across five Clinical and Translational Science Award (CTSA) institutions within the University of California (UC) system, and examines the feasibility of a set of common metrics for evaluating early outcomes. Methods A survey of program administrators provided data related to the institutional environment within which each KL2 program was implemented. Application and progress report data yielded a combined data set that characterized KL2 awardees, their initial productivity, and early career outcomes. Results The pilot project demonstrated the feasibility of aggregating common metrics data across multiple institutions. The data indicated that KL2 awardees were an accomplished set of investigators, both before and after the award period, representing a wide variety of disciplines. Awardees that had completed their trainee period overwhelmingly remained active in translational research conducted within an academic setting. Early indications also suggest high rates of success with obtaining research funding subsequent to the KL2 award. Conclusion This project offers a model for how to collect and analyze common metrics related to the education and training function of the CTSA Consortium. Next steps call for expanding participation to other CTSA sites outside of the University of California system. PMID:26602332

Theories of cognitive distortions in sexual offending: what the current research tells us.

PubMed

O Ciardha, Caoilte; Ward, Tony

2013-01-01

Cognitive distortions in sex offenders are specific or general beliefs/attitudes that violate commonly accepted norms of rationality that have been shown to be associated with the onset and maintenance of sexual offending. In this article, we describe the major theories that have been formulated to explain the role of distorted cognition in initiating and maintaining sexual offending. We evaluate each theory in light of a set of theory appraisal criteria and the available empirical research. Finally, we conclude by drawing together the results of this theory evaluation process and highlight the major implications for treatment and future research.

The enquiry-based learning experience: An evaluation project.

PubMed

Ashby, Jayne; Hubbert, Vanessa; Cotrel-Gibbons, Liz; Cox, Karen; Digan, John; Lewis, Kerry; Langmack, Gill; Matiti, Milika; McCormick, Damion; Roberts, Lorraine; Taylor, Derek; Thom, Natasha; Wiggs, Mary; Wilson, Linda

2006-01-01

A research and nursing development initiative group consisting of health lecturers and lecturer practitioners set out to evaluate how learners and teachers felt about the introduction of an enquiry based learning (EBL) approach to education. Five focus groups, teachers (1 group) post-registration students (1 group) and pre-registration diploma students (3 groups) were interviewed. Discussions were tape recorded, transcribed, and analysed. The results revealed that students and teachers held disparative views on the efficiency of EBL. Teachers, surprisingly, felt more doubtful and discouraged than learners. Several concerns were raised over the ability of EBL to establish a foothold in a curriculum more noted for a pedagogical stance on learning.

Implementation of a state of the art automated system for the production of cloud/water vapor motion winds from geostationary satellites

NASA Technical Reports Server (NTRS)

Velden, Christopher

1994-01-01

Significant progress was attained in this reporting period towards the overall goal of improving the CIMSS satellite wind algorithms through incorporation of new processing options, and testing/evaluating these options on data sets and through case studies. Several new strategies were implemented, and these are outlined. In addition, data from GOES-8 have recently become available during system check-out and evaluation. Initial testing and software adjustments necessary to handle this new and improved data are briefly touched upon in this summary, and will be a main focus of the remaining funds and efforts under this contract.

ARMY GAS-COOLED REACTOR SYSTEMS PROGRAM. Quarterly Progress Report, October 1-December 31, 1963

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

None

1964-02-15

The ML-1 power plant did not operate during the report period; low power reactor physics and shielding experiments were conducted with the ML-1 reactor. Evaluation of moderate corrosion observed on aluminum parts exposed to the ML-1 shield solution indicated no loss of performance capability. Preliminary tests showed that the corrosion probably was caused by heavy metal ions or chlorides in the solution, Massive corrosion observed on the ML-1 fuel element lower spiders was attributed to sub-standard material; failure of some spiders was attributed to a combination of corrosion and sub-standard fabrication. Evaluation indicated that the upper spiders will perform satisfactorilymore » for the design lifetime. Modification, repair, and reassembly of the CSN-1A t-c set was completed. Operation demonstrated bearing stability, but showed that the turbine effective flow area was too large. A bypass flow path in the turbine was being corrected. The TCS-670 t-c set will be stored indefinitely. Since a commercial alternator will be used for the ML-1A, further development of the brushless alternator was postponed indefinitely. Evaluation revealed that the ML-1 improved precooler design was not compatible with ML-1A requirements. Operntion of the IB-17R-2 and -3 test elements in the GETR continued without incident. Preliminary design of the ML-1A power plant was initiated. Design of modifications to the GCRE facility to adapt it to testing the ML-1 reactor skid was initiated. (auth)« less

Development of an electronic manometer for intrapleural pressure monitoring.

PubMed

Krenke, Rafał; Guć, Maciej; Grabczak, Elżbieta Magdalena; Michnikowski, Marcin; Pałko, Krzysztof Jakub; Chazan, Ryszarda; Gólczewski, Tomasz

2011-01-01

Measurement of intrapleural pressure is useful during various pleural procedures. However, a pleural manometer is rarely available. The aim of this study was to (1) construct an electronic pleural manometer, (2) assess the accuracy of the measurements done with the new device, (3) calculate the costs of the manometer construction and (4) perform an initial evaluation of the device in a clinical setting. Only widely accessible elements were used to construct the device. A vascular pressure transducer was used to transform pressure into an electronic signal. Reliability of the measurements was evaluated in a laboratory setting in a prospective, single-blind manner by comparing the results with those measured by a water manometer. Functionality of the device was assessed during therapeutic thoracentesis. The cost of the new pleural manometer was calculated. We built a small, portable device which can precisely measure intrapleural pressure. The measurement results showed very high agreement with those registered with a water manometer (r = 0.999; p < 0.001). The initial evaluation of the electronic manometer during therapeutic thoracentesis showed it was easy to use. The total time needed for 6 measurements after withdrawal of different volumes of pleural fluid in 1 patient did not exceed 6 min. The total cost of the device was calculated to be <2,000 EUR. In the face of very limited offer of commercially available pleural manometers, it is possible to successfully construct a self-made, reliable, electronic pleural manometer at modest costs. The device is easy to use and enables data display and storage in the personal computer. Copyright © 2011 S. Karger AG, Basel.

Practice-Based Research Networks, Part II: A Descriptive Analysis of the Athletic Training Practice-Based Research Network in the Secondary School Setting

PubMed Central

McLeod, Tamara C. Valovich; Lam, Kenneth C.; Bay, R. Curtis; Sauers, Eric L.; Valier, Alison R. Snyder

2012-01-01

Context Analysis of health care service models requires the collection and evaluation of basic practice characterization data. Practice-based research networks (PBRNs) provide a framework for gathering data useful in characterizing clinical practice. Objective To describe preliminary secondary school setting practice data from the Athletic Training Practice-Based Research Network (AT-PBRN). Design Descriptive study. Setting Secondary school athletic training facilities within the AT-PBRN. Patients or Other Participants Clinicians (n = 22) and their patients (n = 2523) from the AT-PBRN. Main Outcome Measure(s) A Web-based survey was used to obtain data on clinical practice site and clinician characteristics. Patient and practice characteristics were obtained via deidentified electronic medical record data collected between September 1, 2009, and April 1, 2011. Descriptive data regarding the clinician and CPS practice characteristics are reported as percentages and frequencies. Descriptive analysis of patient encounters and practice characteristic data was performed, with the percentages and frequencies of the type of injuries recorded at initial evaluation, type of treatment received at initial evaluation, daily treatment, and daily sign-in procedures. Results The AT-PBRN had secondary school sites in 7 states, and most athletic trainers at those sites (78.2%) had less than 5 years of experience. The secondary school sites within the AT-PBRN documented 2523 patients treated across 3140 encounters. Patients most frequently sought care for a current injury (61.3%), followed by preventive services (24.0%), and new injuries (14.7%). The most common diagnoses were ankle sprain/strain (17.9%), hip sprain/strain (12.5%), concussion (12.0%), and knee pain (2.5%). The most frequent procedures were athletic trainer evaluation (53.9%), hot- or cold-pack application (26.0%), strapping (10.3%), and therapeutic exercise (5.7%). The median number of treatments per injury was 3 (interquartile range = 2, 4; range = 2–19). Conclusions These preliminary data describe services provided by clinicians within the AT-PBRN and demonstrate the usefulness of the PBRN model for obtaining such data. PMID:23068594

Mapping of medical acronyms and initialisms to Medical Subject Headings (MeSH) across selected systems

PubMed Central

Shultz, Mary

2006-01-01

Introduction: Given the common use of acronyms and initialisms in the health sciences, searchers may be entering these abbreviated terms rather than full phrases when searching online systems. The purpose of this study is to evaluate how various MEDLINE Medical Subject Headings (MeSH) interfaces map acronyms and initialisms to the MeSH vocabulary. Methods: The interfaces used in this study were: the PubMed MeSH database, the PubMed Automatic Term Mapping feature, the NLM Gateway Term Finder, and Ovid MEDLINE. Acronyms and initialisms were randomly selected from 2 print sources. The test data set included 415 randomly selected acronyms and initialisms whose related meanings were found to be MeSH terms. Each acronym and initialism was entered into each MEDLINE MeSH interface to determine if it mapped to the corresponding MeSH term. Separately, 46 commonly used acronyms and initialisms were tested. Results: While performance differed widely, the success rates were low across all interfaces for the randomly selected terms. The common acronyms and initialisms tested at higher success rates across the interfaces, but the differences between the interfaces remained. Conclusion: Online interfaces do not always map medical acronyms and initialisms to their corresponding MeSH phrases. This may lead to inaccurate results and missed information if acronyms and initialisms are used in search strategies. PMID:17082832

Severe pulmonary hypertension as the initial manifestation of systemic lupus erythematosus: a case report and review of the literature.

PubMed

Prete, M; Fatone, M C; Vacca, A; Racanelli, V; Perosa, F

2014-01-01

Severe pulmonary arterial hypertension (PAH) is rarely observed as the initial manifestation of systemic lupus erythematosus (SLE), and the diagnosis is often delayed. Here we present the case of a 32-year-old woman with severe PAH as the initial manifestation of SLE, who was successfully treated with mycophenolate mofetil and cyclosporine. This case offered the opportunity to critically review the epidemiology data, predictive markers, and pathogenic pathways of SLE-associated PAH (SLE-PAH) in relation to the currently available therapeutic options and to the main clinical trials of the last 10 years focused on the treatment of SLE-PAH. Mycophenolate mofetil and cyclosporine - currently used in the maintenance phase of the disease in certain clinical settings - should be considered, as an alternative to cyclophosphamide, in future clinical trials aimed at evaluating the most effective treatment of SLE-PAH at presentation.

The chocolate-colored expanse of Rogers Dry Lake frames the sleek lines of the Boeing / NASA X-48B subscale demonstrator during a test flight at Edwards AFB

NASA Image and Video Library

2007-08-14

Boeing Phantom Works' subscale Blended Wing Body technology demonstration aircraft began its initial flight tests from NASA's Dryden Flight Research Center at Edwards Air Force Base, Calif. in the summer of 2007. The 8.5 percent dynamically scaled unmanned aircraft, designated the X-48B by the Air Force, is designed to mimic the aerodynamic characteristics of a full-scale large cargo transport aircraft with the same blended wing body shape. The initial flight tests focused on evaluation of the X-48B's low-speed flight characteristics and handling qualities. About 25 flights were planned to gather data in these low-speed flight regimes. Based on the results of the initial flight test series, a second set of flight tests was planned to test the aircraft's low-noise and handling characteristics at transonic speeds.

A Framework for Monitoring Progress Using Summary Measures of Health.

PubMed

Madans, Jennifer H; Weeks, Julie D

2016-10-01

Initiatives designed to monitor health typically incorporate numerous specific measures of health and the health system to assess improvements, or lack thereof, for policy and program purposes. The addition of summary measures provides overarching information which is essential for determining whether the goals of such initiatives are met. Summary measures are identified that relate to the individual indicators but that also reflect movement in the various parts of the system. A hierarchical framework that is conceptually consistent and which utilizes a succinct number of summary measures incorporating indicators of functioning and participation is proposed. While a large set of individual indicators can be useful for monitoring progress, these individual indicators do not provide an overall evaluation of health, defined broadly, at the population level. A hierarchical framework consisting of summary measures is important for monitoring the success of health improvement initiatives. © The Author(s) 2016.

Semantic Image Based Geolocation Given a Map (Author’s Initial Manuscript)

DTIC Science & Technology

2016-09-01

novel technique for detection and identification of building facades from geo-tagged reference view using the map and geometry of the building facades. We...2D map of the environment, and geometry of building facades. We evaluate our approach for building identification and geo-localization on a new...location recognition and building identification is done by matching the query view to a reference set, followed by estimation of 3D building facades

Individual tree height increment model for managed even-aged stands of ponderosa pine throughout the western United States using linear mixed effects models

Treesearch

Fabian Uzoh; William W. Oliver

2006-01-01

A height increment model is developed and evaluated for individual trees of ponderosa pine throughout the species range in western United States. The data set used in this study came from long-term permanent research plots in even-aged, pure stands both planted and of natural origin. The data base consists of six levels-of-growing stock studies supplemented by initial...

Magnetic resonance imaging of cartilage repair.

PubMed

Potter, Hollis G; Chong, Le Roy; Sneag, Darryl B

2008-12-01

Magnetic resonance imaging is an important noninvasive modality in characterizing cartilage morphology, biochemistry, and function. It serves as a valuable objective outcome measure in diagnosing pathology at the time of initial injury, guiding surgical planning, and evaluating postsurgical repair. This article reviews the current literature addressing the recent advances in qualitative and quantitative magnetic resonance imaging techniques in the preoperative setting, and in patients who have undergone cartilage repair techniques such as microfracture, autologous cartilage transplantation, or osteochondral transplantation.

Aircraft Maneuvers for the Evaluation of Flying Qualities and Agility. Volume 1. Maneuver Development Process and Initial Maneuver Set

DTIC Science & Technology

1993-08-01

subtitled "Simulation Data," consists of detailed infonrnation on the design parmneter variations tested, subsequent statistical analyses conducted...used with confidence during the design process. The data quality can be examined in various forms such as statistical analyses of measure of merit data...merit, such as time to capture or nmaximurn pitch rate, can be calculated from the simulation time history data. Statistical techniques are then used

Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis

PubMed Central

Hawkins, Summer Sherburne; Stern, Ariel Dora; Baum, Christopher F; Gillman, Matthew W

2014-01-01

Objective To evaluate the impact of the Baby-Friendly Hospital Initiative (BFHI) on breast-feeding initiation and duration overall and according to maternal education. Design Quasi-experimental study using data from five states (Alaska, Maine, Nebraska, Ohio, Washington) that participated in the Pregnancy Risk Assessment Monitoring System from 1999 to 2009. Using differences-in-differences models that included year and hospital fixed effects, we compared rates of breast-feeding initiation and duration (any and exclusive breast-feeding for ≥4 weeks) before and after BFHI accreditation between mothers who gave birth in hospitals that were accredited or became accredited and mothers from matched non-BFHI facilities. We stratified analyses into lower and higher education groups. Setting Thirteen BFHI hospitals and nineteen matched non-BFHI facilities across five states in the USA. Subjects Mothers (n 11723) who gave birth in BFHI hospitals and mothers (n 13604) from nineteen matched non-BFHI facilities. Results Although we did not find overall differences in breast-feeding initiation between birth facilities that received BFHI accreditation compared with non-Baby-Friendly facilities (adjusted coefficient = 0.024; 95 % CI −0.00, 0.51), breast-feeding initiation increased by 3.8 percentage points among mothers with lower education who delivered in Baby-Friendly facilities (P = 0.05), but not among mothers with higher education (adjusted coefficient = 0.002; 95 % CI −0.04, 0.05). BFHI accreditation also increased exclusive breast-feeding for ≥4 weeks by 4.5 percentage points (P=0.02) among mothers with lower education who delivered in BFHI facilities. Conclusions By increasing breast-feeding initiation and duration among mothers with lower education, the BFHI may reduce socio-economic disparities in breast-feeding. PMID:24625787

Office-based treatment and outcomes for febrile infants with clinically diagnosed bronchiolitis.

PubMed

Luginbuhl, Lynn M; Newman, Thomas B; Pantell, Robert H; Finch, Stacia A; Wasserman, Richard C

2008-11-01

The goals were to describe the (1) frequency of sepsis evaluation and empiric antibiotic treatment, (2) clinical predictors of management, and (3) serious bacterial illness frequency for febrile infants with clinically diagnosed bronchiolitis seen in office settings. The Pediatric Research in Office Settings network conducted a prospective cohort study of 3066 febrile infants (<3 months of age with temperatures >or=38 degrees C) in 219 practices in 44 states. We compared the frequency of sepsis evaluation, parenteral antibiotic treatment, and serious bacterial illness in infants with and without clinically diagnosed bronchiolitis. We identified predictors of sepsis evaluation and parenteral antibiotic treatment in infants with bronchiolitis by using logistic regression models. Practitioners were less likely to perform a complete sepsis evaluation, urine testing, and cerebrospinal fluid culture and to administer parenteral antibiotic treatment for infants with bronchiolitis, compared with those without bronchiolitis. Significant predictors of sepsis evaluation in infants with bronchiolitis included younger age, higher maximal temperature, and respiratory syncytial virus testing. Predictors of parenteral antibiotic use included initial ill appearance, age of <30 days, higher maximal temperature, and general signs of infant distress. Among infants with bronchiolitis (N = 218), none had serious bacterial illness and those with respiratory distress signs were less likely to receive parenteral antibiotic treatment. Diagnoses among 2848 febrile infants without bronchiolitis included bacterial meningitis (n = 14), bacteremia (n = 49), and urinary tract infection (n = 167). In office settings, serious bacterial illness in young febrile infants with clinically diagnosed bronchiolitis is uncommon. Limited testing for bacterial infections seems to be an appropriate management strategy.

Assessment of terminal cleaning in pediatric isolation rooms: Options for low-resource settings.

PubMed

Dramowski, Angela; Whitelaw, Andrew; Cotton, Mark F

2016-12-01

Few studies have evaluated terminal cleaning in low-resource settings. Adequacy of pediatric isolation room terminal cleaning was evaluated using quantitative bacterial surface cultures, ATP bioluminescence assays, and fluorescent high-touch surface markers at Tygerberg Children's Hospital in South Africa (August 1, 2014-October 31, 2015). Cleaning adequacy was assessed by comparing pre- and postcleaning measurements. Influence of verbal feedback was determined by comparing cleaners' first and subsequent cleaning episodes. Cleaning methods were compared for cost, time, and feasibility. Adequacy of terminal cleaning was evaluated in 25 isolation rooms after hospitalization for pulmonary tuberculosis (n = 13), respiratory (n = 5) and enteric viruses (n = 5), pertussis (n = 1), and methicillin-resistant Staphylococcus aureus (n = 1). Mean aerobic colony counts and mean ATP relative light units declined between pre- and postcleaning evaluations (39 ± 41 to 15 ± 30 [P < .001] and 72 ± 40 to 23 ± 11 [P < .001]). Fluorescent marker removal was initially poor, but improved significantly at subsequent cleaning episodes (17 out of 78 [22%] to 121 out of 198 [61%]; P < .001); mean aerobic colony counts and ATP values also declined significantly following feedback. Cost, time, and resources required for ATP and surface cultures far exceeded that required for fluorescent markers. Adequacy of isolation room cleaning improved following feedback to cleaning staff. Fluorescent markers are an inexpensive option for cleaning evaluation and training in low-resource settings. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Validation of the Predictive Value of Modeled Human Chorionic Gonadotrophin Residual Production in Low-Risk Gestational Trophoblastic Neoplasia Patients Treated in NRG Oncology/Gynecologic Oncology Group-174 Phase III Trial.

PubMed

You, Benoit; Deng, Wei; Hénin, Emilie; Oza, Amit; Osborne, Raymond

2016-01-01

In low-risk gestational trophoblastic neoplasia, chemotherapy effect is monitored and adjusted with serum human chorionic gonadotrophin (hCG) levels. Mathematical modeling of hCG kinetics may allow prediction of methotrexate (MTX) resistance, with production parameter "hCGres." This approach was evaluated using the GOG-174 (NRG Oncology/Gynecologic Oncology Group-174) trial database, in which weekly MTX (arm 1) was compared with dactinomycin (arm 2). Database (210 patients, including 78 with resistance) was split into 2 sets. A 126-patient training set was initially used to estimate model parameters. Patient hCG kinetics from days 7 to 45 were fit to: [hCG(time)] = hCG7 * exp(-k * time) + hCGres, where hCGres is residual hCG tumor production, hCG7 is the initial hCG level, and k is the elimination rate constant. Receiver operating characteristic (ROC) analyses defined putative hCGRes predictor of resistance. An 84-patient test set was used to assess prediction validity. The hCGres was predictive of outcome in both arms, with no impact of treatment arm on unexplained variability of kinetic parameter estimates. The best hCGres cutoffs to discriminate resistant versus sensitive patients were 7.7 and 74.0 IU/L in arms 1 and 2, respectively. By combining them, 2 predictive groups were defined (ROC area under the curve, 0.82; sensitivity, 93.8%; specificity, 70.5%). The predictive value of hCGres-based groups regarding resistance was reproducible in test set (ROC area under the curve, 0.81; sensitivity, 88.9%; specificity, 73.1%). Both hCGres and treatment arm were associated with resistance by logistic regression analysis. The early predictive value of the modeled kinetic parameter hCGres regarding resistance seems promising in the GOG-174 study. This is the second positive evaluation of this approach. Prospective validation is warranted.

Teaching autonomy: turning the teaching evaluation of the Applied Optics course from impart knowledge to the new intelligent thinking

NASA Astrophysics Data System (ADS)

Zhao, Huifu; Chen, Yu; Liu, Dongmei

2017-08-01

There is a saying that "The teacher, proselytizes instructs dispels doubt." Traditional teaching methods, constantly let the students learn the knowledge in order to pursue the knowledge of a solid grasp, then assess the teaching result by evaluating of the degree of knowledge and memory. This approach cannot mobilize the enthusiasm of students to learn, and hinders the development of innovative thinking of students. And this assessment results have no practical significance, decoupling from practical application. As we all know, the course of Applied Optics is based on abstract theory. If the same teaching methods using for this course by such a "duck", it is unable to mobilize students' learning initiative, and then students' study results will be affected by passive acceptance of knowledge. How to take the initiative to acquire knowledge in the class to the students, and fully mobilize the initiative of students and to explore the potential of students, finally evaluation contents more research on the practical significance? Scholars continue to innovate teaching methods, as well as teaching evaluation indicators, the best teaching effect to promote the development of students. Therefore, this paper puts forward a set of teaching evaluation model of teaching autonomy. This so-called "autonomous teaching" is that teachers put forward the request or arrange the task and students complete the learning content in the form of a group to discuss learning before the lesson, and to complete the task of the layout, then teachers accept of students' learning achievements and answer questions. Every task is designed to evaluate the effectiveness of teaching. Every lesson should be combined with the progress of science and technology frontier of Applied Optics, let students understand the relationship between research and application in the future, mobilize the students interest in learning, training ability, learn to take the initiative to explore, team cooperation ability. As well, it has practical significance to every evaluation, making the teaching to active learning in teaching, cultivating students' creative potential, deep, solid foundation for the day after learning work.

Optimal Initial Perturbations for Ensemble Prediction of the Madden-Julian Oscillation during Boreal Winter

NASA Technical Reports Server (NTRS)

Ham, Yoo-Geun; Schubert, Siegfried; Chang, Yehui

2012-01-01

An initialization strategy, tailored to the prediction of the Madden-Julian oscillation (MJO), is evaluated using the Goddard Earth Observing System Model, version 5 (GEOS-5), coupled general circulation model (CGCM). The approach is based on the empirical singular vectors (ESVs) of a reduced-space statistically determined linear approximation of the full nonlinear CGCM. The initial ESV, extracted using 10 years (1990-99) of boreal winter hindcast data, has zonal wind anomalies over the western Indian Ocean, while the final ESV (at a forecast lead time of 10 days) reflects a propagation of the zonal wind anomalies to the east over the Maritime Continent an evolution that is characteristic of the MJO. A new set of ensemble hindcasts are produced for the boreal winter season from 1990 to 1999 in which the leading ESV provides the initial perturbations. The results are compared with those from a set of control hindcasts generated using random perturbations. It is shown that the ESV-based predictions have a systematically higher bivariate correlation skill in predicting the MJO compared to those using the random perturbations. Furthermore, the improvement in the skill depends on the phase of the MJO. The ESV is particularly effective in increasing the forecast skill during those phases of the MJO in which the control has low skill (with correlations increasing by as much as 0.2 at 20 25-day lead times), as well as during those times in which the MJO is weak.

Study program to develop and evaluate die and container materials for the growth of silicon ribbons

NASA Technical Reports Server (NTRS)

1978-01-01

Initial sessile drop experiments on SiC, Si3N4 and A1N were conducted. Very promising results were achieved on both SiC and Si3N4 where minimal penetration of these CNTD coatings by molten silicon was observed. More detailed characterization of the CNTD microstructures was accomplished as well as X-ray characterization of the third and fourth candidate materials system sets (i.e. A1N and altered Si3N4). Polished sections of post sessile drop specimens were also prepared and evaluated. The techniques of full scale crucible hot pressing were developed and die grinding development was initiated. The apparatus for measurement of oxygen partial pressure was reconstructed and calibrated. The sessile drop temperature measurement procedure was calibrated for absorption by the pyrex view-port and additional Auger electron analysis was performed at the interface of molten silicon with CNTD Si3N4 and A1N.

My Quest, an Intervention Using Text Messaging to Improve Dietary and Physical Activity Behaviors and Promote Weight Loss in Low-Income Women.

PubMed

Griffin, Jamie B; Struempler, Barb; Funderburk, Katie; Parmer, Sondra M; Tran, Cecilia; Wadsworth, Danielle D

2018-01-01

To evaluate changes in dietary and physical activity behaviors and weight after implementation of a 12-week text messaging initiative (My Quest). The researchers conducted a 1-group, pre- to posttest study design to determine changes after implementation of a text messaging initiative developed using the tenets of the Social Cognitive Theory. A total of 55 Alabama counties (84% rural) with high rates of poverty, overweight/obesity, and chronic diseases. Convenience sample of low-income, primarily overweight/obese women (n = 104). Short texts (n = 2-3/d) provided health tips, reminders, and goal-setting prompts. Weekly electronic newsletters provided tips and recipes. Participant self-monitored body weight weekly. Outcomes included goal setting, self-efficacy, behavioral and environmental factors, self-monitoring, and body weight; data collection occurred through text message response and online surveys. Analyses were conducted using McNemar test (dichotomous data), Wilcoxon signed rank test (ordinal data), or paired t test (continuous data). Participants significantly (P < .05) improved dietary and physical activity behaviors and food environment; increased dietary and physical activity goal setting; and reduced body weight. A low-cost, text messaging initiative particularly targeting women residing in rural communities with high rates of poverty and obesity can promote weight loss and improve dietary and physical activity behaviors. Future studies may include a control group and social support component such as group text messaging. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Predictors of the discharge dosage of an atypical antipsychotic agent among hospitalized, treatment-naive, first-episode psychosis patients in naturalistic, public-sector settings.

PubMed

Compton, Michael T; Kelley, Mary E; Lloyd, Robert Brett; McClam, Tamela; Ramsay, Claire E; Haggard, Patrick J; Augustin, Sara

2011-02-01

Little is known about determinants of second-generation antipsychotic dosages during initial hospitalization of first-episode psychosis. This study examined potential predictors of dosage of an atypical antipsychotic agent, risperidone, at hospital discharge after initial evaluation and treatment of first-episode nonaffective psychosis in 3 naturalistic, public-sector treatment settings. The number of psychotropic agents prescribed and discharge antipsychotic dosage were abstracted from the medical record. Demographic and extensive clinical characteristics were assessed through a clinical research study conducted at the 3 sites. One-way analyses of variance, trend tests using specific linear combinations of estimates, and χ² tests assessed for associations between atypical antipsychotic dosage and 5 hypothesized predictors, as well as 12 exploratory variables. Among 155 hospitalized first-episode patients, 121 (78.1%) were discharged on risperidone, and subsequent analyses focused on that subset. The mean risperidone dosage among those 121 patients was 4.26 mg; 31 received 1 to 2 mg, 45 received 3 to 4 mg, 37 received 5 to 6 mg, and 8 received more than 6 mg. Analyses suggested that older age at hospitalization, the number of psychotropic agents prescribed, excited symptoms, and premorbid social functioning may be predictors of the discharge dosage. Although several factors emerged, in general, predictors of discharge dosages of second-generation agents, here exemplified by risperidone, in real-world practice settings remain to be clarified. Given the importance of antipsychotic initiation during first hospitalization, future research should test an even broader array of potential predictors.

Strategies to sustain a quality improvement initiative in neonatal resuscitation

PubMed Central

van Heerden, Carlien; Janse van Rensburg, Elsie S.

2016-01-01

Background Many neonatal deaths can be prevented globally through effective resuscitation. South Africa (SA) committed towards attaining the Millennium Development Goal 4 (MDG4) set by the World Health Organization (WHO). However, SA’s district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes associated with patient-related, administrative and health care provider factors contribute to neonatal mortality. A quality improvement initiative in neonatal resuscitation could contribute towards decreasing neonatal mortality, thereby contributing towards the attainment of the MDG4. Aim The aim of this study was, (1) to explore and describe the existing situation regarding neonatal resuscitation in a district hospital, (2) to develop strategies to sustain a neonatal resuscitation quality improvement initiative and (3) to decrease neonatal mortality. Changes that occurred and the sustainability of strategies were evaluated. Setting A maternity section of a district hospital in South Africa. Methods The National Health Service (NHS) Sustainability Model formed the theoretical framework for the study. The Problem Resolving Action Research model was applied and the study was conducted in three cycles. Purposive sampling was used for the quantitative and qualitative aspects of data collection. Data was analysed accordingly. Results The findings indicated that the strategies formulated and implemented to address factors related to neonatal resuscitation (training, equipment and stock, staff shortages, staff attitude, neonatal transport and protocols) had probable sustainability and contributed towards a reduction in neonatal mortality in the setting. Conclusion These strategies had the probability of sustainability and could potentially improve neonatal outcomes and reduce neonatal mortality to contribute toward South Africa’s’ drive to attain the MDG4. PMID:27380840

Improving teaching on the basis of student evaluation: integrative teaching consultation.

PubMed

Wibbecke, Gerald; Kahmann, Janine; Pignotti, Tanja; Altenberger, Leander; Kadmon, Martina

2015-01-01

Due to the development of medical education in the past decade the role of teachers has changed and requires higher didactic competence. Student evaluation of teaching alone does not lead to considerable improvement of teaching quality. We present the concept of "Integrative Teaching Consultation", which comprises both the teacher's reflection and own objectives to improve their teaching as well as data from students ratings. Teachers in collaboration with a teaching consultant reflect on their teaching ability and set themselves improvement goals. Then the consultant himself observes a teaching session and subsequently analyses the respective student evaluation in order to give meaningful feedback to the teacher. The combination of student feedback with professional consultation elements can initiate and maintain improvements in teaching. Teaching consultation complements existing faculty development programs and increases the benefit of student evaluations.

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

Sassani, David; Price, Laura L.; Rechard, Robert P.

This report provides an update to Sassani et al. (2016) and includes: (1) an updated set of inputs (Sections 2.3) on various additional waste forms (WF) covering both DOE-managed spent nuclear fuel (SNF) and DOE-managed (as) high-level waste (HLW) for use in the inventory represented in the geologic disposal safety analyses (GDSA); (2) summaries of evaluations initiated to refine specific characteristics of particular WF for future use (Section 2.4); (3) updated development status of the Online Waste Library (OWL) database (Section 3.1.2) and an updated user guide to OWL (Section 3.1.3); and (4) status updates (Section 3.2) for the OWLmore » inventory content, data entry checking process, and external OWL BETA testing initiated in fiscal year 2017.« less

The Southampton Initiative for Health: a complex intervention to improve the diets and increase the physical activity levels of women and children from disadvantaged communities

PubMed Central

Barker, Mary; Lawrence, Wendy; Baird, Janis; Jarman, Megan; Black, Christina; Barnard, Katharine; Cradock, Sue; Davies, Jenny; Margetts, Barrie; Inskip, Hazel; Cooper, Cyrus

2013-01-01

The ‘Southampton Initiative for Health’ (SIH) is a training intervention with Sure Start Children’s Centre staff designed to improve the diets and physical activity levels of women of child-bearing age. Training aims to help staff to support women in making changes to their lifestyles by improving three skills: reflection on current practice; asking ‘open discovery’ questions; and goal setting. The impact of the training on staff practice is being assessed. A before and after non-randomised controlled trial is being used to evaluate the effectiveness and cost-effectiveness of the intervention in improving women’s diets and increasing their physical activity levels. PMID:20709878

How the baby learns to see: Donald O. Hebb Award Lecture, Canadian Society for Brain, Behaviour, and Cognitive Science, Ottawa, June 2015.

PubMed

Maurer, Daphne

2016-09-01

Hebb's (1949) book The Organisation of Behaviour presented a novel hypothesis about how the baby learns to see. This article summarizes the results of my research program that evaluated Hebb's hypothesis: first, by studying infants' eye movements and initial perceptual abilities and second, by studying the effect of visual deprivation (e.g., congenital cataracts) on later perceptual development. Collectively, the results support Hebb's hypothesis that the baby does indeed learn to see. Early visual experience not only drives the baby's initial scanning of objects, but also sets up the neural architecture that will come to underlie adults' perception. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Design of an efficient music-speech discriminator.

PubMed

Tardón, Lorenzo J; Sammartino, Simone; Barbancho, Isabel

2010-01-01

In this paper, the problem of the design of a simple and efficient music-speech discriminator for large audio data sets in which advanced music playing techniques are taught and voice and music are intrinsically interleaved is addressed. In the process, a number of features used in speech-music discrimination are defined and evaluated over the available data set. Specifically, the data set contains pieces of classical music played with different and unspecified instruments (or even lyrics) and the voice of a teacher (a top music performer) or even the overlapped voice of the translator and other persons. After an initial test of the performance of the features implemented, a selection process is started, which takes into account the type of classifier selected beforehand, to achieve good discrimination performance and computational efficiency, as shown in the experiments. The discrimination application has been defined and tested on a large data set supplied by Fundacion Albeniz, containing a large variety of classical music pieces played with different instrument, which include comments and speeches of famous performers.

Neuro-parity pattern recognition system and method

DOEpatents

Gross, Kenneth C.; Singer, Ralph M.; Van Alstine, Rollin G.; Wegerich, Stephan W.; Yue, Yong

2000-01-01

A method and system for monitoring a process and determining its condition. Initial data is sensed, a first set of virtual data is produced by applying a system state analyzation to the initial data, a second set of virtual data is produced by applying a neural network analyzation to the initial data and a parity space analyzation is applied to the first and second set of virtual data and also to the initial data to provide a parity space decision about the condition of the process. A logic test can further be applied to produce a further system decision about the state of the process.

Stability of Initial Autism Spectrum Disorder Diagnoses in Community Settings

ERIC Educational Resources Information Center

Daniels, Amy M.; Rosenberg, Rebecca E.; Law, J. Kiely; Lord, Catherine; Kaufmann, Walter E.; Law, Paul A.

2011-01-01

The study's objectives were to assess diagnostic stability of initial autism spectrum disorder (ASD) diagnoses in community settings and identify factors associated with diagnostic instability using data from a national Web-based autism registry. A Cox proportional hazards model was used to assess the relative risk of change in initial ASD…

Wayfinding the Live 5-2-1-0 Initiative-At the Intersection between Systems Thinking and Community-Based Childhood Obesity Prevention.

PubMed

Amed, Shazhan; Shea, Stephanie; Pinkney, Susan; Wharf Higgins, Joan; Naylor, Patti-Jean

2016-06-21

Childhood obesity is complex and requires a 'systems approach' that collectively engages across multiple community settings. Sustainable Childhood Obesity Prevention through Community Engagement (SCOPE) has implemented Live 5-2-1-0-a multi-sector, multi-component childhood obesity prevention initiative informed by systems thinking and participatory research via an innovative knowledge translation (KT) model (RE-FRAME). This paper describes the protocol for implementing and evaluating RE-FRAME in two 'existing' (>2 years of implementation) and two 'new' Live 5-2-1-0 communities to understand how to facilitate and sustain systems/community-level change. In this mixed-methods study, RE-FRAME was implemented via online resources, webinars, a backbone organization (SCOPE) coordinating the initiative, and a linking system supporting KT. Qualitative and quantitative data were collected using surveys and stakeholder interviews, analyzed using thematic analysis and descriptive statistics, respectively. Existing communities described the consistency of Live 5-2-1-0 and extensive local partnerships/champions as catalysts for synergistic community-wide action; new communities felt that the simplicity of the message combined with the transfer of experiential learning would inform their own strategies and policies/programs to broadly disseminate Live 5-2-1-0. RE-FRAME effectively guided the refinement of the initiative and provided a framework upon which evaluation results described how to implement a community-based systems approach to childhood obesity prevention.

Gridded global surface ozone metrics for atmospheric chemistry model evaluation

NASA Astrophysics Data System (ADS)

Sofen, E. D.; Bowdalo, D.; Evans, M. J.; Apadula, F.; Bonasoni, P.; Cupeiro, M.; Ellul, R.; Galbally, I. E.; Girgzdiene, R.; Luppo, S.; Mimouni, M.; Nahas, A. C.; Saliba, M.; Tørseth, K.

2016-02-01

The concentration of ozone at the Earth's surface is measured at many locations across the globe for the purposes of air quality monitoring and atmospheric chemistry research. We have brought together all publicly available surface ozone observations from online databases from the modern era to build a consistent data set for the evaluation of chemical transport and chemistry-climate (Earth System) models for projects such as the Chemistry-Climate Model Initiative and Aer-Chem-MIP. From a total data set of approximately 6600 sites and 500 million hourly observations from 1971-2015, approximately 2200 sites and 200 million hourly observations pass screening as high-quality sites in regionally representative locations that are appropriate for use in global model evaluation. There is generally good data volume since the start of air quality monitoring networks in 1990 through 2013. Ozone observations are biased heavily toward North America and Europe with sparse coverage over the rest of the globe. This data set is made available for the purposes of model evaluation as a set of gridded metrics intended to describe the distribution of ozone concentrations on monthly and annual timescales. Metrics include the moments of the distribution, percentiles, maximum daily 8-hour average (MDA8), sum of means over 35 ppb (daily maximum 8-h; SOMO35), accumulated ozone exposure above a threshold of 40 ppbv (AOT40), and metrics related to air quality regulatory thresholds. Gridded data sets are stored as netCDF-4 files and are available to download from the British Atmospheric Data Centre (doi: 10.5285/08fbe63d-fa6d-4a7a-b952-5932e3ab0452). We provide recommendations to the ozone measurement community regarding improving metadata reporting to simplify ongoing and future efforts in working with ozone data from disparate networks in a consistent manner.

Evaluation of Xpert MTB/RIF Versus AFB Smear and Culture to Identify Pulmonary Tuberculosis in Patients With Suspected Tuberculosis From Low and Higher Prevalence Settings

PubMed Central

Luetkemeyer, Anne F.; Firnhaber, Cynthia; Kendall, Michelle A.; Wu, Xingye; Mazurek, Gerald H.; Benator, Debra A.; Arduino, Roberto; Fernandez, Michel; Guy, Elizabeth; Johnson, Pamela; Metchock, Beverly; Sattler, Fred; Telzak, Edward; Wang, Yun F.; Weiner, Marc; Swindells, Susan; Sanne, Ian M.; Havlir, Diane V.; Grinsztejn, Beatriz; Alland, David

2016-01-01

Background. The Xpert MTB/RIF (Xpert) assay is a rapid nucleic acid amplification test widely used in settings of high tuberculosis prevalence to detect tuberculosis as well as rpoB mutations associated with rifampin resistance. Data are needed on the diagnostic performance of Xpert in lower-prevalence settings to inform appropriate use for both tuberculosis detection and the need for respiratory isolation. Methods. Xpert was compared to 2 sputum samples, each evaluated with acid-fast bacilli (AFB) smear and mycobacterial culture using liquid and solid culture media, from participants with suspected pulmonary tuberculosis from the United States, Brazil, and South Africa. Results. Of 992 participants enrolled with evaluable results, 22% had culture-confirmed tuberculosis. In 638 (64%) US participants, 1 Xpert result demonstrated sensitivity of 85.2% (96.7% in participants with AFB smear-positive [AFB+] sputum, 59.3% with AFB smear-negative [AFB–] sputum), specificity of 99.2%, negative predictive value (NPV) of 97.6%, and positive predictive value of 94.9%. Results did not differ between higher- and low-prevalence settings. A second Xpert assay increased overall sensitivity to 91.1% (100% if AFB+, 71.4% if AFB–), with specificity of 98.9%. In US participants, a single negative Xpert result predicted the absence of AFB+/culture-positive tuberculosis with an NPV of 99.7%; NPV of 2 Xpert assays was 100%, suggesting a role in removing patients from airborne infection isolation. Xpert detected tuberculosis DNA and mutations associated with rifampin resistance in 5 of 7 participants with rifampin-resistant, culture-positive tuberculosis. Specificity for rifampin resistance was 99.5% and NPV was 98.9%. Conclusions. In the United States, Xpert testing performed comparably to 2 higher-tuberculosis-prevalence settings. These data support the use of Xpert in the initial evaluation of tuberculosis suspects and in algorithms assessing need for respiratory isolation. PMID:26839383

Teleconsultation in school settings: linking classroom teachers and behavior analysts through web-based technology.

PubMed

Frieder, Jessica E; Peterson, Stephanie M; Woodward, Judy; Crane, Jaelee; Garner, Marlane

2009-01-01

This paper describes a technically driven, collaborative approach to assessing the function of problem behavior using web-based technology. A case example is provided to illustrate the process used in this pilot project. A school team conducted a functional analysis with a child who demonstrated challenging behaviors in a preschool setting. Behavior analysts at a university setting provided the school team with initial workshop trainings, on-site visits, e-mail and phone communication, as well as live web-based feedback on functional analysis sessions. The school personnel implemented the functional analysis with high fidelity and scored the data reliably. Outcomes of the project suggest that there is great potential for collaboration via the use of web-based technologies for ongoing assessment and development of effective interventions. However, an empirical evaluation of this model should be conducted before wide-scale adoption is recommended.

Evaluation of NO2 predictions by the plume volume molar ratio method (PVMRM) and ozone limiting method (OLM) in AERMOD using new field observations.

PubMed

Hendrick, Elizabeth M; Tino, Vincent R; Hanna, Steven R; Egan, Bruce A

2013-07-01

The U.S. Environmental Protection Agency (EPA) plume volume molar ratio method (PVMRM) and the ozone limiting method (OLM) are in the AERMOD model to predict the 1-hr average NO2/NO(x) concentration ratio. These ratios are multiplied by the AERMOD predicted NO(x) concentration to predict the 1-hr average NO2 concentration. This paper first briefly reviews PVMRM and OLM and points out some scientific parameterizations that could be improved (such as specification of relative dispersion coefficients) and then discusses an evaluation of the PVMRM and OLM methods as implemented in AERMOD using a new data set. While AERMOD has undergone many model evaluation studies in its default mode, PVMRM and OLM are nondefault options, and to date only three NO2 field data sets have been used in their evaluations. Here AERMOD/PVMRM and AERMOD/OLM codes are evaluated with a new data set from a northern Alaskan village with a small power plant. Hourly pollutant concentrations (NO, NO2, ozone) as well as meteorological variables were measured at a single monitor 500 m from the plant. Power plant operating parameters and emissions were calculated based on hourly operator logs. Hourly observations covering 1 yr were considered, but the evaluations only used hours when the wind was in a 60 degrees sector including the monitor and when concentrations were above a threshold. PVMRM is found to have little bias in predictions of the C(NO2)/C(NO(x)) ratio, which mostly ranged from 0.2 to 0.4 at this site. OLM overpredicted the ratio. AERMOD overpredicts the maximum NO(x) concentration but has an underprediction bias for lower concentrations. AERMOD/PVMRM overpredicts the maximum C(NO2) by about 50%, while AERMOD/OLM overpredicts by a factor of 2. For 381 hours evaluated, there is a relative mean bias in C(NO2) predictions of near zero for AERMOD/PVMRM, while the relative mean bias reflects a factor of 2 overprediction for AERMOD/OLM. This study was initiated because the new stringent 1-hr NO2 NAAQS has prompted modelers to more widely use the PVMRM and OLM methods for conversion of NO(x) to NO2 in the AERMOD regulatory model. To date these methods have been evaluated with a limited number of data sets. This study identified a new data set of ambient pollutant and meteorological monitoring near an isolated power plant in Wainwright, Alaska. To supplement the existing evaluations, this new data were used to evaluate PVMRM and OLM. This new data set has been and will be made available to other scientists for future investigations.

Estimating the gravitational-wave content of initial-data sets for numerical relativity using the Beetle--Burko scalar

NASA Astrophysics Data System (ADS)

Burko, Lior M.

2006-04-01

The Beetle--Burko radiation scalar is a gauge independent, tetrad independent, and background independent quantity that depends only on the radiative degrees of freedom where the notion of radiation is incontrovertible, and can be computed from spatial data as is typical in numerical relativity simulations even for strongly dynamical spacetimes. We show that the Beetle--Burko radiation scalar can be used for estimating the graviational-wave content of initial-data sets in numerical relativity, and can thus be useful for the construction of physically meaningful ones, and the identification of ``junk'' data on the intial value surface. We apply this method for the case of a momentarily stationary black hole binary, and demonstrate how the Beetle-- Burko scalar distinguishes between Misner and Brill--Lindquist initial data. The method, however, is robust, and is applicable to generic initial data sets. In addition to initial data sets, the Beetle--Burko radiation scalar is equally applicable also for evolution data.

Recruitment, selection and retention of nursing and midwifery students in Scottish Universities.

PubMed

Rodgers, Sheila; Stenhouse, Rosie; McCreaddie, May; Small, Pauline

2013-11-01

High attrition rates from pre-registration nursing and midwifery programmes have been reported in both the UK and in other countries. A study was conducted to identify best practice in recruitment, selection and retention across Scottish Universities providing pre-registration programmes. A survey of all universities providing pre-registration programmes in Scotland was conducted. Semi-structured interviews were conducted with key personnel in each university. Documentary evidence was collected to supplement interview data and evidence recruitment, selection and retention practices. All universities in Scotland providing pre-registration nursing and/or midwifery programmes. All 10 identified universities agreed to take part and a total of 18 interviews were conducted. Semi-structured face to face and telephone interviews were conducted. Relevant documentary evidence was collected. All data were subject to thematic analysis. Universities are predominantly concerned with recruiting to the institution and not to the professions. Interviews are widely used, and are a requirement in the United Kingdom. However, there is no evidence base within the literature that they have predictive validity despite creating scales and scoring systems which are largely unvalidated. The study identified initiatives aimed at addressing attrition/retention, however most had not been evaluated often due to the multi-factorial nature of attrition/retention and difficulties with measurement. Recruitment selection and retention initiatives were rarely evaluated, and if so, adopted a relatively superficial approach. Evidence from existing studies to support practices was mostly weakly supportive or absent. The study highlights the need for a coordinated approach, supporting the development of a robust evidence base through the evaluation of local initiatives, and evaluation of new strategies. Evaluation strategies must take account of the local context to facilitate transferability of findings across different settings. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Use of Ebola Convalescent Plasma to Treat Ebola Virus Disease in Resource-Constrained Settings: A Perspective From the Field

PubMed Central

van Griensven, Johan; De Weiggheleire, Anja; Delamou, Alexandre; Smith, Peter G.; Edwards, Tansy; Vandekerckhove, Philippe; Bah, Elhadj Ibrahima; Colebunders, Robert; Herve, Isola; Lazaygues, Catherine; Haba, Nyankoye; Lynen, Lutgarde

2016-01-01

The clinical evaluation of convalescent plasma (CP) for the treatment of Ebola virus disease (EVD) in the current outbreak, predominantly affecting Guinea, Sierra Leone, and Liberia, was prioritized by the World Health Organization in September 2014. In each of these countries, nonrandomized comparative clinical trials were initiated. The Ebola-Tx trial in Conakry, Guinea, enrolled 102 patients by 7 July 2015; no severe adverse reactions were noted. The Ebola-CP trial in Sierra Leone and the EVD001 trial in Liberia have included few patients. Although no efficacy data are available yet, current field experience supports the safety, acceptability, and feasibility of CP as EVD treatment. Longer-term follow-up as well as data from nontrial settings and evidence on the scalability of the intervention are required. CP sourced from within the outbreak is the most readily available source of anti-EVD antibodies. Until the advent of effective antivirals or monoclonal antibodies, CP merits further evaluation. PMID:26261205

Evaluation of SLAR and thematic mapper MSS data for forest cover mapping using computer-aided analysis techniques

NASA Technical Reports Server (NTRS)

Hoffer, R. M. (Principal Investigator)

1979-01-01

The spatial characteristics of the data were evaluated. A program was developed to reduce the spatial distortions resulting from variable viewing distance, and geometrically adjusted data sets were generated. The potential need for some level of radiometric adjustment was evidenced by an along track band of high reflectance across different cover types in the Varian imagery. A multiple regression analysis was employed to explore the viewing angle effect on measured reflectance. Areas in the data set which appeared to have no across track stratification of cover type were identified. A program was developed which computed the average reflectance by column for each channel, over all of the scan lines in the designated areas. A regression analysis was then run using the first, second, and third degree polynomials, for each channel. An atmospheric effect as a component of the viewing angle source of variance is discussed. Cover type maps were completed and training and test field selection was initiated.

Academic-Service Partnerships in Nursing: An Integrative Review

PubMed Central

Beal, Judy A.

2012-01-01

This integrative review summarizes currently available evidence on academic-service partnerships in the profession of nursing. More than 300 articles, published primarily in refereed journals, were accessed. Articles (110) were included in this review as they presented detailed and substantive information about any aspect of a nursing academic-service partnership. The majority were anecdotal in nature. Topics clustered around the following categories: pre-requisites for successful partnerships, benefits of partnerships, types of partnerships, and workforce development with its themes of academic-practice progression and educational re-design. Many examples of partnerships between academic and service settings were thoroughly described and best practices suggested, most often, however, without formal evaluation of outcomes. Nursing leaders in both settings have a long tradition of partnering with very little replicable evidence to support their efforts. It is critical that future initiatives evaluate the effectiveness of these partnerships, not only to ensure quality of patient outcomes but also to maximize efforts at building capacity for tomorrow's workforce. PMID:22548160

Subgrouping For Patients With Low Back Pain: A Multidimensional Approach Incorporating Cluster Analysis & The STarT Back Screening Tool

PubMed Central

Beneciuk, Jason M.; Robinson, Michael E.; George, Steven Z.

2014-01-01

Early screening for psychological distress has been suggested to improve patient management for individuals experiencing low back pain. This study compared two approaches to psychological screening (i.e., multidimensional and unidimensional) so that preliminary recommendations on which approach may be appropriate for use in clinical settings other than primary care could be provided. Specifically, this study investigated STarT Back Screening Tool (SBT): 1) discriminant validity by evaluating its relationship with unidimensional psychological measures and 2) construct validity by evaluating how SBT risk categories compared to empirically derived subgroups using unidimensional psychological and disability measures. Patients (n = 146) receiving physical therapy for LBP were administered the SBT and a battery of unidimensional psychological measures at initial evaluation. Clinical measures consisted of pain intensity and self-reported disability. Several SBT risk dependent relationships (i.e., SBT low < medium < high risk) were identified for unidimensional psychological measure scores with depressive symptom scores associated with the strongest influence on SBT risk categorization. Empirically derived subgroups indicated that there was no evidence of distinctive patterns amongst psychological or disability measures other than high or low profiles, therefore two groups may provide a more clear representation of the level of pain associated psychological distress, maladaptive coping and disability in this setting, as compared to three groups which have been suggested when using the SBT in primary care settings. PMID:25451622

Direct questioning is more effective than patient-initiated report for the detection of sexually transmitted infections in a primary care HIV clinic in Western Kenya.

PubMed

Woo, Victoria Gah Hay; Cohen, Craig R; Bukusi, Elizabeth A; Huchko, Megan J

2013-02-01

In resource-limited settings, detection of sexually transmitted infections (STIs) often relies on self-reported symptoms to initiate management. We found self-report demonstrated poor sensitivity for STI detection. Adding clinician-initiated questions about symptoms improved detection rates. Vaginal examination further increased sensitivity. Including clinician-initiated screening in resource-limited settings would improve management of treatable STIs.

Neuropsychological performance of a patient suspected of dementia taking lorazepam and retested 1 year later following titration.

PubMed

Scott, Bonnie M; Schmitt, Andrew L; Livingston, Ronald B

2016-01-01

The effects of medication on neuropsychological performance have yet to be fully investigated, particularly in older patients. As such, the present case study was undertaken to examine the specific impact of benzodiazepine use on neuropsychological performance by providing a comparison of the test-retest data of an 81-year-old patient taking lorazepam. A comprehensive neuropsychological evaluation was conducted: (a) during the initial referral, while the patient had been taking high doses of lorazepam for approximately 3 years; and (b) 6 months after complete titration, which was 1 year after the initial evaluation. Normative scores derived from the 2 trials were compared via calculation of Reliable Change Indexes. Neuropsychological performance during both evaluations was indicative of dementia, including similar degrees of impairment in delayed memory, verbal fluency, and olfaction. However, scores obtained during the second evaluation were somewhat higher, with significant improvements observed in immediate memory, visuospatial/construction abilities, language function, abstract concept formation, and set shifting. Results of the current case study suggest that several neuropsychological domains may be particularly sensitive to chronic benzodiazepine use. Although the overall diagnostic picture in the present study remained unaltered, clinicians should be cognizant of such medication effects and the potential for these neuropsychological alterations to obscure differential diagnosis.

Greater retention in care among adolescents on antiretroviral treatment accessing "Teen Club" an adolescent-centred differentiated care model compared with standard of care: a nested case-control study at a tertiary referral hospital in Malawi.

PubMed

MacKenzie, Rachel K; van Lettow, Monique; Gondwe, Chrissie; Nyirongo, James; Singano, Victor; Banda, Victor; Thaulo, Edith; Beyene, Teferi; Agarwal, Mansi; McKenney, Allyson; Hrapcak, Susan; Garone, Daniela; Sodhi, Sumeet K; Chan, Adrienne K

2017-11-01

There are numerous barriers to the care and support of adolescents living with HIV (ALHIV) that makes this population particularly vulnerable to attrition from care, poor adherence and virological failure. In 2010, a Teen Club was established in Zomba Central Hospital (ZCH), Malawi, a tertiary referral HIV clinic. Teen Club provides ALHIV on antiretroviral treatment (ART) with dedicated clinic time, sexual and reproductive health education, peer mentorship, ART refill and support for positive living and treatment adherence. The purpose of this study was to evaluate whether attending Teen Club improves retention in ART care. We conducted a nested case-control study with stratified selection, using programmatic data from 2004 to 2015. Cases (ALHIV not retained in care) and controls (ALHIV retained in care) were matched by ART initiation age group. Patient records were reviewed retrospectively and subjects were followed starting in March 2010, the month in which Teen Club was opened. Follow-up ended at the time patients were no longer considered retained in care or on 31 December 2015. Cases and controls were drawn from a study population of 617 ALHIV. Of those, 302 (48.9%) participated in at least two Teen Club sessions. From the study population, 135 (non-retained) cases and 405 (retained) controls were selected. In multivariable analyses, Teen Club exposure, age at the time of selection and year of ART initiation were independently associated with attrition. ALHIV with no Teen Club exposure were less likely to be retained than those with Teen Club exposure (adjusted odds ratio (aOR) 0.27; 95% CI 0.16, 0.45) when adjusted for sex, ART initiation age, current age, reason for ART initiation and year of ART initiation. ALHIV in the age group 15 to 19 were more likely to have attrition from care than ALHIV in the age group 10 to 14 years of age (aOR 2.14; 95% CI 1.12, 4.11). This study contributes to the limited evidence evaluating the effectiveness of service delivery interventions to support ALHIV within healthcare settings. Prospective evaluation of the Teen Club package with higher methodological quality is required for programmes and governments in low- and middle-income settings to prioritize interventions for ALHIV and determine their cost-effectiveness. © 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Verification of the proteus two-dimensional Navier-Stokes code for flat plate and pipe flows

NASA Technical Reports Server (NTRS)

Conley, Julianne M.; Zeman, Patrick L.

1991-01-01

The Proteus Navier-Stokes Code is evaluated for 2-D/axisymmetric, viscous, incompressible, internal, and external flows. The particular cases to be discussed are laminar and turbulent flows over a flat plate, laminar and turbulent developing pipe flows, and turbulent pipe flow with swirl. Results are compared with exact solutions, empirical correlations, and experimental data. A detailed description of the code set-up, including boundary conditions, initial conditions, grid size, and grid packing is given for each case.

SPRUCE S1 Bog Vegetation Survey and Peat Depth Data: 2009

DOE Data Explorer

Hanson, P. J. [Oak Ridge National Laboratory, U.S. Department of Energy, Oak Ridge, Tennessee, U.S.A

2009-12-31

This data set reports the results of a field survey of the S1 Bog to characterize the vegetation and to determine peat depth. The survey was conducted on September 21 and 22, 2009. The initial survey of vegetation and peat depth characteristics of the target bog was conducted to evaluate the logical locations for installing replicated experimental blocks for SPRUCE. The goal was to identify multiple locations of uniform aboveground vegetation and belowground peat depth for positioning experimental units within the bog.

Intermediate load-center photovoltaic application experiments

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

Burgess, E. L.

1980-01-01

A total of nine intermediate load-center photovoltaic systems were carried into the construction phase this year. These nine systems range in size from 20 to 225 kW/sub p/ electrical output and total almost 1 MW/sub p/. They are being installed in a diverse set of applications and locations and represent the bulk of the photovoltaic initial system evaluation experiments (ISEE) for the intermediate load-center sector. Each of these experiments are briefly described and the status of the construction phase is given for each project.

Automated Classification of Phonological Errors in Aphasic Language

PubMed Central

Ahuja, Sanjeev B.; Reggia, James A.; Berndt, Rita S.

1984-01-01

Using heuristically-guided state space search, a prototype program has been developed to simulate and classify phonemic errors occurring in the speech of neurologically-impaired patients. Simulations are based on an interchangeable rule/operator set of elementary errors which represent a theory of phonemic processing faults. This work introduces and evaluates a novel approach to error simulation and classification, it provides a prototype simulation tool for neurolinguistic research, and it forms the initial phase of a larger research effort involving computer modelling of neurolinguistic processes.

Research priorities in health economics and funding for palliative care: views of an international think tank.

PubMed

Harding, Richard; Gomes, Barbara; Foley, Kathleen M; Higginson, Irene J

2009-07-01

At the conclusion of the November 2007 meeting, the assembled international expert group identified the research agenda. The adoption of this agenda would take forward health economic research in palliative care, and generate the necessary data for improved funding decision making, and resource allocation. Recommendations for study included international comparative research into the components of care and settings, evaluative studies, methodologic development and strategies to initiate studies, and make better use of data.

Enhancing Lesbian, Gay, Bisexual, and Transgender Cultural Competence in a Midwestern Primary Care Clinic Setting

PubMed Central

Felsenstein, Denise R.

2018-01-01

The process of initiating lesbian, gay, bisexual, and transgender (LGBT) cultural competencies and educational interventions developed to increase staff knowledge on LGBT culture and health issues is discussed, including a computer-based module and panel discussion. The module intervention showed a statistically significant increase (p = .033) of staff LGBT knowledge from pretest to posttest scores. An evaluation after the panel discussion showed that 72% of staff indicated they were more prepared for LGBT patient care. PMID:29659418

Getting what you need from the hospital to succeed as a traumatologist.

PubMed

Agnew, Samuel G; Jones, Clifford B

2013-10-01

Currently, the market for orthopaedic trauma surgeons is varied. The market consists of university employed, university private, medical group employed, medical group private, private employed, private contracted, and private. Each option has its positives and negatives. The orthopaedic trauma surgeon needs to determine which setting is appropriate for his/her given needs and wants. An experienced mentor(s) is invaluable for advice and guidance. The surgeon then needs to find an administrative leader to initiate, implement, and evaluate certain processes to succeed.

Advances and trends in the development of computational models for tires

NASA Technical Reports Server (NTRS)

Noor, A. K.; Tanner, J. A.

1985-01-01

Status and some recent developments of computational models for tires are summarized. Discussion focuses on a number of aspects of tire modeling and analysis including: tire materials and their characterization; evolution of tire models; characteristics of effective finite element models for analyzing tires; analysis needs for tires; and impact of the advances made in finite element technology, computational algorithms, and new computing systems on tire modeling and analysis. An initial set of benchmark problems has been proposed in concert with the U.S. tire industry. Extensive sets of experimental data will be collected for these problems and used for evaluating and validating different tire models. Also, the new Aircraft Landing Dynamics Facility (ALDF) at NASA Langley Research Center is described.

Perspectives on the state-of-the-science in rehabilitation medicine and its implications for Medicare postacute care policies.

PubMed

Gage, Barbara; Stineman, Margaret; Deutsch, Anne; Mallinson, Trudy; Heinemann, Allen; Bernard, Shulamit; Constantine, Roberta

2007-12-01

Better measurement of the case-mix complexity of patients receiving rehabilitation services is critical to understanding variations in the outcomes achieved by patients treated in different postacute care (PAC) settings. The Medicare program recognized this issue and is undertaking a major initiative to develop a new patient-assessment instrument that would standardize case-mix measurement in inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies. The new instrument, called the Continuity Assessment Record and Evaluation Tool, builds on the scientific advances in measurement to develop standard measures of medical acuity, functional status, cognitive impairment, and social support related to resource need, outcomes, and continuity of care for use in all PAC settings.

A mixed methods approach to adapting and evaluating the functional assessment of HIV infection (FAHI), Swahili version, for use with low literacy populations

PubMed Central

Sigilai, Antipa; Hassan, Amin S.; Thoya, Janet; Odhiambo, Rachael; Van de Vijver, Fons J. R.; Newton, Charles R. J. C.; Abubakar, Amina

2017-01-01

Background Despite bearing the largest HIV-related burden, little is known of the Health-Related Quality of Life (HRQoL) among people living with HIV in sub-Saharan Africa. One of the factors contributing to this gap in knowledge is the lack of culturally adapted and validated measures of HRQoL that are relevant for this setting. Aims We set out to adapt the Functional Assessment of HIV Infection (FAHI) Questionnaire, an HIV-specific measure of HRQoL, and evaluate its internal consistency and validity. Methods The three phase mixed-methods study took place in a rural setting at the Kenyan Coast. Phase one involved a scoping review to describe the evidence base of the reliability and validity of FAHI as well as the geographical contexts in which it has been administered. Phase two involved in-depth interviews (n = 38) to explore the content validity, and initial piloting for face validation of the adapted FAHI. Phase three was quantitative (n = 103) and evaluated the internal consistency, convergent and construct validities of the adapted interviewer-administered questionnaire. Results In the first phase of the study, we identified 16 studies that have used the FAHI. Most (82%) were conducted in North America. Only seven (44%) of the reviewed studies reported on the psychometric properties of the FAHI. In the second phase, most of the participants (37 out of 38) reported satisfaction with word clarity and content coverage whereas 34 (89%) reported satisfaction with relevance of the items, confirming the face validity of the adapted questionnaire during initial piloting. Our participants indicated that HIV impacted on their physical, functional, emotional, and social wellbeing. Their responses overlapped with items in four of the five subscales of the FAHI Questionnaire establishing its content validity. In the third phase, the internal consistency of the scale was found to be satisfactory with subscale Cronbach’s α ranging from 0.55 to 0.78. The construct and convergent validity of the tool were supported by acceptable factor loadings for most of the items on the respective sub-scales and confirmation of expected significant correlations of the FAHI subscale scores with scores of a measure of common mental disorders. Conclusion The adapted interviewer-administered Swahili version of FAHI questionnaire showed initial strong evidence of good psychometric properties with satisfactory internal consistency and acceptable validity (content, face, and convergent validity). It gives impetus for further validation work, especially construct validity, in similar settings before it can be used for research and clinical purposes in the entire East African region. PMID:28380073

Properties of calcium silicate-monobasic calcium phosphate materials for endodontics containing tantalum pentoxide and zirconium oxide.

PubMed

Zamparini, Fausto; Siboni, Francesco; Prati, Carlo; Taddei, Paola; Gandolfi, Maria Giovanna

2018-05-08

The aim of the study was to evaluate chemical-physical properties and apatite-forming ability of three premixed calcium silicate materials containing monobasic calcium phosphate (CaH 4 P 2 O 8 ) bioceramic, tantalum pentoxide and zirconium oxide, recently marketed for endodontics (TotalFill BC-Sealer, BC-RRM-Paste, BC-RRM-Putty). Microchemical and micromorphological analyses, radiopacity, initial and final setting times, calcium release and alkalising activity were tested. The nucleation of calcium phosphates (CaPs) and/or apatite after 28 days ageing was evaluated by ESEM-EDX and micro-Raman spectroscopy. BC-Sealer and BC-RRM-Paste showed similar initial (23 h), prolonged final (52 h) setting times and good radiopacity (> 7 mm Al); BC-RRM-Putty showed fast initial (2 h) and final setting times (27 h) and excellent radiopacity (> 9 mm Al). All materials induced a marked alkalisation (pH 11-12) up to 28 days and showed the release of calcium ions throughout the entire test period (cumulative calcium release 641-806 ppm). After 28 days ageing, a well-distributed mineral layer was present on all samples surface; EDX demonstrated relevant calcium and phosphorous peaks. B-type carbonated apatite and calcite deposits were identified by micro-Raman spectroscopy on all the 28-day-aged samples; the deposit thickness was higher on BC-RRM-Paste and BC-RRM-Putty, in agreement with calcium release data. These materials met the required chemical and physical standards and released biologically relevant ions. The CaSi-CaH 4 P 2 O 8 system present in the materials provided Ca and OH ions release with marked abilities to nucleate a layer of B-type carbonated apatite favoured/accelerated by the bioceramic presence. The ability to nucleate apatite may lead many clinical advantages: In orthograde endodontics, it may improve the sealing ability by the deposition of CaPs at the material-root dentine interface, and in endodontic surgery, it could promote bone and periodontal tissue regeneration. As premixed materials, their application in endodontics may result easier in several complex endodontic situations (apicoectomy, root perforation, presence of wide/wet apices).

Neuropsychological Testing in Pathologically Verified Alzheimer Disease and Frontotemporal Dementia: How Well Do the Uniform Data Set Measures Differentiate Between Diseases?

PubMed

Ritter, Aaron R; Leger, Gabriel C; Miller, Justin B; Banks, Sarah J

2017-01-01

Differences in cognition between frontotemporal dementia (FTD) and Alzheimer disease (AD) are well described in clinical cohorts, but have rarely been confirmed in studies with pathologic verification. For emerging therapeutics to succeed, determining underlying pathology early in the disease course is increasingly important. Neuropsychological evaluation is an important component of the diagnostic workup for AD and FTD. Patients with FTD are thought to have greater deficits in language and executive function while patients with AD are more likely to have deficits in memory. To determine if performance on initial cognitive testing can reliably distinguish between patients with frontotemporal lobar degeneration (FTLD) and AD neuropathology. In addition, are there other factors of the neuropsychological assessment that can be used to enhance the accuracy of underlying pathology? Using a logistic regression we retrospectively compared neurocognitive performance on initial evaluation of 106 patients with pathologically verified FTLD (pvFTLD), with 558 pathologically verified AD (pvAD) patients from the National Alzheimer's Coordinating Center using data from the Uniform Data Set (UDS) and the neuropathology data set. As expected, pvFTLD patients were younger, demonstrated better memory performance, and had more neuropsychiatric symptoms than pvAD patients. Other results were less predictable: pvFTLD patients performed better on one test of executive function (trail making test part B) but worse on another (digit span backward). Performance on language testing did not strongly distinguish the 2 groups. To determine what factors led to a misdiagnosis of AD in patients with FTLD, we further analyzed a small group of pvFTLD patients. These patients demonstrated older age and lower Neuropsychiatric Inventory Questionnaire counts compared with accurately diagnosed cases. Other than memory, numerical scores of neurocognitive performance on the UDS are of limited value in differentiating FTLD from AD at the initial visit. These results highlight the difficulty of obtaining an accurate early diagnosis of FTLD and argue for adding supplemental tests to those included in the UDS to assess cognition in FTD and AD patients.

Case study of evaluations that go beyond clinical outcomes to assess quality improvement diabetes programmes using the Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE).

PubMed

Paquette-Warren, Jann; Harris, Stewart B; Naqshbandi Hayward, Mariam; Tompkins, Jordan W

2016-10-01

Investments in efforts to reduce the burden of diabetes on patients and health care are critical; however, more evaluation is needed to provide evidence that informs and supports future policies and programmes. The newly developed Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE) incorporates the theoretical concepts needed to facilitate the capture of critical information to guide investments, policy and programmatic decision making. The aim of the study is to assess the applicability and value of DEFINE in comprehensive real-world evaluation. Using a critical and positivist approach, this intrinsic and collective case study retrospectively examines two naturalistic evaluations to demonstrate how DEFINE could be used when conducting real-world comprehensive evaluations in health care settings. The variability between the cases and the evaluation designs are described and aligned to the DEFINE goals, steps and sub-steps. The majority of the theoretical steps of DEFINE were exemplified in both cases, although limited for knowledge translation efforts. Application of DEFINE to evaluate diverse programmes that target various chronic diseases is needed to further test the inclusivity and built-in flexibility of DEFINE and its role in encouraging more comprehensive knowledge translation. This case study shows how DEFINE could be used to structure or guide comprehensive evaluations of programmes and initiatives implemented in health care settings and support scale-up of successful innovations. Future use of the framework will continue to strengthen its value in guiding programme evaluation and informing health policy to reduce the burden of diabetes and other chronic diseases. © 2016 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Development of System-level Performance Measures for Evaluation of Models of Care for Inflammatory Arthritis in Canada.

PubMed

Barber, Claire E H; Marshall, Deborah A; Mosher, Dianne P; Akhavan, Pooneh; Tucker, Lori; Houghton, Kristin; Batthish, Michelle; Levy, Deborah M; Schmeling, Heinrike; Ellsworth, Janet; Tibollo, Heidi; Grant, Sean; Khodyakov, Dmitry; Lacaille, Diane

2016-03-01

To develop system-level performance measures for evaluating the care of patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA), psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis. This study involved several methodological phases. Over multiple rounds, various participants were asked to help define a set of candidate measurement themes. A systematic search was conducted of existing guidelines and measures. A set of 6 performance measures was defined and presented to 50 people, including patients with IA, rheumatologists, allied health professionals, and researchers using a 3-round, online, modified Delphi process. Participants rated the validity, feasibility, relevance, and likelihood of use of the measures. Measures with median ratings ≥ 7 for validity and relevance were included in the final set. Six performance measures were developed evaluating the following aspects of care, with each measure being applied separately for each type of IA except where specified: waiting times for rheumatology consultation for patients with new onset IA, percentage of patients with IA seen by a rheumatologist, percentage of patients with IA seen in yearly followup by a rheumatologist, percentage of patients with RA treated with a disease-modifying antirheumatic drug (DMARD), time to DMARD therapy in RA, and number of rheumatologists per capita. The first set of system-level performance measures for IA care in Canada has been developed with broad input. The measures focus on timely access to care and initiation of appropriate treatment for patients with IA, and are likely to be of interest to other arthritis care systems internationally.

Acetabular rim and surface segmentation for hip surgery planning and dysplasia evaluation

NASA Astrophysics Data System (ADS)

Tan, Sovira; Yao, Jianhua; Yao, Lawrence; Summers, Ronald M.; Ward, Michael M.

2008-03-01

Knowledge of the acetabular rim and surface can be invaluable for hip surgery planning and dysplasia evaluation. The acetabular rim can also be used as a landmark for registration purposes. At the present time acetabular features are mostly extracted manually at great cost of time and human labor. Using a recent level set algorithm that can evolve on the surface of a 3D object represented by a triangular mesh we automatically extracted rims and surfaces of acetabulae. The level set is guided by curvature features on the mesh. It can segment portions of a surface that are bounded by a line of extremal curvature (ridgeline or crestline). The rim of the acetabulum is such an extremal curvature line. Our material consists of eight hemi-pelvis surfaces. The algorithm is initiated by putting a small circle (level set seed) at the center of the acetabular surface. Because this surface distinctively has the form of a cup we were able to use the Shape Index feature to automatically extract an approximate center. The circle then expands and deforms so as to take the shape of the acetabular rim. The results were visually inspected. Only minor errors were detected. The algorithm also proved to be robust. Seed placement was satisfactory for the eight hemi-pelvis surfaces without changing any parameters. For the level set evolution we were able to use a single set of parameters for seven out of eight surfaces.

Screening Children for Family Violence: A Review of the Evidence for the US Preventive Services Task Force

PubMed Central

Nygren, Peggy; Nelson, Heidi D.; Klein, Jonathan

2004-01-01

BACKGROUND We wanted to evaluate the benefits and harms of screening children in primary health care settings for abuse and neglect resulting from family violence by examining the evidence on the performance of screening instruments and the effectiveness of interventions. METHODS We searched for relevant studies in MEDLINE, PsycINFO, CINAHL, ERIC, Cochrane Controlled Trials Register, and reference lists. English language abstracts with original data about family violence against children focusing on screening and interventions initiated or based in health care settings were included. We extracted selected information about study design, patient populations and settings, methods of assessment or intervention, and outcome measures, and applied a set of criteria to evaluate study quality. RESULTS All instruments designed to screen for child abuse and neglect were directed to parents, particularly pregnant women. These instruments had fairly high sensitivity but low specificity when administered in high-risk study populations and have not been widely tested in other populations. Randomized controlled trials of frequent nurse home visitation programs beginning during pregnancy that address behavioral and psychological factors indicated improved abuse measures and outcomes. No studies were identified about interventions in older children or harms associated with screening and intervention. CONCLUSIONS No trials of the effectiveness of screening in a health care setting have been published. Clinician referrals to nurse home visitation during pregnancy and in early childhood may reduce abuse in selected populations. There are no studies about harms of screening and interventions. PMID:15083858

Contrasting lexical similarity and formal definitions in SNOMED CT: consistency and implications.

PubMed

Agrawal, Ankur; Elhanan, Gai

2014-02-01

To quantify the presence of and evaluate an approach for detection of inconsistencies in the formal definitions of SNOMED CT (SCT) concepts utilizing a lexical method. Utilizing SCT's Procedure hierarchy, we algorithmically formulated similarity sets: groups of concepts with similar lexical structure of their fully specified name. We formulated five random samples, each with 50 similarity sets, based on the same parameter: number of parents, attributes, groups, all the former as well as a randomly selected control sample. All samples' sets were reviewed for types of formal definition inconsistencies: hierarchical, attribute assignment, attribute target values, groups, and definitional. For the Procedure hierarchy, 2111 similarity sets were formulated, covering 18.1% of eligible concepts. The evaluation revealed that 38 (Control) to 70% (Different relationships) of similarity sets within the samples exhibited significant inconsistencies. The rate of inconsistencies for the sample with different relationships was highly significant compared to Control, as well as the number of attribute assignment and hierarchical inconsistencies within their respective samples. While, at this time of the HITECH initiative, the formal definitions of SCT are only a minor consideration, in the grand scheme of sophisticated, meaningful use of captured clinical data, they are essential. However, significant portion of the concepts in the most semantically complex hierarchy of SCT, the Procedure hierarchy, are modeled inconsistently in a manner that affects their computability. Lexical methods can efficiently identify such inconsistencies and possibly allow for their algorithmic resolution. Copyright © 2013 Elsevier Inc. All rights reserved.

Effective integrated frameworks for assessing mining sustainability.

PubMed

Virgone, K M; Ramirez-Andreotta, M; Mainhagu, J; Brusseau, M L

2018-05-28

The objectives of this research are to review existing methods used for assessing mining sustainability, analyze the limited prior research that has evaluated the methods, and identify key characteristics that would constitute an enhanced sustainability framework that would serve to improve sustainability reporting in the mining industry. Five of the most relevant frameworks were selected for comparison in this analysis, and the results show that there are many commonalities among the five, as well as some disparities. In addition, relevant components are missing from all five. An enhanced evaluation system and framework were created to provide a more holistic, comprehensive method for sustainability assessment and reporting. The proposed framework has five components that build from and encompass the twelve evaluation characteristics used in the analysis. The components include Foundation, Focus, Breadth, Quality Assurance, and Relevance. The enhanced framework promotes a comprehensive, location-specific reporting approach with a concise set of well-defined indicators. Built into the framework is quality assurance, as well as a defined method to use information from sustainability reports to inform decisions. The framework incorporates human health and socioeconomic aspects via initiatives such as community-engaged research, economic valuations, and community-initiated environmental monitoring.

Human exposure assessment and the National Toxicology Program.

PubMed Central

Lucier, G W; Schecter, A

1998-01-01

The National Institute of Environmental Health Sciences/National Toxicology Program (NIEHS/NTP) is developing a new interagency initiative in exposure assessment. This initiative involves the NIEHS, the Centers for Disease Control and Prevention through its National Center for Environmental Health, the National Institute for Occupational Safety and Health, the EPA, and other participating institutes and agencies of the NTP. This initiative will benefit public health and priority setting in a number of ways. First, as discussed above, it will strengthen the scientific foundation for risk assessments by the development of more credible exposure/response relationships in people by improving cross-species extrapolation, the development of biologically based dose-response models, and the identification of sensitive subpopulations and for "margin of exposure" based estimates of risk. Second, it will provide the kind of information necessary for deciding which chemicals should be studied with the limited resources available for toxicological testing. For example, there are 85,000 chemicals in commerce today, and the NTP can only provide toxicological evaluations on 10-20 per year. Third, we would use the information obtained from the exposure initiative to focus our research on mixtures that are actually present in people's bodies. Fourth, we would obtain information on the kinds and amount of chemicals in children and other potentially sensitive subpopulations. Determinations of whether additional safety factors need to be applied to children must rest, in part, upon comparative exposure analyses between children and adults. Fifth, this initiative, taken together with the environmental genome initiative, will provide the science base essential for meaningful studies on gene/environment interactions, particularly for strengthening the evaluation of epidemiology studies. Sixth, efficacy of public health policies aimed at reducing human exposure to chemical agents could be evaluated in a more meaningful way if body burden data were available over time, including remediation around Superfund sites and efforts to achieve environmental justice. The exposure assessment initiative is needed to address public health needs. It is feasible because of recent advances in analytical technology and molecular biology, and it is an example of how different agencies can work together to better fulfill their respective missions. Images Figure 1 Figure 2 PMID:9755136

The "expert patient" approach for non-communicable disease management in low and middle income settings: When the reality confronts the rhetoric.

PubMed

Xiao, Yue

2015-09-01

This paper seeks to explore the relevance between the Western "expert patient" rhetoric and the reality of non-communicable diseases (NCDs) control and management in low and middle income settings from the health sociological perspective. It firstly sets up a conceptual framework of the "expert patient" or the patient self-management approach, showing the rhetoric of the initiative in the developed countries. Then by examining the situation of NCDs control and management in low income settings, the paper tries to evaluate the possibilities of implementing the "expert patient" approach in these countries. Kober and Van Damme's study on the relevance of the "expert patient" for an HIV/AIDS program in low income settings is critically studied to show the relevance of the developed countries' rhetoric of the "expert patient" approach for the reality of developing countries. In addition, the MoPoTsyo diabetes peer educator program is analyzed to show the challenges faced by the low income countries in implementing patient self-management programs. Finally, applications of the expert patient approach in China are discussed as well, to remind us of the possible difficulties in introducing it into rural settings.

Case study of evaluations that go beyond clinical outcomes to assess quality improvement diabetes programmes using the Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE)

PubMed Central

Harris, Stewart B.; Naqshbandi Hayward, Mariam; Tompkins, Jordan W.

2016-01-01

Abstract Rationale, aims and objectives Investments in efforts to reduce the burden of diabetes on patients and health care are critical; however, more evaluation is needed to provide evidence that informs and supports future policies and programmes. The newly developed Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE) incorporates the theoretical concepts needed to facilitate the capture of critical information to guide investments, policy and programmatic decision making. The aim of the study is to assess the applicability and value of DEFINE in comprehensive real‐world evaluation. Method Using a critical and positivist approach, this intrinsic and collective case study retrospectively examines two naturalistic evaluations to demonstrate how DEFINE could be used when conducting real‐world comprehensive evaluations in health care settings. Results The variability between the cases and the evaluation designs are described and aligned to the DEFINE goals, steps and sub‐steps. The majority of the theoretical steps of DEFINE were exemplified in both cases, although limited for knowledge translation efforts. Application of DEFINE to evaluate diverse programmes that target various chronic diseases is needed to further test the inclusivity and built‐in flexibility of DEFINE and its role in encouraging more comprehensive knowledge translation. Conclusions This case study shows how DEFINE could be used to structure or guide comprehensive evaluations of programmes and initiatives implemented in health care settings and support scale‐up of successful innovations. Future use of the framework will continue to strengthen its value in guiding programme evaluation and informing health policy to reduce the burden of diabetes and other chronic diseases. PMID:26804339

Postauthorization safety study of the DPP-4 inhibitor saxagliptin: a large-scale multinational family of cohort studies of five outcomes.

PubMed

Lo Re, Vincent; Carbonari, Dena M; Saine, M Elle; Newcomb, Craig W; Roy, Jason A; Liu, Qing; Wu, Qufei; Cardillo, Serena; Haynes, Kevin; Kimmel, Stephen E; Reese, Peter P; Margolis, David J; Apter, Andrea J; Reddy, K Rajender; Hennessy, Sean; Bhullar, Harshvinder; Gallagher, Arlene M; Esposito, Daina B; Strom, Brian L

2017-01-01

To evaluate the risk of serious adverse events among patients with type 2 diabetes mellitus initiating saxagliptin compared with oral antidiabetic drugs (OADs) in classes other than dipeptidyl peptidase-4 (DPP-4) inhibitors. Cohort studies using 2009-2014 data from two UK medical record data sources (Clinical Practice Research Datalink, The Health Improvement Network) and two USA claims-based data sources (HealthCore Integrated Research Database, Medicare). All eligible adult patients newly prescribed saxagliptin (n=110 740) and random samples of up to 10 matched initiators of non-DPP-4 inhibitor OADs within each data source were selected (n=913 384). Outcomes were hospitalized major adverse cardiovascular events (MACE), acute kidney injury (AKI), acute liver failure (ALF), infections, and severe hypersensitivity events, evaluated using diagnostic coding algorithms and medical records. Cox regression was used to determine HRs with 95% CIs for each outcome. Meta-analyses across data sources were performed for each outcome as feasible. There were no increased incidence rates or risk of MACE, AKI, ALF, infection, or severe hypersensitivity reactions among saxagliptin initiators compared with other OAD initiators within any data source. Meta-analyses demonstrated a reduced risk of hospitalization/death from MACE (HR 0.91, 95% CI 0.85 to 0.97) and no increased risk of hospitalization for infection (HR 0.97, 95% CI 0.93 to 1.02) or AKI (HR 0.99, 95% CI 0.88 to 1.11) associated with saxagliptin initiation. ALF and hypersensitivity events were too rare to permit meta-analysis. Saxagliptin initiation was not associated with increased risk of MACE, infection, AKI, ALF, or severe hypersensitivity reactions in clinical practice settings. NCT01086280, NCT01086293, NCT01086319, NCT01086306, and NCT01377935; Results.

Real-world effectiveness of osteoporosis therapies for fracture reduction in post-menopausal women.

PubMed

Yusuf, Akeem A; Cummings, Steven R; Watts, Nelson B; Feudjo, Maurille Tepie; Sprafka, J Michael; Zhou, Jincheng; Guo, Haifeng; Balasubramanian, Akhila; Cooper, Cyrus

2018-03-21

Studies examining real-world effectiveness of osteoporosis therapies are beset by limitations due to confounding by indication. By evaluating longitudinal changes in fracture incidence, we demonstrated that osteoporosis therapies are effective in reducing fracture risk in real-world practice settings. Osteoporosis therapies have been shown to reduce incidence of vertebral and non-vertebral fractures in placebo-controlled randomized clinical trials. However, information on the real-world effectiveness of these therapies is limited. We examined fracture risk reduction in older, post-menopausal women treated with osteoporosis therapies. Using Medicare claims, we identified 1,278,296 women age ≥ 65 years treated with zoledronic acid, oral bisphosphonates, denosumab, teriparatide, or raloxifene. Fracture incidence rates before and after treatment initiation were described to understand patients' fracture risk profile, and fracture reduction effectiveness of each therapy was evaluated as a longitudinal change in incidence rates. Fracture incidence rates increased during the period leading up to treatment initiation and were highest in the 3-month period most proximal to treatment initiation. Fracture incidence rates following treatment initiation were significantly lower than before treatment initiation. Compared with the 12-month pre-index period, there were reductions in clinical vertebral fractures for denosumab (45%; 95% confidence interval [CI] 39-51%), zoledronic acid (50%; 95% CI 47-52%), oral bisphosphonates (24%; 95% CI 22-26%), and teriparatide (72%; 95% CI 69-75%) during the subsequent 12 months. Relative to the first 3 months after initiation, clinical vertebral fractures were reduced for denosumab (51%; 95% CI 42-59%), zoledronic acid (25%; 95% CI 17-32%), oral bisphosphonates (23%; 95% CI 20-26%), and teriparatide (64%; 95% CI 58-69%) during the subsequent 12 months. In summary, reductions in fracture incidence over time were observed in cohorts of patients treated with osteoporosis therapies.

The Cortex Transform as an image preprocessor for sparse distributed memory: An initial study

NASA Technical Reports Server (NTRS)

Olshausen, Bruno; Watson, Andrew

1990-01-01

An experiment is described which was designed to evaluate the use of the Cortex Transform as an image processor for Sparse Distributed Memory (SDM). In the experiment, a set of images were injected with Gaussian noise, preprocessed with the Cortex Transform, and then encoded into bit patterns. The various spatial frequency bands of the Cortex Transform were encoded separately so that they could be evaluated based on their ability to properly cluster patterns belonging to the same class. The results of this study indicate that by simply encoding the low pass band of the Cortex Transform, a very suitable input representation for the SDM can be achieved.

Multiple-objective evaluation of wastewater treatment plant control alternatives.

PubMed

Flores-Alsina, Xavier; Gallego, Alejandro; Feijoo, Gumersindo; Rodriguez-Roda, Ignasi

2010-05-01

Besides the evaluation of the environmental issues, the correct assessment of wastewater treatment plants (WWTP) should take into account several objectives such as: economic e.g. operation costs; technical e.g. risk of suffering microbiology-related TSS separation problems; or legal e.g. accomplishment with the effluent standards in terms of the different pollution loads. For this reason, the main objective of this paper is to show the benefits of complementing the environmental assessment carried out by life cycle assessment with economical, technical and legal criteria. Using a preliminary version of the BSM2 as a case study, different combinations of controllers are implemented, simulated and evaluated. In the following step, the resulting multi-criteria matrix is mined using multivariate statistical techniques. The results showed that the presence of an external carbon source addition, the type of aeration system and the TSS controller are the key elements creating the differences amongst the alternatives. Also, it was possible to characterize the different control strategies according to a set of aggregated criteria. Additionally, the existing synergies amongst different objectives and their consequent trade-offs were identified. Finally, it was discovered that from the initial extensive list of evaluation criteria, only a small set of five are really discriminant, being useful to differentiate within the generated alternatives. Copyright 2010 Elsevier Ltd. All rights reserved.

Effects of automated immunization registry reporting via an electronic health record deployed in community practice settings.

PubMed

Merrill, J; Phillips, A; Keeling, J; Kaushal, R; Senathirajah, Y

2013-01-01

Among the expected benefits of electronic health records (EHRs) is increased reporting of public health information, such as immunization status. State and local immunization registries aid control of vaccine-preventable diseases and help offset fragmentation in healthcare, but reporting is often slow and incomplete. The Primary Care Information Project (PCIP), an initiative of the NYC Department of Health and Mental Hygiene, has implemented EHRs with immunization reporting capability in community settings. To evaluate the effect of automated reporting via an EHR on use and efficiency of reporting to the NY Citywide Immunization Registry, we conducted a secondary analysis of 1.7 million de-identified records submitted between January 2007 and June 2011 by 217 primary care practices enrolled in PCIP, pre and post launch of automated reporting via an EHR. We examined differences in records submitted per day, lag time, and documentation of eligibility for subsidized vaccines. Mean submissions per day did not change. Automated submissions of new and historical records increased by 18% and 98% respectively. Submissions within 14 days increased from 84% to 87%, and within 2 days increased from 60% to 77%. Median lag time decreased from 13 to 10 days. Documentation of eligibility decreased. Results are significant at p<0.001. Significant improvements in registry use and efficiency of reporting were found after launch of automated reporting via an EHR. A decrease in eligibility documentation was attributed to EHR workflow. The limitations to comprehensive evaluation found in these data, which were extracted from a registry initiated prior to widespread EHR implementation suggests that reliable evaluation of immunization reporting via the EHR may require modifications to legacy registry databases.

Current status and perspectives of interventional clinical trials for glioblastoma - analysis of ClinicalTrials.gov.

PubMed

Cihoric, Nikola; Tsikkinis, Alexandros; Minniti, Giuseppe; Lagerwaard, Frank J; Herrlinger, Ulrich; Mathier, Etienne; Soldatovic, Ivan; Jeremic, Branislav; Ghadjar, Pirus; Elicin, Olgun; Lössl, Kristina; Aebersold, Daniel M; Belka, Claus; Herrmann, Evelyn; Niyazi, Maximilian

2017-01-03

The records of 208.777 (100%) clinical trials registered at ClinicalTrials.gov were downloaded on the 19th of February 2016. Phase II and III trials including patients with glioblastoma were selected for further classification and analysis. Based on the disease settings, trials were classified into three groups: newly diagnosed glioblastoma, recurrent disease and trials with no differentiation according to disease setting. Furthermore, we categorized trials according to the experimental interventions, the primary sponsor, the source of financial support and trial design elements. Trends were evaluated using the autoregressive integrated moving average model. Two hundred sixteen (0.1%) trials were selected for further analysis. Academic centers (investigator initiated trials) were recorded as primary sponsors in 56.9% of trials, followed by industry 25.9%. Industry was the leading source of monetary support for the selected trials in 44.4%, followed by 25% of trials with primarily academic financial support. The number of newly initiated trials between 2005 and 2015 shows a positive trend, mainly through an increase in phase II trials, whereas phase III trials show a negative trend. The vast majority of trials evaluate forms of different systemic treatments (91.2%). In total, one hundred different molecular entities or biologicals were identified. Of those, 60% were involving drugs specifically designed for central nervous system malignancies. Trials that specifically address radiotherapy, surgery, imaging and other therapeutic or diagnostic methods appear to be rare. Current research in glioblastoma is mainly driven or sponsored by industry, academic medical oncologists and neuro-oncologists, with the majority of trials evaluating forms of systemic therapies. Few trials reach phase III. Imaging, radiation therapy and surgical procedures are underrepresented in current trials portfolios. Optimization in research portfolio for glioblastoma is needed.

Hospital benchmarking: are U.S. eye hospitals ready?

PubMed

de Korne, Dirk F; van Wijngaarden, Jeroen D H; Sol, Kees J C A; Betz, Robert; Thomas, Richard C; Schein, Oliver D; Klazinga, Niek S

2012-01-01

Benchmarking is increasingly considered a useful management instrument to improve quality in health care, but little is known about its applicability in hospital settings. The aims of this study were to assess the applicability of a benchmarking project in U.S. eye hospitals and compare the results with an international initiative. We evaluated multiple cases by applying an evaluation frame abstracted from the literature to five U.S. eye hospitals that used a set of 10 indicators for efficiency benchmarking. Qualitative analysis entailed 46 semistructured face-to-face interviews with stakeholders, document analyses, and questionnaires. The case studies only partially met the conditions of the evaluation frame. Although learning and quality improvement were stated as overall purposes, the benchmarking initiative was at first focused on efficiency only. No ophthalmic outcomes were included, and clinicians were skeptical about their reporting relevance and disclosure. However, in contrast with earlier findings in international eye hospitals, all U.S. hospitals worked with internal indicators that were integrated in their performance management systems and supported benchmarking. Benchmarking can support performance management in individual hospitals. Having a certain number of comparable institutes provide similar services in a noncompetitive milieu seems to lay fertile ground for benchmarking. International benchmarking is useful only when these conditions are not met nationally. Although the literature focuses on static conditions for effective benchmarking, our case studies show that it is a highly iterative and learning process. The journey of benchmarking seems to be more important than the destination. Improving patient value (health outcomes per unit of cost) requires, however, an integrative perspective where clinicians and administrators closely cooperate on both quality and efficiency issues. If these worlds do not share such a relationship, the added "public" value of benchmarking in health care is questionable.

World Federation of Pediatric Intensive Care and Critical Care Societies: Global Sepsis Initiative.

PubMed

Kissoon, Niranjan; Carcillo, Joseph A; Espinosa, Victor; Argent, Andrew; Devictor, Denis; Madden, Maureen; Singhi, Sunit; van der Voort, Edwin; Latour, Jos

2011-09-01

According to World Health Organization estimates, sepsis accounts for 60%-80% of lost lives per year in childhood. Measures appropriate for resource-scarce and resource-abundant settings alike can reduce sepsis deaths. In this regard, the World Federation of Pediatric Intensive Care and Critical Care Societies Board of Directors announces the Global Pediatric Sepsis Initiative, a quality improvement program designed to improve quality of care for children with sepsis. To announce the global sepsis initiative; to justify some of the bundles that are included; and to show some preliminary data and encourage participation. The Global Pediatric Sepsis Initiative is developed as a Web-based education, demonstration, and pyramid bundles/checklist tool (http://www.pediatricsepsis.org or http://www.wfpiccs.org). Four health resource categories are included. Category A involves a nonindustrialized setting with mortality rate <5 yrs and >30 of 1,000 children. Category B involves a nonindustrialized setting with mortality rate <5 yrs and <30 of 1,000 children. Category C involves a developing industrialized nation. In category D, developed industrialized nation are determined and separate accompanying administrative and clinical parameters bundles or checklist quality improvement recommendations are provided, requiring greater resources and tasks as resource allocation increased from groups A to D, respectively. In the vanguard phase, data for 361 children (category A, n = 34; category B, n = 12; category C, n = 84; category D, n = 231) were successfully entered, and quality-assurance reports were sent to the 23 participating international centers. Analysis of bundles for categories C and D showed that reduction in mortality was associated with compliance with the resuscitation (odds ratio, 0.369; 95% confidence interval, 0.188-0.724; p < .0004) and intensive care unit management (odds ratio, 0.277; 95% confidence interval, 0.096-0.80) bundles. The World Federation of Pediatric Intensive Care and Critical Care Societies Global Pediatric Sepsis Initiative is online. Success in reducing pediatric mortality and morbidity, evaluated yearly as a measure of global child health care quality improvement, requires ongoing active recruitment of international participant centers. Please join us at http://www.pediatricsepsis.org or http://www.wfpiccs.org.

A nonlinear model for analysis of slug-test data

USGS Publications Warehouse

McElwee, C.D.; Zenner, M.A.

1998-01-01

While doing slug tests in high-permeability aquifers, we have consistently seen deviations from the expected response of linear theoretical models. Normalized curves do not coincide for various initial heads, as would be predicted by linear theories, and are shifted to larger times for higher initial heads. We have developed a general nonlinear model based on the Navier-Stokes equation, nonlinear frictional loss, non-Darcian flow, acceleration effects, radius changes in the well bore, and a Hvorslev model for the aquifer, which explains these data features. The model produces a very good fit for both oscillatory and nonoscillatory field data, using a single set of physical parameters to predict the field data for various initial displacements at a given well. This is in contrast to linear models which have a systematic lack of fit and indicate that hydraulic conductivity varies with the initial displacement. We recommend multiple slug tests with a considerable variation in initial head displacement to evaluate the possible presence of nonlinear effects. Our conclusion is that the nonlinear model presented here is an excellent tool to analyze slug tests, covering the range from the underdamped region to the overdamped region.

Metronidazole stewardship initiative at Christchurch hospitals-achievable with immediate benefits.

PubMed

Gardiner, Sharon J; Metcalf, Sarah Cl; Chin, Paul Kl; Doogue, Matthew P; Dalton, Simon C; Chambers, Stephen T

2018-04-13

To evaluate an antimicrobial stewardship (AMS) initiative to change hospital prescribing practice for metronidazole. In October 2015, the Canterbury District Health Board (CDHB) AMS committee changed advice for metronidazole to promote two times daily dosing for most indications, prioritisation of the oral route and avoidance of double anaerobic cover. Adoption of the initiative was facilitated via change in prescribing guidelines, education and ongoing pharmacy support. Usage and expenditure on metronidazole for adult inpatients were compared for the five years pre- and two years post-change. Other district health boards (DHBs) were surveyed to determine their dosing recommendation for metronidazole IV. Mean annual metronidazole IV use, as defined daily doses per 1,000 occupied bed days, decreased by 43% post-initiative. Use of non-IV (oral or rectal) formulations increased by 104%. Total savings associated with the initiative were approximately $33,400 in drug costs plus $78,200 per annum in IV giving sets and post-dose flushes. Twelve of 20 (60%) DHBs (including CDHB) endorse twice daily IV dosing. In addition to financial savings, reduction in IV doses has potential benefits, including avoidance of IV catheter-associated complications such as bloodstream infections. Approaches to metronidazole dosing vary across DHBs and could benefit from national coordination.

Incidence and Predictors of Advance Care Planning Among Persons with Cognitive Impairment

PubMed Central

Garand, Linda; Dew, Mary Amanda; Lingler, Jennifer H.; DeKosky, Steven T.

2010-01-01

Objective Persons with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) are at heightened risk for future decisional incapacity. We sought to characterize advance care planning (ACP) rates over time in individuals who had no advance directives (living will or durable power of attorney) in place when they initially presented for a cognitive evaluation. Design Retrospective analysis of data that had been prospectively collected. Setting Alzheimer’s Disease Research Center memory disorders clinic. Participants Persons (N=127) with a diagnosis of MCI or early AD (n = 72) or moderate to severe AD (n = 55) and no advance directives upon initial presentation for a cognitive evaluation. Measurements Extraction of responses to items pertaining to advance care planning assessed during annual semi-structured interviews. Results By 5 years of follow-up, 39% of the sample had initiated ACP, with little difference by baseline diagnosis. Younger subjects (under 65 years old) were significantly more likely to initiate advance directives (43%) than were older subjects (37%). This age effect was more pronounced in men than women as well as in married subjects, those with a family history of dementia, no depressive disorder, and subjects with moderate to severe AD (versus those with MCI or early AD) at baseline. Conclusion Only a minority of subjects initiated ACPs. The findings suggest the need for interventions aimed at enhancing ACP completion rates, particularly among older adults with cognitive impairment since these individuals may have a timed-limited opportunity to plan for future medical, financial, and other major life decisions. PMID:21785291

Hemodynamic vascular biomarkers for initiation of paraclinoid internal carotid artery aneurysms using patient-specific computational fluid dynamic simulation based on magnetic resonance imaging.

PubMed

Watanabe, Tomoya; Isoda, Haruo; Takehara, Yasuo; Terada, Masaki; Naito, Takehiro; Kosugi, Takafumi; Onishi, Yuki; Tanoi, Chiharu; Izumi, Takashi

2018-05-01

We performed computational fluid dynamics (CFD) for patients with and without paraclinoid internal carotid artery (ICA) aneurysms to evaluate the distribution of vascular biomarkers at the aneurysm initiation sites of the paraclinoid ICA. This study included 35 patients who were followed up for aneurysms using 3D time of flight (TOF) magnetic resonance angiography (MRA) and 3D cine phase-contrast MR imaging. Fifteen affected ICAs were included in group A with the 15 unaffected contralateral ICAs in group B. Thirty-three out of 40 paraclinoid ICAs free of aneurysms and arteriosclerotic lesions were included in group C. We deleted the aneurysms in group A based on the 3D TOF MRA dataset. We performed CFD based on MR data set and obtained wall shear stress (WSS), its derivatives, and streamlines. We qualitatively evaluated their distributions at and near the intracranial aneurysm initiation site among three groups. We also calculated and compared the normalized highest (nh-) WSS and nh-spatial WSS gradient (SWSSG) around the paraclinoid ICA among three groups. High WSS and SWSSG distribution were observed at and near the aneurysm initiation site in group A. High WSS and SWSSG were also observed at similar locations in group B and group C. However, nh-WSS and nh-SWSSG were significantly higher in group A than in group C, and nh-SWSSG was significantly higher in group A than in group B. Our findings indicated that nh-WSS and nh-SWSSG were good biomarkers for aneurysm initiation in the paraclinoid ICA.

Twelve-month contraceptive continuation among women initiating short- and long-acting reversible contraceptives in North Kivu, Democratic Republic of the Congo.

PubMed

Casey, Sara E; Cannon, Amy; Mushagalusa Balikubirhi, Benjamin; Muyisa, Jean-Bosco; Amsalu, Ribka; Tsolka, Maria

2017-01-01

Despite the inclusion of sexual and reproductive health (SRH) services in the minimum standards of health care in humanitarian settings, access to SRH services, and especially to contraception, is often compromised in war. Very little is known about continuation and switching of contraceptive methods in these settings. An evaluation of a contraceptive services program in North Kivu, Democratic Republic of the Congo (DRC) was conducted to measure 12-month contraceptive continuation by type of contraceptive method (short-acting or long-acting). A stratified systematic sample of women who initiated a contraceptive method 12-18 months prior to data collection was selected retrospectively from facility registers. A total of 548 women was interviewed about their contraceptive use: 304 who began a short-acting method (pills, injectables) and 244 who began a long-acting method (intra-uterine devices, implants). Key characteristics of short-acting method versus long-acting method acceptors were compared using chi-square statistics for categorical data and t-tests for continuous data. Unadjusted and adjusted Cox proportional hazard ratios were estimated to assess factors associated with discontinuation. At 12 months, 81.6% women reported using their baseline contraceptive method continuously, with more long-acting than short-acting contraceptive acceptors (86.1% versus 78.0%, p = .02) continuing contraceptive use. Use of a short-acting method (Hazard ratio (HR) 1.74 [95%CI 1.13-2.67]) and desiring a child within two years (HR 2.58 [95%CI 1.45-4.54]) were associated with discontinuation within the first 12 months of use. The vast majority (88.3%) of women reported no prior contraceptive use. This is the first study of contraceptive continuation in a humanitarian setting. The high percentages of women continuing contraceptive use found here demonstrates that women will choose to initiate and continue use of their desired contraceptive method, even in a difficult, unstable and low contraceptive prevalence setting like North Kivu.

VLBI2010: An Overview

NASA Technical Reports Server (NTRS)

Petrachenko, Bill

2010-01-01

The first concrete actions toward a next generation system for geodetic VLBI began in 2003 when the IVS initiated Working Group 3 to investigate requirements for a new system. The working group set out ambitious performance goals and sketched out initial recommendations for the system. Starting in 2006, developments continued under the leadership of the VLBI2010 Committee (V2C) in two main areas: Monte Carlo simulators were developed to evaluate proposed system changes according to their impact on IVS final products, and a proof-of-concept effort sponsored by NASA was initiated to develop next generation systems and verify the concepts behind VLBI2010. In 2009, the V2C produced a progress report that summarized the conclusions of the Monte Carlo work and outlined recommendations for the next generation system in terms of systems, analysis, operations, and network configuration. At the time of writing: two complete VLBI2010 signal paths have been completed and data is being produced; a number of VLBI2010 antenna projects are under way; and a VLBI2010 Project Executive Group (V2PEG) has been initiated to provide strategic leadership.

[Trends on generation and reproduction of knowledge about economic evaluation and health].

PubMed

Arredondo, A; Parada, I

2001-08-01

This paper identifies the trends and recent progress in the generation and reproduction of knowledge on health economic evaluation. Analysis is organized along nine public health action fields, namely: health determinants and predictors, economic value of health, healthcare demand, healthcare supply, microeconomic evaluation of healthcare, healthcare market balance, evaluation of policy instruments, general evaluation of the health system, and healthcare planning, regulation and supervision. Each action field is defined to place the reader in the proper setting and level of analysis. In addition, thematic research topics developed in each action field are proposed and discussed. The generation and reproduction of knowledge on the different action fields was based on the review of the bibliographic databases MEDLINE and LILACS for the 1992-2000 period. Results lead to the conclusion that development and application of economic evaluation of healthcare has been uneven across different countries and that there is a growing increase of applications starting in 1994, the year of initiation of healthcare reform in Latin America.

Evidence-based nursing-sensitive indicators for patients hospitalized with depression in Thailand.

PubMed

Thapinta, Darawan; Anders, Robert L; Mahatnirunkul, Suwat; Srikosai, Soontaree

2010-12-01

The aim of this study was to develop and validate nursing-sensitive indicators for patients hospitalized with depression in Thailand. The initial draft, consisting of 12 categories with 37 subcategories, was then evaluated by experts in the US and Thailand. Hospital records were then utilized to evaluate the feasibility and efficacy of the indicators. The finalized instrument consisted of 11 categories with 43 items with a validity of .98 and internal consistency of .88. This is the first set of indicators developed to evaluate nursing-sensitivity for patients hospitalized with a diagnosis of depression in Thailand. Having nursing indicators for depressed patients provides nurses with concrete tools to evaluate their work with depressed patients, allowing these staff to assess their work in a very specific, methodical, and consistent manner. When problems are discovered, both the staff and administration can work to address these issues through training, procedural changes, and departmental shifts.

Refractory Metal Heat Pipe Life Test - Test Plan and Standard Operating Procedures

NASA Technical Reports Server (NTRS)

Martin, J. J.; Reid, R. S.

2010-01-01

Refractory metal heat pipes developed during this project shall be subjected to various operating conditions to evaluate life-limiting corrosion factors. To accomplish this objective, various parameters shall be investigated, including the effect of temperature and mass fluence on long-term corrosion rate. The test series will begin with a performance test of one module to evaluate its performance and to establish the temperature and power settings for the remaining modules. The performance test will be followed by round-the-clock testing of 16 heat pipes. All heat pipes shall be nondestructively inspected at 6-month intervals. At longer intervals, specific modules will be destructively evaluated. Both the nondestructive and destructive evaluations shall be coordinated with Los Alamos National Laboratory. During the processing, setup, and testing of the heat pipes, standard operating procedures shall be developed. Initial procedures are listed here and, as hardware is developed, will be updated, incorporating findings and lessons learned.

Substance abuse intervention for health care workers: a preliminary report.

PubMed

Lapham, S C; Chang, I; Gregory, C

2000-05-01

The Workplace Managed Care Cooperative Agreement project targets 3,300 health care professionals in hospital, specialty clinic, and primary care settings located in metropolitan New Mexico communities. This project will evaluate whether enhancements to existing substance abuse prevention/early intervention programs can prevent the onset of risky drinking, reduce prevalence of risky drinking, better identify employees who abuse alcohol and drugs, and improve employee wellness. This article describes one such enhancement (Project WISE [Workplace Initiative in Substance Education]), implemented at Lovelace Health Systems. Project WISE includes relatively low-cost elements such as substance abuse awareness training, information on how to reduce drinking, and brief motivational counseling. Evaluation will consist of baseline comparisons of the intervention and comparison sites, a process evaluation, a qualitative analysis using focus groups, and an outcome evaluation using health and work records. Methodological challenges, solutions, and implications for researchers undertaking similar projects are presented.

A new UK fission yield evaluation UKFY3.7

NASA Astrophysics Data System (ADS)

Mills, Robert William

2017-09-01

The JEFF neutron induced and spontaneous fission product yield evaluation is currently unchanged from JEFF-3.1.1, also known by its UK designation UKFY3.6A. It is based upon experimental data combined with empirically fitted mass, charge and isomeric state models which are then adjusted within the experimental and model uncertainties to conform to the physical constraints of the fission process. A new evaluation has been prepared for JEFF, called UKFY3.7, that incorporates new experimental data and replaces the current empirical models (multi-Gaussian fits of mass distribution and Wahl Zp model for charge distribution combined with parameter extrapolation), with predictions from GEF. The GEF model has the advantage that one set of parameters allows the prediction of many different fissioning nuclides at different excitation energies unlike previous models where each fissioning nuclide at a specific excitation energy had to be fitted individually to the relevant experimental data. The new UKFY3.7 evaluation, submitted for testing as part of JEFF-3.3, is described alongside initial results of testing. In addition, initial ideas for future developments allowing inclusion of new measurements types and changing from any neutron spectrum type to true neutron energy dependence are discussed. Also, a method is proposed to propagate uncertainties of fission product yields based upon the experimental data that underlies the fission yield evaluation. The covariance terms being determined from the evaluated cumulative and independent yields combined with the experimental uncertainties on the cumulative yield measurements.

Maintaining evaluation designs in long term community based health promotion programmes: Heartbeat Wales case study.

PubMed Central

Nutbeam, D; Smith, C; Murphy, S; Catford, J

1993-01-01

STUDY OBJECTIVE--To examine the difficulties of developing and maintaining outcome evaluation designs in long term, community based health promotion programmes. DESIGN--Semistructured interviews of health promotion managers. SETTING--Wales and two reference health regions in England. PARTICIPANTS--Nine health promotion managers in Wales and 18 in England. MEASUREMENTS AND MAIN RESULTS--Information on selected heart health promotion activity undertaken or coordinated by health authorities from 1985-90 was collected. The Heartbeat Wales coronary heart disease prevention programme was set up in 1985, and a research and evaluation strategy was established to complement the intervention. A substantial increase in the budget occurred over the period. In the reference health regions in England this initiative was noted and rapidly taken up, thus compromising their use as control areas. CONCLUSION--Information on large scale, community based health promotion programmes can disseminate quickly and interfere with classic intervention/evaluation control designs through contamination. Alternative experimental designs for assessing the effectiveness of long term intervention programmes need to be considered. These should not rely solely on the use of reference populations, but should balance the measurement of outcome with an assessment of the process of change in communities. The development and use of intervention exposure measures together with well structured and comprehensive process evaluation in both the intervention and reference areas is recommended. PMID:8326270

Constraining biosphere CO2 flux at regional scale with WRF-CO2 4DVar assimilation system

NASA Astrophysics Data System (ADS)

Zheng, T.

2017-12-01

The WRF-CO2 4DVar assimilation system is updated to include (1) operators for tower based observations (2) chemistry initial and boundary condition in the state vector (3) mechanism for aggregation from simulation model grid to state vector space. The update system is first tested with synthetic data to ensure its accuracy. The system is then used to test regional scale CO2 inversion at MCI (Midcontinental intensive) sites where CO2 mole fraction data were collected at multiple high towers during 2007-2008. The model domain is set to center on Iowa and include 8 towers within its boundary, and it is of 12x12km horizontal grid spacing. First, the relative impacts of the initial and boundary condition are assessed by the system's adjoint model. This is done with 24, 48, 72 hour time span. Second, we assessed the impacts of the transport error, including the misrepresentation of the boundary layer and cumulus activities. Third, we evaluated the different aggregation approach from the native model grid to the control variables (including scaling factors for flux, initial and boundary conditions). Four, we assessed the inversion performance using CO2 observation with different time-interval, and from different tower levels. We also examined the appropriate treatment of the background and observation error covariance in relation with these varying observation data sets.

Incentivising innovation in antibiotic drug discovery and development: progress, challenges and next steps

PubMed Central

Simpkin, Victoria L; Renwick, Matthew J; Kelly, Ruth; Mossialos, Elias

2017-01-01

Political momentum and funding for combatting antimicrobial resistance (AMR) continues to build. Numerous major international and national initiatives aimed at financially incentivising the research and development (R&D) of antibiotics have been implemented. However, it remains unclear how to effectively strengthen the current set of incentive programmes to further accelerate antibiotic innovation. Based on a literature review and expert input, this study first identifies and assesses the major international, European Union, US and UK antibiotic R&D funding programmes. These programmes are then evaluated across market and public health criteria necessary for comprehensively improving the antibiotic market. The current set of incentive programmes are an important initial step to improving the economic feasibility of antibiotic development. However, there appears to be a lack of global coordination across all initiatives, which risks duplicating efforts, leaving funding gaps in the value chain and overlooking important AMR goals. This study finds that incentive programmes are overly committed to early-stage push funding of basic science and preclinical research, while there is limited late-stage push funding of clinical development. Moreover, there are almost no pull incentives to facilitate transition of antibiotic products from early clinical phases to commercialisation, focus developer concentration on the highest priority antibiotics and attract large pharmaceutical companies to invest in the market. Finally, it seems that antibiotic sustainability and patient access requirements are poorly integrated into the array of incentive mechanisms. PMID:29089600

Incentivising innovation in antibiotic drug discovery and development: progress, challenges and next steps.

PubMed

Simpkin, Victoria L; Renwick, Matthew J; Kelly, Ruth; Mossialos, Elias

2017-12-01

Political momentum and funding for combatting antimicrobial resistance (AMR) continues to build. Numerous major international and national initiatives aimed at financially incentivising the research and development (R&D) of antibiotics have been implemented. However, it remains unclear how to effectively strengthen the current set of incentive programmes to further accelerate antibiotic innovation. Based on a literature review and expert input, this study first identifies and assesses the major international, European Union, US and UK antibiotic R&D funding programmes. These programmes are then evaluated across market and public health criteria necessary for comprehensively improving the antibiotic market. The current set of incentive programmes are an important initial step to improving the economic feasibility of antibiotic development. However, there appears to be a lack of global coordination across all initiatives, which risks duplicating efforts, leaving funding gaps in the value chain and overlooking important AMR goals. This study finds that incentive programmes are overly committed to early-stage push funding of basic science and preclinical research, while there is limited late-stage push funding of clinical development. Moreover, there are almost no pull incentives to facilitate transition of antibiotic products from early clinical phases to commercialisation, focus developer concentration on the highest priority antibiotics and attract large pharmaceutical companies to invest in the market. Finally, it seems that antibiotic sustainability and patient access requirements are poorly integrated into the array of incentive mechanisms.

Design, implementation and scaling up of the balanced scorecard for hospitals in Lebanon: policy coherence and application lessons for low and middle income countries.

PubMed

El-Jardali, Fadi; Saleh, Shadi; Ataya, Nour; Jamal, Diana

2011-12-01

This paper describes the development and implementation of the first national hospital performance indicators in Lebanon including its institutionalization within existing policy framework and the initiation of independent governance structure for sustainability. Guided by the Ontario Acute Care Balanced Scorecard framework, a step-wise approach was used. Guiding principles were non-punitive reporting, anonymity, voluntary participation, stakeholder involvement, consensus and feasibility. Modified Delphi technique was used, readiness assessment surveys in 52 hospitals were conducted, pilot testing and evaluation were completed in 14 hospitals. Initial balanced set of 21 indicators were selected. Findings showed wide variations in indicators' measurement in hospitals including formulas and tools. Barriers to measurement included lack of quality culture, physician resistance and resources. A gradual implementation strategy was developed and selected indicators were divided into two levels. Most piloted indicators proved to be valid, feasible and reliable. The initiative was linked to the national hospital accreditation system resulting in a balanced set of 40 indicators. An independent, not-for-profit, arm's-length organization was established. This is among the first attempts made in the East Mediterranean Region to adapt the BSC approach and translate the experience of its development to addresses local needs and contextual reality. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

The 50 Most Important Questions Relating to the Maintenance and Restoration of an Ecological Continuum in the European Alps

PubMed Central

Walzer, Chris; Kowalczyk, Christine; Alexander, Jake M.; Baur, Bruno; Bogliani, Giuseppe; Brun, Jean-Jacques; Füreder, Leopold; Guth, Marie-Odile; Haller, Ruedi; Holderegger, Rolf; Kohler, Yann; Kueffer, Christoph; Righetti, Antonio; Spaar, Reto; Sutherland, William J.; Ullrich-Schneider, Aurelia; Vanpeene-Bruhier, Sylvie N.; Scheurer, Thomas

2013-01-01

The European Alps harbour a unique and species-rich biodiversity, which is increasingly impacted by habitat fragmentation through land-use changes, urbanization and expanding transport infrastructure. In this study, we identified the 50 most important questions relating to the maintenance and restoration of an ecological continuum – the connectedness of ecological processes across many scales including trophic relationship and disturbance processes and hydro-ecological flows in the European Alps. We initiated and implemented a trans-national priority setting exercise, inviting 48 institutions including researchers, conservation practitioners, NGOs, policymakers and administrators from the Alpine region. The exercise was composed of an initial call for pertinent questions, a first online evaluation of the received questions and a final discussion and selection process during a joint workshop. The participating institutions generated 484 initial questions, which were condensed to the 50 most important questions by 16 workshop participants. We suggest new approaches in tackling the issue of an ecological continuum in the Alps by analysing and classifying the characteristics of the resulting questions in a non-prioritized form as well as in a visual conceptualisation of the inter-dependencies among these questions. This priority setting exercise will support research and funding institutions in channelling their capacities and resources towards questions that need to be urgently addressed in order to facilitate significant progress in biodiversity conservation in the European Alps. PMID:23341928

Urinary bladder segmentation in CT urography using deep-learning convolutional neural network and level sets

PubMed Central

Cha, Kenny H.; Hadjiiski, Lubomir; Samala, Ravi K.; Chan, Heang-Ping; Caoili, Elaine M.; Cohan, Richard H.

2016-01-01

Purpose: The authors are developing a computerized system for bladder segmentation in CT urography (CTU) as a critical component for computer-aided detection of bladder cancer. Methods: A deep-learning convolutional neural network (DL-CNN) was trained to distinguish between the inside and the outside of the bladder using 160 000 regions of interest (ROI) from CTU images. The trained DL-CNN was used to estimate the likelihood of an ROI being inside the bladder for ROIs centered at each voxel in a CTU case, resulting in a likelihood map. Thresholding and hole-filling were applied to the map to generate the initial contour for the bladder, which was then refined by 3D and 2D level sets. The segmentation performance was evaluated using 173 cases: 81 cases in the training set (42 lesions, 21 wall thickenings, and 18 normal bladders) and 92 cases in the test set (43 lesions, 36 wall thickenings, and 13 normal bladders). The computerized segmentation accuracy using the DL likelihood map was compared to that using a likelihood map generated by Haar features and a random forest classifier, and that using our previous conjoint level set analysis and segmentation system (CLASS) without using a likelihood map. All methods were evaluated relative to the 3D hand-segmented reference contours. Results: With DL-CNN-based likelihood map and level sets, the average volume intersection ratio, average percent volume error, average absolute volume error, average minimum distance, and the Jaccard index for the test set were 81.9% ± 12.1%, 10.2% ± 16.2%, 14.0% ± 13.0%, 3.6 ± 2.0 mm, and 76.2% ± 11.8%, respectively. With the Haar-feature-based likelihood map and level sets, the corresponding values were 74.3% ± 12.7%, 13.0% ± 22.3%, 20.5% ± 15.7%, 5.7 ± 2.6 mm, and 66.7% ± 12.6%, respectively. With our previous CLASS with local contour refinement (LCR) method, the corresponding values were 78.0% ± 14.7%, 16.5% ± 16.8%, 18.2% ± 15.0%, 3.8 ± 2.3 mm, and 73.9% ± 13.5%, respectively. Conclusions: The authors demonstrated that the DL-CNN can overcome the strong boundary between two regions that have large difference in gray levels and provides a seamless mask to guide level set segmentation, which has been a problem for many gradient-based segmentation methods. Compared to our previous CLASS with LCR method, which required two user inputs to initialize the segmentation, DL-CNN with level sets achieved better segmentation performance while using a single user input. Compared to the Haar-feature-based likelihood map, the DL-CNN-based likelihood map could guide the level sets to achieve better segmentation. The results demonstrate the feasibility of our new approach of using DL-CNN in combination with level sets for segmentation of the bladder. PMID:27036584

The outcome competency framework for practitioners in infection prevention and control: use of the outcome logic model for evaluation.

PubMed

Burnett, E; Curran, E; Loveday, H P; Kiernan, M A; Tannahill, M

2014-01-01

Healthcare is delivered in a dynamic environment with frequent changes in populations, methods, equipment and settings. Infection prevention and control practitioners (IPCPs) must ensure that they are competent in addressing the challenges they face and are equipped to develop infection prevention and control (IPC) services in line with a changing world of healthcare provision. A multifaceted Framework was developed to assist IPCPs to enhance competence at an individual, team and organisational level to enable quality performance and improved quality of care. However, if these aspirations are to be met, it is vital that competency frameworks are fit for purpose or they risk being ignored. The aim of this unique study was to evaluate short and medium term outcomes as set out in the Outcome Logic Model to assist with the evaluation of the impact and success of the Framework. This study found that while the Framework is being used effectively in some areas, it is not being used as much or in the ways that were anticipated. The findings will enable future work on revision, communication and dissemination, and will provide intelligence to those initiating education and training in the utilisation of the competences.

Service impact of a national clinical leadership development programme: findings from a qualitative study.

PubMed

Fealy, Gerard M; McNamara, Martin S; Casey, Mary; O'Connor, Tom; Patton, Declan; Doyle, Louise; Quinlan, Christina

2015-04-01

The study reported here was part of a larger study, which evaluated a national clinical leadership development programme with reference to resources, participant experiences, participant outcomes and service impact. The aim of the present study was to evaluate the programme's service impact. Clinical leadership development develops competencies that are expressed in context. The outcomes of clinical leadership development occur at individual, departmental and organisational levels. The methods used to evaluate the service impact were focus groups, group interviews and individual interviews. Seventy participants provided data in 18 separate qualitative data collection events. The data contained numerous accounts of service development activities, initiated by programme participants, which improved service and/or improved the culture of the work setting. Clinical leadership development programmes that incorporate a deliberate service impact element can result in identifiable positive service outcomes. The nuanced relationship between leader development and service development warrants further investigation. This study demonstrates that clinical leadership development can impact on service in distinct and identifiable ways. Clinical leadership development programmes should focus on the setting in which the leadership competencies will be demonstrated. © 2013 John Wiley & Sons Ltd.

The outcome competency framework for practitioners in infection prevention and control: use of the outcome logic model for evaluation

PubMed Central

Curran, E; Loveday, HP; Kiernan, MA; Tannahill, M

2013-01-01

Healthcare is delivered in a dynamic environment with frequent changes in populations, methods, equipment and settings. Infection prevention and control practitioners (IPCPs) must ensure that they are competent in addressing the challenges they face and are equipped to develop infection prevention and control (IPC) services in line with a changing world of healthcare provision. A multifaceted Framework was developed to assist IPCPs to enhance competence at an individual, team and organisational level to enable quality performance and improved quality of care. However, if these aspirations are to be met, it is vital that competency frameworks are fit for purpose or they risk being ignored. The aim of this unique study was to evaluate short and medium term outcomes as set out in the Outcome Logic Model to assist with the evaluation of the impact and success of the Framework. This study found that while the Framework is being used effectively in some areas, it is not being used as much or in the ways that were anticipated. The findings will enable future work on revision, communication and dissemination, and will provide intelligence to those initiating education and training in the utilisation of the competences. PMID:28989348

ViA: a perceptual visualization assistant

NASA Astrophysics Data System (ADS)

Healey, Chris G.; St. Amant, Robert; Elhaddad, Mahmoud S.

2000-05-01

This paper describes an automated visualized assistant called ViA. ViA is designed to help users construct perceptually optical visualizations to represent, explore, and analyze large, complex, multidimensional datasets. We have approached this problem by studying what is known about the control of human visual attention. By harnessing the low-level human visual system, we can support our dual goals of rapid and accurate visualization. Perceptual guidelines that we have built using psychophysical experiments form the basis for ViA. ViA uses modified mixed-initiative planning algorithms from artificial intelligence to search of perceptually optical data attribute to visual feature mappings. Our perceptual guidelines are integrated into evaluation engines that provide evaluation weights for a given data-feature mapping, and hints on how that mapping might be improved. ViA begins by asking users a set of simple questions about their dataset and the analysis tasks they want to perform. Answers to these questions are used in combination with the evaluation engines to identify and intelligently pursue promising data-feature mappings. The result is an automatically-generated set of mappings that are perceptually salient, but that also respect the context of the dataset and users' preferences about how they want to visualize their data.

Development of the private practice management standards for psychology.

PubMed

Mathews, Rebecca; Stokes, David; Littlefield, Lyn; Collins, Leah

2011-01-01

This paper describes the process of developing a set of private practice management standards to support Australian psychologists and promote high quality services to the public. A review of the literature was conducted to identify management standards relevant to psychology, which were further developed in consultation with a panel of experts in psychology or in the development of standards. Forty-three psychologists in independent private practice took part in either a survey (n=22) to provide feedback on the relevance of, and their compliance with, the identified standards, or a 6-month pilot study (n=21) in which a web-based self-assessment instrument evaluating the final set of standards and performance indicators was implemented in their practice to investigate self-reported change in management procedures. The pilot study demonstrated good outcomes for practitioners when evaluation of compliance to the standards was operationalized in a self-assessment format. Study results are based on a small sample size. Nevertheless, relevance and utility of the standards was found providing an initial version of management standards that have relevance to the practice of psychology in Australia, along with a system for evaluating psychological service provision to ensure best practice in service delivery. © 2010 National Association for Healthcare Quality.

Agile convolutional neural network for pulmonary nodule classification using CT images.

PubMed

Zhao, Xinzhuo; Liu, Liyao; Qi, Shouliang; Teng, Yueyang; Li, Jianhua; Qian, Wei

2018-04-01

To distinguish benign from malignant pulmonary nodules using CT images is critical for their precise diagnosis and treatment. A new Agile convolutional neural network (CNN) framework is proposed to conquer the challenges of a small-scale medical image database and the small size of the nodules, and it improves the performance of pulmonary nodule classification using CT images. A hybrid CNN of LeNet and AlexNet is constructed through combining the layer settings of LeNet and the parameter settings of AlexNet. A dataset with 743 CT image nodule samples is built up based on the 1018 CT scans of LIDC to train and evaluate the Agile CNN model. Through adjusting the parameters of the kernel size, learning rate, and other factors, the effect of these parameters on the performance of the CNN model is investigated, and an optimized setting of the CNN is obtained finally. After finely optimizing the settings of the CNN, the estimation accuracy and the area under the curve can reach 0.822 and 0.877, respectively. The accuracy of the CNN is significantly dependent on the kernel size, learning rate, training batch size, dropout, and weight initializations. The best performance is achieved when the kernel size is set to [Formula: see text], the learning rate is 0.005, the batch size is 32, and dropout and Gaussian initialization are used. This competitive performance demonstrates that our proposed CNN framework and the optimization strategy of the CNN parameters are suitable for pulmonary nodule classification characterized by small medical datasets and small targets. The classification model might help diagnose and treat pulmonary nodules effectively.

Experiences from the anatomy track in the ontology alignment evaluation initiative.

PubMed

Dragisic, Zlatan; Ivanova, Valentina; Li, Huanyu; Lambrix, Patrick

2017-12-04

One of the longest running tracks in the Ontology Alignment Evaluation Initiative is the Anatomy track which focuses on aligning two anatomy ontologies. The Anatomy track was started in 2005. In 2005 and 2006 the task in this track was to align the Foundational Model of Anatomy and the OpenGalen Anatomy Model. Since 2007 the ontologies used in the track are the Adult Mouse Anatomy and a part of the NCI Thesaurus. Since 2015 the data in the Anatomy track is also used in the Interactive track of the Ontology Alignment Evaluation Initiative. In this paper we focus on the Anatomy track in the years 2007-2016 and the Anatomy part of the Interactive track in 2015-2016. We describe the data set and the changes it went through during the years as well as the challenges it poses for ontology alignment systems. Further, we give an overview of all systems that participated in the track and the techniques they have used. We discuss the performance results of the systems and summarize the general trends. About 50 systems have participated in the Anatomy track. Many different techniques were used. The most popular matching techniques are string-based strategies and structure-based techniques. Many systems also use auxiliary information. The quality of the alignment has increased for the best performing systems since the beginning of the track and more and more systems check the coherence of the proposed alignment and implement a repair strategy. Further, interacting with an oracle is beneficial.

The Project P.A.T.H.S. in Hong Kong: Work Done and Lessons Learned in a Decade.

PubMed

Shek, Daniel T L; Wu, Florence K Y

2016-02-01

The Project Positive Adolescent Training through Holistic Social Programs is a positive youth development program initiated and financially supported by The Hong Kong Jockey Club Charities Trust. Since 2005, the project has gone through several phases, including the initial phase (2005-2012), school-based extension phase (2009-2016), and community-based extension phase (2013-2017). In the initial phase, with the involvement of academics from 5 universities in Hong Kong, the research team developed youth enhancement programs for junior secondary school students (20 hours per grade), trained the program implementers (20 hours per grade), assisted in the implementation in more than 250 schools, and evaluated the program using multiple evaluation strategies, including a 5-year longitudinal experimental study. In the school-based extension phase, the project was implemented for another cycle (2009-2010 and 2011-2012 school years) and a 6-year longitudinal study was conducted to understand the psychosocial development of Chinese adolescents in Hong Kong. In the community-based extension phase, the programs were administered by social workers in the community settings. Generally speaking, different evaluation findings showed that the programs in Project Positive Adolescent Training through Holistic Social Programs promoted positive development and reduced risk behavior in Chinese adolescents in Hong Kong. Positive youth development attributes and family functioning also have positive contributions to adolescent developmental outcomes over time. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

76 FR 24031 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-29

... Intervention to Promote a Targeted Vaccination program in the Obstetrician- Gynecologist Setting, FOA IP11-009... a Targeted Vaccination Program in the Obstetrician-Gynecologist Setting; FOA IP11-009, initial...

Lessons learned using a values-engaged approach to attend to culture, diversity, and equity in a STEM program evaluation.

PubMed

Boyce, Ayesha S

2017-10-01

Evaluation must attend meaningfully and respectfully to issues of culture, race, diversity, power, and equity. This attention is especially critical within the evaluation of science, technology, engineering, and mathematics (STEM) educational programming, which has an explicit agenda of broadening participation. The purpose of this article is to report lessons learned from the implementation of a values-engaged, educative (Greene et al., 2006) evaluation within a multi-year STEM education program setting. This meta-evaluation employed a case study design using data from evaluator weekly systematic reflections, review of evaluation and program artifacts, stakeholder interviews, and peer review and assessment. The main findings from this study are (a) explicit attention to culture, diversity, and equity was initially challenged by organizational culture and under-developed evaluator-stakeholder professional relationship and (b) evidence of successful engagement of culture, diversity, and equity emerged in formal evaluation criteria and documents, and informal dialogue and discussion with stakeholders. The paper concludes with lessons learned and implications for practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improving selection of markers in nutrition research: evaluation of the criteria proposed by the ILSI Europe Marker Validation Initiative.

PubMed

Calder, Philip C; Boobis, Alan; Braun, Deborah; Champ, Claire L; Dye, Louise; Einöther, Suzanne; Greyling, Arno; Matthys, Christophe; Putz, Peter; Wopereis, Suzan; Woodside, Jayne V; Antoine, Jean-Michel

2017-06-01

The conduct of high-quality nutrition research requires the selection of appropriate markers as outcomes, for example as indicators of food or nutrient intake, nutritional status, health status or disease risk. Such selection requires detailed knowledge of the markers, and consideration of the factors that may influence their measurement, other than the effects of nutritional change. A framework to guide selection of markers within nutrition research studies would be a valuable tool for researchers. A multidisciplinary Expert Group set out to test criteria designed to aid the evaluation of candidate markers for their usefulness in nutrition research and subsequently to develop a scoring system for markers. The proposed criteria were tested using thirteen markers selected from a broad range of nutrition research fields. The result of this testing was a modified list of criteria and a template for evaluating a potential marker against the criteria. Subsequently, a semi-quantitative system for scoring a marker and an associated template were developed. This system will enable the evaluation and comparison of different candidate markers within the same field of nutrition research in order to identify their relative usefulness. The ranking criteria of proven, strong, medium or low are likely to vary according to research setting, research field and the type of tool used to assess the marker and therefore the considerations for scoring need to be determined in a setting-, field- and tool-specific manner. A database of such markers, their interpretation and range of possible values would be valuable to nutrition researchers.

Accelerating Research Impact in a Learning Health Care System

PubMed Central

Elwy, A. Rani; Sales, Anne E.; Atkins, David

2017-01-01

Background: Since 1998, the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) has supported more rapid implementation of research into clinical practice. Objectives: With the passage of the Veterans Access, Choice and Accountability Act of 2014 (Choice Act), QUERI further evolved to support VHA’s transformation into a Learning Health Care System by aligning science with clinical priority goals based on a strategic planning process and alignment of funding priorities with updated VHA priority goals in response to the Choice Act. Design: QUERI updated its strategic goals in response to independent assessments mandated by the Choice Act that recommended VHA reduce variation in care by providing a clear path to implement best practices. Specifically, QUERI updated its application process to ensure its centers (Programs) focus on cross-cutting VHA priorities and specify roadmaps for implementation of research-informed practices across different settings. QUERI also increased funding for scientific evaluations of the Choice Act and other policies in response to Commission on Care recommendations. Results: QUERI’s national network of Programs deploys effective practices using implementation strategies across different settings. QUERI Choice Act evaluations informed the law’s further implementation, setting the stage for additional rigorous national evaluations of other VHA programs and policies including community provider networks. Conclusions: Grounded in implementation science and evidence-based policy, QUERI serves as an example of how to operationalize core components of a Learning Health Care System, notably through rigorous evaluation and scientific testing of implementation strategies to ultimately reduce variation in quality and improve overall population health. PMID:27997456

Comparison of Taxi Time Prediction Performance Using Different Taxi Speed Decision Trees

NASA Technical Reports Server (NTRS)

Lee, Hanbong

2017-01-01

In the STBO modeler and tactical surface scheduler for ATD-2 project, taxi speed decision trees are used to calculate the unimpeded taxi times of flights taxiing on the airport surface. The initial taxi speed values in these decision trees did not show good prediction accuracy of taxi times. Using the more recent, reliable surveillance data, new taxi speed values in ramp area and movement area were computed. Before integrating these values into the STBO system, we performed test runs using live data from Charlotte airport, with different taxi speed settings: 1) initial taxi speed values and 2) new ones. Taxi time prediction performance was evaluated by comparing various metrics. The results show that the new taxi speed decision trees can calculate the unimpeded taxi-out times more accurately.

The role of autologous hematopoietic progenitor and cell reinfusion for intensive chemotherapy in women with poor-prognosis breast cancer. Clinical studies with ex-vivo expanded cells produced with the Aastrom Replicell technology.

PubMed

Chabannon, C; Novakovitch, G; Blache, J L; Olivero, S; Camerlo, J; Genre, D; Maraninchi, D; Viens, P

1999-04-01

In recent years, we have initiated two clinical studies, to evaluate the usefulness of ex-vivo expanded cells in patients with breast cancer who receive sequential high-dose chemotherapy. Ex-vivo expanded cells were produced from autologous cryopreserved bone marrow nucleated cells, using a biomedical device. The Aastrom Replicell system cultures cells in animal serum-replete medium, with a combination of flt3-L, PIXY321 and Epo, for 12 days. The initial pilot trial was set up to establish the feasibility and safety of the technique: 6 patients completed the study. An ongoing randomized study searches to establish whether ex-vivo expanded cells provide a clinical benefit.

[Dialectical Behavior Therapy (DBT)--developments and empirical evidence].

PubMed

Burmeister, Kerstin; Höschel, Klaus; von Auer, Anne Kristin; Reiske, Sophie; Schweiger, Ulrich; Sipos, Valerija; Philipsen, Alexandra; Priebe, Kathlen; Bohus, Martin

2014-07-01

Dialectical Behavior Therapy has been initially designed and evaluated as an outpatient-treatment program for chronic suicidal female patients. Within the last years, several adaptations of DBT for specific comorbidities, other settings or other disorders related to emotion dysregulation have been developed. This report reviews conceptual aspects and the scientific evidence of initially designed Dialectical Behavior Therapy and the adaptations. Systematic literature search and systematic review. Recently, two meta-analyses which are based on randomized controlled trials conclude robust and stabile effects of DBT Evidence from further RCTs and other studies show promise for the properties of many DBT adaptations. The current review of the literature suggests a good effectiveness of DBT, especially on complex disorders with deficits in the field of emotion regulation. © Georg Thieme Verlag KG Stuttgart · New York.

Automation of Shuttle Tile Inspection - Engineering methodology for Space Station

NASA Technical Reports Server (NTRS)

Wiskerchen, M. J.; Mollakarimi, C.

1987-01-01

The Space Systems Integration and Operations Research Applications (SIORA) Program was initiated in late 1986 as a cooperative applications research effort between Stanford University, NASA Kennedy Space Center, and Lockheed Space Operations Company. One of the major initial SIORA tasks was the application of automation and robotics technology to all aspects of the Shuttle tile processing and inspection system. This effort has adopted a systems engineering approach consisting of an integrated set of rapid prototyping testbeds in which a government/university/industry team of users, technologists, and engineers test and evaluate new concepts and technologies within the operational world of Shuttle. These integrated testbeds include speech recognition and synthesis, laser imaging inspection systems, distributed Ada programming environments, distributed relational database architectures, distributed computer network architectures, multimedia workbenches, and human factors considerations.

Drug-induced sleep endoscopy changes snoring management plan very significantly compared to standard clinical evaluation.

PubMed

Pilaete, Karen; De Medts, Joris; Delsupehe, Kathelijne Godelieve

2014-05-01

Drug-induced sleep endoscopy (DISE) is a new tool in the work-up of patients with sleep-disordered breathing (SDB). We assessed the impact of DISE on the treatment plan of snoring patients. This is a single institution prospective longitudinal clinical trial. The setting is a private teaching hospital. A consecutive series of 100 snoring patients prospectively underwent a standardised questionnaire, clinical examination, rhinomanometry, allergy skin prick testing, DISE and polysomnography. Management plan before and after DISE evaluation was compared. In 61 patients (excluding 16 patients sent for continuous positive airway pressure, three patients refused sleep endoscopy and 20 were lost to follow-up), we compared the treatment plans. DISE showed single level airway collapse in 13 and multilevel collapse in 48 patients. The site of flutter did not add additional information as compared to the pattern and the location of the collapse. After DISE, the initial management plan changed in 41% of patients irrespective of the type of initial management plan. The only somewhat accurate initial treatment plan was uvulopalatopharyngoplasty (unchanged in 11/13 patients). Excluding moderate to severe obstructive sleep apnea patients DISE is an indispensable tool in treatment decision in all SDB patients. We suggest to simplify the protocol for DISE reporting.

Distance Learning Can Be as Effective as Traditional Learning for Medical Students in the Initial Assessment of Trauma Patients.

PubMed

Farahmand, Shervin; Jalili, Ebrahim; Arbab, Mona; Sedaghat, Mojtaba; Shirazi, Mandana; Keshmiri, Fatemeh; Azizpour, Arsalan; Valadkhani, Somayeh; Bagheri-Hariri, Shahram

2016-09-01

Distance learning is expanding and replacing the traditional academic medical settings. Managing trauma patients seems to be a prerequisite skill for medical students. This study has been done to evaluate the efficiency of distance learning on performing the initial assessment and management in trauma patients, compared with the traditional learning among senior medical students. One hundred and twenty senior medical students enrolled in this single-blind quasi-experimental study and were equally divided into the experimental (distance learning) and control group (traditional learning). All participants did a written MCQ before the study. The control group attended a workshop with a 50-minute lecture on initial management of trauma patients and a case simulation scenario followed by a hands-on session. On the other hand, the experimental group was given a DVD with a similar 50-minute lecture and a case simulation scenario, and they also attended a hands-on session to practice the skills. Both groups were evaluated by a trauma station in an objective structured clinical examination (OSCE) after a month. The performance in the experimental group was statistically better (P=0.001) in OSCE. Distance learning seems to be an appropriate adjunct to traditional learning.

An open source framework for tracking and state estimation ('Stone Soup')

NASA Astrophysics Data System (ADS)

Thomas, Paul A.; Barr, Jordi; Balaji, Bhashyam; White, Kruger

2017-05-01

The ability to detect and unambiguously follow all moving entities in a state-space is important in multiple domains both in defence (e.g. air surveillance, maritime situational awareness, ground moving target indication) and the civil sphere (e.g. astronomy, biology, epidemiology, dispersion modelling). However, tracking and state estimation researchers and practitioners have difficulties recreating state-of-the-art algorithms in order to benchmark their own work. Furthermore, system developers need to assess which algorithms meet operational requirements objectively and exhaustively rather than intuitively or driven by personal favourites. We have therefore commenced the development of a collaborative initiative to create an open source framework for production, demonstration and evaluation of Tracking and State Estimation algorithms. The initiative will develop a (MIT-licensed) software platform for researchers and practitioners to test, verify and benchmark a variety of multi-sensor and multi-object state estimation algorithms. The initiative is supported by four defence laboratories, who will contribute to the development effort for the framework. The tracking and state estimation community will derive significant benefits from this work, including: access to repositories of verified and validated tracking and state estimation algorithms, a framework for the evaluation of multiple algorithms, standardisation of interfaces and access to challenging data sets. Keywords: Tracking,

Determinants of weight evolution among HIV-positive patients initiating antiretroviral treatment in low resource settings

PubMed Central

Huis in ‘t Veld, D.; Balestre, E.; Buyze, J; Menten, J.; Jaquet, A.; Cooper, D.A.; Dabis, F.; Yiannoutsos, C. T.; Diero, L.; Mutevedzi, P.; Fox, M.P.; Messou, E.; Hoffmann, C.J.; Prozesky, H.W.; Egger, M.; Hemingway-Foday, J.J.; Colebunders, R.

2015-01-01

Background In resource limited settings clinical parameters, including body weight changes, are used to monitor clinical response. Therefore we studied body weight changes in patients on antiretroviral treatment (ART) in different regions of the world. Methods Data were extracted from the “International Epidemiologic Databases to Evaluate AIDS”, a network of ART programmes that prospectively collects routine clinical data. Adults on ART from the Southern-, East-, West- and Central African and the Asia-Pacific regions were selected from the database if baseline data on body weight, gender, ART regimen and CD4 count were available. Body weight change over the first two years and the probability of body weight loss in the second year were modelled using linear mixed models and logistic regression respectively. Results Data from 205,571 patients were analysed. Mean adjusted body weight change in the first 12 months was higher in patients started on tenofovir and/or efavirenz; in patients from Central, West and East Africa, in men, and in patients with a poorer clinical status. In the second year of ART it was greater in patients initiated on tenofovir and/or nevirapine, and for patients not on stavudine, in women, in Southern Africa and in patients with a better clinical status at initiation. Stavudine in the initial regimen was associated with a lower mean adjusted body weight change and with weight loss in the second treatment year. Conclusion Different ART regimens have different effects on body weight change. Body weight loss after one year of treatment in patients on stavudine might be associated with lipoatrophy. PMID:26375465

Early Initiation of ARV During Pregnancy to Move towards Virtual Elimination of Mother-to-Child-Transmission of HIV-1 in Yunnan, China.

PubMed

Meyers, Kathrine; Qian, Haoyu; Wu, Yingfeng; Lao, Yunfei; Chen, Qingling; Dong, Xingqi; Li, Huiqin; Yang, Yiqing; Jiang, Chengqin; Zhou, Zengquan

2015-01-01

To identify factors associated with mother-to-child-transmission and late access to prevention of maternal to child transmission (PMTCT) services among HIV-infected women; and risk factors for infant mortality among HIV-exposed infants in order to assess the feasibility of virtual elimination of vertical transmission and pediatric HIV in this setting. Observational study evaluating the impact of a provincial PMTCT program. The intervention was implemented in 26 counties of Yunnan Province, China at municipal and tertiary health care settings. Log linear regression models with generalized estimating equations were used to identify unadjusted and adjusted correlates for late ARV intervention and MTCT. Cox proportional hazard models with robust sandwich estimation were applied to examine correlates of infant mortality. Mother-to-child- transmission rate of HIV was controlled to 2%, with late initiation of maternal ARV showing a strong association with vertical transmission and infant mortality. Risk factors for late initiation of maternal ARV were age, ethnicity, education, and having a husband not tested for HIV. Mortality rate among HIV-exposed infants was 2.9/100 person-years. In addition to late initiation of maternal ARV, ethnicity, low birth weight and preterm birth were associated with infant mortality. This PMTCT program in Yunnan achieved low rates of MTCT. However the infant mortality rate in this cohort of HIV-exposed children was almost three times the provincial rate. Virtual elimination of MTCT of HIV is an achievable goal in China, but more attention needs to be paid to HIV-free survival.

TRIAD: The Translational Research Informatics and Data Management Grid

PubMed Central

Payne, P.; Ervin, D.; Dhaval, R.; Borlawsky, T.; Lai, A.

2011-01-01

Objective Multi-disciplinary and multi-site biomedical research programs frequently require infrastructures capable of enabling the collection, management, analysis, and dissemination of heterogeneous, multi-dimensional, and distributed data and knowledge collections spanning organizational boundaries. We report on the design and initial deployment of an extensible biomedical informatics platform that is intended to address such requirements. Methods A common approach to distributed data, information, and knowledge management needs in the healthcare and life science settings is the deployment and use of a service-oriented architecture (SOA). Such SOA technologies provide for strongly-typed, semantically annotated, and stateful data and analytical services that can be combined into data and knowledge integration and analysis “pipelines.” Using this overall design pattern, we have implemented and evaluated an extensible SOA platform for clinical and translational science applications known as the Translational Research Informatics and Data-management grid (TRIAD). TRIAD is a derivative and extension of the caGrid middleware and has an emphasis on supporting agile “working interoperability” between data, information, and knowledge resources. Results Based upon initial verification and validation studies conducted in the context of a collection of driving clinical and translational research problems, we have been able to demonstrate that TRIAD achieves agile “working interoperability” between distributed data and knowledge sources. Conclusion Informed by our initial verification and validation studies, we believe TRIAD provides an example instance of a lightweight and readily adoptable approach to the use of SOA technologies in the clinical and translational research setting. Furthermore, our initial use cases illustrate the importance and efficacy of enabling “working interoperability” in heterogeneous biomedical environments. PMID:23616879

TRIAD: The Translational Research Informatics and Data Management Grid.

PubMed

Payne, P; Ervin, D; Dhaval, R; Borlawsky, T; Lai, A

2011-01-01

Multi-disciplinary and multi-site biomedical research programs frequently require infrastructures capable of enabling the collection, management, analysis, and dissemination of heterogeneous, multi-dimensional, and distributed data and knowledge collections spanning organizational boundaries. We report on the design and initial deployment of an extensible biomedical informatics platform that is intended to address such requirements. A common approach to distributed data, information, and knowledge management needs in the healthcare and life science settings is the deployment and use of a service-oriented architecture (SOA). Such SOA technologies provide for strongly-typed, semantically annotated, and stateful data and analytical services that can be combined into data and knowledge integration and analysis "pipelines." Using this overall design pattern, we have implemented and evaluated an extensible SOA platform for clinical and translational science applications known as the Translational Research Informatics and Data-management grid (TRIAD). TRIAD is a derivative and extension of the caGrid middleware and has an emphasis on supporting agile "working interoperability" between data, information, and knowledge resources. Based upon initial verification and validation studies conducted in the context of a collection of driving clinical and translational research problems, we have been able to demonstrate that TRIAD achieves agile "working interoperability" between distributed data and knowledge sources. Informed by our initial verification and validation studies, we believe TRIAD provides an example instance of a lightweight and readily adoptable approach to the use of SOA technologies in the clinical and translational research setting. Furthermore, our initial use cases illustrate the importance and efficacy of enabling "working interoperability" in heterogeneous biomedical environments.

Safety Profile during Initiation of Propranolol for Treatment of Infantile Hemangiomas in an Ambulatory Day-Care Hospitalization Setting.

PubMed

Fogel, Itay; Ollech, Ayelet; Zvulunov, Alex; Valdman-Greenshpon, Yulia; Atar-Sagie, Vered; Friedland, Rivka; Lapidoth, Moshe; Ben-Amitai, Dan

2018-03-24

Propranolol is the mainstay of treatment for infantile hemangioma. Despite its good safety profile, it is not risk-free. Guidelines for propranolol initiation and monitoring have been suggested, but protocols vary among practitioners. This study sought to assess the prevalence of adverse events and clinically significant fluctuations in hemodynamic parameters in children with infantile hemangioma during initiation of treatment with propranolol in a day-hospitalization setting. Children with infantile hemangioma treated with propranolol in a day-hospitalization department of a tertiary pediatric medical center in 2008-2014 were identified retrospectively. The pretreatment evaluation included clinical examination by a pediatric dermatologist and electrocardiography, echocardiography, and clinical examination by a pediatric cardiologist. The propranolol dosage was escalated from 0.5mg/kg/day to 2mg/kg/day, divided into 3 doses/day, over 3 days. Heart rate, blood pressure, and blood glucose level were measured before treatment onset and 60 min after the first two doses each day. The third dose was given at home. The cohort included 220 children aged 1 month to 5 years. No severe treatment-related adverse events were documented; 27 patients had minor side effects. There was a significant decrease in heart rate each day after the first two doses (p<0.001), and in systolic blood pressure, on day 2 (1mg/kg/day) after the first dose (p=0.01). Blood glucose level remained stable. The hemodynamic changes were clinically asymptomatic and did not require intervention. Propranolol treatment (2mg/kg/day in three doses) for infantile hemangioma is well tolerated and safe and may be administered and monitored in an ambulatory setting. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Hypnotic relaxation vs amitriptyline for tension-type headache: let the patient choose.

PubMed

Ezra, Yacov; Gotkine, Marc; Goldman, Sylvie; Adahan, Haim Moshe; Ben-Hur, Tamir

2012-05-01

Although both pharmacological and behavioral interventions may relieve tension-type headache, data are lacking regarding treatment preference, long-term patient compliance, and feasibility of behavioral intervention in a standard neurological outpatient clinic setting. To describe patient choice, long-term compliance, and clinical outcome in a neurological clinic setting where patients are given the choice of the approach they wish to pursue. Patients presenting to the headache clinic with a diagnosis of tension-type headache that justified prophylactic therapy (frequent episodic tension-type headache or chronic tension-type headache) were given the choice of amitriptyline (AMT) treatment or hypnotic relaxation (HR), and were treated accordingly. Patients were given the option to cross-over to the other treatment group at each visit. HR was performed during standard length neurology clinic appointments by a neurologist trained to perform hypnosis (Y.E.). Follow-up interviews were performed between 6 and 12 months following treatment initiation to evaluate patient compliance, changes in headache frequency or severity, and quality-of-life parameters. Ninety-eight patients were enrolled, 92 agreed to receive prophylactic therapy of some kind. Fifty-three (57.6%) patients chose HR of which 36 (67.9%) actually initiated this treatment, while 39 (42.4%) chose pharmacological therapy with AMT of which 25 (64.1%) patients actually initiated therapy. Patients with greater analgesic use were more likely to opt for AMT (P= .0002). Eleven of the patients initially choosing AMT and 2 of the patients initially choosing HR crossed over to the other group. Seventy-four percent of the patients in the HR group and 58% of patients in the AMT group had a 50% reduction in the frequency of headaches (P= .16). Long-term adherence to treatment with HR exceeded that of AMT. At the end of the study period, 26 of 47 patients who tried HR compared with 10 of 27 who tried AMT continued receiving their initial treatment. HR treatment was a more popular choice among patients. Patients choosing HR reported greater symptom relief than those choosing AMT and were found to have greater treatment compliance. Patients receiving HR were less likely to change treatments. HR practiced by a neurologist is feasible in a standard neurological outpatient clinic setting; HR training should be considered for neurologists involved in headache treatment. © 2011 American Headache Society.

Fatigue Properties of the Ultra-High Strength Steel TM210A

PubMed Central

Kang, Xia; Zhao, Gui-ping

2017-01-01

This paper presents the results of an experiment to investigate the high cycle fatigue properties of the ultra-high strength steel TM210A. A constant amplitude rotating bending fatigue experiment was performed at room temperature at stress ratio R = −1. In order to evaluate the notch effect, the fatigue experiment was carried out upon two sets of specimens, smooth and notched, respectively. In the experiment, the rotating bending fatigue life was tested using the group method, and the rotating bending fatigue limit was tested using the staircase method at 1 × 107 cycles. A double weighted least square method was then used to fit the stress-life (S–N) curve. The S–N curves of the two sets of specimens were obtained and the morphologies of the fractures of the two sets of specimens were observed with scanning electron microscopy (SEM). The results showed that the fatigue limit of the smooth specimen for rotating bending fatigue was 615 MPa; the ratio of the fatigue limit to tensile strength was 0.29, and the cracks initiated at the surface of the smooth specimen; while the fatigue limit of the notched specimen for rotating bending fatigue was 363 MPa, and the cracks initiated at the edge of the notch. The fatigue notch sensitivity index of the ultra-high strength maraging steel TM210A was 0.69. PMID:28891934

Developing a "Semi-Systematic" Approach to Using Large-Scale Data-Sets for Small-Scale Interventions: The "Baby Matterz" Initiative as a Case Study

ERIC Educational Resources Information Center

O'Brien, Mark

2011-01-01

The appropriateness of using statistical data to inform the design of any given service development or initiative often depends upon judgements regarding scale. Large-scale data sets, perhaps national in scope, whilst potentially important in informing the design, implementation and roll-out of experimental initiatives, will often remain unused…

Healthy competition drives success in results-based aid: Lessons from the Salud Mesoamérica Initiative.

PubMed

El Bcheraoui, Charbel; Palmisano, Erin B; Dansereau, Emily; Schaefer, Alexandra; Woldeab, Alexander; Moradi-Lakeh, Maziar; Salvatierra, Benito; Hernandez-Prado, Bernardo; Mokdad, Ali H

2017-01-01

The Salud Mesoamérica Initiative (SMI) is a three-operation strategy, and is a pioneer in the world of results-based aid (RBA) in terms of the success it has achieved in improving health system inputs following its initial operation. This success in meeting pre-defined targets is rare in the world of financial assistance for health. We investigated the influential aspects of SMI that could have contributed to its effectiveness in improving health systems, with the aim of providing international donors, bilateral organizations, philanthropies, and recipient countries with new perspectives that can help increase the effectiveness of future assistance for health, specifically in the arena of RBA. Qualitative methods based on the criteria of relevance and effectiveness proposed by the Development Assistance Committee of the Organization for Economic Co-operation and Development. Our methods included document review, key informant interviews, a focus group discussion, and a partnership analysis. A purposive sample of 113 key informants, comprising donors, representatives from the Inter-American Development Bank, ministries of health, technical assistance organizations, evaluation organizations, and health care providers. During May-October 2016, we interviewed regarding the relevance and effectiveness of SMI. Themes emerged relative to the topics we investigated, and covered the design and the drivers of success of the initiative. The success is due to 1) the initiative's regional approach, which pressured recipient countries to compete toward meeting targets, 2) a robust and flexible design that incorporated the richness of input from stakeholders at all levels, 3) the design-embedded evaluation component that created a culture of accountability among recipient countries, and 4) the reflective knowledge environment that created a culture of evidence-based decision-making. A regional approach involving all appropriate stakeholders, and based on knowledge sharing and embedded evaluation can help ensure the effectiveness of future results-based aid programs for health in global settings.

Tribal and Locality Dynamics in Afghanistan: A View from the National Military Academy of Afghanistan

DTIC Science & Technology

2009-01-01

CD VVV ∪= with DV countable and nCV ℜ∈ ; XInit ⊆ is a set of initial states; CXVXf →×: is a vector field, assumed to be 4 globally...DV countable and nCV ℜ∈ ; XInit ⊆ is a set of initial states; CXVXf →×: is a vector field, assumed to be globally Lipschitz in CX and...8217 ; V is a finite collection of input variables. We assume ( )CD VVV ∪= with DV countable and nCV ℜ∈ ; XInit ⊆ is a set of initial states

Evaluation of the Ethiopian Millennium Rural Initiative: Impact on Mortality and Cost-Effectiveness

PubMed Central

Curry, Leslie A.; Byam, Patrick; Linnander, Erika; Andersson, Kyeen M.; Abebe, Yigeremu; Zerihun, Abraham; Thompson, Jennifer W.; Bradley, Elizabeth H.

2013-01-01

Main Objective Few studies have examined the long-term, impact of large-scale interventions to strengthen primary care services for women and children in rural, low-income settings. We evaluated the impact of the Ethiopian Millennium Rural Initiative (EMRI), an 18-month systems-based intervention to improve the performance of 30 primary health care units in rural areas of Ethiopia. Methods We assessed the impact of EMRI on maternal and child survival using The Lives Saved Tool (LiST), Demography (DemProj) and AIDS Impact Model (AIM) tools in Spectrum software, inputting monthly data on 6 indicators 1) antenatal coverage (ANC), 2) skilled birth attendance coverage (SBA), 3) post-natal coverage (PNC), 4) HIV testing during ANC, 5) measles vaccination coverage, and 6) pentavalent 3 vaccination coverages. We calculated a cost-benefit ratio of the EMRI program including lives saved during implementation and lives saved during implementation and 5 year follow-up. Results A total of 134 lives (all children) were estimated to have been saved due to the EMRI interventions during the 18-month intervention in 30 health centers and their catchment areas, with an estimated additional 852 lives (820 children and 2 adults) saved during the 5-year post-EMRI period. For the 18-month intervention period, EMRI cost $37,313 per life saved ($42,366 per life if evaluation costs are included). Calculated over the 18-month intervention plus 5 years post-intervention, EMRI cost $5,875 per life saved ($6,671 per life if evaluation costs are included). The cost effectiveness of EMRI improves substantially if the performance achieved during the 18 months of the EMRI intervention is sustained for 5 years. Scaling up EMRI to operate for 5 years across the 4 major regions of Ethiopia could save as many as 34,908 lives. Significance A systems-based approach to improving primary care in low-income settings can have transformational impact on lives saved and be cost-effective. PMID:24260307

Practice-based research networks, part II: a descriptive analysis of the athletic training practice-based research network in the secondary school setting.

PubMed

Valovich McLeod, Tamara C; Lam, Kenneth C; Bay, R Curtis; Sauers, Eric L; Snyder Valier, Alison R

2012-01-01

Analysis of health care service models requires the collection and evaluation of basic practice characterization data. Practice-based research networks (PBRNs) provide a framework for gathering data useful in characterizing clinical practice. To describe preliminary secondary school setting practice data from the Athletic Training Practice-Based Research Network (AT-PBRN). Descriptive study. Secondary school athletic training facilities within the AT-PBRN. Clinicians (n = 22) and their patients (n = 2523) from the AT-PBRN. A Web-based survey was used to obtain data on clinical practice site and clinician characteristics. Patient and practice characteristics were obtained via deidentified electronic medical record data collected between September 1, 2009, and April 1, 2011. Descriptive data regarding the clinician and CPS practice characteristics are reported as percentages and frequencies. Descriptive analysis of patient encounters and practice characteristic data was performed, with the percentages and frequencies of the type of injuries recorded at initial evaluation, type of treatment received at initial evaluation, daily treatment, and daily sign-in procedures. The AT-PBRN had secondary school sites in 7 states, and most athletic trainers at those sites (78.2%) had less than 5 years of experience. The secondary school sites within the AT-PBRN documented 2523 patients treated across 3140 encounters. Patients most frequently sought care for a current injury (61.3%), followed by preventive services (24.0%), and new injuries (14.7%). The most common diagnoses were ankle sprain/strain (17.9%), hip sprain/strain (12.5%), concussion (12.0%), and knee pain (2.5%). The most frequent procedures were athletic trainer evaluation (53.9%), hot- or cold-pack application (26.0%), strapping (10.3%), and therapeutic exercise (5.7%). The median number of treatments per injury was 3 (interquartile range = 2, 4; range = 2-19). These preliminary data describe services provided by clinicians within the AT-PBRN and demonstrate the usefulness of the PBRN model for obtaining such data.

Study protocol: evaluation of 'JenMe', a commercially-delivered weight management program for adolescents: a randomised controlled trial.

PubMed

Dordevic, Aimee L; Bonham, Maxine P; Ware, Robert S; Brennan, Leah; Truby, Helen

2015-06-19

Early lifestyle intervention with overweight and obese adolescents could help to avoid serious health events in early adulthood, ultimately alleviating some of the strain on the public health system due to obesity-related morbidity. Commercial weight loss programs have wide reach into the community setting, and have demonstrated success in long term weight management in adults, beyond that of current public health care. Commercial weight-management programs have not been evaluated as a method of delivery for overweight and obese adolescents. This study aims to evaluate the efficacy of a new adolescent weight management program in a commercial environment. One hundred and forty adolescents, 13 to 17 years old, will be randomised to either a weight management program intervention or a wait-listed group for 12 weeks. The commercial program will consist of a combined dietary and lifestyle approach targeting improved health behaviours for weight-loss or weight-stability. Participants will be overweight or obese (above the 85(th) percentile for BMI) and without existing co-morbidities. Outcome measures will be assessed at baseline and after 12 weeks. Primary outcome measures will be changes in BMI Z-score and waist-height ratio. Secondary outcome measures will include changes in behaviour, physical activity and psychosocial wellbeing. Intervention participants will be followed up at 6 months following completion of the initial program. Ethics approval has been granted from the Monash University Human Research Ethics Committee (CF11/3687-2011001940). This independent evaluation of a weight management program for adolescents, delivered in a commercial setting, will provide initial evidence for the effectiveness of such programs; which may offer adolescents an avenue of weight-management with ongoing support prior to the development of obesity related co-morbidities. The protocol for this study is registered with the International Clinical Trials Registry ISRCTN13602313.

Leveraging Citizen Science for Healthier Food Environments: A Pilot Study to Evaluate Corner Stores in Camden, New Jersey

PubMed Central

Chrisinger, Benjamin W.; Ramos, Ana; Shaykis, Fred; Martinez, Tanya; Banchoff, Ann W.; Winter, Sandra J.; King, Abby C.

2018-01-01

Over the last 6 years, a coordinated “healthy corner store” network has helped an increasing number of local storeowners stock healthy, affordable foods in Camden, New Jersey, a city with high rates of poverty and unemployment, and where most residents have little or no access to large food retailers. The initiative’s funders and stakeholders wanted to directly engage Camden residents in evaluating this effort to increase healthy food access. In a departure from traditional survey- or focus group-based evaluations, we used an evidence-based community-engaged citizen science research model (called Our Voice) that has been deployed in a variety of neighborhood settings to assess how different features of the built environment both affect community health and wellbeing, and empower participants to create change. Employing the Our Voice model, participants documented neighborhood features in and around Camden corner stores through geo-located photos and audio narratives. Eight adult participants who lived and/or worked in a predefined neighborhood of Camden were recruited by convenience sample and visited two corner stores participating in the healthy corner store initiative (one highly-engaged in the initiative and the other less-engaged), as well as an optional third corner store of their choosing. Facilitators then helped participants use their collected data (in total, 134 images and 96 audio recordings) to identify and prioritize issues as a group, and brainstorm and advocate for potential solutions. Three priority themes were selected by participants from the full theme list (n = 9) based on perceived importance and feasibility: healthy product selection and display, store environment, and store outdoor appearance and cleanliness. Participants devised and presented a set of action steps to community leaders, and stakeholders have begun to incorporate these ideas into plans for the future of the healthy corner store network. Key elements of healthy corner stores were identified as positive, and other priorities, such as improvements to safety, exterior facades, and physical accessibility, may find common ground with other community development initiatives in Camden. Ultimately, this pilot study demonstrated the potential of citizen science to provide a systematic and data-driven process for public health stakeholders to authentically engage community residents in program evaluation. PMID:29632857

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

Piette, Mary Ann; Sezgen, Osman; Watson, David S.

This report describes the results of a research project to develop and evaluate the performance of new Automated Demand Response (Auto-DR) hardware and software technology in large facilities. Demand Response (DR) is a set of activities to reduce or shift electricity use to improve electric grid reliability, manage electricity costs, and ensure that customers receive signals that encourage load reduction during times when the electric grid is near its capacity. The two main drivers for widespread demand responsiveness are the prevention of future electricity crises and the reduction of electricity prices. Additional goals for price responsiveness include equity through costmore » of service pricing, and customer control of electricity usage and bills. The technology developed and evaluated in this report could be used to support numerous forms of DR programs and tariffs. For the purpose of this report, we have defined three levels of Demand Response automation. Manual Demand Response involves manually turning off lights or equipment; this can be a labor-intensive approach. Semi-Automated Response involves the use of building energy management control systems for load shedding, where a preprogrammed load shedding strategy is initiated by facilities staff. Fully-Automated Demand Response is initiated at a building or facility through receipt of an external communications signal--facility staff set up a pre-programmed load shedding strategy which is automatically initiated by the system without the need for human intervention. We have defined this approach to be Auto-DR. An important concept in Auto-DR is that a facility manager is able to ''opt out'' or ''override'' an individual DR event if it occurs at a time when the reduction in end-use services is not desirable. This project sought to improve the feasibility and nature of Auto-DR strategies in large facilities. The research focused on technology development, testing, characterization, and evaluation relating to Auto-DR. This evaluation also included the related decisionmaking perspectives of the facility owners and managers. Another goal of this project was to develop and test a real-time signal for automated demand response that provided a common communication infrastructure for diverse facilities. The six facilities recruited for this project were selected from the facilities that received CEC funds for new DR technology during California's 2000-2001 electricity crises (AB970 and SB-5X).« less

A Report of the Efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative.

PubMed

Kelly, Allison A; Jones, Makoto M; Echevarria, Kelly L; Kralovic, Stephen M; Samore, Matthew H; Goetz, Matthew B; Madaras-Kelly, Karl J; Simbartl, Loretta A; Morreale, Anthony P; Neuhauser, Melinda M; Roselle, Gary A

2017-05-01

OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513-520.

Nest initiation in three North American bumble bees (Bombus): gyne number and presence of honey bee workers influence establishment success and colony size.

PubMed

Strange, James P

2010-01-01

Three species of bumble bees, Bombus appositus Cresson, Bombus bifarius, Cresson and Bombus centralis Cresson (Hymenoptera: Apidae) were evaluated for nest initiation success under three sets of initial conditions. In the spring, gynes of each species were caught in the wild and introduced to nest boxes in one of three ways. Gynes were either introduced in conspecific pairs, singly with two honey bees, Apis mellifera L. (Hymenoptera: Apidae) workers, or alone. Nesting success and colony growth parameters were measured to understand the effects of the various treatments on nest establishment. Colonies initiated from pairs of conspecific gynes were most successful in producing worker bees (59.1%), less successful were colonies initiated with honey bee workers (33.3%), and least successful were bumble bee gynes initiating colonies alone (16.7%). There was a negative correlation between the numbers of days to the emergence of the first worker in a colony to the attainment of ultimate colony size, indicating that gynes that have not commenced oviposition in 21 days are unlikely to result in colonies exceeding 50 workers. B. appositus had the highest rate of nest establishment followed by B. bifarius and B. centralis. Nest establishment rates in three western bumble bee species can be increased dramatically by the addition of either honey bee workers or a second gyne to nesting boxes at colony initiation.

Individual Differences in the Cortisol Responses of Neglected and Comparison Children

PubMed Central

Sullivan, Margaret Wolan; Bennett, David S.; Lewis, Michael

2014-01-01

Neglected children’s acute hypothalamic–pituitary–adrenal axis (HPA axis) reactivity in response to a laboratory visit was contrasted with that of a comparison group. The authors examined initial salivary cortisol response upon entering the laboratory and its trajectory following a set of tasks designed to elicit negative self-evaluation in 64 children (30 with a history of neglect and 34 demographically matched comparison children). Neglected, but not comparison, children showed higher initial cortisol responses. The cortisol response of both groups showed a decline from the sample taken at lab entry, with neglected children’s cortisol exhibiting steeper decline. The groups, however, did not differ in their mean cortisol levels at 20 and 35 min post-task. The results are interpreted in terms of the meaning of initial responses as a “baseline” and as evidence for neglected children’s heightened HPA-axis reactivity as either a reflection of differences in home levels or the consequence of stress/anxiety associated with arrival at the laboratory. PMID:22752003

Individual differences in the cortisol responses of neglected and comparison children.

PubMed

Sullivan, Margaret Wolan; Bennett, David S; Lewis, Michael

2013-02-01

Neglected children's acute hypothalamic-pituitary-adrenal axis (HPA axis) reactivity in response to a laboratory visit was contrasted with that of a comparison group. The authors examined initial salivary cortisol response upon entering the laboratory and its trajectory following a set of tasks designed to elicit negative self-evaluation in 64 children (30 with a history of neglect and 34 demographically matched comparison children). Neglected, but not comparison, children showed higher initial cortisol responses. The cortisol response of both groups showed a decline from the sample taken at lab entry, with neglected children's cortisol exhibiting steeper decline. The groups, however, did not differ in their mean cortisol levels at 20 and 35 min post-task. The results are interpreted in terms of the meaning of initial responses as a "baseline" and as evidence for neglected children's heightened HPA-axis reactivity as either a reflection of differences in home levels or the consequence of stress/anxiety associated with arrival at the laboratory.

Human Exploration Framework Team: Strategy and Status

NASA Technical Reports Server (NTRS)

Muirhead, Brian K.; Sherwood, Brent; Olson, John

2011-01-01

Human Exploration Framework Team (HEFT) was formulated to create a decision framework for human space exploration that drives out the knowledge, capabilities and infrastructure NASA needs to send people to explore multiple destinations in the Solar System in an efficient, sustainable way. The specific goal is to generate an initial architecture that can evolve into a long term, enterprise-wide architecture that is the basis for a robust human space flight enterprise. This paper will discuss the initial HEFT activity which focused on starting up the cross-agency team, getting it functioning, developing a comprehensive development and analysis process and conducting multiple iterations of the process. The outcome of this process will be discussed including initial analysis of capabilities and missions for at least two decades, keeping Mars as the ultimate destination. Details are provided on strategies that span a broad technical and programmatic trade space, are analyzed against design reference missions and evaluated against a broad set of figures of merit including affordability, operational complexity, and technical and programmatic risk.

Influencing organisational change in the NHS: lessons learned from workplace wellness initiatives in practice.

PubMed

Blake, Holly; Lloyd, Scott

2008-01-01

This article presents a discussion of the key issues in influencing organisational change in NHS settings, in the development of workplace wellness interventions to improve employee health and wellbeing. To tackle poor public health and associated rising healthcare costs, there must be a focus on the root cause of many preventable diseases - unhealthy lifestyle choices. Workplace wellness initiatives are now an important prevention strategy adopted by socially responsible organisations to target the health and wellbeing of working age adults. Lessons learned from initiatives in secondary care suggest that effective implementation requires change in organisational 'health culture', through a combination of education, behaviour change intervention, needs-based facilities, and services and strategies for developing supportive and health-promoting work environments. Most of all, employers must demonstrate a commitment to health and wellness that is fully integrated with their mission, values and long-term vision, paving the way for sustainable lifestyle changes. Evaluation systems must be in place to measure the impact and outcomes of wellness schemes.

Variable frequency iteration MPPT for resonant power converters

DOEpatents

Zhang, Qian; Bataresh, Issa; Chen, Lin

2015-06-30

A method of maximum power point tracking (MPPT) uses an MPPT algorithm to determine a switching frequency for a resonant power converter, including initializing by setting an initial boundary frequency range that is divided into initial frequency sub-ranges bounded by initial frequencies including an initial center frequency and first and second initial bounding frequencies. A first iteration includes measuring initial powers at the initial frequencies to determine a maximum power initial frequency that is used to set a first reduced frequency search range centered or bounded by the maximum power initial frequency including at least a first additional bounding frequency. A second iteration includes calculating first and second center frequencies by averaging adjacent frequent values in the first reduced frequency search range and measuring second power values at the first and second center frequencies. The switching frequency is determined from measured power values including the second power values.

Sampling-based ensemble segmentation against inter-operator variability

NASA Astrophysics Data System (ADS)

Huo, Jing; Okada, Kazunori; Pope, Whitney; Brown, Matthew

2011-03-01

Inconsistency and a lack of reproducibility are commonly associated with semi-automated segmentation methods. In this study, we developed an ensemble approach to improve reproducibility and applied it to glioblastoma multiforme (GBM) brain tumor segmentation on T1-weigted contrast enhanced MR volumes. The proposed approach combines samplingbased simulations and ensemble segmentation into a single framework; it generates a set of segmentations by perturbing user initialization and user-specified internal parameters, then fuses the set of segmentations into a single consensus result. Three combination algorithms were applied: majority voting, averaging and expectation-maximization (EM). The reproducibility of the proposed framework was evaluated by a controlled experiment on 16 tumor cases from a multicenter drug trial. The ensemble framework had significantly better reproducibility than the individual base Otsu thresholding method (p<.001).

Development of an Alert System to Detect Drug Interactions with Herbal Supplements using Medical Record Data.

PubMed

Archer, Melissa; Proulx, Joshua; Shane-McWhorter, Laura; Bray, Bruce E; Zeng-Treitler, Qing

2014-01-01

While potential medication-to-medication interaction alerting engines exist in many clinical applications, few systems exist to automatically alert on potential medication to herbal supplement interactions. We have developed a preliminary knowledge base and rules alerting engine that detects 259 potential interactions between 9 supplements, 62 cardiac medications, and 19 drug classes. The rules engine takes into consideration 12 patient risk factors and 30 interaction warning signs to help determine which of three different alert levels to categorize each potential interaction. A formative evaluation was conducted with two clinicians to set initial thresholds for each alert level. Additional work is planned add more supplement interactions, risk factors, and warning signs as well as to continue to set and adjust the inputs and thresholds for each potential interaction.

INITIAL ASSESSMENT OF EMISSIONS FROM HEAT SETTING CARPET YARN

EPA Science Inventory

The report gives initial results of a project to determine the nature of emissions resulting from the heat setting of carpet yarn and to identify possible control options. To collect the necessary technical information, two manufacturing facilities were visited: World Carpets in ...

Spatial Patterns of Geomorphic Surface Features and Fault Morphology Based on Diffusion Equation Modeling of the Kumroch Fault Kamchatka Peninsula, Russia

NASA Astrophysics Data System (ADS)

Heinlein, S. N.

2013-12-01

Remote sensing data sets are widely used for evaluation of surface manifestations of active tectonics. This study utilizes ASTER GDEM and Landsat ETM+ data sets with Google Earth images draped over terrain models. This study evaluates 1) the surrounding surface geomorphology of the study area with these data sets and 2) the morphology of the Kumroch Fault using diffusion modeling to estimate constant diffusivity (κ) and estimate slip rates by means of real ground data measured across fault scarps by Kozhurin et al. (2006). Models of the evolution of fault scarp morphology provide time elapsed since slip initiated on a faults surface and may therefore provide more accurate estimates of slip rate than the rate calculated by dividing scarp offset by the age of the ruptured surface. Profile modeling of scarps collected by Kozhurin et al. (2006) formed by several events distributed through time and were evaluated using a constant slip rate (CSR) solution which yields a value A/κ (1/2 slip rate/diffusivity). Time elapsed since slip initiated on the fault is determined by establishing a value for κ and measuring total scarp offset. CSR nonlinear modeling estimated of κ range from 8m2/ka - 14m2/ka on the Kumroch Fault which indicates a slip rates of 0.6 mm/yr - 1.0 mm/yr since 3.4 ka -3.7 ka. This method provides a quick and inexpensive way to gather data for a regional tectonic study and establish estimated rates of tectonic activity. Analyses of the remote sensing data are providing new insight into the role of active tectonics within the region. Results from fault scarp diffusion models of Mattson and Bruhn (2001) and DuRoss and Bruhn (2004) and Kozhurin et al. (2006), Kozhurin (2007), Kozhurin et al. (2008) and Pinegina et al. 2012 trench profiles of the KF as calibrated age fault scarp diffusion rates were estimated. (-) mean that no data could be determined.

Accuracy of microRNAs as markers for the detection of neck lymph node metastases in patients with head and neck squamous cell carcinoma.

PubMed

de Carvalho, Ana Carolina; Scapulatempo-Neto, Cristovam; Maia, Danielle Calheiros Campelo; Evangelista, Adriane Feijó; Morini, Mariana Andozia; Carvalho, André Lopes; Vettore, André Luiz

2015-05-09

The presence of metastatic disease in cervical lymph nodes of head and neck squamous cell carcinoma (HNSCC) patients is a very important determinant in therapy choice and prognosis, with great impact in overall survival. Frequently, routine lymph node staging cannot detect occult metastases and the post-surgical histologic evaluation of resected lymph nodes is not sensitive in detecting small metastatic deposits. Molecular markers based on tissue-specific microRNA expression are alternative accurate diagnostic markers. Herein, we evaluated the feasibility of using the expression of microRNAs to detect metastatic cells in formalin-fixed paraffin-embedded (FFPE) lymph nodes and in fine-needle aspiration (FNA) biopsies of HNSCC patients. An initial screening compared the expression of 667 microRNAs in a discovery set comprised by metastatic and non-metastatic lymph nodes from HNSCC patients. The most differentially expressed microRNAs were validated by qRT-PCR in two independent cohorts: i) 48 FFPE lymph node samples, and ii) 113 FNA lymph node biopsies. The accuracy of the markers in identifying metastatic samples was assessed through the analysis of sensitivity, specificity, accuracy, negative predictive value, positive predictive value, and area under the curve values. Seven microRNAs highly expressed in metastatic lymph nodes from the discovery set were validated in FFPE lymph node samples. MiR-203 and miR-205 identified all metastatic samples, regardless of the size of the metastatic deposit. Additionally, these markers also showed high accuracy when FNA samples were examined. The high accuracy of miR-203 and miR-205 warrant these microRNAs as diagnostic markers of neck metastases in HNSCC. These can be evaluated in entire lymph nodes and in FNA biopsies collected at different time-points such as pre-treatment samples, intraoperative sentinel node biopsy, and during patient follow-up. These markers can be useful in a clinical setting in the management of HNSCC patients from initial disease staging and therapy planning to patient surveillance.

SU-E-T-27: A Dosimetric Evaluation of Boney Anatomy Versus Fiducial Marker Alignment for the Treatment of Prostate Cancer Using Scanned Beam Proton Therapy

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

Freund, D; Ding, X; Zhang, J

Purpose: In prostate proton radiotherapy, three fiducial markers are used for patient daily alignment. However fiducial alignment can change beamline heterogeneity in proton therapy. The purpose of this study is to determine the difference in fiducial and boney anatomy alignment for patient treatment. Methods and materials: Prostate cancer patients who received proton treatment were included in this study. 3 fiducial markers were implanted before the initial CT. All the patients were re-CT’d every 2 weeks to check the fiducial marker position reproducibility as well as dosimetric consistence of target coverage. In geometry study, re-CT were fused to the initial CTmore » base on the boney anatomy and the average fiducial marker displacement was measured the centers of the fiducials. Dosimetrically, the initial plan was recalculated directly to re-CT image set based on the boney alignment and fiducial alignment to determine the difference from daily treatment. Prostate coverage and hotspots were evaluated using the dose to 98% of the CTV (D98) and dose to 2% (D2), respectively. Results: The shift from the initial 6 patient CT image sets resulted in an average change in the fiducial location of 5.70 +/− 3 mm. Dosimetric comparison from a single patient revealed that differences from the planned dose resulted from both boney and fiducial alignment. Planned clinical treatment volume coverage resulted in a D98 of 70.44Gy and D2 of 70.84Gy compared to a D98 of 70.13Gy and D2 70.94Gy for boney alignment and a D98 of 70.08Gy and D2 71.18Gy for fiducial alignment respectively. Conclusion: This study demonstrates that with boney anatomy alignment there is little change to CTV coverage and only slightly worse CTV coverage and hotspot production with fiducial alignment. An increase patient cohort and further investigation is necessary to determine the whether boney alignment can help better control dose heterogeneity.« less

Salud Mesoamérica 2015 Initiative: design, implementation, and baseline findings.

PubMed

Mokdad, Ali H; Colson, Katherine Ellicott; Zúñiga-Brenes, Paola; Ríos-Zertuche, Diego; Palmisano, Erin B; Alfaro-Porras, Eyleen; Anderson, Brent W; Borgo, Marco; Desai, Sima; Gagnier, Marielle C; Gillespie, Catherine W; Giron, Sandra L; Haakenstad, Annie; Romero, Sonia López; Mateus, Julio; McKay, Abigail; Mokdad, Ali A; Murphy, Tasha; Naghavi, Paria; Nelson, Jennifer; Orozco, Miguel; Ranganathan, Dharani; Salvatierra, Benito; Schaefer, Alexandra; Usmanova, Gulnoza; Varela, Alejandro; Wilson, Shelley; Wulf, Sarah; Hernandez, Bernardo; Lozano, Rafael; Iriarte, Emma; Regalia, Ferdinando

2015-01-01

Health has improved markedly in Mesoamerica, the region consisting of southern Mexico and Central America, over the past decade. Despite this progress, there remain substantial inequalities in health outcomes, access, and quality of medical care between and within countries. Poor, indigenous, and rural populations have considerably worse health indicators than national or regional averages. In an effort to address these health inequalities, the Salud Mesoamérica 2015 Initiative (SM2015), a results-based financing initiative, was established. For each of the eight participating countries, health targets were set to measure the progress of improvements in maternal and child health produced by the Initiative. To establish a baseline, we conducted censuses of 90,000 households, completed 20,225 household interviews, and surveyed 479 health facilities in the poorest areas of Mesoamerica. Pairing health facility and household surveys allows us to link barriers to care and health outcomes with health system infrastructure components and quality of health services. Indicators varied significantly within and between countries. Anemia was most prevalent in Panama and least prevalent in Honduras. Anemia varied by age, with the highest levels observed among children aged 0 to 11 months in all settings. Belize had the highest proportion of institutional deliveries (99%), while Guatemala had the lowest (24%). The proportion of women with four antenatal care visits with a skilled attendant was highest in El Salvador (90%) and the lowest in Guatemala (20%). Availability of contraceptives also varied. The availability of condoms ranged from 83% in Nicaragua to 97% in Honduras. Oral contraceptive pills and injectable contraceptives were available in just 75% of facilities in Panama. IUDs were observed in only 21.5% of facilities surveyed in El Salvador. These data provide a baseline of much-needed information for evidence-based action on health throughout Mesoamerica. Our baseline estimates reflect large disparities in health indicators within and between countries and will facilitate the evaluation of interventions and investments deployed in the region over the next three to five years. SM2015's innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need.

The effect of real-time CPR feedback and post event debriefing on patient and processes focused outcomes: a cohort study: trial protocol.

PubMed

Perkins, Gavin D; Davies, Robin P; Quinton, Sarah; Woolley, Sarah; Gao, Fang; Abella, Ben; Stallard, Nigel; Cooke, Matthew W

2011-10-18

Cardiac arrest affects 30-35, 000 hospitalised patients in the UK every year. For these patients to be given the best chance of survival, high quality cardiopulmonary resuscitation (CPR) must be delivered, however the quality of CPR in real-life is often suboptimal. CPR feedback devices have been shown to improve CPR quality in the pre-hospital setting and post-event debriefing can improve adherence to guidelines and CPR quality. However, the evidence for use of these improvement methods in hospital remains unclear. The CPR quality improvement initiative is a prospective cohort study of the Q-CPR real-time feedback device combined with post-event debriefing in hospitalised adult patients who sustain a cardiac arrest. The primary objective of this trial is to assess whether a CPR quality improvement initiative will improve rate of return of sustained spontaneous circulation in in-hospital-cardiac-arrest patients. The study is set in one NHS trust operating three hospital sites. Secondary objectives will evaluate: any return of spontaneous circulation; survival to hospital discharge and patient cerebral performance category at discharge; quality of CPR variables and cardiac arrest team factors. All three sites will have an initial control phase before any improvements are implemented; site 1 will implement audiovisual feedback combined with post event debriefing, site 2 will implement audiovisual feedback only and site 3 will remain as a control site to measure any changes in outcome due to any other trust-wide changes in resuscitation practice. All adult patients sustaining a cardiac arrest and receiving resuscitation from the hospital cardiac arrest team will be included. Patients will be excluded if; they have a Do-not-attempt resuscitation order written and documented in their medical records, the cardiac arrest is not attended by a resuscitation team, the arrest occurs out-of-hospital or the patient has previously participated in this study. The trial will recruit a total of 912 patients from the three hospital sites. This trial will evaluate patient and process focussed outcomes following the implementation of a CPR quality improvement initiative using real-time audiovisual feedback and post event debriefing. ISRCTN56583860.

Online Magnetic Resonance Image Guided Adaptive Radiation Therapy: First Clinical Applications

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

Acharya, Sahaja; Fischer-Valuck, Benjamin W.; Kashani, Rojano

Purpose: To demonstrate the feasibility of online adaptive magnetic resonance (MR) image guided radiation therapy (MR-IGRT) through reporting of our initial clinical experience and workflow considerations. Methods and Materials: The first clinically deployed online adaptive MR-IGRT system consisted of a split 0.35T MR scanner straddling a ring gantry with 3 multileaf collimator-equipped {sup 60}Co heads. The unit is supported by a Monte Carlo–based treatment planning system that allows real-time adaptive planning with the patient on the table. All patients undergo computed tomography and MR imaging (MRI) simulation for initial treatment planning. A volumetric MRI scan is acquired for each patient atmore » the daily treatment setup. Deformable registration is performed using the planning computed tomography data set, which allows for the transfer of the initial contours and the electron density map to the daily MRI scan. The deformed electron density map is then used to recalculate the original plan on the daily MRI scan for physician evaluation. Recontouring and plan reoptimization are performed when required, and patient-specific quality assurance (QA) is performed using an independent in-house software system. Results: The first online adaptive MR-IGRT treatments consisted of 5 patients with abdominopelvic malignancies. The clinical setting included neoadjuvant colorectal (n=3), unresectable gastric (n=1), and unresectable pheochromocytoma (n=1). Recontouring and reoptimization were deemed necessary for 3 of 5 patients, and the initial plan was deemed sufficient for 2 of the 5 patients. The reasons for plan adaptation included tumor progression or regression and a change in small bowel anatomy. In a subsequently expanded cohort of 170 fractions (20 patients), 52 fractions (30.6%) were reoptimized online, and 92 fractions (54.1%) were treated with an online-adapted or previously adapted plan. The median time for recontouring, reoptimization, and QA was 26 minutes. Conclusion: Online adaptive MR-IGRT has been successfully implemented with planning and QA workflow suitable for routine clinical application. Clinical trials are in development to formally evaluate adaptive treatments for a variety of disease sites.« less

Daniel K. Inouye Solar Telescope: computational fluid dynamic analyses and evaluation of the air knife model

NASA Astrophysics Data System (ADS)

McQuillen, Isaac; Phelps, LeEllen; Warner, Mark; Hubbard, Robert

2016-08-01

Implementation of an air curtain at the thermal boundary between conditioned and ambient spaces allows for observation over wavelength ranges not practical when using optical glass as a window. The air knife model of the Daniel K. Inouye Solar Telescope (DKIST) project, a 4-meter solar observatory that will be built on Haleakalā, Hawai'i, deploys such an air curtain while also supplying ventilation through the ceiling of the coudé laboratory. The findings of computational fluid dynamics (CFD) analysis and subsequent changes to the air knife model are presented. Major design constraints include adherence to the Interface Control Document (ICD), separation of ambient and conditioned air, unidirectional outflow into the coudé laboratory, integration of a deployable glass window, and maintenance and accessibility requirements. Optimized design of the air knife successfully holds full 12 Pa backpressure under temperature gradients of up to 20°C while maintaining unidirectional outflow. This is a significant improvement upon the .25 Pa pressure differential that the initial configuration, tested by Linden and Phelps, indicated the curtain could hold. CFD post- processing, developed by Vogiatzis, is validated against interferometry results of initial air knife seeing evaluation, performed by Hubbard and Schoening. This is done by developing a CFD simulation of the initial experiment and using Vogiatzis' method to calculate error introduced along the optical path. Seeing error, for both temperature differentials tested in the initial experiment, match well with seeing results obtained from the CFD analysis and thus validate the post-processing model. Application of this model to the realizable air knife assembly yields seeing errors that are well within the error budget under which the air knife interface falls, even with a temperature differential of 20°C between laboratory and ambient spaces. With ambient temperature set to 0°C and conditioned temperature set to 20°C, representing the worst-case temperature gradient, the spatial rms wavefront error in units of wavelength is 0.178 (88.69 nm at λ = 500 nm).

Cost analysis of large-scale implementation of the 'Helping Babies Breathe' newborn resuscitation-training program in Tanzania.

PubMed

Chaudhury, Sumona; Arlington, Lauren; Brenan, Shelby; Kairuki, Allan Kaijunga; Meda, Amunga Robson; Isangula, Kahabi G; Mponzi, Victor; Bishanga, Dunstan; Thomas, Erica; Msemo, Georgina; Azayo, Mary; Molinier, Alice; Nelson, Brett D

2016-12-01

Helping Babies Breathe (HBB) has become the gold standard globally for training birth-attendants in neonatal resuscitation in low-resource settings in efforts to reduce early newborn asphyxia and mortality. The purpose of this study was to do a first-ever activity-based cost-analysis of at-scale HBB program implementation and initial follow-up in a large region of Tanzania and evaluate costs of national scale-up as one component of a multi-method external evaluation of the implementation of HBB at scale in Tanzania. We used activity-based costing to examine budget expense data during the two-month implementation and follow-up of HBB in one of the target regions. Activity-cost centers included administrative, initial training (including resuscitation equipment), and follow-up training expenses. Sensitivity analysis was utilized to project cost scenarios incurred to achieve countrywide expansion of the program across all mainland regions of Tanzania and to model costs of program maintenance over one and five years following initiation. Total costs for the Mbeya Region were $202,240, with the highest proportion due to initial training and equipment (45.2%), followed by central program administration (37.2%), and follow-up visits (17.6%). Within Mbeya, 49 training sessions were undertaken, involving the training of 1,341 health providers from 336 health facilities in eight districts. To similarly expand the HBB program across the 25 regions of mainland Tanzania, the total economic cost is projected to be around $4,000,000 (around $600 per facility). Following sensitivity analyses, the estimated total for all Tanzania initial rollout lies between $2,934,793 to $4,309,595. In order to maintain the program nationally under the current model, it is estimated it would cost $2,019,115 for a further one year and $5,640,794 for a further five years of ongoing program support. HBB implementation is a relatively low-cost intervention with potential for high impact on perinatal mortality in resource-poor settings. It is shown here that nationwide expansion of this program across the range of health provision levels and regions of Tanzania would be feasible. This study provides policymakers and investors with the relevant cost-estimation for national rollout of this potentially neonatal life-saving intervention.

Automatic concept extraction from spoken medical reports.

PubMed

Happe, André; Pouliquen, Bruno; Burgun, Anita; Cuggia, Marc; Le Beux, Pierre

2003-07-01

The objective of this project is to investigate methods whereby a combination of speech recognition and automated indexing methods substitute for current transcription and indexing practices. We based our study on existing speech recognition software programs and on NOMINDEX, a tool that extracts MeSH concepts from medical text in natural language and that is mainly based on a French medical lexicon and on the UMLS. For each document, the process consists of three steps: (1) dictation and digital audio recording, (2) speech recognition, (3) automatic indexing. The evaluation consisted of a comparison between the set of concepts extracted by NOMINDEX after the speech recognition phase and the set of keywords manually extracted from the initial document. The method was evaluated on a set of 28 patient discharge summaries extracted from the MENELAS corpus in French, corresponding to in-patients admitted for coronarography. The overall precision was 73% and the overall recall was 90%. Indexing errors were mainly due to word sense ambiguity and abbreviations. A specific issue was the fact that the standard French translation of MeSH terms lacks diacritics. A preliminary evaluation of speech recognition tools showed that the rate of accurate recognition was higher than 98%. Only 3% of the indexing errors were generated by inadequate speech recognition. We discuss several areas to focus on to improve this prototype. However, the very low rate of indexing errors due to speech recognition errors highlights the potential benefits of combining speech recognition techniques and automatic indexing.

Advancing Resident Assessment in Graduate Medical Education

PubMed Central

Swing, Susan R.; Clyman, Stephen G.; Holmboe, Eric S.; Williams, Reed G.

2009-01-01

Background The Outcome Project requires high-quality assessment approaches to provide reliable and valid judgments of the attainment of competencies deemed important for physician practice. Intervention The Accreditation Council for Graduate Medical Education (ACGME) convened the Advisory Committee on Educational Outcome Assessment in 2007–2008 to identify high-quality assessment methods. The assessments selected by this body would form a core set that could be used by all programs in a specialty to assess resident performance and enable initial steps toward establishing national specialty databases of program performance. The committee identified a small set of methods for provisional use and further evaluation. It also developed frameworks and processes to support the ongoing evaluation of methods and the longer-term enhancement of assessment in graduate medical education. Outcome The committee constructed a set of standards, a methodology for applying the standards, and grading rules for their review of assessment method quality. It developed a simple report card for displaying grades on each standard and an overall grade for each method reviewed. It also described an assessment system of factors that influence assessment quality. The committee proposed a coordinated, national-level infrastructure to support enhancements to assessment, including method development and assessor training. It recommended the establishment of a new assessment review group to continue its work of evaluating assessment methods. The committee delivered a report summarizing its activities and 5 related recommendations for implementation to the ACGME Board in September 2008. PMID:21975993

Interrater reliability of the Korean version of the International Spinal Cord Injury Basic Pain Data Set.

PubMed

Kim, H R; Kim, H B; Lee, B S; Ko, H Y; Shin, H I

2014-11-01

To provide a Korean translation of the International Spinal Cord Injury Basic Pain Data Set (ISCIBPDS) and evaluate the interrater reliability of the translated version. Survey of community-dwelling people with spinal cord injury (SCI) in South Korea. The initial translation was performed by two translators with an in-depth knowledge of SCI, and was then checked by another person with a similar background. A total of 115 SCI participants (87 men, 28 women; 48.4±14.1 years) were evaluated using the Korean version of the ISCIBPDS by two different raters. Intraclass correlation coefficient (ICC) or Cohen's kappa (κ) was used for analysis. All 115 participants had at least one pain problem on both surveys. Seventeen (14.8%) participants described their pain as a single pain problem to one rater while reporting the same pain as two or more different pain problems to the other rater. Twenty-two (19.1%) other participants reported their pain problems in a different order of severity on the surveys. The Korean version of the ISCIBPDS had acceptable interrater reliability, except in the 'limit activities (how much do you limit your activities in order to keep your pain from getting worse?)' item (ICC=0.318). Provision of criteria for pain separation may facilitate the consistent application of ISCIBPDS. In addition, the ISCIBPDS, which evaluated pain problems separately, reflected the multiple and complex characteristics of SCI-related pain; this was a strength of this data set.

Development and psychometric evaluation of the Impact of Health Information Technology (I-HIT) scale.

PubMed

Dykes, Patricia C; Hurley, Ann; Cashen, Margaret; Bakken, Suzanne; Duffy, Mary E

2007-01-01

The use of health information technology (HIT) for the support of communication processes and data and information access in acute care settings is a relatively new phenomenon. A means of evaluating the impact of HIT in hospital settings is needed. The purpose of this research was to design and psychometrically evaluate the Impact of Health Information Technology scale (I-HIT). I-HIT was designed to measure the perception of nurses regarding the ways in which HIT influences interdisciplinary communication and workflow patterns and nurses' satisfaction with HIT applications and tools. Content for a 43-item tool was derived from the literature, and supported theoretically by the Coiera model and by nurse informaticists. Internal consistency reliability analysis using Cronbach's alpha was conducted on the 43-item scale to initiate the item reduction process. Items with an item total correlation of less than 0.35 were removed, leaving a total of 29 items. Item analysis, exploratory principal component analysis and internal consistency reliability using Cronbach's alpha were used to confirm the 29-item scale. Principal components analysis with Varimax rotation produced a four-factor solution that explained 58.5% of total variance (general advantages, information tools to support information needs, information tools to support communication needs, and workflow implications). Internal consistency of the total scale was 0.95 and ranged from 0.80-0.89 for four subscales. I-HIT demonstrated psychometric adequacy and is recommended to measure the impact of HIT on nursing practice in acute care settings.