A study of renal function influence by integrating cloud-based manometers and physician order entry systems.

PubMed

Lin, Yuh-Feng; Sheng, Li-Huei; Wu, Mei-Yi; Zheng, Cai-Mei; Chang, Tian-Jong; Li, Yu-Chuan; Huang, Yu-Hui; Lu, Hsi-Peng

2014-12-01

No evidence exists from randomized trials to support using cloud-based manometers integrated with available physician order entry systems for tracking patient blood pressure (BP) to assist in the control of renal function deterioration. We investigated how integrating cloud-based manometers with physician order entry systems benefits our outpatient chronic kidney disease patients compared with typical BP tracking systems. We randomly assigned 36 chronic kidney disease patients to use cloud-based manometers integrated with physician order entry systems or typical BP recording sheets, and followed the patients for 6 months. The composite outcome was that the patients saw improvement both in BP and renal function. We compared the systolic and diastolic BP (SBP and DBP), and renal function of our patients at 0 months, 3 months, and 6 months after using the integrated manometers and typical BP monitoring sheets. Nighttime SBP and DBP were significantly lower in the study group compared with the control group. Serum creatinine level in the study group improved significantly compared with the control group after the end of Month 6 (2.83 ± 2.0 vs. 4.38 ± 3.0, p = 0.018). Proteinuria improved nonsignificantly in Month 6 in the study group compared with the control group (1.05 ± 0.9 vs. 1.90 ± 1.3, p = 0.09). Both SBP and DBP during the nighttime hours improved significantly in the study group compared with the baseline. In pre-end-stage renal disease patients, regularly monitoring BP by integrating cloud-based manometers appears to result in a significant decrease in creatinine and improvement in nighttime BP control. Estimated glomerular filtration rate and proteinuria were found to be improved nonsignificantly, and thus, larger population and longer follow-up studies may be needed.

Personal FM systems for children with autism spectrum disorders (ASD) and/or attention-deficit hyperactivity disorder (ADHD): an initial investigation.

PubMed

Schafer, Erin C; Mathews, Lauren; Mehta, Smita; Hill, Margaret; Munoz, Ashley; Bishop, Rachel; Moloney, Molly

2013-01-01

The goal of this initial investigation was to examine the potential benefit of a frequency modulation (FM) system for 11 children diagnosed with autism spectrum disorders (ASD), attention-deficit hyperactivity disorder (ADHD), or both disorders through measures of speech recognition performance in noise, observed classroom behavior, and teacher-rated educational risk and listening behaviors. Use of the FM system resulted in significant average improvements in speech recognition in noise for the children with ASD and ADHD as well as large effect sizes. When compared to typically functioning peers, children with ASD and ADHD had significantly poorer average speech recognition performance in noise without the FM system but comparable average performance when the FM system was used. Similarly, classroom observations yielded a significant increase in on-task behaviors and large effect sizes when the FM system was in use during two separate trial periods. Although teacher ratings on questionnaires showed no significant improvement in the average level of educational risk of participants, they did indicate significant improvement in average listening behaviors during two trial periods with the FM system. Given the significantly better speech recognition in noise, increased on-task behaviors, and improved teacher ratings of listening behaviors with the FM system, these devices may be a viable option for children who have ASD and ADHD in the classroom. However, an individual evaluation including audiological testing and a functional evaluation in the child's primary learning environment will be necessary to determine the benefit of an FM system for a particular student. 1. The reader will be able to describe the potential benefit of FM systems for children with ASD and/or ADHD. 2. The reader will be able to identify on-task versus off-task listening behaviors in children with ASD and/or ADHD. 3. The reader will be able to explain the components of a successful pre-fit education program that may be necessary prior to fitting an FM system in children with ASD. Copyright © 2012 Elsevier Inc. All rights reserved.

Measurement of SIFT operating system overhead

NASA Technical Reports Server (NTRS)

Palumbo, D. L.; Butler, R. W.

1985-01-01

The overhead of the software implemented fault tolerance (SIFT) operating system was measured. Several versions of the operating system evolved. Each version represents different strategies employed to improve the measured performance. Three of these versions are analyzed. The internal data structures of the operating systems are discussed. The overhead of the SIFT operating system was found to be of two types: vote overhead and executive task overhead. Both types of overhead were found to be significant in all versions of the system. Improvements substantially reduced this overhead; even with these improvements, the operating system consumed well over 50% of the available processing time.

A virtual pointer to support the adoption of professional vision in laparoscopic training.

PubMed

Feng, Yuanyuan; McGowan, Hannah; Semsar, Azin; Zahiri, Hamid R; George, Ivan M; Turner, Timothy; Park, Adrian; Kleinsmith, Andrea; Mentis, Helena M

2018-05-23

To assess a virtual pointer in supporting surgical trainees' development of professional vision in laparoscopic surgery. We developed a virtual pointing and telestration system utilizing the Microsoft Kinect movement sensor as an overlay for any imagine system. Training with the application was compared to a standard condition, i.e., verbal instruction with un-mediated gestures, in a laparoscopic training environment. Seven trainees performed four simulated laparoscopic tasks guided by an experienced surgeon as the trainer. Trainee performance was subjectively assessed by the trainee and trainer, and objectively measured by number of errors, time to task completion, and economy of movement. No significant differences in errors and time to task completion were obtained between virtual pointer and standard conditions. Economy of movement in the non-dominant hand was significantly improved when using virtual pointer ([Formula: see text]). The trainers perceived a significant improvement in trainee performance in virtual pointer condition ([Formula: see text]), while the trainees perceived no difference. The trainers' perception of economy of movement was similar between the two conditions in the initial three runs and became significantly improved in virtual pointer condition in the fourth run ([Formula: see text]). Results show that the virtual pointer system improves the trainer's perception of trainee's performance and this is reflected in the objective performance measures in the third and fourth training runs. The benefit of a virtual pointing and telestration system may be perceived by the trainers early on in training, but this is not evident in objective trainee performance until further mastery has been attained. In addition, the performance improvement of economy of motion specifically shows that the virtual pointer improves the adoption of professional vision- improved ability to see and use laparoscopic video results in more direct instrument movement.

Improved drainage with active chest tube clearance.

PubMed

Shiose, Akira; Takaseya, Tohru; Fumoto, Hideyuki; Arakawa, Yoko; Horai, Tetsuya; Boyle, Edward M; Gillinov, A Marc; Fukamachi, Kiyotaka

2010-05-01

This study was performed to evaluate the efficacy of a novel chest drainage system. This system employs guide wire-based active chest tube clearance to improve drainage and maintain patency. A 32 Fr chest tube was inserted into pleural cavities of five pigs. On the left, a tube was connected to the chest canister, and on the right, the new system was inserted between the chest tube and chest canister. Acute bleeding was mimicked by periodic infusion of blood. The amount of blood drained from each chest cavity was recorded every 15 min for 2 h. After completion of the procedure, all residual blood and clots in each chest cavity were assessed. The new system remained widely patent, and the amount of drainage achieved with this system (670+/-105 ml) was significantly (P=0.01) higher than that with the standard tube (239+/-131 ml). The amount of retained pleural blood and clots with this system (150+/-107 ml) was significantly (P=0.04) lower than that with the standard tube (571+/-248 ml). In conclusion, a novel chest drainage system with active tube clearance significantly improved drainage without tube manipulations. 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

Spray nozzle investigation for the Improved Helicopter Icing Spray System (IHISS)

NASA Technical Reports Server (NTRS)

Peterson, Andrew A.; Oldenburg, John R.

1990-01-01

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

A Randomized, Investigator-Blinded Comparison of Two Topical Regimens in Fitzpatrick Skin Types III-VI With Moderate to Severe Facial Hyperpigmentation.

PubMed

Vanaman Wilson, Monique J; Jones, Isabela T; Bolton, Joanna; Larsen, Lisa; Wu, Douglas C; Goldman, Mitchel P

2017-11-01

Purpose: Though hydroquinone (HQ) remains the gold standard for treatment of hyperpigmentation, concerns about its safety have prompted the development of HQ-free topical skin lightening systems. To compare the efficacy and tolerability of a new HQ-free system and a popular HQ-based system for the improvement of facial hyperpigmentation and photoaging in darker skin types. This investigator-blinded trial randomized 30 subjects of Fitzpatrick skin types III to VI with moderate to severe hyperpigmentation to a new 7-product HQ-free system or a 7-product HQ-based system for 12 weeks. At 4, 8, and 12 week follow-up visits, a blinded investigator assessed efficacy and tolerability using standardized scales. Subjects also performed a self-assessment at each visit. Both the HQ-free and HQ-based systems produced significant improvements in Overall Hyperpigmentation that were sustained through week 12 (P=0.008, 0.0003). The HQ-based system demonstrated better improvement in overall hyperpigmentation at weeks 4, 8, 12 (P=0.01, 0.001, 0.003, respectively). Mottled Pigmentation Area Severity Index (MoPASI) scores improved with both systems (P=0.02, 0.01), with no statistically significant differences between the two treatment groups. Subject-rated hyperpigmentation was not different between groups. Subjects reported significantly more discomfort with the HQ-free system at week 8 (P=0.02); otherwise, measures of irritation were the same between groups. All irritation was described as mild to moderate. At week 12, 100% of subjects in the HQ-free group and 92.3% of subjects in the HQ-based group were satisfied with their outcome. Both a new HQ-free skincare system and a widely-available HQ-based system improved hyperpigmentation in Fitzpatrick skin types III to VI. Though the HQ-based system produced greater improvement in hyperpigmentation when compared to the HQ-free system, there was no difference in MoPASI scores between the treatment groups. Subjects were satisfied with both treatments and reported only mild to moderate irritation using either system.

J Drugs Dermatol. 2017;16(11):1127-1132.

Health management and controls for earth to orbit propulsion systems

NASA Technical Reports Server (NTRS)

Bickford, R. L.

1992-01-01

Fault detection and isolation for advanced rocket engine controllers are discussed focusing on advanced sensing systems and software which significantly improve component failure detection for engine safety and health management. Aerojet's Space Transportation Main Engine controller for the National Launch System is the state of the art in fault tolerant engine avionics. Health management systems provide high levels of automated fault coverage and significantly improve vehicle delivered reliability and lower preflight operations costs. Key technologies, including the sensor data validation algorithms and flight capable spectrometers, have been demonstrated in ground applications and are found to be suitable for bridging programs into flight applications.

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

Zhang, Jie; Cui, Mingjian; Hodge, Bri-Mathias

The large variability and uncertainty in wind power generation present a concern to power system operators, especially given the increasing amounts of wind power being integrated into the electric power system. Large ramps, one of the biggest concerns, can significantly influence system economics and reliability. The Wind Forecast Improvement Project (WFIP) was to improve the accuracy of forecasts and to evaluate the economic benefits of these improvements to grid operators. This paper evaluates the ramp forecasting accuracy gained by improving the performance of short-term wind power forecasting. This study focuses on the WFIP southern study region, which encompasses most ofmore » the Electric Reliability Council of Texas (ERCOT) territory, to compare the experimental WFIP forecasts to the existing short-term wind power forecasts (used at ERCOT) at multiple spatial and temporal scales. The study employs four significant wind power ramping definitions according to the power change magnitude, direction, and duration. The optimized swinging door algorithm is adopted to extract ramp events from actual and forecasted wind power time series. The results show that the experimental WFIP forecasts improve the accuracy of the wind power ramp forecasting. This improvement can result in substantial costs savings and power system reliability enhancements.« less

Design and Testing of a Ground-based System for Phase Stabilized Standard Frequency Transmission

NASA Astrophysics Data System (ADS)

Wang, J. Q.; Jiang, Y. C.; Gou, W.; Yu, L. F.; Liu, Q. H.; Fan, Q. Y.; Lou, F. X.; Lao, B. Q.

2014-09-01

In this paper, a 1.5 GHz phase stabilized frequency transmission system is described. Compatible with the coaxial cable and optical fiber transmission media, the system has both the capabilities of real-time and post phase compensation. The phase stabilizing principle of the equipment is analyzed, and its performance is evaluated. Under the test environment, the results of the prototype system based on a coaxial cable show that the real-time compensation mode can improve the phase stabilities by more than 112 times in comparison with the uncompensated cables. The frequency stabilities are also improved significantly with a 7-second integration time, and one order-of-magnitude improvement is achieved after 60 seconds. The post compensation mode can improve phase fluctuations by 40 times. The frequency stabilities can be improved significantly after 2.5-second integration, while a 10-fold enhancement is achieved after 40 seconds. With longer integration time, both real-time and post compensation modes can improve the frequency stabilities by more than 1.5 orders of magnitude. The proposed equipment can effectively reduce slowly stretching effects due to the factors such as the temperature coefficient variations of the transmission medium and mechanical disturbances.

An initiative to improve the management of clinically significant test results in a large health care network.

PubMed

Roy, Christopher L; Rothschild, Jeffrey M; Dighe, Anand S; Schiff, Gordon D; Graydon-Baker, Erin; Lenoci-Edwards, Jennifer; Dwyer, Cheryl; Khorasani, Ramin; Gandhi, Tejal K

2013-11-01

The failure of providers to communicate and follow up clinically significant test results (CSTR) is an important threat to patient safety. The Massachusetts Coalition for the Prevention of Medical Errors has endorsed the creation of systems to ensure that results can be received and acknowledged. In 2008 a task force was convened that represented clinicians, laboratories, radiology, patient safety, risk management, and information systems in a large health care network with the goals of providing recommendations and a road map for improvement in the management of CSTR and of implementing this improvement plan during the sub-force sequent five years. In drafting its charter, the task broadened the scope from "critical" results to "clinically significant" ones; clinically significant was defined as any result that requires further clinical action to avoid morbidity or mortality, regardless of the urgency of that action. The task force recommended four key areas for improvement--(1) standardization of policies and definitions, (2) robust identification of the patient's care team, (3) enhanced results management/tracking systems, and (4) centralized quality reporting and metrics. The task force faced many challenges in implementing these recommendations, including disagreements on definitions of CSTR and on who should have responsibility for CSTR, changes to established work flows, limitations of resources and of existing information systems, and definition of metrics. This large-scale effort to improve the communication and follow-up of CSTR in a health care network continues with ongoing work to address implementation challenges, refine policies, prepare for a new clinical information system platform, and identify new ways to measure the extent of this important safety problem.

Hybrid Power Management Program Continued

NASA Technical Reports Server (NTRS)

Eichenberg, Dennis J.

2002-01-01

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

Re-engineering pre-employment check-up systems: a model for improving health services.

PubMed

Rateb, Said Abdel Hakim; El Nouman, Azza Abdel Razek; Rateb, Moshira Abdel Hakim; Asar, Mohamed Naguib; El Amin, Ayman Mohammed; Gad, Saad abdel Aziz; Mohamed, Mohamed Salah Eldin

2011-01-01

The purpose of this paper is to develop a model for improving health services provided by the pre-employment medical fitness check-up system affiliated to Egypt's Health Insurance Organization (HIO). Operations research, notably system re-engineering, is used in six randomly selected centers and findings before and after re-engineering are compared. The re-engineering model follows a systems approach, focusing on three areas: structure, process and outcome. The model is based on six main components: electronic booking, standardized check-up processes, protected medical documents, advanced archiving through an electronic content management (ECM) system, infrastructure development, and capacity building. The model originates mainly from customer needs and expectations. The centers' monthly customer flow increased significantly after re-engineering. The mean time spent per customer cycle improved after re-engineering--18.3 +/- 5.5 minutes as compared to 48.8 +/- 14.5 minutes before. Appointment delay was also significantly decreased from an average 18 to 6.2 days. Both beneficiaries and service providers were significantly more satisfied with the services after re-engineering. The model proves that re-engineering program costs are exceeded by increased revenue. Re-engineering in this study involved multiple structure and process elements. The literature review did not reveal similar re-engineering healthcare packages. Therefore, each element was compared separately. This model is highly recommended for improving service effectiveness and efficiency. This research is the first in Egypt to apply the re-engineering approach to public health systems. Developing user-friendly models for service improvement is an added value.

Subjective evaluation of two stereoscopic imaging systems exploiting visual attention to improve 3D quality of experience

NASA Astrophysics Data System (ADS)

Hanhart, Philippe; Ebrahimi, Touradj

2014-03-01

Crosstalk and vergence-accommodation rivalry negatively impact the quality of experience (QoE) provided by stereoscopic displays. However, exploiting visual attention and adapting the 3D rendering process on the fly can reduce these drawbacks. In this paper, we propose and evaluate two different approaches that exploit visual attention to improve 3D QoE on stereoscopic displays: an offline system, which uses a saliency map to predict gaze position, and an online system, which uses a remote eye tracking system to measure real time gaze positions. The gaze points were used in conjunction with the disparity map to extract the disparity of the object-of-interest. Horizontal image translation was performed to bring the fixated object on the screen plane. The user preference between standard 3D mode and the two proposed systems was evaluated through a subjective evaluation. Results show that exploiting visual attention significantly improves image quality and visual comfort, with a slight advantage for real time gaze determination. Depth quality is also improved, but the difference is not significant.

NASA's Earth Science Data Systems - Lessons Learned and Future Directions

NASA Technical Reports Server (NTRS)

Ramapriyan, Hampapuram K.

2010-01-01

In order to meet the increasing demand for Earth Science data, NASA has significantly improved the Earth Science Data Systems over the last two decades. This improvement is reviewed in this slide presentation. Many Earth Science disciplines have been able to access the data that is held in the Earth Observing System (EOS) Data and Information System (EOSDIS) at the Distributed Active Archive Centers (DAACs) that forms the core of the data system.

Transforming the Morbidity and Mortality Conference to Promote Safety and Quality in a PICU.

PubMed

Cifra, Christina L; Bembea, Melania M; Fackler, James C; Miller, Marlene R

2016-01-01

Determine the effectiveness of a structured systems-oriented morbidity and mortality conference in improving the process of reviewing and responding to adverse events in a PICU. Prospective time series analysis before and after implementation of a systems-oriented morbidity and mortality conference. Single tertiary referral PICU in Baltimore, MD. Thirty-three patients discussed before and 31 patients after implementation of a systems-oriented morbidity and mortality conference over a total of 20 morbidity and mortality conferences, from April 2013 to March 2014. Systems-oriented morbidity and mortality conference incorporating elements of medical incident analysis. There was a significant increase in meeting attendance (mean, 12 vs 31 attendees per morbidity and mortality conference; p < 0.001) after the systems-oriented morbidity and mortality conference was instituted. There was no significant difference in the mean number of cases suggested (4.2 vs 4.6) or discussed (3.3 vs 3.1) per morbidity and mortality conference. There was also no significant difference in the mean number of adverse events identified per morbidity and mortality conference (3.4 vs 4.3). However, there was an increase in the proportion of cases discussed using a standard case review tool, but this did not reach statistical significance (27% vs 45%; p = 0.231). Nevertheless, we observed a significant increase in the mean number of quality improvement interventions suggested (2.4 vs 5.6; p < 0.001) and implemented (1.7 vs 4.4; p < 0.001) per morbidity and mortality conference. All adverse event categories identified had corresponding interventions suggested after the systems-oriented morbidity and mortality conference was instituted compared with before (80% vs 100%). Intervention-to-adverse event ratios per category were also higher (mean, 0.6 vs 1.5). A structured systems-oriented PICU morbidity and mortality conference incorporating elements of medical incident analysis improves the process of reviewing and responding to adverse events by significantly increasing quality improvement interventions suggested and implemented. Future work would involve testing locally adapted versions of the systems-oriented morbidity and mortality conference in multiple inpatient settings.

Basic research for the geodynamics program

NASA Technical Reports Server (NTRS)

Mueller, Ivan I.

1988-01-01

Additional results are presented concerning a study that considers improvements over present Earth Rotation Parameter (ERP) determination methods by directly combining observations from various space geodetic systems in one adjustment. Earlier results are extended, showing that in addition to slight improvements in accuracy, substantial (a factor of three or more) improvements in precision and significant reductions in correlations between various parameters can be obtained (by combining Lunar Laser Ranging - LLR, Satellite Laser Ranging - SLR to Lageos, and Very Long Baseline Interferometry - VLBI data in one adjustment) as compared to results from individual systems. Smaller improvements are also seen over the weighted means of the individual system results. Although data transmission would not be significantly reduced, negligible additional computer time would be required if (standardized) normal equations were available from individual solutions. Suggestions for future work and implications for the New Earth Rotation Service (IERS) are also presented.

Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform.

PubMed

Guyon, Ak'ingabe; Perreault, Robert

2016-10-20

Public health is currently being weakened in several Canadian jurisdictions. Unprecedented and arbitrary cuts to the public health budget in Quebec in 2015 were a striking example of this. In order to support public health leaders and citizens in their capacity to advocate for evidence-informed public health reforms, we propose a knowledge synthesis of elements of public health systems that are significantly associated with improved performance. Research consistently and significantly associates four elements of public health systems with improved productivity: 1) increased financial resources, 2) increased staffing per capita, 3) population size between 50,000 and 500,000, and 4) specific evidence-based organizational and administrative features. Furthermore, increased financial resources and increased staffing per capita are significantly associated with improved population health outcomes. We contend that any effort at optimization of public health systems should at least be guided by these four evidence-informed factors. Canada already has existing capacity in carrying out public health systems and services research. Further advancement of our academic and professional expertise on public health systems will allow Canadian public health jurisdictions to be inspired by the best public health models and become stronger advocates for public health's resources, interventions and outcomes when they need to be celebrated or defended.

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

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

Hunt, Farren

2013-12-01

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

Further enhancement of facial appearance with a hydroquinone skin care system plus tretinoin in patients previously treated with botulinum toxin Type A.

PubMed

Schlessinger, Joel; Kenkel, Jeffrey; Werschler, Philip

2011-07-01

A hydroquinone (HQ) skin care system has been designed for use in conjunction with nonsurgical procedures. The authors evaluate the efficacy of this system plus tretinoin for improving facial appearance in comparison to a standard skin care regimen in users of botulinum toxin Type A (BoNT-A). In this multicenter, randomized, investigator-masked, parallel-group study, 61 patients who received upper facial treatment with BoNT-A at a plastic surgery or dermatology clinic were randomly assigned to apply either the HQ system (cleanser, toner, proprietary 4% hydroquinone, exfoliant, and sunscreen) plus 0.05% tretinoin cream or a standard skin care regimen (cleanser, moisturizer, and sunscreen) for 120 days. Outcomes were assessed by the investigators and through a patient questionnaire. Compared with standard skin care, the HQ system plus tretinoin resulted in significantly milder fine lines/wrinkles and hyperpigmentation at Days 30, 90, and 120 (p ≤ .05) and significantly superior overall ratings for each of nine patient assessments at Days 90 and 120 (p ≤ .05). A relatively greater proportion of patients using the HQ system plus tretinoin believed that their study treatment had further enhanced the improvements attained with BoNT-A (86% vs 8%). Both regimens were generally well tolerated. Adjunctive use of the HQ system plus tretinoin can further enhance the improvements in facial appearance attained with BoNT-A. Applying the HQ system plus tretinoin offers multiple clinical benefits over standard skin care, including significantly greater improvements in fine lines/wrinkles and hyperpigmentation.

Staff Preparation, Reward, and Support: Are Quality Rating and Improvement Systems Addressing All of the Key Ingredients Necessary for Change? Policy Report

ERIC Educational Resources Information Center

Austin, Lea J. E.; Whitebook, Marcy; Connors, Maia; Darrah, Rory

2011-01-01

Reflecting the growing momentum in support of quality rating and improvement systems (QRISs) as a key strategy to improve early care and education quality, significant amounts of public dollars have been devoted to their development and implementation. In this brief, the authors report on their investigation of both quality rating and improvement…

Li Anode Technology for Improved Performance

NASA Technical Reports Server (NTRS)

Chen, Tuqiang

2011-01-01

A novel, low-cost approach to stabilization of Li metal anodes for high-performance rechargeable batteries was developed. Electrolyte additives are selected and used in Li cell electrolyte systems, promoting formation of a protective coating on Li metal anodes for improved cycle and safety performance. Li batteries developed from the new system will show significantly improved battery performance characteristics, including energy/power density, cycle/ calendar life, cost, and safety.

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

Kristine Barrett; Shannon Bragg-Sitton

The Advanced Light Water Reactor (LWR) Nuclear Fuel Development Research and Development (R&D) Pathway encompasses strategic research focused on improving reactor core economics and safety margins through the development of an advanced fuel cladding system. To achieve significant operating improvements while remaining within safety boundaries, significant steps beyond incremental improvements in the current generation of nuclear fuel are required. Fundamental improvements are required in the areas of nuclear fuel composition, cladding integrity, and the fuel/cladding interaction to allow power uprates and increased fuel burn-up allowance while potentially improving safety margin through the adoption of an “accident tolerant” fuel system thatmore » would offer improved coping time under accident scenarios. With a development time of about 20 – 25 years, advanced fuel designs must be started today and proven in current reactors if future reactor designs are to be able to use them with confidence.« less

Throughput of Coded Optical CDMA Systems with AND Detectors

NASA Astrophysics Data System (ADS)

Memon, Kehkashan A.; Umrani, Fahim A.; Umrani, A. W.; Umrani, Naveed A.

2012-09-01

Conventional detection techniques used in optical code-division multiple access (OCDMA) systems are not optimal and result in poor bit error rate performance. This paper analyzes the coded performance of optical CDMA systems with AND detectors for enhanced throughput efficiencies and improved error rate performance. The results show that the use of AND detectors significantly improve the performance of an optical channel.

Accuracy and time requirements of a bar-code inventory system for medical supplies.

PubMed

Hanson, L B; Weinswig, M H; De Muth, J E

1988-02-01

The effects of implementing a bar-code system for issuing medical supplies to nursing units at a university teaching hospital were evaluated. Data on the time required to issue medical supplies to three nursing units at a 480-bed, tertiary-care teaching hospital were collected (1) before the bar-code system was implemented (i.e., when the manual system was in use), (2) one month after implementation, and (3) four months after implementation. At the same times, the accuracy of the central supply perpetual inventory was monitored using 15 selected items. One-way analysis of variance tests were done to determine any significant differences between the bar-code and manual systems. Using the bar-code system took longer than using the manual system because of a significant difference in the time required for order entry into the computer. Multiple-use requirements of the central supply computer system made entering bar-code data a much slower process. There was, however, a significant improvement in the accuracy of the perpetual inventory. Using the bar-code system for issuing medical supplies to the nursing units takes longer than using the manual system. However, the accuracy of the perpetual inventory was significantly improved with the implementation of the bar-code system.

Significant improvement of the quality of bystander first aid using an expert system with a mobile multimedia device.

PubMed

Ertl, Lorenz; Christ, Frank

2007-08-01

Better quality bystander first-aid could improve outcome rates for emergency victims significantly. In this case-control study, we hypothesised that expert knowledge presented step-by-step to untrained helpers using a personal digital assistant (PDA), would improve the quality of bystanders basic life support. We confronted 101 lay-helpers with two standard emergency situations. (1) An unconscious trauma victim with severe bleeding. (2) Cardiopulmonary resuscitation (CPR). Performance was assessed using an Objective Structured Clinical Examination (OSCE). One group was supported by a PDA providing visual and audio instructions, whereas the control group acted only with their current knowledge. The expert system was programmed in HTML-code and displayed on the PDA's Internet browser. The maximum score obtainable was 24 points corresponding to optimal treatment. The control group without the PDA reached 14.8+/-3.5 (mean value+/-standard deviation), whereas the PDA supported group scored significantly higher (21.9+/-2.7, p<0.01). The difference in performance was measurable in all criteria tested and particularly notable in the items: placing in recovery position, airway management and quality of CPR. The PDA based expert system increased the performance of untrained helpers supplying emergency care significantly. Since Internet compatible mobile devices have become widely available, a significant quality improvement in bystander first-aid seems possible.

The MiPACQ clinical question answering system.

PubMed

Cairns, Brian L; Nielsen, Rodney D; Masanz, James J; Martin, James H; Palmer, Martha S; Ward, Wayne H; Savova, Guergana K

2011-01-01

The Multi-source Integrated Platform for Answering Clinical Questions (MiPACQ) is a QA pipeline that integrates a variety of information retrieval and natural language processing systems into an extensible question answering system. We present the system's architecture and an evaluation of MiPACQ on a human-annotated evaluation dataset based on the Medpedia health and medical encyclopedia. Compared with our baseline information retrieval system, the MiPACQ rule-based system demonstrates 84% improvement in Precision at One and the MiPACQ machine-learning-based system demonstrates 134% improvement. Other performance metrics including mean reciprocal rank and area under the precision/recall curves also showed significant improvement, validating the effectiveness of the MiPACQ design and implementation.

Potential Improvements to Remote Primary Productivity Estimation in the Southern California Current System

NASA Astrophysics Data System (ADS)

Jacox, M.; Edwards, C. A.; Kahru, M.; Rudnick, D. L.; Kudela, R. M.

2012-12-01

A 26-year record of depth integrated primary productivity (PP) in the Southern California Current System (SCCS) is analyzed with the goal of improving satellite net primary productivity (PP) estimates. The ratio of integrated primary productivity to surface chlorophyll correlates strongly to surface chlorophyll concentration (chl0). However, chl0 does not correlate to chlorophyll-specific productivity, and appears to be a proxy for vertical phytoplankton distribution rather than phytoplankton physiology. Modest improvements in PP model performance are achieved by tuning existing algorithms for the SCCS, particularly by empirical parameterization of photosynthetic efficiency in the Vertically Generalized Production Model. Much larger improvements are enabled by improving accuracy of subsurface chlorophyll and light profiles. In a simple vertically resolved production model, substitution of in situ surface data for remote sensing estimates offers only marginal improvements in model r2 and total log10 root mean squared difference, while inclusion of in situ chlorophyll and light profiles improves these metrics significantly. Autonomous underwater gliders, capable of measuring subsurface fluorescence on long-term, long-range deployments, significantly improve PP model fidelity in the SCCS. We suggest their use (and that of other autonomous profilers such as Argo floats) in conjunction with satellites as a way forward for improved PP estimation in coastal upwelling systems.

Use of the quality management system "JACIE" and outcome after hematopoietic stem cell transplantation.

PubMed

Gratwohl, Alois; Brand, Ronald; McGrath, Eoin; van Biezen, Anja; Sureda, Anna; Ljungman, Per; Baldomero, Helen; Chabannon, Christian; Apperley, Jane

2014-05-01

Competent authorities, healthcare payers and hospitals devote increasing resources to quality management systems but scientific analyses searching for an impact of these systems on clinical outcome remain scarce. Earlier data indicated a stepwise improvement in outcome after allogeneic hematopoietic stem cell transplantation with each phase of the accreditation process for the quality management system "JACIE". We therefore tested the hypothesis that working towards and achieving "JACIE" accreditation would accelerate improvement in outcome over calendar time. Overall mortality of the entire cohort of 107,904 patients who had a transplant (41,623 allogeneic, 39%; 66,281 autologous, 61%) between 1999 and 2006 decreased over the 14-year observation period by a factor of 0.63 per 10 years (hazard ratio: 0.63; 0.58-0.69). Considering "JACIE"-accredited centers as those with programs having achieved accreditation by November 2012, at the latest, this improvement was significantly faster in "JACIE"-accredited centers than in non-accredited centers (approximately 5.3% per year for 49,459 patients versus approximately 3.5% per year for 58,445 patients, respectively; hazard ratio: 0.83; 0.71-0.97). As a result, relapse-free survival (hazard ratio 0.85; 0.75-0.95) and overall survival (hazard ratio 0.86; 0.76-0.98) were significantly higher at 72 months for those patients transplanted in the 162 "JACIE"-accredited centers. No significant effects were observed after autologous transplants (hazard ratio 1.06; 0.99-1.13). Hence, working towards implementation of a quality management system triggers a dynamic process associated with a steeper reduction in mortality over the years and a significantly improved survival after allogeneic stem cell transplantation. Our data support the use of a quality management system for complex medical procedures.

Impact of the single point of access referral system to reduce waiting times and improve clinical outcomes in an assistive technology service.

PubMed

Hosking, Jonathan; Gibson, Colin

2016-07-01

The introduction of a single point referral system that prioritises clients depending on case complexity and overcomes the need for re-admittance to a waiting list via a review system has been shown to significantly reduce maximum waiting times for a Posture and Mobility (Special Seating) Service from 102.0 ± 24.33 weeks to 19.2 ± 8.57 weeks (p = 0.015). Using this service model linear regression revealed a statistically significant improvement in the performance outcome of prescribed seating solutions with shorter Episode of Care completion times (p = 0.023). In addition, the number of Episodes of Care completed per annum was significantly related to the Episode of Care completion time (p = 0.019). In conclusion, it is recommended that it may be advantageous to apply this service model to other assistive technology services in order to reduce waiting times and to improve clinical outcomes.

Finding of No Significant Impact: Replacement of Chemical Cleaning Line Tinker Air Force Base Oklahoma City, Oklahoma

DTIC Science & Technology

2012-05-01

indoor air quality from installation of a new, improved cleaning line ventilation system. Cultural Resources No adverse effect on cultural...EA) has been prepared to assess the potential effects on the human and natural environment of replacing the chemical cleaning line at Tinker Air...providing improved system monitors and controls, reducing the overall energy consumption of the system, and enabling the system to accommodate larger

Improving Papanicolaou test quality and reducing medical errors by using Toyota production system methods.

PubMed

Raab, Stephen S; Andrew-Jaja, Carey; Condel, Jennifer L; Dabbs, David J

2006-01-01

The objective of the study was to determine whether the Toyota production system process improves Papanicolaou test quality and patient safety. An 8-month nonconcurrent cohort study that included 464 case and 639 control women who had a Papanicolaou test was performed. Office workflow was redesigned using Toyota production system methods by introducing a 1-by-1 continuous flow process. We measured the frequency of Papanicolaou tests without a transformation zone component, follow-up and Bethesda System diagnostic frequency of atypical squamous cells of undetermined significance, and diagnostic error frequency. After the intervention, the percentage of Papanicolaou tests lacking a transformation zone component decreased from 9.9% to 4.7% (P = .001). The percentage of Papanicolaou tests with a diagnosis of atypical squamous cells of undetermined significance decreased from 7.8% to 3.9% (P = .007). The frequency of error per correlating cytologic-histologic specimen pair decreased from 9.52% to 7.84%. The introduction of the Toyota production system process resulted in improved Papanicolaou test quality.

Coamorphous Loratadine-Citric Acid System with Enhanced Physical Stability and Bioavailability.

PubMed

Wang, Jin; Chang, Ruimiao; Zhao, Yanan; Zhang, Jiye; Zhang, Ting; Fu, Qiang; Chang, Chun; Zeng, Aiguo

2017-10-01

Coamorphous systems using citric acid as a small molecular excipient were studied for improving physical stability and bioavailability of loratadine, a BCS class II drug with low water solubility and high permeability. Coamorphous loratadine-citric acid systems were prepared by solvent evaporation technique and characterized by differential scanning calorimetry, X-ray powder diffraction, and Fourier transform infrared spectroscopy. Solid-state analysis proofed that coamorphous loratadine-citric acid system (1:1) was amorphous and homogeneous, had a higher T g over amorphous loratadine, and the intermolecular hydrogen bond interactions between loratadine and citric acid exist. The solubility and dissolution of coamorphous loratadine-citric acid system (1:1) were found to be significantly greater than those of crystalline and amorphous form. The pharmacokinetic study in rats proved that coamorphous loratadine-citric acid system (1:1) could significantly improve absorption and bioavailability of loratadine. Coamorphous loratadine-citric acid system (1:1) showed excellently physical stability over a period of 3 months at 25°C under 0% RH and 25°C under 60% RH conditions. The improved stability of coamorphous loratadine-citric acid system (1:1) could be related to an elevated T g over amorphous form and the intermolecular hydrogen bond interactions between loratadine and citric acid. These studies demonstrate that the developed coamorphous loratadine-citric acid system might be a promising oral formulation for improving solubility and bioavailability of loratadine.

Optical design considerations for high-concentration photovoltaics

NASA Astrophysics Data System (ADS)

Garboushian, Vahan; Gordon, Robert

2006-08-01

Over the past 15 years, major advances in Concentrating Photovoltaics (CPV) have been achieved. Ultra-efficient Si solar cells have produced commercial concentration systems which are being fielded today and are competitively priced. Advanced research has primarily focused on significantly more efficient multi-junction solar cells for tomorrow's systems. This effort has produced sophisticated solar cells that significantly improve power production. Additional performance and cost improvements, especially in the optical system area and system integration, must be made before CPV can realize its ultimate commercial potential. Structural integrity and reliability are vital for commercial success. As incremental technical improvements are made in solar cell technologies, evaluation and 'fine-tuning' of optical systems properly matched to the solar cell are becoming increasingly necessary. As we move forward, it is increasingly important to optimize all of the interrelated elements of a CPV system for high performance without sacrificing the marketable cost and structural requirements of the system. Areas such as wavelength absorption of refractive optics need to be carefully matched to the solar cell technology employed. Reflective optics require advanced engineering models to insure uniform flux distribution without excessive losses. In Situ measurement of the 'fine-grain' improvements are difficult as multiple variables such as solar insolation, temperature, wind, altitude, etc. infringe on analytical data. This paper discusses design considerations based on 10 years of field trials of high concentration systems and their relevance for tomorrow's advanced CPV systems.

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

PubMed

Pangalos, G; Sfyroeras, V; Pagkalos, I

2014-01-01

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

The MiPACQ Clinical Question Answering System

PubMed Central

Cairns, Brian L.; Nielsen, Rodney D.; Masanz, James J.; Martin, James H.; Palmer, Martha S.; Ward, Wayne H.; Savova, Guergana K.

2011-01-01

The Multi-source Integrated Platform for Answering Clinical Questions (MiPACQ) is a QA pipeline that integrates a variety of information retrieval and natural language processing systems into an extensible question answering system. We present the system’s architecture and an evaluation of MiPACQ on a human-annotated evaluation dataset based on the Medpedia health and medical encyclopedia. Compared with our baseline information retrieval system, the MiPACQ rule-based system demonstrates 84% improvement in Precision at One and the MiPACQ machine-learning-based system demonstrates 134% improvement. Other performance metrics including mean reciprocal rank and area under the precision/recall curves also showed significant improvement, validating the effectiveness of the MiPACQ design and implementation. PMID:22195068

Multiple Access Interference Reduction Using Received Response Code Sequence for DS-CDMA UWB System

NASA Astrophysics Data System (ADS)

Toh, Keat Beng; Tachikawa, Shin'ichi

This paper proposes a combination of novel Received Response (RR) sequence at the transmitter and a Matched Filter-RAKE (MF-RAKE) combining scheme receiver system for the Direct Sequence-Code Division Multiple Access Ultra Wideband (DS-CDMA UWB) multipath channel model. This paper also demonstrates the effectiveness of the RR sequence in Multiple Access Interference (MAI) reduction for the DS-CDMA UWB system. It suggests that by using conventional binary code sequence such as the M sequence or the Gold sequence, there is a possibility of generating extra MAI in the UWB system. Therefore, it is quite difficult to collect the energy efficiently although the RAKE reception method is applied at the receiver. The main purpose of the proposed system is to overcome the performance degradation for UWB transmission due to the occurrence of MAI during multiple accessing in the DS-CDMA UWB system. The proposed system improves the system performance by improving the RAKE reception performance using the RR sequence which can reduce the MAI effect significantly. Simulation results verify that significant improvement can be obtained by the proposed system in the UWB multipath channel models.

Arterial intelligent transportation systems : infrastructure elements and traveler information requirements.

DOT National Transportation Integrated Search

2009-08-01

Applying Intelligent Transportation Systems (ITS) to arterial systems allows TxDOT to significantly enhance : transportation system operation efficiency and improve traffic mobility. However, no guidelines are available to : assist TxDOT staff in sel...

GPE 2020: Improving Learning and Equity through Stronger Education Systems. Strategic Plan 2016-2020

ERIC Educational Resources Information Center

Global Partnership for Education, 2016

2016-01-01

The Global Partnership for Education (GPE) addresses the most significant education challenges faced by developing countries through supporting governments to improve equity and learning by strengthening their education systems. GPE is a global fund and a partnership focused entirely on education in developing countries. The partnership has a…

Effect of beta blockers (carvedilol or metoprolol XL) in patients with transposition of great arteries and dysfunction of the systemic right ventricle.

PubMed

Doughan, Abdul Rahman K; McConnell, Michael E; Book, Wendy M

2007-03-01

This study evaluated the effects of beta blockers (carvedilol and metoprolol XL) on New York Heart Association functional class and systemic right ventricular (RV) function in patients with complete transposition of the great arteries who had systemic RV dysfunction late after atrial inflow correction. A significant improvement in New York Heart Association functional class was found after 4 months of therapy with beta blockers. Functional recovery was significant mostly in those patients with pacemakers who received higher maintenance doses of carvedilol. RV end-diastolic area was significantly greater in untreated patients at the end of the follow-up period, whereas it was unchanged in treated patients. In conclusion, beta blockers prevent RV remodeling, with a concomitant improvement in exercise tolerance in patients with complete transposition of the great arteries and systemic RV dysfunction.

eLaunch Hypersonics: An Advanced Launch System

NASA Technical Reports Server (NTRS)

Starr, Stanley

2010-01-01

This presentation describes a new space launch system that NASA can and should develop. This approach can significantly reduce ground processing and launch costs, improve reliability, and broaden the scope of what we do in near earth orbit. The concept (not new) is to launch a re-usable air-breathing hypersonic vehicle from a ground based electric track. This vehicle launches a final rocket stage at high altitude/velocity for the final leg to orbit. The proposal here differs from past studies in that we will launch above Mach 1.5 (above transonic pinch point) which further improves the efficiency of air breathing, horizontal take-off launch systems. The approach described here significantly reduces cost per kilogram to orbit, increases safety and reliability of the boost systems, and reduces ground costs due to horizontal-processing. Finally, this approach provides significant technology transfer benefits for our national infrastructure.

Intelligent single switch wheelchair navigation.

PubMed

Ka, Hyun W; Simpson, Richard; Chung, Younghyun

2012-11-01

We have developed an intelligent single switch scanning interface and wheelchair navigation assistance system, called intelligent single switch wheelchair navigation (ISSWN), to improve driving safety, comfort and efficiency for individuals who rely on single switch scanning as a control method. ISSWN combines a standard powered wheelchair with a laser rangefinder, a single switch scanning interface and a computer. It provides the user with context sensitive and task specific scanning options that reduce driving effort based on an interpretation of sensor data together with user input. Trials performed by 9 able-bodied participants showed that the system significantly improved driving safety and efficiency in a navigation task by significantly reducing the number of switch presses to 43.5% of traditional single switch wheelchair navigation (p < 0.001). All participants made a significant improvement (39.1%; p < 0.001) in completion time after only two trials.

A single LipiFlow® Thermal Pulsation System treatment improves meibomian gland function and reduces dry eye symptoms for 9 months.

PubMed

Greiner, Jack V

2012-04-01

To evaluate the effect of a single treatment with the LipiFlow(®) Thermal Pulsation System on signs of meibomian gland dysfunction (MGD) and dry eye symptoms over a 9-month period. Patients (n = 42 eyes, 21 subjects) diagnosed with MGD and dry eye symptoms were recruited for a non-significant risk, prospective, open-label, 1-month clinical trial. Patients received a single 12-minute treatment using the LipiFlow(®) Thermal Pulsation System on each eye. The LipiFlow(®) device applies heat to the conjunctival surfaces of the upper and lower inner eyelids while simultaneously applying pulsatile pressure to the outer eyelid surfaces to express the meibomian glands. Patient symptoms were evaluated using the Ocular Surface Disease Index (OSDI) and Standard Patient Evaluation for Eye Dryness (SPEED) dry eye questionnaires; tear break-up time was measured with the dry eye test (DET™); and meibomian gland function was evaluated using a standardized diagnostic expression technique. Data are presented for patient's pre-treatment (baseline) and at 1-month and 9-month post-treatment. Meibomian gland secretion scores improved significantly from baseline (4.4 ± 4.0) to 1-month post-treatment (11.3 ± 6.2; p < 0.0001) and this improvement was maintained with no significant regression at 9 months (11.7 ± 5.9). Similarly, baseline tear break-up time (4.8 ± 3.2) was significantly increased at 1 month (9.6 ± 7.6; p < 0.001) and this increase was maintained with no significant regression at 9 months (7.1 ± 5.6). Symptom scores on both OSDI and SPEED questionnaires improved significantly at 1 month (p < 0.0001) and this improvement was maintained at 9 months. With such prolonged improvement in signs and symptoms of dry eye disease, the LipiFlow(®) Thermal Pulsation System offers a technological advancement for the treatment of dry eye disease secondary to meibomian gland dysfunction. A single 12-minute LipiFlow(®) treatment results in up to 9 months of sustained improvement of meibomian gland function, tear break-up time and dry eye symptoms that are unparalleled with current dry eye treatments.

Ontogenetic improvement of visual function in the medaka Oryzias latipes based on an optomotor testing system for larval and adult fish

USGS Publications Warehouse

Carvalho, Paulo S. M.; Noltie, Douglas B.; Tillitt, D.E.

2002-01-01

We developed a system for evaluation of visual function in larval and adult fish. Both optomotor (swimming) and optokinetic (eye movement) responses were monitored and recorded using a system of rotating stripes. The system allowed manipulation of factors such as width of the stripes used, rotation speed of the striped drum, and light illuminance levels within both the scotopic and photopic ranges. Precise control of these factors allowed quantitative measurements of visual acuity and motion detection. Using this apparatus, we tested the hypothesis that significant posthatch ontogenetic improvements in visual function occur in the medaka Oryzias latipes, and also that this species shows significant in ovo neuronal development. Significant improvements in the acuity angle alpha (ability to discriminate detail) were observed from approximately 5 degrees at hatch to 1 degree in the oldest adult stages. In addition, we measured a significant improvement in flicker fusion thresholds (motion detection skills) between larval and adult life stages within both the scotopic and photopic ranges of light illuminance. Ranges of flicker fusion thresholds (X±SD) at log I=1.96 (photopic) varied from 37.2±1.6 cycles/s in young adults to 18.6±1.6 cycles/s in young larvae 10 days posthatch. At log I=−2.54 (scotopic), flicker fusion thresholds varied from 5.8±0.7 cycles/s in young adults to 1.7±0.4 cycles/s in young larvae 10 days posthatch. Light sensitivity increased approximately 2.9 log units from early hatched larval stages to adults. The demonstrated ontogenetic improvements in visual function probably enable the fish to explore new resources, thereby enlarging their fundamental niche.

Framework for the Intelligent Transportation System (ITS) Evaluation : ITS Integration Activities

DOT National Transportation Integrated Search

2006-08-01

Intelligent Transportation Systems (ITS) represent a significant opportunity to improve the efficiency and safety of the surface transportation system. ITS includes technologies to support information processing, communications, surveillance and cont...

Towards Biological Inspiration in the Development of Complex Systems

NASA Technical Reports Server (NTRS)

Hinchey, Michael G.; Sterritt, Roy

2006-01-01

Greater understanding of biology in modem times has enabled significant breakthroughs in improving healthcare, quality of life, and eliminating many diseases and congenital illnesses. Simultaneously there is a move towards emulating nature and copying many of the wonders uncovered in biology, resulting in "biologically inspired" systems. Significant results have been reported in a wide range of areas, with systems inspired by nature enabling exploration, communication, and advances that were never dreamed possible just a few years ago. We warn, that as in many other fields of endeavor, we should be inspired by nature and biology, not engage in mimicry. We describe some results of biological inspiration that augur promise in terms of improving the safety and security of systems, and in developing self-managing systems, that we hope will ultimately lead to self-governing systems.

Food choice can improve nursing home resident meal service satisfaction and nutritional status.

PubMed

Crogan, Neva L; Dupler, Alice E; Short, Robert; Heaton, Grace

2013-05-01

The purpose of this study was to test the feasibility of implementing the Eat Right food delivery system and measure its impact on residents' food satisfaction, food intake, and subsequent nutritional status, including serum prealbumin levels and changes in body weight. Two eastern Washington State nursing homes (NHs) were recruited based on a similar case mix, the number of beds, and management's willingness to participate in the study. A total of 61 residents (NH A = 33, NH B = 28) participated. Intervention group residents (NH A) reported significant overall improvement in food service satisfaction and significant improvement in serum prealbumin levels after the intervention (p = 0.001). Changes in intervention group body weight improved after the intervention (p = 0.029). Use of nutritional interventions such as the multidimensional Eat Right system encourages resident decision making and facilitates overall satisfaction with care and improved health. Copyright 2013, SLACK Incorporated.

REopt Improves the Operations of Alcatraz's Solar PV-Battery-Diesel Hybrid System

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

Olis, Daniel R; Walker, H. A; Van Geet, Otto D

This poster identifies operations improvement strategies for a photovoltaic (PV)-battery-diesel hybrid system at the National Park Service's Alcatraz Island using NREL's REopt analysis tool. The current 'cycle charging' strategy results in significant curtailing of energy production from the PV array, requiring excessive diesel use, while also incurring high wear on batteries without benefit of improved efficiency. A simple 'load following' strategy results in near optimal operating cost reduction.

An analysis of total quality management in Aeronautical Systems Division

NASA Astrophysics Data System (ADS)

Caudle, Mark D.

1991-09-01

This study investigated the major schools of thought on various aspects of quality management and quality improvement. Areas covered included definitions of waste and quality, views on the cost of quality, tools and techniques used for quality improvement, and management philosophies and frameworks for continuous improvement. In addition, this study analyzed the structure and training content of the current Total Quality Management program at Aeronautical Systems Division (ASD). Pre- and post-test surveys on employee attitudes toward organizational effectiveness were analyzed from the Advanced Cruise Missile System Program Office (SPO), the F-15 SPO, and the ASD Deputy Chief of Staff for Human Resources (ASD/DP). Data was supplemented with semi-structured, personal interviews with ASD personnel involved in TQM. Survey analysis showed that the ACM SPO significantly improved, ASD/DP significantly digressed, and the F-15 SPO remained basically consistent. This led to the conclusion that ASD allows too much flexibility in the implementation of TQM in the three-letter organizations.

DASHBOARDS & CONTROL CHARTS EXPERIENCES IN IMPROVING SAFETY AT HANFORD WASHINGTON

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

PREVETTE, S.S.

2006-02-27

The aim of this paper is to demonstrate the integration of safety methodology, quality tools, leadership, and teamwork at Hanford and their significant positive impact on safe performance of work. Dashboards, Leading Indicators, Control charts, Pareto Charts, Dr. W. Edward Deming's Red Bead Experiment, and Dr. Deming's System of Profound Knowledge have been the principal tools and theory of an integrated management system. Coupled with involved leadership and teamwork, they have led to significant improvements in worker safety and protection, and environmental restoration at one of the nation's largest nuclear cleanup sites.

Positioning performance improvements with European multiple-frequency satellite navigation - Galileo

NASA Astrophysics Data System (ADS)

Ji, Shengyue

2008-10-01

The rapid development of Global Positioning System has demonstrated the advantages of satellite based navigation systems. In near future, there will be a number of Global Navigation Satellite System (GNSS) available, i.e. modernized GPS, Galileo, restored GLONASS, BeiDou and many other regional GNSS augmentation systems. Undoubtedly, the new GNSS systems will significantly improve navigation performance over current GPS, with a better satellite coverage and multiple satellite signal bands. In this dissertation, the positioning performance improvement of new GNSS has been investigated based on both theoretical analysis and numerical study. First of all, the navigation performance of new GNSS systems has been analyzed, particularly for urban applications. The study has demonstrated that Receiver Autonomous Integrity Monitoring (RAIM) performance can be significantly improved with multiple satellite constellations, although the position accuracy improvement is limited. Based on a three-dimensional urban building model in Hong Kong streets, it is found that positioning availability is still very low in high-rising urban areas, even with three GNSS systems. On the other hand, the discontinuity of navigation solutions is significantly reduced with the combined constellations. Therefore, it is possible to use cheap DR systems to bridge the gaps of GNSS positioning, with high accuracy. Secondly, the ambiguity resolution performance has been investigated with Galileo multiple frequency band signals. The ambiguity resolution performance of three different algorithms is compared, including CAR, ILS and improved CAR methods (a new method proposed in this study). For short baselines, with four frequency Galileo data, it is highly possible to achieve reliable single epoch ambiguity resolution, when the carrier phase noise level is reasonably low (i.e. less than 6mm). For long baselines (up to 800 km), the integer ambiguity can be determined within 1 min on average. Ambiguity validation is crucial for any ambiguity resolution algorithm using searching method. This study has proposed to use both Ellipsoidal Integer Aperture (EIA) estimator and R-ratio test for ambiguity validation. Using real GPS data and simulated Galileo data, it has been demonstrated that the new method performs better than the use of EIA or the R-ratio test alone, with much less ambiguity mis-fixed rate.

An Algorithm for Automated Rating of Reviewers.

ERIC Educational Resources Information Center

Riggs, Tracy; Wilensky, Robert

The current system for scholarly information dissemination may be amenable to significant improvement. In particular, going from the current system of journal publication to one of self-distributed documents offers significant cost and timeliness advantages. A major concern with such alternatives is how to provide the value currently afforded by…

Using a Personalized System of Instruction to Improve the Writing Skills of Undergraduates.

ERIC Educational Resources Information Center

Allen, George J.

1984-01-01

A traditional abnormal psychology course was restructured to emphasize writing using a personalized system of instruction. The major benefit was that students showed significant improvement in writing style and clarity. The major costs of the course were the high student turnover and the abnormally large workload for students and instructor. (RM)

Tune-Up Your Fan Systems for Improved Performance

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

Fans are used extensively in commercial buildings and represent approximately 6% of total energy consumed by commercial buildings. The U.S. Department of Energy (DOE) estimates that fans in commercial buildings consume 158 billion kWh of electricity annually. Maintaining fan systems in proper condition provides energy savings and ensures a comfortable and healthy environment. While many fan systems have significant energy savings opportunities available through improvements in fan selection, system design, and operational practices, it is not always apparent when a fan system needs maintenance or what opportunities are available for improvements. This resource is designed for facility managers and maintenancemore » staff to provide easy-to-implement actionable guidance on fan efficiency measures for existing ducted air systems.« less

Peak power reduction and energy efficiency improvement with the superconducting flywheel energy storage in electric railway system

NASA Astrophysics Data System (ADS)

Lee, Hansang; Jung, Seungmin; Cho, Yoonsung; Yoon, Donghee; Jang, Gilsoo

2013-11-01

This paper proposes an application of the 100 kWh superconducting flywheel energy storage systems to reduce the peak power of the electric railway system. The electric railway systems have high-power characteristics and large amount of regenerative energy during vehicles’ braking. The high-power characteristic makes operating cost high as the system should guarantee the secure capacity of electrical equipment and the low utilization rate of regenerative energy limits the significant energy efficiency improvement. In this paper, it had been proved that the peak power reduction and energy efficiency improvement can be achieved by using 100 kWh superconducting flywheel energy storage systems with the optimally controlled charging or discharging operations. Also, economic benefits had been assessed.

Air Force Journal of Logistics: Logistics Dimensions Improving Bare Base Agile Combat Support, The Path to Integration. Volume 28, Number 2

DTIC Science & Technology

2004-01-01

the system is balanced, there is the right flow of new pilots to match the availability of instructors for initial training missions, the right mix of...which attempted to redesign and streamline the DoD global distribution system , significantly improved delivery time to test locations.4 During its...somewhat confusing priority system that does not guarantee cargo delivery at a specific time and a pricing system that does not adequately differentiate

Engagement with the auditory processing system during targeted auditory cognitive training mediates changes in cognitive outcomes in individuals with schizophrenia.

PubMed

Biagianti, Bruno; Fisher, Melissa; Neilands, Torsten B; Loewy, Rachel; Vinogradov, Sophia

2016-11-01

Individuals with schizophrenia who engage in targeted cognitive training (TCT) of the auditory system show generalized cognitive improvements. The high degree of variability in cognitive gains maybe due to individual differences in the level of engagement of the underlying neural system target. 131 individuals with schizophrenia underwent 40 hours of TCT. We identified target engagement of auditory system processing efficiency by modeling subject-specific trajectories of auditory processing speed (APS) over time. Lowess analysis, mixed models repeated measures analysis, and latent growth curve modeling were used to examine whether APS trajectories were moderated by age and illness duration, and mediated improvements in cognitive outcome measures. We observed significant improvements in APS from baseline to 20 hours of training (initial change), followed by a flat APS trajectory (plateau) at subsequent time-points. Participants showed interindividual variability in the steepness of the initial APS change and in the APS plateau achieved and sustained between 20 and 40 hours. We found that participants who achieved the fastest APS plateau, showed the greatest transfer effects to untrained cognitive domains. There is a significant association between an individual's ability to generate and sustain auditory processing efficiency and their degree of cognitive improvement after TCT, independent of baseline neurocognition. APS plateau may therefore represent a behavioral measure of target engagement mediating treatment response. Future studies should examine the optimal plateau of auditory processing efficiency required to induce significant cognitive improvements, in the context of interindividual differences in neural plasticity and sensory system efficiency that characterize schizophrenia. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Hybrid Power Management Program Evaluated Fuel Cell/Ultracapacitor Combinations and Developed Other New Applications

NASA Technical Reports Server (NTRS)

Eichenberg, Dennis J.

2004-01-01

In fiscal year 2003, the continuation of the Hybrid Power Management (HPM) Program through NASA Glenn Research Center's Commercial Technology Office resulted in several new successful applications of this pioneering technology. HPM is the innovative integration of diverse, state-of-the-art power devices in an optimal configuration for space and terrestrial applications. The appropriate application and control of the various power devices significantly improves overall system performance and efficiency. The advanced power devices include ultracapacitors, fuel cells, and photovoltaics. HPM has extremely wide potential, with applications from nanowatts to megawatts--including power generation, transportation systems, biotechnology systems, and space power systems. HPM has the potential to significantly alleviate global energy concerns, improve the environment, and stimulate the economy. Fuel cells provide excellent efficiency and energy density, but do not have good power density. In contrast, ultracapacitors have excellent power density and virtually unlimited cycle life. To improve the power density of the fuel cell, the combination of fuel cells and ultracapacitors was evaluated.

EGFR-Targeted Adenovirus Dendrimer Coating for Improved Systemic Delivery of the Theranostic NIS Gene

PubMed Central

Grünwald, Geoffrey K; Vetter, Alexandra; Klutz, Kathrin; Willhauck, Michael J; Schwenk, Nathalie; Senekowitsch-Schmidtke, Reingard; Schwaiger, Markus; Zach, Christian; Wagner, Ernst; Göke, Burkhard; Holm, Per S; Ogris, Manfred; Spitzweg, Christine

2013-01-01

We recently demonstrated tumor-selective iodide uptake and therapeutic efficacy of combined radiovirotherapy after systemic delivery of the theranostic sodium iodide symporter (NIS) gene using a dendrimer-coated adenovirus. To further improve shielding and targeting we physically coated replication-selective adenoviruses carrying the hNIS gene with a conjugate consisting of cationic poly(amidoamine) (PAMAM) dendrimer linked to the peptidic, epidermal growth factor receptor (EGFR)-specific ligand GE11. In vitro experiments demonstrated coxsackie-adenovirus receptor-independent but EGFR-specific transduction efficiency. Systemic injection of the uncoated adenovirus in a liver cancer xenograft mouse model led to high levels of NIS expression in the liver due to hepatic sequestration, which were significantly reduced after coating as demonstrated by 123I-scintigraphy. Reduction of adenovirus liver pooling resulted in decreased hepatotoxicity and increased transduction efficiency in peripheral xenograft tumors. 124I-PET-imaging confirmed EGFR-specificity by significantly lower tumoral radioiodine accumulation after pretreatment with the EGFR-specific antibody cetuximab. A significantly enhanced oncolytic effect was observed following systemic application of dendrimer-coated adenovirus that was further increased by additional treatment with a therapeutic dose of 131I. These results demonstrate restricted virus tropism and tumor-selective retargeting after systemic application of coated, EGFR-targeted adenoviruses therefore representing a promising strategy for improved systemic adenoviral NIS gene therapy. PMID:24193032

Noise temperature improvement for magnetic fusion plasma millimeter wave imaging systems.

PubMed

Lai, J; Domier, C W; Luhmann, N C

2014-03-01

Significant progress has been made in the imaging and visualization of magnetohydrodynamic and microturbulence phenomena in magnetic fusion plasmas [B. Tobias et al., Plasma Fusion Res. 6, 2106042 (2011)]. Of particular importance have been microwave electron cyclotron emission imaging and microwave imaging reflectometry systems for imaging T(e) and n(e) fluctuations. These instruments have employed heterodyne receiver arrays with Schottky diode mixer elements directly connected to individual antennas. Consequently, the noise temperature has been strongly determined by the conversion loss with typical noise temperatures of ~60,000 K. However, this can be significantly improved by making use of recent advances in Monolithic Microwave Integrated Circuit chip low noise amplifiers to insert a pre-amplifier in front of the Schottky diode mixer element. In a proof-of-principle design at V-Band (50-75 GHz), significant improvement of noise temperature from the current 60,000 K to measured 4000 K has been obtained.

Heroic Reliability Improvement in Manned Space Systems

NASA Technical Reports Server (NTRS)

Jones, Harry W.

2017-01-01

System reliability can be significantly improved by a strong continued effort to identify and remove all the causes of actual failures. Newly designed systems often have unexpected high failure rates which can be reduced by successive design improvements until the final operational system has an acceptable failure rate. There are many causes of failures and many ways to remove them. New systems may have poor specifications, design errors, or mistaken operations concepts. Correcting unexpected problems as they occur can produce large early gains in reliability. Improved technology in materials, components, and design approaches can increase reliability. The reliability growth is achieved by repeatedly operating the system until it fails, identifying the failure cause, and fixing the problem. The failure rate reduction that can be obtained depends on the number and the failure rates of the correctable failures. Under the strong assumption that the failure causes can be removed, the decline in overall failure rate can be predicted. If a failure occurs at the rate of lambda per unit time, the expected time before the failure occurs and can be corrected is 1/lambda, the Mean Time Before Failure (MTBF). Finding and fixing a less frequent failure with the rate of lambda/2 per unit time requires twice as long, time of 1/(2 lambda). Cutting the failure rate in half requires doubling the test and redesign time and finding and eliminating the failure causes.Reducing the failure rate significantly requires a heroic reliability improvement effort.

Ground and flight test results of a total main rotor isolation system

NASA Technical Reports Server (NTRS)

Halwes, Dennis R.

1987-01-01

A six degree-of-freedom (DOF) isolation system using six LIVE units has been installed under an Army/NASA contract on a Bell 206LM helicopter. This system has been named the Total Rotor Isolation System, or TRIS. To determine the effectiveness of TRIS in reducing helicopter vibration, a flight verification study was conducted at Bell's Flight Research Center in Arlington, Texas. The flight test data indicate that the 4/rev vibration level at the pilot's seat were suppressed below the 0.04g level throughout the transition envelope. Flight tests indicate over 95% suppression of vibration level from the rotor hub to the pilot's seat. The TRIS installation was designed with a decoupled control system and has shown a significant improvement in aircraft flying qualities, such that it permitted the trimmed aircraft to be flown hands-off for a significant period of time, over 90 seconds. The TRIS flight test program has demonstrated a system that greatly reduces vibration levels of a current-generation helicopter, while significantly improving the flying qualities to a point where stability augmentation is no longer a requirement.

Flow Control Opportunities for Propulsion Systems

NASA Technical Reports Server (NTRS)

Cutley, Dennis E.

2008-01-01

The advancement of technology in gas turbine engines used for aerospace propulsion has been focused on achieving significant performance improvements. At the system level, these improvements are expressed in metrics such as engine thrust-to-weight ratio and system and component efficiencies. The overall goals are directed at reducing engine weight, fuel burn, emissions, and noise. At a component level, these goals translate into aggressive designs of each engine component well beyond the state of the art.

The online outpatient booking system 'Choose and Book' improves attendance rates at an audiology clinic: a comparative audit.

PubMed

Parmar, Vijal; Large, Ann; Madden, Colm; Das, Vijay

2009-01-01

The 'Choose and Book' system provides an online booking service which primary care professionals can book in real time or soon after a patient's consultation. It aims to offer patients choice and improve outpatient clinic attendance rates. An audit comparing attendance rates of new patients booked into the Audiological Medicine Clinic using the 'Choose and Book' system with that of those whose bookings were made through the traditional booking system. Data accrued between 1 April 2008 and 31 October 2008 were retrospectively analysed for new patient attendance at the department, and the age and sex of the patients, method of appointment booking used and attendance record were collected. Patients were grouped according to booking system used - 'Choose and Book' or the traditional system. The mean ages of the groups were compared by a t test. The standard error of the difference between proportions was used to compare the data from the two groups. A P value of < or = 0.05 was considered to be significant. 'Choose and Book' patients had a significantly better rate of attendance than traditional appointment patients, P < 0.01 (95% CI 4.3, 20.5%). There was no significant difference between the two groups in terms of sex, P > 0.1 (95% CI-3.0, 16.2%). The 'Choose and Book' patients, however, were significantly older than the traditional appointment patients, P < 0.001 (95% CI 4.35, 12.95%). This audit suggests that when primary care agents book outpatient clinic appointments online it improves outpatient attendance.

Evaluating an online pharmaceutical education system for pharmacy interns in critical care settings.

PubMed

Yeh, Yu-Ting; Chen, Hsiang-Yin; Cheng, Kuei-Ju; Hou, Ssu-An; Yen, Yu-Hsuan; Liu, Chien-Tsai

2014-02-01

Incorporating electronic learning (eLearning) system into professional experimental programs such as pharmacy internships is a challenge. However, none of the current systems can fully support the unique needs of clinical pharmacy internship. In this study we enhanced a commercial eLearning system for clinical pharmacy internship (The Clinical Pharmacy Internship eLearning System, CPIES). The KAP questionnaire was used to evaluate the performance of group A with the traditional teaching model and group B with the CPIES teaching model. The CPIES teaching model showed significant improvement in interns' knowledge and practice (p = 0.002 and 0.031, respectively). The traditional teaching model only demonstrated significant improvement in practice (p = 0.011). Moreover, professionalism, such as attitudes on cooperating with other health professionals, is developed by learning from a good mentor. The on-line teaching and traditional teaching methods should undoubtedly be blended in a complete teaching model in order to improve learners' professional knowledge, facilitate correct attitude, and influence good practice. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Improving organisational systems for diabetes care in Australian Indigenous communities.

PubMed

Bailie, Ross; Si, Damin; Dowden, Michelle; O'Donoghue, Lynette; Connors, Christine; Robinson, Gary; Cunningham, Joan; Weeramanthri, Tarun

2007-05-06

Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from diabetes. There is an urgent need to understand how Indigenous primary care systems are organised to deliver diabetes services to those most in need, to monitor the quality of diabetes care received by Indigenous people, and to improve systems for better diabetes care. The intervention featured two annual cycles of assessment, feedback workshops, action planning, and implementation of system changes in 12 Indigenous community health centres. Assessment included a structured review of health service systems and audit of clinical records. Main process of care measures included adherence to guideline-scheduled services and medication adjustment. Main patient outcome measures were HbA1c, blood pressure and total cholesterol levels. There was good engagement of health centre staff, with significant improvements in system development over the study period. Adherence to guideline-scheduled processes improved, including increases in 6 monthly testing of HbA1c from 41% to 74% (Risk ratio 1.93, 95% CI 1.71-2.10), 3 monthly checking of blood pressure from 63% to 76% (1.27, 1.13-1.37), annual testing of total cholesterol from 56% to 74% (1.36, 1.20-1.49), biennial eye checking by a ophthalmologist from 34% to 54% (1.68, 1.39-1.95), and 3 monthly feet checking from 20% to 58% (3.01, 2.52-3.47). Medication adjustment rates following identification of elevated HbA1c and blood pressure were low, increasing from 10% to 24%, and from 13% to 21% respectively at year 1 audit. However, improvements in medication adjustment were not maintained at the year 2 follow-up. Mean HbA1c value improved from 9.3 to 8.9% (mean difference -0.4%, 95% CI -0.7;-0.1), but there was no improvement in blood pressure or cholesterol control. This quality improvement (QI) intervention has proved to be highly acceptable in the Indigenous Australian primary care setting and has been associated with significant improvements in systems and processes of care and some intermediate outcomes. However, improvements appear to be limited by inadequate attention to abnormal clinical findings and medication management. Greater improvement in intermediate outcomes may be achieved by specifically addressing system barriers to therapy intensification through more effective engagement of medical staff in QI activities and/or greater use of nurse-practitioners.

A novel virtual motor rehabilitation system for Guillain-Barré syndrome. Two single case studies.

PubMed

Albiol-Pérez, S; Forcano-García, M; Muñoz-Tomás, M T; Manzano-Fernández, P; Solsona-Hernández, S; Mashat, M A; Gil-Gómez, J A

2015-01-01

This article is part of the Focus Theme of Methods of Information in Medicine on "New Methodologies for Patients Rehabilitation". For Guillain-Barré patients, motor rehabilitation programs are helpful at the onset to prevent the complications of paralysis and in cases of persistent motor impairment. Traditional motor rehabilitation programs may be tedious and monotonous, resulting in low adherence to the treatments. A Virtual Motor Rehabilitation system has been tested in Guillain-Barré patients to increase patient adherence and to improve clinical results. Two people with Guillain-Barré performed 20 rehabilitation sessions. We tested a novel system based on Motor Virtual Rehabilitation in three periods of time (baseline evaluation, final evaluation, and follow-up. In the training program, the participants carried out a specific treatment using the Active Balance Rehabilitation system (ABAR). The system is composed of customizable virtual games to perform static and dynamic balance rehabilitation. Significant improvements in clinical results were obtained by both participants, with significant results in the static balance clinical test of the Anterior Reach test in the standing position and unipedal stance time. Other significant results were found in dynamic balance clinical tests in the Berg Balance Scale test and the 30-second Sit-to-Stand test. With regard to acceptance of the system, both patients enjoyed the experience, and both patients thought that this system was helpful for their rehabilitation. The results show that Virtual Motor Rehabilitation for Guillain-Barré patients provides clinical improvements in an entertaining way.

Improving Interdisciplinary Provider Communication Through a Unified Paging System.

PubMed

Heidemann, Lauren; Petrilli, Christopher; Gupta, Ashwin; Campbell, Ian; Thompson, Maureen; Cinti, Sandro; Stewart, David A

2016-06-01

Interdisciplinary communication at a Veterans Affairs (VA) academic teaching hospital is largely dependent on alphanumeric paging, which has limitations as a result of one-way communication and lack of reliable physician identification. Adverse patient outcomes related to difficulty contacting the correct consulting provider in a timely manner have been reported. House officers were surveyed on the level of satisfaction with the current VA communication system and the rate of perceived adverse patient outcomes caused by potential delays within this system. Respondents were then asked to identify the ideal paging system. These results were used to develop and deploy a new Web site. A postimplementation survey was repeated 1 year later. This study was conducted as a quality improvement project. House officer satisfaction with the preintervention system was 3%. The majority used more than four modalities to identify consultants, with 59% stating that word of mouth was a typical source. The preferred mode of paging was the university hospital paging system, a Web-based program that is used at the partnering academic institution. Following integration of VA consulting services within the university hospital paging system, the level of satisfaction improved to 87%. Significant decreases were seen in perceived adverse patient outcomes (from 16% to 2%), delays in patient care (from 90% to 16%), and extended hospitalizations (from 46% to 4%). Our study demonstrates significant improvement in physician satisfaction with a newly implemented paging system that was associated with a decreased perceived number of adverse patient events and delays in care.

Radiation dose and image quality of X-ray volume imaging systems: cone-beam computed tomography, digital subtraction angiography and digital fluoroscopy.

PubMed

Paul, Jijo; Jacobi, Volkmar; Farhang, Mohammad; Bazrafshan, Babak; Vogl, Thomas J; Mbalisike, Emmanuel C

2013-06-01

Radiation dose and image quality estimation of three X-ray volume imaging (XVI) systems. A total of 126 patients were examined using three XVI systems (groups 1-3) and their data were retrospectively analysed from 2007 to 2012. Each group consisted of 42 patients and each patient was examined using cone-beam computed tomography (CBCT), digital subtraction angiography (DSA) and digital fluoroscopy (DF). Dose parameters such as dose-area product (DAP), skin entry dose (SED) and image quality parameters such as Hounsfield unit (HU), noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were estimated and compared using appropriate statistical tests. Mean DAP and SED were lower in recent XVI than its previous counterparts in CBCT, DSA and DF. HU of all measured locations was non-significant between the groups except the hepatic artery. Noise showed significant difference among groups (P < 0.05). Regarding CNR and SNR, the recent XVI showed a higher and significant difference compared to its previous versions. Qualitatively, CBCT showed significance between versions unlike the DSA and DF which showed non-significance. A reduction of radiation dose was obtained for the recent-generation XVI system in CBCT, DSA and DF. Image noise was significantly lower; SNR and CNR were higher than in previous versions. The technological advancements and the reduction in the number of frames led to a significant dose reduction and improved image quality with the recent-generation XVI system. • X-ray volume imaging (XVI) systems are increasingly used for interventional radiological procedures. • More modern XVI systems use lower radiation doses compared with earlier counterparts. • Furthermore more modern XVI systems provide higher image quality. • Technological advances reduce radiation dose and improve image quality.

Use of the quality management system “JACIE” and outcome after hematopoietic stem cell transplantation

PubMed Central

Gratwohl, Alois; Brand, Ronald; McGrath, Eoin; van Biezen, Anja; Sureda, Anna; Ljungman, Per; Baldomero, Helen; Chabannon, Christian; Apperley, Jane

2014-01-01

Competent authorities, healthcare payers and hospitals devote increasing resources to quality management systems but scientific analyses searching for an impact of these systems on clinical outcome remain scarce. Earlier data indicated a stepwise improvement in outcome after allogeneic hematopoietic stem cell transplantation with each phase of the accreditation process for the quality management system “JACIE”. We therefore tested the hypothesis that working towards and achieving “JACIE” accreditation would accelerate improvement in outcome over calendar time. Overall mortality of the entire cohort of 107,904 patients who had a transplant (41,623 allogeneic, 39%; 66,281 autologous, 61%) between 1999 and 2006 decreased over the 14-year observation period by a factor of 0.63 per 10 years (hazard ratio: 0.63; 0.58–0.69). Considering “JACIE“-accredited centers as those with programs having achieved accreditation by November 2012, at the latest, this improvement was significantly faster in “JACIE”-accredited centers than in non-accredited centers (approximately 5.3% per year for 49,459 patients versus approximately 3.5% per year for 58,445 patients, respectively; hazard ratio: 0.83; 0.71–0.97). As a result, relapse-free survival (hazard ratio 0.85; 0.75–0.95) and overall survival (hazard ratio 0.86; 0.76–0.98) were significantly higher at 72 months for those patients transplanted in the 162 “JACIE“-accredited centers. No significant effects were observed after autologous transplants (hazard ratio 1.06; 0.99–1.13). Hence, working towards implementation of a quality management system triggers a dynamic process associated with a steeper reduction in mortality over the years and a significantly improved survival after allogeneic stem cell transplantation. Our data support the use of a quality management system for complex medical procedures. PMID:24488562

Comparison of Overridden Medication-related Clinical Decision Support in the Intensive Care Unit between a Commercial System and a Legacy System.

PubMed

Wong, Adrian; Wright, Adam; Seger, Diane L; Amato, Mary G; Fiskio, Julie M; Bates, David

2017-08-23

Electronic health records (EHRs) with clinical decision support (CDS) have shown to be effective at improving patient safety. Despite this, alerts delivered as part of CDS are overridden frequently, which is of concern in the critical care population as this group may have an increased risk of harm. Our organization recently transitioned from an internally-developed EHR to a commercial system. Data comparing various EHR systems, especially after transitions between EHRs, are needed to identify areas for improvement. To compare the two systems and identify areas for potential improvement with the new commercial system at a single institution. Overridden medication-related CDS alerts were included from October to December of the systems' respective years (legacy, 2011; commercial, 2015), restricted to three intensive care units. The two systems were compared with regards to CDS presentation and override rates for four types of CDS: drug-allergy, drug-drug interaction (DDI), geriatric and renal alerts. A post hoc analysis to evaluate for adverse drug events (ADEs) potentially resulting from overridden alerts was performed for 'contraindicated' DDIs via chart review. There was a significant increase in provider exposure to alerts and alert overrides in the commercial system (commercial: n=5,535; legacy: n=1,030). Rates of overrides were higher for the allergy and DDI alerts (p<0.001) in the commercial system. Geriatric and renal alerts were significantly different in incidence and presentation between the two systems. No ADEs were identified in an analysis of 43 overridden contraindicated DDI alerts. The vendor system had much higher rates of both alerts and overrides, although we did not find evidence of harm in a review of DDIs which were overridden. We propose recommendations for improving our current system which may be helpful to other similar institutions; improving both alert presentation and the underlying knowledge base appear important.

Effects of a kinesthetic cursive handwriting intervention for grade 4-6 students.

PubMed

Roberts, Gwenyth I; Siever, Jodi E; Mair, Judith A

2010-01-01

We studied whether Grade 4-6 students who participated in a kinesthetic writing intervention improved in legibility, speed, and personal satisfaction with cursive handwriting. Small groups of students with handwriting difficulties were seen weekly for 7 wk using a kinesthetic writing system. A repeated measures design was used to evaluate change in global legibility, individual letter formation, specific features of handwriting, and personal satisfaction. Analysis revealed (1) a significant increase in ratings of global legibility (p <.01; clinically significant improvements in 39% of students); (2) significant improvements in letter formation and legibility features of baseline, closure, and line quality (all p < .05); (3) increased handwriting speed (p < .05; not clinically significant); and (4) significant increase in measures with personal satisfaction of handwriting (p < .01). CONCLUSION. A kinesthetic handwriting intervention may be effective in improving the skills of students with handwriting challenges.

An antiaging skin care system containing alpha hydroxy acids and vitamins improves the biomechanical parameters of facial skin

PubMed Central

Tran, Diana; Townley, Joshua P; Barnes, Tanya M; Greive, Kerryn A

2015-01-01

Background The demand for antiaging products has dramatically increased in recent years, driven by an aging population seeking to maintain the appearance of youth. This study investigates the effects of an antiaging skin care system containing alpha hydroxy acids (AHAs) in conjunction with vitamins B3, C, and E on the biomechanical parameters of facial skin. Methods Fifty two volunteers followed an antiaging skin care regimen comprising of cleanser, eye cream, day moisturizer, and night moisturizer for 21 days. Wrinkle depth (Ry) and skin roughness (Ra) were measured by skin surface profilometry of the crow’s feet area, and skin elasticity parameters R2 (gross elasticity), R5 (net elasticity), R6 (viscoelastic portion), and R7 (recovery after deformation) were determined for facial skin by cutometer, preapplication and after 7, 14, and 21 days. Volunteers also completed a self-assessment questionnaire. Results Compared to baseline, Ry and Ra significantly improved by 32.5% (P<0.0001) and 42.9% (P<0.0001), respectively, after 21 days of antiaging skin care treatment. These results were observed by the volunteers with 9 out of 10 discerning an improvement in skin texture and smoothness. Compared to baseline, R2 and R5 significantly increased by 15.2% (P<0.0001) and 12.5% (P=0.0449), respectively, while R6 significantly decreased by 17.7% (P<0.0001) after 21 days. R7 increased by 9.7% after 21 days compared to baseline but this was not significant over this time period. Conclusion An antiaging skin care system containing AHAs and vitamins significantly improves the biomechanical parameters of the skin including wrinkles and skin texture, as well as elasticity without significant adverse effects. PMID:25552908

An antiaging skin care system containing alpha hydroxy acids and vitamins improves the biomechanical parameters of facial skin.

PubMed

Tran, Diana; Townley, Joshua P; Barnes, Tanya M; Greive, Kerryn A

2015-01-01

The demand for antiaging products has dramatically increased in recent years, driven by an aging population seeking to maintain the appearance of youth. This study investigates the effects of an antiaging skin care system containing alpha hydroxy acids (AHAs) in conjunction with vitamins B3, C, and E on the biomechanical parameters of facial skin. Fifty two volunteers followed an antiaging skin care regimen comprising of cleanser, eye cream, day moisturizer, and night moisturizer for 21 days. Wrinkle depth (Ry ) and skin roughness (Ra ) were measured by skin surface profilometry of the crow's feet area, and skin elasticity parameters R2 (gross elasticity), R5 (net elasticity), R6 (viscoelastic portion), and R7 (recovery after deformation) were determined for facial skin by cutometer, preapplication and after 7, 14, and 21 days. Volunteers also completed a self-assessment questionnaire. Compared to baseline, Ry and Ra significantly improved by 32.5% (P<0.0001) and 42.9% (P<0.0001), respectively, after 21 days of antiaging skin care treatment. These results were observed by the volunteers with 9 out of 10 discerning an improvement in skin texture and smoothness. Compared to baseline, R2 and R5 significantly increased by 15.2% (P<0.0001) and 12.5% (P=0.0449), respectively, while R6 significantly decreased by 17.7% (P<0.0001) after 21 days. R7 increased by 9.7% after 21 days compared to baseline but this was not significant over this time period. An antiaging skin care system containing AHAs and vitamins significantly improves the biomechanical parameters of the skin including wrinkles and skin texture, as well as elasticity without significant adverse effects.

The AJCC 8th Edition Staging System for Soft Tissue Sarcoma of the Extremities or Trunk: A Cohort Study of the SEER Database.

PubMed

Cates, Justin M M

2018-02-01

Background: The AJCC recently published the 8th edition of its cancer staging system. Significant changes were made to the staging algorithm for soft tissue sarcoma (STS) of the extremities or trunk, including the addition of 2 additional T (size) classifications in lieu of tumor depth and grouping lymph node metastasis (LNM) with distant metastasis as stage IV disease. Whether these changes improve staging system performance is questionable. Patients and Methods: This retrospective cohort analysis of 21,396 adult patients with STS of the extremity or trunk in the SEER database compares the AJCC 8th edition staging system with the 7th edition and a newly proposed staging algorithm using a variety of statistical techniques. The effect of tumor size on disease-specific survival was assessed by flexible, nonlinear Cox proportional hazard regression using restricted cubic splines and fractional polynomials. Results: The slope of covariate-adjusted log hazards for sarcoma-specific survival decreases for tumors >8 cm in greatest dimension, limiting prognostic information contributed by the new T4 classification in the AJCC 8th edition. Anatomic depth independently provides significant prognostic information. LNM is not equivalent to distant, non-nodal metastasis. Based on these findings, an alternative staging system is proposed and demonstrated to outperform both AJCC staging schemes. The analyses presented also disclose no evidence of improved clinical performance of the 8th edition compared with the previous edition. Conclusions: The AJCC 8th edition staging system for STS is no better than the previous 7th edition. Instead, a proposed staging system based on histologic grade, tumor size, and anatomic depth shows significantly higher predictive accuracy, with higher model concordance than either AJCC staging system. Changes to existing staging systems should improve the performance of prognostic models. Until such improvements are documented, AJCC committees should refrain from modifying established staging schemes. Copyright © 2018 by the National Comprehensive Cancer Network.

Factors affecting the sustainability of solid waste management system-the case of Palestine.

PubMed

Al-Khateeb, Ammar J; Al-Sari, Majed I; Al-Khatib, Issam A; Anayah, Fathi

2017-02-01

Understanding the predictors of sustainability in solid waste management (SWM) systems can significantly contribute to eliminate many waste management problems. In this paper, the sustainability elements of SWM systems of interest are (1) attitudes toward separation at the source, (2) behaviour regarding reuse and/or recycling and (3) willingness to pay for an improved service of SWM. The predictors affecting these three elements were studied in two Palestinian cities: Ramallah and Jericho. The data were collected via structured questionnaires and direct interviews with the respondents, and the analysis utilized a logistic regression model. The results showed that the place of residence and dwelling premises are the significant factors influencing attitudes toward separation at the source; the place of residence and age are the significant factors explaining behaviour regarding reuse and/or recycling; while the dwelling premises, gender, level of education and being received education on waste management are the significant factors affecting willingness to pay for an improved service of SWM.

Effect of micro-vibration culture system on embryo development.

PubMed

Hur, Yong Soo; Park, Jeong Hyun; Ryu, Eun Kyung; Park, Sung Jin; Lee, Jun Ho; Lee, Soo Hee; Yoon, Jung; Yoon, San Hyun; Hur, Chang Young; Lee, Won Don; Lim, Jin Ho

2013-06-01

Micro-vibration culture system was examined to determine the effects on mouse and human embryo development and possible improvement of clinical outcomes in poor responders. The embryonic development rates and cell numbers of blastocysts were compared between a static culture group (n = 178) and a micro-vibration culture group (n = 181) in mice. The embryonic development rates and clinical results were compared between a static culture group (n = 159 cycles) and a micro-vibration culture group (n = 166 cycles) in poor responders. A micro-vibrator was set at a frequency of 42 Hz, 5 s/60 min duration for mouse and human embryo development. The embryonic development rate was significantly improved in the micro-vibration culture group in mice (p < 0.05). The cell numbers of mouse blastocysts were significantly higher in the micro-vibration group than in the static culture group (p < 0.05). In the poor responders, the rate of high grade embryos was not significantly improved in the micro-vibration culture group on day 3. However, the optimal embryonic development rate on day 5 was improved in the micro-vibration group, and the total pregnancy rate and implantation rate were significantly higher in the micro-vibration group than in the static culture group (p < 0.05). Micro-vibration culture methods have a beneficial effect on embryonic development in mouse embryos. In poor responders, the embryo development rate was improved to a limited extent under the micro-vibration culture conditions, but the clinical results were significantly improved.

The effect of nursing participation in the design of a critical care information system: a case study in a Chinese hospital.

PubMed

Qin, Yanhong; Zhou, Ranyun; Wu, Qiong; Huang, Xiaodi; Chen, Xinli; Wang, Weiwei; Wang, Xun; Xu, Hua; Zheng, Jing; Qian, Siyu; Bai, Changqing; Yu, Ping

2017-12-06

Intensive care information systems (ICIS) are continuously evolving to meet the ever changing information needs of intensive care units (ICUs), providing the backbone for a safe, intelligent and efficient patient care environment. Although beneficial for the international advancement in building smart environments to transform ICU services, knowledge about the contemporary development of ICIS worldwide, their usage and impacts is limited. This study aimed to fill this knowledge gap by researching the development and implementation of an ICIS in a Chinese hospital, nurses' use of the system, and the impact of system use on critical care nursing processes and outcomes. This descriptive case study was conducted in a 14-bed Respiratory ICU in a tertiary hospital in Beijing. Participative design was the method used for ICU nurses, hospital IT department and a software company to collaboratively research and develop the ICIS. Focus group discussions were conducted to understand the subjective perceptions of the nurses toward the ICIS. Nursing documentation time and quality were compared before and after system implementation. ICU nursing performance was extracted from the annual nursing performance data collected by the hospital. A participative design process was followed by the nurses in the ICU, the hospital IT staff and the software engineers in the company to develop and implement a highly useful ICIS. Nursing documentation was fully digitized and was significantly improved in quality and efficiency. The wrong data, missing data items and calculation errors were significantly reduced. Nurses spent more time on direct patient care after the introduction of the ICIS. The accuracy and efficiency of medication administration was also improved. The outcome was improvement in ward nursing performance as measured by ward management, routine nursing practices, disinfection and isolation, infection rate and mortality rate. Nurses in this ICU unit in China actively participated in the ICIS development and fully used the system to document care. Introduction of the ICIS led to significant improvement in quality and efficiency in nursing documentation, medication order transcription and administration. It allowed nurses to spend more time with patients to improve quality of care. These led to improvement in overall nursing performance. Further study should investigate how the ICIS system contributes to the improvement in decision making of ICU nurses and intensivists.

A prospective interrupted time series study of interventions to improve the quality, rating, framing and structure of goal-setting in community-based brain injury rehabilitation.

PubMed

Hassett, Leanne; Simpson, Grahame; Cotter, Rachel; Whiting, Diane; Hodgkinson, Adeline; Martin, Diane

2015-04-01

To investigate whether the introduction of an electronic goals system followed by staff training improved the quality, rating, framing and structure of goals written by a community-based brain injury rehabilitation team. Interrupted time series design. Two interventions were introduced six months apart. The first intervention comprised the introduction of an electronic goals system. The second intervention comprised a staff goal training workshop. An audit protocol was devised to evaluate the goals. A random selection of goal statements from the 12 months prior to the interventions (Time 1 baseline) were compared with all goal statements written after the introduction of the electronic goals system (Time 2) and staff training (Time 3). All goals were de-identified for client and time-period, and randomly ordered. A total of 745 goals (Time 1 n = 242; Time 2 n = 283; Time 3 n = 220) were evaluated. Compared with baseline, the introduction of the electronic goals system alone significantly increased goal rating, framing and structure (χ(2) tests 144.7, 18.9, 48.1, respectively, p < 0.001). The addition of staff training meant that the improvement in goal quality, which was only a trend at Time 2, was statistically significant at Time 3 (χ(2) 15.0, p ≤ 001). The training also led to a further significant increase in the framing and structuring of goals over the electronic goals system (χ(2) 11.5, 12.5, respectively, p ≤ 0.001). An electronic goals system combined with staff training improved the quality, rating, framing and structure of goal statements. © The Author(s) 2014.

SU-F-T-256: 4D IMRT Planning Using An Early Prototype GPU-Enabled Eclipse Workstation

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

Hagan, A; Modiri, A; Sawant, A

Purpose: True 4D IMRT planning, based on simultaneous spatiotemporal optimization has been shown to significantly improve plan quality in lung radiotherapy. However, the high computational complexity associated with such planning represents a significant barrier to widespread clinical deployment. We introduce an early prototype GPU-enabled Eclipse workstation for inverse planning. To our knowledge, this is the first GPUintegrated Eclipse system demonstrating the potential for clinical translation of GPU computing on a major commercially-available TPS. Methods: The prototype system comprised of four NVIDIA Tesla K80 GPUs, with a maximum processing capability of 8.5 Tflops per K80 card. The system architecture consisted ofmore » three key modules: (i) a GPU-based inverse planning module using a highly-parallelizable, swarm intelligence-based global optimization algorithm, (ii) a GPU-based open-source b-spline deformable image registration module, Elastix, and (iii) a CUDA-based data management module. For evaluation, aperture fluence weights in an IMRT plan were optimized over 9 beams,166 apertures and 10 respiratory phases (14940 variables) for a lung cancer case (GTV = 95 cc, right lower lobe, 15 mm cranio-caudal motion). Sensitivity of the planning time and memory expense to parameter variations was quantified. Results: GPU-based inverse planning was significantly accelerated compared to its CPU counterpart (36 vs 488 min, for 10 phases, 10 search agents and 10 iterations). The optimized IMRT plan significantly improved OAR sparing compared to the original internal target volume (ITV)-based clinical plan, while maintaining prescribed tumor coverage. The dose-sparing improvements were: Esophagus Dmax 50%, Heart Dmax 42% and Spinal cord Dmax 25%. Conclusion: Our early prototype system demonstrates that through massive parallelization, computationally intense tasks such as 4D treatment planning can be accomplished in clinically feasible timeframes. With further optimization, such systems are expected to enable the eventual clinical translation of higher-dimensional and complex treatment planning strategies to significantly improve plan quality. This work was partially supported through research funding from National Institutes of Health (R01CA169102) and Varian Medical Systems, Palo Alto, CA, USA.« less

Communication Skills Training for Physicians Improves Patient Satisfaction.

PubMed

Boissy, Adrienne; Windover, Amy K; Bokar, Dan; Karafa, Matthew; Neuendorf, Katie; Frankel, Richard M; Merlino, James; Rothberg, Michael B

2016-07-01

Skilled physician communication is a key component of patient experience. Large-scale studies of exposure to communication skills training and its impact on patient satisfaction have not been conducted. We aimed to examine the impact of experiential relationship-centered physician communication skills training on patient satisfaction and physician experience. This was an observational study. The study was conducted at a large, multispecialty academic medical center. Participants included 1537 attending physicians who participated in, and 1951 physicians who did not participate in, communication skills training between 1 August 2013 and 30 April 2014. An 8-h block of interactive didactics, live or video skill demonstrations, and small group and large group skills practice sessions using a relationship-centered model. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), Jefferson Scale of Empathy (JSE), Maslach Burnout Inventory (MBI), self-efficacy, and post course satisfaction. Following the course, adjusted overall CGCAHPS scores for physician communication were higher for intervention physicians than for controls (92.09 vs. 91.09, p < 0.03). No significant interactions were noted between physician specialty or baseline CGCAHPS and improvement following the course. Significant improvement in the post-course HCAHPS Respect domain adjusted mean was seen in intervention versus control groups (91.08 vs. 88.79, p = 0.02) and smaller, non-statistically significant improvements were also seen for adjusted HCAHPS communication scores (83.95 vs. 82.73, p = 0.22). Physicians reported high course satisfaction and showed significant improvement in empathy (116.4 ± 12.7 vs. 124 ± 11.9, p < 0.001) and burnout, including all measures of emotional exhaustion, depersonalization, and personal accomplishment. Less depersonalization and greater personal accomplishment were sustained for at least 3 months. System-wide relationship-centered communication skills training improved patient satisfaction scores, improved physician empathy, self-efficacy, and reduced physician burnout. Further research is necessary to examine longer-term sustainability of such interventions.

Multivariate Analyses of Quality Metrics for Crystal Structures in the PDB Archive.

PubMed

Shao, Chenghua; Yang, Huanwang; Westbrook, John D; Young, Jasmine Y; Zardecki, Christine; Burley, Stephen K

2017-03-07

Following deployment of an augmented validation system by the Worldwide Protein Data Bank (wwPDB) partnership, the quality of crystal structures entering the PDB has improved. Of significance are improvements in quality measures now prominently displayed in the wwPDB validation report. Comparisons of PDB depositions made before and after introduction of the new reporting system show improvements in quality measures relating to pairwise atom-atom clashes, side-chain torsion angle rotamers, and local agreement between the atomic coordinate structure model and experimental electron density data. These improvements are largely independent of resolution limit and sample molecular weight. No significant improvement in the quality of associated ligands was observed. Principal component analysis revealed that structure quality could be summarized with three measures (Rfree, real-space R factor Z score, and a combined molecular geometry quality metric), which can in turn be reduced to a single overall quality metric readily interpretable by all PDB archive users. Copyright © 2017 Elsevier Ltd. All rights reserved.

Health care in China: improvement, challenges, and reform.

PubMed

Wang, Chen; Rao, Keqin; Wu, Sinan; Liu, Qian

2013-02-01

Over the past 2 decades, significant progress has been made in improving the health-care system and people's health conditions in China. Following rapid economic growth and social development, China's health-care system is facing new challenges, such as increased health-care demands and expenditure, inefficient use of health-care resources, unsatisfying implementation of disease management guidelines, and inadequate health-care insurance. Facing these challenges, the Chinese government carried out a national health-care reform in 2009. A series of policies were developed and implemented to improve the health-care insurance system, the medical care system, the public health service system, the pharmaceutical supply system, and the health-care institution management system in China. Although these measures have shown promising results, further efforts are needed to achieve the ultimate goal of providing affordable and high-quality care for both urban and rural residents in China. This article not only covers the improvement, challenges, and reform of health care in general in China, but also highlights the status of respiratory medicine-related issues.

[Organizational capacity for continuous improvement of health services].

PubMed

Saturno-Hernández, Pedro J; Hernández-Avila, Mauricio; Magaña-Valladares, Laura; Garcia-Saisó, Sebastián; Vertiz-Ramírez, José de Jesús

2015-01-01

While the Mexican health system has achieved significant progress, as reflected in the growing improvement in population health, heterogeneity in the quality of services and its impact on health in different population groups is still a challenge. The costs or poor quality represent about 20 to 40% of the health system's expenditure. We need to develop organizational capacity to implement quality management systems in order to identify, evaluate, prevent and eventually overcome the health system's challenges. A competency-based comprehensive strategy for training human resources is proposed including undergraduate and graduate education as well as continuing education, which will contribute to improve the quality function at the various levels of responsibility in the health system. The proposed strategy responds to the context of the Mexican health system, but it could be adapted to other systems and contexts.

Measurable improvement in patient safety culture: A departmental experience with incident learning.

PubMed

Kusano, Aaron S; Nyflot, Matthew J; Zeng, Jing; Sponseller, Patricia A; Ermoian, Ralph; Jordan, Loucille; Carlson, Joshua; Novak, Avrey; Kane, Gabrielle; Ford, Eric C

2015-01-01

Rigorous use of departmental incident learning is integral to improving patient safety and quality of care. The goal of this study was to quantify the impact of a high-volume, departmental incident learning system on patient safety culture. A prospective, voluntary, electronic incident learning system was implemented in February 2012 with the intent of tracking near-miss/no-harm incidents. All incident reports were reviewed weekly by a multiprofessional team with regular department-wide feedback. Patient safety culture was measured at baseline with validated patient safety culture survey questions. A repeat survey was conducted after 1 and 2 years of departmental incident learning. Proportional changes were compared by χ(2) or Fisher exact test, where appropriate. Between 2012 and 2014, a total of 1897 error/near-miss incidents were reported, representing an average of 1 near-miss report per patient treated. Reports were filed by a cross section of staff, with the majority of incidents reported by therapists, dosimetrists, and physicists. Survey response rates at baseline and 1 and 2 years were 78%, 80%, and 80%, respectively. Statistically significant and sustained improvements were noted in several safety metrics, including belief that the department was openly discussing ways to improve safety, the sense that reports were being used for safety improvement, and the sense that changes were being evaluated for effectiveness. None of the surveyed dimensions of patient safety culture worsened. Fewer punitive concerns were noted, with statistically significant decreases in the worry of embarrassment in front of colleagues and fear of getting colleagues in trouble. A comprehensive incident learning system can identify many areas for improvement and is associated with significant and sustained improvements in patient safety culture. These data provide valuable guidance as incident learning systems become more widely used in radiation oncology. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

[ENT and head and neck surgery in the German DRG system 2007].

PubMed

Franz, D; Roeder, N; Hörmann, K; Alberty, J

2007-07-01

The German DRG system has been further developed into version 2007. For ENT and head and neck surgery, significant changes in the coding of diagnoses and medical operations as well as in the the DRG structure have been made. New ICD codes for sleep apnoea and acquired tracheal stenosis have been implemented. Surgery on the acoustic meatus, removal of auricle hyaline cartilage for transplantation (e. g. rhinosurgery) and tonsillotomy have been coded in the 2007 version. In addition, the DRG structure has been improved. Case allocation of more than one significant operation has been established. The G-DRG system has gained in complexity. High demands are made on the coding of complex cases, whereas standard cases require mostly only one specific diagnosis and one specific OPS code. The quality of case allocation for ENT patients within the G-DRG system has been improved. Nevertheless, further adjustments of the G-DRG system are necessary.

77 FR 68140 - Privacy Act of 1974; New System of Records, Office of General Counsel E-Discovery Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-15

... System of Records, Office of General Counsel E-Discovery Management System: Republication of System... Counsel (OGC) E- Discovery Management System (EDMS). EDMS was first announced and described in a July 17... for OGC's E-Discovery Management System (OGC-EDMS), a system expected to significantly improve the...

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

NASA Technical Reports Server (NTRS)

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

2009-01-01

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

Filling the Gaps: The Synergistic Application of Satellite Data for the Volcanic Ash Threat to Aviation

NASA Technical Reports Server (NTRS)

Murray, John; Vernier, Jean-Paul; Fairlie, T. Duncan; Pavolonis, Michael; Krotkov, Nickolay A.; Lindsay, Francis; Haynes, John

2013-01-01

Although significant progress has been made in recent years, estimating volcanic ash concentration for the full extent of the airspace affected by volcanic ash remains a challenge. No single satellite, airborne or ground observing system currently exists which can sufficiently inform dispersion models to provide the degree of accuracy required to use them with a high degree of confidence for routing aircraft in and near volcanic ash. Toward this end, the detection and characterization of volcanic ash in the atmosphere may be substantially improved by integrating a wider array of observing systems and advancements in trajectory and dispersion modeling to help solve this problem. The qualitative aspect of this effort has advanced significantly in the past decade due to the increase of highly complementary observational and model data currently available. Satellite observations, especially when coupled with trajectory and dispersion models can provide a very accurate picture of the 3-dimensional location of ash clouds. The accurate estimate of the mass loading at various locations throughout the entire plume, however improving, remains elusive. This paper examines the capabilities of various satellite observation systems and postulates that model-based volcanic ash concentration maps and forecasts might be significantly improved if the various extant satellite capabilities are used together with independent, accurate mass loading data from other observing systems available to calibrate (tune) ash concentration retrievals from the satellite systems.

Telemedicine-based system for quality management and peer review in radiology.

PubMed

Morozov, Sergey; Guseva, Ekaterina; Ledikhova, Natalya; Vladzymyrskyy, Anton; Safronov, Dmitry

2018-06-01

Quality assurance is the key component of modern radiology. A telemedicine-based quality assurance system helps to overcome the "scoring" approach and makes the quality control more accessible and objective. A concept for quality assurance in radiology is developed. Its realization is a set of strategies, actions, and tools. The latter is based on telemedicine-based peer review of 23,199 computed tomography (CT) and magnetic resonance imaging (MRI) images. The conception of the system for quality management in radiology represents a chain of actions: "discrepancies evaluation - routine support - quality improvement activity - discrepancies evaluation". It is realized by an audit methodology, telemedicine, elearning, and other technologies. After a year of systemic telemedicine-based peer reviews, the authors have estimated that clinically significant discrepancies were detected in 6% of all cases, while clinically insignificant ones were found in 19% of cases. Most often, problems appear in musculoskeletal records; 80% of the examinations have diagnostic or technical imperfections. The presence of routine telemedicine support and personalized elearning allowed improving the diagnostics quality. The level of discrepancies has decreased significantly (p < 0.05). The telemedicine-based peer review system allows improving radiology departments' network effectiveness. • "Scoring" approach to radiologists' performance assessment must be changed. • Telemedicine peer review and personalized elearning significantly decrease the number of discrepancies. • Teleradiology allows linking all primary-level hospitals to a common peer review network.

Regulation of Vapor Pressure Deficit by Greenhouse Micro-Fog Systems Improved Growth and Productivity of Tomato via Enhancing Photosynthesis during Summer Season

PubMed Central

Zhang, Dalong; Zhang, Zhongdian; Li, Jianming; Chang, Yibo; Du, Qingjie; Pan, Tonghua

2015-01-01

The role of a proposed micro-fog system in regulating greenhouse environments and enhancing tomato (Solanum lycopersicum L.) productivity during summer season was studied. Experiments were carried out in a multi-span glass greenhouse, which was divided into two identical compartments involving different environments: (1) without environment control and (2) with a micro-fog system operating when the air vapor pressure deficit (VPD) of greenhouse was higher than 0.5 KPa. The micro-fog system effectively alleviated heat stress and evaporative demand in the greenhouse during summer season. The physiologically favourable environment maintained by micro-fog treatment significantly enhanced elongation of leaf and stem, which contributed to a substantial elevation of final leaf area and shoot biomass. These improvements in physiological and morphological traits resulted in around 12.3% increase of marketable tomato yield per plant. Relative growth rate (RGR) of micro-fog treatment was also significantly higher than control plants, which was mainly determined by the substantial elevation in net assimilation rate (NAR), and to a lesser extent caused by leaf area ratio (LAR). Measurement of leaf gas exchange parameters also demonstrated that micro-fog treatment significantly enhanced leaf photosynthesis capacity. Taken together, manipulation of VPD in greenhouses by micro-fog systems effectively enhanced tomato growth and productivity via improving photosynthesis during summer season. PMID:26221726

IMPROVING THE ACCURACY OF HISTORIC SATELLITE IMAGE CLASSIFICATION BY COMBINING LOW-RESOLUTION MULTISPECTRAL DATA WITH HIGH-RESOLUTION PANCHROMATIC DATA

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

Getman, Daniel J

2008-01-01

Many attempts to observe changes in terrestrial systems over time would be significantly enhanced if it were possible to improve the accuracy of classifications of low-resolution historic satellite data. In an effort to examine improving the accuracy of historic satellite image classification by combining satellite and air photo data, two experiments were undertaken in which low-resolution multispectral data and high-resolution panchromatic data were combined and then classified using the ECHO spectral-spatial image classification algorithm and the Maximum Likelihood technique. The multispectral data consisted of 6 multispectral channels (30-meter pixel resolution) from Landsat 7. These data were augmented with panchromatic datamore » (15m pixel resolution) from Landsat 7 in the first experiment, and with a mosaic of digital aerial photography (1m pixel resolution) in the second. The addition of the Landsat 7 panchromatic data provided a significant improvement in the accuracy of classifications made using the ECHO algorithm. Although the inclusion of aerial photography provided an improvement in accuracy, this improvement was only statistically significant at a 40-60% level. These results suggest that once error levels associated with combining aerial photography and multispectral satellite data are reduced, this approach has the potential to significantly enhance the precision and accuracy of classifications made using historic remotely sensed data, as a way to extend the time range of efforts to track temporal changes in terrestrial systems.« less

[Changes of soil physical properties during the conversion of cropland to agroforestry system].

PubMed

Wang, Lai; Gao, Peng Xiang; Liu, Bin; Zhong, Chong Gao; Hou, Lin; Zhang, Shuo Xin

2017-01-01

To provide theoretical basis for modeling and managing agroforestry systems, the influence of conversion of cropland to agroforestry system on soil physical properties was investigated via a walnut (Juglans regia)-wheat (Triticum aestivum) intercropping system, a wide spreading local agroforestry model in northern Weihe River of loess area, with the walnut and wheat monoculture systems as the control. The results showed that the improvement of the intercropping system on soil physical properties mainly appeared in the 0-40 cm soil layer. The intercropping system could prevent soil bulk density rising in the surface soil (0-20 cm), and the plow pan in the 20-40 cm soil layer could be significantly alleviated. The intercropping system had conti-nuous improvement on soil field capacity in each soil layer with the planting age increase, and the soil field capacity was higher than that of each monoculture system in each soil layer (except 20-40 cm soil layer) since the 5th year after planting. The intercropping system had continuous improvement on soil porosity in each soil layer, but mainly in the 0-20 and 20-40 cm soil layer, and the ratio of capillary porosity was also improved. The soil bulk density, field capacity and soil porosity obtained continuous improvement during the conversion of cropland to agroforestry system, and the improvement on soil physical properties was stronger in shallow soil layer than in deep soil.

Cost-effectiveness of an electronic clinical decision support system for improving quality of antenatal and childbirth care in rural Tanzania: an intervention study.

PubMed

Saronga, Happiness Pius; Duysburgh, Els; Massawe, Siriel; Dalaba, Maxwell Ayindenaba; Wangwe, Peter; Sukums, Felix; Leshabari, Melkizedeck; Blank, Antje; Sauerborn, Rainer; Loukanova, Svetla

2017-08-07

QUALMAT project aimed at improving quality of maternal and newborn care in selected health care facilities in three African countries. An electronic clinical decision support system was implemented to support providers comply with established standards in antenatal and childbirth care. Given that health care resources are limited and interventions differ in their potential impact on health and costs (efficiency), this study aimed at assessing cost-effectiveness of the system in Tanzania. This was a quantitative pre- and post- intervention study involving 6 health centres in rural Tanzania. Cost information was collected from health provider's perspective. Outcome information was collected through observation of the process of maternal care. Incremental cost-effectiveness ratios for antenatal and childbirth care were calculated with testing of four models where the system was compared to the conventional paper-based approach to care. One-way sensitivity analysis was conducted to determine whether changes in process quality score and cost would impact on cost-effectiveness ratios. Economic cost of implementation was 167,318 USD, equivalent to 27,886 USD per health center and 43 USD per contact. The system improved antenatal process quality by 4.5% and childbirth care process quality by 23.3% however these improvements were not statistically significant. Base-case incremental cost-effectiveness ratios of the system were 2469 USD and 338 USD per 1% change in process quality for antenatal and childbirth care respectively. Cost-effectiveness of the system was sensitive to assumptions made on costs and outcomes. Although the system managed to marginally improve individual process quality variables, it did not have significant improvement effect on the overall process quality of care in the short-term. A longer duration of usage of the electronic clinical decision support system and retention of staff are critical to the efficiency of the system and can reduce the invested resources. Realization of gains from the system requires effective implementation and an enabling healthcare system. Registered clinical trial at www.clinicaltrials.gov ( NCT01409824 ). Registered May 2009.

Topical negative pressure for the treatment of neonatal post-sternotomy wound dehiscence.

PubMed

Hardwicke, J; Richards, H; Jagadeesan, J; Jones, T; Lester, R

2012-01-01

The use of topical negative pressure (TNP) dressings for sternal wound dehiscence or mediastinitis in the neonatal population is rare. The majority of case reports have focused on wound healing as an endpoint and have not discussed the physiological advantage that TNP dressings may impart with regard to sternal stabilisation, improved respiratory function and early weaning from mechanical ventilation. We present a case of the use of TNP in neonatal post-sternotomy wound dehiscence and mediastinitis, from a UK perspective, with an emphasis on wound healing and physiological optimisation. As well as an improvement in sternal wound healing due to the local effects of the TNP system, serial arterial blood gas analysis revealed a significant improvement in systemic physiological parameters, including a reduction in pCO(2) in the period (days 20-31) after application of TNP (p<0.0001) compared to the period before where simple occlusive dressings were applied. Hydrogen ion concentration also significantly reduced in this period (p=0.0058). The use of the TNP system in association with systemic antibiotics successfully treated the mediastinitis. A sealed, controlled wound environment also allowed ease of nursing and an expedited return to care by the parents. We would recommend the consideration of TNP dressings in similar cases of neonatal and paediatric sternal wound dehiscence. Not only do we observe the local effects of improved wound healing, the systemic effects of improved lung function are also valuable in the early management of such complex cases.

Federal Highway Administration finding of no significant impact for the Council Bluffs Interstate system improvements project tier 2, segment 3 Pottawattamie County, Iowa IMN-029-2(55)49--13-78.

DOT National Transportation Integrated Search

2011-08-23

FHWA and the Iowa Department of Transportation (Iowa DOT) are proposing geometric : and capacity improvements to the Interstate 29 (I-29) and Interstate 80 (I-80) mainline in : Segment 3 and the I-80/I-29 East System interchange, the South Expressway...

Validity of the Japanese Orthopaedic Association scoring system based on patient-reported improvement after posterior lumbar interbody fusion.

PubMed

Fujimori, Takahito; Okuda, Shinya; Iwasaki, Motoki; Yamasaki, Ryoji; Maeno, Takafumi; Yamashita, Tomoya; Matsumoto, Tomiya; Wada, Eiji; Oda, Takenori

2016-06-01

The Japanese Orthopaedic Association (JOA) scoring system is a physician-based outcome that has been used to evaluate treatment effectiveness after lumbar surgery. However, patient-centered evaluation becomes increasingly important. There is no study that has examined the relationship between the JOA scoring system and patients' self-reported improvement. The purpose of the present study was to validate the JOA scoring system for assessment of patient-reported improvement after lumbar surgery. This is a retrospective review of prospectively collected data. The patient sample included 273 mail-in responders of the 466 consecutive patients who underwent posterior lumbar interbody fusion for spondylolisthesis between 1996 and 2008 in a single hospital. The outcome measures were the JOA scoring system and patients' self-reported improvement. Two hundred seventy three patients were divided into five anchoring groups based on self-reported improvement from "Much better" to "Much worse." Outcomes (ie, recovery rate, amount of change from preoperative condition, and postoperative score) based on the JOA scoring system were compared among groups. Using the patient's self-reported improvement scale as an anchor, the association among each of the outcomes was examined. The cutoff point and the area under the curve (AUC) that differentiated "Improved" from "Neither improved nor worse" was calculated using receiver operating characteristic (ROC) curve analysis. The recovery rate and postoperative score were significantly different in 9 of 10 pairs of anchoring groups. The amount of change was significantly different in six pairs. Spearman correlation coefficient for the 5-point scale anchors of patients' self-reported improvement was 0.20 (p=.001) for the baseline score, 0.31 (p<.001) for the amount of change, 0.55 (p<.001) for the recovery rate, and 0.56 (p<.001) for the postoperative score. According to ROC analysis, the best cutoff points and AUCs were 13 points and 0.69, respectively, for the amount of change, 67% and 0.73, respectively, for recovery rate, and 23 points and 0.72, respectively, for postoperative score. The JOA scoring system is a valid method for assessment of patients' self-reported improvement. Patients' self-reported improvement is more likely to be associated with the final condition, such as postoperative score or recovery rate, rather than the change from the preoperative condition. Copyright © 2016 Elsevier Inc. All rights reserved.

Improving the accuracy and usability of Iowa falling weight deflectometer data.

DOT National Transportation Integrated Search

2013-05-01

This study aims to improve the accuracy and usability of Iowa Falling Weight Deflectometer (FWD) data by incorporating significant : enhancements into the fully-automated software system for rapid processing of the FWD data. These enhancements includ...

Phasor Measurement Unit and Its Application in Modern Power Systems

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

Ma, Jian; Makarov, Yuri V.; Dong, Zhao Yang

2010-06-01

The introduction of phasor measuring units (PMUs) in power systems significantly improves the possibilities for monitoring and analyzing power system dynamics. Synchronized measurements make it possible to directly measure phase angles between corresponding phasors in different locations within the power system. Improved monitoring and remedial action capabilities allow network operators to utilize the existing power system in a more efficient way. Improved information allows fast and reliable emergency actions, which reduces the need for relatively high transmission margins required by potential power system disturbances. In this chapter, the applications of PMU in modern power systems are presented. Specifically, the topicsmore » touched in this chapter include state estimation, voltage and transient stability, oscillation monitoring, event and fault detection, situation awareness, and model validation. A case study using Characteristic Ellipsoid method based on PMU to monitor power system dynamic is presented.« less

Preparation of high bioactivity multilayered bone-marrow mesenchymal stem cell sheets for myocardial infarction using a 3D-dynamic system.

PubMed

Wang, Yingwei; Zhang, Jianhua; Qin, Zixi; Fan, Zepei; Lu, Cheng; Chen, Baoxin; Zhao, Jupeng; Li, Xiaojuan; Xiao, Fei; Lin, Xi; Wu, Zheng

2018-05-01

Cell sheet techniques offer a promising future for myocardial infarction (MI) therapy; however, insufficient nutrition supply remains the major limitation in maintaining stem cell bioactivity in vitro. In order to enhance cell sheet mechanical strength and bioactivity, a decellularized porcine pericardium (DPP) scaffold was prepared by the phospholipase A2 method, and aspartic acid was used as a spacer arm to improve the vascular endothelial growth factor crosslink efficiency on the DPP scaffold. Based on this scaffold, multilayered bone marrow mesenchymal stem cell sheets were rapidly constructed, using RAD16-I peptide hydrogel as a temporary 3D scaffold, and cell sheets were cultured in either the 3D-dynamic system (DCcs) or the traditional static condition (SCcs). The multilayered structure, stem cell bioactivity, and ultrastructure of DCcs and SCcs were assessed. The DCcs exhibited lower apoptosis, lower differentiation, and an improved paracrine effect after a 48 h culture in vitro compared to the SCcs. Four groups were set to evaluate the cell sheet effect in rat MI model: sham group, MI control group, DCcs group, and SCcs group. The DCcs group improved cardiac function and decreased the infarcted area compared to the MI control group, while no significant improvements were observed in the SCcs group. Improved cell survival, angiogenesis, and Sca-1 + cell and c-kit + cell amounts were observed in the DCcs group. In conclusion, the DCcs maintained higher stem cell bioactivity by using the 3D-dynamic system to provide sufficient nutrition, and transplanting DCcs significantly improved the cardiac function and angiogenesis. This study provides an efficient method to prepare vascular endothelial growth factor covalent decellularized pericardium scaffold with aspartic acid, and a multilayered bone marrow mesenchymal stem cell (BMSC) sheet is constructed on it using a 3D-dynamic system. The dynamic nutrition supply showed a significant benefit on BMSC bioactivity in vitro, including decreasing cell apoptosis, reducing stem cell differentiation, and improving growth factor secretion. These favorable bioactivity improved BMSC survival, angiogenesis, and cardiac function of the infarcted myocardium. The study highlights the importance of dynamic nutrition supply on maintaining stem cell bioactivity within cell sheet, and it stresses the necessity and significance of setting a standard for assessing cell sheet products before transplantation in the future application. Copyright © 2018 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

High-Performance, Multi-Node File Copies and Checksums for Clustered File Systems

NASA Technical Reports Server (NTRS)

Kolano, Paul Z.; Ciotti, Robert B.

2012-01-01

Modern parallel file systems achieve high performance using a variety of techniques, such as striping files across multiple disks to increase aggregate I/O bandwidth and spreading disks across multiple servers to increase aggregate interconnect bandwidth. To achieve peak performance from such systems, it is typically necessary to utilize multiple concurrent readers/writers from multiple systems to overcome various singlesystem limitations, such as number of processors and network bandwidth. The standard cp and md5sum tools of GNU coreutils found on every modern Unix/Linux system, however, utilize a single execution thread on a single CPU core of a single system, and hence cannot take full advantage of the increased performance of clustered file systems. Mcp and msum are drop-in replacements for the standard cp and md5sum programs that utilize multiple types of parallelism and other optimizations to achieve maximum copy and checksum performance on clustered file systems. Multi-threading is used to ensure that nodes are kept as busy as possible. Read/write parallelism allows individual operations of a single copy to be overlapped using asynchronous I/O. Multinode cooperation allows different nodes to take part in the same copy/checksum. Split-file processing allows multiple threads to operate concurrently on the same file. Finally, hash trees allow inherently serial checksums to be performed in parallel. Mcp and msum provide significant performance improvements over standard cp and md5sum using multiple types of parallelism and other optimizations. The total speed-ups from all improvements are significant. Mcp improves cp performance over 27x, msum improves md5sum performance almost 19x, and the combination of mcp and msum improves verified copies via cp and md5sum by almost 22x. These improvements come in the form of drop-in replacements for cp and md5sum, so are easily used and are available for download as open source software at http://mutil.sourceforge.net.

Can Technology Improve Large Class Learning? The Case of an Upper-Division Business Core Class

ERIC Educational Resources Information Center

Stanley, Denise

2013-01-01

Larger classes are often associated with lower student achievement. The author tested the hypothesis that the introduction of personal response systems significantly improves scores in a 250-seat classroom, through the channels of improved attendance and engagement. She focused on how continuous participation with the technology could change…

Aircraft Photovoltaic Power-Generating System.

NASA Astrophysics Data System (ADS)

Doellner, Oscar Leonard

Photovoltaic cells, appropriately cooled and operating in the combustion-created high radiant-intensity environment of gas-turbine and jet engines, may replace the conventional (gearbox-driven) electrical power generators aboard jet aircraft. This study projects significant improvements not only in aircraft electrical power-generating-system performance, but also in overall aircraft performance. Jet -engine design modifications incorporating this concept not only save weight (and thus fuel), but are--in themselves --favorable to jet-engine performance. The dissertation concentrates on operational, constructional, structural, thermal, optical, radiometrical, thin-film, and solid-state theoretical aspects of the overall project. This new electrical power-generating system offers solid-state reliability with electrical power-output capability comparable to that of existing aircraft electromechanical power-generating systems (alternators and generators). In addition to improvements in aircraft performance, significant aircraft fuel- and weight-saving advantages are projected.

An OSSE Study for Deep Argo Array using the GFDL Ensemble Coupled Data Assimilation System

NASA Astrophysics Data System (ADS)

Chang, You-Soon; Zhang, Shaoqing; Rosati, Anthony; Vecchi, Gabriel A.; Yang, Xiaosong

2018-03-01

An observing system simulation experiment (OSSE) using an ensemble coupled data assimilation system was designed to investigate the impact of deep ocean Argo profile assimilation in a biased numerical climate system. Based on the modern Argo observational array and an artificial extension to full depth, "observations" drawn from one coupled general circulation model (CM2.0) were assimilated into another model (CM2.1). Our results showed that coupled data assimilation with simultaneous atmospheric and oceanic constraints plays a significant role in preventing deep ocean drift. However, the extension of the Argo array to full depth did not significantly improve the quality of the oceanic climate estimation within the bias magnitude in the twin experiment. Even in the "identical" twin experiment for the deep Argo array from the same model (CM2.1) with the assimilation model, no significant changes were shown in the deep ocean, such as in the Atlantic meridional overturning circulation and the Antarctic bottom water cell. The small ensemble spread and corresponding weak constraints by the deep Argo profiles with medium spatial and temporal resolution may explain why the deep Argo profiles did not improve the deep ocean features in the assimilation system. Additional studies using different assimilation methods with improved spatial and temporal resolution of the deep Argo array are necessary in order to more thoroughly understand the impact of the deep Argo array on the assimilation system.

Meeting Air Transportation Demand in 2025 by Using Larger Aircraft and Alternative Routing to Complement NextGen Operational Improvements

NASA Technical Reports Server (NTRS)

Smith, Jeremy C.; Guerreiro, Nelson M.; Viken, Jeffrey K.; Dollyhigh, Samuel M.; Fenbert, James W.

2010-01-01

A study was performed that investigates the use of larger aircraft and alternative routing to complement the capacity benefits expected from the Next Generation Air Transportation System (NextGen) in 2025. National Airspace System (NAS) delays for the 2025 demand projected by the Transportation Systems Analysis Models (TSAM) were assessed using NASA s Airspace Concept Evaluation System (ACES). The shift in demand from commercial airline to automobile and from one airline route to another was investigated by adding the route delays determined from the ACES simulation to the travel times used in the TSAM and re-generating new flight scenarios. The ACES simulation results from this study determined that NextGen Operational Improvements alone do not provide sufficient airport capacity to meet the projected demand for passenger air travel in 2025 without significant system delays. Using larger aircraft with more seats on high-demand routes and introducing new direct routes, where demand warrants, significantly reduces delays, complementing NextGen improvements. Another significant finding of this study is that the adaptive behavior of passengers to avoid congested airline-routes is an important factor when projecting demand for transportation systems. Passengers will choose an alternative mode of transportation or alternative airline routes to avoid congested routes, thereby reducing delays to acceptable levels for the 2025 scenario; the penalty being that alternative routes and the option to drive increases overall trip time by 0.4% and may be less convenient than the first-choice route.

End-tidal CO2-guided automated robot CPR system in the pig. Preliminary communication.

PubMed

Suh, Gil Joon; Park, Jaeheung; Lee, Jung Chan; Na, Sang Hoon; Kwon, Woon Yong; Kim, Kyung Su; Kim, Taegyun; Jung, Yoon Sun; Ko, Jung-In; Shin, So Mi; You, Kyoung Min

2018-06-01

Our aim was to compare the efficacy of the end-tidal CO 2 -guided automated robot CPR (robot CPR) system with manual CPR and mechanical device CPR. We developed the algorithm of the robot CPR system which automatically finds the optimal compression position under the guidance of end-tidal CO 2 feedback in swine models of cardiac arrest. Then, 18 pigs after 11 min of cardiac arrest were randomly assigned to one of three groups, robot CPR, LUCAS CPR, and manual CPR groups (n = 6 each group). Return of spontaneous circulation (ROSC) and Neurological Deficit Score 48 h after ROSC were compared. A ROSC was achieved in 5 pigs, 4 pigs, and 3 pigs in the robot CPR, LUCAS CPR, and manual CPR groups, respectively (p = 0.47). Robot CPR showed a significant difference in Neurological Deficit Score 48 h after ROSC compared to manual CPR, whereas LUCAS CPR showed no significant difference over manual CPR. (p = 0.01; Robot versus Manual adjusted p = 0.04, Robot versus LUCAS adjusted p = 0.07, Manual versus LUCAS adjusted p = 1.00). The end-tidal CO 2 -guided automated robot CPR system did not significantly improve ROSC rate in a swine model of cardiac arrest. However, robot CPR showed significant improvement of Neurological Deficit Score 48 h after ROSC compared to Manual CPR while LUCAS CPR showed no significant improvement compared to Manual CPR. Copyright © 2018 Elsevier B.V. All rights reserved.

Feedback Design Patterns for Math Online Learning Systems

ERIC Educational Resources Information Center

Inventado, Paul Salvador; Scupelli, Peter; Heffernan, Cristina; Heffernan, Neil

2017-01-01

Increasingly, computer-based learning systems are used by educators to facilitate learning. Evaluations of several math learning systems show that they result in significant student learning improvements. Feedback provision is one of the key features in math learning systems that contribute to its success. We have recently been uncovering feedback…

Short and long term improvements in quality of chronic care delivery predict program sustainability.

PubMed

Cramm, Jane Murray; Nieboer, Anna Petra

2014-01-01

Empirical evidence on sustainability of programs that improve the quality of care delivery over time is lacking. Therefore, this study aims to identify the predictive role of short and long term improvements in quality of chronic care delivery on program sustainability. In this longitudinal study, professionals [2010 (T0): n=218, 55% response rate; 2011 (T1): n=300, 68% response rate; 2012 (T2): n=265, 63% response rate] from 22 Dutch disease-management programs completed surveys assessing quality of care and program sustainability. Our study findings indicated that quality of chronic care delivery improved significantly in the first 2 years after implementation of the disease-management programs. At T1, overall quality, self-management support, delivery system design, and integration of chronic care components, as well as health care delivery and clinical information systems and decision support, had improved. At T2, overall quality again improved significantly, as did community linkages, delivery system design, clinical information systems, decision support and integration of chronic care components, and self-management support. Multilevel regression analysis revealed that quality of chronic care delivery at T0 (p<0.001) and quality changes in the first (p<0.001) and second (p<0.01) years predicted program sustainability. In conclusion this study showed that disease-management programs based on the chronic care model improved the quality of chronic care delivery over time and that short and long term changes in the quality of chronic care delivery predicted the sustainability of the projects. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Benefits of Systemic Anti-inflammatory Therapy Versus Fluocinolone Acetonide Intraocular Implant for Intermediate, Posterior and Panuveitis: 54 month results of The Multicenter Uveitis Steroid Treatment Trial (MUST) and Follow-up Study

PubMed Central

2015-01-01

Objective To compare the benefits of fluocinolone acetonide implant therapy versus systemic corticosteroid therapy supplemented (when indicated) with immunosuppression for intermediate, posterior, and panuveitis. Design Additional follow-up of a randomized comparative effectiveness trial cohort Participants 255 patients with intermediate, posterior or panuveitis who had been randomized to implant or systemic therapy. Main Outcome Measures Best-corrected visual acuity (BCVA), visual field mean deviation, activity of uveitis, and presence of macular edema (per Reading Center grading) were ascertained prospectively. Methods Trial participants were followed through 54 months from original randomization. Results The trajectory of visual function in uveitic eyes demonstrated a similar (p = 0.73) degree of modest (not statistically significant) improvement from baseline to 54 months in both groups (mean improvement in BCVA at 54 months: 2.4 and 3.1 letters in the implant and systemic group respectively). Many had excellent initial visual acuity, limiting the potential for improvement. The mean automated perimetry mean deviation score remained similar to baseline throughout 48 months’ follow-up in both groups. Overall control of inflammation was superior in the implant group at every time point assessed (p<0.016), although most eyes in the systemic therapy arm also had substantial inflammatory improvement, achieving complete control or low levels of inflammation. While macular edema improved significantly more often with implant treatment within the first six months, the systemic group gradually improved over time thereafter such that the proportions with macular edema converged in the two groups by 36 months and were overlapping thereafter (p=0.41 at 48 months). Conclusions Visual outcomes of fluocinolone acetonide implant and systemic treatment for intermediate, posterior, and panuveitis were similarly favorable through 54 months. The implant maintains a clear advantage in controlling inflammation through 54 months. Nevertheless, with systemic therapy a large majority of patients also experienced greatly improved inflammatory status. Macular edema improved equally with longer follow-up. Based on cost-effectiveness and side effect considerations, systemic therapy may be indicated as the initial treatment for many bilateral uveitis cases. However, implant therapy is a reasonable alternative approach, especially for unilateral cases, and in situations where systemic therapy is not feasible or is not successful. PMID:26298715

Benefits of Systemic Anti-inflammatory Therapy versus Fluocinolone Acetonide Intraocular Implant for Intermediate Uveitis, Posterior Uveitis, and Panuveitis: Fifty-four-Month Results of the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study.

PubMed

Kempen, John H; Altaweel, Michael M; Drye, Lea T; Holbrook, Janet T; Jabs, Douglas A; Sugar, Elizabeth A; Thorne, Jennifer E

2015-10-01

To compare the benefits of fluocinolone acetonide implant therapy versus systemic corticosteroid therapy supplemented (when indicated) with immunosuppression for intermediate uveitis, posterior uveitis, and panuveitis. Additional follow-up of a randomized comparative effectiveness trial cohort. Two hundred fifty-five patients with intermediate uveitis, posterior uveitis, or panuveitis randomized to implant or systemic therapy. Best-corrected visual acuity (BCVA), visual field mean deviation (MD), activity of uveitis, and presence of macular edema (per reading center grading) ascertained prospectively. Trial participants were followed-up for 54 months from original randomization. The visual function trajectory in uveitic eyes demonstrated a similar (P = 0.73) degree of modest (not statistically significant) improvement from baseline to 54 months in both groups (mean improvement in BCVA at 54 months, 2.4 and 3.1 letters in the implant and systemic groups, respectively). Many had excellent initial visual acuity, limiting the potential for improvement. The mean automated perimetry MD score remained similar to baseline throughout 48 months of follow-up in both groups. Overall control of inflammation was superior in the implant group at every time point assessed (P < 0.016), although most eyes in the systemic therapy arm also showed substantial improvement, achieving complete control or low levels of inflammation. Although macular edema improved significantly more often with implant treatment within the first 6 months, the systemic group gradually improved over time such that the proportions with macular edema converged in the 2 groups by 36 months and overlapped thereafter (P = 0.41 at 48 months). Visual outcomes of fluocinolone acetonide implant and systemic treatment for intermediate uveitis, posterior uveitis, and panuveitis were similarly favorable through 54 months. The implant maintained a clear advantage in controlling inflammation through 54 months. Nevertheless, with systemic therapy, most patients also experienced greatly improved inflammatory status. Macular edema improved equally with longer follow-up. Based on cost effectiveness and side-effect considerations, systemic therapy may be indicated as the initial treatment for many bilateral uveitis cases. However, implant therapy is a reasonable alternative, especially for unilateral cases and when systemic therapy is not feasible or is not successful. Copyright © 2015 American Academy of Ophthalmology. All rights reserved.

Energy, cost and design aspects of coarse- and fine-bubble aeration systems in the MBBR IFAS process.

PubMed

Sander, S; Behnisch, J; Wagner, M

2017-02-01

With the MBBR IFAS (moving bed biofilm reactor integrated fixed-film activated sludge) process, the biomass required for biological wastewater treatment is either suspended or fixed on free-moving plastic carriers in the reactor. Coarse- or fine-bubble aeration systems are used in the MBBR IFAS process. In this study, the oxygen transfer efficiency (OTE) of a coarse-bubble aeration system was improved significantly by the addition of the investigated carriers, even in-process (∼1% per vol-% of added carrier material). In a fine-bubble aeration system, the carriers had little or no effect on OTE. The effect of carriers on OTE strongly depends on the properties of the aeration system, the volumetric filling rate of the carriers, the properties of the carrier media, and the reactor geometry. This study shows that the effect of carriers on OTE is less pronounced in-process compared to clean water conditions. When designing new carriers in order to improve their effect on OTE further, suppliers should take this into account. Although the energy efficiency and cost effectiveness of coarse-bubble aeration systems can be improved significantly by the addition of carriers, fine-bubble aeration systems remain the more efficient and cost-effective alternative for aeration when applying the investigated MBBR IFAS process.

Nanoparticles: Nanoscale Systems for Medical Applications

NASA Astrophysics Data System (ADS)

Wadkins, David Allen

The goal of this project was to develop a series of nano platforms for single cell analysis and drug delivery. Nanoparticles are a promising option to improve our medical therapies by controlling biodistribution and pharmacokinetics of therapeutics. Nanosystems also offer significant opportunity to improve current imaging modalities. The systems developed during this thesis work can be foundations for developing advanced therapies for obesity and improving our fundamental understandings of single cell behavior. The first of the two systems we attempt to create was a drug delivery system that could selectively target adipose tissue to deliver uncoupling agents and drive browning of adipose tissue and associated weight loss. Protonophores have a history of significant toxic side effects in cardiac and neuronal tissues a recently discovered protonophore, but BAM-15, has been shown to have reduced cytotoxicity. We hypothesized that the altered biodistribution of BAM-15 encapsulated in a nanoparticle could provide systemic weight loss with minimized side effects. The second system developed utilized quantum dots to create a fluorescent barcode that could be repeatedly identified using quantitative fluorescent emission readings. This platform would allow for the tracking of individual cells, allowing repeat interrogation across time and space in complex multicellular environments. Ultimately this work demonstrates the process and complexity involved in developing nanoparticulate systems meant to interact with incredibly complex intracellular environments.

Why differentiating between health system support and health system strengthening is needed

PubMed Central

Chee, Grace; Pielemeier, Nancy; Lion, Ann; Connor, Catherine

2013-01-01

There is increasing recognition that efforts to improve global health cannot be achieved without stronger health systems. Interpretation of health system strengthening (HSS) has varied widely however, with much of the focus to-date on alleviating input constraints, whereas less attention has been given to other performance drivers. It is important to distinguish activities that support the health system, from ones that strengthen the health system. Supporting the health system can include any activity that improves services, from distributing mosquito nets to procuring medicines. These activities improve outcomes primarily by increasing inputs. Strengthening the health system is accomplished by more comprehensive changes to performance drivers such as policies and regulations, organizational structures, and relationships across the health system to motivate changes in behavior and/or allow more effective use of resources to improve multiple health services. Even organizations that have made significant investments in health systems have not provided guidance on what HSS entails. While both supporting and strengthening are important and necessary, it is nonetheless important to make a distinction. If activities fail to produce improvements in system performance because they were incorrectly labeled as system strengthening, the value of HSS investments could quickly be discredited. Not distinguishing supportive activities from strengthening ones will lead to unmet expectations of stronger health systems, as well as neglect of critical system strengthening activities. Distinguishing between these two types of activities will improve programming impact. Copyright © 2012 John Wiley & Sons, Ltd. PMID:22777839

Development of Lightweight CubeSat with Multi-Functional Structural Battery Systems

NASA Technical Reports Server (NTRS)

Karkkainen, Ryan L.; Hunter, Roger C.; Baker, Christopher

2017-01-01

This collaborative multi-disciplinary effort aims to develop a lightweight, 1-unit (1U) CubeSat (10x10x10 cm) which utilizes improved and fully integrated structural battery materials for mission life extension, larger payload capability, and significantly reduced mass.The electrolytic carbon fiber material serves the multifunctional capacitive energy system as both a lightweight, load bearing structure and an electrochemical battery system. This implementation will improve traditional multifunctional energy storage concepts with a highly effective energy storage capability.

Multi-objective optimization in quantum parameter estimation

NASA Astrophysics Data System (ADS)

Gong, BeiLi; Cui, Wei

2018-04-01

We investigate quantum parameter estimation based on linear and Kerr-type nonlinear controls in an open quantum system, and consider the dissipation rate as an unknown parameter. We show that while the precision of parameter estimation is improved, it usually introduces a significant deformation to the system state. Moreover, we propose a multi-objective model to optimize the two conflicting objectives: (1) maximizing the Fisher information, improving the parameter estimation precision, and (2) minimizing the deformation of the system state, which maintains its fidelity. Finally, simulations of a simplified ɛ-constrained model demonstrate the feasibility of the Hamiltonian control in improving the precision of the quantum parameter estimation.

Wearable Improved Vision System for Color Vision Deficiency Correction

PubMed Central

Riccio, Daniel; Di Perna, Luigi; Sanniti Di Baja, Gabriella; De Nino, Maurizio; Rossi, Settimio; Testa, Francesco; Simonelli, Francesca; Frucci, Maria

2017-01-01

Color vision deficiency (CVD) is an extremely frequent vision impairment that compromises the ability to recognize colors. In order to improve color vision in a subject with CVD, we designed and developed a wearable improved vision system based on an augmented reality device. The system was validated in a clinical pilot study on 24 subjects with CVD (18 males and 6 females, aged 37.4 ± 14.2 years). The primary outcome was the improvement in the Ishihara Vision Test score with the correction proposed by our system. The Ishihara test score significantly improved (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$p = 0.03$ \\end{document}) from 5.8 ± 3.0 without correction to 14.8 ± 5.0 with correction. Almost all patients showed an improvement in color vision, as shown by the increased test scores. Moreover, with our system, 12 subjects (50%) passed the vision color test as normal vision subjects. The development and preliminary validation of the proposed platform confirm that a wearable augmented-reality device could be an effective aid to improve color vision in subjects with CVD. PMID:28507827

The memory support system for mild cognitive impairment: randomized trial of a cognitive rehabilitation intervention.

PubMed

Greenaway, M C; Duncan, N L; Smith, G E

2013-04-01

Individuals with amnestic mild cognitive impairment (MCI) have few empirically based treatment options for combating their memory loss. This study sought to examine the efficacy of a calendar/notebook rehabilitation intervention, the memory support system (MSS), for individuals with amnestic MCI. Forty individuals with single domain amnestic MCI and their program partners were randomized to receive the MSS, either with training or without (controls). Measures of adherence, activities of daily living, and emotional impact were completed at the first and last intervention sessions and again at 8 weeks and 6 months post intervention. Training in use of a notebook/calendar system significantly improved adherence over those who received the calendars but no training. Functional ability and memory self-efficacy significantly improved for those who received MSS training. Change in functional ability remained significantly better in the intervention group than in the control group out to 8-week follow-up. Care partners in the intervention group demonstrated improved mood by 8-week and 6-month follow-ups, whereas control care partners reported worse caregiver burden by 6-month follow-up. Memory support system training resulted in improvement in activities of daily living and sense of memory self-efficacy for individuals with MCI. Although activities of daily living benefits were maintained out to 8 weeks post intervention, future inclusion of booster sessions may help extend the therapeutic effect out even further. Improved mood of care partners of trained individuals and worsening sense of caregiver burden over time for partners of untrained individuals further support the efficacy of the MSS for MCI. Copyright © 2012 John Wiley & Sons, Ltd.

Implementation of a cloud-based electronic medical record for maternal and child health in rural Kenya.

PubMed

Haskew, John; Rø, Gunnar; Saito, Kaori; Turner, Kenrick; Odhiambo, George; Wamae, Annah; Sharif, Shahnaaz; Sugishita, Tomohiko

2015-05-01

Complete and timely health information is essential to inform public health decision-making for maternal and child health, but is often lacking in resource-constrained settings. Electronic medical record (EMR) systems are increasingly being adopted to support the delivery of health care, and are particularly amenable to maternal and child health services. An EMR system could enable the mother and child to be tracked and monitored throughout maternity shared care, improve quality and completeness of data collected and enhance sharing of health information between outpatient clinic and the hospital, and between clinical and public health services to inform decision-making. This study implemented a novel cloud-based electronic medical record system in a maternal and child health outpatient setting in Western Kenya between April and June 2013 and evaluated its impact on improving completeness of data collected by clinical and public health services. The impact of the system was assessed using a two-sample test of proportions pre- and post-implementation of EMR-based data verification. Significant improvements in completeness of the antenatal record were recorded through implementation of EMR-based data verification. A difference of 42.9% in missing data (including screening for hypertension, tuberculosis, malaria, HIV status or ART status of HIV positive women) was recorded pre- and post-implementation. Despite significant impact of EMR-based data verification on data completeness, overall screening rates in antenatal care were low. This study has shown that EMR-based data verification can improve the completeness of data collected in the patient record for maternal and child health. A number of issues, including data management and patient confidentiality, must be considered but significant improvements in data quality are recorded through implementation of this EMR model. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Frequency control of wind turbine in power system

NASA Astrophysics Data System (ADS)

Xu, Huawei

2018-06-01

In order to improve the stability of the overall frequency of the power system, automatic power generation control and secondary frequency adjustment were applied. Automatic power generation control was introduced into power generation planning. A dual-fed wind generator power regulation model suitable for secondary frequency regulation was established. The results showed that this method satisfied the basic requirements of frequency regulation control of large-scale wind power access power systems and improved the stability and reliability of power system operation. Therefore, this system frequency control method and strategy is relatively simple. The effect is significant. The system frequency can quickly reach a steady state. It is worth applying and promoting.

The impact of sound-field systems on learning and attention in elementary school classrooms.

PubMed

Dockrell, Julie E; Shield, Bridget

2012-08-01

The authors evaluated the installation and use of sound-field systems to investigate the impact of these systems on teaching and learning in elementary school classrooms. Methods The evaluation included acoustic surveys of classrooms, questionnaire surveys of students and teachers, and experimental testing of students with and without the use of sound-field systems. In this article, the authors report students' perceptions of classroom environments and objective data evaluating change in performance on cognitive and academic assessments with amplification over a 6-month period. Teachers were positive about the use of sound-field systems in improving children's listening and attention to verbal instructions. Over time, students in amplified classrooms did not differ from those in nonamplified classrooms in their reports of listening conditions, nor did their performance differ in measures of numeracy, reading, or spelling. Use of sound-field systems in the classrooms resulted in significantly larger gains in performance in the number of correct items on the nonverbal measure of speed of processing and the measure of listening comprehension. Analysis controlling for classroom acoustics indicated that students' listening comprehension scores improved significantly in amplified classrooms with poorer acoustics but not in amplified classrooms with better acoustics. Both teacher ratings and student performance on standardized tests indicated that sound-field systems improved performance on children's understanding of spoken language. However, academic attainments showed no benefits from the use of sound-field systems. Classroom acoustics were a significant factor influencing the efficacy of sound-field systems; children in classes with poorer acoustics benefited in listening comprehension, whereas there was no additional benefit for children in classrooms with better acoustics.

The SEL Adapts to Meet Changing Times

NASA Technical Reports Server (NTRS)

Pajerski, Rose S.; Basili, Victor R.

1997-01-01

Since 1976, the Software Engineering Laboratory (SEL) has been dedicated to understanding and improving the way in which one NASA organization, the Flight Dynamics Division (FDD) at Goddard Space Flight Center, develops, maintains, and manages complex flight dynamics systems. It has done this by developing and refining a continual process improvement approach that allows an organization such as the FDD to fine-tune its process for its particular domain. Experimental software engineering and measurement play a significant role in this approach. The SEL is a partnership of NASA Goddard, its major software contractor, Computer Sciences Corporation (CSC), and the University of Maryland's (LTM) Department of Computer Science. The FDD primarily builds software systems that provide ground-based flight dynamics support for scientific satellites. They fall into two sets: ground systems and simulators. Ground systems are midsize systems that average around 250 thousand source lines of code (KSLOC). Ground system development projects typically last 1 - 2 years. Recent systems have been rehosted to workstations from IBM mainframes, and also contain significant new subsystems written in C and C++. The simulators are smaller systems averaging around 60 KSLOC that provide the test data for the ground systems. Simulator development lasts up to 1 year. Most of the simulators have been built in Ada on workstations. The SEL is responsible for the management and continual improvement of the software engineering processes used on these FDD projects.

Early Warning/Track-and-Trigger Systems to Detect Deterioration and Improve Outcomes in Hospitalized Patients.

PubMed

Shiloh, Ariel L; Lominadze, George; Gong, Michelle N; Savel, Richard H

2016-02-01

As a global effort toward improving patient safety, a specific area of focus has been the early recognition and rapid intervention in deteriorating ward patients. This focus on "failure to rescue" has led to the construction of early warning/track-and-trigger systems. In this review article, we present a description of the data behind the creation and implementation of such systems, including multiple algorithms and strategies for deployment. Additionally, the strengths and weaknesses of the various systems and their evaluation in the literature are emphasized. Despite the limitations of the current literature, the potential benefit of these early warning/track-and-trigger systems to improve patient outcomes remains significant. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

JT9D-70/59 Improved High Pressure Turbine Active Clearance Control System. [for specific fuel consumption improvement

NASA Technical Reports Server (NTRS)

Gaffin, W. O.

1979-01-01

The JT9D-70/59 high pressure turbine active clearance control system was modified to provide reduction of blade tip clearance when the system is activated during cruise operation. The modification increased the flow capacity and air impingement effectiveness of the cooling air manifold to augment turbine case shrinkage capability, and increased responsiveness of the airseal clearance to case shrinkage. The simulated altitude engine testing indicated a significant improvement in specific fuel consumption with the modified system. A 1000 cycle engine endurance test showed no unusual wear or performance deterioration effects on the engine or the clearance control system. Rig tests indicated that the air impingement and seal support configurations used in the engine tests are near optimum.

Phosphodiesterase-4 inhibition as a therapeutic approach to treat capillary leakage in systemic inflammation.

PubMed

Schick, Martin Alexander; Wunder, Christian; Wollborn, Jakob; Roewer, Norbert; Waschke, Jens; Germer, Christoph-Thomas; Schlegel, Nicolas

2012-06-01

In sepsis and systemic inflammation, increased microvascular permeability and consecutive breakdown of microcirculatory flow significantly contribute to organ failure and death. Evidence points to a critical role of cAMP levels in endothelial cells to maintain capillary endothelial barrier properties in acute inflammation. However, approaches to verify this observation in systemic models are rare. Therefore we tested here whether systemic application of the phosphodiesterase-4-inhibitors (PD-4-Is) rolipram or roflumilast to increase endothelial cAMP was effective to attenuate capillary leakage and breakdown of microcirculatory flow in severe lipopolysaccharide (LPS)-induced systemic inflammation in rats. Measurements of cAMP in mesenteric microvessels demonstrated significant LPS-induced loss of cAMP levels which was blocked by application of rolipram. Increased endothelial cAMP by application of either PD-4-I rolipram or roflumilast led to stabilization of endothelial barrier properties as revealed by measurements of extravasated FITC-albumin in postcapillary mesenteric venules. Accordingly, microcirculatory flow in mesenteric venules was significantly increased following PD-4-I treatment and blood gas analyses indicated improved metabolism. Furthermore application of PD-4-I after manifestation of LPS-induced systemic inflammation and capillary leakage therapeutically stabilized endothelial barrier properties as revealed by significantly reduced volume resuscitation for haemodynamic stabilization. Accordingly microcirculation was significantly improved following treatment with PD-4-Is. Our results demonstrate that inflammation-derived loss of endothelial cAMP contributes to capillary leakage which was blocked by systemic PD-4-I treatment. Therefore these data suggest a highly clinically relevant and applicable approach to stabilize capillary leakage in sepsis and systemic inflammation.

Patient flow improvement for an ophthalmic specialist outpatient clinic with aid of discrete event simulation and design of experiment.

PubMed

Pan, Chong; Zhang, Dali; Kon, Audrey Wan Mei; Wai, Charity Sue Lea; Ang, Woo Boon

2015-06-01

Continuous improvement in process efficiency for specialist outpatient clinic (SOC) systems is increasingly being demanded due to the growth of the patient population in Singapore. In this paper, we propose a discrete event simulation (DES) model to represent the patient and information flow in an ophthalmic SOC system in the Singapore National Eye Centre (SNEC). Different improvement strategies to reduce the turnaround time for patients in the SOC were proposed and evaluated with the aid of the DES model and the Design of Experiment (DOE). Two strategies for better patient appointment scheduling and one strategy for dilation-free examination are estimated to have a significant impact on turnaround time for patients. One of the improvement strategies has been implemented in the actual SOC system in the SNEC with promising improvement reported.

Environmental Stability and Oxidation Behavior of HfO2-Si and YbGd(O) Based Environmental Barrier Coating Systems for SiCSiC Ceramic Matrix Composites

NASA Technical Reports Server (NTRS)

Zhu, Dongming; Farmer, Serene; McCue, Terry R.; Harder, Bryan; Hurst, Janet B.

2017-01-01

Ceramic environmental barrier coatings (EBC) and SiCSiC ceramic matrix composites (CMCs) will play a crucial role in future aircraft propulsion systems because of their ability to significantly increase engine operating temperatures, improve component durability, reduce engine weight and cooling requirements. Advanced EBC systems for SiCSiC CMC turbine and combustor hot section components are currently being developed to meet future turbine engine emission and performance goals. One of the significant material development challenges for the high temperature CMC components is to develop prime-reliant, environmental durable environmental barrier coating systems. In this paper, the durability and performance of advanced Electron Beam-Physical Vapor Deposition (EB-PVD) NASA HfO2-Si and YbGdSi(O) EBC bond coat top coat systems for SiCSiC CMC have been summarized. The high temperature thermomechanical creep, fatigue and oxidation resistance have been investigated in the laboratory simulated high-heat-flux environmental test conditions. The advanced NASA EBC systems showed promise to achieve 1500C temperature capability, helping enable next generation turbine engines with significantly improved engine component temperature capability and durability.

Pilot Study Evaluating a Practice-Based Learning and Improvement Curriculum Focusing on the Development of System-Level Quality Improvement Skills

PubMed Central

Tomolo, Anne M; Lawrence, Renée H; Watts, Brook; Augustine, Sarah; Aron, David C; Singh, Mamta K

2011-01-01

Background We developed a practice-based learning and improvement (PBLI) curriculum to address important gaps in components of content and experiential learning activities through didactics and participation in systems-level quality improvement projects that focus on making changes in health care processes. Methods We evaluated the impact of our curriculum on resident PBLI knowledge, self-efficacy, and application skills. A quasi-experimental design assessed the impact of a curriculum (PBLI quality improvement systems compared with non-PBLI) on internal medicine residents' learning during a 4-week ambulatory block. We measured application skills, self-efficacy, and knowledge by using the Systems Quality Improvement Training and Assessment Tool. Exit evaluations assessed time invested and experiences related to the team projects and suggestions for improving the curriculum. Results The 2 groups showed differences in change scores. Relative to the comparison group, residents in the PBLI curriculum demonstrated a significant increase in the belief about their ability to implement a continuous quality improvement project (P  =  .020), comfort level in developing data collection plans (P  =  .010), and total knowledge scores (P < .001), after adjusting for prior PBLI experience. Participants in the PBLI curriculum also demonstrated significant improvement in providing a more complete aim statement for a proposed project after adjusting for prior PBLI experience (P  =  .001). Exit evaluations were completed by 96% of PBLI curriculum participants who reported high satisfaction with team performance. Conclusion Residents in our curriculum showed gains in areas fundamental for PBLI competency. The observed improvements were related to fundamental quality improvement knowledge, with limited gain in application skills. This suggests that while heading in the right direction, we need to conceptualize and structure PBLI training in a way that integrates it throughout the residency program and fosters the application of this knowledge and these skills. PMID:22379523

Pilot study evaluating a practice-based learning and improvement curriculum focusing on the development of system-level quality improvement skills.

PubMed

Tomolo, Anne M; Lawrence, Renée H; Watts, Brook; Augustine, Sarah; Aron, David C; Singh, Mamta K

2011-03-01

We developed a practice-based learning and improvement (PBLI) curriculum to address important gaps in components of content and experiential learning activities through didactics and participation in systems-level quality improvement projects that focus on making changes in health care processes. We evaluated the impact of our curriculum on resident PBLI knowledge, self-efficacy, and application skills. A quasi-experimental design assessed the impact of a curriculum (PBLI quality improvement systems compared with non-PBLI) on internal medicine residents' learning during a 4-week ambulatory block. We measured application skills, self-efficacy, and knowledge by using the Systems Quality Improvement Training and Assessment Tool. Exit evaluations assessed time invested and experiences related to the team projects and suggestions for improving the curriculum. The 2 groups showed differences in change scores. Relative to the comparison group, residents in the PBLI curriculum demonstrated a significant increase in the belief about their ability to implement a continuous quality improvement project (P  =  .020), comfort level in developing data collection plans (P  =  .010), and total knowledge scores (P < .001), after adjusting for prior PBLI experience. Participants in the PBLI curriculum also demonstrated significant improvement in providing a more complete aim statement for a proposed project after adjusting for prior PBLI experience (P  =  .001). Exit evaluations were completed by 96% of PBLI curriculum participants who reported high satisfaction with team performance. Residents in our curriculum showed gains in areas fundamental for PBLI competency. The observed improvements were related to fundamental quality improvement knowledge, with limited gain in application skills. This suggests that while heading in the right direction, we need to conceptualize and structure PBLI training in a way that integrates it throughout the residency program and fosters the application of this knowledge and these skills.

High-precision radiometric tracking for planetary approach and encounter in the inner solar system

NASA Technical Reports Server (NTRS)

Christensen, C. S.; Thurman, S. W.; Davidson, J. M.; Finger, M. H.; Folkner, W. M.

1989-01-01

The benefits of improved radiometric tracking data have been studied for planetary approach within the inner Solar System using the Mars Rover Sample Return trajectory as a model. It was found that the benefit of improved data to approach and encounter navigation was highly dependent on the a priori uncertainties assumed for several non-estimated parameters, including those for frame-tie, Earth orientation, troposphere delay, and station locations. With these errors at their current levels, navigational performance was found to be insensitive to enhancements in data accuracy. However, when expected improvements in these errors are modeled, performance with current-accuracy data significantly improves, with substantial further improvements possible with enhancements in data accuracy.

An intelligent healthcare management system: a new approach in work-order prioritization for medical equipment maintenance requests.

PubMed

Hamdi, Naser; Oweis, Rami; Abu Zraiq, Hamzeh; Abu Sammour, Denis

2012-04-01

The effective maintenance management of medical technology influences the quality of care delivered and the profitability of healthcare facilities. Medical equipment maintenance in Jordan lacks an objective prioritization system; consequently, the system is not sensitive to the impact of equipment downtime on patient morbidity and mortality. The current work presents a novel software system (EQUIMEDCOMP) that is designed to achieve valuable improvements in the maintenance management of medical technology. This work-order prioritization model sorts medical maintenance requests by calculating a priority index for each request. Model performance was assessed by utilizing maintenance requests from several Jordanian hospitals. The system proved highly efficient in minimizing equipment downtime based on healthcare delivery capacity, and, consequently, patient outcome. Additionally, a preventive maintenance optimization module and an equipment quality control system are incorporated. The system is, therefore, expected to improve the reliability of medical equipment and significantly improve safety and cost-efficiency.

COALA-System for Visual Representation of Cryptography Algorithms

ERIC Educational Resources Information Center

Stanisavljevic, Zarko; Stanisavljevic, Jelena; Vuletic, Pavle; Jovanovic, Zoran

2014-01-01

Educational software systems have an increasingly significant presence in engineering sciences. They aim to improve students' attitudes and knowledge acquisition typically through visual representation and simulation of complex algorithms and mechanisms or hardware systems that are often not available to the educational institutions. This paper…

Noise temperature improvement for magnetic fusion plasma millimeter wave imaging systems

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

Lai, J.; Domier, C. W.; Luhmann, N. C.

2014-03-15

Significant progress has been made in the imaging and visualization of magnetohydrodynamic and microturbulence phenomena in magnetic fusion plasmas [B. Tobias et al., Plasma Fusion Res. 6, 2106042 (2011)]. Of particular importance have been microwave electron cyclotron emission imaging and microwave imaging reflectometry systems for imaging T{sub e} and n{sub e} fluctuations. These instruments have employed heterodyne receiver arrays with Schottky diode mixer elements directly connected to individual antennas. Consequently, the noise temperature has been strongly determined by the conversion loss with typical noise temperatures of ∼60 000 K. However, this can be significantly improved by making use of recent advancesmore » in Monolithic Microwave Integrated Circuit chip low noise amplifiers to insert a pre-amplifier in front of the Schottky diode mixer element. In a proof-of-principle design at V-Band (50–75 GHz), significant improvement of noise temperature from the current 60 000 K to measured 4000 K has been obtained.« less

System Dynamics Model and Simulation of Employee Work-Family Conflict in the Construction Industry

PubMed Central

Wu, Guangdong; Duan, Kaifeng; Zuo, Jian; Yang, Jianlin; Wen, Shiping

2016-01-01

The construction industry is a demanding work environment where employees’ work-family conflict is particularly prominent. This conflict has a significant impact on job and family satisfaction and performance of employees. In order to analyze the dynamic evolution of construction industry employee’s work-family conflict between work and family domains, this paper constructs a bi-directional dynamic model framework of work-family conflict by referring to the relevant literature. Consequently, a system dynamics model of employee’s work-family conflict in the construction industry is established, and a simulation is conducted. The simulation results indicate that construction industry employees experience work interference with family conflict (WIFC) levels which are significantly greater than the family interference with work conflict (FIWC) levels. This study also revealed that improving work flexibility and organizational support can have a positive impact on the satisfaction and performance of construction industry employees from a work and family perspective. Furthermore, improving family support can only significantly improve employee job satisfaction. PMID:27801857

System Dynamics Model and Simulation of Employee Work-Family Conflict in the Construction Industry.

PubMed

Wu, Guangdong; Duan, Kaifeng; Zuo, Jian; Yang, Jianlin; Wen, Shiping

2016-10-28

The construction industry is a demanding work environment where employees' work-family conflict is particularly prominent. This conflict has a significant impact on job and family satisfaction and performance of employees. In order to analyze the dynamic evolution of construction industry employee's work-family conflict between work and family domains, this paper constructs a bi-directional dynamic model framework of work-family conflict by referring to the relevant literature. Consequently, a system dynamics model of employee's work-family conflict in the construction industry is established, and a simulation is conducted. The simulation results indicate that construction industry employees experience work interference with family conflict (WIFC) levels which are significantly greater than the family interference with work conflict (FIWC) levels. This study also revealed that improving work flexibility and organizational support can have a positive impact on the satisfaction and performance of construction industry employees from a work and family perspective. Furthermore, improving family support can only significantly improve employee job satisfaction.

Change in children's school behavior after mass administration of praziquantel for Schistosoma mansoni infection in endemic areas of western Kenya: A pilot study using the Behavioral Assessment System for Children (BASC-2).

PubMed

Musuva, Rosemary; Shen, Ye; Wei, Xianjue; Binder, Sue; Ivy, Julianne A; Secor, W Evan; Montgomery, Susan P; King, Charles H; Mwinzi, Pauline N M

2017-01-01

Schistosomiasis is a parasite-related chronic inflammatory condition that can cause anemia, decreased growth, liver abnormalities, and deficits in cognitive functioning among children. This study used the Behavior Assessment System for Children (BASC-2) to collect data on thirty-six 9-12 year old school-attending children's behavioral profiles in an Schistosoma mansoni-endemic area of western Kenya, before and after treatment with praziquantel for S. mansoni infection. BASC-2 T scores were significantly reduced post-treatment (p < 0.05) for each of the 'negative' behavior categories including externalizing problems (hyperactivity, aggression, and conduct problems that are disruptive in nature), internalizing problems (anxiety, depression, somatization, atypicality, and withdrawal), school problems (academic difficulties, included attention problems and learning problems), and the composite behavioral symptoms index (BSI), signifying improved behavior. While the observed improvement in the 'positive' behavior category of adaptive skills (adaptability, functional communication, social skills, leadership, and study skills) was not statistically significant, there were significant improvements in two adaptive skills subcategories: social skills and study skills. Results of this study suggest that children have better school-related behaviors without heavy S. mansoni infection, and that infected children's behaviors, especially disruptive problem behaviors, improve significantly after praziquantel treatment.

Techniques for improving efficiency in the emergency department for patients with acute ischemic stroke.

PubMed

Jauch, Edward C; Holmstedt, Christine; Nolte, Justin

2012-09-01

The past 15 years have witnessed significant strides in the management of acute stroke. The most significant advance, reperfusion therapy, has changed relatively little, but the integrated healthcare systems-stroke systems-established to effectively and safely administer stroke treatments have evolved greatly. Driving change is the understanding that "time is brain." Data are compelling that the likelihood of improvement is directly tied to time of reperfusion. Regional stroke systems of care ensure patients arrive at the most appropriate stroke-capable hospital in which intrahospital systems have been created to process the potential stroke patient as quickly as possible. The hospital-based systems are comprised of prehospital care providers, emergency department physicians and nurses, stroke team members, and critical ancillary services such as neuroimaging and laboratory. Given their complexity, these systems of care require maintenance. Through teamwork and ownership of the process, more patients will be saved from potential death and long-term disability. © 2012 New York Academy of Sciences.

[The main directions of improving the system of state accounting and control of radioactive substances and radioactive waste products].

PubMed

2012-01-01

This paper describes a modification of the basic directions of state accounting and control of radioactive substances and radioactive waste products, whose implementation will significantly improve the efficiency of its operation at the regional level. Selected areas are designed to improve accounting and control system for the submission of the enterprises established by the reporting forms, the quality of the information contained in them, as well as structures of information and process for collecting, analyzing and data processing concerning radioactive substances and waste products.

Improvement of Glycosylated Hemoglobin in Patients with Type 2 Diabetes Mellitus under Insulin Treatment by Reimbursement for Self-Monitoring of Blood Glucose.

PubMed

Song, Young Shin; Koo, Bo Kyung; Kim, Sang Wan; Yi, Ka Hee; Shin, Kichul; Moon, Min Kyong

2018-02-01

In Korea, the costs associated with self-monitoring of blood glucose (SMBG) for patients with type 2 diabetes mellitus (T2DM) under insulin treatment have been reimbursed since November 2015. We investigated whether this new reimbursement program for SMBG has improved the glycemic control in the beneficiaries of this policy. Among all adult T2DM patients with ≥3 months of reimbursement (n=854), subjects without any changes in anti-hyperglycemic agents during the study period were selected. The improvement of glycosylated hemoglobin (HbA1c) was defined as an absolute reduction in HbA1c ≥0.6% or an HbA1c level at follow-up <7%. HbA1c levels significantly decreased from 8.5%±1.3% to 8.2%±1.2% during the follow-up (P<0.001) in all the study subjects (n=409). Among them, 35.5% (n=145) showed a significant improvement in HbA1c. Subjects covered under the Medical Aid system showed a higher prevalence of improvement in HbA1c than those with medical insurance (52.2% vs. 33.3%, respectively, P=0.012). In the improvement group, the baseline HbA1c (P<0.001), fasting C-peptide (P=0.016), and daily dose of insulin/body weight (P=0.024) showed significant negative correlations with the degree of HbA1c change. Multivariate analysis showed that subjects in the Medical Aid system were about 2.5-fold more likely to improve in HbA1c compared to those with medical insurance (odds ratio, 2.459; 95% confidence interval, 1.138 to 5.314; P=0.022). The reimbursement for SMBG resulted in a significant improvement in HbA1c in T2DM subjects using insulin, which was more prominent in subjects with poor glucose control at baseline or covered under the Medical Aid system. Copyright © 2018 Korean Diabetes Association

Passive haptics in a knee arthroscopy simulator: is it valid for core skills training?

PubMed

McCarthy, Avril D; Moody, Louise; Waterworth, Alan R; Bickerstaff, Derek R

2006-01-01

Previous investigation of a cost-effective virtual reality arthroscopic training system, the Sheffield Knee Arthroscopy Training System (SKATS), indicated the desirability of including haptic feedback. A formal task analysis confirmed the importance of knee positioning as a core skill for trainees learning to navigate the knee arthroscopically. The system cost and existing limb interface, which permits knee positioning, would be compromised by the addition of commercial active haptic devices available currently. The validation results obtained when passive haptic feedback (resistance provided by physical structures) is provided indicate that SKATS has construct, predictive and face validity for navigation and triangulation training. When tested using SKATS, experienced surgeons (n = 11) performed significantly faster, located significantly more pathologies, and showed significantly shorter arthroscope path lengths than a less experienced surgeon cohort (n = 12). After SKATS training sessions, novices (n = 3) showed significant improvements in: task completion time, shorter arthroscope path lengths, shorter probe path lengths, and fewer arthroscope tip contacts. Main improvements occurred after the first two practice sessions, indicating rapid familiarization and a training effect. Feedback from questionnaires completed by orthopaedic surgeons indicates that the system has face validity for its remit of basic arthroscopic training.

Comparison of a GPS needle-tracking system, multiplanar imaging and 2D imaging for real-time ultrasound-guided epidural anaesthesia: A randomized, comparative, observer-blinded study on phantoms.

PubMed

Menacé, Cécilia; Choquet, Olivier; Abbal, Bertrand; Bringuier, Sophie; Capdevila, Xavier

2017-04-01

The real-time ultrasound-guided paramedian sagittal oblique approach for neuraxial blockade is technically demanding. Innovative technologies have been developed to improve nerve identification and the accuracy of needle placement. The aim of this study was to evaluate three types of ultrasound scans during ultrasound-guided epidural lumbar punctures in a spine phantom. Eleven sets of 20 ultrasound-guided epidural punctures were performed with 2D, GPS, and multiplanar ultrasound machines (660 punctures) on a spine phantom using an in-plane approach. For all punctures, execution time, number of attempts, bone contacts, and needle redirections were noted by an independent physician. Operator comfort and visibility of the needle (tip and shaft) were measured using a numerical scale. The use of GPS significantly decreased the number of punctures, needle repositionings, and bone contacts. Comfort of the physician was also significantly improved with the GPS system compared with the 2D and multiplanar systems. With the multiplanar system, the procedure was not facilitated and execution time was longer compared with 2D imaging after Bonferroni correction but interaction between the type of ultrasound system and mean execution time was not significant in a linear mixed model. There were no significant differences regarding needle tip and shaft visibility between the systems. Multiplanar and GPS needle-tracking systems do not reduce execution time compared with 2D imaging using a real-time ultrasound-guided paramedian sagittal oblique approach in spine phantoms. The GPS needle-tracking system can improve performance in terms of operator comfort, the number of attempts, needle redirections and bone contacts. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Improving client satisfaction and clinic revenues through systems simulation: the case of a university nutrition clinic.

PubMed

Thompson, R C; Scammon, D L

1994-01-01

A client-responsive strategy was developed based upon input from nutrition clinic personnel, administrators, and clients. Systems simulation identified the strategy most likely to lead to client satisfaction while also meeting the needs of clinic personnel and administration. The strategy was subsequently introduced into the clinic and patient satisfaction and operating revenues were monitored following implementation. Both measures of impact demonstrated significant improvement.

A survey of advanced battery systems for space applications

NASA Technical Reports Server (NTRS)

Attia, Alan I.

1989-01-01

The results of a survey on advanced secondary battery systems for space applications are presented. The objectives were: to identify advanced battery systems capable of meeting the requirements of various types of space missions, with significant advantages over currently available batteries, to obtain an accurate estimate of the anticipated improvements of these advanced systems, and to obtain a consensus for the selection of systems most likely to yield the desired improvements. Few advanced systems are likely to exceed a specific energy of 150 Wh/kg and meet the additional requirements of safety and reliability within the next 15 years. The few that have this potential are: (1) regenerative fuel cells, both alkaline and solid polymer electrolyte (SPE) types for large power systems; (2) lithium-intercalatable cathodes, particularly the metal ozides intercalatable cathodes (MnO2 or CoO2), with applications limited to small spacecrafts requiring limited cycle life and low power levels; (3) lithium molten salt systems (e.g., LiAl-FeS2); and (4) Na/beta Alumina/Sulfur or metal chlorides cells. Likely technological advances that would enhance the performance of all the above systems are also identified, in particular: improved bifunctional oxygen electrodes; improved manufacturing technology for thin film lithium electrodes in combination with polymeric electrolytes; improved seals for the lithium molten salt cells; and improved ceramics for sodium/solid electrolyte cells.

Outcomes of rotigotine clinical trials: effects on motor and nonmotor symptoms of Parkinson's disease.

PubMed

Lyons, Kelly E; Pahwa, Rajesh

2013-08-01

Rotigotine transdermal system is a nonergot, 24-hour dopamine agonist approved for the treatment of early and advanced Parkinson's disease (PD). Recent studies have demonstrated significant improvements with rotigotine in motor function in early PD and significant improvements in daily off-time and motor function in advanced PD. In addition to motor improvements, nonmotor symptoms have been shown to be improved with rotigotine in both early and advanced PD. Rotigotine has been shown in large, controlled studies to be safe and efficacious for the treatment of motor and some nonmotor symptoms of early and advanced PD. Copyright © 2013 Elsevier Inc. All rights reserved.

Mobile-phone-based home exercise training program decreases systemic inflammation in COPD: a pilot study.

PubMed

Wang, Chun-Hua; Chou, Pai-Chien; Joa, Wen-Ching; Chen, Li-Fei; Sheng, Te-Fang; Ho, Shu-Chuan; Lin, Horng-Chyuan; Huang, Chien-Da; Chung, Fu-Tsai; Chung, Kian Fan; Kuo, Han-Pin

2014-08-30

Moderate-intensity exercise training improves skeletal muscle aerobic capacity and increased oxidative enzyme activity, as well as exercise tolerance in COPD patients. To investigate whether the home-based exercise training program can reduce inflammatory biomarkers in patients with COPD, twelve patients using mobile phone assistance and 14 with free walk were assessed by incremental shuttle walk test (ISWT), spirometry, strength of limb muscles, and serum C-reactive protein (CRP) and inflammatory cytokines. Patients in the mobile phone group improved their ISWT walking distance, with decrease in serum CRP after 2 months, and sustained at 6 months. Patients in the control group had no improvement. Serum IL-8 in the mobile phone group was significantly reduced at 2, 3 and 6 months after doing home exercise training compared to baseline. IL-6 and TNF-α were significantly elevated at 3 and 6 months in control group, while there were no changes in mobile phone group. The strength of limb muscles was significantly greater compared to baseline at 3 and 6 months in the mobile phone group. A mobile-phone-based system can provide an efficient home endurance exercise training program with improved exercise capacity, strength of limb muscles and a decrease in serum CRP and IL-8 in COPD patients. Decreased systemic inflammation may contribute to these clinical benefits. (Clinical trial registration No.: NCT01631019).

Rapid-Testing Technology and Systems Improvement for the Elimination of Congenital Syphilis in Haiti: Overcoming the “Technology to Systems Gap”

PubMed Central

Benoit, Daphne; Zhou, Xi K.; Pape, Jean W.; Peeling, Rosanna W.; Fitzgerald, Daniel W.; Mate, Kedar S.

2013-01-01

Background. Despite the availability of rapid diagnostic tests and inexpensive treatment for pregnant women, maternal-child syphilis transmission remains a leading cause of perinatal morbidity and mortality in developing countries. In Haiti, more than 3000 babies are born with congenital syphilis annually. Methods and Findings. From 2007 to 2011, we used a sequential time series, multi-intervention study design in fourteen clinics throughout Haiti to improve syphilis testing and treatment in pregnancy. The two primary interventions were the introduction of a rapid point-of-care syphilis test and systems strengthening based on quality improvement (QI) methods. Syphilis testing increased from 91.5% prediagnostic test to 95.9% after (P < 0.001) and further increased to 96.8% (P < 0.001) after the QI intervention. Despite high rates of testing across all time periods, syphilis treatment lagged behind and only increased from 70.3% to 74.7% after the introduction of rapid tests (P = 0.27), but it improved significantly from 70.2% to 84.3% (P < 0.001) after the systems strengthening QI intervention. Conclusion. Both point-of-care diagnostic testing and health systems-based quality improvement interventions can improve the delivery of specific evidence-based healthcare interventions to prevent congenital syphilis at scale in Haiti. Improved treatment rates for syphilis were seen only after the use of systems-based quality improvement approaches. PMID:26316955

Rapid-Testing Technology and Systems Improvement for the Elimination of Congenital Syphilis in Haiti: Overcoming the "Technology to Systems Gap".

PubMed

Severe, Linda; Benoit, Daphne; Zhou, Xi K; Pape, Jean W; Peeling, Rosanna W; Fitzgerald, Daniel W; Mate, Kedar S

2013-01-01

Background. Despite the availability of rapid diagnostic tests and inexpensive treatment for pregnant women, maternal-child syphilis transmission remains a leading cause of perinatal morbidity and mortality in developing countries. In Haiti, more than 3000 babies are born with congenital syphilis annually. Methods and Findings. From 2007 to 2011, we used a sequential time series, multi-intervention study design in fourteen clinics throughout Haiti to improve syphilis testing and treatment in pregnancy. The two primary interventions were the introduction of a rapid point-of-care syphilis test and systems strengthening based on quality improvement (QI) methods. Syphilis testing increased from 91.5% prediagnostic test to 95.9% after (P < 0.001) and further increased to 96.8% (P < 0.001) after the QI intervention. Despite high rates of testing across all time periods, syphilis treatment lagged behind and only increased from 70.3% to 74.7% after the introduction of rapid tests (P = 0.27), but it improved significantly from 70.2% to 84.3% (P < 0.001) after the systems strengthening QI intervention. Conclusion. Both point-of-care diagnostic testing and health systems-based quality improvement interventions can improve the delivery of specific evidence-based healthcare interventions to prevent congenital syphilis at scale in Haiti. Improved treatment rates for syphilis were seen only after the use of systems-based quality improvement approaches.

Improved Dye Stability in Single-Molecule Fluorescence Experiments

NASA Astrophysics Data System (ADS)

EcheverrÍa Aitken, Colin; Marshall, R. Andrew; Pugi, Joseph D.

Complex biological systems challenge existing single-molecule methods. In particular, dye stability limits observation time in singlemolecule fluorescence applications. Current approaches to improving dye performance involve the addition of enzymatic oxygen scavenging systems and small molecule additives. We present an enzymatic oxygen scavenging system that improves dye stability in single-molecule experiments. Compared to the currently-employed glucose-oxidase/catalase system, the protocatechuate-3,4-dioxygenase system achieves lower dissolved oxygen concentration and stabilizes single Cy3, Cy5, and Alexa488 fluorophores. Moreover, this system possesses none of the limitations associated with the glucose oxidase/catalase system. We also tested the effects of small molecule additives in this system. Biological reducing agents significantly destabilize the Cy5 fluorophore as a function of reducing potential. In contrast, anti-oxidants stabilize the Cy3 and Alexa488 fluorophores. We recommend use of the protocatechuate-3,4,-dioxygenase system with antioxidant additives, and in the absence of biological reducing agents. This system should have wide application to single-molecule fluorescence experiments.

Propulsion system-flight control integration and optimization: Flight evaluation and technology transition

NASA Technical Reports Server (NTRS)

Burcham, Frank W., Jr.; Gilyard, Glenn B.; Myers, Lawrence P.

1990-01-01

Integration of propulsion and flight control systems and their optimization offers significant performance improvements. Research programs were conducted which have developed new propulsion and flight control integration concepts, implemented designs on high-performance airplanes, demonstrated these designs in flight, and measured the performance improvements. These programs, first on the YF-12 airplane, and later on the F-15, demonstrated increased thrust, reduced fuel consumption, increased engine life, and improved airplane performance; with improvements in the 5 to 10 percent range achieved with integration and with no changes to hardware. The design, software and hardware developments, and testing requirements were shown to be practical.

Significant and Sustained Reduction in Chemotherapy Errors Through Improvement Science.

PubMed

Weiss, Brian D; Scott, Melissa; Demmel, Kathleen; Kotagal, Uma R; Perentesis, John P; Walsh, Kathleen E

2017-04-01

A majority of children with cancer are now cured with highly complex chemotherapy regimens incorporating multiple drugs and demanding monitoring schedules. The risk for error is high, and errors can occur at any stage in the process, from order generation to pharmacy formulation to bedside drug administration. Our objective was to describe a program to eliminate errors in chemotherapy use among children. To increase reporting of chemotherapy errors, we supplemented the hospital reporting system with a new chemotherapy near-miss reporting system. After the model for improvement, we then implemented several interventions, including a daily chemotherapy huddle, improvements to the preparation and delivery of intravenous therapy, headphones for clinicians ordering chemotherapy, and standards for chemotherapy administration throughout the hospital. Twenty-two months into the project, we saw a centerline shift in our U chart of chemotherapy errors that reached the patient from a baseline rate of 3.8 to 1.9 per 1,000 doses. This shift has been sustained for > 4 years. In Poisson regression analyses, we found an initial increase in error rates, followed by a significant decline in errors after 16 months of improvement work ( P < .001). After the model for improvement, our improvement efforts were associated with significant reductions in chemotherapy errors that reached the patient. Key drivers for our success included error vigilance through a huddle, standardization, and minimization of interruptions during ordering.

The Significance of the Understanding of Balance and Coordination in Self-Cognitive "Bio-Electro-Biblio/Info" Systems.

ERIC Educational Resources Information Center

Tsai, Bor-sheng

1991-01-01

Examines the information communication process and proposes a fuzzy commonality model for improving communication systems. Topics discussed include components of an electronic information programing and processing system and the flow of the formation and transfer of information, including DOS (disk operating system) commands, computer programing…

Microbial community and removal of nitrogen via the addition of a carrier in a pilot-scale duckweed-based wastewater treatment system.

PubMed

Zhao, Yonggui; Fang, Yang; Jin, Yanling; Huang, Jun; Ma, Xinrong; He, Kaize; He, Zhiming; Wang, Feng; Zhao, Hai

2015-03-01

Carriers were added to a pilot-scale duckweed-based (Lemna japonica 0223) wastewater treatment system to immobilize and enhance microorganisms. This system and another parallel duckweed system without carriers were operated for 1.5 years. The results indicated the addition of the carrier did not significantly affect the growth and composition of duckweed, the recovery of total nitrogen (TN), total phosphorus (TP) and CO2 or the removal of TP. However, it significantly improved the removal efficiency of TN and NH4(+)-N (by 19.97% and 15.02%, respectively). The use of 454 pyrosequencing revealed large differences of the microbial communities between the different components within a system and similarities within the same components between the two systems. The carrier biofilm had the highest bacterial diversity and relative abundance of nitrifying bacteria (3%) and denitrifying bacteria (24% of Rhodocyclaceae), which improved nitrogen removal of the system. An efficient N-removal duckweed system with enhanced microorganisms was established. Copyright © 2014 Elsevier Ltd. All rights reserved.

Ozone inhibits corrosion in cooling towers

NASA Technical Reports Server (NTRS)

French, K. R.; Howe, R. D.; Humphrey, M. F.

1980-01-01

Commercially available corona discharge ozone generator, fitted onto industrial cooling tower, significantly reduces formation of scales (calcium carbonate) and corrosion. System also controls growth of algae and other microorganisms. Modification lowers cost and improves life of cooling system.

Improved amino acid, bioenergetic metabolite and neurotransmitter profiles following human amnion epithelial cell transplant in intermediate maple syrup urine disease mice.

PubMed

Skvorak, Kristen J; Dorko, Kenneth; Marongiu, Fabio; Tahan, Veysel; Hansel, Marc C; Gramignoli, Roberto; Arning, Erland; Bottiglieri, Teodoro; Gibson, K Michael; Strom, Stephen C

2013-06-01

Orthotopic liver transplant (OLT) significantly improves patient outcomes in maple syrup urine disease (MSUD; OMIM: 248600), yet organ shortages point to the need for alternative therapies. Hepatocyte transplantation has shown both clinical and preclinical efficacy as an intervention for metabolic liver diseases, yet the availability of suitable livers for hepatocyte isolation is also limited. Conversely, human amnion epithelial cells (hAEC) may have utility as a hepatocyte substitute, and they share many of the characteristics of pluripotent embryonic stem cells while lacking their safety and ethical concerns. We reported that like hepatocytes, transplantation of hAEC significantly improved survival and lifespan, normalized body weight, and significantly improved branched-chain amino acid (BCAA) levels in sera and brain in a transgenic murine model of intermediate maple syrup urine disease (imsud). In the current report, we detail the neural and peripheral metabolic improvements associated with hAEC transplant in imsud mice, including amino acids associated with bioenergetics, the urea cycle, as well as the neurotransmitter systems for serotonin, dopamine, and gamma-aminobutyric acid (GABA). This stem cell therapy results in significant global correction of the metabolic profile that characterizes the disease, both in the periphery and the central nervous system, the target organ for toxicity in iMSUD. The significant correction of the disease phenotype, coupled with the theoretical benefits of hAEC, particularly their lack of immunogenicity and tumorigenicity, suggests that human amnion epithelial cells deserve serious consideration for clinical application to treat metabolic liver diseases. Copyright © 2013. Published by Elsevier Inc.

Analysis of the environmental and economic indicators of the industrial enterprise

NASA Astrophysics Data System (ADS)

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

2018-05-01

In the paper the features of the analysis of the environmental and economic indicators of the industrial enterprise are considered. The purpose of the study is to improve the system of environmental and economic analysis at the enterprise for more accurate forecasting of its main environmental and economic indicators. The study of the main approaches to the implementation of environmental and economic analysis based on the corresponding systems of indicators with identification of the most significant factors was carried out. The main result of the study is the choice of a system for analyzing the environmental and economic indicators, maximally oriented to a specific enterprise, taking into account its production specific features. The practical significance of the study consists in the selection of an adequate system of indicators at enterprises to improve the effectiveness from preparation of an environmentally safe management decision.

Anomalous TWTA output power spikes and their effect on a digital satellite communications system

NASA Technical Reports Server (NTRS)

May, Brian D.; Kerczewski, Robert J.; Svoboda, James S.

1992-01-01

Several 30 GHz, 60 W traveling wave tube amplifiers (TWTA) were manufactured for the NASA Lewis Research Center's High Burst Rate Link Evaluation Terminal Project. An unusual operating problem characterized by anomalous nonperiodic output power spikes, common to all of the TWTAs proved during testing to significantly affect the performance of a digitally-modulated data transmission test system. Modifications made to the TWTAs significantly curtailed the problem and allowed acceptable system performance to be obtained. This paper presents a discussion of the TWTA output power spike problem, possible causes of the problem, and the solutions implemented by the manufacturer which improved the TWTA performance to an acceptable level. The results of the testing done at NASA Lewis on the TWTAs both before and after the improvement made by Hughes are presented, and the effects of the output power spikes on the performance of the test system are discussed.

Study on the application of NASA energy management techniques for control of a terrestrial solar water heating system

NASA Technical Reports Server (NTRS)

Swanson, T. D.; Ollendorf, S.

1979-01-01

This paper addresses the potential for enhanced solar system performance through sophisticated control of the collector loop flow rate. Computer simulations utilizing the TRNSYS solar energy program were performed to study the relative effect on system performance of eight specific control algorithms. Six of these control algorithms are of the proportional type: two are concave exponentials, two are simple linear functions, and two are convex exponentials. These six functions are typical of what might be expected from future, more advanced, controllers. The other two algorithms are of the on/off type and are thus typical of existing control devices. Results of extensive computer simulations utilizing actual weather data indicate that proportional control does not significantly improve system performance. However, it is shown that thermal stratification in the liquid storage tank may significantly improve performance.

Ka-band MMIC subarray technology program (Ka-Mist)

NASA Technical Reports Server (NTRS)

Pottenger, Warren

1995-01-01

The broad objective of this program was to demonstrate a proof of concept insertion of Monolithic Microwave Integrated Circuit (MMIC) device technology into an innovative (tile architecture) active phased array antenna application supporting advanced EHF communication systems. Ka-band MMIC arrays have long been considered as having high potential for increasing the capability of space, aircraft, and land mobile communication systems in terms of scan performance, data rate, link margin, and flexibility while offering a significant reduction in size, weight, and power consumption. Insertion of MMIC technology into antenna systems, particularly at millimeter wave frequencies using low power and low noise amplifiers in close proximity to the radiating elements, offers a significant improvement in the array transmit efficiency, receive system noise figure, and overall array reliability. Application of active array technology also leads to the use of advanced beamforming techniques that can improve beam agility, diversity, and adaptivity to complex signal environments.

Pressurized vascular systems for self-healing materials

PubMed Central

Hamilton, A. R.; Sottos, N. R.; White, S. R.

2012-01-01

An emerging strategy for creating self-healing materials relies on embedded vascular networks of microchannels to transport reactive fluids to regions of damage. Here we investigate the use of active pumping for the pressurized delivery of a two-part healing system, allowing a small vascular system to deliver large volumes of healing agent. Different pumping strategies are explored to improve the mixing and subsequent polymerization of healing agents in the damage zone. Significant improvements in the number of healing cycles and in the overall healing efficiency are achieved compared with prior passive schemes that use only capillary forces for the delivery of healing agents. At the same time, the volume of the vascular system required to achieve this superior healing performance is significantly reduced. In the best case, nearly full recovery of fracture toughness is attained throughout 15 cycles of damage and healing, with a vascular network constituting just 0.1 vol% of the specimen. PMID:21957119

Cognitive and Adaptive Functioning after Liver Transplantation for Maple Syrup Urine Disease: A Case Series

PubMed Central

Shellmer, D. A.; Dabbs, A. DeVito; Dew, M. A.; Noll, R. B.; Feldman, H.; Strauss, K.; Morton, D. H.; Vockley, G.; Mazariegos, G. V.

2011-01-01

MSUD is a complex metabolic disorder that has been associated with central nervous system damage, developmental delays, and neurocognitive deficits. Although liver transplantation provides a metabolic cure for MSUD, changes in cognitive and adaptive functioning following transplantation have not been investigated. In this report we present data from 14 patients who completed cognitive and adaptive functioning testing pre- and one year and/or three years post-liver transplantation. Findings show either no significant change or improvement in IQ scores pre- to post-liver transplantation. Greater variability was observed in adaptive functioning scores, but the majority of patients evidenced either no significant change or improvement in adaptive scores. In general, findings may indicate that liver transplantation curtails additional central nervous system damage and neurocognitive decline providing an opportunity for stabilization or improvement in functioning. PMID:20946191

Anti-HIV-1 nanotherapeutics: promises and challenges for the future

PubMed Central

Mahajan, Supriya D; Aalinkeel, Ravikumar; Law, Wing-Cheung; Reynolds, Jessica L; Nair, Bindukumar B; Sykes, Donald E; Yong, Ken-Tye; Roy, Indrajit; Prasad, Paras N; Schwartz, Stanley A

2012-01-01

The advent of highly active antiretroviral therapy (HAART) has significantly improved the prognosis for human immunodeficiency virus (HIV)-infected patients, however the adverse side effects associated with prolonged HAART therapy use continue. Although systemic viral load can be undetectable, the virus remains sequestered in anatomically privileged sites within the body. Nanotechnology-based delivery systems are being developed to target the virus within different tissue compartments and are being evaluated for their safety and efficacy. The current review outlines the various nanomaterials that are becoming increasingly used in biomedical applications by virtue of their robustness, safety, multimodality, and multifunctionality. Nanotechnology can revolutionize the field of HIV medicine by not only improving diagnosis, but also by improving delivery of antiretrovirals to targeted regions in the body and by significantly enhancing the efficacy of the currently available antiretroviral medications. PMID:23055735

Development and Property Evaluation of Selected HfO2-Silicon and Rare Earth-Silicon Based Bond Coats and Environmental Barrier Coating Systems for SiC/SiC Ceramic Matrix Composites

NASA Technical Reports Server (NTRS)

Zhu, Dongming

2016-01-01

Ceramic environmental barrier coatings (EBC) and SiC/SiC ceramic matrix composites (CMCs) will play a crucial role in future aircraft propulsion systems because of their ability to significantly increase engine operating temperatures, improve component durability, reduce engine weight and cooling requirements. Advanced EBC systems for SiC/SiC CMC turbine and combustor hot section components are currently being developed to meet future turbine engine emission and performance goals. One of the significant material development challenges for the high temperature CMC components is to develop prime-reliant, high strength and high temperature capable environmental barrier coating bond coat systems, since the current silicon bond coat cannot meet the advanced EBC-CMC temperature and stability requirements. In this paper, advanced NASA HfO2-Si and rare earth Si based EBC bond coat EBC systems for SiC/SiC CMC combustor and turbine airfoil applications are investigated. High temperature properties of the advanced EBC systems, including the strength, fracture toughness, creep and oxidation resistance have been studied and summarized. The advanced NASA EBC systems showed some promise to achieve 1500C temperature capability, helping enable next generation turbine engines with significantly improved engine component temperature capability and durability.

Improving Performance of the System Safety Function at Marshall Space Flight Center

NASA Technical Reports Server (NTRS)

Kiessling, Ed; Tippett, Donald D.; Shivers, Herb

2004-01-01

The Columbia Accident Investigation Board (CAIB) determined that organizational and management issues were significant contributors to the loss of Space Shuttle Columbia. In addition, the CAIB observed similarities between the organizational and management climate that preceded the Challenger accident and the climate that preceded the Columbia accident. To prevent recurrence of adverse organizational and management climates, effective implementation of the system safety function is suggested. Attributes of an effective system safety program are presented. The Marshall Space Flight Center (MSFC) system safety program is analyzed using the attributes. Conclusions and recommendations for improving the MSFC system safety program are offered in this case study.

Improved pressure measurement system for calibration of the NASA LeRC 10x10 supersonic wind tunnel

NASA Technical Reports Server (NTRS)

Blumenthal, Philip Z.; Helland, Stephen M.

1994-01-01

This paper discusses a method used to provide a significant improvement in the accuracy of the Electronically Scanned Pressure (ESP) Measurement System by means of a fully automatic floating pressure generating system for the ESP calibration and reference pressures. This system was used to obtain test section Mach number and flow angularity measurements over the full envelope of test conditions for the 10 x 10 Supersonic Wind Tunnel. The uncertainty analysis and actual test data demonstrated that, for most test conditions, this method could reduce errors to about one-third to one-half that obtained with the standard system.

Liver‐Directed Human Amniotic Epithelial Cell Transplantation Improves Systemic Disease Phenotype in Hurler Syndrome Mouse Model

PubMed Central

Rodriguez, Natalie S.; Yanuaria, Lisa; Parducho, Kevin Murphy R.; Garcia, Irving M.; Varghese, Bino A.; Grubbs, Brendan H.

2017-01-01

Abstract Mucopolysaccharidosis type 1 (MPS1) is an inherited lysosomal storage disorder caused by a deficiency in the glycosaminoglycan (GAG)‐degrading enzyme α‐l‐iduronidase (IDUA). In affected patients, the systemic accumulation of GAGs results in skeletal dysplasia, neurological degeneration, multiple organ dysfunction, and early death. Current therapies, including enzyme replacement and bone marrow transplant, improve life expectancy but the benefits to skeletal and neurological phenotypes are limited. In this study, we tested the therapeutic efficacy of liver‐directed transplantation of a placental stem cell, which possesses multilineage differentiation potential, low immunogenicity, and high lysosomal enzyme activity. Unfractionated human amniotic epithelial cells (hAECs) were transplanted directly into the liver of immunodeficient Idua knockout mouse neonates. The hAECs engraftment was immunohistochemically confirmed with anti‐human mitochondria staining. Enzyme activity assays indicated that hAECs transplantation restored IDUA function in the liver and significantly decreased urinary GAG excretion. Histochemical and micro‐computed tomography analyses revealed reduced GAG deposition in the phalanges joints and composition/morphology improvement of cranial and facial bones. Neurological assessment in the hAEC treated mice showed significant improvement of sensorimotor coordination in the hAEC treated mice compared to untreated mice. Results confirm that partial liver cell replacement with placental stem cells can provide long‐term (>20 weeks) and systemic restoration of enzyme function, and lead to significant phenotypic improvement in the MPS1 mouse model. This preclinical data indicate that liver‐directed placental stem cell transplantation may improve skeletal and neurological phenotypes of MPS1 patients. Stem Cells Translational Medicine 2017;6:1583–1594 PMID:28585336

Liver-Directed Human Amniotic Epithelial Cell Transplantation Improves Systemic Disease Phenotype in Hurler Syndrome Mouse Model.

PubMed

Rodriguez, Natalie S; Yanuaria, Lisa; Parducho, Kevin Murphy R; Garcia, Irving M; Varghese, Bino A; Grubbs, Brendan H; Miki, Toshio

2017-07-01

Mucopolysaccharidosis type 1 (MPS1) is an inherited lysosomal storage disorder caused by a deficiency in the glycosaminoglycan (GAG)-degrading enzyme α-l-iduronidase (IDUA). In affected patients, the systemic accumulation of GAGs results in skeletal dysplasia, neurological degeneration, multiple organ dysfunction, and early death. Current therapies, including enzyme replacement and bone marrow transplant, improve life expectancy but the benefits to skeletal and neurological phenotypes are limited. In this study, we tested the therapeutic efficacy of liver-directed transplantation of a placental stem cell, which possesses multilineage differentiation potential, low immunogenicity, and high lysosomal enzyme activity. Unfractionated human amniotic epithelial cells (hAECs) were transplanted directly into the liver of immunodeficient Idua knockout mouse neonates. The hAECs engraftment was immunohistochemically confirmed with anti-human mitochondria staining. Enzyme activity assays indicated that hAECs transplantation restored IDUA function in the liver and significantly decreased urinary GAG excretion. Histochemical and micro-computed tomography analyses revealed reduced GAG deposition in the phalanges joints and composition/morphology improvement of cranial and facial bones. Neurological assessment in the hAEC treated mice showed significant improvement of sensorimotor coordination in the hAEC treated mice compared to untreated mice. Results confirm that partial liver cell replacement with placental stem cells can provide long-term (>20 weeks) and systemic restoration of enzyme function, and lead to significant phenotypic improvement in the MPS1 mouse model. This preclinical data indicate that liver-directed placental stem cell transplantation may improve skeletal and neurological phenotypes of MPS1 patients. Stem Cells Translational Medicine 2017;6:1583-1594. © 2017 The Authors Stem Cells Translational Medicine published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.

Improvements in Cystic Fibrosis Quarterly Visits, Lung Function Tests, and Respiratory Cultures.

PubMed

Wooldridge, Jamie L; Mason, Susan; Brusatti, Judith; Albers, Gary M; Noyes, Blakeslee E

2015-12-01

The Cystic Fibrosis (CF) Foundation recommends patients attend clinic ≥4 times per year with 4 respiratory cultures and 2 pulmonary function tests (PFTs). However, nationally only 57.4% of patients met these guidelines in 2012. We used a quality improvement program with a goal of 75% of our patients meeting this care guideline by 2012. A 2-stage program was started in 2011. Stage 1: education of patients/caregivers on importance of quarterly visits. Stage 2: quarterly tracking system of patient appointments. Data on clinic visits, respiratory cultures, and PFTs were collected from the CF registry from January 2009 through December 2013. Statistical process control charts were used to track improvements. The average number of clinic visits increased significantly from 4.6 ± 2.3 in 2009 to 6.3 ± 4.6 in 2013 (P < .0001). The percentage of patients ages 6 through 18 completing a clinic visit, PFT, and respiratory culture per quarter increased significantly from 76.2% during 2009 to 86.4% in 2013. The percentage of patients completing ≥4 clinic visits with 4 respiratory cultures and 2 PFTs improved significantly from 47.5% in 2009 to 71.0% in 2013 (P < .0001). A tracking system of patient appointments significantly improved adherence to the care guidelines better than education alone. The multiple-stage quality improvement program we implemented may be modifiable and able to be integrated in other CF centers or other multiple disciplinary chronic illness care centers. Copyright © 2015 by the American Academy of Pediatrics.

Establishment and outcomes of a model primary care pharmacy service system.

PubMed

Carmichael, Jannet M; Alvarez, Autumn; Chaput, Ryan; DiMaggio, Jennifer; Magallon, Heather; Mambourg, Scott

2004-03-01

The establishment and outcomes of a model primary care pharmacy service system are described. A primary care pharmacy practice model was established at a government health care facility in March 1996. The original objective was to establish a primary pharmacy practice model that would demonstrate improved patient outcomes and maximize the pharmacist's contributions to drug therapy. Since its inception, many improvements have been realized and supported by advanced computer and automated systems, expanded disease state management practices, and unique practitioner and administrative support. Many outcomes studies have been performed on the pharmacist-initiated and -managed clinics, leading to improved patient care and conveying the quality-conscious and cost-effective role pharmacists can play as independent practitioners in this environment. These activities demonstrate cutting-edge leadership in health-system pharmacy. Redesign has been used to improve consistent access to a medication expert and has significantly improved the quality of patient care while easing physicians' workload without increasing health care costs. A system using pharmacists as independent practitioners to promote primary care has achieved high-quality and cost-effective patient care.

Scope for improved eco-efficiency varies among diverse cropping systems.

PubMed

Carberry, Peter S; Liang, Wei-li; Twomlow, Stephen; Holzworth, Dean P; Dimes, John P; McClelland, Tim; Huth, Neil I; Chen, Fu; Hochman, Zvi; Keating, Brian A

2013-05-21

Global food security requires eco-efficient agriculture to produce the required food and fiber products concomitant with ecologically efficient use of resources. This eco-efficiency concept is used to diagnose the state of agricultural production in China (irrigated wheat-maize double-cropping systems), Zimbabwe (rainfed maize systems), and Australia (rainfed wheat systems). More than 3,000 surveyed crop yields in these three countries were compared against simulated grain yields at farmer-specified levels of nitrogen (N) input. Many Australian commercial wheat farmers are both close to existing production frontiers and gain little prospective return from increasing their N input. Significant losses of N from their systems, either as nitrous oxide emissions or as nitrate leached from the soil profile, are infrequent and at low intensities relative to their level of grain production. These Australian farmers operate close to eco-efficient frontiers in regard to N, and so innovations in technologies and practices are essential to increasing their production without added economic or environmental risks. In contrast, many Chinese farmers can reduce N input without sacrificing production through more efficient use of their fertilizer input. In fact, there are real prospects for the double-cropping systems on the North China Plain to achieve both production increases and reduced environmental risks. Zimbabwean farmers have the opportunity for significant production increases by both improving their technical efficiency and increasing their level of input; however, doing so will require improved management expertise and greater access to institutional support for addressing the higher risks. This paper shows that pathways for achieving improved eco-efficiency will differ among diverse cropping systems.

Scope for improved eco-efficiency varies among diverse cropping systems

PubMed Central

Carberry, Peter S.; Liang, Wei-li; Twomlow, Stephen; Holzworth, Dean P.; Dimes, John P.; McClelland, Tim; Huth, Neil I.; Chen, Fu; Hochman, Zvi; Keating, Brian A.

2013-01-01

Global food security requires eco-efficient agriculture to produce the required food and fiber products concomitant with ecologically efficient use of resources. This eco-efficiency concept is used to diagnose the state of agricultural production in China (irrigated wheat–maize double-cropping systems), Zimbabwe (rainfed maize systems), and Australia (rainfed wheat systems). More than 3,000 surveyed crop yields in these three countries were compared against simulated grain yields at farmer-specified levels of nitrogen (N) input. Many Australian commercial wheat farmers are both close to existing production frontiers and gain little prospective return from increasing their N input. Significant losses of N from their systems, either as nitrous oxide emissions or as nitrate leached from the soil profile, are infrequent and at low intensities relative to their level of grain production. These Australian farmers operate close to eco-efficient frontiers in regard to N, and so innovations in technologies and practices are essential to increasing their production without added economic or environmental risks. In contrast, many Chinese farmers can reduce N input without sacrificing production through more efficient use of their fertilizer input. In fact, there are real prospects for the double-cropping systems on the North China Plain to achieve both production increases and reduced environmental risks. Zimbabwean farmers have the opportunity for significant production increases by both improving their technical efficiency and increasing their level of input; however, doing so will require improved management expertise and greater access to institutional support for addressing the higher risks. This paper shows that pathways for achieving improved eco-efficiency will differ among diverse cropping systems. PMID:23671071

Aerobic training in adults after atrial switch procedure for transposition of the great arteries improves exercise capacity without impairing systemic right ventricular function.

PubMed

Westhoff-Bleck, Mechthild; Schieffer, Bernhard; Tegtbur, Uwe; Meyer, Gerd Peter; Hoy, Ludwig; Schaefer, Arnd; Tallone, Ezequiel Marcello; Tutarel, Oktay; Mertins, Ramona; Wilmink, Lena Mara; Anker, Stefan D; Bauersachs, Johann; Roentgen, Philipp

2013-12-05

Exercise training safely and efficiently improves symptoms in patients with heart failure due to left ventricular dysfunction. However, studies in congenital heart disease with systemic right ventricle are scarce and results are controversial. In a randomised controlled study we investigated the effect of aerobic exercise training on exercise capacity and systemic right ventricular function in adults with d-transposition of the great arteries after atrial redirection surgery (28.2 ± 3.0 years after Mustard procedure). 48 patients (31 male, age 29.3 ± 3.4 years) were randomly allocated to 24 weeks of structured exercise training or usual care. Primary endpoint was the change in maximum oxygen uptake (peak VO2). Secondary endpoints were systemic right ventricular diameters determined by cardiac magnetic resonance imaging (CMR). Data were analysed per intention to treat analysis. At baseline peak VO2 was 25.5 ± 4.7 ml/kg/min in control and 24.0 ± 5 ml/kg/min in the training group (p=0.3). Training significantly improved exercise capacity (treatment effect for peak VO2 3.8 ml/kg/min, 95% CI: 1.8 to 5.7; p=0.001), work load (p=0.002), maximum exercise time (p=0.002), and NYHA class (p=0.046). Systemic ventricular function and volumes determined by CMR remained unchanged. None of the patients developed signs of cardiac decompensation or arrhythmias while on exercise training. Aerobic exercise training did not detrimentally affect systemic right ventricular function, but significantly improved exercise capacity and heart failure symptoms. Aerobic exercise training can be recommended for patients following atrial redirection surgery to improve exercise capacity and to lessen or prevent heart failure symptoms. ( ClinicalTrials.gov #NCT00837603). © 2013.

Engagement with the auditory processing system during targeted auditory cognitive training mediates changes in cognitive outcomes in individuals with schizophrenia

PubMed Central

Biagianti, Bruno; Fisher, Melissa; Neilands, Torsten B.; Loewy, Rachel; Vinogradov, Sophia

2016-01-01

BACKGROUND Individuals with schizophrenia who engage in targeted cognitive training (TCT) of the auditory system show generalized cognitive improvements. The high degree of variability in cognitive gains maybe due to individual differences in the level of engagement of the underlying neural system target. METHODS 131 individuals with schizophrenia underwent 40 hours of TCT. We identified target engagement of auditory system processing efficiency by modeling subject-specific trajectories of auditory processing speed (APS) over time. Lowess analysis, mixed models repeated measures analysis, and latent growth curve modeling were used to examine whether APS trajectories were moderated by age and illness duration, and mediated improvements in cognitive outcome measures. RESULTS We observed signifcant improvements in APS from baseline to 20 hours of training (initial change), followed by a flat APS trajectory (plateau) at subsequent time-points. Participants showed inter-individual variability in the steepness of the initial APS change and in the APS plateau achieved and sustained between 20–40 hours. We found that participants who achieved the fastest APS plateau, showed the greatest transfer effects to untrained cognitive domains. CONCLUSIONS There is a significant association between an individual's ability to generate and sustain auditory processing efficiency and their degree of cognitive improvement after TCT, independent of baseline neurocognition. APS plateau may therefore represent a behavioral measure of target engagement mediating treatment response. Future studies should examine the optimal plateau of auditory processing efficiency required to induce significant cognitive improvements, in the context of inter-individual differences in neural plasticity and sensory system efficiency that characterize schizophrenia. PMID:27617637

Improved Aqueous Solubility and Antihypercholesterolemic Activity of Ezetimibe on Formulating with Hydroxypropyl-β-Cyclodextrin and Hydrophilic Auxiliary Substances.

PubMed

Srivalli, Kale Mohana Raghava; Mishra, Brahmeshwar

2016-04-01

The purpose of this study was to improve the aqueous solubility, dissolution, and pharmacodynamic properties of a BCS class II drug, ezetimibe (Eze) by preparing ternary cyclodextrin complex systems. We investigated the potential synergistic effect of two novel hydrophilic auxiliary substances, D-α-tocopheryl polyethylene glycol 1000 succinate (TPGS) and L-ascorbic acid-2-glucoside (AA2G) on hydroxypropyl-β-cyclodextrin (HPBCD) solubilization of poorly water-soluble hypocholesterolemic drug, Eze. In solution state, the binary and ternary systems were analyzed by phase solubility studies and Job's plot. The solid complexes prepared by freeze-drying were characterized by Fourier transform infrared (FTIR), differential scanning calorimetry (DSC), powder X-ray diffraction (XRD), nuclear magnetic resonance (NMR), and scanning electron microscopy (SEM). The log P values, aqueous solubility, dissolution, and antihypercholesterolemic activity of all systems were studied. The analytical techniques confirmed the formation of inclusion complexes in the binary and ternary systems. HPBCD complexation significantly (p < 0.05) reduced the log P and improved the solubility, dissolution, and hypocholesterolemic properties of Eze, and the addition of ternary component produced further significant improvement (p < 0.05) even compared to binary system. The remarkable reduction in log P and enhancement in solubility, dissolution, and antihypercholesterolemic activity due to the addition of TPGS or AA2G may be attributed to enhanced wetting, dispersibility, and complete amorphization. The use of TPGS or AA2G as ternary hydrophilic auxiliary substances improved the HPBCD solubilization and antihypercholesterolemic activity of Eze.

Biomass recycle as a means to improve the energy efficiency of CELSS algal culture systems

NASA Technical Reports Server (NTRS)

Radmer, R.; Cox, J.; Lieberman, D.; Behrens, P.; Arnett, K.

1987-01-01

Algal cultures can be very rapid and efficient means to generate biomass and regenerate the atmosphere for closed environmental life support systems. However, as in the case of most higher plants, a significant fraction of the biomass produced by most algae cannot be directly converted to a useful food product by standard food technology procedures. This waste biomass will serve as an energy drain on the overall system unless it can be efficiently recycled without a significant loss of its energy content. Experiments are reported in which cultures of the alga Scenedesmus obliquus were grown in the light and at the expense of an added carbon source, which either replaced or supplemented the actinic light. As part of these experiments, hydrolyzed waste biomass from these same algae were tested to determine whether the algae themselves could be made part of the biological recycling process. Results indicate that hydrolyzed algal (and plant) biomass can serve as carbon and energy sources for the growth of these algae, suggesting that the efficiency of the closed system could be significantly improved using this recycling process.

Quantitative evaluation of three advanced laparoscopic viewing technologies: a stereo endoscope, an image projection display, and a TFT display.

PubMed

Wentink, M; Jakimowicz, J J; Vos, L M; Meijer, D W; Wieringa, P A

2002-08-01

Compared to open surgery, minimally invasive surgery (MIS) relies heavily on advanced technology, such as endoscopic viewing systems and innovative instruments. The aim of the study was to objectively compare three technologically advanced laparoscopic viewing systems with the standard viewing system currently used in most Dutch hospitals. We evaluated the following advanced laparoscopic viewing systems: a Thin Film Transistor (TFT) display, a stereo endoscope, and an image projection display. The standard viewing system was comprised of a monocular endoscope and a high-resolution monitor. Task completion time served as the measure of performance. Eight surgeons with laparoscopic experience participated in the experiment. The average task time was significantly greater (p <0.05) with the stereo viewing system than with the standard viewing system. The average task times with the TFT display and the image projection display did not differ significantly from the standard viewing system. Although the stereo viewing system promises improved depth perception and the TFT and image projection displays are supposed to improve hand-eye coordination, none of these systems provided better task performance than the standard viewing system in this pelvi-trainer experiment.

Promoting Conceptual Change for Complex Systems Understanding: Outcomes of an Agent-Based Participatory Simulation

NASA Astrophysics Data System (ADS)

Rates, Christopher A.; Mulvey, Bridget K.; Feldon, David F.

2016-08-01

Components of complex systems apply across multiple subject areas, and teaching these components may help students build unifying conceptual links. Students, however, often have difficulty learning these components, and limited research exists to understand what types of interventions may best help improve understanding. We investigated 32 high school students' understandings of complex systems components and whether an agent-based simulation could improve their understandings. Pretest and posttest essays were coded for changes in six components to determine whether students showed more expert thinking about the complex system of the Chesapeake Bay watershed. Results showed significant improvement for the components Emergence ( r = .26, p = .03), Order ( r = .37, p = .002), and Tradeoffs ( r = .44, p = .001). Implications include that the experiential nature of the simulation has the potential to support conceptual change for some complex systems components, presenting a promising option for complex systems instruction.

Fabrication, Characterization, and Biological Activity of Avermectin Nano-delivery Systems with Different Particle Sizes

NASA Astrophysics Data System (ADS)

Wang, Anqi; Wang, Yan; Sun, Changjiao; Wang, Chunxin; Cui, Bo; Zhao, Xiang; Zeng, Zhanghua; Yao, Junwei; Yang, Dongsheng; Liu, Guoqiang; Cui, Haixin

2018-01-01

Nano-delivery systems for the active ingredients of pesticides can improve the utilization rates of pesticides and prolong their control effects. This is due to the nanocarrier envelope and controlled release function. However, particles containing active ingredients in controlled release pesticide formulations are generally large and have wide size distributions. There have been limited studies about the effect of particle size on the controlled release properties and biological activities of pesticide delivery systems. In the current study, avermectin (Av) nano-delivery systems were constructed with different particle sizes and their performances were evaluated. The Av release rate in the nano-delivery system could be effectively controlled by changing the particle size. The biological activity increased with decreasing particle size. These results suggest that Av nano-delivery systems can significantly improve the controllable release, photostability, and biological activity, which will improve efficiency and reduce pesticide residues.

MOOSE IPL Extensions (Control Logic)

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

Permann, Cody

In FY-2015, the development of MOOSE was driven by the needs of the NEAMS MOOSE-based applications, BISON, MARMOT, and RELAP-7. An emphasis was placed on the continued upkeep and improvement MOOSE in support of the product line integration goals. New unified documentation tools have been developed, several improvements to regression testing have been enforced and overall better software quality practices have been implemented. In addition the Multiapps and Transfers systems have seen significant refactoring and robustness improvements, as has the “Restart and Recover” system in support of Multiapp simulations. Finally, a completely new “Control Logic” system has been engineered tomore » replace the prototype system currently in use in the RELAP-7 code. The development of this system continues and is expected to handle existing needs as well as support future enhancements.« less

System design and improvement of an emergency department using Simulation-Based Multi-Objective Optimization

NASA Astrophysics Data System (ADS)

Goienetxea Uriarte, A.; Ruiz Zúñiga, E.; Urenda Moris, M.; Ng, A. H. C.

2015-05-01

Discrete Event Simulation (DES) is nowadays widely used to support decision makers in system analysis and improvement. However, the use of simulation for improving stochastic logistic processes is not common among healthcare providers. The process of improving healthcare systems involves the necessity to deal with trade-off optimal solutions that take into consideration a multiple number of variables and objectives. Complementing DES with Multi-Objective Optimization (SMO) creates a superior base for finding these solutions and in consequence, facilitates the decision-making process. This paper presents how SMO has been applied for system improvement analysis in a Swedish Emergency Department (ED). A significant number of input variables, constraints and objectives were considered when defining the optimization problem. As a result of the project, the decision makers were provided with a range of optimal solutions which reduces considerably the length of stay and waiting times for the ED patients. SMO has proved to be an appropriate technique to support healthcare system design and improvement processes. A key factor for the success of this project has been the involvement and engagement of the stakeholders during the whole process.

Are We on the Right Track: Can Our Understanding of Abscission in Model Systems Promote or Derail Making Improvements in Less Studied Crops?

PubMed Central

Patterson, Sara E.; Bolivar-Medina, Jenny L.; Falbel, Tanya G.; Hedtcke, Janet L.; Nevarez-McBride, Danielle; Maule, Andrew F.; Zalapa, Juan E.

2016-01-01

As the world population grows and resources and climate conditions change, crop improvement continues to be one of the most important challenges for agriculturalists. The yield and quality of many crops is affected by abscission or shattering, and environmental stresses often hasten or alter the abscission process. Understanding this process can not only lead to genetic improvement, but also changes in cultural practices and management that will contribute to higher yields, improved quality and greater sustainability. As plant scientists, we have learned significant amounts about this process through the study of model plants such as Arabidopsis, tomato, rice, and maize. While these model systems have provided significant valuable information, we are sometimes challenged to use this knowledge effectively as variables including the economic value of the crop, the uniformity of the crop, ploidy levels, flowering and crossing mechanisms, ethylene responses, cultural requirements, responses to changes in environment, and cellular and tissue specific morphological differences can significantly influence outcomes. The value of genomic resources for lesser-studied crops such as cranberries and grapes and the orphan crop fonio will also be considered. PMID:26858730

Are We on the Right Track: Can Our Understanding of Abscission in Model Systems Promote or Derail Making Improvements in Less Studied Crops?

PubMed

Patterson, Sara E; Bolivar-Medina, Jenny L; Falbel, Tanya G; Hedtcke, Janet L; Nevarez-McBride, Danielle; Maule, Andrew F; Zalapa, Juan E

2015-01-01

As the world population grows and resources and climate conditions change, crop improvement continues to be one of the most important challenges for agriculturalists. The yield and quality of many crops is affected by abscission or shattering, and environmental stresses often hasten or alter the abscission process. Understanding this process can not only lead to genetic improvement, but also changes in cultural practices and management that will contribute to higher yields, improved quality and greater sustainability. As plant scientists, we have learned significant amounts about this process through the study of model plants such as Arabidopsis, tomato, rice, and maize. While these model systems have provided significant valuable information, we are sometimes challenged to use this knowledge effectively as variables including the economic value of the crop, the uniformity of the crop, ploidy levels, flowering and crossing mechanisms, ethylene responses, cultural requirements, responses to changes in environment, and cellular and tissue specific morphological differences can significantly influence outcomes. The value of genomic resources for lesser-studied crops such as cranberries and grapes and the orphan crop fonio will also be considered.

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

PubMed

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

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

Morphology and properties of amine terminated poly(arylene ether ketone) and poly(arylene ether sulfone) modified epoxy resin systems

NASA Technical Reports Server (NTRS)

Cecere, J. A.; Mcgrath, J. E.; Hedrick, J. L.

1986-01-01

Epoxy resin networks cured with DDS were modified by incorporating tough ductile thermoplastics such as the amine terminated polyether sulfones and amine terminated polyether ketones. Both linear copolymers were able to significantly improve the fracture toughness values at the 15 and 30 weight percent concentrations examined. These improvements in fracture toughness were achieved without any significant change in the flexural modulus.

Impact of a Specific Amino Acid Composition with Micronutrients on Well-Being in Subjects with Chronic Psychological Stress and Exhaustion Conditions: A Pilot Study

PubMed Central

Armborst, Deborah; Metzner, Christine; Alteheld, Birgit; Bitterlich, Norman; Rösler, Daniela; Siener, Roswitha

2018-01-01

Chronic work-life stress leads to dysfunction of the hypothalamus–pituitary–adrenal axis, the autonomic nervous system, and the serotonergic system, with resultant impairment of overall well-being. Aim of the study was to improve perceived stress by a specific amino acid composition with micronutrients in the verum versus placebo group. A total of 59 participants (18–65 years) with self-reported perceived chronic stress and exhaustion conditions participated in this randomized, double-blind, placebo-controlled study. The Perceived Stress Questionnaire (PSQ30), amino acid profile, anthropometric, clinical, blood, urine parameters, and dietary intake were assessed. After 12 weeks, the verum group achieved significantly greater improvements in the total PSQ30 score compared with the placebo group. In the verum group, serum taurine concentration, folic acid concentration, urinary magnesium excretion, and the ratio of l-tryptophan to the sum of competing amino acids rose significantly. In the placebo group, serum concentrations of serotonin, protein, and magnesium decreased significantly, whereas the cardiometabolic risk parameters body weight, body mass index, waist circumference, and waist-to-height ratio increased significantly. Compared with placebo, the verum supplementation resulted in a higher improvement in perceived stress. Beneficial effects on the serotonergic system and preventive effects on magnesium homeostasis and some cardiometabolic risk factors were supposed. Additional effects might be caused by the optimized food intake. PMID:29710825

Using interactive voice response to improve disease management and compliance with acute coronary syndrome best practice guidelines: A randomized controlled trial.

PubMed

Sherrard, Heather; Duchesne, Lloyd; Wells, George; Kearns, Sharon Ann; Struthers, Christine

2015-01-01

There is evidence from large clinical trials that compliance with standardized best practice guidelines (BPGs) improves survival of acute coronary syndrome (ACS) patients. However, their application is often suboptimal. In this study, the researchers evaluated whether the use of an interactive voice response (IVR) follow-up system improved ACS BPG compliance. This was a single-centre randomized control trial (RCT) of 1,608 patients (IVR=803; usual care=805). The IVR group received five automated calls in 12 months. The primary composite outcome was increased medication compliance and decreased adverse events. A significant improvement of 60% in the IVR group for the primary composite outcome was found (RR 1.60, 95% CI: 1.29 to 2.00, p <0.001). There was significant improvement in medication compliance (p <0.001) and decrease in unplanned medical visits (p = 0.023). At one year, the majority of patients ( 85%) responded positively to using the system again. Follow-up by IVR produced positive outcomes in ACS patients.

The impact of a physician-directed health information technology system on diabetes outcomes in primary care: a pre- and post-implementation study.

PubMed

Hunt, Jacquelyn S; Siemienczuk, Joseph; Gillanders, William; LeBlanc, Benjamin H; Rozenfeld, Yelena; Bonin, Kerry; Pape, Ginger

2009-01-01

To determine the impact of a physician-directed, multifaceted health information technology (HIT) system on diabetes outcomes. A pre/post-interventional study. The setting was Providence Primary Care Research Network in Oregon, with approximately 71 physicians caring for 117 369 patients in 13 clinic locations. The study covered Network patients with diabetes age 18 years and older. The study intervention included implementation of the CareManager HIT system which augments an electronic medical record (EMR) by automating physician driven quality improvement interventions, including point-of-care decision support and care reminders, diabetes registry with care prompts, performance feedback with benchmarking and access to published evidence and patient educational materials. The primary clinical measures included the change in mean value for low density lipoprotein (LDL) target <100 mg/dL or 2.6 mmol/l, blood pressure (BP) target <130/80 mmHg and glycated haemoglobin (HbA1c) target <7%, and the proportion of patients meeting guideline-recommended targets for those measures. All measures were analysed using closed and open cohort approaches. A total of 6072 patients were identified at baseline, 70% of whom were continuously enrolled during the 24-month study. Significant improvements were observed in all diabetes related outcomes except mean HbA1c. LDL goal attainment improved from 32% to 56% (P=0.002), while mean LDL decreased by 13 mg/dL (0.33 mmol/l, P=0.002). BP goal attainment increased significantly from 30% to 52%, with significant decreases in both mean systolic and diastolic BP. The proportion of patients with an HbA1c below 7% was higher at the end of the study (P=0.008). Mean patient satisfaction remained high, with no significant difference between baseline and follow-up. Total Relative Value Units per patient per year significantly increased as a result of an increase in the number of visits in year one and the coding complexity throughout. Implementation of a physician-directed, multifaceted HIT system in primary care was associated with significantly improved diabetes process and outcome measures.

On the Reprocessing and Reanalysis of Observations for Climate

NASA Technical Reports Server (NTRS)

Bosilovich, Michael G.; Kennedy, John; Dee, Dick; Allan, R.; O'Neill, Alan

2013-01-01

The long observational record is critical to our understanding of the Earths climate, but most observing systems were not developed with a climate objective in mind. As a result, tremendous efforts have gone into assessing and reprocessing the data records to improve their usefulness in climate studies. The purpose of this paper is to both review recent progress in reprocessing and reanalyzing observations, and to summarize the challenges that must be overcome in order to improve our understanding of climate and variability. Reprocessing improves data quality through more scrutiny and improved retrieval techniques for individual observing systems, while reanalysis merges many disparate observations with models through data assimilation, yet both aim to provide an climatology of Earth processes. Many challenges remain, such as tracking the improvement of processing algorithms and limited spatial coverage. Reanalyses have fostered significant research, yet reliable global trends in many physical fields are not yet attainable, despite significant advances in data assimilation and numerical modeling. Oceanic reanalyses have made significant advances in recent years, but will only be discussed here in terms of progress toward integrated Earth system analyses. Climate data sets are generally adequate for process studies and large-scale climate variability. Communication of the strengths, limitations and uncertainties of reprocessed observations and reanalysis data, not only among the community of developers, but also with the extended research community, including the new generations of researchers and the decision makers is crucial for further advancement of the observational data records. It must be emphasized that careful investigation of the data and processing methods are required to use the observations appropriately.

The Memory Support System for Mild Cognitive Impairment: Randomized trial of a cognitive rehabilitation intervention

PubMed Central

Greenaway, M. C.; Duncan, N. L.; Smith, G. E.

2013-01-01

Objective Individuals with amnestic Mild Cognitive Impairment (MCI) have few empirically-based treatment options for combating their memory loss. This study sought to examine the efficacy of a calendar/notebook rehabilitation intervention, the Memory Support System (MSS), for individuals with amnestic MCI. Methods Forty individuals with single domain amnestic MCI and their program partners were randomized to receive the MSS, either with training or without (controls). Measures of adherence, activities of daily living, and emotional impact were completed at the first and last intervention session and again at 8-weeks and 6 months post intervention. Results Training in use of a notebook/calendar system significantly improved adherence over those who received the calendars but no training. Functional ability and memory self efficacy significantly improved for those who received MSS training. Change in functional ability remained significantly better in the intervention group than in the control group out to 8 week follow up. Care partners in the intervention group demonstrated improved mood by 8 week and 6 month follow-up, while control care partners reported worse caregiver burden by 6 month follow up. Conclusions MSS training resulted in improvement in ADLs and sense of memory self efficacy for individuals with MCI. While ADL benefits were maintained out to 8 weeks post intervention, future inclusion of booster sessions may help extend the therapeutic effect out even further. Improved mood of care partners of trained individuals and worsening sense of caregiver burden over time for partners of untrained individuals further supports the efficacy of the MSS for MCI. PMID:22678947

A brain-computer interface based cognitive training system for healthy elderly: a randomized control pilot study for usability and preliminary efficacy.

PubMed

Lee, Tih-Shih; Goh, Siau Juinn Alexa; Quek, Shin Yi; Phillips, Rachel; Guan, Cuntai; Cheung, Yin Bun; Feng, Lei; Teng, Stephanie Sze Wei; Wang, Chuan Chu; Chin, Zheng Yang; Zhang, Haihong; Ng, Tze Pin; Lee, Jimmy; Keefe, Richard; Krishnan, K Ranga Rama

2013-01-01

Cognitive decline in aging is a pressing issue associated with significant healthcare costs and deterioration in quality of life. Previously, we reported the successful use of a novel brain-computer interface (BCI) training system in improving symptoms of attention deficit hyperactivity disorder. Here, we examine the feasibility of the BCI system with a new game that incorporates memory training in improving memory and attention in a pilot sample of healthy elderly. This study investigates the safety, usability and acceptability of our BCI system to elderly, and obtains an efficacy estimate to warrant a phase III trial. Thirty-one healthy elderly were randomized into intervention (n = 15) and waitlist control arms (n = 16). Intervention consisted of an 8-week training comprising 24 half-hour sessions. A usability and acceptability questionnaire was administered at the end of training. Safety was investigated by querying users about adverse events after every session. Efficacy of the system was measured by the change of total score from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) before and after training. Feedback on the usability and acceptability questionnaire was positive. No adverse events were reported for all participants across all sessions. Though the median difference in the RBANS change scores between arms was not statistically significant, an effect size of 0.6SD was obtained, which reflects potential clinical utility according to Simon's randomized phase II trial design. Pooled data from both arms also showed that the median change in total scores pre and post-training was statistically significant (Mdn = 4.0; p<0.001). Specifically, there were significant improvements in immediate memory (p = 0.038), visuospatial/constructional (p = 0.014), attention (p = 0.039), and delayed memory (p<0.001) scores. Our BCI-based system shows promise in improving memory and attention in healthy elderly, and appears to be safe, user-friendly and acceptable to senior users. Given the efficacy signal, a phase III trial is warranted. ClinicalTrials.gov NCT01661894.

Coupling System Design Optimization : A Survey and Assessment of Automatic Coupling Concepts for Rail Freight Cars : Volume 2. Text and Appendices.

DOT National Transportation Integrated Search

1978-05-01

The purpose of this study is to provide an independent identification, classification, and analysis of significant freight car coupling system concepts offering potential for improved safety and operating costs over the present system. The basic meth...

Coupling System Design Optimization : A Survey and Assessment of Automatic Coupling Concepts for Rail Freight Cars : Volume 1. Executive Summary.

DOT National Transportation Integrated Search

1978-05-01

The purpose of this study is to provide an independent identification, classification, and analysis of significant freight car coupling systems concepts offering potential for improved safety and operating costs over the present system. The basic met...

Enterprise Line of Sight Analysis Using Evidential Reasoning

ERIC Educational Resources Information Center

Bunting, William J.

2012-01-01

The overall direction of this research is to improve the development of information systems within federal agency modernization efforts so that the systems produce a value to the federal agency that is significantly greater upon implementation than the investment required to develop the systems. Federal agencies are modernizing at an increasing…

Complex Moving Parts: Assessment Systems and Electronic Portfolios

ERIC Educational Resources Information Center

Larkin, Martha J.; Robertson, Royce L.

2013-01-01

The largest college within an online university of over 50,000 students invested significant resources in translating a complex assessment system focused on continuous improvement and national accreditation into an effective and efficient electronic portfolio (ePortfolio). The team building the system needed a model to address problems met…

Level System Use in Special Education: Classroom Intervention with Prima Facie Appeal.

ERIC Educational Resources Information Center

Smith, Stephen W.; Farrell, Daniel T.

1993-01-01

This article chronicles the development of level systems designed for students with significant behavior problems, to foster student improvement through self-management and positive reinforcement. The article examines assumptions underlying level systems' concepts and components and offers recommendations to guide future research into the design…

Jetliner Alert Systems

NASA Technical Reports Server (NTRS)

1983-01-01

NASA research and design has significantly improved crew alert systems. The Engine Indication and Crew Alerting System (EICAS), developed by Psycho-Linguistic Research Associates, is technologically advanced and able to order alerts by priority. Ames has also developed computer controlled voice synthesizers for readouts during difficult landing approaches. This is available to airplane manufacturers.

CROSS-DISCIPLINARY PHYSICS AND RELATED AREAS OF SCIENCE AND TECHNOLOGY: Diffusion-Based Recommendation in Collaborative Tagging Systems

NASA Astrophysics Data System (ADS)

Shang, Ming-Sheng; Zhang, Zi-Ke

2009-11-01

Recently, collaborative tagging systems have attracted more and more attention and have been widely applied in web systems. Tags provide highly abstracted information about personal preferences and item content, and therefore have the potential to help in improving better personalized recommendations. We propose a diffusion-based recommendation algorithm considering the personal vocabulary and evaluate it in a real-world dataset: Del.icio.us. Experimental results demonstrate that the usage of tag information can significantly improve the accuracy of personalized recommendations.

Analysis of technology requirements and potential demand for general aviation avionics systems for operation in the 1980's

NASA Technical Reports Server (NTRS)

Cohn, D. M.; Kayser, J. H.; Senko, G. M.; Glenn, D. R.

1974-01-01

Avionics systems are identified which promise to reduce economic constraints and provide significant improvements in performance, operational capability and utility for general aviation aircraft in the 1980's.

Failure Scenarios and Mitigations for the BABAR Superconducting Solenoid

NASA Astrophysics Data System (ADS)

Thompson, EunJoo; Candia, A.; Craddock, W. W.; Racine, M.; Weisend, J. G.

2006-04-01

The cryogenic department at the Stanford Linear Accelerator Center is responsible for the operation, troubleshooting, and upgrade of the 1.5 Tesla superconducting solenoid detector for the BABAR B-factory experiment. Events that disable the detector are rare but significantly impact the availability of the detector for physics research. As a result, a number of systems and procedures have been developed over time to minimize the downtime of the detector, for example improved control systems, improved and automatic backup systems, and spares for all major components. Together they can prevent or mitigate many of the failures experienced by the utilities, mechanical systems, controls and instrumentation. In this paper we describe various failure scenarios, their effect on the detector, and the modifications made to mitigate the effects of the failure. As a result of these modifications the reliability of the detector has increased significantly with only 3 shutdowns of the detector due to cryogenics systems over the last 2 years.

Nuclear Thermal Rocket - Arc Jet Integrated System Model

NASA Technical Reports Server (NTRS)

Taylor, Brian D.; Emrich, William

2016-01-01

In the post-shuttle era, space exploration is moving into a new regime. Commercial space flight is in development and is planned to take on much of the low earth orbit space flight missions. With the development of a heavy lift launch vehicle, the Space Launch, System, NASA has become focused on deep space exploration. Exploration into deep space has traditionally been done with robotic probes. More ambitious missions such as manned missions to asteroids and Mars will require significant technology development. Propulsion system performance is tied to the achievability of these missions and the requirements of other developing technologies that will be required. Nuclear thermal propulsion offers a significant improvement over chemical propulsion while still achieving high levels of thrust. Opportunities exist; however, to build upon what would be considered a standard nuclear thermal engine to attain improved performance, thus further enabling deep space missions. This paper discuss the modeling of a nuclear thermal system integrated with an arc jet to further augment performance. The performance predictions and systems impacts are discussed.

Long-term effects of user preference-oriented recommendation method on the evolution of online system

NASA Astrophysics Data System (ADS)

Shi, Xiaoyu; Shang, Ming-Sheng; Luo, Xin; Khushnood, Abbas; Li, Jian

2017-02-01

As the explosion growth of Internet economy, recommender system has become an important technology to solve the problem of information overload. However, recommenders are not one-size-fits-all, different recommenders have different virtues, making them be suitable for different users. In this paper, we propose a novel personalized recommender based on user preferences, which allows multiple recommenders to exist in E-commerce system simultaneously. We find that output of a recommender to each user is quite different when using different recommenders, the recommendation accuracy can be significantly improved if each user is assigned with his/her optimal personalized recommender. Furthermore, different from previous works focusing on short-term effects on recommender, we also evaluate the long-term effect of the proposed method by modeling the evolution of mutual feedback between user and online system. Finally, compared with single recommender running on the online system, the proposed method can improve the accuracy of recommendation significantly and get better trade-offs between short- and long-term performances of recommendation.

Digital Avionics Information System (DAIS): Development and Demonstration.

DTIC Science & Technology

1981-09-01

advances in technology. The DAIS architecture results in improved reliability and availability of avionics systems while at the same time reducing life ...DAIS) represents a significant advance in the technology of avionics system architecture. DAIS is a total systems concept, exploiting standardization...configurations and fully capable of accommodating new advances in technology. These fundamental system charac- teristics are described in this report; the

Fast and robust control of nanopositioning systems: Performance limits enabled by field programmable analog arrays.

PubMed

Baranwal, Mayank; Gorugantu, Ram S; Salapaka, Srinivasa M

2015-08-01

This paper aims at control design and its implementation for robust high-bandwidth precision (nanoscale) positioning systems. Even though modern model-based control theoretic designs for robust broadband high-resolution positioning have enabled orders of magnitude improvement in performance over existing model independent designs, their scope is severely limited by the inefficacies of digital implementation of the control designs. High-order control laws that result from model-based designs typically have to be approximated with reduced-order systems to facilitate digital implementation. Digital systems, even those that have very high sampling frequencies, provide low effective control bandwidth when implementing high-order systems. In this context, field programmable analog arrays (FPAAs) provide a good alternative to the use of digital-logic based processors since they enable very high implementation speeds, moreover with cheaper resources. The superior flexibility of digital systems in terms of the implementable mathematical and logical functions does not give significant edge over FPAAs when implementing linear dynamic control laws. In this paper, we pose the control design objectives for positioning systems in different configurations as optimal control problems and demonstrate significant improvements in performance when the resulting control laws are applied using FPAAs as opposed to their digital counterparts. An improvement of over 200% in positioning bandwidth is achieved over an earlier digital signal processor (DSP) based implementation for the same system and same control design, even when for the DSP-based system, the sampling frequency is about 100 times the desired positioning bandwidth.

Determination of optimum allocation and pricing of distributed generation using genetic algorithm methodology

NASA Astrophysics Data System (ADS)

Mwakabuta, Ndaga Stanslaus

Electric power distribution systems play a significant role in providing continuous and "quality" electrical energy to different classes of customers. In the context of the present restrictions on transmission system expansions and the new paradigm of "open and shared" infrastructure, new approaches to distribution system analyses, economic and operational decision-making need investigation. This dissertation includes three layers of distribution system investigations. In the basic level, improved linear models are shown to offer significant advantages over previous models for advanced analysis. In the intermediate level, the improved model is applied to solve the traditional problem of operating cost minimization using capacitors and voltage regulators. In the advanced level, an artificial intelligence technique is applied to minimize cost under Distributed Generation injection from private vendors. Soft computing techniques are finding increasing applications in solving optimization problems in large and complex practical systems. The dissertation focuses on Genetic Algorithm for investigating the economic aspects of distributed generation penetration without compromising the operational security of the distribution system. The work presents a methodology for determining the optimal pricing of distributed generation that would help utilities make a decision on how to operate their system economically. This would enable modular and flexible investments that have real benefits to the electric distribution system. Improved reliability for both customers and the distribution system in general, reduced environmental impacts, increased efficiency of energy use, and reduced costs of energy services are some advantages.

Quality of the ophthalmological service to outpatients of the public and private healthcare systems.

PubMed

Hercos, Benigno Vicente Santos; Berezovsky, Adriana

2017-01-01

To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

Systemic treatment after whole-brain radiotherapy may improve survival in RPA class II/III breast cancer patients with brain metastasis.

PubMed

Zhang, Qian; Chen, Jian; Yu, Xiaoli; Ma, Jinli; Cai, Gang; Yang, Zhaozhi; Cao, Lu; Chen, Xingxing; Guo, Xiaomao; Chen, Jiayi

2013-09-01

Whole brain radiotherapy (WBRT) is the most widely used treatment for brain metastasis (BM), especially for patients with multiple intracranial lesions. The purpose of this study was to examine the efficacy of systemic treatments following WBRT in breast cancer patients with BM who had different clinical characteristics, based on the classification of the Radiation Therapy Oncology Group recursive partitioning analysis (RPA) and the breast cancer-specific Graded Prognostic Assessment (Breast-GPA). One hundred and one breast cancer patients with BM treated between 2006 and 2010 were analyzed. The median interval between breast cancer diagnosis and identification of BM in the triple-negative patients was shorter than in the luminal A subtype (26 vs. 36 months, respectively; P = 0.021). Univariate analysis indicated that age at BM diagnosis, Karnofsky performance status/recursive partitioning analysis (KPS/RPA) classes, number of BMs, primary tumor control, extracranial metastases and systemic treatment following WBRT were significant prognostic factors for overall survival (OS) (P < 0.05). Multivariate analysis revealed that KPS/RPA classes and systemic treatments following WBRT remained the significant prognostic factors for OS. For RPA class I, the median survival with and without systemic treatments following WBRT was 25 and 22 months, respectively (P = 0.819), while for RPA class II/III systemic treatments significantly improved OS from 7 and 2 months to 11 and 5 months, respectively (P < 0.05). Our results suggested that triple-negative patients had a shorter interval between initial diagnosis and the development of BM than luminal A patients. Systemic treatments following WBRT improved the survival of RPA class II/III patients.

Internal fixation of pilon fractures of the distal radius.

PubMed Central

Trumble, T. E.; Schmitt, S. R.; Vedder, N. B.

1993-01-01

When closed manipulation fails to restore articular congruity in comminuted, displaced fractures of the distal radius, open reduction and internal fixation is required. Results of surgical stabilization and articular reconstruction of these injuries are reviewed in this retrospective study of 49 patients with 52 displaced, intra-articular distal radius fractures. Forty-three patients (87%) with a mean age of 37 years (range of 17 to 79 years) were available for evaluation. The mean follow-up time was 38 months (range 22-69 months). When rated according to the Association for the Study of Internal Fixation (ASIF), 19 were type C2 and 21 were type C3. We devised an Injury Score System based on the initial injury radiographs to classify severely comminuted intra-articular fractures and to identify those associated with carpal injury (3 patients). Post-operative fracture alignment, articular congruity, and radial length were significantly improved following surgery (p < .01). Grip strength averaged 69% +/- 22% of the contralateral side, and the range of motion averaged 75% +/- 18% of the contralateral side post-operatively. A combined outcome rating system that included grip strength, range of motion, and pain relief averaged 76% +/- 19% of the contralateral side. There was a statistically significant decrease in the combined rating with more severe fracture patterns as defined by the ASIF system (p < .01), Malone classification (p < .03), and the Injury Score System (p < .001). The Injury Score System presented here, and in particular the number of fracture fragments, correlated most closely with outcome of all the classification systems studied. Operative treatment of these distal radius fractures with reconstruction of the articular congruity and correction of the articular surface alignment with internal fixation and/or external fixation, can significantly improve the radiographic alignment and functional outcome. Furthermore, the degree to which articular stepoff, gap between fragments, and radial shortening are improved by surgery is strongly correlated with improved outcome, even when the results are corrected for severity of initial injury, whereas correction of radial tilt or dorsal tilt did not correlate with improved outcome. Images Figure 2 PMID:8209554

Improving Health Care Workers for Seasonal Influenza Vaccination at University Health System: A Paradigm for Closing the Quality Chasm

PubMed Central

Patterson, Jan E.; Cadena, Jose; Prigmore, Teresa; Bowling, Jason; Ayala, Beth Ann; Kirkman, Leni; Parekh, Amruta; Scepanski, Theresa

2011-01-01

Significant gaps in quality and patient safety in the US health-care system have been identified and were reported in the past decade by the Institute of Medicine. Despite recognition of these gaps in “knowing versus doing,” change in health care is slow and difficult. The quality improvement and clinical safety movement is increasing among US medical centers. Our health science center implemented the UT System Clinical Safety and Effectiveness course, providing project-based teaching of quality-improvement tools and principles of patient safety. A quality-improvement project that increased healthcare workers' influenza vaccination rate by 17.8% from that in 2008 to a rate of 76.6% in 2009 serves as a paradigm of how physicians can lead quality-improvement project teams to narrow the quality chasm (1). Local efforts to narrow the chasm are discussed in the present paper, including inter-professional education in quality improvement and clinical safety. PMID:21686222

Strategic Planning to Improve EHDI Programs

ERIC Educational Resources Information Center

White, Karl R.; Blaiser, Kristina M.

2011-01-01

Because newborn hearing screening has become the standard of care in the United States, every state has established an early hearing detection and intervention (EHDI) program responsible for establishing, maintaining, and improving the system of services needed to serve children with hearing loss and their families. While significant developments…

The function of the earth observing system - Data information system Distributed Active Archive Centers

NASA Technical Reports Server (NTRS)

Lapenta, C. C.

1992-01-01

The functionality of the Distributed Active Archive Centers (DAACs) which are significant elements of the Earth Observing System Data and Information System (EOSDIS) is discussed. Each DAAC encompasses the information management system, the data archival and distribution system, and the product generation system. The EOSDIS DAACs are expected to improve the access to earth science data set needed for global change research.

[A case report: inhaled nitric oxide improves respiratory function in an infant with pulmonary hypertension].

PubMed

Takeuchi, M; Ueno, T; Fukumitsu, K; Takada, K; Kinouchi, K; Kishimoto, H; Kitamura, S

1998-03-01

Nitric oxide (NO) was administered to an infant in a near fatal crisis of pulmonary hypertension after total correction of double outlet right ventricle. Inhaled NO of 4 parts per million reduced pulmonary arterial pressure (PAP) and increased tidal volume during pressure limit ventilation. Both respiratory system compliance and resistance were improved with NO inhalation. There was a significant negative correlation between mean PAP and respiratory system compliance. We speculated that a reduction in PAP with NO inhalation resulted in the improvement of respiratory function. He was successfully weaned from mechanical ventilation.

Advances in Projection Moire Interferometry Development for Large Wind Tunnel Applications

NASA Technical Reports Server (NTRS)

Fleming, Gary A.; Soto, Hector L.; South, Bruce W.; Bartram, Scott M.

1999-01-01

An instrument development program aimed at using Projection Moire Interferometry (PMI) for acquiring model deformation measurements in large wind tunnels was begun at NASA Langley Research Center in 1996. Various improvements to the initial prototype PMI systems have been made throughout this development effort. This paper documents several of the most significant improvements to the optical hardware and image processing software, and addresses system implementation issues for large wind tunnel applications. The improvements have increased both measurement accuracy and instrument efficiency, promoting the routine use of PMI for model deformation measurements in production wind tunnel tests.

Development of a non-cryogenic nitrogen/oxygen supply system. [for spacecraft environments

NASA Technical Reports Server (NTRS)

1977-01-01

Modular components were refined or replaced to improve the performance of the electrolysis module in a system which generates both oxygen and hydrogen from hydrazine hydrate. Significant mechanical and electrical performance improvements were achieved in the cathode. Improvements were also made in the phase separation area but at considerable cost in time and money and to the detriment of other investigative areas. Only the pump/bubble separator failed in a manner necessitating redesign. Its failure was, however, due to its being operated above the temperature range for which it was designed. The basic electrolysis cell design was not changed.

Global ablation techniques.

PubMed

Woods, Sarah; Taylor, Betsy

2013-12-01

Global endometrial ablation techniques are a relatively new surgical technology for the treatment of heavy menstrual bleeding that can now be used even in an outpatient clinic setting. A comparison of global ablation versus earlier ablation technologies notes no significant differences in success rates and some improvement in patient satisfaction. The advantages of the newer global endometrial ablation systems include less operative time, improved recovery time, and decreased anesthetic risk. Ablation procedures performed in an outpatient surgical or clinic setting provide advantages both of potential cost savings for patients and the health care system and improved patient convenience. Copyright © 2013. Published by Elsevier Inc.

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

Sevik, James; Wallner, Thomas; Pamminger, Michael

The efficiency improvement and emissions reduction potential of lean and exhaust gas recirculation (EGR)-dilute operation of spark-ignition gasoline engines is well understood and documented. However, dilute operation is generally limited by deteriorating combustion stability with increasing inert gas levels. The combustion stability decreases due to reduced mixture flame speeds resulting in significantly increased combustion initiation periods and burn durations. A study was designed and executed to evaluate the potential to extend lean and EGR-dilute limits using a low-energy transient plasma ignition system. The low-energy transient plasma was generated by nanosecond pulses and its performance compared to a conventional transistorized coilmore » ignition (TCI) system operated on an automotive, gasoline direct-injection (GDI) single-cylinder research engine. The experimental assessment was focused on steady-state experiments at the part load condition of 1500 rpm 5.6 bar indicated mean effective pressure (IMEP), where dilution tolerance is particularly critical to improving efficiency and emission performance. Experimental results suggest that the energy delivery process of the low-energy transient plasma ignition system significantly improves part load dilution tolerance by reducing the early flame development period. Statistical analysis of relevant combustion metrics was performed in order to further investigate the effects of the advanced ignition system on combustion stability. Results confirm that at select operating conditions EGR tolerance and lean limit could be improved by as much as 20% (from 22.7 to 27.1% EGR) and nearly 10% (from λ = 1.55 to 1.7) with the low-energy transient plasma ignition system.« less

Innovation in managing the referral process at a Canadian pediatric hospital.

PubMed

MacGregor, Daune; Parker, Sandra; MacMillan, Sharon; Blais, Irene; Wong, Eugene; Robertson, Chris J; Bruce-Barrett, Cindy

2009-01-01

The provision of timely and optimal patient care is a priority in pediatric academic health science centres. Timely access to care is optimized when there is an efficient and consistent referral system in place. In order to improve the patient referral process and, therefore, access to care, an innovative web-based system was developed and implemented. The Ambulatory Referral Management System enables the electronic routing for submission, review, triage and management of all outpatient referrals. The implementation of this system has provided significant metrics that have informed how processes can be improved to increase access to care. Use of the system has improved efficiency in the referral process and has reduced the work associated with the previous paper-based referral system. It has also enhanced communication between the healthcare provider and the patient and family and has improved the security and confidentiality of patient information management. Referral guidelines embedded within the system have helped to ensure that referrals are more complete and that the patient being referred meets the criteria for assessment and treatment in an ambulatory setting. The system calculates and reports on wait times, as well as other measures.

Validation of X1 motorcycle model in industrial plant layout by using WITNESSTM simulation software

NASA Astrophysics Data System (ADS)

Hamzas, M. F. M. A.; Bareduan, S. A.; Zakaria, M. Z.; Tan, W. J.; Zairi, S.

2017-09-01

This paper demonstrates a case study on simulation, modelling and analysis for X1 Motorcycles Model. In this research, a motorcycle assembly plant has been selected as a main place of research study. Simulation techniques by using Witness software were applied to evaluate the performance of the existing manufacturing system. The main objective is to validate the data and find out the significant impact on the overall performance of the system for future improvement. The process of validation starts when the layout of the assembly line was identified. All components are evaluated to validate whether the data is significance for future improvement. Machine and labor statistics are among the parameters that were evaluated for process improvement. Average total cycle time for given workstations is used as criterion for comparison of possible variants. From the simulation process, the data used are appropriate and meet the criteria for two-sided assembly line problems.

Can formal collaborative methodologies improve quality in primary health care in New Zealand? Insights from the EQUIPPED Auckland Collaborative.

PubMed

Palmer, Celia; Bycroft, Janine; Healey, Kate; Field, Adrian; Ghafel, Mazin

2012-12-01

Auckland District Health Board was one of four District Health Boards to trial the Breakthrough Series (BTS) methodology to improve the management of long-term conditions in New Zealand, with support from the Ministry of Health. To improve clinical outcomes, facilitate planned care and promote quality improvement within participating practices in Auckland. Implementation of the Collaborative followed the improvement model / Institute for Healthcare Improvement methodology. Three topic areas were selected: system redesign, cardio-vascular disease/diabetes, and self-management support. An expert advisory group and the Improvement Foundation Australia helped guide project development and implementation. Primary Health Organisation facilitators were trained in the methodology and 15 practice teams participated in the three learning workshops and action periods over 12 months. An independent evaluation study using both quantitative and qualitative methods was conducted. Improvements were recorded in cardiovascular disease risk assessment, practice-level systems of care, self-management systems and follow-up and coordination for patients. Qualitative research found improvements in coordination and teamwork, knowledge of practice populations and understanding of managing long-term conditions. The Collaborative process delivered some real improvements in the systems of care for people with long-term conditions and a change in culture among participating practices. The findings suggest that by strengthening facilitation processes, improving access to comprehensive population audit tools and lengthening the time frame, the process has the potential to make significant improvements in practice. Other organisations should consider this approach when investigating quality improvement programmes.

A new paradigm in personal dosimetry using LiF:Mg,Cu,P.

PubMed

Cassata, J R; Moscovitch, M; Rotunda, J E; Velbeck, K J

2002-01-01

The United States Navy has been monitoring personnel for occupational exposure to ionising radiation since 1947. Film was exclusively used until 1973 when thermoluminescence dosemeters were introduced and used to the present time. In 1994, a joint research project between the Naval Dosimetry Center, Georgetown University, and Saint Gobain Crystals and Detectors (formerly Bicron RMP formerly Harshaw TLD) began to develop a state of the art thermoluminescent dosimetry system. The study was conducted from a large-scale dosimetry processor point of view with emphasis on a systems approach. Significant improvements were achieved by replacing the LiF:Mg,Ti with LiF:Mg,Cu,P TL elements due to the significant sensitivity increase, linearity, and negligible hiding. Dosemeter filters were optimised for gamma and X ray energy discrimination using Monte Carlo modelling (MCNP) resulting in significant improvement in accuracy and precision. Further improvements were achieved through the use of neural-network based dose calculation algorithms. Both back propagation and functional link methods were implemented and the data compared with essentially the same results. Several operational aspects of the system are discussed, including (1) background subtraction using control dosemeters, (2) selection criteria for control dosemeters, (3) optimisation of the TLD readers, (4) calibration methodology, and (5) the optimisation of the heating profile.

Investigator-Blinded, Single-Center Study to Evaluate the Efficacy and Tolerability of a 4% Hydroquinone Skin Care System Plus 0.02% Tretinoin Cream in Mild-to-Moderate Melasma and Photodamage.

PubMed

Rendon, Marta; Dryer, Laurence

2016-04-01

To evaluate the treatment of mild-to-moderate epidermal melasma and photodamage using a 4% hydroquinone skin care system plus tretinoin 0.02% cream. Single-center, investigator-blinded study in 39 adult females with mild-to-moderate epidermal melasma, mild-to-marked pigmentation intensity, and Fitzpatrick skin type III to VI treated for 24 weeks. Improvements in melasma severity, pigmentation intensity, photodamage, and patient satisfaction were assessed at weeks 4, 8, 12, 18, and 24. Cutaneous tolerability was assessed by investigator (erythema, dryness, peeling) and patients (burning and stinging). Adverse events (AEs) were monitored throughout. Melasma severity, pigmentation intensity, and melasma area and severity index (MASI) scores relative to baseline were all significantly reduced from week 4 onward (P<.001). In addition, signs of facial photodamage were significantly improved. At week 24, 87.9% of patients were "satisfied" or "very satisfied" with the overall treatment effectiveness and Quality of Life (QoL) was much improved. No patient discontinued due to lack of efficacy or treatment-related AEs. One patient (2.8%) reported severe cutaneous intolerability (erythema at week 4). Treating mild-to-moderate melasma using a 4% hydroquinone skin care system plus 0.02% tretinoin cream can significantly reduce the severity and intensity of melasma and associated pigmentation, and improve signs of photodamage within four weeks. Treatment was generally well tolerated and associated with high levels of patient satisfaction.

Information adaptive system of NEEDS. [of NASA End to End Data System

NASA Technical Reports Server (NTRS)

Howle, W. M., Jr.; Kelly, W. L.

1979-01-01

The NASA End-to-End Data System (NEEDS) program was initiated by NASA to improve significantly the state of the art in acquisition, processing, and distribution of space-acquired data for the mid-1980s and beyond. The information adaptive system (IAS) is a program element under NEEDS Phase II which addresses sensor specific processing on board the spacecraft. The IAS program is a logical first step toward smart sensors, and IAS developments - particularly the system components and key technology improvements - are applicable to future smart efforts. The paper describes the design goals and functional elements of the IAS. In addition, the schedule for IAS development and demonstration is discussed.

Soft-information flipping approach in multi-head multi-track BPMR systems

NASA Astrophysics Data System (ADS)

Warisarn, C.; Busyatras, W.; Myint, L. M. M.

2018-05-01

Inter-track interference is one of the most severe impairments in bit-patterned media recording system. This impairment can be effectively handled by a modulation code and a multi-head array jointly processing multiple tracks; however, such a modulation constraint has never been utilized to improve the soft-information. Therefore, this paper proposes the utilization of modulation codes with an encoded constraint defined by the criteria for soft-information flipping during a three-track data detection process. Moreover, we also investigate the optimal offset position of readheads to provide the most improvement in system performance. The simulation results indicate that the proposed systems with and without position jitter are significantly superior to uncoded systems.

Design and implementation of streaming media server cluster based on FFMpeg.

PubMed

Zhao, Hong; Zhou, Chun-long; Jin, Bao-zhao

2015-01-01

Poor performance and network congestion are commonly observed in the streaming media single server system. This paper proposes a scheme to construct a streaming media server cluster system based on FFMpeg. In this scheme, different users are distributed to different servers according to their locations and the balance among servers is maintained by the dynamic load-balancing algorithm based on active feedback. Furthermore, a service redirection algorithm is proposed to improve the transmission efficiency of streaming media data. The experiment results show that the server cluster system has significantly alleviated the network congestion and improved the performance in comparison with the single server system.

Design and Implementation of Streaming Media Server Cluster Based on FFMpeg

PubMed Central

Zhao, Hong; Zhou, Chun-long; Jin, Bao-zhao

2015-01-01

Poor performance and network congestion are commonly observed in the streaming media single server system. This paper proposes a scheme to construct a streaming media server cluster system based on FFMpeg. In this scheme, different users are distributed to different servers according to their locations and the balance among servers is maintained by the dynamic load-balancing algorithm based on active feedback. Furthermore, a service redirection algorithm is proposed to improve the transmission efficiency of streaming media data. The experiment results show that the server cluster system has significantly alleviated the network congestion and improved the performance in comparison with the single server system. PMID:25734187

Assessing the evidence of Six Sigma and Lean in the health care industry.

PubMed

DelliFraine, Jami L; Langabeer, James R; Nembhard, Ingrid M

2010-01-01

Popular quality improvement tools such as Six Sigma and Lean Systems (SS/L) claim to provide health care managers the opportunity to improve health care quality on the basis of sound methodology and data. However, it is unclear whether these 2 quality improvement tools actually improve health care quality. The authors conducted a comprehensive literature review to assess the empirical evidence relating SS/L to improved clinical outcomes, processes of care, and financial performance of health care organizations. The authors identified 177 articles on SS/L published in the last 10 years. However, only 34 of them reported any outcomes of the SS/L projects studied, and less than one-third of these articles included statistical analyses to test for significant changes in outcomes. This review demonstrates that there are significant gaps in the SS/L health care quality improvement literature and very weak evidence that SS/L improve health care quality.

Use of a Novel Airway Kit and Simulation in Resident Training on Emergent Pediatric Airways.

PubMed

Melzer, Jonathan M; Hamersley, Erin R S; Gallagher, Thomas Q

2017-06-01

Objective Development of a novel pediatric airway kit and implementation with simulation to improve resident response to emergencies with the goal of improving patient safety. Methods Prospective study with 9 otolaryngology residents (postgraduate years 1-5) from our tertiary care institution. Nine simulated pediatric emergency airway drills were carried out with the existing system and a novel portable airway kit. Response times and time to successful airway control were noted with both the extant airway system and the new handheld kit. Results were analyzed to ensure parametric data and compared with t tests. A Bonferroni adjustment indicated that an alpha of 0.025 was needed for significance. Results Use of the airway kit significantly reduced the mean time of resident arrival by 47% ( P = .013) and mean time of successful intubation by 50% ( P = .007). Survey data indicated 100% improved resident comfort with emergent airway scenarios with use of the kit. Discussion Times to response and meaningful intervention were significantly reduced with implementation of the handheld airway kit. Use of simulation training to implement the new kit improved residents' comfort and airway skills. This study describes an affordable novel mobile airway kit and demonstrates its ability to improve response times. Implications for Practice The low cost of this airway kit makes it a tenable option even for smaller hospitals. Simulation provides a safe and effective way to familiarize oneself with novel equipment, and, when possible, realistic emergent airway simulations should be used to improve provider performance.

Army Energy and Water Reporting System Assessment

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

Deprez, Peggy C.; Giardinelli, Michael J.; Burke, John S.

There are many areas of desired improvement for the Army Energy and Water Reporting System. The purpose of system is to serve as a data repository for collecting information from energy managers, which is then compiled into an annual energy report. This document summarizes reported shortcomings of the system and provides several alternative approaches for improving application usability and adding functionality. The U.S. Army has been using Army Energy and Water Reporting System (AEWRS) for many years to collect and compile energy data from installations for facilitating compliance with Federal and Department of Defense energy management program reporting requirements. Inmore » this analysis, staff from Pacific Northwest National Laboratory found that substantial opportunities exist to expand AEWRS functions to better assist the Army to effectively manage energy programs. Army leadership must decide if it wants to invest in expanding AEWRS capabilities as a web-based, enterprise-wide tool for improving the Army Energy and Water Management Program or simply maintaining a bottom-up reporting tool. This report looks at both improving system functionality from an operational perspective and increasing user-friendliness, but also as a tool for potential improvements to increase program effectiveness. The authors of this report recommend focusing on making the system easier for energy managers to input accurate data as the top priority for improving AEWRS. The next major focus of improvement would be improved reporting. The AEWRS user interface is dated and not user friendly, and a new system is recommended. While there are relatively minor improvements that could be made to the existing system to make it easier to use, significant improvements will be achieved with a user-friendly interface, new architecture, and a design that permits scalability and reliability. An expanded data set would naturally have need of additional requirements gathering and a focus on integrating with other existing data sources, thus minimizing manually entered data.« less

JT8D-15/17 High Pressure Turbine Root Discharged Blade Performance Improvement. [engine design

NASA Technical Reports Server (NTRS)

Janus, A. S.

1981-01-01

The JT8D high pressure turbine blade and seal were modified, using a more efficient blade cooling system, improved airfoil aerodynamics, more effective control of secondary flows, and improved blade tip sealing. Engine testing was conducted to determine the effect of these improvements on performance. The modified turbine package demonstrated significant thrust specific fuel consumption and exhaust gas temperature improvements in sea level and altitude engine tests. Inspection of the improved blade and seal hardware after testing revealed no unusual wear or degradation.

Memory-enhancing effect of aspirin is mediated through opioid system modulation in an AlCl3-induced neurotoxicity mouse model

PubMed Central

RIZWAN, SAIMA; IDREES, AYESHA; ASHRAF, MUHAMMAD; AHMED, TOUQEER

2016-01-01

Neurodegenerative disorders such as Alzheimers disease (AD) are multifaceted and there are currently a limited number of therapeutic strategies available to treat them. Aspirin is known to act on multiple therapeutic targets and is a successful anti-inflammatory agent in various tissues. The present study aimed to ascertain the performance of aspirin when employed as a therapeutic agent to treat neurodegeneration on novel targets, including opioid system genes, in an AlCl3-induced neurotoxicity mouse model. The effects of two doses of aspirin (5 and 20 mg/kg aspirin for 12 days) were investigated in an AlCl3-induced neurotoxicity mouse model (150 mg/kg AlCl3 for 12 days). Neurological improvements were assessed through different behavioral tests and the effects of aspirin on opioid system gene expression levels were assessed by reverse transcription-polymerase chain reaction. Both doses resulted in improvements in cognitive behavior. A 5 mg/kg dose of aspirin was revealed to be effective for spatial memory improvement (7.14±0.84 sec), whilst a 20 mg/kg dose was superior for improving extinction learning (7.63±4.04%). Aspirin (5 mg/kg) also significantly improved contextual memory (48.05±10.6%) when compared with the AlCl3-treated group (1.49±0.62%; P<0.001). Aspirin was also observed to significantly decrease δ-opioid receptor expression in the cortex (1.09±0.08 and 1.27±0.08, respectively) at both doses (5 and 20 mg/kg) when compared with the AlCl3-treated group (3.69±1.43; P<0.05). Furthermore, aspirin at 5 mg/kg significantly reduced expression of prodynorphin in the cortex (0.57±0.20) when compared with the AlCl3-treated group (1.95±0.84; P<0.05). Notably, the effect of aspirin was significant in the cortex but not in the hippocampus. In summary, aspirin was effective in ameliorating the AD-like symptoms via the modulation of opioid systems. However, additional studies are required to determine the long term effects of aspirin on such conditions. PMID:27168835

The Equity of New York State's System of Financing Schools: An Update.

ERIC Educational Resources Information Center

Scheuer, Joan

1983-01-01

This statistical analysis of the equity and efficiency of New York's complex school finance system concludes that legislation since 1975 has neither significantly reduced wide disparities in local spending nor weakened the link between wealth and expenditure because the system cannot be improved without a substantial funding increase. (MJL)

Vaccination prepartum enhances the beneficial effects of melatonin on the immune response and reduces platelet responsiveness in sheep

PubMed Central

2012-01-01

Background Melatonin regulates several physiological processes and its powerful action as antioxidant has been widely reported. Melatonin acts modulating the immune system, showing a protective effect on the cardiovascular system and improving vaccine administration as an adjuvant-like agent. Here, we have investigated the role of melatonin as an adjuvant of the Clostridium perfringens vaccine in prepartum sheep and whether melatonin modulates platelet physiology during peripartum. Results The experiments were carried out in peripartum sheep from a farm located in an area of Mediterranean-type ecosystem. Plasma melatonin levels were determined by ELISA and sheep platelet aggregation was monitored using an aggregometer. Here we demonstrated for the first time that plasma melatonin concentration were higher in pregnant (125 pg/mL) than in non-pregnant sheep (15 pg/mL; P < 0.05). Administration of melatonin prepartum did not significantly modify platelet function but significantly improved the immune response to vaccination against C. perfringens. Conclusion Administration of melatonin as an adjuvant provides a significant improvement in the immune response to vaccine administration prepartum against C. perfringens. PMID:22716226

Improving Growth and Productivity of Oleiferous Brassicas under Changing Environment: Significance of Nitrogen and Sulphur Nutrition, and Underlying Mechanisms

PubMed Central

Anjum, Naser A.; Gill, Sarvajeet S.; Umar, Shahid; Ahmad, Iqbal; Duarte, Armando C.; Pereira, Eduarda

2012-01-01

Mineral nutrients are the integral part of the agricultural systems. Among important plant nutrients, nitrogen (N) and sulphur (S) are known essential elements for growth, development, and various physiological functions in plants. Oleiferous brassicas (rapeseed and mustard) require higher amounts of S in addition to N for optimum growth and yield. Therefore, balancing S-N fertilization, optimization of nutrient replenishment, minimization of nutrient losses to the environment, and the concept of coordination in action between S and N could be a significant strategy for improvement of growth and productivity of oleiferous brassicas. Additionally, positive interaction between S and N has been reported to be beneficial for various aspects of oilseed brassicas. The current paper updates readers on the significance of N and S for the improvement of plant growth, development, and productivity in detail. In addition, S-N nutrition-mediated control of major plant antioxidant defense system components involved in the removal and/or metabolism of stress-induced/generated reactive oxygen species in plants (hence, the control of plant growth, development, and productivity) has been overviewed. PMID:22629181

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

PubMed

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

2016-01-01

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

An audit and feedback system for effective quality improvement in head and neck surgery: Can we become better surgeons?

PubMed

Lewis, Carol M; Monroe, Marcus M; Roberts, Dianna B; Hessel, Amy C; Lai, Stephen Y; Weber, Randal S

2015-05-15

An evaluation system was established for measuring physician performance. This study was designed to determine whether an initial evaluation with surgeon feedback improved subsequent performance. After an evaluation of an initial cohort of procedures (2004-2008), surgeons were given risk-adjusted individual feedback. Procedures in a postfeedback cohort (2009-2010) were then assessed. Both groups were further stratified into high-acuity procedure (HAP) and low-acuity procedure (LAP) groups. Negative performance measures included the length of the perioperative stay (2 days or longer for LAPs and 11 days or longer for HAPs); perioperative blood transfusions; a return to the operating room within 7 days; and readmission, surgical site infections, and mortality within 30 days. There were 2618 procedures in the initial cohort and 1389 procedures in the postfeedback cohort. Factors affecting performance included the surgeon, the procedure's acuity, and patient comorbidities. There were no significant differences in the proportions of LAPs and HAPs or in the prevalence of patient comorbidities between the 2 assessment periods. The mean length of stay significantly decreased for LAPs from 2.1 to 1.5 days (P = .005) and for HAPs from 10.5 to 7 days (P = .003). The incidence of 1 or more negative performance indicators decreased significantly for LAPs from 39.1% to 28.6% (P < .001) and trended downward for HAPs from 60.9% to 53.5% (P = .081). Periodic assessments of performance and outcomes are essential for continual quality improvement. Significant decreases in the length of stay and negative performance indicators were seen after feedback. Therefore, an audit and feedback system may be an effective means of improving quality of care and reducing practice variability within a surgical department. © 2015 American Cancer Society.

Biofloc improves water, effluent quality and growth parameters of Penaeus vannamei in an intensive culture system.

PubMed

Santhana Kumar, V; Pandey, P K; Anand, Theivasigamani; Bhuvaneswari, G Rathi; Dhinakaran, A; Kumar, Saurav

2018-06-01

Biofloc technology was evaluated with a view to analyse utilization of nitrogenous waste from the effluent and to improve water quality and growth parameters of Penaeus vannamei in intensive culture system. The experiment was carried out in two different treatment outdoor earthen ponds of 0.12 ha, one supplemented with carbon source (molasses, wheat and sugar) for biofloc formation and other was feed based control pond with a stocking density of 60 animals m -2 in duplicate for 120 days. Water, sediment and P. vannamei were sampled at regular intervals from the both set of ponds for evaluating physico-chemical parameters, nitrogen content and growth parameters, respectively. A significant reduction in the concentration of total ammonia nitrogen (TAN) and nitrite (NO 2 -N) were found in the biofloc pond than that of control pond. A significant low level of nitrogen was recorded in the effluents of biofloc pond in comparison to the control. In biofloc system, a significantly elevated heterotrophic bacterial count along with reduction in total Vibrio count was noticed. A significant improvement in the feed conversion efficiency (FCR) and growth parameters of P. vannamei was noticed in the biofloc pond. Growth of P. vannamei in the biofloc pond showed positive allometric pattern with an increased survival. The microbial biomass grown in biofloc consumes toxic inorganic nitrogen and converts it into useful protein, making it available for the cultured shrimp. This improved FCR and reduced the discharge of nitrogenous waste into adjacent environment, making intensive shrimp farming an eco-friendly enterprise. Copyright © 2018 Elsevier Ltd. All rights reserved.

Development of 3000 m Subsea Blowout Preventer Experimental Prototype

NASA Astrophysics Data System (ADS)

Cai, Baoping; Liu, Yonghong; Huang, Zhiqian; Ma, Yunpeng; Zhao, Yubin

2017-12-01

A subsea blowout preventer experimental prototype is developed to meet the requirement of training operators, and the prototype consists of hydraulic control system, electronic control system and small-sized blowout preventer stack. Both the hydraulic control system and the electronic system are dual-mode redundant systems. Each system works independently and is switchable when there are any malfunctions. And it significantly improves the operation reliability of the equipment.

Electrochemical, H2O2-Boosted Catalytic Oxidation System

NASA Technical Reports Server (NTRS)

Akse, James R.; Thompson, John O.; Schussel, Leonard J.

2004-01-01

An improved water-sterilizing aqueous-phase catalytic oxidation system (APCOS) is based partly on the electrochemical generation of hydrogen peroxide (H2O2). This H2O2-boosted system offers significant improvements over prior dissolved-oxygen water-sterilizing systems in the way in which it increases oxidation capabilities, supplies H2O2 when needed, reduces the total organic carbon (TOC) content of treated water to a low level, consumes less energy than prior systems do, reduces the risk of contamination, and costs less to operate. This system was developed as a variant of part of an improved waste-management subsystem of the life-support system of a spacecraft. Going beyond its original intended purpose, it offers the advantage of being able to produce H2O2 on demand for surface sterilization and/or decontamination: this is a major advantage inasmuch as the benign byproducts of this H2O2 system, unlike those of systems that utilize other chemical sterilants, place no additional burden of containment control on other spacecraft air- or water-reclamation systems.

A Novel Feed-Forward Modeling System Leads to Sustained Improvements in Attention and Academic Performance.

PubMed

McDermott, Ashley F; Rose, Maya; Norris, Troy; Gordon, Eric

2016-01-28

This study tested a novel feed-forward modeling (FFM) system as a nonpharmacological intervention for the treatment of ADHD children and the training of cognitive skills that improve academic performance. This study implemented a randomized, controlled, parallel design comparing this FFM with a nonpharmacological community care intervention. Improvements were measured on parent- and clinician-rated scales of ADHD symptomatology and on academic performance tests completed by the participant. Participants were followed for 3 months after training. Participants in the FFM training group showed significant improvements in ADHD symptomatology and academic performance, while the control group did not. Improvements from FFM were sustained 3 months later. The FFM appeared to be an effective intervention for the treatment of ADHD and improving academic performance. This FFM training intervention shows promise as a first-line treatment for ADHD while improving academic performance. © The Author(s) 2016.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs.

PubMed

Brosseau, Lucie; Taki, Jade; Desjardins, Brigit; Thevenot, Odette; Fransen, Marlene; Wells, George A; Imoto, Aline Mizusaki; Toupin-April, Karine; Westby, Marie; Gallardo, Inmaculada C Álvarez; Gifford, Wendy; Laferrière, Lucie; Rahman, Prinon; Loew, Laurianne; Angelis, Gino De; Cavallo, Sabrina; Shallwani, Shirin Mehdi; Aburub, Ala'; Bennell, Kim L; Van der Esch, Martin; Simic, Milena; McConnell, Sara; Harmer, Alison; Kenny, Glen P; Paterson, Gail; Regnaux, Jean-Philippe; Lefevre-Colau, Marie-Martine; McLean, Linda

2017-05-01

To identify effective mind-body exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning non-traditional land-based exercises for knee osteoarthritis. A systematic search and adapted selection criteria included comparative controlled trials with mind-body exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, D-) was used, based on statistical significance ( P < 0.5) and clinical importance (⩾15% improvement). The four high-quality studies identified demonstrated that various mind-body exercise programs are promising for improving the management of knee osteoarthritis. Hatha Yoga demonstrated significant improvement for pain relief (Grade B) and physical function (Grade C+). Tai Chi Qigong demonstrated significant improvement for quality of life (Grade B), pain relief (Grade C+) and physical function (Grade C+). Sun style Tai Chi gave significant improvement for pain relief (Grade B) and physical function (Grade B). Mind-body exercises are promising approaches to reduce pain, as well as to improve physical function and quality of life for individuals with knee osteoarthritis.

Evaluation of the Environmental Scoring System in Multiple Child Asthma Intervention Programs in Boston, Massachusetts.

PubMed

Dong, Zhao; Nath, Anjali; Guo, Jing; Bhaumik, Urmi; Chin, May Y; Dong, Sherry; Marshall, Erica; Murphy, Johnna S; Sandel, Megan T; Sommer, Susan J; Ursprung, W W Sanouri; Woods, Elizabeth R; Reid, Margaret; Adamkiewicz, Gary

2018-01-01

To test the applicability of the Environmental Scoring System, a quick and simple approach for quantitatively measuring environmental triggers collected during home visits, and to evaluate its contribution to improving asthma outcomes among various child asthma programs. We pooled and analyzed data from multiple child asthma programs in the Greater Boston Area, Massachusetts, collected in 2011 to 2016, to examine the association of environmental scores (ES) with measures of asthma outcomes and compare the results across programs. Our analysis showed that demographics were important contributors to variability in asthma outcomes and total ES, and largely explained the differences among programs at baseline. Among all programs in general, we found that asthma outcomes were significantly improved and total ES significantly reduced over visits, with the total Asthma Control Test score negatively associated with total ES. Our study demonstrated that the Environmental Scoring System is a useful tool for measuring home asthma triggers and can be applied regardless of program and survey designs, and that demographics of the target population may influence the improvement in asthma outcomes.

Disaster mobile health technology: lessons from Haiti.

PubMed

Callaway, David W; Peabody, Christopher R; Hoffman, Ari; Cote, Elizabeth; Moulton, Seth; Baez, Amado Alejandro; Nathanson, Larry

2012-04-01

Mobile health (mHealth) technology can play a critical role in improving disaster victim tracking, triage, patient care, facility management, and theater-wide decision-making. To date, no disaster mHealth application provides responders with adequate capabilities to function in an austere environment. The Operational Medicine Institute (OMI) conducted a qualitative trial of a modified version of the off-the-shelf application iChart at the Fond Parisien Disaster Rescue Camp during the large-scale response to the January 12, 2010 earthquake in Haiti. The iChart mHealth system created a patient log of 617 unique entries used by on-the-ground medical providers and field hospital administrators to facilitate provider triage, improve provider handoffs, and track vulnerable populations such as unaccompanied minors, pregnant women, traumatic orthopedic injuries and specified infectious diseases. The trial demonstrated that even a non-disaster specific application with significant programmatic limitations was an improvement over existing patient tracking and facility management systems. A unified electronic medical record and patient tracking system would add significant value to first responder capabilities in the disaster response setting.

Remote control improves quality of life in elderly pacemaker patients versus standard ambulatory-based follow-up.

PubMed

Comoretto, Rosanna Irene; Facchin, Domenico; Ghidina, Marco; Proclemer, Alessandro; Gregori, Dario

2017-08-01

Health-related quality of life (HRQoL) improves shortly after pacemaker (PM) implantation. No studies have investigated the HRQoL trend for elderly patients with a remote device monitoring follow-up system. Using EuroQol-5D Questionnaire and the PM-specific Assessment of Quality of Life and Related Events Questionnaire, HRQoL was measured at baseline and then repeatedly during the 6 months following PM implantation in a cohort of 42 consecutive patients. Twenty-five patients were followed-up with standard outpatient visits, while 17 used a remote monitoring system. Aquarel scores were significantly higher in patients with remote device monitoring system regarding chest discomfort and arrhythmia subscales the first month after PM implant and remained stable until 6 months. Remote monitoring affected the rate of HRQoL improvement in the first 3 months after pacemaker implantation more than ambulatory follow-up. Remote device monitoring has a significant impact on HRQoL in pacemaker patients, increasing its levels up to 6 months after implant. © 2017 John Wiley & Sons, Ltd.

A Hybrid 2D/3D User Interface for Radiological Diagnosis.

PubMed

Mandalika, Veera Bhadra Harish; Chernoglazov, Alexander I; Billinghurst, Mark; Bartneck, Christoph; Hurrell, Michael A; Ruiter, Niels de; Butler, Anthony P H; Butler, Philip H

2018-02-01

This paper presents a novel 2D/3D desktop virtual reality hybrid user interface for radiology that focuses on improving 3D manipulation required in some diagnostic tasks. An evaluation of our system revealed that our hybrid interface is more efficient for novice users and more accurate for both novice and experienced users when compared to traditional 2D only interfaces. This is a significant finding because it indicates, as the techniques mature, that hybrid interfaces can provide significant benefit to image evaluation. Our hybrid system combines a zSpace stereoscopic display with 2D displays, and mouse and keyboard input. It allows the use of 2D and 3D components interchangeably, or simultaneously. The system was evaluated against a 2D only interface with a user study that involved performing a scoliosis diagnosis task. There were two user groups: medical students and radiology residents. We found improvements in completion time for medical students, and in accuracy for both groups. In particular, the accuracy of medical students improved to match that of the residents.

Improved Tensile Adhesion Specimens for High Strength Epoxy Systems in Aerospace Applications

NASA Technical Reports Server (NTRS)

Haddock, M. Reed; McLennan, Michael L.

2000-01-01

An improved tensile adhesion button has been designed and tested that results in higher measured tensile adhesion strength while providing increased capability for testing high strength epoxy adhesive systems. The best attributes of two well-established tensile button designs were combined and refined into an optimized tensile button. The most significant design change to the tensile button was to improve alignment of the bonded tensile button specimens during tensile testing by changing the interface between the tensile button and the tensile test machine. The established or old button design uses a test fixture that pulls from a grooved annulus or anvil head while the new button design pulls from a threaded hole in the centerline of the button. Finite element (FE) analysis showed that asymmetric loading of the established anvil head tensile button significantly increases the stress concentration in the adhesive, causing failure at lower tensile test loads. The new tensile button was designed to eliminate asymmetric loading and eliminate misalignment sensitivity. Enhanced alignment resulted in improved tensile adhesion strength measurement up to 13.8 MPa (2000psi) over the established button design. Another design change increased the capability of the button by increasing the threaded hole diameter allowing it to test high strength epoxy systems up to 85 MPa(less than 12,000 psi). The improved tensile button can be used in button- to-button or button-to-panel configurations.

Bayesian Scoring Systems for Military Pelvic and Perineal Blast Injuries: Is it Time to Take a New Approach?

PubMed

Mossadegh, Somayyeh; He, Shan; Parker, Paul

2016-05-01

Various injury severity scores exist for trauma; it is known that they do not correlate accurately to military injuries. A promising anatomical scoring system for blast pelvic and perineal injury led to the development of an improved scoring system using machine-learning techniques. An unbiased genetic algorithm selected optimal anatomical and physiological parameters from 118 military cases. A Naïve Bayesian model was built using the proposed parameters to predict the probability of survival. Ten-fold cross validation was employed to evaluate its performance. Our model significantly out-performed Injury Severity Score (ISS), Trauma ISS, New ISS, and the Revised Trauma Score in virtually all areas; positive predictive value 0.8941, specificity 0.9027, accuracy 0.9056, and area under curve 0.9059. A two-sample t test showed that the predictive performance of the proposed scoring system was significantly better than the other systems (p < 0.001). With limited resources and the simplest of Bayesian methodologies, we have demonstrated that the Naïve Bayesian model performed significantly better in virtually all areas assessed by current scoring systems used for trauma. This is encouraging and highlights that more can be done to improve trauma systems not only for our military injured, but also for civilian trauma victims. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Fabrication and Optimization of Self-Microemulsions to Improve the Oral Bioavailability of Total Flavones of Hippophaë rhamnoides L.

PubMed

Guo, Ruixue; Guo, Xinbo; Hu, Xiaodan; Abbasi, Arshad Mehmood; Zhou, Lin; Li, Tong; Fu, Xiong; Liu, Rui Hai

2017-12-01

The purpose of this work was to improve the oral bioavailability of a poorly soluble functional food ingredient, the total flavones of Hippophaë rhamnoides L. (TFH). A self-microemulsion drug delivery system (SMEDDS) was developed to overcome the problems of poor absorption of TFH in vivo. The optimal SMEDDS significantly enhanced the solubility of TFH up to 530 times compared to that in water. The mean droplet size was 61.76 nm with uniform distribution. And the loaded system was stable at 25 °C for 3 mo with transparent appearance. The in vitro release of TFH from SMEDDS was faster and more complete than that from suspension. After oral administration of TFH-SMEDDS in rats, the relative bioavailability of TFH was dramatically improved for 3.09 times compared with the unencapsulated form. The investigation indicated the potential application of SMEDDS as a vehicle to improve the oral bioavailability of TFH. The lipid-based nanotechnology, namely self-microemulsion drug delivery system (SMEDDS) was used to improve the bioavailability and oral delivery of total flavones of Hippophaë rhamnoides L. (TFH). The relevant bioavailability of TFH could be remarkably 3-fold improved by the optimized SMEDDS. The SMEDDS produced via a simple one-step process for poorly soluble TFH to achieve a significant improvement in the bioavailability, may endorse the promising utilization of TFH in functional foods as well as pharmaceutical fields with an enhanced absorption in vivo. © 2017 Institute of Food Technologists®.

Simulation modelling of central order processing system under resource sharing strategy in demand-driven garment supply chains

NASA Astrophysics Data System (ADS)

Ma, K.; Thomassey, S.; Zeng, X.

2017-10-01

In this paper we proposed a central order processing system under resource sharing strategy for demand-driven garment supply chains to increase supply chain performances. We examined this system by using simulation technology. Simulation results showed that significant improvement in various performance indicators was obtained in new collaborative model with proposed system.

Comparative Study of Professional vs Mass Market Topical Products for Treatment of Facial Photodamage.

PubMed

Reich, Hilary; Wallander, Irmina; Schulte, Lacie; Goodier, Molly; Zelickson, Brian

2016-01-01

Many over the counter topical products claim to reverse the signs of cutaneous photo-damage. To date, the two most studied ingredients for improving the texture, tone, and pigmentation of the skin are topical retinoids and hydroquinone. This split face study compares a mass market skincare regimen with a prescription skin care regimen for improvement in photo damaged skin. Twenty-seven subjects with moderate photo damaged facial skin were enrolled. Each subject was consented and assigned with the mass market anti-aging system (Treatment A) to one side of the face and the prescription anti-aging system (Treatment B or Treatment C) to the other side of the face. Treatment B contained 13 subjects whom did not use 0.025% Retinol cream. Treatment C contained 14 subjects who used a 0.025% Retinol Cream. Subjects had 4 visits over 12 weeks for digital photography and surveys. Photographs were evaluated by blinded physicians. Physician objective analysis showed all three systems to have a statistically significant clinical improvement in photoaged skin seen in as little as 4 weeks of use. Participant's surveys rated the mass market system higher than both of the professional systems for visible skin changes, ease of use, and likelihood to recommend to a friend. Twelve of twenty-seven subjects preferred the mass market system for overall improvement while twelve thought each system gave the same improvement. This study demonstrates that a mass marketed skin care system can give similar clinical improvements in photo-aged skin as a professionally dispensed prescription system and the majority of participants preferred the mass-marketed system.

EHR strategy: top down, bottom up or middle out?

PubMed

Bowden, Thomas C

2011-01-01

Around the world a number of countries have made a concerted effort to embed Information and Communications Technology (ICT) within their health systems. It is widely acknowledged that the successful application of ICT to health systems can bring about significant benefits. A number of areas commonly singled out for improvement include: coordination of care; improved medication management; and streamlining the transfer of a patient's care from one healthcare provider to another. There are also perceived cost-benefits including reduced duplication of services and improved service utilization. Countries across the world have chosen many and varied paths to automating their health systems. Health systems are intrinsically very complicated and changing rapidly. Because they represent a high proportion of government expenditure, it is important to understand what is being achieved by each of the broad approaches that are being taken.

Study of space shuttle orbiter system management computer function. Volume 1: Analysis, baseline design

NASA Technical Reports Server (NTRS)

1975-01-01

A system analysis of the shuttle orbiter baseline system management (SM) computer function is performed. This analysis results in an alternative SM design which is also described. The alternative design exhibits several improvements over the baseline, some of which are increased crew usability, improved flexibility, and improved growth potential. The analysis consists of two parts: an application assessment and an implementation assessment. The former is concerned with the SM user needs and design functional aspects. The latter is concerned with design flexibility, reliability, growth potential, and technical risk. The system analysis is supported by several topical investigations. These include: treatment of false alarms, treatment of off-line items, significant interface parameters, and a design evaluation checklist. An in-depth formulation of techniques, concepts, and guidelines for design of automated performance verification is discussed.

Computerized clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review.

PubMed

Roshanov, Pavel S; Misra, Shikha; Gerstein, Hertzel C; Garg, Amit X; Sebaldt, Rolf J; Mackay, Jean A; Weise-Kelly, Lorraine; Navarro, Tamara; Wilczynski, Nancy L; Haynes, R Brian

2011-08-03

The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations). We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes. Of 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported. A small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes.

Computerized clinical decision support systems for chronic disease management: A decision-maker-researcher partnership systematic review

PubMed Central

2011-01-01

Background The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations). Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes. Results Of 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported. Conclusions A small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes. PMID:21824386

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

PubMed Central

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

2015-01-01

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

Development of solid dispersion systems of dapivirine to enhance its solubility.

PubMed

Gorajana, Adinarayana; Ying, Chan Chiew; Shuang, Yeen; Fong, Pooi; Tan, Zhi; Gupta, Jyoti; Talekar, Meghna; Sharma, Manisha; Garg, Sanjay

2013-06-01

Dapivirine, formerly known as TMC 120, is a poorly-water soluble anti-HIV drug, currently being developed as a vaginal microbicide. The clinical use of this drug has been limited due to its poor solubility. The aim of this study was to design solid dispersion systems of Dapivirine to improve its solubility. Solid dispersions were prepared by solvent and fusion methods. Dapivirine release from the solid dispersion system was determined by conducting in-vitro dissolution studies. The physicochemical characteristics of the drug and its formulation were studied using Differential Scanning Calorimetry (DSC), powder X-ray Diffraction (XRD), Fourier-transform Infrared Spectroscopy (FTIR) and Scanning Electron Microscopy (SEM). A significant improvement in drug dissolution rate was observed with the solid dispersion systems. XRD, SEM and DSC results indicated the transformation of pure Dapivirine which exists in crystalline form into an amorphous form in selected solid dispersion formulations. FTIR and HPLC analysis confirmed the absence of drug-excipient interactions. Solid dispersion systems can be used to improve the dissolution rate of Dapivirine. This improvement could be attributed to the reduction or absence of drug crystallinity, existence of drug particles in an amorphous form and improved wettability of the drug.

An Analysis of Fundamental Waffle Mode in Early AEOS Adaptive Optics Images

NASA Astrophysics Data System (ADS)

Makidon, Russell B.; Sivaramakrishnan, Anand; Perrin, Marshall D.; Roberts, Lewis C., Jr.; Oppenheimer, Ben R.; Soummer, Rémi; Graham, James R.

2005-08-01

Adaptive optics (AO) systems have significantly improved astronomical imaging capabilities over the last decade and are revolutionizing the kinds of science possible with 4-5 m class ground-based telescopes. A thorough understanding of AO system performance at the telescope can enable new frontiers of science as observations push AO systems to their performance limits. We look at recent advances with wave-front reconstruction (WFR) on the Advanced Electro-Optical System (AEOS) 3.6 m telescope to show how progress made in improving WFR can be measured directly in improved science images. We describe how a ``waffle mode'' wave-front error (which is not sensed by a Fried geometry Shack-Hartmann wave-front sensor) affects the AO point-spread function. We model details of AEOS AO to simulate a PSF that matches the actual AO PSF in the I band and show that while the older observed AEOS PSF contained several times more waffle error than expected, improved WFR techniques noticeably improve AEOS AO performance. We estimate the impact of these improved WFRs on H-band imaging at AEOS, chosen based on the optimization of the Lyot Project near-infrared coronagraph at this bandpass. Based on observations made at the Maui Space Surveillance System, operated by Detachment 15 of the US Air Force Research Laboratory's Directed Energy Directorate.

Nurses' Use and Perception of an Information and Communication Technology System for Improving Coordination During Hospital Discharges: A Survey in Swedish Primary Healthcare.

PubMed

Christiansen, Line; Fagerström, Cecilia; Nilsson, Lina

2017-07-01

To facilitate communications between care levels and improve coordination during hospital discharges, there is great potential in using information and communication technology systems, because they can significantly help to deter unnecessary readmissions. However, there is still a lack of knowledge about how often nurses use information and communication technology and the indicators related to its use. The aims of this study were to describe the indicators related to nurses' use of an information and communication technology system for collaboration between care levels and to estimate whether the level of use can be related to nurses' perceptions of the information and communication technology system's contribution to improve coordination during hospital discharges. A quantitative survey of 37 nurses from 11 primary healthcare centers was performed in a county in southern Sweden. The data were analyzed using descriptive and comparative analyses. The results showed that perceptions concerning the information and communication technology system's usability and time consumption differed between nurses who used the system and those who did not. Simultaneously, the nurses were rather unaware of the ability of the information and communication technology system to improve coordination during patient discharges.

Towards improving software security by using simulation to inform requirements and conceptual design

DOE PAGES

Nutaro, James J.; Allgood, Glenn O.; Kuruganti, Teja

2015-06-17

We illustrate the use of modeling and simulation early in the system life-cycle to improve security and reduce costs. The models that we develop for this illustration are inspired by problems in reliability analysis and supervisory control, for which similar models are used to quantify failure probabilities and rates. In the context of security, we propose that models of this general type can be used to understand trades between risk and cost while writing system requirements and during conceptual design, and thereby significantly reduce the need for expensive security corrections after a system enters operation

Black health care in America: a political perspective.

PubMed Central

Rice, M. F.; Winn, M.

1990-01-01

Despite recent improvements in the health status of blacks, significant disparities continue to exist between blacks and whites in nearly every health status index. Contributing to these disparities are biases in the health system; economic bias being the most significant. This article assesses the competitive market strategy, the most recent federal initiative to promote equity in the access to health services in terms of the consequences for black health. Several policy actions are recommended to improve the health status of the black population. PMID:2362299

IEEE Computer Society/Software Engineering Institute Watts S. Humphrey Software Process Achievement Award 2016: Raytheon Integrated Defense Systems Design for Six Sigma Team

DTIC Science & Technology

2017-04-01

notice for non -US Government use and distribution. External use: This material may be reproduced in its entirety, without modification, and freely...Combinatorial Design Methods 4 2.1 Identification of Significant Improvement Opportunity 4 2.2 Methodology Development 4 2.3 Piloting...11 3 Process Performance Modeling and Analysis 13 3.1 Identification of Significant Improvement Opportunity 13 3.2 Methodology Development 13 3.3

Improving esthetic results in benign parotid surgery: statistical evaluation of facelift approach, sternocleidomastoid flap, and superficial musculoaponeurotic system flap application.

PubMed

Bianchi, Bernardo; Ferri, Andrea; Ferrari, Silvano; Copelli, Chiara; Sesenna, Enrico

2011-04-01

The purpose of this article was to analyze the efficacy of facelift incision, sternocleidomastoid muscle flap, and superficial musculoaponeurotic system flap for improving the esthetic results in patients undergoing partial parotidectomy for benign parotid tumor resection. The usefulness of partial parotidectomy is discussed, and a statistical evaluation of the esthetic results was performed. From January 1, 1996, to January 1, 2007, 274 patients treated for benign parotid tumors were studied. Of these, 172 underwent partial parotidectomy. The 172 patients were divided into 4 groups: partial parotidectomy with classic or modified Blair incision without reconstruction (group 1), partial parotidectomy with facelift incision and without reconstruction (group 2), partial parotidectomy with facelift incision associated with sternocleidomastoid muscle flap (group 3), and partial parotidectomy with facelift incision associated with superficial musculoaponeurotic system flap (group 4). Patients were considered, after a follow-up of at least 18 months, for functional and esthetic evaluation. The functional outcome was assessed considering the facial nerve function, Frey syndrome, and recurrence. The esthetic evaluation was performed by inviting the patients and a blind panel of 1 surgeon and 2 secretaries of the department to give a score of 1 to 10 to assess the final cosmetic outcome. The statistical analysis was finally performed using the Mann-Whitney U test for nonparametric data to compare the different group results. P less than .05 was considered significant. No recurrence developed in any of the 4 groups or in any of the 274 patients during the follow-up period. The statistical analysis, comparing group 1 and the other groups, revealed a highly significant statistical difference (P < .0001) for all groups. Also, when group 2 was compared with groups 3 and 4, the difference was highly significantly different statistically (P = .0018 for group 3 and P = .0005 for group 4). Finally, when groups 3 and 4 were compared, the difference was not statistically significant (P = .3467). Partial parotidectomy is the real key point for improving esthetic results in benign parotid surgery. The evaluation of functional complications and the recurrence rate in this series of patients has confirmed that this technique can be safely used for parotid benign tumor resection. The use of a facelift incision alone led to a high statistically significant improvement in the esthetic outcome. When the facelift incision was used with reconstructive techniques, such as the sternocleidomastoid muscle flap or the superficial musculoaponeurotic system flap, the esthetic results improved further. Finally, no statistically significant difference resulted comparing the use of the superficial musculoaponeurotic system and the sternocleidomastoid muscle flap. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Improving access to important recovery information for heart patients with low health literacy: reflections on practice-based initiatives.

PubMed

Naccarella, Lucio; Biuso, Catuscia; Jennings, Amanda; Patsamanis, Harry

2018-05-29

Evidence exists for the association between health literacy and heart health outcomes. Cardiac rehabilitation is critical for recovery from heart attack and reducing hospital readmissions. Despite this, <30% of people participate in a program. Significant patient, hospital and health system challenges exist to improve recovery through increased heart health literacy. This brief case study reflects and documents practice-based initiatives by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. Three key initiatives, namely the Six Steps To Cardiac Recovery resource, the Love Your Heart book and the nurse ambassador program, were implemented informed by mixed methods that assessed need and capacity at the individual, organisational and systems levels. Key outcomes included increased access to recovery information for patients with low health literacy, nurse knowledge and confidence to engage with patients on recovery information, improved education of patients and improved availability and accessibility of information for patients in diverse formats. Given the challenges involved in addressing heart health literacy, multifaceted practice-based approaches are essential to improve access to recovery information for patients with low literacy levels. What is known about the topic? Significant challenges exist for patients with lower health literacy receiving recovery information after a heart attack in hospitals. What does this paper add? This case study provides insights into a practice-based initiative by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. What are the implications for practitioners? Strategies to improve recovery through increased heart health literacy must address the needs of patients, nursing staff and the health system within hospitals. Such strategies need to be multifaceted and designed to build the capacity of nurses, heart patients and their carers, as well as support from hospital management.

Teacher coaching supported by formative assessment for improving classroom practices.

PubMed

Fabiano, Gregory A; Reddy, Linda A; Dudek, Christopher M

2018-06-01

The present study is a wait-list controlled, randomized study investigating a teacher coaching approach that emphasizes formative assessment and visual performance feedback to enhance elementary school teachers' classroom practices. The coaching model targeted instructional and behavioral management practices as measured by the Classroom Strategies Assessment System (CSAS) Observer and Teacher Forms. The sample included 89 general education teachers, stratified by grade level, and randomly assigned to 1 of 2 conditions: (a) immediate coaching, or (b) waitlist control. Results indicated that, relative to the waitlist control, teachers in immediate coaching demonstrated significantly greater improvements in observations of behavior management strategy use but not for observations of instructional strategy use. Observer- and teacher-completed ratings of behavioral management strategy use at postassessment were significantly improved by both raters; ratings of instructional strategy use were significantly improved for teacher but not observer ratings. A brief coaching intervention improved teachers' use of observed behavior management strategies and self-reported use of behavior management and instructional strategies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Optimization of a Biometric System Based on Acoustic Images

PubMed Central

Izquierdo Fuente, Alberto; Del Val Puente, Lara; Villacorta Calvo, Juan J.; Raboso Mateos, Mariano

2014-01-01

On the basis of an acoustic biometric system that captures 16 acoustic images of a person for 4 frequencies and 4 positions, a study was carried out to improve the performance of the system. On a first stage, an analysis to determine which images provide more information to the system was carried out showing that a set of 12 images allows the system to obtain results that are equivalent to using all of the 16 images. Finally, optimization techniques were used to obtain the set of weights associated with each acoustic image that maximizes the performance of the biometric system. These results improve significantly the performance of the preliminary system, while reducing the time of acquisition and computational burden, since the number of acoustic images was reduced. PMID:24616643

Application of Calspan pitch rate control system to the Space Shuttle for approach and landing

NASA Technical Reports Server (NTRS)

Weingarten, N. C.; Chalk, C. R.

1983-01-01

A pitch rate control system designed for use in the shuttle during approach and landing was analyzed and compared with a revised control system developed by NASA and the existing OFT control system. The design concept control system uses filtered pitch rate feedback with proportional plus integral paths in the forward loop. Control system parameters were designed as a function of flight configuration. Analysis included time and frequency domain techniques. Results indicate that both the Calspan and NASA systems significantly improve the flying qualities of the shuttle over the OFT. Better attitude and flight path control and less time delay are the primary reasons. The Calspan system is preferred because of reduced time delay and simpler mechanization. Further testing of the improved flight control systems in an in-flight simulator is recommended.

Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol.

PubMed

Nair, Bala G; Grunzweig, Katherine; Peterson, Gene N; Horibe, Mayumi; Neradilek, Moni B; Newman, Shu-Fang; Van Norman, Gail; Schwid, Howard A; Hao, Wei; Hirsch, Irl B; Patchen Dellinger, E

2016-06-01

Poor perioperative glycemic management can lead to negative surgical outcome. Improved compliance to glucose control protocol could lead to better glucose management. An Anesthesia Information Management System based decision support system-Smart Anesthesia Manager™ (SAM) was used to generate real-time reminders to the anesthesia providers to closely adhere to our institutional glucose management protocol. Compliance to hourly glucose measurements and correct insulin dose adjustments was compared for the baseline period (12 months) without SAM and the intervention period (12 months) with SAM decision support. Additionally, glucose management parameters were compared for the baseline and intervention periods. A total of 1587 cases during baseline and 1997 cases during intervention met the criteria for glucose management (diabetic patients or non-diabetic patients with glucose level >140 mg/dL). Among the intervention cases anesthesia providers chose to use SAM reminders 48.7 % of the time primarily for patients who had diabetes, higher HbA1C or body mass index, while disabling the system for the remaining cases. Compliance to hourly glucose measurement and correct insulin doses increased significantly during the intervention period when compared with the baseline (from 52.6 to 71.2 % and from 13.5 to 24.4 %, respectively). In spite of improved compliance to institutional protocol, the mean glucose levels and other glycemic management parameters did not show significant improvement with SAM reminders. Real-time electronic reminders improved intraoperative compliance to institutional glucose management protocol though glycemic parameters did not improve even when there was greater compliance to the protocol.

Impact of the Local Public Hospital Reform on the Efficiency of Medium-Sized Hospitals in Japan: An Improved Slacks-Based Measure Data Envelopment Analysis Approach.

PubMed

Zhang, Xing; Tone, Kaoru; Lu, Yingzhe

2018-04-01

To assess the change in efficiency and total factor productivity (TFP) of the local public hospitals in Japan after the local public hospital reform launched in late 2007, which was aimed at improving the financial capability and operational efficiency of hospitals. Secondary data were collected from the Ministry of Internal Affairs and Communications on 213 eligible medium-sized hospitals, each operating 100-400 beds from FY2006 to FY2011. The improved slacks-based measure nonoriented data envelopment analysis models (Quasi-Max SBM nonoriented DEA models) were used to estimate dynamic efficiency score and Malmquist Index. The dynamic efficiency measure indicated an efficiency gain in the first several years of the reform and then was followed by a decrease. Malmquist Index analysis showed a significant decline in the TFP between 2006 and 2011. The financial improvement of medium-sized hospitals was not associated with enhancement of efficiency. Hospital efficiency was not significantly different among ownership structure and law-application system groups, but it was significantly affected by hospital location. The results indicate a need for region-tailored health care policies and for a more comprehensive reform to overcome the systemic constraints that might contribute to the decline of the TFP. © Health Research and Educational Trust.

Canagliflozin prevents scopolamine-induced memory impairment in rats: Comparison with galantamine hydrobromide action.

PubMed

Arafa, Nadia M S; Ali, Elham H A; Hassan, Mohamed Kamel

2017-11-01

Canagliflozin (CAN) is a sodium-glucose co-transporter 2 (SGLT2) inhibitor indicated to improve glycemic control in adults with type 2 diabetes mellitus. There is a little information about its effect on the cholinergic system that proposed mechanism for memory improvement occurring by SGLT2 drugs. This study aimed to estimate the effect of CAN as compared to galantamine (GAL) treatments for two weeks on scopolamine hydrobromide (SCO)-induced memory dysfunction in experimental rats. Animals divided into six groups; control (CON), CAN, GAL, SCO, SCO + CAN and SCO + GAL. Results indicated significant decrease in body weights of the CAN groups as compared to control values. Moreover, in the SCO + CAN and SCO + GAL the number of arm entry and number of correct alternation in Y maze task increased and showed improvement in the water maze task, acetylcholinesterase (AChE) activities decreased significantly, while monoamines levels significantly increased compared with the SCO group values. Results also recorded acetylcholine M1 receptor (M1 mAChR) in SCO + CAN or SCO + GAL groups in comparison with the SCO group. The study suggested that canagliflozin might improve memory dysfunction induced by scopolamine hydrobromide via cholinergic and monoamines system. Copyright © 2017 Elsevier B.V. All rights reserved.

[Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

PubMed

Bergholz, W

2008-11-01

In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

Adverse Drug Events in Children: How Big is the Problem?

PubMed

Zed, Peter J

2015-01-01

Adverse drug events in children is an under appreciated but significant cause of health care contact resulting in ED visits and hospital admissions with associated resource utilization. In recent years we have started to better understand the impact of ADEs in children but there remains significant questions that must be addressed to further improve our understanding of the etiology of these ADEs and strategies for prevention and management. This paper will describe what is known regarding the frequency, severity, preventability and classification of ADEs in children. It will also describe some of the challenges and unanswered questions regarding patient, drug and system factors, which contribute to ADEs in children. Finally, areas of future research will be identified to further improve our understanding of ADEs in children to inform prevention strategies as well as early recognition and management approaches to minimize the significant ADEs can have on children, families and our health care system.

Server-based enterprise collaboration software improves safety and quality in high-volume PET/CT practice.

PubMed

McDonald, James E; Kessler, Marcus M; Hightower, Jeremy L; Henry, Susan D; Deloney, Linda A

2013-12-01

With increasing volumes of complex imaging cases and rising economic pressure on physician staffing, timely reporting will become progressively challenging. Current and planned iterations of PACS and electronic medical record systems do not offer workflow management tools to coordinate delivery of imaging interpretations with the needs of the patient and ordering physician. The adoption of a server-based enterprise collaboration software system by our Division of Nuclear Medicine has significantly improved our efficiency and quality of service.

Command & Control (C2) Systems Acquisition Study

DTIC Science & Technology

1982-09-01

34: 0 The movement of substantial capability closer to individual users with significant improvements in the interface between the user and the system...description of the overall capability desired; (2) an archi- teLLural framework where evolution can occur with minimum subsequent redesign; and (3) a

Research Perspectives for Material Requirements Planning Systems. Paper No. 434.

ERIC Educational Resources Information Center

Berry, W. L.; Whybark, D. Clay

Material requirements planning (MRP) systems are described as management tools for planning and controlling production operations. A wide variety of industries and production organizations are credited as reporting significant operating improvements in such areas as inventory control, production scheduling, delivery performance, and production…

First Restructure: Then Empower.

ERIC Educational Resources Information Center

Bailey, William J.

Although empowerment is a necessary change in improving education, the typical school system is not organized or governed in a way that encourages significant change. Educational systems need to be restructured to achieve decentralization in order for organizations to be ready for changes like empowerment. The current structure encourages…

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care

PubMed Central

Percival, Nikki; O’Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

PubMed

Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers.

Electrical Energy Storage for Renewable Energy Systems

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

Helms, C. R.; Cho, K. J.; Ferraris, John

This program focused on development of the fundamental understanding necessary to significantly improve advanced battery and ultra-capacitor materials and systems to achieve significantly higher power and energy density on the one hand, and significantly lower cost on the other. This program spanned all the way from atomic-level theory, to new nanomaterials syntheses and characterization, to system modeling and bench-scale technology demonstration. This program not only delivered significant advancements in fundamental understanding and new materials and technology, it also showcased the power of the cross-functional, multi-disciplinary teams at UT Dallas and UT Tyler for such work. These teams are continuing thismore » work with other sources of funding from both industry and government.« less

Automatic Ammunition Identification Technology Project

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

Weil, B.

1993-01-01

The Automatic Ammunition Identification Technology (AAIT) Project is an activity of the Robotics Process Systems Division at the Oak Ridge National Laboratory (ORNL) for the US Army's Project Manager-Ammunition Logistics (PM-AMMOLOG) at the Picatinny Arsenal in Picatinny, New Jersey. The project objective is to evaluate new two-dimensional bar code symbologies for potential use in ammunition logistics systems and automated reloading equipment. These new symbologies are a significant improvement over typical linear bar codes since machine-readable alphanumeric messages up to 2000 characters long are achievable. These compressed data symbologies are expected to significantly improve logistics and inventory management tasks and permitmore » automated feeding and handling of ammunition to weapon systems. The results will be increased throughout capability, better inventory control, reduction of human error, lower operation and support costs, and a more timely re-supply of various weapon systems. This paper will describe the capabilities of existing compressed data symbologies and the symbol testing activities being conducted at ORNL for the AAIT Project.« less

Automatic Ammunition Identification Technology Project. Ammunition Logistics Program

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

Weil, B.

1993-03-01

The Automatic Ammunition Identification Technology (AAIT) Project is an activity of the Robotics & Process Systems Division at the Oak Ridge National Laboratory (ORNL) for the US Army`s Project Manager-Ammunition Logistics (PM-AMMOLOG) at the Picatinny Arsenal in Picatinny, New Jersey. The project objective is to evaluate new two-dimensional bar code symbologies for potential use in ammunition logistics systems and automated reloading equipment. These new symbologies are a significant improvement over typical linear bar codes since machine-readable alphanumeric messages up to 2000 characters long are achievable. These compressed data symbologies are expected to significantly improve logistics and inventory management tasks andmore » permit automated feeding and handling of ammunition to weapon systems. The results will be increased throughout capability, better inventory control, reduction of human error, lower operation and support costs, and a more timely re-supply of various weapon systems. This paper will describe the capabilities of existing compressed data symbologies and the symbol testing activities being conducted at ORNL for the AAIT Project.« less

Rolling scheduling of electric power system with wind power based on improved NNIA algorithm

NASA Astrophysics Data System (ADS)

Xu, Q. S.; Luo, C. J.; Yang, D. J.; Fan, Y. H.; Sang, Z. X.; Lei, H.

2017-11-01

This paper puts forth a rolling modification strategy for day-ahead scheduling of electric power system with wind power, which takes the operation cost increment of unit and curtailed wind power of power grid as double modification functions. Additionally, an improved Nondominated Neighbor Immune Algorithm (NNIA) is proposed for solution. The proposed rolling scheduling model has further improved the operation cost of system in the intra-day generation process, enhanced the system’s accommodation capacity of wind power, and modified the key transmission section power flow in a rolling manner to satisfy the security constraint of power grid. The improved NNIA algorithm has defined an antibody preference relation model based on equal incremental rate, regulation deviation constraints and maximum & minimum technical outputs of units. The model can noticeably guide the direction of antibody evolution, and significantly speed up the process of algorithm convergence to final solution, and enhance the local search capability.

Nanostructure enhanced ionic transport in fullerene reinforced solid polymer electrolytes.

PubMed

Sun, Che-Nan; Zawodzinski, Thomas A; Tenhaeff, Wyatt E; Ren, Fei; Keum, Jong Kahk; Bi, Sheng; Li, Dawen; Ahn, Suk-Kyun; Hong, Kunlun; Rondinone, Adam J; Carrillo, Jan-Michael Y; Do, Changwoo; Sumpter, Bobby G; Chen, Jihua

2015-03-28

Solid polymer electrolytes, such as polyethylene oxide (PEO) based systems, have the potential to replace liquid electrolytes in secondary lithium batteries with flexible, safe, and mechanically robust designs. Previously reported PEO nanocomposite electrolytes routinely use metal oxide nanoparticles that are often 5-10 nm in diameter or larger. The mechanism of those oxide particle-based polymer nanocomposite electrolytes is under debate and the ion transport performance of these systems is still to be improved. Herein we report a 6-fold ion conductivity enhancement in PEO/lithium bis(trifluoromethanesulfonyl) imide (LiTFSI)-based solid electrolytes upon the addition of fullerene derivatives. The observed conductivity improvement correlates with nanometer-scale fullerene crystallite formation, reduced crystallinities of both the (PEO)6:LiTFSI phase and pure PEO, as well as a significantly larger PEO free volume. This improved performance is further interpreted by enhanced decoupling between ion transport and polymer segmental motion, as well as optimized permittivity and conductivity in bulk and grain boundaries. This study suggests that nanoparticle induced morphological changes, in a system with fullerene nanoparticles and no Lewis acidic sites, play critical roles in their ion conductivity enhancement. The marriage of fullerene derivatives and solid polymer electrolytes opens up significant opportunities in designing next-generation solid polymer electrolytes with improved performance.

An Approach to Establishing System Benefits for Technologies In NASA's Spaceliner Investment Area

NASA Technical Reports Server (NTRS)

Hueter, Uwe; Pannell, Bill; Lyles, Garry M. (Technical Monitor)

2001-01-01

NASA's has established long term goals for access-to-space. The third generation launch systems are to be fully reusable and operational around 2025. The goals for the third generation launch system are to significantly reduce cost and improve safety over current systems. The Advanced Space Transportation Program Office (ASTP) at the NASA's Marshall Space Flight Center in Huntsville, AL has the agency lead to develop space transportation technologies. Within ASTP, under the Spaceliner Investment Area, third generation technologies are being pursued. The Spaceliner Investment Area's primary objective is to mature vehicle technologies to enable substantial increases in the design and operating margins of third generation RLVs (current Space Shuttle is considered the first generation RLV) by incorporating advanced propulsion systems, materials, structures, thermal protection systems, power, and avionics technologies. Advancements in design tools and better characterization of the operational environment will result in reduced design and operational variabilities leading to improvements in margins. Improvements in operational efficiencies will be obtained through the introduction of integrated vehicle health management, operations and range technologies. Investments in these technologies will enable the reduction in the high operational costs associated with today's vehicles by allowing components to operate well below their design points resulting in improved component operating life, reliability, and safety which in turn reduces both maintenance and refurbishment costs. The introduction of advanced technologies may enable horizontal takeoff by significantly reducing the takeoff weight and allowing use of existing infrastructure. This would be a major step toward the goal of airline-like operation. These factors in conjunction with increased flight rates, resulting from reductions in transportation costs, will result in significant improvements of future vehicles. The real-world problem is that resources are limited and technologies need to be prioritized to assure the resources are spent on technologies that provide the highest system level benefits. Toward that end, a systems approach is being taken to determine the benefits of technologies for the Spaceliner Investment Area. Technologies identified to be enabling will be funded. However, the other technologies will be funded based on their system's benefits. Since the final launch system concept will not be decided for many years, several vehicle concepts are being evaluated to determine technology benefits. Not only performance, but also cost and operability are being assessed. This will become an annual process to assess these technologies against their goals and the benefits to various launch systems concepts. The paper describes the system process, tools and concepts used to determine the technology benefits. Preliminary results will be presented along with the current technology investments that are being made by ASTP's Spaceliner Investment Area.

Present status of metrology of electro-optical surveillance systems

NASA Astrophysics Data System (ADS)

Chrzanowski, K.

2017-10-01

There has been a significant progress in equipment for testing electro-optical surveillance systems over the last decade. Modern test systems are increasingly computerized, employ advanced image processing and offer software support in measurement process. However, one great challenge, in form of relative low accuracy, still remains not solved. It is quite common that different test stations, when testing the same device, produce different results. It can even happen that two testing teams, while working on the same test station, with the same tested device, produce different results. Rapid growth of electro-optical technology, poor standardization, limited metrology infrastructure, subjective nature of some measurements, fundamental limitations from laws of physics, tendering rules and advances in artificial intelligence are major factors responsible for such situation. Regardless, next decade should bring significant improvements, since improvement in measurement accuracy is needed to sustain fast growth of electro-optical surveillance technology.

[Aerosolized iloprost therapy for pulmonary hypertensive crisis in 4 patients with idiopathic pulmonary arterial hypertension].

PubMed

Deng, Ke-wu; Zhou, Yu-jie; Xu, Xi-qi; Wu, Ming-ying; Wang, Guo-hong; Bian, Hong; Chen, Bo; Wang, Chun-bo

2012-10-01

To summary the efficacy and safety of aerosolized iloprost in patients with pulmonary hypertensive crisis. On the basis of conventional therapy, aerosolized iloprost (10 µg per time for 10 - 15 min in 2 hours interval, 8 times per day) was administered to four patients with idiopathic pulmonary arterial hypertension and pulmonary hypertensive crisis. Blood pressure, heart rate, systemic artery oxygen saturation, systolic pulmonary arterial pressure (sPAP) measured by echocardiography and the adverse events were analyzed. After aerosolized iloprost therapy, sPAP was significantly decreased and systemic artery oxygen saturation was improved. Adverse events (nausea, vomiting, diarrhea, dry cough) were observed in two patients, and the iloprost use was stopped in one patient due to severe vomiting and diarrhea. Aerosolized iloprost could significantly reduce the sPAP and improve the systemic artery oxygen saturation in patients with pulmonary hypertension crisis.

Ranking agricultural practices on soil water improvements: a meta-analysis

NASA Astrophysics Data System (ADS)

Basche, A.; DeLonge, M. S.; Gonzalez, J.

2016-12-01

Increased rainfall variability is well documented in the historic record and predicted to intensify with future climate change. Managing excess water in periods of heavy rain and a lack of water in periods of inadequate precipitation will continue to be a challenge. Improving soil resiliency through increased water storage is a promising strategy to combat effects of both rainfall extremes. The goal of this research is to quantify to what extent various conservation and ecological practices can improve soil hydrology. We are conducting a global meta-analysis focused on studies where conservation and ecological practices are compared to more conventional management. To date we have analyzed 100 studies with more than 450 paired comparisons to understand the effect of management on water infiltration rates, a critical process that ensures water enters the soil profile for crop use, water storage and runoff prevention. The database will be expanded to include studies measuring soil porosity and the water retained at field capacity. Statistical analysis has been done both with both a bootstrap method and a mixed model that weights studies based on precision while accounting for between-study variation. We find that conservation and ecological practices, ranging from no-till, cover crops, crop rotation, perennial crops and agroforestry, on average significantly increased water infiltration rates relative to more conventional practice controls (mean of 75%, standard error 25%). There were significant differences between practices, where perennial and agroforestry systems show the greatest potential for improving water infiltration rates (> 100% increase). Cover crops also lead to a significant increase in water infiltration rates (> 60%) while crop rotations and no-till systems did not consistently demonstrate increases. We also found that studies needed to include alternative management for more than two years to detect a significant increase. Overall this global meta-analysis improves understanding of how alternative management, notably the use of continuous cover in agricultural systems, improves water dynamics. Policies should be designed in a way that allows agricultural producers to prioritize and implement practices that offer greater water conservation while maintaining crop productivity.

Data Acquisition Systems

NASA Technical Reports Server (NTRS)

1989-01-01

Technology developed during a joint research program with Langley and Kinetic Systems Corporation led to Kinetic Systems' production of a high speed Computer Automated Measurement and Control (CAMAC) data acquisition system. The study, which involved the use of CAMAC equipment applied to flight simulation, significantly improved the company's technical capability and produced new applications. With Digital Equipment Corporation, Kinetic Systems is marketing the system to government and private companies for flight simulation, fusion research, turbine testing, steelmaking, etc.

An assessment of future computer system needs for large-scale computation

NASA Technical Reports Server (NTRS)

Lykos, P.; White, J.

1980-01-01

Data ranging from specific computer capability requirements to opinions about the desirability of a national computer facility are summarized. It is concluded that considerable attention should be given to improving the user-machine interface. Otherwise, increased computer power may not improve the overall effectiveness of the machine user. Significant improvement in throughput requires highly concurrent systems plus the willingness of the user community to develop problem solutions for that kind of architecture. An unanticipated result was the expression of need for an on-going cross-disciplinary users group/forum in order to share experiences and to more effectively communicate needs to the manufacturers.

Characteristics of a New X-Ray Imaging System for Interventional Procedures: Improved Image Quality and Reduced Radiation Dose.

PubMed

Schernthaner, Ruediger E; Haroun, Reham R; Nguyen, Sonny; Duran, Rafael; Sohn, Jae Ho; Sahu, Sonia; Chapiro, Julius; Zhao, Yan; Radaelli, Alessandro; van der Bom, Imramsjah M; Mauti, Maria; Hong, Kelvin; Geschwind, Jean-François H; Lin, MingDe

2018-03-01

To compare image quality and radiation exposure between a new angiographic imaging system and the preceding generation system during uterine artery embolization (UAE). In this retrospective, IRB-approved two-arm study, 54 patients with symptomatic uterine fibroids were treated with UAE on two different angiographic imaging systems. The new system includes optimized acquisition parameters and real-time image processing algorithms. Air kerma (AK), dose area product (DAP) and acquisition time for digital fluoroscopy (DF) and digital subtraction angiography (DSA) were recorded. Body mass index was noted as well. DF image quality was assessed objectively by image noise measurements. DSA image quality was rated by two blinded, independent readers on a four-rank scale. Statistical differences were assessed with unpaired t tests and Wilcoxon rank-sum tests. There was no significant difference between the patients treated on the new (n = 36) and the old system (n = 18) regarding age (p = 0.10), BMI (p = 0.18), DF time (p = 0.35) and DSA time (p = 0.17). The new system significantly reduced the cumulative AK and DAP by 64 and 72%, respectively (median 0.58 Gy and 145.9 Gy*cm 2 vs. 1.62 Gy and 526.8 Gy*cm 2 , p < 0.01 for both). Specifically, DAP for DF and DSA decreased by 59% (75.3 vs. 181.9 Gy*cm 2 , p < 0.01) and 78% (67.6 vs. 312.2 Gy*cm 2 , p < 0.01), respectively. The new system achieved a significant decrease in DF image noise (p < 0.01) and a significantly better DSA image quality (p < 0.01). The new angiographic imaging system significantly improved image quality and reduced radiation exposure during UAE procedures.

Electronic and mechanical improvement of the receiving terminal of a free-space microwave power transmission system

NASA Technical Reports Server (NTRS)

Brown, W. C.

1977-01-01

Significant advancements were made in a number of areas: improved efficiency of basic receiving element at low power density levels, improved resolution and confidence in efficiency measurements mathematical modelling and computer simulation of the receiving element and the design, construction, and testing of an environmentally protected two-plane construction suitable for low cost, highly automated construction of large receiving arrays.

Shared Learning and the Drive to Improve Patient Safety: Lessons Learned from the Pittsburgh Regional Healthcare Initiative

DTIC Science & Technology

2005-01-01

the environmental, cultural, and infrastructure changes in health care that will be necessary to achieve significant, widespread patient safety...to improved patient outcomes. Achievement of improved patient safety requires enhanced health care leadership commitment and learning systems that... health care organizations and practitioners to work together to identify and solve patient safety problems. Providing safe care requires a learning

Comparison of the viewing wand and the BRW stereotaxy systems

NASA Astrophysics Data System (ADS)

Heiferman, Kenneth S.; Cramer, Kevin E.

1993-09-01

Intracranial lesions are invisible and exploration can be hazardous to the patient's postoperative quality of life. The first generation of neurosurgeons relied on their knowledge of neurology and anatomy to try to locate the patient's lesion. In general, this did not produce satisfactory results. Improvements in neuroradiology, neuroanesthesia, and neurosurgical techniques have diminished the proportion of the brain viewed as inoperable. These improvements have significantly improved patient outcomes.

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

Nyflot, MJ; Kusano, AS; Zeng, J

Purpose: Interest in incident learning systems (ILS) for improving safety and quality in radiation oncology is growing, as evidenced by the upcoming release of the national ILS. However, an institution implementing such a system would benefit from quantitative metrics to evaluate performance and impact. We developed metrics to measure volume of reporting, severity of reported incidents, and changes in staff attitudes over time from implementation of our institutional ILS. Methods: We analyzed 2023 incidents from our departmental ILS from 2/2012–2/2014. Incidents were prospectively assigned a near-miss severity index (NMSI) at multidisciplinary review to evaluate the potential for error ranging frommore » 0 to 4 (no harm to critical). Total incidents reported, unique users reporting, and average NMSI were evaluated over time. Additionally, departmental safety attitudes were assessed through a 26 point survey adapted from the AHRQ Hospital Survey on Patient Safety Culture before, 12 months, and 24 months after implementation of the incident learning system. Results: Participation in the ILS increased as demonstrated by total reports (approximately 2.12 additional reports/month) and unique users reporting (0.51 additional users reporting/month). Also, the average NMSI of reports trended lower over time, significantly decreasing after 12 months of reporting (p<0.001) but with no significant change at months 18 or 24. In survey data significant improvements were noted in many dimensions, including perceived barriers to reporting incidents such as concern of embarrassment (37% to 18%; p=0.02) as well as knowledge of what incidents to report, how to report them, and confidence that these reports were used to improve safety processes. Conclusion: Over a two-year period, our departmental ILS was used more frequently, incidents became less severe, and staff confidence in the system improved. The metrics used here may be useful for other institutions seeking to create or evaluate their own incident learning systems.« less

Meeting the imperative to improve physician well-being: assessment of an innovative program.

PubMed

Dunn, Patrick M; Arnetz, Bengt B; Christensen, John F; Homer, Louis

2007-11-01

Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being. From 2000 to 2005, 22-32 physicians regularly completed 3 questionnaires coded for privacy. Results were anonymously reported to physicians and the organization. Data-guided interventions to enhance physician and organizational well-being were built on physician control over the work environment, order in the clinical setting, and clinical meaning. Questionnaires included an ACP/ASIM survey on physician satisfaction, the Maslach Burnout Inventory (MBI), and the Quality Work Competence (QWC) survey. Emotional and work-related exhaustion decreased significantly over the study period (MBI, p = 0.002; QWC, p = 0.035). QWC measures of organizational health significantly improved initially and remained acceptable and stable during the rest of the study. A data-guided program on physician well-being, using validated instruments and process improvement methods, enhanced physician and organizational well-being. Given the increases in physician burnout, organizations are encouraged to urgently create individual and systems approaches to lessen burnout risk.

Information and Communication Technologies for the Dissemination of Clinical Practice Guidelines to Health Professionals: A Systematic Review.

PubMed

De Angelis, Gino; Davies, Barbara; King, Judy; McEwan, Jessica; Cavallo, Sabrina; Loew, Laurianne; Wells, George A; Brosseau, Lucie

2016-11-30

The transfer of research knowledge into clinical practice can be a continuous challenge for researchers. Information and communication technologies, such as websites and email, have emerged as popular tools for the dissemination of evidence to health professionals. The objective of this systematic review was to identify research on health professionals' perceived usability and practice behavior change of information and communication technologies for the dissemination of clinical practice guidelines. We used a systematic approach to retrieve and extract data about relevant studies. We identified 2248 citations, of which 21 studies met criteria for inclusion; 20 studies were randomized controlled trials, and 1 was a controlled clinical trial. The following information and communication technologies were evaluated: websites (5 studies), computer software (3 studies), Web-based workshops (2 studies), computerized decision support systems (2 studies), electronic educational game (1 study), email (2 studies), and multifaceted interventions that consisted of at least one information and communication technology component (6 studies). Website studies demonstrated significant improvements in perceived usefulness and perceived ease of use, but not for knowledge, reducing barriers, and intention to use clinical practice guidelines. Computer software studies demonstrated significant improvements in perceived usefulness, but not for knowledge and skills. Web-based workshop and email studies demonstrated significant improvements in knowledge, perceived usefulness, and skills. An electronic educational game intervention demonstrated a significant improvement from baseline in knowledge after 12 and 24 weeks. Computerized decision support system studies demonstrated variable findings for improvement in skills. Multifaceted interventions demonstrated significant improvements in beliefs about capabilities, perceived usefulness, and intention to use clinical practice guidelines, but variable findings for improvements in skills. Most multifaceted studies demonstrated significant improvements in knowledge. The findings suggest that health professionals' perceived usability and practice behavior change vary by type of information and communication technology. Heterogeneity and the paucity of properly conducted studies did not allow for a clear comparison between studies and a conclusion on the effectiveness of information and communication technologies as a knowledge translation strategy for the dissemination of clinical practice guidelines. ©Gino De Angelis, Barbara Davies, Judy King, Jessica McEwan, Sabrina Cavallo, Laurianne Loew, George A Wells, Lucie Brosseau. Originally published in JMIR Medical Education (http://mededu.jmir.org), 30.11.2016.

Breaking down IT silos: a "connected" way to improve customer experience and the bottom line.

PubMed

Hallowell, Bruce; Turisco, Frances

2009-03-01

Hospitals can provide customer service like Amazon.com without purchasing new technology. Making technology interactive requires sharing patient data across applications and enhancing existing IT with decision support. Breaking down technology silos between hospital and outpatient care provider systems significantly improves efficiency, lowers costs, and speeds care delivery.

Innovative pharmaceutical development based on unique properties of nanoscale delivery formulation

PubMed Central

Mozhi, Anbu; Zhang, Xu; Zhao, Yuanyuan; Xue, Xiangdong; Hao, Yanli; Zhang, Xiaoning; Wang, Paul C.; Liang, Xing-Jie

2014-01-01

The advent of nanotechnology has reignited interest in the field of pharmaceutical science for the development of nanomedicine. Nanomedicinal formulations are nanometer-sized carrier materials designed for increasing the drug tissue bioavailability, thereby improving the treatment of systemically applied chemotherapeutic drugs. Nanomedicine is a new approach to deliver the pharmaceuticals through different routes of administration with safer and more effective therapies compared to conventional methods. To date, various kinds of nanomaterials have been developed over the years to make delivery systems more effective for the treatment of various diseases. Even though nanomaterials have significant advantages due to their unique nanoscale properties, there are still significant challenges in the improvement and development of nanoformulations with composites and other materials. Here in this review, we highlight the nanomedicinal formulations aiming to improve the balance between the efficacy and the toxicity of therapeutic interventions through different routes of administration and how to design nanomedicine for safer and more effective ways to improve the treatment quality. We also emphasize the environmental and health prospects of nanomaterials for human health care. PMID:23860639

Innovative pharmaceutical development based on unique properties of nanoscale delivery formulation

NASA Astrophysics Data System (ADS)

Kumar, Anil; Chen, Fei; Mozhi, Anbu; Zhang, Xu; Zhao, Yuanyuan; Xue, Xiangdong; Hao, Yanli; Zhang, Xiaoning; Wang, Paul C.; Liang, Xing-Jie

2013-08-01

The advent of nanotechnology has reignited interest in the field of pharmaceutical science for the development of nanomedicine. Nanomedicinal formulations are nanometer-sized carrier materials designed for increasing the drug tissue bioavailability, thereby improving the treatment of systemically applied chemotherapeutic drugs. Nanomedicine is a new approach to deliver the pharmaceuticals through different routes of administration with safer and more effective therapies compared to conventional methods. To date, various kinds of nanomaterials have been developed over the years to make delivery systems more effective for the treatment of various diseases. Even though nanomaterials have significant advantages due to their unique nanoscale properties, there are still significant challenges in the improvement and development of nanoformulations with composites and other materials. Here in this review, we highlight the nanomedicinal formulations aiming to improve the balance between the efficacy and the toxicity of therapeutic interventions through different routes of administration and how to design nanomedicine for safer and more effective ways to improve the treatment quality. We also emphasize the environmental and health prospects of nanomaterials for human health care.

Patient satisfaction with maxillary 3-implant overdentures using different attachment systems opposing mandibular 2-implant overdentures.

PubMed

Al-Zubeidi, Mohammed I; Alsabeeha, Nabeel H M; Thomson, W Murray; Payne, Alan G T

2012-05-01

Patient-based outcomes with maxillary overdentures on a minimum number of implants, opposing mandibular 2-implant overdentures are not evident in the literature. To evaluate patient's satisfaction with maxillary 3-implant overdentures, opposing mandibular 2-implant overdentures, using two different attachment systems over the first 2 years of service. Forty participants wearing mandibular 2-implant overdentures for 3 years were randomly allocated to one of two similar implant system groups to receive maxillary 3-implant overdentures. Twenty participants were allocated to splinted and unsplinted attachment system treatment groups for each system. Patient satisfaction with pre-treatment complete maxillary dentures, with maxillary 3-implant overdentures at baseline and annually for 2 years, was measured using visual analogue scale questionnaires and the oral health impact profiles. Palatal coverage of the maxillary overdentures was reduced at the first annual recall. Data showed significant improvement in pain reduction, comfort, stability, and function variables of the visual analogue scale after treatment. Analysis by prosthodontic design using visual analogue scale showed no significant difference. The total oral health impact profile-14 scores after treatment for all participants, regardless of prosthodontic design, were significantly lower (more satisfied). The overall oral health impact profile-20E score at baseline was significantly higher (more satisfied) compared with pre-treatment conventional maxillary dentures. No significant changes were observed in the first or second years compared with baseline results. Twenty-two participants (84.6%) preferred reduced palatal coverage, regardless of prosthodontic design, after 1 year. Twenty participants (76.9%) still preferred reduced palatal coverage at the end of the second year. The provision of maxillary 3-implant overdentures to oppose mandibular 2-implant overdentures significantly improve levels of patient satisfaction compared with conventional maxillary dentures. © 2011 Wiley Periodicals, Inc.

A Statistical Analysis of a Traffic-Light Food Rating System to Promote Healthy Nutrition and Body Weight.

PubMed

Larrivee, Sandra; Greenway, Frank L; Johnson, William D

2015-06-30

Restaurant eating while optimizing nutrition and maintaining a healthy weight is challenging. Even when nutritional information is available, consumers often consider only calories. A quick and easy method to rate both caloric density and nutrition is an unmet need. A food rating system created to address that need is assessed in this study. The food rating system categorizes food items into 3 color-coded categories: most healthy (green), medium healthy (yellow), or least healthy (red) based on calorie density and general nutritional quality from national guidelines. Nutritional information was downloaded from 20 popular fast-food chains. Nutritional assessments and the 3 color coded categories were compared using the Wilcoxon and Median tests to demonstrate the significance of nutrition differences. Green foods were significantly lower than yellow foods, which in turn were significantly lower than red foods, for calories and calories from fat, in addition to content of total fat, saturated fat and carbohydrates per 100 g serving weight (all P < .02). The green foods had significantly lower cholesterol than the yellow (P = .0006) and red (P < .0001) foods. Yellow foods had less sugar than red foods (P < .0001). Yellow foods were significantly higher in dietary fiber than red foods (P = .001). The food rating color-coded system identifies food items with superior nutrition, and lower caloric density. The smartphone app, incorporating the system, has the potential to improve nutrition; reduce the risk of developing diabetes, hypertension, heart disease, and stroke; and improve public health. © 2015 Diabetes Technology Society.

A Statistical Analysis of a Traffic-Light Food Rating System to Promote Healthy Nutrition and Body Weight

PubMed Central

Larrivee, Sandra; Greenway, Frank L.; Johnson, William D.

2015-01-01

Background: Restaurant eating while optimizing nutrition and maintaining a healthy weight is challenging. Even when nutritional information is available, consumers often consider only calories. A quick and easy method to rate both caloric density and nutrition is an unmet need. A food rating system created to address that need is assessed in this study. Methods: The food rating system categorizes food items into 3 color-coded categories: most healthy (green), medium healthy (yellow), or least healthy (red) based on calorie density and general nutritional quality from national guidelines. Nutritional information was downloaded from 20 popular fast-food chains. Nutritional assessments and the 3 color coded categories were compared using the Wilcoxon and Median tests to demonstrate the significance of nutrition differences. Results: Green foods were significantly lower than yellow foods, which in turn were significantly lower than red foods, for calories and calories from fat, in addition to content of total fat, saturated fat and carbohydrates per 100 g serving weight (all P < .02). The green foods had significantly lower cholesterol than the yellow (P = .0006) and red (P < .0001) foods. Yellow foods had less sugar than red foods (P < .0001). Yellow foods were significantly higher in dietary fiber than red foods (P = .001). Conclusion: The food rating color-coded system identifies food items with superior nutrition, and lower caloric density. The smartphone app, incorporating the system, has the potential to improve nutrition; reduce the risk of developing diabetes, hypertension, heart disease, and stroke; and improve public health. PMID:26134833

Advances in Schoolwide Inclusive School Reform

ERIC Educational Resources Information Center

Sailor, Wayne

2015-01-01

This article highlights three significant advances in schoolwide inclusive school reform and suggests three next steps to improve educational outcomes for "all" students, particularly for students for whom typical instruction is not effective. Significant advances are as follows: (a) a multi-tiered system of support (MTSS) with embedded…

Airborne electromagnetic bathymetry investigations in Port Lincoln, South Australia - comparison with an equivalent floating transient electromagnetic system

NASA Astrophysics Data System (ADS)

Vrbancich, Julian

2011-09-01

Helicopter time-domain airborne electromagnetic (AEM) methodology is being investigated as a reconnaissance technique for bathymetric mapping in shallow coastal waters, especially in areas affected by water turbidity where light detection and ranging (LIDAR) and hyperspectral techniques may be limited. Previous studies in Port Lincoln, South Australia, used a floating AEM time-domain system to provide an upper limit to the expected bathymetric accuracy based on current technology for AEM systems. The survey lines traced by the towed floating system were also flown with an airborne system using the same transmitter and receiver electronic instrumentation, on two separate occasions. On the second occasion, significant improvements had been made to the instrumentation to reduce the system self-response at early times. A comparison of the interpreted water depths obtained from the airborne and floating systems is presented, showing the degradation in bathymetric accuracy obtained from the airborne data. An empirical data correction method based on modelled and observed EM responses over deep seawater (i.e. a quasi half-space response) at varying survey altitudes, combined with known seawater conductivity measured during the survey, can lead to significant improvements in interpreted water depths and serves as a useful method for checking system calibration. Another empirical data correction method based on observed and modelled EM responses in shallow water was shown to lead to similar improvements in interpreted water depths; however, this procedure is notably inferior to the quasi half-space response because more parameters need to be assumed in order to compute the modelled EM response. A comparison between the results of the two airborne surveys in Port Lincoln shows that uncorrected data obtained from the second airborne survey gives good agreement with known water depths without the need to apply any empirical corrections to the data. This result significantly decreases the data-processing time thereby enabling the AEM method to serve as a rapid reconnaissance technique for bathymetric mapping.

Prognostic significance of tumor histology and computed tomographic staging for radiation treatment response of canine nasal tumors.

PubMed

Adams, William M; Kleiter, Miriam M; Thrall, Donald E; Klauer, Julia M; Forrest, Lisa J; La Due, Tracy A; Havighurst, Thomas C

2009-01-01

Prognostic significance of tumor histology and four computed tomography (CT) staging methods was tested retrospectively in dogs from three treatment centers that underwent intent-to-cure-radiotherapy for intranasal neoplasia. Disease-free and overall survival times were available for 94 dogs. A grouping of anaplastic, squamous cell, and undifferentiated carcinomas had a significantly shorter median disease-free survival (4.4 mo) than a grouping of all sarcomas (10.6 months). Disease-free survivals were not significantly different, when all carcinomas were compared with all sarcomas. The published original and modified WHO staging methods did not significantly relate to either survival endpoint. A modified human maxillary tumor staging system previously applied to canine nasal tumors was prognostically significant for both survival endpoints; a further modified version of that CT-based staging system resulted in improved significance for both survival endpoints. Dogs with unilateral intranasal involvement without bone destruction beyond the turbinates on CT, had longest median survival (23.4 months); CT evidence of cribriform plate involvement was associated with shortest median survival (6.7 months). Combining CT and histology statistically improved prognostic significance for both survival endpoints over the proposed CT staging method alone. Significance was lost when CT stages were collapsed to < four categories or histopathology groupings were collapsed to < three categories.

Effects of a wearable exoskeleton stride management assist system (SMA®) on spatiotemporal gait characteristics in individuals after stroke: a randomized controlled trial.

PubMed

Buesing, Carolyn; Fisch, Gabriela; O'Donnell, Megan; Shahidi, Ida; Thomas, Lauren; Mummidisetty, Chaithanya K; Williams, Kenton J; Takahashi, Hideaki; Rymer, William Zev; Jayaraman, Arun

2015-08-20

Robots offer an alternative, potentially advantageous method of providing repetitive, high-dosage, and high-intensity training to address the gait impairments caused by stroke. In this study, we compared the effects of the Stride Management Assist (SMA®) System, a new wearable robotic device developed by Honda R&D Corporation, Japan, with functional task specific training (FTST) on spatiotemporal gait parameters in stroke survivors. A single blinded randomized control trial was performed to assess the effect of FTST and task-specific walking training with the SMA® device on spatiotemporal gait parameters. Participants (n=50) were randomly assigned to FTST or SMA. Subjects in both groups received training 3 times per week for 6-8 weeks for a maximum of 18 training sessions. The GAITRite® system was used to collect data on subjects' spatiotemporal gait characteristics before training (baseline), at mid-training, post-training, and at a 3-month follow-up. After training, significant improvements in gait parameters were observed in both training groups compared to baseline, including an increase in velocity and cadence, a decrease in swing time on the impaired side, a decrease in double support time, an increase in stride length on impaired and non-impaired sides, and an increase in step length on impaired and non-impaired sides. No significant differences were observed between training groups; except for SMA group, step length on the impaired side increased significantly during self-selected walking speed trials and spatial asymmetry decreased significantly during fast-velocity walking trials. SMA and FTST interventions provided similar, significant improvements in spatiotemporal gait parameters; however, the SMA group showed additional improvements across more parameters at various time points. These results indicate that the SMA® device could be a useful therapeutic tool to improve spatiotemporal parameters and contribute to improved functional mobility in stroke survivors. Further research is needed to determine the feasibility of using this device in a home setting vs a clinic setting, and whether such home use provides continued benefits. This study is registered under the title "Development of walk assist device to improve community ambulation" and can be located in clinicaltrials.gov with the study identifier: NCT01994395 .

Enteric nervous system abnormalities are present in human necrotizing enterocolitis: potential neurotransplantation therapy

PubMed Central

2013-01-01

Introduction Intestinal dysmotility following human necrotizing enterocolitis suggests that the enteric nervous system is injured during the disease. We examined human intestinal specimens to characterize the enteric nervous system injury that occurs in necrotizing enterocolitis, and then used an animal model of experimental necrotizing enterocolitis to determine whether transplantation of neural stem cells can protect the enteric nervous system from injury. Methods Human intestinal specimens resected from patients with necrotizing enterocolitis (n = 18), from control patients with bowel atresia (n = 8), and from necrotizing enterocolitis and control patients undergoing stoma closure several months later (n = 14 and n = 6 respectively) were subjected to histologic examination, immunohistochemistry, and real-time reverse-transcription polymerase chain reaction to examine the myenteric plexus structure and neurotransmitter expression. In addition, experimental necrotizing enterocolitis was induced in newborn rat pups and neurotransplantation was performed by administration of fluorescently labeled neural stem cells, with subsequent visualization of transplanted cells and determination of intestinal integrity and intestinal motility. Results There was significant enteric nervous system damage with increased enteric nervous system apoptosis, and decreased neuronal nitric oxide synthase expression in myenteric ganglia from human intestine resected for necrotizing enterocolitis compared with control intestine. Structural and functional abnormalities persisted months later at the time of stoma closure. Similar abnormalities were identified in rat pups exposed to experimental necrotizing enterocolitis. Pups receiving neural stem cell transplantation had improved enteric nervous system and intestinal integrity, differentiation of transplanted neural stem cells into functional neurons, significantly improved intestinal transit, and significantly decreased mortality compared with control pups. Conclusions Significant injury to the enteric nervous system occurs in both human and experimental necrotizing enterocolitis. Neural stem cell transplantation may represent a novel future therapy for patients with necrotizing enterocolitis. PMID:24423414

Improving engineering effectiveness

NASA Technical Reports Server (NTRS)

Fiero, J. D.

1985-01-01

Methodologies to improve engineering productivity were investigated. The rocky road to improving engineering effectiveness is reviewed utilizing a specific semiconductor engineering organization as a case study. The organization had a performance problem regarding new product introductions. With the help of this consultant as a change agent the engineering team used a systems approach to through variables that were effecting their output significantly. Critical factors for improving this engineering organization's effectiveness and the roles/responsibilities of management, the individual engineers and the internal consultant are discussed.

Indirect gonioscopy system for imaging iridocorneal angle of eye

NASA Astrophysics Data System (ADS)

Perinchery, Sandeep M.; Fu, Chan Yiu; Baskaran, Mani; Aung, Tin; Murukeshan, V. M.

2017-08-01

Current clinical optical imaging systems do not provide sufficient structural information of trabecular meshwork (TM) in the iridocorneal angle (ICA) of the eye due to their low resolution. Increase in the intraocular pressure (IOP) can occur due to the abnormalities in TM, which could subsequently lead to glaucoma. Here, we present an indirect gonioscopy based imaging probe with significantly improved visualization of structures in the ICA including TM region, compared to the currently available tools. Imaging quality of the developed system was tested in porcine samples. Improved direct high quality visualization of the TM region through this system can be used for Laser trabeculoplasty, which is a primary treatment of glaucoma. This system is expected to be used complementary to angle photography and gonioscopy.

The value of information as applied to the Landsat Follow-on benefit-cost analysis

NASA Technical Reports Server (NTRS)

Wood, D. B.

1978-01-01

An econometric model was run to compare the current forecasting system with a hypothetical (Landsat Follow-on) space-based system. The baseline current system was a hybrid of USDA SRS domestic forecasts and the best known foreign data. The space-based system improved upon the present Landsat by the higher spatial resolution capability of the thematic mapper. This satellite system is a major improvement for foreign forecasts but no better than SRS for domestic forecasts. The benefit analysis was concentrated on the use of Landsat Follow-on to forecast world wheat production. Results showed that it was possible to quantify the value of satellite information and that there are significant benefits in more timely and accurate crop condition information.

The positive impact of simultaneous implementation of the BD FocalPoint GS Imaging System and lean principles on the operation of gynecologic cytology.

PubMed

Wong, Rebecca; Levi, Angelique W; Harigopal, Malini; Schofield, Kevin; Chhieng, David C

2012-02-01

Our cytology laboratory, like many others, is under pressure to improve quality and provide test results faster while decreasing costs. We sought to address these issues by introducing new technology and lean principles. To determine the combined impact of the FocalPoint Guided Screener (GS) Imaging System (BD Diagnostics-TriPath, Burlington, North Carolina) and lean manufacturing principles on the turnaround time (TAT) and productivity of the gynecologic cytology operation. We established a baseline measure of the TAT for Papanicolaou tests. We then compared that to the performance after implementing the FocalPoint GS Imaging System and lean principles. The latter included value-stream mapping, workflow modification, and a first in-first out policy. The mean (SD) TAT for Papanicolaou tests before and after the implementation of FocalPoint GS Imaging System and lean principles was 4.38 (1.28) days and 3.20 (1.32) days, respectively. This represented a 27% improvement in the average TAT, which was statistically significant (P < .001). In addition, the productivity of staff improved 17%, as evidenced by the increase in slides screened from 8.85/h to 10.38/h. The false-negative fraction decreased from 1.4% to 0.9%, representing a 36% improvement. In our laboratory, the implementation of FocalPoint GS Imaging System in conjunction with lean principles resulted in a significant decrease in the average TAT for Papanicolaou tests and a substantial increase in the productivity of cytotechnologists while maintaining the diagnostic quality of gynecologic cytology.

Immunoconjugates and long circulating systems: Origins, current state of the art and future directions☆

PubMed Central

Koshkaryev, Alexander; Sawant, Rupa; Deshpande, Madhura; Torchilin, Vladimir

2012-01-01

Significant progress has been made recently in the area of immunoconjugated drugs and drug delivery systems (DDS). The immuno-modification of either the drug or DDS has proven to be a very promising approach that has significantly improved the targeted accumulation in pathological sites while decreasing its undesirable side effects in healthy tissues. The arrangement for both prolonged life in the circulation and specific target recognition represents another potent strategy in the development of immuno-targeted systems. The longevity of immuno-targeted DDS such as immunoliposomes and immunomicelles improves their targetability even in the presence of the additional passive accumulation in areas with a compromised vasculature. The added use of the immuno-targeted systems takes advantage of the specific microenvironment of pathological sites including lowered pH, increased temperature, and variation in the enzymatic activity. “Smart” stimulus-responsive systems combine different valuable functionalities including PEG-protection, targeting antibody, cell-penetration, and stimulus-sensitive functions. In this review we examined the evolution, current status and future directions in the area of therapeutical immunoconjugates and long-circulating immuno-targeted DDS. PMID:22964425

Diabetes Patient Tracker, a personal digital assistant-based diabetes management system for primary care practices in Oklahoma.

PubMed

Nagykaldi, Zsolt; Mold, James W

2003-01-01

It has been demonstrated that electronic patient registries combined with a clinical decision support system have a significant positive impact on the documentation and delivery of services provided by health care professionals. While implementation of available commercial systems has not always been proven effective in a number of primary care practices, development and implementation of such a system in a practice-based research network might enhance successful implementation. Physicians in our practice-based research network (Oklahoma Physicians Resource/Research Network) initiated a project that aimed at designing, testing, and implementing a personal digital assistant-based diabetes management system. We utilized the "best practice" approach to determine the principles on which the application must operate. System development and beta testing were also accomplished based on the direct feedback of user clinicians. Practice Enhancement Assistants (PEAs) were available in the practices for assistance with implementation. Implementation of the Diabetes Patient Tracker (DPT) resulted in a significant improvement (p<0.05) in nine of 10 diabetic quality of care measures compared with pre-intervention levels in 20 primary care practices. Regular PEA visits similarly increased the number of foot exams and retinal exams performed in the last year (p=0.03 and 0.02, respectively). DPT is a low-cost, feasible, easily implementable, and very effective paper-less tool that significantly improves patient care and documentation in primary care practices.

Enhancing the Effectiveness of Significant Event Analysis: Exploring Personal Impact and Applying Systems Thinking in Primary Care

PubMed Central

McNaughton, Elaine; Bruce, David; Holly, Deirdre; Forrest, Eleanor; Macleod, Marion; Kennedy, Susan; Power, Ailsa; Toppin, Denis; Black, Irene; Pooley, Janet; Taylor, Audrey; Swanson, Vivien; Kelly, Moya; Ferguson, Julie; Stirling, Suzanne; Wakeling, Judy; Inglis, Angela; McKay, John; Sargeant, Joan

2016-01-01

Introduction: Significant event analysis (SEA) is well established in many primary care settings but can be poorly implemented. Reasons include the emotional impact on clinicians and limited knowledge of systems thinking in establishing why events happen and formulating improvements. To enhance SEA effectiveness, we developed and tested “guiding tools” based on human factors principles. Methods: Mixed-methods development of guiding tools (Personal Booklet—to help with emotional demands and apply a human factors analysis at the individual level; Desk Pad—to guide a team-based systems analysis; and a written Report Format) by a multiprofessional “expert” group and testing with Scottish primary care practitioners who submitted completed enhanced SEA reports. Evaluation data were collected through questionnaire, telephone interviews, and thematic analysis of SEA reports. Results: Overall, 149/240 care practitioners tested the guiding tools and submitted completed SEA reports (62.1%). Reported understanding of how to undertake SEA improved postintervention (P < .001), while most agreed that the Personal Booklet was practical (88/123, 71.5%) and relevant to dealing with related emotions (93/123, 75.6%). The Desk Pad tool helped focus the SEA on systems issues (85/123, 69.1%), while most found the Report Format clear (94/123, 76.4%) and would recommend it (88/123, 71.5%). Most SEA reports adopted a systems approach to analyses (125/149, 83.9%), care improvement (74/149, 49.7), or planned actions (42/149, 28.2%). Discussion: Applying human factors principles to SEA potentially enables care teams to gain a systems-based understanding of why things go wrong, which may help with related emotional demands and with more effective learning and improvement. PMID:27583996

Chesapeake Inundation Prediction System (CIPS): A regional prototype for a national problem

USGS Publications Warehouse

Stamey, B.; Smith, W.; Carey, K.; Garbin, D.; Klein, F.; Wang, Hongfang; Shen, J.; Gong, W.; Cho, J.; Forrest, D.; Friedrichs, C.; Boicourt, W.; Li, M.; Koterba, M.; King, D.; Titlow, J.; Smith, E.; Siebers, A.; Billet, J.; Lee, J.; Manning, Douglas R.; Szatkowski, G.; Wilson, D.; Ahnert, P.; Ostrowski, J.

2007-01-01

Recent Hurricanes Katrina and Isabel, among others, not only demonstrated their immense destructive power, but also revealed the obvious, crucial need for improved storm surge forecasting and information delivery to save lives and property in future storms. Current operational methods and the storm surge and inundation products do not adequately meet requirements needed by Emergency Managers (EMs) at local, state, and federal levels to protect and inform our citizens. The Chesapeake Bay Inundation Prediction System (CIPS) is being developed to improve the accuracy, reliability, and capability of flooding forecasts for tropical cyclones and non-tropical wind systems such as nor'easters by modeling and visualizing expected on-land storm-surge inundation along the Chesapeake Bay and its tributaries. An initial prototype has been developed by a team of government, academic and industry partners through the Chesapeake Bay Observing System (CBOS) of the Mid-Atlantic Coastal Ocean Observing Regional Association (MACOORA) within the Integrated Ocean Observing System (IOOS). For demonstration purposes, this initial prototype was developed for the tidal Potomac River in the Washington, DC metropolitan area. The preliminary information from this prototype shows great potential as a mechanism by which NOAA National Weather Service (NWS) Forecast Offices (WFOs) can provide more specific and timely forecasts of likely inundation in individual localities from significant storm surge events. This prototype system has shown the potential to indicate flooding at the street level, at time intervals of an hour or less, and with vertical resolution of one foot or less. This information will significantly improve the ability of EMs and first responders to mitigate life and property loss and improve evacuation capabilities in individual communities. This paper provides an update and expansion of the initial prototype that was presented at the Oceans 2006 MTS/IEEE Conference in Boston, MA. ??2007 MTS.

Enhancing the Effectiveness of Significant Event Analysis: Exploring Personal Impact and Applying Systems Thinking in Primary Care.

PubMed

Bowie, Paul; McNaughton, Elaine; Bruce, David; Holly, Deirdre; Forrest, Eleanor; Macleod, Marion; Kennedy, Susan; Power, Ailsa; Toppin, Denis; Black, Irene; Pooley, Janet; Taylor, Audrey; Swanson, Vivien; Kelly, Moya; Ferguson, Julie; Stirling, Suzanne; Wakeling, Judy; Inglis, Angela; McKay, John; Sargeant, Joan

2016-01-01

Significant event analysis (SEA) is well established in many primary care settings but can be poorly implemented. Reasons include the emotional impact on clinicians and limited knowledge of systems thinking in establishing why events happen and formulating improvements. To enhance SEA effectiveness, we developed and tested "guiding tools" based on human factors principles. Mixed-methods development of guiding tools (Personal Booklet-to help with emotional demands and apply a human factors analysis at the individual level; Desk Pad-to guide a team-based systems analysis; and a written Report Format) by a multiprofessional "expert" group and testing with Scottish primary care practitioners who submitted completed enhanced SEA reports. Evaluation data were collected through questionnaire, telephone interviews, and thematic analysis of SEA reports. Overall, 149/240 care practitioners tested the guiding tools and submitted completed SEA reports (62.1%). Reported understanding of how to undertake SEA improved postintervention (P < .001), while most agreed that the Personal Booklet was practical (88/123, 71.5%) and relevant to dealing with related emotions (93/123, 75.6%). The Desk Pad tool helped focus the SEA on systems issues (85/123, 69.1%), while most found the Report Format clear (94/123, 76.4%) and would recommend it (88/123, 71.5%). Most SEA reports adopted a systems approach to analyses (125/149, 83.9%), care improvement (74/149, 49.7), or planned actions (42/149, 28.2%). Applying human factors principles to SEA potentially enables care teams to gain a systems-based understanding of why things go wrong, which may help with related emotional demands and with more effective learning and improvement.

78 FR 18083 - Regulation Systems Compliance and Integrity

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-25

... and procedures reasonably designed to ensure that their systems have levels of capacity, integrity... 1980s.\\13\\ The Commission acknowledged improvements in efficiency during that time period, but noted... an as-needed basis, as well as provide real- time notification of unusual events, such as significant...

Implementing System-Level Graduation Standards

ERIC Educational Resources Information Center

Moore, Carol A.; Wilks, Karrin E.

2011-01-01

Driven by external pressure for increased accountability and internal pressure for improved learning outcomes, colleges across the country have been developing and refining assessment systems for several decades. In some cases, assessment results have significant positive impact. In other cases, the results have little impact, are not seen as…

Conservation agriculture improves yield and reduces weeding activity in sandy soils of Cambodia

USDA-ARS?s Scientific Manuscript database

Intensive tillage in many less-developed countries, including Cambodia have caused significant decline in agriculture’s natural resources and sustainability. With limited available data, long-term conventional tillage system (CT) and conservation agriculture system (CA) can affect changes in soil pr...

Intelligent transportation systems for improving traffic energy efficiency and reducing GHG emissions from roadways : a white paper from the National Center for Sustainable Transportation.

DOT National Transportation Integrated Search

2015-11-01

The field of Intelligent Transportation Systems (ITS) has : witnessed significantly increased activity in recent years, : with the application of modern control, communications, : and information technologies to vehicles and roadway : infrastructure....

Oil-Free Rotor Support Technologies for an Optimized Helicopter Propulsion System

NASA Technical Reports Server (NTRS)

DellaCorte, Christopher; Bruckner, Robert J.

2007-01-01

An optimized rotorcraft propulsion system incorporating a foil air bearing supported Oil-Free engine coupled to a high power density gearbox using high viscosity gear oil is explored. Foil air bearings have adequate load capacity and temperature capability for the highspeed gas generator shaft of a rotorcraft engine. Managing the axial loads of the power turbine shaft (low speed spool) will likely require thrust load support from the gearbox through a suitable coupling or other design. Employing specially formulated, high viscosity gear oil for the transmission can yield significant improvements (approx. 2X) in allowable gear loading. Though a completely new propulsion system design is needed to implement such a system, improved performance is possible.

Integrated Flight-propulsion Control Concepts for Supersonic Transport Airplanes

NASA Technical Reports Server (NTRS)

Burcham, Frank W., Jr.; Gilyard, Glenn B.; Gelhausen, Paul A.

1990-01-01

Integration of propulsion and flight control systems will provide significant performance improvements for supersonic transport airplanes. Increased engine thrust and reduced fuel consumption can be obtained by controlling engine stall margin as a function of flight and engine operating conditions. Improved inlet pressure recovery and decreased inlet drag can result from inlet control system integration. Using propulsion system forces and moments to augment the flight control system and airplane stability can reduce the flight control surface and tail size, weight, and drag. Special control modes may also be desirable for minimizing community noise and for emergency procedures. The overall impact of integrated controls on the takeoff gross weight for a generic high speed civil transport is presented.

ThedaCare's business performance system: sustaining continuous daily improvement through hospital management in a lean environment.

PubMed

Barnas, Kim

2011-09-01

For 2003-2008, ThedaCare, a community health system in Wisconsin, achieved significant improvements in quality and the elimination of waste through the development of an improvement system, which included Value Stream analysis, rapid improvement events, and projects applied to specific processes. However, to meet its continuous daily improvement goals, particularly the goal of increasing productivity by 10% annually, ThedaCare needed to change the way its managers and leaders (in its hospital division) conduct and manage their daily work. Accordingly, it developed its Business Performance System (BPS) to achieve and sustain continuous daily improvement. BUILDING THE BPS: ThedaCare devised a multipart pilot project, consisting of "learning to see" and then, "problem solving." On completion of the 15-week alpha phase (6 units) in July 2009, the BPS was spread to the beta pilot (12 units; September 2009-January 2010) and then to cohort 3 (10 units; September 2010-January 2011). Each alpha unit improved performance on (1) the key driver metric of increasing productivity from 2008 to year-end 2009 (by 1%-11%) and (2) its respective safety/ quality drivers over the respective 2008 baselines. For 2010, improvements across the alpha, beta, and cohort 3 units were found for 11 of the 14 safety/quality drivers-85% of the 11 customer satisfaction drivers, 83% of 6 people engagement drivers; and 48% of 23 financial stewardship drivers. The tools developed for the BPS have enabled teams to see, prioritize, and pursue continuous daily improvement opportunities. Unit leaders now have a structured management reporting system to reduce variation in their management styles. Leaders all now follow leadership standard work, and their daily work is now consistently aligned with the hospital and system strategy.

Walking ability as a measure of treatment effect in early rheumatoid arthritis.

PubMed

Hamilton, J; Brydson, G; Fraser, S; Grant, M

2001-04-01

To assess the clinical usefulness of a prototype walkmat system in patients with early rheumatoid arthritis (RA). Twenty-four subjects with early RA and symptomatic forefoot disease requiring therapy with second-line drugs were recruited. Each subject underwent clinical assessment together with gait analysis on the contact sensitive walkmat system and Kistler forceplate before and after six months of treatment with second-line drugs. Two subjects were lost to follow-up. There was the expected improvement in disease activity in response to therapy. Significant differences were also demonstrated in defined gait parameters that indicated improved weight-bearing and enhanced forefoot propulsion. Medical therapy improved walking ability in patients with RA and the walkmat system provided a useful adjunct to existing outcome measures in the assessment of lower limb function.

The precision of today's satellite laser ranging systems

NASA Astrophysics Data System (ADS)

Dunn, Peter J.; Torrence, Mark H.; Hussen, Van S.; Pearlman, Michael R.

1993-06-01

Recent improvements in the accuracy of modern satellite laser ranging (SLR) systems are strengthened by the new capability of many instruments to track an increasing number of geodetic satellite targets without significant scheduling conflict. This will allow the refinement of some geophysical parameters, such as solid Earth tidal effects and GM, and the improved temporal resolution of others, such as Earth orientation and station position. Better time resolution for the locations of fixed observatories will allow us to monitor more subtle motions at the stations, and transportable systems will be able to provide indicators of long term trends with shorter occupations. If we are to take advantage of these improvements, care must be taken to preserve the essential accuracy of an increasing volume of range observations at each stage of the data reduction process.

The precision of today's satellite laser ranging systems

NASA Technical Reports Server (NTRS)

Dunn, Peter J.; Torrence, Mark H.; Hussen, Van S.; Pearlman, Michael R.

1993-01-01

Recent improvements in the accuracy of modern satellite laser ranging (SLR) systems are strengthened by the new capability of many instruments to track an increasing number of geodetic satellite targets without significant scheduling conflict. This will allow the refinement of some geophysical parameters, such as solid Earth tidal effects and GM, and the improved temporal resolution of others, such as Earth orientation and station position. Better time resolution for the locations of fixed observatories will allow us to monitor more subtle motions at the stations, and transportable systems will be able to provide indicators of long term trends with shorter occupations. If we are to take advantage of these improvements, care must be taken to preserve the essential accuracy of an increasing volume of range observations at each stage of the data reduction process.

The role of public insurance and the public delivery system in improving birth outcomes for low-income pregnant women.

PubMed

Susan Marquis, M; Long, Stephen H

2002-11-01

Insurance expansions and service delivery system expansions are alternative policy instruments used to try to improve birth outcomes for low-income women. The objective of this research is to investigate the effect of expansions of public insurance on access and birth outcomes for pregnant women and the role of different delivery systems in these outcomes. The experience in Florida during the years 1989-1994 is studied. Data are from linked birth certificates, hospital discharge data, Medicaid eligibility and claims files, and county health department records. Use of prenatal care and birthweight for low-income women is compared under different financing for prenatal care and for those using different delivery systems. Several approaches to control for self-selection are adopted, and similar results are obtained with each. Women enrolled in Medicaid have more prenatal care visits than the uninsured. Outcomes for those on Medicaid and the uninsured are significantly better if they receive care in the public health system than if they receive care in the private system-including private offices, clinics, and HMOs. Over time, the gap in outcomes between those in the public system and those receiving prenatal care from private physicians has diminished. Public insurance improves access to services, but the delivery system is a key factor in improving outcomes.

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

PubMed

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

2016-01-01

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

Improving Balance Function Using Low Levels of Electrical Stimulation of the Balance Organs

NASA Technical Reports Server (NTRS)

Bloomberg, Jacob; Reschke, Millard; Mulavara, Ajitkumar; Wood, Scott; Serrador, Jorge; Fiedler, Matthew; Kofman, Igor; Peters, Brian T.; Cohen, Helen

2012-01-01

Crewmembers returning from long-duration space flight face significant challenges due to the microgravity-induced inappropriate adaptations in balance/sensorimotor function. The Neuroscience Laboratory at JSC is developing a method based on stochastic resonance to enhance the brain's ability to detect signals from the balance organs of the inner ear and use them for rapid improvement in balance skill, especially when combined with balance training exercises. This method involves a stimulus delivery system that is wearable/portable and provides imperceptible electrical stimulation to the balance organs of the human body. Stochastic resonance (SR) is a phenomenon whereby the response of a nonlinear system to a weak periodic input signal is optimized by the presence of a particular non-zero level of noise. This phenomenon of SR is based on the concept of maximizing the flow of information through a system by a non-zero level of noise. Application of imperceptible SR noise coupled with sensory input in humans has been shown to improve motor, cardiovascular, visual, hearing, and balance functions. SR increases contrast sensitivity and luminance detection; lowers the absolute threshold for tone detection in normal hearing individuals; improves homeostatic function in the human blood pressure regulatory system; improves noise-enhanced muscle spindle function; and improves detection of weak tactile stimuli using mechanical or electrical stimulation. SR noise has been shown to improve postural control when applied as mechanical noise to the soles of the feet, or when applied as electrical noise at the knee and to the back muscles. SR using imperceptible stochastic electrical stimulation of the vestibular system (stochastic vestibular stimulation, SVS) applied to normal subjects has shown to improve the degree of association between the weak input periodic signals introduced via venous blood pressure receptors and the heart-rate responses. Also, application of SVS over 24 hours improves the long-term heart-rate dynamics and motor responsiveness as indicated by daytime trunk activity measurements in patients with multi-system atrophy, Parkinson s disease, or both, including patients who were unresponsive to standard therapy for Parkinson s disease. Recent studies conducted at the NASA JSC Neurosciences Laboratories showed that imperceptible SVS, when applied to normal young healthy subjects, leads to significantly improved balance performance during postural disturbances on unstable compliant surfaces. These studies have shown the benefit of SR noise characteristic optimization with imperceptible SVS in the frequency range of 0-30 Hz, and amplitudes of stimulation have ranged from 100 to 400 microamperes.

What's happened to Georgia's mental health reform?

PubMed

Elliott, R L

1995-02-01

In April 1993, Governor Miller signed House Bill (HB) 100, intended to reform Georgia's mental health system. This legislation called for, among other things, the creation of Regional and Community Service Boards designed to empower consumers and families served by the mental health system. This report reviews the rationale behind HB 100 and progress made toward implementing the legislation. Several problems are discussed which may severely impede actual reform, including the system fragmentation created by the new Regional Board system. A proposal is made to further improve Georgia's mental health system by creating a separate Department of Mental Health governed by a Board having significant consumer and family membership, reducing the number of Regional Boards, and developing a system of performance measures to monitor the progress of reform and to improve accountability.

Importance of relationship quality in the success of data warehouse systems

NASA Astrophysics Data System (ADS)

Almabhouh, Alaaeddin; Saleh, Abdul; Ahmad, Azizah

2011-10-01

Increased organizational dependence on data warehouse (DW) systems drives management attention towards improving DW systems success. However, the successful implementation rate of DW systems is low and many firms did not achieve intended goals. A recent studies show that improves and evaluates DW success is one of the top concerns facing IT/DW executives. Existing information system (IS) research has studied DW success more from information quality and system quality. Researchers argue in this study that we should also take the relationship quality, which has significant research and practical implications in that it connects to IS success directly. As our first attempt, this study, referring to both IS and marketing literature, examines how communication, coordination, cooperation, commitment, and trust can be achieved to some degrees by high quality relationships between DW parties.

Leveraging Health Information Technology to Improve Quality in Federal Healthcare.

PubMed

Weigel, Fred K; Switaj, Timothy L; Hamilton, Jessica

2015-01-01

Healthcare delivery in America is extremely complex because it is comprised of a fragmented and nonsystematic mix of stakeholders, components, and processes. Within the US healthcare structure, the federal healthcare system is poised to lead American medicine in leveraging health information technology to improve the quality of healthcare. We posit that through developing, adopting, and refining health information technology, the federal healthcare system has the potential to transform federal healthcare quality by managing the complexities associated with healthcare delivery. Although federal mandates have spurred the widespread use of electronic health records, other beneficial technologies have yet to be adopted in federal healthcare settings. The use of health information technology is fundamental in providing the highest quality, safest healthcare possible. In addition, health information technology is valuable in achieving the Agency for Healthcare Research and Quality's implementation goals. We conducted a comprehensive literature search using the Google Scholar, PubMed, and Cochrane databases to identify an initial list of articles. Through a thorough review of the titles and abstracts, we identified 42 articles as having relevance to health information technology and quality. Through our exclusion criteria of currency of the article, citation frequency, applicability to the federal health system, and quality of research supporting conclusions, we refined the list to 11 references from which we performed our analysis. The literature shows that the use of computerized physician order entry has significantly increased accurate medication dosage and decreased medication errors. The use of clinical decision support systems have significantly increased physician adherence to guidelines, although there is little evidence that indicates any significant correlation to patient outcomes. Research shows that interoperability and usability are continuing challenges for implementation. The Veterans Administration is the only entity within the federal health system that has published research on the use of health information technology to improve quality. The federal healthcare system has existing systems in place with computerized physician order entry systems and clinical decision support systems, but these should be advanced. Particular focus and attention should be placed on data mining capabilities, integrating the electronic health record across all aspects of care, using the electronic health record to improve quality at the point of care, and developing interoperable and usable health information technology.

Computer Security: The Human Element.

ERIC Educational Resources Information Center

Guynes, Carl S.; Vanacek, Michael T.

1981-01-01

The security and effectiveness of a computer system are dependent on the personnel involved. Improved personnel and organizational procedures can significantly reduce the potential for computer fraud. (Author/MLF)

Building Capacity for Trauma-Informed Care in the Child Welfare System: Initial Results of a Statewide Implementation.

PubMed

Lang, Jason M; Campbell, Kimberly; Shanley, Paul; Crusto, Cindy A; Connell, Christian M

2016-05-01

Exposure to childhood trauma is a major public health concern and is especially prevalent among children in the child welfare system (CWS). State and tribal CWSs are increasingly focusing efforts on identifying and serving children exposed to trauma through the creation of trauma-informed systems. This evaluation of a statewide initiative in Connecticut describes the strategies used to create a trauma-informed CWS, including workforce development, trauma screening, policy change, and improved access to evidence-based trauma-focused treatments during the initial 2-year implementation period. Changes in system readiness and capacity to deliver trauma-informed care were evaluated using stratified random samples of child welfare staff who completed a comprehensive assessment prior to (N = 223) and 2 years following implementation (N = 231). Results indicated significant improvements in trauma-informed knowledge, practice, and collaboration across nearly all child welfare domains assessed, suggesting system-wide improvements in readiness and capacity to provide trauma-informed care. Variability across domains was observed, and frontline staff reported greater improvements than supervisors/managers in some domains. Lessons learned and recommendations for implementation and evaluation of trauma-informed care in child welfare and other child-serving systems are discussed. © The Author(s) 2016.

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

PubMed Central

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

2006-01-01

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

Applying dynamic data collection to improve dry electrode system performance for a P300-based brain-computer interface

NASA Astrophysics Data System (ADS)

Clements, J. M.; Sellers, E. W.; Ryan, D. B.; Caves, K.; Collins, L. M.; Throckmorton, C. S.

2016-12-01

Objective. Dry electrodes have an advantage over gel-based ‘wet’ electrodes by providing quicker set-up time for electroencephalography recording; however, the potentially poorer contact can result in noisier recordings. We examine the impact that this may have on brain-computer interface communication and potential approaches for mitigation. Approach. We present a performance comparison of wet and dry electrodes for use with the P300 speller system in both healthy participants and participants with communication disabilities (ALS and PLS), and investigate the potential for a data-driven dynamic data collection algorithm to compensate for the lower signal-to-noise ratio (SNR) in dry systems. Main results. Performance results from sixteen healthy participants obtained in the standard static data collection environment demonstrate a substantial loss in accuracy with the dry system. Using a dynamic stopping algorithm, performance may have been improved by collecting more data in the dry system for ten healthy participants and eight participants with communication disabilities; however, the algorithm did not fully compensate for the lower SNR of the dry system. An analysis of the wet and dry system recordings revealed that delta and theta frequency band power (0.1-4 Hz and 4-8 Hz, respectively) are consistently higher in dry system recordings across participants, indicating that transient and drift artifacts may be an issue for dry systems. Significance. Using dry electrodes is desirable for reduced set-up time; however, this study demonstrates that online performance is significantly poorer than for wet electrodes for users with and without disabilities. We test a new application of dynamic stopping algorithms to compensate for poorer SNR. Dynamic stopping improved dry system performance; however, further signal processing efforts are likely necessary for full mitigation.

Do Online Information Retrieval Systems Help Experienced Clinicians Answer Clinical Questions?

PubMed Central

Westbrook, Johanna I.; Coiera, Enrico W.; Gosling, A. Sophie

2005-01-01

Objective: To assess the impact of clinicians' use of an online information retrieval system on their performance in answering clinical questions. Design: Pre-/post-intervention experimental design. Measurements: In a computer laboratory, 75 clinicians (26 hospital-based doctors, 18 family practitioners, and 31 clinical nurse consultants) provided 600 answers to eight clinical scenarios before and after the use of an online information retrieval system. We examined the proportion of correct answers pre- and post-intervention, direction of change in answers, and differences between professional groups. Results: System use resulted in a 21% improvement in clinicians' answers, from 29% (95% confidence interval [CI] 25.4–32.6) correct pre- to 50% (95% CI 46.0–54.0) post-system use. In 33% (95% CI 29.1–36.9) answers were changed from incorrect to correct. In 21% (95% CI 17.1–23.9) correct pre-test answers were supported by evidence found using the system, and in 7% (95% CI 4.9–9.1) correct pre-test answers were changed incorrectly. For 40% (35.4–43.6) of scenarios, incorrect pre-test answers were not rectified following system use. Despite significant differences in professional groups' pre-test scores [family practitioners: 41% (95% CI 33.0–49.0), hospital doctors: 35% (95% CI 28.5–41.2), and clinical nurse consultants: 17% (95% CI 12.3–21.7; χ2 = 29.0, df = 2, p < 0.01)], there was no difference in post-test scores. (χ2 = 2.6, df = 2, p = 0.73). Conclusions: The use of an online information retrieval system was associated with a significant improvement in the quality of answers provided by clinicians to typical clinical problems. In a small proportion of cases, use of the system produced errors. While there was variation in the performance of clinical groups when answering questions unaided, performance did not differ significantly following system use. Online information retrieval systems can be an effective tool in improving the accuracy of clinicians' answers to clinical questions. PMID:15684126

Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial.

PubMed

Fiks, Alexander G; Mayne, Stephanie L; Michel, Jeremy J; Miller, Jeffrey; Abraham, Manju; Suh, Andrew; Jawad, Abbas F; Guevara, James P; Grundmeier, Robert W; Blum, Nathan J; Power, Thomas J

2017-10-01

To evaluate a distance-learning, quality improvement intervention to improve pediatric primary care provider use of attention-deficit/hyperactivity disorder (ADHD) rating scales. Primary care practices were cluster randomized to a 3-part distance-learning, quality improvement intervention (web-based education, collaborative consultation with ADHD experts, and performance feedback reports/calls), qualifying for Maintenance of Certification (MOC) Part IV credit, or wait-list control. We compared changes relative to a baseline period in rating scale use by study arm using logistic regression clustered by practice (primary analysis) and examined effect modification by level of clinician participation. An electronic health record-linked system for gathering ADHD rating scales from parents and teachers was implemented before the intervention period at all sites. Rating scale use was ascertained by manual chart review. One hundred five clinicians at 19 sites participated. Differences between arms were not significant. From the baseline to intervention period and after implementation of the electronic system, clinicians in both study arms were significantly more likely to administer and receive parent and teacher rating scales. Among intervention clinicians, those who participated in at least 1 feedback call or qualified for MOC credit were more likely to give parents rating scales with differences of 14.2 (95% confidence interval [CI], 0.6-27.7) and 18.8 (95% CI, 1.9-35.7) percentage points, respectively. A 3-part clinician-focused distance-learning, quality improvement intervention did not improve rating scale use. Complementary strategies that support workflows and more fully engage clinicians may be needed to bolster care. Electronic systems that gather rating scales may help achieve this goal. Index terms: ADHD, primary care, quality improvement, clinical decision support.

Launcher Systems Development Cost: Behavior, Uncertainty, Influences, Barriers and Strategies for Reduction

NASA Technical Reports Server (NTRS)

Shaw, Eric J.

2001-01-01

This paper will report on the activities of the IAA Launcher Systems Economics Working Group in preparations for its Launcher Systems Development Cost Behavior Study. The Study goals include: improve launcher system and other space system parametric cost analysis accuracy; improve launcher system and other space system cost analysis credibility; and provide launcher system and technology development program managers and other decisionmakers with useful information on development cost impacts of their decisions. The Working Group plans to explore at least the following five areas in the Study: define and explain development cost behavior terms and concepts for use in the Study; identify and quantify sources of development cost and cost estimating uncertainty; identify and quantify significant influences on development cost behavior; identify common barriers to development cost understanding and reduction; and recommend practical, realistic strategies to accomplish reductions in launcher system development cost.

Effectiveness of a computer-aided neuroanatomy program for entry-level physical therapy students: anatomy and clinical examination of the dorsal column-medial lemniscal system.

PubMed

McKeough, D Michael; Mattern-Baxter, Katrin; Barakatt, Edward

2010-01-01

The purpose of this study was to determine if a computer-aided instruction learning module improves students' knowledge of the neuroanatomy/physiology and clinical examination of the dorsal column-medial lemniscal (DCML) system. Sixty-one physical therapy students enrolled in a clinical neurology course in entry-level PT educational programs at two universities participated in the study. Students from University-1 (U1;) had not had a previous neuroanatomy course, while students from University-2 (U2;) had taken a neuroanatomy course in the previous semester. Before and after working with the learning module, students took a paper-and-pencil test on the neuroanatomy/physiology and clinical examination of the DCML system. Kruskal-Wallis one-way ANOVA and Mann-Whitney tests were used to determine if differences existed between neuroanatomy/physiology examination scores and clinical examination scores before and after taking the learning module, and between student groups based on university attended. For students from U1, neuroanatomy/physiology post-test scores improved significantly over pre-test scores (p < 0.001), while post-test scores of students from U2 did not (p = 0.60). Neuroanatomy/physiology pre-test scores from U2 were significantly better than those from U1 (p < 0.001); there was no significant difference in post-test scores (p = 0.062). Clinical examination pre-test and post-test scores from U2 were significantly better than those from U1 (p < 0.001). Clinical examination post-test scores improved significantly from the pre-test scores for both U1 (p < 0.001) and U2 (p < 0.001).

Design of lipid-based delivery systems for improving lymphatic transport and bioavailability of delta-tocopherol and nobiletin

NASA Astrophysics Data System (ADS)

Xia, Chunxin

Lymphatic drug transport can confer bioavailability advantage by avoiding the first-pass metabolism normally observed in the portal vein hepatic route. It was reported that long chain lipid-based delivery systems can stimulate the formation of chylomicron and thus promote the lymphatic transport of drugs. In this study, a novel delta-tocopherol (delta-T) loaded Solid Lipid Nanoparticle (SLN) system was developed to investigate its effect on promoting the lymphatic transport of delta-T. The delta-T SLN was prepared with hot melt emulsification method by using glyceryl behenate (compritol RTM888) as the lipid phase and lecithin (PC75) as the emulsifier. Formula configuration, processing condition and loading capacity were carefully optimized. Physicochemical properties (particle size, surface charge, morphology) were also characterized. Moreover, excellent stability of the developed delta-T SLN in the gastrointestinal environment was observed by using an in vitro digestion model. Further investigations of the SLN in stimulating delta-T lymphatic transport were performed on mice without cannulation. Compared with the control group (delta-T corn oil dispersion), much lower delta-T levels in both blood and liver indicated reduced portal vein and hepatic transport of delta-T in the form of SLN. On the other hand, significantly higher concentrations of delta-T were observed in thymus, a major lymphatic tissue, indicating improved lymphatic transport of delta-T with the SLN delivery system. Finally, the far less excreted delta-T level in feces further confirmed improved lymphatic transport and overall bioavailability of delta-T by using SLN system. Nobiletin (NOB), one of most abundant polymethoxyflavones (PMFs) found in Citrus genus, has a low solubility in both water and oil at ambient temperatures. Thus it tends to form crystals when the loading exceeds its saturation level in the carrier system. This character greatly impaired its bioavailability and application. To overcome these problems, an O/W nanoemulsion was developed for NOB delivery with the presence of cremophor EL (a polyethoxylated excipient). The developed formulation can achieve a high NOB loading (0.5 wt%) with significantly reduced crystallinity and excellent physical stability. NOB's bioaccessibility and permeation rate across the enterocytes were demonstrated to be significantly improved by the in vitro digestion model and Caco-2 cell monolayer, respectively. It is thus predictable that NOB's bioavailability can be improved with our developed nanoemulsion formulation.

Improved simulation of river water and groundwater exchange in an alluvial plain using the SWAT model

USDA-ARS?s Scientific Manuscript database

Hydrological interaction between surface and subsurface water systems has a significant impact on water quality, ecosystems and biogeochemistry cycling of both systems. Distributed models have been developed to simulate this function, but they require detailed spatial inputs and extensive computati...

Improved System Yields $100,000 Annual Savings (Systems Analysis at Alcoa Yields Significant Savings)

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

None

1999-01-01

In another Office of Industrial Technologies Motor Challenge Success Story, Alcoa (formerly Alumax) aluminum reduced annual energy consumption by 12% and reduced both maintenance and noise levels. Order this fact sheet now to learn how your company can both increase energy efficiency and decrease pollution.

Systematically Evaluating the Effectiveness of Quality Assurance Programmes in Leading to Improvements in Institutional Performance

ERIC Educational Resources Information Center

Lillis, Deirdre

2012-01-01

Higher education institutions worldwide invest significant resources in their quality assurance systems. Little empirical evidence exists that demonstrates the effectiveness (or otherwise) of these systems. Methodological approaches for determining effectiveness are also underdeveloped. Self-study-with-peer-review is a widely used model for…

Climate impacts on water quality in the Fort Cobb Reservoir (OK) watershed

USDA-ARS?s Scientific Manuscript database

Agriculture is a dominant land use in the U.S., and significant water quality concerns are associated with agricultural systems and practices. It is essential to understand interactive effects of geology, geomorphology, soils, and climate, with agricultural systems so that we can improve environmen...

Putting Data to Work: Interim Recommendations from The Benchmarking Project

ERIC Educational Resources Information Center

Miles, Marty; Maguire, Sheila; Woodruff-Bolte, Stacy; Clymer, Carol

2010-01-01

As public and private funders have focused on evaluating the effectiveness of workforce development programs, a myriad of data collection systems and reporting processes have taken shape. Navigating these systems takes significant time and energy and often saps frontline providers' capacity to use data internally for program improvement.…

NASA's Earth Science Data Systems: A "Bit of History" and Observations

NASA Technical Reports Server (NTRS)

Ramapriyan, H. K.

2008-01-01

NASA has significantly improved its Earth Science Data Systems over the last two decades. Open data policy and inexpensive (or free) availability of data has promoted data usage by broad research and applications communities. Flexibility, accommodation of diversity, evolvability, responsiveness to community feedback are key to success.

The "REST" Program: A New Treatment System for the Oppositional Defiant Adolescent.

ERIC Educational Resources Information Center

Stein, David B.; Smith, Edward D.

1990-01-01

Compared REST (Real Economy System for Teens) program, which combines behavioral treatment and cognitive restructuring, with traditional talk therapy, which uses primarily cognitive restructuring, in treatment of oppositional defiant adolescents. Results showed significantly greater improvement on all target behaviors (room care, personal hygiene,…

Alternate Assessments Based on Alternate Achievement Standards: Principals' Perceptions

ERIC Educational Resources Information Center

Towles-Reeves, Elizabeth; Kleinert, Harold; Anderman, Lynley

2008-01-01

To improve teaching and assessment for students with the most significant cognitive disabilities and to truly ensure that state accountability systems address the performance of these students, a better understanding of the instructional effects of accountability systems as perceived by school leaders (i.e., principals) is critically important.…

Longitudinal Vision-Related Quality of Life for Patients with Noninfectious Uveitis Treated with Fluocinolone Acetonide Implant or Systemic Corticosteroid Therapy.

PubMed

Sugar, Elizabeth A; Venugopal, Vidya; Thorne, Jennifer E; Frick, Kevin D; Holland, Gary N; Wang, Robert C; Almanzor, Robert; Jabs, Douglas A; Holbrook, Janet T

2017-11-01

To evaluate longitudinal vision-related quality of life (VRQoL) in patients with noninfectious uveitis. Cohort study using randomized controlled trial data. Patients with active or recently active intermediate uveitis, posterior uveitis, or panuveitis enrolled in the Multicenter Steroid Treatment Trial and Follow-up Study. Data from the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) for the first 3 years after randomization were evaluated semiannually. Analyses were stratified by assigned treatment (129 implants vs. 126 systemic therapies) because of substantial differences in the trajectories of VRQoL. The impact of baseline measurements of visual function (visual acuity and visual field), demographics, and disease characteristics was assessed using generalized estimating equations. Primary outcome was the NEI-VFQ-25 composite score over 3 years after randomization. Individuals in both treatment groups showed similar improvement in NEI-VFQ-25 scores after 3 years of follow-up (implant: 11.9 points; 95% confidence interval [CI], 8.6-15.2; P < 0.001; systemic: 9.0 points; 95% CI, 5.6-12.3; P < 0.001; P = 0.21 for interaction). Individuals in the implant group showed a substantial improvement during the first 6 months followed by stable scores, whereas individuals in the systemic group showed a steady improvement over the course of follow-up. Worse initial visual acuity and visual fields were associated with lower initial NEI-VFQ-25 scores for both treatment groups. In the systemic group, these differences were maintained throughout follow-up. In the implant group, individuals with initial visual acuity worse than 20/40 showed additional improvement in NEI-VFQ-25 score to come within -7 points (95% CI, -15.0 to 0.9) of those with visual acuity 20/40 or better initially, a clinically meaningful but not statistically significant difference (P = 0.081). Results based on sensitivity analyses showed similar patterns. Both treatment groups demonstrated significant improvements in NEI-VFQ-25 scores; however, the improvement was immediate for the implant group as opposed to gradual for the systemic group. Poorer visual function was associated significantly with initial differences in NEI-VFQ-25 scores. However, only individuals in the implant group with poor visual acuity were able to overcome their initial deficits by the end of 3 years. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke.

PubMed

Rong, Wei; Li, Waiming; Pang, Mankit; Hu, Junyan; Wei, Xijun; Yang, Bibo; Wai, Honwah; Zheng, Xiaoxiang; Hu, Xiaoling

2017-04-26

It is a challenge to reduce the muscular discoordination in the paretic upper limb after stroke in the traditional rehabilitation programs. In this study, a neuromuscular electrical stimulation (NMES) and robot hybrid system was developed for multi-joint coordinated upper limb physical training. The system could assist the elbow, wrist and fingers to conduct arm reaching out, hand opening/grasping and arm withdrawing by tracking an indicative moving cursor on the screen of a computer, with the support from the joint motors and electrical stimulations on target muscles, under the voluntary intention control by electromyography (EMG). Subjects with chronic stroke (n = 11) were recruited for the investigation on the assistive capability of the NMES-robot and the evaluation of the rehabilitation effectiveness through a 20-session device assisted upper limb training. In the evaluation, the movement accuracy measured by the root mean squared error (RMSE) during the tracking was significantly improved with the support from both the robot and NMES, in comparison with those without the assistance from the system (P < 0.05). The intra-joint and inter-joint muscular co-contractions measured by EMG were significantly released when the NMES was applied to the agonist muscles in the different phases of the limb motion (P < 0.05). After the physical training, significant improvements (P < 0.05) were captured by the clinical scores, i.e., Modified Ashworth Score (MAS, the elbow and the wrist), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT). The EMG-driven NMES-robotic system could improve the muscular coordination at the elbow, wrist and fingers. ClinicalTrials.gov. NCT02117089 ; date of registration: April 10, 2014.

Improvement in the workflow efficiency of treating non-emergency outpatients by using a WLAN-based real-time location system in a level I trauma center.

PubMed

Stübig, Timo; Suero, Eduardo; Zeckey, Christian; Min, William; Janzen, Laura; Citak, Musa; Krettek, Christian; Hüfner, Tobias; Gaulke, Ralph

2013-01-01

Patient localization can improve workflow in outpatient settings, which might lead to lower costs. The existing wireless local area network (WLAN) architecture in many hospitals opens up the possibility of adopting real-time patient tracking systems for capturing and processing position data; once captured, these data can be linked with clinical patient data. To analyze the effect of a WLAN-based real-time patient localization system for tracking outpatients in our level I trauma center. Outpatients from April to August 2009 were included in the study, which was performed in two different stages. In phase I, patient tracking was performed with the real-time location system, but acquired data were not displayed to the personnel. In phase II tracking, the acquired data were automatically collected and displayed. Total treatment time was the primary outcome parameter. Statistical analysis was performed using multiple linear regression, with the significance level set at 0.05. Covariates included sex, age, type of encounter, prioritization, treatment team, number of residents, and radiographic imaging. 1045 patients were included in our study (540 in phase I and 505 in phase 2). An overall improvement of efficiency, as determined by a significantly decreased total treatment time (23.7%) from phase I to phase II, was noted. Additionally, significantly lower treatment times were noted for phase II patients even when other factors were considered (increased numbers of residents, the addition of imaging diagnostics, and comparison among various localization zones). WLAN-based real-time patient localization systems can reduce process inefficiencies associated with manual patient identification and tracking.

The impact of major trauma network triage systems on patients with major burns.

PubMed

Nizamoglu, Metin; O'Connor, Edmund Fitzgerald; Bache, Sarah; Theodorakopoulou, Evgenia; Sen, Sankhya; Sherren, Peter; Barnes, David; Dziewulski, Peter

2016-12-01

Trauma is a leading cause of death and disability worldwide. Patients presenting with severe trauma and burns benefit from specifically trained multidisciplinary teams. Regional trauma systems have shown improved outcomes for trauma patients. The aim of this study is to determine whether the development of major trauma systems have improved the management of patients with major burns. A retrospective study was performed over a four-year period reviewing all major burns in adults and children received at a regional burns centre in the UK before and after the implementation of the regional trauma systems and major trauma centres (MTC). Comparisons were drawn between three areas: (1) Patients presenting before the introduction of MTC and after the introduction of MTC. (2) Patients referred from MTC and non-MTC within the region, following the introduction of MTC. (3) Patients referred using the urban trauma protocol and the rural trauma protocol. Following the introduction of regional trauma systems and major trauma centres (MTC), isolated burn patients seen at our regional burns centre did not show any significant improvement in transfer times, admission resuscitation parameters, organ dysfunction or survival when referred from a MTC compared to a non-MTC emergency department. There was also no significant difference in survival when comparing referrals from all hospitals pre and post establishment of the major trauma network. No significant outcome benefit was demonstrated for burns patients referred via MTCs compared to non-MTCs. We suggest further research is needed to ascertain whether burns patients benefit from prolonged transfer times to a MTC compared to those seen at their local hospitals prior to transfer to a regional burns unit for further specialist care. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Improvement in the workflow efficiency of treating non-emergency outpatients by using a WLAN-based real-time location system in a level I trauma center

PubMed Central

Stübig, Timo; Suero, Eduardo; Zeckey, Christian; Min, William; Janzen, Laura; Citak, Musa; Krettek, Christian; Hüfner, Tobias; Gaulke, Ralph

2013-01-01

Background Patient localization can improve workflow in outpatient settings, which might lead to lower costs. The existing wireless local area network (WLAN) architecture in many hospitals opens up the possibility of adopting real-time patient tracking systems for capturing and processing position data; once captured, these data can be linked with clinical patient data. Objective To analyze the effect of a WLAN-based real-time patient localization system for tracking outpatients in our level I trauma center. Methods Outpatients from April to August 2009 were included in the study, which was performed in two different stages. In phase I, patient tracking was performed with the real-time location system, but acquired data were not displayed to the personnel. In phase II tracking, the acquired data were automatically collected and displayed. Total treatment time was the primary outcome parameter. Statistical analysis was performed using multiple linear regression, with the significance level set at 0.05. Covariates included sex, age, type of encounter, prioritization, treatment team, number of residents, and radiographic imaging. Results/discussion 1045 patients were included in our study (540 in phase I and 505 in phase 2). An overall improvement of efficiency, as determined by a significantly decreased total treatment time (23.7%) from phase I to phase II, was noted. Additionally, significantly lower treatment times were noted for phase II patients even when other factors were considered (increased numbers of residents, the addition of imaging diagnostics, and comparison among various localization zones). Conclusions WLAN-based real-time patient localization systems can reduce process inefficiencies associated with manual patient identification and tracking. PMID:23676246

Defense Acquisitions: How and Where DOD Spends Its Contracting Dollars

DTIC Science & Technology

2015-04-30

process . GSA is undertaking a multi-year effort to improve the reliability and usefulness of the information contained in FPDS and other federal... Improve FPDS According to GSA, a number of data systems, including FPDS, are undergoing a significant overhaul. This overhaul is a multi-year process ...data accuracy and completeness, then initiating a process to ensure that these standards are met, would improve data accuracy and completeness.” U.S

Development and implementation of an expert system to improve the control of nitrification and denitrification in the Vic wastewater treatment plant.

PubMed

Ribas, F; Rodríguez-Roda, I; Serrat, J; Clara, P; Comas, J

2008-05-01

Wastewater treatment plants employ various physical, chemical and biological processes to reduce pollutants from raw wastewater. One of the most important is the biological nitrogen removal process through nitrification and denitrification steps taking place in various sections of the biological reactor. One of the most extensively used configurations to achieve the biological nitrogen removal is an activated sludge system using oxidation ditch or extended aeration. To improve nitrogen removal in the wastewater treatment plant (WWTP) of Vic (Catalonia, NE Spain), the automatic aeration control system was complemented with an Expert System to always provide the most appropriate aeration or anoxia sequence based on the values of ammonium and nitrates given by an automatic analyzer. This article illustrates the development and implementation of this knowledge-based system within the framework of a Decision Support System, which performs SCADA functions. The paper also shows that the application of the decision support system in the Vic WWTP resulted in significant improvements to the biological nitrogen removal.

Documentation Driven Development for Complex Real-Time Systems

DTIC Science & Technology

2004-12-01

This paper presents a novel approach for development of complex real - time systems , called the documentation-driven development (DDD) approach. This... time systems . DDD will also support automated software generation based on a computational model and some relevant techniques. DDD includes two main...stakeholders to be easily involved in development processes and, therefore, significantly improve the agility of software development for complex real

Efficiency and the proposed reforms to the NHS research ethics system

PubMed Central

Hunter, David

2007-01-01

Significant changes are proposed for the research ethics system governing the review of the conduct of medical research in the UK. This paper examines these changes and whether they will meet the aimed‐for goal of improving the efficiency of the research ethics system. The author concludes that, unfortunately, they will not and thus should be rejected. PMID:17971468

A Structural Model for Students' Adoption of Learning Management Systems: An Empirical Investigation in the Higher Education Context

ERIC Educational Resources Information Center

Findik-Coskunçay, Duygu; Alkis, Nurcan; Özkan-Yildirim, Sevgi

2018-01-01

With the recent advances in information technologies, Learning Management Systems have taken on a significant role in providing educational resources. The successful use of these systems in higher education is important for the implementation, management and continuous improvement of e-learning services to increase the quality of learning. This…

Hybrid Power Management Program Evaluated Ultracapacitors for the Next Generation Launch Transportation Project

NASA Technical Reports Server (NTRS)

Eichenberg, Dennis J.

2005-01-01

The NASA Glenn Research Center initiated baseline testing of ultracapacitors to obtain empirical data in determining the feasibility of using ultracapacitors for the Next Generation Launch Transportation (NGLT) Project. There are large transient loads associated with NGLT that require a very large primary energy source or an energy storage system. The primary power source used for this test was a proton-exchange-membrane (PEM) fuel cell. The energy storage system can consist of batteries, flywheels, or ultracapacitors. Ultracapacitors were used for these tests. NASA Glenn has a wealth of experience in ultracapacitor technology through the Hybrid Power Management (HPM) Program, which the Avionics, Power and Communications Branch of Glenn s Engineering Development Division initiated for the Technology Transfer and Partnership Office. HPM is the innovative integration of diverse, state-ofthe- art power devices in optimal configurations for space and terrestrial applications. The appropriate application and control of the various advanced power devices (such as ultracapacitors and fuel cells) significantly improves overall system performance and efficiency. HPM has extremely wide potential. Applications include power generation, transportation systems, biotechnology systems, and space power systems. HPM has the potential to significantly alleviate global energy concerns, improve the environment, and stimulate the economy.

Implementation of a departmental picture archiving and communication system: a productivity and cost analysis.

PubMed

Macyszyn, Luke; Lega, Brad; Bohman, Leif-Erik; Latefi, Ahmad; Smith, Michelle J; Malhotra, Neil R; Welch, William; Grady, Sean M

2013-09-01

Digital radiology enhances productivity and results in long-term cost savings. However, the viewing, storage, and sharing of outside imaging studies on compact discs at ambulatory offices and hospitals pose a number of unique challenges to a surgeon's efficiency and clinical workflow. To improve the efficiency and clinical workflow of an academic neurosurgical practice when evaluating patients with outside radiological studies. Open-source software and commercial hardware were used to design and implement a departmental picture archiving and communications system (PACS). The implementation of a departmental PACS system significantly improved productivity and enhanced collaboration in a variety of clinical settings. Using published data on the rate of information technology problems associated with outside studies on compact discs, this system produced a cost savings ranging from $6250 to $33600 and from $43200 to $72000 for 2 cohorts, urgent transfer and spine clinic patients, respectively, therefore justifying the costs of the system in less than a year. The implementation of a departmental PACS system using open-source software is straightforward and cost-effective and results in significant gains in surgeon productivity when evaluating patients with outside imaging studies.

Improvement of impaired albumin binding capacity in acute-on-chronic liver failure by albumin dialysis.

PubMed

Klammt, Sebastian; Mitzner, Steffen R; Stange, Jan; Loock, Jan; Heemann, Uwe; Emmrich, Jörg; Reisinger, Emil C; Schmidt, Reinhard

2008-09-01

Extracorporeal albumin dialysis (ECAD) enables the elimination of albumin bound substances and is used as artificial liver support system. Albumin binding function for the benzodiazepine binding site specific marker Dansylsarcosine was estimated in plasma samples of 22 patients with cirrhosis and hyperbilirubinaemia (ECAD: n = 12; control: n = 10) during a period of 30 days in a randomized controlled clinical ECAD trial. Albumin Binding Capacity (ABiC) at baseline was reduced to 31.8% (median; range 24%-74%) and correlated to the severity of liver disease. Within two weeks a significant improvement of ABiC and a reduction of the albumin bound markers bilirubin and bile acids were observed in the ECAD group. During single treatments a significant decrease of albumin bound substances (bilirubin and bile acids) as well as an increase in ABiC was observed. In the control group, baseline ABiC was significantly lower in patients who died during study period (34.2% vs. 41.7%; P < 0.028), whereas no significant differences were observed for CHILD, coagulation factors, albumin, bile acids nor bilirubin. At baseline 13 patients had a severely impaired ABiC (<40%), improvement of ABiC was more frequent in the ECAD group (5/6) than in the SMT group (2/7). Reduced albumin binding function is present in decompensated liver failure and is related to severity and 30 day survival. ABiC can be improved by ECAD. The beneficial effect of this treatment may be related to the improvement of albumin binding function more than to the elimination of specific substances. Characterization of albumin function by the ABiC test may help to evaluate different liver support systems and other therapeutic measures.

Does a foot-drop implant improve kinetic and kinematic parameters in the foot and ankle?

PubMed

Daniilidis, Kiriakos; Jakubowitz, Eike; Thomann, Anna; Ettinger, Sarah; Stukenborg-Colsman, Christina; Yao, Daiwei

2017-04-01

Unlike the drop foot therapy with ortheses, the therapeutic effect of an implantable peroneus nerve stimulator (iPNS) is not well described. IPNS is a dynamic therapy option which is placed directly to the motoric part of the peroneal nerve and evokes a dorsiflexion of the paralysed foot. This retrospective study evaluates the kinematics and kinetics in drop foot patients who were treated with an iPNS. 18 subjects (mean age 51.3 years) with a chronic stroke-related drop foot were treated with an implantable peroneal nerve stimulator. After a mean follow-up from 12.5 months, kinematics and kinetics as well as spatiotemporal parameters were evaluated and compared in activated and deactivated iPNS. Therefore, a gait analysis with motion capture system (Vicon Motion System Ltd®, Oxford, UK) and Plug-in-Gait model was performed. The study showed significantly improved results in ankle dorsiflexion from 6.8° to 1.8° at the initial contact and from -7.3° to 0.9° during swing phase (p ≤ 0.004 and p ≤ 0.005, respectively). Likewise, we could measure improved kinetics, i.a. with a statistically significant improvement in vertical ground reaction force at loading response from 99.76 to 106.71 N/kg (p = 0.043). Enhanced spatiotemporal results in cadence, douple support, stride length, and walking speed could also be achieved, but without statistical significance (p > 0.05). The results show statistically significant improvement in ankle dorsiflexion and vertical ground reaction forces. These facts indicate a more gait stability and gait efficacy. Therefore, the use of an iPNS appears an encouraging therapeutic option for patients with a stroke-related drop foot.

Performance Analysis on Carrier Phase-Based Tightly-Coupled GPS/BDS/INS Integration in GNSS Degraded and Denied Environments

PubMed Central

Han, Houzeng; Wang, Jian; Wang, Jinling; Tan, Xinglong

2015-01-01

The integration of Global Navigation Satellite Systems (GNSS) carrier phases with Inertial Navigation System (INS) measurements is essential to provide accurate and continuous position, velocity and attitude information, however it is necessary to fix ambiguities rapidly and reliably to obtain high accuracy navigation solutions. In this paper, we present the notion of combining the Global Positioning System (GPS), the BeiDou Navigation Satellite System (BDS) and low-cost micro-electro-mechanical sensors (MEMS) inertial systems for reliable navigation. An adaptive multipath factor-based tightly-coupled (TC) GPS/BDS/INS integration algorithm is presented and the overall performance of the integrated system is illustrated. A twenty seven states TC GPS/BDS/INS model is adopted with an extended Kalman filter (EKF), which is carried out by directly fusing ambiguity fixed double-difference (DD) carrier phase measurements with the INS predicted pseudoranges to estimate the error states. The INS-aided integer ambiguity resolution (AR) strategy is developed by using a dynamic model, a two-step estimation procedure is applied with adaptively estimated covariance matrix to further improve the AR performance. A field vehicular test was carried out to demonstrate the positioning performance of the combined system. The results show the TC GPS/BDS/INS system significantly improves the single-epoch AR reliability as compared to that of GPS/BDS-only or single satellite navigation system integrated strategy, especially for high cut-off elevations. The AR performance is also significantly improved for the combined system with adaptive covariance matrix in the presence of low elevation multipath related to the GNSS-only case. A total of fifteen simulated outage tests also show that the time to relock of the GPS/BDS signals is shortened, which improves the system availability. The results also indicate that TC integration system achieves a few centimeters accuracy in positioning based on the comparison analysis and covariance analysis, even in harsh environments (e.g., in urban canyons), thus we can see the advantage of positioning at high cut-off elevations that the combined GPS/BDS brings. PMID:25875191

Performance analysis on carrier phase-based tightly-coupled GPS/BDS/INS integration in GNSS degraded and denied environments.

PubMed

Han, Houzeng; Wang, Jian; Wang, Jinling; Tan, Xinglong

2015-04-14

The integration of Global Navigation Satellite Systems (GNSS) carrier phases with Inertial Navigation System (INS) measurements is essential to provide accurate and continuous position, velocity and attitude information, however it is necessary to fix ambiguities rapidly and reliably to obtain high accuracy navigation solutions. In this paper, we present the notion of combining the Global Positioning System (GPS), the BeiDou Navigation Satellite System (BDS) and low-cost micro-electro-mechanical sensors (MEMS) inertial systems for reliable navigation. An adaptive multipath factor-based tightly-coupled (TC) GPS/BDS/INS integration algorithm is presented and the overall performance of the integrated system is illustrated. A twenty seven states TC GPS/BDS/INS model is adopted with an extended Kalman filter (EKF), which is carried out by directly fusing ambiguity fixed double-difference (DD) carrier phase measurements with the INS predicted pseudoranges to estimate the error states. The INS-aided integer ambiguity resolution (AR) strategy is developed by using a dynamic model, a two-step estimation procedure is applied with adaptively estimated covariance matrix to further improve the AR performance. A field vehicular test was carried out to demonstrate the positioning performance of the combined system. The results show the TC GPS/BDS/INS system significantly improves the single-epoch AR reliability as compared to that of GPS/BDS-only or single satellite navigation system integrated strategy, especially for high cut-off elevations. The AR performance is also significantly improved for the combined system with adaptive covariance matrix in the presence of low elevation multipath related to the GNSS-only case. A total of fifteen simulated outage tests also show that the time to relock of the GPS/BDS signals is shortened, which improves the system availability. The results also indicate that TC integration system achieves a few centimeters accuracy in positioning based on the comparison analysis and covariance analysis, even in harsh environments (e.g., in urban canyons), thus we can see the advantage of positioning at high cut-off elevations that the combined GPS/BDS brings.

Integrated Chassis Control of Active Front Steering and Yaw Stability Control Based on Improved Inverse Nyquist Array Method

PubMed Central

2014-01-01

An integrated chassis control (ICC) system with active front steering (AFS) and yaw stability control (YSC) is introduced in this paper. The proposed ICC algorithm uses the improved Inverse Nyquist Array (INA) method based on a 2-degree-of-freedom (DOF) planar vehicle reference model to decouple the plant dynamics under different frequency bands, and the change of velocity and cornering stiffness were considered to calculate the analytical solution in the precompensator design so that the INA based algorithm runs well and fast on the nonlinear vehicle system. The stability of the system is guaranteed by dynamic compensator together with a proposed PI feedback controller. After the response analysis of the system on frequency domain and time domain, simulations under step steering maneuver were carried out using a 2-DOF vehicle model and a 14-DOF vehicle model by Matlab/Simulink. The results show that the system is decoupled and the vehicle handling and stability performance are significantly improved by the proposed method. PMID:24782676

Integrated chassis control of active front steering and yaw stability control based on improved inverse nyquist array method.

PubMed

Zhu, Bing; Chen, Yizhou; Zhao, Jian

2014-01-01

An integrated chassis control (ICC) system with active front steering (AFS) and yaw stability control (YSC) is introduced in this paper. The proposed ICC algorithm uses the improved Inverse Nyquist Array (INA) method based on a 2-degree-of-freedom (DOF) planar vehicle reference model to decouple the plant dynamics under different frequency bands, and the change of velocity and cornering stiffness were considered to calculate the analytical solution in the precompensator design so that the INA based algorithm runs well and fast on the nonlinear vehicle system. The stability of the system is guaranteed by dynamic compensator together with a proposed PI feedback controller. After the response analysis of the system on frequency domain and time domain, simulations under step steering maneuver were carried out using a 2-DOF vehicle model and a 14-DOF vehicle model by Matlab/Simulink. The results show that the system is decoupled and the vehicle handling and stability performance are significantly improved by the proposed method.

Towards a global IT system for personalized medicine: the Medicine Safety Code initiative.

PubMed

Samwald, Matthias; Minarro-Giménez, José Antonio; Blagec, Kathrin; Adlassnig, Klaus-Peter

2014-01-01

The availability of pharmacogenomic data of individual patients can significantly improve physicians' prescribing behavior, lead to a reduced incidence of adverse drug events and an improvement of effectiveness of treatment. The Medicine Safety Code (MSC) initiative is an effort to improve the ability of clinicians and patients to share pharmacogenomic data and to use it at the point of care. The MSC is a standardized two-dimensional barcode that captures individual pharmacogenomic data. The system is backed by a web service that allows the decoding and interpretation of anonymous MSCs without requiring the installation of dedicated software. The system is based on a curated, ontology-based knowledge base representing pharmacogenomic definitions and clinical guidelines. The MSC system performed well in preliminary tests. To evaluate the system in realistic health care settings and to translate it into practical applications, the future participation of stakeholders in clinical institutions, researchers, pharmaceutical companies, genetic testing providers, health IT companies and health insurance organizations will be essential.

Towards a global IT system for personalized medicine: the Medicine Safety Code initiative.

PubMed

Samwald, Matthias; Minarro-Giménez, José Antonio; Blagec, Kathrin; Adlassnig, Klaus-Peter

2014-01-01

The availability of pharmacogenomic data of individual patients can significantly improve physicians' prescribing behavior, lead to a reduced incidence of adverse drug events and an improvement of effectiveness of treatment. The Medicine Safety Code (MSC) initiative is an effort to improve the ability of clinicians and patients to share pharmacogenomic data and to use it at the point of care. The MSC is a standardized two-dimensional barcode that captures individual pharmacogenomic data. The system is backed by a web service that allows the decoding and interpretation of anonymous MSCs without requiring the installation of dedicated software. The system is based on a curated, ontology-based knowledge base representing pharmacogenomic definitions and clinical guidelines. The MSC system performed well in preliminary tests. To evaluate the system in realistic health care settings and to translate it into practical applications, the future participation of stakeholders in clinical institutions, medical researchers, pharmaceutical companies, genetic testing providers, health IT companies and health insurance organizations will be essential.

Time Varying Compensator Design for Reconfigurable Structures Using Non-Collocated Feedback

NASA Technical Reports Server (NTRS)

Scott, Michael A.

1996-01-01

Analysis and synthesis tools are developed to improved the dynamic performance of reconfigurable nonminimum phase, nonstrictly positive real-time variant systems. A novel Spline Varying Optimal (SVO) controller is developed for the kinematic nonlinear system. There are several advantages to using the SVO controller, in which the spline function approximates the system model, observer, and controller gain. They are: The spline function approximation is simply connected, thus the SVO controller is more continuous than traditional gain scheduled controllers when implemented on a time varying plant; ft is easier for real-time implementations in storage and computational effort; where system identification is required, the spline function requires fewer experiments, namely four experiments; and initial startup estimator transients are eliminated. The SVO compensator was evaluated on a high fidelity simulation of the Shuttle Remote Manipulator System. The SVO controller demonstrated significant improvement over the present arm performance: (1) Damping level was improved by a factor of 3; and (2) Peak joint torque was reduced by a factor of 2 following Shuttle thruster firings.

Performance improvements of a highly integrated digital electronic control system for an F-15 airplane

NASA Technical Reports Server (NTRS)

Putnam, T. W.; Burcham, F. W., Jr.; Andries, M. G.; Kelly, J. B.

1985-01-01

The NASA highly integrated digital electronic control (HIDEC) program is structured to conduct flight research into the benefits of integrating an aircraft flight control system with the engine control system. A brief description of the HIDEC system installed on an F-15 aircraft is provided. The adaptive engine control system (ADECS) mode is described in detail, together with simulation results and analyses that show the significant excess thrust improvements achievable with the ADECS mode. It was found that this increased thrust capability is accompanied by reduced fan stall margin and can be realized during flight conditions where engine face distortion is low. The results of analyses and simulations also show that engine thrust response is improved and that fuel consumption can be reduced. Although the performance benefits that accrue because of airframe and engine control integration are being demonstrated on an F-15 aircraft, the principles are applicable to advanced aircraft such as the advanced tactical fighter and advanced tactical aircraft.

A small electron donor in cobalt complex electrolyte significantly improves efficiency in dye-sensitized solar cells

PubMed Central

Hao, Yan; Yang, Wenxing; Zhang, Lei; Jiang, Roger; Mijangos, Edgar; Saygili, Yasemin; Hammarström, Leif; Hagfeldt, Anders; Boschloo, Gerrit

2016-01-01

Photoelectrochemical approach to solar energy conversion demands a kinetic optimization of various light-induced electron transfer processes. Of great importance are the redox mediator systems accomplishing the electron transfer processes at the semiconductor/electrolyte interface, therefore affecting profoundly the performance of various photoelectrochemical cells. Here, we develop a strategy—by addition of a small organic electron donor, tris(4-methoxyphenyl)amine, into state-of-art cobalt tris(bipyridine) redox electrolyte—to significantly improve the efficiency of dye-sensitized solar cells. The developed solar cells exhibit efficiency of 11.7 and 10.5%, at 0.46 and one-sun illumination, respectively, corresponding to a 26% efficiency improvement compared with the standard electrolyte. Preliminary stability tests showed the solar cell retained 90% of its initial efficiency after 250 h continuous one-sun light soaking. Detailed mechanistic studies reveal the crucial role of the electron transfer cascade processes within the new redox system. PMID:28000672

Strong Performers and Successful Reformers in Education: Education Policy Advice for Greece

ERIC Educational Resources Information Center

OECD Publishing (NJ1), 2011

2011-01-01

The future of Greece's well-being will depend on improving educational performance to boost productivity and improve social outcomes. In the current economic context, with the need to get best value for spending, Greece must and can address inefficiencies in its education system. The challenges are significant. For example, Greece lags behind many…

Increasing productivity of the McAuto CAD/CAE system by user-specific applications programming

NASA Technical Reports Server (NTRS)

Plotrowski, S. M.; Vu, T. H.

1985-01-01

Significant improvements in the productivity of the McAuto Computer-Aided Design/Computer-Aided Engineering (CAD/CAE) system were achieved by applications programming using the system's own Graphics Interactive Programming language (GRIP) and the interface capabilities with the main computer on which the system resides. The GRIP programs for creating springs, bar charts, finite element model representations and aiding management planning are presented as examples.

Multiple benefits of personal FM system use by children with auditory processing disorder (APD).

PubMed

Johnston, Kristin N; John, Andrew B; Kreisman, Nicole V; Hall, James W; Crandell, Carl C

2009-01-01

Children with auditory processing disorders (APD) were fitted with Phonak EduLink FM devices for home and classroom use. Baseline measures of the children with APD, prior to FM use, documented significantly lower speech-perception scores, evidence of decreased academic performance, and psychosocial problems in comparison to an age- and gender-matched control group. Repeated measures during the school year demonstrated speech-perception improvement in noisy classroom environments as well as significant academic and psychosocial benefits. Compared with the control group, the children with APD showed greater speech-perception advantage with FM technology. Notably, after prolonged FM use, even unaided (no FM device) speech-perception performance was improved in the children with APD, suggesting the possibility of fundamentally enhanced auditory system function.

Structural tests on space shuttle thermal protection system constructed with nondensified and densified Li 900 and LI 2200 tile

NASA Technical Reports Server (NTRS)

Williams, J. G.

1981-01-01

Structural tests were conducted on thermal protection systems (TPS) LI 900 and LI 2200 tiles and .41 cm and .23 cm thick strain isolation pads. The bond surface of selected tiles was densified to obtain improved strength. Four basic types of experiments were conducted including tension tests, substrate mismatch (initial imperfection) tests, tension loads eccentrically applied, and pressure loads applied rapidly to the tile top surface. A small initial imperfection mismatch (2.29 m spherical radius on the substrate) did not influence significantly the ultimate failure strength. Densification of the tile bond region improved the strength of TPS constructed both of LI 900 tile and of LI 2200 tile. Pressure shock conditions studied did not significantly affect the TPS strength.

Reduced nutrient pollution in a rural stream following septic tank upgrade and installation of runoff retention measures.

PubMed

Ockenden, M C; Quinton, J N; Favaretto, N; Deasy, C; Surridge, B

2014-07-01

Surface water quality in the UK and much of Western Europe has improved in recent decades, in response to better point source controls and the regulation of fertilizer, manure and slurry use. However, diffuse sources of pollution, such as leaching or runoff of nutrients from agricultural fields, and micro-point sources including farmyards, manure heaps and septic tank sewerage systems, particularly systems without soil adsorption beds, are now hypothesised to contribute a significant proportion of the nutrients delivered to surface watercourses. Tackling such sources in an integrated manner is vital, if improvements in freshwater quality are to continue. In this research, we consider the combined effect of constructing small field wetlands and improving a septic tank system on stream water quality within an agricultural catchment in Cumbria, UK. Water quality in the ditch-wetland system was monitored by manual sampling at fortnightly intervals (April-October 2011 and February-October 2012), with the septic tank improvement taking place in February 2012. Reductions in nutrient concentrations were observed through the catchment, by up to 60% when considering total phosphorus (TP) entering and leaving a wetland with a long residence time. Average fluxes of TP, soluble reactive phosphorus (SRP) and ammonium-N (NH4-N) at the head of the ditch system in 2011 (before septic tank improvement) compared to 2012 (after septic tank improvement) were reduced by 28%, 9% and 37% respectively. However, TP concentration data continue to show a clear dilution with increasing flow, indicating that the system remained point source dominated even after the septic tank improvement.

A performance improvement case study in aircraft maintenance and its implications for hazard identification.

PubMed

Ward, Marie; McDonald, Nick; Morrison, Rabea; Gaynor, Des; Nugent, Tony

2010-02-01

Aircraft maintenance is a highly regulated, safety critical, complex and competitive industry. There is a need to develop innovative solutions to address process efficiency without compromising safety and quality. This paper presents the case that in order to improve a highly complex system such as aircraft maintenance, it is necessary to develop a comprehensive and ecologically valid model of the operational system, which represents not just what is meant to happen, but what normally happens. This model then provides the backdrop against which to change or improve the system. A performance report, the Blocker Report, specific to aircraft maintenance and related to the model was developed gathering data on anything that 'blocks' task or check performance. A Blocker Resolution Process was designed to resolve blockers and improve the current check system. Significant results were obtained for the company in the first trial and implications for safety management systems and hazard identification are discussed. Statement of Relevance: Aircraft maintenance is a safety critical, complex, competitive industry with a need to develop innovative solutions to address process and safety efficiency. This research addresses this through the development of a comprehensive and ecologically valid model of the system linked with a performance reporting and resolution system.

[Introduction of an accreditation system for hospital informed consent forms].

PubMed

López-Picazo, J J; Tomás-Garcia, N; Calle-Urra, J E; Parra-Hidalgo, P; Valverde-Iniesta, J J

2015-01-01

To describe an accreditation system for informed consent forms (ICF) in a tertiary hospital, as an intervention to improve their quality, and to check the improvements achieved. Following an external evaluation of the ICF quality in a public hospital in Murcia (Spain), an accreditation committee set the ICF requirements and associated procedures. Effectiveness is assessed by comparing two external evaluations carried out by the EMCA Program (2011 and 2013) and based on 19 criteria and a sample of 60 ICF for every public hospital in Murcia Region. To be accredited, every ICF must meet the 19 external criteria plus 5 based on legibility, readability and scientific and technical validity. A form to fill in the contents of every ICF was agreed, which would be reviewed, approved and validated for five years. Before the implementation, 8.2 defects/ICF were detected. The accreditation system obtained an 89% improvement (0.9 defects/ICF) and achieved significant improvements in 18 criteria, 16 of which are benchmarked. The accreditation system achieved a substantial improvement in the ICF (obtaining a better result in external evaluations) and guarantees their contents, legibility and readability. This system needs to be extended to other hospitals, since it is not clear whether common ICFs would be suitable. However, this improvement is structural and does not guarantee that the overall information/consent procedure is done properly, thus complementary strategies for measurement and improvement are required. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Wii-based movement therapy to promote improved upper extremity function post-stroke: a pilot study.

PubMed

Mouawad, Marie R; Doust, Catherine G; Max, Madeleine D; McNulty, Penelope A

2011-05-01

Virtual-reality is increasingly used to improve rehabilitation outcomes. The Nintendo Wii offers an in-expensive alternative to more complex systems. To investigate the efficacy of Wii-based therapy for post-stroke rehabilitation. Seven patients (5 men, 2 women, aged 42-83 years; 1-38 months post-stroke, mean 15.3 months) and 5 healthy controls (3 men, 2 women, aged 41-71 years) undertook 1 h of therapy on 10 consecutive weekdays. Patients progressively increased home practice to 3 h per day. Functional ability improved for every patient. The mean performance time significantly decreased per Wolf Motor Function Test task, from 3.2 to 2.8 s, and Fugl-Meyer Assessment scores increased from 42.3 to 47.3. Upper extremity range-of-motion increased by 20.1º and 14.33º for passive and active movements, respectively. Mean Motor Activity Log (Quality of Movement scale) scores increased from 63.2 to 87.5, reflecting a transfer of functional recovery to everyday activities. Balance and dexterity did not improve significantly. No significant change was seen in any of these measures for healthy controls, despite improved skill levels for Wii games. An intensive 2-week protocol resulted in significant and clinically relevant improvements in functional motor ability post-stroke. These gains translated to improvement in activities of daily living.

[Nanotechnology, nanomedicine and nanopharmacology].

PubMed

Fernández, Pedro Lorenzo

2007-01-01

Based on Nanotechnology methods, Nanomedicine and Nanotecnology will obtain significant advances in areas such as Diagnostic, Regenerative Medicine and pharmacological Therapeutics. With nanotechnology-based drug delivery systems,important improvement on pharmacokinetics of drugs will take place, due to increased solubility, protection against decrease in drug effects due to excessive metabolism and subsequent increase of bioavailability. Improvement on pharmacodynamic parameters will occur also due to increased drug concentration in target tissues. Also the use of Nanotechnology in the modern pharmacology will serve for a more accurate control of doses, which will decrease significantly drug toxicity.

Estimating Snow Water Storage in North America Using CLM4, DART, and Snow Radiance Data Assimilation

NASA Technical Reports Server (NTRS)

Kwon, Yonghwan; Yang, Zong-Liang; Zhao, Long; Hoar, Timothy J.; Toure, Ally M.; Rodell, Matthew

2016-01-01

This paper addresses continental-scale snow estimates in North America using a recently developed snow radiance assimilation (RA) system. A series of RA experiments with the ensemble adjustment Kalman filter are conducted by assimilating the Advanced Microwave Scanning Radiometer for Earth Observing System (AMSR-E) brightness temperature T(sub B) at 18.7- and 36.5-GHz vertical polarization channels. The overall RA performance in estimating snow depth for North America is improved by simultaneously updating the Community Land Model, version 4 (CLM4), snow/soil states and radiative transfer model (RTM) parameters involved in predicting T(sub B) based on their correlations with the prior T(sub B) (i.e., rule-based RA), although degradations are also observed. The RA system exhibits a more mixed performance for snow cover fraction estimates. Compared to the open-loop run (0.171m RMSE), the overall snow depth estimates are improved by 1.6% (0.168m RMSE) in the rule-based RA whereas the default RA (without a rule) results in a degradation of 3.6% (0.177mRMSE). Significant improvement of the snow depth estimates in the rule-based RA as observed for tundra snow class (11.5%, p < 0.05) and bare soil land-cover type (13.5%, p < 0.05). However, the overall improvement is not significant (p = 0.135) because snow estimates are degraded or marginally improved for other snow classes and land covers, especially the taiga snow class and forest land cover (7.1% and 7.3% degradations, respectively). The current RA system needs to be further refined to enhance snow estimates for various snow types and forested regions.

Socio-technical strategies and behavior change to increase the adoption and sustainability of wastewater resource recovery systems.

PubMed

Prouty, Christine; Mohebbi, Shima; Zhang, Qiong

2018-06-15

Given the increasing vulnerability of communities to the negative impacts of untreated wastewater, resource recovery (RR) systems provide a paradigm shift away from a traditional approach of waste separation and treatment towards a productive recovery of water, energy and nutrients. The aim of this research is to understand the relationships between factors that influence the adoption and sustainability of wastewater-based RR systems to inform technology implementation strategies. The study presents a theory-informed, community-influenced system dynamics (SD) model to provide decision-makers with an adaptable tool that simulates system-level responses to the strategies that are developed for the coastal town of Placencia, Belize. The modeling framework is informed by literature-based theories such as the theory of diffusion of innovations (TDI) and the theory of planned behavior (TPB). Various methods, including surveys, interviews, participatory observations, and a water constituents mass balance analysis are used to validate relationships and numerically populate the model. The SD model was evaluated with field data and simulated to identify strategies that will improve the adoption and sustainability of RR systems. Site demonstrations (marketing strategy) made a significant impact on the stock of adopted RR systems. The stock of sustained RR systems is driven by the sustainability rate (i.e. economic and environmental viability) which can be improved by more site demonstrations and tank options (technical strategy). These strategies, however, only contributed to incremental improvements in the system's sustainability performance. This study shows that changing community behaviors (i.e. reporting the correct number of users and reclaiming resources), represented by structural change in the SD model, is the more significant way to influence the sustainable management of the community's wastewater resources. Copyright © 2018 Elsevier Ltd. All rights reserved.

Enabling fast charging - Vehicle considerations

NASA Astrophysics Data System (ADS)

Meintz, Andrew; Zhang, Jiucai; Vijayagopal, Ram; Kreutzer, Cory; Ahmed, Shabbir; Bloom, Ira; Burnham, Andrew; Carlson, Richard B.; Dias, Fernando; Dufek, Eric J.; Francfort, James; Hardy, Keith; Jansen, Andrew N.; Keyser, Matthew; Markel, Anthony; Michelbacher, Christopher; Mohanpurkar, Manish; Pesaran, Ahmad; Scoffield, Don; Shirk, Matthew; Stephens, Thomas; Tanim, Tanvir

2017-11-01

To achieve a successful increase in the plug-in battery electric vehicle (BEV) market, it is anticipated that a significant improvement in battery performance is required to increase the range that BEVs can travel and the rate at which they can be recharged. While the range that BEVs can travel on a single recharge is improving, the recharge rate is still much slower than the refueling rate of conventional internal combustion engine vehicles. To achieve comparable recharge times, we explore the vehicle considerations of charge rates of at least 400 kW. Faster recharge is expected to significantly mitigate the perceived deficiencies for long-distance transportation, to provide alternative charging in densely populated areas where overnight charging at home may not be possible, and to reduce range anxiety for travel within a city when unplanned charging may be required. This substantial increase in charging rate is expected to create technical issues in the design of the battery system and the vehicle's electrical architecture that must be resolved. This work focuses on vehicle system design and total recharge time to meet the goals of implementing improved charge rates and the impacts of these expected increases on system voltage and vehicle components.

Enabling fast charging – Vehicle considerations

DOE PAGES

Meintz, Andrew; Zhang, Jiucai; Vijayagopal, Ram; ...

2017-11-01

To achieve a successful increase in the plug-in battery electric vehicle (BEV) market it is anticipated that a significant improvement in battery performance is required to improve the range that BEVs can travel. While the range that BEVs can travel on a single recharge is improving, the rate at which these vehicles can be recharged is still much slower than conventional internal combustion engine vehicles. To achieve comparable recharge times we explore the vehicle considerations of charge rates up to 350 kW. This faster recharge is expected to significantly mitigate the perceived deficiencies for long-distance transportation, to provide alternative chargingmore » in densely populated areas where overnight charging at home may not be possible, and to reduce range anxiety for travel within a city when unplanned charging maybe required. This substantial increase in the charging rate is expected to create technical issues in the design of the battery system and the vehicle electrical architecture that must be resolved. This work will focus on the battery system thermal design and total recharge time to meet the goals of implementing higher charge rates as well as the impacts of the expected increase in system voltage on the components of the vehicle.« less

Enabling fast charging – Vehicle considerations

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

Meintz, Andrew; Zhang, Jiucai; Vijayagopal, Ram

To achieve a successful increase in the plug-in battery electric vehicle (BEV) market it is anticipated that a significant improvement in battery performance is required to improve the range that BEVs can travel. While the range that BEVs can travel on a single recharge is improving, the rate at which these vehicles can be recharged is still much slower than conventional internal combustion engine vehicles. To achieve comparable recharge times we explore the vehicle considerations of charge rates up to 350 kW. This faster recharge is expected to significantly mitigate the perceived deficiencies for long-distance transportation, to provide alternative chargingmore » in densely populated areas where overnight charging at home may not be possible, and to reduce range anxiety for travel within a city when unplanned charging maybe required. This substantial increase in the charging rate is expected to create technical issues in the design of the battery system and the vehicle electrical architecture that must be resolved. This work will focus on the battery system thermal design and total recharge time to meet the goals of implementing higher charge rates as well as the impacts of the expected increase in system voltage on the components of the vehicle.« less

New Insight in Improving Therapeutic Efficacy of Antipsychotic Agents: An Overview of Improved In Vitro and In Vivo Performance, Efficacy Upgradation and Future Prospects.

PubMed

Ei Thu, Hnin; Hussain, Zahid; Shuid, Ahmad Nazrun

2018-01-01

Psychotic disorders are recognized as severe mental disorders that rigorously affect patient's personality, critical thinking, and perceptional ability. High prevalence, global dissemination and limitations of conventional pharmacological approaches compel a significant burden to the patient, medical professionals and the healthcare system. To date, numerous orally administered therapies are available for the management of depressive disorders, schizophrenia, anxiety, bipolar disorders and autism spectrum problems. However, poor water solubility, erratic oral absorption, extensive first-pass metabolism, low oral bioavailability and short half-lives are the major factors which limit the pharmaceutical significance and therapeutic feasibility of these agents. In recent decades, nanotechnology-based delivery systems have gained remarkable attention of the researchers to mitigate the pharmaceutical issues related to the antipsychotic therapies and to optimize their oral drug delivery, therapeutic outcomes, and patient compliance. Therefore, the present review was aimed to summarize the available in vitro and in vivo evidences signifying the pharmaceutical importance of the advanced delivery systems in improving the aqueous solubility, transmembrane permeability, oral bioavailability and therapeutic outcome of the antipsychotic agents. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Computational efficiency improvements for image colorization

NASA Astrophysics Data System (ADS)

Yu, Chao; Sharma, Gaurav; Aly, Hussein

2013-03-01

We propose an efficient algorithm for colorization of greyscale images. As in prior work, colorization is posed as an optimization problem: a user specifies the color for a few scribbles drawn on the greyscale image and the color image is obtained by propagating color information from the scribbles to surrounding regions, while maximizing the local smoothness of colors. In this formulation, colorization is obtained by solving a large sparse linear system, which normally requires substantial computation and memory resources. Our algorithm improves the computational performance through three innovations over prior colorization implementations. First, the linear system is solved iteratively without explicitly constructing the sparse matrix, which significantly reduces the required memory. Second, we formulate each iteration in terms of integral images obtained by dynamic programming, reducing repetitive computation. Third, we use a coarseto- fine framework, where a lower resolution subsampled image is first colorized and this low resolution color image is upsampled to initialize the colorization process for the fine level. The improvements we develop provide significant speedup and memory savings compared to the conventional approach of solving the linear system directly using off-the-shelf sparse solvers, and allow us to colorize images with typical sizes encountered in realistic applications on typical commodity computing platforms.

Examining the impact of child parent relationship therapy (CPRT) on family functioning.

PubMed

Cornett, Nick; Bratton, Sue C

2014-07-01

Research supports that child parent relationship therapy (CPRT), a filial therapy approach, has strong effects on participating parents and children. Some speculate that filial therapy improves the family system; however, minimal research exists to support this claim. Using a single-case design, researchers examined CPRT's impact on the functioning of 8 families. Results revealed that 6 families experienced statistically significant improvements in targeted areas of family functioning. Results from self-reported measures indicated that 7 families improved in family satisfaction, 4 in cohesion, 3 in communication, and 1 in flexibility. Observational measures also revealed improvements: 5 families in flexibility, 4 families in cohesion, and 4 families in communication. The results support that the benefits of CPRT may extend to the family system. © 2013 American Association for Marriage and Family Therapy.

Electronic dietary recording system improves nutrition knowledge, eating attitudes and habitual physical activity: a randomised controlled trial.

PubMed

Chung, Louisa Ming Yan; Law, Queenie Pui Sze; Fong, Shirley Siu Ming; Chung, Joanne Wai Yee

2014-08-01

This study's objective was to investigate whether use of an electronic dietary recording system improves nutrition knowledge, eating attitudes and habitual physical activity levels compared to use of a food diary and no self-monitoring. Sixty adults aged 20-60 with a body mass index ≥25 were recruited and randomly assigned to one of three groups: a group using an electronic system (EG), a group using a food diary (FD) and a control group using nothing (CG) to record food intake. All participants took part in three 60-90 nutrition seminars and completed three questionnaires on general nutrition knowledge, habitual physical activity levels and eating attitudes at the beginning and end of the 12-week study. The pre- and post-test scores for each questionnaire were analysed using a paired sample t-test. Significant improvements in the domain of 'dietary recommendations' were found in the EG (p=0.009) and FD groups (p=0.046). Great improvements were found in 'sources of nutrients', 'choosing everyday foods' and 'diet-disease relationships' in EG and FD groups. EG group showed greater improvement in the work index and sport index. An electronic dietary recording system may improve eating and exercise behaviour in a self-monitoring process. Copyright © 2014 Elsevier Ltd. All rights reserved.

Description of Selected Algorithms and Implementation Details of a Concept-Demonstration Aircraft VOrtex Spacing System (AVOSS)

NASA Technical Reports Server (NTRS)

Hinton, David A.

2001-01-01

A ground-based system has been developed to demonstrate the feasibility of automating the process of collecting relevant weather data, predicting wake vortex behavior from a data base of aircraft, prescribing safe wake vortex spacing criteria, estimating system benefit, and comparing predicted and observed wake vortex behavior. This report describes many of the system algorithms, features, limitations, and lessons learned, as well as suggested system improvements. The system has demonstrated concept feasibility and the potential for airport benefit. Significant opportunities exist however for improved system robustness and optimization. A condensed version of the development lab book is provided along with samples of key input and output file types. This report is intended to document the technical development process and system architecture, and to augment archived internal documents that provide detailed descriptions of software and file formats.

Spacecraft Multiple Array Communication System Performance Analysis

NASA Technical Reports Server (NTRS)

Hwu, Shian U.; Desilva, Kanishka; Sham, Catherine C.

2010-01-01

The Communication Systems Simulation Laboratory (CSSL) at the NASA Johnson Space Center is tasked to perform spacecraft and ground network communication system simulations, design validation, and performance verification. The CSSL has developed simulation tools that model spacecraft communication systems and the space and ground environment in which the tools operate. In this paper, a spacecraft communication system with multiple arrays is simulated. Multiple array combined technique is used to increase the radio frequency coverage and data rate performance. The technique is to achieve phase coherence among the phased arrays to combine the signals at the targeting receiver constructively. There are many technical challenges in spacecraft integration with a high transmit power communication system. The array combining technique can improve the communication system data rate and coverage performances without increasing the system transmit power requirements. Example simulation results indicate significant performance improvement can be achieved with phase coherence implementation.

Computer-aided detection of breast masses: Four-view strategy for screening mammography

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

Wei Jun; Chan Heangping; Zhou Chuan

2011-04-15

Purpose: To improve the performance of a computer-aided detection (CAD) system for mass detection by using four-view information in screening mammography. Methods: The authors developed a four-view CAD system that emulates radiologists' reading by using the craniocaudal and mediolateral oblique views of the ipsilateral breast to reduce false positives (FPs) and the corresponding views of the contralateral breast to detect asymmetry. The CAD system consists of four major components: (1) Initial detection of breast masses on individual views, (2) information fusion of the ipsilateral views of the breast (referred to as two-view analysis), (3) information fusion of the corresponding viewsmore » of the contralateral breast (referred to as bilateral analysis), and (4) fusion of the four-view information with a decision tree. The authors collected two data sets for training and testing of the CAD system: A mass set containing 389 patients with 389 biopsy-proven masses and a normal set containing 200 normal subjects. All cases had four-view mammograms. The true locations of the masses on the mammograms were identified by an experienced MQSA radiologist. The authors randomly divided the mass set into two independent sets for cross validation training and testing. The overall test performance was assessed by averaging the free response receiver operating characteristic (FROC) curves of the two test subsets. The FP rates during the FROC analysis were estimated by using the normal set only. The jackknife free-response ROC (JAFROC) method was used to estimate the statistical significance of the difference between the test FROC curves obtained with the single-view and the four-view CAD systems. Results: Using the single-view CAD system, the breast-based test sensitivities were 58% and 77% at the FP rates of 0.5 and 1.0 per image, respectively. With the four-view CAD system, the breast-based test sensitivities were improved to 76% and 87% at the corresponding FP rates, respectively. The improvement was found to be statistically significant (p<0.0001) by JAFROC analysis. Conclusions: The four-view information fusion approach that emulates radiologists' reading strategy significantly improves the performance of breast mass detection of the CAD system in comparison with the single-view approach.« less

Development and Performance Evaluations of HfO2-Si and Rare Earth-Si Based Environmental Barrier Bond Coat Systems for SiC/SiC Ceramic Matrix Composites

NASA Technical Reports Server (NTRS)

Zhu, Dongming

2014-01-01

Ceramic environmental barrier coatings (EBC) and SiCSiC ceramic matrix composites (CMCs) will play a crucial role in future aircraft propulsion systems because of their ability to significantly increase engine operating temperatures, improve component durability, reduce engine weight and cooling requirements. Advanced EBC systems for SiCSiC CMC turbine and combustor hot section components are currently being developed to meet future turbine engine emission and performance goals. One of the significant material development challenges for the high temperature CMC components is to develop prime-reliant, high strength and high temperature capable environmental barrier coating bond coat systems, since the current silicon bond coat cannot meet the advanced EBC-CMC temperature and stability requirements. In this paper, advanced NASA HfO2-Si based EBC bond coat systems for SiCSiC CMC combustor and turbine airfoil applications are investigated. The coating design approach and stability requirements are specifically emphasized, with the development and implementation focusing on Plasma Sprayed (PS) and Electron Beam-Physic Vapor Deposited (EB-PVD) coating systems and the composition optimizations. High temperature properties of the HfO2-Si based bond coat systems, including the strength, fracture toughness, creep resistance, and oxidation resistance were evaluated in the temperature range of 1200 to 1500 C. Thermal gradient heat flux low cycle fatigue and furnace cyclic oxidation durability tests were also performed at temperatures up to 1500 C. The coating strength improvements, degradation and failure modes of the environmental barrier coating bond coat systems on SiCSiC CMCs tested in simulated stress-environment interactions are briefly discussed and supported by modeling. The performance enhancements of the HfO2-Si bond coat systems with rare earth element dopants and rare earth-silicon based bond coats are also highlighted. The advanced bond coat systems, when integrated with advanced EBC top coats, showed promise to achieve 1500 C temperature capability, helping enable next generation turbine engines with significantly improved engine component temperature capability and long-term durability.

Autoverification process improvement by Six Sigma approach: Clinical chemistry & immunoassay.

PubMed

Randell, Edward W; Short, Garry; Lee, Natasha; Beresford, Allison; Spencer, Margaret; Kennell, Marina; Moores, Zoë; Parry, David

2018-05-01

This study examines effectiveness of a project to enhance an autoverification (AV) system through application of Six Sigma (DMAIC) process improvement strategies. Similar AV systems set up at three sites underwent examination and modification to produce improved systems while monitoring proportions of samples autoverified, the time required for manual review and verification, sample processing time, and examining characteristics of tests not autoverified. This information was used to identify areas for improvement and monitor the impact of changes. Use of reference range based criteria had the greatest impact on the proportion of tests autoverified. To improve AV process, reference range based criteria was replaced with extreme value limits based on a 99.5% test result interval, delta check criteria were broadened, and new specimen consistency rules were implemented. Decision guidance tools were also developed to assist staff using the AV system. The mean proportion of tests and samples autoverified improved from <62% for samples and <80% for tests, to >90% for samples and >95% for tests across all three sites. The new AV system significantly decreased turn-around time and total sample review time (to about a third), however, time spent for manual review of held samples almost tripled. There was no evidence of compromise to the quality of testing process and <1% of samples held for exceeding delta check or extreme limits required corrective action. The Six Sigma (DMAIC) process improvement methodology was successfully applied to AV systems resulting in an increase in overall test and sample AV by >90%, improved turn-around time, reduced time for manual verification, and with no obvious compromise to quality or error detection. Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Interactive wiimote gaze stabilization exercise training system for patients with vestibular hypofunction

PubMed Central

2012-01-01

Background Peripheral vestibular hypofunction is a major cause of dizziness. When complicated with postural imbalance, this condition can lead to an increased incidence of falls. In traditional clinical practice, gaze stabilization exercise is commonly used to rehabilitate patients. In this study, we established a computer-aided vestibular rehabilitation system by coupling infrared LEDs to an infrared receiver. This system enabled the subjects’ head-turning actions to be quantified, and the training was performed using vestibular exercise combined with computer games and interactive video games that simulate daily life activities. Methods Three unilateral and one bilateral vestibular hypofunction patients volunteered to participate in this study. The participants received 30 minutes of computer-aided vestibular rehabilitation training 2 days per week for 6 weeks. Pre-training and post-training assessments were completed, and a follow-up assessment was completed 1 month after the end of the training period. Results After 6 weeks of training, significant improvements in balance and dynamic visual acuity (DVA) were observed in the four participants. Self-reports of dizziness, anxiety and depressed mood all decreased significantly. Significant improvements in self-confidence and physical performance were also observed. The effectiveness of this training was maintained for at least 1 month after the end of the training period. Conclusion Real-time monitoring of training performance can be achieved using this rehabilitation platform. Patients demonstrated a reduction in dizziness symptoms after 6 weeks of training with this short-term interactive game approach. This treatment paradigm also improved the patients’ balance function. This system could provide a convenient, safe and affordable treatment option for clinical practitioners. PMID:23043886

Nonsurgical periodontal-therapy improves glycosylated hemoglobin levels in pre-diabetic patients with chronic periodontitis

PubMed Central

Joseph, Rosamma; Sasikumar, Meera; Mammen, Jerry; Joseraj, M G; Radhakrishnan, Chandni

2017-01-01

AIM To evaluate the effect of nonsurgical periodontal therapy on glycosylated haemoglobin levels in pre-diabetic patients with chronic periodontitis (CHP). METHODS Sixty pre-diabetic patients with CHP were selected and equally allocated to case and control group. All subjects were evaluated at base line for periodontal parameters (plaque index, oral hygiene index, modified gingival index, probing pocket depth, clinical attachment level) and systemic parameters [glycosylated hemoglobin (HbA1c), fasting lipid profile, and fasting blood glucose]. The case group received non-surgical periodontal therapy. Subjects were re-evaluated for periodontal and systemic parameters after three months. RESULTS Both groups were comparable at baseline. Three months after non surgical periodontal therapy (NSPT), there was significant improvement in periodontal parameters in case group. The mean difference in systemic parameters like HbA1c and fasting plasma glucose from baseline to fourth month for case group was 0.22 ± 0.11 and 3.90 ± 8.48 respectively and control group was -0.056 ± 0.10 and -1.66 ± 6.04 respectively, which was significant between case and control group (P < 0.05). In the case group there was a significant decrease in HbA1c from baseline to three months following NSPT (P < 0.05). CONCLUSION This study showed that periodontal inflammation could affect the glycemic control in otherwise systemically healthy individuals. Periodontal therapy improved periodontal health status and decreased glycosylated haemoglobin levels, thus reducing the probability of occurrence of inflammation induced prediabetes in patients with CHP. PMID:28572882

Interactive wiimote gaze stabilization exercise training system for patients with vestibular hypofunction.

PubMed

Chen, Po-Yin; Hsieh, Wan-Ling; Wei, Shun-Hwa; Kao, Chung-Lan

2012-10-09

Peripheral vestibular hypofunction is a major cause of dizziness. When complicated with postural imbalance, this condition can lead to an increased incidence of falls. In traditional clinical practice, gaze stabilization exercise is commonly used to rehabilitate patients. In this study, we established a computer-aided vestibular rehabilitation system by coupling infrared LEDs to an infrared receiver. This system enabled the subjects' head-turning actions to be quantified, and the training was performed using vestibular exercise combined with computer games and interactive video games that simulate daily life activities. Three unilateral and one bilateral vestibular hypofunction patients volunteered to participate in this study. The participants received 30 minutes of computer-aided vestibular rehabilitation training 2 days per week for 6 weeks. Pre-training and post-training assessments were completed, and a follow-up assessment was completed 1 month after the end of the training period. After 6 weeks of training, significant improvements in balance and dynamic visual acuity (DVA) were observed in the four participants. Self-reports of dizziness, anxiety and depressed mood all decreased significantly. Significant improvements in self-confidence and physical performance were also observed. The effectiveness of this training was maintained for at least 1 month after the end of the training period. Real-time monitoring of training performance can be achieved using this rehabilitation platform. Patients demonstrated a reduction in dizziness symptoms after 6 weeks of training with this short-term interactive game approach. This treatment paradigm also improved the patients' balance function. This system could provide a convenient, safe and affordable treatment option for clinical practitioners.

Enabling MPEG-2 video playback in embedded systems through improved data cache efficiency

NASA Astrophysics Data System (ADS)

Soderquist, Peter; Leeser, Miriam E.

1999-01-01

Digital video decoding, enabled by the MPEG-2 Video standard, is an important future application for embedded systems, particularly PDAs and other information appliances. Many such system require portability and wireless communication capabilities, and thus face severe limitations in size and power consumption. This places a premium on integration and efficiency, and favors software solutions for video functionality over specialized hardware. The processors in most embedded system currently lack the computational power needed to perform video decoding, but a related and equally important problem is the required data bandwidth, and the need to cost-effectively insure adequate data supply. MPEG data sets are very large, and generate significant amounts of excess memory traffic for standard data caches, up to 100 times the amount required for decoding. Meanwhile, cost and power limitations restrict cache sizes in embedded systems. Some systems, including many media processors, eliminate caches in favor of memories under direct, painstaking software control in the manner of digital signal processors. Yet MPEG data has locality which caches can exploit if properly optimized, providing fast, flexible, and automatic data supply. We propose a set of enhancements which target the specific needs of the heterogeneous types within the MPEG decoder working set. These optimizations significantly improve the efficiency of small caches, reducing cache-memory traffic by almost 70 percent, and can make an enhanced 4 KB cache perform better than a standard 1 MB cache. This performance improvement can enable high-resolution, full frame rate video playback in cheaper, smaller system than woudl otherwise be possible.

A categorization of water system breakdowns: Evidence from Liberia, Nigeria, Tanzania, and Uganda.

PubMed

Klug, Tori; Cronk, Ryan; Shields, Katherine F; Bartram, Jamie

2018-04-01

In rural sub-Saharan Africa, one in three handpumps are non-functional at any time. While there is some evidence describing factors associated with non-functional water systems, there is little evidence describing the categories of water system breakdowns that commonly occur. Insufficient water availability from broken down systems can force people to use unimproved water sources, which undermines the health benefits of an improved water source. We categorized common water system breakdowns using quantitative and qualitative monitoring data from Liberia, Nigeria, Tanzania, and Uganda (each N>3600 water systems) and examined how breakdown category varies by water system type and management characteristics. Specific broken parts were mentioned more frequently than all other reasons for breakdown; hardware parts frequently found at fault for breakdown were aprons (Liberia), pipes (Tanzania and Uganda), taps/spouts (Tanzania and Uganda), and lift mechanisms (Nigeria). Statistically significant differences in breakdown category were identified based on system type, age, management type, and fee collection type. Categorization can help to identify common reasons for water system breakdown. The analysis of these data can be used to develop improved monitoring instruments to inform actors of different breakdown types and provide reasons for system non-functionality. Improved monitoring instruments would enable actors to target appropriate resources to address specific breakdowns likely to arise based on system type and management characteristics in order to inform improved implementation of and post-construction support for water systems in sub-Saharan Africa. Copyright © 2017 Elsevier B.V. All rights reserved.

The Contribution of Mesoscale Convective Weather Systems to the Warm-Season Precipitation in the United States.

NASA Astrophysics Data System (ADS)

Fritsch, J. M.; Kane, R. J.; Chelius, C. R.

1986-10-01

The contribution of precipitation from mesoscale convective weather systems to the warm-season (April-September) rainfall in the United States is evaluated. Both Mesoscale Convective Complexes (MCC's) and other large, long-lived mesoscale convective systems that do not quite meet Maddox's criteria for being termed an MCC are included in the evaluation. The distribution and geographical limits of the precipitation from the convective weather systems are constructed for the warm seasons of 1982, a `normal' year, and 1983, a drought year. Precipitation characteristics of the systems are compared for the 2 years to determine how large-scale drought patterns affect their precipitation production.The frequency, precipitation characteristics and hydrologic ramifications of multiple occurrences, or series, of convective weather systems are presented and discussed. The temporal and spatial characteristics of the accumulated precipitation from a series of convective complexes is investigated and compared to that of Hurricane Alicia.It is found that mesoscale convective weather systems account for approximately 30% to 70% of the warm-season (April-September) precipitation over much of the region between the Rocky Mountains and the Mississippi River. During the June through August period, their contribution is even larger. Moreover, series of convective weather systems are very likely the most prolific precipitation producer in the United States, rivaling and even exceeding that of hurricanes.Changes in the large-scale circulation patterns affected the seasonal precipitation from mesoscale convective weather systems by altering the precipitation characteristics of individual systems. In particular, for the drought period of 1983, the frequency of the convective systems remained nearly the same as in the `normal' year (1982); however, the average precipitation area and the average volumetric production significantly decreased. Nevertheless, the rainfall that was produced by mesoscale convective weather systems in the drought year accounted for most of the precipitation received during the critical crop growth period.It is concluded that mesoscale convective weather systems may be a crucial precipitation-producing deterrent to drought and an important mechanism for enhancing midsummer crop growth throughout the midwestern United States. Furthermore, because mesoscale convective weather systems account for such a large fraction of the warm-season precipitation, significant improvements in prediction of such systems would likely translate into significant improvements in quantitative precipitation forecast skill and corresponding improvements in hydrologic forecasts of runoff.

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

Bueno, G.; Ruiz, M.; Sanchez, S

Breast cancer continues to be an important health problem between women population. Early detection is the only way to improve breast cancer prognosis and significantly reduce women mortality. It is by using CAD systems that radiologist can improve their ability to detect, and classify lesions in mammograms. In this study the usefulness of using B-spline based on a gradient scheme and compared to wavelet and adaptative filtering has been investigated for calcification lesion detection and as part of CAD systems. The technique has been applied to different density tissues. A qualitative validation shows the success of the method.

Intelligent process mapping through systematic improvement of heuristics

NASA Technical Reports Server (NTRS)

Ieumwananonthachai, Arthur; Aizawa, Akiko N.; Schwartz, Steven R.; Wah, Benjamin W.; Yan, Jerry C.

1992-01-01

The present system for automatic learning/evaluation of novel heuristic methods applicable to the mapping of communication-process sets on a computer network has its basis in the testing of a population of competing heuristic methods within a fixed time-constraint. The TEACHER 4.1 prototype learning system implemented or learning new postgame analysis heuristic methods iteratively generates and refines the mappings of a set of communicating processes on a computer network. A systematic exploration of the space of possible heuristic methods is shown to promise significant improvement.

Redesigning a risk-management process for tracking injuries.

PubMed

Wenzel, G R

1998-01-01

The changing responsibilities of registered nurses are challenging even the most dedicated professionals. To survive within her newly-defined roles, one nurse used a total quality improvement model to understand, analyze, and improve a medical center's system for tracking inpatient injuries. This process led to the drafting of an original software design that implemented a nursing informatics tracking system. It has resulted in significant savings of time and money and has far surpassed the accuracy, efficiency, and scope of the previous method. This article presents an overview of the design process.

Effects of a case-based interactive e-learning course on knowledge and attitudes about patient safety: a quasi-experimental study with third-year medical students.

PubMed

Gaupp, Rainer; Körner, Mirjam; Fabry, Götz

2016-07-11

Patient safety (PS) is influenced by a set of factors on various levels of the healthcare system. Therefore, a systems-level approach and systems thinking is required to understand and improve PS. The use of e-learning may help to develop a systems thinking approach in medical students, as case studies featuring audiovisual media can be used to visualize systemic relationships in organizations. The goal of this quasi-experimental study was to determine if an e-learning can be utilized to improve systems thinking, knowledge, and attitudes towards PS. A quasi-experimental, longitudinal within- subjects design was employed. Participants were 321 third-year medical students who received online surveys before and after they participated in an e-learning course on PS. Primary outcome measures where levels of systems thinking and attitudes towards PS. Secondary outcome measures were the improvement of PS specific knowledge through the e-learning course. Levels of systems thinking showed significant improvement (58.72 vs. 61.27; p < .001) after the e-learning. Student's attitudes towards patient safety improved in several dimensions: After the course, students rated the influence of fatigue on safety higher (6.23 vs. 6.42, p < .01), considered patient empowerment more important (5.16 vs. 5.93, p < .001) and realized more often that human error is inevitable (5.75 vs. 5.97, p < .05). Knowledge on PS improved from 36.27 % correct answers before to 76.45 % after the e-learning (p < .001). Our results suggest that e-learning can be used to teach PS. Attitudes towards PS improved on several dimensions. Furthermore, we were able to demonstrate that a specifically designed e-learning program can foster the development of conceptual frameworks such as systems thinking, which facilitates the understanding of complex socio-technical systems within healthcare organisations.

Device to improve detection in electro-chromatography

DOEpatents

Garguilo, Michael G.; Paul, Phillip H.; Rakestraw, David J.

2000-01-01

Apparatus and method for improving the resolution of non-pressure driven capillary chromatographic systems, and particularly for capillary electrochromatography (CEC) systems. By reducing the cross-sectional area of a packed capillary column by means of a second open capillary contiguous with the outlet end of a packed capillary column, where the packed capillary column has a cross sectional area of between about 2 and 5 times that of the open capillary column, the phenomenon of band broadening in the transition region between the open capillary and the packed capillary column, where the individual components of the mixture are analyzed, can be eliminated, thereby providing for a significant improvement in resolution and more accurate detection and analysis.

Device to improve detection in electro-chromatography

DOEpatents

Garguilo, Michael G.; Paul, Phillip H.; Rakestraw, David J.

2002-01-01

Apparatus and method for improving the resolution of non-pressure driven capillary chromatographic systems, and particularly for capillary electrochromatography (CEC) systems. By reducing the cross-sectional area of a packed capillary column by means of a second open capillary contiguous with the outlet end of a packed capillary column, where the packed capillary column has a cross sectional area of between about 2 and 5 times that of the open capillary column, the phenomenon of band broadening in the transition region between the open capillary and the packed capillary column, where the individual components of the mixture are analyzed, can be eliminated, thereby providing for a significant improvement in resolution and more accurate detection and analysis.

Comparative Evaluation of Recombinant Protein Production in Different Biofactories: The Green Perspective

PubMed Central

Capaldi, Stefano

2014-01-01

In recent years, the production of recombinant pharmaceutical proteins in heterologous systems has increased significantly. Most applications involve complex proteins and glycoproteins that are difficult to produce, thus promoting the development and improvement of a wide range of production platforms. No individual system is optimal for the production of all recombinant proteins, so the diversity of platforms based on plants offers a significant advantage. Here, we discuss the production of four recombinant pharmaceutical proteins using different platforms, highlighting from these examples the unique advantages of plant-based systems over traditional fermenter-based expression platforms. PMID:24745008

Material Challenges and Opportunities for Commercial Electric Aircraft

NASA Technical Reports Server (NTRS)

Misra, Ajay

2014-01-01

Significant reduction in carbon dioxide emission for future air transportation system will require adoption of electric propulsion system and more electric architectures. Various options for aircraft electric propulsion include hybrid electric, turboelectric, and full electric system. Realization of electric propulsion system for commercial aircraft applications will require significant increases in power density of electric motors and energy density of energy storage system, such as the batteries and fuel cells. In addition, transmission of MW of power in the aircraft will require high voltage power transmission system to reduce the weight of the power transmission system. Finally, there will be significant thermal management challenges. Significant advances in material technologies will be required to meet these challenges. Technologies of interest include materials with higher electrical conductivity than Cu, high thermal conductivity materials, and lightweight electrically insulating materials with high breakdown voltage, high temperature magnets, advanced battery and fuel cell materials, and multifunctional materials. The presentation will include various challenges for commercial electric aircraft and provide an overview of material improvements that will be required to meet these challenges.

Software life cycle methodologies and environments

NASA Technical Reports Server (NTRS)

Fridge, Ernest

1991-01-01

Products of this project will significantly improve the quality and productivity of Space Station Freedom Program software processes by: improving software reliability and safety; and broadening the range of problems that can be solved with computational solutions. Projects brings in Computer Aided Software Engineering (CASE) technology for: Environments such as Engineering Script Language/Parts Composition System (ESL/PCS) application generator, Intelligent User Interface for cost avoidance in setting up operational computer runs, Framework programmable platform for defining process and software development work flow control, Process for bringing CASE technology into an organization's culture, and CLIPS/CLIPS Ada language for developing expert systems; and methodologies such as Method for developing fault tolerant, distributed systems and a method for developing systems for common sense reasoning and for solving expert systems problems when only approximate truths are known.

Propulsion system-flight control integration-flight evaluation and technology transition

NASA Technical Reports Server (NTRS)

Burcham, Frank W., Jr.; Gilyard, Glenn B.; Myers, Lawrence P.

1990-01-01

Integration of propulsion and flight control systems and their optimization offering significant performance improvement are assessed. In particular, research programs conducted by NASA on flight control systems and propulsion system-flight control interactions on the YF-12 and F-15 aircraft are addressed; these programs have demonstrated increased thrust, reduced fuel consumption, increased engine life, and improved aircraft performance. Focus is placed on altitude control, speed-Mach control, integrated controller design, as well as flight control systems and digital electronic engine control. A highly integrated digital electronic control program is analyzed and compared with a performance seeking control program. It is shown that the flight evaluation and demonstration of these technologies have been a key part in the transition of the concepts to production and operational use on a timely basis.

Probabilistic Reasoning for Plan Robustness

NASA Technical Reports Server (NTRS)

Schaffer, Steve R.; Clement, Bradley J.; Chien, Steve A.

2005-01-01

A planning system must reason about the uncertainty of continuous variables in order to accurately project the possible system state over time. A method is devised for directly reasoning about the uncertainty in continuous activity duration and resource usage for planning problems. By representing random variables as parametric distributions, computing projected system state can be simplified in some cases. Common approximation and novel methods are compared for over-constrained and lightly constrained domains. The system compares a few common approximation methods for an iterative repair planner. Results show improvements in robustness over the conventional non-probabilistic representation by reducing the number of constraint violations witnessed by execution. The improvement is more significant for larger problems and problems with higher resource subscription levels but diminishes as the system is allowed to accept higher risk levels.

Primary care access improvement: an empowerment-interaction model.

PubMed

Ledlow, G R; Bradshaw, D M; Shockley, C

2000-05-01

Improving community primary care access is a difficult and dynamic undertaking. Realizing a need to improve appointment availability, a systematic approach based on measurement, empowerment, and interaction was developed. The model fostered exchange of information and problem solving between interdependent staff sections within a managed care system. Measuring appointments demanded but not available proved to be a credible customer-focused approach to benchmark against set goals. Changing the organizational culture to become more sensitive to changing beneficiary needs was a paramount consideration. Dependent-group t tests were performed to compare the pretreatment and posttreatment effect. The empowerment-interaction model significantly improved the availability of routine and wellness-type appointments. The availability of urgent appointments improved but not significantly; a better prospective model needs to be developed. In aggregate, appointments demanded but not available (empowerment-interaction model) were more than 10% before the treatment and less than 3% with the treatment.

A systematic review of the effectiveness of interruptive medication prescribing alerts in hospital CPOE systems to change prescriber behavior and improve patient safety.

PubMed

Page, N; Baysari, M T; Westbrook, J I

2017-09-01

To assess the evidence of the effectiveness of different categories of interruptive medication prescribing alerts to change prescriber behavior and/or improve patient outcomes in hospital computerized provider order entry (CPOE) systems. PubMed, Embase, CINAHL and the Cochrane Library were searched for relevant articles published between January 2000 and February 2016. Studies were included if they compared the outcomes of automatic, interruptive medication prescribing alert/s to a control/comparison group to determine alert effectiveness. Twenty-three studies describing 32 alerts classified into 11 alert categories were identified. The most common alert categories studied were drug-condition interaction (n=6), drug-drug interaction alerts (n=6) and corollary order alerts (n=6). All 23 papers investigated the effect of the intervention alert on at least one outcome measure of prescriber behavior. Just over half of the studies (53%, n=17) reported a statistically significant beneficial effect from the intervention alert; 34% (n=11) reported no statistically significant effect, and 6% (n=2) reported a significant detrimental effect. Two studies also evaluated the effect of alerts on patient outcome measures; neither finding that patient outcomes significantly improved following alert implementation (6%, n=2). The greatest volume of evidence relates to three alert categories: drug-condition, drug-drug and corollary order alerts. Of these, drug-condition alerts had the greatest number of studies reporting positive effects (five out of six studies). Only two of six studies of drug-drug interaction and one of six of corollary alerts reported positive benefits. The current evidence-base does not show a clear indication that particular categories of alerts are more effective than others. While the majority of alert categories were shown to improve outcomes in some studies, there were also many cases where outcomes did not improve. This lack of evidence hinders decisions about the amount and type of decision support that should be integrated into CPOE systems to increase safety while reducing the risk of alert fatigue. Virtually no studies have sought to investigate the impact on changes to prescriber behavior and outcomes overall when alerts from multiple categories are incorporated within the same system. Copyright © 2017 Elsevier B.V. All rights reserved.

Are performance measurement systems useful? Perceptions from health care.

PubMed

Demartini, Chiara; Trucco, Sara

2017-01-31

Prior literature identified the use of Performance Measurement Systems (PMS) as crucial in addressing improved processes of care. Moreover, a strategic use of PMS has been found to enhance quality, compared to non-strategic use, although a clear understanding of this linkage is still to be achieved. This paper deals with the test of direct and indirect models related to the link between the strategic use of PMS and the level of improved processes in health care organizations. Indirect models were mediated by the degree of perceived managerial discretion. A PLS analysis on a survey of 97 Italian managers working for health care organizations in the Lombardy region was conducted. The response rate was 77.6%. The strategic use of PMS in health care organizations directly and significantly (p < 0.001) enhances performance in terms of improved processes. Perceived managerial discretion is positively and significantly (p < 0.001) affected by the strategic use of PMS, whereas the mediation effect is non-significant. This study contributes to the literature investigating the design and implementation of a non-financial measurement tool, such as the non-financial information included into a balanced scorecard (BSC), in health care organizations. Managers in health care organizations can benefit from the strategic use of PMS to effectively allocate their time to strategic opportunities and threats, which might arise and affect organizational, output-related performance, such as improving processes.

Fish oil-enriched nutrition combined with systemic chemotherapy for gastrointestinal cancer patients with cancer cachexia.

PubMed

Shirai, Yumiko; Okugawa, Yoshinaga; Hishida, Asahi; Ogawa, Aki; Okamoto, Kyoko; Shintani, Miki; Morimoto, Yuki; Nishikawa, Ryutaro; Yokoe, Takeshi; Tanaka, Koji; Urata, Hisashi; Toiyama, Yuji; Inoue, Yasuhiro; Tanaka, Motoyoshi; Mohri, Yasuhiko; Goel, Ajay; Kusunoki, Masato; McMillan, Donald C; Miki, Chikao

2017-07-06

Despite recent advances in chemotherapy for gastrointestinal cancer, a crucial factor related to poor prognosis is reduced tolerance to chemotherapy induced by cancer cachexia. Fish oil (FO)-derived eicosapentaenoic acid (EPA) modulates inflammation in patients with various malignancies; however, the impact of FO-enriched nutrition as a combined modality therapy on clinical outcomes remains controversial. We systemically analysed chronological changes in biochemical and physiological status using bioelectrical impedance analysis in 128 gastrointestinal cancer patients provided with or without FO-enriched nutrition during chemotherapy. Furthermore, we evaluated the clinical significance of FO-enriched nutrition and clarified appropriate patient groups that receive prognostic benefits from FO-enriched nutrition during treatment of gastrointestinal cancer. The control group showed significant up-regulation of serum CRP) levels and no significant difference in both skeletal muscle mass and lean body mass. In contrast, the FO-enriched nutrition group showed no changes in serum CRP concentration and significantly increased skeletal muscle mass and lean body mass over time. Furthermore, high CRP levels significantly correlated with reduced tolerance to chemotherapy, and FO-enriched nutrition improved chemotherapy tolerance and prognosis, particularly in gastrointestinal cancer patients with a modified Glasgow prognostic score (mGPS) of 1 or 2. We conclude that FO-enriched nutrition may improve the prognosis of patients with cancer cachexia and systemic inflammation (i.e., those with a mGPS of 1 or 2).

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

NASA Astrophysics Data System (ADS)

Gu, Rui

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

Macroinvertebrate Community Response to the Elimination of Concentrated Feedlot Runoff to a Headwater Stream

NASA Astrophysics Data System (ADS)

Snitgen, J. L.; Moren, M. M.

2005-05-01

During rainfall and snow melt events, a first order, cold-water stream was receiving varying amounts of liquefied manure from a concentrated feed lot. Stream restoration efforts included the implementation of best management practices to prevent further discharge of the water/manure mixture to the stream. Physical, chemical and biological data were collected pre-construction and two years post-construction of the containment system at a fixed location downstream of the feedlot. Hilsenhoff Biotic Index scores improved significantly, from 6.79 or "Fairly Poor" before the installation of the manure containment system, to 5.28 or "Good" after the installation of the manure containment system. Taxa richness improved from 25 to 34 and the EPT score improved from 0 to 4. Key words: macroinvertebrate, community response, manure, feedlot runoff, stream restoration

A novel computerized surgeon-machine interface for robot-assisted laser phonomicrosurgery.

PubMed

Mattos, Leonardo S; Deshpande, Nikhil; Barresi, Giacinto; Guastini, Luca; Peretti, Giorgio

2014-08-01

To introduce a novel computerized surgical system for improved usability, intuitiveness, accuracy, and controllability in robot-assisted laser phonomicrosurgery. Pilot technology assessment. The novel system was developed involving a newly designed motorized laser micromanipulator, a touch-screen display, and a graphics stylus. The system allows the control of a CO2 laser through interaction between the stylus and the live video of the surgical area. This empowers the stylus with the ability to have actual effect on the surgical site. Surgical enhancements afforded by this system were established through a pilot technology assessment using randomized trials comparing its performance with a state-of-the-art laser microsurgery system. Resident surgeons and medical students were chosen as subjects in performing sets of trajectory-following exercises. Image processing-based techniques were used for an objective performance assessment. A System Usability Scale-based questionnaire was used for the qualitative assessment. The computerized interface demonstrated superiority in usability, accuracy, and controllability over the state-of-the-art system. Significant ease of use and learning experienced by the subjects were demonstrated by the usability score assigned to the two compared interfaces: computerized interface = 83.96% versus state-of-the-art = 68.02%. The objective analysis showed a significant enhancement in accuracy and controllability: computerized interface = 90.02% versus state-of-the-art = 75.59%. The novel system significantly enhances the accuracy, usability, and controllability in laser phonomicrosurgery. The design provides an opportunity to improve the ergonomics and safety of current surgical setups. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Toyota production system quality improvement initiative improves perioperative antibiotic therapy.

PubMed

Burkitt, Kelly H; Mor, Maria K; Jain, Rajiv; Kruszewski, Matthew S; McCray, Ellesha E; Moreland, Michael E; Muder, Robert R; Obrosky, David Scott; Sevick, Mary Ann; Wilson, Mark A; Fine, Michael J

2009-09-01

To assess the role of a Toyota production system (TPS) quality improvement (QI) intervention on appropriateness of perioperative antibiotic therapy and in length of hospital stay (LOS) among surgical patients. Pre-post quasi-experimental study using local and national retrospective cohorts. We used TPS methods to implement a multifaceted intervention to reduce nosocomial methicillin-resistant Staphylococcus aureus infections on a Veterans Affairs surgical unit, which led to a QI intervention targeting appropriate perioperative antibiotic prophylaxis. Appropriate perioperative antibiotic therapy was defined as selection of the recommended antibiotic agents for a duration not exceeding 24 hours from the time of the operation. The local computerized medical record system was used to identify patients undergoing the 25 most common surgical procedures and to examine changes in appropriate antibiotic therapy and LOS over time. Overall, 2550 surgical admissions were identified from the local computerized medical records. The proportion of surgical admissions receiving appropriate perioperative antibiotics was significantly higher (P <.01) in 2004 after initiation of the TPS intervention (44.0%) compared with the previous 4 years (range, 23.4%-29.8%) primarily because of improvements in compliance with antibiotic therapy duration rather than appropriate antibiotic selection. There was no statistically significant decrease in LOS over time. The use of TPS methods resulted in a QI intervention that was associated with an increase in appropriate perioperative antibiotic therapy among surgical patients, without affecting LOS.

Glucagon-Like Peptide 1 Recruits Muscle Microvasculature and Improves Insulin’s Metabolic Action in the Presence of Insulin Resistance

PubMed Central

Chai, Weidong; Zhang, Xingxing; Barrett, Eugene J.

2014-01-01

Glucagon-like peptide 1 (GLP-1) acutely recruits muscle microvasculature, increases muscle delivery of insulin, and enhances muscle use of glucose, independent of its effect on insulin secretion. To examine whether GLP-1 modulates muscle microvascular and metabolic insulin responses in the setting of insulin resistance, we assessed muscle microvascular blood volume (MBV), flow velocity, and blood flow in control insulin-sensitive rats and rats made insulin-resistant acutely (systemic lipid infusion) or chronically (high-fat diet [HFD]) before and after a euglycemic-hyperinsulinemic clamp (3 mU/kg/min) with or without superimposed systemic GLP-1 infusion. Insulin significantly recruited muscle microvasculature and addition of GLP-1 further expanded muscle MBV and increased insulin-mediated glucose disposal. GLP-1 infusion potently recruited muscle microvasculature in the presence of either acute or chronic insulin resistance by increasing muscle MBV. This was associated with an increased muscle delivery of insulin and muscle interstitial oxygen saturation. Muscle insulin sensitivity was completely restored in the presence of systemic lipid infusion and significantly improved in rats fed an HFD. We conclude that GLP-1 infusion potently expands muscle microvascular surface area and improves insulin’s metabolic action in the insulin-resistant states. This may contribute to improved glycemic control seen in diabetic patients receiving incretin-based therapy. PMID:24658303

Update on laser vision correction using wavefront analysis with the CustomCornea system and LADARVision 193-nm excimer laser

NASA Astrophysics Data System (ADS)

Maguen, Ezra I.; Salz, James J.; McDonald, Marguerite B.; Pettit, George H.; Papaioannou, Thanassis; Grundfest, Warren S.

2002-06-01

A study was undertaken to assess whether results of laser vision correction with the LADARVISION 193-nm excimer laser (Alcon-Autonomous technologies) can be improved with the use of wavefront analysis generated by a proprietary system including a Hartman-Schack sensor and expressed using Zernicke polynomials. A total of 82 eyes underwent LASIK in several centers with an improved algorithm, using the CustomCornea system. A subgroup of 48 eyes of 24 patients was randomized so that one eye undergoes conventional treatment and one eye undergoes treatment based on wavefront analysis. Treatment parameters were equal for each type of refractive error. 83% of all eyes had uncorrected vision of 20/20 or better and 95% were 20/25 or better. In all groups, uncorrected visual acuities did not improve significantly in eyes treated with wavefront analysis compared to conventional treatments. Higher order aberrations were consistently better corrected in eyes undergoing treatment based on wavefront analysis for LASIK at 6 months postop. In addition, the number of eyes with reduced RMS was significantly higher in the subset of eyes treated with a wavefront algorithm (38% vs. 5%). Wavefront technology may improve the outcomes of laser vision correction with the LADARVISION excimer laser. Further refinements of the technology and clinical trials will contribute to this goal.

Xiao Yao San Improves Depressive-Like Behaviors in Rats with Chronic Immobilization Stress through Modulation of Locus Coeruleus-Norepinephrine System.

PubMed

Ding, Xiu-Fang; Zhao, Xiao-Hua; Tao, Yang; Zhong, Wei-Chao; Fan, Qin; Diao, Jian-Xin; Liu, Yuan-Liang; Chen, Yu-Yao; Chen, Jia-Xu; Lv, Zhi-Ping

2014-01-01

Most research focuses on the hypothalamic-pituitary-adrenal (HPA) axis, hypothalamus-pituitary-thyroid (HPT) axis, and hypothalamus-pituitary-gonadal (HPGA) axis systems of abnormalities of emotions and behaviors induced by stress, while no studies of Chinese herbal medicine such as Xiao Yao San (XYS) on the mechanisms of locus coeruleus-norepinephrine (LC-NE) system have been reported. Therefore, experiments were carried out to observe mechanism of LC-NE system in response to chronic immobilization stress (CIS) and explore the antidepressant effect of XYS. Rat model was established by CIS. LC morphology in rat was conducted. The serum norepinephrine (NE) concentrations and NE biosynthesis such as tyrosine hydroxylase (TH), dopamine-β-hydroxylase (DBH), and corticotrophin-releasing-factor (CRF) in LC were determined. Results showed that there were no discernible alterations in LC in rats. The serum NE concentrations, positive neurons, mean optical density (MOD), and protein levels of TH, DBH, and CRF in model group were significantly increased compared to the control group. But XYS-treated group displayed a significantly decreased in NE levels and expressions of TH, DBH, and CRF compared to the model group. In conclusion, CIS can activate LC-NE system to release NE and then result in a significant decrease in rats. XYS treatment can effectively improve depressive-like behaviors in rats through inhibition of LC-NE neurons activity.

Xiao Yao San Improves Depressive-Like Behaviors in Rats with Chronic Immobilization Stress through Modulation of Locus Coeruleus-Norepinephrine System

PubMed Central

Ding, Xiu-Fang; Zhao, Xiao-Hua; Tao, Yang; Zhong, Wei-Chao; Fan, Qin; Diao, Jian-Xin; Liu, Yuan-Liang; Chen, Yu-Yao; Chen, Jia-Xu; Lv, Zhi-Ping

2014-01-01

Most research focuses on the hypothalamic-pituitary-adrenal (HPA) axis, hypothalamus-pituitary-thyroid (HPT) axis, and hypothalamus-pituitary-gonadal (HPGA) axis systems of abnormalities of emotions and behaviors induced by stress, while no studies of Chinese herbal medicine such as Xiao Yao San (XYS) on the mechanisms of locus coeruleus-norepinephrine (LC-NE) system have been reported. Therefore, experiments were carried out to observe mechanism of LC-NE system in response to chronic immobilization stress (CIS) and explore the antidepressant effect of XYS. Rat model was established by CIS. LC morphology in rat was conducted. The serum norepinephrine (NE) concentrations and NE biosynthesis such as tyrosine hydroxylase (TH), dopamine-β-hydroxylase (DBH), and corticotrophin-releasing-factor (CRF) in LC were determined. Results showed that there were no discernible alterations in LC in rats. The serum NE concentrations, positive neurons, mean optical density (MOD), and protein levels of TH, DBH, and CRF in model group were significantly increased compared to the control group. But XYS-treated group displayed a significantly decreased in NE levels and expressions of TH, DBH, and CRF compared to the model group. In conclusion, CIS can activate LC-NE system to release NE and then result in a significant decrease in rats. XYS treatment can effectively improve depressive-like behaviors in rats through inhibition of LC-NE neurons activity. PMID:25610478

Experimental evaluation of fingerprint verification system based on double random phase encoding

NASA Astrophysics Data System (ADS)

Suzuki, Hiroyuki; Yamaguchi, Masahiro; Yachida, Masuyoshi; Ohyama, Nagaaki; Tashima, Hideaki; Obi, Takashi

2006-03-01

We proposed a smart card holder authentication system that combines fingerprint verification with PIN verification by applying a double random phase encoding scheme. In this system, the probability of accurate verification of an authorized individual reduces when the fingerprint is shifted significantly. In this paper, a review of the proposed system is presented and preprocessing for improving the false rejection rate is proposed. In the proposed method, the position difference between two fingerprint images is estimated by using an optimized template for core detection. When the estimated difference exceeds the permissible level, the user inputs the fingerprint again. The effectiveness of the proposed method is confirmed by a computational experiment; its results show that the false rejection rate is improved.

Comparing Aedes vigilax Eggshell Densities in Saltmarsh and Mangrove Systems with Implications for Management.

PubMed

Dale, Pat; Knight, Jon; Griffin, Lachlan

2014-12-12

Aedes vigilax (Skuse), a nuisance and disease vector, is prolific in intertidal wetlands in Australia. Aedine mosquitoes oviposit directly onto substrate. The eggshells are relatively stable spatially and temporally, providing an estimate of mosquito larval production. The aims of the research were to compare, at a general level, oviposition in mangroves and saltmarshes, and to compare oviposition between different habitats within mangroves and saltmarshes. The results indicated that there were no significant differences between production in mangrove and saltmarsh overall. However, within each system there were significant differences between habitat classes, with mangrove hummocks being the most productive. All classes, except for fringing mangrove forests, produced sufficient densities of eggshells (>0.05/cc) to warrant concern. While mosquito production in mangroves is known, the significantly higher production rates in the mangrove hummock habitats had not been demonstrated. This warrants improved management strategies that both specifically target these parts of mangrove systems and, secondly, addresses the longer-term potential for mangrove hummock habitats developing in the future; such as, in response to sea level rise and mangrove encroachment into saltmarsh. A strategy to increase tidal flushing within the systems would improve water quality and mitigate adverse impacts while providing a source reduction outcome.

Preparedness and Emergency Response Research Centers: Using a Public Health Systems Approach to Improve All-Hazards Preparedness and Response

PubMed Central

Leinhos, Mary; Williams-Johnson, Mildred

2014-01-01

In 2008, at the request of the Centers for Disease Control and Prevention (CDC), the Institute of Medicine (IOM) prepared a report identifying knowledge gaps in public health systems preparedness and emergency response and recommending near-term priority research areas. In accordance with the Pandemic and All-Hazards Preparedness Act mandating new public health systems research for preparedness and emergency response, CDC provided competitive awards establishing nine Preparedness and Emergency Response Research Centers (PERRCs) in accredited U.S. schools of public health. The PERRCs conducted research in four IOM-recommended priority areas: (1) enhancing the usefulness of public health preparedness and response (PHPR) training, (2) creating and maintaining sustainable preparedness and response systems, (3) improving PHPR communications, and (4) identifying evaluation criteria and metrics to improve PHPR for all hazards. The PERRCs worked closely with state and local public health, community partners, and advisory committees to produce practice-relevant research findings. PERRC research has generated more than 130 peer-reviewed publications and nearly 80 practice and policy tools and recommendations with the potential to significantly enhance our nation's PHPR to all hazards and that highlight the need for further improvements in public health systems. PMID:25355970

Increased Use of No-till Cropping Systems Improves Stream Ecosystem Quality

NASA Astrophysics Data System (ADS)

Yates, A. G.; Bailey, R. C.; Schwindt, J. A.

2005-05-01

Release of sediments to streams from tilled lands has been a significant stressor to streams in agro-ecosystems for decades and has been shown to impact aquatic biota in a variety of ways. To limit soil erosion from cultivated lands, conservation tillage techniques, including the use of no-till systems, have been developed and widely adopted throughout the region. However, there haves been no tests of the effects of no-till systems on stream quality at a watershed scale. We measured habitat and water quality and sampled the benthic macroinvertebrate (BMI) and fish communities in 32 small (100-1400 ha) subwatersheds along a gradient of the proportion of land under no-till cropping systems to determine relationships between the use of no-till and stream quality. Our results demonstrate that with increasing proportions of no-till, habitat scores improve, the quantities of sediment and sediment associated stressors in the water decline, the BMI community exhibits reduced dominance by Oligocheata and Sphaeriidae, as well as improved Family Biotic Index (FBI) scores, and fish species richness increases. We concluded that increased use of no-till cropping systems by farmers does contribute to improved quality of streams in agro-ecosystems.

Comprehensive Environmental Informatics System (CEIS) Integrating Crew and Vehicle Environmental Health

NASA Technical Reports Server (NTRS)

Nall, Mark E.

2006-01-01

Integrated Vehicle Health Management (IVHM) systems have been pursued as highly integrated systems that include smart sensors, diagnostic and prognostics software for assessments of real-time and life-cycle vehicle health information. Inclusive to such a system is the requirement to monitor the environmental health within the vehicle and the occupants of the vehicle. In this regard an enterprise approach to informatics is used to develop a methodology entitled, Comprehensive Environmental Informatics System (CEIS). The hardware and software technologies integrated into this system will be embedded in the vehicle subsystems, and maintenance operations, to provide both real-time and life-cycle health information of the environment within the vehicle cabin and of its occupants. This comprehensive information database will enable informed decision making and logistics management. One key element of the CEIS is interoperability for data acquisition and archive between environment and human system monitoring. With comprehensive components the data acquired in this system will use model based reasoning systems for subsystem and system level managers, advanced on-board and ground-based mission and maintenance planners to assess system functionality. Knowledge databases of the vehicle health state will be continuously updated and reported for critical failure modes, and routinely updated and reported for life cycle condition trending. Sufficient intelligence, including evidence-based engineering practices which are analogous to evidencebased medicine practices, will be included in the CEIS to result in more rapid recognition of off-nominal operation to enable quicker corrective actions. This will result from better information (rather than just data) for improved crew/operator situational awareness, which will produce significant vehicle and crew safety improvements, as well as increasing the chance for mission success, future mission planning as well as training. Other benefits include improved reliability, increase safety in operations and cost of operations. The cost benefits stem from significantly reduced processing and operations manpower, predictive maintenance for systems and subjects. The improvements in vehicle functionality and cost will result from increased prognostic and diagnostic capability due to the detailed total human exploration system health knowledge from CEIS. A collateral benefit is that there will be closer observations of the vehicle occupants as wrist watch sized devices are worn for continuous health monitoring. Additional database acquisition will stem from activities in countermeasure practices to ensure peak performance capability by occupants of the vehicle. The CEIS will provide data from advanced sensing technologies and informatics modeling which will be useful in problem troubleshooting, and improving NASA s awareness of systems during operation.

A cable-driven locomotor training system for restoration of gait in human SCI.

PubMed

Wu, Ming; Hornby, T George; Landry, Jill M; Roth, Heidi; Schmit, Brian D

2011-02-01

A novel cable-driven robotic locomotor training system was developed to provide compliant assistance/resistance forces to the legs during treadmill training in patients with incomplete spinal cord injury (SCI). Eleven subjects with incomplete SCI were recruited to participate in two experiments to test the feasibility of the robotic gait training system. Specifically, 10 subjects participated in one experimental session to test the characteristics of the robotic gait training system and one subject participated in repeated testing sessions over 8 weeks with the robotic device to test improvements in locomotor function. Limb kinematics were recorded in one experiment to evaluate the system characteristics of the cable-driven locomotor trainer and the overground gait speed and 6 min walking distance were evaluated at pre, 4 and 8 weeks post treadmill training of a single subject as well. The results indicated that the cable driven robotic gait training system improved the kinematic performance of the leg during treadmill walking and had no significant impact on the variability of lower leg trajectory, suggesting a high backdrivability of the cable system. In addition, results from a patient with incomplete SCI indicated that prolonged robotic gait training using the cable robot improved overground gait speed. Results from this study suggested that a cable driven robotic gait training system is effective in improving leg kinematic performance, yet allows variability of gait kinematics. Thus, it seems feasible to improve the locomotor function in human SCI using this cable driven robotic system, warranting testing with a larger group of patients. Copyright © 2010 Elsevier B.V. All rights reserved.

Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

PubMed Central

Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

2015-01-01

Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: ‘infrastructure’, ‘information’, ‘finance’, and ‘quality and safety’ to examine changes over time. Results Significant improvements were found in three of four domains: ‘quality and safety’ (F=22.81, p<0.01), ‘information’ (F=27.901, p<0.01) and ‘finance’ (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). Conclusions The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. PMID:25900466

Significant accomplishments, 2009

DOT National Transportation Integrated Search

2009-01-01

BTS data is vital to improve transportation decision : making, as well as evaluations of performance and : what works in the nations transportation systems. : As BTS continues its course of producing relevant, : accurate, and timely transpor...

Modulation of the Metabiome by Rifaximin in Patients with Cirrhosis and Minimal Hepatic Encephalopathy

PubMed Central

Bajaj, Jasmohan S.; Heuman, Douglas M.; Sanyal, Arun J.; Hylemon, Phillip B.; Sterling, Richard K.; Stravitz, R. Todd; Fuchs, Michael; Ridlon, Jason M.; Daita, Kalyani; Monteith, Pamela; Noble, Nicole A.; White, Melanie B.; Fisher, Andmorgan; Sikaroodi, Masoumeh; Rangwala, Huzefa; Gillevet, Patrick M.

2013-01-01

Hepatic encephalopathy (HE) represents a dysfunctional gut-liver-brain axis in cirrhosis which can negatively impact outcomes. This altered gut-brain relationship has been treated using gut-selective antibiotics such as rifaximin, that improve cognitive function in HE, especially its subclinical form, minimal HE (MHE). However, the precise mechanism of the action of rifaximin in MHE is unclear. We hypothesized that modulation of gut microbiota and their end-products by rifaximin would affect the gut-brain axis and improve cognitive performance in cirrhosis. Aim To perform a systems biology analysis of the microbiome, metabolome and cognitive change after rifaximin in MHE. Methods Twenty cirrhotics with MHE underwent cognitive testing, endotoxin analysis, urine/serum metabolomics (GC and LC-MS) and fecal microbiome assessment (multi-tagged pyrosequencing) at baseline and 8 weeks post-rifaximin 550 mg BID. Changes in cognition, endotoxin, serum/urine metabolites (and microbiome were analyzed using recommended systems biology techniques. Specifically, correlation networks between microbiota and metabolome were analyzed before and after rifaximin. Results There was a significant improvement in cognition(six of seven tests improved,p<0.01) and endotoxemia (0.55 to 0.48 Eu/ml, p = 0.02) after rifaximin. There was a significant increase in serum saturated (myristic, caprylic, palmitic, palmitoleic, oleic and eicosanoic) and unsaturated (linoleic, linolenic, gamma-linolenic and arachnidonic) fatty acids post-rifaximin. No significant microbial change apart from a modest decrease in Veillonellaceae and increase in Eubacteriaceae was observed. Rifaximin resulted in a significant reduction in network connectivity and clustering on the correlation networks. The networks centered on Enterobacteriaceae, Porphyromonadaceae and Bacteroidaceae indicated a shift from pathogenic to beneficial metabolite linkages and better cognition while those centered on autochthonous taxa remained similar. Conclusions Rifaximin is associated with improved cognitive function and endotoxemia in MHE, which is accompanied by alteration of gut bacterial linkages with metabolites without significant change in microbial abundance. Trial Registration ClinicalTrials.gov NCT01069133 PMID:23565181

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

NASA Technical Reports Server (NTRS)

Tanzilli, R. A. (Editor)

1973-01-01

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

Improving care transitions from hospital to home: standardized orders for home health nursing with remote telemonitoring.

PubMed

Heeke, Sheila; Wood, Felecia; Schuck, Jennifer

2014-01-01

A task force at a multihospital health care system partnered with home health agencies to improve gaps during the discharge transition process. A standardized order template for home health nursing and remote telemonitoring was developed to decrease discrepancies in communication between hospital health care providers and home health nurses caring for patients with heart failure. Pilot results showed significantly improved communication with no readmissions, using the order template.

Evaluation of Sixth Edition of AJCC Staging System for Nasopharyngeal Carcinoma and Proposed Improvement

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

Liu Mengzhong; Tang Linglong; Zong Jingfeng

2008-03-15

Purpose: To evaluate the 6th edition of the International Union Against Cancer/American Joint Committee on Cancer staging system for nasopharyngeal carcinoma and to search for ways to improve the system. Methods and Materials: We performed a retrospective review of data from 749 biopsy-proven nonmetastatic nasopharyngeal carcinoma patients. All patients had undergone contrast-enhanced computed tomography and had received radiotherapy as their primary treatment. Results: The T stage, N stage, and stage group were significant, independent predictors for disease-specific death. No significant differences were found between Stage T2a and T1 in local failure-free survival or between Stage N3a and N2 in distantmore » failure-free survival. Survival curves of the different T/N subsets showed a better segregation when T2a and N3a were downstaged to T1 and N2, respectively. The hazard ratio of disease-specific deaths for patients with T2N0 disease was similar to that of patients with T1N0 disease; the same result was found for the T3N0 and T4N0 subsets. Downstaging the T2N0 subset to Stage I, T3N0 to Stage II, and T4N0 to Stage III resulted in a more balanced patient distribution, better hazard consistency among subgroups, and improved hazard discrimination between overall stages. Conclusion: Using the 6th edition of the American Joint Committee on Cancer staging system produced an acceptable distribution of patient numbers and segregation of survival curves among the different stage groups. The prognostic accuracy of the staging system could be improved by recategorization of the T, N, and group stage criteria.« less

The improvement of the quality of polluted irrigation water through a phytoremediation process in a hydroponic batch culture system

NASA Astrophysics Data System (ADS)

Retnaningdyah, Catur

2017-11-01

The objective of this research was to determine the effectiveness of a phytoremediation process using some local hydro macrophytes to reduce fertilizer residue in irrigation water in order to support healthy agriculture and to prevent eutrophication and algae bloom in water. A phytoremediation process was carried out in a hydroponic floating system by using transparent plastic bags of 1 m in diameter and 1 m in height that were placed in collecting ponds before they were used for agricultural activities. Paddy soils were used as substrates in this system. The irrigation water was treated with nutrient enrichment (Urea and SP-36 fertilizers). Then, the system was planted with remediation actors (Azolla sp., Ipomoea aquatica, Limnocharis flava, Marsilea crenata, polyculture of those hydro macrophytes and control). The improvement of the water quality as a result of the phytoremediation process was characterized by a decline in the concentration of some physicochemical parameters, which were measured at 7 days after incubation, as well as an increase in the plankton diversity index value. The results showed that all of the hydro macrophytes used in this research, which was grown in the hydroponic batch culture system for a period of 7 days, were able to significantly improve the irrigation water quality, which was enriched by the synthetic fertilizers Urea and SP36. This was reflected by a significant decrease in the concentration of water TSS, nitrate, BOD, COD and total phosphate and an increase in the value of water DO at 7 days after incubation. Improvement of the water quality is also reflected in the increasing plankton diversity index value as a bioindicator of water pollution indicating a change in the pollution status from moderately polluted to slightly polluted at 7 days after incubation.

Meeting the Imperative to Improve Physician Well-being: Assessment of an Innovative Program

PubMed Central

Arnetz, Bengt B.; Christensen, John F.; Homer, Louis

2007-01-01

BACKGROUND Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. OBJECTIVE To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being. DESIGN AND PARTICIPANTS From 2000 to 2005, 22–32 physicians regularly completed 3 questionnaires coded for privacy. Results were anonymously reported to physicians and the organization. Data-guided interventions to enhance physician and organizational well-being were built on physician control over the work environment, order in the clinical setting, and clinical meaning. MEASUREMENTS Questionnaires included an ACP/ASIM survey on physician satisfaction, the Maslach Burnout Inventory (MBI), and the Quality Work Competence (QWC) survey. RESULTS Emotional and work-related exhaustion decreased significantly over the study period (MBI, p = 0.002; QWC, p = 0.035). QWC measures of organizational health significantly improved initially and remained acceptable and stable during the rest of the study. CONCLUSIONS A data-guided program on physician well-being, using validated instruments and process improvement methods, enhanced physician and organizational well-being. Given the increases in physician burnout, organizations are encouraged to urgently create individual and systems approaches to lessen burnout risk. PMID:17891503

A pilot investigation of a mobile phone application and progressive reminder system to improve adherence to daily prevention treatment in adolescents and young adults with migraine.

PubMed

Ramsey, Rachelle R; Holbein, Christina E; Powers, Scott W; Hershey, Andrew D; Kabbouche, Marielle A; O'Brien, Hope L; Kacperski, Joanne; Shepard, Jeffrey; Hommel, Kevin A

2018-01-01

Background Effective management of migraine requires adherence to treatment recommendations; however, adolescents with migraine take their daily medications only 75% of the time. Low-cost adherence-focused interventions using technology may improve adherence, but have not been investigated. Methods Thirty-five adolescents and young adults (13-21 years) with migraine participated in an AB-design pilot study to assess the use of a mobile phone adherence-promotion application ("app") and progressive reminder system. Adherence was calculated using electronic monitoring during the baseline period and medication adherence intervention. Results Relative to baseline, adherence significantly improved during the first month of the intervention. Specifically, improvements existed for older participants with lower baseline adherence. Self-reported app-based adherence rates were significantly lower than electronically monitored adherence rates. Participants rated the intervention as acceptable and easy to use. Conclusions "Apps" have the potential to improve medication adherence and are a promising intervention for adolescents and young adults with low adherence. Involving parents in the intervention is also helpful. Providers should assess barriers to adherence and use of technology-based interventions, encourage parents to incorporate behavioral incentives, and provide referrals for more intensive interventions to improve long-term outcomes. Further, tracking adherence in an app may result in an underestimation of adherence. Future full-scale studies should be conducted to examine adherence promotion app interventions.

Biologic and Conventional Systemic Therapies Show Similar Safety and Efficacy in Elderly and Adult Patients With Moderate to Severe Psoriasis.

PubMed

Garber, Caren; Plotnikova, Natalia; Au, Shiu-chung; Sorensen, Eric P; Gottlieb, Alice

2015-08-01

Despite the aging population, few studies have documented the treatment of geriatric psoriasis. The purpose of this study is to compare the efficacy, safety, and prescribing patterns of biologics and conventional systemic medications in elderly versus adult psoriasis. All patient visits coded for psoriasis or psoriatic arthritis (ICD-9 696.1 or 696.0) at the Tufts Medical Center General Dermatology Clinic from January 1, 2008, to March 1, 2015 were included in this retrospective cohort study. The outcome measure used was the validated simple-measure for assessing psoriasis activity (S-MAPA), the product of the physician's global assessment and the body surface area. 194 patients who underwent 278 treatment courses were included in the study. 48 patients were included in the elderly cohort (≥ 65 years old) and 146 in the adult cohort (18-64 years old). There was no significant difference in S-MAPA improvement at 12 weeks between the two cohorts when treated with biologics (42.92% improvement in adults, 48.77% in elderly; P=0.498) or conventional systemics (43.96% and 51.82%, respectively; P=0.448). Within the elderly cohort, there was no significant difference in efficacy of biologics versus conventional systemics at any time point. Topical prescription rates were significantly higher in the elderly cohort ( P=0.004) while biologic prescription rates were significantly lower ( P=0.014) despite the same baseline S-MAPA in both age groups. For both biologics and conventional systemics, there was no statistically significant intergroup difference in the rate of adverse events ( P=0.322 for biologics; P=0.581 for conventional systemics) or infection ( P=0.753 for biologics; P=0.828 for conventional systemics). Within the elderly cohort, there was a higher rate of adverse events with conventional systemic treatment than with biologic treatment ( P=0.033). This study provides preliminary evidence to suggest that biologic and conventional systemic therapies are similarly safe and effective in the elderly and non-elderly cohorts. Within the elderly population, biologics may be a safer option than conventional systemic agents.

An Accelerated Recursive Doubling Algorithm for Block Tridiagonal Systems

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

Seal, Sudip K

2014-01-01

Block tridiagonal systems of linear equations arise in a wide variety of scientific and engineering applications. Recursive doubling algorithm is a well-known prefix computation-based numerical algorithm that requires O(M^3(N/P + log P)) work to compute the solution of a block tridiagonal system with N block rows and block size M on P processors. In real-world applications, solutions of tridiagonal systems are most often sought with multiple, often hundreds and thousands, of different right hand sides but with the same tridiagonal matrix. Here, we show that a recursive doubling algorithm is sub-optimal when computing solutions of block tridiagonal systems with multiplemore » right hand sides and present a novel algorithm, called the accelerated recursive doubling algorithm, that delivers O(R) improvement when solving block tridiagonal systems with R distinct right hand sides. Since R is typically about 100 1000, this improvement translates to very significant speedups in practice. Detailed complexity analyses of the new algorithm with empirical confirmation of runtime improvements are presented. To the best of our knowledge, this algorithm has not been reported before in the literature.« less

Towards ontology personalization to enrich social conversations on AAC systems

NASA Astrophysics Data System (ADS)

Mancilla V., Daniela; Sastoque H., Sebastian; Iregui G., Marcela

2015-01-01

Communication is one of the essential needs of human beings. Augmentative and Alternative Communication Systems (AAC) seek to help in the generation of oral and written language to people with physical disorders that limit their natural communication. These systems present significant challenges such as: the composition of consistent messages according to syntactic and semantic rules, the improvement of message production times, the application to social contexts and, consequently, the incorporation of user-specific information. This work presents an original ontology personalization approach for an AAC instant messaging system incorporating personalized information to improve the efficacy and efficiency of the message production. This proposal is based on a projection of a general ontology into a more specific one, avoiding storage redundancy and data coupling, representing a big opportunity to enrich communication capabilities of current AAC systems. The evaluation was performed for a study case based on an AAC system for assistance in composing messages. The results show that adding user-specific information allows generation of enriched phrases, so improving the accuracy of the message, facilitating the communication process.

Water Quality Improvement through Reductions of Pollutant Loads on Small Scale of Bioretention System

NASA Astrophysics Data System (ADS)

Elyza Muha, Norshafa; Mohd Sidek, Lariyah; Jajarmizadeh, Milad

2016-03-01

Bioretention system is introduced as an important topic namely Urban Storm Water Management Manual for Malaysia (MSMA) by the Department of Irrigation and Drainage Malaysia (DID) in May 2012. The main objective of this paper is to evaluate the performance of water quality for small scale bioretention system under tropical climate via MUSIC model. Two bioretention systems 1 and 2 are observed based on the difference media depth. The result of bioretention system is compared with a reference model which has infrastructure with Urban Stormwater Improvement Conceptualisation (MUSIC) for pollutants load reduction and water quality results. Assessment of results via MUSIC software indicates a significant percentage of reduction for Total Suspended Solid (TSS), Total Phosphorus (TP) and Total Nitrogen (TN). The prediction of pollutant reduction via using MUSIC has the harmony for requirement in MSMA. TSS pollutant reduction is more than 80%, while for TP and TN more than 50%. The outcome of this study can be helpful for improvement of the existing MSMA guidelines for application of bioretention systems in Malaysia.

Precise visual navigation using multi-stereo vision and landmark matching

NASA Astrophysics Data System (ADS)

Zhu, Zhiwei; Oskiper, Taragay; Samarasekera, Supun; Kumar, Rakesh

2007-04-01

Traditional vision-based navigation system often drifts over time during navigation. In this paper, we propose a set of techniques which greatly reduce the long term drift and also improve its robustness to many failure conditions. In our approach, two pairs of stereo cameras are integrated to form a forward/backward multi-stereo camera system. As a result, the Field-Of-View of the system is extended significantly to capture more natural landmarks from the scene. This helps to increase the pose estimation accuracy as well as reduce the failure situations. Secondly, a global landmark matching technique is used to recognize the previously visited locations during navigation. Using the matched landmarks, a pose correction technique is used to eliminate the accumulated navigation drift. Finally, in order to further improve the robustness of the system, measurements from low-cost Inertial Measurement Unit (IMU) and Global Positioning System (GPS) sensors are integrated with the visual odometry in an extended Kalman Filtering framework. Our system is significantly more accurate and robust than previously published techniques (1~5% localization error) over long-distance navigation both indoors and outdoors. Real world experiments on a human worn system show that the location can be estimated within 1 meter over 500 meters (around 0.1% localization error averagely) without the use of GPS information.

Performance characterization of image and video analysis systems at Siemens Corporate Research

NASA Astrophysics Data System (ADS)

Ramesh, Visvanathan; Jolly, Marie-Pierre; Greiffenhagen, Michael

2000-06-01

There has been a significant increase in commercial products using imaging analysis techniques to solve real-world problems in diverse fields such as manufacturing, medical imaging, document analysis, transportation and public security, etc. This has been accelerated by various factors: more advanced algorithms, the availability of cheaper sensors, and faster processors. While algorithms continue to improve in performance, a major stumbling block in translating improvements in algorithms to faster deployment of image analysis systems is the lack of characterization of limits of algorithms and how they affect total system performance. The research community has realized the need for performance analysis and there have been significant efforts in the last few years to remedy the situation. Our efforts at SCR have been on statistical modeling and characterization of modules and systems. The emphasis is on both white-box and black box methodologies to evaluate and optimize vision systems. In the first part of this paper we review the literature on performance characterization and then provide an overview of the status of research in performance characterization of image and video understanding systems. The second part of the paper is on performance evaluation of medical image segmentation algorithms. Finally, we highlight some research issues in performance analysis in medical imaging systems.

A comparison of clinical- and patient-reported outcomes of the cemented ATTUNE and PFC sigma fixed bearing cruciate sacrificing knee systems in patients who underwent total knee replacement with both prostheses in opposite knees.

PubMed

Carey, Brian W; Harty, James

2018-03-15

The ATTUNE Knee by DePuy Synthes was introduced in 2013. It is designed to provide better range of motion and address patient-reported instability. The PFC Sigma Knee, an earlier prosthesis by DePuy Synthes, is a common knee replacement with a strong clinical track record. Our aim is to compare the outcomes after primary total knee replacement for end-stage knee osteoarthritis of the PFC and ATTUNE knee systems in 21 patients who each have prosthesis in opposite knees using WOMAC, Oxford Knee and SF-12 scores and evaluation of range of motion. A review was carried out on 21 patients who underwent primary total knee replacement with both the ATTUNE and PFC knee systems. These were staged operations performed in the same institution and by the same surgeon. All cases were followed up for a minimum of 6 months. WOMAC, Oxford Knee and SF-12 scores, as well as knee range of motion were recorded preoperatively and at 6 months postoperatively. There was a significant difference in pre- to 6-month post-operative outcomes in PFC and ATTUNE groups with regard to improvement in range of motion (10° ± 8 and 13° ± 11, respectively). There was also a significant improvement in WOMAC scores (PFC group) and Oxford Knee Scores (ATTUNE group) (8.9 ± 7.7 and 12.1 ± 8.4, respectively). There was a significant improvement in SF-12 Score in both groups (10.1 ± 9.3 for PFC and 15.8 ± 13.3 for ATTUNE). The minimum clinically important difference (MCID) in scoring systems at 6 months was reached by 6 patients in the PFC group and 12 in the ATTUNE group. A significant difference was demonstrated in clinical outcome at 6 months postoperatively between PFC and ATTUNE knee systems in patients who underwent total knee arthroplasty with both prostheses. Superior results were recorded for the ATTUNE knee system.

Root system-based limits to agricultural productivity and efficiency: the farming systems context

PubMed Central

Thorup-Kristensen, Kristian; Kirkegaard, John

2016-01-01

Background There has been renewed global interest in both genetic and management strategies to improve root system function in order to improve agricultural productivity and minimize environmental damage. Improving root system capture of water and nutrients is an obvious strategy, yet few studies consider the important interactions between the genetic improvements proposed, and crop management at a system scale that will influence likely success. Scope To exemplify these interactions, the contrasting cereal-based farming systems of Denmark and Australia were used, where the improved uptake of water and nitrogen from deeper soil layers has been proposed to improve productivity and environmental outcomes in both systems. The analysis showed that water and nitrogen availability, especially in deeper layers (>1 m), was significantly affected by the preceding crops and management, and likely to interact strongly with deeper rooting as a specific trait of interest. Conclusions In the semi-arid Australian environment, grain yield impacts from storage and uptake of water from depth (>1 m) could be influenced to a stronger degree by preceding crop choice (0·42 t ha–1), pre-crop fallow management (0·65 t ha–1) and sowing date (0·63 t ha–1) than by current genetic differences in rooting depth (0·36 t ha–1). Matching of deep-rooted genotypes to management provided the greatest improvements related to deep water capture. In the wetter environment of Denmark, reduced leaching of N was the focus. Here the amount of N moving below the root zone was also influenced by previous crop choice or cover crop management (effects up to 85 kg N ha–1) and wheat crop sowing date (up to 45 kg ha–1), effects which over-ride the effects of differences in rooting depth among genotypes. These examples highlight the need to understand the farming system context and important G × E × M interactions in studies on proposed genetic improvements to root systems for improved productivity or environmental outcomes. PMID:27411680

The effects of motion and g-seat cues on pilot simulator performance of three piloting tasks

NASA Technical Reports Server (NTRS)

Showalter, T. W.; Parris, B. L.

1980-01-01

Data are presented that show the effects of motion system cues, g-seat cues, and pilot experience on pilot performance during takeoffs with engine failures, during in-flight precision turns, and during landings with wind shear. Eight groups of USAF pilots flew a simulated KC-135 using four different cueing systems. The basic cueing system was a fixed-base type (no-motion cueing) with visual cueing. The other three systems were produced by the presence of either a motion system or a g-seat, or both. Extensive statistical analysis of the data was performed and representative performance means were examined. These data show that the addition of motion system cueing results in significant improvement in pilot performance for all three tasks; however, the use of g-seat cueing, either alone or in conjunction with the motion system, provides little if any performance improvement for these tasks and for this aircraft type.

Improving Services for Women with Depression in Primary Care Settings

ERIC Educational Resources Information Center

Katon, Wayne J.; Ludman, Evette J.

2003-01-01

Women have a higher prevalence of depressive disorders compared to men. The current system of care for women with depressive disorders provides significant financial barriers for patients with lower incomes to access mental health services. Primary care systems are used extensively by women and have the potential to diagnose patients at early…

What Affect Student Cognitive Style in the Development of Hypermedia Learning System?

ERIC Educational Resources Information Center

Lee, Catherine Hui Min; Cheng, Yuk Wing; Rai, Shri; Depickere, Arnold

2005-01-01

Recent developments in learning technology such as hypermedia is becoming widespread and offer significant contribution to improve the delivery of learning and teaching materials. A key factor in the development of hypermedia learning system is cognitive style (CS) as it relates to users' information processing habits, representing individual…

Enabling Air Force Satellite Ground System Automation Through Software Engineering

DTIC Science & Technology

US Air Force satellite ground stations require significant manpower to operate due to their fragmented legacy architectures . To improve operating...daily operations, but also the development, maintainability, and the extensibility of such systems. This thesis researches challenges to Air Force...satellite automation: 1) existing architecture of legacy systems, 2) space segment diversity, and 3) unclear definition and scoping of the term, automation

Improving GPR image resolution in lossy ground using dispersive migration

USGS Publications Warehouse

Oden, C.P.; Powers, M.H.; Wright, D.L.; Olhoeft, G.R.

2007-01-01

As a compact wave packet travels through a dispersive medium, it becomes dilated and distorted. As a result, ground-penetrating radar (GPR) surveys over conductive and/or lossy soils often result in poor image resolution. A dispersive migration method is presented that combines an inverse dispersion filter with frequency-domain migration. The method requires a fully characterized GPR system including the antenna response, which is a function of the local soil properties for ground-coupled antennas. The GPR system response spectrum is used to stabilize the inverse dispersion filter. Dispersive migration restores attenuated spectral components when the signal-to-noise ratio is adequate. Applying the algorithm to simulated data shows that the improved spatial resolution is significant when data are acquired with a GPR system having 120 dB or more of dynamic range, and when the medium has a loss tangent of 0.3 or more. Results also show that dispersive migration provides no significant advantage over conventional migration when the loss tangent is less than 0.3, or when using a GPR system with a small dynamic range. ?? 2007 IEEE.

Handling performance control for hybrid 8-wheel-drive vehicle and simulation verification

NASA Astrophysics Data System (ADS)

Ni, Jun; Hu, Jibin

2016-08-01

In order to improve handling performance of a hybrid 8-Wheel-Drive vehicle, the handling performance control strategy was proposed. For armoured vehicle, besides handling stability in high speed, the minimum steer radius in low speed is also a key tactical and technical index. Based on that, the proposed handling performance control strategy includes 'Handling Stability' and 'Radius Minimization' control modes. In 'Handling Stability' control mode, 'Neutralsteer Radio' is defined to adjust the steering characteristics to satisfy different demand in different speed range. In 'Radius Minimization' control mode, the independent motors are controlled to provide an additional yaw moment to decrease the minimum steer radius. In order to verify the strategy, a simulation platform was built including engine and continuously variable transmission systems, generator and battery systems, independent motors and controllers systems, vehicle dynamic and tyre mechanical systems. The simulation results show that the handling performance of the vehicle can be enhanced significantly, and the minimum steer radius can be decreased by 20% which is significant improvement compared to the common level of main battle armoured vehicle around the world.

Thermal and Environmental Barrier Coatings for Advanced Propulsion Engine Systems

NASA Technical Reports Server (NTRS)

Zhu, Dong-Ming; Miller, Robert A.

2004-01-01

Ceramic thermal and environmental barrier coatings (TEBCs) are used in gas turbine engines to protect engine hot-section components in the harsh combustion environments, and extend component lifetimes. For future high performance engines, the development of advanced ceramic barrier coating systems will allow these coatings to be used to simultaneously increase engine operating temperature and reduce cooling requirements, thereby leading to significant improvements in engine power density and efficiency. In order to meet future engine performance and reliability requirements, the coating systems must be designed with increased high temperature stability, lower thermal conductivity, and improved thermal stress and erosion resistance. In this paper, ceramic coating design and testing considerations will be described for high temperature and high-heat-flux engine applications in hot corrosion and oxidation, erosion, and combustion water vapor environments. Further coating performance and life improvements will be expected by utilizing advanced coating architecture design, composition optimization, and improved processing techniques, in conjunction with modeling and design tools.

SU-E-I-88: The Effect of System Dead Time On Real-Time Plastic and GOS Based Fiber-Optic Dosimetry Systems

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

Hoerner, M; Hintenlang, D

Purpose: A methodology is presented to correct for measurement inaccuracies at high detector count rates using a plastic and GOS scintillation fibers coupled to a photomultiplier tube with digital readout. This system allows temporal acquisition and manipulation of measured data. Methods: The detection system used was a plastic scintillator and a separate gadolinium scintillator, both (0.5 diameter) coupled to an optical fiber with a Hamamatsu photon counter with a built-in microcontroller and digital interface. Count rate performance of the system was evaluated using the nonparalzable detector model. Detector response was investigated across multiple radiation sources including: orthovoltage x-ray system, colbat-60more » gamma rays, proton therapy beam, and a diagnostic radiography x-ray tube. The dead time parameter was calculated by measuring the count rate of the system at different exposure rates using a reference detector. Results: The system dead time was evaluated for the following sources of radiation used clinically: diagnostic energy x-rays, cobalt-60 gamma rays, orthovoltage xrays, particle proton accelerator, and megavoltage x-rays. It was found that dead time increased significantly when exposing the detector to sources capable of generating Cerenkov radiation, all of the sources sans the diagnostic x-rays, with increasing prominence at higher photon energies. Percent depth dose curves generated by a dedicated ionization chamber and compared to the detection system demonstrated that correcting for dead time improves accuracy. On most sources, nonparalzable model fit provided an improved system response. Conclusion: Overall, the system dead time was variable across the investigated radiation particles and energies. It was demonstrated that the system response accuracy was greatly improved by correcting for dead time effects. Cerenkov radiation plays a significant role in the increase in the system dead time through transient absorption effects attributed to electron hole-pair creations within the optical waveguide.« less

A randomised controlled trial of an SMS-based mobile epilepsy education system.

PubMed

Lua, Pei Lin; Neni, Widiasmoro Selamat

2013-01-01

We evaluated an epilepsy education programme based on text messaging (SMS). Epilepsy outpatients from three hospitals in Malaysia were randomised into two groups: intervention and control. Patients in the control group were supplied with printed epilepsy educational material while those in the intervention group also received text messages from the Mobile Epilepsy Educational System (MEES). A total of 136 patients completed the study (mean age 31 years; 91% Malay; 51% with an illness duration of more than 5 years). A between-group analysis showed that the awareness, knowledge and attitudes (AKA) about epilepsy did not significantly differ between the groups at baseline (P > 0.05). The intervention patients reported better AKA levels during follow-up compared to the control patients (P < 0.05). A within-group analysis showed that in intervention patients, there were significant improvements in all AKA domains with larger effect sizes (P < 0.01) while control patients also exhibited significant improvement in most domains except for Awareness but with smaller effect sizes. After controlling for possible confounding variables (age, gender, educational qualification, monthly income and baseline mean for each domain), the intervention group still reported significantly higher AKA than the control group particularly in Awareness (P < 0.001) and Total AKA (P = 0.003). There was also significantly better medication adherence and clinic attendance in the intervention group (P < 0.05). The results suggest that the addition of the MEES to conventional epilepsy education is effective in improving AKA.

Two-year clinical results of patients with sacroiliac joint syndrome treated by arthrodesis using a triangular implant system.

PubMed

Bornemann, Rahel; Roessler, Philip P; Strauss, Andreas C; Sander, Kirsten; Rommelspacher, Yorck; Wirtz, Dieter C; Pflugmacher, Robert; Frey, Sönke P

2017-01-01

Sacroiliac joint (SIJ) syndrome can cause various symptoms and may also be one reason for persistent low back pain, especially in patients with prior spinal fusions. If conservative treatments fail to improve symptoms, arthrodesis surgery can be considered. Minimally invasive approaches have emerged recently providing a good alternative to conventional methods. A novel triangular implant system (iFuse) can achieve an arthrodesis of the SIJ without the use of additional screws or bone material. Aim of the present study was an evaluation of short-term safety and efficacy of the implant system. Twenty-four patients were included in the study and treated with the iFuse system. In addition to demographic data, pain intensity (visual analogue scale) and functional impairment (Oswestry-disability index) were assessed prior to surgery and 1 month, 3 months, 6 months, 12 months and 24 months thereafter. During surgery and the follow up period all adverse events were documented and the correct implant position was controlled via plain radiographs. VAS scores and ODI improved significantly directly after surgery from 84.3 ± 9.2 mm to 40.7 ± 9.2 mm and from 76.8 ± 9.2% to 40.7 ± 9.2 % (p < 0.001). The ODI improved further to 31 ± 5.4% after 24 months whereas the VAS improved until the 3 months examination and ten stayed constant between 27.7 mm and 26.5 mm to 27 ± 6.6 mm at 24 months. No adverse events, intraoperative complications, implant malpositioning or loosening could be recorded at any time. The iFuse system is an effective and safe treatment for minimally invasive surgical arthrodesis of the SIJ. Pain and functional impairment can be significantly improved. However, in addition to this case series, further controlled studies are necessary, particularly in terms of a previous spinal fusion history.

A Hybrid Approach to Detect Driver Drowsiness Utilizing Physiological Signals to Improve System Performance and Wearability.

PubMed

Awais, Muhammad; Badruddin, Nasreen; Drieberg, Micheal

2017-08-31

Driver drowsiness is a major cause of fatal accidents, injury, and property damage, and has become an area of substantial research attention in recent years. The present study proposes a method to detect drowsiness in drivers which integrates features of electrocardiography (ECG) and electroencephalography (EEG) to improve detection performance. The study measures differences between the alert and drowsy states from physiological data collected from 22 healthy subjects in a driving simulator-based study. A monotonous driving environment is used to induce drowsiness in the participants. Various time and frequency domain feature were extracted from EEG including time domain statistical descriptors, complexity measures and power spectral measures. Features extracted from the ECG signal included heart rate (HR) and heart rate variability (HRV), including low frequency (LF), high frequency (HF) and LF/HF ratio. Furthermore, subjective sleepiness scale is also assessed to study its relationship with drowsiness. We used paired t -tests to select only statistically significant features ( p < 0.05), that can differentiate between the alert and drowsy states effectively. Significant features of both modalities (EEG and ECG) are then combined to investigate the improvement in performance using support vector machine (SVM) classifier. The other main contribution of this paper is the study on channel reduction and its impact to the performance of detection. The proposed method demonstrated that combining EEG and ECG has improved the system's performance in discriminating between alert and drowsy states, instead of using them alone. Our channel reduction analysis revealed that an acceptable level of accuracy (80%) could be achieved by combining just two electrodes (one EEG and one ECG), indicating the feasibility of a system with improved wearability compared with existing systems involving many electrodes. Overall, our results demonstrate that the proposed method can be a viable solution for a practical driver drowsiness system that is both accurate and comfortable to wear.

Time course and predictors of median nerve conduction after carpal tunnel release.

PubMed

Rotman, Mitchell B; Enkvetchakul, Bobby V; Megerian, J Thomas; Gozani, Shai N

2004-05-01

To identify predictors of outcome and of electrophysiologic recovery in patients with carpal tunnel syndrome (CTS) treated by endoscopic carpal tunnel release using a nerve conduction testing system (NC-Stat; NEUROMetrix, Inc, Waltham, MA). Validity of the automated nerve conduction testing system was shown by comparing presurgical distal motor latencies (DMLs) against a reference obtained by referral to an electromyography laboratory. The DML was evaluated in 48 patients with CTS. Measurements were obtained within 1 hour of surgery and at 2 weeks, 6 weeks, 3 months, and 6 months after carpal tunnel release. Presurgical and postsurgical DMLs were then compared and correlated with variables and possible predictors of outcome including age, body mass index, gender, and presurgical DMLs. The automated nerve conduction testing system DMLs matched those of reference electromyography/nerve conduction study values with high correlation. Sensitivity of the automated nerve conduction testing system when compared with a standardized CTS case definition was 89%, with a specificity of 95%. A significant correlation was found between the DML before release and the DML 1 hour after release. Moreover, maximal postsurgical DML improvement was highly dependent on the presurgical DML, with no improvement shown for the <4-ms group, mild improvement for the 4-to-6-ms group, and maximal improvement in the >6-ms group. Among the clinical variables of age, gender, and body mass index only age was mildly predictive of postrelease DML changes at 6 months. No other correlations between clinical variables and postsurgical DMLs were significant. In addition the predictive value of age was lost when combined with the presurgical DML in a multivariate analysis. Postsurgical changes in the median nerve DML were highly dependent on the prerelease latency. The sensitivity and specificity of a nerve conduction monitoring system in detecting and aiding in the diagnosis of CTS is useful in the long-term management of patients with CTS and can aid in determining the level of improvement in median nerve function after endoscopic carpal tunnel release.

Systems approach to managing educational quality in the engineering classroom

NASA Astrophysics Data System (ADS)

Grygoryev, Kostyantyn

Today's competitive environment in post-secondary education requires universities to demonstrate the quality of their programs in order to attract financing, and student and academic talent. Despite significant efforts devoted to improving the quality of higher education, systematic, continuous performance measurement and management still have not reached the level where educational outputs and outcomes are actually produced---the classroom. An engineering classroom is a complex environment in which educational inputs are transformed by educational processes into educational outputs and outcomes. By treating a classroom as a system, one can apply tools such as Structural Equation Modeling, Statistical Process Control, and System Dynamics in order to discover cause-and-effect relationships among the classroom variables, control the classroom processes, and evaluate the effect of changes to the course organization, content, and delivery, on educational processes and outcomes. Quality improvement is best achieved through the continuous, systematic application of efforts and resources. Improving classroom processes and outcomes is an iterative process that starts with identifying opportunities for improvement, designing the action plan, implementing the changes, and evaluating their effects. Once the desired objectives are achieved, the quality improvement cycle may start again. The goal of this research was to improve the educational processes and outcomes in an undergraduate engineering management course taught at the University of Alberta. The author was involved with the course, first, as a teaching assistant, and, then, as a primary instructor. The data collected from the course over four years were used to create, first, a static and, then, a dynamic model of a classroom system. By using model output and qualitative feedback from students, changes to the course organization and content were introduced. These changes led to a lower perceived course workload and increased the students' satisfaction with the instructor, but the students' overall satisfaction with the course did not change significantly, and their attitude toward the course subject actually became more negative. This research brought performance measurement to the level of a classroom, created a dynamic model of the classroom system based on the cause-and-effect relationships discovered by using statistical analysis, and used a systematic, continuous improvement approach to modify the course in order to improve selected educational processes and outcomes.

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

NASA Technical Reports Server (NTRS)

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

Long-term (12-month) improvement in meibomian gland function and reduced dry eye symptoms with a single thermal pulsation treatment.

PubMed

Greiner, Jack V

2013-08-01

To determine the 1-year post-treatment dry eye status of subjects with meibomian gland dysfunction and dry eye symptoms after receiving a single LipiFlow Thermal Pulsation System treatment. Single-centre, prospective, observational, open-label, 1-month-registered clinical trial with a 1-year follow-up examination. Patients with evaporative dry eye disease with meibomian gland dysfunction and dry eye symptoms who had participated in the registered 1-month clinical trial. Eighteen of 30 subjects initially enrolled were able to return for a 1-year follow-up. Both eyes of all patients were treated with a single 12-min treatment using the LipiFlow Thermal Pulsation System. Meibomian gland function, tear break-up time and dry eye symptoms were measured. Data are presented for pretreatment (baseline), and 1-month and 1-year post-treatment. Meibomian gland secretion scores, and tear break-up time and dry eye symptoms. Significant improvement in meibomian gland secretion scores from baseline measurements (4.0 ± 3.4) to 1-month post-treatment (11.3 ± 4.7; P < 0.0005) was maintained at 1-year (7.3 ± 4.6; P < 0.05). Baseline tear break-up time (4.9 ± 3.0) was significantly increased at 1-month (9.5 ± 6.9; P < 0.05); however, this improvement was no longer evident at 1-year post-treatment (6.0 ± 4.4). The significant improvement in symptom scores on Ocular Surface Disease Index and Standard Patient Evaluation of Eye Dryness questionnaires observed at 1-month (P < 0.0005) was maintained at 1-year (Ocular Surface Disease Index [P < 0.05]; Standard Patient Evaluation of Eye Dryness [P < 0.0005]). A single 12-min treatment with the Lipi Flow Thermal Pulsation System offers an effective treatment for evaporative dry eye and meibomian gland dysfunction resulting in significant and sustained improvement in signs and symptoms for up to 1 year. © 2012 The Author. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

[Evaluation on a demonstration project of ecological restoration of ditches at Qianwei Village of Chongming County, Shanghai].

PubMed

Zhou, Xiang-Xiang; Zhang, Li-Quan; Yuan, Lian-Qi

2008-02-01

By using biological slope-protection techniques, oxidation pond system, and zeolite treatment system, a demonstration project of ecological restoration of ditches at the Qianwei Village of Chongming County in Shanghai was implemented, and an evaluation on the project was made via a runoff simulation experiment and the measurements of the parameters soil shear strength, biodiversity, and ditch water quality. The results showed that covering the dich slopes with shrub could significantly increase soil shear strength, compactness and moisture content, and the formed vegetation had significant effects on retarding runoff and removing TSS (P < 0.05). Applying live fascines could significantly increase soil shear strength and TSS removal rate (P < 0.05), but its effects on increasing soil compactness and moisture content and retaining runoff were not significant. After the implement of the demonstration project, the total N and P concentrations in ditch water decreased significantly, habitat quality and aesthetic value of ditch slope improved, and biodiversity enhanced greatly. The integration of the biological techniques with other ecological restoration measures could stabilize ditch slope, improve ditch habitat quality, and restore the ecological environment of the ditches.

Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: A randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures.

PubMed

Emanuelsson, Peter; Gunnarsson, Ulf; Dahlstrand, Ursula; Strigård, Karin; Stark, Birgit

2016-11-01

The primary aim of this prospective, randomized, clinical, 2-armed trial was to evaluate the risk for recurrence using 2 different operative techniques for repair of abdominal rectus diastasis. Secondary aims were comparison of pain, abdominal muscle strength, and quality of life and to compare those outcomes to a control group receiving physical training only. Eighty-six patients were enrolled. Twenty-nine patients were allocated to retromuscular polypropylene mesh and 27 to double-row plication with Quill technology. Thirty-two patients participated in a 3-month training program. Diastasis was evaluated with computed tomography scan and clinically. Pain was assessed using the ventral hernia pain questionnaire, a quality-of-life survey, SF-36, and abdominal muscle strength using the Biodex System-4. One early recurrence occurred in the Quill group, 2 encapsulated seromas in the mesh group, and 3 in the suture group. Significant improvements in perceived pain, the ventral hernia pain questionnaire, and quality of life appeared at the 1-year follow-up with no difference between the 2 operative groups. Significant muscular improvement was obtained in all groups (Biodex System-4). Patient perceived gain in muscle strength assessed with a visual analog scale improved similarly in both operative groups. This improvement was significantly greater than that seen in the training group. Patients in the training group still experienced bodily pain at follow-up. There was no difference between the Quill technique and retromuscular mesh in the effect on abdominal wall stability, with a similar complication rate 1 year after operation. An operation improves functional ability and quality of life. Training strengthens the abdominal muscles, but patients still experience discomfort and pain. Copyright © 2016 Elsevier Inc. All rights reserved.

Combination of Collagen Barrier Membrane with Enamel Matrix Derivative-Liquid Improves Osteoblast Adhesion and Differentiation.

PubMed

Miron, Richard J; Fujioka-Kobayashi, Masako; Buser, Daniel; Zhang, Yufeng; Bosshardt, Dieter D; Sculean, Anton

Collagen barrier membranes were first introduced to regenerative periodontal and oral surgery to prevent fast ingrowing soft tissues (ie, epithelium and connective tissue) into the defect space. More recent attempts have aimed at combining collagen membranes with various biologics/growth factors to speed up the healing process and improve the quality of regenerated tissues. Recently, a new formulation of enamel matrix derivative in a liquid carrier system (Osteogain) has demonstrated improved physico-chemical properties for the adsorption of enamel matrix derivative to facilitate protein adsorption to biomaterials. The aim of this pioneering study was to investigate the use of enamel matrix derivative in a liquid carrier system in combination with collagen barrier membranes for its ability to promote osteoblast cell behavior in vitro. Undifferentiated mouse ST2 stromal bone marrow cells were seeded onto porcine-derived collagen membranes alone (control) or porcine membranes + enamel matrix derivative in a liquid carrier system. Control and enamel matrix derivative-coated membranes were compared for cell recruitment and cell adhesion at 8 hours; cell proliferation at 1, 3, and 5 days; and real-time polymerase chain reaction (PCR) at 3 and 14 days for genes encoding Runx2, collagen1alpha2, alkaline phosphatase, and bone sialoprotein. Furthermore, alizarin red staining was used to investigate mineralization. A significant increase in cell adhesion was observed at 8 hours for barrier membranes coated with enamel matrix derivative in a liquid carrier system, whereas no significant difference could be observed for cell proliferation or cell recruitment. Enamel matrix derivative in a liquid carrier system significantly increased alkaline phosphatase mRNA levels 2.5-fold and collagen1alpha2 levels 1.7-fold at 3 days, as well as bone sialoprotein levels twofold at 14 days postseeding. Furthermore, collagen membranes coated with enamel matrix derivative in a liquid carrier system demonstrated a sixfold increase in alizarin red staining at 14 days when compared with collagen membrane alone. The combination of enamel matrix derivative in a liquid carrier system with a barrier membrane significantly increased cell attachment, differentiation, and mineralization of osteoblasts in vitro. Future animal testing is required to fully characterize the additional benefits of combining enamel matrix derivative in a liquid carrier system with a barrier membrane for guided bone or tissue regeneration.

Off-site manufacturing significantly beneficial.

PubMed

MacDonald, Murdo

2007-03-01

Off-site manufacture of energy centre systems could help the NHS improve its track record of delivering major projects on time and on budget, argues Murdo MacDonald, major projects manager for Spirax Sarco.

Advanced Traffic Signal Control Algorithms

DOT National Transportation Integrated Search

2016-05-01

Vehicle convoys (platoons) hold a promise for significant efficiency improvements of freight and passenger transportation through better system integration. Through the use of advanced driver assistance, vehicles in a convoy can keep shorter distance...

Impact of an Event Reporting System on Resident Complication Reporting in Plastic Surgery Training: Addressing an ACGME and Plastic Surgery Milestone Project Core Competency.

PubMed

Parikh, Rajiv P; Snyder-Warwick, Alison; Naidoo, Sybill; Skolnick, Gary B; Patel, Kamlesh B

2017-11-01

The Accreditation Council for Graduate Medical Education and Plastic Surgery Milestone Project has identified practice-based learning and improvement, which involves systematically analyzing current practices and implementing changes, as a core competency in residency education. In surgical care, complication reporting is an essential component of practice-based learning and improvement as complications are analyzed in morbidity and mortality conference for quality improvement. Unfortunately, current methods for capturing a comprehensive profile of complications may significantly underestimate the true occurrence of complications. Therefore, the objectives of this study are to evaluate an intervention for complication reporting and compare this to current practice, in a plastic surgery training program. This is a preintervention and postintervention study evaluating resident reporting of complications on a plastic surgery service. The intervention was an online event reporting system developed by department leadership and patient safety experts. The cohorts consisted of all patients undergoing surgery during two separate 3-month blocks bridged by an implementation period. A trained reviewer recorded complications, and this served as the reference standard. Fisher's exact test was used for binary comparisons. There were 32 complications detected in 219 patients from June to August of 2015 and 35 complications in 202 patients from October to December of 2015. The proportion of complications reported in the preintervention group was nine of 32 (28.1 percent). After the intervention, this significantly increased to 32 of 35 (91.4 percent) (p < 0.001). An intervention using an event reporting system, supported by departmental leadership, led to significant improvements in complication reporting by plastic surgery residents.

Environmental sustainability of bioethanol produced from sweet sorghum stem on saline-alkali land.

PubMed

Wang, Mingxin; Pan, Xinxing; Xia, Xunfeng; Xi, Beidou; Wang, Lijun

2015-01-01

Life cycle assessment was conducted to evaluate the energy efficiency and environmental impacts of a bioethanol production system that uses sweet sorghum stem on saline-alkali land as feedstock. The system comprises a plant cultivation unit, a feedstock transport unit, and a bioethanol conversion unit, with 1000L of bioethanol as a functional unit. The net energy ratio is 3.84, and the net energy gain is 17.21MJ/L. Agrochemical production consumes 76.58% of the life cycle fossil energy. The category with the most significant impact on the environment is eutrophication, followed by acidification, fresh water aquatic ecotoxicity, human toxicity, and global warming. Allocation method, waste recycling approach, and soil salinity significantly influence the results. Using vinasse to produce pellet fuel for steam generation significantly improves energy efficiency and decreases negative environmental impacts. Promoting reasonable management practices to alleviate saline stress and increasing agrochemical utilization efficiency can further improve environmental sustainability. Copyright © 2015 Elsevier Ltd. All rights reserved.

How to improve an un-alterable model forecast? A sequential data assimilation based error updating approach

NASA Astrophysics Data System (ADS)

Gragne, A. S.; Sharma, A.; Mehrotra, R.; Alfredsen, K. T.

2012-12-01

Accuracy of reservoir inflow forecasts is instrumental for maximizing value of water resources and influences operation of hydropower reservoirs significantly. Improving hourly reservoir inflow forecasts over a 24 hours lead-time is considered with the day-ahead (Elspot) market of the Nordic exchange market in perspectives. The procedure presented comprises of an error model added on top of an un-alterable constant parameter conceptual model, and a sequential data assimilation routine. The structure of the error model was investigated using freely available software for detecting mathematical relationships in a given dataset (EUREQA) and adopted to contain minimum complexity for computational reasons. As new streamflow data become available the extra information manifested in the discrepancies between measurements and conceptual model outputs are extracted and assimilated into the forecasting system recursively using Sequential Monte Carlo technique. Besides improving forecast skills significantly, the probabilistic inflow forecasts provided by the present approach entrains suitable information for reducing uncertainty in decision making processes related to hydropower systems operation. The potential of the current procedure for improving accuracy of inflow forecasts at lead-times unto 24 hours and its reliability in different seasons of the year will be illustrated and discussed thoroughly.

The ambulance services in northern Norway 2004–2008: improved competence, more tasks, better logistics and increased costs

PubMed Central

Elsbak, Trond M.

2010-01-01

Background The ambulance services in northern Norway have undergone significant development during recent years. Aims The objective of this study was to describe these changes in terms of tasks performed, distance driven, resources spent and level of competence in terms of education. Methods A retrospective analysis was performed. The ambulance fleet’s activity during the time period 2004–2008 was analysed. The subject was the ambulance fleet in northern Norway and its crew members. Tasks done, kilometres driven, resources spent per thousand inhabitants and level of competence were the main outcome measures. Results The major findings were almost doubled costs (92%), increasing number of tasks performed (13%) and a stable situation concerning kilometres driven. We also revealed improving competence in terms of education. A 20% absolute increase in crew members having a certificate of competence (fagbrev) was observed. Conclusions Significant economic resources have been invested in the fleet. Improved level of competence and an upgraded coordination system have improved logistics and hopefully treatment outcome. The latter should be further elucidated when the electronic patient record (EPR) system has been implemented. PMID:20606813

Changes in disability following physical therapy intervention for patients with low back pain: dependence on symptom duration.

PubMed

Badke, Mary Beth; Boissonnault, William G

2006-06-01

To assess the impact of symptom duration on functional outcome, functional improvement, pain, and patient perception of recovery after a physical therapy (PT) program for low back pain (LBP) and to determine what variables are significantly associated with improved function. Retrospective case series. Outpatient setting at a tertiary care facility. Patients (N=130) who were seen for PT between June 2003 and November 2004. A customized rehabilitation program was developed for each patient based on examination findings and included a combination of the following interventions: mobilization/manipulation, flexibility exercises, strengthening exercises, endurance exercises, massage techniques, and heat and cold modalities. Functional outcome, functional improvement, perceived pain, and perceived improvement scores in the CareConnections Outcomes System (formerly TAOS) database. Persons whose symptom duration was greater than 6 months had significantly less functional improvement than persons whose symptom duration was less than 1 month. The median percentage improvement score for perceived recovery was also significantly lower for the chronic group than for the acute group. There was no significant difference in the percentage decrease in pain among the acute, subacute, and chronic groups. In regression analyses, a model with age (P=.001), symptom duration (P=.002), and inclusion of strengthening, flexibility, and mobilization and manipulation exercises (P=.001) fit the data well and explained 55.5% of the variance in functional improvement score for all 3 groups combined. Patients showed improvements in function following a rehabilitation program for LBP. The functional improvement score is influenced by age, symptom duration, and inclusion of mobilization/manipulation and strengthening and flexibility exercises.

Super-Resolution Image Reconstruction Applied to Medical Ultrasound

NASA Astrophysics Data System (ADS)

Ellis, Michael

Ultrasound is the preferred imaging modality for many diagnostic applications due to its real-time image reconstruction and low cost. Nonetheless, conventional ultrasound is not used in many applications because of limited spatial resolution and soft tissue contrast. Most commercial ultrasound systems reconstruct images using a simple delay-and-sum architecture on receive, which is fast and robust but does not utilize all information available in the raw data. Recently, more sophisticated image reconstruction methods have been developed that make use of far more information in the raw data to improve resolution and contrast. One such method is the Time-Domain Optimized Near-Field Estimator (TONE), which employs a maximum a priori estimation to solve a highly underdetermined problem, given a well-defined system model. TONE has been shown to significantly improve both the contrast and resolution of ultrasound images when compared to conventional methods. However, TONE's lack of robustness to variations from the system model and extremely high computational cost hinder it from being readily adopted in clinical scanners. This dissertation aims to reduce the impact of TONE's shortcomings, transforming it from an academic construct to a clinically viable image reconstruction algorithm. By altering the system model from a collection of individual hypothetical scatterers to a collection of weighted, diffuse regions, dTONE is able to achieve much greater robustness to modeling errors. A method for efficient parallelization of dTONE is presented that reduces reconstruction time by more than an order of magnitude with little loss in image fidelity. An alternative reconstruction algorithm, called qTONE, is also developed and is able to reduce reconstruction times by another two orders of magnitude while simultaneously improving image contrast. Each of these methods for improving TONE are presented, their limitations are explored, and all are used in concert to reconstruct in vivo images of a human testicle. In all instances, the methods presented here outperform conventional image reconstruction methods by a significant margin. As TONE and its variants are general image reconstruction techniques, the theories and research presented here have the potential to significantly improve not only ultrasound's clinical utility, but that of other imaging modalities as well.

A novel pen-based Bluetooth-enabled insulin delivery system with insulin dose tracking and advice.

PubMed

Bailey, Timothy S; Stone, Jenine Y

2017-05-01

Diabetes is growing in prevalence internationally. As more individuals require insulin as part of their treatment, technology evolves to optimize delivery, improve adherence, and reduce dosing errors. Insulin pens outperform vial and syringe in simplicity, dosing accuracy, and user preference. Bolus advisors improve dosing confidence and treatment adherence. The InPen System offers a novel approach to treatment via a wireless pen that syncs to a mobile application featuring a bolus advisor, enabling convenient insulin dose tracking and more accurate bolus advice among other features. Areas covered: Existing technology for insulin delivery and bolus advice are reviewed. The mechanics and functionality of the InPen device are delineated. Findings from formative testing and usability studies of the InPen system are reported. Future directions for the InPen system in the treatment of diabetes are discussed. Expert opinion: Diabetes management is complex and largely data-driven. The InPen System offers a promising new opportunity to avail insulin pen-users of features known to improve treatment efficacy, which have otherwise primarily been available to those using pumps. Given that the majority of insulin users do not use insulin pumps, the InPen System is poised to improve glucose control in a significant portion of the diabetes population.

NASA Workshop on Distributed Parameter Modeling and Control of Flexible Aerospace Systems

NASA Technical Reports Server (NTRS)

Marks, Virginia B. (Compiler); Keckler, Claude R. (Compiler)

1994-01-01

Although significant advances have been made in modeling and controlling flexible systems, there remains a need for improvements in model accuracy and in control performance. The finite element models of flexible systems are unduly complex and are almost intractable to optimum parameter estimation for refinement using experimental data. Distributed parameter or continuum modeling offers some advantages and some challenges in both modeling and control. Continuum models often result in a significantly reduced number of model parameters, thereby enabling optimum parameter estimation. The dynamic equations of motion of continuum models provide the advantage of allowing the embedding of the control system dynamics, thus forming a complete set of system dynamics. There is also increased insight provided by the continuum model approach.

Reliability enhancement of common module systems

NASA Astrophysics Data System (ADS)

Schellenberger, Gisbert; Ruehlich, Ingo; Korf, Herbert; Petrie, Juergen J.; Muenter, Rolf

2004-08-01

Several thousands of 1st Gen IR Systems operated by Integral Stirling Cooler HD1033 are still in service worldwide. Replacing the HD 1033 Stirling by a Linear Drive Cooler will result in a significant reliability enhancement of these IR system of about a factor of three. These attempts had been unsuccessful in the past due to excessive EMI noise induced by the linear cooler compressor. So a main goal for such a development is the elimination of various EMI distortions in the IR system by EMI filtering and shielding. Additionally, the synchronization of the cooler power to the predominant scanning frequency of the IR system significantly improves the image quality. Technical details of the solution, MTTF data and performance data are described in detail.

High-frequency - Spinal Cord Stimulation.

PubMed

Rapcan, R; Mlaka, J; Venglarcik, M; Vinklerova, V; Gajdos, M; Illes, R

2015-01-01

Our clinical experience with high - frequency SCS for FBSS in patients with predominant low back pain is presented. After a trial period, 100 % (21 out of 21) of patients with FBSS with predominant low back pain reported a significant improvement in visual analog scale (VAS) pain score and underwent permanent implantation of the high - frequency SCS system. SCS trials lasted 7-14 days (median 9 days). SCS leads were mostly positioned at the T8-10 or T8-12 vertebral levels . We used both single and dual lead placement. VAS, patient satisfaction, patient performance status, opioid consumption and complication rate were assessed for the period of 12 months. The mean VAS score before implantation (8.7) compared to VAS 12 months after implantation (4.0) was significantly lower (CI95[3.9-5.4], p < 0.001). There was a significant improvement in performance status when comparing PS before implantation (3.0) and 12 months after implantation (1.8) (CI95[0.9-1.6], p < 0.001). The mean patient satisfaction scores (PSS) did not differ throughout the whole one year follow-up period. Our group of 21 patients with implanted high - frequency SCS systems reported significant low back pain and leg pain relief within the period of 12 months as well as significant improvement in their performance status. We had a special subgroup of 5 patients with regular change of frequencies between high frequency and conventional frequency (with paresthesia) also with significant leg and low back pain relief (Tab. 2, Fig. 1, Ref. 8). Text in PDF www.elis.sk.

Compare the efficacy of inhaled budesonide and systemic methylprednisolone on systemic inflammation of AECOPD.

PubMed

Sun, Xuejiao; He, Zhiyi; Zhang, Jianquan; Deng, Jingmin; Bai, Jing; Li, Meihua; Zhong, Xiaoning

2015-04-01

Corticosteroids have been shown to improve the outcome of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, whether inhaled corticosteroids (IC) alone have similar effects with systemic corticosteroid (SCS) is still unclear. To compare the efficacy of inhaled budesonide and systemic methylprednisolone on systemic inflammation of AECOPD. 30 AECOPD patients were randomly divided into two group. Budesonide group (15 cases) were treated with inhaled budesonide (3 mg Bid); methylprednisolone group (15 cases) were treated with systemic methylprednisolone (methylprednisolone acetate injectable suspension 40 mg Qd for three days and then methylprednisolone tablets 8 mg Bid). Observe symptoms, lung function, blood gas analysis and adverse effects of the patients in two groups. Peripheral blood samples were collected before and after treatment for 1 day, 4 days and 7 days. Interleukin-8 (IL-8) and TNF-α levels were determined by an enzyme linked immunosorbent assay (ELISA). Hs-CRP levels were detected by automatic biochemical analyzer. Western blotting was used to determine histone deacetylase 2 (HDAC2) protein expression. Symptoms, pulmonary function and blood gas analysis were significantly improved after treatment in the two groups (P < 0.05) and no significant differences between the two groups (P > 0.05). There were no significant differences of IL-8, TNF-α and hs-CRP levels in the two groups (P > 0.05). Besides, the levels of HDAC2 protein expression before treatment were significantly lower comparing to that after treatment for 4 and 7 days. Incidence of adverse events (heart rate, blood pressure, glycemic, sleep condition, gastrointestinal symptoms) in budesonide group was lower than methylprednisolone group (P < 0.05). Inhaled budesonide and systemic methylprednisolone have the same effects on systemic inflammation of AECOPD. Inhaled corticosteroid alone could instead systemic corticosteroid in AECOPD treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

Immunology-directed methods for distributed robotics: a novel immunity-based architecture for robust control and coordination

NASA Astrophysics Data System (ADS)

Singh, Surya P. N.; Thayer, Scott M.

2002-02-01

This paper presents a novel algorithmic architecture for the coordination and control of large scale distributed robot teams derived from the constructs found within the human immune system. Using this as a guide, the Immunology-derived Distributed Autonomous Robotics Architecture (IDARA) distributes tasks so that broad, all-purpose actions are refined and followed by specific and mediated responses based on each unit's utility and capability to timely address the system's perceived need(s). This method improves on initial developments in this area by including often overlooked interactions of the innate immune system resulting in a stronger first-order, general response mechanism. This allows for rapid reactions in dynamic environments, especially those lacking significant a priori information. As characterized via computer simulation of a of a self-healing mobile minefield having up to 7,500 mines and 2,750 robots, IDARA provides an efficient, communications light, and scalable architecture that yields significant operation and performance improvements for large-scale multi-robot coordination and control.

Employment of sawtooth-shaped-function excitation signal and oversampling for improving resistance measurement accuracy

NASA Astrophysics Data System (ADS)

Lin, Ling; Li, Shujuan; Yan, Wenjuan; Li, Gang

2016-10-01

In order to achieve higher measurement accuracy of routine resistance without increasing the complexity and cost of the system circuit of existing methods, this paper presents a novel method that exploits a shaped-function excitation signal and oversampling technology. The excitation signal source for resistance measurement is modulated by the sawtooth-shaped-function signal, and oversampling technology is employed to increase the resolution and the accuracy of the measurement system. Compared with the traditional method of using constant amplitude excitation signal, this method can effectively enhance the measuring accuracy by almost one order of magnitude and reduce the root mean square error by 3.75 times under the same measurement conditions. The results of experiments show that the novel method can attain the aim of significantly improve the measurement accuracy of resistance on the premise of not increasing the system cost and complexity of the circuit, which is significantly valuable for applying in electronic instruments.

Joint Optics Structures Experiment (JOSE)

NASA Technical Reports Server (NTRS)

Founds, David

1987-01-01

The objectives of the JOSE program is to develop, demonstrate, and evaluate active vibration suppression techniques for Directed Energy Weapons (DEW). DEW system performance is highly influenced by the line-of-sight (LOS) stability and in some cases by the wave front quality. The missions envisioned for DEW systems by the Strategic Defense Initiative require LOS stability and wave front quality to be significantly improved over any current demonstrated capability. The Active Control of Space Structures (ACOSS) program led to the development of a number of promising structural control techniques. DEW structures are vastly more complex than any structures controlled to date. They will be subject to disturbances with significantly higher magnitudes and wider bandwidths, while holding higher tolerances on allowable motions and deformations. Meeting the performance requirements of the JOSE program requires upgrading the ACOSS techniques to meet new more stringent requirements, the development of requisite sensors and acturators, improved control processors, highly accurate system identification methods, and the integration of hardware and methodologies into a successful demonstration.

“Wine-Dark Sea” in an Organic Flow Battery: Storing Negative Charge in 2,1,3-Benzothiadiazole Radicals Leads to Improved Cyclability

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

Duan, Wentao; Huang, Jinhua; Kowalski, Jeffrey A.

Redox-active organic materials (ROMs) have shown great promise for redox flow battery applications but generally encounter limited cycling efficiency and stability at relevant redox material concentrations in nonaqueous systems. Here we report a new heterocyclic organic anolyte molecule, 2,1,3-benzothiadiazole, that has high solubility, a low redox potential, and fast electrochemical kinetics. Coupling it with a benchmark catholyte ROM, the nonaqueous organic flow battery demonstrated significant improvement in cyclable redox material concentrations and cell efficiencies compared to the state-of-the-art nonaqueous systems. Especially, this system produced exceeding cyclability with relatively stable efficiencies and capacities at high ROM concentrations (>0.5 M), which ismore » ascribed to the highly delocalized charge densities in the radical anions of 2,1,3-benzothiadiazole, leading to good chemical stability. As a result, this material development represents significant progress toward promising next-generation energy storage.« less

Smartphone-based system to improve transportation access for the cognitively impaired.

PubMed

Anderson, Shane M; Riehle, Timothy H; Lichter, Patrick A; Brown, Allen W; Panescu, Dorin

2015-01-01

This project developed and evaluated a smartphone-based system to improve mobility and transportation access for the cognitively impaired. The proposed system is intended to allow the cognitively impaired to use public transportation systems, community transportation and dedicated transportation services for the disabled with greater ease and safety. Individuals with cognitive disabilities are often unable to operate an automobile, or may require a prolonged recovery period before resuming driving. Public transportation systems represent a significant means to allow these individuals to maintain independence. Yet public transportation systems can pose significant challenges to individuals with cognitive impairment. The goal of this project is to develop a system to reduce these barriers via a technological solution consisting of components developed both for the cognitively impaired user and their caregiver or family member. The first component consists of a cognitive prosthetic device featuring traditional memory cueing and reminders as well as custom location-based transportation specific functions. This cognitive mobility assistant will leverage the computing power and GPS location determination capabilities of inexpensive, powerful smart phones. The second component consists of a management application which offers caregivers the ability to configure and program the reminder and transit functions remotely via the Internet. Following completion of the prototype system a pilot human test was performed with cognitively disabled individuals and family members or caregivers to assess the usability and acceptability of both system components.

Subtalar fusion for pes valgus in cerebral palsy: results of a modified technique in the setting of single event multilevel surgery.

PubMed

Shore, Benjamin J; Smith, Katherine R; Riazi, Arash; Symons, Sean B V; Khot, Abhay; Graham, Kerr

2013-06-01

We studied the use of cortico-cancellous circular allograft combined with cannulated screw fixation for the correction of dorsolateral peritalar subluxation in a series of children with bilateral spastic cerebral palsy undergoing single event multilevel surgery. Forty-six children who underwent bilateral subtalar fusion between January 1999 and December 2004 were retrospectively reviewed. Gait laboratory records, Gross Motor Function Classification System (GMFCS) levels, Functional Mobility Scale (FMS) scores, and radiographs were reviewed. The surgical technique used an Ollier type incision with a precut cortico-cancellous allograft press-fit into the prepared sinus tarsi. One or two 7.3 mm fully threaded cancellous screws were used to fix the subtalar joint. Radiographic analysis included preoperative and postoperative standing lateral radiographs measuring the lateral talocalcaneal angle, lateral talo-first metatarsal angle, and navicular cuboid overlap. Fusion rate was assessed with radiographs >12 months after surgery. The mean patient age was 12.9 years (range, 7.8 to 18.4 y) with an average follow-up of 55 months. Statistically significant improvement postoperatively was found for all 3 radiographic indices: lateral talocalcaneal angle, mean improvement 20 degrees (95% CI, 17.5-22.1; P<0.001); lateral talo-first metatarsal angle, mean improvement 21 degrees (95% CI, 19.2-23.4; P<0.001); and navicular cuboid overlap, mean improvement 29% (95% CI, 25.7%-32.6%; P<0.001). FMS improved across all patients, with Gross Motor Function Classification System III children experiencing a 70% improvement across all 3 FMS distances (5, 50, and 500 m). All 3 radiographic measures improved significantly (P<0.001). Fusion was achieved in 45 patients and there were no wound complications. With this study, we demonstrate significant improvement in radiographic segmental alignment and overall function outcome with this modified subtalar fusion technique. We conclude that this technique is an effective complement for children with dorsolateral peritalar subluxation undergoing single event multilevel surgery. Level IV.

The association between improved quality diabetes indicators, health outcomes and costs: towards constructing a "business case" for quality of diabetes care--a time series study.

PubMed

Wilf-Miron, Rachel; Bolotin, Arkadi; Gordon, Nesia; Porath, Avi; Peled, Ronit

2014-12-01

In primary health care systems where member's turnover is relatively low, the question, whether investment in quality of care improvement can make a business case, or is cost effective, has not been fully answered.The objectives of this study were: (1) to investigate the relationship between improvement in selected measures of diabetes (type 2) care and patients' health outcomes; and (2) to estimate the association between improvement in performance and direct medical costs. A time series study with three quality indicators - Hemoglobin A1c (HbA1c) testing, HbA1C and LDL- cholesterol (LDL-C) control - which were analyzed in patients with diabetes, insured by a large health fund. Health outcomes measures used: hospitalization days, Emergency Department (ED) visits and mortality. Poisson, GEE and Cox regression models were employed. Covariates: age, gender and socio-economic rank. 96,553 adult (age >18) patients with diabetes were analyzed. The performance of the study indicators, significantly and steadily improved during the study period (2003-2009). Poor HbA1C (>9%) and inappropriate LDL-C control (>100 mg/dl) were significantly associated with number of hospitalization days. ED visits did not achieve statistical significance. Improvement in HbA1C control was associated with an annual average of 2% reduction in hospitalization days, leading to substantial reduction in tertiary costs. The Hazard ratio for mortality, associated with poor HbA1C and LDL-C, control was 1.78 and 1.17, respectively. Our study demonstrates the effect of continuous improvement in quality care indicators, on health outcomes and resource utilization, among patients with diabetes. These findings support the business case for quality, especially in healthcare systems with relatively low enrollee turnover, where providers, in the long term, could "harvest" their investments in improving quality.