A Data-Driven Conceptualization of Teacher Evaluation

ERIC Educational Resources Information Center

Namaghi, Seyyed Ali Ostovar

2010-01-01

Research perspectives on teacher evaluation present evaluators with a set of possible acts. Local evaluation systems, on the other hand, specify a permissible set of acts from the total universe. The acts specified within a given locality act as conditions for teacher action. Using the sampling and analytical procedures of grounded theory, this…

An Initial Formulation. Research, Diagnosis and Development in Urban Education.

ERIC Educational Resources Information Center

Gappert, Gary

Described in this report are factors which affect and/or limit urban educational research and dimensions of cities which should be considered in making social and organizational research in urban education more relevant. Some of these considerations are learning, institutional and management deficits, the lack of a total systems perspective on the…

Juvenile Diversion as Agency Policy: A Twenty-Year Perspective.

ERIC Educational Resources Information Center

Seng, Magnus J.; Bensinger, Gad J.

1994-01-01

Examines a youth service bureau over a 20-year period, with a total client population of some 47,000 during this period. Findings indicate that this agency maintained its emphasis on diversion of juveniles from the traditional juvenile justice system not because of funding agency pressure, but because diversion is sound policy. (LKS)

Managing Change to a Quality Philosophy: A Partnership Perspective.

ERIC Educational Resources Information Center

Snyder, Karolyn J.; Acker-Hocevar, Michele

Within the past 5 years there has been an international movement to adapt the principles and practices of Total Quality Management work environments to school-restructuring agendas. This paper reports on the development of a model called the Educational Quality System, a benchmark assessment tool for identifying the essential elements of quality…

Kids without Family Privilege: Mobilizing Youth Development

ERIC Educational Resources Information Center

Seita, John R.

2005-01-01

While many youth are disconnected from adults, the people seem clueless as to what to do about this serious problem. The quality of connections is directly related to the quality of the total interpersonal environment. This article takes a systems perspective on the problem of connecting with youth, with particular emphasis on what communities,…

Community perspectives on roles and responsibilities for strengthening primary health care in rural Ethiopia.

PubMed

Curry, Leslie A; Alpern, Rachelle; Webster, Tashonna R; Byam, Patrick; Zerihun, Abraham; Tarakeshwar, Nalini; Cherlin, Emily J; Bradley, Elizabeth H

2012-01-01

Government-community partnerships are central to developing effective, sustainable models of primary health care in low-income countries; however, evidence about the nature of partnerships lacks the perspective of community members. Our objective was to characterise community perspectives regarding the respective roles and responsibilities of government and the community in efforts to strengthen primary health care in low-income settings. We conducted a qualitative study using focus groups (n=14 groups in each of seven primary health care units in Amhara and Oromia, Ethiopia, with a total of 140 participants) in the context of the Ethiopian Millennium Rural Initiative. Results indicated that community members defined important roles and responsibilities for both communities and governments. Community roles included promoting recommended health behaviours; influencing social norms regarding health; and contributing resources as feasible. Government roles included implementing oversight of health centres; providing human resources, infrastructure, equipment, medication and supplies; and demonstrating support for community health workers, who are seen as central to the rural health system. Renewed efforts in health system strengthening highlight the importance of community participation in initiatives to improve primary health care in rural settings. Community perspectives provide critical insights to defining, implementing and sustaining partnerships in these settings.

Study of the impact of automation on productivity in bus-maintenance facilities. Final report

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

Sumanth, D.J.; Weiss, H.J.; Adya, B.

1988-12-01

Whether or not the various types of automation and new technologies introduced in a bus-transit system really have an impact on productivity is the question addressed in the study. The report describes a new procedure of productivity measurement and evaluation for a county-transit system and provides an objective perspective on the impact of automation on productivity in bus maintenance facilities. The research objectives were: to study the impact of automation on total productivity in transit maintenance facilities; to develop and apply a methodology for measuring the total productivity of a Floridian transit maintenance facility (Bradenton-Manatee County bus maintenance facility whichmore » has been introducing automation since 1983); and to develop a practical step-by-step implementation scheme for the total productivity-based productivity measurement system that any bus manager can use. All 3 objectives were successfully accomplished.« less

Private English Tutoring and Adolescents' Motivation to Learn English as a Foreign Language: A Self System Perspective

ERIC Educational Resources Information Center

Huang, Hung-Tzu

2017-01-01

The present study investigated how self-related English learning motivation among Taiwanese adolescent learners differs between students who only receive English instruction in formal schooling and those who have additional private tutoring. A total of 1,698 teenage English learners in public secondary schools across Taiwan completed a…

Textbook Questions in Context-Based and Traditional Chemistry Curricula Analysed from a Content Perspective and a Learning Activities Perspective

ERIC Educational Resources Information Center

Overman, Michelle; Vermunt, Jan D.; Meijer, Paulien C.; Bulte, Astrid M. W.; Brekelmans, Mieke

2013-01-01

In this study, questions in context-based and traditional chemistry textbooks were analysed from two perspectives that are at the heart of chemistry curricula reforms: a content perspective and a learning activities perspective. To analyse these textbook questions, we developed an instrument for each perspective. In total, 971 textbook questions…

US FDA perspective on regulatory issues affecting circulatory assist devices.

PubMed

Sapirstein, Wolf; Chen, Eric; Swain, Julie; Zuckerman, Bram

2006-11-01

There has been a rapid development in mechanical circulatory support systems in the decade since the US FDA first approved a mechanical device to provide the circulatory support lacking from a failing heart. Devices are presently approved for marketing by the FDA to replace a failing ventricle, the Ventricular Assist Device or the entire heart, Total Artificial Heart. Contemporaneous with, and permitted by, improvement in technology and design, devices have evolved from units located extracorporeally to paracorporeal systems and totally implanted devices. Clinical studies have demonstrated a parallel improvement in the homeostatic adequacy of the circulatory support provided. Thus, while the circulatory support was initially tolerated for short periods to permit recovery of cardiac function, this technology eventually provided effective circulatory support for increasing periods that permitted the FDA to approve devices for bridging patients in end-stage cardiac failure awaiting transplant and eventually a device for destination therapy where patients in end-stage heart failure are not cardiac transplant candidates. The approved devices have relied on displacement pumps that mimic the pulsatility of the physiological system. Accelerated development of more compact devices that rely on alternative pump mechanisms have challenged both the FDA and device manufacturers to assure that the regulatory requirements for safety and effectiveness are met for use of mechanical circulatory support systems in expanded target populations. An FDA regulatory perspective is reviewed of what can be a potentially critical healthcare issue.

Applied Space Systems Engineering. Chapter 17; Manage Technical Data

NASA Technical Reports Server (NTRS)

Kent, Peter

2008-01-01

Effective space systems engineering (SSE) is conducted in a fully electronic manner. Competitive hardware, software, and system designs are created in a totally digital environment that enables rapid product design and manufacturing cycles, as well as a multitude of techniques such as modeling, simulation, and lean manufacturing that significantly reduce the lifecycle cost of systems. Because the SSE lifecycle depends on the digital environment, managing the enormous volumes of technical data needed to describe, build, deploy, and operate systems is a critical factor in the success of a project. This chapter presents the key aspects of Technical Data Management (TDM) within the SSE process. It is written from the perspective of the System Engineer tasked with establishing the TDM process and infrastructure for a major project. Additional perspectives are reflected from the point of view of the engineers on the project who work within the digital engineering environment established by the TDM toolset and infrastructure, and from the point of view of the contactors who interface via the TDM infrastructure. Table 17.1 lists the TDM process as it relates to SSE.

Effects of operational decisions on the diffusion of epidemic disease: A system dynamics modeling of the MERS-CoV outbreak in South Korea.

PubMed

Shin, Nina; Kwag, Taewoo; Park, Sangwook; Kim, Yon Hui

2017-05-21

We evaluated the nosocomial outbreak of Middle East Respiratory Syndrome (MERS) Coronavirus (CoV) in the Republic of Korea, 2015, from a healthcare operations management perspective. Establishment of healthcare policy in South Korea provides patients' freedom to select and visit multiple hospitals. Current policy enforces hospitals preference for multi-patient rooms to single-patient rooms, to lower financial burden. Existing healthcare systems tragically contributed to 186 MERS outbreak cases, starting from single "index patient" into three generations of secondary infections. By developing a macro-level health system dynamics model, we provide empirical knowledge to examining the case from both operational and financial perspectives. In our simulation, under base infectivity scenario, high emergency room occupancy circumstance contributed to an estimated average of 101 (917%) more infected patients, compared to when in low occupancy circumstance. Economic patient room design showed an estimated 702% increase in the number of infected patients, despite the overall 98% savings in total expected costs compared to optimal room design. This study provides first time, system dynamics model, performance measurements from an operational perspective. Importantly, the intent of this study was to provide evidence to motivate public, private, and government healthcare administrators' recognition of current shortcomings, to optimize performance as a whole system, rather than mere individual aspects. Copyright © 2017 Elsevier Ltd. All rights reserved.

Design and modeling of sustainable bioethanol supply chain by minimizing the total ecological footprint in life cycle perspective.

PubMed

Ren, Jingzheng; Manzardo, Alessandro; Toniolo, Sara; Scipioni, Antonio; Tan, Shiyu; Dong, Lichun; Gao, Suzhao

2013-10-01

The purpose of this paper is to develop a model for designing the most sustainable bioethanol supply chain. Taking into consideration of the possibility of multiple-feedstock, multiple transportation modes, multiple alternative technologies, multiple transport patterns and multiple waste disposal manners in bioethanol systems, this study developed a model for designing the most sustainable bioethanol supply chain by minimizing the total ecological footprint under some prerequisite constraints including satisfying the goal of the stakeholders', the limitation of resources and energy, the capacity of warehouses, the market demand and some technological constraints. And an illustrative case of multiple-feedstock bioethanol system has been studied by the proposed method, and a global best solution by which the total ecological footprint is the minimal has been obtained. Copyright © 2013 Elsevier Ltd. All rights reserved.

From control to causation: Validating a 'complex systems model' of running-related injury development and prevention.

PubMed

Hulme, A; Salmon, P M; Nielsen, R O; Read, G J M; Finch, C F

2017-11-01

There is a need for an ecological and complex systems approach for better understanding the development and prevention of running-related injury (RRI). In a previous article, we proposed a prototype model of the Australian recreational distance running system which was based on the Systems Theoretic Accident Mapping and Processes (STAMP) method. That model included the influence of political, organisational, managerial, and sociocultural determinants alongside individual-level factors in relation to RRI development. The purpose of this study was to validate that prototype model by drawing on the expertise of both systems thinking and distance running experts. This study used a modified Delphi technique involving a series of online surveys (December 2016- March 2017). The initial survey was divided into four sections containing a total of seven questions pertaining to different features associated with the prototype model. Consensus in opinion about the validity of the prototype model was reached when the number of experts who agreed or disagreed with survey statement was ≥75% of the total number of respondents. A total of two Delphi rounds was needed to validate the prototype model. Out of a total of 51 experts who were initially contacted, 50.9% (n = 26) completed the first round of the Delphi, and 92.3% (n = 24) of those in the first round participated in the second. Most of the 24 full participants considered themselves to be a running expert (66.7%), and approximately a third indicated their expertise as a systems thinker (33.3%). After the second round, 91.7% of the experts agreed that the prototype model was a valid description of the Australian distance running system. This is the first study to formally examine the development and prevention of RRI from an ecological and complex systems perspective. The validated model of the Australian distance running system facilitates theoretical advancement in terms of identifying practical system-wide opportunities for the implementation of sustainable RRI prevention interventions. This 'big picture' perspective represents the first step required when thinking about the range of contributory causal factors that affect other system elements, as well as runners' behaviours in relation to RRI risk. Copyright © 2017 Elsevier Ltd. All rights reserved.

TQM and Higher Education: A Critical Systems Perspective on Fitness for Purpose

ERIC Educational Resources Information Center

Houston, Don

2007-01-01

Total Quality Management (TQM) is a poor fit with higher education and can only be made to fit by major reshaping either of TQM to a more appropriate methodology (and hence not TQM), or of higher education to an image of organisation that fits TQM. The paper revisits longstanding concerns about multiple aspects of TQM from a critical systems…

Grand challenges in mass storage: A system integrator's perspective

NASA Technical Reports Server (NTRS)

Mintz, Dan; Lee, Richard

1993-01-01

The grand challenges are the following: to develop more innovation in approach; to expand the I/O barrier; to achieve increased volumetric efficiency and incremental cost improvements; to reinforce the 'weakest link' software; to implement improved architectures; and to minimize the impact of self-destructing technologies. Mass storage is defined as any type of storage system exceeding 100 GBytes in total size, under the control of a centralized file management scheme. The topics covered are presented in viewgraph form.

Designing appropriate blended courses: a students' perspective.

PubMed

Tsai, Chia-Wen

2010-10-01

The computing education in Taiwan's vocational schools usually focuses on how to help students enhance their professional skills and pass certified examinations. In addition, due to national education policy and universities' regulations, pure online courses are not permitted in Taiwan. In order to design appropriate blended learning (BL) courses, the author explored the effects of web-mediated self-regulated learning (SRL) with variations in online class frequency on enhancing students' computing skills and their perspective of the blended courses. A total of 172 students, divided into four groups, participated in the experiment. The results showed that students in the SRL and BL group with five online classes had the highest scores for using a database management system (DBMS), and the highest pass rate on certified examinations. Students in this group also expressed their positive perspective on the arrangement of their blended course with the intervention of web-mediated SRL.

Body representation disorders predict left right orientation impairments after stroke: A voxel-based lesion symptom mapping study.

PubMed

van Stralen, Haike E; Dijkerman, H Chris; Biesbroek, J Matthijs; Kuijf, Hugo J; van Gemert, H Maarten A; Sluiter, David; Kappelle, L Jaap; van Zandvoort, Martine J E

2017-06-07

Deficits in the ability to distinguish between the left and right side of the body can severely impair daily life functioning. The current study examined the relation between left right orientation (LRO) impairments and somatosensory related deficits, ranging from primary somatosensory impairments to body representation impairments, in patients who suffered a recent stroke. We also examined which areas in the brain are associated with LRO impairments using a Voxel-based Lesion Symptom Mapping (VLSM) analysis. We tested 47 first-ever stroke patients and 48 age-matched healthy controls. LRO was assessed with the Bergen Right Left Discrimination Test (BRLD). Impairments on primary somatosensory function (touch perception, proprioception), higher order somatosensory function (finger gnosis, subjective sense of body ownership) and other cognitive functions (language, attention & working memory, visuospatial neglect) were entered as predictors in a logistic regression analyses. Outcome measures consisted of the BRLD-total performance which was further subdivided in performance for 1) first person perspective stimuli, 2) third person perspective stimuli, 3) alternating between first- and third person perspective. Impairments on BRLD-total performance was predicted by impairments in finger gnosis and visuospatial neglect. For items placed in third person perspective, performance was predicted by body representation impairments; finger agnosia and the subjective sense of body ownership. VLSM analysis showed a significant association between LRO impairments and damage to the right insula. The current study suggests that the somatosensory system is important for LRO. Furthermore, the results indicate that an affected body representation may hinder adopting a third person perspective that may subsequently also lead to LRO impairments. The right insular cortex appeared crucially involved in these processes. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Army National Guard: Part of the Operational Force and Strategic Reserve

DTIC Science & Technology

2016-05-26

avoiding the war. The limited use of the RC in the Vietnam 6 Patrick M. Cronin, The Total Force Policy in Historical Perspective, No. CRM -87-78. Center...Cronin, Patrick M. The Total Force Policy in Historical Perspective. No. CRM -87-78. Center for Naval Analyses, Alexandria, VA: Naval Planning

Obesity-related costs and the economic impact of laparoscopic adjustable gastric banding procedures: benefits in the Texas Employees Retirement System.

PubMed

Perryman, M Ray; Gleghorn, Virginia

2010-01-01

To assess the return on investment (ROI) and economic impact of providing insurance coverage for the laparoscopic adjustable gastric banding (LAGB) procedure in classes II and III obese members of the Texas Employees Retirement System (ERS) and their dependents from payer, employer, and societal perspectives. Classes II and III obese employee members and their adult dependents were identified in a Texas ERS database using self-reported health risk assessment (HRA) data. Direct health costs and related absenteeism and mortality losses were estimated using data from previous research. A dynamic input-output model was then used to calculate overall economic effects by incorporating direct, indirect, and induced impacts. Direct health costs were inflation-adjusted to 2008 US dollars using the Consumer Price Index for Medical Care and other spending categories were similarly adjusted using relevant consumer and industrial indices. The future cost savings and other monetary benefits were discounted to present value using a real rate of 4.00%. From the payer perspective (ERS), the payback period for direct health costs associated with the LAGB procedure was 23-24 months and the annual return (over 5 years) was 28.8%. From the employer perspective (State of Texas), the costs associated with the LAGB procedure were recouped within 17-19 months (in terms of direct, indirect, and induced gains as they translated into State revenue) and the annual return (over 5 years) was 45.5%. From a societal perspective, the impact on total business activity for Texas (over 5 years) included gains of $195.3 million in total expenditures, $93.8 million in gross product, and 1354 person-years of employment. The analysis was limited by the following: reliance on other studies for methodology and use of a control sample; restriction of cost savings to 2.5 years which required out-of-sample forecasting; conservative assumptions related to the cost of the procedure; exclusion of presenteeism; and no sensitivity analyses performed. This analysis indicates that providing benefits for the LAGB procedure to eligible members of the Texas ERS and their dependents is worthy of support from payer, employer, and societal perspectives.

A Global Perspective on Early Childhood Care and Education: A Proposed Model. Action Research in Family and Early Childhood. UNESCO Education Sector Monograph.

ERIC Educational Resources Information Center

Lillemyr, Ole Fredrik; Fagerli, Oddvar; Sobstad, Frode

This monograph describes an alternative model for early childhood care and education involving a complex and integrated system that allows for more collaboration among early childhood care and education activities. The model, with its emphasis on values in all educational practices, is intended to promote a more global and total approach to…

Total Cost of Ownership, System Acceptance and Perceived Success of Enterprise Resource Planning Software: Simulating a Dynamic Feedback Perspective of ERP in the Higher Education Environment

ERIC Educational Resources Information Center

Fryling, Meg

2010-01-01

Enterprise Research Planning (ERP) software is advertised as the product that will "run the enterprise", improving data access and accuracy as well as enhancing business process efficiency. Unfortunately, organizations often make implementation decisions with little consideration for the maintenance phase of an ERP, resulting in significant…

Cost-Effectiveness Analysis of Universal Vaccination of Adults Aged 60 Years with 23-Valent Pneumococcal Polysaccharide Vaccine versus Current Practice in Brazil.

PubMed

de Soárez, Patrícia Coelho; Sartori, Ana Marli Christovam; Freitas, Angela Carvalho; Nishikawa, Álvaro Mitsunori; Novaes, Hillegonda Maria Dutilh

2015-01-01

To evaluate the cost-effectiveness of introducing universal vaccination of adults aged 60 years with the 23-valent pneumococcal polysaccharide vaccine (PPV23) into the National Immunization Program (NIP) in Brazil. Economic evaluation using a Markov model to compare two strategies: (1) universal vaccination of adults aged 60 years with one dose of PPV23 and 2) current practice (vaccination of institutionalized elderly and elderly with underlying diseases). The perspective was from the health system and society. Temporal horizon was 10 years. Discount rate of 5% was applied to costs and benefits. Clinical syndromes of interest were invasive pneumococcal disease (IPD) including meningitis, sepsis and others and pneumonia. Vaccine efficacy against IPD was obtained from a meta-analysis of randomized control trials and randomized studies, whereas vaccine effectiveness against pneumonia was obtained from cohort studies. Resource utilization and costs were obtained from the Brazilian Health Information Systems. The primary outcome was cost per life year saved (LYS). Univariate and multivariate sensitivity analysis were performed. The universal vaccination strategy avoided 7,810 hospitalizations and 514 deaths, saving 3,787 years of life and costing a total of USD$31,507,012 and USD$44,548,180, respectively, from the health system and societal perspective. The universal immunization would result in ICERs of USD$1,297 per LYS, from the perspective of the health system, and USD$904 per LYS, from the societal perspective. The results suggest that universal vaccination of adults aged 60 years with the 23-valent pneumococcal polysaccharide vaccine (PPV23) is a very cost-effective intervention for preventing hospitalization and deaths for IPD and pneumonia is this age group in Brazil.

Pulmonary artery pressure-guided heart failure management: US cost-effectiveness analyses using the results of the CHAMPION clinical trial.

PubMed

Martinson, Melissa; Bharmi, Rupinder; Dalal, Nirav; Abraham, William T; Adamson, Philip B

2017-05-01

Haemodynamic-guided heart failure (HF) management effectively reduces decompensation events and need for hospitalizations. The economic benefit of clinical improvement requires further study. An estimate of the cost-effectiveness of haemodynamic-guided HF management was made based on observations published in the randomized, prospective single-blinded CHAMPION trial. A comprehensive analysis was performed including healthcare utilization event rates, survival, and quality of life demonstrated in the randomized portion of the trial (18 months). Markov modelling with Monte Carlo simulation was used to approximate comprehensive costs and quality-adjusted life years (QALYs) from a payer perspective. Unit costs were estimated using the Truven Health MarketScan database from April 2008 to March 2013. Over a 5-year horizon, patients in the Treatment group had average QALYs of 2.56 with a total cost of US$56 974; patients in the Control group had QALYs of 2.16 with a total cost of US$52 149. The incremental cost-effectiveness ratio (ICER) was US$12 262 per QALY. Using comprehensive cost modelling, including all anticipated costs of HF and non-HF hospitalizations, physician visits, prescription drugs, long-term care, and outpatient hospital visits over 5 years, the Treatment group had a total cost of US$212 004 and the Control group had a total cost of US$200 360. The ICER was US$29 593 per QALY. Standard economic modelling suggests that pulmonary artery pressure-guided management of HF using the CardioMEMS™ HF System is cost-effective from the US-payer perspective. This analysis provides the background for further modelling in specific country healthcare systems and cost structures. © 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Using global health initiatives to strengthen health systems: a civil society perspective.

PubMed

Cohn, Jennifer; Russell, Asia; Baker, Brook; Kayongo, Alice; Wanjiku, Esther; Davis, Paul

2011-01-01

Research into the effects of global health initiatives (GHIs) on health systems has largely left out the viewpoints and contributions of civil society. This study details civil society's perspective regarding the effects of two GHIs, the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), on country health systems and the added value of civil society interacting with GHIs to strengthen health systems. The study employed qualitative data collection methods using semi-structured interviews administered during focus groups and key informant interviews. A range of health system stakeholders were interviewed in Kenya, Malawi, Uganda and Zambia. Data were coded and analysed for themes and sub-themes. In total, 2910 civil society participants provided information individually or in focus groups. Respondents reported that GHIs have contributed to dramatic health benefits within and outside of a disease-specific focus, including health systems strengthening efforts. However, opportunities for synergy between GHIs and health systems have been missed, and GHIs have not worked sufficiently to close capacity gaps of grassroots civil society organisations. Despite some governance innovations, civil society's opportunities to participate meaningfully in GHI priority setting efforts are limited. Recommendations are included on how to best use GHIs to strengthen health systems by partnering with civil society.

The socioeconomic costs of mental illness in Spain.

PubMed

Oliva-Moreno, Juan; López-Bastida, Julio; Montejo-González, Angel Luis; Osuna-Guerrero, Rubén; Duque-González, Beatriz

2009-10-01

Mental illness affects a large number of people in the world, seriously impairing their quality of life and resulting in high socioeconomic costs for health care systems and society. Our aim is to estimate the socioeconomic impact of mental illness in Spain for the year 2002, including health care resources, informal care and loss of labour productivity. A prevalence-based approach was used to estimate direct medical costs, direct non-medical costs, and loss of labour productivity. The total costs of mental illness have been estimated at 7,019 million euros. Direct medical costs represented 39.6% of the total costs and 7.3% of total public healthcare expenditure in Spain. Informal care costs represented 17.7% of the total costs. Loss of labour productivity accounted for 42.7% of total costs. In conclusion, the costs of mental illness in Spain make a considerable economic impact from a societal perspective.

Extent of Implementing the Total Quality Management Principles by Academic Departments Heads at Najran University from Faculty Members' Perspectives

ERIC Educational Resources Information Center

Al-Din, Hesham Moustafa Kamal; Abouzid, Mohamed Mahmoud

2016-01-01

This study aimed to identify the implementing degree of Total Quality Management (TQM) principals by Academic Departmental Heads (ADH) at the Najran University from faculty members' perspectives. It also aimed to determine significant differences between the average estimate of sample section of faculty members about the implementing degree of TQM…

Time Perspectives and Boredom Coping Strategies of Undergraduate Students from Turkey

ERIC Educational Resources Information Center

Eren, Altay; Coskun, Hamit

2015-01-01

Using person-centered and variable-centered analyses, this study examined the relationships between undergraduate students' time perspectives and boredom coping strategies. A total of 719 undergraduate students voluntarily participated in the study. Results of the study showed that undergraduate students' time perspectives can be reliably defined…

Cost-Effectiveness of Staphylococcus aureus Decolonization Strategies in High-Risk Total Joint Arthroplasty Patients.

PubMed

Williams, Devin M; Miller, Andy O; Henry, Michael W; Westrich, Geoffrey H; Ghomrawi, Hassan M K

2017-09-01

The risk of prosthetic joint infection increases with Staphylococcus aureus colonization. The cost-effectiveness of decolonization is controversial. We evaluated cost-effectiveness decolonization protocols in high-risk arthroplasty patients. An analytical model evaluated risk under 3 protocols: 4 swabs, 2 swabs, and nasal swab alone. These were compared to no-screening and universal decolonization strategies. Cost-effectiveness was evaluated from the hospital, patient, and societal perspective. Under base case conditions, universal decolonization and 4-swab strategies were most effective. The 2-swab and universal decolonization strategy were most cost-effective from patient and societal perspectives. From the hospital perspective, universal decolonization was the dominant strategy (much less costly and more effective). S aureus decolonization may be cost-effective for reducing prosthetic joint infections in high-risk patients. These results may have important implications for treatment of patients and for cost containment in a bundled payment system. Copyright © 2017 Elsevier Inc. All rights reserved.

Utility Estimates of Disease-Specific Health States in Prostate Cancer from Three Different Perspectives.

PubMed

Gries, Katharine S; Regier, Dean A; Ramsey, Scott D; Patrick, Donald L

2017-06-01

To develop a statistical model generating utility estimates for prostate cancer specific health states, using preference weights derived from the perspectives of prostate cancer patients, men at risk for prostate cancer, and society. Utility estimate values were calculated using standard gamble (SG) methodology. Study participants valued 18 prostate-specific health states with the five attributes: sexual function, urinary function, bowel function, pain, and emotional well-being. Appropriateness of model (linear regression, mixed effects, or generalized estimating equation) to generate prostate cancer utility estimates was determined by paired t-tests to compare observed and predicted values. Mixed-corrected standard SG utility estimates to account for loss aversion were calculated based on prospect theory. 132 study participants assigned values to the health states (n = 40 men at risk for prostate cancer; n = 43 men with prostate cancer; n = 49 general population). In total, 792 valuations were elicited (six health states for each 132 participants). The most appropriate model for the classification system was a mixed effects model; correlations between the mean observed and predicted utility estimates were greater than 0.80 for each perspective. Developing a health-state classification system with preference weights for three different perspectives demonstrates the relative importance of main effects between populations. The predicted values for men with prostate cancer support the hypothesis that patients experiencing the disease state assign higher utility estimates to health states and there is a difference in valuations made by patients and the general population.

The lifetime cost of spinal cord injury in Ontario, Canada: A population-based study from the perspective of the public health care payer.

PubMed

Chan, Brian Chun-Fai; Cadarette, Suzanne M; Wodchis, Walter P; Krahn, Murray D; Mittmann, Nicole

2018-06-20

To determine the publicly funded health care system lifetime cost-of-illness of spinal cord injury (SCI) from the perspective of the Ontario Ministry of Health and Long-term Care. Individuals hospitalized for their first SCI between the years 2005 and 2011 were identified and their health care costs were calculated using Ontario administrative health care data. From this information, lifetime costs were estimated using phase-based costing methods. The spinal cord injured cohort was matched to a non-spinal cord injured using propensity score matching. Net costs were determined by calculating the difference in costs between the two matched groups. Net costs were also presented for subgroups stratified by demographic characteristics. A total of 1,716 individuals with SCI were identified and matched in our study. The net lifetime cost of SCI was $336,000 per person. Much of the costs were observed in the first year post-SCI. The lifetime cost of SCI for individuals with a concurrent pressure ulcer at the initial hospitalization rises to $479,600. Costs were also higher for individuals with cervical or thoracic injury or requiring inpatient rehabilitation. Spinal cord injury is a substantial burden to the health care system. Our results are limited to the direct health care costs from the publicly funded health care payer perspective. Further analysis with a broader perspective is needed to understand the full economic impact of this catastrophic condition.

Toward an Integrative Social Identity Model of Collective Action: A Quantitative Research Synthesis of Three Socio-Psychological Perspectives

ERIC Educational Resources Information Center

van Zomeren, Martijn; Postmes, Tom; Spears, Russell

2008-01-01

An integrative social identity model of collective action (SIMCA) is developed that incorporates 3 socio-psychological perspectives on collective action. Three meta-analyses synthesized a total of 182 effects of perceived injustice, efficacy, and identity on collective action (corresponding to these socio-psychological perspectives). Results…

Assessment of the integration capability of system architectures from a complex and distributed software systems perspective

NASA Astrophysics Data System (ADS)

Leuchter, S.; Reinert, F.; Müller, W.

2014-06-01

Procurement and design of system architectures capable of network centric operations demand for an assessment scheme in order to compare different alternative realizations. In this contribution an assessment method for system architectures targeted at the C4ISR domain is presented. The method addresses the integration capability of software systems from a complex and distributed software system perspective focusing communication, interfaces and software. The aim is to evaluate the capability to integrate a system or its functions within a system-of-systems network. This method uses approaches from software architecture quality assessment and applies them on the system architecture level. It features a specific goal tree of several dimensions that are relevant for enterprise integration. These dimensions have to be weighed against each other and totalized using methods from the normative decision theory in order to reflect the intention of the particular enterprise integration effort. The indicators and measurements for many of the considered quality features rely on a model based view on systems, networks, and the enterprise. That means it is applicable to System-of-System specifications based on enterprise architectural frameworks relying on defined meta-models or domain ontologies for defining views and viewpoints. In the defense context we use the NATO Architecture Framework (NAF) to ground respective system models. The proposed assessment method allows evaluating and comparing competing system designs regarding their future integration potential. It is a contribution to the system-of-systems engineering methodology.

Green innovation and sustainable industrial systems within sustainability and company improvement perspective

NASA Astrophysics Data System (ADS)

Edi Nugroho Soebandrija, Khristian

2017-12-01

This paper comprises discussion of Green Innovation and Sustainable Industrial Systems within Sustainability and Company Improvement Perspective of beverage manufacturing company (BMC). The stakeholder theory is the grand theory for the company improvement perspective in this paper. The data processing in this paper is conducted through software which are SEM-PLS with SmartPLS 2.0 and SPSS 19. The specified objective of this paper has focus on sustainability as one of 6 variables, in lieu of those 6 variables as the big picture. The reason behind this focus on sustainability is the fact that there are assorted challenges in sustainability that is ranging from economic, environment and company perspectives. Those challenges in sustainability include the sustainable service supply chain management and its involvement of society. The overall objective is to analyze relationship hypothesis of 6 variables, 4 of them (leadership, organizational learning, innovation, and performance) are based on Malcolm Baldrige’s performance excellence concept to achieve sustainability and competitive advantage through company-competitor and customer questionnaire, and its relation to Total Quality Management (TQM) and Quality Management System (QMS). In conclusion, the spearheaded of company improvement in this paper is in term of consumer satisfaction through 99.997% quality standards. These can be achieved by ambidexterity through exploitation and exploration innovation. Furthermore, in this paper, TQM enables to obtain popularity brand index achievement that is greater than 45.9%. Subsequently, ISO22000 of food security standard encompasses quality standard of ISO9000 and HACCP. Through the ambidexterity of exploitation and exploration (Non Standard Product Inspection) NOSPI machine, the company improvement generates the achievement of 75% automation, 99.997% quality control standard and 80% of waste reduction.

A Perspective on Commissioning and Education -- Total Quality, Total Force

DTIC Science & Technology

1993-04-01

regarding literacy or other critical skills , creative thinking, social values, and the relative ability to support economic development and adaptation to...people. ROTC is seen as another flexible, expandable source of commissioned officers with broad civilian perspectives and specific skills , as well as...measured by the performance of selected (often psychomotor ) tasks, but the effectiveness of programs with broader goals is more difficult to measure. As

National Offshore Wind Energy Grid Interconnection Study

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

Daniel, John P.; Liu, Shu; Ibanez, Eduardo

2014-07-30

The National Offshore Wind Energy Grid Interconnection Study (NOWEGIS) considers the availability and potential impacts of interconnecting large amounts of offshore wind energy into the transmission system of the lower 48 contiguous United States. A total of 54GW of offshore wind was assumed to be the target for the analyses conducted. A variety of issues are considered including: the anticipated staging of offshore wind; the offshore wind resource availability; offshore wind energy power production profiles; offshore wind variability; present and potential technologies for collection and delivery of offshore wind energy to the onshore grid; potential impacts to existing utility systemsmore » most likely to receive large amounts of offshore wind; and regulatory influences on offshore wind development. The technologies considered the reliability of various high-voltage ac (HVAC) and high-voltage dc (HVDC) technology options and configurations. The utility system impacts of GW-scale integration of offshore wind are considered from an operational steady-state perspective and from a regional and national production cost perspective.« less

Diabetes: An Investor's Perspective

PubMed Central

Harris, Bernard

2008-01-01

Total health care expenditure in 2006 was $2.1 trillion. This figure is estimated to double within the next few years as the cost of treating diabetes and other chronic conditions continues to rise. Moreover, the baby boomer demographic is anticipated to place an enormous burden on the health care system and employer-based health insurance premiums were increased at rates as high as 10% per year in 2006. The quest to address these challenges has also created opportunities for investment, particularly in the fields of telemedicine, health care information technology, and medical technology. The author shares his business perspective, informed by years of experience as a physician and astronaut at NASA, and describes new applications of exciting technologies that deliver effective and efficient health care to diabetes patients, no matter where they may be. PMID:19885357

The Impact of Gender and Role Perspective on Moral Judgment.

ERIC Educational Resources Information Center

Oakes, Ruth; Quina, Katherine

A study was made of the effects of role perspective and gender on the moral judgments of children. Because they represent a transitional period in cognitive development from heteronomy to autonomy, a total of 25 male and 38 female third-grade students of approximately 9 years of age were selected for participation. The effect of perspective taking…

Using the Teaching Perspectives Inventory (TPI) to Examine the Relationship between Teaching Perspectives and Disciplines in Higher Education

ERIC Educational Resources Information Center

Rotidi, Georgia; Collins, John B.; Karalis, Thanassis; Lavidas, Konstantinos

2017-01-01

This study examined the relationship between different views of teaching and dimensions that differentiate academic disciplines. A total of 114 academics within Greece and 127 academics from similar disciplines but other countries were compared using the Teaching Perspectives Inventory (TPI). Distinctions among disciplines for both groups were…

Islamic value to the modification of BSC model (a case study in evaluating company performance)

NASA Astrophysics Data System (ADS)

Harwati; Permana, Y.

2017-12-01

Halal is the key word for the Muslim community in consuming goods or services. Providing halal products is the main focus for companies with the largest consumers from the Muslim community. Halal is not only from the ingredients but also from the process in its production. The purpose of this study is to design a model of performance measurement for a company in order to provide halal products. Balance Score Card (BSC) is used as a framework. BSC as a performance measurement system has advantages not only focus on financial aspect but also non finance. Islamic values are incorporated into four perspective of BSC. They are: Selection of sharia financial institutions in financial perspective, payment method by consumer in consumer perspective, number of product with halal certificate and menu clarify in internal business process perspective, then accuracy of payroll time in learning and growth perspective. The modified BSC model obtains 17 Key Performance Indicators (KPI). The model is applied in a culinary industry (restaurant). Structured questionnaires and scheduled interviews are used to collect the important data. The result show that these industry fail to meet 8 from total 17 KPI so performance achievement is only 70.81%, and only reach 22.58% in Islamic value aspect. This is recorded by the company as an input to improve their performance in order to compete in halal food business.

An evaluation of the total quality management implementation strategy for the advanced solid rocket motor project at NASA's Marshall Space Flight Center. M.S. Thesis - Tennessee Univ.

NASA Technical Reports Server (NTRS)

Schramm, Harry F.; Sullivan, Kenneth W.

1991-01-01

An evaluation of the NASA's Marshall Space Flight Center (MSFC) strategy to implement Total Quality Management (TQM) in the Advanced Solid Rocket Motor (ASRM) Project is presented. The evaluation of the implementation strategy reflected the Civil Service personnel perspective at the project level. The external and internal environments at MSFC were analyzed for their effects on the ASRM TQM strategy. Organizational forms, cultures, management systems, problem solving techniques, and training were assessed for their influence on the implementation strategy. The influence of ASRM's effort was assessed relative to its impact on mature projects as well as future projects at MSFC.

The Impact Of Optical Storage Technology On Image Processing Systems

NASA Astrophysics Data System (ADS)

Garges, Daniel T.; Durbin, Gerald T.

1984-09-01

The recent announcement of commercially available high density optical storage devices will have a profound impact on the information processing industry. Just as the initial introduction of random access storage created entirely new processing strategies, optical technology will allow dramatic changes in the storage, retrieval, and dissemination of engineering drawings and other pictorial or text-based documents. Storage Technology Corporation has assumed a leading role in this arena with the introduction of the 7600 Optical Storage Subsystem, and the formation of StorageTek Integrated Systems, a subsidiary chartered to incorporate this new technology into deliverable total systems. This paper explores the impact of optical storage technology from the perspective of a leading-edge manufacturer and integrator.

Assessment of 6th Grade Elementary School Students, Their Parents' and Branch Teachers' Perspective on Physical Education Classes

ERIC Educational Resources Information Center

Boyraz, Sirin; Ozbar, Nurper; Yetgin, Meral Kucuk; Koksalan, Burke

2015-01-01

A total of 437 volunteers including 54 teachers, 218 6th grade students and 102 parents from Beykoz Elementary Schools participated in this study to understand the perspectives of students, families and teachers on Physical Education classes. The perspectives of students, families and teachers of other branches are identified by survey method.…

Cost-effectiveness analysis of sensor-augmented pump therapy with low glucose-suspend in patients with type 1 diabetes mellitus and high risk of hypoglycemia in Spain.

PubMed

Conget, Ignacio; Martín-Vaquero, Pilar; Roze, Stéphane; Elías, Isabel; Pineda, Cristina; Álvarez, María; Delbaere, Alexis; Ampudia-Blasco, Francisco Javier

2018-05-19

To compare the cost-effectiveness of sensor-augmented pump therapy (SAP) [continuous subcutaneous insulin infusion (CSII) plus real-time continuous glucose monitoring (RT-CGM)] with low glucose suspend (MiniMed™ Veo™) and CSII alone in patients with type 1 diabetes mellitus (T1DM) at high risk of hypoglycemia in Spain. The IQVIA CORE Diabetes Model was used to estimate healthcare outcomes as life-years gained (LYGs) and quality-adjusted life years (QALYs), and to project lifetime costs. Information about efficacy, resource utilization, and unit costs (€2016) was taken from published sources and validated by an expert panel. Analyses were performed from both the Spanish National Health System (NHS) perspective and the societal perspective. From the NHS perspective, SAP with low glucose suspend was associated to a €47,665 increase in direct healthcare costs and to increases of 0.19 LYGs and 1.88 QALYs, both discounted, which resulted in an incremental cost-effectiveness ratio (ICER) of €25,394/QALY. From the societal perspective, SAP with low glucose suspend increased total costs (including direct and indirect healthcare costs) by €41,036, with a resultant ICER of €21,862/QALY. Considering the willingness-to-pay threshold of €30,000/QALY in Spain, SAP with low glucose suspend represents a cost-effective option from both the NHS and societal perspectives. Sensitivity analyses confirmed the robustness of the model. From both the Spanish NHS perspective and the societal perspective, SAP with low glucose suspend is a cost-effective option for the treatment of T1DM patients at high risk of hypoglycemia. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Cost-effectiveness analysis of the introduction of rotavirus vaccine in Iran.

PubMed

Javanbakht, Mehdi; Moradi-Lakeh, Maziar; Yaghoubi, Mohsen; Esteghamati, Abdoulreza; Mansour Ghanaie, Roxana; Mahmoudi, Sussan; Shamshiri, Ahmad-Reza; Zahraei, Seyed Mohsen; Baxter, Louise; Shakerian, Sareh; Chaudhri, Irtaza; Fleming, Jessica A; Munier, Aline; Baradaran, Hamid R

2015-05-07

Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children <5 years old. Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq (RV5)) in Iran, from the viewpoints of Iran's health system and society. The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3% was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results. Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US$ 499.91 million. Also, US$ 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US$ 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario. Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to the national immunization program is an efficient use of available funds to reduce child mortality and morbidity in Iran. Copyright © 2014 Elsevier Ltd. All rights reserved.

The transfer of safety training in work organizations: a systems perspective to continuous learning.

PubMed

Ford, J K; Fisher, S

1994-01-01

The effectiveness of safety and health programs can be evaluated from a "transfer" perspective, which evaluates the effectiveness of training in individual programs, and from a "systems" perspective that contends that a safety training program cannot be isolated from the organizational system of which it is a part. This chapter explores the effectiveness of training from a systems perspective and includes recommendations for improving safety and health training.

Understanding Health Needs and Perspectives of Middle Age and Older Women Experiencing Homelessness

PubMed Central

Salem, Benissa E.; Ma-Pham, Jennifer

2015-01-01

Middle age and older homeless women have unique health and social delivery needs; yet, limited data exists about such needs. The purpose of this qualitative study was to understand perspectives among prefrail and frail homeless women (N=20; ages 43-62) that included a quantitative description of sample characteristics using frequencies, percents and means; and a qualitative analysis of focus group data utilizing content analysis. The average age was 53.4; the majority of the sample was African American (70%). In total, 60% reported living in a shelter for the last 30 days, while 20% were unsheltered. The majority of the sample reported walking independently (80%) and not using an assistive device (65%). Over one third (35%) fell in the last 30 days and 70% fell in the last year. Content analysis revealed several themes that included (1) healthcare needs and challenges experienced; (2) perspectives on sexual decision making; (3) employment difficulties; (4) existing support systems; and (5) development of future program planning. Future research development and implications are discussed. PMID:25832775

U.S. Army Unmanned Aircraft Systems (UAS) - A Historical Perspective to Identifying and Understanding Stakeholder Relationships

DTIC Science & Technology

2014-06-01

the aviation community vs . 35 Intelligence Community have proponency for the mission? Who should pilot UAS, the officer ranks or the enlisted ranks...quickly and effectively respond to emergencies and natural or man-made disasters within the homeland. The ARNG provides the total Army with 30 of 80...should” fly planes and the Army “should” fly helicopters, but there are other examples, such as that “UAS are intelligence assets vs . aviation assets

[Medical economics research on awareness of community pharmacists about raising pharmaceutical questions regarding prescriptions issued by physicians].

PubMed

Shikamura, Yoshiaki; Oyama, Akiko; Takahashi, Junichi; Akagi, Yuuki; Negishi, Kenichi; Ijyuin, Kazushige; Kamimura, Naoki; Aoyama, Takao

2012-01-01

This study examined the impact of pharmaceutical inquiries regarding prescriptions on drug costs by surveying the actual condition of inquiries at 13 pharmacies. The study also investigated the significance of inquiries from a medical economics perspective by calculating the medical cost savings realized by preventing adverse drug reactions (ADRs). As a result, the total change in drug costs for the 13 pharmacies after pharmaceutical inquiries represented an increase of ¥9,018/month. However, upon recalculating the cost of drugs by assuming that those with an "Incomplete entry in the prescription (compared with previous prescription, etc.)" should in fact have been prescribed, and excluding them, the total drug costs for the 13 pharmacies is decreased to ¥154,743/month, translating to a cost-savings of ¥7.2/prescription. The study then undertook a comprehensive assessment based on the Diagnosis Procedure Combination (DPC) system to determine the total medical cost-savings for 5 patients in whom ADRs could have occurred if the prescriptions had not been modified as a result of pharmaceutical inquiries. The obtained figure of ¥1,188,830 suggests that pharmaceutical inquiries contribute to reduced medical costs. The findings of this study indicate that pharmaceutical inquiries regarding prescriptions by staff pharmacists not only ensure the proper delivery of drug therapy to patients, but are also effective from a medical economics perspective.

Sensing systems efficiency evaluation and comparison for homeland security and homeland defense

NASA Astrophysics Data System (ADS)

Pakhomov, Alexander A.

2010-04-01

Designers and consumers of various security, intelligence, surveillance and reconnaissance (ISR) systems as well as various unattended ground sensors pay most attention to their commonly used performance characteristics such as probability of a target detection and probability of a false alarm. These characteristics are used for systems comparison and evaluation. However, it is not enough for end-users of these systems as well as for their total/final effectiveness assessment. This article presents and discusses a system approach to an efficiency estimation of the security and ISR systems. Presented approach aims at final result of the system's function and use. It allows setting up reasonable technical and structural requirements for the security and ISR systems, to make trustworthy comparison and practical application planning of such systems. It also allows finding forward-looking, perspective ways of systems development. Presented results can be guidance to both designers and consumers.

Future trends in dental benefits.

PubMed

Anderson, Maxwell H

2005-05-01

Dentistry and dental payment systems as we know them today will continue to evolve. Dentistry as practiced today and the prepayment systems of dentistry are substantially different than they were fifty years ago when dental insurance as we know it was first developed. Dentistry has always changed with the development of our science and the expression of dentistry's diseases in the populations we serve. The changes that are likely to occur in the future will be focused on improving health outcomes across risk-analyzed populations with the goals of providing optimal health outcomes at reasonable costs. Dentists will increasingly become engaged in the whole health of their patients. Where sufficient correlations can be leveraged between dentistry and overall health, medical plans will play an increasing role in dentistry's future for two reasons. Given favorably altered therapeutic outcomes for medical systems that preserve scarce resources, it will be an economic imperative to engage the dental system. It will also be the right thing to do from a total health perspective. In the final analysis, this elevates the role of dentistry and empowers the dentist to participate in the total health of their patients.

Toward an electrical power utility for space exploration

NASA Technical Reports Server (NTRS)

Bercaw, Robert W.

1989-01-01

Future electrical power requirements for space exploration are discussed. Megawatts of power with enough reliability for multi-year missions and with enough flexibility to adapt to needs unanticipated at design time are some of the criteria which space power systems must be able to meet. The reasons for considering the power management and distribution in the various systems, from a total mission perspective rather than simply extrapolating current spacecraft design practice, are discussed. A utility approach to electric power integrating requirements from a broad selection of current development programs, with studies in which both space and terrestrial technologies are conceptually applied to exploration mission scenarios, is described.

Broader Perspective on Ecosystem Sustainability: Consequences for Decision Making

EPA Science Inventory

Although the concept of ecosystem sustainability has a long-term focus, it is often viewed from a static system perspective. Because most ecosystems are dynamic, we explore sustainability assessments from three additional perspectives: resilient systems; systems where tipping poi...

Agricultural Education from a Knowledge Systems Perspective: From Teaching to Facilitating Joint Inquiry and Learning.

ERIC Educational Resources Information Center

Engel, Paul G. H.; van den Bor, Wout

1995-01-01

Application of a knowledge and information systems perspective shows how agricultural innovation can be enhanced through networking. In the Netherlands, a number of alternative systems of inquiry and learning are infused with this perspective: participatory technology development, participatory rural appraisal, soft systems methodology, and rapid…

Pharmacists' perspectives on the Patient Protection and Affordable Care Act.

PubMed

Khanna, Rahul; Mahabaleshwarkar, Rohan; Holmes, Erin R; Jariwala, Krutika

2015-01-01

Passed in 2010, the Patient Protection and Affordable Care Act (PPACA) resulted in significant changes to the health care system in the United States (US). Though general population surveys reveal the fractious political debate surrounding the law, insights on pharmacists' perspectives on the PPACA are lacking in the literature. The objectives of this study were to determine pharmacists' perspectives on the PPACA and determine whether pharmacists' demographic and practice-related characteristics and political beliefs influence their perspectives on the PPACA. This study was conducted using a descriptive, cross-sectional design. Study data were collected with a self-administered online questionnaire distributed to 21,769 registered pharmacists in five states. A total of 1127 completed surveys were received (5.6% response rate). Roughly 37% of pharmacists reported that they understood the major provisions of the PPACA although most (89%) respondents agreed that understanding such policies is important for practicing pharmacy. Just over half (50.6%) of respondents did not support the PPACA while 47.7% supported the legislation. Political orientation, age, gender, and race were found to be significantly related to pharmacists' perspectives on the PPACA. Respondent pharmacists' perceptions of the PPACA appear to be related to political orientation and demographic characteristics. Given that pharmacists will be impacted by the implementation of the PPACA and are so accessible to the public, additional information on health care policy and PPACA should be provided to pharmacists. Copyright © 2015 Elsevier Inc. All rights reserved.

Cost Evaluation of Dried Blood Spot Home Sampling as Compared to Conventional Sampling for Therapeutic Drug Monitoring in Children

PubMed Central

Martial, Lisa C.; Aarnoutse, Rob E.; Schreuder, Michiel F.; Henriet, Stefanie S.; Brüggemann, Roger J. M.; Joore, Manuela A.

2016-01-01

Dried blood spot (DBS) sampling for the purpose of therapeutic drug monitoring can be an attractive alternative for conventional blood sampling, especially in children. This study aimed to compare all costs involved in conventional sampling versus DBS home sampling in two pediatric populations: renal transplant patients and hemato-oncology patients. Total costs were computed from a societal perspective by adding up healthcare cost, patient related costs and costs related to loss of productivity of the caregiver. Switching to DBS home sampling was associated with a cost reduction of 43% for hemato-oncology patients (€277 to €158) and 61% for nephrology patients (€259 to €102) from a societal perspective (total costs) per blood draw. From a healthcare perspective, costs reduced with 7% for hemato-oncology patients and with 21% for nephrology patients. Total savings depend on the number of hospital visits that can be avoided by using home sampling instead of conventional sampling. PMID:27941974

Cost Evaluation of Dried Blood Spot Home Sampling as Compared to Conventional Sampling for Therapeutic Drug Monitoring in Children.

PubMed

Martial, Lisa C; Aarnoutse, Rob E; Schreuder, Michiel F; Henriet, Stefanie S; Brüggemann, Roger J M; Joore, Manuela A

2016-01-01

Dried blood spot (DBS) sampling for the purpose of therapeutic drug monitoring can be an attractive alternative for conventional blood sampling, especially in children. This study aimed to compare all costs involved in conventional sampling versus DBS home sampling in two pediatric populations: renal transplant patients and hemato-oncology patients. Total costs were computed from a societal perspective by adding up healthcare cost, patient related costs and costs related to loss of productivity of the caregiver. Switching to DBS home sampling was associated with a cost reduction of 43% for hemato-oncology patients (€277 to €158) and 61% for nephrology patients (€259 to €102) from a societal perspective (total costs) per blood draw. From a healthcare perspective, costs reduced with 7% for hemato-oncology patients and with 21% for nephrology patients. Total savings depend on the number of hospital visits that can be avoided by using home sampling instead of conventional sampling.

Reframing the Dissemination Challenge: A Marketing and Distribution Perspective

PubMed Central

Bernhardt, Jay M.

2009-01-01

A fundamental obstacle to successful dissemination and implementation of evidence-based public health programs is the near-total absence of systems and infrastructure for marketing and distribution. We describe the functions of a marketing and distribution system, and we explain how it would help move effective public health programs from research to practice. Then we critically evaluate the 4 dominant strategies now used to promote dissemination and implementation, and we explain how each would be enhanced by marketing and distribution systems. Finally, we make 6 recommendations for building the needed system infrastructure and discuss the responsibility within the public health community for implementation of these recommendations. Without serious investment in such infrastructure, application of proven solutions in public health practice will continue to occur slowly and rarely. PMID:19833993

Reframing the dissemination challenge: a marketing and distribution perspective.

PubMed

Kreuter, Matthew W; Bernhardt, Jay M

2009-12-01

A fundamental obstacle to successful dissemination and implementation of evidence-based public health programs is the near-total absence of systems and infrastructure for marketing and distribution. We describe the functions of a marketing and distribution system, and we explain how it would help move effective public health programs from research to practice. Then we critically evaluate the 4 dominant strategies now used to promote dissemination and implementation, and we explain how each would be enhanced by marketing and distribution systems. Finally, we make 6 recommendations for building the needed system infrastructure and discuss the responsibility within the public health community for implementation of these recommendations. Without serious investment in such infrastructure, application of proven solutions in public health practice will continue to occur slowly and rarely.

Determining Training Device Requirements in Army Aviation Systems

NASA Technical Reports Server (NTRS)

Poumade, M. L.

1984-01-01

A decision making methodology which applies the systems approach to the training problem is discussed. Training is viewed as a total system instead of a collection of individual devices and unrelated techniques. The core of the methodology is the use of optimization techniques such as the transportation algorithm and multiobjective goal programming with training task and training device specific data. The role of computers, especially automated data bases and computer simulation models, in the development of training programs is also discussed. The approach can provide significant training enhancement and cost savings over the more traditional, intuitive form of training development and device requirements process. While given from an aviation perspective, the methodology is equally applicable to other training development efforts.

Budgetary Impact Analysis of Reimbursement Varenicline for the Smoking-Cessation Treatment in Patients with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease or Type-2 Diabetes Mellitus: A National Health System Perspective.

PubMed

Cedillo, Sergio; Sicras-Mainar, Antoni; Jiménez-Ruiz, Carlos A; Fernández de Bobadilla, Jaime; Rejas-Gutiérrez, Javier

2017-01-01

The study aimed to assess the budgetary impact (BI) of reimbursing varenicline in patients with chronic obstructive pulmonary disease (COPD), type-2 diabetes mellitus (t2-DM) or cardiovascular diseases (CVD). The BI was estimated comparing the current non-reimbursed scenario versus a projected reimbursed scenario using the Spanish National Health System (SNHS) perspective. A hybrid model was developed using epidemiological data and Markov chains to estimate smoking cessation rates with varenicline during a 5-year horizon. Costs of cessation were considered in the reimbursement scenario only. Efficacy, expressed as a 1-year continuous abstinence rate, was derived from clinical trials. Cost savings due to smoking cessation were extracted from local cost-of-illness studies. Results are shown as incremental cost savings. Univariate sensitivity analysis was also applied. A total of 68,684 patients stopped smoking in the reimbursed scenario compared with 15,208 without reimbursement. In the reimbursed scenario, total savings accounted for €36.3 million, showing 14.6 million accumulated additional savings compared with the scenario without reimbursement. Sensitivity analyses showed results to be robust with monetary savings starting in the third year of modeling. Reimbursement of varenicline in smoking cessation is a cost-effective health policy in the SNHS in COPD, t2-DM or CVD, and could produce cost savings starting in the third year of implementation. © 2016 S. Karger AG, Basel.

Direct cost comparison of totally endoscopic versus open ear surgery.

PubMed

Patel, N; Mohammadi, A; Jufas, N

2018-02-01

Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.

Estimates of cost-effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema.

PubMed

Hubble, Michael W; Richards, Michael E; Wilfong, Denise A

2008-01-01

To estimate the cost-effectiveness of continuous positive airway pressure (CPAP) in managing prehospital acute pulmonary edema in an urban EMS system. Using estimates from published reports on prehospital and emergency department CPAP, a cost-effectiveness model of implementing CPAP in a typical urban EMS system was derived from the societal perspective as well as the perspective of the implementing EMS system. To assess the robustness of the model, a series of univariate and multivariate sensitivity analyses was performed on the input variables. The cost of consumables, equipment, and training yielded a total cost of $89 per CPAP application. The theoretical system would be expected to use CPAP 4 times per 1000 EMS patients and is expected to save 0.75 additional lives per 1000 EMS patients at a cost of $490 per life saved. CPAP is also expected to result in approximately one less intubation per 6 CPAP applications and reduce hospitalization costs by $4075 per year for each CPAP application. Through sensitivity analyses the model was verified to be robust across a wide range of input variable assumptions. Previous studies have demonstrated the clinical effectiveness of CPAP in the management of acute pulmonary edema. Through a theoretical analysis which modeled the costs and clinical benefits of implementing CPAP in an urban EMS system, prehospital CPAP appears to be a cost-effective treatment.

[Conflicting values in Colombia's health system: balancing the market economy and constitutional legislation, 2007-2009].

PubMed

Molina, Gloria; Ramírez, Andrés

2013-04-01

To present the conflicting moral issues that arise in clinical and administrative decision-making processes in Colombia's General Health Social Security System (SGSSS). A study was conducted between 2007 and 2009 in six Colombian cities (Barranquilla, Bogotá, Bucaramanga, Leticia, Medellín, and Pasto) using a theory-based qualitative methodology. A total of 179 in-depth interviews were held with physicians, nursing personnel, and administrators with broad experience in the health sector, as well as 10 focus groups representing users and leaders of community organizations involved in health. The interviews, which followed a predetermined script and used semistructured questions, gathered personal and professional information from the respondents. The health care decision-making process in Colombia is seen from two different moral perspectives: the rentier, or profit-making, motive, characterized by a neoliberal view of the market economy (the practical perspective), and the constitutional axiology of social democracy (the regulatory perspective). It was found that the utilitarian and individualistic motive predominates, in which individual and business profits are promoted over the collective interest, and this trend favors practices that undermine the rights of people and the community. Predominance of a morality that views the Colombian SGSSS in terms of the market model generates conditions that go against the principles and values that are supposed to guide the health system as guarantor of the right to health and human dignity. Health decisions should take into account not only technical and scientific criteria but also the principles and values involved, and consideration should be given to safeguarding them.

Health system reconstruction: Perspectives of Iraqi physicians

PubMed Central

Squires, A.; Sindi, A.; Fennie, K.

2010-01-01

In conflict or post-conflict situations, health system reconstruction becomes a critical component of ensuring stability. The purpose of this study was to determine the priorities for health system reconstruction among Iraqi physicians residing in the northern region of the country. A convenience sample of practicing male and female physicians residing in the Kurdish region completed a 13-item survey about health system reconstruction. A total of 1001 practitioners completed the survey with gender breakdown of 29% female and 71% male, all working in different specialty areas. Significant differences between the providers based on gender (p = 0.001), specialty (p = 0.001) and geographic location (p = 0.004) were found to affect the responses of the participants. This study demonstrates that input from healthcare professionals is important for health system reconstruction, but that gender, geography and medical specialty make the process complex. PMID:20155543

Computer-assisted total hip arthroplasty: coding the next generation of navigation systems for orthopedic surgery.

PubMed

Renkawitz, Tobias; Tingart, Markus; Grifka, Joachim; Sendtner, Ernst; Kalteis, Thomas

2009-09-01

This article outlines the scientific basis and a state-of-the-art application of computer-assisted orthopedic surgery in total hip arthroplasty (THA) and provides a future perspective on this technology. Computer-assisted orthopedic surgery in primary THA has the potential to couple 3D simulations with real-time evaluations of surgical performance, which has brought these developments from the research laboratory all the way to clinical use. Nonimage- or imageless-based navigation systems without the need for additional pre- or intra-operative image acquisition have stood the test to significantly reduce the variability in positioning the acetabular component and have shown precise measurement of leg length and offset changes during THA. More recently, computer-assisted orthopedic surgery systems have opened a new frontier for accurate surgical practice in minimally invasive, tissue-preserving THA. The future generation of imageless navigation systems will switch from simple measurement tasks to real navigation tools. These software algorithms will consider the cup and stem as components of a coupled biomechanical system, navigating the orthopedic surgeon to find an optimized complementary component orientation rather than target values intraoperatively, and are expected to have a high impact on clinical practice and postoperative functionality in modern THA.

Evaluating the Cost-Effectiveness of Lifestyle Modification versus Metformin Therapy for the Prevention of Diabetes in Singapore

PubMed Central

Png, May Ee; Yoong, Joanne Su-Yin

2014-01-01

Background In Singapore, as diabetes is an increasingly important public health issue, the cost-effectiveness of pursuing lifestyle modification programs and/or alternative prevention strategies is of critical importance for policymakers. While the US Diabetes Prevention Program (DPP) compared weight loss through lifestyle modification with oral treatment of diabetes drug metformin to prevent/delay the onset of type 2 diabetes in pre-diabetic subjects, no data on either the actual or potential cost effectiveness of such a program is available for East or South-east Asian populations. This study estimates the 3-year cost-effectiveness of lifestyle modification and metformin among pre-diabetic subjects from a Singapore health system and societal perspective. Methodology Cost effectiveness was analysed from 2010–2012 using a decision-based model to estimate the rates of getting diabetes, healthcare costs and health-related quality of life. Cost per quality-adjusted life year (QALY) was estimated using costs relevant to the time horizon of the study from Singapore. All costs are expressed in 2012 US dollars. Principal Findings The total economic cost for non-diabetic subjects from the societal perspective was US$25,867, US$28,108 and US$26,177 for placebo, lifestyle modification and metformin intervention respectively. For diabetic patients, the total economic cost from the societal perspective was US$32,921, US$35,163 and US$33,232 for placebo, lifestyle modification and metformin intervention respectively. Lifestyle modification relative to placebo is likely to be associated with an incremental cost per QALY gained at US$36,663 while that of metformin intervention is likely to be US$6,367 from a societal perspective. Conclusion Based on adaptation of the DPP data to local conditions, both lifestyle modification and metformin intervention are likely to be cost-effective and worth implementing in Singapore to prevent or delay the onset of type 2 diabetes. However, the cost of lifestyle modification from the societal perspective would have to be reduced in order to match the cost-effectiveness of metformin intervention. PMID:25203633

Second national green pricing and green power marketing conference: Proceedings. Final report

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

Swezey, B.G.; Peterson, T.M.

1997-10-01

On May 13--14, 1997, DOE, EPRI, and EEI, in association with Central and South West Services, Inc., organized and conducted the second national green power conference in Corpus Christi, TX to: (1) provide an update and overview of existing and new green-pricing programs, (2) discuss lessons learned from selling green power in retail access pilot programs, and (3) hear perspectives on market facilitating issues such as green power certification and information disclosure. From a policy perspective, there was a general feeling that total reliance on market forces to foster greater renewables deployment is not desirable, particularly in the short termmore » as the rules of the competitive market are being developed. Policies that establish a minimum public obligation to fund renewables, such as universal system benefits charges and a renewables portfolio standard, should still be considered.« less

Counseling Exceptional Individuals and Their Families: A Systems Perspective

ERIC Educational Resources Information Center

Thomas, Volker; Ray, Karen E.

2006-01-01

This article presents three models of counseling exceptional students from a systems perspective. The authors present their definition of counseling, the goals of counseling, and the counseling relationship from a systems perspective. Each model is described, including assessment and intervention techniques appropriate for working with children,…

What can volunteer co-providers contribute to health systems? The role of people living with HIV in the Thai paediatric HIV programme.

PubMed

Tulloch, Olivia; Taegtmeyer, Miriam; Ananworanich, Jintanat; Chasombat, Sanchai; Kosalaraksa, Pope; Theobald, Sally

2015-11-01

In Thailand people living with HIV (PLHIV) have played a major role in shaping policy and practice. They have acted as volunteer co-providers, although their potential in terms of paediatric service provision has seldom been explored from a health systems perspective. We describe the Thai paediatric HIV care system and use both demand- and supply-side perspectives to explore the impact, opportunities and challenges of PLHIV acting as volunteer co-providers. We employed qualitative methods to assess experiences and perceptions and triangulate stakeholder perspectives. Data were collected in Khon Kaen province, in the poorest Northeastern region of Thailand: three focus group discussions and two workshops (total participants n = 31) with co-providers and hospital staff; interviews with ART service-users (n = 35). Nationally, key informant interviews were conducted with policy actors (n = 20). Volunteer co-providers were found to be ideally placed to broker the link between clinic and communities for HIV infected children and played an important part in the vital psychosocial support component of HIV care. As co-providers they were recognized as having multiple roles linking and delivering services in clinics and communities. Clear emerging needs include strengthened coordination and training as well as strategies to support funding. Using motivated volunteers with a shared HIV status as co-providers for specific clinical services can contribute to strengthening health systems in Asia; they are critical players in delivering care (supply side) and being responsive to service-users needs (demand side). Co-providers blur the boundaries between these two spheres. Sustaining and optimising co-providers' contribution to health systems strengthening requires a health systems approach. Our findings help to guide policy makers and service providers on how to balance clinical priorities with psycho-social responsiveness and on how best to integrate the views and experience of volunteers into a holistic model of care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Developmental trajectory of time perspective: From children to older adults.

PubMed

Chen, Tao; Liu, Lu-Lu; Cui, Ji-Fang; Chen, Xing-Jie; Wang, Ya

2016-12-01

Time perspective is a fundamental dimension of the psychological time construct, with a pervasive and powerful influence on human behavior. However, the developmental trajectory of time perspective across a human lifespan remains unclear. The current study aimed to portray the developmental trajectory of all dimensions of time perspectives from children to older adults in a large sample. A total of 1,901 individuals (aged 9-84 years) completed measures of time perspective. They were then divided into five age groups: children, teenagers, young adults, middle-aged adults, and older adults. Results suggested that each time perspective showed a unique developmental pattern across the lifespan. Moreover, perceived economic situation and education were related to some dimensions of time perspective. © 2016 The Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.

Total Body Photography as an Aid to Skin Self-examination: A Patient's Perspective.

PubMed

Secker, Lisanne J; Bergman, Wilma; Kukutsch, Nicole A

2016-02-01

Skin self-examination can help patients who are at high risk for developing melanoma to become more involved in their own surveillance and treatment. This study examined the use of total body photography as an aid to skin self-examination from the patients' perspective. A total of 179 individuals at high risk for developing melanoma who had undergone total body photography (60.5% response rate) completed a self-reported questionnaire assessing the frequency of skin self-examination, perceived usefulness of total body photography, and a variety of potential demographic, clinical and psychological factors. Only approximately half of the participants indicated skin self-examination as useful and 78.9% preferred clinical skin examination by a specialist. Finding total body photography useful was associated with having received instructions on how to perform skin self-examination, the use of a (hand)mirror, and confidence to detect changing moles. These findings allow us to develop strategies to further improve patients' self-screening behaviours.

A novel estimating method for steering efficiency of the driver with electromyography signals

NASA Astrophysics Data System (ADS)

Liu, Yahui; Ji, Xuewu; Hayama, Ryouhei; Mizuno, Takahiro

2014-05-01

The existing research of steering efficiency mainly focuses on the mechanism efficiency of steering system, aiming at designing and optimizing the mechanism of steering system. In the development of assist steering system especially the evaluation of its comfort, the steering efficiency of driver physiological output usually are not considered, because this physiological output is difficult to measure or to estimate, and the objective evaluation of steering comfort therefore cannot be conducted with movement efficiency perspective. In order to take a further step to the objective evaluation of steering comfort, an estimating method for the steering efficiency of the driver was developed based on the research of the relationship between the steering force and muscle activity. First, the steering forces in the steering wheel plane and the electromyography (EMG) signals of the primary muscles were measured. These primary muscles are the muscles in shoulder and upper arm which mainly produced the steering torque, and their functions in steering maneuver were identified previously. Next, based on the multiple regressions of the steering force and EMG signals, both the effective steering force and the total force capacity of driver in steering maneuver were calculated. Finally, the steering efficiency of driver was estimated by means of the estimated effective force and the total force capacity, which represented the information of driver physiological output of the primary muscles. This research develops a novel estimating method for driver steering efficiency of driver physiological output, including the estimation of both steering force and the force capacity of primary muscles with EMG signals, and will benefit to evaluate the steering comfort with an objective perspective.

The social burden and quality of life of patients with haemophilia in Italy

PubMed Central

Kodra, Yllka; Cavazza, Marianna; Schieppati, Arrigo; De Santis, Marta; Armeni, Patrizio; Arcieri, Romano; Calizzani, Gabriele; Fattore, Giovanni; Manzoli, Lamberto; Mantovani, Lorenzo; Taruscio, Domenica

2014-01-01

Background In Italy, the project on the social burden and quality of life (QoL) of patients with haemophilia investigates costs from a society perspective and provides an overview of their quality of life. Moreover, as life expectancy increased in recent years along with new treatment strategies implemented in the last decades, it analyses trends of costs other than drugs simulating impacts during patient whole life. Material and methods We ran a web-based cross-sectional survey supported by the Italian Federation of Haemophilia Societies in recruiting patients with haemophilia and their caregivers. We developed a questionnaire to collect information on demographic characteristics, healthcare and social services consumption, formal and informal care utilisation, productivity loss and quality of life. In particular, quality of life was assessed through the EuroQoL tool. Last, we applied the illness cost method from a society perspective. Results On average, quality of life is worse in adult patients compared to child and caregivers: more than 75% of adult patients declare physical problems, 43% of adult patients and 54% of their parents have anxiety problems. Assuming a society perspective, the estimated mean annual total cost per patient in 2012 is 117,732 €. Drugs represent 92% of total costs. Focusing on costs other than drugs, each additional point of EuroQoL tool implies a costs’ reduction of 279 €. The impact of age varies across age groups: each added year implies a total decrease of costs up to 46.6 years old. Afterwards, every additional year increases costs. Discussion Quality of life of patients with haemophilia and their caregivers improved and it influences positively on consumed resources and on their contribution to the social-economic system. Costs other than drugs for patients with haemophilia follow the same trends of general population. PMID:24922297

The economic cost of road traffic crashes in an urban setting

PubMed Central

García‐Altés, A; Pérez, K

2007-01-01

The objective of this article is to assess the total economic costs of road traffic crashes in Barcelona, a metropolitan city located in Southern Europe. A cost‐of‐illness study was conducted using a prevalence approximation, a societal and healthcare system perspective, and a 1‐year time horizon. Results were measured in terms of Euros in 2003. Total costs of road traffic crashes in Barcelona in 2003 were €367 million. Direct costs equalled €329 million (89.8% of total costs), including property damage costs, insurance administration costs and hospital costs. Police, emergency costs and transportation costs had a minimum effect on total direct costs. Indirect costs were €37 million, including lost productivity due to hospitalization and mortality. The results of the sensitivity analysis showed the upper limit of total economic cost of road traffic crashes in Barcelona to be €782 million. This is the first study to estimate the costs of road traffic crashes for a city in a developed country. The importance of the problem calls for further interventions to reduce road traffic crashes. PMID:17296693

Implementation of enterprise resource planning systems: a user perspective

NASA Astrophysics Data System (ADS)

Reitsma, E.; Hilletofth, P.; Mukhtar, U.

2018-04-01

The purpose of this study is to evaluate critical success factors (CSFs) for the implementation of an enterprise resource planning (ERP) system from a user perspective. Users play a vital role when implementing an ERP system, but their perspective has been neglected in the literature. A better understanding of their perspective promises to contribute to the design of more effective ERP systems, its implementation, and management. In order to identify the user perspective, a survey was conducted within three Pakistani companies that recently have implemented a new ERP system. The questionnaire was developed based on thirteen CSFs deduced from literature. Based on each CSF’s level of importance, they are ranked in order of importance and divided into three groups: most important, important and not important. Findings reveal that users believe that management should prioritize the following four CSFs when implementing an ERP system: education and training, strategic decision-making, communication, and business process alignment.

How Long Can the Hubble Space Telescope Operate Reliably? A Total Dose Perspective

NASA Technical Reports Server (NTRS)

Xapsos, M. A.; Stauffer, C.; Jordan, T.; Poivey, C.; Haskins, D. N.; Lum, G.; Pergosky, A. M.; Smith, D. C.; LaBel, K. A.

2014-01-01

The Hubble Space Telescope has been at the forefront of discoveries in the field of astronomy for more than 20 years. It was the first telescope designed to be serviced in space and the last such servicing mission occurred in May 2009. The question of how much longer this valuable resource can continue to return science data remains. In this paper a detailed analysis of the total dose exposure of electronic parts at the box level is performed using solid angle sectoring/3-dimensional ray trace and Monte Carlo radiation transport simulations. Results are related to parts that have been proposed as possible total dose concerns. The spacecraft subsystem that appears to be at the greatest risk for total dose failure is identified. This is discussed with perspective on the overall lifetime of the spacecraft.

Benefits and Drawbacks of Computer-Based Assessment and Feedback Systems: Student and Educator Perspectives

ERIC Educational Resources Information Center

Debuse, Justin C. W.; Lawley, Meredith

2016-01-01

Providing students with high quality feedback is important and can be achieved using computer-based systems. While student and educator perspectives of such systems have been investigated, a comprehensive multidisciplinary study has not yet been undertaken. This study examines student and educator perspectives of a computer-based assessment and…

Definitions of School Bullying in Taiwan: A Comparison of Multiple Perspectives

ERIC Educational Resources Information Center

Cheng, Ying-Yao; Chen, Li-Ming; Ho, Hsiao-Chi; Cheng, Chih-Ling

2011-01-01

Investigating teachers' and students' different definitions of school bullying is important for necessary prevention and effective intervention. This study compared definitions of bullying from the perspectives of bystanders, bullies, victims, and educators. A total of 1,558 secondary educators and students in Taiwan participated in this research,…

Pastoral Perspectives of Humor's Use in Ministry Contexts

ERIC Educational Resources Information Center

Young, Jonathan W.

2012-01-01

Results from a qualitative component of a mixed-methods research design are reported regarding the use of humor in pastoral ministry. Thirteen Southern Baptist (SB) pastors were interviewed, from a total of 37 exemplars identified in the quantitative component of the study, regarding their perspectives toward humor in ministry. Results overall…

Stakeholder Perspectives: CLIL Programme Management in Estonia

ERIC Educational Resources Information Center

Mehisto, Peeter; Asser, Hiie

2007-01-01

In 2000, Estonia launched a voluntary Estonian language CLIL programme for seven year-olds in four Russian-medium schools. The programme has expanded rapidly to a total of 48 kindergartens and schools. This paper reports on research into stakeholder perspectives on programme management. In addition to surveying parents, teachers, vice-principals…

Learner Perspectives Regarding Device Type in Technology-Assisted Language Learning

ERIC Educational Resources Information Center

Ko, Myong-Hee

2017-01-01

This study compared learner perspectives regarding using PCs and smartphones as learning devices. A total of 167 Korean university students completed online assignments designed to maximize interaction with these devices. The assignments required students to submit their responses regarding assigned reading passages for a semester. Then they…

Comparing Teacher and Administrator Perspectives on Multiple Dimensions of Teacher Professionalism

ERIC Educational Resources Information Center

Tichenor, Mercedes; Tichenor, John

2009-01-01

In this paper, we compare teacher and administrator perspectives on multiple dimensions of teacher professionalism. An instrument with a total of 51 professional behaviors and characteristics that operationalize the multiple dimensions of professionalism was developed. Survey participants, including 216 teachers and 89 administrators, were asked…

High School Band Students' Perspectives of Teacher Turnover

ERIC Educational Resources Information Center

Kloss, Thomas E.

2013-01-01

Teacher turnover remains an important issue in education. The least researched perspectives, though, are those of the students who experience teacher turnover. The purpose of this study was to examine how high school band students experience teacher turnover. A total of twelve students were interviewed, representing three schools that experienced…

Alumni Perspectives Survey, 2010. Survey Report

ERIC Educational Resources Information Center

Sheikh, Sabeen

2010-01-01

During the months of April and September of 2009, the Graduate Management Admission Council[R] (GMAC[R]) conducted the Alumni Perspectives Survey, a longitudinal study of prior respondents to the Global Management Education Graduate Survey of management students nearing graduation. A total of 3,708 alumni responded to the April 2009 survey,…

Impact Of Health Care Delivery System Innovations On Total Cost Of Care.

PubMed

Smith, Kevin W; Bir, Anupa; Freeman, Nikki L B; Koethe, Benjamin C; Cohen, Julia; Day, Timothy J

2017-03-01

Using delivery system innovations to advance health care reform continues to be of widespread interest. However, it is difficult to generalize about the success of specific types of innovations, since they have been examined in only a few studies. To gain a broader perspective, we analyzed the results of forty-three ambulatory care programs funded by the first round of the Center for Medicare and Medicaid Innovation's Health Care Innovations Awards. The innovations' impacts on total cost of care were estimated by independent evaluators using multivariable difference-in-differences models. Through the first two years, most of the innovations did not show a significant effect on total cost of care. Using meta-regression, we assessed the effects on costs of five common components of these innovations. Innovations that used health information technology or community health workers achieved the greatest cost savings. Savings were also relatively large in programs that targeted clinically fragile patients-clinically complex populations at risk for disease progression. While the magnitude of these effects was often substantial, none achieved conventional levels of significance in our analyses. Meta-analyses of a larger number of delivery system innovations are needed to more clearly establish their potential for patient care cost savings. Project HOPE—The People-to-People Health Foundation, Inc.

Mobile app self-care versus in-office care for stress reduction: a cost minimization analysis.

PubMed

Luxton, David D; Hansen, Ryan N; Stanfill, Katherine

2014-12-01

We calculated the cost of providing stress reduction care with a mobile phone app (Breathe2Relax) in comparison with normal in-person care, the standard method for managing stress in military and civilian populations. We conducted a cost-minimization analysis. The total cost to the military healthcare system of treating 1000 patients with the app was $106,397. Treating 1000 patients with in-office care cost $68,820. Treatment using the app became less expensive than in-office treatment at approximately 1600 users. From the perspective of the civilian healthcare system, treatment using the app became less expensive than in-office treatment at approximately 1500 users. An online tool was used to obtain data about the number of app downloads and usage sessions. A total of 47,000 users had accessed the app for 10-30 min sessions in the 2.5 years since the release of the app. Assuming that all 47,000 users were military beneficiaries, the savings to the military healthcare system would be $2.7 million; if the 47,000 users were civilian, the savings to the civilian healthcare system would be $2.9 million. Because of the large number of potential users, the total societal savings resulting from self-care using the app may be considerable. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

A power-efficient analog integrated circuit for amplification and detection of neural signals.

PubMed

Borghi, T; Bonfanti, A; Gusmeroli, R; Zambra, G; Spinelli, A S

2008-01-01

We present a neural amplifier that optimizes the trade-off between power consumption and noise performance down to the best so far reported. In the perspective of realizing a fully autonomous implantable system we also address the problem of spike detection by using a new simple algorithm and we discuss the implementation with analog integrated circuits. Implemented in 0.35-microm CMOS technology and with total current consumption of about 20 microA, the whole circuit occupies an area of 0.18 mm(2). Reduced power consumption and small area make it suited to be used in chronic multichannel recording systems for neural prosthetics and neuroscience experiments.

A scoping review of appropriateness of care research activity in Canada from a health system-level perspective.

PubMed

Brien, Susan; Gheihman, Galina; Tse, Yi Ki Yvonne; Byrnes, Mary; Harrison, Sophia; Dobrow, Mark J

2014-05-01

Jurisdictions are increasingly focusing on appropriate use of healthcare services and interventions as a means to improve health system performance. Our objectives were to conduct a scoping review to (a) map Canadian research and related activity on system-level appropriateness of care and (b) create a resource database that could be used to inform evidence-based decision-making and future research priorities in this area. We searched Medline, EMBASE and CINAHL databases between 2003-2013 using terms including "appropriate," "inappropriate," "health technology assessment" and "cost-effectiveness." Articles were included if they were Canadian-based and relevant to our definition. The database search was complemented by a website search of relevant Canadian organizations. 4,979 articles were identified through the literature search, and 103 articles relevant to system-level appropriateness of care across Canada were charted. Of these, 64 contained an evaluation of appropriateness, 30 used a method of cost-effectiveness or total cost impact analysis and 9 involved another methodology. The most common health service categories included drug therapy (n=40) and health service utilization (n=33). Fifty-eight websites were summarized containing material relevant to system-level appropriateness of care. Our review identifies Canadian research and related activity pertaining to appropriateness of healthcare from a system-level perspective and provides a useful resource both to support evidence-based decision-making and to guide future appropriateness research. Copyright © 2014 Longwoods Publishing.

Shareholding relationships in the Euro Area banking market: A network perspective

NASA Astrophysics Data System (ADS)

Pecora, Nicolò; Spelta, Alessandro

2015-09-01

In this paper we analyze the topological properties of the network of the Euro Area banking market network, with the primary aim of assessing the importance of a bank in the financial system with respect to ownership and control of other credit institutions. The network displays power law distributions in both binary and weighted degree metrics indicating a robust yet fragile structure and a direct link between an increase of control diversification and a rise in the market power. Therefore while in good time the network is seemingly robust, in bad times many banks can simultaneously go into distress. This behavior paves the way for Central bank's actions. In particular we investigate whether the Single Supervisory Mechanism introduced by the European Central Banks and based on banks' total asset is a good proxy to quantify their systemic importance. Results indicate that not all the financial institutions with high valued total assets are systemically important but only few of them. Moreover the network structure reveals that control is highly concentrated, with few important shareholders approximately controlling a separate subset of banks.

Setting priorities in the health care sector - the case of oral anticoagulants in nonvalvular atrial fibrillation in Denmark.

PubMed

Poulsen, Peter Bo; Johnsen, Søren Paaske; Hansen, Morten Lock; Brandes, Axel; Husted, Steen; Harboe, Louise; Dybro, Lars

2017-01-01

Resources devoted to health care are limited, therefore setting priorities is required. It differs between countries whether decision-making concerning health care technologies focus on broad economic perspectives or whether focus is narrow on single budgets ("silo mentality"). The cost perspective as one part of the full health economic analysis is important for decision-making. With the case of oral anticoagulants in patients with nonvalvular atrial fibrillation (NVAF), the aim is to discuss the implication of the use of different cost perspectives for decision-making and priority setting. In a cost analysis, the annual average total costs of five oral anticoagulants (warfarin and non-vitamin K oral anticoagulants [NOACs; dabigatran, rivaroxaban, apixaban, and edoxaban]) used in daily clinical practice in Denmark for the prevention of stroke in NVAF patients are analyzed. This is done in pairwise comparisons between warfarin and each NOAC based on five potential cost perspectives, from a "drug cost only" perspective up to a "societal" perspective. All comparisons of warfarin and NOACs show that the cost perspective based on all relevant costs, ie, total costs perspective, is essential for the choice of therapy. Focusing on the reimbursement costs of the drugs only, warfarin is the least costly option. However, with the aim of therapy to prevent strokes and limit bleedings, including the economic impact of this, all NOACs, except rivaroxaban, result in slightly lower health care costs compared with warfarin. The same picture was found applying the societal perspective. Many broad cost-effectiveness analyses of NOACs exist. However, in countries with budget focus in decision-making this information does not apply. The present study's case of oral anticoagulants has shown that decision-making should be based on health care or societal cost perspectives for optimal use of limited resources. Otherwise, the risk is that suboptimal decisions will be likely.

Beyond bridging the know-do gap: a qualitative study of systemic interaction to foster knowledge exchange in the public health sector in The Netherlands.

PubMed

van den Driessen Mareeuw, Francine; Vaandrager, Lenneke; Klerkx, Laurens; Naaldenberg, Jenneken; Koelen, Maria

2015-09-19

Despite considerable attention currently being given to facilitating the use of research results in public health practice, several concerns remain, resulting in the so-called know-do gap. This article aims to identify the key tensions causing the know-do gap from a broad perspective by using a systemic approach and considering the public health sector as an innovation system. An exploratory qualitative design including in-depth semi-structured interviews was used, with 33 interviewees from different actor categories in the Dutch public health innovation system. The analyses employed an innovation system matrix to highlight the principal tensions causing the know-do gap. Seven key tensions were identified, including: research priorities determined by powerful players; no consensus about criteria for knowledge quality; different perceptions about the knowledge broker role; competition engendering fragmentation; thematic funding engendering fragmentation; predominance of passive knowledge sharing; and lack of capacity among users to use and influence research. The identified tensions indicate that bridging the know-do gap requires much more than linking research to practice or translating knowledge. An innovation system perspective is crucial in providing information on the total picture of knowledge exchange within the Dutch public health sector. Such a system includes broader stakeholder involvement as well as the creation of social, economic, and contextual conditions (achieving shared visions, building networks, institutional change, removing financial and infrastructural barriers), as these create conducive factors at several system levels and induce knowledge co-creation and innovation.

FRED: an innovative approach to nursing home level-of-care assignments.

PubMed

Morris, J N; Sherwood, S; May, M I; Bernstein, E

1987-04-01

A clear need currently exists to consider new approaches for classifying nursing home residents. The traditional intermediate care facility/skilled nursing facility (ICF/SNF) dichotomy cannot provide adequate information on the type of care required by any one individual, and it provides only the most limited information required to address the care and quality-of-life needs of the total patient population within a facility, as well as the level of reimbursement appropriate for their care. This article describes an alternative procedure for allocating nursing home residents according to a more comprehensive array of internally homogeneous categories. This system is based on an operational perspective focused on the total nursing and staffing requirements for types of nursing home residents. The tool is titled "Functionally Ranked Explanatory Designations," or FRED.

FRED: an innovative approach to nursing home level-of-care assignments.

PubMed Central

Morris, J N; Sherwood, S; May, M I; Bernstein, E

1987-01-01

A clear need currently exists to consider new approaches for classifying nursing home residents. The traditional intermediate care facility/skilled nursing facility (ICF/SNF) dichotomy cannot provide adequate information on the type of care required by any one individual, and it provides only the most limited information required to address the care and quality-of-life needs of the total patient population within a facility, as well as the level of reimbursement appropriate for their care. This article describes an alternative procedure for allocating nursing home residents according to a more comprehensive array of internally homogeneous categories. This system is based on an operational perspective focused on the total nursing and staffing requirements for types of nursing home residents. The tool is titled "Functionally Ranked Explanatory Designations," or FRED. PMID:3570811

Influence of rhizobacterial volatiles on the root system architecture and the production and allocation of biomass in the model grass Brachypodium distachyon (L.) P. Beauv.

PubMed

Delaplace, Pierre; Delory, Benjamin M; Baudson, Caroline; Mendaluk-Saunier de Cazenave, Magdalena; Spaepen, Stijn; Varin, Sébastien; Brostaux, Yves; du Jardin, Patrick

2015-08-12

Plant growth-promoting rhizobacteria are increasingly being seen as a way of complementing conventional inputs in agricultural systems. The effects on their host plants are diverse and include volatile-mediated growth enhancement. This study sought to assess the effects of bacterial volatiles on the biomass production and root system architecture of the model grass Brachypodium distachyon (L.) Beauv. An in vitro experiment allowing plant-bacteria interaction throughout the gaseous phase without any physical contact was used to screen 19 bacterial strains for their growth-promotion ability over a 10-day co-cultivation period. Five groups of bacteria were defined and characterised based on their combined influence on biomass production and root system architecture. The observed effects ranged from unchanged to greatly increased biomass production coupled with increased root length and branching. Primary root length was increased only by the volatile compounds emitted by Enterobacter cloacae JM22 and Bacillus pumilus T4. Overall, the most significant results were obtained with Bacillus subtilis GB03, which induced an 81 % increase in total biomass, as well as enhancing total root length, total secondary root length and total adventitious root length by 88.5, 201.5 and 474.5 %, respectively. This study is the first report on bacterial volatile-mediated growth promotion of a grass plant. Contrasting modulations of biomass production coupled with changes in root system architecture were observed. Most of the strains that increased total plant biomass also modulated adventitious root growth. Under our screening conditions, total biomass production was strongly correlated with the length and branching of the root system components, except for primary root length. An analysis of the emission kinetics of the bacterial volatile compounds is being undertaken and should lead to the identification of the compounds responsible for the observed growth-promotion effects. Within the context of the inherent characteristics of our in vitro system, this paper identifies the next critical experimental steps and discusses them from both a fundamental and an applied perspective.

[Direct health care costs in patients with type 2 diabetes mellitus six months after starting insulin treatment in Spain: the INSTIGATE study].

PubMed

Costi, María; Smith, Helen; Reviriego, Jesús; Castell, Conxa; Goday, Alberto; Dilla, Tatiana

2011-01-01

The INSTIGATE study was designed to assess direct health care costs incurred by patients with type 2 diabetes mellitus (T2DM) who start insulin therapy in Spain. It was a multicenter, observational, non-interventional, prospective study. Direct costs per patient in standard clinical practice were assessed for 6 months before and after the start of insulin therapy from the perspective of the Spanish health care system perspective. A total of 188 patients (42.6% women) with a mean age of 65.3 years, a mean body mass index of 29.7 kg/m(2), and a mean disease duration of 10.7 years were assessed. Before insulin therapy was started, mean (standard deviation) values of various clinical parameters were: hemoglobin A(1c) (%), 9.22 (1.58); fasting plasma glucose (mmol/L), 12.03 (3.62); and total cholesterol (mmol/L), 4.90 (1.1). These values decreased after insulin therapy was started. Mean total direct health care costs per patient 6 months before and after insulin start were €639 and €1,110, respectively. Mean total costs 6 months after insulin was started included costs of hospitalization (30.5%, €339), insulin (16.2%, €180), primary care (14.3%, €159), blood glucose monitoring (13.8%, €153), specialized care (13.3%, €148), oral antidiabetics (7.8%, €87), and other diabetes-related treatments (3.9%, €43). The clinical outcomes of T2DM patients improved after insulin therapy was started. This improvement was associated to increases in resource utilization and direct health care costs in the first 6 months of insulin therapy. Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.

The convergence of health care financing structures: empirical evidence from OECD-countries.

PubMed

Leiter, Andrea M; Theurl, Engelbert

2012-02-01

The convergence/divergence of health care systems between countries is an interesting facet of the health care system research from a macroeconomic perspective. In this paper, we concentrate on an important dimension of every health care system, namely the convergence/divergence of health care financing (HCF). Based on data from 22 OECD countries in the time period 1970-2005, we use the public financing ratio (public financing in % of total HCF) and per capita public HCF as indicators for convergence. By applying different concepts of convergence, we find that HCF is converging. This conclusion also holds when we look at smaller subgroups of countries and shorter time periods. However, we find evidence that countries do not move towards a common mean and that the rate of convergence is decreasing over time.

Structural Model for the Effects of Environmental Elements on the Psychological Characteristics and Performance of the Employees of Manufacturing Systems.

PubMed

Realyvásquez, Arturo; Maldonado-Macías, Aidé Aracely; García-Alcaraz, Jorge; Cortés-Robles, Guillermo; Blanco-Fernández, Julio

2016-01-05

This paper analyzes the effects of environmental elements on the psychological characteristics and performance of employees in manufacturing systems using structural equation modeling. Increasing the comprehension of these effects may help optimize manufacturing systems regarding their employees' psychological characteristics and performance from a macroergonomic perspective. As the method, a new macroergonomic compatibility questionnaire (MCQ) was developed and statistically validated, and 158 respondents at four manufacture companies were considered. Noise, lighting and temperature, humidity and air quality (THAQ) were used as independent variables and psychological characteristics and employees' performance as dependent variables. To propose and test the hypothetical causal model of significant relationships among the variables, a data analysis was deployed. Results found that the macroergonomic compatibility of environmental elements presents significant direct effects on employees' psychological characteristics and either direct or indirect effects on the employees' performance. THAQ had the highest direct and total effects on psychological characteristics. Regarding the direct and total effects on employees' performance, the psychological characteristics presented the highest effects, followed by THAQ conditions. These results may help measure and optimize manufacturing systems' performance by enhancing their macroergonomic compatibility and quality of life at work of the employees.

A program-level management system for the life cycle environmental and economic assessment of complex building projects

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

Kim, Chan-Joong; Kim, Jimin; Hong, Taehoon

Climate change has become one of the most significant environmental issues, of which about 40% come from the building sector. In particular, complex building projects with various functions have increased, which should be managed from a program-level perspective. Therefore, this study aimed to develop a program-level management system for the life-cycle environmental and economic assessment of complex building projects. The developed system consists of three parts: (i) input part: database server and input data; (ii) analysis part: life cycle assessment and life cycle cost; and (iii) result part: microscopic analysis and macroscopic analysis. To analyze the applicability of the developedmore » system, this study selected ‘U’ University, a complex building project consisting of research facility and residential facility. Through value engineering with experts, a total of 137 design alternatives were established. Based on these alternatives, the macroscopic analysis results were as follows: (i) at the program-level, the life-cycle environmental and economic cost in ‘U’ University were reduced by 6.22% and 2.11%, respectively; (ii) at the project-level, the life-cycle environmental and economic cost in research facility were reduced 6.01% and 1.87%, respectively; and those in residential facility, 12.01% and 3.83%, respective; and (iii) for the mechanical work at the work-type-level, the initial cost was increased 2.9%; but the operation and maintenance phase was reduced by 20.0%. As a result, the developed system can allow the facility managers to establish the operation and maintenance strategies for the environmental and economic aspects from a program-level perspective. - Highlights: • A program-level management system for complex building projects was developed. • Life-cycle environmental and economic assessment can be conducted using the system. • The design alternatives can be analyzed from the microscopic perspective. • The system can be used to establish the optimal O&M strategy at the program-level. • It can be applied to any other country or sector in the global environment.« less

Discourses on Gender in Early Childhood Education and Care (ECEC) Setting: Equally Discriminated Against

ERIC Educational Resources Information Center

Breneselovic, Dragana Pavlovic; Krnjaja, Živka

2016-01-01

The paper addresses gender issues in the practice of ECEC through research with children. The research examines children's perspectives of kindergarten practice, acknowledging the importance of the child's perspective in critical investigations of this nature. In total, fifty children from thirty kindergartens across Serbia participated in the…

Parents' Perspectives on Adopting English Names in Taiwan

ERIC Educational Resources Information Center

Huang, Chiu-Yen; Ke, I-Chung

2016-01-01

This study investigated the adoption of English names in Taiwan through questionnaires and interviews with parents of junior high school students. In total, 564 parents filled out a questionnaire regarding their adoption of an English name, reasons for needing an English name, and their perspectives about their child's English name. We interviewed…

Tools Used to Evaluate Written Medicine and Health Information: Document and User Perspectives

ERIC Educational Resources Information Center

Luk, Alice; Aslani, Parisa

2011-01-01

This study aims to identify and review tools used to evaluate consumer-oriented written medicine (WMI) and health (WHI) information from a document and user perspective. Articles that met the following inclusion criteria were reviewed: studies evaluating readability, presentation, suitability, quality of WMI/WHI. A total of 152 articles were…

Prospective Teachers' Future Time Perspective and Professional Plans about Teaching: The Mediating Role of Academic Optimism

ERIC Educational Resources Information Center

Eren, Altay

2012-01-01

This study aimed to examine the mediating role of prospective teachers' academic optimism in the relationship between their future time perspective and professional plans about teaching. A total of 396 prospective teachers voluntarily participated in the study. Correlation, regression, and structural equation modeling analyses were conducted in…

Low-energy fusion dynamics of weakly bound nuclei: A time dependent perspective

NASA Astrophysics Data System (ADS)

Diaz-Torres, A.; Boselli, M.

2016-05-01

Recent dynamical fusion models for weakly bound nuclei at low incident energies, based on a time-dependent perspective, are briefly presented. The main features of both the PLATYPUS model and a new quantum approach are highlighted. In contrast to existing timedependent quantum models, the present quantum approach separates the complete and incomplete fusion from the total fusion. Calculations performed within a toy model for 6Li + 209Bi at near-barrier energies show that converged excitation functions for total, complete and incomplete fusion can be determined with the time-dependent wavepacket dynamics.

Dual Systems for Spatial Updating in Immediate and Retrieved Environments: Evidence from Bias Analysis.

PubMed

Liu, Chuanjun; Xiao, Chengli

2018-01-01

The spatial updating and memory systems are employed during updating in both the immediate and retrieved environments. However, these dual systems seem to work differently, as the difference of pointing latency and absolute error between the two systems vary across environments. To verify this issue, the present study employed the bias analysis of signed errors based on the hypothesis that the transformed representation will bias toward the original one. Participants learned a spatial layout and then either stayed in the learning location or were transferred to a neighboring room directly or after being disoriented. After that, they performed spatial judgments from perspectives aligned with the learning direction, aligned with the direction they faced during the test, or a novel direction misaligned with the two above-mentioned directions. The patterns of signed error bias were consistent across environments. Responses for memory aligned perspectives were unbiased, whereas responses for sensorimotor aligned perspectives were biased away from the memory aligned perspective, and responses for misaligned perspectives were biased toward sensorimotor aligned perspectives. These findings indicate that the spatial updating system is consistently independent of the spatial memory system regardless of the environments, but the updating system becomes less accessible as the environment changes from immediate to a retrieved one.

Dual Systems for Spatial Updating in Immediate and Retrieved Environments: Evidence from Bias Analysis

PubMed Central

Liu, Chuanjun; Xiao, Chengli

2018-01-01

The spatial updating and memory systems are employed during updating in both the immediate and retrieved environments. However, these dual systems seem to work differently, as the difference of pointing latency and absolute error between the two systems vary across environments. To verify this issue, the present study employed the bias analysis of signed errors based on the hypothesis that the transformed representation will bias toward the original one. Participants learned a spatial layout and then either stayed in the learning location or were transferred to a neighboring room directly or after being disoriented. After that, they performed spatial judgments from perspectives aligned with the learning direction, aligned with the direction they faced during the test, or a novel direction misaligned with the two above-mentioned directions. The patterns of signed error bias were consistent across environments. Responses for memory aligned perspectives were unbiased, whereas responses for sensorimotor aligned perspectives were biased away from the memory aligned perspective, and responses for misaligned perspectives were biased toward sensorimotor aligned perspectives. These findings indicate that the spatial updating system is consistently independent of the spatial memory system regardless of the environments, but the updating system becomes less accessible as the environment changes from immediate to a retrieved one. PMID:29467698

A Qualitative Analysis of Physician Perspectives on Missed and Delayed Outpatient Diagnosis: The Focus on System-Related Factors.

PubMed

Sarkar, Urmimala; Simchowitz, Brett; Bonacum, Doug; Strull, William; Lopez, Andrea; Rotteau, Leahora; Shojania, Kaveh G

2014-10-01

Delayed and missed diagnoses lead to significant patient harm. Because physician actions are fundamental to the outpatient diagnostic process, a study was conducted to explore physician perspectives on diagnosis. As part of a quality improvement initiative, an integrated health system conducted six physician focus groups in 2004 and 2005. The focus groups included questions about the process of diagnosis, specific factors contributing to missed diagnosis, use of guidelines, atypical vs. typical presentations of disease, diagnostic tools, and follow-up, all with regard to delays in the diagnostic process. The interviews were analyzed (1) deductively, with application of the Systems Engineering Initiative for Patient Safety (SEIPS) model, which addresses systems design, quality management, job design, and technology implementations that affect safety-related patient and organizational and/or staff outcomes, and (2) inductively, with identification of novel themes using content analysis. A total of 25 physicians participated in the six focus groups, which yielded 12 hours of discussion. Providers identified multiple barriers to timely and accurate diagnosis, including organizational culture, information availability, and communication factors. Multiple themes relating to each of the participants in the diagnostic process-health system, provider, and patient-emerged. Concerns about health system structure and providers' interactions with one another and with patients far exceeded discussion of the cognitive factors that might affect the diagnostic process. The results suggest that, at least in physicians' views, improving the diagnostic process requires attention to the organization of the health system in addition to the cognitive aspects of diagnosis.

Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs.

PubMed

Nwachukwu, Benedict U; McLawhorn, Alexander S; Simon, Matthew S; Hamid, Kamran S; Demetracopoulos, Constantine A; Deland, Jonathan T; Ellis, Scott J

2015-07-15

Total ankle replacement and ankle fusion are costly but clinically effective treatments for ankle arthritis. Prior cost-effectiveness analyses for the management of ankle arthritis have been limited by a lack of consideration of indirect costs and nonoperative management. The purpose of this study was to compare the cost-effectiveness of operative and nonoperative treatments for ankle arthritis with inclusion of direct and indirect costs in the analysis. Markov model analysis was conducted from a health-systems perspective with use of direct costs and from a societal perspective with use of direct and indirect costs. Costs were derived from the 2012 Nationwide Inpatient Sample (NIS) and expressed in 2013 U.S. dollars; effectiveness was expressed in quality-adjusted life years (QALYs). Model transition probabilities were derived from the available literature. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). In the direct-cost analysis for the base case, total ankle replacement was associated with an ICER of $14,500/QALY compared with nonoperative management. When indirect costs were included, total ankle replacement was both more effective and resulted in $5900 and $800 in lifetime cost savings compared with the lifetime costs following nonoperative management and ankle fusion, respectively. At a $100,000/QALY threshold, surgical management of ankle arthritis was preferred for patients younger than ninety-six years and total ankle replacement was increasingly more cost-effective in younger patients. Total ankle replacement, ankle fusion, and nonoperative management were the preferred strategy in 83%, 12%, and 5% of the analyses, respectively; however, our model was sensitive to patient age, the direct costs of total ankle replacement, the failure rate of total ankle replacement, and the probability of arthritis after ankle fusion. Compared with nonoperative treatment for the management of end-stage ankle arthritis, total ankle replacement is preferred over ankle fusion; total ankle replacement is cost-saving when indirect costs are considered and demonstrates increasing cost-effectiveness in younger patients. As indications for and utilization of total ankle replacement increase, continued research is needed to define appropriate subgroups of patients who would likely derive the greatest clinical benefit from that procedure. Economic and decision analysis Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Total Quality Management in a Knowledge Management Perspective.

ERIC Educational Resources Information Center

Johannsen, Carl Gustav

2000-01-01

Presents theoretical considerations on both similarities and differences between information management and knowledge management and presents a conceptual model of basic knowledge management processes. Discusses total quality management and quality control in the context of information management. (Author/LRW)

The personal financial burden of chronic rhinosinusitis: A Canadian perspective.

PubMed

Yip, Jonathan; Vescan, Allan D; Witterick, Ian J; Monteiro, Eric

2017-07-01

Previous studies describe the financial burden of chronic rhinosinusitis (CRS) from the perspective of third-party payers, but, to our knowledge, none analyze the costs borne by patients (i.e., out-of-pocket expenses [OOPE]). Furthermore, this burden has not been previously investigated in the context of a publicly funded health care system. The purpose of this study was to characterize the financial impact of CRS on patients, specifically by evaluating its associated OOPEs and the perceived financial burden. The secondary aim was to determine the factors predictive of OOPEs and perceived burden. Patients with CRS at a tertiary care sinus center completed a self-administered questionnaire that assessed their socioeconomic characteristics, disease-specific quality of life (22-item Sino-Nasal Outcome Test [SNOT-22]), workdays missed due to CRS, perceived financial burden, and direct medical and nonmedical OOPEs over a 12-month period. Total OOPEs were calculated from the sum of direct medical and nonmedical OOPEs. Regression analyses determined factors predictive of OOPEs and the perceived burden. A total of 84 patients completed the questionnaires. After accounting for health insurance coverage and the median direct medical, direct nonmedical, and total OOPEs per patient over a 12-month period were Canadian dollars (CAD) $336.00 (2011) [U.S. $339.85], CAD $129.87 [U.S. $131.86], and CAD $607.10 [U.S. $614.06], respectively. CRS resulted in an average of 20.6 workdays missed over a 12-month period. Factors predictive of a higher financial burden included younger age, a greater number of previous sinus surgeries, <80% health insurance coverage, residing out of town, and higher SNOT-22 scores. Total OOPEs incurred from the treatment of CRS may amount to CAD $607.10 [U.S. $614.06] per patient per year, within the context of a single-payer health care system. Managing clinicians should be aware of patient groups with a greater perceived financial burden and consider counseling them on strategies to offset expenses, including obtaining travel grants, using telemedicine for follow-up assessments, providing drug samples, and streamlining diagnostic testing with medical visits.

Food waste conversion options in Singapore: environmental impacts based on an LCA perspective.

PubMed

Khoo, Hsien H; Lim, Teik Z; Tan, Reginald B H

2010-02-15

Proper management and recycling of huge volumes of food waste is one of the challenges faced by Singapore. Semakau island - the only offshore landfill of the nation - only accepts inert, inorganic solid waste and therefore a large bulk of food waste is directed to incinerators. A remaining small percent is sent for recycling via anaerobic digestion (AD), followed by composting of the digestate material. This article investigates the environmental performance of four food waste conversion scenarios - based on a life cycle assessment perspective - taking into account air emissions, useful energy from the incinerators and AD process, as well as carbon dioxide mitigation from the compost products derived from the digestate material and a proposed aerobic composting system. The life cycle impact results were generated for global warming, acidification, eutrophication, photochemical oxidation and energy use. The total normalized results showed that a small-scale proposed aerobic composting system is more environmentally favorable than incinerators, but less ideal compared to the AD process. By making full use of the AD's Recycling Phase II process alone, the Singapore Green Plan's 2012 aim to increase the recycling of food waste to 30% can easily be achieved, along with reduced global warming impacts.

Cost minimization analysis of two treatment regimens for low-risk rhabdomyosarcoma in children: a report from the Children's Oncology Group.

PubMed

Russell, Heidi; Swint, J Michael; Lal, Lincy; Meza, Jane; Walterhouse, David; Hawkins, Douglas S; Okcu, M Fatih

2014-06-01

Recent Children's Oncology Group trials for low-risk rhabdomyosarcoma attempted to reduce therapy while maintaining excellent outcomes. D9602 delivered 45 weeks of outpatient vincristine and dactinomycin (VA) for patients in Subgroup A. ARST0331 reduced the duration of therapy to 22 weeks but added four doses of cyclophosphamide to VA for patients in Subset 1. Failure-free survival was similar. We undertook a cost minimization comparison to help guide future decision-making. Addressing the costs of treatment from the healthcare perspective we modeled a simple decision-analytic model from aggregate clinical trial data. Medical care inputs and probabilities were estimated from trial reports and focused chart review. Costs of radiation, surgery and off-therapy surveillance were excluded. Unit costs were obtained from literature and national reimbursement and inpatient utilization databases and converted to 2012 US dollars. Model uncertainty was assessed with first-order sensitivity analysis. Direct medical costs were $46,393 for D9602 and $43,261 for ARST0331 respectively, making ARST0331 the less costly strategy. Dactinomycin contributed the most to D9602 total costs but varied with age (42-69%). Chemotherapy administration costs accounted for the largest proportion of ARST0331 total costs (39-57%). ARST0331 incurred fewer costs than D9602 under most alternative distributive models and alternative clinical practice assumptions. Cost analysis suggests that ARST0331 may incur fewer costs than D9602 from the healthcare system's perspective. Attention to the services driving the costs provides directions for future efficiency improvements. Future studies should prospectively consider the patient and family's perspective. © 2014 Wiley Periodicals, Inc.

Implementation of a Surgical Safety Checklist: Impact on Surgical Team Perspectives

PubMed Central

Papaconstantinou, Harry T.; Jo, ChanHee; Reznik, Scott I.; Smythe, W. Roy; Wehbe-Janek, Hania

2013-01-01

Background The World Health Organization (WHO) surgical safety checklist has been shown to decrease mortality and complications and has been adopted worldwide. However, system flaws and human errors persist. Identifying provider perspectives of patient safety initiatives may identify strategies for improvement. The purpose of this study was to determine provider perspectives of surgical safety checklist implementation in an effort to improve initiatives that enhance surgical patients' safety. Methods In September 2010, a WHO-adapted surgical safety checklist was implemented at our institution. Surgical teams were invited to complete a checklist-focused questionnaire 1 month before and 1 year after implementation. Baseline and follow-up results were compared. Results A total of 437 surgical care providers responded to the survey: 45% of providers responded at baseline and 64% of providers responded at follow-up. Of the total respondents, 153 (35%) were nurses, 104 (24%) were anesthesia providers, and 180 (41%) were surgeons. Overall, we found an improvement in the awareness of patient safety and quality of care, with significant improvements in the perception of the value of and participation in the time-out process, in surgical team communication, and in the establishment and clarity of patient care needs. Some discordance was noted between surgeons and other surgical team members, indicating that barriers in communication still exist. Overall, approximately 65% of respondents perceived that the checklist improved patient safety and patient care; however, we found a strong negative perception of operating room efficiency. Conclusion Implementation of a surgical safety checklist improves perceptions of surgical safety. Barriers to implementation exist, but staff feedback may be used to enhance the sustainability and success of patient safety initiatives. PMID:24052757

The perspective of patients with congenital heart disease: does health care meet their needs?

PubMed

Schoormans, Dounya; Sprangers, Mirjam A G; Pieper, Petronella G; van Melle, Joost P; van Dijk, Arie P J; Sieswerda, Gertjan Tj; Hulsbergen-Zwarts, Mariët S; Plokker, Thijs H W M; Brunninkhuis, Leo G H; Vliegen, Hubert W; Mulder, Barbara J M

2011-01-01

A first step in the delivery of tailored care is answering the following question: does health care meet the needs of patients? Therefore patients' perspective on health care use and their needs was examined. The design used was cross-sectional questionnaire study. A total of 1109 adult congenital heart defect (CHD) patients attending one of eight Dutch hospitals were randomly selected from a national database (10% of all registered patients). Patient reported questionnaires on in- and outpatient health care use during the past year and need for additional care. A total of 66% and 40% of patients had contact with their cardiologist and general practitioner, respectively. Six to 10 percent were hospitalized, operated upon, or visited the emergency room. For the majority, the amount of contact was sufficient. Most patients indicated that the communication skills and expertise of the cardiologist and general practitioner were sufficient, and health care improvements were not necessary. Frequent health care users had a poor functional status and frequent contact with their cardiologist and general practitioner. Patients who want more contact with their cardiologist rated the communication skills of the cardiologist as insufficient. For most patients, the amount and quality of care are both sufficient. Patients who rate the communication skills of the cardiologist as insufficient have need more contact. In addition to the recommended training program as described in the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) guidelines, we recommend the incorporation of communication training. This is the first study to provide insight into health care use and needs of CHD patients in countries with a compulsory health insurance system from the patient perspective. © 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.

Economic Evaluation of Global Endometrial Ablation Versus Inpatient and Outpatient Hysterectomy for Treatment of Abnormal Uterine Bleeding: US Commercial and Medicaid Payer Perspectives.

PubMed

Miller, Jeffrey D; Bonafede, Machaon M; Cai, Qian; Pohlman, Scott K; Troeger, Kathleen A; Cholkeri-Singh, Aarathi

2018-03-01

Every year, abnormal uterine bleeding (AUB) exacts a heavy toll on women's health and leads to high costs for the US health care system. The literature shows that endometrial ablation results in fewer complications, shorter recovery and lower costs than more commonly performed hysterectomy procedures. The objective of this study was to model clinical-economic outcomes, budget impact, and cost-effectiveness of global endometrial ablation (GEA) versus outpatient hysterectomy (OPH) and inpatient hysterectomy (IPH) procedures. A decision tree, state-transition (semi-Markov) economic model was developed to simulate 3 hypothetical cohorts of women who received surgical treatment for AUB (GEA, OPH, and IPH) over 1, 2, and 3 years to evaluate clinical and economic outcomes for GEA vs. OPH and GEA vs. IPH. Two versions of the model were created to reflect both commercial health care payer and US Medicaid perspectives, and analyses were conducted for both payer types. Total health care costs in the first year after GEA were substantially lower compared with those for IPH and OPH. Budget impact analysis results showed that increasing GEA utilization yields total annual cost savings of about $906,000 for a million-member commercial health plan and about $152,000 in cost savings for a typical-sized state Medicaid plan with 1.4 million members. Cost-effectiveness analysis results for both perspectives showed GEA as economically dominant (conferring greater benefit at lower cost) over both OPH and IPH in the 1-year commercial scenario. This study demonstrates that, for some patients, GEA may prove to be a safe, uterus-sparing, cost-effective alternative to OPH and IPH for the surgical treatment of AUB.

Time perspective and weight management behaviors in newly diagnosed Type 2 diabetes: a mediational analysis.

PubMed

Hall, Peter A; Fong, Geoffrey T; Cheng, Alice Y

2012-12-01

The primary objective of the current study was to examine the extent to which domain-specific time perspective predicts weight management behaviors (dietary behavior and physical activity) among those newly diagnosed with Type 2 diabetes. A secondary objective was to test potential mediators of the hypothesized effect (behavioral intention, self-efficacy and control beliefs). A total of 204 adults newly diagnosed (≤6 months) with Type 2 diabetes participated in the study, which included a baseline assessment of domain-general and domain-specific time perspective, as well as strength of intention to perform two weight-management behaviors (dietary choice and physical activity); both weight-management behaviors were assessed again at 6 month follow-up. Hierarchical multiple regression analyses revealed a prospective association between domain-specific time perspective and uptake of weight management behaviors. Individuals with newly diagnosed T2DM possessing a future-oriented time perspective reported making less frequent fatty food choices and greater increases in physical activity over the 6-month follow-up interval. These effects were selectively mediated by intention strength, and not competing social cognitive variables. For both behaviors, the total effects and meditational models were robust to adjustments for demographics, body composition and disease variables. A future-oriented time perspective is prospectively associated with superior uptake of weight management behaviors among those with newly diagnosed Type 2 diabetes. The facilitating effect of future-oriented thinking appears to occur via enhanced strength of intentions to perform weight management behaviors.

Using wide area differential GPS to improve total system error for precision flight operations

NASA Astrophysics Data System (ADS)

Alter, Keith Warren

Total System Error (TSE) refers to an aircraft's total deviation from the desired flight path. TSE can be divided into Navigational System Error (NSE), the error attributable to the aircraft's navigation system, and Flight Technical Error (FTE), the error attributable to pilot or autopilot control. Improvement in either NSE or FTE reduces TSE and leads to the capability to fly more precise flight trajectories. The Federal Aviation Administration's Wide Area Augmentation System (WAAS) became operational for non-safety critical applications in 2000 and will become operational for safety critical applications in 2002. This navigation service will provide precise 3-D positioning (demonstrated to better than 5 meters horizontal and vertical accuracy) for civil aircraft in the United States. Perhaps more importantly, this navigation system, which provides continuous operation across large regions, enables new flight instrumentation concepts which allow pilots to fly aircraft significantly more precisely, both for straight and curved flight paths. This research investigates the capabilities of some of these new concepts, including the Highway-In-The Sky (HITS) display, which not only improves FTE but also reduces pilot workload when compared to conventional flight instrumentation. Augmentation to the HITS display, including perspective terrain and terrain alerting, improves pilot situational awareness. Flight test results from demonstrations in Juneau, AK, and Lake Tahoe, CA, provide evidence of the overall feasibility of integrated, low-cost flight navigation systems based on these concepts. These systems, requiring no more computational power than current-generation low-end desktop computers, have immediate applicability to general aviation flight from Cessnas to business jets and can support safer and ultimately more economical flight operations. Commercial airlines may also, over time, benefit from these new technologies.

Expanding the News Frame: The Systems Theory Perspective.

ERIC Educational Resources Information Center

Hendrickson, Laura J.; Tankard, James W., Jr.

1997-01-01

Outlines the main features of the systems perspective, focusing on general systems theory. Suggests that teaching future reporters to think of news events and issues in systems terms may be one approach to expanding the news frame. (PA)

Embodied Perspective Taking in Learning about Complex Systems

ERIC Educational Resources Information Center

Soylu, Firat; Holbert, Nathan; Brady, Corey; Wilensky, Uri

2017-01-01

In this paper we present a learning design approach that leverages perspective-taking to help students learn about complex systems. We define perspective-taking as projecting one's identity onto external entities (both animate and inanimate) in an effort to predict and anticipate events based on ecological cues, to automatically sense the…

Time perspective and medication adherence among individuals with hypertension or diabetes mellitus.

PubMed

Sansbury, Brittany; Dasgupta, Abhijit; Guthrie, Lori; Ward, Michael

2014-04-01

The study determined if time perspective was associated with medication adherence among people with hypertension and diabetes. Using the Health Beliefs Model, we used path analysis to test direct and indirect effects of time perspective and health beliefs on adherence among 178 people who participated in a community-based survey near Washington, D.C. We measured three time perspectives (future, present fatalistic, and present hedonistic) with the Zimbardo Time Perspective Inventory and medication adherence by self-report. The total model demonstrated a good fit (RMSEA=0.17, 90% CI [0.10, 0.28], p=0.003; comparative fit index=0.91). Future time perspective and age showed direct effects on increased medication adherence; an increase by a single unit in future time perspective was associated with a 0.32 standard deviation increase in reported adherence. There were no significant indirect effects of time perspective with reported medication adherence through health beliefs. The findings provide the first evidence that time perspective plays an under-recognized role as a psychological motivator in medication adherence. Patient counseling for medication adherence may be enhanced if clinicians incorporate consideration of the patient's time perspective. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Time perspective and environmental engagement: a meta-analysis.

PubMed

Milfont, Taciano L; Wilson, Jessie; Diniz, Pollyane

2012-01-01

Environmental issues entail both a social conflict (private vs. public interests) and a temporal conflict (short- vs. long-term interests). This paper focuses on the role temporal concerns play in influencing environmental engagement by quantitatively integrating results of studies that assessed the associations between time perspective and proenvironmental attitudes and behaviors. The meta-analysis included a total of 19 independent samples and 6,301 participants from seven countries (Australia, Brazil, Germany, Mexico, New Zealand, Norway, and the United States). Results showed that the associations between time perspective and proenvironmental behaviors were higher than those for proenvironmental attitudes. Supporting predictions, the associations between future time perspective and proenvironmental behaviors were strong and nontrivial compared to those for the combined past-present time perspective. The findings indicate that future time perspective seems to play an important role in influencing individuals' attitudes and behaviors towards the environment. Implications of the findings for theory and practice are discussed.

Factors Influencing Teaching Choice, Professional Plans about Teaching, and Future Time Perspective: A Mediational Analysis

ERIC Educational Resources Information Center

Eren, Altay; Tezel, Kadir Vefa

2010-01-01

This study aimed to examine the mediating role of prospective English teachers' future time perspectives in relation to their motivations for teaching, beliefs about the profession, career choice satisfaction, and professional plans. A total of 423 prospective English teachers voluntarily participated in the study. The mediating role of the future…

Self-Regulation in Children and Minors in Institutional Care

ERIC Educational Resources Information Center

Hrbackova, Karla; Vavrova, Sona

2015-01-01

The study deals with self-regulation in children and minors (aged 11 to 19 years) living in so-called "total institutions". It examines the degree of self-regulation of behaviour from the perspective of the children and minors themselves and from the perspective of their key workers. Children and minors and their key workers differ…

Nordic Children's Conceptualizations of Healthy Eating in Relation to School Lunch

ERIC Educational Resources Information Center

Berggren, Linda; Talvia, Sanna; Fossgard, Eldbjørg; Arnfjörð, Unnur Björk; Hörnell, Agneta; Ólafsdóttir, Anna Sigríður; Gunnarsdóttir, Ingibjörg; Wergedahl, Hege; Lagström, Hanna; Waling, Maria; Olsson, Cecilia

2017-01-01

Purpose: Pupils' perspective should be better taken into account when developing nutrition education at school. The purpose of this paper is to explore Nordic children's perspectives on the healthiness of meals in the context of school lunches. Design/methodology/approach: In total, 78 focus group discussions were conducted with 10-11-year-old…

Challenges of Females with Autism: A Parental Perspective

ERIC Educational Resources Information Center

Mademtzi, Marilena; Singh, Pavita; Shic, Fred; Koenig, Kathy

2018-01-01

Most studies investigating the experiences and needs of individuals with ASD have largely focused on males. Hence, this study investigates parents' perspectives on the challenges that their daughters with ASD face. In total, 40 parents of 40 females with autism (age range = 4-29 years; mean = 15.9) participated in the study. Five separate, 2-h…

Why Students Do Not Prepare for Math Placement Exams: Student Perspectives. CCRC Research Brief. Number 57

ERIC Educational Resources Information Center

Fay, Maggie P.; Bickerstaff, Susan; Hodara, Michelle

2013-01-01

Drawn from surveys completed by 122 students enrolled in developmental math at four community colleges and from seven student focus groups with a total of 34 developmental math students at those same colleges, this research brief illuminates student experiences with and perspectives on the math assessment and placement process. Findings suggest…

Total Quality Management and nuclear weapons: A historian`s perspective

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

Meade, R.A.

1993-11-01

Total Quality Management (TQM) has become a significant management theme at Los Alamos National Laboratory. This paper discusses the historical roots of TQM at Los Alamos and how TQM has been used in the development of nuclear weapons.

Control Theory Perspective of Effects-Based Thinking and Operations: Modelling Operations as a Feedback Control System

DTIC Science & Technology

2007-11-01

Control Theory Perspective of Effects-Based Thinking and Operations Modelling “Operations” as a Feedback Control System Philip S. E... Theory Perspective of Effects-Based Thinking and Operations Modelling “Operations” as a Feedback Control System Philip S. E. Farrell...Abstract This paper explores operations that involve effects-based thinking (EBT) using Control Theory techniques in order to highlight the concept’s

Managing costs, managing benefits: employer decisions in local health care markets.

PubMed

Christianson, Jon B; Trude, Sally

2003-02-01

To better understand employer health benefit decision making, how employer health benefits strategies evolve over time, and the impact of employer decisions on local health care systems. Data were collected as part of the Community Tracking Study (CTS), a longitudinal analysis of health system change in 12 randomly selected communities. This is an observational study with data collection over a six-year period. The study used semistructured interviews with local respondents, combined with monitoring of local media, to track changes in health care systems over time and their impact on community residents. Interviewing began in 1996 and was carried out at two-year intervals, with a total of approximately 2,200 interviews. The interviews provided a variety of perspectives on employer decision making concerning health benefits; these perspectives were triangulated to reach conclusions. The tight labor market during the study period was the dominant consideration in employer decision making regarding health benefits. Employers, in managing employee compensation, made independent decisions in pursuit of individual goals, but these decisions were shaped by similar labor market conditions. As a result, within and across our study sites, employer decisions in aggregate had an important impact on local health care systems, although employers' more highly visible public efforts to bring about health system change often met with disappointing results. General economic conditions in the 1990s had an important impact on the configuration of local health systems through their effect on employer decision making regarding health benefits offered to employees, and the responses of health plans and providers to those decisions.

Patients' perspectives on the medical primary-secondary care interface: systematic review and synthesis of qualitative research.

PubMed

Sampson, Rod; Cooper, Jamie; Barbour, Rosaline; Polson, Rob; Wilson, Philip

2015-10-15

To synthesise the published literature on the patient experience of the medical primary-secondary care interface and to determine priorities for future work in this field aimed at improving clinical outcomes. Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore patients' perspectives of the medical primary-secondary care interface. International primary-secondary care interface. EMBASE, MEDLINE, CINAHL Plus with Full text, PsycINFO, Psychology and Behavioural Sciences Collection, Health Business Elite, Biomedica Reference Collection: Comprehensive Library, Information Science & Technology Abstracts, eBook Collection, Web of Science Core Collection: Citation Indexes and Social Sciences Citation Index, and grey literature. Studies were eligible for inclusion if they were full research papers employing qualitative methodology to explore patients' perspectives of the medical primary-secondary care interface. The 7-step metaethnographic approach described by Noblit and Hare, which involves cross-interpretation between studies while preserving the context of the primary data. The search identified 690 articles, of which 39 were selected for full-text review. 20 articles were included in the systematic review that encompassed a total of 689 patients from 10 countries. 4 important areas specific to the primary-secondary care interface from the patients' perspective emerged: barriers to care, communication, coordination, and 'relationships and personal value'. Patients should be the focus of any transfer of care between primary and secondary systems. From their perspective, areas for improvement may be classified into four domains that should usefully guide future work aimed at improving quality at this important interface. PROSPERO CRD42014009486. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Patients’ perspectives on the medical primary–secondary care interface: systematic review and synthesis of qualitative research

PubMed Central

Sampson, Rod; Cooper, Jamie; Barbour, Rosaline; Polson, Rob; Wilson, Philip

2015-01-01

Objectives To synthesise the published literature on the patient experience of the medical primary–secondary care interface and to determine priorities for future work in this field aimed at improving clinical outcomes. Design Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore patients’ perspectives of the medical primary–secondary care interface. Setting International primary–secondary care interface. Data sources EMBASE, MEDLINE, CINAHL Plus with Full text, PsycINFO, Psychology and Behavioural Sciences Collection, Health Business Elite, Biomedica Reference Collection: Comprehensive Library, Information Science & Technology Abstracts, eBook Collection, Web of Science Core Collection: Citation Indexes and Social Sciences Citation Index, and grey literature. Eligibility criteria for selecting studies Studies were eligible for inclusion if they were full research papers employing qualitative methodology to explore patients’ perspectives of the medical primary–secondary care interface. Review methods The 7-step metaethnographic approach described by Noblit and Hare, which involves cross-interpretation between studies while preserving the context of the primary data. Results The search identified 690 articles, of which 39 were selected for full-text review. 20 articles were included in the systematic review that encompassed a total of 689 patients from 10 countries. 4 important areas specific to the primary–secondary care interface from the patients’ perspective emerged: barriers to care, communication, coordination, and ‘relationships and personal value’. Conclusions and implications of key findings Patients should be the focus of any transfer of care between primary and secondary systems. From their perspective, areas for improvement may be classified into four domains that should usefully guide future work aimed at improving quality at this important interface. Trial registration number PROSPERO CRD42014009486. PMID:26474939

Remote entanglement between a single atom and a Bose-Einstein condensate.

PubMed

Lettner, M; Mücke, M; Riedl, S; Vo, C; Hahn, C; Baur, S; Bochmann, J; Ritter, S; Dürr, S; Rempe, G

2011-05-27

Entanglement between stationary systems at remote locations is a key resource for quantum networks. We report on the experimental generation of remote entanglement between a single atom inside an optical cavity and a Bose-Einstein condensate (BEC). To produce this, a single photon is created in the atom-cavity system, thereby generating atom-photon entanglement. The photon is transported to the BEC and converted into a collective excitation in the BEC, thus establishing matter-matter entanglement. After a variable delay, this entanglement is converted into photon-photon entanglement. The matter-matter entanglement lifetime of 100 μs exceeds the photon duration by 2 orders of magnitude. The total fidelity of all concatenated operations is 95%. This hybrid system opens up promising perspectives in the field of quantum information. © 2011 American Physical Society

Support following total laryngectomy: Exploring the concept from different perspectives.

PubMed

Bickford, J M; Coveney, J; Baker, J; Hersh, D

2018-04-19

Adjustment after total laryngectomy is complex, and the resultant support needs are extensive. Current practice is often guided by health-related quality of life measures. While useful, many of these tools were developed without considering the perspectives of people who have experienced the surgery. To improve understanding of the support needs after total laryngectomy, multiple viewpoints were examined, for example individuals with a laryngectomy (IWL), significant others (SO) and health professionals (HP). A qualitative study explored the perspectives of 28 individuals (IWL-seven men and five women, nine SO and seven HP). Data were collected through in-depth, semi-structured interviews and analysed using constructivist grounded theory and symbolic interactionism. The data suggested that the construct "being supported to develop competence and resilience" is a multidimensional and nonlinear phenomenon underpinned by the interactive processes "perceiving influencing factors," "building trusting relationships" and "sharing and balancing the care." The findings highlight the significant contribution the care triad (i.e., IWL, SO and HP) plays and the factors influencing care, safety and dignity for IWL. Furthermore, support is optimised when all stakeholders are competent with the care. In turn, reduced competence increases the burden for one or all in the triad. © 2018 John Wiley & Sons Ltd.

The trend of changes in the evaluation scores of faculty members from administrators' and students' perspectives at the medical school over 10 years.

PubMed

Yamani, Nikoo; Changiz, Tahereh; Feizi, Awat; Kamali, Farahnaz

2018-01-01

To assess the trend of changes in the evaluation scores of faculty members and discrepancy between administrators' and students' perspectives in a medical school from 2006 to 2015. This repeated cross-sectional study was conducted on the 10-year evaluation scores of all faculty members of a medical school (n=579) in an urban area of Iran. Data on evaluation scores given by students and administrators and the total of these scores were evaluated. Data were analyzed using descriptive and inferential statistics including linear mixed effect models for repeated measures via the SPSS software. There were statistically significant differences between the students' and administrators' perspectives over time ( p <0.001). The mean of the total evaluation scores also showed a statistically significant change over time ( p <0.001). Furthermore, the mean of changes over time in the total evaluation score between different departments was statistically significant ( p <0.001). The trend of changes in the student's evaluations was clear and positive, but the trend of administrators' evaluation was unclear. Since the evaluation of faculty members is affected by many other factors, there is a need for more future studies.

Complexity Leadership: A Theoretical Perspective

ERIC Educational Resources Information Center

Baltaci, Ali; Balci, Ali

2017-01-01

Complex systems are social networks composed of interactive employees interconnected through collaborative, dynamic ties such as shared goals, perspectives and needs. Complex systems are largely based on "the complex system theory". The complex system theory focuses mainly on finding out and developing strategies and behaviours that…

A qualitative exploration of youth in the "new" China: perspectives on tobacco use from adolescents in southwest China.

PubMed

Okamoto, Janet; Sakuma, Kari-Lyn; Yan, He; Qiu, Peiyuan; Palmer, Paula H; Johnson, C Anderson

2012-03-01

School-based prevention programs are not common in China and the attempts to modify successful Western prevention programs have largely shown little effect. Distinct cultural and social systems differences could explain why modified programs have been unsuccessful. Smoking behavior is examined from the perspective of Chinese adolescents as part of the development of a large intervention trial. A total of 16 focus groups with 128 participants were conducted in Chengdu in Sichuan province of China. Impressions of adolescent smokers were mixed, most seeing the behavior as common among boys. Smokers were seen as being overwhelmed and stressed. Girls' smoking was mostly seen as universally "bad" and reflecting poorly on a girl's character. However, a small portion of focus group participants suggested that female smoking was fashionable and trendy. With social norms changing rapidly in the "new" China, understanding what the new generation of Chinese youth thinks about smoking is critical in determining how to address and tailor prevention efforts.

Expert panel on practice patterns in the management of cow's milk protein allergy and associated economic burden of disease on health service in Turkey.

PubMed

Sekerel, Bulent Enis; Seyhun, Oznur

2017-09-01

To evaluate practice patterns in the management of cow's milk protein allergy (CMPA) and associated economic burden of disease on health service in Turkey. This study was based on experts' views on the practice patterns in management of CMPA manifesting with either proctocolitis or eczema symptoms and, thereby, aimed to estimate economic burden of CMPA. Practice patterns were determined via patient flow charts developed by experts using the modified Delphi method for CMPA presented with proctocolitis and eczema. Per patient total 2-year direct medical costs were calculated, including cost items of physician visits, laboratory tests, and treatment. According to the consensus opinion of experts, 2-year total direct medical cost from a payer perspective and societal perspective was calculated to be $US2,116.05 and $US2,435.84, respectively, in an infant with CMPA presenting with proctocolitis symptoms, and $US4,001.65 and $US4,828.90, respectively, in an infant with CMPA presenting with eczema symptoms. Clinical nutrition was the primary cost driver that accounted for 89-92% of 2-year total direct medical costs, while the highest total direct medical cost estimated from a payer perspective and societal perspective was noted for the management of an exclusively formula-fed infant presenting either with proctocolitis ($US3,743.85 and $US4,025.63, respectively) or eczema ($US6,854.10 and $US7,917.30, respectively). The first line use of amino acid based formula (AAF) was associated with total direct cost increment $US1,848.08 and $US3,444.52 in the case of proctocolitis and eczema, respectively. Certain limitations to this study should be considered. First, being focused only on direct costs, the lack of data on indirect costs or intangible costs of illness seems to be a major limitation of the present study, which likely results in a downward bias in the estimates of the economic cost of CMPA. Second, given the limited number of studies concerning epidemiology and practice patterns in CMPA in Turkey, use of expert clinical opinion of the panel members rather than real-life data on practice patterns that were used to identify direct medical costs might raise a concern with the validity and reliability of the data. Also, while this was a three-step study with six experts included in the first stage (developing local guidelines for diagnosis, treatment, and follow-up of infants with CMPA in Turkey) and 410 pediatricians included in the second stage (a cross-sectional questionnaire-survey to determine pediatricians' awareness and practice of CMPA in infants and children), only four members were included in the present Delphi panel, which allows a limited discussion. Third, lack of sensitivity analyses and exclusion of indirect costs and costs related to alterations in quality of life, behavior of infants, and general well-being of infants and their parents from the cost-analysis seems to be another limitation that may have caused under-estimation of relative cost-effectiveness of the formulae. Fourth, calculation of costs per local guidelines rather than real-life practice patterns is another limitation that, otherwise, would extend the knowledge achieved in the current study. Notwithstanding these limitations, the present expert panel provided practice patterns in the management of CMPA and an estimate of the associated costs, depending on the symptom profile at initial admission for the first time in Turkey. In conclusion, in providing the first health economic data on CMPA in Turkey, the findings revealed that CMPA imposes a substantial burden on the Turkish healthcare system from both a payer perspective and societal perspective, and indicated clinical nutrition as a primary cost driver. Management of infants presenting with eczema, exclusively formula-fed infants, and first line use of AAF were associated with higher estimates for 2-year direct medical costs.

Finding Multi-scale Connectivity in Our Geospace Observational System: A New Perspective for Total Electron Content Data Through Network Analysis

NASA Astrophysics Data System (ADS)

McGranaghan, R. M.; Mannucci, A. J.; Verkhoglyadova, O. P.; Malik, N.

2017-12-01

How do we evolve beyond current traditional methods in order to innovate into the future? In what disruptive innovations will the next frontier of space physics and aeronomy (SPA) be grounded? We believe the answer to these compelling, yet equally challenging, questions lies in a shift of focus: from a narrow, field-specific view to a radically inclusive, interdisciplinary new modus operandi at the intersection of SPA and the information and data sciences. Concretely addressing these broader themes, we present results from a novel technique for knowledge discovery in the magnetosphere-ionosphere-thermosphere (MIT) system: complex network analysis (NA). We share findings from the first NA of ionospheric total electron content (TEC) data, including hemispheric and interplanetary magnetic field clock angle dependencies [1]. Our work shows that NA complements more traditional approaches for the investigation of TEC structure and dynamics, by both reaffirming well-established understanding, giving credence to the method, and identifying new connections, illustrating the exciting potential. We contextualize these new results through a discussion of the potential of data-driven discovery in the MIT system when innovative data science techniques are embraced. We address implications and potentially disruptive data analysis approaches for SPA in terms of: 1) the future of the geospace observational system; 2) understanding multi-scale phenomena; and 3) machine learning. [1] McGranaghan, R. M., A. J. Mannucci, O. Verkhoglyadova, and N. Malik (2017), Finding multiscale connectivity in our geospace observational system: Network analysis of total electron content, J. Geophys. Res. Space Physics, 122, doi:10.1002/2017JA024202.

Cost-effectiveness of a National Telemedicine Diabetic Retinopathy Screening Program in Singapore.

PubMed

Nguyen, Hai V; Tan, Gavin Siew Wei; Tapp, Robyn Jennifer; Mital, Shweta; Ting, Daniel Shu Wei; Wong, Hon Tym; Tan, Colin S; Laude, Augustinus; Tai, E Shyong; Tan, Ngiap Chuan; Finkelstein, Eric A; Wong, Tien Yin; Lamoureux, Ecosse L

2016-12-01

To determine the incremental cost-effectiveness of a new telemedicine technician-based assessment relative to an existing model of family physician (FP)-based assessment of diabetic retinopathy (DR) in Singapore from the health system and societal perspectives. Model-based, cost-effectiveness analysis of the Singapore Integrated Diabetic Retinopathy Program (SiDRP). A hypothetical cohort of patients aged 55 years with type 2 diabetes previously not screened for DR. The SiDRP is a new telemedicine-based DR screening program using trained technicians to assess retinal photographs. We compared the cost-effectiveness of SiDRP with the existing model in which FPs assess photographs. We developed a hybrid decision tree/Markov model to simulate the costs, effectiveness, and incremental cost-effectiveness ratio (ICER) of SiDRP relative to FP-based DR screening over a lifetime horizon. We estimated the costs from the health system and societal perspectives. Effectiveness was measured in terms of quality-adjusted life-years (QALYs). Result robustness was calculated using deterministic and probabilistic sensitivity analyses. The ICER. From the societal perspective that takes into account all costs and effects, the telemedicine-based DR screening model had significantly lower costs (total cost savings of S$173 per person) while generating similar QALYs compared with the physician-based model (i.e., 13.1 QALYs). From the health system perspective that includes only direct medical costs, the cost savings are S$144 per person. By extrapolating these data to approximately 170 000 patients with diabetes currently being screened yearly for DR in Singapore's primary care polyclinics, the present value of future cost savings associated with the telemedicine-based model is estimated to be S$29.4 million over a lifetime horizon. While generating similar health outcomes, the telemedicine-based DR screening using technicians in the primary care setting saves costs for Singapore compared with the FP model. Our data provide a strong economic rationale to expand the telemedicine-based DR screening program in Singapore and elsewhere. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Shape equivalence under perspective and projective transformations.

PubMed

Wagemans, J; Lamote, C; Van Gool, L

1997-06-01

When a planar shape is viewed obliquely, it is deformed by a perspective deformation. If the visual system were to pick up geometrical invariants from such projections, these would necessarily be invariant under the wider class of projective transformations. To what extent can the visual system tell the difference between perspective and nonperspective but still projective deformations of shapes? To investigate this, observers were asked to indicate which of two test patterns most resembled a standard pattern. The test patterns were related to the standard pattern by a perspective or projective transformation, or they were completely unrelated. Performance was slightly better in a matching task with perspective and unrelated test patterns (92.6%) than in a projective-random matching task (88.8%). In a direct comparison, participants had a small preference (58.5%) for the perspectively related patterns over the projectively related ones. Preferences were based on the values of the transformation parameters (slant and shear). Hence, perspective and projective transformations yielded perceptual differences, but they were not treated in a categorically different manner by the human visual system.

Measuring management's perspective of data quality in Pakistan's Tuberculosis control programme: a test-based approach to identify data quality dimensions.

PubMed

Ali, Syed Mustafa; Anjum, Naveed; Kamel Boulos, Maged N; Ishaq, Muhammad; Aamir, Javariya; Haider, Ghulam Rasool

2018-01-16

Data quality is core theme of programme's performance assessment and many organizations do not have any data quality improvement strategy, wherein data quality dimensions and data quality assessment framework are important constituents. As there is limited published research about the data quality specifics that are relevant to the context of Pakistan's Tuberculosis control programme, this study aims at identifying the applicable data quality dimensions by using the 'fitness-for-purpose' perspective. Forty-two respondents pooled a total of 473 years of professional experience, out of which 223 years (47%) were in TB control related programmes. Based on the responses against 11 practical cases, adopted from the routine recording and reporting system of Pakistan's TB control programme (real identities of patient were masked), completeness, accuracy, consistency, vagueness, uniqueness and timeliness are the applicable data quality dimensions relevant to the programme's context, i.e. work settings and field of practice. Based on a 'fitness-for-purpose' approach to data quality, this study used a test-based approach to measure management's perspective and identified data quality dimensions pertinent to the programme and country specific requirements. Implementation of a data quality improvement strategy and achieving enhanced data quality would greatly help organizations in promoting data use for informed decision making.

Possible strand of the North Anatolian fault in the Thrace basin, Turkey - An interpretation

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

Perincek, D.

1991-02-01

This study focuses on the presence of a major strike-slip fault system in the Thrace basin. This new discovery is important for the geology of the Thrace basin and also brings a new perspective to petroleum exploration. The wrench fault system is named the Thrace strike-slip fault system (Perincek, 1988). Similarities with the North Anatolian fault zone prompted an investigation of the relationship between these two fault system.s The study area covers most of the Thrace region of Turkey. The purposes of this paper are (1) to outline the geometry of the Thrace fault system, (2) to demonstrate its tectonicmore » relation with other major structures of the region, (3) to define the age of its inception, and (4) to discuss possible magnitudes of the lateral displacement. The interpretation is based mainly on seismic data consisting of 180 seismic reflection profiles that have a total cumulative length of 2,800 km. Seismic data are complemented with subsurface control from 54 wells.« less

The Effects of University Mergers in China since 1990s: From the Perspective of Knowledge Production

ERIC Educational Resources Information Center

Mao, Ya-qing; Du, Yuan; Liu, Jing-juan

2009-01-01

Purpose: The purpose of this paper is to discover and better understand the efficiency of university mergers from the perspective of knowledge production, with the research capability as the point of contact. Design/methodology/approach: In total, 20 colleges and universities directly under the central ministries that merged in 2000 were taken as…

Adolescent Suicide and Intervention in Perspective.

ERIC Educational Resources Information Center

Smith, Rebecca M.

In 1976, suicides in the 15-24 year-old group (N=4,747) made up over 17% of all suicides in all age groups (N=26,750). In 1968, adolescent suicides (N=2,591) were only 12% of the total (N=21,000). Adolescent suicide rate is alarming unless put into perspective with the accident rate and the cultural belief in individual rights, responsibility, and…

Current concepts and future perspectives in computer-assisted navigated total knee replacement.

PubMed

Matsumoto, Tomoyuki; Nakano, Naoki; Lawrence, John E; Khanduja, Vikas

2018-05-12

Total knee replacements (TKR) aim to restore stability of the tibiofemoral and patella-femoral joints and provide relief of pain and improved quality of life for the patient. In recent years, computer-assisted navigation systems have been developed with the aim of reducing human error in joint alignment and improving patient outcomes. We examined the current body of evidence surrounding the use of navigation systems and discussed their current and future role in TKR. The current body of evidence shows that the use of computer navigation systems for TKR significantly reduces outliers in the mechanical axis and coronal prosthetic position. Also, navigation systems offer an objective assessment of soft tissue balancing that had previously not been available. Although these benefits represent a technical superiority to conventional TKR techniques, there is limited evidence to show long-term clinical benefit with the use of navigation systems, with only a small number of studies showing improvement in outcome scores at short-term follow-up. Because of the increased costs and operative time associated with their use as well as the emergence of more affordable and patient-specific technologies, it is unlikely for navigation systems to become more widely used in the near future. Whilst this technology helps surgeons to achieve improved component positioning, it is important to consider the clinical and functional implications, as well as the added costs and potential learning curve associated with adopting new technology.

Game Theory and Risk-Based Levee System Design

NASA Astrophysics Data System (ADS)

Hui, R.; Lund, J. R.; Madani, K.

2014-12-01

Risk-based analysis has been developed for optimal levee design for economic efficiency. Along many rivers, two levees on opposite riverbanks act as a simple levee system. Being rational and self-interested, land owners on each river bank would tend to independently optimize their levees with risk-based analysis, resulting in a Pareto-inefficient levee system design from the social planner's perspective. Game theory is applied in this study to analyze decision making process in a simple levee system in which the land owners on each river bank develop their design strategies using risk-based economic optimization. For each land owner, the annual expected total cost includes expected annual damage cost and annualized construction cost. The non-cooperative Nash equilibrium is identified and compared to the social planner's optimal distribution of flood risk and damage cost throughout the system which results in the minimum total flood cost for the system. The social planner's optimal solution is not feasible without appropriate level of compensation for the transferred flood risk to guarantee and improve conditions for all parties. Therefore, cooperative game theory is then employed to develop an economically optimal design that can be implemented in practice. By examining the game in the reversible and irreversible decision making modes, the cost of decision making myopia is calculated to underline the significance of considering the externalities and evolution path of dynamic water resource problems for optimal decision making.

Assessing dry weather flow contribution in TSS and COD storm events loads in combined sewer systems.

PubMed

Métadier, M; Bertrand-Krajewski, J L

2011-01-01

Continuous high resolution long term turbidity measurements along with continuous discharge measurements are now recognised as an appropriate technique for the estimation of in sewer total suspended solids (TSS) and Chemical Oxygen Demand (COD) loads during storm events. In the combined system of the Ecully urban catchment (Lyon, France), this technique is implemented since 2003, with more than 200 storm events monitored. This paper presents a method for the estimation of the dry weather (DW) contribution to measured total TSS and COD event loads with special attention devoted to uncertainties assessment. The method accounts for the dynamics of both discharge and turbidity time series at two minutes time step. The study is based on 180 DW days monitored in 2007-2008. Three distinct classes of DW days were evidenced. Variability analysis and quantification showed that no seasonal effect and no trend over the year were detectable. The law of propagation of uncertainties is applicable for uncertainties estimation. The method has then been applied to all measured storm events. This study confirms the interest of long term continuous discharge and turbidity time series in sewer systems, especially in the perspective of wet weather quality modelling.

Structural Model for the Effects of Environmental Elements on the Psychological Characteristics and Performance of the Employees of Manufacturing Systems

PubMed Central

Realyvásquez, Arturo; Maldonado-Macías, Aidé Aracely; García-Alcaraz, Jorge; Cortés-Robles, Guillermo; Blanco-Fernández, Julio

2016-01-01

This paper analyzes the effects of environmental elements on the psychological characteristics and performance of employees in manufacturing systems using structural equation modeling. Increasing the comprehension of these effects may help optimize manufacturing systems regarding their employees’ psychological characteristics and performance from a macroergonomic perspective. As the method, a new macroergonomic compatibility questionnaire (MCQ) was developed and statistically validated, and 158 respondents at four manufacture companies were considered. Noise, lighting and temperature, humidity and air quality (THAQ) were used as independent variables and psychological characteristics and employees’ performance as dependent variables. To propose and test the hypothetical causal model of significant relationships among the variables, a data analysis was deployed. Results found that the macroergonomic compatibility of environmental elements presents significant direct effects on employees’ psychological characteristics and either direct or indirect effects on the employees’ performance. THAQ had the highest direct and total effects on psychological characteristics. Regarding the direct and total effects on employees’ performance, the psychological characteristics presented the highest effects, followed by THAQ conditions. These results may help measure and optimize manufacturing systems’ performance by enhancing their macroergonomic compatibility and quality of life at work of the employees. PMID:26742054

Incremental sanitation improvement strategy: comparison of options for Hanoi, Vietnam.

PubMed

Harada, H; Matsui, S; Dong, N T; Shimizu, Y; Fujii, S

2010-01-01

Urban sanitation issues should be tackled strategically, and may be addressed effectively when sewage development is pursued in conjunction with complementary sanitation measures. Five sanitation improvement scenarios employing sewage, night-soil collection-and-treatment (NSCT) system, and/or septic-tank improvement by annual dislodging were analyzed from the perspective of COD loads, total nitrogen loads, and cost under the conditions found in Hanoi, Vietnam. Compared to the development of sewage alone, the scenario of developing NSCT systems in a complementary manner with sewage development was estimated to be the most effective for a rapid decrease of both COD and total nitrogen loads. However, it may be difficult in some cases to replace ordinary water-flush toilet by the micro-flush toilet that are used in NSCT systems. In this case, the scenario employing septic-tank improvement in conjunction with sewage development may be effective for a rapid decrease of COD in locations where septic tanks are widely used under poor maintenance conditions and nitrogen pollution is not serious compared to COD. It was calculated that the two scenarios above would respectively require cost increases of 16 and 22% over the sewage development scenario.

Article Screening System

NASA Technical Reports Server (NTRS)

Fernandez, Kenneth R. (Inventor)

2004-01-01

During the last ten years patents directed to luggage scanning apparatus began to appear in the patent art. Absent from the variety of approaches in the art is stereoscopic imaging that entails exposing two or more images of the same object, each taken from a slightly different perspective. If the perspectives are too different, that is. if there is too much separation of the X-ray exposures, the image will look flat. Yet with a slight separation, a stereo separation, interference occurs. Herein a system is provided for the production of stereo pairs. One perspective, a left or a right perspective angle, is first established. Next, the other perspective angle is computed. Using these left and right perspectives the X-ray sources can then be spaced away from each other.

A polymeric micro total analysis system for single-cell analysis

NASA Astrophysics Data System (ADS)

Lai, Hsuan-Hong

The advancement of microengineering has enabled the manipulation and analysis of single cells, which is critical in understanding the molecular mechanisms underlying the basic physiological functions from the point of view of modern biologists. Unfortunately, analysis of single cells remains challenging from a technical perspective, mainly because of the miniature nature of the cell and the high throughput requirements of the analysis. Lab-on-a-chip (LOC) emerges as a research field that shows great promise in this perspective. We have demonstrated a micro total analysis system (mu-TAS) combining chip-based electrophoretic separation, fluorescence detection, and a pulsed Nd:YAG laser cell lysis system, in a Poly(dimethylsiloxane) (PDMS) microfluidic analytical platform for the implementation of single-cell analysis. To accomplish the task, a polymeric microfluidic device was fabricated and UV graft polymerization surface modification techniques were used. To optimize the conditions for the surface treatment techniques, the modified surfaces of PDMS were characterized using AIR-IR spectrum and sessile water drop contact angle measurements, and in-channel surfaces were characterized by their electroosmotic flow mobility. Accurate single-cell analysis relies on rapid cell lysis and therefore an optical measure of fast cell lysis was implemented and optimized in a microscopic station. The influences of pulse energy and the location of the laser beam with respect to the cell in the microchannel were explored. The observation from the cell disruption experiments suggested that the cell lysis was enabled mainly via a thermo-mechanical instead of a plasma-mediated mechanism. Finally, after chip-based electrophoresis and a laser-induced fluorescence (LIF) detection system were incorporated with the laser lysis system in a microfluidic analytical station, a feasibility demonstration of single-cell analysis was implemented. The analytical platform exhibited the capability of fluidic transportation, optical lysis of single cells, separation, and analysis of the lysates by electrophoresis and LIF detection. In comparison with the control experiment, the migration times of the fluorescent signals for the cytosolic fluorophores were in good agreement with those for the standard fluorophores, which confirmed the feasibility of the analytical processes.

Making the Grade in a Portfolio-Based System: Student Performance and the Student Perspective

PubMed Central

Nowacki, Amy S.

2013-01-01

Assessment is such an integral part of the educational system that we rarely reflect on its value and impact. Portfolios have gained in popularity, but much attention has emphasized the end-user and portfolio assessment. Here we focus on the portfolio creator (the student) and examine whether their educational needs are met with such an assessment method. This study aims to investigate how assessment practices influence classroom performance and the learning experience of the student in a graduate education setting. Studied were 33 medical students at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, a program utilizing a portfolio-based system. The students may elect to simultaneously enroll in a Masters program; however, these programs employ traditional letter grades. Thus creating a unique opportunity to assess 25 portfolio only (P) students and 8 portfolio and grade (PG) students concurrently taking a course that counts for both programs. Classroom performance was measured via a comprehensive evaluation where the PG students scored modestly better (median total scores, 72% P vs. 76% PG). Additionally, a survey was conducted to gain insight into student’s perspective on how assessment method impacts the learning experience. The students in the PG group (those receiving a grade) reported increased stress but greater affirmation and self-assurance regarding their knowledge and skill mastery. Incorporation of such affirmation remains a challenge for portfolio-based systems and an area for investigation and improvement. PMID:23565103

Making the grade in a portfolio-based system: student performance and the student perspective.

PubMed

Nowacki, Amy S

2013-01-01

Assessment is such an integral part of the educational system that we rarely reflect on its value and impact. Portfolios have gained in popularity, but much attention has emphasized the end-user and portfolio assessment. Here we focus on the portfolio creator (the student) and examine whether their educational needs are met with such an assessment method. This study aims to investigate how assessment practices influence classroom performance and the learning experience of the student in a graduate education setting. Studied were 33 medical students at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, a program utilizing a portfolio-based system. The students may elect to simultaneously enroll in a Masters program; however, these programs employ traditional letter grades. Thus creating a unique opportunity to assess 25 portfolio only (P) students and 8 portfolio and grade (PG) students concurrently taking a course that counts for both programs. Classroom performance was measured via a comprehensive evaluation where the PG students scored modestly better (median total scores, 72% P vs. 76% PG). Additionally, a survey was conducted to gain insight into student's perspective on how assessment method impacts the learning experience. The students in the PG group (those receiving a grade) reported increased stress but greater affirmation and self-assurance regarding their knowledge and skill mastery. Incorporation of such affirmation remains a challenge for portfolio-based systems and an area for investigation and improvement.

Parts Selection for Space Systems - An Overview and Radiation Perspective

NASA Technical Reports Server (NTRS)

LaBel, Kenneth A.

2008-01-01

This viewgraph presentation describes the selection of electronic parts for aerospace systems from a space radiation perspective. The topics include: 1) The Trade Space Involved with Part Selection; 2) Understanding Risk; 3) Technical/Design Aspects; 4) Programmatic Overview; 5) Radiation Perspective; 6) Reliability Considerations; 7) An Example Ad hoc Battle; and 8) Sources of Radiation Data.

The role of cognitive and emotional perspective taking in economic decision making in the ultimatum game.

PubMed

Takagishi, Haruto; Koizumi, Michiko; Fujii, Takayuki; Schug, Joanna; Kameshima, Shinya; Yamagishi, Toshio

2014-01-01

We conducted a simple resource allocation game known as the ultimatum game (UG) with preschoolers to examine the role of cognitive and emotional perspective-taking ability on allocation and rejection behavior. A total of 146 preschoolers played the UG and completed a false belief task and an emotional perspective-taking test. Results showed that cognitive perspective taking ability had a significant positive effect on the proposer's offer and a negative effect on the responder's rejection behavior, whereas emotional perspective taking ability did not impact either the proposer's or responder's behavior. These results imply that the ability to anticipate the responder's beliefs, but not their emotional state, plays an important role in the proposer's choice of a fair allocation in an UG, and that children who have not acquired theory of mind still reject unfair offers.

Learning from and with Museum Objects: Design Perspectives, Environment, and Emerging Learning Systems

ERIC Educational Resources Information Center

Vartiainen, Henriikka; Enkenberg, Jorma

2013-01-01

Sociocultural approaches emphasize the systemic, context-bound nature of learning, which is mediated by other people, physical and conceptual artifacts, and tools. However, current educational systems tend not to approach learning from the systemic perspective, and mostly situate learning within classroom environments. This design-based research…

[Public free anonymous HIV testing centers: cost analysis and financing options].

PubMed

Dozol, Adrien; Tribout, Martin; Labalette, Céline; Moreau, Anne-Christine; Duteil, Christelle; Bertrand, Dominique; Segouin, Christophe

2011-01-01

The services of general interest provided by hospitals, such as free HIV clinics, have been funded since 2005 by a lump sum covering all costs. The allocation of the budget was initially determined based on historical and declarative data. However, the French Ministry of Health (MoH) recently outlined new rules for determining the allocation of financial resources and contracting hospitals for each type of services of general interest provided. The aim of this study was to estimate the annual cost of a public free anonymous HIV-testing center and to assess the budgetary implications of new financing systems. Three financing options were compared: the historic block grant; a mixed system recommended by the MoH associating a lump sum covering the recurring costs of an average center and a variable part based on the type and volume of services provided; and a fee-for-services system. For the purposes of this retrospective study, the costs and activity data of the HIV testing clinic of a public hospital located in the North of Paris were obtained for 2007. The costs were analyzed from the perspective of the hospital. The total cost was estimated at 555,698 euros. Personnel costs accounted for 31% of the total costs, while laboratory expenses accounted for 36% of the total costs. While the estimated deficit was 292,553 euros under the historic system, the financial balance of the clinic was found to be positive under a fee-for-services system. The budget allocated to the HIV clinic under the system recommended by the MoH covers most of the current expenses of the HIV clinic while meeting the requirements of free confidential care.

Assessing the Role of the Family/Support System Perspective in Patients With Glaucoma.

PubMed

Shtein, Roni M; Newman-Casey, Paula A; Herndon, Leon; Coleman, Anne L; Lee, Paul P

2016-07-01

To investigate the role of the family/friends support system for patients with glaucoma and their perspective on barriers to effective glaucoma management. Six focus groups were conducted in 3 geographically and ethnically diverse areas of the United States (Los Angeles, CA; Rochester, MN; Durham, NC) that included 31 participants; 68% (21/31) were family members and friends of glaucoma patients with poor vision and 32% (10/31) were support system individuals of patients with good vision. Content analysis was used to identify important themes. Semiquantitative analysis was used to measure the frequency of each theme. A total of 134 relevant comments were made in the 6 focus groups and 72% of relevant comments were made by individuals providing support for patients with poor vision. Family members and friends mentioned the following areas of concern regarding patients' glaucoma care: patient education (19.4%), doctor-patient relationship (17.9%), their own lack of involvement in the patient's medical care (17.2%), frustration with glaucoma and with the patient (14.9%), patient dependency on caregivers (14.9%), patient frustration with the disease (10.4%), and sex differences in coping mechanisms (5.2%). Support system individuals tend to be minimally involved in the patient's glaucoma status and care. This is especially true for support system members of patients with glaucoma who maintain good vision and those who do not have any other personal experiences with difficulties from glaucoma. Many of these family members express an interest in acquiring more education about glaucoma and becoming more involved in the patient's glaucoma care.

Sociotechnical attributes of safe and unsafe work systems.

PubMed

Kleiner, Brian M; Hettinger, Lawrence J; DeJoy, David M; Huang, Yuang-Hsiang; Love, Peter E D

2015-01-01

Theoretical and practical approaches to safety based on sociotechnical systems principles place heavy emphasis on the intersections between social-organisational and technical-work process factors. Within this perspective, work system design emphasises factors such as the joint optimisation of social and technical processes, a focus on reliable human-system performance and safety metrics as design and analysis criteria, the maintenance of a realistic and consistent set of safety objectives and policies, and regular access to the expertise and input of workers. We discuss three current approaches to the analysis and design of complex sociotechnical systems: human-systems integration, macroergonomics and safety climate. Each approach emphasises key sociotechnical systems themes, and each prescribes a more holistic perspective on work systems than do traditional theories and methods. We contrast these perspectives with historical precedents such as system safety and traditional human factors and ergonomics, and describe potential future directions for their application in research and practice. The identification of factors that can reliably distinguish between safe and unsafe work systems is an important concern for ergonomists and other safety professionals. This paper presents a variety of sociotechnical systems perspectives on intersections between social--organisational and technology--work process factors as they impact work system analysis, design and operation.

Children's Perspective of Game: A Comparison of the Public and Private Schools

ERIC Educational Resources Information Center

Gündüz, Nevin; Taspinar, Tugçe; Demis, Nurdan

2017-01-01

The purpose of this research is to determine what the game means from the perspectives of children studying at public and private schools. Four questionnaires were applied to all the third grade parents of four schools; two public and two private schools in Ankara, and questionnaires were completed and sent back by 212 parents. A total of 32…

Incorporating a Socio-Ecological-Technological Systems (SETS) perspective into the adaptive management framework

EPA Science Inventory

Incorporating a social-ecological-technological systems (SETS) perspective to the adaptive management process requires that stakeholders and managers conceptualize restoration projects as part of coupled human and natural systems and assess underlying social drivers and accrued b...

A Way to Understand Inpatients Based on the Electronic Medical Records in the Big Data Environment

PubMed Central

2017-01-01

In recent decades, information technology in healthcare, such as Electronic Medical Record (EMR) system, is potential to improve service quality and cost efficiency of the hospital. The continuous use of EMR systems has generated a great amount of data. However, hospitals tend to use these data to report their operational efficiency rather than to understand their patients. Base on a dataset of inpatients' medical records from a Chinese general public hospital, this study applies a configuration analysis from a managerial perspective and explains inpatients management in a different way. Four inpatient configurations (valued patients, managed patients, normal patients, and potential patients) are identified by the measure of the length of stay and the total hospital cost. The implications of the finding are discussed. PMID:28280506

Elaborating on systems thinking in health promotion practice.

PubMed

Naaldenberg, Jenneken; Vaandrager, Lenneke; Koelen, Maria; Wagemakers, Anne-Marie; Saan, Hans; de Hoog, Kees

2009-03-01

Health and well-being are the result of a series of complex processes in which an individual interacts with other people and the environment. A systematic approach ensures incorporation of individual, ecological, social and political factors. However, interactions between these factors can be overlooked within a systematical approach. A systemic approach can provide additional information by incorporating interactions and communication. The opportunities of a systems thinking perspective for health promotion were investigated for this paper. Although others have also made attempts to explore systems thinking in the field of health promotion, the implications of systems thinking in practice need attention. Other fields such as agricultural extension studies, organizational studies and development studies provide useful experiences with the use of a systems thinking perspective in practice. Building on experiences from these fields, we give a theoretical background in which processes of social learning and innovation play an important role. From this background, we derive an overview of important concepts for the practical application of a systems thinking perspective. These concepts are the structure of the system, meanings attached to actions, and power relations between actors. To make these concepts more explicit and reduce the theoretical character of systems thinking, we use an illustration to elaborate on these concepts in practice. For this purpose, we describe a health promotion partnership in The Netherlands using the concepts structure, meaning and power relations. We show how a systems perspective increases insight in the functioning of a partnership and how this can facilitate processes of social learning and innovation. This article concludes by identifying future opportunities and challenges in adopting systems thinking for health promotion practice. A systems perspective towards health promotion can help projects reaching a more integral and sustainable approach in which the complex nature of health promotion processes is supported. Practical applications of systems thinking are necessary to adapt this perspective.

Classroom-Oriented Research from a Complex Systems Perspective

ERIC Educational Resources Information Center

Larsen-Freeman, Diane

2016-01-01

Bringing a complex systems perspective to bear on classroom-oriented research challenges researchers to think differently, seeing the classroom ecology as one dynamic system nested in a hierarchy of such systems at different levels of scale, all of which are spatially and temporally situated. This article begins with an introduction to complex…

Comparison between solar utilization of a closed microalgae-based bio-loop and that of a stand-alone photovoltaic system.

PubMed

Jin, Qiang; Chen, Lei; Li, Aimin; Liu, Fuqiang; Long, Chao; Shan, Aidang; Borthwick, Alistair G L

2015-05-01

This study compared the solar energy utilization of a closed microalgae-based bio-loop for energy efficient production of biogas with fertilizer recovery against that of a stand-alone photovoltaic (PV) system. The comparison was made from the perspective of broad life cycle assessment, simultaneously taking exergy to be the functional unit. The results indicated that the bio-loop was more environmentally competitive than an equivalent stand-alone PV system, but had higher economic cost due to high energy consumption during the operational phase. To fix the problem, a patented, interior pressurization scheduling method was used to operate the bio-loop, with microalgae and aerobic bacterial placed together in the same reactor. As a result, the overall environmental impact and total investment were respectively reduced by more than 75% and 84%, a vast improvement on the bio-loop. Copyright © 2014 Elsevier Ltd. All rights reserved.

Improving capacity to monitor and support sustainability of mental health peer-run organizations.

PubMed

Ostrow, Laysha; Leaf, Philip J

2014-02-01

Peer-run mental health organizations are managed and staffed by people with lived experience of the mental health system. These understudied organizations are increasingly recognized as an important component of the behavioral health care and social support systems. This Open Forum describes the National Survey of Peer-Run Organizations, which was conducted in 2012 to gather information about peer-run organizations and programs, organizational operations, policy perspectives, and service systems. A total of 895 entities were identified and contacted as potential peer-run organizations. Information was obtained for 715 (80%) entities, and 380 of the 715 responding entities met the criteria for a peer-run organization. Implementation of the Affordable Care Act may entail benefits and unintended consequences for peer-run organizations. It is essential that we understand this population of organizations and continue to monitor changes associated with policies intended to provide better access to care that promotes wellness and recovery.

Joint investigation of working conditions, environmental and system performance at recycling centres--development of instruments and their usage.

PubMed

Engkvist, I-L; Eklund, J; Krook, J; Björkman, M; Sundin, E; Svensson, R; Eklund, M

2010-05-01

Recycling is a new and developing industry, which has only been researched to a limited extent. This article describes the development and use of instruments for data collection within a multidisciplinary research programme "Recycling centres in Sweden - working conditions, environmental and system performance". The overall purpose of the programme was to form a basis for improving the function of recycling centres with respect to these three perspectives and the disciplines of: ergonomics, safety, external environment, and production systems. A total of 10 instruments were developed for collecting data from employees, managers and visitors at recycling centres, including one instrument for observing visitors. Validation tests were performed in several steps. This, along with the quality of the collected data, and experience from the data collection, showed that the instruments and methodology used were valid and suitable for their purpose. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

Social vs. Clinical Perspectives on the Use of Information: Implications for School-based Information Systems. Systemic Evaluation Project.

ERIC Educational Resources Information Center

Sirotnik, Kenneth A.; And Others

This paper presents a study of the contrast of social and clinical perspectives on the selection and use of information by school staff, including: (1) an outline of the context and activities of the study; (2) a definition and discussion of the basic distinction between social and clinical perspectives; (3) an examination of case material…

Managing Costs, Managing Benefits: Employer Decisions in Local Health Care Markets

PubMed Central

Christianson, Jon B; Trude, Sally

2003-01-01

Objectives To better understand employer health benefit decision making, how employer health benefits strategies evolve over time, and the impact of employer decisions on local health care systems. Data Sources/Study Setting. Data were collected as part of the Community Tracking Study (CTS), a longitudinal analysis of health system change in 12 randomly selected communities. Study Design This is an observational study with data collection over a six-year period. Data Collection/Extraction Methods The study used semistructured interviews with local respondents, combined with monitoring of local media, to track changes in health care systems over time and their impact on community residents. Interviewing began in 1996 and was carried out at two-year intervals, with a total of approximately 2,200 interviews. The interviews provided a variety of perspectives on employer decision making concerning health benefits; these perspectives were triangulated to reach conclusions. Principal Findings The tight labor market during the study period was the dominant consideration in employer decision making regarding health benefits. Employers, in managing employee compensation, made independent decisions in pursuit of individual goals, but these decisions were shaped by similar labor market conditions. As a result, within and across our study sites, employer decisions in aggregate had an important impact on local health care systems, although employers' more highly visible public efforts to bring about health system change often met with disappointing results. Conclusions General economic conditions in the 1990s had an important impact on the configuration of local health systems through their effect on employer decision making regarding health benefits offered to employees, and the responses of health plans and providers to those decisions. PMID:12650371

Scaled CMOS Reliability and Considerations for Spacecraft Systems: Bottom-Up and Top-Down Perspective

NASA Technical Reports Server (NTRS)

White, Mark

2012-01-01

New space missions will increasingly rely on more advanced technologies because of system requirements for higher performance, particularly in instruments and high-speed processing. Component-level reliability challenges with scaled CMOS in spacecraft systems from a bottom-up perspective have been presented. Fundamental Front-end and Back-end processing reliability issues with more aggressively scaled parts have been discussed. Effective thermal management from system-level to the componentlevel (top-down) is a key element in overall design of reliable systems. Thermal management in space systems must consider a wide range of issues, including thermal loading of many different components, and frequent temperature cycling of some systems. Both perspectives (top-down and bottom-up) play a large role in robust, reliable spacecraft system design.

Cost-effectiveness of quadrivalent influenza vaccine in Hong Kong - A decision analysis.

PubMed

You, Joyce H S; Ming, Wai-Kit; Chan, Paul K S

2015-01-01

Trivalent influenza vaccine (TIV) selects one of the 2 co-circulating influenza B lineages whereas quadrivalent influenza vaccine (QIV) includes both lineages. We examined potential cost-effectiveness of QIV versus TIV from perspectives of healthcare provider and society of Hong Kong. A decision tree was designed to simulate the outcomes of QIV vs. TIV in 6 age groups: 0-4 years, 5-9 years, 10-14 years, 15-64 years, 65-79 y and ≥80 years. Direct cost alone, direct and indirect costs, and quality-adjusted life-years (QALYs) loss due to TIV-unmatched influenza B infection were simulated for each study arm. Outcome measure was incremental cost per QALY (ICER). In base-case analysis, QIV was more effective than TIV in all-age population with additional direct cost per QALY (ICER-direct cost) and additional total cost per QALY (ICER-total cost) of USD 22,603 and USD 12,558, respectively. Age-stratified analysis showed that QIV was cost-effective in age groups 6 months to 9 y and ≥80 years from provider's perspective, and it was cost-effective in all age group except 15-64 y from societal perspective. Percentage of TIV-unmatched influenza B in circulation and additional vaccine cost of QIV were key influential factors. From perspectives of healthcare provider and society, QIV was the preferred option in 52.77% and 66.94% of 10,000 Monte Carlo simulations, respectively. QIV appears to be cost-effective in Hong Kong population, except for age group 15-64 years, from societal perspective. From healthcare provider's perspective, QIV seems to be cost-effective in very young (6 months-9 years) and older (≥80 years) age groups.

Perspectives of Turkish Intern and Non-Intern Students towards Sport Management Internship within the Context of Field Experience

ERIC Educational Resources Information Center

Coknaz, Dilsad

2014-01-01

The purpose of this study was to examine differences between intern and non-intern students in terms of their perspectives on sport management internship within the context of field experience. The subjects of the study were a total of 189 students. They were 4th year students who completed their internship and 3rd year students who were yet to…

Challenging Students' Perceptions of Sustainability Using an Earth Systems Science Approach

ERIC Educational Resources Information Center

Clark, Ian F.; Zeegers, Yvonne

2015-01-01

This study investigated whether an Earth Systems-based course focused on raising postgraduate students' awareness of sustainability, from a systems-thinking perspective, would produce graduates with commitment to drive the sustainability agenda forward with a broad perspective. It investigated students' pre and post-course perceptions of…

A Systemic Perspective of Communication and Sexism.

ERIC Educational Resources Information Center

Drecksel, Debra

Communication and sexism are analyzed from a systemic perspective, illustrating how sexism is perpetuated through sexist interaction and symbol systems. Sexism is shown to be a disease in our society, which creates a societal situation with double-binding sex-role symbols which limit our adaptability. A remedy for sexism is suggested which…

Educational Research and Theory Perspectives on Intelligent Computer-Assisted Instruction.

ERIC Educational Resources Information Center

Tennyson, Robert D.; Christensen, Dean L.

This paper defines the next generation of intelligent computer-assisted instructional systems (ICAI) by depicting the elaborations and extensions offered by educational research and theory perspectives to enhance the ICAI environment. The first section describes conventional ICAI systems, which use expert systems methods and have three modules: a…

Sociotechnical attributes of safe and unsafe work systems

PubMed Central

Kleiner, Brian M.; Hettinger, Lawrence J.; DeJoy, David M.; Huang, Yuang-Hsiang; Love, Peter E.D.

2015-01-01

Theoretical and practical approaches to safety based on sociotechnical systems principles place heavy emphasis on the intersections between social–organisational and technical–work process factors. Within this perspective, work system design emphasises factors such as the joint optimisation of social and technical processes, a focus on reliable human–system performance and safety metrics as design and analysis criteria, the maintenance of a realistic and consistent set of safety objectives and policies, and regular access to the expertise and input of workers. We discuss three current approaches to the analysis and design of complex sociotechnical systems: human–systems integration, macroergonomics and safety climate. Each approach emphasises key sociotechnical systems themes, and each prescribes a more holistic perspective on work systems than do traditional theories and methods. We contrast these perspectives with historical precedents such as system safety and traditional human factors and ergonomics, and describe potential future directions for their application in research and practice. Practitioner Summary: The identification of factors that can reliably distinguish between safe and unsafe work systems is an important concern for ergonomists and other safety professionals. This paper presents a variety of sociotechnical systems perspectives on intersections between social–organisational and technology–work process factors as they impact work system analysis, design and operation. PMID:25909756

Executive Support Systems: An Innovation Decision Perspective

DTIC Science & Technology

1990-01-01

of the requirements for the degree of Master of Science Department of Management Science and Information Systems 1990 0 4 28 071 This thesis for the...Master of Science degree by Vern Edwin Hasenstein has been approved for the Department of Management Science and -formation Systems by James C...Dist Speolal Hasenstein, Vern Edwin (M.S., Management Science and Information Systems) Executive Support Systems: An Innovation-decision Perspective

Enhancing Critical Thinking Via a Clinical Scholar Approach.

PubMed

Simpson, Vicki; McComb, Sara A; Kirkpatrick, Jane M

2017-11-01

Safety, quality improvement, and a systems perspective are vital for nurses to provide quality evidence-based care. Responding to the call to prepare nurses with these perspectives, one school of nursing used a clinical scholar approach, enhanced by systems engineering to more intentionally develop the ability to clinically reason and apply evidence-based practice. A two-group, repeated-measures control trial was used to determine the effects of systems engineering content and support on nursing students' clinical judgment and critical thinking skills. Findings indicated this approach had a positive effects on student's clinical judgment and clinical reasoning skills. This approach helped students view health care issues from a broader perspective and use evidence to guide solution development, enhancing the focus on evidence-based practice, and quality improvement. Intentional integration of an evidence-based, systems perspective by nursing faculty supports development of nurses who can function safely and effectively in the current health care system. [J Nurs Educ. 2017;56(11):679-682.]. Copyright 2017, SLACK Incorporated.

Experiential Learning and Literacy: Preservice Teachers' Perspectives

ERIC Educational Resources Information Center

Pittman, Ramona T.; Dorel, Theresa G.

2014-01-01

In this study, we sought to determine preservice teachers' perceptions about participating in an experiential learning literacy program. A total of 86 preservice teachers participated in two hours of training and then tutored elementary students for a total of eight hours. The preservice teachers engaged in 10 hours of experiential learning…

Insights into Tropical Tropospheric Ozone from Satellite and Sonde Data

NASA Technical Reports Server (NTRS)

Thompson, Anne M.

2003-01-01

The first climatological overview of total, stratospheric and tropospheric ozone in the southern hemisphere tropical and subtropics is based on ozone sounding data from 10 sites comprising the Southern Hemisphere Additional OZonesondes (SHADOZ) network. Observations were made over: Ascension Island; Nairobi, Kenya; Irene, South Africa; Reunion Island; Watukosek, Java; Fiji; Tahiti; American Samoa; San Cristobal, Galapagos; Natal, Brazil. The data reside at: http://code916.gsfc.nasa.gov/Data_services/shadoz. SHADOZ ozone time-series and profiles give a perspective on tropical total, stratospheric and tropospheric ozone. Prominent features are highly variable tropospheric ozone and a zonal wave-one pattern in total (and tropospheric) column ozone. Dynamical and chemical influences appear to be of comparable magnitude though model studies are needed to quantify this. In addition to leading the SHADOZ network, we have been producing near-real tropical tropospheric ozone ('TTO') data from the Total Ozone Mapping Spectrometer (TOMS) since 1997 with Prof. Hudson and students at the University of Maryland: http://metosrv2.umd.edu/tropo. Further perspective on the complexity of tropospheric ozone variability is shown using satellite observations.

Understanding patient requirements for technology systems that support pain management in palliative care services: A qualitative study.

PubMed

Allsop, Matthew J; Taylor, Sally; Bennett, Michael I; Bewick, Bridgette M

2017-11-01

Approaches to pain management using electronic systems are being developed for use in palliative care. This article explores palliative care patients' perspectives on managing and talking about pain, the role of technology in their lives and how technology could support pain management. Face-to-face interviews were used to understand patient needs and concerns to inform how electronic systems are developed. A total of 13 interviews took place with a convenience sample of community-based patients with advanced cancer receiving palliative care through a hospice. Data were analysed using framework analysis. Four meta-themes emerged: Technology could be part of my care; I'm trying to understand what is going on; My pain is ever-changing and difficult to control; and I'm selective about who to tell about pain. Patients described technology as peripheral to existing processes of care. To be relevant, systems may need to take account of the complexity of a patient's pain experience alongside existing relationships with health professionals.

["Vocational perspective" - concept and acceptance of a group treatment for patients with extensive work-related problems].

PubMed

Dorn, M; Bönisch, A; Ehlebracht-König, I

2011-02-01

The treatment programme "Vocational Perspective" was developed for patients with health-related social problems, e. g. long-term sick leave, job loss due to disability, job insecurity and psychosocial disabilities. It intends the patient-oriented imparting of information referring to social system, legal rights, earning capacity and occupational reintegration as well as an early feedback of the sociomedical assessment by the physicians. Participants during in-patient rehabilitation are supported to deal with their occupational situation; motivation to stay employed is strengthened. The group programme contains five psychoeducative modules and an additional sociomedical "ward round". The aim of the study was to examine the acceptance of the newly developed sociomedical vocational therapy module. A total of 179 patients participated in 21 "vocational perspective" seminars within the scope of a controlled quasi-experimental trial. In the experimental group the data on acceptance of the treatment was assessed by questionnaire at the end of the intervention. Experiences with implementation of the programme are described in order to complete the patient-related perspective. The identification of a demand for work-related interventions in medical rehabilitation seemed successful: Sociodemographic and socioeconomical parameters of the sample proved high risk in view of the social-medical perspective (poor education, high unemployment rates and long-term sick leave). Self-estimations revealed high suffering of the participants, e. g. due to the occupational situation, anxiety and depression, and confirmed high interest in work-related issues. The patients showed quite high acceptance of the programme (regarding importance of seminar, comprehensibility, usefulness of information, atmosphere of the group, mode and extent of the programme). 82.7% of the participants would recommend the programme to other people with work-related problems. Altogether, the experiences during the implementation of the programme can be described as positive. Nevertheless, organizing took much effort and the treatment was very demanding for the therapists. Finally, it is also necessary that the physicians agree to realize high transparency in the process of sociomedical assessment. The sociomedical programme "Vocational Perspective" helps patients to deal with relevant information referring to social system and occupational reintegration. Problematical sociomedical issues can be handled in a therapeutic way during rehabilitation process. Therefore, the programme can be used as meaningful supplement in regular medical rehabilitation. For final conclusions, the results of short-term and follow-up evaluations described elsewhere have to be considered. © Georg Thieme Verlag KG Stuttgart · New York.

Analysis of Students' Conceptions of Basic Magnetism from a Complex Systems Perspective

NASA Astrophysics Data System (ADS)

Lemmer, Miriam; Kriek, Jeanne; Erasmus, Benita

2018-03-01

This study established whether 12 South African secondary school physics students had incorrect conceptions of basic magnetism and if they had, to what extent they consistently applied such conceptions. Different scenarios in the form of thought experiments were presented in a clinical interview approach. A complex systems perspective underpinned the study and was firstly used to analyze 12 students' conceptions in terms of intuitive fragments of knowledge elements, structured misconceptions, and theory-like system of knowledge elements. Secondly, coherence in each student's ideas expressed across ten themes using thought experiments was analyzed in an effort to determine variations or coherence in responses. Examples of student explanations and sketches are discussed in the paper to illustrate the conceptual structures they applied. Most of the students in this study used a variety of knowledge elements in accord with a complex systems perspective, but three students seemed to prefer a specific perspective. One student's ideas tended to be mainly fragmented, a second exposed a number of structured misconceptions, while another student's reasoning can be described as a theory-like system of knowledge elements. Accordingly, the emphasis of physics education research should no longer be on the compilation of a list of misconceptions that have to be remedied or replaced, but on the conceptual connections, students make and their associative reasoning patterns (i.e., knowledge systems revealed). It remains for the teacher to use the complex systems perspective as a framework to facilitate students' conceptual development and understanding, proceeding on their existing knowledge systems.

Cost-analysis of XELOX and FOLFOX4 for treatment of colorectal cancer to assist decision-making on reimbursement.

PubMed

Tse, Vicki C; Ng, Wai Tong; Lee, Victor; Lee, Anne W M; Chua, Daniel T T; Chau, June; McGhee, Sarah M

2011-07-09

XELOX (capecitabine + oxaliplatin) and FOLFOX 4 (5-FU + folinic acid + oxaliplatin) have shown similar improvements in survival in patients with metastatic colorectal cancer (MCRC). A US cost-minimization study found that the two regimens had similar costs from a healthcare provider perspective but XELOX had lower costs than FOLFOX4 from a societal perspective, while a Japanese cost-effectiveness study found XELOX had superior cost-effectiveness. This study compared the costs of XELOX and FOLFOX4 in patients with MCRC recently treated in two oncology departments in Hong Kong. Cost data were collected from the medical records of 60 consecutive patients (30 received XELOX and 30 FOLFOX4) from two hospitals. Drug costs, outpatient visits, hospital days and investigations were recorded and expressed as cost per patient from the healthcare provider perspective. Estimated travel and time costs were included in a societal perspective analysis. All costs were classed as either scheduled (associated with planned chemotherapy and follow-up) or unscheduled (unplanned visits or admissions and associated tests and medicines). Costs were based on government and hospital sources and expressed in US dollars (US$). XELOX patients received an average of 7.3 chemotherapy cycles (of the 8 planned cycles) and FOLFOX4 patients received 9.2 cycles (of the 12 planned cycles). The scheduled cost per patient per cycle was $2,046 for XELOX and $2,152 for FOLFOX4, while the unscheduled cost was $240 and $421, respectively. Total treatment cost per patient was $16,609 for XELOX and $23,672 for FOLFOX4; the total cost for FOLFOX4 was 37% greater than that of XELOX. The addition of the societal costs increased the total treatment cost per patient to $17,836 for XELOX and $27,455 for FOLFOX4. Sensitivity analyses showed XELOX was still less costly than FOLFOX4 when using full drug regimen costs, incorporating data from a US model with costs and adverse event data from their clinical trial and with the removal of oxaliplatin from both treatment arms. Capecitabine would have to cost around four times its present price in Hong Kong for the total resource cost of treatment with XELOX to equal that of FOLFOX4. XELOX costs less than FOLFOX4 for this patient group with MCRC from both the healthcare provider and societal perspectives.

Cost-analysis of XELOX and FOLFOX4 for treatment of colorectal cancer to assist decision-making on reimbursement

PubMed Central

2011-01-01

Background XELOX (capecitabine + oxaliplatin) and FOLFOX 4 (5-FU + folinic acid + oxaliplatin) have shown similar improvements in survival in patients with metastatic colorectal cancer (MCRC). A US cost-minimization study found that the two regimens had similar costs from a healthcare provider perspective but XELOX had lower costs than FOLFOX4 from a societal perspective, while a Japanese cost-effectiveness study found XELOX had superior cost-effectiveness. This study compared the costs of XELOX and FOLFOX4 in patients with MCRC recently treated in two oncology departments in Hong Kong. Methods Cost data were collected from the medical records of 60 consecutive patients (30 received XELOX and 30 FOLFOX4) from two hospitals. Drug costs, outpatient visits, hospital days and investigations were recorded and expressed as cost per patient from the healthcare provider perspective. Estimated travel and time costs were included in a societal perspective analysis. All costs were classed as either scheduled (associated with planned chemotherapy and follow-up) or unscheduled (unplanned visits or admissions and associated tests and medicines). Costs were based on government and hospital sources and expressed in US dollars (US$). Results XELOX patients received an average of 7.3 chemotherapy cycles (of the 8 planned cycles) and FOLFOX4 patients received 9.2 cycles (of the 12 planned cycles). The scheduled cost per patient per cycle was $2,046 for XELOX and $2,152 for FOLFOX4, while the unscheduled cost was $240 and $421, respectively. Total treatment cost per patient was $16,609 for XELOX and $23,672 for FOLFOX4; the total cost for FOLFOX4 was 37% greater than that of XELOX. The addition of the societal costs increased the total treatment cost per patient to $17,836 for XELOX and $27,455 for FOLFOX4. Sensitivity analyses showed XELOX was still less costly than FOLFOX4 when using full drug regimen costs, incorporating data from a US model with costs and adverse event data from their clinical trial and with the removal of oxaliplatin from both treatment arms. Capecitabine would have to cost around four times its present price in Hong Kong for the total resource cost of treatment with XELOX to equal that of FOLFOX4. Conclusion XELOX costs less than FOLFOX4 for this patient group with MCRC from both the healthcare provider and societal perspectives. PMID:21740590

Alternative Theoretical Bases for the Study of Human Communication: The Systems Perspective.

ERIC Educational Resources Information Center

Monge, Peter R.

Three potentially useful perspectives for the scientific development of human communication theory are the law model, the systems approach, and the rules paradigm. It is the purpose of this paper to indicate the utility of the systems approach. The first section of this paper provides a brief account of the systems view of the world. Outlined in…

Economic burden of multimorbidity among older adults: impact on healthcare and societal costs.

PubMed

Picco, Louisa; Achilla, Evanthia; Abdin, Edimansyah; Chong, Siow Ann; Vaingankar, Janhavi Ajit; McCrone, Paul; Chua, Hong Choon; Heng, Derrick; Magadi, Harish; Ng, Li Ling; Prince, Martin; Subramaniam, Mythily

2016-05-10

Multimorbidity is not uncommon and the associated impact it places on healthcare utilisation and societal costs is of increased concern. The aim of the current study was to estimate the economic burden of multimorbidity among older adults in Singapore by investigating its association with the healthcare and societal resource use and cost. The Well-being of the Singapore Elderly (WiSE) study was a single phase, cross sectional survey among a nationally representative sample of Singapore residents (N = 2565) aged 60 years and above. Multimorbidity was defined in this study as having two or more chronic conditions, from a list of 10 conditions. Care was classified into healthcare which included direct medical care, intermediate and long-term care, indirect care, and social care, provided by paid caregivers and family members or friends. Costs were calculated from the societal perspective, including healthcare and social care costs, by multiplying each service unit with the relevant unit cost. Generalized linear models were used to investigate the relationship between total annual costs and various socio-demographic factors. The prevalence of multimorbidity was 51.5 %. Multimorbid respondents utilised more healthcare and social care resources than those with one or no chronic conditions. The total societal cost of multimorbidity equated to SGD$15,148 per person, annually, while for those with one or no chronic conditions the total annual societal costs per person were SGD$5,610 and SGD$2,806, respectively. Each additional chronic condition was associated with increased healthcare (SGD$2,265) and social care costs (SGD$3,177). Older age (i.e. 75-84 years old, and especially over 85 years), Indian ethnicity and being retired were significantly associated with higher total costs from the societal perspective, while older age (75 years and above) and 'Other' ethnicity were significantly associated with higher total healthcare costs. Multimorbidity was associated with substantially higher healthcare utilisation and social care costs among older adults in Singapore. With the prevalence of multimorbidity increasing, especially as the population ages, we need healthcare systems that are evolving to address the emerging challenges associated with multimorbidity and the respective healthcare and societal costs.

Assessment of Novel Routes of Biomethane Utilization in a Life Cycle Perspective

PubMed Central

Moghaddam, Elham Ahmadi; Ahlgren, Serina; Nordberg, Åke

2016-01-01

Biomethane, as a replacement for natural gas, reduces the use of fossil-based sources and supports the intended change from fossil to bio-based industry. The study assessed different biomethane utilization routes for production of methanol, dimethyl ether (DME), and ammonia, as fuel or platform chemicals and combined heat and power (CHP). Energy efficiency and environmental impacts of the different pathways was studied in a life cycle perspective covering the technical system from biomass production to the end product. Among the routes studied, CHP had the highest energy balance and least environmental impact. DME and methanol performed competently in energy balance and environmental impacts in comparison with the ammonia route. DME had the highest total energy output, as fuel, heat, and steam, among the different routes studied. Substituting the bio-based routes for fossil-based alternatives would give a considerable reduction in environmental impacts such as global warming potential and acidification potential for all routes studied, especially CHP, DME, and methanol. Eutrophication potential was mainly a result of biomass and biomethane production, with marginal differences between the different routes. PMID:28066762

A feminist critique of research on cancer pain.

PubMed

Im, E O; Chee, W

2001-11-01

A number of studies on cancer pain have been conducted but the researchers rarely considered gender and ethnic differences in cancer pain. In this article, nursing research on cancer pain is critiqued from a feminist perspective, and directions for future nursing research are proposed. A total of 82 nursing articles published in the United States were retrieved through MEDLINE and MELVYL data retrieval systems, and analyzed and critiqued in terms of four basic elements of research from a feminist perspective (bias as resources, dependability, credibility and adequacy, and intersubjectivity). In this article, the critique is presented with four themes that may provide reasons why nursing research on cancer pain rarely incorporated gender and ethnic differences: absence of participants' own views and experiences, androcentrism and ethnocentrism, lack of consideration on contextual factors, and distant relationships between researchers and research participants. To overcome the limitations, six critical elements including gender and ethnic sensitivity, avoidance of distorted views, respectfor participants' own views and interests, trust and openness, empowerment, and multiple methods are suggested to be incorporated in future nursing research on cancer pain.

CO{sub 2} mitigation potential of efficient demand-side technologies: The case of Thailand

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

Shrestha, R.M.; Biswas, W.K.; Timilsina, G.R.

This study assesses the techno-economic potential of selected demand-side efficient appliances to mitigate CO{sub 2} emission from the power sector in Thailand under national, consumer, and utility perspectives. A key finding of this study is that about 5.5--7% of the total annual CO{sub 2} emission from the electricity sector of the country can be reduced during 1996--2011 from the national perspective.

Evaluation of the 10th Grade Computerized Mathematics Curriculum from the Perspective of the Teachers and Educational Supervisors in the Southern Region in Jordan

ERIC Educational Resources Information Center

Al-Tarawneh, Sabri Hassan; Al-Qadi, Haitham Mamdouh

2016-01-01

This study aimed at evaluating the 10th grade computerized mathematics curriculum from the perspective of the teachers and supervisors in the southern region in Jordan. The study population consisted of all the teachers who teach the 10th grade in the southern region, with the total of (309) teachers and (20) supervisors. The sample consisted of…

Physiological Characterization of the SynCardia Total Artificial Heart in a Mock Circulation System

PubMed Central

Crosby, Jessica R.; DeCook, Katrina J.; Tran, Phat L.; Smith, Richard G.; Larson, Douglas F.; Khalpey, Zain I.; Burkhoff, Daniel; Slepian, Marvin J.

2014-01-01

The SynCardia total artificial heart (TAH) has emerged as an effective, life-saving bi-ventricular replacement system for a wide variety of patients with end-stage heart failure. While the clinical performance of the TAH is established, modern physiologic characterization, in terms of elastance behavior and pressure-volume characterization has not been defined. Herein we examine the TAH in terms of elastance using a non-ejecting left-ventricle, and then characterize the pressure-volume relationship of the TAH by varying preload and afterload parameters using a Donovan Mock Circulatory System. We demonstrate that the TAH does not operate with time-varying elastance, differing from the human heart. Further, we show that the TAH has a pressure-volume relationship behavior that also differs from that of the human heart. The TAH does exhibit Starling-like behavior, with output increasing via preload dependent mechanisms, without reliance on an alteration of inotropic state within the operating window of the TAH. Within our testing range, the TAH is insensitive to variations in afterload, however this insensitivity has a limit, the limit being the maximum driving pressure of the pneumatic driver. Understanding the physiology of the TAH affords insight into the functional parameters that govern artificial heart behavior providing perspective on differences compared to the human heart. PMID:25551416

Physiological characterization of the SynCardia total artificial heart in a mock circulation system.

PubMed

Crosby, Jessica R; DeCook, Katrina J; Tran, Phat L; Smith, Richard G; Larson, Douglas F; Khalpey, Zain I; Burkhoff, Daniel; Slepian, Marvin J

2015-01-01

The SynCardia total artificial heart (TAH) has emerged as an effective, life-saving biventricular replacement system for a wide variety of patients with end-stage heart failure. Although the clinical performance of the TAH is established, modern physiological characterization, in terms of elastance behavior and pressure-volume (PV) characterization has not been defined. Herein, we examine the TAH in terms of elastance using a nonejecting left ventricle, and then characterize the PV relation of the TAH by varying preload and afterload parameters using a Donovan Mock Circulatory System. We demonstrate that the TAH does not operate with time-varying elastance, differing from the human heart. Furthermore, we show that the TAH has a PV relation behavior that also differs from that of the human heart. The TAH does exhibit Starling-like behavior, with output increasing via preload-dependent mechanisms, without reliance on an alteration of inotropic state within the operating window of the TAH. Within our testing range, the TAH is insensitive to variations in afterload; however, this insensitivity has a limit, the limit being the maximum driving pressure of the pneumatic driver. Understanding the physiology of the TAH affords insight into the functional parameters that govern artificial heart behavior providing perspective on differences compared with the human heart.

Can Additional Homeopathic Treatment Save Costs? A Retrospective Cost-Analysis Based on 44500 Insured Persons

PubMed Central

Ostermann, Julia K.; Reinhold, Thomas; Witt, Claudia M.

2015-01-01

Objectives The aim of this study was to compare the health care costs for patients using additional homeopathic treatment (homeopathy group) with the costs for those receiving usual care (control group). Methods Cost data provided by a large German statutory health insurance company were retrospectively analysed from the societal perspective (primary outcome) and from the statutory health insurance perspective. Patients in both groups were matched using a propensity score matching procedure based on socio-demographic variables as well as costs, number of hospital stays and sick leave days in the previous 12 months. Total cumulative costs over 18 months were compared between the groups with an analysis of covariance (adjusted for baseline costs) across diagnoses and for six specific diagnoses (depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache). Results Data from 44,550 patients (67.3% females) were available for analysis. From the societal perspective, total costs after 18 months were higher in the homeopathy group (adj. mean: EUR 7,207.72 [95% CI 7,001.14–7,414.29]) than in the control group (EUR 5,857.56 [5,650.98–6,064.13]; p<0.0001) with the largest differences between groups for productivity loss (homeopathy EUR 3,698.00 [3,586.48–3,809.53] vs. control EUR 3,092.84 [2,981.31–3,204.37]) and outpatient care costs (homeopathy EUR 1,088.25 [1,073.90–1,102.59] vs. control EUR 867.87 [853.52–882.21]). Group differences decreased over time. For all diagnoses, costs were higher in the homeopathy group than in the control group, although this difference was not always statistically significant. Conclusion Compared with usual care, additional homeopathic treatment was associated with significantly higher costs. These analyses did not confirm previously observed cost savings resulting from the use of homeopathy in the health care system. PMID:26230412

Gadolinium-Induced Fibrosis.

PubMed

Todd, Derrick J; Kay, Jonathan

2016-01-01

Gadolinium-based contrast agents (GBCAs), once believed to be safe for patients with renal disease, have been strongly associated with nephrogenic systemic fibrosis (NSF), a severe systemic fibrosing disorder that predominantly afflicts individuals with advanced renal dysfunction. We provide a historical perspective on the appearance and disappearance of NSF, including its initial recognition as a discrete clinical entity, its association with GBCA exposure, and the data supporting a causative relationship between GBCA exposure and NSF. On the basis of this body of evidence, we propose that the name gadolinium-induced fibrosis (GIF) more accurately reflects the totality of knowledge regarding this disease. Use of high-risk GBCAs, such as formulated gadodiamide, should be avoided in patients with renal disease. Restriction of GBCA use in this population has almost completely eradicated new cases of this debilitating condition. Emerging antifibrotic therapies may be useful for patients who suffer from GIF.

Perspectives on Networking.

ERIC Educational Resources Information Center

Levy, Sue

1992-01-01

Presents a library automation vendor's perspective on networking based on activities at Ameritech Information Systems. Topics discussed include the information explosion; information technology; user expectations and needs; remote access; the library of the future; systems integration; ownership versus access; copyright laws; and the role of the…

HOPIS: hybrid omnidirectional and perspective imaging system for mobile robots.

PubMed

Lin, Huei-Yung; Wang, Min-Liang

2014-09-04

In this paper, we present a framework for the hybrid omnidirectional and perspective robot vision system. Based on the hybrid imaging geometry, a generalized stereo approach is developed via the construction of virtual cameras. It is then used to rectify the hybrid image pair using the perspective projection model. The proposed method not only simplifies the computation of epipolar geometry for the hybrid imaging system, but also facilitates the stereo matching between the heterogeneous image formation. Experimental results for both the synthetic data and real scene images have demonstrated the feasibility of our approach.

HOPIS: Hybrid Omnidirectional and Perspective Imaging System for Mobile Robots

PubMed Central

Lin, Huei-Yung.; Wang, Min-Liang.

2014-01-01

In this paper, we present a framework for the hybrid omnidirectional and perspective robot vision system. Based on the hybrid imaging geometry, a generalized stereo approach is developed via the construction of virtual cameras. It is then used to rectify the hybrid image pair using the perspective projection model. The proposed method not only simplifies the computation of epipolar geometry for the hybrid imaging system, but also facilitates the stereo matching between the heterogeneous image formation. Experimental results for both the synthetic data and real scene images have demonstrated the feasibility of our approach. PMID:25192317

The Many Dimensions of Program Management

NASA Technical Reports Server (NTRS)

Dean, Edwin B.

1992-01-01

For the purposes of this paper, program refers to a collection of activities or projects which must be performed according to a plan or schedule. The Space Exploration Initiative within the National Aeronautics and Space Administration (NASA) is an example. Dimensionality refers to both the various perspectives of a program and to the components within that perspective. It is, thus, appropriate to think of dimensions of dimensionality. For example, one dimension or perspective of a program is the projects which perform the program. Within the project dimension, the individual projects are the components of that dimensionality. The number of projects defines the spatial dimensionality of the project dimension. Thus, each perspective or dimension has a dimensionality of its own. The structure and associated values of all the various perspectives of a program define the program. A project refers to the collection of activities required to conceive, sell, design, develop, evaluate, produce, operate, support, evolve, and retire a given system. A project thus effects the life cycle of given system. A project is, thus, the system to conceive, sell, design, develop, evaluate, produce, operate, support, evolve, and retire a system. A program, thus, effects the life cycle of the collection of projects required to effect the collection of systems required to implement the program.

Functional outcomes after shoulder resection: the patient's perspective.

PubMed

Stevens, Nicole M; Kim, H Mike; Armstrong, April D

2015-09-01

Resection arthroplasty is a salvage procedure used for the treatment of deep-seated infections after total shoulder arthroplasty, hemiarthroplasty, and reverse total shoulder arthroplasty. Previous studies have reported a 50% to 66% rate of pain relief after resection arthroplasty but with significant functional limitations. Our study aimed to qualify the perspective of the patients on their limitations and satisfaction with resection arthroplasty. A retrospective record review of resection arthroplasties performed between September 2003 and December 2012 yielded 14 patients, and 7 completed the survey. The patients completed surveys with the focus on the "patient perspective." Functional scores, including American Shoulder and Elbow Surgeons, Simple Shoulder Test, Disabilities of the Arm, Shoulder, and Hand (DASH), DASH work, and DASH sports, were determined. Pain reduction and functional outcomes were similar to past reports of resection arthroplasty. Five of the 7 patients (71%) reported satisfaction with their resection arthroplasty, and 6 of the 7 patients (86%) would undergo the procedure again if given the choice. Five of the 7 patients (71%) were able to most of activities of daily living. Patients in our study were generally satisfied with their resection arthroplasty. Resection arthroplasty is a reasonable option for treatment of deep-seated periprosthetic infections or for patients with multiple previous failed procedures for total shoulder arthroplasty, hemiarthroplasty. and reverse shoulder arthroplasty. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Cost Utility Analysis of the Cervical Artificial Disc vs Fusion for the Treatment of 2-Level Symptomatic Degenerative Disc Disease: 5-Year Follow-up.

PubMed

Ament, Jared D; Yang, Zhuo; Nunley, Pierce; Stone, Marcus B; Lee, Darrin; Kim, Kee D

2016-07-01

The cervical total disc replacement (cTDR) was developed to treat cervical degenerative disc disease while preserving motion. Cost-effectiveness of this intervention was established by looking at 2-year follow-up, and this update reevaluates our analysis over 5 years. Data were derived from a randomized trial of 330 patients. Data from the 12-Item Short Form Health Survey were transformed into utilities by using the SF-6D algorithm. Costs were calculated by extracting diagnosis-related group codes and then applying 2014 Medicare reimbursement rates. A Markov model evaluated quality-adjusted life years (QALYs) for both treatment groups. Univariate and multivariate sensitivity analyses were conducted to test the stability of the model. The model adopted both societal and health system perspectives and applied a 3% annual discount rate. The cTDR costs $1687 more than anterior cervical discectomy and fusion (ACDF) over 5 years. In contrast, cTDR had $34 377 less productivity loss compared with ACDF. There was a significant difference in the return-to-work rate (81.6% compared with 65.4% for cTDR and ACDF, respectively; P = .029). From a societal perspective, the incremental cost-effective ratio (ICER) for cTDR was -$165 103 per QALY. From a health system perspective, the ICER for cTDR was $8518 per QALY. In the sensitivity analysis, the ICER for cTDR remained below the US willingness-to-pay threshold of $50 000 per QALY in all scenarios (-$225 816 per QALY to $22 071 per QALY). This study is the first to report the comparative cost-effectiveness of cTDR vs ACDF for 2-level degenerative disc disease at 5 years. The authors conclude that, because of the negative ICER, cTDR is the dominant modality. ACDF, anterior cervical discectomy and fusionAWP, average wholesale priceCE, cost-effectivenessCEA, cost-effectiveness analysisCPT, Current Procedural TerminologycTDR, cervical total disc replacementCUA, cost-utility analysisDDD, degenerative disc diseaseDRG, diagnosis-related groupFDA, US Food and Drug AdministrationICER, incremental cost-effectiveness ratioIDE, Investigational Device ExemptionNDI, neck disability indexQALY, quality-adjusted life yearsRCT, randomized controlled trialRTW, return-to-workSF-12, 12-Item Short Form Health SurveyVAS, visual analog scaleWTP, willingness-to-pay.

Systems Science and Childhood Obesity: A Systematic Review and New Directions

PubMed Central

Foster, E. Michael

2013-01-01

As a public health problem, childhood obesity operates at multiple levels, ranging from individual health behaviors to school and community characteristics to public policies. Examining obesity, particularly childhood obesity, from any single perspective is likely to fail, and systems science methods offer a possible solution. We systematically reviewed studies that examined the causes and/or consequences of obesity from a systems science perspective. The 21 included studies addressed four general areas of systems science in obesity: (1) translating interventions to a large scale, (2) the effect of obesity on other health or economic outcomes, (3) the effect of geography on obesity, and (4) the effect of social networks on obesity. In general, little research addresses obesity from a true, integrated systems science perspective, and the available research infrequently focuses on children. This shortcoming limits the ability of that research to inform public policy. However, we believe that the largely incremental approaches used in current systems science lay a foundation for future work and present a model demonstrating the system of childhood obesity. Systems science perspective and related methods are particularly promising in understanding the link between childhood obesity and adult outcomes. Systems models emphasize the evolution of agents and their interactions; such evolution is particularly salient in the context of a developing child. PMID:23710344

Forest nurseries in Venezuela: Current efforts and future perspectives

Treesearch

J. A. Wright

2002-01-01

Current production of forest seedlings in Venezuela totals more than 100 million plants per year. There are four large nurseries that account for more than 75% of the total production with several hundred small nurseries that account for the remainder. Major species used are pines, eucalyptus, mahogany, and numerous other native tree species. Limitations in forest...

Interannual Variation in Phytoplankton Class-specific Primary Production at a Global Scale

NASA Technical Reports Server (NTRS)

Rousseaux, Cecile; Gregg, Watson

2014-01-01

Phytoplankton is responsible for over half of the net primary production on earth. The knowledge on the contribution of various phytoplankton groups to the total primary production is still poorly understood. Data from satellite observations suggest that for upwelling regions, photosynthetic rates by microplankton is higher than that of nanoplankton but that when the spatial extent is considered, the production by nanoplankton is comparable or even larger than microplankton. Here, we used the NASA Ocean Biogeochemical Model (NOBM) combined with remote sensing data via assimilation to evaluate the contribution of 4 phytoplankton groups to the total primary production. Globally, diatoms were the group that contributed the most to the total phytoplankton production (approx. 50%) followed by coccolithophores and chlorophytes. Primary production by diatoms was highest in high latitude (>45 deg) and in major upwelling systems (Equatorial Pacific and Benguela system). We assessed the effects of climate variability on the class-specific primary production using global (i.e. Multivariate El Nino Index, MEI) and 'regional' climate indices (e.g. Southern Annular Mode (SAM), Pacific Decadal Oscillation (PDO) and North Atlantic Oscillation (NAO)). Most interannual variability occurred in the Equatorial Pacific and was associated with climate variability. These results provide a modeling and data assimilation perspective to phytoplankton partitioning of primary production and contribute to our understanding of the dynamics of the carbon cycle in the oceans at a global scale.

Analysis of time domain reflectometry data from LTPP seasonal monitoring program test sections

DOT National Transportation Integrated Search

1996-07-01

This report documents an approach for designing an Advanced Traffic Management System (ATMS) from a human factors perspective. In designing the ATMS from a human factors perspective, a user-centered top-down system analysis was conducted. Methodologi...

Analysing Finnish Steering System from the Perspective of Social Space: The Case of the "Campus University"

ERIC Educational Resources Information Center

Treuthardt, Leena; Valimaa, Jussi

2008-01-01

The present study analyses Finnish higher education steering system, management by results, from the perspective of higher education institutions. We ask what happens inside a higher education institution, called here the "Campus University", during the actual negotiations related to the national steering system. We analyse not only the…

Integrating Recovery and the Narrative Attachment Systems Perspective to Working through Borderline Personality Disorder

ERIC Educational Resources Information Center

Bernardon, Stephanie; Pernice-Duca, Francesca

2012-01-01

Borderline personality disorder (BPD) presents a number of symptoms and adjustment issues for individuals, but it is also associated with a myriad of risks for the larger family system. A systemic perspective is crucial to comprehending the development of BPD. Promoting healthy relationships with one or more supportive adult enables the child to…

The role of consumer perspectives in estimating population need for substance use services: a scoping review.

PubMed

Hyshka, Elaine; Karekezi, Kamagaju; Tan, Benjamin; Slater, Linda G; Jahrig, Jesse; Wild, T Cameron

2017-03-20

A growing body of research assesses population need for substance use services. However, the extent to which survey research incorporates expert versus consumer perspectives on service need is unknown. We conducted a large, international review to (1) describe extant research on population need for substance use services, and the extent to which it incorporates expert and consumer perspectives on service need, (2) critically assess methodological and measurement approaches used to study consumer-defined need, and (3) examine the potential for existing research that prioritizes consumer perspectives to inform substance use service system planning. Systematic searches of seven databases identified 1930 peer-reviewed articles addressing population need for substance use services between January 1980 and May 2015. Empirical studies (n = 1887) were categorized according to source(s) of data used to derive population estimates of service need (administrative records, biological samples, qualitative data, and/or quantitative surveys). Quantitative survey studies (n = 1594) were categorized as to whether service need was assessed from an expert and/or consumer perspective; studies employing consumer-defined need measures (n = 217) received further in-depth quantitative coding to describe study designs and measurement strategies. Almost all survey studies (96%; n = 1534) used diagnostically-oriented measures derived from an expert perspective to assess service need. Of the small number (14%, n = 217) of survey studies that assessed consumer's perspectives, most (77%) measured perceived need for generic services (i.e. 'treatment'), with fewer (42%) examining self-assessed barriers to service use, or informal help-seeking from family and friends (10%). Unstandardized measures were commonly used, and very little research was longitudinal or tested hypotheses. Only one study used a consumer-defined need measure to estimate required service system capacity. Rhetorical calls for including consumer perspectives in substance use service system planning are belied by the empirical literature, which is dominated by expert-driven approaches to measuring population need. Studies addressing consumer-defined need for substance use services are conceptually underdeveloped, and exhibit methodological and measurement weaknesses. Further scholarship is needed to integrate multidisciplinary perspectives in this literature, and fully realize the promise of incorporating consumer perspectives into substance use service system planning.

Migration to Earth Observation Satellite Product Dissemination System at JAXA

NASA Astrophysics Data System (ADS)

Ikehata, Y.; Matsunaga, M.

2017-12-01

JAXA released "G-Portal" as a portal web site for search and deliver data of Earth observation satellites in February 2013. G-Portal handles ten satellites data; GPM, TRMM, Aqua, ADEOS-II, ALOS (search only), ALOS-2 (search only), MOS-1, MOS-1b, ERS-1 and JERS-1 and archives 5.17 million products and 14 million catalogues in total. Users can search those products/catalogues in GUI web search and catalogue interface(CSW/Opensearch). In this fiscal year, we will replace this to "Next G-Portal" and has been doing integration, test and migrations. New G-Portal will treat data of satellites planned to be launched in the future in addition to those handled by G - Portal. At system architecture perspective, G-Portal adopted "cluster system" for its redundancy, so we must replace the servers into those with higher specifications when we improve its performance ("scale up approach"). This requests a lot of cost in every improvement. To avoid this, Next G-Portal adopts "scale out" system: load balancing interfaces, distributed file system, distributed data bases. (We reported in AGU fall meeting 2015(IN23D-1748).) At customer usability perspective, G-Portal provides complicated interface: "step by step" web design, randomly generated URLs, sftp (needs anomaly tcp port). Customers complained about the interfaces and the support team had been tired from answering them. To solve this problem, Next G-Portal adopts simple interfaces: "1 page" web design, RESTful URL, and Normal FTP. (We reported in AGU fall meeting 2016(IN23B-1778).) Furthermore, Next G-Portal must merge GCOM-W data dissemination system to be terminated in the next March as well as the current G-Portal. This might arrise some difficulties, since the current G-Portal and GCOM-W data dissemination systems are quite different from Next G-Portal. The presentation reports the knowledge obtained from the process of merging those systems.

Evidence of motor-control difficulties in children with attention deficit hyperactivity disorder, explored through a hierarchical motor-systems perspective.

PubMed

Macoun, Sarah J; Kerns, Kimberly A

2016-01-01

Attention deficit hyperactivity disorder (ADHD) may reflect a disorder of neural systems that regulate motor control. The current study investigates motor dysfunction in children with ADHD using a hierarchical motor-systems perspective where frontal-striatal/"medial" brain systems are viewed as regulating parietal/"lateral" brain systems in a top down manner, to inhibit automatic environmentally driven responses in favor of goal-directed behavior. It was hypothesized that due to frontal-striatal hypoactivation, children with ADHD would have difficulty with higher order motor control tasks felt to be dependent on these systems, yet have preserved general motor function. A total of 63 children-ADHD and matched controls-completed experimental motor tasks that required maintenance of internal motor representations and the ability to inhibit visually driven responses. Children also completed a measure of motor inhibition, and a portion of the sample completed general motor function tasks. On motor tasks that required them to maintain internal motor representations and to inhibit automatic motor responses, children with ADHD had significantly greater difficulty than controls, yet on measures of general motor dexterity, their performance was comparable. Children with ADHD displayed significantly greater intraindividual (subject) variability than controls. Intraindividual variability (IIV) contributed to variations in performance across the motor tasks, but did not account for all of the variance on all tasks. These findings suggest that children with ADHD may be more controlled by external stimuli than by internally represented information, possibly due to dysfunction of the medial motor system. However, it is likely that children with ADHD also display general motor-execution problems (as evidenced by IIV findings), suggesting that atypicalities may extend to both medial and lateral motor systems. Findings are interpreted within the context of contemporary theories regarding motor dysfunction in ADHD, and implications for understanding externalizing behaviors in ADHD are discussed.

Recovery outcomes of schizophrenia patients treated with paliperidone palmitate in a community setting: patient and provider perspectives on recovery.

PubMed

Williams, Wesley; McKinney, Christopher; Martinez, Larry; Benson, Carmela

2016-01-01

This study evaluated the effect of paliperidone palmitate long-acting injectable (LAI) antipsychotic on recovery-oriented mental health outcomes from the perspective of healthcare providers and patients during the treatment of patients with schizophrenia or schizoaffective disorders. Archival data for patients with a primary diagnosis of schizophrenia or schizoaffective disorder receiving ≥6 months of paliperidone palmitate LAI were retrieved from the electronic medical records system at the Mental Health Center of Denver. Mental health recovery was assessed from both a provider's (Recovery Markers Inventory [RMI]) and patient's (Consumer Recovery Measure [CRM]) perspective. A three-level hierarchical linear model (HLM) was utilized to determine changes in CRM and RMI scores by including independent variables in the models: intercept, months from treatment (slope), treatment time period (pretreatment and treatment), age, gender, primary diagnosis, substance abuse diagnosis, concurrent medications, and adherence to paliperidone palmitate LAI. A total of 219 patients were identified and included in the study. Results of the final three-level HLMs indicated an overall increase in CRM scores (p < 0.05), an overall increase (p < 0.01), and an increased rate of change (p < 0.05) in RMI scores during the paliperidone palmitate LAI treatment period vs the pre-treatment period. This study contained a retrospective, non-comparative design, and did not adjust for multiplicity Conclusions: The current study demonstrates that changes in recovery-oriented mental health outcomes can be detected following the administration of a specific antipsychotic treatment in persons with schizophrenia or schizoaffective disorders. Furthermore, patients receiving paliperidone palmitate LAI can effectively improve recovery-oriented outcomes, thereby supporting the drug's use as schizophrenia treatment from a recovery-oriented perspective.

[Skull base meningiomas: a predictive system to know the extent of their surgical resection and patient outcome].

PubMed

Morales, F; Maillo, A; Díaz-Alvarez, A; Merino, M; Muñoz-Herrera, A; Hernández, J; Santamarta, D

2005-12-01

The aim of this study was to build a preoperative predictive system which could provide reliable information about: 1 degrees which skull base meningiomas can be total or partially removed, and 2 degrees their surgical outcome. Patient histories and imaging data were reviewed retrospectively from 85 consecutive skull base meningiomas patients who underwent surgery from 1990 and 2002. From the preoperative data, nine variables were selected for conventional statistical analysis as regards their relationship with: 1 degrees total vs partial tumor resection and 2 degrees with patients outcome according to the degree of tumour removal. From the nine variables analysed only two had a statistical association with the type of tumour resection performed (total vs partial) and the patient outcome: 1) arteries encasement and 2) cranial nerves involvement. Upon correlating these two variables with the type of tumour resection performed (total vs partial) and with the Karnofsky'scale to evaluate patients surgical outcome, the following grading groups were identified: Grade I: skull base meningiomas which did not involve cranial nerves or artery or only encased one artery or one cranial nerve. In these cases the incidence of gross tumour resection was 98.3% (p< 0.0001) and the perspective to reach 70 points in the Karnofsky'scale was of 96.5% ( p=0.001). Grade II: skull base meningiomas which involved one cranial nerve and encased, at least, two main cerebral arteries. In these cases, the frequency of total resection, decreased to 83.3% (p<0.0001) and the probability to reach 70 points in the Karnofsky'scale was 70.6% (p=0.001). Grade III: skull base meningiomas which involved two or more cranial nerves and encased several arteries In this group, the frequency of a total resection was of 42.9% (p<0.0001) and the probability of reaching 70 points in the Karnofsky'scale was only 60% (p=0.001). We propose a preoperative grading system for skull base meningiomas that helps predicting both whether total or partial tumor removal will be achieved during surgery and the immediate postsurgical outcome of the patient. In applying this predictive system we will be able to reduce surgical morbidity, to advance the possibility of a radiosurgical treatment and give a more precise information to the patients and their families about our surgical decision-making process.

Toward a More Usable Home-Based Video Telemedicine System: A Heuristic Evaluation of the Clinician User Interfaces of Home-Based Video Telemedicine Systems

PubMed Central

Welch, Brandon; Brinda, FNU

2017-01-01

Background Telemedicine is the use of technology to provide and support health care when distance separates the clinical service and the patient. Home-based telemedicine systems involve the use of such technology for medical support and care connecting the patient from the comfort of their homes with the clinician. In order for such a system to be used extensively, it is necessary to understand not only the issues faced by the patients in using them but also the clinician. Objectives The aim of this study was to conduct a heuristic evaluation of 4 telemedicine software platforms—Doxy.me, Polycom, Vidyo, and VSee—to assess possible problems and limitations that could affect the usability of the system from the clinician’s perspective. Methods It was found that 5 experts individually evaluated all four systems using Nielsen’s list of heuristics, classifying the issues based on a severity rating scale. Results A total of 46 unique problems were identified by the experts. The heuristics most frequently violated were visibility of system status and Error prevention amounting to 24% (11/46 issues) each. Esthetic and minimalist design was second contributing to 13% (6/46 issues) of the total errors. Conclusions Heuristic evaluation coupled with a severity rating scale was found to be an effective method for identifying problems with the systems. Prioritization of these problems based on the rating provides a good starting point for resolving the issues affecting these platforms. There is a need for better transparency and a more streamlined approach for how physicians use telemedicine systems. Visibility of the system status and speaking the users’ language are keys for achieving this. PMID:28438724

The Effectiveness of the School Performance, by Using the Total Quality Standards within the Education District of Al-Petra Province, from the Perspective of the Public Schools Principals and Teachers

ERIC Educational Resources Information Center

Alobiedat, Ahmad

2011-01-01

This study aimed to detect the level of appreciation by the school principals, teachers and the Education District, for the effectiveness of school performance, within different variables of the study from the perspective of public school principals and teachers of Al-Petra province, for the academic year 2008/2009. The study aimed to answer the…

Cost-of-illness in patients with moderate to severe psoriasis: a cross-sectional survey in Hungarian dermatological centres.

PubMed

Balogh, Orsolya; Brodszky, Valentin; Gulácsi, László; Herédi, Emese; Herszényi, Krisztina; Jókai, Hajnalka; Kárpáti, Sarolta; Baji, Petra; Remenyik, Éva; Szegedi, Andrea; Holló, Péter

2014-05-01

Despite the widespread availability of biological drugs in psoriasis, there is a shortage of disease burden studies. To assess the cost-of-illness and quality of life of patients with moderate to severe psoriasis in Hungary. Consecutive patients with Psoriasis Area and Severity Index (PASI) > 10 and Dermatology Life Quality Index (DLQI) > 10, or treated with traditional systemic (TST) or biological systemic treatment (BST) were included. Demographic data, clinical characteristics, psoriasis related medication, health care utilizations and employment status in the previous 12 months were recorded. Costing was performed from the societal perspective applying the human capital approach. Quality of life was assessed using DLQI and EQ-5D measures. Two-hundred patients were involved (females 32%) with a mean age of 51 (SD 13) years, 103 (52%) patients were on BST. Mean PASI, DLQI and EQ-5D scores were 8 (SD 10), 6 (SD 7) and 0.69 (SD 0.3), respectively. The mean total cost was €9,254/patient/year (SD 8,502) with direct costs accounting for 86%. The main cost driver was BST (mean €7,339/patient/year). Total costs differed significantly across treatment subgroups, mean (SD): no systemic therapy €2,186 (4,165), TST €2,388 (4,106) and BST €15,790 (6,016) (p < 0,001). Patients with BST had better PASI and DLQI scores (p < 0.01) than the other two subgroups. Patients with biological treatment have a significantly better quality of life and higher total costs than patients with or without traditional systemic treatment. Our study is the largest in Europe and the first in the CEE region that provides cost-of-illness data in psoriasis involving patients with BST.

Agoraphobia and Paradigm Strain: A Family Systems Perspective.

ERIC Educational Resources Information Center

Shean, Glenn; Rohrbaugh, Michael

Agoraphobia is an increasingly common, often chronically incapacitating anxiety disorder. Both behavior therapy and pharmacotherapy can be effective in reducing the intensity of agoraphobic symptoms. There are promising new developments, however, from a family systems perspective. Researchers are finding that an agoraphobic's marriage and family…

Optimizing Referral Management: A Multiple Service Health System Perspective Anyone Can Use

DTIC Science & Technology

2011-01-26

RET  LOS  OFFICER 5 0 1 0 1 0 0 7 2‐8701 USA ACTIVE DUTY ENLISTED 0 6 0 0 1 0 0 7 3‐2589 USAF ACTIVE DUTY 7 0 0 0 0 0 0 7 Grand Total 20 13 13 8 2 0 0...NBIRO ORTHO All.IRCiY PUlM VASCULAR DIRM URO OPH HEMOC BAMC-IlOFR External Consults Timeline by Appointed MTF by Top 10 Spedalty by Volume Avg First...Review • Avg Booking W Avg from Bod< to Appt Dab! • Avg Resulting DRlHO CARDIO WOMBf"S VASCULAR NBJRO PULM HLlH WHMC-Rm:R URO CARDIO PULM OPH

Study on the Selection of Equipment Suppliers for Wind Power Generation EPC Project

NASA Astrophysics Data System (ADS)

Yang, Yuanyue; Li, Huimin

2017-12-01

In the EPC project, the purchase cost of equipments accounted for about 60% of the total project cost, thus, the selection of equipment suppliers has an important influence on the EPC project. This paper, took EPC project for the phase I engineering of Guizhou Huaxi Yunding wind power plant as research background, constructed the evaluation index system for the selection of equipment suppliers for wind power generation EPC project from multiple perspectives, and introduced matter-element extension evaluation model to evaluate the selection of equipment suppliers for this project from the qualitative and quantitative point of view. The result is consistent with the actual situation, which verifies the validity and operability of this method.

Toward an electrical power utility for space exploration

NASA Technical Reports Server (NTRS)

Bercaw, Robert W.

1989-01-01

Plans for space exploration depend on today's technology programs addressing the novel requirements of space-based enterprise. The requirements for electrical power will be formidable: megawatts in magnitude, reliability for multi-year missions and the flexibility to adapt to needs unanticipated at design time. The reasons for considering the power management and distribution in the various systems from a total mission perspective, rather than simply extrapolating current spacecraft design practice, are discussed. A utility approach to electric power being developed at the Lewis Research Center is described. It integrates requirements from a broad selection of current development programs with studies in which both space and terrestrial technologies are conceptually applied to exploration mission scenarios.

Knowledge Management Enablers and Process in Hospital Organizations.

PubMed

Lee, Hyun-Sook

2017-02-01

This research aimed to investigate the effects of knowledge management enablers, such as organizational structure, leadership, learning, information technology systems, trust, and collaboration, on the knowledge management process of creation, storage, sharing, and application. Using data from self-administered questionnaires in four Korean tertiary hospitals, this survey investigated the main organizational factors affecting the knowledge management process in these organizations. A total of 779 questionnaires were analyzed using SPSS 18.0 and AMOS 18.0. The results showed that organizational factors affect the knowledge management process differently in each hospital organization. From a managerial perspective, the implications of these factors for developing organizational strategies that encourage and foster the knowledge management process are discussed.

A novel critical infrastructure resilience assessment approach using dynamic Bayesian networks

NASA Astrophysics Data System (ADS)

Cai, Baoping; Xie, Min; Liu, Yonghong; Liu, Yiliu; Ji, Renjie; Feng, Qiang

2017-10-01

The word resilience originally originates from the Latin word "resiliere", which means to "bounce back". The concept has been used in various fields, such as ecology, economics, psychology, and society, with different definitions. In the field of critical infrastructure, although some resilience metrics are proposed, they are totally different from each other, which are determined by the performances of the objects of evaluation. Here we bridge the gap by developing a universal critical infrastructure resilience metric from the perspective of reliability engineering. A dynamic Bayesian networks-based assessment approach is proposed to calculate the resilience value. A series, parallel and voting system is used to demonstrate the application of the developed resilience metric and assessment approach.

Pituitary adenomas: historical perspective, surgical management and future directions

PubMed Central

Theodros, Debebe; Patel, Mira; Ruzevick, Jacob; Lim, Michael; Bettegowda, Chetan

2016-01-01

Pituitary adenomas are among the most common central nervous system tumors. They represent a diverse group of neoplasms that may or may not secrete hormones based on their cell of origin. Epidemiologic studies have documented the incidence of pituitary adenomas within the general population to be as high as 16.7%. A growing body of work has helped to elucidate the pathogenesis of these tumors. Each subtype has been shown to demonstrate unique cellular changes potentially leading to tumorigenesis. Surgical advancements over several decades have included microsurgery and the employment of the endoscope for surgical resection. These advancements increase the likelihood of gross-total resection and have resulted in decreased patient morbidity. PMID:26497533

Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial

PubMed Central

2012-01-01

Introduction The EPaNIC randomized controlled multicentre trial showed that postponing initiation of parenteral nutrition (PN) in ICU-patients to beyond the first week (Late-PN) enhanced recovery, as compared with Early-PN. This was mediated by fewer infections, accelerated recovery from organ failure and reduced duration of hospitalization. Now, the trial's preplanned cost analysis (N = 4640) from the Belgian healthcare payers' perspective is reported. Methods Cost data were retrieved from individual patient invoices. Undiscounted total healthcare costs were calculated for the index hospital stay. A cost tree based on acquisition of new infections and on prolonged length-of-stay was constructed. Contribution of 8 cost categories to total hospitalization costs was analyzed. The origin of drug costs was clarified in detail through the Anatomical Therapeutic Chemical (ATC) classification system. The potential impact of Early-PN on total hospitalization costs in other healthcare systems was explored in a sensitivity analysis. Results ICU-patients developing new infection (24.4%) were responsible for 42.7% of total costs, while ICU-patients staying beyond one week (24.3%) accounted for 43.3% of total costs. Pharmacy-related costs represented 30% of total hospitalization costs and were increased by Early-PN (+608.00 EUR/patient, p = 0.01). Notably, costs for ATC-J (anti-infective agents) (+227.00 EUR/patient, p = 0.02) and ATC-B (comprising PN) (+220.00 EUR/patient, p = 0.006) drugs were increased by Early-PN. Sensitivity analysis revealed a mean total cost increase of 1,210.00 EUR/patient (p = 0.02) by Early-PN, when incorporating the full PN costs. Conclusions The increased costs by Early-PN were mainly pharmacy-related and explained by higher expenditures for PN and anti-infective agents. The use of Early-PN in critically ill patients can thus not be recommended for both clinical (no benefit) and cost-related reasons. Trial registration ClinicalTrials.gov NCT00512122. PMID:22632574

AIR QUALITY MODELING OF AMMONIA: A REGIONAL MODELING PERSPECTIVE

EPA Science Inventory

The talk will address the status of modeling of ammonia from a regional modeling perspective, yet the observations and comments should have general applicability. The air quality modeling system components that are central to modeling ammonia will be noted and a perspective on ...

A Learning Style Perspective to Investigate the Necessity of Developing Adaptive Learning Systems

ERIC Educational Resources Information Center

Hwang, Gwo-Jen; Sung, Han-Yu; Hung, Chun-Ming; Huang, Iwen

2013-01-01

Learning styles are considered to be one of the factors that need to be taken into account in developing adaptive learning systems. However, few studies have been conducted to investigate if students have the ability to choose the best-fit e-learning systems or content presentation styles for themselves in terms of learning style perspective. In…

Growing Together, Learning Together: What Cities Have Discovered about Building Afterschool Systems. Perspective

ERIC Educational Resources Information Center

Browne, Daniel

2015-01-01

With many cities showing an interest in afterschool system building and research providing a growing body of useful information, this Wallace Perspective offers a digest of the latest thinking on how to build and sustain an afterschool system, and the challenges and opportunities that lie ahead for this promising work. The report (a follow-up to a…

Investigation of the Effects of a Nursing Information System by Using the Technology Acceptance Model.

PubMed

Hsu, Hung-Hsiou; Wu, Ya-Hui

2017-06-01

The purposes of this study are to investigate the effectiveness of implementing a nursing information system and to discuss several issues affecting its successful deployment from the perspectives of nurses, the major users of the system. The methodology was based on the theory of the technology acceptance model. This study adopted a cross-sectional study method to survey and collect data. In total, 167 questionnaires were distributed to subjects. Approximately 94.6%, or 158 valid questionnaires, were collected. The data were analyzed using SPSS and PLS software.The data analysis indicated that the factors that most significantly influenced the willingness of nurses to use the nursing information system were their degrees of satisfaction with the system and their perceptions of its usefulness. A nursing information system that can provide functions that are useful and convenient and that facilitate the avoidance of tedious repetitive writing and improve the quality of provided care can encourage nurse satisfaction with the system and thus stimulate their interest in using it for their work. The ease of use of the system can also affect the willingness of nurses to use it.

Efficiency performance of China's health care delivery system.

PubMed

Zhang, Luyu; Cheng, Gang; Song, Suhang; Yuan, Beibei; Zhu, Weiming; He, Li; Ma, Xiaochen; Meng, Qingyue

2017-07-01

Improving efficiency performance of the health care delivery system has been on the agenda for the health system reform that China initiated in 2009. This study examines the changes in efficiency performance and determinants of efficiency after the reform to provide evidence to assess the progress of the reform from the perspective of efficiency. Descriptive analysis, Data Envelopment Analysis, the Malmquist Index, and multilevel regressions are used with data from multiple sources, including the World Bank, the China Health Statistical Yearbook, and routine reports. The results indicate that over the last decade, health outcomes compared with health investment were relatively higher in China than in most other countries worldwide, and the trend was stable. The overall efficiency and total factor productivity increased after the reform, indicating that the reform was likely to have had a positive impact on the efficiency performance of the health care delivery system. However, the health care delivery structure showed low system efficiency, mainly attributed to the weakened primary health care system. Strengthening the primary health care system is central to enhancing the future performance of China's health care delivery system. Copyright © 2017 John Wiley & Sons, Ltd.

Factors Associated with School Counselors' Use of a Family Systems Perspective

ERIC Educational Resources Information Center

Martin, Dottie Marie

2013-01-01

Six hundred fifty-seven (657) members of the American School Counseling Association responded to the researcher-developed survey, the "School Counselors Perceptions of Family Systems Perspectives Questionnaire" (SCP-FSPQ). The instrument assessed school counselors' perceptions of preparedness, competency, importance and frequency of…

Field Systems Research: Sport Pedagogy Perspectives.

ERIC Educational Resources Information Center

Locke, Lawrence F.; And Others

1992-01-01

These articles contain responses from several scholars on the issue of field systems analysis (FSA). The scholars offer critiques from their sport pedagogy perspectives, a reaction relating FSA to personal examinations of teaching expertise, and a discussion of how computer simulation informs the study of expert teachers. (SM)

Power and Assessment: A Genealogical Analysis of the CLASS

ERIC Educational Resources Information Center

Gaches, Sonya; Hill, Diana

2017-01-01

The CLASS (classroom assessment scoring system) has become integrally linked with quality rating and improvement systems (QRIS) throughout the United States and other international locations. This relationship reinforces the neoliberal consumer-based perspectives of quality and devalues localized perspectives. This article challenges the notion of…

A Selectionist Perspective on Systemic and Behavioral Change in Organizations

ERIC Educational Resources Information Center

Sandaker, Ingunn

2009-01-01

This article provides a discussion of how different dynamics in production processes and communication structures in the organization serve as different environmental contingencies favoring different behavioral patterns and variability of performance in organizations. Finally, an elaboration on a systems perspective on the selection of corporate…

Parental "Intrapreneurship" in Action: Theoretical Elaboration through the Israeli Case Study

ERIC Educational Resources Information Center

Yemini, Miri; Ramot, Rony; Sagie, Netta

2016-01-01

Parents are widely acknowledged as prominent actors in schools' success; consequently, school-parent interactions are heavily investigated from sociological, psychological, political, and cultural perspectives. By applying the "open system" perspective to schools as an eco-system, this study addresses parents as integrative stakeholders…

Teaching with a Global Perspective

ERIC Educational Resources Information Center

Richardson, Percy

2012-01-01

The benefits of teaching from a global perspective far outweigh the disadvantages. Teaching from a global perspective provides the employer with global workers. Such teaching produces students who possess the knowledge of languages, culture, social systems, dress, religion, and cultural norms, as well as skills for employment in the global…

Coalitions in Primary Triads: Reexamining the Theoretical Constructs From A Feminist Perspective.

ERIC Educational Resources Information Center

Milstein, Kaylene; Baldwin, Cynthia

1997-01-01

Examines the theoretical constructs about the effects of coalitions in the father-mother-child triad from a family systems perspective. How this triadic view interacts with the historical patriarchal structure and with issues of power is addressed from a feminist perspective. (Author/MKA)

The View Finder: International Perspectives on Special Education Technology. Volume 3.

ERIC Educational Resources Information Center

Edyburn, Dave L.; And Others

The four articles in this monograph present issues in the application of technology to special education from an international perspective. In the first chapter, "Augmentative and Alternative Communication Systems--Computer Applications for Individuals with Disabilities: An International Perspective," Richard Cardinali and George McMurdo…

Memory perspective and self-concept in social anxiety: an exploratory study.

PubMed

Stopa, Lusia; Bryant, Tess

2004-07-01

The mental representation of self and observer perspective images are important maintaining factors in cognitive models of social phobia (Clark & Wells, 1995; Rapee & Heimberg, 1997). This study investigates Libby and Eibach's (2002) hypothesis that the observer perspective is used to recall memories that are incongruent with current self-concept. A total of 60 participants (divided into high and low social anxiety groups) completed a questionnaire in which they described current self-concept, recalled four memories of social occasions (two congruent, two incongruent), and rated memory age and vividness. Congruence was defined as memories that "fit" with current self-descriptions. A qualitative analysis of self-concept showed that both groups used a similar range of themes. High socially anxious participants recalled more observer perspective memories in the second incongruent memory. Congruence did not influence vividness, but public self-consciousness did. The implications of the results are discussed and suggestions made for future research.

Research developments in methods to reduce the carbon footprint of the food system: a review.

PubMed

Xu, Zhongyue; Sun, Da-Wen; Zeng, Xin-An; Liu, Dan; Pu, Hongbin

2015-01-01

Global warming is a worldwide issue with its evident impact across a wide range of systems and sectors. It is caused by a number of greenhouse gases (GHGs) emissions, in which food system has made up of a large part. Recently, reduction of GHG emissions has become an urgent issue to be resolved in the food system. Many governments and organizations are making great endeavors to alleviate the adverse effect of this phenomenon. In this review, methods to reduce the carbon footprint within the life cycle of a food system are presented from the technical, consumption behavior and environmental policies perspectives. The whole food system including raw material acquisition, processing, packaging, preservation, transportation, consumption, and disposal are covered. Improving management techniques, and adopting advanced technology and equipment are critical for every stage of a food system. Rational site selection is important to alleviate the influence of land use change. In addition, environmental choices of packaging stage, reduction in refrigeration dependence, and correct waste treatment are essential to reduce the total carbon footprint of the production. However, only technical methods cannot radically reverse the trend of climate change, as consumption behaviors present a great deal of influence over climate change. Appropriate purchase patterns and substitution within food product categories by low carbon products can reduce GHG emissions. Development of methods to calculate the carbon footprint of every kind of food and its processing technology enable people to make environmental choice. Policy can shape and cultivate the new code of consumption and influence the direction of emerging technology and science. From political perspectives, government intervention and carbon offset are common tools, especially for carbon tax and a real or implicit price of carbon. Finally, by mitigating the methodologies described above, the rate and magnitude of climate changes can be also reduced to some extent.

Research Methodology on Language Development from a Complex Systems Perspective

ERIC Educational Resources Information Center

Larsen-Freeman, Diane; Cameron, Lynne

2008-01-01

Changes to research methodology motivated by the adoption of a complexity theory perspective on language development are considered. The dynamic, nonlinear, and open nature of complex systems, together with their tendency toward self-organization and interaction across levels and timescales, requires changes in traditional views of the functions…

Volunteers in Leisure. A Management Perspective.

ERIC Educational Resources Information Center

Tedrick, Ted; Henderson, Karla

The first chapter of this monograph presents some major themes and fundamental issues surrounding leisure activities volunteers and their management from a system perspective. Chapter 2 discusses the results of a survey conducted to obtain a status report of selected volunteer system characteristics. The third chapter focuses on dealing with…

Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation: a Canadian payer perspective.

PubMed

Sorensen, S V; Kansal, A R; Connolly, S; Peng, S; Linnehan, J; Bradley-Kennedy, C; Plumb, J M

2011-05-01

Oral dabigatran etexilate is indicated for the prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) in whom anticoagulation is appropriate. Based on the RE-LY study we investigated the cost-effectiveness of Health Canada approved dabigatran etexilate dosing (150 mg bid for patients <80 years, 110 mg bid for patients ≥80 years) versus warfarin and "real-world" prescribing (i.e. warfarin, aspirin, or no treatment in a cohort of warfarin-eligible patients) from a Canadian payer perspective. A Markov model simulated AF patients at moderate to high risk of stroke while tracking clinical events [primary and recurrent ischaemic strokes, systemic embolism, transient ischaemic attack, haemorrhage (intracranial, extracranial, and minor), acute myocardial infarction and death] and resulting functional disability. Acute event costs and resulting long-term follow-up costs incurred by disabled stroke survivors were based on a Canadian prospective study, published literature, and national statistics. Clinical events, summarized as events per 100 patient-years, quality-adjusted life years (QALYs), total costs, and incremental cost effectiveness ratios (ICER) were calculated. Over a lifetime, dabigatran etexilate treated patients experienced fewer intracranial haemorrhages (0.49 dabigatran etexilate vs. 1.13 warfarin vs. 1.05 "real-world" prescribing) and fewer ischaemic strokes (4.40 dabigatran etexilate vs. 4.66 warfarin vs. 5.16 "real-world" prescribing) per 100 patient-years. The ICER of dabigatran etexilate was $10,440/QALY versus warfarin and $3,962/QALY versus "real-world" prescribing. This study demonstrates that dabigatran etexilate is a highly cost-effective alternative to current care for the prevention of stroke and systemic embolism among Canadian AF patients.

Operational Merits of Maritime Superconductivity

NASA Astrophysics Data System (ADS)

Ross, R.; Bosklopper, J. J.; van der Meij, K. H.

The perspective of superconductivity to transfer currents without loss is very appealing in high power applications. In the maritime sector many machines and systems exist in the roughly 1-100 MW range and the losses are well over 50%, which calls for dramatic efficiency improvements. This paper reports on three studies that aimed at the perspectives of superconductivity in the maritime sector. It is important to realize that the introduction of superconductivity comprises two technology transitions namely firstly electrification i.e. the transition from mechanical drives to electric drives and secondly the transition from normal to superconductive electrical machinery. It is concluded that superconductivity does reduce losses, but its impact on the total energy chain is of little significance compared to the investments and the risk of introducing a very promising but as yet not proven technology in the harsh maritime environment. The main reason of the little impact is that the largest losses are imposed on the system by the fossil fueled generators as prime movers that generate the electricity through mechanical torque. Unless electric power is supplied by an efficient and reliable technology that does not involve mechanical torque with the present losses both normal as well as superconductive electrification of the propulsion will hardly improve energy efficiency or may even reduce it. One exception may be the application of degaussing coils. Still appealing merits of superconductivity do exist, but they are rather related to the behavior of superconductive machines and strong magnetic fields and consequently reduction in volume and mass of machinery or (sometimes radically) better performance. The merits are rather convenience, design flexibility as well as novel applications and capabilities which together yield more adequate systems. These may yield lower operational costs in the long run, but at present the added value of superconductivity rather seems more adequate than cheaper systems.

Do they see eye to eye? Management and employee perspectives of high-performance work systems and influence processes on service quality.

PubMed

Liao, Hui; Toya, Keiko; Lepak, David P; Hong, Ying

2009-03-01

Extant research on high-performance work systems (HPWSs) has primarily examined the effects of HPWSs on establishment or firm-level performance from a management perspective in manufacturing settings. The current study extends this literature by differentiating management and employee perspectives of HPWSs and examining how the two perspectives relate to employee individual performance in the service context. Data collected in three phases from multiple sources involving 292 managers, 830 employees, and 1,772 customers of 91 bank branches revealed significant differences between management and employee perspectives of HPWSs. There were also significant differences in employee perspectives of HPWSs among employees of different employment statuses and among employees of the same status. Further, employee perspective of HPWSs was positively related to individual general service performance through the mediation of employee human capital and perceived organizational support and was positively related to individual knowledge-intensive service performance through the mediation of employee human capital and psychological empowerment. At the same time, management perspective of HPWSs was related to employee human capital and both types of service performance. Finally, a branch's overall knowledge-intensive service performance was positively associated with customer overall satisfaction with the branch's service. (c) 2009 APA, all rights reserved.

U.S. Natural Gas System Methane Emissions: State of Knowledge from LCAs, Inventories, and Atmospheric Measurements (Presentation)

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

Heath, G.

Natural gas (NG) is a potential "bridge fuel" during transition to a decarbonized energy system: It emits less carbon dioxide during combustion than other fossil fuels and can be used in many industries. However, because of the high global warming potential of methane (CH4, the major component of NG), climate benefits from NG use depend on system leakage rates. Some recent estimates of leakage have challenged the benefits of switching from coal to NG, a large near-term greenhouse gas (GHG) reduction opportunity. During this presentation, Garvin will review evidence from multiple perspectives - life cycle assessments (LCAs), inventories and measurementsmore » - about NG leakage in the US. Particular attention will be paid to a recent article in Science magazine which reviewed over 20 years of published measurements to better understand what we know about total methane emissions and those from the oil and gas sectors. Scientific and policy implications of the state of knowledge will be discussed.« less

The immune signaling pathways of Manduca sexta

PubMed Central

Cao, Xiaolong; He, Yan; Hu, Yingxia; Wang, Yang; Chen, Yun-Ru; Bryant, Bart; Clem, Rollie J.; Schwartz, Lawrence M.; Blissard, Gary; Jiang, Haobo

2015-01-01

Signal transduction pathways and their coordination are critically important for proper functioning of animal immune systems. Our knowledge of the constituents of the intracellular signaling network in insects mainly comes from genetic analyses in Drosophila melanogaster. To facilitate future studies of similar systems in the tobacco hornworm and other lepidopteran insects, we have identified and examined the homologous genes in the genome of Manduca sexta. Based on 1:1 orthologous relationships in most cases, we hypothesize that the Toll, Imd, MAPK-JNK-p38 and JAK-STAT pathways are intact and operative in this species, as are most of the regulatory mechanisms. Similarly, cellular processes such as autophagy, apoptosis and RNA interference probably function in similar ways, because their mediators and modulators are mostly conserved in this lepidopteran species. We have annotated a total of 186 genes encoding 199 proteins, studied their domain structures and evolution, and examined their mRNA levels in tissues at different life stages. Such information provides a genomic perspective of the intricate signaling system in a non-drosophiline insect. PMID:25858029

Impact of automation on mass spectrometry.

PubMed

Zhang, Yan Victoria; Rockwood, Alan

2015-10-23

Mass spectrometry coupled to liquid chromatography (LC-MS and LC-MS/MS) is an analytical technique that has rapidly grown in popularity in clinical practice. In contrast to traditional technology, mass spectrometry is superior in many respects including resolution, specificity, multiplex capability and has the ability to measure analytes in various matrices. Despite these advantages, LC-MS/MS remains high cost, labor intensive and has limited throughput. This specialized technology requires highly trained personnel and therefore has largely been limited to large institutions, academic organizations and reference laboratories. Advances in automation will be paramount to break through this bottleneck and increase its appeal for routine use. This article reviews these challenges, shares perspectives on essential features for LC-MS/MS total automation and proposes a step-wise and incremental approach to achieve total automation through reducing human intervention, increasing throughput and eventually integrating the LC-MS/MS system into the automated clinical laboratory operations. Copyright © 2015 Elsevier B.V. All rights reserved.

Research Perspectives and Best Practices in Educational Technology Integration

ERIC Educational Resources Information Center

Keengwe, Jared

2013-01-01

With advancements in technology continuing to influence all areas of society, students in current classrooms have a different understanding and perspective of learning than the educational system has been designed to teach. Research Perspectives and Best Practices in Educational Technology Integration highlights the emerging digital age, its…

Global Perspectives: Some Questions and Answers.

ERIC Educational Resources Information Center

Center for Global Perspectives, New York, NY.

To enlighten the reader on the status, objectives, and needs of global education, this paper poses and answers questions related to global perspectives. A global perspective is interpreted to include heightened awareness and understanding of the global system as well as increased consciousness of the intimate relationship of self, humankind, and…

Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in patients with atrial fibrillation--a real patient data analysis in a Hong Kong teaching hospital.

PubMed

Chang, Andy M; Ho, Jason C S; Yan, Bryan P; Yu, Cheuk Man; Lam, Yat Yin; Lee, Vivian W Y

2013-05-01

To compare the management cost and cost-effectiveness of dabigatran with warfarin in patients with nonvalvular atrial fibrillation (AF) from the hospital's and patients' perspectives. Dabigatran is more cost-effective than warfarin for stroke prevention of AF in Hong Kong. The analysis was performed in conjunction with a drug utilization evaluation of dabigatran study in a teaching hospital in Hong Kong. The study recruited 244 patients who received either dabigatran or warfarin for stroke prevention of AF. A cost-effectiveness analysis was performed and was expressed as an incremental cost-effectiveness ratio (ICER) in averting a cardiac event or a bleeding event. A sensitivity analysis was used on all relevant variables to test the robustness. From the hospital's perspective, the dabigatran group had a lower total cost of management than that of the warfarin group (median: US$421 vs US$1306, P < 0.001) (US$1 = HK$7.75) and was dominant over warfarin. From the patients' perspective, the total cost of management in the dabigatran group was higher than that in warfarin group (median: US$1751 vs US$70, P < 0.001), and the ICER in preventing a cardiac or bleeding event of dabigatran vs warfarin was estimated at US$68,333 and US$20,500, respectively. If dabigatran was subsidized by the hospital, a higher cost would be incurred by the hospital (median: US$1679 vs US$1306, ICER (cardiac and bleeding events): US$15,163 and US$4549, respectively). The study favored dabigatran for stroke prophylaxis in patients with nonvalvular AF in Hong Kong under the current hospital's perspective and provided a reference for further comparisons under patient and subsidization perspectives. © 2013 Wiley Periodicals, Inc.

The importance of professional values from clinical nurses' perspective in hospitals of a medical university in Iran.

PubMed

Poorchangizi, Batool; Farokhzadian, Jamileh; Abbaszadeh, Abbas; Mirzaee, Moghaddameh; Borhani, Fariba

2017-03-01

Today, nurses are required to have knowledge and awareness concerning professional values as standards to provide safe and high-quality ethical care. Nurses' perspective on professional values affects decision-making and patient care. Therefore, the present study aimed to investigate the importance of professional values from clinical nurses' perspective. The present cross-sectional study was conducted in 2016 in four educational hospitals of Kerman University of Medical Sciences, Iran. Data were collected via the Persian version of Nursing Professional Values Scale-Revised (NPVS-R) by Weis and Schank. Sampling was conducted through the use of stratified random sampling method and 250 clinical nurses participated in the study. Results indicated that the total score of the nurses' professional values was high. (102.57 ± 11.94). From nurses' perspective items such as "Maintaining confidentiality of patients" and "Safeguarding patients' right to privacy" had more importance; however, "Recognizing role of professional nursing associations in shaping healthcare policy" and "Participating in nursing research and/or implementing research findings appropriate to practice had less importance. A statistically significant relationship was observed between NPVS-R mean scores and nurses' age, work experience as well as participation in professional ethical training (P < 0.05). Although the total score related to the clinical nurses' perspective on professional values was high, the importance of certain values was at a lower level. Owing to the emerging ethical challenges, it is indispensable to design educational programs in order to improve nurses' awareness and understanding of the comprehensive importance of professional values. Furthermore, it is recommended that mixed methods studies should be conducted in order to design an instrument to evaluate the use of values in nursing practice.

A Two-stage Approach for Water Demand Prediction under Constrained total water use and Water Environmental Capacity

NASA Astrophysics Data System (ADS)

He, Y.; Xiaohong, C.; Lin, K.; Wang, Z.

2016-12-01

Water demand (WD) is the basis for water allocation (WA) because it can fully reflect the pressure on water resources from population and socioeconomic development. To deal with the great uncertainties and the absence of consideration of water environmental capacity (WEC) in traditional water demand prediction methods, e.g. Statistical models, System Dynamics and quota method, this study develops a two-stage approach to predict WD under constrained total water use from the perspective of ecological restraint. Regional total water demand (RTWD) is constrained by WEC, available water resources amount and total water use quota. Based on RTWD, WD is allocated in two stages according to the game theory, including predicting sub regional total water demand (SRWD) by calculating the sub region weights based on the selected indicators of socioeconomic development and predicting industrial water demand (IWD) according to the game theory. Taking the Dongjiang river basin, South China as an example of WD prediction, according to its constrained total water use quota and WEC, RTWD in 2020 is 9.83 billion m3, and IWD for agriculture, industry, service, ecology (off-stream), and domesticity are 2.32 billion m3, 3.79 billion m3, 0.75 billion m3 , 0.18 billion m3and 1.79 billion m3 respectively. The results from this study provide useful insights for effective water allocation under climate change and the strict policy of water resources management.

Renewable Electricity Futures for the United States

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

Mai, Trieu; Hand, Maureen; Baldwin, Sam F.

2014-04-14

This paper highlights the key results from the Renewable Electricity (RE) Futures Study. It is a detailed consideration of renewable electricity in the United States. The paper focuses on technical issues related to the operability of the U. S. electricity grid and provides initial answers to important questions about the integration of high penetrations of renewable electricity technologies from a national perspective. The results indicate that the future U. S. electricity system that is largely powered by renewable sources is possible and the further work is warranted to investigate this clean generation pathway. The central conclusion of the analysis ismore » that renewable electricity generation from technologies that are commercially available today, in combination with a more flexible electric system, is more than adequate to supply 80% of the total U. S. electricity generation in 2050 while meeting electricity demand on an hourly basis in every region of the United States.« less

Traffic Management Coordinator Evaluation of the Dynamic Weather Routes Concept and System

NASA Technical Reports Server (NTRS)

Gong, Chester

2014-01-01

Dynamic Weather Routes (DWR) is a weather-avoidance system for airline dispatchers and FAA traffic managers that continually searches for and advises the user of more efficient routes around convective weather. NASA and American Airlines (AA) have been conducting an operational trial of DWR since July 17, 2012. The objective of this evaluation is to assess DWR from a traffic management coordinator (TMC) perspective, using recently retired TMCs and actual DWR reroutes advisories that were rated acceptable by AA during the operational trial. Results from the evaluation showed that the primary reasons for a TMC to modify or reject airline reroute requests were related to airspace configuration. Approximately 80 percent of the reroutes evaluated required some coordination before implementation. Analysis showed TMCs approved 62 percent of the requested DWR reroutes, resulting in 57 percent of the total requested DWR time savings.

Alternative systems in Malaysian drug rehabilitation: organization and control in comparative perspective.

PubMed

Lee, R L

1985-01-01

This paper examines four drug rehabilitation systems in Malaysia from an organizational perspective. It focuses on authority structures in rehabilitation centres and their impact on rehabilitees' identities. The findings show that there are important differences between government-run and private centres in terms of administration and approach to therapy. Some policy implications are derived from a comparison of these systems.

Leading in Times of Change: Principals' Perspectives of Their Role in a New Pay-for-Performance System

ERIC Educational Resources Information Center

Ortiz-Torres, Amanda

2012-01-01

The purpose of this qualitative study was to explore principals' perspectives on how they make sense of their leadership roles in a new pay-for-performance system. The study describes the perceptions of six principals, two each from elementary, middle, and high school levels, regarding leadership in a recently changed system. Principals were…

A Future with Hybrid Electric Propulsion Systems: A NASA Perspective

NASA Technical Reports Server (NTRS)

DelRosario, Ruben

2014-01-01

The presentation highlights a NASA perspective on Hybrid Electric Propulsion Systems for aeronautical applications. Discussed are results from NASA Advance Concepts Study for Aircraft Entering service in 2030 and beyond and the potential use of hybrid electric propulsion systems as a potential solution to the requirements for energy efficiency and environmental compatibility. Current progress and notional potential NASA research plans are presented.

Ethics: An Indispensable Dimension in the University Rankings.

PubMed

Khaki Sedigh, Ali

2017-02-01

University ranking systems attempt to provide an ordinal gauge to make an expert evaluation of the university's performance for a general audience. University rankings have always had their pros and cons in the higher education community. Some seriously question the usefulness, accuracy, and lack of consensus in ranking systems and therefore multidimensional ranking systems have been proposed to overcome some shortcomings of the earlier systems. Although the present ranking results may rather be rough, they are the only available sources that illustrate the complex university performance in a tangible format. Their relative accuracy has turned the ranking systems into an essential feature of the academic lifecycle within the foreseeable future. The main concern however, is that the present ranking systems totally neglect the ethical issues involved in university performances. Ethics should be a new dimension added into the university ranking systems, as it is an undisputable right of the public and all the parties involved in higher education to have an ethical evaluation of the university's achievements. In this paper, to initiate ethical assessment and rankings, the main factors involved in the university performances are reviewed from an ethical perspective. Finally, a basic benchmarking model for university ethical performance is presented.

What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation

PubMed Central

Liddy, Clare; Drosinis, Paul; Deri Armstrong, Catherine; McKellips, Fanny; Afkham, Amir; Keely, Erin

2016-01-01

Objective This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Design Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Setting Champlain health region in Eastern Ontario, Canada. Population Primary care providers and specialists registered to use the eConsult service. Main outcome measures Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. Results A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. Conclusions Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner. PMID:27338880

An investigation on task-technology fit of mobile nursing information systems for nursing performance.

PubMed

Hsiao, Ju-Ling; Chen, Rai-Fu

2012-05-01

This study investigates factors affecting the fit between nursing tasks and mobile nursing information systems and the relationships between the task-technology fit of mobile nursing information systems and nurse performance from the perspective of task-technology fit. Survey research recruited nursing staffs as subjects from selected case hospital. A total of 310 questionnaires were sent out, and 219 copies were obtained, indicating a valid response rate of 70.6%. Collected data were analyzed using the structural equation modeling technique. Our study found that dependence tasks have positive effects on information acquisition (γ=0.234, P<.05) and information identification (γ=0.478, P<.001), and independent tasks have significant effects on information acquisition (γ=0.213, P<.05). Therefore, the introduction of mobile nursing information systems in assisting nursing practices can help facilitate both independent and dependent nursing tasks. Our study discovered that the supporting functions of mobile nursing information systems have positive effects on information integration and interpretation (γ=0.365, P<.001), as well as information acquisition (γ=0.253, P<.05). The service supports of mobile nursing information systems have positive effects on information acquisition (γ=0.318, P<.001) and information integration and interpretation (γ=0.143, P<.01). Furthermore, information identification (β=.055, P<.05), information acquisition (β=.176, P<.001), and information integration and interpretation (β=.706, P<.001) provided using mobile nursing information systems have positive effects on nursing performance, indicating 83.2% of totally explained variance. As shown, the use of mobile nursing information systems could provide nursing staffs with real-time and accurate information to increase efficiency and effectiveness in patient-care duties, further improving nursing performance.

Follow-up care practices and barriers to breast cancer survivorship: perspectives from Asian oncology practitioners.

PubMed

Ng, Terence; Toh, Ming Ren; Cheung, Yin Ting; Chan, Alexandre

2015-11-01

The aim of this study is to evaluate the perspectives of Asian oncology practitioners on the physical and psychosocial issues experienced by breast cancer survivors (BCS), current survivorship care practices, and the barriers to follow-up care. This was a cross-sectional survey study. Oncology practitioners were recruited from a major cancer center in Singapore and through two regional cancer meetings that took place in Singapore and Malaysia in 2013. A total of 126 oncology practitioners from various Southeast Asian countries, mostly nurses (58.7 %) and physicians (37.3 %), were recruited. The majority of the respondents agreed that fatigue (78.4 %) and anxiety (69.1 %) were the most common physical and psychosocial problems experienced by BCS. Monitoring for physical and treatment-related adverse effects (80.7 %) and reviewing patients' noncancer medical history (65.3 %) were the most practiced aspects of follow-up care. Compared with the other practitioners, the physicians were more likely to communicate with other healthcare professionals (adjusted OR = 4.24, 95 % CI 1.54 to 11.72; p = 0.005). Most of the respondents also agreed that patient-specific barriers were the main impediments to follow-up care. This study provides insights into the various aspects of breast cancer survivorship care from the perspectives of oncology practitioners and shows that survivorship care is relatively inadequate in Asia. There is a need for new survivorship care models to meet the needs of Asian BCS and to complement the unique healthcare systems of Asia.

Achieving work-life balance in the National Collegiate Athletic Association Division I setting, part II: perspectives from head athletic trainers.

PubMed

Goodman, Ashley; Mazerolle, Stephanie M; Pitney, William A

2015-01-01

Work-life balance has been examined at the collegiate level from multiple perspectives except for the athletic trainer (AT) serving in a managerial or leadership role. To investigate challenges and strategies used in achieving work-life balance from the perspective of the head AT at a National Collegiate Athletic Association Division I university. Qualitative study. Web-based management system. A total of 18 head ATs (13 men, 5 women; age = 44 ± 8 years, athletic training experience = 22 ± 7 years) volunteered. Participants journaled their thoughts and experiences in response to a series of questions. To establish data credibility, we included multiple-analyst triangulation, stakeholder checks, and peer review. We used a general inductive approach to analyze the data. Two higher-order themes emerged from our analysis of the data: organizational challenges and work-life balance strategies. The organizational challenges theme contained 2 lower-order themes: lack of autonomy and role demands. The work-life balance strategies theme contained 3 lower-order themes: prioritization of commitments, strategic boundary setting, and work-family integration. Head ATs are susceptible to experiencing work-life imbalance just as ATs in nonsupervisory roles are. Although not avoidable, the causes are manageable. Head ATs are encouraged to prioritize their personal time, make efforts to spend time away from their demanding positions, and reduce the number of additional responsibilities that can impede time available to spend away from work.

Mortality among inpatients of a psychiatric hospital: Indian perspective.

PubMed

Shinde, Shireesh Shatwaji; Nagarajaiah; Narayanaswamy, Janardhanan C; Viswanath, Biju; Kumar, Naveen C; Gangadhar, B N; Math, Suresh Bada

2014-04-01

The objective of this study is to assess mortality and its correlates among psychiatric inpatients of a tertiary care neuropsychiatric hospital. Given the background that such a study has never been undertaken in India, the findings would have a large bearing on policy making from a mental health-care perspective. The medical records of those psychiatric inpatients (n = 333) who died during their stay at the National Institute of Mental Health and Neurosciences in past 26 years (January 1983 to December 2008) constituted the study population. During the 26 years, there were a total of 103,252 psychiatric in-patient admissions, out of which 333 people died during their inpatient stay. Majority (n = 135, 44.6%) of the mortality was seen in the age group of 21-40 years. Most of the subjects were males (n = 202, 67%), married (n = 172, 56.8%) and from urban areas (n = 191, 63%). About, 54% of the subjects had short inpatient stay (<5 days, median for the sample). In 118 (39%) of the subjects, there was a history of physical illness. Leading cause of death were cardiovascular system disorders (n = 132, 43.6%), followed by respiratory system disorders (n = 45, 14.9%), nervous system disorders (n = 30, 9.9%) and infections (n = 31, 10.1%). In 21 (7%), cause of death was suicide. Identifying the factors associated with the death of inpatients is of utmost importance in assessing the care in a neuropsychiatric hospital and in formulating better treatment plan and policy in mental health. The discussion focuses on the analysis of different factors associated with inpatient mortality.

Quality registry, a tool for patient advantages - from a preventive caring perspective.

PubMed

Rosengren, Kristina; Höglund, Pär J; Hedberg, Berith

2012-03-01

The aim of this study was to describe nurses' experiences of a recently implemented quality register, Senior Alert, at two hospitals in Sweden. In Sweden, in recent decades, a system of national quality registries has been established in health and medical services for better outcomes for patients, professional development and a better functioning system. Senior Alert (SA) is one quality registry, aimed at preventing malnutrition, pressure ulcers and falls in elderly care. The study comprised a total of eight interviews with nurses working with SA at the ward level. The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. All persons who were asked to participate in the study consented to do so. One category 'Patient Advantages' and three subcategories 'Conscious Persevering', 'Supporting Structure' and 'Committed Leadership' were identified to describe staff experiences of implementing SA. Implementation processes need to be sustainable at both staff and managerial levels. A key factor in implementing and using a quality registry in prevention care could be described as keeping the flame burning. However, further research is needed on how patient advantages could be developed using other quality registries in order to improve care from a patient perspective. The results of this study could help other organizations implement quality registries or other change processes, for example new guidelines and treatment. Strategies concerning organizational structure and committed leadership could increase the usefulness of knowledge systems on all levels, which could enable continuous learning and quality improvement in health care. © 2012 Blackwell Publishing Ltd.

Information Engineering and Workflow Design in a Clinical Decision Support System for Colorectal Cancer Screening in Iran.

PubMed

Maserat, Elham; Seied Farajollah, Seiede Sedigheh; Safdari, Reza; Ghazisaeedi, Marjan; Aghdaei, Hamid Asadzadeh; Zali, Mohammad Reza

2015-01-01

Colorectal cancer is a major cause of morbidity and mortality throughout the world. Colorectal cancer screening is an optimal way for reducing of morbidity and mortality and a clinical decision support system (CDSS) plays an important role in predicting success of screening processes. DSS is a computer-based information system that improves the delivery of preventive care services. The aim of this article was to detail engineering of information requirements and work flow design of CDSS for a colorectal cancer screening program. In the first stage a screening minimum data set was determined. Developed and developing countries were analyzed for identifying this data set. Then information deficiencies and gaps were determined by check list. The second stage was a qualitative survey with a semi-structured interview as the study tool. A total of 15 users and stakeholders' perspectives about workflow of CDSS were studied. Finally workflow of DSS of control program was designed by standard clinical practice guidelines and perspectives. Screening minimum data set of national colorectal cancer screening program was defined in five sections, including colonoscopy data set, surgery, pathology, genetics and pedigree data set. Deficiencies and information gaps were analyzed. Then we designed a work process standard of screening. Finally workflow of DSS and entry stage were determined. A CDSS facilitates complex decision making for screening and has key roles in designing optimal interactions between colonoscopy, pathology and laboratory departments. Also workflow analysis is useful to identify data reconciliation strategies to address documentation gaps. Following recommendations of CDSS should improve quality of colorectal cancer screening.

Patient, Primary Care Provider, and Specialist Perspectives on Specialty Care Coordination in an Integrated Health Care System.

PubMed

Vimalananda, Varsha G; Dvorin, Kelly; Fincke, B Graeme; Tardiff, Nicole; Bokhour, Barbara G

Successful coordination of specialty care requires understanding the perspectives of patients, primary care providers, and specialists-that is, the specialty care "triad." This study used qualitative methods to compare these perspectives in an integrated health care system, using diabetes specialty care as an exemplar. Primary care providers and endocrinologists relied on interclinician relationships to coordinate care. Clinicians rarely included patients or other staff in their conceptualization of specialty care coordination. Patients often assumed responsibility for specialty care coordination but struggled to succeed. We identified several opportunities to improve coordination across the triad. In an integrated medical system, the shared organizational structure can facilitate these efforts.

Vertical viewing angle enhancement for the 360  degree integral-floating display using an anamorphic optic system.

PubMed

Erdenebat, Munkh-Uchral; Kwon, Ki-Chul; Yoo, Kwan-Hee; Baasantseren, Ganbat; Park, Jae-Hyeung; Kim, Eun-Soo; Kim, Nam

2014-04-15

We propose a 360 degree integral-floating display with an enhanced vertical viewing angle. The system projects two-dimensional elemental image arrays via a high-speed digital micromirror device projector and reconstructs them into 3D perspectives with a lens array. Double floating lenses relate initial 3D perspectives to the center of a vertically curved convex mirror. The anamorphic optic system tailors the initial 3D perspectives horizontally and vertically disperse light rays more widely. By the proposed method, the entire 3D image provides both monocular and binocular depth cues, a full-parallax demonstration with high-angular ray density and an enhanced vertical viewing angle.

Appropriateness for Total Joint Replacement: Perspectives of Decision-Makers

PubMed Central

Clavel, Nathalie; De coster, Carolyn; Pomey, Marie-Pascale; Sanmartin, Claudia; Bohm, Éric; Dunbar, Michael J.; Frank, CY; Hawker, Gillian; Noseworthy, Tom

2016-01-01

Background: Improving access to total joint replacement (TJR) has been a priority. Without robust mechanisms to ensure appropriateness, these procedures may be overused, incurring substantial costs. In that context, decision-makers are particularly concerned with the appropriateness of TJR. Objective: While our previous research focused on the appropriateness of TJR from clinical and patient perspectives, this study is aimed at understanding decision-makers' perspectives. Methods: Using a semi-structured guide, we interviewed a convenience sample of decision-makers in four Canadian provinces (Alberta, Manitoba, Nova Scotia and Quebec) between February and March 2013. For the purposes of this study, a decision-maker was defined as a manager, institutional leader or policy maker. Results: Fifteen interviews were conducted with decision-makers at ministry (n = 3), regional (n = 6) and institutional levels (n = 8). Decision-makers see themselves as having a key role in the appropriateness discourse, that of optimizing resource allocation and efficient delivery of services for TJR, to improve population outcomes. Conclusion: The decision-makers' view of appropriateness recognizes the importance of the clinical view, but it offers a very different input into the appropriateness discourse, more closely aligned with appropriateness of setting, which refers to cost-effectiveness considerations. PMID:27027795

Changes in dispositional empathy in American college students over time: a meta-analysis.

PubMed

Konrath, Sara H; O'Brien, Edward H; Hsing, Courtney

2011-05-01

The current study examines changes over time in a commonly used measure of dispositional empathy. A cross-temporal meta-analysis was conducted on 72 samples of American college students who completed at least one of the four subscales (Empathic Concern, Perspective Taking, Fantasy, and Personal Distress) of the Interpersonal Reactivity Index (IRI) between 1979 and 2009 (total N = 13,737). Overall, the authors found changes in the most prototypically empathic subscales of the IRI: Empathic Concern was most sharply dropping, followed by Perspective Taking. The IRI Fantasy and Personal Distress subscales exhibited no changes over time. Additional analyses found that the declines in Perspective Taking and Empathic Concern are relatively recent phenomena and are most pronounced in samples from after 2000.

Role of intestinal flora in colorectal cancer from the metabolite perspective: a systematic review

PubMed Central

Han, Shuwen; Gao, Jianlan; Zhou, Qing; Liu, Shanshan; Wen, Caixia

2018-01-01

Colorectal cancer is one of the most common human malignant tumors. Recent research has shown that colorectal cancer is a dysbacteriosis-induced disease; however, the role of intestinal bacteria in colorectal cancer is unclear. This review explores the role of intestinal flora in colorectal cancer. In total, 57 articles were included after identification and screening. The pertinent literature on floral metabolites in colorectal cancer from three metabolic perspectives – including carbohydrate, lipid, and amino acid metabolism – was analyzed. An association network regarding the role of intestinal flora from a metabolic perspective was constructed by analyzing the previous literature to provide direction and insight for further research on intestinal flora in colorectal cancer. PMID:29440929

Symbolic and Interactional Perspectives on Leadership: An Integrative Framework.

DTIC Science & Technology

1985-05-01

RD-RI55 24? SYMBOLIC AND INTERACTIONAL PERSPECTIVES ON LEADERSHIP: 1/1 AN INTEGRATIVE FRA..(U) TEXAS A AND M UNIV COLLEGE STATION DEPT OF MANAGEMENT...Processing Systems Office of Naval Research Technical Report Series Symbolic and Interactional 11% Perspectives on Leadership: An Integrative Framework...Richard Daft -~ and Ricky Griffin CAs * Principal Investigators IThi. dmmu asbom apro 1W ~ ~ 1W ~ w 4 d a% f dkbsa Symbolic and Interactional Perspectives

[Quality of case allocation of orthopedics and trauma surgery in the 2004 and 2014 versions of the German DRG system. An interim assessment of the development process].

PubMed

Franz, D; Schemmann, F; Selter, D D; Auhuber, T; Gehweiler, D; Roeder, N; Siebert, H; Mahlke, L

2014-10-01

Since 2004 the German diagnosis-related groups (DRG) system has been applied nationwide in all German somatic hospitals. The G-DRG system is updated annually in order to increase the quality of case allocation. What developments have occurred since 2004 from the perspective of orthopedics and trauma surgery? This article takes stock of the developments between 2004 and 2014. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2004 and 2014 based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). The number of G-DRGs in the whole system increased by 45.1 % between 2004 and 2014. The number of G-DRGs in the major diagnostic category (MDC) 08 that contains the majority of orthopedic and trauma surgery categories increased in the same period by 61.6 %. The reduction of variance of inlier costs in the MDC 08 category, a statistical measure of the performance of the G-DRG system, was below the corresponding value of the total system in 2004 as well in 2014. However, the reduction of variance of inlier costs in MDC 08 (+ 30.0 %) rose more from 2004 to 2014 than the corresponding value of the overall system (+ 21.5 %). Many modifications of the classification systems of diagnoses (ICD-10-GM) and medical procedures (OPS) and the structures of the G-DRG system could significantly improve the quality of case allocation from the perspective of orthopedics and trauma surgery between 2004 and 2014. Th assignment of cases could be differentiated so that complex cases with more utilization of resources were allocated to higher rated G-DRGs and vice versa. However, further improvements of the G-DRG system are necessary. Only correct and complete documentation and coding can provide a high quality of calculation of costs as a basis for a correct case allocation in future G-DRG systems.

Evaluating the accuracy of the Wechsler Memory Scale-Fourth Edition (WMS-IV) logical memory embedded validity index for detecting invalid test performance.

PubMed

Soble, Jason R; Bain, Kathleen M; Bailey, K Chase; Kirton, Joshua W; Marceaux, Janice C; Critchfield, Edan A; McCoy, Karin J M; O'Rourke, Justin J F

2018-01-08

Embedded performance validity tests (PVTs) allow for continuous assessment of invalid performance throughout neuropsychological test batteries. This study evaluated the utility of the Wechsler Memory Scale-Fourth Edition (WMS-IV) Logical Memory (LM) Recognition score as an embedded PVT using the Advanced Clinical Solutions (ACS) for WAIS-IV/WMS-IV Effort System. This mixed clinical sample was comprised of 97 total participants, 71 of whom were classified as valid and 26 as invalid based on three well-validated, freestanding criterion PVTs. Overall, the LM embedded PVT demonstrated poor concordance with the criterion PVTs and unacceptable psychometric properties using ACS validity base rates (42% sensitivity/79% specificity). Moreover, 15-39% of participants obtained an invalid ACS base rate despite having a normatively-intact age-corrected LM Recognition total score. Receiving operating characteristic curve analysis revealed a Recognition total score cutoff of < 61% correct improved specificity (92%) while sensitivity remained weak (31%). Thus, results indicated the LM Recognition embedded PVT is not appropriate for use from an evidence-based perspective, and that clinicians may be faced with reconciling how a normatively intact cognitive performance on the Recognition subtest could simultaneously reflect invalid performance validity.

Fluid Intelligence as a Mediator of the Relationship between Executive Control and Balanced Time Perspective.

PubMed

Zajenkowski, Marcin; Stolarski, Maciej; Witowska, Joanna; Maciantowicz, Oliwia; Łowicki, Paweł

2016-01-01

This study examined the cognitive foundations of the balanced time perspective (BTP) proposed by Zimbardo and Boyd (1999). Although BTP is defined as the mental ability to switch effectively between different temporal perspectives, its connection with cognitive functioning has not yet been established. We addressed this by exploring the relationships between time perspectives and both fluid intelligence (measured with Raven's and Cattell's tests) and executive control (Go/No-go and anti-saccade tasks). An investigation conducted among Polish adults ( N = 233) revealed that more balanced TP profile was associated with higher fluid intelligence, and higher executive control. Moreover, we found that the relationship between executive control and BTP was completely mediated by fluid intelligence with the effect size (the ratio of the indirect effect to the total effect) of 0.75, which suggests that cognitive abilities play an important role in adoption of temporal balance. The findings have relevance to time perspective theory as they provide valuable insight into the mechanisms involved in assigning human experience to certain time frames.

Using the Family Autobiography in School Counselor Preparation: An Introduction to a Systemic Perspective

ERIC Educational Resources Information Center

Holcomb-McCoy, Cheryl

2004-01-01

School counseling professionals are recognizing the need to address family issues as an intervention strategy with children. Counselor educators can assist school counselor trainees in understanding the family systems' perspective by using the family autobiography as a course requirement. This article presents a description of the family…

Survey of Spouse Abuse Shelters: A Family Systems Perspective.

ERIC Educational Resources Information Center

Lindegren, Tina M.

Traditional psychological theories which focus on the pathological tendencies of the individual account for little of the reported widespread spouse abuse. Social exchange and general systems theories focus on problems in the relationship rather than problems in the person. Given that a family perspective may be helpful in long-term treatment of…

School Engagement and Positive Youth Development: A Relational Developmental Systems Perspective

ERIC Educational Resources Information Center

Li, Yibing; Agans, Jennifer P.; Chase, Paul A.; Arbeit, Miriam R.; Weiner, Michelle B.; Lerner, Richard M.

2014-01-01

This chapter explains the links between relational developmental systems theory and the strength-based, positive youth development (PYD) perspective. The Five Cs model of PYD (involving competence, confidence, connection, character, and caring) is used to assess the role of school engagement in PYD. [This article originally appeared as NSSE…

Bilingual Education in New York City.

ERIC Educational Resources Information Center

Jenkins, Mary

This report attempts to place in perspective the position of bilingual education in New York City. It is divided into the following sections: (1) Bilingual Education--A Historical Perspective, (2) The Puerto Rican Child in the New York City School System, (3) Bilingual Education in the New York City School System, (4) Funding for Bilingual…

Intimate Relationships among Adolescent Romantic Partners and Same-Sex Friends: Individual and Systemic Perspectives.

ERIC Educational Resources Information Center

Shulman, Shmuel; Levy-Shiff, Rachel; Kedem, Peri; Alon, Eiton

1997-01-01

Examined adolescent intimacy in close friendships and romantic relationships from a systemic perspective. Found qualitative sex-related differences in how partners balance closeness and individuality in the two types of close friendships. Development of an intimate romantic relationship was also found to require greater commitment for males than…

A Simulation-Based Approach for Teaching the Systems Perspective of Strategic Performance Management

ERIC Educational Resources Information Center

Capelo, Carlos; Lopes, Ana; Mata, Ana

2015-01-01

Kaplan and Norton introduced the balanced scorecard (BSC), which is based on a systems perspective of the business strategy and performance measurement. Many organisations around the world use the BSC to define, implement and manage strategy. Nevertheless, there are studies that identify problems and limitations associated with the implementation…

Embracing Connectedness and Change: A Complex Dynamic Systems Perspective for Applied Linguistic Research

ERIC Educational Resources Information Center

Cameron, Lynne

2015-01-01

Complex dynamic systems (CDS) theory offers a powerful metaphorical model of applied linguistic processes, allowing holistic descriptions of situated phenomena, and addressing the connectedness and change that often characterise issues in our field. A recent study of Kenyan conflict transformation illustrates application of a CDS perspective. Key…

A Complex Dynamic Systems Perspective on Identity and Its Development: The Dynamic Systems Model of Role Identity

ERIC Educational Resources Information Center

Kaplan, Avi; Garner, Joanna K.

2017-01-01

Current prominent models of identity face challenges in bridging across divergent perspectives and apparent dichotomies such as personal or social-collective, conscious or unconscious, and epigenetic or discursive-relational, and affording pursuit of research questions that allows integrative answers. This article presents a coherent theoretical…

The substantative knowledge base for travel and tourism: a systems model

Treesearch

David S. Solan

1992-01-01

Strategies for education and professional preparation in travel and tourism have generally been based in traditional tourism-related disciplines providing somewhat narrow perspectives of the tourism phenomenon. The need exists for models that provide comprehensive, holistic perspectives of travel and tourism. This paper presents one such systems model showing that...

Christian Education in Chile: Is the Seventh-Day Adventist System at Risk?

ERIC Educational Resources Information Center

Grajales G., Tevni; Leon V., Vicente H.; Elias, Galiya

2010-01-01

Diverse perspectives with respect to Christian Education constitute a potential path for misunderstanding and contradictions; this study considers this situation in the context of a Seventh-day Adventist Christian system with students and parents from different religious perspectives in Chile. The parents/sponsors of the eighth graders were…

The economic impact of assisted reproductive technology: a review of selected developed countries.

PubMed

Chambers, Georgina M; Sullivan, Elizabeth A; Ishihara, Osamu; Chapman, Michael G; Adamson, G David

2009-06-01

To compare regulatory and economic aspects of assisted reproductive technologies (ART) in developed countries. Comparative policy and economic analysis. Couples undergoing ART treatment in the United States, Canada, United Kingdom, Scandinavia, Japan, and Australia. Description of regulatory and financing arrangements, cycle costs, cost-effectiveness ratios, total expenditure, utilization, and price elasticity. Regulation and financing of ART share few general characteristics in developed countries. The cost of treatment reflects the costliness of the underlying healthcare system rather than the regulatory or funding environment. The cost (in 2006 United States dollars) of a standard IVF cycle ranged from $12,513 in the United States to $3,956 in Japan. The cost per live birth was highest in the United States and United Kingdom ($41,132 and $40,364, respectively) and lowest in Scandinavia and Japan ($24,485 and $24,329, respectively). The cost of an IVF cycle after government subsidization ranged from 50% of annual disposable income in the United States to 6% in Australia. The cost of ART treatment did not exceed 0.25% of total healthcare expenditure in any country. Australia and Scandinavia were the only country/region to reach levels of utilization approximating demand, with North America meeting only 24% of estimated demand. Demand displayed variable price elasticity. Assisted reproductive technology is expensive from a patient perspective but not from a societal perspective. Only countries with funding arrangements that minimize out-of-pocket expenses met expected demand. Funding mechanisms should maximize efficiency and equity of access while minimizing the potential harm from multiple births.

COMSAC: Computational Methods for Stability and Control. Part 1

NASA Technical Reports Server (NTRS)

Fremaux, C. Michael (Compiler); Hall, Robert M. (Compiler)

2004-01-01

Work on stability and control included the following reports:Introductory Remarks; Introduction to Computational Methods for Stability and Control (COMSAC); Stability & Control Challenges for COMSAC: a NASA Langley Perspective; Emerging CFD Capabilities and Outlook A NASA Langley Perspective; The Role for Computational Fluid Dynamics for Stability and Control:Is it Time?; Northrop Grumman Perspective on COMSAC; Boeing Integrated Defense Systems Perspective on COMSAC; Computational Methods in Stability and Control:WPAFB Perspective; Perspective: Raytheon Aircraft Company; A Greybeard's View of the State of Aerodynamic Prediction; Computational Methods for Stability and Control: A Perspective; Boeing TacAir Stability and Control Issues for Computational Fluid Dynamics; NAVAIR S&C Issues for CFD; An S&C Perspective on CFD; Issues, Challenges & Payoffs: A Boeing User s Perspective on CFD for S&C; and Stability and Control in Computational Simulations for Conceptual and Preliminary Design: the Past, Today, and Future?

The spectrum of ethical issues in a Learning Health Care System: a systematic qualitative review.

PubMed

McLennan, Stuart; Kahrass, Hannes; Wieschowski, Susanne; Strech, Daniel; Langhof, Holger

2018-04-01

To determine systematically the spectrum of ethical issues that is raised for stakeholders in a 'Learning Health Care System' (LHCS). The systematic review was conducted in PubMed and Google Books between the years 2007 and 2015. The literature search retrieved 1258 publications. Each publication was independently screened by two reviewers for eligibility for inclusion. Ethical issues were defined as arising when a relevant normative principle is not adequately considered or two principles come into conflict. A total of 65 publications were included in the final analysis and were analysed using an adapted version of qualitative content analysis. A coding frame was developed inductively from the data, only the highest-level categories were generated deductively for a life-cycle perspective. A total of 67 distinct ethical issues could be categorized under different phases of the LHCS life-cycle. An overarching theme that was repeatedly raised was the conflict between the current regulatory system and learning health care. The implementation of a LHCS can help realize the ethical imperative to continuously improve the quality of health care. However, the implementation of a LHCS can also raise a number of important ethical issues itself. This review highlights the importance for health care leaders and policy makers to balance the need to protect and respect individual participants involved in learning health care activities with the social value of improving health care.

Modelling the resource implications and budget impact of managing cow milk allergy in Australia.

PubMed

Guest, J F; Nagy, E

2009-02-01

To estimate the resource implications and budget impact of current clinical practice for managing cow milk allergy (CMA) in Australia, from the perspective of the publicly funded healthcare system. A decision model was constructed using published clinical outcomes and clinician-derived resource utilisation estimates. The model was used to estimate the expected 6-monthly levels of healthcare resource use and corresponding costs attributable to managing 6150 new CMA sufferers following referral to a specialist. The expected 6-monthly costs of managing 6150 newly-diagnosed infants with CMA following referral to a specialist was an estimated (Australian dollars, AU$) AU$6.5 million at 2006/07 prices. Clinical nutrition preparations were found to be the primary cost driver accounting for 62% of the total 6-monthly cost and clinician visits were the secondary cost driver accounting for up to a further 28% of the total 6-monthly cost. Sensitivity analysis showed there would be fewer visits to hospital-based paediatric gastroenterologists and paediatric immunologists/allergists if all newly-diagnosed patients were prescribed an amino acid formula (AAF) following referral to a specialist, instead of being managed according to current practice. CMA imposes a substantial burden on the publicly funded healthcare system in Australia. However, using an AAF as the initial treatment for CMA can potentially release limited hospital resources for alternative use within the paediatric healthcare system.

Facing Global Challenges: A European University Perspective. Policy Perspectives

ERIC Educational Resources Information Center

Swail, Watson Scott

2014-01-01

This EPI Policy Perspectives covers a presentation given at the European University Association Annual Convention (March 20, 2009, in Prague, Czech Republic) that addresses the Bologna process in the European Union. The process raised many questions regarding the role of the university, and the entire tertiary/postsecondary system of education.…

Authentic Education, the Deeper and Multidisciplinary Perspective of Education, from the Viewpoint of Analytical Psychology

ERIC Educational Resources Information Center

Watagodakumbura, Chandana

2014-01-01

In this paper, the authentic education system defined with multidisciplinary perspectives (Watagodakumbura, 2013a, 2013b) is viewed from an additional perspective of analytical psychology. Analytical psychology provides insights into human development and is becoming more and more popular among practicing psychologist in the recent past. In…

Eportfolio Adoption's Mediating Influence on Faculty Perspectives: An Activity Theory View

ERIC Educational Resources Information Center

Thomas, Jonathan M.

2017-01-01

A case-comparative mixed methods approach was used to discover how faculty members' teaching perspectives changed as they adopted an eportfolio tool (Pathbrite). Ten faculty members took the Teaching Perspectives Inventory (TPI) before and after using the tool during Fall semester 2015. Also, systems logs were collected and interviews were…

Parent Perspectives on Community Mental Health Services for Children with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Brookman-Frazee, Lauren; Baker-Ericzen, Mary; Stadnick, Nicole; Taylor, Robin

2012-01-01

The community mental health (CMH) system provides treatment for behavioral and psychiatric problems in children with autism spectrum disorders (ASD). Although parent stakeholder perspectives are important to improving care, these perspectives have not been systematically examined for this population in the CMH sector. Twenty-one semi-structured…

Developing Foreign Language Curriculum in the Total School Setting: The Macro-Picture. The ACTFL Foreign Language Education Series, Vol. 10.

ERIC Educational Resources Information Center

Zais, Robert S.

Four broad questions are addressed in this consideration of foreign language study in the total school setting. The first part deals with the broad perspective that is needed in order to integrate the educational enterprise and to form a community of educators each with a special contribution to make. Some considerations relevant to this question…

Arctic tipping points in an Earth system perspective.

PubMed

Wassmann, Paul; Lenton, Timothy M

2012-02-01

We provide an introduction to the volume The Arctic in the Earth System perspective: the role of tipping points. The terms tipping point and tipping element are described and their role in current science, general debates, and the Arctic are elucidated. From a wider perspective, the volume focuses upon the role of humans in the Arctic component of the Earth system and in particular the envelope for human existence, the Arctic ecosystems. The Arctic climate tipping elements, the tipping elements in Arctic ecosystems and societies, and the challenges of governance and anticipation are illuminated through short summaries of eight publications that derive from the Arctic Frontiers conference in 2011 and the EU FP7 project Arctic Tipping Points. Then some ideas based upon resilience thinking are developed to show how wise system management could ease pressures on Arctic systems in order to keep them away from tipping points.

A Global Perspective on Drinking-Water and Sanitation Classification: An Evaluation of Census Content

PubMed Central

Yu, Weiyu; Wardrop, Nicola A.; Bain, Robert E. S.; Lin, Yanzhao; Zhang, Ce; Wright, Jim A.

2016-01-01

Following the recent expiry of the United Nations’ 2015 Millennium Development Goals (MDGs), new international development agenda covering 2030 water, sanitation and hygiene (WASH) targets have been proposed, which imply new demands on data sources for monitoring relevant progress. This study evaluates drinking-water and sanitation classification systems from national census questionnaire content, based upon the most recent international policy changes, to examine national population census’s ability to capture drinking-water and sanitation availability, safety, accessibility, and sustainability. In total, 247 censuses from 83 low income and lower-middle income countries were assessed using a scoring system, intended to assess harmonised water supply and sanitation classification systems for each census relative to the typology needed to monitor the proposed post-2015 indicators of WASH targets. The results signal a lack of international harmonisation and standardisation in census categorisation systems, especially concerning safety, accessibility, and sustainability of services in current census content. This suggests further refinements and harmonisation of future census content may be necessary to reflect ambitions for post-2015 monitoring. PMID:26986472

Analysis of Factors for Incorporating User Preferences in Air Traffic Management: A system Perspective

NASA Technical Reports Server (NTRS)

Sheth, Kapil S.; Gutierrez-Nolasco, Sebastian

2010-01-01

This paper presents an analysis of factors that impact user flight schedules during air traffic congestion. In pre-departure flight planning, users file one route per flight, which often leads to increased delays, inefficient airspace utilization, and exclusion of user flight preferences. In this paper, first the idea of filing alternate routes and providing priorities on each of those routes is introduced. Then, the impact of varying planning interval and system imposed departure delay increment is discussed. The metrics of total delay and equity are used for analyzing the impact of these factors on increased traffic and on different users. The results are shown for four cases, with and without the optional routes and priority assignments. Results demonstrate that adding priorities to optional routes further improves system performance compared to filing one route per flight and using first-come first-served scheme. It was also observed that a two-hour planning interval with a five-minute system imposed departure delay increment results in highest delay reduction. The trend holds for a scenario with increased traffic.

A Global Perspective on Drinking-Water and Sanitation Classification: An Evaluation of Census Content.

PubMed

Yu, Weiyu; Wardrop, Nicola A; Bain, Robert E S; Lin, Yanzhao; Zhang, Ce; Wright, Jim A

2016-01-01

Following the recent expiry of the United Nations' 2015 Millennium Development Goals (MDGs), new international development agenda covering 2030 water, sanitation and hygiene (WASH) targets have been proposed, which imply new demands on data sources for monitoring relevant progress. This study evaluates drinking-water and sanitation classification systems from national census questionnaire content, based upon the most recent international policy changes, to examine national population census's ability to capture drinking-water and sanitation availability, safety, accessibility, and sustainability. In total, 247 censuses from 83 low income and lower-middle income countries were assessed using a scoring system, intended to assess harmonised water supply and sanitation classification systems for each census relative to the typology needed to monitor the proposed post-2015 indicators of WASH targets. The results signal a lack of international harmonisation and standardisation in census categorisation systems, especially concerning safety, accessibility, and sustainability of services in current census content. This suggests further refinements and harmonisation of future census content may be necessary to reflect ambitions for post-2015 monitoring.

Effect of physician perspective on allocation of Medicare resources for patients with advanced cancer.

PubMed

Rocke, Daniel J; Beumer, Halton W; Thomas, Steven; Lee, Walter T

2014-05-01

To assess how physician perspective (perspective of patient vs perspective of physician) affects Medicare resource allocation for patients with advanced cancer and compare physician allocations with actual cancer patient and caregiver allocations. Cross-sectional assessment. National assessment. Otolaryngologists. Physicians used a validated tool to create a Medicare plan for patients with advanced cancer. Participants took the perspective of an advanced cancer patient and made resource allocations between 15 benefit categories (assessment 2, November/December 2012). Results were compared with data from a prior assessment made from a physician's perspective (assessment 1, February/March 2012) and with data from a separate study with patients with cancer and caregivers. In total, 767 physicians completed assessment 1 and 237 completed assessment 2. Results were compared with 146 cancer patient and 114 caregiver assessments. Assessment 1 physician responses differed significantly from patients/caregivers in 14 categories (P < .05), while assessment 2 differed in 11. When comparing physician data, assessment 2 allocations differed significantly from assessment 1 in 7 categories. When these 7 categories were compared with patient/caregiver data, assessment 2 allocations in emotional care, drug coverage, and nursing facility categories were not significantly different. Assessment 1 allocations in cosmetic care, dental, home care, and primary care categories were more similar to patient/caregiver preferences, although all but home care were still significantly different. Otolaryngology-head and neck surgery physician perspectives on end-of-life care differ significantly from cancer patient/caregiver perspectives, even when physicians take a patient's perspective when allocating resources. This demonstrates the challenges inherent in end-of-life discussions.

Early Components of the Complement Classical Activation Pathway in Human Systemic Autoimmune Diseases

PubMed Central

Lintner, Katherine E.; Wu, Yee Ling; Yang, Yan; Spencer, Charles H.; Hauptmann, Georges; Hebert, Lee A.; Atkinson, John P.; Yu, C. Yung

2016-01-01

The complement system consists of effector proteins, regulators, and receptors that participate in host defense against pathogens. Activation of the complement system, via the classical pathway (CP), has long been recognized in immune complex-mediated tissue injury, most notably systemic lupus erythematosus (SLE). Paradoxically, a complete deficiency of an early component of the CP, as evidenced by homozygous genetic deficiencies reported in human, are strongly associated with the risk of developing SLE or a lupus-like disease. Similarly, isotype deficiency attributable to a gene copy-number (GCN) variation and/or the presence of autoantibodies directed against a CP component or a regulatory protein that result in an acquired deficiency are relatively common in SLE patients. Applying accurate assay methodologies with rigorous data validations, low GCNs of total C4, and heterozygous and homozygous deficiencies of C4A have been shown as medium to large effect size risk factors, while high copy numbers of total C4 or C4A as prevalent protective factors, of European and East-Asian SLE. Here, we summarize the current knowledge related to genetic deficiency and insufficiency, and acquired protein deficiencies for C1q, C1r, C1s, C4A/C4B, and C2 in disease pathogenesis and prognosis of SLE, and, briefly, for other systemic autoimmune diseases. As the complement system is increasingly found to be associated with autoimmune diseases and immune-mediated diseases, it has become an attractive therapeutic target. We highlight the recent developments and offer a balanced perspective concerning future investigations and therapeutic applications with a focus on early components of the CP in human systemic autoimmune diseases. PMID:26913032

Perspectives of displaced Syrian women and service providers on fertility behaviour and available services in West Bekaa, Lebanon.

PubMed

Kabakian-Khasholian, Tamar; Mourtada, Rima; Bashour, Hyam; Kak, Faysal El; Zurayk, Huda

2017-10-01

Prior to the conflict, Syria had relatively high fertility rates. In 2010, it had the sixth highest total fertility rate in the Arab World, but it witnessed a fertility decline before the conflict in 2011. Displacement during conflict influences fertility behaviour, and meeting the contraceptive needs of displaced populations is complex. This study explored the perspectives of women and service providers about fertility behaviour of and service provision to Syrian refugee women in Bekaa, Lebanon. We used qualitative methodology to conduct 12 focus group discussions with Syrian refugee women grouped in different age categories and 13 in-depth interviews with care providers from the same region. Our findings indicate that the displacement of Syrians to Lebanon had implications on the fertility behaviour of the participants. Women brought their beliefs about preferred family size and norms about decision-making into an environment where they were exposed to both aid and hardship. The unaffordability of contraceptives in the Lebanese privatised health system compared to their free provision in Syria limited access to family planning services. Efforts are needed to maintain health resources and monitor health needs of the refugee population in order to improve access and use of services.

Importance-satisfaction analysis for primary care physicians' perspective on EHRs in Taiwan.

PubMed

Ho, Cheng-Hsun; Wene, Hsyien-Chia; Chu, Chi-Ming; Wu, Yi-Syuan; Wang, Jen-Leng

2014-06-06

The Taiwan government has been promoting Electronic Health Records (EHRs) to primary care physicians. How to extend EHRs adoption rate by measuring physicians' perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale). The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance), 4.12, 3.51 (product effectiveness), 4.10, 3.31 (system function) and 4.34, 3.70 (customer service) respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians.

Aspects of Equality in Mandatory Partnerships - From the Perspective of Municipal Care in Norway.

PubMed

Kirchhoff, Ralf; Ljunggren, Birgitte

2016-05-18

This paper raises questions about equality in partnerships, since imbalance in partnerships may effect collaboration outcomes in integrated care. We address aspects of equality in mandatory, public-public partnerships, from the perspective of municipal care. We have developed a questionnaire wherein the Norwegian Coordination Reform is an illustrative example. The following research question is addressed: What equality dimensions are important for municipals related to mandatory partnerships with hospitals? Since we did not find any instrument to measure equality in partnerships, an explorative design was chosen. The development of the instrument was based on the theory on partnership and knowledge about the field and context. A national online survey was emitted to all 429 Norwegian municipalities in 2013. The response rate was in total 58 percent (n = 248). The data were mainly analysed using Principal component analysis. It seems that the two dimensions "learning and expertise equality" and "contractual equality" collects reliable and valid data to measure aspects of equality in partnerships. Partnerships are usually based on voluntarism. The results indicate that mandatory partnerships, within a public health care system, can be appropriate to equalize partnerships between health care providers at different care levels.

Online surveillance of media health event reporting in Nepal: digital disease detection from a One Health perspective.

PubMed

Schwind, Jessica S; Norman, Stephanie A; Karmacharya, Dibesh; Wolking, David J; Dixit, Sameer M; Rajbhandari, Rajesh M; Mekaru, Sumiko R; Brownstein, John S

2017-09-21

Traditional media and the internet are crucial sources of health information. Media can significantly shape public opinion, knowledge and understanding of emerging and endemic health threats. As digital communication rapidly progresses, local access and dissemination of health information contribute significantly to global disease detection and reporting. Health event reports in Nepal (October 2013-December 2014) were used to characterize Nepal's media environment from a One Health perspective using HealthMap - a global online disease surveillance and mapping tool. Event variables (location, media source type, disease or risk factor of interest, and affected species) were extracted from HealthMap. A total of 179 health reports were captured from various sources including newspapers, inter-government agency bulletins, individual reports, and trade websites, yielding 108 (60%) unique articles. Human health events were reported most often (n = 85; 79%), followed by animal health events (n = 23; 21%), with no reports focused solely on environmental health. By expanding event coverage across all of the health sectors, media in developing countries could play a crucial role in national risk communication efforts and could enhance early warning systems for disasters and disease outbreaks.

Future sensor system needs for staring arrays

NASA Astrophysics Data System (ADS)

Miller, John Lester

2011-05-01

This is a systems application paper regarding how sensor systems may use future technology FPAs. A historical perspective is discussed along with lessons learned from previous technologies. Future system requirements for strained super-lattice (SLS), quantum dots (QDOT) and traditional quantum well infrared photo-diodes (QWIP) arrays will be presented from both a commercial and military perspective. New potential markets will open up in the future if certain FPA technologies can reduce cost and provide higher sensitivities at higher operating temperatures.

High fructose corn syrup and diabetes prevalence: a global perspective.

PubMed

Goran, Michael I; Ulijaszek, Stanley J; Ventura, Emily E

2013-01-01

The overall aim of this study was to evaluate, from a global and ecological perspective, the relationships between availability of high fructose corn syrup (HFCS) and prevalence of type 2 diabetes. Using published resources, country-level estimates (n =43 countries) were obtained for: total sugar, HFCS and total calorie availability, obesity, two separate prevalence estimates for diabetes, prevalence estimate for impaired glucose tolerance and fasting plasma glucose. Pearson's correlations and partial correlations were conducted in order to explore associations between dietary availability and obesity and diabetes prevalence. Diabetes prevalence was 20% higher in countries with higher availability of HFCS compared to countries with low availability, and these differences were retained or strengthened after adjusting for country-level estimates of body mass index (BMI), population and gross domestic product (adjusted diabetes prevalence=8.0 vs. 6.7%, p=0.03; fasting plasma glucose=5.34 vs. 5.22 mmol/L, p=0.03) despite similarities in obesity and total sugar and calorie availability. These results suggest that countries with higher availability of HFCS have a higher prevalence of type 2 diabetes independent of obesity.

Cost implication of irrational prescribing of chloroquine in Lagos State general hospitals.

PubMed

Aina, Bolajoko A; Tayo, Fola; Taylor, Ogori

2008-02-01

A major share of the hospital budget is spent on drugs. Irrational use of these drugs is a waste of financial and human resources that could have been deployed for another use within the hospital setting especially in cases where such drugs are provided free to patients. Also there is increased morbidity and progression of severity with irrational use. The objective of this study was to determine the irrational use of chloroquine and the subsequent cost implications in Lagos State general hospitals. A retrospective study period of one year (January to December, 2000) was selected. A total of 18,781 prescription forms of "Free Eko Malaria" were sampled for children and adults from all the Lagos State general hospitals. Drug costs in each prescription form were identified. Cost effectiveness analysis of chloroquine tablet and intramuscular injection was undertaken. The average cost of medicine per prescription was 132.071 ($1.03) which should have been 94.22 ($0.73) if prescribed rationally. The total cost of prescriptions for malaria under study was 2,480,425.00 ($19,348.09). About 68% {(1,679,444.00) ($13,100.19)} of the total cost was lost to irrational prescribing. This is a waste of scarce resources. When the prescriptions were differentiated into the different dosage forms prescribed, the prescriptions containing intramuscular injections only had over 90% of the cost lost to irrational prescribing. Cost effectiveness analysis showed that chloroquine tablet was 17 times more cost effective than chloroquine injection (intramuscular) from a health care system perspective while it was 14 times more cost effective from a patient perspective. There is waste of scarce resources with irrational dispensing of drugs and these resources could have been deployed to other uses or areas within the hospitals. The tablet chloroquine was more cost effective than injection chloroquine (intramuscular). Increasing the cost of tablets, decreasing effectiveness of tablets, decreasing the cost of injections and increasing the effectiveness of injections did not change the cost effectiveness conclusion.

Operationalising a social-ecological system perspective on the Arctic Ocean.

PubMed

Crépin, Anne-Sophie; Gren, Åsa; Engström, Gustav; Ospina, Daniel

2017-12-01

We propose a framework to support management that builds on a social-ecological system perspective on the Arctic Ocean. We illustrate the framework's application for two policy-relevant scenarios of climate-driven change, picturing a shift in zooplankton composition and alternatively a crab invasion. We analyse archetypical system dynamics between the socio-economic, the natural, and the governance systems in these scenarios. Our holistic approach can help managers identify looming problems arising from complex system interactions and prioritise among problems and solutions, even when available data are limited.

The effect of inertia on the Dirac electron, the spin Hall current and the momentum space Berry curvature

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

Chowdhury, Debashree, E-mail: debashreephys@gmail.com; Basu, B., E-mail: sribbasu@gmail.com

2013-02-15

We have studied the spin dependent force and the associated momentum space Berry curvature in an accelerating system. The results are derived by taking into consideration the non-relativistic limit of a generally covariant Dirac equation with an electromagnetic field present, where the methodology of the Foldy-Wouthuysen transformation is applied to achieve the non-relativistic limit. Spin currents appear due to the combined action of the external electric field, the crystal field and the induced inertial electric field via the total effective spin-orbit interaction. In an accelerating frame, the crucial role of momentum space Berry curvature in the spin dynamics has alsomore » been addressed from the perspective of spin Hall conductivity. For time dependent acceleration, the expression for the spin polarization has been derived. - Highlights: Black-Right-Pointing-Pointer We study the effect of acceleration on the Dirac electron in the presence of an electromagnetic field, where the acceleration induces an electric field. Black-Right-Pointing-Pointer Spin currents appear due to the total effective electric field via the total spin-orbit interaction. Black-Right-Pointing-Pointer We derive the expression for the spin dependent force and the spin Hall current, which is zero for a particular acceleration. Black-Right-Pointing-Pointer The role of the momentum space Berry curvature in an accelerating system is discussed. Black-Right-Pointing-Pointer An expression for the spin polarization for time dependent acceleration is derived.« less

Performance evaluation of Al-Zahra academic medical center based on Iran balanced scorecard model.

PubMed

Raeisi, Ahmad Reza; Yarmohammadian, Mohammad Hossein; Bakhsh, Roghayeh Mohammadi; Gangi, Hamid

2012-01-01

Growth and development in any country's national health system, without an efficient evaluation system, lacks the basic concepts and tools necessary for fulfilling the system's goals. The balanced scorecard (BSC) is a technique widely used to measure the performance of an organization. The basic core of the BSC is guided by the organization's vision and strategies, which are the bases for the formation of four perspectives of BSC. The goal of this research is the performance evaluation of Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences, based on Iran BSC model. This is a combination (quantitative-qualitative) research which was done at Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences in 2011. The research populations were hospital managers at different levels. Sampling method was purposive sampling in which the key informed personnel participated in determining the performance indicators of hospital as the BSC team members in focused discussion groups. After determining the conceptual elements in focused discussion groups, the performance objectives (targets) and indicators of hospital were determined and sorted in perspectives by the group discussion participants. Following that, the performance indicators were calculated by the experts according to the predetermined objectives; then, the score of each indicator and the mean score of each perspective were calculated. Research findings included development of the organizational mission, vision, values, objectives, and strategies. The strategies agreed upon by the participants in the focus discussion group included five strategies, which were customer satisfaction, continuous quality improvement, development of human resources, supporting innovation, expansion of services and improving the productivity. Research participants also agreed upon four perspectives for the Al-Zahra hospital BSC. In the patients and community perspective (customer), two objectives and three indicators were agreed upon, with a mean score of 75.9%. In the internal process perspective, 4 objectives and 14 indicators were agreed upon, with a mean score of 79.37%. In the learning and growth perspective, four objectives and eight indicators were agreed upon, with a mean score of 81.11%. Finally, in the financial perspective, two objectives and five indicators were agreed upon, with a mean score of 67.15%. One way to create demand for hospital services is performance evaluation by paying close attention to all BSC perspectives, especially the non-financial perspectives such as customers and internal processes perspectives. In this study, the BSC showed the differences in performance level of the organization in different perspectives, which would assist the hospital managers improve their performance indicators. The learning and growth perspective obtained the highest score, and the financial perspective obtained the least score. Since the learning and growth perspective acts as a base for all other perspectives and they depend on it, hospitals must continuously improve the service processes and the quality of services by educating staff and updating their policies and procedures. This can increase customer satisfaction and productivity and finally improve the BSC in financial perspective.

A Systemic Perspective on School Reform: Principals' and Chief Education Officers' Perspectives on School Development

ERIC Educational Resources Information Center

Pyhalto, Kirsi; Soini, Tiina; Pietarinen, Janne

2011-01-01

Purpose: This study aims to gain better understanding of the perceptions comprehensive school principals and chief education officers have about the implementation of school reform and the means they use to facilitate the development of such. Design/methodology/approach: This research project was carried out using a systemic design research…

Teaching Standard Italian to Dialect Speakers: A Pedagogical Perspective of Linguistic Systems in Contact

ERIC Educational Resources Information Center

Danesi, Marcel

1974-01-01

The teaching of standard Italian to speakers of Italian dialects both in Italy and in North America is discussed, specifically through a specialized pedagogical program within the framework of a sociolinguistic and psycholinguistic perspective, and based on a structural analysis of linguistic systems in contact. Italian programs in Toronto are…

Defining, Assessing, and Promoting E-Learning Success: An Information Systems Perspective

ERIC Educational Resources Information Center

Holsapple, Clyde W.; Lee-Post, Anita

2006-01-01

This research advances the understanding of how to define, evaluate, and promote e-learning success from an information systems perspective. It introduces the E-Learning Success Model, which posits that the overall success of an e-learning initiative depends on the attainment of success at each of the three stages of e-learning systems…

The Challenge of Multiple Perspectives: Multiple Solution Tasks for Students Incorporating Diverse Tools and Representation Systems

ERIC Educational Resources Information Center

Kordaki, Maria

2015-01-01

This study focuses on the role of multiple solution tasks (MST) incorporating multiple learning tools and representation systems (MTRS) in encouraging each student to develop multiple perspectives on the learning concepts under study and creativity of thought. Specifically, two types of MST were used, namely tasks that allowed and demanded…

Faculty and Administrator Perspectives of Merit Pay Compensation Systems in Private Higher Education: A Mixed Methods Analysis

ERIC Educational Resources Information Center

Power, Anne L.

2013-01-01

The purpose of this explanatory sequential mixed methods study is to explore faculty and administrator perspectives of faculty merit pay compensation systems in private, higher education institutions. The study focuses on 10 small, private, four-year institutions which are religiously affiliated. All institutions are located in Nebraska, Iowa, and…

The Current Ecosystem of Learning Management Systems in Higher Education: Student, Faculty, and IT Perspectives

ERIC Educational Resources Information Center

Dahlstrom, Eden; Brooks, D. Christopher; Bichsel, Jacqueline

2014-01-01

This study explores faculty and student perspectives on learning management systems (LMSs) in the context of current institutional investments. In 2013, nearly 800 institutions participated in the EDUCAUSE Core Data Service (CDS) survey, sharing their current information technology practices and metrics across all IT service domains. In 2014, more…

Silicon Valley's Processing Needs versus San Jose State University's Manufacturing Systems Processing Component: Implications for Industrial Technology

ERIC Educational Resources Information Center

Obi, Samuel C.

2004-01-01

Manufacturing professionals within universities tend to view manufacturing systems from a global perspective. This perspective tends to assume that manufacturing processes are employed equally in every manufacturing enterprise, irrespective of the geography and the needs of the people in those diverse regions. But in reality local and societal…

System Members at Odds: Managing Divergent Perspectives in the Higher Education Change Process

ERIC Educational Resources Information Center

Barnett, Kathy

2011-01-01

Achieving a shared vision is often cited as a prerequisite to successful organisational change. What change strategists do not take into consideration is how this concept applies to complex systems such as those found in higher education. This paper explores and identifies the divergent perspectives and meanings found among the multiplicity of…

Phase Transitions in Development of Writing Fluency from a Complex Dynamic Systems Perspective

ERIC Educational Resources Information Center

Baba, Kyoko; Nitta, Ryo

2014-01-01

This study explored patterns in L2 writing development by focusing on one of the linguistic features of texts (fluency) from a complex dynamic systems perspective. It investigated whether two English-as-a-foreign-language university students would experience discontinuous change (phase transition) in their writing fluency through repetition of a…

Comparing Public and Private Institutions That Have and Have Not Implemented Enterprise Resource Planning (ERP) Systems: A Resource Dependence Perspective

ERIC Educational Resources Information Center

Sendhil, Geetha R.

2012-01-01

The purpose of this national study was to utilize quantitative methods to examine institutional characteristics, financial resource variables, personnel variables, and customer variables of public and private institutions that have and have not implemented enterprise resource planning (ERP) systems, from a resource dependence perspective.…

Are Sojourners Natural Comparativists? Critical Perspectives on the Learning Experiences of International Students

ERIC Educational Resources Information Center

Schweisfurth, Michele

2012-01-01

Students who spend a period of time studying outside of their own national systems have a number of advantages in terms of developing a comparative perspective on education. The experience of living and studying abroad provides them with the opportunity to act as participant observers of at least two different systems, and the natural…

The Importance of Motor Functional Levels from the Activity Limitation Perspective of ICF in Children with Cerebral Palsy

ERIC Educational Resources Information Center

Mutlu, Akmer

2010-01-01

Our purpose in this study was to evaluate performance and capacity as defined by Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) from the "activity limitation" perspective of International Classification of Functioning, Disability, and Health (ICF) and to investigate the relationship between the…

Impact of orphan drugs on Latvian budget.

PubMed

Logviss, Konstantins; Krievins, Dainis; Purvina, Santa

2016-05-11

Number of orphan medicinal products on the market and number of rare disease patients, taking these usually expensive products, are increasing. As a result, budget impact of orphan drugs is growing. This factor, along with the cost-effectiveness of orphan drugs, is often considered in the reimbursement decisions, directly affecting accessibility of rare disease therapies. The current study aims to assess the budget impact of orphan drugs in Latvia. Our study covered a 5-year period, from 2010 to 2014. Impact of orphan drugs on Latvian budget was estimated from the National Health Service's perspective. It was calculated in absolute values and relative to total pharmaceutical market and total drug reimbursement budget. A literature review was performed for comparison with other European countries. Orphan drug annual expenditure ranged between EUR 2.065 and 3.065 million, with total 5-year expenditure EUR 12.467 million. It constituted, on average, 0.84 % of total pharmaceutical market and 2.14 % of total drug reimbursement budget, respectively. Average annual per patient expenditures varied widely, from EUR 1 534 to EUR 580 952. The most costly treatment was enzyme replacement therapy (Elaprase) for MPS II. Glivec had the highest share (34 %) of the total orphan drug expenditure. Oncological drugs represented more than a half of the total orphan drug expenditure, followed by drugs for metabolic and endocrine conditions and medicines for cardiopulmonary diseases. Three indications: Ph+ CML, MPS II, and PAH accounted for nearly 90 % of the total orphan drug expenditure. Budget impact of orphan drugs in Latvia is very small. It increased slightly over a period of five years, due to the slight increase in the number of patients and the number of orphan drugs reimbursed. Current Latvian drug reimbursement system is not sufficient for most orphan drugs.

A systems approach to water recovery testing for space life support - Initial biomedical results from the ECLSS Water Recovery Test and plans for testbed utilization

NASA Technical Reports Server (NTRS)

Aten, Laurie A.; Crump, William J.; Sauer, Richard L.

1992-01-01

Among the challenges of designing and constructing Space Station Freedom is the development of the water system. A review of past efforts in reclaiming waste water in enclosed environments reveals that there are many gaps in the biomedical understanding of this process. Some of the key uncertainties of human interaction with a closed water system include determining potential contaminants and establishing safe levels of multiple compounds in the enclosed system of Space Station. Another uncertainty is the microbial constituency of such a system and what impact it could have on crew health and performance. The use of iodine as the passive biocide may have both an indirect and direct impact on the crew. In this paper the initial results of the Water Recovery Test are reviewed from a biomedical perspective, revealing areas where more information is needed to develop the ECLSS water system. By including the approach of 'man as a subsystem', consideration is given to how man interacts with the total water system. Taking this systems approach to providing the crew with a safe source of water gives useful insight into the most efficient design and utilization of closed system testbeds.

Disability Policy Implementation From a Cross-Cultural Perspective.

PubMed

Verdugo, Miguel A; Jenaro, Cristina; Calvo, Isabel; Navas, Patricia

2017-07-01

Implementation of disability policy is influenced by social, political, and cultural factors. Based on published work, this article discusses four guidelines considered critical for successful policy implementation from a cross-cultural perspective. These guidelines are to: (a) base policy implementation on a contextual analysis, (b) employ a value-based approach, (c) align the service delivery system both vertically and horizontally, and (d) engage in a partnership in policy implementation. Public policy should be understood from a systems perspective that includes cross-cultural issues, such as how different stakeholders are acting and the way they plan and implement policy.

An Additional Way of Thinking about Organizational Life and Leadership: The Quantum Perspective

ERIC Educational Resources Information Center

Fris, Joe; Lazaridou, Angeliki

2006-01-01

In this paper our first purpose is to outline a way of thinking about organizations and administration that has recently been gaining ground among theoreticians and practitioners, one that is portrayed frequently as a replacement for the well established newtonian or systems perspective. This way of thinking is the quantum perspective. Our second…

Racism? Administrative and Community Perspectives in Data-Driven Decision Making: Systemic Perspectives versus Technical-Rational Perspectives

ERIC Educational Resources Information Center

Khalifa, Muhammad A.; Jennings, Michael E.; Briscoe, Felecia; Oleszweski, Ashley M.; Abdi, Nimo

2014-01-01

This case study describes tensions that became apparent between community members and school administrators after a proposal to close a historically African American public high school in a large urban Southwestern city. When members of the city's longstanding African American community responded with outrage, the school district's senior…

"We Were Sad and We Were Angry": A Systematic Review of Parents' Perspectives on Bullying

ERIC Educational Resources Information Center

Harcourt, Susan; Jasperse, Marieke; Green, Vanessa A.

2014-01-01

Background: The social-ecological systems perspective describes bullying as a complex social phenomenon, influenced by numerous social variables within a child's school, home, peer, and community environments. As such, it is important to gain the perspective of a wide range of stakeholders within these environments, in order to truly…

Alternative Theoretical Bases for the Study of Human Communication: The Rules Perspective.

ERIC Educational Resources Information Center

Cushman, Donald P.

Three potentially useful perspectives for the scientific development of human communication theory are the law model, the systems approach, and the rules paradigm. It is the purpose of this paper to indicate the utility of the rules perspective. For the purposes of this analysis, human communication is viewed as the successful transfer of symbolic…

Video Perspectivity Meets Wild and Crazy Teens: A Design Ethnography

ERIC Educational Resources Information Center

Goldman, Ricki

2004-01-01

This article is a digital video design ethnography describing the first phase of introducing a perspectivity meme into a classroom. A meme is an idea that spreads throughout a system. A perspectivity meme is the idea that people who share their viewpoints and interpretations will gradually affect role changes in the learning environment. They will…

A perspective on CELSS control issues

NASA Technical Reports Server (NTRS)

Blackwell, Ann L.

1990-01-01

Some issues of Closed Ecological Life Support System (CELSS) analysis and design are effectively addressed from a systems control perspective. CELSS system properties that may be elucidated using control theory in conjunction with mathematical and simulation modeling are enumerated. The approach that is being taken to the design of a control strategy for the Crop Growth Research Chamber (CGRC) and the relationship of that approach to CELSS plant growth unit subsystems control is described.

[Parents' and Children's Perspectives of Parental Mediation Strategies in Association with Children's Internet Skills].

PubMed

Glüer, Michael; Lohaus, Arnold

2018-02-01

Parents' and Children's Perspectives of Parental Mediation Strategies in Association with Children's Internet Skills The purpose of this study was to examine the association of parental mediation strategies (from parents' and children's perspective) and children's internet skills. In total 194 parent-child dyads were questioned about their parent's mediation strategies. The children (fifth to ninth grade) additionally answered questions about their internet skills and the amount of time they spent daily on the internet. Parents' and children's ratings of the parental mediation strategies showed moderate associations. Parents reported to use more often mediation strategies than was perceived by their children. The mediation strategies had only limited value for the prediction of the children's internet skills. Parents' and children's perspective about restrictive content mediation were both negatively associated to children's internet skills. After controlling for children's age, sex and time spent daily on the internet, results showed that only congruencies between children's and parental perspectives regarding the parental restrictive content mediation were associated with decreased technical and social internet skills. Additionally, discrepancies between the children's and parental perspectives regarding the parental use of technical mediation were associated with decreased technical internet skills. Discrepancies regarding the parental mediation strategy monitoring were related to increased information navigation skills.

Understanding health systems, health economies and globalization: the need for social science perspectives.

PubMed

Murray, Susan F; Bisht, Ramila; Baru, Rama; Pitchforth, Emma

2012-08-31

The complex relationship between globalization and health calls for research from many disciplinary and methodological perspectives. This editorial gives an overview of the content trajectory of the interdisciplinary journal 'Globalization and Health' over the first six years of production, 2005 to 2010. The findings show that bio-medical and population health perspectives have been dominant but that social science perspectives have become more evident in recent years. The types of paper published have also changed, with a growing proportion of empirical studies. A special issue on 'Health systems, health economies and globalization: social science perspectives' is introduced, a collection of contributions written from the vantage points of economics, political science, psychology, sociology, business studies, social policy and research policy. The papers concern a range of issues pertaining to the globalization of healthcare markets and governance and regulation issues. They highlight the important contribution that can be made by the social sciences to this field, and also the practical and methodological challenges implicit in the study of globalization and health.

Value-Focused Approach to Improving Water Quality: Albany-Millersburg Talking Water Gardens

EPA Pesticide Factsheets

To meet new total maximum daily load requirements, the cities of Albany and Millersburg in Oregon worked together to design and fund a project that addresses wastewater treatment from a natural hydrological perspective.

A cognitive computational model inspired by the immune system response.

PubMed

Abdo Abd Al-Hady, Mohamed; Badr, Amr Ahmed; Mostafa, Mostafa Abd Al-Azim

2014-01-01

The immune system has a cognitive ability to differentiate between healthy and unhealthy cells. The immune system response (ISR) is stimulated by a disorder in the temporary fuzzy state that is oscillating between the healthy and unhealthy states. However, modeling the immune system is an enormous challenge; the paper introduces an extensive summary of how the immune system response functions, as an overview of a complex topic, to present the immune system as a cognitive intelligent agent. The homogeneity and perfection of the natural immune system have been always standing out as the sought-after model we attempted to imitate while building our proposed model of cognitive architecture. The paper divides the ISR into four logical phases: setting a computational architectural diagram for each phase, proceeding from functional perspectives (input, process, and output), and their consequences. The proposed architecture components are defined by matching biological operations with computational functions and hence with the framework of the paper. On the other hand, the architecture focuses on the interoperability of main theoretical immunological perspectives (classic, cognitive, and danger theory), as related to computer science terminologies. The paper presents a descriptive model of immune system, to figure out the nature of response, deemed to be intrinsic for building a hybrid computational model based on a cognitive intelligent agent perspective and inspired by the natural biology. To that end, this paper highlights the ISR phases as applied to a case study on hepatitis C virus, meanwhile illustrating our proposed architecture perspective.

A Cognitive Computational Model Inspired by the Immune System Response

PubMed Central

Abdo Abd Al-Hady, Mohamed; Badr, Amr Ahmed; Mostafa, Mostafa Abd Al-Azim

2014-01-01

The immune system has a cognitive ability to differentiate between healthy and unhealthy cells. The immune system response (ISR) is stimulated by a disorder in the temporary fuzzy state that is oscillating between the healthy and unhealthy states. However, modeling the immune system is an enormous challenge; the paper introduces an extensive summary of how the immune system response functions, as an overview of a complex topic, to present the immune system as a cognitive intelligent agent. The homogeneity and perfection of the natural immune system have been always standing out as the sought-after model we attempted to imitate while building our proposed model of cognitive architecture. The paper divides the ISR into four logical phases: setting a computational architectural diagram for each phase, proceeding from functional perspectives (input, process, and output), and their consequences. The proposed architecture components are defined by matching biological operations with computational functions and hence with the framework of the paper. On the other hand, the architecture focuses on the interoperability of main theoretical immunological perspectives (classic, cognitive, and danger theory), as related to computer science terminologies. The paper presents a descriptive model of immune system, to figure out the nature of response, deemed to be intrinsic for building a hybrid computational model based on a cognitive intelligent agent perspective and inspired by the natural biology. To that end, this paper highlights the ISR phases as applied to a case study on hepatitis C virus, meanwhile illustrating our proposed architecture perspective. PMID:25003131

The pipeline and the porcupine: alternate metaphors of the physician-industry relationship.

PubMed

Mather, Charles

2005-03-01

Industry and medicine share a complicated relationship that engenders a considerable degree of controversy. Although they share a relationship, industry and medicine have different perspectives toward their involvement with each other. Industry conceives of medicine as one aspect of the "drug pipeline", a larger set of relationships that is necessary for producing and marketing products. In contrast, select physicians refer to medicine's relationship with industry as "dancing with the porcupine", an inherently difficult and dangerous activity. This paper compares the "pipeline" and "porcupine" metaphors, and draws upon ethnographic data from fieldwork conducted among clinical neuroscientists at a Canadian medical school to further elucidate the perspectives of physicians toward industry and the nature of the physician-industry relationship. The paper argues that the physician-industry relationship is akin to a type of gift-exchange known as a total prestation, and that this form of total prestation is part of a strategy of capital reconversion.

Exploring gender and elder abuse from the perspective of professionals.

PubMed

Weeks, Lori; Dupuis-Blanchard, Suzanne; Arseneault, Rina; MacQuarrie, Colleen; Gagnon, Danie; LeBlanc, Ginette Marie

2018-01-01

We conducted an online survey of professionals working in two Canadian provinces to learn about their knowledge of elder abuse from a gender-based perspective. A total of 169 professionals (90% women) completed a survey in either French or English. Five topic areas emerged from the analysis: the influence of gender on the risk of abuse; types of abuse detected; knowledge gaps; capacity to respond to gender-based abuse; and awareness of resources. To gain further insight into these results, we conducted three focus groups with a total of 24 professionals. Professionals held relatively little recognition of, or knowledge about, gender related to elder abuse. Our results indicate the need to develop educational and awareness raising opportunities for professionals who work with abused older adults in both French and English to identify and respond to the unique needs of older women and men.

The economic impact of Marfan syndrome: a non-experimental, retrospective, population-based matched cohort study

PubMed Central

2014-01-01

Background Marfan syndrome is a rare disease of the connective tissues, affecting multiple organ systems. Elevated morbidity and mortality in these patients raises the issue of costs for sickness funds and society. To date, there has been no study analysing the costs of Marfan syndrome from a sickness fund and societal perspective. Objective To estimate excess health resource utilisation, direct (non-)medical and indirect costs attributable to Marfan syndrome from a healthcare payer and a societal perspective in Germany in 2008. Methods A retrospective matched cohort study design is applied, using claims data. For isolating the causal effect of Marfan syndrome on excess costs, a genetic matching algorithm was used to reduce differences in observable characteristics between Marfan syndrome patients and the control group. 892 patients diagnosed with Marfan syndrome (ICD-10 Q87.4) were matched from a pool of 26,645 control individuals. After matching, we compared health resource utilisation and costs. Results From the sickness fund perspective, an average Marfan syndrome patient generates excess annual costs of €2496 compared with a control individual. From the societal perspective, excess annual costs amount to €15,728. For the sickness fund, the strongest cost drivers are inpatient treatment and care by non-physicians. From the sickness fund perspective, the third (25–41 years) and first (0–16 years) age quartiles reveal the greatest surplus in total costs. Marfan syndrome patients have 39% more physician contacts, a 153% longer average length of hospital stay, 119% more inpatient stays, 33% more prescriptions, 236% more medical imaging and 20% higher average prescription costs than control individuals. Depending on the prevalence, the economic impact from the sickness fund perspective ranges between €24.0 million and €61.4 million, whereas the societal economic impact extends from €151.3 million to €386.9 million. Conclusions Relative to its low frequency, Marfan syndrome requires high healthcare expenditure. Not only the high costs of Marfan syndrome but also its burden on patients’ lives call for more awareness from policy-makers, physicians and clinical researchers. Consequently, the diagnosis and treatment of Marfan syndrome should begin as soon as possible in order to prevent disease complications, early mortality and substantial healthcare expenditure. PMID:24954169

The economic impact of Marfan syndrome: a non-experimental, retrospective, population-based matched cohort study.

PubMed

Achelrod, Dmitrij; Blankart, Carl Rudolf; Linder, Roland; von Kodolitsch, Yskert; Stargardt, Tom

2014-06-23

Marfan syndrome is a rare disease of the connective tissues, affecting multiple organ systems. Elevated morbidity and mortality in these patients raises the issue of costs for sickness funds and society. To date, there has been no study analysing the costs of Marfan syndrome from a sickness fund and societal perspective. To estimate excess health resource utilisation, direct (non-)medical and indirect costs attributable to Marfan syndrome from a healthcare payer and a societal perspective in Germany in 2008. A retrospective matched cohort study design is applied, using claims data. For isolating the causal effect of Marfan syndrome on excess costs, a genetic matching algorithm was used to reduce differences in observable characteristics between Marfan syndrome patients and the control group. 892 patients diagnosed with Marfan syndrome (ICD-10 Q87.4) were matched from a pool of 26,645 control individuals. After matching, we compared health resource utilisation and costs. From the sickness fund perspective, an average Marfan syndrome patient generates excess annual costs of €2496 compared with a control individual. From the societal perspective, excess annual costs amount to €15,728. For the sickness fund, the strongest cost drivers are inpatient treatment and care by non-physicians. From the sickness fund perspective, the third (25-41 years) and first (0-16 years) age quartiles reveal the greatest surplus in total costs. Marfan syndrome patients have 39% more physician contacts, a 153% longer average length of hospital stay, 119% more inpatient stays, 33% more prescriptions, 236% more medical imaging and 20% higher average prescription costs than control individuals. Depending on the prevalence, the economic impact from the sickness fund perspective ranges between €24.0 million and €61.4 million, whereas the societal economic impact extends from €151.3 million to €386.9 million. Relative to its low frequency, Marfan syndrome requires high healthcare expenditure. Not only the high costs of Marfan syndrome but also its burden on patients' lives call for more awareness from policy-makers, physicians and clinical researchers. Consequently, the diagnosis and treatment of Marfan syndrome should begin as soon as possible in order to prevent disease complications, early mortality and substantial healthcare expenditure.

National trends in prescription drug expenditures and projections for 2016.

PubMed

Schumock, Glen T; Li, Edward C; Suda, Katie J; Wiest, Michelle D; Stubbings, JoAnn; Matusiak, Linda M; Hunkler, Robert J; Vermeulen, Lee C

2016-07-15

Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2016 in nonfederal hospitals, clinics, and overall (all sectors). Drug expenditure data through calendar year 2015 were obtained from the IMS Health National Sales Perspectives database and analyzed. Other factors that may influence drug spending in hospitals and clinics in 2016, including new drug approvals and patent expirations, were also reviewed. Expenditure projections for 2016 were based on a combination of quantitative analyses and expert opinion. Total U.S. prescription sales in the 2015 calendar year were $419.4 billion, which was 11.7% higher than sales in 2014. Prescription expenditures in clinics and nonfederal hospitals totaled $56.7 billion (a 15.9% increase) and $33.6 billion (a 10.7% increase), respectively, in 2015. In nonfederal hospitals, growth in spending was driven primarily by increased prices for existing drugs. The hepatitis C combination drug ledipasvir-sofosbuvir was the top drug overall in terms of 2015 expenditures ($14.3 billion); in both clinics and nonfederal hospitals, infliximab was the top drug. Individual drugs with the greatest increases in expenditures in 2015 were specialty agents and older generics; these agents are likely to continue to influence total spending in 2016. We project an 11-13% increase in total drug expenditures overall in 2016, with a 15-17% increase in clinic spending and a 10-12% increase in hospital spending. Health-system pharmacy leaders should carefully examine local drug utilization patterns in projecting their own organization's drug spending in 2016. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Mitigation of power sector environmental emissions through energy efficiency improvements: The case of Pakistan

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

Shrestha, R.M.; Biswas, W.K.; Jalal, A.I.

1998-11-01

This paper assesses the potential of selected efficient electrical appliances for avoiding power generation and for mitigation of selected air pollutants from the power sector in Pakistan from technical as well as national, utility and user perspectives. The study shows that about 14, 21 and 35% of the total CO{sub 2}, SO{sub 2} and NO{sub x} emissions in the business as usual (BAU) case could be avoided by the adoption of selected efficient appliances during 1997--2015 from the national perspective, while the corresponding figures from the user perspective are 12, 17 and 29%, respectively. All selected efficient appliances would bemore » cost effective to the users if electricity prices were set at the long-run marginal cost of supply.« less

The costs of heart failure in Poland from the public payer's perspective. Polish programme assessing diagnostic procedures, treatment and costs in patients with heart failure in randomly selected outpatient clinics and hospitals at different levels of care: POLKARD.

PubMed

Czech, Marcin; Opolski, Grzegorz; Zdrojewski, Tomasz; Dubiel, Jacek S; Wizner, Barbara; Bolisęga, Dorota; Fedyk-Łukasik, Małgorzata; Grodzicki, Tomasz

2013-01-01

Heart failure (HF) is a chronic disease of great clinical and economic significance for both the healthcare system and patients themselves. To determine the consumption of medical resources for treatment and care of HF patients and to estimate the related costs. The study involved 400 primary care practices and 396 specialist outpatient clinics, as well as 259 hospitals at all reference levels. The sample was representative and supplemented with patient interview data. Based on the consumption of particular resources and the unit costs of services in 2011, costs of care for HF patients in Poland were estimated. Separate analyses were conducted depending on the stage of the disease (according to NYHA classification I-IV). The public payer's perspective and a one year time horizon were adopted. Direct annual costs of an HF patient's treatment in Poland may range between PLN 3,373.23 and 7,739.49 (2011), the main cost item being hospitalisation. The total costs for the healthcare system could be as high as PLN 1,703 million, which is 3.16% of the National Health Fund's budget (Ex. rate from 05.03.2012: 1 EUR = 4.14 PLN). The costs of treating heart failure in Poland are high; proper allocation of resources to diagnostic procedures and treatment may contribute to rationalisation of the relevant expenditure.

Sustainability of three modified soil conservation methods in agriculture area

NASA Astrophysics Data System (ADS)

Setiawan, M. A.; Sara, F. H.; Christanto, N.; Sartohadi, J.; Samodra, G.; Widicahyono, A.; Ardiana, N.; Widiyati, C. N.; Astuti, E. M.; Martha, G. K.; Malik, R. F.; Sambodo, A. P.; Rokhmaningtyas, R. P.; Swastanto, G. A.; Gomez, C.

2018-04-01

Recent innovations in soil conservation methods do not present any breakthrough. Providing more attractive soil conservation methods from the farmer’s perspective is however still of critical importance. Contributing to this soil research gap we attempt to evaluate the sustainable use of three modified conservation methods, namely JALAPA (Jala Sabut Kelapa - geotextile made of coconut fibres), wood sediment trap, and polybag system compared to traditional tillage without conservation method. This research provides both qualitative and quantitative analysis on the performance of each conservation measures. Therefore, in addition to the total sediment yield value and investment cost – as quantitative analysis, we also evaluate qualitatively the indicator of soil loss, installation, maintenance, and the durability of conservation medium. Those criteria define the sustainability use of each conservation method. The results show that JALAPA is the most effective method for controlling soil loss, but it also requires the most expensive cost for installation. However, our finding confirms that geotextile is sensitive to sun heating by which the coconut fibre can become dry and shrink. Wood sediment trap is the cheapest and easiest to install; however it is easily damaged by termite. Polybag method results in the highest productivity, but requires more time during the first installation. In terms of the farmer’s perspective, soil conservation using polybag system was the most accepted technique due to its high benefits; even if it is less effective at reducing soil loss compared to JALAPA.

Gain versus loss framing in adherence-promoting communication targeting patients with chronic diseases: the moderating effect of individual time perspective.

PubMed

Zhao, Xiaoquan; Villagran, Melinda M; Kreps, Gary L; McHorney, Colleen

2012-01-01

This study investigated the joint effect of message framing and time perspective in adherence-promoting communication targeting patients with chronic diseases. Based on previous framing and time perspective research, it was hypothesized that the gain frame would show an advantage over the loss frame among future-oriented patients; for present-oriented patients, it was hypothesized that the framing effect would be relatively indistinct. In total, 1,108 currently nonadherent patients with chronic disease participated in an experiment where they were randomly assigned to either gain- or loss-framed messages addressing key beliefs underlying their nonadherence or a no-message control condition. Intention and attitude regarding future adherence as well as message perceptions were measured after message presentation. Results of this study generally supported the hypotheses. Message topics-whether the messages addressed patients' perceived need for medications or concerns about side effects-did not moderate the effect of framing or the interaction between framing and time perspective. Theoretical and practical implications are discussed.

Perspectives on pasture versus indoor feeding of dairy cows.

PubMed

Knaus, Wilhelm

2016-01-15

The dairy industry in many regions of the world has moved towards a high-input/high-output system maximising annual milk production per cow, primarily through increasing concentrate-based total mixed rations fed indoors year round, as opposed to allowing cows to feed on pasture. Pasture-based dairy systems in regions like New Zealand and Ireland are oriented towards maximum milk yield per unit of pasture, which has led to Holstein strains that are 50 to 100 kg lighter, exhibit a higher body condition score, and produce roughly half the annual amount of milk as compared to their Holstein counterparts kept in confinement in North America and Europe. Freedom from hunger might not be guaranteed when high-yielding dairy cows are kept on pasture without any supplemental feed, but at the same time no access to pasture can be considered an animal welfare concern, because pasturing is generally beneficial to the animals' health. On pasture, lighter-weight dairy cows with a medium milk production potential have proven to be superior with regard to feed efficiency and fertility. The year-round indoor feeding of high-yielding dairy cows with total mixed rations containing substantial amounts of human-edible crops from arable land puts global food security at risk and fails to utilise the evolutionary advantages of ruminants. © 2015 Society of Chemical Industry.

Nitrous Oxide and Methane Fluxes in Responses to Conservation Management across Cropping Systems in Asia from a Data-Model Integration Perspective

NASA Astrophysics Data System (ADS)

Ren, W.; Huang, Y.; Tao, B.; Zhu, X.; Tian, H.

2017-12-01

The agriculture sector is estimated to be responsible for 12% of the total greenhouse gas emissions, particularly for 52% of CH4 and 84% of N2O. It has been predicted that the world population would reach 9.7 billion by 2050 and require a 60 percent increase in total agricultural production above the level of 2005-07, which would potentially further boost greenhouse gas emissions from agroecosystems. The growing concerns over food security and rapid rate of global warming necessitates the development of conservation management (or climate-smart soil management) that can ensure high crop yield and meanwhile markedly enhance soil sequestration and reduce GHG emissions. In this study, we synthesize multi-source datasets and apply an improved agroecosystem model to quantitatively investigate the dynamics of CH4 and N2O fluxes as influenced by conservation management practices in cropping systems of Asia (such as wheat, corn, and rice) for exploring the potential of those practices to mitigate and adapt to climate change. Our preliminary results suggest that the conservation tillage (e.g., reduced and no tillage) can largely suppress CH4 emissions from Asia's rice paddies, although they, to some extent, may stimulate NO2 emissions, comparing with the conventional tillage.

[European Union Network for Patient Safety and Quality of Care (PASQ). Development and preliminary results in Europe and in the Spanish National Health System].

PubMed

Agra-Varela, Y; Fernández-Maíllo, M; Rivera-Ariza, S; Sáiz-Martínez-Acitorez, I; Casal-Gómez, J; Palanca-Sánchez, I; Bacou, J

2015-01-01

The joint action, European Union Network for Patient Safety and Quality of Care: PaSQ, aims to promote patient safety (PS) in the European Union (EU) and to facilitate the exchange of experiences among Member States (MS) and stakeholders on issues related to quality of care, PS, and patient involvement. The development and preliminary results are presented here, especially as regards the Spanish National Health System (SNHS). PaSQ is developed through 7 work packages, primarily aimed at sharing good practices (GP), which were identified using specific questionnaires and selected by means of explicit criteria, as well as to implement safe clinical practices (SCP) of proven effectiveness and agreed among MS. A total of 482 GP (39% provided by Spanish professionals) were identified. The 34 events organised in the EU, 11 including Spanish participation, facilitate sharing these practices. A total of 194 Health Care centres (49% in Spain) are implementing SCP (hand hygiene, safe surgery, medication reconciliation, and paediatric early warning scores) ACHIEVEMENTS AND FUTURE PERSPECTIVES: PaSQ is making it possible to strengthen collaboration between organizations and professionals at EU and SNHS level regarding PS and quality of care. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

Measuring attributes of health literate health care organizations from the patients' perspective: Development and validation of a questionnaire to assess health literacy-sensitive communication (HL-COM).

PubMed

Ernstmann, Nicole; Halbach, Sarah; Kowalski, Christoph; Pfaff, Holger; Ansmann, Lena

2017-04-01

Studies addressing the organizational contexts of care that may help increase the patients' ability to cope with a disease and to navigate through the health care system are still rare. Especially instruments allowing the assessment of such organizational efforts from the patients' perspective are missing. The aim of our study was to develop a survey instrument assessing organizational health literacy (HL) from the patients' perspective, i. e., health care organizations' responsiveness to patients' individual needs. A pool of 30 items was developed by a group of experts based on a literature review. The items were developed, tested and prioritized according to their importance in 11 semi-structured interviews and cognitive think-aloud interviews with cancer patients. The resulting 16 items were rated in a standardized postal survey involving a total of N=453 colon and breast cancer patients treated in cancer centers in Germany. An exploratory factor analysis, a confirmatory factor analysis and structural equation modelling were conducted. Item properties were analyzed. 83.2 % of the patients were diagnosed with breast cancer, 16.8 % had a diagnosis of colon cancer. The patients' mean age was 61 (26-88), 89.4 % were female. The most common comorbidities were hypertension (34.0 %) and cardiovascular disease (11.0 %). The final prediction model included nine items measuring the degree of health literacy-sensitivity of communication. The model showed an acceptable model fit. The nine items showed corrected item-total correlations between .622 and .762 and item difficulties between 0.77 and 0.87. Cronbach's α was .912. In a comprehensive development process, the original item pool comprising several aspects of organizational HL was reduced to a one-dimensional scale. The instrument measures an important aspect of organizational HL; i.e., the degree of health literacy-sensitivity of communication (HL-COM). HL-COM was found to impact patient enablement, mediated through the support by physicians. Future research will have to test these associations in the context of other diseases or institutions. Copyright © 2017. Published by Elsevier GmbH.

Economic analysis of remote monitoring of cardiac implantable electronic devices: Results of the Health Economics Evaluation Registry for Remote Follow-up (TARIFF) study.

PubMed

Ricci, Renato Pietro; Vicentini, Alfredo; D'Onofrio, Antonio; Sagone, Antonio; Rovaris, Giovanni; Padeletti, Luigi; Morichelli, Loredana; Fusco, Antonio; De Vivo, Stefano; Lombardi, Leonida; Denaro, Alessandra; Pollastrelli, Annalisa; Colangelo, Irene; Santini, Massimo

2017-01-01

Remote monitoring (RM) of cardiac implantable electronic devices has been demonstrated to improve outpatient clinic workflow and patient management. However, few data are available on the socioeconomic impact of RM. The aim of this study was to assess the costs and benefits of RM compared with standard care (SC). We used 12-month patient data from the Health Economics Evaluation Registry for Remote Follow-up (TARIFF) study (N = 209; RM: n = 102 (48.81%); SC: n = 107 (51.19%)). Cost comparison was made from 2 perspectives: the health care system (HCS) and patients. The use of health care resources was defined on the basis of hospital clinical folders. Out-of-pocket expenses were reported directly by patients. HCS perspective: The overall mean annual cost per patient in the SC group (€1044.89 ± €1990.47) was significantly higher than in the RM group (€482.87 ± €2488.10) (P < .0001), with a reduction of 53.87% being achieved in the RM group. The primary driver of cost reduction was the cost of cardiovascular hospitalizations (SC: €`886.67 ± €1979.13 vs RM: €432.34 ± €2488.10; P = .0030). Patient and caregiver perspective: The annual cost incurred by patients was significantly higher in the SC group than in the RM group (SC: €169.49 ± €189.50 vs RM: €56.87 ± €80.22; P < .0001). Patients' quality-adjusted life-years were not significantly different between the groups. Provider perspective: The total number of inhospital device follow-up visits was reduced by 58.78% in the RM group. RM of patients with cardiac implantable electronic devices (CIEDs) is cost saving from the perspectives of the HCS, patients, and caregivers. Introducing appropriate reimbursements will make RM sustainable even for the provider, i.e. the hospitals which provide the service and encourage widespread adoption of RM. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Methodology of development and students' perceptions of a psychiatry educational smartphone application.

PubMed

Zhang, Melvyn W B; Ho, Cyrus S H; Ho, Roger C M

2014-01-01

The usage of Smartphones and smartphone applications in the recent decade has indeed become more prevalent. Previous research has highlighted the lack of critical appraisal of new applications. In addition, previous research has highlighted a method of using just the Internet Browser and a text editor to create an application, but this does not eliminate the challenges faced by clinicians. In addition, even though there has been a high rate of smartphone applications usage and acceptance, it is common knowledge that it would cost clinicians as well as their centers a lot to develop smartphone applications that could be catered to their needs, and help them in their daily educational needs. The objectives of the current research are thus to highlight a cost-effective methodology of development of interactive education smartphone applications, and also to determine whether medical students are receptive towards having smartphone applications and their perspectives with regards to the contents within. In this study, we will elaborate how the Mastering Psychiatry Online Portal and web-based mobile application were developed using HTML5 as the core programming language. The online portal and web-based application was launched in July 2012 and usage data were obtained. Subsequently, a native application was developed, as it was funded by an educational grant and students are recruited after their end of posting clinical examination to fill up a survey questionnaire relating to perspectives. Our initial analytical results showed that since inception to date, for the online portal, there have been a total of 15,803 views, with a total of 2,109 copies of the online textbook being downloaded. As for the online videos, 5,895 viewers have watched the training videos from the start till the end. 722 users have accessed the mobile textbook application. A total of 185 students participated in the perspective survey, with the majority having positive perspectives about the implementation of a smartphone application in psychiatry. This is one of the few studies that describe how an educational application could be developed using a simple and cost effective methodology and this study has also demonstrated students' perspectives towards Smartphone in psychiatric education. Our methods might apply to future research involving the use of technology in education.

Space Weathering Perspectives on Europa Amidst the Tempest of the Jupiter Magnetospheric System

NASA Technical Reports Server (NTRS)

Cooper, J. F.; Hartle, R. E.; Lipatov, A. S.; Sittler, E. C.; Cassidy, T. A.; Ip. W.-H.

2010-01-01

Europa resides within a "perfect storm" tempest of extreme external field, plasma, and energetic particle interactions with the magnetospheric system of Jupiter. Missions to Europa must survive, functionally operate, make useful measurements, and return critical science data, while also providing full context on this ocean moon's response to the extreme environment. Related general perspectives on space weathering in the solar system are applied to mission and instrument science requirements for Europa.

[Immigration in Spain and the health system: a fiscal policy perspective].

PubMed

Blanco Moreno, Angela; Hernández Pascual, Javier

2009-12-01

The Spanish population has grown by over 6 million people in the last 10 years and immigrants account for 4.5 million of this increase. Although this influx has largely been motivated by economic reasons, stimulated by the sharp growth of the Spanish economy, sociological factors must also be considered to assess the impact of immigration shock on public expenditure and the social welfare system. On the one hand, the demographic growth caused by immigration temporarily balances the pension system, as immigrants have a lower average age and a higher fertility rate. On the other hand, the demographic and economic features of the immigrant community make additional demands on the social welfare system. Universal access to basic public services such as the education and health systems is a crucial asset in the integration policy aimed at the immigrant collective, and compensates for its possible effect as an incentive to immigrate. In the short term, the huge population growth has led to health services' congestion, especially in primary health care, because of the unequal geographic distribution of immigrants. The health expenditure imputable to immigrants is lower than their share in the total population and is highly concentrated in four autonomous regions.

SLS Core Stage Simulator

NASA Image and Video Library

2015-02-02

CHRISTOPHER CRUMBLY, MANAGER OF THE SPACECRAFT PAYLOAD INTEGRATION AND EVOLUTION OFFICE, GAVE VISITORS AN INSIDER'S PERSPECTIVE ON THE CORE STAGE SIMULATOR AT MARSHALL AND ITS IMPORTANCE TO DEVELOPMENT OF THE SPACE LAUNCH SYSTEM. CHRISTOPHER CRUMBLY, MANAGER OF THE SPACECRAFT PAYLOAD INTEGRATION AND EVOLUTION OFFICE, GAVE VISITORS AN INSIDER'S PERSPECTIVE ON THE CORE STAGE SIMULATOR AT MARSHALL AND ITS IMPORTANCE TO DEVELOPMENT OF THE SPACE LAUNCH SYSTEM.

A Call for Integrating a Mental Health Perspective into Systems of Care for Abused and Neglected Infants and Young Children

ERIC Educational Resources Information Center

Osofsky, Joy D.; Lieberman, Alicia F.

2011-01-01

A system of care for abused and neglected infants and young children should adopt a comprehensive perspective, with mental health considerations systematically incorporated into policies and decisions affecting children and their families. Children age birth to 5 years have disproportionately high rates of maltreatment, with long-term consequences…

The Importance of Play in Early Childhood Education: A Critical Perspective on Current Policies and Practices in Germany and Hong Kong

ERIC Educational Resources Information Center

Faas, Stefan; Wu, Shu-chen; Geiger, Steffen

2017-01-01

In order to reflect international reform movements in a system- and culture-comparative perspective, the following article investigates the early childhood education systems in Germany and in Hong Kong, with reference to the respective social and educational roots, pedagogical development lines, and basic educational approaches. In addition,…

Rural Renaissance--A Perspective and a Process.

ERIC Educational Resources Information Center

Axinn, George H.

If the path to a better rural life is to be a change preferred by the rural people involved, recent world experience would suggest that it must be a change born from within the given rural social system, be controlled by its beneficiaries, and be integrated into the larger system of which it is a part. Such a perspective and such a process might…

Professor as Facilitator: Shaping an Emerging, Living System of Shared Leadership in the Classroom

ERIC Educational Resources Information Center

Bright, David S.; Turesky, Elizabeth Fisher; Putzel, Roger; Stang, Thomas

2012-01-01

From the perspective of emergence, professors can facilitate and shape a class as a complex, adaptive, and living system. A case study illustrates phases of emergence in the classroom by tracing how a professor may use this perspective to empower students to share in the leadership of the classroom. Instead of presenting lessons, the professor…

Re-Visiting the Role of Disability Coordinators: The Changing Needs of Disabled Students and Current Support Strategies from a UK University

ERIC Educational Resources Information Center

Koca-Atabey, Mujde

2017-01-01

This study aimed to investigate the system designed to support disabled university students from the perspective of disability coordinators. The research on this topic specifically is limited. Disability coordinators from a particular UK university were interviewed to better understand the support system from their own perspective. Interpretative…

What information do people use, trust, and find useful during a disaster? Evidence from five large wildfires

Treesearch

Toddi A. Steelman; Sarah M. McCaffrey; Anne-Lise Knox Velez; Jason Alexander Briefel

2015-01-01

The communication system through which information flows during a disaster can be conceived of as a set of relationships among sources and recipients who are concerned about key information characteristics. The recipient perspective is often neglected within this system. In this article, we explore recipient perspectives related to what information was used, useful,...

Inter-Regional Performance of the Public Health System in a High-Inequality Country

PubMed Central

Gramani, Maria Cristina

2014-01-01

Previous cross-country studies have revealed a relationship between health and socio-economic factors. However, multinational studies that use aggregate figures could obfuscate the actual situation in each individual region, or even in each individual federal unit, mainly in a developing country that spans a continent and has large socioeconomic inequalities. We conducted a within-country study, in Brazil, of health system performance that examined data in the four perspectives that most strongly affect the performance of public health systems: financial, customer, internal processes and learning&growth. After estimating the interregional health system performance from each perspective, we identified the determinants of inefficiency (i.e., the factors that have the greatest potential for improvement in each region). The results showed that the major determinants of inefficiency in the less efficient regions (N and NE) are concentrated in the perspective of learning&growth (the number of health professionals and the number of graduates with a health-related undergraduate degree) and, in the regions with the best performance (S and SE) the major determinants of inefficiency are concentrated in the financial perspective (spending on health care and the amount paid for hospitalization). PMID:24466201

Ecological and economic dynamics of the Shunde agricultural system under China's small city development strategy.

PubMed

Lu, Hongfang; Campbell, Daniel E

2009-06-01

The agricultural and industrial development of small cities is the primary environmental management strategy employed to make full use of extra labor in the rural areas of China. The ecological and economic consequences of this development strategy will affect over 100 million people and change the organization of the Chinese landscape. In this study, we examined the agricultural development of Shunde, a small city in Guangdong Province, over the period 1978 until 2000. Our analysis of the ecological and economic dynamics of the agricultural system revealed the dominant role of labor in the intensification of agricultural production, even though the use of fuels, fertilizers and machines also increased during this time. The Shunde agricultural system was examined from both biophysical or donor-based and human utility or receiver-based perspectives, using emergy and economic methods, respectively. After 22 years of urbanization, the Shunde agricultural system was still able to fill 96% of the local demand for agricultural products using only 6% of its total yield compared to using 14% of the total yield in 1978. Aquaculture developed quickly during the study period as grain production decreased. In 2000, the production of fish, pork, and vegetables accounted for 92% of the total emergy output of the system; however, the emergy buying power of the money received in exchange was lower than the emergy contained in the products exported. The excess emergy exported is the basis for a high quality diet delivered to city dwellers at a relatively low price. In the 1980s, the productivity of both land and labor increased; but after 1992 the productivity of labor decreased, causing the efficiency of the whole agricultural system to decrease. We recommend that processing plants be established for the main agricultural products of Shunde to decrease the emergy loss in trading and to increase employment. The effect of including monetized ecosystem services in the balance between the emergy delivered to the markets in agricultural products and the emergy buying power of the money received was to decrease the emergy gained by the Shunde agricultural system.

Rethinking Human-Centered Computing: Finding the Customer and Negotiated Interactions at the Airport

NASA Technical Reports Server (NTRS)

Wales, Roxana; O'Neill, John; Mirmalek, Zara

2003-01-01

The breakdown in the air transportation system over the past several years raises an interesting question for researchers: How can we help improve the reliability of airline operations? In offering some answers to this question, we make a statement about Huuman-Centered Computing (HCC). First we offer the definition that HCC is a multi-disciplinary research and design methodology focused on supporting humans as they use technology by including cognitive and social systems, computational tools and the physical environment in the analysis of organizational systems. We suggest that a key element in understanding organizational systems is that there are external cognitive and social systems (customers) as well as internal cognitive and social systems (employees) and that they interact dynamically to impact the organization and its work. The design of human-centered intelligent systems must take this outside-inside dynamic into account. In the past, the design of intelligent systems has focused on supporting the work and improvisation requirements of employees but has often assumed that customer requirements are implicitly satisfied by employee requirements. Taking a customer-centric perspective provides a different lens for understanding this outside-inside dynamic, the work of the organization and the requirements of both customers and employees In this article we will: 1) Demonstrate how the use of ethnographic methods revealed the important outside-inside dynamic in an airline, specifically the consequential relationship between external customer requirements and perspectives and internal organizational processes and perspectives as they came together in a changing environment; 2) Describe how taking a customer centric perspective identifies places where the impact of the outside-inside dynamic is most critical and requires technology that can be adaptive; 3) Define and discuss the place of negotiated interactions in airline operations, identifying how these interactions between customers and airline employees provided new insights into design problems in the airline system; 4) Show how taking a customer-centric perspective influences the HCC design of an airline system and make recommendations for new architectures and intelligent devices that will enable airline systems to adapt flexibly to delay situations, supporting both customers and airline employees.

VBOT: Motivating computational and complex systems fluencies with constructionist virtual/physical robotics

NASA Astrophysics Data System (ADS)

Berland, Matthew W.

As scientists use the tools of computational and complex systems theory to broaden science perspectives (e.g., Bar-Yam, 1997; Holland, 1995; Wolfram, 2002), so can middle-school students broaden their perspectives using appropriate tools. The goals of this dissertation project are to build, study, evaluate, and compare activities designed to foster both computational and complex systems fluencies through collaborative constructionist virtual and physical robotics. In these activities, each student builds an agent (e.g., a robot-bird) that must interact with fellow students' agents to generate a complex aggregate (e.g., a flock of robot-birds) in a participatory simulation environment (Wilensky & Stroup, 1999a). In a participatory simulation, students collaborate by acting in a common space, teaching each other, and discussing content with one another. As a result, the students improve both their computational fluency and their complex systems fluency, where fluency is defined as the ability to both consume and produce relevant content (DiSessa, 2000). To date, several systems have been designed to foster computational and complex systems fluencies through computer programming and collaborative play (e.g., Hancock, 2003; Wilensky & Stroup, 1999b); this study suggests that, by supporting the relevant fluencies through collaborative play, they become mutually reinforcing. In this work, I will present both the design of the VBOT virtual/physical constructionist robotics learning environment and a comparative study of student interaction with the virtual and physical environments across four middle-school classrooms, focusing on the contrast in systems perspectives differently afforded by the two environments. In particular, I found that while performance gains were similar overall, the physical environment supported agent perspectives on aggregate behavior, and the virtual environment supported aggregate perspectives on agent behavior. The primary research questions are: (1) What are the relative affordances of virtual and physical constructionist robotics systems towards computational and complex systems fluencies? (2) What can middle school students learn using computational/complex systems learning environments in a collaborative setting? (3) In what ways are these environments and activities effective in teaching students computational and complex systems fluencies?

Reorienting health systems to meet the demand for consumer health solutions.

PubMed

Buckeridge, David L

2014-01-01

There is a clear and pronounced gap between the demand for and access to consumer health solutions. Existing health information systems and broader health system factors such as funding models are reasons for this gap. There are strong arguments from the perspectives of the consumer and population health for closing this gap, but the case from the perspective of the current health system is mixed. Closing the gap will require a concerted effort to reorient health information systems and funding models to support online access by consumers to health information and health services.

An Overview of Value, Perspective, and Decision Context-A Health Economics Approach: An ISPOR Special Task Force Report [2].

PubMed

Garrison, Louis P; Pauly, Mark V; Willke, Richard J; Neumann, Peter J

2018-02-01

The second section of our Special Task Force builds on the discussion of value and perspective in the previous article of the report by 1) defining a health economics approach to the concept of value in health care systems; 2) discussing the relationship of value to perspective and decision context, that is, how recently proposed value frameworks vary by the types of decisions being made and by the stakeholders involved; 3) describing the patient perspective on value because the patient is a key stakeholder, but one also wearing the hat of a health insurance purchaser; and 4) discussing how value is relevant in the market-based US system of mixed private and public insurance, and differs from its use in single-payer systems. The five recent value frameworks that motivated this report vary in the types of decisions they intend to inform, ranging from coverage, access, and pricing decisions to those defining appropriate clinical pathways and to supporting provider-clinician shared decision making. Each of these value frameworks must be evaluated in its own decision context for its own objectives. Existing guidelines for cost-effectiveness analysis emphasize the importance of clearly specifying the perspective from which the analysis is undertaken. Relevant perspectives may include, among others, 1) the health plan enrollee, 2) the patient, 3) the health plan manager, 4) the provider, 5) the technology manufacturer, 6) the specialty society, 7) government regulators, or 8) society as a whole. A valid and informative cost-effectiveness analysis could be conducted from the perspective of any of these stakeholders, depending on the decision context. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of childhood rotavirus vaccination in Taiwan.

PubMed

Wu, Chia-Ling; Yang, Yi-Ching; Huang, Li-Min; Chen, Kow-Tong

2009-03-04

Rotavirus is the most common cause of severe diarrhea in children. Two rotavirus vaccines (RotaTeq and Rotarix) have been licensed in Taiwan. We have investigated whether routine infant immunization with either vaccine could be cost-effective in Taiwan. We modeled specific disease outcomes including hospitalization, emergency department visits, hospital outpatient visits, physician office visits, and death. Cost-effectiveness was analyzed from the perspectives of the health care system and society. A decision tree was used to estimate the disease burden and costs based on data from published and unpublished sources. A routine rotavirus immunization program would prevent 146,470 (Rotarix) or 149,937 (RotaTeq) cases of rotavirus diarrhea per year, and would prevent 21,106 (Rotarix) and 23,057 (RotaTeq) serious cases (hospitalizations, emergency department visits, and death). At US$80 per dose for the Rotarix vaccine, the program would cost US$32.7 million, provided an increasing cost offset of US$19.8 million to the health care system with $135 per case averted. Threshold analysis identified a break-even price per dose of US$27 from the health care system perspective and US$41 from a societal perspective. At US$60.0 per dose of RotaTeq vaccine, the program would cost US$35.4 million and provide an increasing cost offset of US$22.5 million to the health care system, or US$150 per case averted. Threshold analysis identified a break-even price per dose of US$20.0 from the health care system perspective and $29 from the societal perspective. Greater costs of hospitalization and lower vaccine price could increase cost-effectiveness. Despite a higher burden of serious rotavirus disease than estimated previously, routine rotavirus vaccination would unlikely be cost-saving in Taiwan at present unless the price fell to US$41 (Rotarix) or US$29 (RotaTeq) per dose from societal perspective, respectively. Nonetheless, rotavirus immunization could reduce the substantial burden of short-term morbidity due to rotavirus.

The future orientation of constructive memory: an evolutionary perspective on therapeutic hypnosis and brief psychotherapy.

PubMed

Rossi, Ernest; Erickson-Klein, Roxanna; Rossi, Kathryn

2008-04-01

We explore a new distinction between the future, prospective memory system being investigated in current neuroscience and the past, retrospective memory system, which was the original theoretical foundation of therapeutic hypnosis, classical psychoanalysis, and psychotherapy. We then generalize a current evolutionary theory of sleep and dreaming, which focuses on the future, prospective memory system, to conceptualize a new evolutionary perspective on therapeutic hypnosis and brief psychotherapy. The implication of current neuroscience research is that activity-dependent gene expression and brain plasticity are the psychobiological basis of adaptive behavior, consciousness, and creativity in everyday life as well as psychotherapy. We summarize a case illustrating how this evolutionary perspective can be used to quickly resolve problems with past obstructive procrastination in school to facilitate current and future academic success.

Cost-minimization analysis in a blind randomized trial on small-incision versus laparoscopic cholecystectomy from a societal perspective: sick leave outweighs efforts in hospital savings

PubMed Central

Keus, Frederik; de Jonge, Trudy; Gooszen, Hein G; Buskens, Erik; van Laarhoven, Cornelis JHM

2009-01-01

Background After its introduction, laparoscopic cholecystectomy rapidly expanded around the world and was accepted the procedure of choice by consensus. However, analysis of evidence shows no difference regarding primary outcome measures between laparoscopic and small-incision cholecystectomy. In absence of clear clinical benefit it may be interesting to focus on the resource use associated with the available techniques, a secondary outcome measure. This study focuses on a difference in costs between laparoscopic and small-incision cholecystectomy from a societal perspective with emphasis on internal validity and generalisability Methods A blinded randomized single-centre trial was conducted in a general teaching hospital in The Netherlands. Patients with reasonable to good health diagnosed with symptomatic cholecystolithiasis scheduled for cholecystectomy were included. Patients were randomized between laparoscopic and small-incision cholecystectomy. Total costs were analyzed from a societal perspective. Results Operative costs were higher in the laparoscopic group using reusable laparoscopic instruments (difference 203 euro; 95% confidence interval 147 to 259 euro). There were no significant differences in the other direct cost categories (outpatient clinic and admittance related costs), indirect costs, and total costs. More than 60% of costs in employed patients were caused by sick leave. Conclusion Based on differences in costs, small-incision cholecystectomy seems to be the preferred operative technique over the laparoscopic technique both from a hospital and societal cost perspective. Sick leave associated with convalescence after cholecystectomy in employed patients results in considerable costs to society. Trial registration ISRCTN Register, number ISRCTN67485658. PMID:19732431

The relationship between borderline symptoms and vantage perspective during autobiographical memory retrieval in a community sample.

PubMed

Van den Broeck, Kris; Reza, Jasmin; Nelis, Sabine; Claes, Laurence; Pieters, Guido; Raes, Filip

2014-01-01

Recent findings show that (previously) depressed and traumatised patients, compared to controls, make more frequently use of an observer perspective (as set against a field perspective) when retrieving memories. Because patients with borderline personality disorder (BPD) often report mood disturbances and past traumatic experiences, it would be plausible to expect that these patients too would retrieve higher proportions of observer memories. Therefore, and given the phenotypical variance of BPD, we examined whether vantage perspective during recall is associated with one or more BPD symptom clusters. A community sample consisting of 148 volunteers (66 males) completed the Autobiographical Memory Test, the Borderline Syndrome Index, and the Depression Scale of the Depression Anxiety Stress Scales. Interpersonal and anxious-neurotic BPD features were associated with higher proportions of observer memories. The proportion of observer memories was not associated with the total number of BPD symptoms. Nevertheless, our data suggest the existence of substantial connections between perspective taking during recall on the one hand and interpersonal difficulties and anxious-neurotic symptoms on the other hand, especially following cues that tap into domains that are highly discrepant towards one's actual self-concept.

Barriers that practitioners face when initiating insulin therapy in general practice settings and how they can be overcome

PubMed Central

Bin rsheed, Abdulaziz; Chenoweth, Ian

2017-01-01

AIM To explore primary care physicians’ perspectives on possible barriers to the use of insulin. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight electronic databases were searched (between January 1, 1994 and August 31, 2014) for relevant studies. A search for grey literature and a review of the references in the retrieved studies were also conducted. Studies that focused on healthcare providers’ perspectives on possible barriers to insulin initiation with type 2 diabetic patients were included, as well as articles suggesting solutions for these barriers. Review articles and studies that only considered patients’ perspectives were excluded. RESULTS A total of 19 studies met the inclusion criteria and were therefore included in this study: 10 of these studies used qualitative methods, 8 used quantitative methods and 1 used mixed methods. Studies included a range of different health care settings. The findings are reported under four broad categories: The perceptions of primary care physicians about the barriers to initiate insulin therapy for type 2 diabetes patients, how primary care physicians assess patients prior to initiating insulin, professional roles and possible solutions to overcome these barriers. The barriers described were many and covered doctor, patient, system and technological aspects. Interventions that focused on doctor training and support, or IT-based decision support were few, and did not result in significant improvement. CONCLUSION Primary care physicians’ known delay in insulin initiation is multifactorial. Published reports of attempts to find solutions for these barriers were limited in number. PMID:28138362

Community Pharmacists' Perspectives on Dispensing Medications With the Potential for Misuse, Diversion, and Intentional Overdose: Results of a Province-Wide Survey of Community Pharmacists in Canada.

PubMed

Leong, Christine; Alessi-Severini, Silvia; Sareen, Jitender; Enns, Murray W; Bolton, James

2016-11-09

Community pharmacists frequently encounter patients at risk of medication misuse, diversion, and intentional overdose. However, few studies have examined the perspective of the pharmacist on the identification and management of these patients. To understand the perspective of community pharmacists on the dispensing of select medications commonly associated with misuse, diversion, and overdose. An online survey was disseminated by electronic mail to community pharmacists listed in the College of Pharmacists of Manitoba directory. The survey was open from July to September 2014. Descriptive statistics were used to describe demographic information of the pharmacist and practice setting, and pharmacists' perceptions on the dispensing of select medications. A total of 82 community pharmacists completed the survey. Most pharmacists considered a one-month supply appropriate for a psychotropic agent; but a 7-10 day-supply was considered appropriate for an opioid for acute pain. Factors that aid pharmacist decisions on providing select medications to patients include familiarity with the patient, ease of access to medical history information, and ease of access to the prescribing physician. Only 10.3%, 16.2%, and 32.4% felt they have received adequate training on the management of patients at risk for suicide, drug diversion, and medication misuse, respectively. Findings from this study demonstrated a need for improved systems for managing patients at risk for medication misuse, diversion, and overdose. Strategies that warrant further attention for limiting the means of medication misuse include increased access to electronic medical records and providing additional continuing education support for community pharmacists.

Achieving Work-Life Balance in the National Collegiate Athletic Association Division I Setting, Part II: Perspectives From Head Athletic Trainers

PubMed Central

Goodman, Ashley; Mazerolle, Stephanie M.; Pitney, William A.

2015-01-01

Context: Work-life balance has been examined at the collegiate level from multiple perspectives except for the athletic trainer (AT) serving in a managerial or leadership role. Objective: To investigate challenges and strategies used in achieving work-life balance from the perspective of the head AT at a National Collegiate Athletic Association Division I university. Design: Qualitative study. Setting: Web-based management system. Patients or Other Participants: A total of 18 head ATs (13 men, 5 women; age = 44 ± 8 years, athletic training experience = 22 ± 7 years) volunteered. Data Collection and Analysis: Participants journaled their thoughts and experiences in response to a series of questions. To establish data credibility, we included multiple-analyst triangulation, stakeholder checks, and peer review. We used a general inductive approach to analyze the data. Results: Two higher-order themes emerged from our analysis of the data: organizational challenges and work-life balance strategies. The organizational challenges theme contained 2 lower-order themes: lack of autonomy and role demands. The work-life balance strategies theme contained 3 lower-order themes: prioritization of commitments, strategic boundary setting, and work-family integration. Conclusions: Head ATs are susceptible to experiencing work-life imbalance just as ATs in nonsupervisory roles are. Although not avoidable, the causes are manageable. Head ATs are encouraged to prioritize their personal time, make efforts to spend time away from their demanding positions, and reduce the number of additional responsibilities that can impede time available to spend away from work. PMID:25098746

Tensions in perspectives on suicide prevention between men who have attempted suicide and their support networks: Secondary analysis of qualitative data.

PubMed

Fogarty, Andrea S; Spurrier, Michael; Player, Michael J; Wilhelm, Kay; Whittle, Erin L; Shand, Fiona; Christensen, Helen; Proudfoot, Judith

2018-02-01

Men generally have higher rates of suicide, despite fewer overt indicators of risk. Differences in presentation and response suggest a need to better understand why suicide prevention is less effective for men. To explore the views of at-risk men, friends and family about the tensions inherent in suicide prevention and to consider how prevention may be improved. Secondary analysis of qualitative interview and focus group data, using thematic analysis techniques, alongside bracketing, construction and contextualisation. A total of 35 men who had recently made a suicide attempt participated in interviews, and 47 family and friends of men who had made a suicide attempt took part in focus groups. Participants recounted their experiences with men's suicide attempts and associated interventions, and suggested ways in which suicide prevention may be improved. Five tensions in perspectives emerged between men and their support networks, which complicated effective management of suicide risk: (i) respecting privacy vs monitoring risk, (ii) differentiating normal vs risky behaviour changes, (iii) familiarity vs anonymity in personal information disclosure, (iv) maintaining autonomy vs imposing constraints to limit risk, and (v) perceived need for vs failures of external support services. Tension between the different perspectives increased systemic stress, compounding problems and risk, thereby decreasing the effectiveness of detection of and interventions for men at risk of suicide. Suggested solutions included improving risk communication, reducing reliance on single source supports and increasing intervention flexibility in response to individual needs. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Analysis of Minimum Efficiency Performance Standards for Residential General Service Lighting in Chile

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

Letschert, Virginie E.; McNeil, Michael A.; Leiva Ibanez, Francisco Humberto

2011-06-01

Minimum Efficiency Performance Standards (MEPS) have been chosen as part of Chile's national energy efficiency action plan. As a first MEPS, the Ministry of Energy has decided to focus on a regulation for lighting that would ban the sale of inefficient bulbs, effectively phasing out the use of incandescent lamps. Following major economies such as the US (EISA, 2007) , the EU (Ecodesign, 2009) and Australia (AS/NZS, 2008) who planned a phase out based on minimum efficacy requirements, the Ministry of Energy has undertaken the impact analysis of a MEPS on the residential lighting sector. Fundacion Chile (FC) and Lawrencemore » Berkeley National Laboratory (LBNL) collaborated with the Ministry of Energy and the National Energy Efficiency Program (Programa Pais de Eficiencia Energetica, or PPEE) in order to produce a techno-economic analysis of this future policy measure. LBNL has developed for CLASP (CLASP, 2007) a spreadsheet tool called the Policy Analysis Modeling System (PAMS) that allows for evaluation of costs and benefits at the consumer level but also a wide range of impacts at the national level, such as energy savings, net present value of savings, greenhouse gas (CO2) emission reductions and avoided capacity generation due to a specific policy. Because historically Chile has followed European schemes in energy efficiency programs (test procedures, labelling program definitions), we take the Ecodesign commission regulation No 244/2009 as a starting point when defining our phase out program, which means a tiered phase out based on minimum efficacy per lumen category. The following data were collected in order to perform the techno-economic analysis: (1) Retail prices, efficiency and wattage category in the current market, (2) Usage data (hours of lamp use per day), and (3) Stock data, penetration of efficient lamps in the market. Using these data, PAMS calculates the costs and benefits of efficiency standards from two distinct but related perspectives: (1) The Life-Cycle Cost (LCC) calculation examines costs and benefits from the perspective of the individual household; and (2) The National Perspective projects the total national costs and benefits including both financial benefits, and energy savings and environmental benefits. The national perspective calculations are called the National Energy Savings (NES) and the Net Present Value (NPV) calculations. PAMS also calculate total emission mitigation and avoided generation capacity. This paper describes the data and methodology used in PAMS and presents the results of the proposed phase out of incandescent bulbs in Chile.« less

Performance evaluation of Al-Zahra academic medical center based on Iran balanced scorecard model

PubMed Central

Raeisi, Ahmad Reza; Yarmohammadian, Mohammad Hossein; Bakhsh, Roghayeh Mohammadi; Gangi, Hamid

2012-01-01

Background: Growth and development in any country's national health system, without an efficient evaluation system, lacks the basic concepts and tools necessary for fulfilling the system's goals. The balanced scorecard (BSC) is a technique widely used to measure the performance of an organization. The basic core of the BSC is guided by the organization's vision and strategies, which are the bases for the formation of four perspectives of BSC. The goal of this research is the performance evaluation of Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences, based on Iran BSC model. Materials and Methods: This is a combination (quantitative–qualitative) research which was done at Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences in 2011. The research populations were hospital managers at different levels. Sampling method was purposive sampling in which the key informed personnel participated in determining the performance indicators of hospital as the BSC team members in focused discussion groups. After determining the conceptual elements in focused discussion groups, the performance objectives (targets) and indicators of hospital were determined and sorted in perspectives by the group discussion participants. Following that, the performance indicators were calculated by the experts according to the predetermined objectives; then, the score of each indicator and the mean score of each perspective were calculated. Results: Research findings included development of the organizational mission, vision, values, objectives, and strategies. The strategies agreed upon by the participants in the focus discussion group included five strategies, which were customer satisfaction, continuous quality improvement, development of human resources, supporting innovation, expansion of services and improving the productivity. Research participants also agreed upon four perspectives for the Al-Zahra hospital BSC. In the patients and community perspective (customer), two objectives and three indicators were agreed upon, with a mean score of 75.9%. In the internal process perspective, 4 objectives and 14 indicators were agreed upon, with a mean score of 79.37%. In the learning and growth perspective, four objectives and eight indicators were agreed upon, with a mean score of 81.11%. Finally, in the financial perspective, two objectives and five indicators were agreed upon, with a mean score of 67.15%. Conclusion: One way to create demand for hospital services is performance evaluation by paying close attention to all BSC perspectives, especially the non-financial perspectives such as customers and internal processes perspectives. In this study, the BSC showed the differences in performance level of the organization in different perspectives, which would assist the hospital managers improve their performance indicators. The learning and growth perspective obtained the highest score, and the financial perspective obtained the least score. Since the learning and growth perspective acts as a base for all other perspectives and they depend on it, hospitals must continuously improve the service processes and the quality of services by educating staff and updating their policies and procedures. This can increase customer satisfaction and productivity and finally improve the BSC in financial perspective. PMID:23555104

Mortality Among Inpatients of a Psychiatric Hospital: Indian Perspective

PubMed Central

Shinde, Shireesh Shatwaji; Nagarajaiah; Narayanaswamy, Janardhanan C.; Viswanath, Biju; Kumar, Naveen C.; Gangadhar, B. N.; Math, Suresh Bada

2014-01-01

Objective: The objective of this study is to assess mortality and its correlates among psychiatric inpatients of a tertiary care neuropsychiatric hospital. Given the background that such a study has never been undertaken in India, the findings would have a large bearing on policy making from a mental health-care perspective. Materials and Methods: The medical records of those psychiatric inpatients (n = 333) who died during their stay at the National Institute of Mental Health and Neurosciences in past 26 years (January 1983 to December 2008) constituted the study population. Results: During the 26 years, there were a total of 103,252 psychiatric in-patient admissions, out of which 333 people died during their inpatient stay. Majority (n = 135, 44.6%) of the mortality was seen in the age group of 21-40 years. Most of the subjects were males (n = 202, 67%), married (n = 172, 56.8%) and from urban areas (n = 191, 63%). About, 54% of the subjects had short inpatient stay (<5 days, median for the sample). In 118 (39%) of the subjects, there was a history of physical illness. Leading cause of death were cardiovascular system disorders (n = 132, 43.6%), followed by respiratory system disorders (n = 45, 14.9%), nervous system disorders (n = 30, 9.9%) and infections (n = 31, 10.1%). In 21 (7%), cause of death was suicide. Conclusions: Identifying the factors associated with the death of inpatients is of utmost importance in assessing the care in a neuropsychiatric hospital and in formulating better treatment plan and policy in mental health. The discussion focuses on the analysis of different factors associated with inpatient mortality. PMID:24860214

Dynamic metabolism modelling of urban water services--demonstrating effectiveness as a decision-support tool for Oslo, Norway.

PubMed

Venkatesh, G; Sægrov, Sveinung; Brattebø, Helge

2014-09-15

Urban water services are challenged from many perspectives and different stakeholders demand performance improvements along economic, social and environmental dimensions of sustainability. In response, urban water utilities systematically give more attention to criteria such as water safety, climate change adaptation and mitigation, environmental life cycle assessment (LCA), total cost efficiency, and on how to improve their operations within the water-energy-carbon nexus. The authors of this paper collaborated in the development of a 'Dynamic Metabolism Model' (DMM). The model is developed for generic use in the sustainability assessment of urban water services, and it has been initially tested for the city of Oslo, Norway. The purpose has been to adopt a holistic systemic perspective to the analysis of metabolism and environmental impacts of resource flows in urban water and wastewater systems, in order to offer a tool for the examination of future strategies and intervention options in such systems. This paper describes the model and its application to the city of Oslo for the analysis time period 2013-2040. The external factors impacting decision-making and interventions are introduced along with realistic scenarios developed for the testing, after consultation with officials at the Oslo Water and Wastewater Works (Norway). Possible interventions that the utility intends to set in motion are defined and numerically interpreted for incorporation into the model, and changes in the indicator values over the time period are determined. This paper aims to demonstrate the effectiveness and usefulness of the DMM, as a decision-support tool for water-wastewater utilities. The scenarios considered and interventions identified do not include all possible scenarios and interventions that can be relevant for water-wastewater utilities. Copyright © 2014 Elsevier Ltd. All rights reserved.

Stapled hemorrhoidopexy, an innovative surgical procedure for hemorrhoidal prolapse: cost-utility analysis.

PubMed

Ribarić, Goran; Kofler, Justus; Jayne, David G

2011-08-15

To undertake full economic evaluation of stapled hemorrhoidopexy (PPH) to establish its cost-effectiveness and investigate whether PPH can become cost-saving compared to conventional excisional hemorrhoidectomy (CH). A cost-utility analysis in hospital and health care system (UK) was undertaken using a probabilistic, cohort-based decision tree to compare the use of PPH with CH. Sensitivity analyses allowed showing outcomes in regard to the variations in clinical practice of PPH procedure. The participants were patients undergoing initial surgical treatment of third and fourth degree hemorrhoids within a 1-year time-horizon. Data on clinical effectiveness were obtained from a systematic review of the literature. Main outcome measures were the cost per procedure at the hospital level, total direct costs from the health care system perspective, quality adjusted life years (QALY) gained and incremental cost per QALY gained. A decrease in operating theater time and hospital stay associated with PPH led to a cost saving compared to CH of GBP 27 (US $43.11, €30.50) per procedure at the hospital level and to an incremental cost of GBP 33 (US $52.68, €37.29) after one year from the societal perspective. Calculation of QALYs induced an incremental QALY of 0.0076 and showed an incremental cost-effective ratio (ICER) of GBP 4316 (US $6890.47, €4878.37). Taking into consideration recent literature on clinical outcomes, PPH becomes cost saving compared to CH for the health care system. PPH is a cost-effective procedure with an ICER of GBP 4136 and it seems that an innovative surgical procedure could be cost saving in routine clinical practice.

How long is too long in contemporary peer review? Perspectives from authors publishing in conservation biology journals.

PubMed

Nguyen, Vivian M; Haddaway, Neal R; Gutowsky, Lee F G; Wilson, Alexander D M; Gallagher, Austin J; Donaldson, Michael R; Hammerschlag, Neil; Cooke, Steven J

2015-01-01

Delays in peer reviewed publication may have consequences for both assessment of scientific prowess in academics as well as communication of important information to the knowledge receptor community. We present an analysis on the perspectives of authors publishing in conservation biology journals regarding their opinions on the importance of speed in peer-review as well as how to improve review times. Authors were invited to take part in an online questionnaire, of which the data was subjected to both qualitative (open coding, categorizing) and quantitative analyses (generalized linear models). We received 637 responses to a total of 6,547 e-mail invitations sent. Peer-review speed was generally perceived as slow, with authors experiencing a typical turnaround time of 14 weeks while their perceived optimal review time is six weeks. Male and younger respondents seem to have higher expectations of review speed than females and older respondents. Majority of participants attributed lengthy review times to the 'stress' on the peer-review system (i.e., reviewer and editor fatigue), while editor persistence and journal prestige were believed to speed up the review process. Negative consequences of lengthy review times appear to be greater for early career researchers and can also have impact on author morale (e.g. motivation or frustration). Competition among colleagues were also of concern to respondents. Incentivizing peer review was among the top suggested alterations to the system along with training graduate students in peer review, increased editorial persistence, and changes to the norms of peer-review such as opening the peer-review process to the public. It is clear that authors surveyed in this study view the peer-review system as under stress and we encourage scientists and publishers to push the envelope for new peer review models.

The economic burden of diabetes in India: a review of the literature.

PubMed

Yesudian, Charles A K; Grepstad, Mari; Visintin, Erica; Ferrario, Alessandra

2014-12-02

Diabetes and its complications are a major cause of morbidity and mortality in India, and the prevalence of type 2 diabetes is on the rise. This calls for an assessment of the economic burden of the disease. To conduct a critical review of the literature on cost of illness studies of diabetes and its complications in India. A comprehensive literature review addressing the study objective was conducted. An extraction table and a scoring system to assess the quality of the studies reviewed were developed. A total of nineteen articles from different regions of India met the study inclusion criteria. The third party payer perspective was the most common study design (17 articles) while fewer articles (n =2) reported on costs from a health system or societal perspective. All the articles included direct costs and only a few (n =4) provided estimates for indirect costs based on income loss for patients and carers. Drug costs proved to be a significant cost component in several studies (n =12). While middle and high-income groups had higher expenditure in absolute terms, costs constituted a higher proportion of income for the poor. The economic burden was highest among urban groups. The overall quality of the studies is low due to a number of methodological weaknesses. The most frequent epidemiological approach employed was the prevalence-based one (n =18) while costs were mainly estimated using a bottom up approach (n =15). The body of literature on the costs of diabetes and its complications in India provides a fragmented picture that has mostly concentrated on the direct costs borne by individuals rather than the healthcare system. There is a need to develop a robust methodology to perform methodologically rigorous and transparent cost of illness studies to inform policy decisions.

Cost-utility analysis of Palivizumab for Respiratory Syncytial Virus infection prophylaxis in preterm infants: update based on the clinical evidence in Spain.

PubMed

Sanchez-Luna, M; Burgos-Pol, R; Oyagüez, I; Figueras-Aloy, J; Sánchez-Solís, M; Martinón-Torres, F; Carbonell-Estrany, X

2017-10-17

This study aimed at estimating the efficiency of palivizumab in the prevention of Respiratory Syncytial Virus (RSV) infection and its sequelae in preterm infants (32 day 1 -35 day 0 weeks of gestational age -wGA-) in Spain. A decision-tree model was developed to compare health benefits (Quality Adjusted Life Years-QALYs) and costs of palivizumab versus a non-prophylaxis strategy over 6 years. A hypothetical cohort of 1,000 preterm infants, 32 day 1 -35 day 0 wGA (4.356 kg average weight) at the beginning of the prophylaxis (15 mg/kg of palivizumab; 3.88 average number of injections per RSV season) was analysed. The model considered the most recent evidence from Spanish observational and epidemiological studies on RSV infection: the FLIP II study provided hospital admission and Intensive Care Unit (ICU) admission rates; in-hospital mortality rate was drawn from an epidemiological study from 2004 to 2012; recurrent wheezing rates associated to RSV infection from SPRING study were adjusted by the evidence on the palivizumab effect from clinical trials. Quality of life baseline value, number of hospitalized infants and the presence of recurrent wheezing over time were granted to estimate QALYs. National Health Service and societal perspective (included also recurrent wheezing indirect cost) were analysed. Total costs (€, 2016) included pharmaceutical and administration costs, hospitalization costs and recurrent wheezing management annual costs. A discount rate of 3.0% was applied annually for both costs and health outcomes. Over 6 years, the base case analysis showed that palivizumab was associated to an increase of 0.0731 QALYs compared to non-prophylaxis. Total costs were estimated in €2,110.71 (palivizumab) and €671.68 (non-prophylaxis) from the National Health System (NHS) perspective, resulting in an incremental cost utility ratio (ICUR) of €19,697.69/QALYs gained (prophylaxis vs non-prophylaxis). Results derived from the risk-factors population subgroups analysed were in line with the total population results. From the societal perspective, the incremental cost associated to palivizumab decreased to an €1,253.14 (ICUR = €17,153.16€/QALYs gained for palivizumab vs non-prophylaxis). One-way and probabilistic sensitivity analyses confirmed the robustness of the model. The prophylaxis with palivizumab is efficient for preventing from RSV infections in preterm infants 32 day 1 -35 day 0 wGA in Spain.

Trainee perspectives on postdoctoral recruitment in clinical neuropsychology: reflections on commentaries by Bodin and Grote (2016) and Nelson et al. (2016).

PubMed

Towns, S J; Hahn-Ketter, A E; Halpern, J; Block, C K

2018-01-01

The aim of the current invited paper is to provide the trainees' perspective on recent commentaries on recruitment for postdoctoral fellowship in clinical neuropsychology. The current system of recruitment includes both a match and non-match process and has been problematic for trainees and training programs alike. The author team completed a non-systematic review of previously published commentaries on the current state of postdoctoral fellowship recruitment, which are briefly summarized in the current paper. The trainee perspective is addressed using both survey data and anecdotal experiences of the authors. Trainees report high levels of dissatisfaction with the current dual recruitment system; however, there is no clear preference from trainees for either a match or non-match system. Trainees from both recruitment systems report high levels of satisfaction with their training experience. It seems that either a match or non-match approach, if it led to a unified system, would improve trainee satisfaction.

Global Economic Burden of Norovirus Gastroenteritis

PubMed Central

Bartsch, Sarah M.; Lopman, Benjamin A.; Ozawa, Sachiko; Hall, Aron J.; Lee, Bruce Y.

2016-01-01

Background Despite accounting for approximately one fifth of all acute gastroenteritis illnesses, norovirus has received comparatively less attention than other infectious pathogens. With several candidate vaccines under development, characterizing the global economic burden of norovirus could help funders, policy makers, public health officials, and product developers determine how much attention and resources to allocate to advancing these technologies to prevent and control norovirus. Methods We developed a computational simulation model to estimate the economic burden of norovirus in every country/area (233 total) stratified by WHO region and globally, from the health system and societal perspectives. We considered direct costs of illness (e.g., clinic visits and hospitalization) and productivity losses. Results Globally, norovirus resulted in a total of $4.2 billion (95% UI: $3.2–5.7 billion) in direct health system costs and $60.3 billion (95% UI: $44.4–83.4 billion) in societal costs per year. Disease amongst children <5 years cost society $39.8 billion, compared to $20.4 billion for all other age groups combined. Costs per norovirus illness varied by both region and age and was highest among adults ≥55 years. Productivity losses represented 84–99% of total costs varying by region. While low and middle income countries and high income countries had similar disease incidence (10,148 vs. 9,935 illness per 100,000 persons), high income countries generated 62% of global health system costs. In sensitivity analysis, the probability of hospitalization had the largest impact on health system cost estimates ($2.8 billion globally, assuming no hospitalization costs), while the probability of missing productive days had the largest impact on societal cost estimates ($35.9 billion globally, with a 25% probability of missing productive days). Conclusions The total economic burden is greatest in young children but the highest cost per illness is among older age groups in some regions. These large costs overwhelmingly are from productivity losses resulting from acute illness. Low, middle, and high income countries all have a considerable economic burden, suggesting that norovirus gastroenteritis is a truly global economic problem. Our findings can help identify which age group(s) and/or geographic regions may benefit the most from interventions. PMID:27115736

Global Economic Burden of Norovirus Gastroenteritis.

PubMed

Bartsch, Sarah M; Lopman, Benjamin A; Ozawa, Sachiko; Hall, Aron J; Lee, Bruce Y

2016-01-01

Despite accounting for approximately one fifth of all acute gastroenteritis illnesses, norovirus has received comparatively less attention than other infectious pathogens. With several candidate vaccines under development, characterizing the global economic burden of norovirus could help funders, policy makers, public health officials, and product developers determine how much attention and resources to allocate to advancing these technologies to prevent and control norovirus. We developed a computational simulation model to estimate the economic burden of norovirus in every country/area (233 total) stratified by WHO region and globally, from the health system and societal perspectives. We considered direct costs of illness (e.g., clinic visits and hospitalization) and productivity losses. Globally, norovirus resulted in a total of $4.2 billion (95% UI: $3.2-5.7 billion) in direct health system costs and $60.3 billion (95% UI: $44.4-83.4 billion) in societal costs per year. Disease amongst children <5 years cost society $39.8 billion, compared to $20.4 billion for all other age groups combined. Costs per norovirus illness varied by both region and age and was highest among adults ≥55 years. Productivity losses represented 84-99% of total costs varying by region. While low and middle income countries and high income countries had similar disease incidence (10,148 vs. 9,935 illness per 100,000 persons), high income countries generated 62% of global health system costs. In sensitivity analysis, the probability of hospitalization had the largest impact on health system cost estimates ($2.8 billion globally, assuming no hospitalization costs), while the probability of missing productive days had the largest impact on societal cost estimates ($35.9 billion globally, with a 25% probability of missing productive days). The total economic burden is greatest in young children but the highest cost per illness is among older age groups in some regions. These large costs overwhelmingly are from productivity losses resulting from acute illness. Low, middle, and high income countries all have a considerable economic burden, suggesting that norovirus gastroenteritis is a truly global economic problem. Our findings can help identify which age group(s) and/or geographic regions may benefit the most from interventions.

Urban transportation: Perspectives on mobility and choice

NASA Technical Reports Server (NTRS)

Sincoff, M. Z. (Editor); Dajani, J. S. (Editor); Arnold, G. R.; Bird, J. W.; Brooks, C. M. (Editor); Cobb, W. E.; Cross, J. E.; Darby, L. F.; Erb, N. H.; Ficht, J. C.

1974-01-01

A study of urban transportation systems are presented characterized by intensive scrutiny of many ideas, philosophies, and academic perspectives. This report is intended to communicate some dimensions of the urban transportation problem to the general public.

Total Ownership Cost a Decade Into the 21st Century

DTIC Science & Technology

2012-09-30

lecturer and academic associate for Program Management Curricula, Graduate School of Business and Public Policy, Naval Postgraduate School. While on...F cost $15,346 per flight hour of operation—40% higher than the $10,979 predicted in 1999. Institute for Defense Analyses Study: The Major Causes of...this working paper perceive as a shortsighted goal of obtaining funds for development and procurement to the more complete perspective of total life

Toward a More Usable Home-Based Video Telemedicine System: A Heuristic Evaluation of the Clinician User Interfaces of Home-Based Video Telemedicine Systems.

PubMed

Agnisarman, Sruthy; Narasimha, Shraddhaa; Chalil Madathil, Kapil; Welch, Brandon; Brinda, Fnu; Ashok, Aparna; McElligott, James

2017-04-24

Telemedicine is the use of technology to provide and support health care when distance separates the clinical service and the patient. Home-based telemedicine systems involve the use of such technology for medical support and care connecting the patient from the comfort of their homes with the clinician. In order for such a system to be used extensively, it is necessary to understand not only the issues faced by the patients in using them but also the clinician. The aim of this study was to conduct a heuristic evaluation of 4 telemedicine software platforms-Doxy.me, Polycom, Vidyo, and VSee-to assess possible problems and limitations that could affect the usability of the system from the clinician's perspective. It was found that 5 experts individually evaluated all four systems using Nielsen's list of heuristics, classifying the issues based on a severity rating scale. A total of 46 unique problems were identified by the experts. The heuristics most frequently violated were visibility of system status and Error prevention amounting to 24% (11/46 issues) each. Esthetic and minimalist design was second contributing to 13% (6/46 issues) of the total errors. Heuristic evaluation coupled with a severity rating scale was found to be an effective method for identifying problems with the systems. Prioritization of these problems based on the rating provides a good starting point for resolving the issues affecting these platforms. There is a need for better transparency and a more streamlined approach for how physicians use telemedicine systems. Visibility of the system status and speaking the users' language are keys for achieving this. ©Sruthy Agnisarman, Shraddhaa Narasimha, Kapil Chalil Madathil, Brandon Welch, FNU Brinda, Aparna Ashok, James McElligott. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 24.04.2017.

Integrated Healthcare Delivery: A Qualitative Research Approach to Identifying and Harmonizing Perspectives of Integrated Neglected Tropical Disease Programs

PubMed Central

Jacobson, Julie; Mosher, Aryc W.; Walson, Judd L.

2016-01-01

Background While some evidence supports the beneficial effects of integrating neglected tropical disease (NTD) programs to optimize coverage and reduce costs, there is minimal information regarding when or how to effectively operationalize program integration. The lack of systematic analyses of integration experiences and of integration processes may act as an impediment to achieving more effective NTD programming. We aimed to learn about the experiences of NTD stakeholders and their perceptions of integration. Methodology We evaluated differences in the definitions, roles, perceived effectiveness, and implementation experiences of integrated NTD programs among a variety of NTD stakeholder groups, including multilateral organizations, funding partners, implementation partners, national Ministry of Health (MOH) teams, district MOH teams, volunteer rural health workers, and community members participating in NTD campaigns. Semi-structured key informant interviews were conducted. Coding of themes involved a mix of applying in-vivo open coding and a priori thematic coding from a start list. Findings In total, 41 interviews were conducted. Salient themes varied by stakeholder, however dominant themes on integration included: significant variations in definitions, differential effectiveness of specific integrated NTD activities, community member perceptions of NTD programs, the influence of funders, perceived facilitators, perceived barriers, and the effects of integration on health system strength. In general, stakeholder groups provided unique perspectives, rather than contrarian points of view, on the same topics. The stakeholders identified more advantages to integration than disadvantages, however there are a number of both unique facilitators and challenges to integration from the perspective of each stakeholder group. Conclusions Qualitative data suggest several structural, process, and technical opportunities that could be addressed to promote more effective and efficient integrated NTD elimination programs. We highlight a set of ten recommendations that may address stakeholder concerns and perceptions regarding these key opportunities. For example, public health stakeholders should embrace a broader perspective of community-based health needs, including and beyond NTDs, and available platforms for addressing those needs. PMID:27776127

Estimated Cost-Effectiveness, Cost Benefit, and Risk Reduction Associated with an Endocrinologist-Pharmacist Diabetes Intense Medical Management "Tune-Up" Clinic.

PubMed

Hirsch, Jan D; Bounthavong, Mark; Arjmand, Anisa; Ha, David R; Cadiz, Christine L; Zimmerman, Andrew; Ourth, Heather; Morreale, Anthony P; Edelman, Steven V; Morello, Candis M

2017-03-01

In 2012 U.S. diabetes costs were estimated to be $245 billion, with $176 billion related to direct diabetes treatment and associated complications. Although a few studies have reported positive glycemic and economic benefits for diabetes patients treated under primary care physician (PCP)-pharmacist collaborative practice models, no studies have evaluated the cost-effectiveness of an endocrinologist-pharmacist collaborative practice model treating complex diabetes patients versus usual PCP care for similar patients. To estimate the cost-effectiveness and cost benefit of a collaborative endocrinologist-pharmacist Diabetes Intense Medical Management (DIMM) "Tune-Up" clinic for complex diabetes patients versus usual PCP care from 3 perspectives (clinic, health system, payer) and time frames. Data from a retrospective cohort study of adult patients with type 2 diabetes mellitus (T2DM) and glycosylated hemoglobin A1c (A1c) ≥ 8% who were referred to the DIMM clinic at the Veterans Affairs San Diego Health System were used for cost analyses against a comparator group of PCP patients meeting the same criteria. The DIMM clinic took more time with patients, compared with usual PCP visits. It provided personalized care in three 60-minute visits over 6 months, combining medication therapy management with patient-specific diabetes education, to achieve A1c treatment goals before discharge back to the PCP. Data for DIMM versus PCP patients were used to evaluate cost-effectiveness and cost benefit. Analyses included incremental cost-effectiveness ratios (ICERs) at 6 months, 3-year estimated total medical costs avoided and return on investment (ROI), absolute risk reduction of complications, resultant medical costs, and quality-adjusted life-years (QALYs) over 10 years. Base case ICER results indicated that from the clinic perspective, the DIMM clinic costs $21 per additional percentage point of A1c improvement and $115-$164 per additional patient at target A1c goal level compared with the PCP group. From the health system perspective, medical cost avoidance due to improved A1c was $8,793 per DIMM patient versus $3,506 per PCP patient (P = 0.009), resulting in an ROI of $9.01 per dollar spent. From the payer perspective, DIMM patients had estimated lower total medical costs, a greater number of QALYs gained, and appreciable risk reductions for diabetes-related complications over 2-, 5- and 10-year time frames, indicating that the DIMM clinic was dominant. Sensitivity analyses indicated results were robust, and overall conclusions did not change appreciably when key parameters (including DIMM clinic effectiveness and cost) were varied within plausible ranges. The DIMM clinic endocrinologist-pharmacist collaborative practice model, in which the pharmacist spent more time providing personalized care, improved glycemic control at a minimal cost per additional A1c benefit gained and produced greater cost avoidance, appreciable ROI, reduction in long-term complication risk, and lower cost for a greater gain in QALYs. Overall, the DIMM clinic represents an advanced pharmacy practice model with proven clinical and economic benefits from multiple perspectives for patients with T2DM and high medication and comorbidity complexity. No outside funding supported this study. The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Preliminary versions of the study data were presented in abstract form at the American Pharmacists Association Annual Meeting & Exposition; March 27, 2015; San Diego, California, and the Academy of Managed Care Pharmacy Annual Meeting; April 21, 2016; San Francisco, California. Study concept and design were contributed by Hirsch, Bounthavong, and Edelman, along with Morello and Morreale. Arjmand, Ourth, Ha, Cadiz, and Zimmerman collected the data. Data interpretation was performed by Ha, Morreale, and Morello, along with Cadiz, Ourth, and Hirsch. The manuscript was written primarily by Hirsch and Zimmerman, along with Arjamand, Ourth, and Morello, and was revised by Hirsch and Cadiz, along with Bounthavong, Ha, Morreale, and Morello.

A Study on the Perceptions About Potential Advantages of FMS (Foreign Military Sales) and Commercial Sales: Seller and Buyer Perspectives

DTIC Science & Technology

1987-09-01

SFl WILE coP DTIC ELECTEI DEC0 419871 OFD IIN A STUDY ON THE PERCEPTIONS ABOUT COMMERCIAL SALES: SELLER ANDI • BUYER PERSPECTIVES THESIS Yong Sang Kim...PERCEPTIONS ABOUT H𔃾 POTENTIAL ADVANTAGES OF FMS AND COMMERCIAL SALES: SELLER AND BUYER PERSPECTIVES THESIS Accession For Yong Sang Kim NTIS ,RA&I Major...AND COMMERCIAL SALES: SELLER AND BUYER PERSPECTIVES THESIS Presented to the Faculty of the School of Systems and Logistics of the Air Force Institute

Safe teleradiology: information assurance as project planning methodology

NASA Astrophysics Data System (ADS)

Collmann, Jeff R.; Alaoui, Adil; Nguyen, Dan; Lindisch, David

2003-05-01

This project demonstrates use of OCTAVE, an information security risk assessment method, as an approach to the safe design and planning of a teleradiology system. By adopting this approach to project planning, we intended to provide evidence that including information security as an intrinsic component of project planning improves information assurance and that using information assurance as a planning tool produces and improves the general system management plan. Several considerations justify this approach to planning a safe teleradiology system. First, because OCTAVE was designed as a method for retrospectively assessing and proposing enhancements for the security of existing information management systems, it should function well as a guide to prospectively designing and deploying a secure information system such as teleradiology. Second, because OCTAVE provides assessment and planning tools for use primarily by interdisciplinary teams from user organizations, not consultants, it should enhance the ability of such teams at the local level to plan safe information systems. Third, from the perspective of sociological theory, OCTAVE explicitly attempts to enhance organizational conditions identified as necessary to safely manage complex technologies. Approaching information system design from the perspective of information security risk management proactively integrates health information assurance into a project"s core. This contrasts with typical approaches that perceive "security" as a secondary attribute to be "added" after designing the system and with approaches that identify information assurance only with security devices and user training. The perspective of health information assurance embraces so many dimensions of a computerized health information system"s design that one may successfully deploy a method for retrospectively assessing information security risk as a prospective planning tool. From a sociological perspective, this approach enhances the general conditions as well as establishes specific policies and procedures for reliable performance of health information assurance.

Patients' perspective of the design of provider-patients electronic communication services.

PubMed

Silhavy, Petr; Silhavy, Radek; Prokopova, Zdenka

2014-06-12

Information Delivery is one the most important tasks in healthcare practice. This article discusses patient's tasks and perspectives, which are then used to design a new Effective Electronic Methodology. The system design methods applicable to electronic communication in the healthcare sector are also described. The architecture and the methodology for the healthcare service portal are set out in the proposed system design.

Coulombic Interaction in Finnish Middle School Chemistry: A Systemic Perspective on Students' Conceptual Structure of Chemical Bonding

ERIC Educational Resources Information Center

Joki, Jarkko; Lavonen, Jari; Juuti, Kalle; Aksela, Maija

2015-01-01

The aim of this study was to design a novel and holistic way to teach chemical bonding at the middle school level according to research on the teaching and learning of bonding. A further aim was to investigate high achieving middle school students' conceptual structures concerning chemical bonding by using a systemic perspective. Students in one…

The Future Justification to Adopt Governance System at the Jordan Universities from the Perspective of Educational Experts

ERIC Educational Resources Information Center

Abu-Nair, Natheer Sihan

2015-01-01

The aim of the study was to reveal the future justification to adopt governance system at the Jordanian Universities from the perspective of educational experts. The study society was the academic staff in the field of education at Al-Balqa Applied University and Jordan University, at the first semester of the academic year 2013-2014. The study…

The Transition to Preschool: A Problem or an Opportunity for Children? A Sociological Perspective in the Context of a "Split System"

ERIC Educational Resources Information Center

Amerijckx, Gaëlle; Humblet, Perrine C.

2015-01-01

This article discusses the central issue of the transition to preschool. Individual semi-structured interviews with school professionals and parents in the Brussels region revealed that this issue is crucial for the well-being of young children, from both an educational and a social perspective. We discovered that the education system works under…

Rethinking intractable conflict: the perspective of dynamical systems.

PubMed

Vallacher, Robin R; Coleman, Peter T; Nowak, Andrzej; Bui-Wrzosinska, Lan

2010-01-01

Intractable conflicts are demoralizing. Beyond destabilizing the families, communities, or international regions in which they occur, they tend to perpetuate the very conditions of misery and hate that contributed to them in the first place. Although the common factors and processes associated with intractable conflicts have been identified through research, they represent an embarrassment of riches for theory construction. Thus, the current task in this area is integrating these diverse factors into an account that provides a coherent perspective yet allows for prediction and a basis for conflict resolution in specific conflict settings. We suggest that the perspective of dynamical systems provides such an account. This article outlines the key concepts and hypotheses associated with this approach. It is organized around a set of basic questions concerning intractable conflict for which the dynamical perspective offers fresh insight and testable propositions. The questions and answers are intended to provide readers with basic concepts and principles of complexity and dynamical systems that are useful for rethinking the nature of intractable conflict and the means by which such conflict can be transformed. Copyright 2010 APA, all rights reserved.

What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation.

PubMed

Liddy, Clare; Drosinis, Paul; Deri Armstrong, Catherine; McKellips, Fanny; Afkham, Amir; Keely, Erin

2016-06-23

This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Champlain health region in Eastern Ontario, Canada. Primary care providers and specialists registered to use the eConsult service. Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Cost utility, budget impact, and scenario analysis of racecadotril in addition to oral rehydration for acute diarrhea in children in Malaysia

PubMed Central

Rautenberg, Tamlyn Anne; Zerwes, Ute; Lee, Way Seah

2018-01-01

Objective To perform cost utility (CU) and budget impact (BI) analyses augmented by scenario analyses of critical model structure components to evaluate racecadotril as adjuvant to oral rehydration solution (ORS) for children under 5 years with acute diarrhea in Malaysia. Methods A CU model was adapted to evaluate racecadotril plus ORS vs ORS alone for acute diarrhea in children younger than 5 years from a Malaysian public payer’s perspective. A bespoke BI analysis was undertaken in addition to detailed scenario analyses with respect to critical model structure components. Results According to the CU model, the intervention is less costly and more effective than comparator for the base case with a dominant incremental cost-effectiveness ratio of −RM 1,272,833/quality-adjusted life year (USD −312,726/quality-adjusted life year) in favor of the intervention. According to the BI analysis (assuming an increase of 5% market share per year for racecadotril+ORS for 5 years), the total cumulative incremental percentage reduction in health care expenditure for diarrhea in children is 0.136578%, resulting in a total potential cumulative cost savings of −RM 73,193,603 (USD −17,983,595) over a 5-year period. Results hold true across a range of plausible scenarios focused on critical model components. Conclusion Adjuvant racecadotril vs ORS alone is potentially cost-effective from a Malaysian public payer perspective subject to the assumptions and limitations of the model. BI analysis shows that this translates into potential cost savings for the Malaysian public health care system. Results hold true at evidence-based base case values and over a range of alternate scenarios. PMID:29588606

Potentially inappropriate medication in the elderly in Germany: an economic appraisal of the PRISCUS list.

PubMed

Pohl-Dernick, Katharina; Meier, Florian; Maas, Renke; Schöffski, Oliver; Emmert, Martin

2016-04-01

Several lists of potentially inappropriate medication (PIM) for elderly patients have been developed worldwide in recent years. Those lists intend to reduce prescriptions of drugs that carry an unnecessarily high risk of adverse drug events in elderly patients. In 2010, an expert panel published the PRISCUS list for the German drug market. This study calculates the amount of drug reimbursement for PIM in Germany and potential cost effects from the perspective of statutory health insurance when these are replaced by the substitutes recommended by the PRISCUS list. Register-based data for the 30 top-selling drugs on the PRISCUS list in 2009 for patients greater than or equal to 65 years of age were provided by the Scientific Institute of the German Local Health Care Fund. We calculated the percentage of sales and defined daily doses for patients greater than or equal to 65 years of age compared with the total statutory health insurance population. Reimbursement costs for the recommended substitutions were estimated by considering different scenarios. In 2009, drug reimbursement for the 30 top-selling PIM prescribed to patients greater than or equal to 65 years of age were calculated to be €305.7 million. Prescribing the recommended substitution medication instead of PIM would lead to an increased total reimbursement cost for the German health care system ranging between from €325.9 million to €810.0 million. The results show that the substitution of PIM by medication deemed to be more appropriate for the elderly comes along with additional costs. Consequently, there is no short-term incentive for doing so from a payer perspective. Future studies have to consider the long-term effects and other sectors.

Benefits from a geographers' perspective on human-water systems - the waterscape concept

NASA Astrophysics Data System (ADS)

Evers, Mariele; Höllermann, Britta; Almoradie, Adrian; Taft, Linda

2016-04-01

Recently a couple of theoretical foundations and concepts were developed such as hydro-sociology, hydro-economics and integrated water resources management in order to structure and process parameterizations of hydrological research and reflect human-water-interrelations. However, a remaining challenge in human-water-system research is that approaches like socio-hydrology still struggle to formalize hypotheses which are capable to capture the basic driving mechanisms of the dynamic human-water system beyond optimizing algorithms or the principle of optimality or entropy as the societal values and experiences may unfold diverging policy and society responses (cf. Troy et al. 2015). Another challenge that we see is the integration of physical and social sciences with regard to the different epistemologies and perspectives: positivist thinking common in natural sciences and engineering and constructivist conceptualisation common in the social sciences. Here, geographic research seeks to acknowledge multi-spatial perspectives of the different actors and entities and their integration into the physical system that needs mutual recognition of natural and social sciences concepts, theories and methods. We suggest for human-water system research a more geographic perspective, which we call waterscape concept. Water can be regarded as a key structuring element for landscape and its management and, hence, from our perspective, the dynamics in water resources and interrelation of actors and entities in its management also helps to better understand current landscape patterns, their developments and interrelations, respectively. By our definition, a waterscape includes sources and users of water, their interactions, feedbacks and external influencing factors. It is therefore not only the physical space but rather includes the arena of actors and entities interacting. Against this understanding, waterscapes are defined by reciprocal boundary conditions which allow integrating the knowledge of natural and social sciences by acknowledging their different epistemologies, concepts and methods at the same time, hereby, fostering a true integration of the disciplines. Space and time and feedback loops are the three key factors to understand human-water interactions. Especially, by recognizing the degree of feedback sensitive system parameters can be detected and allow for emerging a set of multiple framings and possible development paths. Therefore, the geographical perspective on the waterscape concept proposes a search apart from one solution or best practice as, in our assumption, there are no single best answers because the human dimension and their action and reaction are guided also beyond perceptions, preferences, benefits and costs. Our waterscape concept allows a multi-spatial and multi-disciplinary perspective on water and its projection into space by acknowledging multiple meanings, alternative framings and possible development paths, hence fostering an integrative perspective on human-water systems. It further provides a fruitful framework for transdisciplinary research approaches since it is open and supports societal co-production and reframing of knowledge and policies. Troy, T. J., Pavao-Zuckerman, M., and Evans, T. P.: Debates Perspectives on socio-hydrology: Socio-hydrologic modeling: Tradeoffs, hypothesis testing, and validation, Water Resour Res, 51, 4806-4814, 10.1002/2015WR017046, 2015

Adopting a corporate perspective on databases. Improving support for research and decision making.

PubMed

Meistrell, M; Schlehuber, C

1996-03-01

The Veterans Health Administration (VHA) is at the forefront of designing and managing health care information systems that accommodate the needs of clinicians, researchers, and administrators at all levels. Rather than using one single-site, centralized corporate database VHA has constructed several large databases with different configurations to meet the needs of users with different perspectives. The largest VHA database is the Decentralized Hospital Computer Program (DHCP), a multisite, distributed data system that uses decoupled hospital databases. The centralization of DHCP policy has promoted data coherence, whereas the decentralization of DHCP management has permitted system development to be done with maximum relevance to the users'local practices. A more recently developed VHA data system, the Event Driven Reporting system (EDR), uses multiple, highly coupled databases to provide workload data at facility, regional, and national levels. The EDR automatically posts a subset of DHCP data to local and national VHA management. The development of the EDR illustrates how adoption of a corporate perspective can offer significant database improvements at reasonable cost and with modest impact on the legacy system.

Parasites, ecosystems and sustainability: an ecological and complex systems perspective.

PubMed

Horwitz, Pierre; Wilcox, Bruce A

2005-06-01

Host-parasite relationships can be conceptualised either narrowly, where the parasite is metabolically dependent on the host, or more broadly, as suggested by an ecological-evolutionary and complex systems perspective. In this view Host-parasite relationships are part of a larger set of ecological and co-evolutionary interdependencies and a complex adaptive system. These interdependencies affect not just the hosts, vectors, parasites, the immediate agents, but also those indirectly or consequentially affected by the relationship. Host-parasite relationships also can be viewed as systems embedded within larger systems represented by ecological communities and ecosystems. So defined, it can be argued that Host-parasite relationships may often benefit their hosts and contribute significantly to the structuring of ecological communities. The broader, complex adaptive system view also contributes to understanding the phenomenon of disease emergence, the ecological and evolutionary mechanisms involved, and the role of parasitology in research and management of ecosystems in light of the apparently growing problem of emerging infectious diseases in wildlife and humans. An expanded set of principles for integrated parasite management is suggested by this perspective.

Coronary artery disease in Brazil: contemporary management and future perspectives.

PubMed

Polanczyk, C A; Ribeiro, J P

2009-06-01

Cardiovascular diseases are responsible for 32% of total mortality in Brazil, mostly due to cerebrovascular and coronary artery disease. Epidemiological and socio-economical factors play a pivotal role on the distribution, severity and management of coronary artery disease, and the burden is greater in the southeast and south regions of the country, with a higher mortality in low-income populations. The Brazilian healthcare structure is divided into two complementary systems-public and private-but 75% of the population is covered exclusively by the public system. Some Brazilian institutions offer state-of-the-art care to patients with acute and chronic coronary artery disease, but regional inequalities in medical care are still significant. National policies will have to be implemented to fight risk factors, to ensure primary prevention strategies, including assistance on drugs with known protective effects, areas to be tackled by both the private and the public health sectors. Finally, large investments will have to be made to improve tertiary care, to reorganise systems of care for acute patients and mainly to ensure prompt access and continuity of cardiac care and secondary prevention strategies for the whole population.

Primary Health Care and Public Health: Foundations of Universal Health Systems

PubMed Central

White, Franklin

2015-01-01

The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. PMID:25591411

The Mother’s Perspective: Factors Considered When Choosing to Enter a Stay-at-Home Father and Working Mother Relationship

PubMed Central

Rushing, Cassie; Sparks, Misti

2017-01-01

A qualitative study was conducted to examine the decision-making factors of entering a stay-at-home father and working mother relationship based on the mother’s perspective. A total of 20 married, heterosexual, working mothers with biological children aged 1 to 4 years were asked questions regarding how they decided to enter a stay-at-home father and working mother relationship as well as contributing factors to this decision. The findings presented in this article were part of a larger study that examined mothers’ overall perspectives of the working mother stay-at-home father dynamics. The themes that emerged regarding how the decision was made to enter this kind of relationship were creating a work–family life balance, utilizing the cost-benefit ratio, and applying personality/trait strengths. PMID:28198208

The Mother's Perspective: Factors Considered When Choosing to Enter a Stay-at-Home Father and Working Mother Relationship.

PubMed

Rushing, Cassie; Sparks, Misti

2017-07-01

A qualitative study was conducted to examine the decision-making factors of entering a stay-at-home father and working mother relationship based on the mother's perspective. A total of 20 married, heterosexual, working mothers with biological children aged 1 to 4 years were asked questions regarding how they decided to enter a stay-at-home father and working mother relationship as well as contributing factors to this decision. The findings presented in this article were part of a larger study that examined mothers' overall perspectives of the working mother stay-at-home father dynamics. The themes that emerged regarding how the decision was made to enter this kind of relationship were creating a work-family life balance, utilizing the cost-benefit ratio, and applying personality/trait strengths.

The horizon line, linear perspective, interposition, and background brightness as determinants of the magnitude of the pictorial moon illusion.

PubMed

Jones, Stephanie A H; Wilson, Alexander E

2009-01-01

A total of 110 undergraduate students participated in a series of three experiments that explored the magnitude of the moon illusion in pictures. Experiment 1 examined the role of the number and salience of depth cues and background brightness. Experiment 2 examined the role of the horizon line, linear perspective, interposition, and background brightness. In Experiment 3, comparative distance judgments of the moon as a function of linear perspective, interposition, and the size of the standard moon were obtained. The magnitude of the moon illusion increased as a function of the number and salience of depth cues and changes in background brightness. Experiment 2 failed to support the role of the horizon line in affecting the illusion. Experiment 3 provided additional support for the illusory distance component of the moon illusion.

Making a Difference for Overweight Children: The School Nurse Role

ERIC Educational Resources Information Center

Mosca, Nancy W.

2005-01-01

This manual discusses the school nurse's role in prevention and management of overweight children from an individual student perspective and, perhaps more important, from a system perspective. Manual includes the BMI (Body Mass Index) Wheel.

A reliability and mass perspective of SP-100 Stirling cycle lunar-base powerplant designs

NASA Technical Reports Server (NTRS)

Bloomfield, Harvey S.

1991-01-01

The purpose was to obtain reliability and mass perspectives on selection of space power system conceptual designs based on SP-100 reactor and Stirling cycle power-generation subsystems. The approach taken was to: (1) develop a criterion for an acceptable overall reliability risk as a function of the expected range of emerging technology subsystem unit reliabilities; (2) conduct reliability and mass analyses for a diverse matrix of 800-kWe lunar-base design configurations employing single and multiple powerplants with both full and partial subsystem redundancy combinations; and (3) derive reliability and mass perspectives on selection of conceptual design configurations that meet an acceptable reliability criterion with the minimum system mass increase relative to reference powerplant design. The developed perspectives provided valuable insight into the considerations required to identify and characterize high-reliability and low-mass lunar-base powerplant conceptual design.

Barriers and enablers of health system adoption of kangaroo mother care: a systematic review of caregiver perspectives.

PubMed

Smith, Emily R; Bergelson, Ilana; Constantian, Stacie; Valsangkar, Bina; Chan, Grace J

2017-01-25

Despite improvements in child survival in the past four decades, an estimated 6.3 million children under the age of five die each year, and more than 40% of these deaths occur in the neonatal period. Interventions to reduce neonatal mortality are needed. Kangaroo mother care (KMC) is one such life-saving intervention; however it has not yet been fully integrated into health systems around the world. Utilizing a conceptual framework for integration of targeted health interventions into health systems, we hypothesize that caregivers play a critical role in the adoption, diffusion, and assimilation of KMC. The objective of this research was to identify barriers and enablers of implementation and scale up of KMC from caregivers' perspective. We searched Pubmed, Embase, Web of Science, Scopus, and WHO regional databases using search terms 'kangaroo mother care' or 'kangaroo care' or 'skin to skin care'. Studies published between January 1, 1960 and August 19, 2015 were included. To be eligible, published work had to be based on primary data collection regarding barriers or enablers of KMC implementation from the family perspective. Abstracted data were linked to the conceptual framework using a deductive approach, and themes were identified within each of the five framework areas using Nvivo software. We identified a total of 2875 abstracts. After removing duplicates and ineligible studies, 98 were included in the analysis. The majority of publications were published within the past 5 years, had a sample size less than 50, and recruited participants from health facilities. Approximately one-third of the studies were conducted in the Americas, and 26.5% were conducted in Africa. We identified four themes surrounding the interaction between families and the KMC intervention: buy in and bonding (i.e. benefits of KMC to mothers and infants and perceptions of bonding between mother and infant), social support (i.e. assistance from other people to perform KMC), sufficient time to perform KMC, and medical concerns about mother or newborn health. Furthermore, we identified barriers and enablers of KMC adoption by caregivers within the context of the health system regarding financing and service delivery. Embedded within the broad social context, barriers to KMC adoption by caregivers included adherence to traditional newborn practices, stigma surrounding having a preterm infant, and gender roles regarding childcare. Efforts to scale up and integrate KMC into health systems must reduce barriers in order to promote the uptake of the intervention by caregivers.

Zonal-flow dynamics from a phase-space perspective

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

Ruiz, D. E.; Parker, J. B.; Shi, E. L.

The wave kinetic equation (WKE) describing drift-wave (DW) turbulence is widely used in the studies of zonal flows (ZFs) emerging from DW turbulence. But, this formulation neglects the exchange of enstrophy between DWs and ZFs and also ignores effects beyond the geometrical-optics limit. Furthermore, we derive a modified theory that takes both of these effects into account, while still treating DW quanta (“driftons”) as particles in phase space. The drifton dynamics is described by an equation of the Wigner–Moyal type, which is commonly known in the phase-space formulation of quantum mechanics. In the geometrical-optics limit, this formulation features additional termsmore » missing in the traditional WKE that ensure exact conservation of the total enstrophy of the system, in addition to the total energy, which is the only conserved invariant in previous theories based on the WKE. We present numerical simulations to illustrate the importance of these additional terms. The proposed formulation can be considered as a phase-space representation of the second-order cumulant expansion, or CE2.« less

Zonal-flow dynamics from a phase-space perspective

DOE PAGES

Ruiz, D. E.; Parker, J. B.; Shi, E. L.; ...

2016-12-16

The wave kinetic equation (WKE) describing drift-wave (DW) turbulence is widely used in the studies of zonal flows (ZFs) emerging from DW turbulence. But, this formulation neglects the exchange of enstrophy between DWs and ZFs and also ignores effects beyond the geometrical-optics limit. Furthermore, we derive a modified theory that takes both of these effects into account, while still treating DW quanta (“driftons”) as particles in phase space. The drifton dynamics is described by an equation of the Wigner–Moyal type, which is commonly known in the phase-space formulation of quantum mechanics. In the geometrical-optics limit, this formulation features additional termsmore » missing in the traditional WKE that ensure exact conservation of the total enstrophy of the system, in addition to the total energy, which is the only conserved invariant in previous theories based on the WKE. We present numerical simulations to illustrate the importance of these additional terms. The proposed formulation can be considered as a phase-space representation of the second-order cumulant expansion, or CE2.« less

Useful measures and models for analytical quality management in medical laboratories.

PubMed

Westgard, James O

2016-02-01

The 2014 Milan Conference "Defining analytical performance goals 15 years after the Stockholm Conference" initiated a new discussion of issues concerning goals for precision, trueness or bias, total analytical error (TAE), and measurement uncertainty (MU). Goal-setting models are critical for analytical quality management, along with error models, quality-assessment models, quality-planning models, as well as comprehensive models for quality management systems. There are also critical underlying issues, such as an emphasis on MU to the possible exclusion of TAE and a corresponding preference for separate precision and bias goals instead of a combined total error goal. This opinion recommends careful consideration of the differences in the concepts of accuracy and traceability and the appropriateness of different measures, particularly TAE as a measure of accuracy and MU as a measure of traceability. TAE is essential to manage quality within a medical laboratory and MU and trueness are essential to achieve comparability of results across laboratories. With this perspective, laboratory scientists can better understand the many measures and models needed for analytical quality management and assess their usefulness for practical applications in medical laboratories.

Computer-generated tailored feedback letters for smoking cessation: theoretical and empirical variability of tailoring.

PubMed

Schumann, Anja; John, Ulrich; Ulbricht, Sabina; Rüge, Jeannette; Bischof, Gallus; Meyer, Christian

2008-11-01

This study examines tailored feedback letters of a smoking cessation intervention that is conceptually based on the transtheoretical model, from a content-based perspective. Data of 2 population-based intervention studies, both randomized controlled trials, with total N=1044 were used. The procedure of the intervention, the tailoring principle for the feedback letters, and the content of the intervention materials are described in detail. Theoretical and empirical frequencies of unique feedback letters are presented. The intervention system was able to generate a total of 1040 unique letters with normative feedback only, and almost half a million unique letters with normative and ipsative feedback. Almost every single smoker in contemplation, preparation, action, and maintenance had an empirically unique combination of tailoring variables and received a unique letter. In contrast, many smokers in precontemplation shared a combination of tailoring variables and received identical letters. The transtheoretical model provides an enormous theoretical and empirical variability of tailoring. However, tailoring for a major subgroup of smokers, i.e. those who do not intend to quit, needs improvement. Conceptual ideas for additional tailoring variables are discussed.

[Systemic biopsychological perspective of basic emotions].

PubMed

Poisson, Benoît

The systemic biopsychological perspective of basic emotions is a heuristic model that allows a better understanding of how people learn to adapt to their environment through different emotions that developed gradually along neurohormonal circuit myelination from birth until about the age of twenty-one. These same emotions, acting in complementarity, will allow the individual to maintain a balance throughout his life.Five basic emotions were retained in line with the five emotions related to neuronal circuits, which are defined in the literature, and these are the five circuits described by Panksepp as follows: aggressiveness (Rage, angry), stress (Fear- surprise), developed by LeDoux, reward (Seeking-joy), developed by Tassin, empathy (Panic-sadness), developed by Decety, and consciousness (consciousness-happiness), developed by Damasio.Several studies on myelination (Kinney, 1988, Parazzini, 2002, Deoni, 2012), Miller, 2012, and Welker, 2012) provide us with a scientific platform to determine the order of development of the neurohormonal circuits underlying basic emotions.Neurohormonal circuits development begins at conception and will continue up until the age of 20-30 years. This article specifically addresses the first three years of life. It offers a systemic biopsychological perspective of basic emotions developed from the latest data in neuroscience. These informations have been integrated into a coherent whole that allows understanding the origin, the development and the functioning of basic emotions.In addition to the information output from the thalamus to the midbrain that set in motion the somatic nervous system there exist, according to Roberge (1998), two other brain information sources that are managed by the hypothalamus (the limbic system). These two information sources allow the refining of the behavioural responses and they favour the homeostasis of the organism. The first information source goes from the midbrain to the hypothalamus to activate the peripheral nervous system. The latter is divided into two: the sympathetic (norepinephrine) that accelerates the motor response and the parasympathetic (acetylcholine), which slows it down. These two systems work in tandem. As for the second release of information, it is endocrine, thus it will follow the hypothalamus-pituitary-adrenal axis to cortisol, the hypothalamus-pituitary axis to endorphin and oxytocin and the hypothalamus-pineal axis to melatonin. The different emotional behaviours result from one of these two sources of information or from a combination of these two and are then managed by the limbic system, which is in continuous connection with the neocortex.In short, no specific centre totally controls human behaviour. Control is achieved through a group of brain structures and relays, permitting adaptive behaviour and maintenance of balance by means of permanent exchanges. Anger, for instance, is a survival emotion, which allows protecting one's physical integrity. It is very useful as an immediate response in an emergency situation, but it can also be harmful if it is used extensively in all situations, giving way to conduct disorders. Thus, the other neurohormonal circuits will regulate anger.Emotions are an integral part of human behaviour. They allow the individual to constantly adapt to the physical and social environment. This approach brings a new perspective to understand how each person maintains balance to avoid the onset of clinical disorders. The understanding of neurochemical mechanisms underlying basic emotions opens up the door to several clinical applications.

Retrospective and prospective analysis of water use and point source pollution from an economic perspective-a case study of Urumqi, China.

PubMed

Wang, Bing; Liu, Lei; Huang, Guohe

2017-11-01

Using the Environmental Kuznets Curve (EKC) hypothesis, this study explored the dynamic trends of water use and point source pollution in Urumqi (2000-2014) from an economic perspective. Retrospective analysis results indicated that total GDP and GDP per capita increased around tenfold and a fivefold since 2000. Total, municipal and industrial water use had average annual growth rates of 3.96, 7.01, and 3.69%, respectively. However, agricultural water use, emissions of COD and NH 3 -N showed average annual decreases of 3.06, 12.40, and 4.74%. Regression models reveal that total water demand in Urumqi would keep monotonically increasing relationships with GDP and GDP per capita in the foreseeable years. However, the relations of specific water usage and economic growth showed diverse trends. In the future, the discharge of COD and NH 3 -N would further reduce with economic growth. It could be concluded that Urumqi has almost passed the stage where economic growth had caused serious environment deterioration, but the increasing water demand in Urumqi is still an urgent problem. The obtained results would be helpful for water resources management and pollution control in the future.

The intersectionality framework and identity intersections in the Journal of Counseling Psychology and The Counseling Psychologist: A content analysis.

PubMed

Shin, Richard Q; Welch, Jamie C; Kaya, Aylin E; Yeung, Jeffrey G; Obana, Chynna; Sharma, Rajni; Vernay, Collin N; Yee, Stephanie

2017-10-01

The framework of intersectionality is a powerful analytical tool for making sense of how interlocking systems of privilege and oppression are experienced by individuals and groups. Despite the long history of the concept, intersectionality has only recently gained attention in psychology. We conducted a content analysis to assess counseling psychology's engagement with an intersectional perspective. All articles published in the Journal of Counseling Psychology (n = 4,800) and The Counseling Psychologist (n = 1,915) from their first issues until July 2016 were reviewed to identify conceptual and empirical work focused on intersectionality. A total of 40 articles were identified and examined for themes. Limitations and future directions are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Cost minimization analysis of a store-and-forward teledermatology consult system.

PubMed

Pak, Hon S; Datta, Santanu K; Triplett, Crystal A; Lindquist, Jennifer H; Grambow, Steven C; Whited, John D

2009-03-01

The aim of this study was to perform a cost minimization analysis of store-and-forward teledermatology compared to a conventional dermatology referral process (usual care). In a Department of Defense (DoD) setting, subjects were randomized to either a teledermatology consult or usual care. Accrued healthcare utilization recorded over a 4-month period included clinic visits, teledermatology visits, laboratories, preparations, procedures, radiological tests, and medications. Direct medical care costs were estimated by combining utilization data with Medicare reimbursement rates and wholesale drug prices. The indirect cost of productivity loss for seeking treatment was also included in the analysis using an average labor rate. Total and average costs were compared between groups. Teledermatology patients incurred $103,043 in total direct costs ($294 average), while usual-care patients incurred $98,365 ($283 average). However, teledermatology patients only incurred $16,359 ($47 average) in lost productivity cost while usual-care patients incurred $30,768 ($89 average). In total, teledermatology patients incurred $119,402 ($340 average) and usual-care patients incurred $129,133 ($372 average) in costs. From the economic perspective of the DoD, store-and-forward teledermatology was a cost-saving strategy for delivering dermatology care compared to conventional consultation methods when productivity loss cost is taken into consideration.

Using Interdisciplinary Workgroups to Educate Surgery Residents in Systems-Based Practice.

PubMed

Gillen, Jacob R; Ramirez, Adriana G; Farineau, Diane W; Hoke, Tracey R; Schirmer, Bruce D; Williams, Michael D; Lau, Christine L

Meaningful education of residents in systems-based practice is notoriously challenging, despite its recognition as 1 of the 6 Accreditation Council for Graduate Medical Education core competencies. To address this challenge, surgery residents and other members of the health care team were organized into interdisciplinary workgroups that were tasked with developing solutions to "systems issues" confronted on a daily basis. The project's goals included providing more meaningful, hands-on educational experience for residents in system-based practice, while also generating practical solutions to workflow issues through interprofessional collaboration. Project participants included all surgery residents at the University of Virginia in Charlottesville, VA, as well as surgical health care professionals across all disciplines. Participants were organized into workgroups. Over the course of 3 sessions, each of 1-hour, each workgroup identified commonly encountered systems issues, chose 1 issue to address, and determined an implementable solution for this issue. In total, 140 participants were divided among 13 workgroups. Workgroup topics ranged from improving paging etiquette to standardizing interdisciplinary communication. In total, 9 of the 13 proposals have been piloted or fully implemented as standard practice at our institution, either within a single unit or over the entire health system. This project demonstrates an innovative approach toward resident education in system-based practice, providing residents with a hands-on experience in problem solving from a systems perspective. These interdisciplinary workgroups generated effective solutions to issues that were meaningful to frontline health care providers. Interdisciplinary collaboration within the workgroups served as a valuable team-building exercise to improve relations between the disciplines. This project can serve as a model for other institutions desiring meaningful education in the Accreditation Council for Graduate Medical Education competency of systems-based practice. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Direct healthcare cost of obesity in brazil: an application of the cost-of-illness method from the perspective of the public health system in 2011.

PubMed

de Oliveira, Michele Lessa; Santos, Leonor Maria Pacheco; da Silva, Everton Nunes

2015-01-01

Obesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems. To estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011. Public hospitals and outpatient care. A cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web. Direct costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men. The cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.

Why total knees fail-A modern perspective review.

PubMed

Lum, Zachary C; Shieh, Alvin K; Dorr, Lawrence D

2018-04-18

Historically, the most common mechanism of total knee arthroplasty (TKA) failures included aseptic loosening, instability and malalignment. As polyethylene production improved, modes of failure from polyethylene wear and subsequent osteolysis became less prevalent. Newer longitudinal studies report that infection has become the primary acute cause of failure with loosening and instability remaining as the overall greatest reasons for revision. Clinical database and worldwide national registries confirm these reports. With an increasing amount of TKA operations performed in the United States, and with focus on value-based healthcare, it is imperative to understand why total knees fail.

Employee benefits in a total rewards framework.

PubMed

Kwon, Jane; Hein, Pam

2013-01-01

Benefits represent one of the largest investments a company makes in its talent. However, our tendency can be to design, deliver and communicate benefits programs independently, without fully considering how those programs fit within a bigger picture of total rewards. Sure, we need to manage and execute individual benefit programs--but not at the expense of getting a real return on our more significant investment in talent. This article provides employers with perspectives on the value of managing benefits within the broader framework of total rewards, why it works and, most importantly, how to make it work.

Health care organizations as complex systems: new perspectives on design and management.

PubMed

McDaniel, Reuben R; Driebe, Dean J; Lanham, Holly Jordan

2013-01-01

We discuss the impact of complexity science on the design and management of health care organizations over the past decade. We provide an overview of complexity science issues and their impact on thinking about health care systems, particularly with the rising importance of information systems. We also present a complexity science perspective on current issues in today's health care organizations and suggest ways that this perspective might help in approaching these issues. We review selected research, focusing on work in which we participated, to identify specific examples of applications of complexity science. We then take a look at information systems in health care organizations from a complexity viewpoint. Complexity science is a fundamentally different way of understanding nature and has influenced the thinking of scholars and practitioners as they have attempted to understand health care organizations. Many scholars study health care organizations as complex adaptive systems and through this perspective develop new management strategies. Most important, perhaps, is the understanding that attention to relationships and interdependencies is critical for developing effective management strategies. Increased understanding of complexity science can enhance the ability of researchers and practitioners to develop new ways of understanding and improving health care organizations. This analysis opens new vistas for scholars and practitioners attempting to understand health care organizations as complex adaptive systems. The analysis holds value for those already familiar with this approach as well as those who may not be as familiar.

A Quantitative Approach to Assessing System Evolvability

NASA Technical Reports Server (NTRS)

Christian, John A., III

2004-01-01

When selecting a system from multiple candidates, the customer seeks the one that best meets his or her needs. Recently the desire for evolvable systems has become more important and engineers are striving to develop systems that accommodate this need. In response to this search for evolvability, we present a historical perspective on evolvability, propose a refined definition of evolvability, and develop a quantitative method for measuring this property. We address this quantitative methodology from both a theoretical and practical perspective. This quantitative model is then applied to the problem of evolving a lunar mission to a Mars mission as a case study.

Scaled CMOS Reliability and Considerations for Spacecraft Systems : Bottom-Up and Top-Down Perspectives

NASA Technical Reports Server (NTRS)

White, Mark

2012-01-01

The recently launched Mars Science Laboratory (MSL) flagship mission, named Curiosity, is the most complex rover ever built by NASA and is scheduled to touch down on the red planet in August, 2012 in Gale Crater. The rover and its instruments will have to endure the harsh environments of the surface of Mars to fulfill its main science objectives. Such complex systems require reliable microelectronic components coupled with adequate component and system-level design margins. Reliability aspects of these elements of the spacecraft system are presented from bottom- up and top-down perspectives.

Advanced autostereoscopic display for G-7 pilot project

NASA Astrophysics Data System (ADS)

Hattori, Tomohiko; Ishigaki, Takeo; Shimamoto, Kazuhiro; Sawaki, Akiko; Ishiguchi, Tsuneo; Kobayashi, Hiromi

1999-05-01

An advanced auto-stereoscopic display is described that permits the observation of a stereo pair by several persons simultaneously without the use of special glasses and any kind of head tracking devices for the viewers. The system is composed of a right eye system, a left eye system and a sophisticated head tracking system. In the each eye system, a transparent type color liquid crystal imaging plate is used with a special back light unit. The back light unit consists of a monochrome 2D display and a large format convex lens. The unit distributes the light of the viewers' correct each eye only. The right eye perspective system is combined with a left eye perspective system is combined with a left eye perspective system by a half mirror in order to function as a time-parallel stereoscopic system. The viewer's IR image is taken through and focused by the large format convex lens and feed back to the back light as a modulated binary half face image. The auto-stereoscopic display employs the TTL method as the accurate head tracking. The system was worked as a stereoscopic TV phone between Duke University Department Tele-medicine and Nagoya University School of Medicine Department Radiology using a high-speed digital line of GIBN. The applications are also described in this paper.

Weatherwise: evaluation of a cue-based training approach for the recognition of deteriorating weather conditions during flight.

PubMed

Wiggins, Mark; O'Hare, David

2003-01-01

Inappropriate and ineffective weather-related decision making continues to account for a significant proportion of general aviation fatalities in the United States and elsewhere. This study details the evaluation of a computer-based training system that was developed to provide visual pilots with the skills necessary to recognize and respond to the cues associated with deteriorating weather conditions during flight. A total of 66 pilots were assigned to one of two groups, and the evaluation process was undertaken at both a self-report and performance level. At the self-report level, the results suggested that pilots were more likely to use the cues following exposure to the training program. From a performance perspective, there is evidence to suggest that cue-based training can improve the timeliness of weather-related decision making during visual flight rules flight. Actual or potential applications of this research include the development of computer-based training systems for fault diagnosis in complex industrial environments.

Rural Development Policy: Promises Made and Promises Denied.

ERIC Educational Resources Information Center

Hyman, Drew

1991-01-01

Presents historical trends toward rural development policy. Describes the agrarian perspective and the industrial and urbanization perspective as current visions which guide policy. Recommends a new vision focusing on "livability for people" and "viability of community systems." (KS)

Modeling the Eclipse

ERIC Educational Resources Information Center

Thornburgh, William R.; Tretter, Thomas R.

2017-01-01

This article describes a unit in which students investigate total solar eclipses, such as the one coming August 21, from several perspectives. It incorporates mathematical thinking and aligns with the "Next Generation Science Standard." This article refers to physical, virtual, and mathematical modeling. Various models and perspectives…

Socio-Ecohydrologic Agents And Services: Integrating Human And Natural Components To Address Coupled System Resilience

NASA Astrophysics Data System (ADS)

Pavao-zuckerman, M.; Pope, A.; Chan, D.; Curl, K.; Gimblett, H. R.; Hough, M.; House-Peters, L.; Lee, R.; Scott, C. A.

2012-12-01

Riparian corridors in arid regions are highly valued for their relative scarcity, and because healthy riparian systems support high levels of biodiversity, can meet human demand for water and water-related resources and functions. Our team is taking a transdiciplinary social-ecological systems approach to assessing riparian corridor resilience in two watersheds (the San Pedro River in USA and Mexico, and the Rio San Miguel in Mexico) through a project funded by the NSF CNH program ("Strengthening Resilience of Arid Region Riparian Corridors"). Multiple perspectives are integrated in the project, including hydrology, ecology, institutional dynamics, and decision making (at the level of both policy and individual choice), as well as the perspectives of various stakeholder groups and individuals in the watersheds. Here we discuss initial findings that center around linking changes in ecohydrology and livelihoods related to decisions in response to climatic, ecological, and social change. The research team is implementing two approaches to integrate the disparate disciplines participating in the research (and the varied perspectives among the stakeholders in this binational riparian context): (1) ecosystem service assessment, and (2) agent based model simulation. We are developing an ecosystem service perspective that provides a bridge between ecological dynamics in the landscape and varied stakeholder perspectives on the implications of ecohydrology for well-being (economic, cultural, ecological). Services are linked on one hand to the spatial patterns of traits of individuals within species (allowing a more predictive application of ecosystem services as they vary with community change in time), and to stakeholder perspectives (facilitating integration of ecosystem services into our understanding of decision making processes) in a case study in the San Pedro River National Conservation Area. The agent- based model (ABM) approach incorporates the influence of human decision-making on spatially-explicit landscapes in a mechanistic way, taking into account social interaction, adaptation, and decision-making at different levels, allowing individual stakeholders to make decisions based on their unique perceptions of their environment, be it economic, social, or ecological awareness. Initial parameterization of the ABM proceeds from a case study centered in the town of Rayón, Sonora, Mexico, where semi-structured interviews were used to elicit perceptions by water resource users of CNH function, change, and solutions relating to livelihood changes in response to several drivers. In both case studies, we see the potential and limitations for an approach to adaptive management and decision support related to water resources that links ecosystem services and agent-based modeling. Methodologically, synthetic approaches such as these may allow coupling of systems for improved assessment and analysis, while at the same time lack a connection to the perspectives of water users and managers on the ground. There is thus potential for a either a loss of system resilience in the face of external change, or an opportunity to increase system resilience by building off perspectives already in place within these coupled socio-ecohydrologic systems.

Examining the effectiveness of municipal solid waste management systems: An integrated cost-benefit analysis perspective with a financial cost modeling in Taiwan

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

Weng, Yu-Chi, E-mail: clyde.weng@gmail.com; Fujiwara, Takeshi

2011-06-15

In order to develop a sound material-cycle society, cost-effective municipal solid waste (MSW) management systems are required for the municipalities in the context of the integrated accounting system for MSW management. Firstly, this paper attempts to establish an integrated cost-benefit analysis (CBA) framework for evaluating the effectiveness of MSW management systems. In this paper, detailed cost/benefit items due to waste problems are particularly clarified. The stakeholders of MSW management systems, including the decision-makers of the municipalities and the citizens, are expected to reconsider the waste problems in depth and thus take wise actions with the aid of the proposed CBAmore » framework. Secondly, focusing on the financial cost, this study develops a generalized methodology to evaluate the financial cost-effectiveness of MSW management systems, simultaneously considering the treatment technological levels and policy effects. The impacts of the influencing factors on the annual total and average financial MSW operation and maintenance (O and M) costs are analyzed in the Taiwanese case study with a demonstrative short-term future projection of the financial costs under scenario analysis. The established methodology would contribute to the evaluation of the current policy measures and to the modification of the policy design for the municipalities.« less

Professional School Counselors as Leaders and Active Participants in School Reform: A Phenomenological Exploratory Study to Examine the Perspectives of System-Level Supervisors of School Counselors

ERIC Educational Resources Information Center

Cicero, Gayle M.

2010-01-01

Professional school counselors' leadership capacity may well play a pivotal role in educational reform in the twenty-first century. Crucial to the success of this vision, supported by the American School Counseling Association, is the perspective of system-level supervisors of school counselors. This exploratory qualitative study employed in-depth…

The Morality of Employing Remotely Piloted Weapon Systems in Combat

DTIC Science & Technology

2013-03-01

ethics of remotely piloted weapon systems involve utilitarianism and Just War Theory. Although the other two perspectives, pacifism and realism, do...perspectives of utilitarianism , Just War Theory, pacifism, and realism are evaluated to justify the claim. With the exception of pacifism, each of these...of utilitarianism , Just War Theory, pacifism, and realism are evaluated to justify the claim. With the exception of pacifism, each of these

Zymomonas mobilis as a model system for production of biofuels and biochemicals

DOE PAGES

Yang, Shihui; Fei, Qiang; Zhang, Yaoping; ...

2016-09-15

Zymomonas mobilis is a natural ethanologen with many desirable industrial biocatalyst characteristics. In this review, we will discuss work to develop Z. mobilis as a model system for biofuel production from the perspectives of substrate utilization, development for industrial robustness, potential product spectrum, strain evaluation and fermentation strategies. Lastly, this review also encompasses perspectives related to classical genetic tools and emerging technologies in this context.

Assessing repository technology: Where do we go from here?

NASA Technical Reports Server (NTRS)

Eichmann, David A.

1992-01-01

Three sample information retrieval systems, archie, autoLib, and Wide Area Information Service (WAIS), are compared with regard to their expressiveness and usefulness, first in the general context of information retrieval, and then as perspective software reuse repositories. While the representational capabilities of these systems are limited, they provide a useful foundation for future repository efforts, particularly from the perspective of repository distribution and coherent user interface design.

Zymomonas mobilis as a model system for production of biofuels and biochemicals

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

Yang, Shihui; Fei, Qiang; Zhang, Yaoping

Zymomonas mobilis is a natural ethanologen with many desirable industrial biocatalyst characteristics. In this review, we will discuss work to develop Z. mobilis as a model system for biofuel production from the perspectives of substrate utilization, development for industrial robustness, potential product spectrum, strain evaluation and fermentation strategies. Lastly, this review also encompasses perspectives related to classical genetic tools and emerging technologies in this context.

Tidewater Multi-Service Market Perspectives: Driving change through MTF and market-level assessment and strategies

DTIC Science & Technology

2011-01-25

The Quadruple Aim: Working Together, Achieving Success 2011 Military Health System Conference Driving change through MTF and market -level assessment...and strategies Tidewater Multi-Service Market Perspectives January 25, 2011 Rear Admiral A. Stocks, MC, USN Colonel E. Stone, MC, USAF...Colonel K. Gausman, NC, USA 1 Military Health System Conference Tidewater Multi-Service Market Report Documentation Page Form ApprovedOMB No. 0704-0188

State of the States' Teacher Evaluation and Support Systems: A Perspective from Exemplary Teachers. Policy Information Report and ETS Research Report Series No. RR-17-30

ERIC Educational Resources Information Center

Goe, Laura; Wylie, E. Caroline; Bosso, David; Olson, Derek

2017-01-01

As states reconsider their current evaluation systems, stakeholders are offering their views about what revisions should be made to existing measures and processes. This report offers a unique perspective to these conversations by capturing and synthesizing the views of some of America's exemplary teachers: State Teachers of the Year (STOYs) and…

Patients’ Perspective of the Design of Provider-Patients Electronic Communication Services

PubMed Central

Silhavy, Petr; Silhavy, Radek; Prokopova, Zdenka

2014-01-01

Information Delivery is one the most important tasks in healthcare practice. This article discusses patient’s tasks and perspectives, which are then used to design a new Effective Electronic Methodology. The system design methods applicable to electronic communication in the healthcare sector are also described. The architecture and the methodology for the healthcare service portal are set out in the proposed system design. PMID:24927038

Advanced technologies impact on compressor design and development: A perspective

NASA Technical Reports Server (NTRS)

Ball, Calvin L.

1989-01-01

A historical perspective of the impact of advanced technologies on compression system design and development for aircraft gas turbine applications is presented. A bright view of the future is projected in which further advancements in compression system technologies will be made. These advancements will have a significant impact on the ability to meet the ever-more-demanding requirements being imposed on the propulsion system for advanced aircraft. Examples are presented of advanced compression system concepts now being studied. The status and potential impact of transitioning from an empirically derived design system to a computationally oriented system are highlighted. A current NASA Lewis Research Center program to enhance this transitioning is described.

The Anthropocene: A Planetary Perspective

NASA Astrophysics Data System (ADS)

Anbar, A. D.; Hartnett, H. E.; York, A.; Selin, C.

2016-12-01

The Anthropocene is a new planetary epoch defined by the emergence of human activity as one of the most important driving forces on Earth, rivaling and also stressing the other systems that govern the planet's habitability. Public discussions and debates about the challenges of this epoch tend to be polarized. One extreme denies that humans have a planetary-scale impact, while the other wishes that this impact could disappear. The tension between these perspectives is often paralyzing. Effective adaptation and mitigation requires a new perspective that reframes the conversation. We propose a planetary perspective according to which this epoch is the result of a recent major innovation in the 4 ­billion ­year history of life on Earth: the emergence of an energy-intensive planetary civilization. The rate of human energy use is already within an order of magnitude of that of the rest of the biosphere, and rising rapidly, and so this innovation is second only to the evolution of photosynthesis in terms of energy capture and utilization by living systems. Such energy use has and will continue to affect Earth at planetary scale. This reality cannot be denied nor wished away. From this pragmatic perspective, the Anthropocene is not an unnatural event that can be reversed, as though humanity is separate from the Earth systems with which we are co-evolving. Rather, it is an evolutionary transition to be managed. This is the challenge of turning a carelessly altered planet into a carefully designed and managed world, maintaining a "safe operating space" for human civilization (Steffen et al., 2011). To do so, we need an integrated approach to Earth systems science that considers humans as a natural and integral component of Earth's systems. Insights drawn from the humanities and the social sciences must be integrated with the natural sciences in order to thrive in this new epoch. This type of integrated perspective is relatively uncontroversial on personal, local, and even regional scales. It is, however, intimidating at the global scale, for good reason: it is a daunting challenge that we barely understand and for which we are poorly prepared. In this presentation, we will address approaches to adaptation and mitigation that illustrate the promise - and pitfalls - of a planetary design perspective relevant to food, energy, water, and climate.

The political economy of sexism in industrial health.

PubMed

Felker, M

1982-01-01

In the last several years, increasing numbers of American women have lost their industrial jobs or have been refused jobs because they are of child-bearing age. Industrial physicians and management in manufacturing plants using various chemicals have decided that the risk their women workers take of having deformed children as a result of workplace hazards is such that the women must be 'protected'. An alternative 'choice' given to many of these women is proof of sterilization in order to maintain or attain jobs. In choosing to approach the growing problem of workplace contamination in this fashion, management and industrial physicians ignore the effects of chemical toxins on male employees' reproductive systems, and obscure the larger problem of hazards to all employees' total body systems. This paper explores the political economy of the interactions between Society, the Medical System and Women in a Capitalist State, in order to uncover the flow of forces operating in this conflict. Using an historical perspective, a feminist analysis is made of the social order, and a model is presented which demonstrates the articulations between the domains mentioned above, particularly the historical control by the medical system as an agent of the state.

Understanding the experiences of racialized older people through an intersectional life course perspective.

PubMed

Ferrer, Ilyan; Grenier, Amanda; Brotman, Shari; Koehn, Sharon

2017-04-01

This article proposes the development of an intersectional life course perspective that is capable of exploring the links between structural inequalities and the lived experience of aging among racialized older people. Merging key concepts from intersectionality and life course perspectives, the authors suggest an analytic approach to better account for the connections between individual narratives and systems of domination that impinge upon the everyday lives of racialized older people. Our proposed intersectional life course perspective includes four dimensions: 1) identifying key events and their timing, 2) examining locally and globally linked lives, 3) exploring categories of difference and how they shape identities, 4) and assessing how processes of differentiation, and systems of domination shape the lives, agency and resistance among older people. Although applicable to various forms of marginalization, we examine the interplay of racialization, immigration, labour and care in later life to highlight relationships between systems, events, trajectories, and linked lives. The illustrative case example used in this paper emerged from a larger critical ethnographic study of aging in the Filipino community in Montreal, Canada. We suggest that an intersectional life course perspective has the potential to facilitate a deeper understanding of the nexus of structural, personal and relational processes that are experienced by diverse groups of older people across the life course and into late life. Copyright © 2017 Elsevier Inc. All rights reserved.

Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management.

PubMed

Samuel, Cleo A; Turner, Kea; Donovan, Heidi A S; Beckjord, Ellen; Cardy, Alexandra; Dew, Mary Amanda; van Londen, G J

2017-12-01

Adjuvant endocrine therapy (AET) utilization is linked to improved clinical outcomes among breast cancer survivors (BCS); yet, AET adherence rates remain suboptimal. Little is known about provider perspectives regarding barriers and facilitators to AET-related symptom management (SM). In this study, we examined provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. We conducted three focus groups (FGs) with a multidisciplinary group of healthcare providers (n = 13) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM. FGs were audiotaped, transcribed, and analyzed using qualitative software to identify key themes. Providers described patient-, provider-, and system-level barriers and facilitators to AET-related SM. At the patient-level, barriers included competing demands, limited time/resources, and possible misattribution of some symptoms to AET, while family/social relationships and insurance emerged as important facilitators. Discomfort with SM, limited time, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Provider-level facilitators included routine symptom documentation and strong provider relationships. Care fragmentation and complexity of the cancer care delivery system were described as system-level barriers; however, survivor clinics were endorsed by providers. Provider perspectives on AET-related SM can shed light on SM barriers and facilitators spanning multiple levels of the cancer care delivery system. Strategies for improving AET-related SM in BCS include increasing patients' knowledge and engagement in SM, equipping providers with efficient SM strategies, and improving coordination of symptom-related services through survivorship programs.

Nurse practitioner and physician assistant students' knowledge, attitudes, and perspectives of chiropractic.

PubMed

Bowden, Briana S; Ball, Lisa

2016-10-01

The purpose of this study was to assess nurse practitioner (NP) and physician assistant (PA) students' views of chiropractic. As the role of these providers progresses in primary care settings, providers' views and knowledge of chiropractic will impact interprofessional collaboration and patient outcomes. Understanding how NP and PA students perceive chiropractic may be beneficial in building integrative health care systems. This descriptive quantitative pilot study utilized a 56-item survey to examine attitudes, knowledge, and perspectives of NP and PA students in their 2nd year of graduate studies. Frequencies and binomial and multinomial logistic regression models were used to examine responses to survey totals. Ninety-two (97%) students completed the survey. There were conflicting results as to whether participants viewed chiropractic as mainstream or alternative. The majority of participants indicated lack of awareness regarding current scientific evidence for chiropractic and indicated a positive interest in learning more about the profession. Students who reported prior experience with chiropractic had higher attitude-positive responses compared to those without experience. Participants were found to have substantial knowledge deficits in relation to chiropractic treatments and scope of practice. The results of this study emphasize the need for increased integrative initiatives and chiropractic exposure in NP and PA education to enhance future interprofessional collaboration in health care.

Medicare utilization, screening, and costs among participants in the Southeastern Diabetes Initiative: A population-based evaluation.

PubMed

Van Houtven, Courtney H; Greiner, Melissa A; Heidenfelder, Brooke; Spratt, Susan E; Granger, Bradi B; Dunham, Ashley A; Qualls, Laura G; Curtis, Lesley H

2018-04-01

Type 2 diabetes mellitus imposes significant burdens on patients and health care systems. Population-level interventions are being implemented to reach large numbers of patients at risk of or diagnosed with diabetes. We describe a population-based evaluation of the Southeastern Diabetes Initiative (SEDI) from the perspective of a payer, the Centers for Medicare & Medicaid Services (CMS). The purpose of this paper is to describe the population-based evaluation approach of the SEDI intervention from a Medicare utilization and cost perspective. We measured associations between the SEDI intervention and receipt of diabetes screening (i.e., HbA1c test, eye exam, lipid profile), health care resource use, and costs among intervention enrollees, compared with a control cohort of Medicare beneficiaries in geographically adjacent counties. The intervention cohort had slightly lower 1-year screening in 2 of 3 domains (4% for HbA1c; 9% for lipid profiles) in the post-intervention period, compared with the control cohort. The SEDI intervention cohort did not have different Medicare utilization or total Medicare costs in the post-intervention period from surrounding control counties. Our analytic approach may be useful to others evaluating CMS demonstration projects in which population-level health is targeted for improvement in a well-defined clinical population. Published by Elsevier Ltd.

Aspects of Equality in Mandatory Partnerships – From the Perspective of Municipal Care in Norway

PubMed Central

Ljunggren, Birgitte

2016-01-01

Introduction: This paper raises questions about equality in partnerships, since imbalance in partnerships may effect collaboration outcomes in integrated care. We address aspects of equality in mandatory, public-public partnerships, from the perspective of municipal care. We have developed a questionnaire wherein the Norwegian Coordination Reform is an illustrative example. The following research question is addressed: What equality dimensions are important for municipals related to mandatory partnerships with hospitals? Theory/methods: Since we did not find any instrument to measure equality in partnerships, an explorative design was chosen. The development of the instrument was based on the theory on partnership and knowledge about the field and context. A national online survey was emitted to all 429 Norwegian municipalities in 2013. The response rate was in total 58 percent (n = 248). The data were mainly analysed using Principal component analysis. Results: It seems that the two dimensions “learning and expertise equality” and “contractual equality” collects reliable and valid data to measure aspects of equality in partnerships. Discussion: Partnerships are usually based on voluntarism. The results indicate that mandatory partnerships, within a public health care system, can be appropriate to equalize partnerships between health care providers at different care levels. PMID:27616962

Implications of case managers' perceptions and attitude on safety of home-delivered care.

PubMed

Jones, Sarahjane

2015-12-01

Perceptions on safety in community care have been relatively unexplored. A project that sought to understand the multiple perspectives on safety in the NHS case-management programme was carried out in relation to the structure, process, and outcome of care. This article presents a component of the nursing perspective that highlights an important element in the structure of nursing care that could potentially impede the nurses' ability to be fully effective and safe. A single case study of the case-management programme was undertaken. Three primary care organisations from three strategic health authorities participated, and three focus groups were conducted (one within each organisation). In total, 17 case management nurses participated. Data were audiotaped and transcribed verbatim and subjected to framework analysis. Nursing staff attitudes were identified as a structure of care that influence safety outcomes, particularly their perceptions of the care setting and the implications it has on their role and patient behaviour. Greater understanding of the expected role of the community nurse is necessary, and relevant training is required for nurses to be successful in empowering patients to perform more safely. In addition, efforts need to be made to improve patients' trust in the health-care system to prevent harm and promote more effective utilisation of resources.

Living With Hepatocellular Carcinoma Near the End of Life: Family Caregivers' Perspectives.

PubMed

Hansen, Lissi; Rosenkranz, Susan J; Wherity, Kathleen; Sasaki, Anna

2017-09-01

To explore family caregivers' perspectives of caring for patients with terminal hepatocellular carcinoma (HCC) as patients approached the end of life.
. Longitudinal, qualitative descriptive design.
. Oregon Health and Science University in Portland and Veterans Affairs Portland Health Care System in Oregon.
. 13 family caregivers with a mean age of 56 years (range = 22-68 years). The majority of family caregivers were female (n = 10) and identified as White (n = 11).
. Interview data were collected from family caregivers once a month for as many as six months, for a total of 39 interviews. Data were analyzed using conventional content analysis.
. Five core categories and nine subcategories were identified. From the time of the terminal diagnosis to the end of life, family caregivers felt unprepared, uncertain, and in need of information. They struggled with whether symptoms were HCC- or cirrhosis-related.
. Nurses can support family caregivers by eliciting their knowledge and concerns, and attending to symptom presentation and interpretation and to treatment challenges. Understanding challenges caregivers experience is crucial for developing interventions that address their desire for information, support, and help along the HCC disease trajectory.
. Nurses play a critical role in preparing caregivers to understand the importance of pain assessment and management and early referral to palliative care.

Importance-Satisfaction Analysis for Primary Care Physicians’ Perspective on EHRs in Taiwan †

PubMed Central

Ho, Cheng-Hsun; Wen, Hsyien-Chia; Chu, Chi-Ming; Wu, Yi-Syuan; Wang, Jen-Leng

2014-01-01

The Taiwan government has been promoting Electronic Health Records (EHRs) to primary care physicians. How to extend EHRs adoption rate by measuring physicians’ perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale). The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance), 4.12, 3.51 (product effectiveness), 4.10, 3.31 (system function) and 4.34, 3.70 (customer service) respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians. PMID:24914640

Moral motivation based on multiple developmental structures: an exploration of cognitive and emotional dynamics.

PubMed

Kaplan, Ulas; Tivnan, Terrence

2014-01-01

Intrapersonal variability and multiplicity in the complexity of moral motivation were examined from Dynamic Systems and Self-Determination Theory perspectives. L. Kohlberg's (1969) stages of moral development are reconceptualized as soft-assembled and dynamically transformable process structures of motivation that may operate simultaneously within person in different degrees. Moral motivation is conceptualized as the real-time process of self-organization of cognitive and emotional dynamics out of which moral judgment and action emerge. A detailed inquiry into intrapersonal variation in moral motivation is carried out based on the differential operation of multiple motivational structures. A total of 74 high school students and 97 college students participated in the study by completing a new questionnaire, involving 3 different hypothetical moral judgments. As hypothesized, findings revealed significant multiplicity in the within-person operation of developmental stage structures, and intrapersonal variability in the degrees to which stages were used. Developmental patterns were found in terms of different distributions of multiple stages between high school and college samples, as well as the association between age and overall motivation scores. Differential relations of specific emotions to moral motivation revealed and confirmed the value of differentiating multiple emotions. Implications of the present theoretical perspective and the findings for understanding the complexity of moral judgment and motivation are discussed.

Perspectives of 30 English Patients on Call Light Technology, Eloquence Revisited.

PubMed

Montie, Mary; Shuman, Clayton; Galinato, Jose; Patak, Lance; Titler, Marita

2018-01-01

Call light technology is important because it serves as a direct link for patients to get their healthcare needs fulfilled by their healthcare providers. As primary users of call light technology, patient perspectives are important and warranted. Despite this fact, there is a lack of published literature regarding patient perspectives and call light technology. The present study examined a technologically advanced call light system (Eloquence) by incorporating 30 patient participants' perspectives regarding its usefulness, effectiveness, and appropriateness gathered from individual interviews. Using qualitative descriptive research methods, five major themes and multiple minor themes emerged from the data.

M1A2 tank commander's independent thermal viewer optics: system engineering perspective

NASA Astrophysics Data System (ADS)

Ratcliff, David D.

1993-08-01

As successful as the M1A1 Abrams tank was in the Gulf War, a program has been under way for several years to improve and modernize the M1A1 to keep pace with new threats and to take advantage of new technology. This program has resulted in the M1A2 upgrade program which significantly improves the survivability and lethality of the tank. First, the point-to-point wiring and analog signal processing was replaced with digital processing and control with a modern, aircraft-style digital data bus. Additional command and control aspects of the upgrade greatly improved the situational awareness of the M1A2 commander. Finally, an additional thermal imaging system was added for the commander. This system, the M1A2 Commander's Independent Thermal Viewer (CITV) is the topic of the following paper, which details the design from a system engineering perspective, and a companion paper that presents the optical design perspective.

Applying social network analysis to the examination of interruptions in healthcare.

PubMed

McCurdie, Tara; Sanderson, Penelope; Aitken, Leanne M

2018-02-01

Examinations of interruptions in healthcare often focus on a single clinical discipline, and solutions are targeted accordingly. This approach does not take into account the inter-disciplinary dependencies and other sociotechnical aspects that make up the healthcare work system, and suggested solutions may not meet the needs of all stakeholders. In this article a sociotechnical systems perspective is used to uncover the interdependencies between 16 unique work roles that result in interruptions in an intensive care unit (ICU). By applying social network analysis techniques to data collected using the Dual Perspectives Method, we identified targeted systems-based interventions that may reduce unnecessary interruptions while avoiding unintended consequences that impose additional burden on ICU staff. The rich insights gained into the interruptive communication patterns in the ICU work system stand in contrast to findings that would have otherwise been obtained by focusing only on a single clinical discipline or a single perspective. Copyright © 2017. Published by Elsevier Ltd.

Interdisciplinarity and the Question of Being

ERIC Educational Resources Information Center

Welch, James, IV

2012-01-01

The question of being adds another dimension to interdisciplinary theory and practice. The interdisciplinary approach to complex problems requires engaging with multiple perspectives from various disciplines, schools of thought, ideologies, and belief systems. All of these perspectives possess underlying and often unacknowledged ontological…

Indigenous Education and Empowerment: International Perspectives

ERIC Educational Resources Information Center

Abu-Saad, Ismael, Ed.; Champagne, Duane, Ed.

2005-01-01

Indigenous people have often been confronted with education systems that ignore their cultural and historical perspectives. This insightful volume contributes to the understanding of indigenous empowerment through education, and creates a new foundation for implementing specialized indigenous/minority education worldwide, engaging the simultaneous…

[Occupational health and safety management systems: scenarios and perspectives for occupational physicians].

PubMed

Santantonio, P; Casciani, M; Bartolucci, G B

2008-01-01

This paper analyzes the role of the occupational physicians, taking into account the new Italian legislation within the frame of CSR, that puts in a new light the physicians inside the Organizations. In this context, Occupational Medicine and Workplace Health Promotion play a central role in most of the items of the Occupational Health and safety management systems, from H&S politics to training, from First Aid to audit and revision systems. From this innovative perspective, the authors try to identify the occupational physician's new challenges and opportunities.

Relational use of an electronic quality of life and practice support system in hospital palliative consult care: A pilot study.

PubMed

Krawczyk, Marian; Sawatzky, Richard

2018-03-08

This study is part of an overarching research initiative on the development and integration of an electronic Quality of Life and Practice Support System (QPSS) that uses patient-reported outcome and experience measures in clinical practice. The current study focused on palliative nurse consultants trialing the QPSS with older hospitalized adults receiving acute care. The primary aim of the study was to better understand consultants' and patients' experiences and perspectives of use. The project involved two nurse specialists within a larger palliative outreach consult team (POCT) and consenting older adult patients (age 55+) in a large tertiary acute care hospital in western Canada. User-centered design of the QPSS was informed by three focus groups with the entire POCT team, and implementation was evaluated by direct observation as well as interviews with the POCT nurses and three patients. Thematic analysis of interviews and field notes was informed by theoretical perspectives from social sciences. Result Over 9 weeks, the POCT nurses used the QPSS at least once with 20 patients, for a total of 47 administrations. The nurses most often assisted patients in using the QPSS. Participants referenced three primary benefits of relational use: enhanced communication, strengthened therapeutic relations, and cocreation of new insights about quality of life and care experiences. The nurses also reported increased visibility of quality of life concerns and positive development as relational care providers. Significance of results Participants expressed that QPSS use positively influenced relations of care and enhanced practices consistent with person-centered care. Results also indicate that electronic assessment systems may, in some instances, function as actor-objects enabling new knowledge and relations of care rather than merely as a neutral technological platform. This is the first study to examine hospital palliative consult clinicians' use of a tablet-based system for routine collection of patient-reported outcome and experience measures.

Cost-Effectiveness of Pediatric Cochlear Implantation in Rural China.

PubMed

Qiu, Jianxin; Yu, Chongxian; Ariyaratne, Thathya V; Foteff, Chris; Ke, Zhangmin; Sun, Yi; Zhang, Li; Qin, Feifei; Sanderson, Georgina

2017-07-01

To evaluate the cost utility of cochlear implantation (CI) for severe to profound sensorineural hearing loss (SNHL) among children from rural settings in P.R. China (China). A cost-utility analysis (CUA) was undertaken using data generated from a single-center substudy of the Cochlear Pediatric Implanted Recipient Observational Study (Cochlear P-IROS). The data were projected over a 20-year time horizon using a decision tree model. The Chinese healthcare payer and patient perspectives were adopted. Unilateral CI of children with a severe-to-profound SNHL compared with their preimplantation state of no treatment or amplification with hearing aids ("no CI" status). Incremental costs per quality adjusted life year (QALY) gained. The mean total discounted cost of unilateral CI was CNY 252,506 (37,876 USD), compared with CNY 29,005 (4,351 USD) for the no CI status from the healthcare payer plus patient perspective. A total discounted benefit of 8.9 QALYs was estimated for CI recipients compared with 6.7 QALYs for the no CI status. From the healthcare payer plus patient perspective, incremental cost-effectiveness ratio (ICER) for unilateral CI compared with no CI was CNY 100,561 (15,084 USD) per QALY. The healthcare payer perspective yielded an ICER of CNY 40,929 (6,139 USD) per QALY. Both ICERs fell within one to three times China's gross domestic product per capita (GDP, 2011-2015), considered "cost-effective" by World Health Organization (WHO) standards. Treatment with unilateral CI is a cost-effective hearing solution for children with severe to profound SNHL in rural China. Increased access to mainstream education and greater opportunities for employment, are potential downstream benefits of CI that may yield further societal and economic benefits. CI may be considered favorably for broader inclusion in medical insurance schemes across China.

Modelling lifetime cost consequences of ReSTOR® in cataract surgery in four European countries

PubMed Central

Lafuma, Antoine; Berdeaux, Gilles

2008-01-01

Background To compare the lifetime costs of liberating patients from spectacles after cataract surgery by implanting the multifocal intraocular lens (IOL) 'ReSTOR®' versus monofocal IOLs in France, Italy, Germany and Spain. Methods A Markov model was created to follow patient cohorts from cataract surgery until death. Prevalence rates of patients not needing spectacles after cataract surgery were obtained from clinical trials. Resource utilisation included implant surgery, IOLs, spectacles, visits to ophthalmologists and eye centres, transport, and time lost by patients. Economic perspectives were those of Society and Sickness Funds (SFs). Results The mean number of spectacles purchased after ReSTOR® was 1.34–1.61 and after monofocal IOLs 6.05–7.27. From the societal perspective, total cost estimates discounted by 3% were between €3,551 and €4,052 with ReSTOR® compared to €3,989 and €5,548 with monofocal IOLs. Undiscounted savings related to ReSTOR® ranged from €815 to €2,164. From the SFs' perspective total cost estimates discounted by 3% were between €2,150 and €2,524 with ReSTOR® compared to €2,324 and €2,610 with monofocal IOLs. Savings related to ReSTOR®, once costs discounted, ranged from €61 to €219. Discount and spectacle freedom prevalence rates were the most sensitive parameters. Conclusion The bulk of the savings related to ReSTOR® were realized outside the SF. From both a societal and SF perspective, savings, after a 3% discounting, achieved by liberating patients from spectacles counterbalanced the initially higher cost of ReSTOR®. ReSTOR® is a cost saving alternative to spectacles for patients requiring cataract surgery. PMID:18627594

Economic Burden of Osteoporosis in South Korea: Claim Data of the National Health Insurance Service from 2008 to 2011.

PubMed

Ha, Yong-Chan; Kim, Ha-Young; Jang, Sunmee; Lee, Young-Kyun; Kim, Tae-Young

2017-12-01

The purpose of this study was to estimate the current economic burden of osteoporosis in South Korea using national claim data of the Korean National Health Insurance Service (KNHIS) from 2008 to 2011. Patients aged 50 years or older were identified from KNHIS nationwide database for all records of outpatient visits or hospital admissions. Healthcare costs for osteoporotic patients included direct medical costs for hospitalization, outpatient care, and prescription drugs for the year after discharge. Healthcare costs were estimated based on the perspective of KNHIS, and calculated using a bottom-up approach. Between 2008 and 2011, total healthcare costs for osteoporotic patients increased from 3976 million USD to 5126 million USD, with an annual increase of 9.2% which accounted for one-sixth (16.7%) of national healthcare expenditure. Healthcare cost for hospitalization was the highest ($1903 million, 40.0% of total healthcare cost), followed by cost for outpatient care ($1474 million, 31.0%) and cost for prescription drugs ($1379 million, 29.0%). Although total healthcare cost for osteoporotic men was 6 times lower than that for osteoporotic women, the cost per person was 1.5 times higher than that for women. Total healthcare cost for osteoporotic patients without fractures was higher than that for osteoporotic patients with fractures. However, cost per person was the opposite. Osteoporosis entails substantial epidemiologic and economic burden in South Korea. This study provides information about the total healthcare burden, which could be important when determining what attention and awareness osteoporosis should be given in the public health system.

PARTITIONING OF TOTAL MERCURY AND METHYLMERCURY TO THE COLLOIDAL PHASE IN FRESHWATERS. (R827629)

EPA Science Inventory

The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

Workforce Reductions. An Annotated Bibliography.

ERIC Educational Resources Information Center

Hickok, Thomas A.; Hickok, Thomas A.

This report, which is based on a review of practitioner-oriented sources and scholarly journals, uses a three-part framework to organize annotated bibliographies that, together, list a total of 104 sources that provide the following three perspectives on work force reduction issues: organizational, organizational-individual relationship, and…

Detection of Protozoa in Surface and Finished Waters

EPA Science Inventory

Humans are known to be the host to approximately 1500 infectious agents, out of which 66 are protozoa and 287 are helminths. Therefore, from a global perspective helminths and protozoan parasites account for approximately one fourth of the total infectious diseases of humans. A s...

Wetland Perspectives: Ways of Looking at the Landscape (July 10-July 21, 1995). An Education Program for K-12 Teachers and Environmental Educators Focusing on Various Ways of Understanding Natural Aquatic Systems. Final Report.

ERIC Educational Resources Information Center

Wisconsin Univ., Madison. Inst. for Environmental Studies.

Wetland Perspectives, a 2-week teacher workshop held in July 1995, aimed to increase teacher understanding of some aquatic habitats of Wisconsin through Western scientific and Native American cultural perspectives. Workshop objectives included giving participants a more complete understanding of Wisconsin's wetlands, an opportunity to learn about…

[Cost-benefit analysis of a school-based smoking prevention program].

PubMed

Hormigo Amaro, Jordi; García-Altés, Anna; López, M José; Bartoll, Xavier; Nebot, Manel; Ariza, Carles

2009-01-01

To analyze the efficiency of a school-based smoking prevention program in Barcelona (PASE.bcn program). A cost-benefit analysis was performed. As costs we included those corresponding to the design and implementation of the program. As benefits we considered healthcare costs and the productivity losses avoided. This study was conducted from a societal perspective, and the estimations of costs and benefits related to 2005. Assuming an effectiveness of 1%, the PASE.bcn program would achieve a total benefit of 1,558,311.46euro. The healthcare benefits per prevented smoker were 1997.57euro, and the indirect benefits per prevented smoker were 21,260.80euro. Given the total cost of the school-based program (68,526.03euro), the cost-benefit ratio was 22.74. From a societal perspective, the benefits of school-based tobacco prevention programs, in terms of healthcare costs and productivity losses avoided, are far greater than the costs. These results support universal application of this type of intervention.

Age differences in the understanding of wealth and power: the mediating role of future time perspective.

PubMed

Li, Tianyuan; Tsang, Vivian Hiu-Ling

2016-12-01

Individuals' understanding of wealth and power largely determines their use of resources. Moreover, the age range of wealth and power holders is increasing in modern societies. Thus, the current study examines how people of different ages understand wealth and power. As varying future time perspective is related to changes in prioritised life goals, it was tested as a potential mediator of the age differences. A total of 133 participants aged 18-78 years were asked 8 open-ended questions regarding their understanding of the possible use and desired use of wealth and power, after which they reported their future time perspective. Compared with possible use, the participants mentioned relatively more prosocial elements when they talked about their desired use of the resources, especially power. The older adults expressed more prosocial understanding in regard to the desired use of wealth and the possible use of power compared to their younger counterparts. The age differences were fully mediated by future time perspective. The results suggest that age is a critical factor that influences individuals' conceptualisation of wealth and power. Life-span developmental stage and future time perspective are important factors to consider for explaining individual differences in the exercise of wealth and power and for promoting their prosocial usage.

The economic burden of pneumonia and meningitis among children less than five years old in Hanoi, Vietnam.

PubMed

Le, Phuc; Griffiths, Ulla K; Anh, Dang D; Franzini, Luisa; Chan, Wenyaw; Pham, Ha; Swint, John M

2014-11-01

To estimate the average treatment costs of pneumonia and meningitis among children under five years of age in a tertiary hospital in Hanoi, Vietnam from societal, health sector and household perspectives. We used a cost-of-illness approach to identify cost categories to be included for different perspectives. A prospective survey was conducted among eligible patients to get detailed personal costing items. From the perspective of the health sector, the mean costs for treating a case of pneumonia and meningitis were USD 180 and USD 300, respectively. From the household's perspective, the average treatment costs were USD 272 for pneumonia and USD 534 for meningitis. When also including indirect costs, the average total treatment costs from the societal perspective were USD 318 for pneumonia and USD 727 for meningitis. The study contributed to limited evidence on the high treatment costs of pneumonia and meningitis to the Vietnamese society, which is useful for a cost-effectiveness analysis of Haemophilus influenzae type b vaccine or other relevant disease preventions. It also indicated a need to re-evaluate the health insurance policy for children under 6 years old, so that the unnecessarily high out-of-pocket costs of these diseases are reduced. © 2014 John Wiley & Sons Ltd.

Eleanor Clarke Slagle Lectureship, 1984: transformation of a profession.

PubMed

Gilfoyle, E M

1984-09-01

Professional evolution includes a period of disunity, a phase when old values and concepts are being examined, and new perspectives emerge. Disunity can be a positive impetus for dynamic change. Transformation provides a higher level reintegration through which new understanding and progress unfold. Occupational therapy's transformation is now; it is time for careful analysis and creative synthesis. Transformation is a three-fold process of integration of past, present, and future into an upward spiral of professional development. Transformation is a constant flow of activities influenced by both internal and external factors. Although there are multidimensions that influence occupational therapy's transformation, three major components are inherent in the profession's paradigm shift: society's decline in patriarchal authority; decline in allegiance to a biomedical model; and shift in values, dimensions of practice, and education that form the reality of occupational therapy. Transformation of our profession will be a paradigm shift: in our value system of purposeful activity to a new perspective of occupation and occupational, in our quest to develop a unifying theory for recognition of the unifying force of values, in our concepts and theories to include the science of occupation and the art of purposefulness from total allegiance to scientific knowledge to include intuitive knowledge, from being an allied medical field to an independent health profession that is both educationally and medically related, from a biomedical model to a paradigm of wellness, in balancing of feminine and masculine values of human nature in organizing educational curricula and entry-level requirements that reflect our value system and predicted practice dimensions.

The perspective of healthcare providers and patients on health literacy: a systematic review of the quantitative and qualitative studies.

PubMed

Rajah, Retha; Ahmad Hassali, Mohamed Azmi; Jou, Lim Ching; Murugiah, Muthu Kumar

2018-03-01

Health literacy (HL) is a multifaceted concept, thus understanding the perspective of healthcare providers, patients, and the system is vital. This systematic review examines and synthesises the available studies on HL-related knowledge, attitude, practice, and perceived barriers. CINAHL and Medline (via EBSCOhost), Google Scholar, PubMed, ProQuest, Sage Journals, and Science Direct were searched. Both quantitative and/or qualitative studies in the English language were included. Intervention studies and studies focusing on HL assessment tools and prevalence of low HL were excluded. The risk of biasness reduced with the involvement of two reviewers independently assessing study eligibility and quality. A total of 30 studies were included, which consist of 19 quantitative, 9 qualitative, and 2 mixed-method studies. Out of 17 studies, 13 reported deficiency of HL-related knowledge among healthcare providers and 1 among patients. Three studies showed a positive attitude of healthcare providers towards learning about HL. Another three studies demonstrated patients feel shame exposing their literacy and undergoing HL assessment. Common HL communication techniques reported practiced by healthcare providers were the use of everyday language, teach-back method, and providing patients with reading materials and aids, while time constraint was the most reported HL perceived barriers by both healthcare providers and patients. Significant gaps exists in HL knowledge among healthcare providers and patients that needs immediate intervention. Such as, greater effort placed in creating a health system that provides an opportunity for healthcare providers to learn about HL and patients to access health information with taking consideration of their perceived barriers.

Economic evaluation of the new oral anticoagulants for the prevention of thromboembolic events: a cost-minimization analysis.

PubMed

Marcolino, Milena Soriano; Polanczyk, Carisi Anne; Bovendorp, Ana Carolina Caixeta; Marques, Naiara Silveira; Silva, Lilian Azevedo da; Turquia, Cintia Proveti Barbosa; Ribeiro, Antonio Luiz

2016-01-01

Randomized clinical trials have shown that the new oral anticoagulants have at least similar impact regarding reduction of thromboembolic events, compared with warfarin, with similar or improved safety profiles. There is little data on real costs within clinical practice. Our aim here was to perform economic analysis on these strategies from the perspective of Brazilian society and the public healthcare system. Cost-minimization analysis; anticoagulation clinic of Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brazil. Patients at the anticoagulation clinic were recruited between August and October 2011, with minimum follow-up of four weeks. Operational and non-operational costs were calculated and corrected to 2015. This study included 633 patients (59% women) of median age 62 years (interquartile range -49-73). The mean length of follow-up was 64 ± 28 days. The average cost per patient per month was $ 54.26 (US dollars). Direct costs accounted for 32.5% of the total cost. Of these, 69.5% were related to healthcare professionals. With regards to indirect costs, 52.4% were related to absence from work and 47.6% to transportation. Apixaban, dabigatran and rivaroxaban were being sold to Brazilian public institutions, on average, for $ 49.87, $ 51.40 and $ 52.16 per patient per month, respectively, which was lower than the costs relating to warfarin treatment. In the Brazilian context, from the perspective of society and the public healthcare system, the cumulative costs per patient using warfarin with follow-up in anticoagulation clinics is currently higher than the strategy of prescribing the new oral anticoagulants.

"We Can't Make Him Fit into the System": Parental Reflections on the Reasons Why Home Education Is the Only Option for Their Child Who Has Special Educational Needs

ERIC Educational Resources Information Center

Kendall, Lynne; Taylor, Elizabeth

2016-01-01

This small-scale study investigates the perspectives of parents whose children have special educational needs/disabilities and who have elected to withdraw their children from the state-maintained education system in England and educate them at home. The study draws on data gathered from seven parents and their perspectives of home education…

A Consideration of Constraints on Aircraft Departure Operations

NASA Technical Reports Server (NTRS)

Darr, Stephen T.; Morello, Samuel A.; Shay, Richard F.; Lemos, Katherine A.; Jacobsen, Robert

2009-01-01

This paper presents a system-level perspective on the operational issues and constraints that limit departure capacity at large metropolitan airports in today's air transportation system. It examines the influence of constraints evident in en route airspace, in metroplex operations, and at individual airports from today's perspective and with a view toward future gate-to-cruise operations. Cross cutting organizational and technological challenges are discussed in relation to their importance in addressing the constraints.

Culture and meaning: expanding the metaphorical repertoire of family therapy.

PubMed

Paré, D A

1996-03-01

This essay proposes that a family therapy founded on a contemporary, postmodern perspective demands an expanded range of metaphors for the family and the work of therapy. It describes a perspective that emphasizes a view of the family as a culture, as opposed to a system. A cultural perspective naturally addresses issues of meaning and language, narrative, politics, and practices of power-critical contemporary concerns not adequately encompassed by traditional systemic formulations. The essay explores the relationship between theory and metaphor, and contrasts the views of persons and of the family offered by the metaphors of culture and system. Case illustrations demonstrate how a cultural view effectively fashions an expanded therapeutic discourse, shifting the focus of family therapy from normative prescriptions for family "functionality" to issues of intercultural harmony. This shift in emphasis also extends to individual work, where the therapeutic task is construed as a peace-making between conflicting stories that intersect in the client's life.

The reconstruction of narrative identity during mental health recovery: a complex adaptive systems perspective.

PubMed

Kerr, Douglas J R; Crowe, Trevor P; Oades, Lindsay G

2013-06-01

1) to understand the reconstruction of narrative identity during mental health recovery using a complex adaptive systems perspective, 2) to address the need for alternative approaches that embrace the complexities of health care. A narrative review of published literature was conducted. A complex adaptive systems perspective offers a framework and language that can assist individuals to make sense of their experiences and reconstruct their narratives during an often erratic and uncertain life transition. It is a novel research direction focused on a critical area of recovery and addresses the need for alternative approaches that embrace the complexities of health care. A complexity research approach to narrative identity reconstruction is valuable. It is an accessible model for addressing the complexities of recovery and may underpin the development of simple, practical recovery coaching tools. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Measuring self-rated productivity: factor structure and variance component analysis of the Health and Work Questionnaire.

PubMed

von Thiele Schwarz, Ulrica; Sjöberg, Anders; Hasson, Henna; Tafvelin, Susanne

2014-12-01

To test the factor structure and variance components of the productivity subscales of the Health and Work Questionnaire (HWQ). A total of 272 individuals from one company answered the HWQ scale, including three dimensions (efficiency, quality, and quantity) that the respondent rated from three perspectives: their own, their supervisor's, and their coworkers'. A confirmatory factor analysis was performed, and common and unique variance components evaluated. A common factor explained 81% of the variance (reliability 0.95). All dimensions and rater perspectives contributed with unique variance. The final model provided a perfect fit to the data. Efficiency, quality, and quantity and three rater perspectives are valid parts of the self-rated productivity measurement model, but with a large common factor. Thus, the HWQ can be analyzed either as one factor or by extracting the unique variance for each subdimension.

Interannual Variation in Phytoplankton Class-Specific Primary Production at a Global Scale

NASA Technical Reports Server (NTRS)

Rousseaux, Cecile Severine; Gregg, Watson W.

2014-01-01

We used the NASA Ocean Biogeochemical Model (NOBM) combined with remote sensing data via assimilation to evaluate the contribution of 4 phytoplankton groups to the total primary production. First we assessed the contribution of each phytoplankton groups to the total primary production at a global scale for the period 1998-2011. Globally, diatoms were the group that contributed the most to the total phytoplankton production (50, the equivalent of 20 PgC y-1. Coccolithophores and chlorophytes each contributed to 20 (7 PgC y-1 of the total primary production and cyanobacteria represented about 10 (4 PgC y(sub-1) of the total primary production. Primary production by diatoms was highest in high latitude (45) and in major upwelling systems (Equatorial Pacific and Benguela system). We then assessed interannual variability of this group-specific primary production over the period 1998-2011. Globally the annual relative contribution of each phytoplankton groups to the total primary production varied by maximum 4 (1-2 PgC y-1. We assessed the effects of climate variability on the class-specific primary production using global (i.e. Multivariate El Nio Index, MEI) and regional climate indices (e.g. Southern Annular Mode (SAM), Pacific Decadal Oscillation (PDO) and North Atlantic Oscillation (NAO)). Most interannual variability occurred in the Equatorial Pacific and was associated with climate variability as indicated by significant correlation (p 0.05) between the MEI and the class-specific primary production from all groups except coccolithophores. In the Atlantic, climate variability as indicated by NAO was significantly correlated to the primary production of 2 out of the 4 groups in the North Central Atlantic (diatomscyanobacteria) and in the North Atlantic (chlorophytes and coccolithophores). We found that climate variability as indicated by SAM had only a limited effect on the class-specific primary production in the Southern Ocean. These results provide a modeling and data assimilation perspective to phytoplankton partitioning of primary production and contribute to our understanding of the dynamics of the carbon cycle in the oceans at a global scale.

Interannual Variation in Phytoplankton Primary Production at a Global Scale

NASA Technical Reports Server (NTRS)

Rousseaux, Cecile Severine; Gregg, Watson W.

2013-01-01

We used the NASA Ocean Biogeochemical Model (NOBM) combined with remote sensing data via assimilation to evaluate the contribution of four phytoplankton groups to the total primary production. First, we assessed the contribution of each phytoplankton groups to the total primary production at a global scale for the period 1998-2011. Globally, diatoms contributed the most to the total phytoplankton production ((is)approximately 50%, the equivalent of 20 PgC·y1). Coccolithophores and chlorophytes each contributed approximately 20% ((is) approximately 7 PgC·y1) of the total primary production and cyanobacteria represented about 10% ((is) approximately 4 PgC·y1) of the total primary production. Primary production by diatoms was highest in the high latitudes ((is) greater than 40 deg) and in major upwelling systems (Equatorial Pacific and Benguela system). We then assessed interannual variability of this group-specific primary production over the period 1998-2011. Globally the annual relative contribution of each phytoplankton groups to the total primary production varied by maximum 4% (1-2 PgC·y1). We assessed the effects of climate variability on group-specific primary production using global (i.e., Multivariate El Niño Index, MEI) and "regional" climate indices (e.g., Southern Annular Mode (SAM), Pacific Decadal Oscillation (PDO) and North Atlantic Oscillation (NAO)). Most interannual variability occurred in the Equatorial Pacific and was associated with climate variability as indicated by significant correlation (p (is) less than 0.05) between the MEI and the group-specific primary production from all groups except coccolithophores. In the Atlantic, climate variability as indicated by NAO was significantly correlated to the primary production of 2 out of the 4 groups in the North Central Atlantic (diatoms/cyanobacteria) and in the North Atlantic (chlorophytes and coccolithophores). We found that climate variability as indicated by SAM had only a limited effect on group-specific primary production in the Southern Ocean. These results provide a modeling and data assimilation perspective to phytoplankton partitioning of primary production and contribute to our understanding of the dynamics of the carbon cycle in the oceans at a global scale.

Three essays on the effect of wind generation on power system planning and operations

NASA Astrophysics Data System (ADS)

Davis, Clay Duane

While the benefits of wind generation are well known, some drawbacks are still being understood as wind power is integrated into the power grid at increasing levels. The primary difference between wind generation and other forms of generation is the intermittent, and somewhat unpredictable, aspect of this resource. The somewhat uncontrollable aspect of wind generation makes it important to consider the relationship between this resource and load, and also how the operation of other non-wind generation resources may be affected. The three essays that comprise this dissertation focus on these and other important issues related to wind generation; leading to an improved understanding of how to better plan for and utilize this resource. The first essay addresses the cost of increased levels of installed wind capacity from both a capacity planning and economic dispatch perspective to arrive at the total system cost of installing a unit of wind capacity. This total includes not only the cost of the wind turbine and associated infrastructure, but also the cost impact an additional unit of wind capacity has on the optimal mix and operation of other generating units in the electricity supply portfolio. The results of the model showed that for all wind expansion scenarios, wind capacity is not cost-effective regardless of the level of the wind production tax credit and carbon prices that were considered. Larger levels of installed wind capacity result in reduced variable cost, but this reduction is not able to offset increases in capital cost, as a unit of installed wind capacity does not result in an equal reduction in other non-wind capacity needs. The second essay develops a methodology to better handle unexpected short term fluctuations in wind generation within the existing power system. The methodology developed in this essay leads to lower expected costs by anticipating and planning for fluctuations in wind generation by focusing on key constraints in the system. The modified methodology achieves expected costs for the UC-ED problem that are as low as the full stochastic model and markedly lower than the deterministic model. The final essay focuses on valuing energy storage located at a wind site through multiple revenue streams, where energy storage is valued from the perspective of a profit maximizing investor. Given the current state of battery storage technology, a battery capacity of zero is optimal in the setting considered in this essay. The results presented in this essay are dependent on a technological breakthrough that substantially reduces battery cost and conclude that allowing battery storage to simultaneously participate in multiple wholesale markets is optimal relative to participating in any one market alone. Also, co-locating battery storage and wind provides value by altering the optimal transmission line capacity to the battery and wind site. This dissertation considers problems of wind integration from an economic perspective and builds on existing work in this area. The economics of wind integration and utilization are important because wind generation levels are already significant and will likely become more so in the future. While this dissertation adds to the existing literature, additional work is needed in this area to ensure wind generation adds as much value to the overall system as possible.

A messy reality: an analysis of New Zealand's elective surgery scoring system via media sources, 200–2006

PubMed Central

Derrett, Sarah; Cousins, Kim; Gauld, Robin

2013-01-01

Waiting lists for elective procedures are a characteristic feature of tax-funded universal health systems. New Zealand has gained a reputation for its ‘booking system’ for waiting list management, introduced in the early-1990s. The New Zealand system uses criteria to ‘score’ and then ‘book’ qualifying patients for surgery. This article aims to (i) describe key issues focused on by the media, (ii) identify local strategies and (iii) present evidence of variation. Newspaper sources were searched (2000–2006). A total of 1199 booking system stories were identified. Findings demonstrate, from a national system perspective, the extraordinarily difficult nature of maintaining overall control and coordination. Equity and national consistency are affected when hospitals respond to local pressure by reducing access to elective treatment. Findings suggest that central government probably needs to be closely involved in local-level management and policy adjustments; that through the study period, the New Zealand system appears to have been largely out of the control of government; and that governments elsewhere may need to be cautious when considering developing similar systems. Developing and implementing scoring and booking systems may always be a ‘messy reality’ with unintended consequences and throwing regional differences in service management and access into stark relief. Copyright © 2012 John Wiley & Sons, Ltd. PMID:22815091

Distance Education in Taiwan: A Model Validated.

ERIC Educational Resources Information Center

Shih, Mei-Yau; Zvacek, Susan M.

The Triad Perspective Model of Distance Education (TPMDE) guides researchers in developing research questions, gathering data, and producing a comprehensive description of a distance education program. It was developed around three theoretical perspectives: (1) curriculum development theory (Tyler's four questions, 1949); (2) systems theory…