75 FR 70487 - Proposed Rules for Implementing the Whistleblower Provisions of Section 21F of the Securities...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

.... With this possible tension in mind, we have included provisions in the proposed rules intended not to... submission of high- quality tips and to enhance the utility of the information reported to the Commission. More frequent reporting of high-quality information promotes greater deterrence by enhancing the...

Effects of crop load on distribution and utilization of 13C and 15N and fruit quality for dwarf apple trees.

PubMed

Ding, Ning; Chen, Qian; Zhu, Zhanling; Peng, Ling; Ge, Shunfeng; Jiang, Yuanmao

2017-10-26

In order to define the effects of fruit crop load on the distribution and utilization of carbon and nitrogen in dwarf apple trees, we conducted three crop load levels (High-crop load, 6 fruits per trunk cross-sectional area (cm 2 , TCA)), Medium-crop load (4 fruits cm -2 TCA), Low-crop load (2 fruits cm -2 TCA)) in 2014 and 2015. The results indicated that the 15 N derived from fertilizer (Ndff) values of fruits decreased with the reduction of crop load, but the Ndff values of annual branches, leaves and roots increased. The plant 15 N-urea utilization rates on Medium and Low-crop load were 1.12-1.35 times higher than the High-crop load. With the reduction of crop load, the distribution rate of 13 C and 15 N in fruits was gradually reduced, but in contrast, the distribution of 13 C and 15 N gradually increased in annual branches, leaves and roots. Compared with High-crop load, the Medium and Low-crop load significantly improved fruit quality p < 0.05. Hence, controlling fruit load effectively regulated the distribution of carbon and nitrogen in plants, improved the nitrogen utilization rate and fruit quality. The appropriate crop load level for mature M.26 interstocks apple orchards was deemed to be 4.0 fruits cm -2 TCA.

Variations and relationship of quality and NIR spectral characteristics of cotton fibers collected from multi-location field performance trials

USDA-ARS?s Scientific Manuscript database

High volume instrumentation (HVITM) and advanced fiber information system (AFIS) measurements are increasingly being utilized as primary and routine means of acquiring fiber quality data by cotton breeders and fiber processors. There is amount of information regarding fiber and yarn qualities, but l...

Bio-analytical applications of microbial fuel cell-based biosensors for onsite water quality monitoring.

PubMed

ElMekawy, A; Hegab, H M; Pant, D; Saint, C P

2018-01-01

Globally, sustainable provision of high-quality safe water is a major challenge of the 21st century. Various chemical and biological monitoring analytics are presently utilized to guarantee the availability of high-quality water. However, these techniques still face some challenges including high costs, complex design and onsite and online limitations. The recent technology of using microbial fuel cell (MFC)-based biosensors holds outstanding potential for the rapid and real-time monitoring of water source quality. MFCs have the advantages of simplicity in design and efficiency for onsite sensing. Even though some sensing applications of MFCs were previously studied, e.g. biochemical oxygen demand sensor, recently numerous research groups around the world have presented new practical applications of this technique, which combine multidisciplinary scientific knowledge in materials science, microbiology and electrochemistry fields. This review presents the most updated research on the utilization of MFCs as potential biosensors for monitoring water quality and considers the range of potentially toxic analytes that have so far been detected using this methodology. The advantages of MFCs over established technology are also considered as well as future work required to establish their routine use. © 2017 The Society for Applied Microbiology.

Levers supporting tariff growth for water services: evidence from a contingent valuation analysis.

PubMed

Guerrini, Andrea; Vigolo, Vania; Romano, Giulia; Testa, Federico

2018-02-01

The backwardness of the water utilities sector necessitates urgent investment in infrastructure to improve water quality and efficiency in water supply networks. A policy of tariff growth represents the main source to sustain such investments. Therefore, customer engagement in the form of willingness to pay (WTP) is highly desirable by water utilities to obtain social legitimization and support. This study examines the determinants of consumers' WTP for improvement programs for three drinking water issues: quality of water sources, renewal of water mains, and building of new wastewater treatment plants. The study is based on a survey conducted among a sample of 587 customers of a water utility located in the province of Verona in the north of Italy. The contingence valuation method is used to measure WTP. Specifically, an ordinal logistic regression model yields the following significant determinants of WTP: quality of water and services provided, preference for privatization of the water utility, sustainable consumption of water, and some socio-demographic variables. The findings provide interesting insights into the drivers of WTP as well as managerial recommendations for water utilities. In particular, the findings show that water utilities need to improve service and water quality to increase customers' acceptance of tariff growth. In addition, utilities should invest in customer education and communication activities focusing on specific age groups (e.g., older customers) to enhance their WTP. Finally, communication strategies should reinforce the possible role of liberalization and privatization in supporting infrastructure investments. Copyright © 2017 Elsevier Ltd. All rights reserved.

Quality and safety in pediatric anesthesia: how can guidelines, checklists, and initiatives improve the outcome?

PubMed

Hagerman, Nancy S; Varughese, Anna M; Kurth, C Dean

2014-06-01

Cognitive aids are tangible or intangible instruments that guide users in decision-making and in the completion of a complex series of tasks. Common examples include mnemonics, checklists, and algorithms. Cognitive aids constitute very effective approaches to achieve well tolerated, high quality healthcare because they promote highly reliable processes that reduce the likelihood of failure. This review describes recent advances in quality improvement for pediatric anesthesiology with emphasis on application of cognitive aids to impact patient safety and outcomes. Quality improvement encourages the examination of systems to create stable processes and ultimately high-value care. Quality improvement initiatives in pediatric anesthesiology have been shown to improve outcomes and the delivery of efficient and effective care at many institutions. The use of checklists, in particular, improves adherence to evidence-based care in crisis situations, decreases catheter-associated bloodstream infections, reduces blood product utilization, and improves communication during the patient handoff process. Use of this simple tool has been associated with decreased morbidity, fewer medical errors, improved provider satisfaction, and decreased mortality in nonanesthesia disciplines as well. Successful quality improvement initiatives utilize cognitive aids such as checklists and have been shown to optimize pediatric patient experience and anesthesia outcomes and reduce perioperative complications.

Understanding the Haugh Unit.

USDA-ARS?s Scientific Manuscript database

Objectively determining interior egg quality in a fast, efficient manner is difficult. Candling is most often utilized as a quick method for non-destructive assessment of egg quality, but is highly subjective. As you have experienced this week when candling, it is almost impossible for multiple pe...

The use of ion beam cleaning to obtain high quality cold welds with minimal deformation

NASA Technical Reports Server (NTRS)

Sater, B. L.; Moore, T. J.

1978-01-01

This paper describes a variation of cold welding which utilizes an ion beam to clean mating surfaces prior to joining in a vacuum environment. High quality solid state welds were produced with minimal deformation. Due to experimental fixture limitation in applying pressure work has been limited to a few low yield strength materials.

[Incorporation of Information and Communication Technologies and quality of primary healthcare in Brazil].

PubMed

Santos, Alaneir de Fátima Dos; Fonseca, Délcio; Araujo, Lucas Lobato; Procópio, Cristiane da Silva Diniz; Lopes, Érica Araújo Silva; Lima, Angela Maria de Lourdes Dayrell de; Reis, Clarice Magalhães Rodrigues Dos; Abreu, Daisy Maria Xavier de; Jorge, Alzira Oliveira; Matta-Machado, Antonio Thomaz

2017-06-05

Information and Communication Technologies (ICTs) are means to handle information, streamline communication, and contribute to patient care. This article describes the incorporation of Information and Communication Technologies in primary care and its association with quality, based on the Brazilian National Program for the Improvement of Access and Quality in Primary Care (PMAQ in portuguese). This was a cross-sectional study with 17,053 teams. An Index of Incorporation of ICTs was created, which included: information infrastructure, systems, and utilization. Regression analysis was used to assess associations. Only 13.5% of the teams had a high degree of ICTs. The strongest association was seen in the utilization of information. ICTs can contribute to improving quality of primary care.

Health services utilization of women following a traumatic birth.

PubMed

Turkstra, E; Creedy, D K; Fenwick, J; Buist, A; Scuffham, P A; Gamble, J

2015-12-01

This cohort study compared 262 women with high childbirth distress to 138 non-distressed women. At 12 months, high distress women had lower health-related quality of life compared to non-distressed women (EuroQol five-dimensional (EQ-5D) scale 0.90 vs. 0.93, p = 0.008), more visits to general practitioners (3.5 vs. 2.6, p = 0.002) and utilized more additional services (e.g. maternal health clinics), with no differences for infants. Childbirth distress has lasting adverse health effects for mothers and increases health-care utilization.

Simulation modeling for stratified breast cancer screening - a systematic review of cost and quality of life assumptions.

PubMed

Arnold, Matthias

2017-12-02

The economic evaluation of stratified breast cancer screening gains momentum, but produces also very diverse results. Systematic reviews so far focused on modeling techniques and epidemiologic assumptions. However, cost and utility parameters received only little attention. This systematic review assesses simulation models for stratified breast cancer screening based on their cost and utility parameters in each phase of breast cancer screening and care. A literature review was conducted to compare economic evaluations with simulation models of personalized breast cancer screening. Study quality was assessed using reporting guidelines. Cost and utility inputs were extracted, standardized and structured using a care delivery framework. Studies were then clustered according to their study aim and parameters were compared within the clusters. Eighteen studies were identified within three study clusters. Reporting quality was very diverse in all three clusters. Only two studies in cluster 1, four studies in cluster 2 and one study in cluster 3 scored high in the quality appraisal. In addition to the quality appraisal, this review assessed if the simulation models were consistent in integrating all relevant phases of care, if utility parameters were consistent and methodological sound and if cost were compatible and consistent in the actual parameters used for screening, diagnostic work up and treatment. Of 18 studies, only three studies did not show signs of potential bias. This systematic review shows that a closer look into the cost and utility parameter can help to identify potential bias. Future simulation models should focus on integrating all relevant phases of care, using methodologically sound utility parameters and avoiding inconsistent cost parameters.

A proteomics performance standard to support measurement quality in proteomics.

PubMed

Beasley-Green, Ashley; Bunk, David; Rudnick, Paul; Kilpatrick, Lisa; Phinney, Karen

2012-04-01

The emergence of MS-based proteomic platforms as a prominent technology utilized in biochemical and biomedical research has increased the need for high-quality MS measurements. To address this need, National Institute of Standards and Technology (NIST) reference material (RM) 8323 yeast protein extract is introduced as a proteomics quality control material for benchmarking the preanalytical and analytical performance of proteomics-based experimental workflows. RM 8323 yeast protein extract is based upon the well-characterized eukaryote Saccharomyces cerevisiae and can be utilized in the design and optimization of proteomics-based methodologies from sample preparation to data analysis. To demonstrate its utility as a proteomics quality control material, we coupled LC-MS/MS measurements of RM 8323 with the NIST MS Quality Control (MSQC) performance metrics to quantitatively assess the LC-MS/MS instrumentation parameters that influence measurement accuracy, repeatability, and reproducibility. Due to the complexity of the yeast proteome, we also demonstrate how NIST RM 8323, along with the NIST MSQC performance metrics, can be used in the evaluation and optimization of proteomics-based sample preparation methods. © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Metrics for the Evaluation the Utility of Air Quality Forecasting

NASA Astrophysics Data System (ADS)

Sumo, T. M.; Stockwell, W. R.

2013-12-01

Global warming is expected to lead to higher levels of air pollution and therefore the forecasting of both long-term and daily air quality is an important component for the assessment of the costs of climate change and its impact on human health. Some of the risks associated with poor air quality days (where the Air Pollution Index is greater than 100), include hospital visits and mortality. Accurate air quality forecasting has the potential to allow sensitive groups to take appropriate precautions. This research builds metrics for evaluating the utility of air quality forecasting in terms of its potential impacts. Our analysis of air quality models focuses on the Washington, DC/Baltimore, MD region over the summertime ozone seasons between 2010 and 2012. The metrics that are relevant to our analysis include: (1) The number of times that a high ozone or particulate matter (PM) episode is correctly forecasted, (2) the number of times that high ozone or PM episode is forecasted when it does not occur and (3) the number of times when the air quality forecast predicts a cleaner air episode when the air was observed to have high ozone or PM. Our evaluation of the performance of air quality forecasts include those forecasts of ozone and particulate matter and data available from the U.S. Environmental Protection Agency (EPA)'s AIRNOW. We also examined observational ozone and particulate matter data available from Clean Air Partners. Overall the forecast models perform well for our region and time interval.

National Utility Rate Database: Preprint

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

Ong, S.; McKeel, R.

2012-08-01

When modeling solar energy technologies and other distributed energy systems, using high-quality expansive electricity rates is essential. The National Renewable Energy Laboratory (NREL) developed a utility rate platform for entering, storing, updating, and accessing a large collection of utility rates from around the United States. This utility rate platform lives on the Open Energy Information (OpenEI) website, OpenEI.org, allowing the data to be programmatically accessed from a web browser, using an application programming interface (API). The semantic-based utility rate platform currently has record of 1,885 utility rates and covers over 85% of the electricity consumption in the United States.

Farm-scale variation of soil quality indices and association with edaphic properties

USDA-ARS?s Scientific Manuscript database

Soil organisms are indicators of dynamic soil quality because their community structure and population density are sensitive to management changes. However, edaphic properties can also affect soil organisms and high spatial variability can confound their utility for soil evaluation. In the present...

SEMPATH Ontology: modeling multidisciplinary treatment schemes utilizing semantics.

PubMed

Alexandrou, Dimitrios Al; Pardalis, Konstantinos V; Bouras, Thanassis D; Karakitsos, Petros; Mentzas, Gregoris N

2012-03-01

A dramatic increase of demand for provided treatment quality has occurred during last decades. The main challenge to be confronted, so as to increase treatment quality, is the personalization of treatment, since each patient constitutes a unique case. Healthcare provision encloses a complex environment since healthcare provision organizations are highly multidisciplinary. In this paper, we present the conceptualization of the domain of clinical pathways (CP). The SEMPATH (SEMantic PATHways) Oontology comprises three main parts: 1) the CP part; 2) the business and finance part; and 3) the quality assurance part. Our implementation achieves the conceptualization of the multidisciplinary domain of healthcare provision, in order to be further utilized for the implementation of a Semantic Web Rules (SWRL rules) repository. Finally, SEMPATH Ontology is utilized for the definition of a set of SWRL rules for the human papillomavirus) disease and its treatment scheme. © 2012 IEEE

Fermentation Quality and Additives: A Case of Rice Straw Silage

PubMed Central

Oladosu, Yusuff; Magaji, Usman; Hussin, Ghazali; Ramli, Asfaliza; Miah, Gous

2016-01-01

Rice cultivation generates large amount of crop residues of which only 20% are utilized for industrial and domestic purposes. In most developing countries especially southeast Asia, rice straw is used as part of feeding ingredients for the ruminants. However, due to its low protein content and high level of lignin and silica, there is limitation to its digestibility and nutritional value. To utilize this crop residue judiciously, there is a need for improvement of its nutritive value to promote its utilization through ensiling. Understanding the fundamental principle of ensiling is a prerequisite for successful silage product. Prominent factors influencing quality of silage product include water soluble carbohydrates, natural microbial population, and harvesting conditions of the forage. Additives are used to control the fermentation processes to enhance nutrient recovery and improve silage stability. This review emphasizes some practical aspects of silage processing and the use of additives for improvement of fermentation quality of rice straw. PMID:27429981

Fermentation Quality and Additives: A Case of Rice Straw Silage.

PubMed

Oladosu, Yusuff; Rafii, Mohd Y; Abdullah, Norhani; Magaji, Usman; Hussin, Ghazali; Ramli, Asfaliza; Miah, Gous

2016-01-01

Rice cultivation generates large amount of crop residues of which only 20% are utilized for industrial and domestic purposes. In most developing countries especially southeast Asia, rice straw is used as part of feeding ingredients for the ruminants. However, due to its low protein content and high level of lignin and silica, there is limitation to its digestibility and nutritional value. To utilize this crop residue judiciously, there is a need for improvement of its nutritive value to promote its utilization through ensiling. Understanding the fundamental principle of ensiling is a prerequisite for successful silage product. Prominent factors influencing quality of silage product include water soluble carbohydrates, natural microbial population, and harvesting conditions of the forage. Additives are used to control the fermentation processes to enhance nutrient recovery and improve silage stability. This review emphasizes some practical aspects of silage processing and the use of additives for improvement of fermentation quality of rice straw.

Dynamic stability and handling qualities tests on a highly augmented, statically unstable airplane

NASA Technical Reports Server (NTRS)

Gera, Joseph; Bosworth, John T.

1987-01-01

Novel flight test and analysis techniques in the flight dynamics and handling qualities area are described. These techniques were utilized at NASA Ames-Dryden during the initial flight envelope clearance of the X-29A aircraft. It is shown that the open-loop frequency response of an aircraft with highly relaxed static stability can be successfully computed on the ground from telemetry data. Postflight closed-loop frequency response data were obtained from pilot-generated frequency sweeps and it is found that the current handling quality requirements for high-maneuverability aircraft are generally applicable to the X-29A.

Structural conceptualization of learning experiences in nursing master's degree programs utilized in occupational health nursing activities.

PubMed

Aoyama, Wakako; Tatsumi, Asami

2017-01-31

In this study, concepts were constructed that express learning experiences in nursing master's degree programs utilized in occupational health nursing activities with the aim of clarifying those characteristics. This was based on the idea that elucidation of the characteristics of learning experiences in nursing master's degree programs used in occupational health nursing activities would be meaningful in providing high-quality occupational health services that respond to the needs of society. Semi-structured interviews were conducted with 10 people who fulfilled the three conditions of having completed a master's degree programs, working as an occupational health nurse after completion of the program, and not continuing on to a doctoral program. The nursing conceptualization method of Naomi Funashima was used. From the obtained data, 512 code items expressing learning experiences in master's degree programs utilized in occupational health nursing activities were identified. These items included five core categories (concepts), 34 categories, and 69 subcategories. The five concepts constructed were "Pursuit of expertise and self-evaluation," "Mutual understanding of various people that leads to human resources utilization," "Theoretical and academic learning that influences changes in activities," "Research learning that lead to activities based on scientific evidence," and "Learning that leads to high-quality activities making use of expertise." It was found that various learning experiences in the master's program to pursue the specialty of occupational health nurses in order to recognize their roles as well as the experiences to take the initiative in learning had been integrated in their activities after completion of the course and had contributed to their high-quality occupational health nursing activities. It was suggested that the learning experiences in the master's program, which had been revealed in this study, were the experiences necessary for providing high-quality occupational health nursing activities to satisfy the social needs.

A rating scale is a proper method to evaluate changes in quality of life due to dry eye symptoms.

PubMed

Xue, Wenwen; Xu, Xian; Zou, Haidong

2018-02-07

To determine which utility value assessment method is more suitable to evaluate changes in the quality of life due to dry eye symptoms. Dry eye outpatients with a presenting visual acuity of 20/25 or better in the worse-seeing eye were recruited. Presenting distance visual acuity, tear film break-up time, Schirmer I test and fluorescein were assessed. The severity of dry eye symptoms was assessed using the Ocular Surface Disease Index (OSDI), and utility values were measured using the time trade-off (TTO), standard gamble (SG1 and SG2) and rating scale (RS) methods. Different utility values were compared with each other. The most appropriate utility value method to evaluate quality-of-life changes solely due to dry eye symptoms is determined by calculating the correlation between the OSDI score and different utility values. A total of 104 patients were enrolled. The three sections of OSDI in the order of high to low scores were as follows: "environmental trigger," "eye discomfort" and "visual function." The utility scores measured with TTO, SG1, SG2 and RS were 0.95 ± 0.11, 0.96 ± 0.10, 0.99 ± 0.07 and 0.89 ± 0.10, respectively. The utility scores evaluated by the TTO, SG1, SG2 and RS methods were significantly different from each other (p < 0.05). Only the utility scores measured with RS were significantly correlated with the composite OSDI score, "environmental trigger" and "eye discomfort" section scores (p < 0.05). RS is more sensitive than TTO and SG for the evaluation of altered quality of life due to dry eye symptoms.

The Effects of Website Information Utility on the Outcomes of User-Website Interactions

ERIC Educational Resources Information Center

Hasley, Joseph Paul

2010-01-01

This study investigates the relationships between website information content utility and various outcomes of user interactions with e-tail websites. Although previous research has consistently identified high quality information content as a critical factor of successful e-commerce websites, those studies have not reported how to identify the…

Community College Dual Enrollment Faculty Orientation: A Utilization-Focused Approach

ERIC Educational Resources Information Center

Charlier, Hara D.; Duggan, Molly H.

2010-01-01

The current climate of accountability demands that institutions engage in data-driven program evaluation. In order to promote quality dual enrollment (DE) programs, institutions must support the adjunct faculty teaching college courses in high schools. This study uses Patton's utilization-focused model (1997) to conduct a formative evaluation of a…

Global Pressures on Education Research: Quality, Utility, and Infrastructure

ERIC Educational Resources Information Center

Herrington, Carolyn D.; Summers, Katherine P.

2014-01-01

This article provides an overview of issues likely to drive educational research globally over the next decade, and it examines the "Asia Pacific Education Review" ("APER")'s role in responding to these issues, shaping research agendas, and delivering high-quality research. We also look at the implications of these…

A profile of women at the highest risk of maternal death in Pakistan.

PubMed

Agha, Sohail

2015-09-01

Traditionally, health interventions implemented in Pakistan have been designed to increase the supply of maternal health services, but have not focused on reaching the poorest women or on providing high-quality services. Demand-side barriers to the utilization of health services are substantial in Pakistan, as are supply-side constraints to the provision of quality health care. This study uses data from the Pakistan Demographic and Health Survey 2006-07 to develop a profile of the poorest women in Pakistan in order to understand demand-side barriers to accessing maternal health care. The study shows stark differences in human capital, material and demographic resources between the poorest women and other women. It illustrates how these differences translate into low levels of service utilization among the poorest women. The purpose of the study is to stimulate a discussion of both the difficulty and the importance of reaching the poorest women with high-quality maternal health interventions. The findings from several pilot projects in Pakistan suggest that the poorest women can be reached at disproportionately higher rates than non-poor women through targeted, community-based, interventions. There is little demonstrable evidence, however, that high-quality care has been provided through these interventions. Evidence-based approaches, which have the potential to overcome financial and sociocultural barriers to service utilization, should be scaled up as soon as possible. However, measures should be taken to ensure that the quality of care provided through these interventions is adequate and able to lead to significant reductions in mortality. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Quality of life among obese patients seeking weight loss surgery: the importance of obesity-related social stigma and functional status.

PubMed

Wee, Christina C; Davis, Roger B; Huskey, Karen W; Jones, Daniel B; Hamel, Mary B

2013-02-01

Obesity is a stigmatizing condition associated with adverse psychosocial consequences. The relative importance of weight stigma in reducing health utility or the value a person places on their current health state is unknown. We conducted a telephone survey of patients with obesity. All were seeking weight loss surgery at two bariatric centers (70 % response rate). We assessed patients' health utility (preference-based quality life measure) via a series of standard gamble scenarios assessing patients' willingness to risk death to lose various amounts of weight or achieve perfect health (range 0 to 1; 0 = death and 1 = most valued health/weight state). Multivariable models assessed associations among quality of life domains from the Short-form 36 (SF-36) and Impact of Weight on Quality of Life-lite (IWQOL-lite) and patients' health utility. Our study sample (n = 574) had a mean body mass index of 46.5 kg/m(2) and a mean health utility of 0.87, reflecting the group's average willingness to accept a 13 % risk of death to achieve their most desired health/weight state; utilities were highly variable, however, with 10 % reporting a utility of 1.00 and 27 % reporting a utility lower than 0.90. Among the IWQOL-lite subscales, Public Distress and Work Life were the only two subscales significantly associated with patients' utility after adjustment for sociodemographic factors. Among the SF-36 subscales, Role Physical, Physical Functioning, and Role Emotional were significantly associated with patients' utility. When the leading subscales on both IWQOL-lite and SF-36 were considered together, Role Physical, Public Distress, and to a lesser degree Role Emotional remained independently associated with patients' health utility. Patients seeking weight loss surgery report health utilities similar to those reported for people living with diabetes or with laryngeal cancer; however, utility values varied widely with more than a quarter of patients willing to accept more than a 10 % risk of death to achieve their most valued health/weight state. Interference with role functioning due to physical limitations and obesity-related social stigma were strong determinants of reduced health utility.

Oxytocin, Social Support and Sleep Quality In Low Income Minority Women Living with HIV

PubMed Central

Fekete, Erin M.; Seay, Julia; Antoni, Michael H.; Mendez, Armando J.; Fletcher, Mary Ann; Szeto, Angela; Schneiderman, Neil

2013-01-01

Sleep disturbances are highly prevalent in women with HIV and few studies examine potential protective factors that may reduce risk for sleep disturbances in this high-risk population. We predicted that HIV-specific social support from various sources (i.e., friends, family, spouses), as well as oxytocin (OT), would explain sleep quality in 71 low income minority women living with HIV. Social support from family members was associated with better sleep quality in women. For women with high OT, support from friends was associated with better sleep quality, while for women with low OT, support from friends was associated with poorer sleep quality. Women with low OT may not effectively interpret and utilize available support resources, which may be associated with sleep disturbances. PMID:23799864

Immunoassay for wheat processing quality: utilization of a sandwich assay incorporating an immobilized single-chain fragment.

PubMed

Hill, A S; Giersch, T M; Loh, C S; Skerritt, J H

1999-10-01

A single-chain fragment (scFv) was engineered from a monoclonal antibody to high molecular weight glutenin subunits (HMW-GS), wheat flour polypeptides that play a major role in determining the mixing- and extension strength-related properties of dough and its subsequent baking performance. The scFv was expressed in a thioredoxin mutant Escherichia coli strain that allows disulfide bond formation in the cytoplasm and incorporated into a diagnostic test for wheat quality. Although the scFv lacks the more highly conserved antibody constant regions usually involved with immobilization, it was able to be directly immobilized to a polystyrene microwell solid phase without chemical or covalent modification of the protein or solid phase and utilized as a capture antibody in a double-antibody (two-site) immunoassay. In the sandwich assay, increasing HMW-GS concentrations produced increasing assay color, and highly significant correlations were obtained between optical densities obtained in the ELISA using the scFv and the content of large glutenin polymers in flours as well as measures of dough strength as measured by resistance to dough extension in rheological testing. The assay using the scFv was able to be carried out at lower flour sample extract dilutions than that required for a similar assay utilizing a monoclonal capture antibody. This research shows that engineered antibody fragments can be utilized to provide superior assay performance in two-site ELISAs over monoclonal antibodies and is the first application of an engineered antibody to the analysis of food processing quality.

Is quality of care a key predictor of perinatal health care utilization and patient satisfaction in Malawi?

PubMed

Creanga, Andreea A; Gullo, Sara; Kuhlmann, Anne K Sebert; Msiska, Thumbiko W; Galavotti, Christine

2017-05-22

The Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care. Efforts to sustain or increase current levels of perinatal service utilization may not achieve desired gains if the quality of care provided is neglected. This study examined predictors of perinatal service utilization and patients' satisfaction with these services with a focus on quality of care. We used baseline, two-stage cluster sampling household survey data collected between November and December, 2012 before implementation of CARE's Community Score Card© intervention in Ntcheu district, Malawi. Women with a birth during the last year (N = 1301) were asked about seeking: 1) family planning, 2) antenatal, 3) delivery, and 4) postnatal care; the quality of care received; and their overall satisfaction with the care received. Specific quality of care items were assessed for each type of service, and up to five such items per type of service were used in analyses. Separate logistic regression models were fitted to examine predictors of family planning, antenatal, delivery, and postnatal service utilization and of complete satisfaction with each of these services; all models were adjusted for women's socio-demographic characteristics, perceptions of the closest facility to their homes, service use indicators, and quality of care items. We found higher levels of perinatal service use than previously documented in Malawi (baseline antenatal care 99.4%; skilled birth attendance 97.3%; postnatal care 77.5%; current family planning use 52.8%). Almost 73% of quality of perinatal care items assessed were favorably reported by > 90% of women. Women reported high overall satisfaction (≥85%) with all types of services examined, higher for antenatal and postnatal care than for family planning and delivery care. We found significant associations between perceived and actual quality of care and both women's use and satisfaction with the perinatal health services received. Quality of care is a key predictor of perinatal health service utilization and complete patient satisfaction with such services in Malawi. The current heightened attention toward perinatal health services and outcomes should be coupled with efforts to improve the actual quality of care offered to women in this country.

Where Would You Go for Your Next Hospitalization?

PubMed Central

Jung, Kyoungrae; Feldman, Roger; Scanlon, Dennis

2014-01-01

We examine the effects of diverse dimensions of hospital quality – including consumers’ perceptions of unobserved attributes – on future hospital choice. We utilize consumers’ stated preference weights to obtain hospital-specific estimates of perceptions about unmeasured attributes such as reputation. We report three findings. First, consumers’ perceptions of reputation and medical services contribute substantially to utility for a hospital choice. Second, consumers tend to select hospitals with high clinical quality scores even before the scores are publicized. However, the effect of clinical quality on hospital choice is relatively small. Third, satisfaction with a prior hospital admission has a large impact on future hospital choice. Our findings suggest that including measures of consumers’ experience in report cards may increase their responsiveness to publicized information, but other strategies are needed to overcome the large effects of consumers’ beliefs about other quality attributes. PMID:21665300

Image Information Mining Utilizing Hierarchical Segmentation

NASA Technical Reports Server (NTRS)

Tilton, James C.; Marchisio, Giovanni; Koperski, Krzysztof; Datcu, Mihai

2002-01-01

The Hierarchical Segmentation (HSEG) algorithm is an approach for producing high quality, hierarchically related image segmentations. The VisiMine image information mining system utilizes clustering and segmentation algorithms for reducing visual information in multispectral images to a manageable size. The project discussed herein seeks to enhance the VisiMine system through incorporating hierarchical segmentations from HSEG into the VisiMine system.

Fitness in paradise: quality of forensic reports submitted to the Hawaii judiciary.

PubMed

Robinson, Richard; Acklin, Marvin W

2010-01-01

This paper examined quality of forensic reports submitted to the Hawaii Judiciary. Hawaii utilizes a three panel system for assessing fitness to proceed, where two psychologists and one psychiatrist submit independent reports to the Court. Utilizing a survey instrument based on previous research and nationally-derived quality standards, 150 competency to stand trial (CST) reports were examined. Reports demonstrated pervasive mediocrity with respect to quality (Mean QC=68.95, SD=15.21). One quarter (N=38) of the reports scored at or above 80% of the maximum possible score. Levels of CST agreement between evaluators and evaluators and judges were high. Report quality did not differ as a function of evaluator professional identity. Full-time employed evaluators submitted a greater number of reports above the quality criterion. For those evaluators who attended the March training, reports demonstrated significantly improved quality. Suggestions for enhancing report quality are offered with a special attention to inclusion of report elements, focus on inclusion of historical elements, and clearly described rationales supporting forensic opinions. (7664 words. Competency to stand trial, inter-rater agreement).

76 FR 21369 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-15

... program. The goals of the CCTP are to improve transitions of beneficiaries from the inpatient hospital setting to other care settings, to improve quality of care, to reduce readmissions for high risk...) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) the use...

Does pulse-grazing influence within- and between-grazing season dietary quality of yearling steers in shortgrass steppe?

USDA-ARS?s Scientific Manuscript database

Pulse-grazing, high stock density with short grazing periods (weeks) followed by long (months to > 1 year) rest periods, is a grazing management strategy posited to decrease preferential selection by cattle and increase utilization of forage, but influences on dietary quality of grazing animals in s...

Factors associated with high-quality/low-cost hospital performance.

PubMed

Jiang, H Joanna; Friedman, Bernard; Begun, James W

2006-01-01

This study explores organizational and market characteristics associated with superior hospital performance in both quality and cost of care, using the Healthcare Cost and Utilization Project State Inpatient Databases for ten states in 1997 and 2001. After controlling for a variety of patient factors, we found that for-profit ownership, hospital competition, and the number of HMOs were positively associated with the likelihood of attaining high-quality/low-cost performance. Furthermore, we examined interactions between organizational and market characteristics and identified a number of significant interactions. For example, the positive likelihood associated with for-profit hospitals diminished in markets with high HMO penetration.

Fourth High Alpha Conference, volume 1

NASA Technical Reports Server (NTRS)

1994-01-01

The goal of the Fourth High Alpha Conference was to focus on the flight validation of high angle-of-attack technologies and provide an in-depth review of the latest high angle-of-attack activities. Areas that were covered include: high angle-of-attack aerodynamics, propulsion and inlet dynamics, thrust vectoring, control laws and handling qualities, tactical utility, and forebody controls.

Mill demonstration of TMP production from forest thinnings : pulp quality, refining energy, and handsheet properties

Treesearch

J.Y. Zhu; C. Tim Scott; Roland Gleisner; Doreen Mann; D.P. Dykstra; G. Holton Quinn; Louis L. Edwards

2007-01-01

High-value, large-volume utilization of forest thinning materials from U.S. National Forests is a potentially important contributor to sustainable forest health. This study demonstrated the utilization of wood chips produced from thinnings for the production of thermomechanical pulp (TMP). Both whole-log chips (primarily from small-diameter logs, tops, and reject logs...

Mill demonstration of TMP production from forest thinnings: pulp quality, refining energy, and handsheet properties

Treesearch

J.Y. Zhu; C. Tim Scott; Roland Gleisner; Doreen Mann; D.P. Dykstra; G. Holton Quinn; Louis L. Edwards

2007-01-01

High-value, large-volume utilization of forest thinning materials from U.S. national forests is a potentially important contributor to sustainable forest health. This study demonstrated the utilization of wood chips produced from thinnings for the production of thermomechanical pulp (TMP). Both whole-log chips (primarily from small-diameter logs, tops, and reject logs...

Effect of Power Ultrasound on Food Quality

NASA Astrophysics Data System (ADS)

Lee, Hyoungill; Feng, Hao

Recent food processing technology innovations have been centered around producing foods with fresh-like attributes through minimal processing or nonthermal processing technologies. Instead of using thermal energy to secure food safety that is often accompanied by quality degradation in processed foods, the newly developed processing modalities utilize other types of physical energy such as high pressure, pulsed electric field or magnetic field, ultraviolet light, or acoustic energy to process foods. An improvement in food quality by the new processing methods has been widely reported. In comparison with its low-energy (high-frequency) counterpart which finds applications in food quality inspection, the use of high-intensity ultrasound, also called power ultrasound, in food processing is a relatively new endeavor. To understand the effect of high-intensity ultrasound treatment on food quality, it is important to understand the interactions between acoustic energy and food ingredients, which is covered in Chapter 10. In this chapter, the focus will be on changes in overall food quality attributes that are caused by ultrasound, such as texture, color, flavor, and nutrients.

Quality of life and health care utilization in patients with chronic respiratory diseases.

PubMed

Kurpas, D; Mroczek, B; Sitko, Z; Helicka, D; Kuchar, E

2015-01-01

High quality of life (QoL) may reduce the costs of medical care of chronically ill patients due to lower health care utilization. The purpose of this study was to establish the influence of the QoL of primary care patients with chronic respiratory diseases on the level of health care utilization and the predictors of hospitalization. The study group consisted of 594 adult patients with chronic respiratory diseases of the mean age 59.8±14.9 years. The highest QoL was observed in the social relationship domain and the lowest in the physical domain. Low QoL was associated with a low level of health care utilization among patients with chronic respiratory diseases. Most patients were hospitalized during the past 3 years. In a group of patients with chronic respiratory diseases, chances for hospitalization were: higher among patients with low QoL and health satisfaction, low QoL levels in the physical and social relationship domains, high QoL levels in the psychological domain, those with higher education, residents of rural areas, patients using frequent consultations over the phone, and those with at least an average index of services.

High-Quality TiS2 For Li/TiS2 Cells

NASA Technical Reports Server (NTRS)

Huang, Chen-Kuo; Surampudi, Subbarao; Shen, David H.; Delgiannis, Fotios; Halpert, Gerald

1992-01-01

Modified process for synthesis of battery-grade titanium sulfide (TiS2) yields substantially improved material for Li/TiS2 electrochemical cells. Includes all-vapor-phase reaction between sulfur and titanium. Product less dense and more homogeneous, consists of smaller particles of higher crystalline quality, and purer. Cells have high cathode utilization and long cycle life performance. Expected to find applications in rechargeable lithium batteries for spacecraft, military equipment, telecommunication systems, automobiles, and consumer products.

Oriented modulation for watermarking in direct binary search halftone images.

PubMed

Guo, Jing-Ming; Su, Chang-Cheng; Liu, Yun-Fu; Lee, Hua; Lee, Jiann-Der

2012-09-01

In this paper, a halftoning-based watermarking method is presented. This method enables high pixel-depth watermark embedding, while maintaining high image quality. This technique is capable of embedding watermarks with pixel depths up to 3 bits without causing prominent degradation to the image quality. To achieve high image quality, the parallel oriented high-efficient direct binary search (DBS) halftoning is selected to be integrated with the proposed orientation modulation (OM) method. The OM method utilizes different halftone texture orientations to carry different watermark data. In the decoder, the least-mean-square-trained filters are applied for feature extraction from watermarked images in the frequency domain, and the naïve Bayes classifier is used to analyze the extracted features and ultimately to decode the watermark data. Experimental results show that the DBS-based OM encoding method maintains a high degree of image quality and realizes the processing efficiency and robustness to be adapted in printing applications.

Electric utility of the year for 1984: Potomac Electric Power

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

Not Available

1984-11-01

High performance, efficiency improvements, a modest construction program, a clear balance sheet, and an effort to expend power plant life were among the qualities that earned Potomac Electric Power (PEPCO) the title of 1984 Utility of the Year. Other key elements in the utility's selection were its strategy for purchasing power, a load management plan, diversified investments into subsidiary businesses, community concern that considers the aesthetics of transmission facilities, and its interest in personnel development, especially among minorities. 3 figures.

Water Quality Response to Forest Biomass Utilization

Treesearch

Benjamin Rau; Augustine Muwamba; Carl Trettin; Sudhanshu Panda; Devendra Amatya; Ernest Tollner

2017-01-01

Forested watersheds provide approximately 80% of freshwater drinking resources in the United States (Fox et al. 2007). The water originating from forested watersheds is typically of high quality when compared to agricul¬tural watersheds, and concentrations of nitrogen and phosphorus are nine times higher, on average, in agricultur¬al watersheds when compared to...

The Motivation Impact of Open Educational Resources Utilization on Physics Learning Using Quipper School App

ERIC Educational Resources Information Center

Sulisworo, Dwi; Sulistyo, Eko Nur; Akhsan, Rifai Nur

2017-01-01

The distribution of the education quality in Indonesia is relatively uneven. This affects the quality of secondary school graduates. On the other hand, the national growth of Information Communication Technology usage in Indonesia is very high, including the use of mobile technology. This is an opportunity for the application of OER (Open…

Electron-beam lithography with character projection technique for high-throughput exposure with line-edge quality control

NASA Astrophysics Data System (ADS)

Ikeno, Rimon; Maruyama, Satoshi; Mita, Yoshio; Ikeda, Makoto; Asada, Kunihiro

2016-07-01

The high throughput of character projection (CP) electron-beam (EB) lithography makes it a promising technique for low-to-medium volume device fabrication with regularly arranged layouts, such as for standard-cell logics and memory arrays. However, non-VLSI applications such as MEMS and MOEMS may not be able to fully utilize the benefits of the CP method due to the wide variety of layout figures including curved and oblique edges. In addition, the stepwise shapes that appear because of the EB exposure process often result in intolerable edge roughness, which degrades device performances. In this study, we propose a general EB lithography methodology for such applications utilizing a combination of the CP and variable-shaped beam methods. In the process of layout data conversion with CP character instantiation, several control parameters were optimized to minimize the shot count, improve the edge quality, and enhance the overall device performance. We have demonstrated EB shot reduction and edge-quality improvement with our methodology by using a leading-edge EB exposure tool, ADVANTEST F7000S-VD02, and a high-resolution hydrogen silsesquioxane resist. Atomic force microscope observations were used to analyze the resist edge profiles' quality to determine the influence of the control parameters used in the data conversion process.

Utility of alfalfa stemlage for feeding dairy heifers

USDA-ARS?s Scientific Manuscript database

Dairy heifers are typically offered high-forage diets to control weight gains; however, these forage-based diets often contain significant portions of corn silage or other high-quality forages with low fiber concentrations. Inadequate concentrations of dietary fiber can lead to greater feed and ener...

Development of quality standards for inclusion of high recycled asphalt pavement content in asphalt mixtures - phase II, [tech brief].

DOT National Transportation Integrated Search

2015-03-01

The objective of this research is to 1) build a test section utilizing HMA : mix designs with up to 40% RAP materials, 2) evaluate the moisture : sensitivity of High-RAP mixtures, 3) characterize the low-temperature : fracture behavior of High-RAP mi...

Effective drinking water collaborations are not accidental: interagency relationships in the international water utility sector.

PubMed

Jalba, D I; Cromar, N J; Pollard, S J T; Charrois, J W; Bradshaw, R; Hrudey, S E

2014-02-01

The role that deficient institutional relationships have played in aggravating drinking water incidents over the last 30 years has been identified in several inquiries of high profile drinking water safety events, peer-reviewed articles and media reports. These indicate that collaboration between water utilities and public health agencies (PHAs) during normal operations, and in emergencies, needs improvement. Here, critical elements of these interagency collaborations, that can be integrated within the corporate risk management structures of water utilities and PHAs alike, were identified using a grounded theory approach and 51 semi-structured interviews with utility and PHA staff. Core determinants of effective interagency relationships are discussed. Intentionally maintained functional relationships represent a key ingredient in assuring the delivery of safe, high quality drinking water. © 2013.

42 CFR 478.10 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS RECONSIDERATIONS AND APPEALS Utilization and Quality Control Quality Improvement... procedures for— (a) Reconsiderations conducted by a Utilization and Quality Control Quality Improvement...

42 CFR 478.10 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS RECONSIDERATIONS AND APPEALS Utilization and Quality Control Quality Improvement... procedures for— (a) Reconsiderations conducted by a Utilization and Quality Control Quality Improvement...

42 CFR 478.10 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS RECONSIDERATIONS AND APPEALS Utilization and Quality Control Quality Improvement... procedures for— (a) Reconsiderations conducted by a Utilization and Quality Control Quality Improvement...

42 CFR 478.10 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS RECONSIDERATIONS AND APPEALS Utilization and Quality Control Quality Improvement... procedures for— (a) Reconsiderations conducted by a Utilization and Quality Control Quality Improvement...

42 CFR 478.10 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS RECONSIDERATIONS AND APPEALS Utilization and Quality Control Quality Improvement... procedures for— (a) Reconsiderations conducted by a Utilization and Quality Control Quality Improvement...

A novel way to upgrade the coarse part of a high calcium fly ash for reuse into cement systems.

PubMed

Antiohos, S K; Tsimas, S

2007-01-01

Reject fly ash (rFA) represents a significant portion of the fly ashes produced from coal-fired power plants. Due to the high carbon content and large particle mean diameter, rFA is not utilized in the construction sector (for example, as supplementary cementing material) and is currently dumped into landfills, thus representing an additional environmental burden. Recently, the feasibility of using rFA in a relatively small number of applications, like solidification/stabilization of other wastes, has been investigated by different researchers. However, as the overall amount of fly ash utilized in such applications is still limited, there is a need to investigate other possibilities for rFA utilization starting from a deeper understanding of its properties. In the work presented herein, mechanical and hydration properties of cementitious materials prepared by blending the coarse fraction of a lignite high-calcium fly ash with ordinary cement were monitored and compared with the respective ones of a good quality fly ash-cement mixture. The results of this work reveal that a relatively cheap, bilateral classification-grinding method is able to promote the pozzolanic behavior of the rFAs, so that the overall performances of rFA containing cements are drastically improved. The evaluation of these results supports the belief that appropriate utilization of non-standardized materials may lead to new environmental-friendly products of superior quality.

Islet Oxygen Consumption Rate (OCR) Dose Predicts Insulin Independence in Clinical Islet Autotransplantation.

PubMed

Papas, Klearchos K; Bellin, Melena D; Sutherland, David E R; Suszynski, Thomas M; Kitzmann, Jennifer P; Avgoustiniatos, Efstathios S; Gruessner, Angelika C; Mueller, Kathryn R; Beilman, Gregory J; Balamurugan, Appakalai N; Loganathan, Gopalakrishnan; Colton, Clark K; Koulmanda, Maria; Weir, Gordon C; Wilhelm, Josh J; Qian, Dajun; Niland, Joyce C; Hering, Bernhard J

2015-01-01

Reliable in vitro islet quality assessment assays that can be performed routinely, prospectively, and are able to predict clinical transplant outcomes are needed. In this paper we present data on the utility of an assay based on cellular oxygen consumption rate (OCR) in predicting clinical islet autotransplant (IAT) insulin independence (II). IAT is an attractive model for evaluating characterization assays regarding their utility in predicting II due to an absence of confounding factors such as immune rejection and immunosuppressant toxicity. Membrane integrity staining (FDA/PI), OCR normalized to DNA (OCR/DNA), islet equivalent (IE) and OCR (viable IE) normalized to recipient body weight (IE dose and OCR dose), and OCR/DNA normalized to islet size index (ISI) were used to characterize autoislet preparations (n = 35). Correlation between pre-IAT islet product characteristics and II was determined using receiver operating characteristic analysis. Preparations that resulted in II had significantly higher OCR dose and IE dose (p<0.001). These islet characterization methods were highly correlated with II at 6-12 months post-IAT (area-under-the-curve (AUC) = 0.94 for IE dose and 0.96 for OCR dose). FDA/PI (AUC = 0.49) and OCR/DNA (AUC = 0.58) did not correlate with II. OCR/DNA/ISI may have some utility in predicting outcome (AUC = 0.72). Commonly used assays to determine whether a clinical islet preparation is of high quality prior to transplantation are greatly lacking in sensitivity and specificity. While IE dose is highly predictive, it does not take into account islet cell quality. OCR dose, which takes into consideration both islet cell quality and quantity, may enable a more accurate and prospective evaluation of clinical islet preparations.

A systematic review of goal directed fluid therapy: rating of evidence for goals and monitoring methods.

PubMed

Wilms, Heath; Mittal, Anubhav; Haydock, Matthew D; van den Heever, Marc; Devaud, Marcello; Windsor, John A

2014-04-01

To review the literature on goal directed fluid therapy and evaluate the quality of evidence for each combination of goal and monitoring method. A search of major digital databases and hand search of references was conducted. All studies assessing the clinical utility of a specific fluid therapy goal or set of goals using any monitoring method were included. Data was extracted using a pre-determined pro forma and papers were evaluated using GRADE principles to assess evidence quality. Eighty-one papers met the inclusion criteria, investigating 31 goals and 22 methods for monitoring fluid therapy in 13052 patients. In total there were 118 different goal/method combinations. Goals with high evidence quality were central venous lactate and stroke volume index. Goals with moderate quality evidence were sublingual microcirculation flow, the oxygen extraction ratio, cardiac index, cardiac output, and SVC collapsibility index. This review has highlighted the plethora of goals and methods for monitoring fluid therapy. Strikingly, there is scant high quality evidence, in particular for non-invasive G/M combinations in non-operative and non-intensive care settings. There is an urgent need to address this research gap, which will be helped by methodologies to compare utility of G/M combinations. Copyright © 2014 Elsevier Inc. All rights reserved.

Activities of the Institute of Chemical Processing of Coal at Zabrze

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

Dreszer, K.

1995-12-31

The Institute of Chemical Processing of Coal at Zabrze was established in 1955. The works on carbochemical technologies have been, therefore, carried out at the Institute for 40 years. The targets of the Institute`s activities are research, scientific and developing works regarding a sensible utilization of fuels via their processing into more refined forms, safe environment, highly efficient use of energy carriers and technological products of special quality. The Institute of Chemical Processing of Coal has been dealing with the following: optimized use of home hard coals; improvement of classic coal coking technologies, processing and utilization of volatile coking products;more » production technologies of low emission rate fuels for communal management; analyses of coal processing technologies; new technologies aimed at increasing the efficiency of coal utilization for energy-generating purposes, especially in industry and studies on the ecological aspects of these processes; production technologies of sorbents and carbon activating agents and technologies of the utilization; rationalization of water and wastes management in the metallurgical and chemical industries in connection with removal of pollution especially dangerous to the environment from wastes; utilization technologies of refined materials (electrode cokes, binders, impregnating agents) for making electrodes, refractories and new generation construction carbon materials; production technologies of high quality bituminous and bituminous and resin coating, anti-corrosive and insulation materials; environmentally friendly utilization technologies for power station, mine and other wastes, and dedusting processes in industrial gas streams.« less

Cataract surgery cost utility revisited in 2012: a new economic paradigm.

PubMed

Brown, Gary C; Brown, Melissa M; Menezes, Alicia; Busbee, Brandon G; Lieske, Heidi B; Lieske, Philip A

2013-12-01

To assess the 2012 cost utility of cataract surgery in the United States and to compare 2012 cost-utility data with those from 2000. Value-Based Medicine (Flourtown, PA), patient preference-based, comparative effectiveness analysis and cost-utility analysis using 2012 real United States dollars. Previously published Patient Outcomes Research Team Study data and time tradeoff utilities obtained from patients with vision loss. Visual acuity measurements from patients wtih untreated cataract were used as controls. Thirteen-year, average, first-eye and second-eye cataract surgery cost-utility analysis using the societal and third-party insurer cost perspectives. Patient value gain in quality-adjusted life years (QALYs) and percent gain in quality of life as well as the cost-utility ratio using the dollars expended per QALY gained. Patient and financial value outcomes were discounted at 3% annually with net present value analysis. First-eye cataract surgery conferred 1.6212 QALYs over the 13-year model, a 20.8% quality-of-life gain. Bilateral cataract surgery conferred 2.8152 QALYs over 13 years, a 36.2% improvement in quality of life. The direct ophthalmic medical cost for unilateral cataract surgery in 2012 United States nominal dollars was $2653, an inflation-adjusted 34.2% less than in 2000 and 85% less than in 1985. The 2012 inflation-adjusted physician fee was 10.1% of that in 1985. The 13-year societal cost perspective, financial return on investment (ROI) for first-eye cataract surgery was $121,198, a 4567% gain. The third-party insurer cost perspective average cost-utility ratio was $2653/1.6212 = $1636/QALY for unilateral cataract surgery, whereas the societal cost perspective average cost-utility ratio was -$121,198/1.6212 = -$74,759/QALY. The net 13-year $123.4-billion financial ROI from a 1-year cohort of cataract surgery patients was accrued: Medicare, $36.4 billion; Medicaid, $3.3 billion; other insurers, $9.6 billion; patients, $48.6 billion; and increased United States national productivity, $25.4 billion. Cataract surgery in 2012 greatly improved quality of life and was highly cost effective. It was 34.4% less expensive than in 2000 and 85% less expensive than in 1985. Initial cataract surgery yielded an extraordinary 4567% financial ROI to society over the 13-year model. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Does quality influence utilization of primary health care? Evidence from Haiti.

PubMed

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

Trade Books in the Mathematics Classroom: The Impact of Many, Varied Perspectives on Determinations of Quality

ERIC Educational Resources Information Center

Nesmith, Suzanne; Cooper, Sandi

2010-01-01

The integration of children's trade books in the mathematics classroom has experienced a dramatic surge in its popularity; yet, though the positive benefits of this strategy have been well documented, these benefits may only be realized if the literature is of high quality. Utilizing a mathematics trade book evaluation instrument, this inquiry…

Evaluating Journal Quality: Is the H-Index a Better Measure than Impact Factors?

ERIC Educational Resources Information Center

Hodge, David R.; Lacasse, Jeffrey R.

2011-01-01

Objectives: This study evaluates the utility of a new measure--the h-index--that may provide a more valid approach to evaluating journal quality in the social work profession. Method: H-index values are compared with Thomson ISI 5-year impact factors and expert opinion. Results: As hypothesized, the h-index correlates highly with ISI 5-year impact…

Stocking, growth, and yield of oak stands

Treesearch

Samuel F. Gingrich

1971-01-01

An appraisal of stocking in even-aged upland oak stands is a prerequisite for determining the cultural needs of a given stand. Most oak stands have sufficient stocking to utilize the site, but are deficient in high-quality trees. Thinning such stands offers a good opportunity to upgrade the relative quality of the growing stock and enhance the growth and yield...

Fluoxetine and imipramine: are there differences in cost-utility for depression in primary care?

PubMed

Serrano-Blanco, Antoni; Suárez, David; Pinto-Meza, Alejandra; Peñarrubia, Maria T; Haro, Josep Maria

2009-02-01

Depressive disorders generate severe personal burden and high economic costs. Cost-utility analyses of the different therapeutical options are crucial to policy-makers and clinicians. Previous cost-utility studies, comparing selective serotonin reuptake inhibitors and tricyclic antidepressants, have used modelling techniques or have not included indirect costs in the economic analyses. To determine the cost-utility of fluoxetine compared with imipramine for treating depressive disorders in primary care. A 6-month randomized prospective naturalistic study comparing fluoxetine with imipramine was conducted in three primary care centres in Spain. One hundred and three patients requiring antidepressant treatment for a DSM-IV depressive disorder were included in the study. Patients were randomized either to fluoxetine (53 patients) or to imipramine (50 patients) treatment. Patients were treated with antidepressants according to their general practitioner's usual clinical practice. Outcome measures were the quality of life tariff of the European Quality of Life Questionnaire: EuroQoL-5D (five domains), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and after 1, 3 and 6 months. Incremental cost-utility ratios (ICUR) were obtained. To address uncertainty in the ICUR's sampling distribution, non-parametric bootstrapping was carried out. Taking into account adjusted total costs and incremental quality of life gained, imipramine dominated fluoxetine with 81.5% of the bootstrap replications in the dominance quadrant. Imipramine seems to be a better cost-utility antidepressant option for treating depressive disorders in primary care.

Comparison of Psychotropic Drug Prescribing Quality between Zagreb, Croatia and Sarajevo, B&H.

PubMed

Polić-Vižintin, Marina; Štimac, Danijela; Čatić, Tarik; Šostar, Zvonimir; Zelić, Ana; Živković, Krešimir; Draganić, Pero

2014-12-01

The purpose of this paper was to compare outpatient consumption and quality of psychotropic drug prescribing between Croatia and Bosnia & Herzegovina 2006-2010. Data on drug utilization from Zagreb Municipal Pharmacy and Sarajevo Public Pharmacy were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/TID) using the WHO Anatomical-Therapeutic-Chemical methodology. Total utilization of psychopharmaceuticals increased in both cities; however, it was higher in Zagreb than in Sarajevo throughout the study period. The utilization of psycholeptics increased in Zagreb by 2.4% (from 74.5 to 76.3 DDD/TID) and in Sarajevo by 3.8% (from 62.4 to 64.8 DDD/TID). The utilization of anxiolytics decreased in Zagreb by 2.1% and in Sarajevo by even 18.7%. The utilization of antidepressants increased in both cities with predominance of SSRI over TCA utilization, greater in Sarajevo (96.6%) than in Zagreb (10.2%). The anxiolytic/antidepressant ratio decreased by 11.1% in Zagreb (from 2.87 to 2.55) and by 58.7% in Sarajevo (from 5.66 to 2.34). Outpatient utilization of antipsychotics increased significantly in Sarajevo, predominated by typical ones, whereas in Zagreb the utilization of antipsychotics was stable, predominated by atypical ones. In Croatia and Bosnia & Herzegovina, there was an obvious tendency to follow western trends in drug prescribing, as demonstrated by the increased use of antidepressants and reduced use of anxiolytics. Despite some improvement observed in the prescribing quality, high use of antipsychotics with dominance of typical antipsychotics in Sarajevo points to the need of prescribing guidelines for antipsychotics.

Fourth High Alpha Conference, volume 3

NASA Technical Reports Server (NTRS)

1994-01-01

Thie goal of this conference was to focus on the flight validation of high-angle-of-attack technologies and provide an in-depth review of the latest high-angle-of-attack activities. Areas covered include: (1) high-angle-of-attack aerodynamics; (2) propulsion and inlet dynamics; (3) thrust vectoring; (4) control laws and handling qualities; (5) tactical utility; and (6) forebody controls.

Active Semi-Supervised Community Detection Based on Must-Link and Cannot-Link Constraints

PubMed Central

Cheng, Jianjun; Leng, Mingwei; Li, Longjie; Zhou, Hanhai; Chen, Xiaoyun

2014-01-01

Community structure detection is of great importance because it can help in discovering the relationship between the function and the topology structure of a network. Many community detection algorithms have been proposed, but how to incorporate the prior knowledge in the detection process remains a challenging problem. In this paper, we propose a semi-supervised community detection algorithm, which makes full utilization of the must-link and cannot-link constraints to guide the process of community detection and thereby extracts high-quality community structures from networks. To acquire the high-quality must-link and cannot-link constraints, we also propose a semi-supervised component generation algorithm based on active learning, which actively selects nodes with maximum utility for the proposed semi-supervised community detection algorithm step by step, and then generates the must-link and cannot-link constraints by accessing a noiseless oracle. Extensive experiments were carried out, and the experimental results show that the introduction of active learning into the problem of community detection makes a success. Our proposed method can extract high-quality community structures from networks, and significantly outperforms other comparison methods. PMID:25329660

Outpatient management of oral vitamin K antagonist therapy: defining and measuring high-quality management.

PubMed

Phillips, Katherine W; Ansell, Jack

2008-01-01

Oral anticoagulation therapy with warfarin is the mainstay of prevention and treatment of thromboembolic disease. However, it remains one of the leading causes of harmful medication errors and medication-related adverse events. The beneficial outcomes of oral anticoagulation therapy are directly dependent upon the quality of dose and anticoagulation management, but the literature is not robust with regards to what constitutes such management. This review focuses on, and attempts to define, the parameters of high-quality anticoagulation management and identifies the appropriate outcome measures constituting high-quality management. Elements discussed include the most fundamental measure, time in therapeutic range, along with other parameters including therapy initiation, time to therapeutic range, dosing management when patients are not in therapeutic range, perioperative dosing management, patient education, and other important outcome measures. Healthcare providers who manage oral anticoagulation therapy should utilize these parameters as a measure of their performance in an effort to achieve high-quality anticoagulation management.

Presence and Quality of Kindergarten Children’s Friendships: Concurrent and Longitudinal Associations with Child Adjustment in the Early School Years

PubMed Central

Engle, Jennifer M.; McElwain, Nancy L.

2010-01-01

The presence and quality of friendships are posited to have developmental significance, yet little is known about the extent to which children without friends versus low-quality friendships compare on socioemotional adjustment. The current study utilized data from a subsample of 567 children (289 boys) participating in the NICHD Study of Early Child Care and Youth Development. Based on maternal reports at kindergarten, four friendship groups were formed: no friends, low quality, average quality, and high quality, and these groups were used to predict teacher-reported behavior problems and social skills concurrently (in kindergarten) and longitudinally (in first and third grade). Concurrently, low-quality friendships were associated with greater externalizing behavior, whereas high-quality friendships were associated with greater social skills. Longitudinally, having no friends in kindergarten was associated with higher levels of externalizing behavior for boys, but lower levels for girls. Children without friends also showed more internalizing problems at first grade. Lastly, having a high-quality friendship in kindergarten was associated with greater social skills in first and third grades, but only for boys. Results underscore high-quality friendship as a context for the development of social skills and indicate different trajectories of problem behavior for kindergarten children with no friends versus low-quality friendships. PMID:21822401

The New Tropospheric Product of the International GNSS Service

NASA Technical Reports Server (NTRS)

Byun, Sung H.; Bar-Sever, Yoaz E.; Gendt, Gerd

2005-01-01

We compare this new approach for generating the IGS tropospheric products with the previous approach, which was based on explicit combination of total zenith delay contributions from the IGS ACs. The new approach enables the IGS to rapidly generate highly accurate and highly reliable total zenith delay time series for many hundreds of sites, thus increasing the utility of the products to weather modelers, climatologists, and GPS analysts. In this paper we describe this new method, and discuss issues of accuracy, quality control, utility of the new products and assess its benefits.

GaAs Monolithic Microwave Subsystem Technology Base

DTIC Science & Technology

1980-01-01

To provide a captive source of reliable, high-quality GaAs substrates, a new crystal growth and substrate preparation facility which utilizes a high...Symp. GaAs and Related Compounds, Inst. Phys. Conf. Ser. 24, 6. 20. Wood, Woodcock and Harris (1978) GaAs and Related Compounds, Inst. Phys. Conf

42 CFR 476.160 - General quality of care review procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false General quality of care review procedures. 476.160... SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Review Functions...

Historical instrumental climate data for Australia - quality and utility for palaeoclimatic studies

NASA Astrophysics Data System (ADS)

Nicholls, Neville; Collins, Dean; Trewin, Blair; Hope, Pandora

2006-10-01

The quality and availability of climate data suitable for palaeoclimatic calibration and verification for the Australian region are discussed and documented. Details of the various datasets, including problems with the data, are presented. High-quality datasets, where such problems are reduced or even eliminated, are discussed. Many climate datasets are now analysed onto grids, facilitating the preparation of regional-average time series. Work is under way to produce such high-quality, gridded datasets for a variety of hitherto unavailable climate data, including surface humidity, pan evaporation, wind, and cloud. An experiment suggests that only a relatively small number of palaeoclimatic time series could provide a useful estimate of long-term changes in Australian annual average temperature. Copyright

Evaluation of service quality in family planning clinics in Lusaka, Zambia.

PubMed

Hancock, Nancy L; Vwalika, Bellington; Sitali, Elizabeth Siyama; Mbwili-Muleya, Clara; Chi, Benjamin H; Stuart, Gretchen S

2015-10-01

To determine the quality of contraceptive services in family planning clinics in Lusaka, Zambia, using a standardized approach. We utilized the Quick Investigation of Quality, a cross-sectional survey tool consisting of a facility assessment, client-provider observation and client exit interview, in public-sector family planning clinics. Data were collected on availability of seven contraceptive methods, information given to clients, interpersonal relations between providers and clients, providers' technical competence and mechanisms for continuity and follow-up. Data were collected from five client-provider observations and client exit interviews in each of six public-sector family planning clinics. All clinics had at least two contraceptive methods continuously available for the preceding 6 months. Most providers asked clients about concerns with their contraceptive method (80%) and told clients when to return to the clinic (87%). Most clients reported that the provider advised what to do if a problem develops (93%), described possible side effects (89%), explained how to use the method effectively (85%) and told them when to come for follow-up (83%). Clients were satisfied with services received (93%). This application of the Quick Investigation of Quality showed that the participating family planning clinics in Lusaka, Zambia, were prepared to offer high-quality services with the available commodities and that clients were satisfied with the received services. Despite the subjective client satisfaction, quality improvement efforts are needed to increase contraceptive availability. Although clients perceived the quality of care received to be high, family planning service quality could be improved to continuously offer the full spectrum of contraceptive options. The Quick Investigation of Quality was easily implemented in Lusaka, Zambia, and this simple approach could be utilized in a variety of settings as a modality for quality improvement. Copyright © 2015 Elsevier Inc. All rights reserved.

Automatic non-destructive system for quality assurance of welded elements in the aircraft industry

NASA Astrophysics Data System (ADS)

Chady, Tomasz; Waszczuk, Paweł; Szydłowski, Michał; Szwagiel, Mariusz

2018-04-01

Flaws that might be a result of the welding process have to be detected, in order to assure high quality thus reliability of elements exploited in aircraft industry. Currently the inspection stage is conducted manually by a qualified workforce. There are no commercially available systems that could support or replace humans in the flaw detection process. In this paper authors present a novel non-destructive system developed for quality assurance purposes of welded elements utilized in the aircraft industry.

Fabrication of graphite/epoxy cases for orbit insertion motors

NASA Technical Reports Server (NTRS)

Schmidt, W. W.

1973-01-01

The fabrication procedures are described for filament-wound rocket motor cases, approximately 26.25 inches long by 25.50 inches diameter, utilizing graphite fibers. The process utilized prepreg tape which consists of Fortafil 4-R fibers in the E-759 epoxy resin matrix. This fabrication effect demonstrated an ability to fabricate high quality graphite/epoxy rocket motor cases in the 26.25 inch by 25.50 inch size range.

Utilization of Maternal and Child Health Care Services by Primigravida Females in Urban and Rural Areas of India

PubMed Central

2014-01-01

Maternal complications and poor perinatal outcome are highly associated with nonutilisation of antenatal and delivery care services and poor socioeconomic conditions of the patient. It is essential that all pregnant women have access to high quality obstetric care throughout their pregnancies. Present longitudinal study was carried out to compare utilization of maternal and child health care services by urban and rural primigravida females. A total of 240 study participants were enrolled in this study. More illiteracy and less mean age at the time of marriage were observed in rural population. Poor knowledge about prelacteal feed, colostrums, tetanus injection and iron-follic acid tablet consumption was noted in both urban and rural areas. Very few study participants from both areas were counselled for HIV testing before pregnancy. More numbers of abortions (19.2%) were noted in urban study participants compared to rural area. Thus utilization of maternal and child health care (MCH) services was poor in both urban and rural areas. A sustained and focussed IEC campaign to improve the awareness amongst community on MCH will help in improving community participation. This may improve the quality, accessibility, and utilization of maternal health care services provided by the government agencies in both rural and urban areas. PMID:24977099

Wind farm electrical system

DOEpatents

Erdman, William L.; Lettenmaier, Terry M.

2006-07-04

An approach to wind farm design using variable speed wind turbines with low pulse number electrical output. The output of multiple wind turbines are aggregated to create a high pulse number electrical output at a point of common coupling with a utility grid network. Power quality at each individual wind turbine falls short of utility standards, but the aggregated output at the point of common coupling is within acceptable tolerances for utility power quality. The approach for aggregating low pulse number electrical output from multiple wind turbines relies upon a pad mounted transformer at each wind turbine that performs phase multiplication on the output of each wind turbine. Phase multiplication converts a modified square wave from the wind turbine into a 6 pulse output. Phase shifting of the 6 pulse output from each wind turbine allows the aggregated output of multiple wind turbines to be a 24 pulse approximation of a sine wave. Additional filtering and VAR control is embedded within the wind farm to take advantage of the wind farm's electrical impedence characteristics to further enhance power quality at the point of common coupling.

Utilization of different waste proteins to create a novel PGPR-containing bio-organic fertilizer

PubMed Central

Huang, Yan; Sun, Li; Zhao, Jianshu; Huang, Rong; Li, Rong; Shen, Qirong

2015-01-01

High-quality bio-organic fertilizers (BIOs) cannot be produced without the addition of some proteins, while many waste proteins are haphazardly disposed, causing serious environmental pollution. In this study, several waste proteins were used as additives to assist with the reproduction of the functional microbe (Bacillus amyloliquefaciens SQR9) inoculated into matured composts to produce BIOs. An optimized composition of solid-state fermentation (SSF) raw materials was predicted by response surface methodology and experimental validation. The results showed that 7.61% (w/w, DW, the same below) rapeseed meal, 8.85% expanded feather meal, 6.47% dewatered blue algal sludge and 77.07% chicken compost resulted in maximum biomass of strain SQR-9 and the maximum amount of lipopeptides 7 days after SSF. Spectroscopy experiments showed that the inner material structural changes in the novel SSF differed from the control and the novel BIO had higher dissolved organic matter. This study offers a high value-added utilization of waste proteins for producing economical but high-quality BIO. PMID:25586328

Utilization of different waste proteins to create a novel PGPR-containing bio-organic fertilizer

NASA Astrophysics Data System (ADS)

Huang, Yan; Sun, Li; Zhao, Jianshu; Huang, Rong; Li, Rong; Shen, Qirong

2015-01-01

High-quality bio-organic fertilizers (BIOs) cannot be produced without the addition of some proteins, while many waste proteins are haphazardly disposed, causing serious environmental pollution. In this study, several waste proteins were used as additives to assist with the reproduction of the functional microbe (Bacillus amyloliquefaciens SQR9) inoculated into matured composts to produce BIOs. An optimized composition of solid-state fermentation (SSF) raw materials was predicted by response surface methodology and experimental validation. The results showed that 7.61% (w/w, DW, the same below) rapeseed meal, 8.85% expanded feather meal, 6.47% dewatered blue algal sludge and 77.07% chicken compost resulted in maximum biomass of strain SQR-9 and the maximum amount of lipopeptides 7 days after SSF. Spectroscopy experiments showed that the inner material structural changes in the novel SSF differed from the control and the novel BIO had higher dissolved organic matter. This study offers a high value-added utilization of waste proteins for producing economical but high-quality BIO.

Health state utilities among contemporary prostate cancer patients on active surveillance.

PubMed

Loeb, Stacy; Curnyn, Caitlin; Walter, Dawn; Fagerlin, Angela; Siebert, Uwe; Mühlberger, Nick; Braithwaite, R Scott; Schwartz, Mark D; Lepor, Herbert; Sedlander, Erica

2018-04-01

Active surveillance (AS) is the most rapidly expanding management option for favorable-risk prostate cancer (PCa). Early studies suggested substantial decrements in utility (quality of life weights) from disease-related anxiety. Our objective was to determine utilities for contemporary AS patients using different instruments. We performed a systematic review of PubMed, PMC and OVID for utility measurements in modern AS patients. We then examined utilities among 37 men on AS participating in focus groups between 2015-2016 using the generic EurQol five dimensions questionnaire (EQ-5D-3L) and Patient Oriented Prostate Utility Scale (PORPUS), a PCa-specific instrument. The systematic review found previous studies with utilities for PCa treatment and historical watchful waiting populations, but none specifically in contemporary AS. In our AS population, the mean EQ-5D-3L score was 0.90±0.16 (median, 1.00; range, 0.21-1.00) and PORPUS was 0.98±0.03 (median, 0.99; range, 0.84-1.00). The Spearman correlation between the EQ-5D-3L and PORPUS was 0.87 (P<0.0001), and 38% of patients had a difference >0.1 between instruments. Most contemporary AS patients had high utility scores suggesting that they perceive themselves in good health without a major decrement in quality of life from the disease. However, some patients had substantial differences in utility measured with generic versus disease-specific instruments. Further study is warranted into the optimal instrument for utility assessment in contemporary AS patients.

Power quality improvement by using STATCOM control scheme in wind energy generation interface to grid

NASA Astrophysics Data System (ADS)

Kirmani, Sheeraz; Kumar, Brijesh

2018-01-01

“Electric Power Quality (EPQ) is a term that refers to maintaining the near sinusoidal waveform of power distribution bus voltages and currents at rated magnitude and frequency”. Today customers are more aware of the seriousness that the power quality possesses, this prompt the utilities to assure good quality of power to their customer. The power quality is basically customer centric. Increased focus of utilities toward maintaining reliable power supply by employing power quality improvement tools has reduced the power outages and black out considerably. Good power quality is the characteristic of reliable power supply. Low power factor, harmonic pollution, load imbalance, fast voltage variations are some common parameters which are used to define the power quality. If the power quality issues are not checked i.e. the parameters that define power quality doesn't fall within the predefined standards than it will lead into high electricity bill, high running cost in industries, malfunctioning of equipments, challenges in connecting renewable. Capacitor banks, FACTS devices, harmonic filters, SVC’s (static voltage compensators), STATCOM (Static-Compensator) are the solutions to achieve the power quality. The performance of Wind turbine generators is affected by poor quality power, at the same time these wind power generating plant affects the power quality negatively. This paper presents the STATCOM-BESS (battery energy storage system) system and studies its impact on the power quality in a system which consists of wind turbine generator, non linear load, hysteresis controller for controlling the operation of STATCOM and grid. The model is simulated in the MATLAB/Simulink. This scheme mitigates the power quality issues, improves voltage profile and also reduces harmonic distortion of the waveforms. BESS level out the imbalances caused in real power due to intermittent nature of wind power available due to varying wind speeds.

Solid phase synthesis of phosphorothioate oligonucleotides utilizing diethyldithiocarbonate disulfide (DDD) as an efficient sulfur transfer reagent.

PubMed

Cheruvallath, Zacharia S; Kumar, R Krishna; Rentel, Claus; Cole, Douglas L; Ravikumar, Vasulinga T

2003-04-01

Diethyldithiodicarbonate (DDD), a cheap and easily prepared compound, is found to be a rapid and efficient sulfurizing reagent in solid phase synthesis of phosphorothioate oligodeoxyribonucleotides via the phosphoramidite approach. Product yield and quality based on IP-LC-MS compares well with high quality oligonucleotides synthesized using phenylacetyl disulfide (PADS) which is being used for manufacture of our antisense drugs.

SQA of finite element method (FEM) codes used for analyses of pit storage/transport packages

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

Russel, E.

1997-11-01

This report contains viewgraphs on the software quality assurance of finite element method codes used for analyses of pit storage and transport projects. This methodology utilizes the ISO 9000-3: Guideline for application of 9001 to the development, supply, and maintenance of software, for establishing well-defined software engineering processes to consistently maintain high quality management approaches.

Diversity of the Eastern Hardwood Resource and How This Diversity Influences Timber Utilization

Treesearch

William Luppold; Scott A. Pugh

2016-01-01

The eastern hardwood resource is often associated with high-quality sawtimber used in the production of grade products, but this segment of the resource accounts for approximately 20 percent of the cubic volume of all live trees. By contrast, 17 percent of the hardwood timber volume is classified as cull trees, and an additional 14 percent is low-quality sawlog-size...

42 CFR 476.104 - Coordination of activities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Review Functions...

42 CFR 476.104 - Coordination of activities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Review Functions... coordinate its activities (including information exchanges) with the activities of— (a) Medicare fiscal...

42 CFR 476.104 - Coordination of activities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Review Functions... coordinate its activities (including information exchanges) with the activities of— (a) Medicare...

42 CFR 476.104 - Coordination of activities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Review Functions... coordinate its activities (including information exchanges) with the activities of— (a) Medicare fiscal...

Contrast-to-noise ratio in magnification mammography: a Monte Carlo study

NASA Astrophysics Data System (ADS)

Koutalonis, M.; Delis, H.; Spyrou, G.; Costaridou, L.; Tzanakos, G.; Panayiotakis, G.

2007-06-01

Magnification views are a common way to perform a secondary examination when suspicious abnormalities are found in a screening mammogram. The visibility of microcalcifications and breast lesions is restricted by the compromise between the image quality and the absorbed dose. In this study, image quality characteristics in magnification mammography were evaluated based on Monte Carlo techniques. A breast phantom was utilized, simulating a homogeneous mixture of adipose and glandular tissue in various percentages of glandularity, containing inhomogeneities of various sizes and compositions. The effect of the magnification degree, breast glandularity, tube voltage and anode/filter material combination on image quality characteristics was investigated in terms of a contrast-to-noise ratio (CNR). A performance index PIν was introduced in order to study the overall performance of various anode/filter combinations under different exposure parameters. Results demonstrate that CNR is improved with the degree of magnification and degraded as the breast glandularity is increased. Degree of magnification 1.3 offers the best overall performance for most of the anode/filter combinations utilized. Under magnification conditions, the role of dose is demoted against the image quality, as magnification views are secondary, diagnostic examinations and not screening procedures oriented to non-symptomatic women. For decreased image quality weighting, some anode/filter combinations different from Mo/0.030mmMo can be utilized as they offer a similar performance index. However, if the desired weighting for the image quality is high, the Mo/0.030mmMo combination has the best overall performance.

Biological and functional relevance of CASP predictions

PubMed Central

Liu, Tianyun; Ish‐Shalom, Shirbi; Torng, Wen; Lafita, Aleix; Bock, Christian; Mort, Matthew; Cooper, David N; Bliven, Spencer; Capitani, Guido; Mooney, Sean D.

2017-01-01

Abstract Our goal is to answer the question: compared with experimental structures, how useful are predicted models for functional annotation? We assessed the functional utility of predicted models by comparing the performances of a suite of methods for functional characterization on the predictions and the experimental structures. We identified 28 sites in 25 protein targets to perform functional assessment. These 28 sites included nine sites with known ligand binding (holo‐sites), nine sites that are expected or suggested by experimental authors for small molecule binding (apo‐sites), and Ten sites containing important motifs, loops, or key residues with important disease‐associated mutations. We evaluated the utility of the predictions by comparing their microenvironments to the experimental structures. Overall structural quality correlates with functional utility. However, the best‐ranked predictions (global) may not have the best functional quality (local). Our assessment provides an ability to discriminate between predictions with high structural quality. When assessing ligand‐binding sites, most prediction methods have higher performance on apo‐sites than holo‐sites. Some servers show consistently high performance for certain types of functional sites. Finally, many functional sites are associated with protein‐protein interaction. We also analyzed biologically relevant features from the protein assemblies of two targets where the active site spanned the protein‐protein interface. For the assembly targets, we find that the features in the models are mainly determined by the choice of template. PMID:28975675

Sulphur extended asphalt : research report.

DOT National Transportation Integrated Search

1980-05-01

Extensive research has been directed toward the addition of sulphur to asphaltic concrete mixes to function as either a quality aggregate or as an asphalt cement extender. By utilizing a high sulphur/asphalt ratio sulphur extended asphalt mix, it was...

Introduction of Transplant Registry Unified Management Program 2 (TRUMP2): scripts for TRUMP data analyses, part I (variables other than HLA-related data).

PubMed

Atsuta, Yoshiko

2016-01-01

Collection and analysis of information on diseases and post-transplant courses of allogeneic hematopoietic stem cell transplant recipients have played important roles in improving therapeutic outcomes in hematopoietic stem cell transplantation. Efficient, high-quality data collection systems are essential. The introduction of the Second-Generation Transplant Registry Unified Management Program (TRUMP2) is intended to improve data quality and more efficient data management. The TRUMP2 system will also expand possible uses of data, as it is capable of building a more complex relational database. The construction of an accessible data utilization system for adequate data utilization by researchers would promote greater research activity. Study approval and management processes and authorship guidelines also need to be organized within this context. Quality control of processes for data manipulation and analysis will also affect study outcomes. Shared scripts have been introduced to define variables according to standard definitions for quality control and improving efficiency of registry studies using TRUMP data.

Rapid underway profiling of water quality in Queensland estuaries.

PubMed

Hodge, Jonathan; Longstaff, Ben; Steven, Andy; Thornton, Phillip; Ellis, Peter; McKelvie, Ian

2005-01-01

We present an overview of a portable underway water quality monitoring system (RUM-Rapid Underway Monitoring), developed by integrating several off-the-shelf water quality instruments to provide rapid, comprehensive, and spatially referenced 'snapshots' of water quality conditions. We demonstrate the utility of the system from studies in the Northern Great Barrier Reef (Daintree River) and the Moreton Bay region. The Brisbane dataset highlights RUM's utility in characterising plumes as well as its ability to identify the smaller scale structure of large areas. RUM is shown to be particularly useful when measuring indicators with large small-scale variability such as turbidity and chlorophyll-a. Additionally, the Daintree dataset shows the ability to integrate other technologies, resulting in a more comprehensive analysis, whilst sampling offshore highlights some of the analytical issues required for sampling low concentration data. RUM is a low cost, highly flexible solution that can be modified for use in any water type, on most vessels and is only limited by the available monitoring technologies.

42 CFR 476.83 - Initial denial determinations.

Code of Federal Regulations, 2010 CFR

2010-10-01

....83 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Review Functions...

42 CFR 476.100 - Use of norms and criteria.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Review Functions...

Review on Bamboo Utilization as Biocomposites, Pulp and Bioenergy

NASA Astrophysics Data System (ADS)

Yusuf, Sulaeman; Syamani, F. A.; Fatriasari, W.; Subyakto

2018-03-01

One of potential non wood bioresources utilized in industrial application is bamboos. Bamboos are include in graminae family which have high biomass productivity, easy and rapid production, wide avability and high holocellulose content. Indonesia has a huge potential of bamboos, more than 162 bamboo species are found however only some of them are planted that have a high economic value. Bamboos have some advantages such as can be harvested at 3 years, straight culm, high strength, easy to be processed, and relatively cheap. Research Center for Biomaterials has developed utilization of bamboo culm for ply bamboo product as alternative of plywood since 1995, using gombong bamboo, tali bamboo, sembilang bamboo, andong bamboo with PF resin as adhesive. Other biocomposite products from bamboos include particle board, cement board and polymer-bamboo fiber composites. In term of processing technique and final product quality, bamboo composites from ply bamboo are the most prospectable material to be utilized in industrial application. Yellow bamboo and betung bamboo have also been developed as pulp and paper. Biopulping using soda and kraft pulping after biological pretreatment using white rot fungi to remove lignin was used as pulping method in this conversion. Biokraft pulping with Trametes versicolor for 45 days with inoculum loading of 10% resulted better pulp quality compared to the other fungi. Betung bamboo had good morphological characteristics and chemical component content to be converted into bioenergy such as bioethanol. Several pretreatment methods have been developed in order to result high sugar yield. Microwave assisted acid hydrolysis was preferedin producing higher yield from the pretreated bamboo compared to enzymatic hydrolysis. By using this method, the bamboo pretreated by biological-microwave pretreatment results higher improvement to increase sugar yield.

Fourth High Alpha Conference, volume 2

NASA Technical Reports Server (NTRS)

1994-01-01

The goal of the Fourth High Alpha Conference, held at the NASA Dryden Flight Research Center on July 12-14, 1994, was to focus on the flight validation of high angle of attack technologies and provide an in-depth review of the latest high angle of attack activities. Areas that were covered include high angle of attack aerodynamics, propulsion and inlet dynamics, thrust vectoring, control laws and handling qualities, and tactical utility.

Toward a Climate OSSE for NASA Earth Sciences

NASA Astrophysics Data System (ADS)

Leroy, S. S.; Collins, W. D.; Feldman, D.; Field, R. D.; Ming, Y.; Pawson, S.; Sanderson, B.; Schmidt, G. A.

2016-12-01

In the Continuity Study, the National Academy of Sciences advised that future space missions be rated according to five categories: the importance of a well-defined scientific objective, the utility of the observation in addressing the scientific objective, the quality with which the observation can be made, the probability of the mission's success, and the mission's affordability. The importance, probability, and affordability are evaluated subjectively by scientific consensus, by engineering review panels, and by cost models; however, the utility and quality can be evaluated objectively by a climate observation system simulation experiment (COSSE). A discussion of the philosophical underpinnings of a COSSE for NASA Earth Sciences will be presented. A COSSE is built upon a perturbed physics ensemble of a sophisticated climate model that can simulate a mission's prospective observations and its well-defined quantitative scientific objective and that can capture the uncertainty associated with each. A strong correlation between observation and scientific objective after consideration of physical uncertainty leads to a high quality. Persistence of a high correlation after inclusion of the proposed measurement error leads to a high utility. There are five criteria that govern that nature of a particular COSSE: (1) whether the mission's scientific objective is one of hypothesis testing or climate prediction, (2) whether the mission is empirical or inferential, (3) whether the core climate model captures essential physical uncertainties, (4) the level of detail of the simulated observations, and (5) whether complementarity or redundancy of information is to be valued. Computation of the quality and utility is done using Bayesian statistics, as has been done previously for multi-decadal climate prediction conditioned on existing data. We advocate for a new program within NASA Earth Sciences to establish a COSSE capability. Creation of a COSSE program within NASA Earth Sciences will require answers from the climate research community to basic questions, such as whether a COSSE capability should be centralized or de-centralized. Most importantly, the quantified scientific objective of a proposed mission must be defined with extreme specificity for a COSSE to be applied.

Handling qualities of a wide-body transport airplane utilizing Pitch Active Control Systems (PACS) for relaxed static stability application

NASA Technical Reports Server (NTRS)

Grantham, William D.; Person, Lee H., Jr.; Brown, Philip W.; Becker, Lawrence E.; Hunt, George E.; Rising, J. J.; Davis, W. J.; Willey, C. S.; Weaver, W. A.; Cokeley, R.

1985-01-01

Piloted simulation studies have been conducted to evaluate the effectiveness of two pitch active control systems (PACS) on the flying qualities of a wide-body transport airplane when operating at negative static margins. These two pitch active control systems consisted of a simple 'near-term' PACS and a more complex 'advanced' PACS. Eight different flight conditions, representing the entire flight envelope, were evaluated with emphasis on the cruise flight conditions. These studies were made utilizing the Langley Visual/Motion Simulator (VMS) which has six degrees of freedom. The simulation tests indicated that (1) the flying qualities of the baseline aircraft (PACS off) for the cruise and other high-speed flight conditions were unacceptable at center-of-gravity positions aft of the neutral static stability point; (2) within the linear static stability flight envelope, the near-term PACS provided acceptable flying qualities for static stabilty margins to -3 percent; and (3) with the advanced PACS operative, the flying qualities were demonstrated to be good (satisfactory to very acceptable) for static stabilty margins to -20 percent.

Higher Education Faculty Perceptions of Open Textbook Adoption

ERIC Educational Resources Information Center

Jung, Eulho; Bauer, Christine; Heaps, Allan

2017-01-01

The high cost of tuition and textbooks can have a negative impact on potential students from lower socioeconomic backgrounds. Open Educational Resources (OER) offers students a way to save educational costs while utilizing high-quality open textbooks. Up until now, there have been few studies focused on a specific provider of open textbooks. This…

Methods for Performing Survival Curve Quality-of-Life Assessments.

PubMed

Sumner, Walton; Ding, Eric; Fischer, Irene D; Hagen, Michael D

2014-08-01

Many medical decisions involve an implied choice between alternative survival curves, typically with differing quality of life. Common preference assessment methods neglect this structure, creating some risk of distortions. Survival curve quality-of-life assessments (SQLA) were developed from Gompertz survival curves fitting the general population's survival. An algorithm was developed to generate relative discount rate-utility (DRU) functions from a standard survival curve and health state and an equally attractive alternative curve and state. A least means squared distance algorithm was developed to describe how nearly 3 or more DRU functions intersect. These techniques were implemented in a program called X-Trade and tested. SQLA scenarios can portray realistic treatment choices. A side effect scenario portrays one prototypical choice, to extend life while experiencing some loss, such as an amputation. A risky treatment scenario portrays procedures with an initial mortality risk. A time trade scenario mimics conventional time tradeoffs. Each SQLA scenario yields DRU functions with distinctive shapes, such as sigmoid curves or vertical lines. One SQLA can imply a discount rate or utility if the other value is known and both values are temporally stable. Two SQLA exercises imply a unique discount rate and utility if the inferred DRU functions intersect. Three or more SQLA results can quantify uncertainty or inconsistency in discount rate and utility estimates. Pilot studies suggested that many subjects could learn to interpret survival curves and do SQLA. SQLA confuse some people. Compared with SQLA, standard gambles quantify very low utilities more easily, and time tradeoffs are simpler for high utilities. When discount rates approach zero, time tradeoffs are as informative and easier to do than SQLA. SQLA may complement conventional utility assessment methods. © The Author(s) 2014.

42 CFR 423.153 - Drug utilization management, quality assurance, and medication therapy management programs (MTMPs).

Code of Federal Regulations, 2010 CFR

2010-10-01

... PRESCRIPTION DRUG BENEFIT Cost Control and Quality Improvement Requirements § 423.153 Drug utilization... 42 Public Health 3 2010-10-01 2010-10-01 false Drug utilization management, quality assurance, and medication therapy management programs (MTMPs). 423.153 Section 423.153 Public Health CENTERS FOR MEDICARE...

Consumers' quality perception of national branded, national store branded, and imported store branded beef.

PubMed

Banović, Marija; Grunert, Klaus G; Barreira, Maria Madalena; Fontes, Magda Aguiar

2010-01-01

This study investigated the differences in the consumers' quality perception of national branded, national store branded, and imported store branded beef. Partial Least Squares analysis is used for modelling the quality perception process. Results show that consumers perceived national branded Carnalentejana beef, as better on all quality cues and quality aspects than the other two store branded beefs. Preference for Carnalentejana beef stayed highly consistent even after the blind test, where consumers differentiated this beef from the other two beef brands on all sensory dimensions: taste, tenderness, and juiciness, and chose it as the preferred one. Consumers utilized more perceived intrinsic cues to infer expected eating quality of store branded beefs.

42 CFR 480.101 - Scope and definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs... Quality Control Quality Improvement Organization (QIO) (or the review component of a QIO subcontractor) in... sought under Title XVIII of the Act. Aggregate statistical data means any utilization, admission...

42 CFR 476.70 - Statutory bases and applicability.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 476.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) General Provisions § 476...

42 CFR 476.76 - Cooperation with health care facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 476.76 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) General Provisions...

Health-related quality of life in the Brazilian Amazon: a population-based cross-sectional study.

PubMed

Silva, Marcus Tolentino; Caicedo Roa, Monica; Galvao, Tais Freire

2017-08-14

To analyze perceptions of health-related quality of life and associated factors in populations from the Manaus Metropolitan Region. We conducted a population-based cross-sectional study from May to August 2015. Adults aged 18 years and older were selected using probabilistic three-phase cluster sampling and stratified by sex and age, based on official estimates. Quality of life data were collected using the European Quality of Life 5-Dimensions 3-Levels (EQ-5D-3L) along with socioeconomic, demographic, and health perception data. Utility scores were calculated using the Brazilian version of the EQ-5D-3L. Descriptive statistics were derived, and a multivariate Tobit regression model with correction for complex sampling was performed to identify the variables that influence utility levels. A total of 4001 participants were included. The average utility score was 0.886 (95% confidence interval [CI]: 0.881-0.890) with significant differences according to living area (the capital (0.882 ± 0.144) or inner cities (0.908 ± 0.122; p < 0.001)). The dimension for which the highest proportion of people reported moderate to severe problems was pain/discomfort (39%), followed by anxiety/depression (18%). Men had a higher quality of life than women (β = 0.041, p < 0.001). Not working was a factor that increased quality of life compared with being formally employed (β = 0.031, p = 0.037). The poorest people had a lower quality of life than the richest people (β = -0.118, p < 0.001). Better health perceptions increased utility scores (p < 0.001), while being separated decreased the scores (β = -0.052, p = 0.001). Health-related quality of life in the Manaus Metropolitan Region was high, as expected for the general population, and was higher among individuals who lived in the inner cities, men and those in higher social classes. Gender discrepancies and differences in quality of life between the capital and inner cities should be further investigated.

Assessment of medical care by elderly people: general satisfaction and physician quality.

PubMed Central

Lee, Y; Kasper, J D

1998-01-01

OBJECTIVE: To identify personal characteristics and factors related to health and patterns of healthcare utilization associated with the elderly people's satisfaction with medical care. DATA SOURCES/STUDY SETTING: Data from the 1991 Medicare Current Beneficiary Survey (MCBS) on 8,859 persons age 65 and over living in the community. STUDY DESIGN: Items reflecting general satisfaction with care and views of physician quality are examined and, based on factor analysis, grouped in dimensions of two (global quality, access) and three (technical skills, interpersonal manner, information-giving), respectively. The relationship of high levels of satisfaction in each dimension to personal characteristics of elderly people, and to measures of access and utilization, is assessed using logistic regression. PRINCIPAL FINDINGS: While satisfaction is high, with over 90 percent surveyed expressing some satisfaction, there is substantial variation with less likelihood of high satisfaction among those 80 or older, with less education and income and in poorer health. Longer waiting time at visits and less frequent visits are factors in lower satisfaction as well. A favorable perception of physician quality, especially regarding technical skills, appears to play a significant role in satisfaction with global quality of care. CONCLUSIONS: Studies of patient satisfaction in elderly people are rare. Some factors expected to be related to positive assessment based on earlier studies, were, e.g., better health and shorter waiting time, while others were not, e.g., increasing age. Elderly people appear to place greater importance on physician technical skills, as opposed to interpersonal dimensions, in assessing global quality. These findings suggest the need for a better understanding of how elderly people evaluate care and what they value in interactions with the healthcare system. Images Figure 1 PMID:9460484

Mapping of the DLQI scores to EQ-5D utility values using ordinal logistic regression.

PubMed

Ali, Faraz Mahmood; Kay, Richard; Finlay, Andrew Y; Piguet, Vincent; Kupfer, Joerg; Dalgard, Florence; Salek, M Sam

2017-11-01

The Dermatology Life Quality Index (DLQI) and the European Quality of Life-5 Dimension (EQ-5D) are separate measures that may be used to gather health-related quality of life (HRQoL) information from patients. The EQ-5D is a generic measure from which health utility estimates can be derived, whereas the DLQI is a specialty-specific measure to assess HRQoL. To reduce the burden of multiple measures being administered and to enable a more disease-specific calculation of health utility estimates, we explored an established mathematical technique known as ordinal logistic regression (OLR) to develop an appropriate model to map DLQI data to EQ-5D-based health utility estimates. Retrospective data from 4010 patients were randomly divided five times into two groups for the derivation and testing of the mapping model. Split-half cross-validation was utilized resulting in a total of ten ordinal logistic regression models for each of the five EQ-5D dimensions against age, sex, and all ten items of the DLQI. Using Monte Carlo simulation, predicted health utility estimates were derived and compared against those observed. This method was repeated for both OLR and a previously tested mapping methodology based on linear regression. The model was shown to be highly predictive and its repeated fitting demonstrated a stable model using OLR as well as linear regression. The mean differences between OLR-predicted health utility estimates and observed health utility estimates ranged from 0.0024 to 0.0239 across the ten modeling exercises, with an average overall difference of 0.0120 (a 1.6% underestimate, not of clinical importance). This modeling framework developed in this study will enable researchers to calculate EQ-5D health utility estimates from a specialty-specific study population, reducing patient and economic burden.

Cost-utility of a cardiovascular prevention program in highly educated adults: intermediate results of a randomized controlled trial.

PubMed

Jacobs, Nele; Evers, Silvia; Ament, Andre; Claes, Neree

2010-01-01

Little is known about the costs and the effects of cardiovascular prevention programs targeted at medical and behavioral risk factors. The aim was to evaluate the cost-utility of a cardiovascular prevention program in a general sample of highly educated adults after 1 year of intervention. The participants were randomly assigned to intervention (n = 208) and usual care conditions (n = 106). The intervention consisted of medical interventions and optional behavior-change interventions (e.g., a tailored Web site). Cost data were registered from a healthcare perspective, and questionnaires were used to determine effectiveness (e.g., quality-adjusted life-years [QALYs]). A cost-utility analysis and sensitivity analyses using bootstrapping were performed on the intermediate results. When adjusting for baseline utility differences, the incremental cost was 433 euros and the incremental effectiveness was 0.016 QALYs. The incremental cost-effectiveness ratio was 26,910 euros per QALY. The intervention was cost-effective compared with usual care in this sample of highly educated adults after 1 year of intervention. Increased participation would make this intervention highly cost-effective.

Meteorological and air pollution modeling for an urban airport

NASA Technical Reports Server (NTRS)

Swan, P. R.; Lee, I. Y.

1980-01-01

Results are presented of numerical experiments modeling meteorology, multiple pollutant sources, and nonlinear photochemical reactions for the case of an airport in a large urban area with complex terrain. A planetary boundary-layer model which predicts the mixing depth and generates wind, moisture, and temperature fields was used; it utilizes only surface and synoptic boundary conditions as input data. A version of the Hecht-Seinfeld-Dodge chemical kinetics model is integrated with a new, rapid numerical technique; both the San Francisco Bay Area Air Quality Management District source inventory and the San Jose Airport aircraft inventory are utilized. The air quality model results are presented in contour plots; the combined results illustrate that the highly nonlinear interactions which are present require that the chemistry and meteorology be considered simultaneously to make a valid assessment of the effects of individual sources on regional air quality.

Case management in an acute-care hospital: collaborating for quality, cost-effective patient care.

PubMed

Grootveld, Kim; Wen, Victoria; Bather, Michelle; Park, Joan

2014-01-01

Case management has recently been advanced as a valuable component in achieving quality patient care that is also cost-effective. At St. Michael's Hospital, in Toronto, Ontario, case managers from a variety of professional backgrounds are central to a new care initiative--Rapid Assessment and Planning to Inform Disposition (RAPID)--in the General Internal Medicine (GIM) Unit that is designed to improve patient care and reconcile high emergency department volumes through "smart bed spacing." Involved in both planning and RAPID, GIM's case managers are the link between patient care and utilization management. These stewards of finite resources strive to make the best use of dollars spent while maintaining a commitment to quality care. Collaborating closely with physicians and others across the hospital, GIM's case managers have been instrumental in bringing about significant improvements in care coordination, utilization management and process redesign. Copyright © 2014 Longwoods Publishing.

42 CFR 480.101 - Scope and definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ORGANIZATION INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) General... governing— (1) Disclosure of information collected, acquired or generated by a Utilization and Quality... of the problem and follow-up. Quality review study information means all documentation related to the...

42 CFR 480.101 - Scope and definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ORGANIZATION INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) General... governing— (1) Disclosure of information collected, acquired or generated by a Utilization and Quality... of the problem and follow-up. Quality review study information means all documentation related to the...

42 CFR 480.101 - Scope and definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ORGANIZATION INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) General... governing— (1) Disclosure of information collected, acquired or generated by a Utilization and Quality... of the problem and follow-up. Quality review study information means all documentation related to the...

42 CFR 476.82 - Continuation of functions not assumed by QIOs.

Code of Federal Regulations, 2010 CFR

2010-10-01

....82 Section 476.82 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs...

42 CFR 476.80 - Coordination with Medicare fiscal intermediaries and carriers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and carriers. 476.80 Section 476.80 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement...

Egg shell quality in Japanese quail: characteristics, heritabilities and genetic and phenotypic relationships.

PubMed

Narinc, D; Aygun, A; Karaman, E; Aksoy, T

2015-07-01

The objective of the present study was to estimate heritabilities as well as genetic and phenotypic correlations for egg weight, specific gravity, shape index, shell ratio, egg shell strength, egg length, egg width and shell weight in Japanese quail eggs. External egg quality traits were measured on 5864 eggs of 934 female quails from a dam line selected for two generations. Within the Bayesian framework, using Gibbs Sampling algorithm, a multivariate animal model was applied to estimate heritabilities and genetic correlations for external egg quality traits. The heritability estimates for external egg quality traits were moderate to high and ranged from 0.29 to 0.81. The heritability estimates for egg and shell weight of 0.81 and 0.76 were fairly high. The genetic and phenotypic correlations between egg shell strength with specific gravity, shell ratio and shell weight ranging from 0.55 to 0.79 were relatively high. It can be concluded that it is possible to determine egg shell quality using the egg specific gravity values utilizing its high heritability and fairly high positive correlation with most of the egg shell quality traits. As a result, egg specific gravity may be the choice of selection criterion rather than other external egg traits for genetic improvement of egg shell quality in Japanese quails.

Broken symmetry dielectric resonators for high quality factor Fano metasurfaces

DOE PAGES

Campione, Salvatore; Liu, Sheng; Basilio, Lorena I.; ...

2016-10-25

We present a new approach to dielectric metasurface design that relies on a single resonator per unit cell and produces robust, high quality factor Fano resonances. Our approach utilizes symmetry breaking of highly symmetric resonator geometries, such as cubes, to induce couplings between the otherwise orthogonal resonator modes. In particular, we design perturbations that couple “bright” dipole modes to “dark” dipole modes whose radiative decay is suppressed by local field effects in the array. Our approach is widely scalable from the near-infrared to radio frequencies. We first unravel the Fano resonance behavior through numerical simulations of a germanium resonator-based metasurfacemore » that achieves a quality factor of ~1300 at ~10.8 μm. Then, we present two experimental demonstrations operating in the near-infrared (~1 μm): a silicon-based implementation that achieves a quality factor of ~350; and a gallium arsenide-based structure that achieves a quality factor of ~600, the highest near-infrared quality factor experimentally demonstrated to date with this kind of metasurface. Importantly, large electromagnetic field enhancements appear within the resonators at the Fano resonant frequencies. Here, we envision that combining high quality factor, high field enhancement resonances with nonlinear and active/gain materials such as gallium arsenide will lead to new classes of active optical devices.« less

Broken symmetry dielectric resonators for high quality factor Fano metasurfaces

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

Campione, Salvatore; Liu, Sheng; Basilio, Lorena I.

We present a new approach to dielectric metasurface design that relies on a single resonator per unit cell and produces robust, high quality factor Fano resonances. Our approach utilizes symmetry breaking of highly symmetric resonator geometries, such as cubes, to induce couplings between the otherwise orthogonal resonator modes. In particular, we design perturbations that couple “bright” dipole modes to “dark” dipole modes whose radiative decay is suppressed by local field effects in the array. Our approach is widely scalable from the near-infrared to radio frequencies. We first unravel the Fano resonance behavior through numerical simulations of a germanium resonator-based metasurfacemore » that achieves a quality factor of ~1300 at ~10.8 μm. Then, we present two experimental demonstrations operating in the near-infrared (~1 μm): a silicon-based implementation that achieves a quality factor of ~350; and a gallium arsenide-based structure that achieves a quality factor of ~600, the highest near-infrared quality factor experimentally demonstrated to date with this kind of metasurface. Importantly, large electromagnetic field enhancements appear within the resonators at the Fano resonant frequencies. Here, we envision that combining high quality factor, high field enhancement resonances with nonlinear and active/gain materials such as gallium arsenide will lead to new classes of active optical devices.« less

Utility of registries for post-marketing evaluation of medicines. A survey of Swedish health care quality registries from a regulatory perspective.

PubMed

Feltelius, Nils; Gedeborg, Rolf; Holm, Lennart; Zethelius, Björn

2017-06-01

The aim of this study was to describe content and procedures in some selected Swedish health care quality registries (QRs) of relevance to regulatory decision-making. A workshop was organized with participation of seven Swedish QRs which subsequently answered a questionnaire regarding registry content on drug treatments and outcomes. Patient populations, coverage, data handling and quality control, as well as legal and ethical aspects are presented. Scientific publications from the QRs are used as a complementary measure of quality and scientific relevance. The registries under study collect clinical data of high relevance to regulatory and health technology agencies. Five out of seven registries provide information on the drug of interest. When applying external quality criteria, we found a high degree of fulfillment, although information on medication was not sufficient to answer all questions of regulatory interest. A notable strength is the option for linkage to the Prescribed Drug Registry and to information on education and socioeconomic status. Data on drugs used during hospitalization were also collected to some extent. Outcome measures collected resemble those used in relevant clinical trials. All registries collected patient-reported outcome measures. The number of publications from the registries was substantial, with studies of appropriate design, including randomized registry trials. Quality registries may provide a valuable source of post-marketing data on drug effectiveness, safety, and cost-effectiveness. Closer collaboration between registries and regulators to improve quality and usefulness of registry data could benefit both regulatory utility and value for health care providers.

Utility of registries for post-marketing evaluation of medicines. A survey of Swedish health care quality registries from a regulatory perspective

PubMed Central

Feltelius, Nils; Gedeborg, Rolf; Holm, Lennart; Zethelius, Björn

2017-01-01

Aim The aim of this study was to describe content and procedures in some selected Swedish health care quality registries (QRs) of relevance to regulatory decision-making. Methods A workshop was organized with participation of seven Swedish QRs which subsequently answered a questionnaire regarding registry content on drug treatments and outcomes. Patient populations, coverage, data handling and quality control, as well as legal and ethical aspects are presented. Scientific publications from the QRs are used as a complementary measure of quality and scientific relevance. Results The registries under study collect clinical data of high relevance to regulatory and health technology agencies. Five out of seven registries provide information on the drug of interest. When applying external quality criteria, we found a high degree of fulfillment, although information on medication was not sufficient to answer all questions of regulatory interest. A notable strength is the option for linkage to the Prescribed Drug Registry and to information on education and socioeconomic status. Data on drugs used during hospitalization were also collected to some extent. Outcome measures collected resemble those used in relevant clinical trials. All registries collected patient-reported outcome measures. The number of publications from the registries was substantial, with studies of appropriate design, including randomized registry trials. Conclusions Quality registries may provide a valuable source of post-marketing data on drug effectiveness, safety, and cost-effectiveness. Closer collaboration between registries and regulators to improve quality and usefulness of registry data could benefit both regulatory utility and value for health care providers. PMID:28276780

Barriers and Facilitators of Utilizing Research Among Nurses in Nepal.

PubMed

Kc, Srijana; Subramaniam, Prithwi Raj; Paudel, Sarita

2016-04-01

This study determined the perceived barriers to and facilitators of Nepalese nurses in utilizing research in the workplace. Evidence-based nursing practice provides the synergy for high-quality patient care, but it does not seem to be the case in underdeveloped countries, such as Nepal. A descriptive, cross-sectional study involving 97 nurses from Nepal was conducted. Data were collected using the BARRIERS Scale and a facilitator questionnaire. The top three barriers to research utilization in Nepalese nurses are (a) research reports and articles are not readily available (80.5%), (b) inadequate facilities for implementation (75.3%), and (c) research reports and articles are not published fast enough (71.6%). The top three facilitators perceived to encourage Nepalese nurses to utilize or participate in research are (a) initiation of nursing research projects (27.4%), (b) educational update on research methods (16.7%), and (c) provision of funding for research (15.5%). Findings from this study mirror the barriers to research utilization experienced by nurses in other countries. Macro- and micro-level support are needed to foster a culture of evidence-based practice among Nepalese nurses to empower them in making informed decisions based on research in providing quality patient care. Copyright 2016, SLACK Incorporated.

Cost Utility Analysis of Percutaneous Adhesiolysis in Managing Pain of Post-lumbar Surgery Syndrome and Lumbar Central Spinal Stenosis.

PubMed

Manchikanti, Laxmaiah; Helm, Standiford; Pampati, Vidyasagar; Racz, Gabor B

2015-06-01

The increase in the number of interventions for the management of chronic pain and associated escalation of healthcare costs has captured the attention of health policymakers, in no small part due to the lack of documentation of efficacy, cost-effectiveness, or cost utility analysis. A recent cost utility analysis of caudal epidural injections in managing chronic low back pain of various pathologies showed a high cost utility with improvement in quality of life years, competitive with various other modalities of treatments. However, there are no analyses derived from high-quality controlled studies related to the cost utility of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome or lumbar central spinal stenosis. This analysis is based on 2 previously published controlled studies. To assess the cost utility of percutaneous adhesiolysis procedures in managing chronic low back and lower extremity pain secondary to post-lumbar surgery syndrome and lumbar central spinal stenosis. A private, specialty referral interventional pain management center in the United States. Two controlled studies were conducted assessing the clinical effectiveness of percutaneous adhesiolysis for post-lumbar surgery syndrome and lumbar central spinal stenosis in an interventional pain management setting utilizing contemporary interventional pain management practices. A cost utility analysis was performed with direct payment data for a total of 130 patients in treatment groups over a 2-year period. Various outcome measures were included with significant improvement, defined as at least 50% improvement with reduction in pain and disability status. The results of 2 controlled studies of low back pain with 60 and 70 patients and a 2-year follow-up with the actual reimbursement data showed cost utility for 1 year of quality-adjusted life year (QALY) of USD $2,652 for post-lumbar surgery syndrome and USD $2,649 for lumbar central spinal stenosis. The results of this assessment show that the cost utility of managing chronic, intractable low back pain with percutaneous adhesiolysis at a QALY that is similar or lower in price than medical therapy only, physical therapy, manipulation, spinal cord stimulation, and surgery. The limitations of this cost utility analysis are that it is a single-center evaluation, with the inclusion of costs of adhesiolysis procedures in an ambulatory surgery center and physician visits, rather than all related costs including drug therapy and costs of disability in multiple settings. This cost utility analysis of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome and lumbar central spinal stenosis shows the clinical effectiveness and cost utility of these procedures at USD $2,650 per one year of QALY when performed in an ambulatory surgery center. © 2014 World Institute of Pain.

Tamoxifen for breast cancer risk reduction: impact of alternative approaches to quality-of-life adjustment on cost-effectiveness analysis.

PubMed

Melnikow, Joy; Birch, Stephen; Slee, Christina; McCarthy, Theodore J; Helms, L Jay; Kuppermann, Miriam

2008-09-01

In cost-effectiveness analysis (CEA), the effects of health-care interventions on multiple health dimensions typically require consideration of both quantity and quality of life. To explore the impact of alternative approaches to quality-of-life adjustment using patient preferences (utilities) on the outcome of a CEA on use of tamoxifen for breast cancer risk reduction. A state transition Markov model tracked hypothetical cohorts of women who did or did not take 5 years of tamoxifen for breast cancer risk reduction. Incremental quality-adjusted effectiveness and cost-effectiveness ratios (ICERs) for models including and excluding a utility adjustment for menopausal symptoms were compared with each other and to a global utility model. Two hundred fifty-five women aged 50 and over with estimated 5-year breast cancer risk >or=1.67% participated in utility assessment interviews. Standard gamble utilities were assessed for specified tamoxifen-related health outcomes, current health, and for a global assessment of possible outcomes of tamoxifen use. Inclusion of a utility for menopausal symptoms in the outcome-specific models substantially increased the ICER; at the threshold 5-year breast cancer risk of 1.67%, tamoxifen was dominated. When a global utility for tamoxifen was used in place of outcome-specific utilities, tamoxifen was dominated under all circumstances. CEAs may be profoundly affected by the types of outcomes considered for quality-of-life adjustment and how these outcomes are grouped for utility assessment. Comparisons of ICERs across analyses must consider effects of different approaches to using utilities for quality-of-life adjustment.

Utilization of the Quality Assurance Handbook in Secondary School Supervision of Instruction in Enugu State, Nigeria

ERIC Educational Resources Information Center

Chidobi, R. U.; Eze Thecla, A. Y.

2016-01-01

The purpose of this study is to investigate the extent of utilization of Quality Assurance Handbook in the supervision of instruction in secondary schools. Descriptive survey design was employed. The quantitative data were collected through an 18-item questionnaire titled, "Extent of Utilization of Quality Assurance Handbook in Secondary…

42 CFR 476.73 - Notification of QIO designation and implementation of review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of review. 476.73 Section 476.73 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement...

The relationship between motivation, monetary compensation, and data quality among US- and India-based workers on Mechanical Turk.

PubMed

Litman, Leib; Robinson, Jonathan; Rosenzweig, Cheskie

2015-06-01

In this study, we examined data quality among Amazon Mechanical Turk (MTurk) workers based in India, and the effect of monetary compensation on their data quality. Recent studies have shown that work quality is independent of compensation rates, and that compensation primarily affects the quantity but not the quality of work. However, the results of these studies were generally based on compensation rates below the minimum wage, and far below a level that was likely to play a practical role in the lives of workers. In this study, compensation rates were set around the minimum wage in India. To examine data quality, we developed the squared discrepancy procedure, which is a task-based quality assurance approach for survey tasks whose goal is to identify inattentive participants. We showed that data quality is directly affected by compensation rates for India-based participants. We also found that data were of a lesser quality among India-based than among US participants, even when optimal payment strategies were utilized. We additionally showed that the motivation of MTurk users has shifted, and that monetary compensation is now reported to be the primary reason for working on MTurk, among both US- and India-based workers. Overall, MTurk is a constantly evolving marketplace where multiple factors can contribute to data quality. High-quality survey data can be acquired on MTurk among India-based participants when an appropriate pay rate is provided and task-specific quality assurance procedures are utilized.

Quality of life after TIA and stroke: ten-year results of the Oxford Vascular Study.

PubMed

Luengo-Fernandez, Ramon; Gray, Alastair M; Bull, Linda; Welch, Sarah; Cuthbertson, Fiona; Rothwell, Peter M

2013-10-29

To evaluate the 5-year impact of stroke and TIA on utility and quality-adjusted survival. TIA and stroke patients from a UK population-based study (Oxford Vascular Study) were recruited from 2002 to 2007, and followed up until 2012. Quality of life was assessed over 5 years using the EQ-5D (EuroQol-5 Dimensions), with responses converted into utilities ranging from -0.59 (worse than death) to 1 (perfect health), using UK population valuations. Utilities for stroke and TIA patients were compared with those in matched controls obtained from the 2006 Health Survey for England. Five-year quality-adjusted life years were estimated by combining utility and survival information. Four hundred forty TIA and 748 stroke patients were ascertained and included. Utility remained constant at approximately 0.78 over the 5 years after TIA. Utility improved from 0.64 one month after stroke to 0.70 at 6 months (p = 0.006), remaining at approximately 0.70 thereafter. Matched controls had considerably higher utility levels than stroke/TIA patients (0.85, p < 0.001). Event severity and recurrent stroke were significant predictors of decreased long-term utility. Five-year quality-adjusted life expectancy was 3.32 (95% confidence interval: 3.22-3.48) quality-adjusted life years after TIA and 2.21 (2.15-2.37) after stroke, varying considerably by severity (minor: 2.94; moderate: 1.65; and severe: 0.70). Quality-adjusted survival is low over the 5 years after stroke and TIA, with severity and recurrent stroke being major predictors. There remains considerable scope for improvements in acute treatment and secondary prevention to improve the quality of life after TIA and stroke.

High quality fuel gas from biomass pyrolysis with calcium oxide.

PubMed

Zhao, Baofeng; Zhang, Xiaodong; Chen, Lei; Sun, Laizhi; Si, Hongyu; Chen, Guanyi

2014-03-01

The removal of CO2 and tar in fuel gas produced by biomass thermal conversion has aroused more attention due to their adverse effects on the subsequent fuel gas application. High quality fuel gas production from sawdust pyrolysis with CaO was studied in this paper. The results of pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) experiments indicate that the mass ratio of CaO to sawdust (Ca/S) remarkably affects the behavior of sawdust pyrolysis. On the basis of Py-GC/MS results, one system of a moving bed pyrolyzer coupled with a fluid bed combustor has been developed to produce high quality fuel gas. The lower heating value (LHV) of the fuel gas was above 16MJ/Nm(3) and the content of tar was under 50mg/Nm(3), which is suitable for gas turbine application to generate electricity and heat. Therefore, this technology may be a promising route to achieve high quality fuel gas for biomass utilization. Copyright © 2014 Elsevier Ltd. All rights reserved.

A Systematic Process for Developing High Quality SaaS Cloud Services

NASA Astrophysics Data System (ADS)

La, Hyun Jung; Kim, Soo Dong

Software-as-a-Service (SaaS) is a type of cloud service which provides software functionality through Internet. Its benefits are well received in academia and industry. To fully utilize the benefits, there should be effective methodologies to support the development of SaaS services which provide high reusability and applicability. Conventional approaches such as object-oriented methods do not effectively support SaaS-specific engineering activities such as modeling common features, variability, and designing quality services. In this paper, we present a systematic process for developing high quality SaaS and highlight the essentiality of commonality and variability (C&V) modeling to maximize the reusability. We first define criteria for designing the process model and provide a theoretical foundation for SaaS; its meta-model and C&V model. We clarify the notion of commonality and variability in SaaS, and propose a SaaS development process which is accompanied with engineering instructions. Using the proposed process, SaaS services with high quality can be effectively developed.

MultiGeMS: detection of SNVs from multiple samples using model selection on high-throughput sequencing data.

PubMed

Murillo, Gabriel H; You, Na; Su, Xiaoquan; Cui, Wei; Reilly, Muredach P; Li, Mingyao; Ning, Kang; Cui, Xinping

2016-05-15

Single nucleotide variant (SNV) detection procedures are being utilized as never before to analyze the recent abundance of high-throughput DNA sequencing data, both on single and multiple sample datasets. Building on previously published work with the single sample SNV caller genotype model selection (GeMS), a multiple sample version of GeMS (MultiGeMS) is introduced. Unlike other popular multiple sample SNV callers, the MultiGeMS statistical model accounts for enzymatic substitution sequencing errors. It also addresses the multiple testing problem endemic to multiple sample SNV calling and utilizes high performance computing (HPC) techniques. A simulation study demonstrates that MultiGeMS ranks highest in precision among a selection of popular multiple sample SNV callers, while showing exceptional recall in calling common SNVs. Further, both simulation studies and real data analyses indicate that MultiGeMS is robust to low-quality data. We also demonstrate that accounting for enzymatic substitution sequencing errors not only improves SNV call precision at low mapping quality regions, but also improves recall at reference allele-dominated sites with high mapping quality. The MultiGeMS package can be downloaded from https://github.com/cui-lab/multigems xinping.cui@ucr.edu Supplementary data are available at Bioinformatics online. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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

Dawson, F.N. Jr.

The Dynacracking process developed by Hydrocarbon Research, Inc., is a non-catalytic process capable of upgrading heavy oil whose sulfur, metal, and carbon contents may be high. It converts residual stocks to distillates with high naphtha yields, and to synthetic fuel gas of high quality (700-800 Btu/ft/sup 3/). It has esentially no air polution emissions and requires a relatively small amount of water and utilities. The process generates sufficient heat internally such that, except for start-up, no boilers, furnaces, or external heaters are required to operate the plant. Several aspects of the process are discussed: chemistry, hardware, feedstock, flexibility in themore » product mix, product quality, and economics.« less

Severe situation of rural nonpoint source pollution and efficient utilization of agricultural wastes in the Three Gorges Reservoir Area.

PubMed

Zhang, Tong; Ni, Jiupai; Xie, Deti

2015-11-01

Rural nonpoint source (NPS) pollution caused by agricultural wastes has become increasingly serious in the Three Gorges Reservoir Area (TGRA), significantly affecting the reservoir water quality. The grim situation of rural NPS pollution in the TGRA indicated that agrochemicals (chemical fertilizer and pesticide) were currently the highest contributor of rural NPS pollution (50.38%). The harmless disposal rates of livestock excrement, crop straws, rural domestic refuse, and sewage also cause severe water pollution. More importantly, the backward agricultural economy and the poor environmental awareness of farmers in the hinterland of the TGRA contribute to high levels of rural NPS pollution. Over the past decade, researchers and the local people have carried out various successful studies and practices to realize the effective control of rural NPS pollution by efficiently utilizing agricultural wastes in the TGRA, including agricultural waste biogas-oriented utilization, crop straw gasification, decentralized land treatment of livestock excrement technology, and crop straw modification. These technologies have greatly increased the renewable resource utilization of agricultural wastes and improved water quality and ecological environment in the TGRA.

Safe, High-Performance, Sustainable Precast School Design

ERIC Educational Resources Information Center

Finsen, Peter I.

2011-01-01

School design utilizing integrated architectural and structural precast and prestressed concrete components has gained greater acceptance recently for numerous reasons, including increasingly sophisticated owners and improved learning environments based on material benefits such as: sustainability, energy efficiency, indoor air quality, storm…

Microwave plasma assisted supersonic gas jet deposition of thin film materials

DOEpatents

Schmitt, III, Jerome J.; Halpern, Bret L.

1993-01-01

An apparatus for fabricating thin film materials utilizing high speed gas dynamics relies on supersonic free jets of carrier gas to transport depositing vapor species generated in a microwave discharge to the surface of a prepared substrate where the vapor deposits to form a thin film. The present invention generates high rates of deposition and thin films of unforeseen high quality at low temperatures.

42 CFR 476.90 - Lack of cooperation by a health care facility or practitioner.

Code of Federal Regulations, 2010 CFR

2010-10-01

... practitioner. 476.90 Section 476.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs...

42 CFR 476.86 - Correlation of Title XI functions with Title XVIII functions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... functions. 476.86 Section 476.86 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs...

[A review on studies and applications of near infrared spectroscopy technique(NIRS) in detecting quality of hay].

PubMed

Ding, Wu-Rong; Gan, You-Min; Guo, Xu-Sheng; Yang, Fu-Yu

2009-02-01

The quality of hay can directly affect the price of hay and also livestock productivity. Many kinds of methods have been developed for detecting the quality of hay and the method of near infrared spectroscopy (NIRS) has been widely used with consideration of its fast, effective and nondestructive characteristics during detecting process. In the present paper, the feasibility and effectiveness of application of NIRS to detecting hay quality were expounded. Meanwhile, the advance in the study of using NIRS to detect chemical compositions, extent of incursion by epiphyte, amount of toxicant excreted by endogenetic epiphyte and some minim components that can not be detected by using chemical methods were also introduced detailedly. Based on the review of the progresses in using NIRS to detect the quality of hay, it can be concluded that using NIRS to detect hay quality can avoid the disadvantages of time wasting, complication and high cost when using traditional chemical method. And for better utilization of NIRS in practice, some more studies still need to be implemented to further perfect and improve the utilization of NIRS for detecting forage quality, and more accurate modes and systematic analysis software need to be established in times to come.

Perspectives and Practices of Successful Teachers in Diverse Rural South Texas High-Performing High-Needs Elementary Schools

ERIC Educational Resources Information Center

Pate, Roberta Simnacher

2012-01-01

Texas rural schools, educating more than half a million students annually, and rural schools across the nation have been under scrutiny for the inability to provide quality education through course offerings, facilities, and qualified teachers. To address this issue, the investigator utilized Spradley's (1980) seminal work, "Participant…

Health Information Retrieval Tool (HIRT)

PubMed Central

Nyun, Mra Thinzar; Ogunyemi, Omolola; Zeng, Qing

2002-01-01

The World Wide Web (WWW) is a powerful way to deliver on-line health information, but one major problem limits its value to consumers: content is highly distributed, while relevant and high quality information is often difficult to find. To address this issue, we experimented with an approach that utilizes three-dimensional anatomic models in conjunction with free-text search.

Strength and Stiffness Properties of Sweetgum and Yellow-poplar Structural Lumber

Treesearch

Timothy D. Faust; Robert H. McAlister; Stanley J. Zarnoch

1990-01-01

The forest resource base in the Southeast is rapidly changing. Dwindling reserves of high quality pine sawlogs will provide incentives to utilize low-density hardwoods such as yellow-poplar and sweetgum for structural lumber. Inventories of sweetgum (Liriodendron tulipifera L.) are currently high and growth is exceeding removals. The mechanical propertiees of dimension...

The effect of telehealth, telephone support or usual care on quality of life, mortality and healthcare utilization in elderly high-risk patients with multiple chronic conditions. A prospective study.

PubMed

Valdivieso, Bernardo; García-Sempere, Anibal; Sanfélix-Gimeno, Gabriel; Faubel, Raquel; Librero, Julian; Soriano, Elisa; Peiró, Salvador

2018-04-25

To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients. 472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline. EQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08-0.30), but was not different to telephone support (diff: 0.04, -0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p<0.001), and with a gain of 0.13 points for the telephone support group (p<0.001). No differences in mortality or utilization were found, except for a borderline significant increase in General Practitioner visits. Telehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562). Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Heart failure patients utilizing an electric home monitor: What effects does heart failure have on their quality of life?

NASA Astrophysics Data System (ADS)

Simuel, Gloria J.

Heart Failure continues to be a major public health problem associated with high mortality and morbidity. Heart Failure is the leading cause of hospitalization for persons older than 65 years, has a poor prognosis and is associated with poor quality of life. More than 5.3 million American adults are living with heart failure. Despite maximum medical therapy and frequent hospitalizations to stabilize their condition, one in five heart failure patients die within the first year of diagnosis. Several disease-management programs have been proposed and tested to improve the quality of heart failure care. Studies have shown that hospital admissions and emergency room visits decrease with increased nursing interventions in the home and community setting. An alternative strategy for promoting self-management of heart failure is the use of electronic home monitoring. The purpose of this study was to examine what effects heart failure has on patient's quality of life that had been monitoring on an electronic home monitor longer than 2 months. Twenty-one questionnaires were given to patients utilizing an electronic home monitor by their home health agency nurse. Eleven patients completed the questionnaire. The findings showed that there is some deterioration in quality of life with more association with the physical aspects of life than with the emotional aspects of life, which probably was due to the small sample size. There was no significant difference in readmission rates in patients utilizing an electronic home monitor. Further research is needed with a larger population of patients with chronic heart failure and other chronic diseases which may provide more data, and address issues such as patient compliance with self-care, impact of heart failure on patient's quality of life, functional capacity, and heart failure patient's utilization of the emergency rooms and hospital. Telemonitoring holds promise for improving the self-care abilities of persons with HF.

Quality electric motor repair: A guidebook for electric utilities

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

Schueler, V.; Douglass, J.

This guidebook provides utilities with a resource for better understanding and developing their roles in relation to electric motor repair shops and the industrial and commercial utility customers that use them. The guidebook includes information and tools that utilities can use to raise the quality of electric motor repair practices in their service territories.

Diabetes quality of care and outpatient utilization associated with electronic patient-provider messaging: a cross-sectional analysis.

PubMed

Harris, Lynne T; Haneuse, Sebastien J; Martin, Diane P; Ralston, James D

2009-07-01

To test the hypothesis that electronic patient-provider messaging is associated with high care quality for diabetes and lower outpatient utilization. We conducted a cross-sectional analysis of electronic patient-provider messaging over a 15-month period between 1 January 2004 and 31 March 2005. The study was set at Group Health Cooperative--a consumer-governed, nonprofit health care system that operates in Washington and Idaho. Participants included all patients aged >or=18 years with a diagnosis of diabetes. In addition to usual care, all patients had the option to use electronic messaging to communicate with their care providers. The primary outcome measures were diabetes-related quality-of-care indicators (A1C, blood pressure, and LDL cholesterol) and outpatient visits (primary care, specialty care, and emergency). Nineteen percent of patients with diabetes used electronic messaging to communicate with their care providers during the study period (n = 2,924) (overall study cohort: 15,427 subjects). In multivariate models, frequent use of electronic messaging was associated with A1C <7% (relative risk [RR] 1.36 [95% CI 1.16-1.58]). Contrary to our hypothesis, frequent use of electronic messaging was also associated with a higher rate of outpatient visits (1.39 [1.26-1.53]). Frequent use of electronic secure messaging is associated with better glycemic control and increased outpatient utilization. Electronic patient-provider communication may represent one strategy to meet the health care needs of this unique population. More research is necessary to assess the effect of electronic messaging on care quality and utilization.

42 CFR 476.72 - Review of the quality of care of risk-basis health maintenance organizations and competitive...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Review of the quality of care of risk-basis health... MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control...

Value-Based Medicine and Pharmacoeconomics.

PubMed

Brown, Gary C; Brown, Melissa M

2016-01-01

Pharmacoeconomics is assuming increasing importance in the pharmaceutical field since it is entering the public policy arena in many countries. Among the variants of pharmacoeconomic analysis are cost-minimization, cost-benefit, cost-effectiveness and cost-utility analyses. The latter is the most versatile and sophisticated in that it integrates the patient benefit (patient value) conferred by a drug in terms of improvement in length and/or quality of life. It also incorporates the costs expended for that benefit, as well as the dollars returned to patients and society from the use of a drug (financial value). Unfortunately, one cost-utility analysis in the literature is generally not comparable to another because of the lack of standardized formats and standardized input variables (costs, cost perspective, quality-of-life measurement instruments, quality-of-life respondents, discounting and so forth). Thus, millions of variants can be used. Value-based medicine® (VBM) cost-utility analysis standardizes these variants so that one VBM analysis is comparable to another. This system provides a highly rational methodology that allows providers and patients to quantify and compare the patient value and financial value gains associated with the use of pharmaceutical agents for example. © 2016 S. Karger AG, Basel.

[Health-related quality of life in Chilean patients with chronic obstructive pulmonary disease].

PubMed

Collado-Mateo, Daniel; Adsuar, José C; Olivares, Pedro R; García-Gordillo, Miguel Ángel

2017-02-01

Chronic obstructive pulmonary disease (COPD) has a relevant impact on health-related quality of life (HRQoL). Short Form 6 dimensions (SF-6D) quality of life tool allows researchers to calculate preference-based utilities using data from SF-12 or SF-36 questionnaires. To provide normative values of SF-6D derived from SF-12 for Chilean patients with COPD. SF-6D utility index was calculated using data from the 2009/2010 Chilean National Health Survey. Sixty-nine male and 120 female patients with COPD participated in the survey. Data was stratified by gender, age, region, marital status, smoking status, monthly incomes, educational level and area. The mean (± SD) SF-6D utility index for Chilean patients with COPD was 0.65 ± 0.15. The scores for men and women were 0.68 ± 0.15 and 0.64 ± 0.15, respectively. Patients with high incomes and educational level reported higher SF-6D scores. Ceiling effect was not a limitation when SF-6D was used in these Chilean patients. The current study provides normative values of SF-6D derived from SF-12 for Chilean patients with COPD.

Large beam deflection using cascaded prism array

NASA Astrophysics Data System (ADS)

Wang, Wei-Chih; Tsui, Chi-Leung

2012-04-01

Endoscopes have been utilize in the medical field to observe the internals of the human body to assist the diagnosis of diseases, such as breathing disorders, internal bleeding, stomach ulcers, and urinary tract infections. Endoscopy is also utilized in the procedure of biopsy for the diagnosis of cancer. Conventional endoscopes suffer from the compromise between overall size and image quality due to the required size of the sensor for acceptable image quality. To overcome the size constraint while maintaining the capture image quality, we propose an electro-optic beam steering device based on thermal-plastic polymer, which has a small foot-print (~5mmx5mm), and can be easily fabricated using conventional hot-embossing and micro-fabrication techniques. The proposed device can be implemented as an imaging device inside endoscopes to allow reduction in the overall system size. In our previous work, a single prism design has been used to amplify the deflection generated by the index change of the thermal-plastic polymer when a voltage is applied; it yields a result of 5.6° deflection. To further amplify the deflection, a new design utilizing a cascading three-prism array has been implemented and a deflection angle to 29.2° is observed. The new design amplifies the beam deflection, while keeping the advantage of simple fabrication made possible by thermal-plastic polymer. Also, a photo-resist based collimator lens array has been added to reduce and provide collimation of the beam for high quality imaging purposes. The collimator is able to collimate the exiting beam at 4 μm diameter for up to 25mm, which potentially allows high resolution image capturing.

Factors Affecting the Use of Human Tissues in Biomedical Research: Implications in the Design and Operation of a Biorepository.

PubMed

Atherton, Daniel S; Sexton, Katherine C; Otali, Dennis; Bell, Walter C; Grizzle, William E

2016-01-01

The availability of high-quality human tissues is necessary to advance medical research. Although there are inherent and induced limitations on the use of human tissues in research, biorepositories play critical roles in minimizing the effects of such limitations. Specifically, the optimal utilization of tissues in research requires tissues to be diagnosed accurately, and the actual specimens provided to investigators must be carefully described (i.e., there must be quality control of each aliquot of the tissue provided for research, including a description of any damage to tissues). Tissues also should be collected, processed, stored, and distributed (i.e., handled) uniformly under a rigorous quality management system (QMS). Frequently, tissues are distributed to investigators by tissue banks which have collected, processed, and stored them by standard operating procedures (SOPs). Alternatively, tissues for research may be handled via SOPs that are modified to the specific requirements of investigators (i.e., using a prospective biorepository model). The primary goal of any type of biorepository should be to ensure its specimens are of high quality and are utilized appropriately in research; however, approaches may vary based on the tissues available and requested. For example, extraction of specific molecules (e.g., microRNA) to study molecular characteristics of a tissue may require less clinical annotation than tissues that are utilized to identify how the molecular expression might be used to clarify a clinical outcome of a disease or the response to a specific therapy. This review focuses on the limitations of the use of tissues in research and how the design and operations of a tissue biorepository can minimize some of these limitations.

Biological and functional relevance of CASP predictions.

PubMed

Liu, Tianyun; Ish-Shalom, Shirbi; Torng, Wen; Lafita, Aleix; Bock, Christian; Mort, Matthew; Cooper, David N; Bliven, Spencer; Capitani, Guido; Mooney, Sean D; Altman, Russ B

2018-03-01

Our goal is to answer the question: compared with experimental structures, how useful are predicted models for functional annotation? We assessed the functional utility of predicted models by comparing the performances of a suite of methods for functional characterization on the predictions and the experimental structures. We identified 28 sites in 25 protein targets to perform functional assessment. These 28 sites included nine sites with known ligand binding (holo-sites), nine sites that are expected or suggested by experimental authors for small molecule binding (apo-sites), and Ten sites containing important motifs, loops, or key residues with important disease-associated mutations. We evaluated the utility of the predictions by comparing their microenvironments to the experimental structures. Overall structural quality correlates with functional utility. However, the best-ranked predictions (global) may not have the best functional quality (local). Our assessment provides an ability to discriminate between predictions with high structural quality. When assessing ligand-binding sites, most prediction methods have higher performance on apo-sites than holo-sites. Some servers show consistently high performance for certain types of functional sites. Finally, many functional sites are associated with protein-protein interaction. We also analyzed biologically relevant features from the protein assemblies of two targets where the active site spanned the protein-protein interface. For the assembly targets, we find that the features in the models are mainly determined by the choice of template. © 2017 The Authors Proteins: Structure, Function and Bioinformatics Published by Wiley Periodicals, Inc.

Determinants of Utilization and Community Experiences with Community Health Volunteers for Treatment of Childhood Illnesses in Rural Sierra Leone.

PubMed

Yansaneh, Aisha I; George, Asha S; Sharkey, Alyssa; Brieger, William R; Moulton, Lawrence H; Yumkella, Fatu; Bangura, Peter; Kabano, Augustin; Diaz, Theresa

2016-04-01

In 2010, at the same time as the national roll out of the Free Health Care Initiative (FHCI), which removed user fees for facility based health care, trained community health volunteers (CHVs) were deployed to provide integrated community case management of diarrhea, malaria and pneumonia to children under 5 years of age (U5) in Kambia and Pujehun districts, Sierra Leone. After 2 years of implementation and in the context of FHCI, CHV utilization rate was 14.0 %. In this study, we examine the factors associated with this level of CHV utilization. A cross-sectional household-cluster survey of 1590 caregivers of 2279 children U5 was conducted in 2012; with CHV utilization assessed using a multiple logistic regression model. Focus groups and in-depth interviews were also conducted to understand communities' experiences with CHVs. Children with diarrhea (OR = 3.17, 95 % CI: 1.17-8.60), from female-headed households (OR = 4.55, 95 % CI: 1.88-11.00), and whose caregivers reported poor quality of care as a barrier to facility care-seeking (OR = 8.53, 95 % CI: 3.13-23.16) were more likely to receive treatment from a CHV. Despite low utilization, caregivers were highly familiar and appreciative of CHVs, but were concerned about the lack of financial remuneration for CHVs. CHVs remained an important source of care for children from female-headed households and whose caregivers reported poor quality of care at health facilities. CHVs are an important strategy for certain populations even when facility utilization is high or when facility services are compromised, as has happened with the recent Ebola epidemic in Sierra Leone.

UTILIZATION OF TREATABILITY AND PILOT TESTS TO PREDICT CAH BIOREMEDIATION

EPA Science Inventory

Multiple tools have been suggested to help in the design of enhanced anaerobic bioremediation systems for CAHs:
- Extensive high quality microcosm testing followed by small-scale, thoroughly observed field pilot tests (i.e., RABITT Protocol, Morse 1998)
- More limited ...

Does transit work? A conservative reappraisal

DOT National Transportation Integrated Search

1999-05-01

The American people need a dependable and affordable means to get to work and back each day; roughly half of all Americans have any transit available to them and a still smaller number have the high quality transit available that would be utilized ve...

Operational Draft Regional Guidebook for the Functional Assessment of High-Gradient Headwater Streams and Low-Gradient Perennial Streams in Appalachia

DTIC Science & Technology

rapid assessments provided in this guidebook utilize structural components of streams and their watershed and can be used in conjunction with assessment of water quality and biotic communities if desired.

42 CFR 476.90 - Lack of cooperation by a health care facility or practitioner.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs... and a reasonable amount of time to respond to a request for information about a claim, and if the...

42 CFR 476.93 - Opportunity to discuss proposed initial denial determination and changes as a result of a DRG...

Code of Federal Regulations, 2010 CFR

2010-10-01

... MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Review Functions § 476.93 Opportunity to discuss proposed...

42 CFR 476.88 - Examination of the operations and records of health care facilities and practitioners.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality... information on charges) that are pertinent to health care services furnished to Medicare beneficiaries and are...

42 CFR 476.96 - Review period and reopening of initial denial determinations and changes as a result of DRG...

Code of Federal Regulations, 2010 CFR

2010-10-01

... MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Review Functions § 476.96 Review period and reopening of...

42 CFR 476.85 - Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Review Functions § 476.85 Conclusive effect of QIO initial...

Measuring high spectral resolution specific absorption coefficients for use with hyperspectral imagery

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

Keller, M.; Bostater, C.

1997-06-01

A portable, long path length (50 cm), flow through, absorption tube system is utilized to obtain in-situ specific absorption coefficients from various water environments consisting of both clear and turbid water conditions from an underway ship or vessel. The high spectral resolution absorption signatures can be obtained and correlated with measured water quality parameters along a ship track. The long path cuvette system is capable of measuring important water quality parameters such as chlorophyll-a, seston or total suspended matter, tannins, humics, fulvic acids, or dissolved organic matter (dissolved organic carbon, DOC). The various concentrations of these substances can be determinedmore » and correlated with laboratory measurements using the double inflection ratio (DIR) of the spectra based upon derivative spectroscopy. The DIR is determined for all of the possible combinations of the bands ranging from 362-1115 nm using 252 channels, as described previously by Bostater. The information gathered from this system can be utilized in conjunction with hyperspectral imagery that allows one to relate reflectance and absorption to water quality of a particular environment. A comparison is made between absorption signatures and reflectance obtained from the Banana River, Florida.« less

Single-electron random-number generator (RNG) for highly secure ubiquitous computing applications

NASA Astrophysics Data System (ADS)

Uchida, Ken; Tanamoto, Tetsufumi; Fujita, Shinobu

2007-11-01

Since the security of all modern cryptographic techniques relies on unpredictable and irreproducible digital keys generated by random-number generators (RNGs), the realization of high-quality RNG is essential for secure communications. In this report, a new RNG, which utilizes single-electron phenomena, is proposed. A room-temperature operating silicon single-electron transistor (SET) having nearby an electron pocket is used as a high-quality, ultra-small RNG. In the proposed RNG, stochastic single-electron capture/emission processes to/from the electron pocket are detected with high sensitivity by the SET, and result in giant random telegraphic signals (GRTS) on the SET current. It is experimentally demonstrated that the single-electron RNG generates extremely high-quality random digital sequences at room temperature, in spite of its simple configuration. Because of its small-size and low-power properties, the single-electron RNG is promising as a key nanoelectronic device for future ubiquitous computing systems with highly secure mobile communication capabilities.

The effect of comorbidities upon ocular and systemic health-related quality of life.

PubMed

Real, F J; Brown, G C; Brown, H C; Brown, M M

2008-06-01

The purpose of the study was to assess whether, and to what degree, comorbidities affect patient quality of life. A cross-sectional, quality-of-life study of 170 consecutive vitreoretinal patients compared the utility associated with a participant's primary (most incapacitating) disease and the utility associated with a grouping of all of the participants' diseases. The ocular diseases present included diabetic retinopathy (44%), macular degeneration (30%), lattice degeneration/retinal tear (14%), retinal vascular obstruction (5%), uveitis, macular oedema, macular pucker (5%) and others (2%). Participants underwent interviewer-administered, time trade-off utility questions for each disease, then for a compilation of all diseases. Their primary disease was defined by the lowest utility reported for a single disease, while other health conditions were considered comorbidities. A two-tailed, paired t test was used to compare the means of the primary disease utilities and compilation utilities. The study was powered to have a 90% chance of detecting an 8% difference in mean utility between the two utility groups The mean lowest utility for the most disabling single health condition (primary disease) was 0.82 (SD 0.22; 95% CI 0.79 to 0.85. The mean utility for the grouping together of all diseases was 0.80 (SD 0.24, 95% CI 0.76 to 0.84). No significant difference was found between the mean utilities of the two groups (p = 0.56). The overall health-related quality of life of a patient in an ophthalmic population with serious diseases appears to be primarily determined by the single disease that most adversely affects the individual's quality of life. This conclusion has significant implications in clinical care and when considering the use of comorbidities in cost-utility analyses.

Microwave plasma assisted supersonic gas jet deposition of thin film materials

DOEpatents

Schmitt, J.J. III; Halpern, B.L.

1993-10-26

An apparatus for fabricating thin film materials utilizing high speed gas dynamics relies on supersonic free jets of carrier gas to transport depositing vapor species generated in a microwave discharge to the surface of a prepared substrate where the vapor deposits to form a thin film. The present invention generates high rates of deposition and thin films of unforeseen high quality at low temperatures. 5 figures.

Maximizing coupling-efficiency of high-power diode lasers utilizing hybrid assembly technology

NASA Astrophysics Data System (ADS)

Zontar, D.; Dogan, M.; Fulghum, S.; Müller, T.; Haag, S.; Brecher, C.

2015-03-01

In this paper, we present hybrid assembly technology to maximize coupling efficiency for spatially combined laser systems. High quality components, such as center-turned focusing units, as well as suitable assembly strategies are necessary to obtain highest possible output ratios. Alignment strategies are challenging tasks due to their complexity and sensitivity. Especially in low-volume production fully automated systems are economically at a disadvantage, as operator experience is often expensive. However reproducibility and quality of automatically assembled systems can be superior. Therefore automated and manual assembly techniques are combined to obtain high coupling efficiency while preserving maximum flexibility. The paper will describe necessary equipment and software to enable hybrid assembly processes. Micromanipulator technology with high step-resolution and six degrees of freedom provide a large number of possible evaluation points. Automated algorithms are necess ary to speed-up data gathering and alignment to efficiently utilize available granularity for manual assembly processes. Furthermore, an engineering environment is presented to enable rapid prototyping of automation tasks with simultaneous data ev aluation. Integration with simulation environments, e.g. Zemax, allows the verification of assembly strategies in advance. Data driven decision making ensures constant high quality, documents the assembly process and is a basis for further improvement. The hybrid assembly technology has been applied on several applications for efficiencies above 80% and will be discussed in this paper. High level coupling efficiency has been achieved with minimized assembly as a result of semi-automated alignment. This paper will focus on hybrid automation for optimizing and attaching turning mirrors and collimation lenses.

A data-driven approach for quality assessment of radiologic interpretations.

PubMed

Hsu, William; Han, Simon X; Arnold, Corey W; Bui, Alex At; Enzmann, Dieter R

2016-04-01

Given the increasing emphasis on delivering high-quality, cost-efficient healthcare, improved methodologies are needed to measure the accuracy and utility of ordered diagnostic examinations in achieving the appropriate diagnosis. Here, we present a data-driven approach for performing automated quality assessment of radiologic interpretations using other clinical information (e.g., pathology) as a reference standard for individual radiologists, subspecialty sections, imaging modalities, and entire departments. Downstream diagnostic conclusions from the electronic medical record are utilized as "truth" to which upstream diagnoses generated by radiology are compared. The described system automatically extracts and compares patient medical data to characterize concordance between clinical sources. Initial results are presented in the context of breast imaging, matching 18 101 radiologic interpretations with 301 pathology diagnoses and achieving a precision and recall of 84% and 92%, respectively. The presented data-driven method highlights the challenges of integrating multiple data sources and the application of information extraction tools to facilitate healthcare quality improvement. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Assessment of health utilities and quality of life in patients with non-alcoholic fatty liver disease

PubMed Central

Sayiner, Mehmet; Stepanova, Maria; Pham, Huong; Noor, Bashir; Walters, Mercedes; Younossi, Zobair M

2016-01-01

Background Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease associated with increased liver-related mortality. Additionally, NAFLD could potentially impair health-related quality of life. Although an approved treatment for NAFLD does not exist, a number of new drugs for treatment of NAFLD are being developed. As the efficacy and safety of these regimens are being established, their cost-effectiveness, which requires the use of quality of life metrics and health utility scores to quality-adjusted outcomes, must also be assessed. The aim of this study was to report quality of life and health utilities in patients with NAFLD with and without cirrhosis for future use. Methods Patients with NAFLD were seen in an outpatient clinic setting. Each patient had extensive clinical data and completed the Short Form-36 (SF-36 V.1) questionnaire. The SF-6D health utility scores were calculated. Results There were 89 patients with the spectrum of NAFLD completed the SF-36 questionnaire: 59 with non-cirrhotic NAFLD and 30 with cirrhosis. Patients with NAFLD had significantly lower quality of life and health utility scores than the general population (all p<0.0001). Furthermore, patients with cirrhosis had lower quality of life and utility scores than non-cirrhotic NAFLD patients: SF-6D 0.660±0.107 in non-cirrhotic NAFLD vs 0.551±0.138 in cirrhotic NAFLD (p=0.0003). Conclusions Health utilities and quality of life scores are impaired in patients with cirrhotic NAFLD. These values should be used in cost-effectiveness analysis of the upcoming treatment regimens for advanced NAFLD. PMID:27648297

Impact of instructional Approaches to Teaching Elementary Science on Student Achievement

NASA Astrophysics Data System (ADS)

Kensinger, Seth H.

Strengthening our science education in the United States is essential to the future success of our country in the global marketplace. Immersing our elementary students with research-based quality science instruction is a critical component to build a strong foundation and motivate our students to become interested in science. The research for this study pertained to the type of elementary science instruction in correlation to academic achievement and gender. Through this study, the researcher answered the following questions: 1. What is the difference in achievement for elementary students who have been taught using one of the three science instructional approaches analyzed in this study: traditional science instruction, inquiry-based science instruction with little or no professional development and inquiry-based science instruction with high-quality professional development? 2. What is the difference in student achievement between inquiry-based instruction and non-inquiry based (traditional) instruction? 3. What is the difference in student achievement between inquiry with high quality professional development and inquiry with little or no professional development? 4. Do the three instructional approaches have differentiated effects across gender? The student achievement was measured using the 2010 fourth grade Pennsylvania System of School Assessment (PSSA) in Science. Data was collected from 15 elementary schools forming three main groupings of similar schools based on the results from the 2009 third grade PSSA in Mathematics and student and community demographics. In addition, five sub-group triads were formed to further analyze the data and each sub-group was composed of schools with matching demographic data. Each triad contained a school using a traditional approach to teaching science, a school utilizing an inquiry science approach with little or no professional development, and a school incorporating inquiry science instruction with high quality professional development. The five schools which provided its students with inquiry science and high quality professional development were Science Its Elementary (SIE) schools, as provided through a grant from the Pennsylvania Department of Education (PDE). The findings of the study indicated that there is evidence to suggest that elementary science achievement improves significantly when teachers have utilized inquiry instruction after receiving high-quality professional development. Specifically, the analysis of the whole group and the majority of the triad sub-groupings did result in a consistent trend to support science instruction utilizing inquiry with high-quality professional development compared to a traditional approach and an inquiry-based approach with little or no professional development. The gender analysis of this study focused on whether or not girls at the elementary school level would perform better than boys depending upon method of science instruction. The study revealed no relationship between approach to teaching science and achievement level based on gender. The whole group results and sub-group triads produced no significant findings for this part of the data analysis.

Nickel-cadmium cells

NASA Technical Reports Server (NTRS)

Rubin, E. J.; Turchan, M. J.

1974-01-01

A high energy density nickel cadmium cell of aerospace quality was designed. The approach used was to utilize manufacturing techniques which produce highly uniform and controlled starting materials in addition to improvements in the overall design. Parameters controlling the production of plaque and both positive and negative plate were studied. Quantities of these materials were produced and prototype cells were assembled to test the proposed design.

42 CFR 476.94 - Notice of QIO initial denial determination and changes as a result of a DRG validation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality... validation; (2) For day outliers in hospitals, the date on which the stay or services in the facility will...

Improving the Quality of Patient Care Utilizing Tracer Methodology

DTIC Science & Technology

2011-01-25

Sharing Knowledge: Achieving Breakthrough Performance 2011 Military Health System Conference Improving the Quality of Patient Care Utilizing Tracer...Methodology 25 Jan 2011 Leslie Atkins, RN 1 Military Health System Conference T e Quadruple Aim Working Together, Achieving Success USA MEDDAC...25 JAN 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Improving the Quality of Patient Care Utilizing

UTILIZATION OF TREATABILITY AND PILOT TESTS TO PREDICT CAH BIOREMEDIATION (Battelle)

EPA Science Inventory

Multiple tools have been suggested to help in the design of enhanced anaerobic bioremediation systems for CAHs:
Extensive high quality microcosm testing followed by small-scale, thoroughly observed, induced flow field pilot tests (i.e. RABITT Protocol, Morse 1998)
More...

Instructional Coaching as High-Quality Professional Development

ERIC Educational Resources Information Center

Desimone, Laura M.; Pak, Katie

2017-01-01

In response to policy initiatives calling for the implementation of evidence-based classroom practice, instructional coaches are frequently utilized as providers of professional development (PD). Despite the demand for instructional coaches, there is little empirical evidence that coaching improves teacher practice. We address this limitation by…

Preparation of a Breadfruit Flour Bar.

PubMed

Nochera, Carmen L; Ragone, Diane

2016-05-20

Breadfruit is a nutritious, high energy food with a low quantity of protein but excellent protein quality. It has the potential to be developed into desired products which will help increase its utilization and add value to the crop. The overall purposes of this investigation were to develop a portable, nutritious, ready-to-eat breadfruit product (bar), test the sensory qualities of the product, and evaluate the nutritional properties of the product. Flour made from the Micronesian variety, Meinpadahk ( Artocarpus altilis × Artocarpus mariannensis ), was utilized for the development of the breadfruit bar. Breadfruit is a rich source of fiber, vitamins such as vitamin C, minerals such as potassium, and phytochemicals such as flavonoids. Nutritional labeling indicates that the breadfruit bar is high in carbohydrates and low in fat, and sensory evaluation indicates that 81% of the panelists found the bar acceptable while 19% disliked the bar. The breadfruit bar can provide an appealing and inexpensive gluten-free food source based on locally available breadfruit.

High-contrast multilayer imaging of biological organisms through dark-field digital refocusing.

PubMed

Faridian, Ahmad; Pedrini, Giancarlo; Osten, Wolfgang

2013-08-01

We have developed an imaging system to extract high contrast images from different layers of biological organisms. Utilizing a digital holographic approach, the system works without scanning through layers of the specimen. In dark-field illumination, scattered light has the main contribution in image formation, but in the case of coherent illumination, this creates a strong speckle noise that reduces the image quality. To remove this restriction, the specimen has been illuminated with various speckle-fields and a hologram has been recorded for each speckle-field. Each hologram has been analyzed separately and the corresponding intensity image has been reconstructed. The final image has been derived by averaging over the reconstructed images. A correlation approach has been utilized to determine the number of speckle-fields required to achieve a desired contrast and image quality. The reconstructed intensity images in different object layers are shown for different sea urchin larvae. Two multimedia files are attached to illustrate the process of digital focusing.

An Analysis of Organizational Performance Based on Hospital Specialization Level and Strategy Type

PubMed Central

Kim, Han-Sung; Kim, Young-Hoon; Woo, Jung-Sik; Hyun, Sook-Jung

2015-01-01

Introduction Hospitals are studying the focused factory concept and attempting to increase their power in a competitive industry by becoming more specialized. Methodology This study uses the information theory index (ITI) and the Herfindahl-Hirschman index (HHI) to analyze the extent of specialization by Korean hospitals that receive national health insurance reimbursements. Hierarchical regression analysis is used to assess the impact of hospital specialization on the following four aspects of operational performance: productivity, profitability, efficiency and quality of care. Study Results The results show that a focused strategy (high HHI) improves the income and adjusted number of patients per specialist through the efficient utilization of human resources. However, a diversified strategy (high ITI) improves the hospital utilization ratio, income per bed and adjusted number of patients per bed (controlling for material resources such as beds). In addition, as the concentration index increases, case-mix mortality rates and referral rates decrease, indicating that specialization has a positive relationship with quality of care. PMID:26218570

An Analysis of Organizational Performance Based on Hospital Specialization Level and Strategy Type.

PubMed

Kim, Han-Sung; Kim, Young-Hoon; Woo, Jung-Sik; Hyun, Sook-Jung

2015-01-01

Hospitals are studying the focused factory concept and attempting to increase their power in a competitive industry by becoming more specialized. This study uses the information theory index (ITI) and the Herfindahl-Hirschman index (HHI) to analyze the extent of specialization by Korean hospitals that receive national health insurance reimbursements. Hierarchical regression analysis is used to assess the impact of hospital specialization on the following four aspects of operational performance: productivity, profitability, efficiency and quality of care. The results show that a focused strategy (high HHI) improves the income and adjusted number of patients per specialist through the efficient utilization of human resources. However, a diversified strategy (high ITI) improves the hospital utilization ratio, income per bed and adjusted number of patients per bed (controlling for material resources such as beds). In addition, as the concentration index increases, case-mix mortality rates and referral rates decrease, indicating that specialization has a positive relationship with quality of care.

Methodological quality of behavioural weight loss studies: a systematic review

PubMed Central

Lemon, S. C.; Wang, M. L.; Haughton, C. F.; Estabrook, D. P.; Frisard, C. F.; Pagoto, S. L.

2018-01-01

Summary This systematic review assessed the methodological quality of behavioural weight loss intervention studies conducted among adults and associations between quality and statistically significant weight loss outcome, strength of intervention effectiveness and sample size. Searches for trials published between January, 2009 and December, 2014 were conducted using PUBMED, MEDLINE and PSYCINFO and identified ninety studies. Methodological quality indicators included study design, anthropometric measurement approach, sample size calculations, intent-to-treat (ITT) analysis, loss to follow-up rate, missing data strategy, sampling strategy, report of treatment receipt and report of intervention fidelity (mean = 6.3). Indicators most commonly utilized included randomized design (100%), objectively measured anthropometrics (96.7%), ITT analysis (86.7%) and reporting treatment adherence (76.7%). Most studies (62.2%) had a follow-up rate >75% and reported a loss to follow-up analytic strategy or minimal missing data (69.9%). Describing intervention fidelity (34.4%) and sampling from a known population (41.1%) were least common. Methodological quality was not associated with reporting a statistically significant result, effect size or sample size. This review found the published literature of behavioural weight loss trials to be of high quality for specific indicators, including study design and measurement. Identified for improvement include utilization of more rigorous statistical approaches to loss to follow up and better fidelity reporting. PMID:27071775

A quantum leap into the IED age

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

Patterson, R.C.

1996-11-01

The integration of pattern recognition, artificial intelligence and advanced communication technologies in utility substation IED`s (Intelligent Electronic Devices) has opened the door to practical and cost effective automation of power distribution systems. A major driver for the application of these new technologies has been the research directed toward the detection of high-impedance faults. The commercial products which embody these complex detection functions have already expanded to include most of the protection, control, and monitoring required at a utility substation. These new Super-IED`s enable major utility initiatives, such as power quality management, improved public safety, operation and maintenance productivity, and powermore » system automation.« less

The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons.

PubMed

Levy, Adrian R; Kowdley, Kris V; Iloeje, Uchenna; Tafesse, Eskinder; Mukherjee, Jayanti; Gish, Robert; Bzowej, Natalie; Briggs, Andrew H

2008-01-01

Chronic hepatitis B (CHB) is a condition that results in substantial morbidity and mortality worldwide because of progressive liver damage. Investigators undertaking economic evaluations of new therapeutic agents require estimates of health-related quality of life (HRQOL). Recently, evidence has begun to accumulate that differences in cultural backgrounds have a quantifiable impact on perceptions of health. The objective was to elicit utilities for six health states that occur after infection with the hepatitis B virus from infected and uninfected respondents living in jurisdictions with low and with high CHB endemicity. Standard gamble utilities were elicited from hepatitis patients and uninfected respondents using an interviewer-administered survey in the United States, Canada, United Kingdom, Spain, Hong Kong, and mainland China. Generalized linear models were used to the effect on utilities of current health, age and sex, jurisdiction and, for infected respondents, current disease state. The sample included 534 CHB-infected patients and 600 uninfected respondents. CHB and compensated cirrhosis had a moderate impact on HRQOL with utilities ranging from 0.68 to 0.80. Decompensated cirrhosis and hepatocellular carcinoma had a stronger impact with utilities ranging from 0.35 to 0.41. Significant variation was observed between countries, with both types of respondents in mainland China and Hong Kong reporting systematically lower utilities. Health states related to CHB infection have substantial reductions in HRQOL and the utilities reported in this study provide valuable information for comparing new treatment options. The observed intercountry differences suggest that economic evaluations may benefit from country-specific utility estimates. The extent that systematic intercountry differences in utilities hold true for other infectious and chronic diseases remains an open question and has considerable implications for the proper conduct and interpretation of economic evaluations.

Cross-Border Utilization of Health Care: Evidence from a Population-Based Study in South Texas

PubMed Central

Su, Dejun; Richardson, Chad; Wen, Ming; Pagán, José A

2011-01-01

Objective To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross-border utilization of health care services. Data and Methods This study used primary data from a population-based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico. Principal Findings Forty-nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self-rated health status. Conclusions The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.–Mexico border region. PMID:21158855

High-Price And Low-Price Physician Practices Do Not Differ Significantly On Care Quality Or Efficiency

PubMed Central

Roberts, Eric T.; Mehrotra, Ateev; McWilliams, J. Michael

2017-01-01

Provider consolidation has intensified concerns that providers with market power may be able to charge higher prices without having to deliver better care. Providers have argued that higher prices cover the costs of delivering higher-quality care. We examined the relationship between physician practice prices for outpatient services and the quality and efficiency of care provided to their patients. Using commercial claims, we classified practices as high-priced or low-priced. We compared care quality, utilization, and spending between high-priced and low-priced practices in the same areas using data from the Consumer Assessment of Health Care Providers and Systems survey and linked claims for Medicare beneficiaries. Compared with low-priced practices, high-priced practices were much larger and received 36% higher prices. Patients of high-priced practices reported significantly higher scores on some measures of care coordination and management, but did not differ meaningfully in their overall care ratings, other domains of patient experiences (including physician ratings and access to care), receipt of mammography, vaccinations, or diabetes services, acute care use, or total Medicare spending. These findings suggest an overall weak relationship between practices’ prices and the quality and efficiency of care they provide, calling into question claims that high-priced providers deliver substantially higher-value care. PMID:28461352

Village-Level Identification of Nitrate Sources: Collaboration of Experts and Local Population in Benin, Africa

NASA Astrophysics Data System (ADS)

Crane, P.; Silliman, S. E.; Boukari, M.; Atoro, I.; Azonsi, F.

2005-12-01

Deteriorating groundwater quality, as represented by high nitrates, in the Colline province of Benin, West Africa was identified by the Benin national water agency, Direction Hydraulique. For unknown reasons the Colline province had consistently higher nitrate levels than any other region of the country. In an effort to address this water quality issue, a collaborative team was created that incorporated professionals from the Universite d'Abomey-Calavi (Benin), the University of Notre Dame (USA), Direction l'Hydraulique (a government water agency in Benin), Centre Afrika Obota (an educational NGO in Benin), and the local population of the village of Adourekoman. The goals of the project were to: (i) identify the source of nitrates, (ii) test field techniques for long term, local monitoring, and (iii) identify possible solutions to the high levels of groundwater nitrates. In order to accomplish these goals, the following methods were utilized: regional sampling of groundwater quality, field methods that allowed the local population to regularly monitor village groundwater quality, isotopic analysis, and sociological methods of surveys, focus groups, and observations. It is through the combination of these multi-disciplinary methods that all three goals were successfully addressed leading to preliminary identification of the sources of nitrates in the village of Adourekoman, confirmation of utility of field techniques, and initial assessment of possible solutions to the contamination problem.

78 FR 9016 - Approval and Promulgation of Air Quality Implementation Plans; Massachusetts; Revisions to Fossil...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-07

... Promulgation of Air Quality Implementation Plans; Massachusetts; Revisions to Fossil Fuel Utilization and..., inspection, maintenance and testing requirements for certain fossil fuel utilization facilities, rename and... fossil fuel utilization facility regulation, source registration regulation, and new industrial...

Efficient resource allocation scheme for visible-light communication system

NASA Astrophysics Data System (ADS)

Kim, Woo-Chan; Bae, Chi-Sung; Cho, Dong-Ho; Shin, Hong-Seok; Jung, D. K.; Oh, Y. J.

2009-01-01

A visible-light communication utilizing LED has many advantagies such as visibility of information, high SNR (Signal to Noise Ratio), low installation cost, usage of existing illuminators, and high security. Furthermore, exponentially increasing needs and quality of LED have helped the development of visible-light communication. The visibility is the most attractive property in visible-light communication system, but it is difficult to ensure visibility and transmission efficiency simultaneously during initial access because of the small amount of initial access process signals. In this paper, we propose an efficient resource allocation scheme at initial access for ensuring visibility with high resource utilization rate and low data transmission failure rate. The performance has been evaluated through the numerical analysis and simulation results.

Context aware adaptive security service model

NASA Astrophysics Data System (ADS)

Tunia, Marcin A.

2015-09-01

Present systems and devices are usually protected against different threats concerning digital data processing. The protection mechanisms consume resources, which are either highly limited or intensively utilized by many entities. The optimization of these resources usage is advantageous. The resources that are saved performing optimization may be utilized by other mechanisms or may be sufficient for longer time. It is usually assumed that protection has to provide specific quality and attack resistance. By interpreting context situation of business services - users and services themselves, it is possible to adapt security services parameters to countermeasure threats associated with current situation. This approach leads to optimization of used resources and maintains sufficient security level. This paper presents architecture of adaptive security service, which is context-aware and exploits quality of context data issue.

Monitoring the quality of welding based on welding current and ste analysis

NASA Astrophysics Data System (ADS)

Mazlan, Afidatusshimah; Daniyal, Hamdan; Izzani Mohamed, Amir; Ishak, Mahadzir; Hadi, Amran Abdul

2017-10-01

Qualities of welding play an important part in industry especially in manufacturing field. Post-welding non-destructive test is one of the importance process to ensure the quality of welding but it is time consuming and costly. To reduce the chance of defects, online monitoring had been utilized by continuously sense some of welding parameters and predict welding quality. One of the parameters is welding current, which is rich of information but lack of study focus on extract them at signal analysis level. This paper presents the analysis of welding current using Short Time Energy (STE) signal processing to quantify the pattern of the current. GMAW set with carbon steel specimens are used in this experimental study with high-bandwidth and high sampling rate oscilloscope capturing the welding current. The results indicate welding current as signatures have high correlation with the welding process. Continue with STE analysis, the value below 5000 is declare as good welding, meanwhile the STE value more than 6000 is contained defect.

High performance catalytic distillation using CNTs-based holistic catalyst for production of high quality biodiesel

PubMed Central

Zhang, Dongdong; Wei, Dali; Li, Qi; Ge, Xin; Guo, Xuefeng; Xie, Zaiku; Ding, Weiping

2014-01-01

For production of biodiesel from bio oils by heterogeneous catalysis, high performance catalysts of transesterification and the further utilization of glycerol have been the two points of research. The process seemed easy, however, has never been well established. Here we report a novel design of catalytic distillation using hierachically integrated CNTs-based holistic catalyst to figure out the two points in one process, which shows high performance both for the conversion of bio oils to biodiesel and, unexpectedly, for the conversion of glycerol to more valuable chemicals at the same time. The method, with integration of nano, meso to macro reactor, has overwhelming advantages over common technologies using liquid acids or bases to catalyze the reactions, which suffer from the high cost of separation and unsolved utilization of glycerol. PMID:24503897

High performance catalytic distillation using CNTs-based holistic catalyst for production of high quality biodiesel

NASA Astrophysics Data System (ADS)

Zhang, Dongdong; Wei, Dali; Li, Qi; Ge, Xin; Guo, Xuefeng; Xie, Zaiku; Ding, Weiping

2014-02-01

For production of biodiesel from bio oils by heterogeneous catalysis, high performance catalysts of transesterification and the further utilization of glycerol have been the two points of research. The process seemed easy, however, has never been well established. Here we report a novel design of catalytic distillation using hierachically integrated CNTs-based holistic catalyst to figure out the two points in one process, which shows high performance both for the conversion of bio oils to biodiesel and, unexpectedly, for the conversion of glycerol to more valuable chemicals at the same time. The method, with integration of nano, meso to macro reactor, has overwhelming advantages over common technologies using liquid acids or bases to catalyze the reactions, which suffer from the high cost of separation and unsolved utilization of glycerol.

Economic Evaluations of Pathology Tests, 2010-2015: A Scoping Review.

PubMed

Watts, Rory D; Li, Ian W; Geelhoed, Elizabeth A; Sanfilippo, Frank M; St John, Andrew

2017-09-01

Concerns about pathology testing such as the value provided by new tests and the potential for inappropriate utilization have led to a greater need to assess costs and benefits. Economic evaluations are a formal method of analyzing costs and benefits, yet for pathology tests, questions remain about the scope and quality of the economic evidence. To describe the extent and quality of published evidence provided by economic evaluations of pathology tests from 2010 to 2015. Economic evaluations relating to pathology tests from 2010 to 2015 were reviewed. Eight databases were searched for published studies, and details recorded for the country, clinical focus, type of testing, and consideration of sensitivity, specificity, and false test results. The reporting quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist and cost-effectiveness ratios were analyzed for publication bias. We found 356 economic evaluations of pathology tests, most of which regarded developed countries. The most common economic evaluations were cost-utility analyses and the most common clinical focus was infectious diseases. More than half of the studies considered sensitivity and specificity, but few studies considered the impact of false test results. The average Consolidated Health Economic Evaluation Reporting Standards checklist score was 17 out of 24. Cost-utility ratios were commonly less than $10,000/quality-adjusted life-year or more than $200,000/quality-adjusted life-year. The number of economic evaluations of pathology tests has increased in recent years, but the rate of increase has plateaued. Furthermore, the quality of studies in the past 5 years was highly variable, and there is some question of publication bias in reporting cost-effectiveness ratios. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The Influence of Physical Therapy Guideline Adherence on Healthcare Utilization and Costs among Patients with Low Back Pain: A Systematic Review of the Literature

PubMed Central

Liu, Xinliang; Kolber, Morey J.

2016-01-01

Background Low back pain (LBP) is common and associated healthcare costs are significant. While clinical practice guidelines have been established in an attempt to reduce costs and healthcare utilization, it is unclear if adherence to physical therapy guidelines for those with LBP is efficacious. Therefore, the purpose of this study was to assess current evidence and evaluate the impact of physical therapy guideline adherence on subsequent healthcare costs and utilization for patients with LBP. Methods An electronic search was conducted in PubMed, CINAHL (EBSCO Host), AMED (Ovid), and PEDro. Studies included in this review were published in peer reviewed journals and the primary mode of treatment was administered by a physical therapist. Also, the definition of adherence was clearly defined based on claims data and at least one measure of cost or utilization reported. Quality assessment was evaluated via a modified Downs and Black checklist. Due to the conceptual heterogeneity in variable measurements, data were qualitatively synthesized and stratified by reported utilization and cost measures. Results A total of 256 results were identified and after omitting duplicates, 4 articles were retained, which were all retrospective in nature. Quality scores ranged between 19 and 21 points out of a possible 26 on the modified Downs and Black checklist. All identified studies used the same definition of guideline adherence, which focused on billing active codes and minimizing use of passive codes. The results demonstrated trends that, with a few exceptions, suggested those patients with LBP that were treated with an adherent guideline program demonstrated decreased healthcare utilization and an overall healthcare savings. Conclusion Preliminary evidence suggests that adherence to established clinical practice guidelines may assist with decreasing healthcare utilization and costs. Additional research based on prospective randomized controlled trials are needed to provide high quality evidence regarding the impact of guideline adherence among patients with LBP. PMID:27285608

The Use of Gene Modification and Advanced Molecular Structure Analyses towards Improving Alfalfa Forage.

PubMed

Lei, Yaogeng; Hannoufa, Abdelali; Yu, Peiqiang

2017-01-29

Alfalfa is one of the most important legume forage crops in the world. In spite of its agronomic and nutritive advantages, alfalfa has some limitations in the usage of pasture forage and hay supplement. High rapid degradation of protein in alfalfa poses a risk of rumen bloat to ruminants which could cause huge economic losses for farmers. Coupled with the relatively high lignin content, which impedes the degradation of carbohydrate in rumen, alfalfa has unbalanced and asynchronous degradation ratio of nitrogen to carbohydrate (N/CHO) in rumen. Genetic engineering approaches have been used to manipulate the expression of genes involved in important metabolic pathways for the purpose of improving the nutritive value, forage yield, and the ability to resist abiotic stress. Such gene modification could bring molecular structural changes in alfalfa that are detectable by advanced structural analytical techniques. These structural analyses have been employed in assessing alfalfa forage characteristics, allowing for rapid, convenient and cost-effective analysis of alfalfa forage quality. In this article, we review two major obstacles facing alfalfa utilization, namely poor protein utilization and relatively high lignin content, and highlight genetic studies that were performed to overcome these drawbacks, as well as to introduce other improvements to alfalfa quality. We also review the use of advanced molecular structural analysis in the assessment of alfalfa forage for its potential usage in quality selection in alfalfa breeding.

The Use of Gene Modification and Advanced Molecular Structure Analyses towards Improving Alfalfa Forage

PubMed Central

Lei, Yaogeng; Hannoufa, Abdelali; Yu, Peiqiang

2017-01-01

Alfalfa is one of the most important legume forage crops in the world. In spite of its agronomic and nutritive advantages, alfalfa has some limitations in the usage of pasture forage and hay supplement. High rapid degradation of protein in alfalfa poses a risk of rumen bloat to ruminants which could cause huge economic losses for farmers. Coupled with the relatively high lignin content, which impedes the degradation of carbohydrate in rumen, alfalfa has unbalanced and asynchronous degradation ratio of nitrogen to carbohydrate (N/CHO) in rumen. Genetic engineering approaches have been used to manipulate the expression of genes involved in important metabolic pathways for the purpose of improving the nutritive value, forage yield, and the ability to resist abiotic stress. Such gene modification could bring molecular structural changes in alfalfa that are detectable by advanced structural analytical techniques. These structural analyses have been employed in assessing alfalfa forage characteristics, allowing for rapid, convenient and cost-effective analysis of alfalfa forage quality. In this article, we review two major obstacles facing alfalfa utilization, namely poor protein utilization and relatively high lignin content, and highlight genetic studies that were performed to overcome these drawbacks, as well as to introduce other improvements to alfalfa quality. We also review the use of advanced molecular structural analysis in the assessment of alfalfa forage for its potential usage in quality selection in alfalfa breeding. PMID:28146083

Delaminated Transfer of CVD Graphene

NASA Astrophysics Data System (ADS)

Clavijo, Alexis; Mao, Jinhai; Tilak, Nikhil; Altvater, Michael; Andrei, Eva

Single layer graphene is commonly synthesized by dissociation of a carbonaceous gas at high temperatures in the presence of a metallic catalyst in a process known as Chemical Vapor Deposition or CVD. Although it is possible to achieve high quality graphene by CVD, the standard transfer technique of etching away the metallic catalyst is wasteful and jeopardizes the quality of the graphene film by contamination from etchants. Thus, development of a clean transfer technique and preservation of the parent substrate remain prominent hurdles to overcome. In this study, we employ a copper pretreatment technique and optimized parameters for growth of high quality single layer graphene at atmospheric pressure. We address the transfer challenge by utilizing the adhesive properties between a polymer film and graphene to achieve etchant-free transfer of graphene films from a copper substrate. Based on this concept we developed a technique for dry delamination and transferring of graphene to hexagonal boron nitride substrates, which produced high quality graphene films while at the same time preserving the integrity of the copper catalyst for reuse. DOE-FG02-99ER45742, Ronald E. McNair Postbaccalaureate Achievement Program.

Characteristics utilization of public space in Padang City based on good public space index

NASA Astrophysics Data System (ADS)

Eriawan, T.

2017-06-01

Padang is a metropolitan city which has 40 units of open space like plansum park, playground, and sports park with 10,88 hectar of total area. These open spaces are publics’, but not all of them are able to use as active public open spaces it caused by some of the parks are dormant parks beacuse they only for planted ground not for public activites.This study conducted to assess the quality of public space that exsist in Padang; Imam Bonjol park (representing of city open space (go-green)), H. Agus Salim sport center ( representing of sports park) and Pantai Muaro Padang area (representing of recreation/tourism).The method of this research conducted in several stages, first was the identification toward space’s function (Carmona,2008) and assess the space utilization index based approach to public space index (Metha,2007). The spaced quality is measured based on variable in Good Public Space Index which is the intensity of use, social activities, duration of activities, variation and pattern of use. The urgency of this research related to the effort to evaluate the policy of space arrangement and space control through the assessment of the use of existed spaces, until it can be references to Padang goverment in improving and increasing the quality of space thorugh development of spaces that have high quality.The assesment of quality of public open spaces in Padang conducted by assessed five space quality variables, result of analysis, utilization of public space was 0.69. based on the result it can be concluded the quality of public space in some parks in Padang has moderate index quality. This is caused by the time differentiation of the society, there is no interaction among society, and short time duration of the society in visiting the public space.

Making genomic medicine evidence-based and patient-centered: a structured review and landscape analysis of comparative effectiveness research.

PubMed

Phillips, Kathryn A; Deverka, Patricia A; Sox, Harold C; Khoury, Muin J; Sandy, Lewis G; Ginsburg, Geoffrey S; Tunis, Sean R; Orlando, Lori A; Douglas, Michael P

2017-10-01

Comparative effectiveness research (CER) in genomic medicine (GM) measures the clinical utility of using genomic information to guide clinical care in comparison to appropriate alternatives. We summarized findings of high-quality systematic reviews that compared the analytic and clinical validity and clinical utility of GM tests. We focused on clinical utility findings to summarize CER-derived evidence about GM and identify evidence gaps and future research needs. We abstracted key elements of study design, GM interventions, results, and study quality ratings from 21 systematic reviews published in 2010 through 2015. More than half (N = 13) of the reviews were of cancer-related tests. All reviews identified potentially important clinical applications of the GM interventions, but most had significant methodological weaknesses that largely precluded any conclusions about clinical utility. Twelve reviews discussed the importance of patient-centered outcomes, although few described evidence about the impact of genomic medicine on these outcomes. In summary, we found a very limited body of evidence about the effect of using genomic tests on health outcomes and many evidence gaps for CER to address.Genet Med advance online publication 13 April 2017.

Australian health-related quality of life population norms derived from the SF-6D.

PubMed

Norman, Richard; Church, Jody; van den Berg, Bernard; Goodall, Stephen

2013-02-01

To investigate population health-related quality of life norms in an Australian general sample by age, gender, BMI, education and socioeconomic status. The SF-36 was included in the 2009/10 wave of the Household, Income and Labour Dynamics in Australia (HILDA) survey (n=17,630 individuals across 7,234 households), and converted into SF-6D utility scores. Trends across the various population subgroups were investigated employing population weights to ensure a balanced panel, and were all sub-stratified by gender. SF-6D scores decline with age beyond 40 years, with decreasing education and by higher levels of socioeconomic disadvantage. Scores were also lower at very low and very high BMI levels. Males reported higher SF-6D scores than females across most analyses. This study reports Australian population utility data measured using the SF-6D, based on a national representative sample. These results can be used in a range of policy settings such as cost-utility analysis or exploration of health-related inequality. In general, the patterns are similar to those reported using other multi-attribute utility instruments and in different countries. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

Making genomic medicine evidence-based and patient-centered: a structured review and landscape analysis of comparative effectiveness research

PubMed Central

Phillips, Kathryn A.; Deverka, Patricia A.; Sox, Harold C.; Khoury, Muin J.; Sandy, Lewis G.; Ginsburg, Geoffrey S.; Tunis, Sean R.; Orlando, Lori A.; Douglas, Michael P.

2017-01-01

Comparative effectiveness research (CER) in genomic medicine (GM) measures the clinical utility of using genomic information to guide clinical care in comparison to appropriate alternatives. We summarized findings of high-quality systematic reviews that compared the analytic and clinical validity and clinical utility of GM tests. We focused on clinical utility findings to summarize CER-derived evidence about GM and identify evidence gaps and future research needs. We abstracted key elements of study design, GM interventions, results, and study quality ratings from 21 systematic reviews published in 2010 through 2015. More than half (N = 13) of the reviews were of cancer-related tests. All reviews identified potentially important clinical applications of the GM interventions, but most had significant methodological weaknesses that largely precluded any conclusions about clinical utility. Twelve reviews discussed the importance of patient-centered outcomes, although few described evidence about the impact of genomic medicine on these outcomes. In summary, we found a very limited body of evidence about the effect of using genomic tests on health outcomes and many evidence gaps for CER to address. Genet Med advance online publication 13 April 2017 PMID:28406488

Soft-lithography fabrication of microfluidic features using thiol-ene formulations.

PubMed

Ashley, John F; Cramer, Neil B; Davis, Robert H; Bowman, Christopher N

2011-08-21

In this work, a novel thiol-ene based photopolymerizable resin formulation was shown to exhibit highly desirable characteristics, such as low cure time and the ability to overcome oxygen inhibition, for the photolithographic fabrication of microfluidic devices. The feature fidelity, as well as various aspects of the feature shape and quality, were assessed as functions of various resin attributes, particularly the exposure conditions, initiator concentration and inhibitor to initiator ratio. An optical technique was utilized to evaluate the feature fidelity as well as the feature shape and quality. These results were used to optimize the thiol-ene resin formulation to produce high fidelity, high aspect ratio features without significant reductions in feature quality. For structures with aspect ratios below 2, little difference (<3%) in feature quality was observed between thiol-ene and acrylate based formulations. However, at higher aspect ratios, the thiol-ene resin exhibited significantly improved feature quality. At an aspect ratio of 8, raised feature quality for the thiol-ene resin was dramatically better than that achieved by using the acrylate resin. The use of the thiol-ene based resin enabled fabrication of a pinched-flow microfluidic device that has complex channel geometry, small (50 μm) channel dimensions, and high aspect ratio (14) features. This journal is © The Royal Society of Chemistry 2011

Morphology, geology and water quality assessment of former tin mining catchment.

PubMed

Ashraf, Muhammad Aqeel; Maah, Mohd Jamil; Yusoff, Ismail

2012-01-01

Bestari Jaya, former tin mining catchment covers an area of 2656.31 hectares comprised of four hundred and forty-two different-size lakes and ponds. The present study area comprise of 92 hectares of the catchment that include four large size lakes. Arc GIS version 9.2 used to develop bathymetric map, Global Positioning System (GPS) for hydrographical survey and flow meter was utilized for water discharge analysis (flow routing) of the catchment. The water quality parameters (pH, temperature, electric conductivity, dissolved oxygen DO, total dissolved solids TDS, chlorides, ammonium, nitrates) were analyzed by using Hydrolab. Quality assurance (QA) and quality control (QC) procedures were strictly followed throughout the field work and data analysis. Different procedures were employed to evaluate the analytical data and to check for possible transcription or dilution errors, changes during analysis, or unusual or unlikely values. The results obtained are compared with interim national water quality standards for Malaysia indicates that water quality of area is highly degraded. It is concluded that Bestri Jaya ex-mining catchment has a high pollution potential due to mining activities and River Ayer Hitam, recipient of catchment water, is a highly polluted river.

Morphology, Geology and Water Quality Assessment of Former Tin Mining Catchment

PubMed Central

Ashraf, Muhammad Aqeel; Maah, Mohd. Jamil; Yusoff, Ismail

2012-01-01

Bestari Jaya, former tin mining catchment covers an area of 2656.31 hectares comprised of four hundred and forty-two different-size lakes and ponds. The present study area comprise of 92 hectares of the catchment that include four large size lakes. Arc GIS version 9.2 used to develop bathymetric map, Global Positioning System (GPS) for hydrographical survey and flow meter was utilized for water discharge analysis (flow routing) of the catchment. The water quality parameters (pH, temperature, electric conductivity, dissolved oxygen DO, total dissolved solids TDS, chlorides, ammonium, nitrates) were analyzed by using Hydrolab. Quality assurance (QA) and quality control (QC) procedures were strictly followed throughout the field work and data analysis. Different procedures were employed to evaluate the analytical data and to check for possible transcription or dilution errors, changes during analysis, or unusual or unlikely values. The results obtained are compared with interim national water quality standards for Malaysia indicates that water quality of area is highly degraded. It is concluded that Bestri Jaya ex-mining catchment has a high pollution potential due to mining activities and River Ayer Hitam, recipient of catchment water, is a highly polluted river. PMID:22761549

High-dose chemotherapy for patients with high-risk breast cancer: a clinical and economic assessment using a quality-adjusted survival analysis.

PubMed

Marino, Patricia; Roché, Henri; Moatti, Jean-Paul

2008-04-01

The benefit of high-dose chemotherapy (HDC) has not been clearly demonstrated. It may offer disease-free survival improvement at the expense of major toxicity and increasing cost. We evaluated the trade-offs between toxicity, relapse, and costs using a quality-adjusted time without symptoms or toxicity (Q-TWiST) analysis. The analysis was conducted in the context of a randomized trial (PEGASE 01) evaluating the benefit of HDC for 314 patients with high-risk breast cancer. A Q-TWiST analysis was first performed to compare HDC with standard chemotherapy. We then used the results of this Q-TWiST analysis to inform a cost per quality-adjusted life-year (QALY) comparison between treatments. Q-TWiST durations were in favor of HDC, whatever the weighting coefficients used for the analysis. This benefit was significant when the weighting coefficient related to the time spent after relapse was low (<0.38). For quite high values of this coefficient (>0.78), HDC offered no benefit. For intermediate values, the results depended on the weighting coefficient attributed to the toxicity period. The incremental cost per QALY ranged from 12,691euro/QALY to 26,439euro/QALY, according to the coefficients used to weight toxicity and relapse. The benefits of HDC outweigh the burdens of treatment for a wide range of utility coefficients. Economic impact is not a barrier to HDC diffusion in this situation. Nevertheless, no significant benefit was demonstrated for a certain range of utility values.

Nonlinear Trimodal Regression Analysis of Radiodensitometric Distributions to Quantify Sarcopenic and Sequelae Muscle Degeneration

PubMed Central

Árnadóttir, Í.; Gíslason, M. K.; Carraro, U.

2016-01-01

Muscle degeneration has been consistently identified as an independent risk factor for high mortality in both aging populations and individuals suffering from neuromuscular pathology or injury. While there is much extant literature on its quantification and correlation to comorbidities, a quantitative gold standard for analyses in this regard remains undefined. Herein, we hypothesize that rigorously quantifying entire radiodensitometric distributions elicits more muscle quality information than average values reported in extant methods. This study reports the development and utility of a nonlinear trimodal regression analysis method utilized on radiodensitometric distributions of upper leg muscles from CT scans of a healthy young adult, a healthy elderly subject, and a spinal cord injury patient. The method was then employed with a THA cohort to assess pre- and postsurgical differences in their healthy and operative legs. Results from the initial representative models elicited high degrees of correlation to HU distributions, and regression parameters highlighted physiologically evident differences between subjects. Furthermore, results from the THA cohort echoed physiological justification and indicated significant improvements in muscle quality in both legs following surgery. Altogether, these results highlight the utility of novel parameters from entire HU distributions that could provide insight into the optimal quantification of muscle degeneration. PMID:28115982

Monitoring the delivery of cancer care: Commission on Cancer and National Cancer Data Base.

PubMed

Williams, Richelle T; Stewart, Andrew K; Winchester, David P

2012-07-01

The primary objective of the Commission on Cancer (CoC) is to ensure the delivery of comprehensive, high-quality care that improves survival while maintaining quality of life for patients with cancer. This article examines the initiatives of the CoC toward achieving this goal, utilizing data from the National Cancer Data Base (NCDB) to monitor treatment patterns and outcomes, to develop quality measures, and to benchmark hospital performance. The article also highlights how these initiatives align with the Institute of Medicine's recommendations for improving the quality of cancer care and briefly explores future projects of the CoC and NCDB. Copyright © 2012 Elsevier Inc. All rights reserved.

Ultrafast Silicon-based Modulators using Optical Switching of Vanadium Dioxide

DTIC Science & Technology

2014-12-04

demonstrated by using photothermal heating to induce the VO2 semiconductor-to- metal phase transition and modulate the transmitted optical signal...speeds. By utilizing the sub-picosecond semiconductor-to- metal transition (SMT) in VO2 as the active switching mechanism that enables direct... metallic phases. The steep slope, high contrast, and relatively narrow hysteresis exhibited by these reflectivity measurements indicate the high quality

Effect of fly ash on the strength of porous concrete using recycled coarse aggregate to replace low-quality natural coarse aggregate

NASA Astrophysics Data System (ADS)

Arifi, Eva; Cahya, Evi Nur; Christin Remayanti, N.

2017-09-01

The performance of porous concrete made of recycled coarse aggregate was investigated. Fly ash was used as cement partial replacement. In this study, the strength of recycled aggregate was coMPared to low quality natural coarse aggregate which has high water absorption. Compression strength and tensile splitting strength test were conducted to evaluate the performance of porous concrete using fly ash as cement replacement. Results have shown that the utilization of recycled coarse aggregate up to 75% to replace low quality natural coarse aggregate with high water absorption increases compressive strength and splitting tensile strength of porous concrete. Using fly ash up to 25% as cement replacement improves compressive strength and splitting tensile strength of porous concrete.

Health services research in urology.

PubMed

Yu, Hua-Yin; Ulmer, William; Kowalczyk, Keith J; Hu, Jim C

2011-06-01

Health services research (HSR) is increasingly important given the focus on patient-centered, cost-effective, high-quality health care. We examine how HSR affects contemporary evidence-based urologic practice and its role in shaping future urologic research and care. PubMed, urologic texts, and lay literature were reviewed for terms pertaining to HSR/outcomes research and urologic disease processes. HSR is a broad discipline that focuses on access, cost, and outcomes of Health care. Its use has been applied to a myriad of urologic conditions to identify deficiencies in access, to evaluate cost-effectiveness of therapies, and to evaluate structural, process, and outcome quality measures. HSR utilizes an evidence-based approach to identify the most effective ways to organize/manage, finance, and deliver high-quality urologic care and to tailor care optimized to individuals.

Baseline utilization of breast radiotherapy before institution of the Medicare practice quality reporting initiative.

PubMed

Smith, Benjamin D; Smith, Grace L; Roberts, Kenneth B; Buchholz, Thomas A

2009-08-01

In 2007, Medicare implemented the Physician Quality Reporting Initiative (PQRI), which provides financial incentives to physicians who report their performance on certain quality measures. PQRI measure #74 recommends radiotherapy for patients treated with conservative surgery (CS) for invasive breast cancer. As a first step in evaluating the potential impact of this measure, we assessed baseline use of radiotherapy among women diagnosed with invasive breast cancer before implementation of PQRI. Using the SEER-Medicare data set, we identified women aged 66-70 diagnosed with invasive breast cancer and treated with CS between 2000 and 2002. Treatment with radiotherapy was determined using SEER and claims data. Multivariate logistic regression tested whether receipt of radiotherapy varied significantly across clinical, pathologic, and treatment covariates. Of 3,674 patients, 94% (3,445) received radiotherapy. In adjusted analysis, the presence of comorbid illness (odds ratio [OR] 1.69; 95% confidence interval [CI], 1.19-2.42) and unmarried marital status were associated with omission of radiotherapy (OR 1.65; 95% CI, 1.22-2.20). In contrast, receipt of chemotherapy was protective against omission of radiotherapy (OR 0.25; 95% CI, 0.16-0.38). Race and geographic region did not correlate with radiotherapy utilization. Utilization of radiotherapy following CS was high for patients treated before institution of PQRI, suggesting that at most 6% of patients could benefit from measure #74. Further research is needed to determine whether institution of PQRI will affect radiotherapy utilization.

Sleep quality and health service utilization in Chinese general population: a cross-sectional study in Dongguan, China.

PubMed

Zhang, Hui-Shan; Mai, Yan-Bing; Li, Wei-Da; Xi, Wen-Tao; Wang, Jin-Ming; Lei, Yi-Xiong; Wang, Pei-Xi

The aims of this study were to explore the Pittsburgh Sleep Quality Index (PSQI) and health service utilization in Chinese general population, to investigate the association between PSQI and health service utilization and to identify the independent contributions of social demographic variables, health related factors and PSQI to health service utilization. In a cross-sectional community-based health survey using a multi-instrument questionnaire, 4067 subjects (≥15 years old) were studied. The Chinese version of the PSQI was used to assess sleep quality. Health service utilization was measured by recent two-week physician visit and annual hospitalization rates. Higher PSQI scores were associated with more frequent health service utilization. Higher scores in subjective sleep quality were associated with higher rate of recent two-week physician visit (adjusted OR = 1.24 per SD increase, P = 0.015). Higher scores in habitual sleep efficiency (adjusted OR = 1.24 per SD increase, P = 0.038) and sleep disturbances (adjusted OR = 2.09 per SD increase, P < 0.001) were associated with more frequent annual hospitalization. The independent influence of PSQI on the risk of recent two-week physician visit was 0.7%, and that of annual hospitalization 31.4%. Poorer sleep quality predicted more frequent health service utilization. The independent contribution of PSQI on health service utilization was smaller than social demographic variables. Copyright © 2016. Published by Elsevier B.V.

The Economic Impact of Closed-Incision Negative-Pressure Therapy in High-Risk Abdominal Incisions: A Cost-Utility Analysis.

PubMed

Chopra, Karan; Gowda, Arvind U; Morrow, Chris; Holton, Luther; Singh, Devinder P

2016-04-01

Complex abdominal wall reconstruction is beset by postoperative complications. A recent meta-analysis comparing the use of closed-incision negative-pressure therapy to standard dressings found a statistically significant reduction in surgical-site infection. The use of closed-incision negative-pressure therapy is gaining acceptance in this population; however, the economic impact of this innovative dressing remains unknown. In this study, a cost-utility analysis was performed assessing closed-incision negative-pressure therapy and standard dressings following closure of abdominal incisions in high-risk patients. Cost-utility methodology involved reviewing literature related to closed-incision negative-pressure therapy in abdominal wall surgery, obtaining utility estimates to calculate quality-adjusted life-year scores for successful surgery and surgery complicated by surgical-site infection, summing costs using Medicare Current Procedural Terminology codes, and creating a decision tree illuminating the most cost-effective dressing strategy. One-way sensitivity analysis was performed to assess the robustness of the results. The aforementioned meta-analysis comparing closed-incision negative-pressure therapy to standard dressings included a subset of five studies assessing abdominal wall surgery in 829 patients (260 closed-incision negative-pressure therapy and 569 standard dressings). Decision tree analysis revealed an estimated savings of $1546.52 and a gain of 0.0024 quality-adjusted life-year with closed-incision negative-pressure therapy compared with standard dressings; therefore, closed-incision negative-pressure therapy is a dominant treatment strategy. One-way sensitivity analysis revealed that closed-incision negative-pressure therapy is a cost-effective option when the surgical-site infection rate is greater than 16.39 percent. The use of closed-incision negative-pressure therapy is cost-saving following closure of abdominal incisions in high-risk patients.

High power parallel ultrashort pulse laser processing

NASA Astrophysics Data System (ADS)

Gillner, Arnold; Gretzki, Patrick; Büsing, Lasse

2016-03-01

The class of ultra-short-pulse (USP) laser sources are used, whenever high precession and high quality material processing is demanded. These laser sources deliver pulse duration in the range of ps to fs and are characterized with high peak intensities leading to a direct vaporization of the material with a minimum thermal damage. With the availability of industrial laser source with an average power of up to 1000W, the main challenge consist of the effective energy distribution and disposition. Using lasers with high repetition rates in the MHz region can cause thermal issues like overheating, melt production and low ablation quality. In this paper, we will discuss different approaches for multibeam processing for utilization of high pulse energies. The combination of diffractive optics and conventional galvometer scanner can be used for high throughput laser ablation, but are limited in the optical qualities. We will show which applications can benefit from this hybrid optic and which improvements in productivity are expected. In addition, the optical limitations of the system will be compiled, in order to evaluate the suitability of this approach for any given application.

A contourlet transform based algorithm for real-time video encoding

NASA Astrophysics Data System (ADS)

Katsigiannis, Stamos; Papaioannou, Georgios; Maroulis, Dimitris

2012-06-01

In recent years, real-time video communication over the internet has been widely utilized for applications like video conferencing. Streaming live video over heterogeneous IP networks, including wireless networks, requires video coding algorithms that can support various levels of quality in order to adapt to the network end-to-end bandwidth and transmitter/receiver resources. In this work, a scalable video coding and compression algorithm based on the Contourlet Transform is proposed. The algorithm allows for multiple levels of detail, without re-encoding the video frames, by just dropping the encoded information referring to higher resolution than needed. Compression is achieved by means of lossy and lossless methods, as well as variable bit rate encoding schemes. Furthermore, due to the transformation utilized, it does not suffer from blocking artifacts that occur with many widely adopted compression algorithms. Another highly advantageous characteristic of the algorithm is the suppression of noise induced by low-quality sensors usually encountered in web-cameras, due to the manipulation of the transform coefficients at the compression stage. The proposed algorithm is designed to introduce minimal coding delay, thus achieving real-time performance. Performance is enhanced by utilizing the vast computational capabilities of modern GPUs, providing satisfactory encoding and decoding times at relatively low cost. These characteristics make this method suitable for applications like video-conferencing that demand real-time performance, along with the highest visual quality possible for each user. Through the presented performance and quality evaluation of the algorithm, experimental results show that the proposed algorithm achieves better or comparable visual quality relative to other compression and encoding methods tested, while maintaining a satisfactory compression ratio. Especially at low bitrates, it provides more human-eye friendly images compared to algorithms utilizing block-based coding, like the MPEG family, as it introduces fuzziness and blurring instead of artificial block artifacts.

Quality assessment of dental health services provided at the Faculty of Dentistry, King Abdulaziz University.

PubMed

Hassan, Ali H; Amer, Hala A; Maghrabi, Abdulhamaid A

2005-01-01

The objectives of this research were to assess the quality of dental services delivered in King Abdulaziz University and highlight the necessary recommendations that would improve it. The methods used were live photographs illustrating the structure of dental services of the faculty presented in the clinic buildings, waiting places, equipments, instruments and supplies, as well as the comfort and privacy. Review of official records of the faculty for the number, qualifications and training of the dental staff and auxiliary personnel, as well as the process of care (starting from patient registration until completion of treatment). Records also demonstrated the access and utilization of services delivered in the various departments, the quality of these services and of infection control measures and procedures. The results revealed the high quality of services delivered through evaluating the structure and process of care in the university dental clinics. Dental services of King Abdulaziz University conform to high quality standards, with implementation of some changes for improvement and development.

QSRA: a quality-value guided de novo short read assembler.

PubMed

Bryant, Douglas W; Wong, Weng-Keen; Mockler, Todd C

2009-02-24

New rapid high-throughput sequencing technologies have sparked the creation of a new class of assembler. Since all high-throughput sequencing platforms incorporate errors in their output, short-read assemblers must be designed to account for this error while utilizing all available data. We have designed and implemented an assembler, Quality-value guided Short Read Assembler, created to take advantage of quality-value scores as a further method of dealing with error. Compared to previous published algorithms, our assembler shows significant improvements not only in speed but also in output quality. QSRA generally produced the highest genomic coverage, while being faster than VCAKE. QSRA is extremely competitive in its longest contig and N50/N80 contig lengths, producing results of similar quality to those of EDENA and VELVET. QSRA provides a step closer to the goal of de novo assembly of complex genomes, improving upon the original VCAKE algorithm by not only drastically reducing runtimes but also increasing the viability of the assembly algorithm through further error handling capabilities.

The Application of Remote Sensing Techniques to Urban Data Acquisition

NASA Technical Reports Server (NTRS)

Horton, F. E.

1971-01-01

The application of remote sensing techniques useful in acquiring data concerning housing quality is discussed. Conclusions reached from the investigation were: (1) Use of individuals with a higher degree of training in photointerpretation should significantly increase the percentage of successful classifications. (2) Small area classification of urban housing quality can definitely be accomplished via high resolution aerial photography. Such surveys, at the levels of accuracy demonstrated, can be of major utility in quick look surveys. (3) Survey costs should be significantly reduced.

Dimensional Precision Research of Wax Molding Rapid Prototyping based on Droplet Injection

NASA Astrophysics Data System (ADS)

Mingji, Huang; Geng, Wu; yan, Shan

2017-11-01

The traditional casting process is complex, the mold is essential products, mold quality directly affect the quality of the product. With the method of rapid prototyping 3D printing to produce mold prototype. The utility wax model has the advantages of high speed, low cost and complex structure. Using the orthogonal experiment as the main method, analysis each factors of size precision. The purpose is to obtain the optimal process parameters, to improve the dimensional accuracy of production based on droplet injection molding.

Dynamic stability and handling qualities tests on a highly augmented, statically unstable airplane

NASA Technical Reports Server (NTRS)

Gera, Joseph; Bosworth, John T.

1987-01-01

This paper describes some novel flight tests and analysis techniques in the flight dynamics and handling qualities area. These techniques were utilized during the initial flight envelope clearance of the X-29A aircraft and were largely responsible for the completion of the flight controls clearance program without any incidents or significant delays. The resulting open-loop and closed-loop frequency responses and the time history comparison using flight and linear simulation data are discussed.

Space Technology 5 - A Successful Micro-Satellite Constellation Mission

NASA Technical Reports Server (NTRS)

Carlisle, Candace; Webb, Evan H.

2007-01-01

The Space Technology 5 (ST5) constellation of three micro-satellites was launched March 22, 2006. During the three-month flight demonstration phase, the ST5 team validated key technologies that will make future low-cost micro-sat constellations possible, demonstrated operability concepts for future micro-sat science constellation missions, and demonstrated the utility of a micro-satellite constellation to perform research-quality science. The ST5 mission was successfully completed in June 2006, demonstrating high-quality science and technology validation results.

Information retrieval based on single-pixel optical imaging with quick-response code

NASA Astrophysics Data System (ADS)

Xiao, Yin; Chen, Wen

2018-04-01

Quick-response (QR) code technique is combined with ghost imaging (GI) to recover original information with high quality. An image is first transformed into a QR code. Then the QR code is treated as an input image in the input plane of a ghost imaging setup. After measurements, traditional correlation algorithm of ghost imaging is utilized to reconstruct an image (QR code form) with low quality. With this low-quality image as an initial guess, a Gerchberg-Saxton-like algorithm is used to improve its contrast, which is actually a post processing. Taking advantage of high error correction capability of QR code, original information can be recovered with high quality. Compared to the previous method, our method can obtain a high-quality image with comparatively fewer measurements, which means that the time-consuming postprocessing procedure can be avoided to some extent. In addition, for conventional ghost imaging, the larger the image size is, the more measurements are needed. However, for our method, images with different sizes can be converted into QR code with the same small size by using a QR generator. Hence, for the larger-size images, the time required to recover original information with high quality will be dramatically reduced. Our method makes it easy to recover a color image in a ghost imaging setup, because it is not necessary to divide the color image into three channels and respectively recover them.

The costs and effects of contrast-enhanced magnetic resonance angiography and digital substraction angiography on quality of life in patients with peripheral arterial disease.

PubMed

Bosma, Jan; Dijksman, Lea M; Lam, Kayan; Wisselink, Willem; van Swijndregt, Alexander D Montauban; Vahl, Anco

2014-04-01

Contrast-enhanced magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (DSA) both have a high diagnostic performance in the imaging of peripheral arterial occlusive disease (PAOD). However, little is known about the effects of initial, preoperative imaging using MRA or DSA on quality of life (QoL) in relation to costs (cost-utility). To compare cost-utility of treatment strategies using either MRA or DSA as the principal imaging tool, related to QoL, in patients with PAOD. In a prospective subgroup analysis of patients randomized between MRA and DSA (n = 79) for preoperative imaging, QoL questionnaires (SF-36) were obtained at randomization and at 4-month follow-up. Cost-effectiveness from hospital perspective was subsequently compared between groups and the difference in gained or lost QoL per € spent assessed using bootstrap analysis. No difference in quality of life was found. A treatment trajectory employing MRA as the principal imaging modality was almost 20% cheaper, leading to a better cost-utility ratio in favor of MRA. A treatment plan for peripheral arterial occlusive disease employing MRA versus DSA as the principal imaging modality yields a better cost/QoL ratio for MRA.

Usage Data as Indicators of OER Utility

ERIC Educational Resources Information Center

Mardis, Marcia A.; Ambavarapu, Chandrahasa R.

2017-01-01

A key component of online and blended learning content, open educational resources, (OER) are heralded in a global movement toward high-quality, affordable, accessible, and personalized education. However, stakeholders have expressed concern about scaling OER use due to a lack of means to ensure a fit between learner, resource, and task. Usage…

Limnological Studies at Eau Galle Lake, Wisconsin. Report 1. Introduction and Water Quality Monitoring Studies.

DTIC Science & Technology

1985-03-01

the phototrophic zone, high photo- ;ynthetic activity utilized CO thus reducing the alkalinity; at the 2’ ;ame time, the release of bicarbonate...1982). Like turbidity, suspended solids levels were elevated in the phototrophic zone due to phytoplankton blooms. This was especially noticeable

Pitting Corrosion of Copper in Waters with High pH and Low Alkalinity

EPA Science Inventory

Localized or pitting corrosion of copper pipes used in household drinking-water plumbing is a problem for many water utilities and their customers. Extreme attack can lead to pinhole water leaks that may result in water damage, mold growth, and costly repairs. Water quality has b...

South Coast Air Quality Management District Truck Testing | Transportation

Science.gov Websites

movement of cargo containers, also known as drayage, creates substantial air pollution in the vicinity of and U.S. Hybrid Corporation, transport cargo containers between the port complex and local rail yards and distribution centers. Utilizing advanced batteries and high-efficiency components, the electric

Skype Synchronous Interaction Effectiveness in a Quantitative Management Science Course

ERIC Educational Resources Information Center

Strang, Kenneth David

2012-01-01

An experiment compared asynchronous versus synchronous instruction in an online quantitative course. Mann-Whitney U-tests, correlation, analysis of variance, t tests, and multivariate analysis of covariance (MANCOVA) were utilized to test the hypothesis that more high-quality online experiential learning interactions would increase grade.…

Meeting the Challenge: Providing High-Quality School Environments through Energy Performance Contracting.

ERIC Educational Resources Information Center

Birr, David

2000-01-01

Energy performance contracting allows schools to pay for needed new energy equipment and modernization improvements with savings from reduced utility and maintenance costs. Improved energy efficiency reduces demand for burning fossil fuels, which reduces air pollution, leading to improved learning environments and budgets (through improved average…

Squaring the Circle: A New Alternative to Alternative-Assessment

ERIC Educational Resources Information Center

Williams, Peter

2014-01-01

Many quality assurance systems rely on high-stakes assessment for course certification. Such methods are not as objective as they might appear; they can have detrimental effects on student motivation and may lack relevance to the needs of degree courses increasingly oriented to vocational utility. "Alternative assessment" methods can…

Drinking Water Microbiome as a Screening Tool for Nitrification in Chloraminated Drinking Water Distribution Systems (abstract)

EPA Science Inventory

Many water utilities in the US using chloramine as disinfectant treatment in their distribution systems have experienced nitrification episodes, which detrimentally impact the water quality. Here, we used 16S rRNA sequencing data to generate high-resolution taxonomic profiles of...

Two year measurement of nitrous oxide emission from high frequency surface and subsurface drip irrigations in pomegranate orchard

USDA-ARS?s Scientific Manuscript database

Building resiliency in California agriculture means utilizing adaptive farming practices that will produce better yields while overcoming the State’s current challenges, such as diminishing water supply and deteriorating water quality. In addition, California agriculture also needs to take proactive...

The Newick utilities: high-throughput phylogenetic tree processing in the UNIX shell.

PubMed

Junier, Thomas; Zdobnov, Evgeny M

2010-07-01

We present a suite of Unix shell programs for processing any number of phylogenetic trees of any size. They perform frequently-used tree operations without requiring user interaction. They also allow tree drawing as scalable vector graphics (SVG), suitable for high-quality presentations and further editing, and as ASCII graphics for command-line inspection. As an example we include an implementation of bootscanning, a procedure for finding recombination breakpoints in viral genomes. C source code, Python bindings and executables for various platforms are available from http://cegg.unige.ch/newick_utils. The distribution includes a manual and example data. The package is distributed under the BSD License. thomas.junier@unige.ch

Hyperspectral microscope for in vivo imaging of microstructures and cells in tissues

DOEpatents

Demos,; Stavros, G [Livermore, CA

2011-05-17

An optical hyperspectral/multimodal imaging method and apparatus is utilized to provide high signal sensitivity for implementation of various optical imaging approaches. Such a system utilizes long working distance microscope objectives so as to enable off-axis illumination of predetermined tissue thereby allowing for excitation at any optical wavelength, simplifies design, reduces required optical elements, significantly reduces spectral noise from the optical elements and allows for fast image acquisition enabling high quality imaging in-vivo. Such a technology provides a means of detecting disease at the single cell level such as cancer, precancer, ischemic, traumatic or other type of injury, infection, or other diseases or conditions causing alterations in cells and tissue micro structures.

A conceptual demonstration of freeze desalination-membrane distillation (FD-MD) hybrid desalination process utilizing liquefied natural gas (LNG) cold energy.

PubMed

Wang, Peng; Chung, Tai-Shung

2012-09-01

The severe global water scarcity and record-high fossil oil price have greatly stimulated the research interests on new desalination technologies which can be driven by renewable energy or waste energy. In this study, a hybrid desalination process comprising freeze desalination and membrane distillation (FD-MD) processes was developed and explored in an attempt to utilize the waste cold energy released from re-gasification of liquefied natural gas (LNG). The concept of this technology was demonstrated using indirect-contact freeze desalination (ICFD) and direct-contact membrane distillation (DCMD) configurations. By optimizing the ICFD operation parameters, namely, the usage of nucleate seeds, operation duration and feed concentration, high quality drinkable water with a low salinity ∼0.144 g/L was produced in the ICFD process. At the same time, using the optimized hollow fiber module length and packing density in the DCMD process, ultra pure water with a low salinity of 0.062 g/L was attained at a condition of high energy efficiency (EE). Overall, by combining FD and MD processes and adopting the optimized operation parameters, the hybrid FD-MD system has been successfully demonstrated. A high total water recovery of 71.5% was achieved, and the water quality obtained met the standard for drinkable water. In addition, with results from specific energy calculation, it was proven that the hybrid process is an energy-saving process and utilization of LNG cold energy could greatly reduce the total energy consumption. Copyright © 2012 Elsevier Ltd. All rights reserved.

Assessment of emergency general surgery care based on formally developed quality indicators.

PubMed

Ingraham, Angela; Nathens, Avery; Peitzman, Andrew; Bode, Allison; Dorlac, Gina; Dorlac, Warren; Miller, Preston; Sadeghi, Mahsa; Wasserman, Deena D; Bilimoria, Karl

2017-08-01

Emergency general surgery outcomes vary widely across the United States. The utilization of quality indicators can reduce variation and assist providers in administering care aligned with established recommendations. Previous quality indicators have not focused on emergency general surgery patients. We identified indicators of high-quality emergency general surgery care and assessed patient- and hospital-level compliance with these indicators. We utilized a modified Delphi technique (RAND Appropriateness Methodology) to develop quality indicators. Through 2 rankings, an expert panel ranked potential quality indicators for validity. We then examined historic compliance with select quality indicators after 4 nonelective procedures (cholecystectomy, appendectomy, colectomy, small bowel resection) at 4 academic centers. Of 25 indicators rated as valid, 13 addressed patient-level quality and 12 addressed hospital-level quality. Adherence with 18 indicators was assessed. Compliance with performing a cholecystectomy for acute cholecystitis within 72 hours of symptom onset ranged from 45% to 76%. Compliance with surgery start times within 3 hours from the decision to operate for uncontained perforated viscus ranged from 20% to 100%. Compliance with exploration of patients with small bowel obstructions with ischemia/impending perforation within 3 hours of the decision to operate was 0% to 88%. For 3 quality indicators (auditing 30-day unplanned readmissions/operations for patients previously managed nonoperatively, monitoring time to source control for intra-abdominal infections, and having protocols for bypass/transfer), none of the hospitals were compliant. Developing indicators for providers to assess their performance provides a foundation for specific initiatives. Adherence to quality indicators may improve the quality of emergency general surgery care provided for which current outcomes are potentially modifiable. Copyright © 2017 Elsevier Inc. All rights reserved.

Year rather than farming system influences protein utilization and energy value of vegetables when measured in a rat model.

PubMed

Jørgensen, Henry; Brandt, Kirsten; Lauridsen, Charlotte

2008-12-01

The aim of the study was to measure protein utilization and energy value of dried apple, carrot, kale, pea, and potato prepared for human consumption and grown in 2 consecutive years with 3 different farming systems: (1) low input of fertilizer without pesticides (LIminusP), (2) low input of fertilizers and high input of pesticides (LIplusP), (3) and high input of fertilizers and high input of pesticides (HIplusP). In addition, the study goal was to verify the nutritional values, taking into consideration the physiologic state. In experiment 1, the nutritive values, including protein digestibility-corrected amino acid score, were determined in single ingredients in trials with young rats (3-4 weeks) as recommended by the Food and Agriculture Organization of the United Nations/World Health Organization for all age groups. A second experiment was carried out with adult rats to assess the usefulness of digestibility values to predict the digestibility and nutritive value of mixed diets and study the age aspect. Each plant material was included in the diet with protein-free basal mixtures or casein to contain 10% dietary protein. The results showed that variations in protein utilization and energy value determined on single ingredients between cultivation strategies were inconsistent and smaller than between harvest years. Overall, dietary crude fiber was negatively correlated with energy digestibility. The energy value of apple, kale, and pea was lower than expected from literature values. A mixture of plant ingredients fed to adult rats showed lower protein digestibility and higher energy digestibility than predicted. The protein digestibility data obtained using young rats in the calculation of protein digestibility-corrected amino acid score overestimates protein digestibility and quality and underestimates energy value for mature rats. The present study provides new data on protein utilization and energy digestibility of some typical plant foods that may contribute new information for databases on food quality. Growing year but not cultivation system influenced the protein quality and energy value of the vegetables and fruit typical for human consumption.

Regeneration of high-quality silk fibroin fiber by wet spinning from CaCl2-formic acid solvent.

PubMed

Zhang, Feng; Lu, Qiang; Yue, Xiaoxiao; Zuo, Baoqi; Qin, Mingde; Li, Fang; Kaplan, David L; Zhang, Xueguang

2015-01-01

Silks spun by silkworms and spiders feature outstanding mechanical properties despite being spun under benign conditions. The superior physical properties of silk are closely related to its complicated hierarchical structures constructed from nanoscale building blocks, such as nanocrystals and nanofibrils. Here, we report a novel silk dissolution behavior, which preserved nanofibrils in CaCl2-formic acid solution, that enables spinning of high-quality fibers with a hierarchical structure. This process is characterized by simplicity, high efficiency, low cost, environmental compatibility and large-scale industrialization potential, as well as having utility and potential for the recycling of silk waste and the production of silk-based functional materials. Copyright © 2014. Published by Elsevier Ltd.

An investigation of turbulence structure in a low-Reynolds-number incompressible turbulent boundary

NASA Technical Reports Server (NTRS)

White, B. R.; Strataridakis, C. J.

1987-01-01

An existing high turbulence intensity level (5%) atmospheric boundary-layer wind tunnel has been successfully converted to a relatively low level turbulence (0.3%) wind tunnel through extensive modification, testing, and calibration. A splitter plate was designed, built, and installed into the wind-tunnel facility to create thick, mature, two-dimensional turbulent boundary layer flow at zero pressure gradient. Single and cross hot-wire measurements show turbulent boundary layer characteristics of good quality with unusually large physical size, i.e., viscous sublayer of the order of 1 mm high. These confirm the potential ability of the tunnel to be utilized for future high-quality near-wall turbulent boundary layer measurements. It compares very favorably with many low turbulence research tunnels.

High Efficiency InP Solar Cells from Low Toxicity Tertiarybutylphosphine

NASA Technical Reports Server (NTRS)

Hoffman, Richard W., Jr.; Fatemi, Navid S.; Wilt, David M.; Jenkins, Phillip P.; Brinker, David J.; Scheiman, David A.

1994-01-01

Large scale manufacture of phosphide based semiconductor devices by organo-metallic vapor phase epitaxy (OMVPE) typically requires the use of highly toxic phosphine. Advancements in phosphine substitutes have identified tertiarybutylphosphine (TBP) as an excellent precursor for OMVPE of InP. High quality undoped and doped InP films were grown using TBP and trimethylindium. Impurity doped InP films were achieved utilizing diethylzinc and silane for p and n type respectively. 16 percent efficient solar cells under air mass zero, one sun intensity were demonstrated with Voc of 871 mV and fill factor of 82.6 percent. It was shown that TBP could replace phosphine, without adversely affecting device quality, in OMVPE deposition of InP thus significantly reducing toxic gas exposure risk.

Thermally-enhanced oil recovery method and apparatus

DOEpatents

Stahl, Charles R.; Gibson, Michael A.; Knudsen, Christian W.

1987-01-01

A thermally-enhanced oil recovery method and apparatus for exploiting deep well reservoirs utilizes electric downhole steam generators to provide supplemental heat to generate high quality steam from hot pressurized water which is heated at the surface. A downhole electric heater placed within a well bore for local heating of the pressurized liquid water into steam is powered by electricity from the above-ground gas turbine-driven electric generators fueled by any clean fuel such as natural gas, distillate or some crude oils, or may come from the field being stimulated. Heat recovered from the turbine exhaust is used to provide the hot pressurized water. Electrical power may be cogenerated and sold to an electric utility to provide immediate cash flow and improved economics. During the cogeneration period (no electrical power to some or all of the downhole units), the oil field can continue to be stimulated by injecting hot pressurized water, which will flash into lower quality steam at reservoir conditions. The heater includes electrical heating elements supplied with three-phase alternating current or direct current. The injection fluid flows through the heater elements to generate high quality steam to exit at the bottom of the heater assembly into the reservoir. The injection tube is closed at the bottom and has radial orifices for expanding the injection fluid to reservoir pressure.

The role of fine-grained annotations in supervised recognition of risk factors for heart disease from EHRs.

PubMed

Roberts, Kirk; Shooshan, Sonya E; Rodriguez, Laritza; Abhyankar, Swapna; Kilicoglu, Halil; Demner-Fushman, Dina

2015-12-01

This paper describes a supervised machine learning approach for identifying heart disease risk factors in clinical text, and assessing the impact of annotation granularity and quality on the system's ability to recognize these risk factors. We utilize a series of support vector machine models in conjunction with manually built lexicons to classify triggers specific to each risk factor. The features used for classification were quite simple, utilizing only lexical information and ignoring higher-level linguistic information such as syntax and semantics. Instead, we incorporated high-quality data to train the models by annotating additional information on top of a standard corpus. Despite the relative simplicity of the system, it achieves the highest scores (micro- and macro-F1, and micro- and macro-recall) out of the 20 participants in the 2014 i2b2/UTHealth Shared Task. This system obtains a micro- (macro-) precision of 0.8951 (0.8965), recall of 0.9625 (0.9611), and F1-measure of 0.9276 (0.9277). Additionally, we perform a series of experiments to assess the value of the annotated data we created. These experiments show how manually-labeled negative annotations can improve information extraction performance, demonstrating the importance of high-quality, fine-grained natural language annotations. Copyright © 2015 Elsevier Inc. All rights reserved.

A robotics platform for automated batch fabrication of high density, microfluidics-based DNA microarrays, with applications to single cell, multiplex assays of secreted proteins

NASA Astrophysics Data System (ADS)

Ahmad, Habib; Sutherland, Alex; Shin, Young Shik; Hwang, Kiwook; Qin, Lidong; Krom, Russell-John; Heath, James R.

2011-09-01

Microfluidics flow-patterning has been utilized for the construction of chip-scale miniaturized DNA and protein barcode arrays. Such arrays have been used for specific clinical and fundamental investigations in which many proteins are assayed from single cells or other small sample sizes. However, flow-patterned arrays are hand-prepared, and so are impractical for broad applications. We describe an integrated robotics/microfluidics platform for the automated preparation of such arrays, and we apply it to the batch fabrication of up to eighteen chips of flow-patterned DNA barcodes. The resulting substrates are comparable in quality with hand-made arrays and exhibit excellent substrate-to-substrate consistency. We demonstrate the utility and reproducibility of robotics-patterned barcodes by utilizing two flow-patterned chips for highly parallel assays of a panel of secreted proteins from single macrophage cells.

A robotics platform for automated batch fabrication of high density, microfluidics-based DNA microarrays, with applications to single cell, multiplex assays of secreted proteins

PubMed Central

Ahmad, Habib; Sutherland, Alex; Shin, Young Shik; Hwang, Kiwook; Qin, Lidong; Krom, Russell-John; Heath, James R.

2011-01-01

Microfluidics flow-patterning has been utilized for the construction of chip-scale miniaturized DNA and protein barcode arrays. Such arrays have been used for specific clinical and fundamental investigations in which many proteins are assayed from single cells or other small sample sizes. However, flow-patterned arrays are hand-prepared, and so are impractical for broad applications. We describe an integrated robotics/microfluidics platform for the automated preparation of such arrays, and we apply it to the batch fabrication of up to eighteen chips of flow-patterned DNA barcodes. The resulting substrates are comparable in quality with hand-made arrays and exhibit excellent substrate-to-substrate consistency. We demonstrate the utility and reproducibility of robotics-patterned barcodes by utilizing two flow-patterned chips for highly parallel assays of a panel of secreted proteins from single macrophage cells. PMID:21974603

A robotics platform for automated batch fabrication of high density, microfluidics-based DNA microarrays, with applications to single cell, multiplex assays of secreted proteins.

PubMed

Ahmad, Habib; Sutherland, Alex; Shin, Young Shik; Hwang, Kiwook; Qin, Lidong; Krom, Russell-John; Heath, James R

2011-09-01

Microfluidics flow-patterning has been utilized for the construction of chip-scale miniaturized DNA and protein barcode arrays. Such arrays have been used for specific clinical and fundamental investigations in which many proteins are assayed from single cells or other small sample sizes. However, flow-patterned arrays are hand-prepared, and so are impractical for broad applications. We describe an integrated robotics/microfluidics platform for the automated preparation of such arrays, and we apply it to the batch fabrication of up to eighteen chips of flow-patterned DNA barcodes. The resulting substrates are comparable in quality with hand-made arrays and exhibit excellent substrate-to-substrate consistency. We demonstrate the utility and reproducibility of robotics-patterned barcodes by utilizing two flow-patterned chips for highly parallel assays of a panel of secreted proteins from single macrophage cells. © 2011 American Institute of Physics

An importance-performance analysis of hospital information system attributes: A nurses' perspective.

PubMed

Cohen, Jason F; Coleman, Emma; Kangethe, Matheri J

2016-02-01

Health workers have numerous concerns about hospital IS (HIS) usage. Addressing these concerns requires understanding the system attributes most important to their satisfaction and productivity. Following a recent HIS implementation, our objective was to identify priorities for managerial intervention based on user evaluations of the performance of the HIS attributes as well as the relative importance of these attributes to user satisfaction and productivity outcomes. We collected data along a set of attributes representing system quality, data quality, information quality, and service quality from 154 nurse users. Their quantitative responses were analysed using the partial least squares approach followed by an importance-performance analysis. Qualitative responses were analysed using thematic analysis to triangulate and supplement the quantitative findings. Two system quality attributes (responsiveness and ease of learning), one information quality attribute (detail), one service quality attribute (sufficient support), and three data quality attributes (records complete, accurate and never missing) were identified as high priorities for intervention. Our application of importance-performance analysis is unique in HIS evaluation and we have illustrated its utility for identifying those system attributes for which underperformance is not acceptable to users and therefore should be high priorities for intervention. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The Gain of Resource Delegation in Distributed Computing Environments

NASA Astrophysics Data System (ADS)

Fölling, Alexander; Grimme, Christian; Lepping, Joachim; Papaspyrou, Alexander

In this paper, we address job scheduling in Distributed Computing Infrastructures, that is a loosely coupled network of autonomous acting High Performance Computing systems. In contrast to the common approach of mutual workload exchange, we consider the more intuitive operator's viewpoint of load-dependent resource reconfiguration. In case of a site's over-utilization, the scheduling system is able to lease resources from other sites to keep up service quality for its local user community. Contrary, the granting of idle resources can increase utilization in times of low local workload and thus ensure higher efficiency. The evaluation considers real workload data and is done with respect to common service quality indicators. For two simple resource exchange policies and three basic setups we show the possible gain of this approach and analyze the dynamics in workload-adaptive reconfiguration behavior.

Diabetes in the African-American Medicare population. Morbidity, quality of care, and resource utilization.

PubMed

Chin, M H; Zhang, J X; Merrell, K

1998-07-01

To determine whether African-American Medicare recipients with diabetes are at increased risk for morbidity, poor quality of care, and high resource utilization. We analyzed 1,376 patients with diabetes who were > or = 65 years of age and in the 1993 Medicare Current Beneficiary Survey. Morbidity measures were the Katz Index of Activities of Daily Living, Instrumental Activities of Daily Living, overall health perception, Charlson Comorbidity Index score, and diabetic complications. Quality of care standards were glycosylated hemoglobin measurements, ophthalmological visits, lipid testing, mammography, influenza vaccination, readmission within 30 days of hospital discharge, and outpatient visits within 4 weeks of hospital discharge. We stratified Medicare reimbursement by type of service and adjusted for sex, education, and age in multivariable analyses. Compared with white patients, African-American patients had worse health perception and lower quality of care. They were more likely to visit the emergency department and had fewer physician visits per year. African-Americans had higher reimbursement for home health services, but total reimbursement was similar after case-mix adjustment. Improved access to preventive care for older African-Americans with diabetes may improve health perception and use of the emergency department. The potential effect on total reimbursement is unclear. Future policy interventions to improve quality of care among Medicare patients with diabetes should especially target African-Americans.

Cost-utility of ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Spain.

PubMed

Hidalgo-Vega, Alvaro; Ramos-Goñi, Juan Manuel; Villoro, Renata

2014-12-01

Ranolazine is an antianginal agent that was approved in the EU in 2008 as an add-on therapy for symptomatic chronic angina pectoris treatment in patients who are inadequately controlled by, or are intolerant to, first-line antianginal therapies. These patients' quality of life is significantly affected by more frequent angina events, which increase the risk of revascularization. To assess the cost-utility of ranolazine versus placebo as an add-on therapy for the symptomatic treatment of patients with chronic angina pectoris in Spain. A decision tree model with 1-year time horizon was designed. Transition probabilities and utility values for different angina frequencies were obtained from the literature. Costs were obtained from Spanish official DRGs for patients with chronic angina pectoris. We calculated the incremental cost-utility ratio of using ranolazine compared with a placebo. Sensitivity analyses, by means of Monte Carlo simulations, were performed. Acceptability curves and expected value of perfect information were calculated. The incremental cost-utility ratio was €8,455 per quality-adjusted life-year (QALY) per patient in Spain. Sensitivity analyses showed that if the decision makers' willingness to pay is €15,000 per QALY, the treatment with ranolazine will be cost effective at a 95 % level of confidence. The incremental cost-utility ratio is particularly sensitive to changes in utility values of those non-hospitalized patients with mild or moderate angina frequency. Ranolazine is a highly efficient add-on therapy for the symptomatic treatment of chronic angina pectoris in patients who are inadequately controlled by, or intolerant to, first-line antianginal therapies in Spain.

"Fibromyalgia and quality of life: mapping the revised fibromyalgia impact questionnaire to the preference-based instruments".

PubMed

Collado-Mateo, Daniel; Chen, Gang; Garcia-Gordillo, Miguel A; Iezzi, Angelo; Adsuar, José C; Olivares, Pedro R; Gusi, Narcis

2017-05-30

The revised version of the Fibromyalgia Impact Questionnaire (FIQR) is one of the most widely used specific questionnaires in FM studies. However, this questionnaire does not allow calculation of QALYs as it is not a preference-based measure. The aim of this study was to develop mapping algorithm which enable FIQR scores to be transformed into utility scores that can be used in the cost utility analyses. A cross-sectional survey was conducted. One hundred and 92 Spanish women with Fibromyalgia were asked to complete four general quality of life questionnaires, i.e. EQ-5D-5 L, 15D, AQoL-8D and SF-12, and one specific disease instrument, the FIQR. A direct mapping approach was adopted to derive mapping algorithms between the FIQR and each of the four multi-attribute utility (MAU) instruments. Health state utility was treated as the dependent variable in the regression analysis, whilst the FIQR score and age were predictors. The mean utility scores ranged from 0.47 (AQoL-8D) to 0.69 (15D). All correlations between the FIQR total score and MAU instruments utility scores were highly significant (p < 0.0001) with magnitudes larger than 0.5. Although very slight differences in the mean absolute error were found between ordinary least squares (OLS) estimator and generalized linear model (GLM), models based on GLM were better for EQ-5D-5 L, AQoL-8D and 15D. Mapping algorithms developed in this study enable the estimation of utility values from scores in a fibromyalgia specific questionnaire.

Scoping review of pediatric tonsillectomy quality of life assessment instruments.

PubMed

Kao, Stephen Shih-Teng; Peters, Micah D J; Dharmawardana, Nuwan; Stew, Benjamin; Ooi, Eng Hooi

2017-10-01

Sleep-disordered breathing or recurrent tonsillitis have detrimental effects on the child's physical health and quality of life. Tonsillectomy is commonly performed to treat these common conditions and improve the child's quality of life. This scoping review aims to present a comprehensive and descriptive analysis of quality of life questionnaires as a resource for clinicians and researchers when deciding which tool to use when assessing the quality of life effects after tonsillectomy. A comprehensive search strategy was undertaken across MEDLINE (PubMed), CINAHL, Embase, and Cochrane CENTRAL. Quality of life questionnaires utilized in studies investigating pediatric patients undergoing tonsillectomy for chronic tonsillitis or sleep-disordered breathing were included. Methodological quality and data extraction were conducted as per Joanna Briggs Institute methodology. Ten questionnaires were identified, consisting of six generic and four disease-specific instruments. The Pediatric Quality of Life Inventory was the most commonly utilized generic questionnaire. The Obstructive Sleep Apnea-18 was the most commonly utilized disease-specific questionnaire. This review identified a range of generic and disease-specific quality of life questionnaires utilized in pediatric patients who have undergone tonsillectomy with or without adenoidectomy for sleep-disordered breathing or chronic tonsillitis. Important aspects of each questionnaire have been summarized to aid researchers and clinicians in choosing the appropriate questionnaire when evaluating the quality of life effects of tonsillectomy. NA Laryngoscope, 127:2399-2406, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Societal Value of Surgery for Facial Reanimation.

PubMed

Su, Peiyi; Ishii, Lisa E; Joseph, Andrew; Nellis, Jason; Dey, Jacob; Bater, Kristin; Byrne, Patrick J; Boahene, Kofi D O; Ishii, Masaru

2017-03-01

Patients with facial paralysis are perceived negatively by society in a number of domains. Society's perception of the health utility of varying degrees of facial paralysis and the value society places on reconstructive surgery for facial reanimation need to be quantified. To measure health state utility of varying degrees of facial paralysis, willingness to pay (WTP) for a repair, and the subsequent value of facial reanimation surgery as perceived by society. This prospective observational study conducted in an academic tertiary referral center evaluated a group of 348 casual observers who viewed images of faces with unilateral facial paralysis of 3 severity levels (low, medium, and high) categorized by House-Brackmann grade. Structural equation modeling was performed to understand associations among health utility metrics, WTP, and facial perception domains. Data were collected from July 16 to September 26, 2015. Observer-rated (1) quality of life (QOL) using established health utility metrics (standard gamble, time trade-off, and a visual analog scale) and (2) their WTP for surgical repair. Among the 348 observers (248 women [71.3%]; 100 men [28.7%]; mean [SD] age, 29.3 [11.6] years), mixed-effects linear regression showed that WTP increased nonlinearly with increasing severity of paralysis. Participants were willing to pay $3487 (95% CI, $2362-$4961) to repair low-grade paralysis, $8571 (95% CI, $6401-$11 234) for medium-grade paralysis, and $20 431 (95% CI, $16 273-$25 317) for high-grade paralysis. The dominant factor affecting the participants' WTP was perceived QOL. Modeling showed that perceived QOL decreased with paralysis severity (regression coefficient, -0.004; 95% CI, -0.005 to -0.004; P < .001) and increased with attractiveness (regression coefficient, 0.002; 95% CI, 0.002 to 0.003; P < .001). Mean (SD) health utility scores calculated by the standard gamble metric for low- and high-grade paralysis were 0.98 (0.09) and 0.77 (0.25), respectively. Time trade-off and visual analog scale measures were highly correlated. We calculated mean (SD) WTP per quality-adjusted life-year, which ranged from $10 167 ($14 565) to $17 008 ($38 288) for low- to high-grade paralysis, respectively. Society perceives the repair of facial paralysis to be a high-value intervention. Societal WTP increases and perceived health state utility decreases with increasing House-Brackmann grade. This study demonstrates the usefulness of WTP as an objective measure to inform dimensions of disease severity and signal the value society places on proper facial function. NA.

Drinking water sources, availability, quality, access and utilization for goats in the Karak Governorate, Jordan.

PubMed

Al-Khaza'leh, Ja'far Mansur; Reiber, Christoph; Al Baqain, Raid; Valle Zárate, Anne

2015-01-01

Goat production is an important agricultural activity in Jordan. The country is one of the poorest countries in the world in terms of water scarcity. Provision of sufficient quantity of good quality drinking water is important for goats to maintain feed intake and production. This study aimed to evaluate the seasonal availability and quality of goats' drinking water sources, accessibility, and utilization in different zones in the Karak Governorate in southern Jordan. Data collection methods comprised interviews with purposively selected farmers and quality assessment of water sources. The provision of drinking water was considered as one of the major constraints for goat production, particularly during the dry season (DS). Long travel distances to the water sources, waiting time at watering points, and high fuel and labor costs were the key reasons associated with the problem. All the values of water quality (WQ) parameters were within acceptable limits of the guidelines for livestock drinking WQ with exception of iron, which showed slightly elevated concentration in one borehole source in the DS. These findings show that water shortage is an important problem leading to consequences for goat keepers. To alleviate the water shortage constraint and in view of the depleted groundwater sources, alternative water sources at reasonable distance have to be tapped and monitored for water quality and more efficient use of rainwater harvesting systems in the study area is recommended.

High-Price And Low-Price Physician Practices Do Not Differ Significantly On Care Quality Or Efficiency.

PubMed

Roberts, Eric T; Mehrotra, Ateev; McWilliams, J Michael

2017-05-01

Consolidation of physician practices has intensified concerns that providers with greater market power may be able to charge higher prices without having to deliver better care, compared to providers with less market power. Providers have argued that higher prices cover the costs of delivering higher-quality care. We examined the relationship between physician practice prices for outpatient services and practices' quality and efficiency of care. Using commercial claims data, we classified practices as being high- or low-price. We used national data from the Consumer Assessment of Healthcare Providers and Systems survey and linked claims for Medicare beneficiaries to compare high- and low-price practices in the same geographic area in terms of care quality, utilization, and spending. Compared with low-price practices, high-price practices were much larger and received 36 percent higher prices. Patients of high-price practices reported significantly higher scores on some measures of care coordination and management but did not differ meaningfully in their overall care ratings, other domains of patient experiences (including physician ratings and access to care), receipt of preventive services, acute care use, or total Medicare spending. This suggests an overall weak relationship between practice prices and the quality and efficiency of care and calls into question claims that high-price providers deliver substantially higher-value care. Project HOPE—The People-to-People Health Foundation, Inc.

Fostering a Commitment to Quality: Best Practices in Safety-net Hospitals.

PubMed

Hochman, Michael; Briggs-Malonson, Medell; Wilkes, Erin; Bergman, Jonathan; Daskivich, Lauren Patty; Moin, Tannaz; Brook, Ilanit; Ryan, Gery W; Brook, Robert H; Mangione, Carol M

2016-01-01

In 2007, the Martin Luther King, Jr.-Harbor Hospital (MLK-Harbor), which served a large safety-net population in South Los Angeles, closed due to quality challenges. Shortly thereafter, an agreement was made to establish a new hospital, Martin Luther King, Jr. Community Hospital (MLKCH), to serve the unmet needs of the community. To assist the newly appointed MLKCH Board of Directors in building a culture of quality, we conducted a series of interviews with five high-performing hospital systems. In this report, we describe our findings. The hospitals we interviewed achieved a culture of quality by: 1) developing guiding principles that foster quality; 2) hiring and retaining personnel who are stewards of quality; 3) promoting efficient resource utilization; 4) developing a well-organized quality improvement infrastructure; and 5) cultivating integrated, patient-centric care. The institutions highlighted in this report provide important lessons for MLKCH and other safety-net institutions.

A study on the quality of outpatient prescription of psychopharmaceuticals in the City of Zagreb 2006-2009.

PubMed

Zivković, Kresimir; Zelić-Kerep, Ana; Stimac, Danijela; Ozić, Sanja; Zivković, Nikica

2014-06-01

The lack of Croatian studies which could determine the justifiability of excessive psychopharmaceutical utilization was an encouragement to conduct this research. Furthermore, regarding the conduction of this study, it would be possible to determine whether the trend of drug utilization has increased, decreased or perhaps stabilized. The data on the outpatient utilization of psycholeptics and psychoanaleptics were collected from all Zagreb pharmacies, 2006-2009. Based on the collected data for all N05 and N06 groups of drugs, the defined daily doses (DDD) and DDD per thousand inhabitants per day (DDD/TID) have been calculated using the Anatomical-Therapeutic-Chemical classification (ATC) for 2006, 2007, 2008 and 2009. To indicate the quality of drug prescription the Drug Utilization 90% (DU 90%) method was used. Moreover, in order to determine a more precise quality of individual drug group prescriptions, the indicators have been calculated by determining the proportion of the total utilization of individual therapeutic and pharmacological therapeutic subgroups in DDD/TID a day. The utilization of anxiolytics (N05B) accounts for most of the psycholeptic utilization in the City of Zagreb throughout the entire study period. In the study period, the utilization of antidepressants has slightly increased, by 10.5%, taking the first and the last years of the period into account. In 2006, 5 benzodiazepines and the hypnotic zolpidem, as well as 5 selective serotonin reuptake inhibitors (SSRIs) and 1 third generation antipsychotic (olanzapin) were found in the DU 90% segment. In 2009, the DU 90% segment also comprised 5 benzodiazepines and the hypnotic zolpidem, as well as 6 SSRIs and 1 third generation antipsychotic (olanzapin). In the City of Zagreb, a general insight into the quality of psychopharmaceutical prescriptions indicates stability in comparison to earlier studies. The ratio index of the first generation antipsychotic utilization, compared to the third generation antipsychotics, shows an increase in the quality of prescription. Also, the ratio index of total tricyclic antidepressants (TCA) and SSRI utilization indicates improvement in quality of prescription. The ratio index of the entire outpatient utilization of anxiolytics and antidepressants expressed in DDD/TID unfortunately shows a very mild increase of prescription quality. Benzodiazepines accounted for more than 50% of the outpatient utilization of psychopharmaceuticals throughout the study period, which proves the need for precise guidelines as the most significant means of drug rationalization and utilization. It is necessary to identify priorities and problems in order to solve them successfully, by monitoring drug utilization and prescription on a national level. Results demonstrate that within the primary health care system, there is a need for constant education on rational prescription of this drug group.

Comparison of Nondestructive Testing Methods for Evaluating No. 2 Southern Pine Lumber: Part A, Modulus of Elasticity

Treesearch

B.Z. Yang; R.D. Seale; R. Shmulsky; J. Dahlen; Xiping Wang

2015-01-01

Modulus of elasticity (MOE, or E) is one of the main quality indicators in structural lumber stress grading systems. Due to a relatively high amount of variability in contemporary sawn lumber, it is important that nondestructive evaluation technology be utilized to better discern high-E-value pieces from low-E-value pieces. The research described in this study is from...

Synthesis of thin films and materials utilizing a gaseous catalyst

DOEpatents

Morse, Daniel E; Schwenzer, Birgit; Gomm, John R; Roth, Kristian M; Heiken, Brandon; Brutchey, Richard

2013-10-29

A method for the fabrication of nanostructured semiconducting, photoconductive, photovoltaic, optoelectronic and electrical battery thin films and materials at low temperature, with no molecular template and no organic contaminants. High-quality metal oxide semiconductor, photovoltaic and optoelectronic materials can be fabricated with nanometer-scale dimensions and high dopant densities through the use of low-temperature biologically inspired synthesis routes, without the use of any biological or biochemical templates.

Transforming High School Classrooms with Free/Open Source Software: "It's Time for an Open Source Software Revolution"

ERIC Educational Resources Information Center

Pfaffman, Jay

2008-01-01

Free/Open Source Software (FOSS) applications meet many of the software needs of high school science classrooms. In spite of the availability and quality of FOSS tools, they remain unknown to many teachers and utilized by fewer still. In a world where most software has restrictions on copying and use, FOSS is an anomaly, free to use and to…

Creating a Statewide Educational Data System for Accountability and Improvement: A Comprehensive Information and Assessment System for Making Evidence-Based Change at School, District, and Policy Levels

ERIC Educational Resources Information Center

Felner, Robert D.; Bolton, Natalie; Seitsinger, Anne M.; Brand, Stephen; Burns, Amy

2008-01-01

This article reports on one ongoing statewide effort to create a high-quality data reporting and utilization system (i.e., High-Performance Learning Community [HiPlaces] Assessment) to inform educational accountability and improvement efforts system. This effort has undergoing refinement for more than a decade. The article describes the features…

Identifying impediments to long-distance mammal migrations.

PubMed

Seidler, Renee G; Long, Ryan A; Berger, Joel; Bergen, Scott; Beckmann, Jon P

2015-02-01

In much of the world, the persistence of long-distance migrations by mammals is threatened by development. Even where human population density is relatively low, there are roads, fencing, and energy development that present barriers to animal movement. If we are to conserve species that rely on long-distance migration, then it is critical that we identify existing migration impediments. To delineate stopover sites associated with anthropogenic development, we applied Brownian bridge movement models to high-frequency locations of pronghorn (Antilocapra americana) in the Greater Yellowstone Ecosystem. We then used resource utilization functions to assess the threats to long-distance migration of pronghorn that were due to fences and highways. Migrating pronghorn avoided dense developments of natural gas fields. Highways with relatively high volumes of traffic and woven-wire sheep fence acted as complete barriers. At crossings with known migration bottlenecks, use of high-quality forage and shrub habitat by pronghorn as they approached the highway was lower than expected based on availability of those resources. In contrast, pronghorn consistently utilized high-quality forage close to the highway at crossings with no known migration bottlenecks. Our findings demonstrate the importance of minimizing development in migration corridors in the future and of mitigating existing pressure on migratory animals by removing barriers, reducing the development footprint, or installing crossing structures. © 2014 Society for Conservation Biology.

Use of Six Sigma strategies to pull the line on central line-associated bloodstream infections in a neurotrauma intensive care unit.

PubMed

Loftus, Kelli; Tilley, Terry; Hoffman, Jason; Bradburn, Eric; Harvey, Ellen

2015-01-01

The creation of a consistent culture of safety and quality in an intensive care unit is challenging. We applied the Six Sigma Define-Measure-Analyze-Improve-Control (DMAIC) model for quality improvement (QI) to develop a long-term solution to improve outcomes in a high-risk neurotrauma intensive care unit. We sought to reduce central line utilization as a cornerstone in preventing central line-associated bloodstream infections (CLABSIs). This study describes the successful application of the DMAIC model in the creation and implementation of evidence-based quality improvement designed to reduce CLABSIs to below national benchmarks.

Association of suicidal ideation with poor sleep quality among Ethiopian adults.

PubMed

Gelaye, Bizu; Okeiga, Joseph; Ayantoye, Idris; Berhane, Hanna Y; Berhane, Yemane; Williams, Michelle A

2016-12-01

The objective of this study was to examine the extent to which poor sleep quality is associated with suicidal ideation among Ethiopian adults. A cross-sectional study was conducted among 1054 adults attending outpatient clinical facilities in Ethiopia. Standardized questionnaires were utilized to collect data on demographics, sleep quality, lifestyle, and depression status. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 (PHQ-9), while the Pittsburgh Sleep Quality Index (PSQI) questionnaire was utilized to assess sleep quality. Multivariate logistic regression models were fit to estimate adjusted odds ratio (AOR) and 95 % confidence intervals (95 % CI). The prevalence of suicidal ideation was 24.3 % while poor sleep quality (PSQI global score of >5 vs. ≤5) was endorsed by 60.2 % of participants. After adjustment for confounders including depression, poor sleep quality was associated with more than 3-fold increased odds of suicidal ideation (AOR = 3.59; 95 % CI 2.34-5.51). When assessed as a continuous variable, each 1-unit increase in the global PSQI score resulted in a 20 % increased odds for suicidal ideation, even after adjusting for depression (AOR = 1.20; 95 % CI 1.14-1.27). Participants with both poor sleep quality and depression had much higher odds (AOR = 23.22, 95 % CI 14.10-38.28) of suicidal ideation as compared with those who had good sleep quality and no depression although inferences from this analysis are limited due to the wide 95 % CI. Suicidal ideation and poor sleep quality are highly prevalent. Individuals with poor sleep quality have higher odds of suicidal ideation. If confirmed, mental health services need to address sleep disturbances seriously to prevent suicidal episodes.

Association of Suicidal Ideation with Poor Sleep Quality among Ethiopian Adults

PubMed Central

Gelaye, Bizu; Okeiga, Joseph; Ayantoye, Idris; Berhane, Hanna Y.; Berhane, Yemane; Williams, Michelle A.

2016-01-01

Objective To examine the extent to which poor sleep quality is associated with suicidal ideation among Ethiopian adults. Methods A cross-sectional study was conducted among 1,054 adults attending outpatient clinical facilities in Ethiopia. Standardized questionnaires were utilized to collect data on demographics, sleep quality, lifestyle, and depression status. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 (PHQ-9), while the Pittsburgh Sleep Quality Index (PSQI) questionnaire was utilized to assess sleep quality. Multivariate logistic regression models were fit to estimate adjusted odds ratio (AOR) and 95% confidence intervals (95%CI). Results The prevalence of suicidal ideation was 24.3% while poor sleep quality (PSQI global score of > 5vs. ≤5) was endorsed by 60.2% of participants. After adjustment for confounders including depression, poor sleep quality was associated with more than 3-fold increased odds of suicidal ideation (AOR=3.46; 95%CI 2.27–5.26). When assessed as a continuous variable, each 1-unit increase in the global PSQI score resulted in a 20% increased odds for suicidal ideation, even after adjusting for depression (AOR=1.20; 95%CI 1.14–1.27). Participants with both poor sleep quality and depression had much higher odds (AOR=24.9, 95% CI 15.2–40.8) of suicidal ideation as compared with those who had good sleep quality and no depression although inferences from this analysis are limited due to the wide 95%CI. Conclusion Suicidal ideation and poor sleep quality are highly prevalent. Individuals with poor sleep quality have higher odds of suicidal ideation. If confirmed, mental health services need to address sleep disturbances seriously to prevent suicidal episodes. PMID:27771845

Utilizing Educational Corporate Culture To Create a Quality School.

ERIC Educational Resources Information Center

Osborne, Bill

Strategies for utilizing educational corporate culture to create a quality school are presented in this paper, which argues that the understanding of the shared belief system of organizational members is crucial to the process. Creating a quality school entails moving from a "teach the process" oriented model to one that internalizes the…

40 CFR 52.2630 - Prevention of significant deterioration of air quality.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Skie, EPA, dated May 18, 1989, Charles A. Collins, Administrator of the Air Quality Divisions stated: * * * The Division, will, as a matter of practice, utilize the “Guideline on Air Quality Models” as revised, including Supplement A, in all PSD permit application reviews. The Division will utilize any future...

Integrated concurrent utilization quality review, Part one.

PubMed

Caterinicchio, R P

1987-01-01

This article is the first of a two-part series which argues for the concurrent management of the appropriateness, necessity, and quality of patient care. Intensifying scrutiny by the credentialing groups, the PROs and all third-party payors underscores the vital need to implement cost-effective information systems which integrate the departmentalized functions of patient-physician profiling, DRG case-mix analyses, length of stay monitoring, pre-admission/admission and continued stay review, discharge planning, risk management, incident reporting and quality review. In the domain of physician performance regarding admitting and practice patterns, the ability to exercise concurrent utilization-quality review means early detection and prevention of events which would otherwise result in denials of payment and/or compromised patient care. Concurrent utilization-quality review must, by definition, be managerially invasive and focused; hence, it is integral to maintaining the integrity of the services and product lines offered by the provider. In fact, if PPO status is a marketing agenda, then the institutional objectives of cost-effectiveness, productivity, value, and competitiveness can only be achieved through concurrent utilization-quality review.

Working on the Work Framework for Engagement: Impacting Students' Perceived Learning, Attitudes toward School, and Achievement

ERIC Educational Resources Information Center

Forehand, Michael Joshua

2014-01-01

A quasi-experimental, pre-test post-test nonequivalent control group study was utilized to determine the difference in students' perceived learning, attitudes toward school, and achievement when participating in classes utilizing engagement design qualities as compared to students in classes not utilizing engagement design qualities. To inform the…

The Moderating Role of Dysfunctional Parent-Child Relationships on the Association Between Outward Anger Expression and Physical Health in Youth From Low-Income Families.

PubMed

Guenther, Kassie D; Van Dyk, Tori R; Kidwell, Katherine M; Nelson, Timothy D

2016-01-01

The purpose of this study is to examine the role of outward anger expression on physical health outcomes (number of illnesses in the past year, 2-year medical service utilization, and health-related quality of life) while also expanding on previous research by assessing the moderating effect of parent-child dysfunction. An ethnically diverse sample of 125 children, ages 8 to 11 years, was recruited from a family medicine practice serving a low-income population. High levels of outward anger expression were related to a greater number of illnesses, greater medical service utilization, and lower health-related quality of life. Additionally, worse parent-child dysfunction exacerbated this relationship for a number of illnesses and medical service utilization. Results suggest that health care providers should consider the influence of environmental and familial factors on the physical health of children with anger. Recommendations for identifying at-risk youth and improving anger expression as well as parent-child relationships are provided. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Methodological Issues Surrounding the Use of Baseline Health-Related Quality of Life Data to Inform Trial-Based Economic Evaluations of Interventions Within Emergency and Critical Care Settings: A Systematic Literature Review.

PubMed

Dritsaki, Melina; Achana, Felix; Mason, James; Petrou, Stavros

2017-05-01

Trial-based cost-utility analyses require health-related quality of life data that generate utility values in order to express health outcomes in terms of quality-adjusted life years (QALYs). Assessments of baseline health-related quality of life are problematic where trial participants are incapacitated or critically ill at the time of randomisation. This review aims to identify and critique methods for handling non-availability of baseline health-related quality of life data in trial-based cost-utility analyses within emergency and critical illness settings. A systematic literature review was conducted, following PRISMA guidelines, to identify trial-based cost-utility analyses of interventions within emergency and critical care settings. Databases searched included the National Institute for Health Research (NIHR) Journals Library (1991-July 2016), Cochrane Library (all years); National Health Service (NHS) Economic Evaluation Database (all years) and Ovid MEDLINE/Embase (without time restriction). Strategies employed to handle non-availability of baseline health-related quality of life data in final QALY estimations were identified and critiqued. A total of 4224 published reports were screened, 19 of which met the study inclusion criteria (mean trial size 1670): 14 (74 %) from the UK, four (21%) from other European countries and one (5%) from India. Twelve studies (63%) were based in emergency departments and seven (37%) in intensive care units. Only one study was able to elicit patient-reported health-related quality of life at baseline. To overcome the lack of baseline data when estimating QALYs, eight studies (42%) assigned a fixed utility weight corresponding to either death, an unconscious health state or a country-specific norm to patients at baseline, four (21%) ignored baseline utilities, three (16%) applied values from another study, one (5%) generated utility values via retrospective recall and one (5%) elicited utilities from experts. A preliminary exploration of these methods shows that incremental QALY estimation is unlikely to be biased if balanced trial allocation is achieved and subsequent collection of health-related quality of life data occurs at the earliest possible opportunity following commencement of treatment, followed by an adequate number of follow-up assessments. Trial-based cost-utility analyses within emergency and critical illness settings have applied different methods for QALY estimation, employing disparate assumptions about the health-related quality of life of patients at baseline. Where baseline measurement is not practical, measurement at the earliest opportunity following commencement of treatment should minimise bias in QALY estimation.

Do efforts to standardize, assess and improve the quality of health service provision to adolescents by government-run health services in low and middle income countries, lead to improvements in service-quality and service-utilization by adolescents?

PubMed

Chandra-Mouli, Venkatraman; Chatterjee, Subidita; Bose, Krishna

2016-02-06

Researchers and implementers working in adolescent health, and adolescents themselves question whether government-run health services in conservative and resource-constrained settings can be made adolescent friendly. This paper aims to find out what selected low and middle income country (LMIC) governments have set out to do to improve the quality of health service provision to adolescents; whether their efforts led to measurable improvements in quality and to increased health service-utilization by adolescents. We gathered normative guidance and reports from eight LMICs in Asia, Africa, Central and Eastern Europe and the Western Pacific. We analysed national quality standards for adolescent friendly health services, findings from the assessments of the quality of health service provision, and findings on the utilization of health services. Governments of LMICs have set out to improve the accessibility, acceptability, equity, appropriateness and effectiveness of health service provision to adolescents by defining standards and actions to achieve them. Their actions have led to measurable improvements in quality and to increases in health service utilisation by adolescents. With support, government-run health facilities in LMICs can improve the quality of health services and their utilization by adolescents.

Recognizable or Not: Towards Image Semantic Quality Assessment for Compression

NASA Astrophysics Data System (ADS)

Liu, Dong; Wang, Dandan; Li, Houqiang

2017-12-01

Traditionally, image compression was optimized for the pixel-wise fidelity or the perceptual quality of the compressed images given a bit-rate budget. But recently, compressed images are more and more utilized for automatic semantic analysis tasks such as recognition and retrieval. For these tasks, we argue that the optimization target of compression is no longer perceptual quality, but the utility of the compressed images in the given automatic semantic analysis task. Accordingly, we propose to evaluate the quality of the compressed images neither at pixel level nor at perceptual level, but at semantic level. In this paper, we make preliminary efforts towards image semantic quality assessment (ISQA), focusing on the task of optical character recognition (OCR) from compressed images. We propose a full-reference ISQA measure by comparing the features extracted from text regions of original and compressed images. We then propose to integrate the ISQA measure into an image compression scheme. Experimental results show that our proposed ISQA measure is much better than PSNR and SSIM in evaluating the semantic quality of compressed images; accordingly, adopting our ISQA measure to optimize compression for OCR leads to significant bit-rate saving compared to using PSNR or SSIM. Moreover, we perform subjective test about text recognition from compressed images, and observe that our ISQA measure has high consistency with subjective recognizability. Our work explores new dimensions in image quality assessment, and demonstrates promising direction to achieve higher compression ratio for specific semantic analysis tasks.

Quality of Care Measures for the Management of Unhealthy Alcohol Use

PubMed Central

Hepner, Kimberly A.; Watkins, Katherine E.; Farmer, Carrie M.; Rubenstein, Lisa; Pedersen, Eric R.; Pincus, Harold Alan

2017-01-01

There is a paucity of quality measures to assess the care for the range of unhealthy alcohol use, ranging from risky drinking to alcohol use disorders. Using a two-phase expert panel review process, we sought to develop an expanded set of quality of care measures for unhealthy alcohol use, focusing on outpatient care delivered in both primary care and specialty care settings. This process generated 25 candidate measures. Eight measures address screening and assessment, 11 address aspects of treatment, and six address follow-up. These quality measures represent high priority targets for future development, including creating detailed technical specifications and pilot testing them to evaluate their utility in terms of feasibility, reliability, and validity. PMID:28340902

INTEGRATED POWER GENERATION SYSTEMS FOR COAL MINE WASTE METHANE UTILIZATION

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

Peet M. Soot; Dale R. Jesse; Michael E. Smith

2005-08-01

An integrated system to utilize the waste coal mine methane (CMM) at the Federal No. 2 Coal Mine in West Virginia was designed and built. The system includes power generation, using internal combustion engines, along with gas processing equipment to upgrade sub-quality waste methane to pipeline quality standards. The power generation has a nominal capacity of 1,200 kw and the gas processing system can treat about 1 million cubic feet per day (1 MMCFD) of gas. The gas processing is based on the Northwest Fuel Development, Inc. (NW Fuel) proprietary continuous pressure swing adsorption (CPSA) process that can remove nitrogenmore » from CMM streams. The two major components of the integrated system are synergistic. The byproduct gas stream from the gas processing equipment can be used as fuel for the power generating equipment. In return, the power generating equipment provides the nominal power requirements of the gas processing equipment. This Phase III effort followed Phase I, which was comprised of a feasibility study for the project, and Phase II, where the final design for the commercial-scale demonstration was completed. The fact that NW Fuel is desirous of continuing to operate the equipment on a commercial basis provides the validation for having advanced the project through all of these phases. The limitation experienced by the project during Phase III was that the CMM available to operate the CPSA system on a commercial basis was not of sufficiently high quality. NW Fuel's CPSA process is limited in its applicability, requiring a relatively high quality of gas as the feed to the process. The CPSA process was demonstrated during Phase III for a limited time, during which the processing capabilities met the expected results, but the process was never capable of providing pipeline quality gas from the available low quality CMM. The NW Fuel CPSA process is a low-cost ''polishing unit'' capable of removing a few percent nitrogen. It was never intended to process CMM streams containing high levels of nitrogen, as is now the case at the Federal No.2 Mine. Even lacking the CPSA pipeline delivery demonstration, the project was successful in laying the groundwork for future commercial applications of the integrated system. This operation can still provide a guide for other coal mines which need options for utilization of their methane resources. The designed system can be used as a complete template, or individual components of the system can be segregated and utilized separately at other mines. The use of the CMM not only provides an energy fuel from an otherwise wasted resource, but it also yields an environmental benefit by reducing greenhouse gas emissions. The methane has twenty times the greenhouse effect as compared to carbon dioxide, which the combustion of the methane generates. The net greenhouse gas emission mitigation is substantial.« less

Quality of Subjective Experience in a Summer Science Program for Academically Talented Adolescents.

ERIC Educational Resources Information Center

Tuss, Paul

This study utilized the flow theory of intrinsic motivation to evaluate the subjective experience of 78 academically talented high school sophomores participating in an 8-day summer research apprenticeship program in materials and nuclear science. The program involved morning lectures on such topics as physics of electromagnetic radiation, energy…

Research Committee Issues Brief: Professional Development for Virtual Schooling and Online Learning

ERIC Educational Resources Information Center

Davis, Niki; Rose, Ray

2007-01-01

This report examines the types of professional development necessary to implement successful online learning initiatives. The potential for schools utilizing online learning is tremendous: schools can develop new distribution methods to enable equity and access for all students, they can provide high quality content for all students and they can…

Value addition of wild apricot fruits grown in North-West Himalayan regions-a review.

PubMed

Sharma, Rakesh; Gupta, Anil; Abrol, G S; Joshi, V K

2014-11-01

Wild apricot (Prunus armeniaca L.) commonly known as chulli is a potential fruit widely distributed in North-West Himalayan regions of the world. The fruits are good source of carbohydrates, vitamins, minerals besides having attractive colour and typical flavour. Unlike table purpose varieties of apricots like New Castle, the fruits of wild apricot are unsuitable for fresh consumption because of its high acid and low sugar content. However, the fruits are traditionally utilized for open sun drying, pulping to prepare different products such as jams, chutney and naturally fermented and distilled liquor. But, scientific literature on processing and value addition of wild apricot is scanty. Preparation of jam with 25 % wild apricot +75 % apple showed maximum score for organoleptic characteristics due to better taste and colour. Osmotic dehydration has been found as a suitable method for drying of wild type acidic apricots. A good quality sauce using wild apricot pulp and tomato pulp in the ratio of 1:1 has been prepared, while chutney of good acceptability prepared from wild apricot pulp (100 %) has also been documented. Preparation of apricot-soy protein enriched products like apricot-soya leather, toffee and fruit bars has been reported, which are reported to meet the protein requirements of adult and children as per the recommendations of ICMR. Besides these processed products, preparation of alcoholic beverages like wine, vermouth and brandy from wild apricot fruits has also been reported by various researchers. Further, after utilization of pulp for preparation of value added products, the stones left over have been successfully utilized for oil extraction which has medicinal and cosmetic value. The traditional method of oil extraction has been reported to be unhygienic and result in low oil yield with poor quality, whereas improved mechanical method of oil extraction has been found to produce good quality oil. The apricot kernel oil and press cake have successfully been utilized for preparation of various value added products such as facial cream, lip balm, essential oil and protein isolate with good quality attributes and consumer acceptability. However, no scientific information on utilization of shells remained after kernel separation is available, but the shells are traditionally utilized for burning purpose during winters by the farmers. Therefore, it seems that every part of wild apricot can be utilized for conversion into value-added products and commercial utilization of this fruit will certainly add value to this underutilized fruit and also increase the economy of farmers.

The Use of Gene Modification and Advanced Molecular Structure Analyses towards Improving Alfalfa Forage

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

Lei, Yaogeng; Hannoufa, Abdelali; Yu, Peiqiang

Alfalfa is one of the most important legume forage crops in the world. In spite of its agronomic and nutritive advantages, alfalfa has some limitations in the usage of pasture forage and hay supplement. High rapid degradation of protein in alfalfa poses a risk of rumen bloat to ruminants which could cause huge economic losses for farmers. Coupled with the relatively high lignin content, which impedes the degradation of carbohydrate in rumen, alfalfa has unbalanced and asynchronous degradation ratio of nitrogen to carbohydrate (N/CHO) in rumen. Genetic engineering approaches have been used to manipulate the expression of genes involved inmore » important metabolic pathways for the purpose of improving the nutritive value, forage yield, and the ability to resist abiotic stress. Such gene modification could bring molecular structural changes in alfalfa that are detectable by advanced structural analytical techniques. These structural analyses have been employed in assessing alfalfa forage characteristics, allowing for rapid, convenient and cost-effective analysis of alfalfa forage quality. In this article, we review two major obstacles facing alfalfa utilization, namely poor protein utilization and relatively high lignin content, and highlight genetic studies that were performed to overcome these drawbacks, as well as to introduce other improvements to alfalfa quality. We also review the use of advanced molecular structural analysis in the assessment of alfalfa forage for its potential usage in quality selection in alfalfa breeding.« less

Quality assessment of economic evaluation studies in pediatric surgery: a systematic review.

PubMed

Fotso Kamdem, Arnaud; Nerich, Virginie; Auber, Frederic; Jantchou, Prévost; Ecarnot, Fiona; Woronoff-Lemsi, Marie-Christine

2015-04-01

To assess economic evaluation studies (EES) in pediatric surgery and to identify potential factors associated with high-quality studies. A systematic review of the literature using PubMed and Cochrane databases was conducted to identify EES in pediatric surgery published between 1 June 1993 and 30 June 2013. Assessment criteria are derived from the Drummond checklist. A high quality study was defined as a Drummond score ≥7. Logistic regression analysis was used to determine factors associated with high quality studies. 119 studies were included. 43.7% (n=52) of studies were full EES. Cost-effectiveness analysis was the most frequent (61.5%) type of full EES. Only 31.6% of studies had a Drummond score ≥7 and 73% of these were full EES. The factors associated with high quality were identification of costs (OR: 14.08; 95% CI: 3.38-100; p<0.001), estimation of utility value (OR: 8.13; 95% CI: 2.02-43.47; p=0.005) and study funding (OR: 3.50; 95% CI: 1.27-10.10; p=0.02). This review shows that the number and the quality of EES are low despite the increasing number of studies published in recent years. In the current context of budget constraints, our results should encourage pediatric surgeons to focus more on EES. Copyright © 2015 Elsevier Inc. All rights reserved.

Patient mobility and health care quality when regions and patients differ in income.

PubMed

Brekke, Kurt R; Levaggi, Rosella; Siciliani, Luigi; Straume, Odd Rune

2016-12-01

We study the effects of cross-border patient mobility on health care quality and welfare when income varies across and within regions. We use a Salop model with a high-, middle-, and low-income region. In each region, a policy maker chooses health care quality to maximise the utility of its residents when health care costs are financed by general income taxation. In equilibrium, regions with higher income offer better quality, which creates an incentive for patient mobility from lower- to higher-income regions. Assuming a prospective payment scheme based on DRG-pricing, we find that lower non-monetary (administrative) mobility costs have (i) no effect on quality or welfare in the high-income region; (ii) a negative effect on quality but a positive effect on welfare for the middle-income region; and (iii) ambiguous effects on quality and welfare for the low-income region. Lower monetary mobility costs (copayments) might reduce welfare in both the middle- and low-income region. Thus, health policies that stimulate cross-border patient mobility can be counterproductive when regions differ in income. Copyright © 2016 Elsevier B.V. All rights reserved.

Outpatient Pain Predicts Subsequent One-Year Acute Health Care Utilization Among Adults With Sickle Cell Disease

PubMed Central

Ezenwa, Miriam O.; Molokie, Robert E.; Wang, Zaijie Jim; Yao, Yingwei; Suarez, Marie L.; Angulo, Veronica; Wilkie, Diana J.

2014-01-01

Context Patient demographic and clinical factors have known associations with acute health care utilization (AHCU) among patients with sickle cell disease (SCD), but it is unknown if pain measured predominantly in an outpatient setting is a predictor of future AHCU in patients with SCD. Objectives To determine whether multidimensional pain scores obtained predominantly in an outpatient setting predicted subsequent one-year AHCU by 137 adults with SCD and whether the pain measured at a second visit also predicted AHCU. Methods Pain data included the Composite Pain Index (CPI), a single score representative of a multidimensional pain experience (number of pain sites, intensity, quality, and pattern). Based on the distribution of AHCU events, we divided patients into three groups: (1) zero events (Zero), (2) 1–3 events (Low), or (3) 4–23 events (High). Results The initial CPI scores differed significantly by the three groups (F(2,134)=7.38, P=0.001). Post hoc comparisons showed that the Zero group had lower CPI scores than both the Low group (P<0.01) and the High group (P<0.001). In multiviariate, overdispersed Poisson regression analyses, age, and CPI scores (at both measurement times) were statistically significant predictors of utilization events. Pain intensity scores at both measurement times were significant predictors of utilization, but other pain scores (number of pain sites, quality, and pattern) were not. Conclusion Findings support use of outpatient CPI scores or pain intensity and age to identify at-risk young adults with SCD who are likely to benefit from improved outpatient pain management plans. PMID:24636960

Pharmacist Advancement of Transitions of Care to Home (PATCH) Service.

PubMed

Trang, Joseph; Martinez, Amanda; Aslam, Sadaf; Duong, Minh-Tri

2015-11-01

There is a paucity of literature on a well-defined role of a pharmacist in different aspects of transition of care service (TCS). Although health care institutions have specific details on the discharge process, there is a need for a sustainable TCS with a well-defined role of pharmacists. To describe the impact of a pharmacist-led TCS on acute health care utilization, clinic quality indicators, and identification and resolution of medication-related problems (MRPs). A pharmacist-managed TCS service, referred to as the Pharmacist Advancement of Transitions of Care to Home (PATCH) service, was established at an academic medical center, where high-risk patients received a postdischarge phone call from a pharmacist followed by a face-to-face meeting with the pharmacist and the patient's primary care provider (PCP). In a prospective transitions of care group (n = 74), outcomes of patients such as acute health care utilization (an emergency department visit or an inpatient readmission, within 30 days post discharge), clinic quality indicators, and identification and resolution of MRPs were compared to a retrospective control group (n = 87) who received the standard of care. Utilization of acute health care services was significantly lower in the prospective group compared to the retrospective control group (23% vs 41.4%; P = .013). A total of 49 MRPs were discovered in patients who received the TCS. Pharmacists play an integral role in improving the transitions of care to reduce acute health care utilization. In addition, they may improve care transitions by optimizing clinic quality indicators and by identifying and resolving MRPs.

Is procalcitonin-guided antimicrobial use cost-effective in adult patients with suspected bacterial infection and sepsis?

PubMed

Harrison, Michelle; Collins, Curtis D

2015-03-01

Procalcitonin has emerged as a promising biomarker of bacterial infection. Published literature demonstrates that use of procalcitonin testing and an associated treatment pathway reduces duration of antibiotic therapy without impacting mortality. The objective of this study was to determine the financial impact of utilizing a procalcitonin-guided treatment algorithm in hospitalized patients with sepsis. Cost-minimization and cost-utility analysis. Hypothetical cohort of adult ICU patients with suspected bacterial infection and sepsis. Utilizing published clinical and economic data, a decision analytic model was developed from the U.S. hospital perspective. Effectiveness and utility measures were defined using cost-per-clinical episode and cost per quality-adjusted life years (QALYs). Upper and lower sensitivity ranges were determined for all inputs. Univariate and probabilistic sensitivity analyses assessed the robustness of our model and variables. Incremental cost-effectiveness ratios (ICERs) were calculated and compared to predetermined willingness-to-pay thresholds. Base-case results predicted the use of a procalcitonin-guided treatment algorithm dominated standard care with improved quality (0.0002 QALYs) and decreased overall treatment costs ($65). The model was sensitive to a number of key variables that had the potential to impact results, including algorithm adherence (<42.3%), number and cost of procalcitonin tests ordered (≥9 and >$46), days of antimicrobial reduction (<1.6 d), incidence of nephrotoxicity and rate of nephrotoxicity reduction. The combination of procalcitonin testing with an evidence-based treatment algorithm may improve patients' quality of life while decreasing costs in ICU patients with suspected bacterial infection and sepsis; however, results were highly dependent on a number of variables and assumptions.

Drug utilization research in primary health care as exemplified by physicians' quality assessment groups.

PubMed

von Ferber, L; Luciano, A; Köster, I; Krappweis, J

1992-11-01

Drugs in primary health care are often prescribed for nonrational reasons. Drug utilization research investigates the prescription of drugs with an eye to medical, social and economic causes and consequences of the prescribed drug's utilization. The results of this research show distinct differences in drug utilization in different age groups and between men and women. Indication and dosage appear irrational from a textbook point of view. This indicates nonpharmacological causes of drug utilization. To advice successfully changes for the better quality assessment groups of primary health care physicians get information about their established behavior by analysis of their prescriptions. The discussion and the comparisons in the group allow them to recognize their irrational prescribing and the social, psychological and economic reasons behind it. Guidelines for treatment are worked out which take into account the primary health care physician's situation. After a year with 6 meetings of the quality assessment groups the education process is evaluated by another drug utilization analysis on the basis of the physicians prescription. The evaluation shows a remarkable improvement of quality and cost effectiveness of the drug therapy of the participating physicians.

Measurement of utility.

PubMed

Thavorncharoensap, Montarat

2014-05-01

The Quality Adjusted Life Year (QALY) is the most widely recommended health outcome measure for use in economic evaluations. The QALY gives a value to the effect of a given health intervention in terms of both quantity and quality. QALYs are calculated by multiplying the duration of time spent in a given health state, in years, by the quality of life weighted, known as utility. Utility can range from 0 (the worst health state-the equivalent of death) to 1 (the best health state-full health). This paper provides an overview of the various methods that can be used to measure utility and outlines the recommended protocol for measuring utility, as described in the Guidelines for Health Technology Assessment in Thailand (second edition). The recommendations are as follows: Wherever possible, primary data collection using EQ-5D-3L in patients using Thai value sets generated from the general public should be used. Where the EQ-5D-3L is considered inappropriate, other methods such as Standard gamble (SG), Time-trade-off (TTO), Visual analogue scale (VAS), Health Utilities Index (HUI), SF-6D, or Quality of well being (QWB) can be used. However, justification and full details on the chosen instrument should always be provided.

Estimates of utility weights in hemophilia: implications for cost-utility analysis of clotting factor prophylaxis

PubMed Central

Grosse, Scott D; Chaugule, Shraddha S; Hay, Joel W

2015-01-01

Estimates of preference-weighted health outcomes or health state utilities are needed to assess improvements in health in terms of quality-adjusted life-years. Gains in quality-adjusted life-years are used to assess the cost–effectiveness of prophylactic use of clotting factor compared with on-demand treatment among people with hemophilia, a congenital bleeding disorder. Published estimates of health utilities for people with hemophilia vary, contributing to uncertainty in the estimates of cost–effectiveness of prophylaxis. Challenges in estimating utility weights for the purpose of evaluating hemophilia treatment include selection bias in observational data, difficulty in adjusting for predictors of health-related quality of life and lack of preference-based data comparing adults with lifetime or primary prophylaxis versus no prophylaxis living within the same country and healthcare system. PMID:25585817

Attractive "quiet" courtyards: a potential modifier of urban residents' responses to road traffic noise?

PubMed

Gidlöf-Gunnarsson, Anita; Ohrström, Evy

2010-09-01

The present paper explores the influence of the physical environmental qualities of "quiet". courtyards (degree of naturalness and utilization) on residents' noise responses. A questionnaire study was conducted in urban residential areas with road-traffic noise exposure between L(Aeq,24h) 58 to 68 dB at the most exposed façade. The dwellings had "quiet" indoor section/s and faced a "quiet" outdoor courtyard (L(Aeq,24h) < 48 dB façade reflex included). Data were collected from 385 residents and four groups were formed based on sound-level categories (58-62 and 63-68 dB) and classification of the "quiet" courtyards into groups with low and high physical environmental quality. At both sound-level categories, the results indicate that access to high-quality "quiet" courtyards is associated with less noise annoyance and noise-disturbed outdoor activities among the residents. Compared to low-quality "quiet" courtyards, high-quality courtyards can function as an attractive restorative environment providing residents with a positive soundscape, opportunities for rest, relaxation and play as well as social relations that potentially reduce the adverse effects of noise. However, access to quietness and a high-quality courtyard can only compensate partly for high sound levels at façades facing the streets, thus, 16% and 29% were still noise annoyed at 58-62 and 63-68 dB, respectively. Implications of the "quiet"-side concept are discussed.

Attractive “Quiet” Courtyards: A Potential Modifier of Urban Residents’ Responses to Road Traffic Noise?

PubMed Central

Gidlöf-Gunnarsson, Anita; Öhrström, Evy

2010-01-01

The present paper explores the influence of the physical environmental qualities of “quiet”. courtyards (degree of naturalness and utilization) on residents’ noise responses. A questionnaire study was conducted in urban residential areas with road-traffic noise exposure between LAeq,24h 58 to 68 dB at the most exposed façade. The dwellings had “quiet” indoor section/s and faced a “quiet” outdoor courtyard (LAeq,24h < 48 dB façade reflex included). Data were collected from 385 residents and four groups were formed based on sound-level categories (58–62 and 63–68 dB) and classification of the “quiet” courtyards into groups with low and high physical environmental quality. At both sound-level categories, the results indicate that access to high-quality “quiet” courtyards is associated with less noise annoyance and noise-disturbed outdoor activities among the residents. Compared to low-quality “quiet” courtyards, high-quality courtyards can function as an attractive restorative environment providing residents with a positive soundscape, opportunities for rest, relaxation and play as well as social relations that potentially reduce the adverse effects of noise. However, access to quietness and a high-quality courtyard can only compensate partly for high sound levels at façades facing the streets, thus, 16% and 29% were still noise annoyed at 58–62 and 63–68 dB, respectively. Implications of the “quiet”-side concept are discussed. PMID:20948929

Harm reduction with pharmacotherapy for homeless people with alcohol dependence: Protocol for a randomized controlled trial

PubMed Central

Collins, Susan E.; Saxon, Andrew J.; Duncan, Mark H.; Smart, Brian F.; Merrill, Joseph O.; Malone, Daniel K.; Jackson, T. Ron; Clifasefi, Seema L.; Joesch, Jutta; Ries, Richard K.

2014-01-01

Background Interventions requiring abstinence from alcohol are neither preferred by nor shown to be highly effective with many homeless individuals with alcohol dependence. It is therefore important to develop lower-threshold, patient-centered interventions for this multimorbid and high-utilizing population. Harm-reduction counseling requires neither abstinence nor use reduction and pairs a compassionate style with patient-driven goal-setting. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving and may support achievement of harm-reduction goals. Together, harm-reduction counseling and XR-NTX may support alcohol harm reduction and quality-of-life improvement. Aims Study aims include testing: a) the relative efficacy of XR-NTX and harm-reduction counseling compared to a community-based, supportive-services-as-usual control, b) theory-based mediators of treatment effects, and c) treatment effects on publicly funded service costs. Methods This RCT involves four arms: a) XR-NTX+harm-reduction counseling, b) placebo+harm-reduction counseling, c) harm-reduction counseling only, and d) community-based, supportive-services-as-usual control conditions. Participants are currently/formerly homeless, alcohol dependent individuals (N=300). Outcomes include alcohol variables (i.e., craving, quantity/frequency, problems and biomarkers), health-related quality of life, and publicly funded service utilization and associated costs. Mediators include 10-point motivation rulers and the Penn Alcohol Craving Scale. XR-NTX and harm-reduction counseling are administered every 4 weeks over the 12-week treatment course. Follow-up assessments are conducted at weeks 24 and 36. Discussion If found efficacious, XR-NTX and harm-reduction counseling will be well-positioned to support reductions in alcohol-related harm, decreases in costs associated with publicly funded service utilization, and increases in quality of life among homeless, alcohol-dependent individuals. PMID:24846619

Harm reduction with pharmacotherapy for homeless people with alcohol dependence: protocol for a randomized controlled trial.

PubMed

Collins, Susan E; Saxon, Andrew J; Duncan, Mark H; Smart, Brian F; Merrill, Joseph O; Malone, Daniel K; Jackson, T Ron; Clifasefi, Seema L; Joesch, Jutta; Ries, Richard K

2014-07-01

Interventions requiring abstinence from alcohol are neither preferred by nor shown to be highly effective with many homeless individuals with alcohol dependence. It is therefore important to develop lower-threshold, patient-centered interventions for this multimorbid and high-utilizing population. Harm-reduction counseling requires neither abstinence nor use reduction and pairs a compassionate style with patient-driven goal-setting. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving and may support achievement of harm-reduction goals. Together, harm-reduction counseling and XR-NTX may support alcohol harm reduction and quality-of-life improvement. Study aims include testing: a) the relative efficacy of XR-NTX and harm-reduction counseling compared to a community-based, supportive-services-as-usual control, b) theory-based mediators of treatment effects, and c) treatment effects on publicly funded service costs. This RCT involves four arms: a) XR-NTX+harm-reduction counseling, b) placebo+harm-reduction counseling, c) harm-reduction counseling only, and d) community-based, supportive-services-as-usual control conditions. Participants are currently/formerly homeless, alcohol dependent individuals (N=300). Outcomes include alcohol variables (i.e., craving, quantity/frequency, problems and biomarkers), health-related quality of life, and publicly funded service utilization and associated costs. Mediators include 10-point motivation rulers and the Penn Alcohol Craving Scale. XR-NTX and harm-reduction counseling are administered every 4weeks over the 12-week treatment course. Follow-up assessments are conducted at weeks 24 and 36. If found efficacious, XR-NTX and harm-reduction counseling will be well-positioned to support reductions in alcohol-related harm, decreases in costs associated with publicly funded service utilization, and increases in quality of life among homeless, alcohol-dependent individuals. Copyright © 2014 Elsevier Inc. All rights reserved.

Health status, quality of life, residential stability, substance use, and health care utilization among adults applying to a supportive housing program.

PubMed

Hwang, Stephen W; Gogosis, Evie; Chambers, Catharine; Dunn, James R; Hoch, Jeffrey S; Aubry, Tim

2011-12-01

Supportive housing, defined as subsidized housing in conjunction with site-based social services, may help improve the health and residential stability of highly disadvantaged individuals. This study examined changes in health status, quality of life, substance use, health care utilization, and residential stability among 112 homeless and vulnerably housed individuals who applied to a supportive housing program in Toronto, Canada, from December 2005 to June 2007. Follow-up interviews were conducted every 6 months for 18 months. Comparisons were made between individuals who were accepted into the program (intervention) and those who were wait-listed (usual care) using repeated-measures analyses. Individuals who were accepted into the housing program experienced significantly greater improvements in satisfaction with living situation compared with individuals in the usual care group (time, F(3,3,261) = 47.68, p < 0.01; group × time, F(3,3,261) = 14.60, p < 0.01). There were no significant differences in other quality of life measures, health status, health care utilization, or substance use between the two groups over time. Significant improvement in residential stability occurred over time, independent of assigned housing group (time, F(3,3,261) = 9.96, p < 0.01; group × time, F(3,3,261) = 1.74, p = 0.17). The ability to examine the effects of supportive housing on homeless individuals was limited by the small number of participants who were literally homeless at baseline and by the large number of participants who gained stable housing during the study period regardless of their assigned housing status. Nonetheless, this study shows that highly disadvantaged individuals with a high prevalence of poor physical and mental health and substance use can achieve stable housing.

Potentials and problems of sustainable irrigation with water high in salts

NASA Astrophysics Data System (ADS)

Ben-Gal, Alon

2015-04-01

Water scarcity and need to expand agricultural productivity have led to ever growing utilization of poor quality water for irrigation of crops. Almost in all cases, marginal or alternative water sources for irrigation contain relatively high concentrations of dissolved salts. When salts are present, irrigation water management, especially in the dry regions where water requirements are highest, must consider leaching in addition to crop evapotranspiration requirements. Leaching requirements for agronomic success are calculable and functions of climate, soil, and very critically, of crop sensitivity and the actual salinity of the irrigation water. The more sensitive the crop and more saline the water, the higher the agronomic cost and the greater the quantitative need for leaching. Israel is a forerunner in large-scale utilization of poor quality water for irrigation and can be used as a case study looking at long term repercussions of policy alternatively encouraging irrigation with recycled water or brackish groundwater. In cases studied in desert conditions of Israel, as much of half of the water applied to crops including bell peppers in greenhouses and date palms is actually used to leach salts from the root zone. The excess water used to leach salts and maintain agronomic and economic success when irrigating with water containing salts can become an environmental hazard, especially in dry areas where natural drainage is non-existent. The leachate often contains not only salts but also agrochemicals including nutrients, and natural contaminants can be picked up and transported as well. This leachate passes beyond the root zone and eventually reaches ground or surface water resources. This, together with evidence of ongoing increases in sodium content of fresh produce and increased SAR levels of soils, suggest that the current policy and practice in Israel of utilization of high amounts of low quality irrigation water is inherently non- sustainable. Current trends and technologies allowing economically feasible desalination at large scales present a sustainable alternative where salts are removed from water prior to irrigation.

Utilization of Activated Carbon Prepared from Aceh Coffee Grounds as Bio-sorbent for Treatment of Fertilizer Industrial Waste Water

NASA Astrophysics Data System (ADS)

Mariana, M.; Mahidin, M.; Mulana, F.; Aman, F.

2018-05-01

The people of Aceh are well known as coffee drinkers. Therefore, a lot of coffee shops have been established in Aceh in the past decade. The growing of coffee shops resulting to large amounts of coffee waste produced in Aceh Province that will become solid waste if not wisely utilized. The high carbon content in coffee underlined as background of this research to be utilized those used coffee grounds as bio-sorbent. The preparation of activated carbon from coffee grounds by using carbonization method that was initially activated with HCl was expected to increase the absorption capacity. The prepared activated carbon with high reactivity was applied to adsorb nitrite, nitrate and ammonia in wastewater outlet of PT. PIM wastewater pond. Morphological structure of coffee waste was analyzed by using Scanning Electron Microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). The result showed that the adsorption capacity of iodine was equal to 856.578 mg/g. From the characterization results, it was concluded that the activated carbon from coffee waste complied to the permitted quality standards in accordance with the quality requirements of activated carbon SNI No. 06-3730-1995. Observed from the adsorption efficiency, the bio-sorbent showed a tendency of adsorbing more ammonia than nitrite and nitrate of PT. PIM wastewater with ammonia absorption efficiency of 56%.

Potential emissions reduction in road transport sector using biofuel in developing countries

NASA Astrophysics Data System (ADS)

Liaquat, A. M.; Kalam, M. A.; Masjuki, H. H.; Jayed, M. H.

2010-10-01

Use of biofuels as transport fuel has high prospect in developing countries as most of them are facing severe energy insecurity and have strong agricultural sector to support production of biofuels from energy crops. Rapid urbanization and economic growth of developing countries have spurred air pollution especially in road transport sector. The increasing demand of petroleum based fuels and their combustion in internal combustion (IC) engines have adverse effect on air quality, human health and global warming. Air pollution causes respiratory problems, adverse effects on pulmonary function, leading to increased sickness absenteeism and induces high health care service costs, premature birth and even mortality. Production of biofuels promises substantial improvement in air quality through reducing emission from biofuel operated automotives. Some of the developing countries have started biofuel production and utilization as transport fuel in local market. This paper critically reviews the facts and prospects of biofuel production and utilization in developing countries to reduce environmental pollution and petro dependency. Expansion of biofuel industries in developing countries can create more jobs and increase productivity by non-crop marginal lands and wastelands for energy crops plantation. Contribution of India and China in biofuel industry in production and utilization can dramatically change worldwide biofuel market and leap forward in carbon cut as their automotive market is rapidly increasing with a souring proportional rise of GHG emissions.

Sacramento Municipal Utility District PV and Smart Grid Pilot at Anatolia

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

Rawson, Mark; Sanchez, Eddie Paul

2013-12-30

Under DE-FOA-0000085 High Penetration Solar Deployment, the U. S. Department of Energy funded agreements with SMUD and Navigant Consulting, SunPower, GridPoint, the National Renewable Energy Laboratory, and the California Energy Commission for this pilot demonstration project. Funding was $5,962,409.00. Cost share of $500,000 was also provided by the California Energy Commission. The project has strategic implications for SMUD, other utilities and the PV and energy-storage industries in business and resource planning, technology deployment and asset management. These implications include: -At this point, no dominant business models have emerged and the industry is open for new ideas. -Demonstrated two business modelsmore » for using distributed PV and energy storage, and brainstormed several dozen more, each with different pros and cons for SMUD, its customers and the industry. -Energy storage can be used to manage high penetrations of PV and mitigate potential issues such as reverse power flow, voltage control violations, power quality issues, increased wear and tear on utility equipment, and system wide power supply issues. - Smart meters are another tool utilities can use to manage high penetrations of PV. The necessary equipment and protocols exist, and the next step is to determine how to integrate the functionality with utility programs and what level of utility control is required. - Time-of-use rates for the residential customers who hosted energy storage systems did not cause a significant change in energy usage patterns. However, the rates we used were not optimized for PV and energy storage. Opportunities exist for utilities to develop new structures.« less

The Newick utilities: high-throughput phylogenetic tree processing in the Unix shell

PubMed Central

Junier, Thomas; Zdobnov, Evgeny M.

2010-01-01

Summary: We present a suite of Unix shell programs for processing any number of phylogenetic trees of any size. They perform frequently-used tree operations without requiring user interaction. They also allow tree drawing as scalable vector graphics (SVG), suitable for high-quality presentations and further editing, and as ASCII graphics for command-line inspection. As an example we include an implementation of bootscanning, a procedure for finding recombination breakpoints in viral genomes. Availability: C source code, Python bindings and executables for various platforms are available from http://cegg.unige.ch/newick_utils. The distribution includes a manual and example data. The package is distributed under the BSD License. Contact: thomas.junier@unige.ch PMID:20472542

The Economic Value of Air Quality Forecasting

NASA Astrophysics Data System (ADS)

Anderson-Sumo, Tasha

Both long-term and daily air quality forecasts provide an essential component to human health and impact costs. According the American Lung Association, the estimated current annual cost of air pollution related illness in the United States, adjusted for inflation (3% per year), is approximately $152 billion. Many of the risks such as hospital visits and morality are associated with poor air quality days (where the Air Quality Index is greater than 100). Groups such as sensitive groups become more susceptible to the resulting conditions and more accurate forecasts would help to take more appropriate precautions. This research focuses on evaluating the utility of air quality forecasting in terms of its potential impacts by building on air quality forecasting and economical metrics. Our analysis includes data collected during the summertime ozone seasons between 2010 and 2012 from air quality models for the Washington, DC/Baltimore, MD region. The metrics that are relevant to our analysis include: (1) The number of times that a high ozone or particulate matter (PM) episode is correctly forecasted, (2) the number of times that high ozone or PM episode is forecasted when it does not occur and (3) the number of times when the air quality forecast predicts a cleaner air episode when the air was observed to have high ozone or PM. Our collection of data included available air quality model forecasts of ozone and particulate matter data from the U.S. Environmental Protection Agency (EPA)'s AIRNOW as well as observational data of ozone and particulate matter from Clean Air Partners. We evaluated the performance of the air quality forecasts with that of the observational data and found that the forecast models perform well for the Baltimore/Washington region and the time interval observed. We estimate the potential amount for the Baltimore/Washington region accrues to a savings of up to 5,905 lives and 5.9 billion dollars per year. This total assumes perfect compliance with bad air quality warning and forecast air quality forecasts. There is a difficulty presented with evaluating the economic utility of the forecasts. All may not comply and even with a low compliance rate of 5% and 72% as the average probability of detection of poor air quality days by the air quality models, we estimate that the forecasting program saves 412 lives or 412 million dollars per year for the region. The totals we found are great or greater than other typical yearly meteorological hazard programs such as tornado or hurricane forecasting and it is clear that the economic value of air quality forecasting in the Baltimore/Washington region is vital.

Water Quality Analysis of Yosemite Creek Watershed, San Francisco, California

NASA Astrophysics Data System (ADS)

Davis, J. R.; Snow, M. K.; Aquino, A.; Huang, C.; Thai, A.; Yuen, C.

2003-12-01

Surface water quality in urban settings can become contaminated by anthropogenic inputs. Yosemite Creek watershed is situated on the east side of San Francisco near Bayview Hunters Point and provides an ideal location for water quality investigations in urban environments. Accordingly, students from Philip and Sala Burton High School monitored water quality at three locations for their physicochemical and biological characteristics. Water was tested for pH, dissolved oxygen, conductivity, total dissolved solids, salinity, and oxidation reduction potential. In addition, a Hach DR 850 digital colorimeter was utilized to measure chlorine, fluorine, nitrogen, phosphorous, and sulfate. The biological component was assessed via monitoring benthic macro invertebrates. Specifically, the presence of caddisfly (Trichoptera) were used to indicate low levels of contaminants and good water quality. Our results indicate that water quality and macro invertebrate populations varied spatially within the watershed. Further investigation is needed to pinpoint the precise location of contaminant inputs.

Utilization of the Deep Space Atomic Clock for Europa Gravitational Tide Recovery

NASA Technical Reports Server (NTRS)

Seubert, Jill; Ely, Todd

2015-01-01

Estimation of Europa's gravitational tide can provide strong evidence of the existence of a subsurface liquid ocean. Due to limited close approach tracking data, a Europa flyby mission suffers strong coupling between the gravity solution quality and tracking data quantity and quality. This work explores utilizing Low Gain Antennas with the Deep Space Atomic Clock (DSAC) to provide abundant high accuracy uplink-only radiometric tracking data. DSAC's performance, expected to exhibit an Allan Deviation of less than 3e-15 at one day, provides long-term stability and accuracy on par with the Deep Space Network ground clocks, enabling one-way radiometric tracking data with accuracy equivalent to that of its two-way counterpart. The feasibility of uplink-only Doppler tracking via the coupling of LGAs and DSAC and the expected Doppler data quality are presented. Violations of the Kalman filter's linearization assumptions when state perturbations are included in the flyby analysis results in poor determination of the Europa gravitational tide parameters. B-plane targeting constraints are statistically determined, and a solution to the linearization issues via pre-flyby approach orbit determination is proposed and demonstrated.

The quality of service in passenger transport terminals

NASA Astrophysics Data System (ADS)

Oprea, C.; Roşca, E.; Popa, M.; Ilie, A.; Dinu, O.; Roşca, M.

2016-11-01

The quality of service in transport terminals is differently perceived by engineers, economists, transport operators and sociologists. The traveler's perception is nevertheless decisive. The quality of service is well connected with the inside design of terminals, with the facilities in terminals and with the provided service standards. In order to provide a high level of service, the activities taking place in the public transport terminal and the maximum travelers flow size must be carefully analyzed and dimensioned. The purpose of modelling is to find the best route for each traveler from origin (entrance) to destination (exit) through all the intermediate service points, taking into consideration the instant network conditions. In developing the model we consider the walking, the waiting and the serving time. Using a simulation program written in ARENA we determine the waiting time. For validation, the model is used to evaluate the performance level in Bucharest Basarab station. By comparing the total walking distance for the possible routes and the utility function that describes the utility of all activities from entrance to exit we can find the optimal route.

From clinically relevant outcome measures to quality of life in epilepsy: A time trade-off study.

PubMed

de Kinderen, Reina J A; Wijnen, Ben F M; van Breukelen, Gerard; Postulart, Debby; Majoie, Marian H J M; Aldenkamp, Albert P; Evers, Silvia M A A

2016-09-01

A proposed method for bridging the gap between clinically relevant epilepsy outcome measures and quality-adjusted life years is to derive utility scores for epilepsy health states. The aim of this study is to develop such a utility-function and to investigate the impact of the epilepsy outcome measures on utility. Health states, based on clinically important epilepsy attributes (e.g. seizure frequency, seizure severity, side-effects), were valued by a sample of the Dutch population (N=525) based on the time trade-off method. In addition to standard demographics, every participant was asked to rate 10 or 11 different health state scenarios. A multilevel regression analysis was performed to account for the nested structure of the data. Results show that the best health state (no seizures and no side-effects) is estimated at 0.89 and the worst state (seizures type 5 twice a day plus severe side-effects) at 0.22 (scale: 0-1). An increase in seizure frequency, occurrence of side-effects, and seizure severity were all significantly associated with lower utility values. Furthermore, seizure severity has the largest impact on quality of life compared with seizure frequency and side-effects. This study provides a utility-function for transforming clinically relevant epilepsy outcome measures into utility estimates. We advise using our utility-function in economic evaluations, when quality of life is not directly measured in a study and hence, no health state utilities are available, or when there is convincing empirical evidence of the insensitivity of a generic quality-of-life-instrument within epilepsy. Copyright © 2016 Elsevier B.V. All rights reserved.

The goal of value-based medicine analyses: comparability. The case for neovascular macular degeneration.

PubMed

Brown, Gary C; Brown, Melissa M; Brown, Heidi C; Kindermann, Sylvia; Sharma, Sanjay

2007-01-01

To evaluate the comparability of articles in the peer-reviewed literature assessing the (1) patient value and (2) cost-utility (cost-effectiveness) associated with interventions for neovascular age-related macular degeneration (ARMD). A search was performed in the National Library of Medicine database of 16 million peer-reviewed articles using the key words cost-utility, cost-effectiveness, value, verteporfin, pegaptanib, laser photocoagulation, ranibizumab, and therapy. All articles that used an outcome of quality-adjusted life-years (QALYs) were studied in regard to (1) percent improvement in quality of life, (2) utility methodology, (3) utility respondents, (4) types of costs included (eg, direct healthcare, direct nonhealthcare, indirect), (5) cost bases (eg, Medicare, National Health Service in the United Kingdom), and (6) study cost perspective (eg, government, societal, third-party insurer). To qualify as a value-based medicine analysis, the patient value had to be measured using the outcome of the QALYs conferred by respective interventions. As with value-based medicine analyses, patient-based time tradeoff utility analysis had to be utilized, patient utility respondents were necessary, and direct medical costs were used. Among 21 cost-utility analyses performed on interventions for neovascular macular degeneration, 15 (71%) met value-based medicine criteria. The 6 others (29%) were not comparable owing to (1) varying utility methodology, (2) varying utility respondents, (3) differing costs utilized, (4) differing cost bases, and (5) varying study perspectives. Among value-based medicine studies, laser photocoagulation confers a 4.4% value gain (improvement in quality of life) for the treatment of classic subfoveal choroidal neovascularization. Intravitreal pegaptanib confers a 5.9% value gain (improvement in quality of life) for classic, minimally classic, and occult subfoveal choroidal neovascularization, and photodynamic therapy with verteporfin confers a 7.8% to 10.7% value gain for the treatment of classic subfoveal choroidal neovascularization. Intravitreal ranibizumab therapy confers greater than a 15% value gain for the treatment of subfoveal occult and minimally classic subfoveal choroidal neovascularization. The majority of cost-utility studies performed on interventions for neovascular macular degeneration are value-based medicine studies and thus are comparable. Value-based analyses of neovascular ARMD monotherapies demonstrate the power of value-based medicine to improve quality of care and concurrently maximize the efficacy of healthcare resource use in public policy. The comparability of value-based medicine cost-utility analyses has important implications for overall practice standards and public policy. The adoption of value-based medicine standards can greatly facilitate the goal of higher-quality care and maximize the best use of healthcare funds.

THE GOAL OF VALUE-BASED MEDICINE ANALYSES: COMPARABILITY. THE CASE FOR NEOVASCULAR MACULAR DEGENERATION

PubMed Central

Brown, Gary C.; Brown, Melissa M.; Brown, Heidi C.; Kindermann, Sylvia; Sharma, Sanjay

2007-01-01

Purpose To evaluate the comparability of articles in the peer-reviewed literature assessing the (1) patient value and (2) cost-utility (cost-effectiveness) associated with interventions for neovascular age-related macular degeneration (ARMD). Methods A search was performed in the National Library of Medicine database of 16 million peer-reviewed articles using the key words cost-utility, cost-effectiveness, value, verteporfin, pegaptanib, laser photocoagulation, ranibizumab, and therapy. All articles that used an outcome of quality-adjusted life-years (QALYs) were studied in regard to (1) percent improvement in quality of life, (2) utility methodology, (3) utility respondents, (4) types of costs included (eg, direct healthcare, direct nonhealthcare, indirect), (5) cost bases (eg, Medicare, National Health Service in the United Kingdom), and (6) study cost perspective (eg, government, societal, third-party insurer). To qualify as a value-based medicine analysis, the patient value had to be measured using the outcome of the QALYs conferred by respective interventions. As with value-based medicine analyses, patient-based time tradeoff utility analysis had to be utilized, patient utility respondents were necessary, and direct medical costs were used. Results Among 21 cost-utility analyses performed on interventions for neovascular macular degeneration, 15 (71%) met value-based medicine criteria. The 6 others (29%) were not comparable owing to (1) varying utility methodology, (2) varying utility respondents, (3) differing costs utilized, (4) differing cost bases, and (5) varying study perspectives. Among value-based medicine studies, laser photocoagulation confers a 4.4% value gain (improvement in quality of life) for the treatment of classic subfoveal choroidal neovascularization. Intravitreal pegaptanib confers a 5.9% value gain (improvement in quality of life) for classic, minimally classic, and occult subfoveal choroidal neovascularization, and photodynamic therapy with verteporfin confers a 7.8% to 10.7% value gain for the treatment of classic subfoveal choroidal neovascularization. Intravitreal ranibizumab therapy confers greater than a 15% value gain for the treatment of subfoveal occult and minimally classic subfoveal choroidal neovascularization. Conclusions The majority of cost-utility studies performed on interventions for neovascular macular degeneration are value-based medicine studies and thus are comparable. Value-based analyses of neovascular ARMD monotherapies demonstrate the power of value-based medicine to improve quality of care and concurrently maximize the efficacy of healthcare resource use in public policy. The comparability of value-based medicine cost-utility analyses has important implications for overall practice standards and public policy. The adoption of value-based medicine standards can greatly facilitate the goal of higher-quality care and maximize the best use of healthcare funds. PMID:18427606

Effects of outsourced nursing on quality outcomes in long-term acute-care hospitals.

PubMed

Alvarez, M Raymond; Kerr, Bernard J; Burtner, Joan; Ledlow, Gerald; Fulton, Larry V

2011-03-01

Use of outsourced nurses is often a stop-gap measure for unplanned vacancies in smaller healthcare facilities such as long-term acute-care hospitals (LTACHs). However, the relationship of utilization levels (low, medium, or high percentages) of nonemployees covering staff schedules often is perceived to have negative relationships with quality outcomes. To assess this issue, the authors discuss the outcomes of their national study of LTACH hospitals that indicated no relationship existed between variations in percentage of staffing by contracted nurses and selected outcomes in this post-acute-care setting.

Jet printing of convex and concave polymer micro-lenses.

PubMed

Blattmann, M; Ocker, M; Zappe, H; Seifert, A

2015-09-21

We describe a novel approach for fabricating customized convex as well as concave micro-lenses using substrates with sophisticated pinning architecture and utilizing a drop-on-demand jet printer. The polymeric lens material deposited on the wafer is cured by UV light irradiation yielding lenses with high quality surfaces. Surface shape and roughness of the cured polymer lenses are characterized by white light interferometry. Their optical quality is demonstrated by imaging an USAF1951 test chart. The evaluated modulation transfer function is compared to Zemax simulations as a benchmark for the fabricated lenses.

Modeling of High-Quality Factor XNOR Gate Using Quantum-Dot Semiconductor Optical Amplifiers at 1 Tb/s

NASA Astrophysics Data System (ADS)

Kotb, Amer

2015-06-01

The modeling of all-optical logic XNOR gate is realized by a series combination of XOR and INVERT gates. This Boolean function is simulated by using Mach-Zehnder interferometers (MZIs) utilizing quantum-dots semiconductor optical amplifiers (QDs-SOAs). The study is carried out when the effect of amplified spontaneous emission (ASE) is included. The dependence of the output quality factor ( Q-factor) on signals and QDs-SOAs' parameters is also investigated and discussed. The simulation is conducted under a repetition rate of ˜1 Tb/s.

The Role of Value-Based Care in Patients with Cirrhosis.

PubMed

Volk, Michael L

2017-02-01

Value-based care means delivering high-quality care while keeping costs at a reasonable level. Many physicians have long viewed quality care and the responsible utilization of resources to be an integral part of their professional responsibilities. As the health care system changes, however, physicians are increasingly being asked to objectively demonstrate value. In this review article, the author describes the reimbursement and regulatory shift toward value-based care, and provides specific strategies for meeting this care. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Improved Phase Characterization of Far-Regional Body Wave Arrivals in Central Asia

DTIC Science & Technology

2009-09-30

array processing techniques. The regional seismic arrays that have been built in the last fifteen years should be a rich data source for the study of...far-regional phase behavior. The arrays are composed of high-quality borehole seismometers that make high fidelity, low-noise recordings. However...that propagate from the different seismic regions of South-Central Asia, utilizing recordings from the Makanchi (MKAR) and Karatau (KKAR) arrays in

Total-body photography in skin cancer screening: the clinical utility of standardized imaging.

PubMed

Rosenberg, Alexandra; Meyerle, Jon H

2017-05-01

Early detection of skin cancer is essential to reducing morbidity and mortality from both melanoma and nonmelanoma skin cancers. Total-body skin examinations (TBSEs) may improve early detection of malignant melanomas (MMs) but are controversial due to the poor quality of data available to establish a mortality benefit from skin cancer screening. Total-body photography (TBP) promises to provide a way forward by lowering the costs of dermatologic screening while simultaneously leveraging technology to increase patient access to dermatologic care. Standardized TBP also offers the ability for dermatologists to work synergistically with modern computer technology involving algorithms capable of analyzing high-quality images to flag concerning lesions that may require closer evaluation. On a population level, inexpensive TBP has the potential to increase access to skin cancer screening and it has several specific applications in a military population. The utility of standardized TBP is reviewed in the context of skin cancer screening and teledermatology.

Facile synthesis of graphene on dielectric surfaces using a two-temperature reactor CVD system

NASA Astrophysics Data System (ADS)

Zhang, C.; Man, B. Y.; Yang, C.; Jiang, S. Z.; Liu, M.; Chen, C. S.; Xu, S. C.; Sun, Z. C.; Gao, X. G.; Chen, X. J.

2013-10-01

Direct deposition of graphene on a dielectric substrate is demonstrated using a chemical vapor deposition system with a two-temperature reactor. The two-temperature reactor is utilized to offer sufficient, well-proportioned floating Cu atoms and to provide a temperature gradient for facile synthesis of graphene on dielectric surfaces. The evaporated Cu atoms catalyze the reaction in the presented method. C atoms and Cu atoms respectively act as the nuclei for forming graphene film in the low-temperature zone and the zones close to the high-temperature zones. A uniform and high-quality graphene film is formed in an atmosphere of sufficient and well-proportioned floating Cu atoms. Raman spectroscopy, scanning electron microscopy and atomic force microscopy confirm the presence of uniform and high-quality graphene.

Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents.

PubMed

Sharma, Ravi; Lebrun-Harris, Lydie A; Ngo-Metzger, Quyen

2014-01-01

Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS' Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA's Uniform Data System) and number of low-income residents (American Community Survey). We estimated access to primary care in each HRR by "health center penetration" (health center patients as a proportion of low-income residents). We calculated total Medicare spending (adjusted for population size, local input prices, and health risk). We assessed clinical quality by preventable hospital admissions, hospital readmissions, and emergency department visits. We sorted HRRs by health center penetration rate and compared spending and quality measures between the high- and low-penetration deciles. We also employed linear regressions to estimate spending and quality measures as a function of health center penetration. The high-penetration decile had 9.7% lower Medicare spending ($926 per capita, p=0.01) than the low-penetration decile, and no different clinical quality outcomes. Compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings. Limited evidence suggests that these savings do not compromise clinical quality.

Contact and non-contact ultrasonic measurement in the food industry: a review

NASA Astrophysics Data System (ADS)

Taufiq Mohd Khairi, Mohd; Ibrahim, Sallehuddin; Yunus, Mohd Amri Md; Faramarzi, Mahdi

2016-01-01

The monitoring of the food manufacturing process is vital since it determines the safety and quality level of foods which directly affect the consumers’ health. Companies which produce high quality products will gain trust from consumers. This factor helps the companies to make profits. The use of efficient and appropriate sensors for the monitoring process can also reduce cost. The food assessing process based on an ultrasonic sensor has attracted the attention of the food industry due to its excellent capabilities in several applications. The utilization of low or high frequencies for the ultrasonic transducer has provided an enormous benefit for analysing, modifying and guaranteeing the quality of food. The contact and non-contact ultrasonic modes for measurement also contributed significantly to the food processing. This paper presents a review of the application of the contact and non-contact mode of ultrasonic measurement focusing on safety and quality control areas. The results from previous researches are shown and elaborated.

Optimization of a micro-scale, high throughput process development tool and the demonstration of comparable process performance and product quality with biopharmaceutical manufacturing processes.

PubMed

Evans, Steven T; Stewart, Kevin D; Afdahl, Chris; Patel, Rohan; Newell, Kelcy J

2017-07-14

In this paper, we discuss the optimization and implementation of a high throughput process development (HTPD) tool that utilizes commercially available micro-liter sized column technology for the purification of multiple clinically significant monoclonal antibodies. Chromatographic profiles generated using this optimized tool are shown to overlay with comparable profiles from the conventional bench-scale and clinical manufacturing scale. Further, all product quality attributes measured are comparable across scales for the mAb purifications. In addition to supporting chromatography process development efforts (e.g., optimization screening), comparable product quality results at all scales makes this tool is an appropriate scale model to enable purification and product quality comparisons of HTPD bioreactors conditions. The ability to perform up to 8 chromatography purifications in parallel with reduced material requirements per run creates opportunities for gathering more process knowledge in less time. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Qualification of a Quantitative Method for Monitoring Aspartate Isomerization of a Monoclonal Antibody by Focused Peptide Mapping.

PubMed

Cao, Mingyan; Mo, Wenjun David; Shannon, Anthony; Wei, Ziping; Washabaugh, Michael; Cash, Patricia

Aspartate (Asp) isomerization is a common post-translational modification of recombinant therapeutic proteins that can occur during manufacturing, storage, or administration. Asp isomerization in the complementarity-determining regions of a monoclonal antibody may affect the target binding and thus a sufficiently robust quality control method for routine monitoring is desirable. In this work, we utilized a liquid chromatography-mass spectrometry (LC/MS)-based approach to identify the Asp isomerization in the complementarity-determining regions of a therapeutic monoclonal antibody. To quantitate the site-specific Asp isomerization of the monoclonal antibody, a UV detection-based quantitation assay utilizing the same LC platform was developed. The assay was qualified and implemented for routine monitoring of this product-specific modification. Compared with existing methods, this analytical paradigm is applicable to identify Asp isomerization (or other modifications) and subsequently develop a rapid, sufficiently robust quality control method for routine site-specific monitoring and quantitation to ensure product quality. This approach first identifies and locates a product-related impurity (a critical quality attribute) caused by isomerization, deamidation, oxidation, or other post-translational modifications, and then utilizes synthetic peptides and MS to assist the development of a LC-UV-based chromatographic method that separates and quantifies the product-related impurities by UV peaks. The established LC-UV method has acceptable peak specificity, precision, linearity, and accuracy; it can be validated and used in a good manufacturing practice environment for lot release and stability testing. Aspartate isomerization is a common post-translational modification of recombinant proteins during manufacture process and storage. Isomerization in the complementarity-determining regions (CDRs) of a monoclonal antibody A (mAb-A) has been detected and has been shown to have impact on the binding affinity to the antigen. In this work, we utilized a mass spectrometry-based peptide mapping approach to detect and quantitate the Asp isomerization in the CDRs of mAb-A. To routinely monitor the CDR isomerization of mAb-A, a focused peptide mapping method utilizing reversed phase chromatographic separation and UV detection has been developed and qualified. This approach is generally applicable to monitor isomerization and other post-translational modifications of proteins in a specific and high-throughput mode to ensure product quality. © PDA, Inc. 2016.

Quality of life and costs of spasticity treatment in German stroke patients.

PubMed

Rychlik, Reinhard; Kreimendahl, Fabian; Schnur, Nicole; Lambert-Baumann, Judith; Dressler, Dirk

2016-12-01

To gather data about the medical and non-medical health service in patients suffering from post-stroke spasticity of the upper limb and evaluate treatment effectiveness and tolerability as well as costs over the treatment period of one year. Prospective, non-interventional, multicenter, parallel-group study comparing effectivenessand costs of incobotulinumtoxinA (INCO) treatment (n = 118) to conventional (CON) antispastic therapy (n = 110) for upper limb spasticity after stroke in 47 clinical practices across Germany over a 1-year treatment period. IncobotulinumtoxinA was applied according to the individual treatment algorithms of each participating site and additional antispastic treatments were allowed. Primary efficacy objective was the reduction of the muscle tone measured by Ashworth scale. Responder analyses and logistic regressions were performed. Quality of life, measured by SF-12 questionnaire and functional disability were assessed. Besides calculating treatment costs, a cost-utility analysis was performed. Responder rates of all muscle groups of the upper extremities were significantly higher in the treatment group (62.9-86.2 % vs. 15.5-26.9 %, p < 0.01). Total health service costs were twice as high in the INCO group, however cost-utility ratios were consistently superior compared to the control group. Lowest incremental costs were documented to improve the "physical health" dimension in quality of life. Higher responder rates, higher increases in quality of life and superior cost-utility ratios in the BoNT/A-treatment group underline guideline recommendations for botulinum toxin A treatment in focal or segmental spasticity. Results may partially be influenced by different patient demographics or disease severity at study entry.

Quality-of-Life Assessment of Fibroid Treatment Options and Outcomes

PubMed Central

Kong, Chung Yin; Tempany, Clare M.; Swan, J. Shannon

2011-01-01

Purpose: To obtain utilities (a unit of measure of a person’s relative preferences for different health states compared with death or worst possible outcome) for uterine fibroids before and after treatment and to measure short-term utilities for the following uterine fibroid treatments: abdominal hysterectomy, magnetic resonance (MR) imaging–guided focused ultrasound surgery, and uterine artery embolization (UAE). Materials and Methods: This retrospective study was approved by the institutional review board and was HIPAA compliant. The waiting trade-off (WTO) method, a variation on the time trade-off (TTO) method, is used to obtain utilities for diagnostic procedures on the basis of the fact that people wait longer to avoid noxious tests and/or procedures. The WTO method provides short-term quality of life tolls in terms of quality-adjusted life-weeks by scaling wait times with pre- and posttreatment utilities. Utilities for uterine fibroids before and after treatment were obtained with the TTO method and a visual analog scale (VAS) by using a questionnaire administered by means of a phone interview. WTO wait times were adjusted for quality of life with VAS and TTO utilities and a transformation of VAS. Wait times were compared by using nonparametric tests. The study participants included 62 patients who had undergone abdominal hysterectomy, 74 who had undergone UAE, and 61 who had undergone MR imaging–guided focused ultrasound surgery. Results: Quality of life increased with all treatments. The median WTO wait time was higher for hysterectomy (21.6 weeks) than for UAE or MR imaging–guided focused ultrasound surgery (14.1 weeks for both) (P < .05). Quality-adjusted life-week tolls were smaller when scaled according to TTO than when scaled according to VAS or transformation of VAS. Conclusion: Quality of life increased after all fibroid treatments. WTO is feasible for assessing the quality-adjusted morbidity of treatment procedures. © RSNA, 2011 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11100704/-/DC1 PMID:21364084

Highly qualified does not equal high quality: A study of urban stakeholders' perceptions of quality in science teaching

NASA Astrophysics Data System (ADS)

Miranda, Rommel Joseph

By employing qualitative methods, this study sought to determine the perceptions that urban stakeholders hold about what characteristics should distinguish a high school science teacher whom they would consider to demonstrate high quality in science teaching. A maximum variation sample of six science teachers, three school administrators, six parents and six students from a large urban public school district were interviewed using semi-structured, in-depth interview techniques. From these data, a list of observable characteristics which urban stakeholders hold as evidence of high quality in science teaching was generated. Observational techniques were utilized to determine the extent to which six urban high school science teachers, who meet the NCLB Act criteria for being "highly qualified", actually possessed the characteristics which these stakeholders hold as evidence of high quality in science teaching. Constant comparative analysis was used to analyze the data set. The findings suggest that urban stakeholders perceive that a high school science teacher who demonstrates high quality in science teaching should be knowledgeable about their subject matter, their student population, and should be resourceful; should possess an academic background in science and professional experience in science teaching; should exhibit professionalism, a passion for science and teaching, and a dedication to teaching and student learning; should be skillful in planning and preparing science lessons and in organizing the classroom, in presenting the subject matter to students, in conducting a variety of hands-on activities, and in managing a classroom; and should assess whether students complete class goals and objectives, and provide feedback about grades for students promptly. The findings further reveal that some of the urban high school science teachers who were deemed to be "highly qualified", as defined by the NCLB Act, engaged in practices that threatened quality in science teaching and often failed to display the characteristics which urban stakeholders hold as evidence of high quality in science teaching. Thus, the criteria for "highly qualified" prescribed by policy makers and politicians do not necessarily translate into effective science teaching in urban settings. These findings emphasize the importance of stakeholder involvement in the design of educational reform initiatives.

Appropriate Importation and Effective Utilization of Top Quality Foreign Higher Education Resources for Sino-Foreign Cooperation in Running Schools

ERIC Educational Resources Information Center

Jinhui, Lin; Zhiping, Liu

2009-01-01

The appropriate importation and effective utilization of superior-quality foreign higher education resources are crucial to enhance the level and quality of school administration cooperation with foreign partners because it can not only make up for the shortage in domestic education resources and push forward China's higher education reform but…

Factors Associated with the Utilization and Quality of Prenatal Care in Western Rural Regions of China

ERIC Educational Resources Information Center

Dongxu, Wang; Yuhui, Shi; Stewart, Donald; Chun, Chang; Chaoyang, Li

2012-01-01

Purpose: The paper seeks to identify key features of prenatal care utilization and quality in western regions of China and to determine the factors affecting the quality of prenatal care. Design/methodology/approach: A descriptive, cross-sectional study was conducted. The instrument for the study was a 10-stem respondent-administered, structured…

Quantifying and predicting meat and meat products quality attributes using electromagnetic waves: an overview.

PubMed

Damez, Jean-Louis; Clerjon, Sylvie

2013-12-01

The meat industry needs reliable meat quality information throughout the production process in order to guarantee high-quality meat products for consumers. Besides laboratory researches, food scientists often try to adapt their tools to industrial conditions and easy handling devices useable on-line and in slaughterhouses already exist. This paper overviews the recently developed approaches and latest research efforts related to assessing the quality of different meat products by electromagnetic waves and examines the potential for their deployment. The main meat quality traits that can be assessed using electromagnetic waves are sensory characteristics, chemical composition, physicochemical properties, health-protecting properties, nutritional characteristics and safety. A wide range of techniques, from low frequency, high frequency impedance measurement, microwaves, NMR, IR and UV light, to X-ray interaction, involves a wide range of physical interactions between the electromagnetic wave and the sample. Some of these techniques are now in a period of transition between experimental and applied utilization and several sensors and instruments are reviewed. Copyright © 2013 Elsevier Ltd. All rights reserved.

An empirical assessment of high-performing medical groups: results from a national study.

PubMed

Shortell, Stephen M; Schmittdiel, Julie; Wang, Margaret C; Li, Rui; Gillies, Robin R; Casalino, Lawrence P; Bodenheimer, Thomas; Rundall, Thomas G

2005-08-01

The performance of medical groups is receiving increased attention. Relatively little conceptual or empirical work exists that examines the various dimensions of medical group performance. Using a national database of 693 medical groups, this article develops a scorecard approach to assessing group performance and presents a theory-driven framework for differentiating between high-performing versus low-performing medical groups. The clinical quality of care, financial performance, and organizational learning capability of medical groups are assessed in relation to environmental forces, resource acquisition and resource deployment factors, and a quality-centered culture. Findings support the utility of the performance scorecard approach and identification of a number of key factors differentiating high-performing from low-performing groups including, in particular, the importance of a quality-centered culture and the requirement of outside reporting from third party organizations. The findings hold a number of important implications for policy and practice, and the framework presented provides a foundation for future research.

Can state-of-the-art HVS-based objective image quality criteria be used for image reconstruction techniques based on ROI analysis?

NASA Astrophysics Data System (ADS)

Dostal, P.; Krasula, L.; Klima, M.

2012-06-01

Various image processing techniques in multimedia technology are optimized using visual attention feature of the human visual system. Spatial non-uniformity causes that different locations in an image are of different importance in terms of perception of the image. In other words, the perceived image quality depends mainly on the quality of important locations known as regions of interest. The performance of such techniques is measured by subjective evaluation or objective image quality criteria. Many state-of-the-art objective metrics are based on HVS properties; SSIM, MS-SSIM based on image structural information, VIF based on the information that human brain can ideally gain from the reference image or FSIM utilizing the low-level features to assign the different importance to each location in the image. But still none of these objective metrics utilize the analysis of regions of interest. We solve the question if these objective metrics can be used for effective evaluation of images reconstructed by processing techniques based on ROI analysis utilizing high-level features. In this paper authors show that the state-of-the-art objective metrics do not correlate well with subjective evaluation while the demosaicing based on ROI analysis is used for reconstruction. The ROI were computed from "ground truth" visual attention data. The algorithm combining two known demosaicing techniques on the basis of ROI location is proposed to reconstruct the ROI in fine quality while the rest of image is reconstructed with low quality. The color image reconstructed by this ROI approach was compared with selected demosaicing techniques by objective criteria and subjective testing. The qualitative comparison of the objective and subjective results indicates that the state-of-the-art objective metrics are still not suitable for evaluation image processing techniques based on ROI analysis and new criteria is demanded.

Utility of a scanning densitometer in analyzing remotely sensed imagery

NASA Technical Reports Server (NTRS)

Dooley, J. T.

1976-01-01

The utility of a scanning densitometer for analyzing imagery in the NASA Lewis Research Center's regional remote sensing program was evaluated. Uses studied include: (1) quick-look screening of imagery by means of density slicing, magnification, color coding, and edge enhancement; (2) preliminary category classification of both low- and high-resolution data bases; and (3) quantitative measurement of the extent of features within selected areas. The densitometer was capable of providing fast, convenient, and relatively inexpensive preliminary analysis of aerial and satellite photography and scanner imagery involving land cover, water quality, strip mining, and energy conservation.

A method of object recognition for single pixel imaging

NASA Astrophysics Data System (ADS)

Li, Boxuan; Zhang, Wenwen

2018-01-01

Computational ghost imaging(CGI), utilizing a single-pixel detector, has been extensively used in many fields. However, in order to achieve a high-quality reconstructed image, a large number of iterations are needed, which limits the flexibility of using CGI in practical situations, especially in the field of object recognition. In this paper, we purpose a method utilizing the feature matching to identify the number objects. In the given system, approximately 90% of accuracy of recognition rates can be achieved, which provides a new idea for the application of single pixel imaging in the field of object recognition

Recent results and new hardware developments for protein crystal growth in microactivity

NASA Technical Reports Server (NTRS)

Delucas, L. J.; Long, M. M.; Moore, K. M.; Smith, C.; Carson, M.; Narayana, S. V. L.; Carter, D.; Clark, A. D., Jr.; Nanni, R. G.; Ding, J.

1993-01-01

Protein crystal growth experiments have been performed on 16 space shuttle missions since April, 1985. The initial experiments utilized vapor diffusion crystallization techniques similar to those used in laboratories for earth-based experiments. More recent experiments have utilized temperature induced crystallization as an alternative method for growing high quality protein crystals in microgravity. Results from both vapor diffusion and temperature induced crystallization experiments indicate that proteins grown in microgravity may be larger, display more uniform morphologies, and yield diffraction data to significantly higher resolutions than the best crystals of these proteins grown on earth.

Health-related quality of life and associated factors in Jordanian cancer patients: A cross-sectional study.

PubMed

Mosleh, Sultan M

2018-06-04

Understanding the factors associated with patients' health-related quality of life along with their social networks can help identify who may benefit from supportive programmes. This study sought to evaluate the impact of a cancer diagnosis on Jordanian cancer patients' health-related quality of life and its relationship with social support and emotional status. A descriptive design was utilized, and 226 clients were participated. Participants completed European Organization for Research and Treatment of cancer quality of life questionnaire (EORTC-version 3), the Hospice Comfort Questionnaire, and the Hospital Anxiety and Depression scale. The results revealed that participants demonstrated unsatisfactory quality of life and many complained of fatigue. A multiple linear regression analysis revealed that social support, hospitalization readmission and being a nonsmoker were significant predictors for poor global quality of life score. In addition, a high educational level, less rehospitalization and high anxiety and depression scores were significant predictors for comfort level. In conclusion, patients with cancer are at an elevated risk of impaired physical functioning and report unsatisfactory quality of life, particularly if they are anxious, depressed and lack social support. The associated factors with decreased quality of life or low comfort level could be amenable to change with appropriate interventions. © 2018 John Wiley & Sons Ltd.

Mapping between 6 Multiattribute Utility Instruments.

PubMed

Chen, Gang; Khan, Munir A; Iezzi, Angelo; Ratcliffe, Julie; Richardson, Jeff

2016-02-01

Cost-utility analyses commonly employ a multiattribute utility (MAU) instrument to estimate the health state utilities, which are needed to calculate quality-adjusted life years. Different MAU instruments predict significantly different utilities, which makes comparison of results from different evaluation studies problematical. This article presents mapping functions ("crosswalks") from 6 MAU instruments (EQ-5D-5L, SF-6D, Health Utilities Index 3 [HUI 3], 15D, Quality of Well-Being [QWB], and Assessment of Quality of Life 8D [AQoL-8D]) to each of the other 5 instruments in the study: a total of 30 mapping functions. Data were obtained from a multi-instrument comparison survey of the public and patients in 7 disease areas conducted in 6 countries (Australia, Canada, Germany, Norway, United Kingdom, and United States). The 8022 respondents were administered each of the 6 study instruments. Mapping equations between each instrument pair were estimated using 4 econometric techniques: ordinary least squares, generalized linear model, censored least absolute deviations, and, for the first time, a robust MM-estimator. Goodness-of-fit indicators for each of the results are within the range of published studies. Transformations reduced discrepancies between predicted utilities. Incremental utilities, which determine the value of quality-related health benefits, are almost perfectly aligned at the sample means. Transformations presented here align the measurement scales of MAU instruments. Their use will increase confidence in the comparability of evaluation studies, which have employed different MAU instruments. © The Author(s) 2015.

Quality of life, health status, and health service utilization related to a new measure of health literacy: FLIGHT/VIDAS.

PubMed

Ownby, Raymond L; Acevedo, Amarilis; Jacobs, Robin J; Caballero, Joshua; Waldrop-Valverde, Drenna

2014-09-01

Researchers have identified significant limitations in some currently used measures of health literacy. The purpose of this paper is to present data on the relation of health-related quality of life, health status, and health service utilization to performance on a new measure of health literacy in a nonpatient population. The new measure was administered to 475 English- and Spanish-speaking community-dwelling volunteers along with existing measures of health literacy and assessments of health-related quality of life, health status, and healthcare service utilization. Relations among measures were assessed via correlations and health status and utilization was tested across levels of health literacy using ANCOVA models. The new health literacy measure is significantly related to existing measures of health literacy as well as to participants' health-related quality of life. Persons with lower levels of health literacy reported more health conditions, more frequent physical symptoms, and greater healthcare service utilization. The new measure of health literacy is valid and shows relations to measures of conceptually related constructs such as quality of life and health behaviors. FLIGHT/VIDAS may be useful to researchers and clinicians interested in a computer administered and scored measure of health literacy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Impact of a Usual Source of Care on Health Care Use, Spending, and Quality Among Adults With Mental Health Conditions.

PubMed

Fullerton, Catherine A; Witt, Whitney P; Chow, Clifton M; Gokhale, Manjusha; Walsh, Christine E; Crable, Erika L; Naeger, Sarah

2018-05-01

Physical comorbidities associated with mental health conditions contribute to high health care costs. This study examined the impact of having a usual source of care (USC) for physical health on health care utilization, spending, and quality for adults with a mental health condition using Medicaid administrative data. Having a USC decreased the probability of inpatient admissions and readmissions. It decreased expenditures on emergency department visits for physical health, 30-day readmissions, and behavioral health inpatient admissions. It also had a positive effect on several quality measures. Results underscore the importance of a USC for physical health and integrated care for adults with mental health conditions.

UV / Visible / Near-Infrared Reflectance Models for the Rapid and Non-Destructive Prediction and Classification of Cotton Color and Physical Indices

USDA-ARS?s Scientific Manuscript database

High volume instrumentation (HVI), utilized in the cotton industry to determine the qualities and classifications of cotton fibers, is time consuming, and prone to day-to-day and location-to-location variations. UV / visible / NIR spectroscopy, a rapid and easy sampling technique, was investigated a...

Chronic Absenteeism: A Key Indicator of Student Success. Policy Analysis

ERIC Educational Resources Information Center

Rafa, Alyssa

2017-01-01

Research shows that chronic absenteeism can affect academic performance in later grades and is a key early warning sign that a student is more likely to drop out of high school. Several states enacted legislation to address this issue, and many states are currently discussing the utility of chronic absenteeism as an indicator of school quality or…

Get It? Got It. Good!: Utilizing Get It Now Article Delivery Service at a Health Sciences Library

ERIC Educational Resources Information Center

Jarvis, Christy; Gregory, Joan M.

2016-01-01

With journal price increases continuing to outpace inflation and library collection funds remaining stagnant or shrinking, libraries are seeking innovative ways to control spending while continuing to provide patrons with high-quality content. The Spencer S. Eccles Health Sciences Library reports on the evaluation, implementation, and use of…

Mothers' Resolution of Their Young Children's Psychiatric Diagnoses: Associations with Child, Parent, and Relationship Characteristics

ERIC Educational Resources Information Center

Kearney, Joan A.; Britner, Preston A.; Farrell, Anne F.; Robinson, JoAnn L.

2011-01-01

Maternal resolution of a child's diagnosis relates to sensitive caregiving and healthy attachment. Failure to resolve is associated with maternal distress, high caregiving burden, and the quality of marital and social support. This study examined maternal resolution of diagnosis in a child psychiatric population utilizing the Reaction to Diagnosis…

The interaction of the soybean seed high oleic acid oil trait with other fatty acid modifications

USDA-ARS?s Scientific Manuscript database

Oil value is determined by the functional qualities imparted from the fatty acid profile. Soybean oil historically had excellent utilization in both food and industrial uses, but the need to increase the stability of the oil without negative health consequences has led to a significant decline in s...

An Examination of Instructional Interactions between Volunteer-Tutors and Students Who Show Differential Gains in Reading Comprehension

ERIC Educational Resources Information Center

Newcomer, Laurie J.

2010-01-01

It is essential to provide high quality interventions designed to improve struggling readers' reading comprehension while making use of limited resources. This study explored, through an holistic, multiple-case study design, volunteer-student interactions and activities in an after school reading program utilizing minimally-trained volunteers. The…

Test-Wiseness Cues in the Options of Mathematics Items.

ERIC Educational Resources Information Center

Kuntz, Patricia

The quality of mathematics multiple choice items and their susceptibility to test wiseness were examined. Test wiseness was defined as "a subject's capacity to utilize the characteristics and formats of the test and/or test taking situation to receive a high score." The study used results of the Graduate Record Examinations Aptitude Test (GRE) and…

SEM vouchers and genomic data from an individual specimen: maximizing the utility of delicate and rare specimens

USDA-ARS?s Scientific Manuscript database

Specimen vouchering is a critical aspect of systematics, especially in genetic studies where the identity of a DNA sample needs to be assured. It can be difficult to obtain a high quality voucher after DNA extraction when dealing with tiny and delicate invertebrates that often do not survive the ext...

Educational Statistics Authentic Learning CAPSULES: Community Action Projects for Students Utilizing Leadership and E-Based Statistics

ERIC Educational Resources Information Center

Thompson, Carla J.

2009-01-01

Since educational statistics is a core or general requirement of all students enrolled in graduate education programs, the need for high quality student engagement and appropriate authentic learning experiences is critical for promoting student interest and student success in the course. Based in authentic learning theory and engagement theory…

Video Use in Teacher Education: A Survey of Teacher-Educators' Practices across Disciplines

ERIC Educational Resources Information Center

Arya, Poonam; Christ, Tanya; Chiu, Ming Ming

2016-01-01

Video methods utilize tenets of high quality teacher education and support education students' learning and application of learning to teaching practices. However, how frequently video is used in teacher education, and in what ways is unknown. Therefore, this study used survey data to identify the extent to which 94 teacher-educators used video in…

'HoneySweet' (C5), the first genetically engineered Plum pox virus-resistant plum (Prunus domestica L.) cultivar

USDA-ARS?s Scientific Manuscript database

‘HoneySweet’ plum was released by the U.S. Department of Agriculture, Agricultural Research Service, to provide U.S. growers and P. domestica plum breeders with a high fruit quality plum cultivar resistant to Plum pox virus (PPV). ‘HoneySweet’ was developed through genetic engineering utilizing the...

Testing the Digital Divide: Does Access to High-Quality Use of Technology in Schools Affect Student Achievement?

ERIC Educational Resources Information Center

Talley, Gregory Keith

2012-01-01

This study investigates the relationship between access, use of technology and student achievement in public middle schools in Maryland. The objective of this study was to determine whether a digital divide (differences in access and utilization of technology based on student characteristics of race, socioeconomic status, and gender) exists among…

Remote sensing of land use and water quality relationships - Wisconsin shore, Lake Michigan

NASA Technical Reports Server (NTRS)

Haugen, R. K.; Marlar, T. L.

1976-01-01

This investigation assessed the utility of remote sensing techniques in the study of land use-water quality relationships in an east central Wisconsin test area. The following types of aerial imagery were evaluated: high altitude (60,000 ft) color, color infrared, multispectral black and white, and thermal; low altitude (less than 5000 ft) color infrared, multispectral black and white, thermal, and passive microwave. A non-imaging hand-held four-band radiometer was evaluated for utility in providing data on suspended sediment concentrations. Land use analysis includes the development of mapping and quantification methods to obtain baseline data for comparison to water quality variables. Suspended sediment loads in streams, determined from water samples, were related to land use differences and soil types in three major watersheds. A multiple correlation coefficient R of 0.85 was obtained for the relationship between the 0.6-0.7 micrometer incident and reflected radiation data from the hand-held radiometer and concurrent ground measurements of suspended solids in streams. Applications of the methods and baseline data developed in this investigation include: mapping and quantification of land use; input to watershed runoff models; estimation of effects of land use changes on stream sedimentation; and remote sensing of suspended sediment content of streams. High altitude color infrared imagery was found to be the most acceptable remote sensing technique for the mapping and measurement of land use types.

Vision and quality-of-life.

PubMed Central

Brown, G C

1999-01-01

OBJECTIVE: To determine the relationship of visual acuity loss to quality of life. DESIGN: Three hundred twenty-five patients with visual loss to a minimum of 20/40 or greater in at least 1 eye were interviewed in a standardized fashion using a modified VF-14, questionnaire. Utility values were also obtained using both the time trade-off and standard gamble methods of utility assessment. MAIN OUTCOME MEASURES: Best-corrected visual acuity was correlated with the visual function score on the modified VF-14 questionnaire, as well as with utility values obtained using both the time trade-off and standard gamble methods. RESULTS: Decreasing levels of vision in the eye with better acuity correlated directly with decreasing visual function scores on the modified VF-14 questionnaire, as did decreasing utility values using the time trade-off method of utility evaluation. The standard gamble method of utility evaluation was not as directly correlated with vision as the time trade-off method. Age, level of education, gender, race, length of time of visual loss, and the number of associated systemic comorbidities did not significantly affect the time trade-off utility values associated with visual loss in the better eye. The level of reduced vision in the better eye, rather than the specific disease process causing reduced vision, was related to mean utility values. The average person with 20/40 vision in the better seeing eye was willing to trade 2 of every 10 years of life in return for perfect vision (utility value of 0.8), while the average person with counting fingers vision in the better eye was willing to trade approximately 5 of every 10 remaining years of life (utility value of 0.52) in return for perfect vision. CONCLUSIONS: The time trade-off method of utility evaluation appears to be an effective method for assessing quality of life associated with visual loss. Time trade-off utility values decrease in direct conjunction with decreasing vision in the better-seeing eye. Unlike the modified VF-14 test and its counterparts, utility values allow the quality of life associated with visual loss to be more readily compared to the quality of life associated with other health (disease) states. This information can be employed for cost-effective analyses that objectively compare evidence-based medicine, patient-based preferences and sound econometric principles across all specialties in health care. PMID:10703139

Correlates of care for young men with Duchenne and Becker muscular dystrophy.

PubMed

Andrews, Jennifer G; Davis, Melinda F; Meaney, F John

2014-01-01

In progressive conditions, such as Duchenne and Becker muscular dystrophy (DBMD), the need for care may outpace care use. We examined correlates that contribute to utilization of needed care. Structured interviews were conducted on use of care among 34 young men with DBMD who were born before 1982. Disease severity, per capita income, and presence of other relatives with DBMD predicted greater use of services. Race/ethnicity, acculturation, and level of caregiver education did not significantly predict service utilization. We identified disparities in receipt of healthcare and related services in adult men with DBMD that can affect quality of life. Despite the high disease severity identified in this population, these men utilized only half of the services available to individuals with significant progressive conditions. Providers should be aware of low service utilization and focus on awareness and assistance to ensure access to available care. Copyright © 2013 Wiley Periodicals, Inc.

At-Home Versus In-Clinic INR Monitoring: A Cost-Utility Analysis from The Home INR Study (THINRS).

PubMed

Phibbs, Ciaran S; Love, Sean R; Jacobson, Alan K; Edson, Robert; Su, Pon; Uyeda, Lauren; Matchar, David B

2016-09-01

Effective management of patients using warfarin is resource-intensive, requiring frequent in-clinic testing of the international normalized ratio (INR). Patient self-testing (PST) using portable at-home INR monitoring devices has emerged as a convenient alternative. As revealed by The Home INR Study (THINRS), event rates for PST were not significantly different from those for in-clinic high-quality anticoagulation management (HQACM), and a cumulative gain in quality of life was observed for patients undergoing PST. To perform a cost-utility analysis of weekly PST versus monthly HQACM and to examine the sensitivity of these results to testing frequency. In this study, 2922 patients taking warfarin for atrial fibrillation or mechanical heart valve, and who demonstrated PST competence, were randomized to either weekly PST (n = 1465) or monthly in-clinic testing (n = 1457). In a sub-study, 234 additional patients were randomized to PST once every 4 weeks (n = 116) or PST twice weekly (n = 118). The endpoints were quality of life (measured by the Health Utilities Index), health care utilization, and costs over 2 years of follow-up. PST and HQACM participants were similar with regard to gender, age, and CHADS2 score. The total cost per patient over 2 years of follow-up was $32,484 for HQACM and $33,460 for weekly PST, representing a difference of $976. The incremental cost per quality-adjusted life year gained with PST once weekly was $5566 (95 % CI, -$11,490 to $25,142). The incremental cost-effectiveness ratio (ICER) was sensitive to testing frequency: weekly PST dominated PST twice weekly and once every 4 weeks. Compared to HQACM, weekly PST was associated with statistically significant and clinically meaningful improvements in quality of life. The ICER for weekly PST versus HQACM was well within accepted standards for cost-effectiveness, and was preferred over more or less frequent PST. These results were robust to sensitivity analyses of key assumptions. Weekly PST is a cost-effective alternative to monthly HQACM and a preferred testing frequency compared to twice weekly or monthly PST.

Utilization of Light Detection and Ranging for Quality Control and Quality Assurance of Pavement Grades

DOT National Transportation Integrated Search

2018-02-01

Light Detection and Ranging (Lidar) technology is a useful tool that can assist transportation agencies during the design, construction, and maintenance phases of transportation projects. To demonstrate the utility of Lidar, this report discusses how...

Cost-utility analysis of an adjunctive recombinant activated factor VIIa for on-demand treatment of bleeding episodes in dengue haemorrhagic fever.

PubMed

Naing, Cho; Poovorawan, Yong; Mak, Joon Wah; Aung, Kyan; Kamolratankul, Pirom

2015-06-01

The present study aimed to assess the cost-utility analysis of using an adjunctive recombinant activated factor VIIa (rFVIIa) in children for controlling life-threatening bleeding in dengue haemorrhagic fever (DHF)/dengue shock syndrome (DSS). We constructed a decision-tree model, comparing a standard care and the use of an additional adjuvant rFVIIa for controlling life-threatening bleeding in children with DHF/DSS. Cost and utility benefit were estimated from the societal perspective. The outcome measure was cost per quality-adjusted life years (QALYs). Overall, treatment with adjuvant rFVIIa gained QALYs, but the total cost was higher. The incremental cost-utility ratio for the introduction of adjuvant rFVIIa was $4241.27 per additional QALY. Sensitivity analyses showed the utility value assigned for calculation of QALY was the most sensitive parameter. We concluded that despite high cost, there is a role for rFVIIa in the treatment of life-threatening bleeding in patients with DHF/DSS.

A multifunctional energy-storage system with high-power lead-acid batteries

NASA Astrophysics Data System (ADS)

Wagner, R.; Schroeder, M.; Stephanblome, T.; Handschin, E.

A multifunctional energy storage system is presented which is used to improve the utilization of renewable energy supplies. This system includes three different functions: (i) uninterruptible power supply (UPS); (ii) improvement of power quality; (iii) peak-load shaving. The UPS application has a long tradition and is used whenever a reliable power supply is needed. Additionally, nowadays, there is a growing demand for high quality power arising from an increase of system perturbation of electric grids. Peak-load shaving means in this case the use of renewable energy stored in a battery for high peak-load periods. For such a multifunctional application large lead-acid batteries with high power and good charge acceptance, as well as good cycle life are needed. OCSM batteries as with positive tubular plates and negative copper grids have been used successfully for a multitude of utility applications. This paper gives two examples where multifunctional energy storage systems have started operation recently in Germany. One system was installed in combination with a 1 MW solar plant in Herne and another one was installed in combination with a 2 MW wind farm in Bocholt. At each place, a 1.2 MW h (1 h-rate) lead-acid battery has been installed. The batteries consist of OCSM cells with the standard design but modified according to the special demand of a multifunctional application.

Quantification of the effects of quality investment on the Cost of Poor Quality: A quasi-experimental study

NASA Astrophysics Data System (ADS)

Tamimi, Abdallah Ibrahim

Quality management is a fundamental challenge facing businesses. This research attempted to quantify the effect of quality investment on the Cost of Poor Quality (COPQ) in an aerospace company utilizing 3 years of quality data at United Launch Alliance, a Boeing -- Lockheed Martin Joint Venture Company. Statistical analysis tools, like multiple regressions, were used to quantify the relationship between quality investments and COPQ. Strong correlations were evident by the high correlation coefficient R2 and very small p-values in multiple regression analysis. The models in the study helped produce an Excel macro that based on preset constraints, optimized the level of quality spending to minimize COPQ. The study confirmed that as quality investments were increased, the COPQ decreased steadily until a point of diminishing return was reached. The findings may be used to develop an approach to reduce the COPQ and enhance product performance. Achieving superior quality in rocket launching enhances the accuracy, reliability, and mission success of delivering satellites to their precise orbits in pursuit of knowledge, peace, and freedom while assuring safety for the end user.

Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.

PubMed

Kakyo, Tracy Alexis; Xiao, Lily Dongxia

2017-06-01

Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention. © 2017 John Wiley & Sons Australia, Ltd.

Societal Value of Surgery for Facial Reanimation

PubMed Central

Su, Peiyi; Ishii, Lisa E.; Joseph, Andrew; Nellis, Jason; Dey, Jacob; Bater, Kristin; Byrne, Patrick J.; Boahene, Kofi D. O.; Ishii, Masaru

2017-01-01

IMPORTANCE Patients with facial paralysis are perceived negatively by society in a number of domains. Society’s perception of the health utility of varying degrees of facial paralysis and the value society places on reconstructive surgery for facial reanimation need to be quantified. OBJECTIVE To measure health state utility of varying degrees of facial paralysis, willingness to pay (WTP) for a repair, and the subsequent value of facial reanimation surgery as perceived by society. DESIGN, SETTING, AND PARTICIPANTS This prospective observational study conducted in an academic tertiary referral center evaluated a group of 348 casual observers who viewed images of faces with unilateral facial paralysis of 3 severity levels (low, medium, and high) categorized by House-Brackmann grade. Structural equation modeling was performed to understand associations among health utility metrics, WTP, and facial perception domains. Data were collected from July 16 to September 26, 2015. MAIN OUTCOMES AND MEASURES Observer-rated (1) quality of life (QOL) using established health utility metrics (standard gamble, time trade-off, and a visual analog scale) and (2) their WTP for surgical repair. RESULTS Among the 348 observers (248 women [71.3%]; 100 men [28.7%]; mean [SD] age, 29.3 [11.6] years), mixed-effects linear regression showed that WTP increased nonlinearly with increasing severity of paralysis. Participants were willing to pay $3487 (95% CI, $2362–$4961) to repair low-grade paralysis, $8571 (95% CI, $6401–$11 234) for medium-grade paralysis, and $20 431 (95% CI, $16 273–$25 317) for high-grade paralysis. The dominant factor affecting the participants’ WTP was perceived QOL. Modeling showed that perceived QOL decreased with paralysis severity (regression coefficient, −0.004; 95% CI, −0.005 to −0.004; P < .001) and increased with attractiveness (regression coefficient, 0.002; 95% CI, 0.002 to 0.003; P < .001). Mean (SD) health utility scores calculated by the standard gamble metric for low- and high-grade paralysis were 0.98 (0.09) and 0.77 (0.25), respectively. Time trade-off and visual analog scale measures were highly correlated. We calculated mean (SD) WTP per quality-adjusted life-year, which ranged from $10 167 ($14 565) to $17 008 ($38 288) for low- to high-grade paralysis, respectively. CONCLUSIONS AND RELEVANCE Society perceives the repair of facial paralysis to be a high-value intervention. Societal WTP increases and perceived health state utility decreases with increasing House-Brackmann grade. This study demonstrates the usefulness of WTP as an objective measure to inform dimensions of disease severity and signal the value society places on proper facial function. LEVEL OF EVIDENCE NA. PMID:27892977

Comparison of organic electroluminescence and liquid crystal displays for clinical utility in orthopedic endoscopic surgery.

PubMed

Dezawa, Akira; Sairyo, Koichi

2014-05-01

Organic electroluminescence displays (OELD) use organic materials that self-emit light with the passage of an electric current. OELD provide high contrast, excellent color reproducibility at low brightness, excellent video images, and less restricted viewing angles. OELD are thus promising for medical use. This study compared the utility of an OELD with conventional liquid crystal displays (LCD) for imaging in orthopedic endoscopic surgery. One OELD and two conventional LCD that were indistinguishable in external appearance were used in this study. Images from 18 patients were displayed simultaneously on three monitors and evaluated by six orthopedic surgeons with extensive surgical experience. Images were shown for 2 min, repeated twice, and viewed from the front and side (diagonally). Surgeon rated both clinical utility (12 parameters) and image quality (11 parameters) for each image on a 5-point scale: 1, very good; 2, good; 3, average; 4, poor; and 5, very poor. For clinical utility in 16 percutaneous endoscopic discectomy cases, mean scores for all 12 parameters were significantly better on the OELD than on the LCD, including organ distinguishability (2.1 vs 3.2, respectively), lesion identification (2.2 vs 3.1), and overall viewing impression (2.1 vs 3.1). For image quality, all 11 parameters were better on the OELD than on LCD. Significant differences were identified in six parameters, including contrast (1.8 vs 2.9), color reproducibility in dark areas (1.8 vs 2.9), and viewing angle (2.2 vs 2.9). The high contrast and excellent color reproducibility of the OELD reduced the constraints of imaging under endoscopy, in which securing a field of view may be difficult. Distinguishability of organs was good, including ligaments, dura mater, nerves, and adipose tissue, contributing to good stereoscopic images of the surgical field. These findings suggest the utility of OELD for excellent display of surgical images and for enabling safe and highly accurate endoscopic surgery. © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

Application of Satellite and Ozonesonde Data to the Study of Nighttime Tropospheric Ozone Impacts and Relationship to Air Quality

NASA Astrophysics Data System (ADS)

Osterman, G. B.; Eldering, A.; Neu, J. L.; Tang, Y.; McQueen, J.; Pinder, R. W.

2011-12-01

To help protect human health and ecosystems, regional-scale atmospheric chemistry models are used to forecast high ozone events and to design emission control strategies to decrease the frequency and severity of ozone events. Despite the impact that nighttime aloft ozone can have on surface ozone, regional-scale atmospheric chemistry models often do not simulate the nighttime ozone concentrations well and nor do they sufficiently capture the ozone transport patterns. Fully characterizing the importance of the nighttime ozone has been hampered by limited measurements of the vertical distribution of ozone and ozone-precursors. The main focus of this work is to begin to utilize remote sensing data sets to characterize the impact of nighttime aloft ozone to air quality events. We will describe our plans to use NASA satellite data sets, transport models and air quality models to study ozone transport, focusing primarily on nighttime ozone and provide initial results. We will use satellite and ozonesonde data to help understand how well the air quality models are simulating ozone in the lower free troposphere and attempt to characterize the impact of nighttime ozone to air quality events. Our specific objectives are: 1) Characterize nighttime aloft ozone using remote sensing data and sondes. 2) Evaluate the ability of the Community Multi-scale Air Quality (CMAQ) model and the National Air Quality Forecast Capability (NAQFC) model to capture the nighttime aloft ozone and its relationship to air quality events. 3) Analyze a set of air quality events and determine the relationship of air quality events to the nighttime aloft ozone. We will achieve our objectives by utilizing the ozone profile data from the NASA Earth Observing System (EOS) Tropospheric Emission Spectrometer (TES) and other sensors, ozonesonde data collected during the Aura mission (IONS), EPA AirNow ground station ozone data, the CMAQ continental-scale air quality model, and the National Air Quality Forecast model.

A customer oriented systematic framework to extract business strategy in Indian electricity services

NASA Astrophysics Data System (ADS)

Satapathy, Suchismita; Mishra, Pravudatta

2013-11-01

Competition in the electric service industry is highlighting the importance of a number of issues affecting the nature and quality of customer service. The quality of service(s) provided to electricity customers may be enhanced by competition, if doing so offers service suppliers a competitive advantage. On the other hand, service quality offered to some consumers could decline if utilities focus their attention on those customers most likely to exercise choice, while reducing effort and investment to serve customers less likely to choose alternatives. Service quality is defined as the way in which the utility interacts with and responds to the needs of its customers. To achieve maximum consumer satisfaction in electricity service, This paper has designed a framework by QFD by measuring service quality of electricity utility sector in ANN and also find interrelationship between these design requirements by ISM.

Indoor air quality in public utility environments-a review.

PubMed

Śmiełowska, Monika; Marć, Mariusz; Zabiegała, Bożena

2017-04-01

Indoor air quality has been the object of interest for scientists and specialists from the fields of science such as chemistry, medicine and ventilation system design. This results from a considerable number of potential factors, which may influence the quality of the broadly understood indoor air in a negative way. Poor quality of indoor air in various types of public utility buildings may significantly affect an increase in the incidence of various types of civilisation diseases. This paper presents information about a broad spectrum of chemical compounds that were identified and determined in the indoor environment of various types of public utility rooms such as churches, museums, libraries, temples and hospitals. An analysis of literature data allowed for identification of the most important transport paths of chemical compounds that significantly influence the quality of the indoor environment and thus the comfort of living and the health of persons staying in it.

Using incentives to improve resource utilization: a quasi-experimental evaluation of an ICU quality improvement program

PubMed Central

Murphy, David J.; Lyu, Peter F.; Gregg, Sara R.; Martin, Greg S.; Hockenberry, Jason M.; Coopersmith, Craig M.; Sterling, Michael; Buchman, Timothy G.; Sevransky, Jonathan

2015-01-01

Objective Healthcare systems strive to provide quality care at lower cost. Arterial blood gas testing (ABGs), chest radiographs (CXRs), and red blood cell transfusions (RBCs) provide an important example of opportunities to reduce excess resource utilization within the ICU. We describe the effect of a multifaceted quality improvement program designed to decrease avoidable ABGs, CXRs, and RBCs utilization on utilization of these resources and patient outcomes. Design Prospective pre-post cohort study Setting Seven ICUs in an academic healthcare system Patients All adult ICU patients admitted to study ICUs during consecutive baseline (n=7,357), intervention (n=7,553), and follow up (n=7,657) years between September 2010 and August 2013. Interventions A multifaceted quality improvement program including provider education, audit and feedback, and unit-based provider financial incentives targeting ABG, CXR, and RBC utilization. Measurements and Main Results The primary outcome was the number of orders for ABGs, CXRs, and RBCs per patient. Compared to the baseline period, unadjusted ABG, CXR, and RBC utilization in the intervention period was reduced by 42%, 26%, and 17%, respectively (p<0.01). After adjusting for potentially relevant patient factors, the intervention was associated with 128 fewer ABGs, 73 fewer CXRs, and 16 fewer RBCs per 100 patients (p<0.01). This effect was durable during the follow up year. This reduction yielded an approximate net savings of $1.5 M in direct costs over the intervention and follow-up years after accounting for the direct costs of the program. Unadjusted hospital mortality decreased from 7% in the baseline period to 5.2% in the intervention period (p<0.01). This reduction remained significant after adjusting for patient factors (OR= 0.43, P<0.01). Conclusions Implementation of a multifaceted quality improvement program including financial incentives was associated with significant improvements in resource utilization. Our findings provide evidence supporting the safety, effectiveness, and sustainability of incentive-based quality improvement interventions. PMID:26496444

Continuous-tone applications in digital hard-copy output devices

NASA Astrophysics Data System (ADS)

Saunders, Jeffrey C.

1990-11-01

Dye diffusion technology has made a recent entry into the hardcopy printer arena making it now possible to achieve near-photographic quality images from digital raster image data. Whereas the majority of low cost printers utilizing ink-jet, thermal wax, or dotmatrix technologies advertise high resolution printheads, the restrictions which dithering algorithms apply to these inherently binary printing systems force them to sacrifice spatial resolution capability for tone scale reproduction. Dye diffusion technology allows a fully continuous range of density at each pixel location thus preserving the full spatial resolution capability of the printhead; spatial resolution is not sacrificed for tone scale. This results in images whose quality is far superior to the ink-jet or wax-transfer products; image quality so high in fact, to the unaided eye, dye diffusion images are indistinguishable from their silver-halide counterparts. Eastman Kodak Co. offers a highly refined application of dye diffusion technology in the Kodak XL 7700 Digital Continuous Tone Printer and Kodak EKTATHERM media products. The XL . 7700 Printer represents a serious alternative to expensive laser-based film recorders for applications which require high quality image output from digital data files. This paper presents an explanation of dye diffusion printing, what distinguishes it from other technologies, sensitometric control and image quality parameters, and applications within the industry, particularly that of Airborne Reconnaissance and Remote Sensing.

Genetic divergence for high-molecular weight glutenin subunits (HMW-GS) in indigenous landraces and commercial cultivars of bread wheat of Pakistan.

PubMed

Yasmeen, F; Khurshid, H; Ghafoor, A

2015-05-11

Wheat flour quality is an important consideration in the breeding and development of new cultivars. A strong association between high-molecular weight glutenin subunits (HMW-GS) and bread making quality has resulted in the widespread utilization of HMW-GS in wheat breeding. In this study, we analyzed 242 lines of wheat, including landraces from the provinces of Punjab and Baluchistan, as well as the commercial varieties of Pakistan, to determine allelic variation in the Glu-A1, Glu-B1, and Glu-D1 loci encoding HMW-GS. Higher genetic diversity was observed for HMW-GS in landraces from Baluchistan, followed by landraces collected from Punjab and then commercial varieties. Rare and uncommon subunits were observed in Glu-B1, whereas Glu-A1 was less polymorphic. However, Glu-B1 was the highest contributor to overall diversity (78%), with a total of 31 rare alleles, followed by Glu-D1 (20%) with the high quality 5+10 allele and other variants. Commercial cultivars possessed favorable alleles, potentially from indirect selection for wheat flour quality by the breeders; however, this indirect selection has decreased the pedigree base of commercial cultivars. The allelic combinations, including 2*, 5+10, and 17+18, showing high quality scores were frequent among landraces, indicating their usefulness in future crop improvement and breeding programs.

Dynamic stability and handling qualities tests on a highly augmented, statically unstable airplane

NASA Technical Reports Server (NTRS)

Gera, Joseph; Bosworth, John T.

1987-01-01

Initial envelope clearance and subsequent flight testing of a new, fully augmented airplane with an extremely high degree of static instability can place unusual demands on the flight test approach. Previous flight test experience with these kinds of airplanes is very limited or nonexistent. The safe and efficient flight testing may be further complicated by a multiplicity of control effectors that may be present on this class of airplanes. This paper describes some novel flight test and analysis techniques in the flight dynamics and handling qualities area. These techniques were utilized during the initial flight envelope clearance of the X-29A aircraft and were largely responsible for the completion of the flight controls clearance program without any incidents or significant delays.

Improving suicide risk assessment in a managed-care environment.

PubMed

Brown, G S; Jones, Edward R; Betts, Ellen; Wu, Jingyang

2003-01-01

This article describes the quality improvement intervention of a managed behavioral healthcare company to improve the quality of suicide risk assessments by its panel of providers. At-risk cases are identified by the patient's self-reported high frequency of suicidal ideation on a standardized outcome measure. Clinicians also assess severity of suicidal ideation based on clinical interviews. The clinician's assessment is identified as probably erroneous if the patient report indicates a high frequency of suicidal ideation and the clinicians assessment of suicidal ideation is none. The article describes the methods used to encourage clinicians to utilize information from the patient self-report measure as part of the clinical assessment. Probable suicidal ideation assessment errors were subsequently reduced by 29% over a 1-year period of administration.

Quality of life and healthcare service utilization among methadone maintenance patients in a mountainous area of Northern Vietnam.

PubMed

Nguyen, Long Hoang; Nguyen, Lan Huong Thi; Boggiano, Victoria L; Hoang, Canh Dinh; Van Nguyen, Hung; Le, Huong Thi; Le, Hai Quan; Tran, Tho Dinh; Tran, Bach Xuan; Latkin, Carl A; Zary, Nabil; Vu, Minh Thuc Thi

2017-04-20

The expansion of methadone maintenance treatment in mountainous areas in still limited and little is known about its health impacts on drug users. This study aimed to examine health-related quality of life (HRQOL) and health care access among patients engaging in methadone maintenance treatment (MMT) in Tuyen Quang, a mountainous province in Vietnam. We conducted a cross-sectional survey with 241 patients conveniently recruited in two MMT clinics (Son Duong and Tuyen Quang). EuroQol-5 Dimensions - 5 levels (EQ-5D-5 L) and Visual analogue scale (VAS) were employed to measure HRQOL. Multivariate logistic and tobit regressions were used to determine the factors associated with HRQOL and health care utilization. The overall mean score of the EQ-5D index and EQ-VAS were 0.88 (SD = 0.20) and 81.8% (SD = 15.27%), respectively. Only 8.7% utilized inpatient services, and 14.9% used outpatient services. Being more highly educated, suffering acute diseases, and using health service within the last 12 months were associated with a decreased EQ-5D index. Individuals who were multiple substance abusers and those who recently had inpatient care were more likely to have a lower VAS. Older respondents, those taking their medications at the more impoverished clinic, substance abusers, and individuals who were struggling with anxiety/depression or their usual daily activities were more likely to use both inpatient and outpatient care. In summary, we observed good HRQOL, but high prevalence of anxiety/depression and low rates of service utilization among MMT patients in Tuyen Quang province. To improve the outcomes of MMT services in mountainous areas, it is necessary to introduce personalized and integrative services models with counseling and interventions on multiple substance use.

Development and validation of the Pediatric Stroke Quality of Life Measure.

PubMed

Fiume, Andrea; Deveber, Gabrielle; Jang, Shu-Hyun; Fuller, Colleen; Viner, Shani; Friefeld, Sharon

2018-06-01

To develop and validate a disease-specific parent proxy and child quality of life (QoL) measure for patients aged 2 to 18 years surviving cerebral sinovenous thrombosis (CSVT) and arterial ischaemic stroke (AIS). Utilizing qualitative and quantitative methods, we developed a 75-item Pediatric Stroke Quality of Life Measure (PSQLM) questionnaire. We mailed the PSQLM and a standardized generic QoL measure, Pediatric Quality of Life Inventory (PedsQL), to 353 families. Stroke type, age at stroke, and neurological outcome on the Pediatric Stroke Outcome Measure were documented. We calculated the internal consistency, validity, and reliability of the PSQLM. The response rate was 29%, yielding a sample of 101 patients (mean age 9y 9mo [SD 4.30]; 69 AIS [68.3%], 32 CSVT [31.7%]). The internal consistency of the PSQLM was high (Cronbach's α=0.94-0.97). Construct validity for the PSQLM was moderately strong (r=0.3-0.4; p<0.003) and, as expected, correlation with the PedsQL was moderate, suggesting the PSQLM operationalizes QoL distinct from the PedsQL. Test-retest reliability at 2 weeks was very good (intraclass correlation coefficient [ICC] 0.85-0.95; 95% confidence interval 0.83-0.97) and good agreement was established between parent and child report (ICC 0.63-0.76). The PSQLM demonstrates sound psychometric properties. Further research will seek to increase its clinical utility by reducing length and establishing responsiveness for descriptive and longitudinal evaluative assessment. A pediatric stroke-specific quality of life (QoL) measurement tool for assessments based on perceptions of importance and satisfaction. Moderate-to-high reliability and validity established for a new clinical scale evaluating QoL among children with stroke. Perceived QoL measured using the Pediatric Stroke Quality of Life Measure appears lower in children with neurological impairment. © 2018 Mac Keith Press.

Development and application of the microbial fate and transport module for the Agricultural Policy/Environmental eXtender (APEX) model

NASA Astrophysics Data System (ADS)

Hong, E.; Park, Y.; Muirhead, R.; Jeong, J.; Pachepsky, Y. A.

2017-12-01

Pathogenic microorganisms in recreational and irrigation waters remain the subject of concern. Water quality models are used to estimate microbial quality of water sources, to evaluate microbial contamination-related risks, to guide the microbial water quality monitoring, and to evaluate the effect of agricultural management on the microbial water quality. The Agricultural Policy/Environmental eXtender (APEX) is the watershed-scale water quality model that includes highly detailed representation of agricultural management. The APEX currently does not have microbial fate and transport simulation capabilities. The objective of this work was to develop the first APEX microbial fate and transport module that could use the APEX conceptual model of manure removal together with recently introduced conceptualizations of the in-stream microbial fate and transport. The module utilizes manure erosion rates found in the APEX. Bacteria survival in soil-manure mixing layer was simulated with the two-stage survival model. Individual survival patterns were simulated for each manure application date. Simulated in-stream microbial fate and transport processes included the reach-scale passive release of bacteria with resuspended bottom sediment during high flow events, the transport of bacteria from bottom sediment due to the hyporheic exchange during low flow periods, the deposition with settling sediment, and the two-stage survival. Default parameter values were available from recently published databases. The APEX model with the newly developed microbial fate and transport module was applied to simulate seven years of monitoring data for the Toenepi watershed in New Zealand. Based on calibration and testing results, the APEX with the microbe module reproduced well the monitored pattern of E. coli concentrations at the watershed outlet. The APEX with the microbial fate and transport module will be utilized for predicting microbial quality of water under various agricultural practices, evaluating monitoring protocols, and supporting the selection of management practices based on regulations that rely on fecal indicator bacteria concentrations.

Quality tools and resources to support organisational improvement integral to high-quality primary care: a systematic review of published and grey literature.

PubMed

Janamian, Tina; Upham, Susan J; Crossland, Lisa; Jackson, Claire L

2016-04-18

To conduct a systematic review of the literature to identify existing online primary care quality improvement tools and resources to support organisational improvement related to the seven elements in the Primary Care Practice Improvement Tool (PC-PIT), with the identified tools and resources to progress to a Delphi study for further assessment of relevance and utility. Systematic review of the international published and grey literature. CINAHL, Embase and PubMed databases were searched in March 2014 for articles published between January 2004 and December 2013. GreyNet International and other relevant websites and repositories were also searched in March-April 2014 for documents dated between 1992 and 2012. All citations were imported into a bibliographic database. Published and unpublished tools and resources were included in the review if they were in English, related to primary care quality improvement and addressed any of the seven PC-PIT elements of a high-performing practice. Tools and resources that met the eligibility criteria were then evaluated for their accessibility, relevance, utility and comprehensiveness using a four-criteria appraisal framework. We used a data extraction template to systematically extract information from eligible tools and resources. A content analysis approach was used to explore the tools and resources and collate relevant information: name of the tool or resource, year and country of development, author, name of the organisation that provided access and its URL, accessibility information or problems, overview of each tool or resource and the quality improvement element(s) it addresses. If available, a copy of the tool or resource was downloaded into the bibliographic database, along with supporting evidence (published or unpublished) on its use in primary care. This systematic review identified 53 tools and resources that can potentially be provided as part of a suite of tools and resources to support primary care practices in improving the quality of their practice, to achieve improved health outcomes.

The evolving landscape of quality measurement for heart failure

PubMed Central

Fitzgerald, Ashley A.; Allen, Larry A.; Masoudi, Frederick A.

2013-01-01

Heart failure (HF) is a major cause of mortality and morbidity, representing a leading cause of death and hospitalization among U.S. Medicare beneficiaries. Advances in science have generated effective interventions to reduce adverse outcomes in HF, particularly in patients with reduced left ventricular ejection fraction. Unfortunately, effective therapies for heart failure are often not utilized in an effective, safe, timely, equitable, patient-centered, and efficient manner. Further, the risk of adverse outcomes for HF remains high. The last decades have witnessed the growth of efforts to measure and improve the care and outcomes of patients with HF. This paper will review the evolution of quality measurement for HF, including a brief history of quality measurement in medicine; the measures that have been employed to characterize quality in heart failure; how the measures are obtained; how measures are employed; and present and future challenges surrounding quality measurement in heart failure. PMID:22548579

Measurement properties, feasibility and clinical utility of the Doloplus-2 pain scale in older adults with cognitive impairment: a systematic review.

PubMed

Rostad, Hanne Marie; Utne, Inger; Grov, Ellen Karine; Puts, Martine; Halvorsrud, Liv

2017-11-02

The Doloplus-2 is a pain assessment scale for assessing pain in older adults with cognitive impairment. It is used in clinical practice and research. However, evidence for its measurement properties, feasibility and clinical utility remain incomplete. This systematic review synthesizes previous research on the measurement properties, feasibility and clinical utility of the scale. We conducted a systematic search in three databases (CINAHL, Medline and PsycINFO) for studies published in English, French, German, Dutch/Flemish or a Scandinavian language between 1990 and April 2017. We also reviewed the Doloplus-2 homepage and reference lists of included studies to supplement our search. Two reviewers independently reviewed titles and abstracts and performed the quality assessment and data abstraction. A total of 24 studies were included in this systematic review. The quality of the studies varied, but many lacked sufficient detail about the samples and response rates. The Doloplus-2 has been studied using diverse samples in a variety of settings; most study participants were in long-term care and in people with dementia. Sixteen studies addressed various aspects of the scale's feasibility and clinical utility, but their results are limited and inconsistent across settings and samples. Support for the scale's reliability, validity and responsiveness varied widely across the studies. Generally, the reliability coefficients reached acceptable benchmarks, but the evidence for different aspects of the scale's validity and responsiveness was incomplete. Additional high-quality studies are warranted to determine in which populations of older adults with cognitive impairment the Doloplus-2 is reliable, valid and feasible. The ability of the Doloplus-2 to meaningfully quantify pain, measure treatment response and improve patient outcomes also needs further investigation. PROSPERO reg. no.: CRD42016049697 registered 20. Oct. 2016.

Development and expansion of high-quality control region databases to improve forensic mtDNA evidence interpretation.

PubMed

Irwin, Jodi A; Saunier, Jessica L; Strouss, Katharine M; Sturk, Kimberly A; Diegoli, Toni M; Just, Rebecca S; Coble, Michael D; Parson, Walther; Parsons, Thomas J

2007-06-01

In an effort to increase the quantity, breadth and availability of mtDNA databases suitable for forensic comparisons, we have developed a high-throughput process to generate approximately 5000 control region sequences per year from regional US populations, global populations from which the current US population is derived and global populations currently under-represented in available forensic databases. The system utilizes robotic instrumentation for all laboratory steps from pre-extraction through sequence detection, and a rigorous eight-step, multi-laboratory data review process with entirely electronic data transfer. Over the past 3 years, nearly 10,000 control region sequences have been generated using this approach. These data are being made publicly available and should further address the need for consistent, high-quality mtDNA databases for forensic testing.

Analysis of bystander CPR quality during out-of-hospital cardiac arrest using data derived from automated external defibrillators.

PubMed

Fernando, Shannon M; Vaillancourt, Christian; Morrow, Stanley; Stiell, Ian G

2018-07-01

Little is known regarding the quality of cardiopulmonary resuscitation (CPR) performed by bystanders in out-of-hospital cardiac arrest (OHCA). We sought to determine quality of bystander CPR provided during OHCA using CPR quality data stored by Automated External Defibrillators (AEDs). We used the Resuscitation Outcomes Consortium database to identify OHCA cases of presumed cardiac etiology where an AED was utilized. We then matched AED data to each case identified. AED data was analyzed using manufacturer software in order to determine overall measures of bystander CPR quality, changes in bystander CPR quality over time, and adherence to existing 2010 Resuscitation Quality Guidelines. 100 cases of OHCA of presumed cardiac etiology involving bystander CPR and with corresponding AED data. Mean age was 62.3 years, and 75% were male. Bystanders demonstrated high-quality CPR over all minutes of resuscitation, with a chest compression fraction of 76%, a compression depth of 5.3 cm, and a compression rate of 111.2 compressions/min. Mean perishock pause was 26.8 s. Adherence rates to 2010 Resuscitation Guidelines for compression rate and depth were found to be 66% and 55%, respectively. CPR quality was lowest in the first minute, resulting from increased delay to rhythm analysis (mean 40.7 s). In cases involving shock delivery, latency from initiation of AED to shock delivery was 59.2 s. We found that bystanders perform high-quality CPR, with strong adherence rates to existing Resuscitation Guidelines. High-quality CPR is maintained over the first five minutes of resuscitation, but was lowest in the first minute. Copyright © 2018 Elsevier B.V. All rights reserved.

Oropharyngeal dysphagia: surveying practice patterns of the speech-language pathologist.

PubMed

Martino, Rosemary; Pron, Gaylene; Diamant, Nicholas E

2004-01-01

The present study was designed to obtain a comprehensive view of the dysphagia assessment practice patterns of speech-language pathologists and their opinion on the importance of these practices using survey methods and taking into consideration clinician, patient, and practice-setting variables. A self-administered mail questionnaire was developed following established methodology to maximize response rates. Eight dysphagia experts independently rated the new survey for content validity. Test-retest reliability was assessed with a random sample of 23 participants. The survey was sent to 50 speech-language pathologists randomly selected from the Canadian professional association database of members who practice in dysphagia. Surveys were mailed according to the Dillman Total Design Method and included an incentive offer. High survey (64%) and item response (95%) rates were achieved and clinicians were reliable reporters of their practice behaviors (ICC>0.60). Of all the clinical assessment items, 36% were reported with high (>80%) utilization and 24% with low (<20%) utilization, the former pertaining to tongue motion and vocal quality after food/fluid intake and the latter to testing of oral sensation without food. One-third (33%) of instrumental assessment items were highly utilized and included assessment of bolus movement and laryngeal response to bolus misdirection. Overall, clinician experience and teaching institutions influenced greater utilization. Opinions of importance were similar to utilization behaviors (r = 0.947, p = 0.01). Of all patients referred for dysphagia assessment, full clinical assessments were administered to 71% of patients but instrumental assessments to only 36%. A hierarchical model of practice behavior is proposed to explain this pattern of progressively decreasing item utilization.

Comparative evaluation of two asthma care quality measures among Medicaid beneficiaries.

PubMed

Samnaliev, Mihail; Baxter, Jeffrey D; Clark, Robin E

2009-05-01

The relative performance of asthma care quality measures has not been evaluated in Medicaid populations. Using complete claims and pharmaceutical data for 19,076 patients with persistent asthma (based on Health Effectiveness and Data Information Set criteria) in five Medicaid populations, we compared the following two measures of asthma care quality: filling prescriptions for controller asthma medications within 1 year and the ratio of controller medication to the total number of asthma medication prescriptions filled within 1 year. We calculated whether meeting each quality measure was associated with decreased odds of emergency department (ED) treatment episodes. We then compared the odds ratios, receiver operating characteristic (ROC) curves, and deviances between models, using each measure to predict ED utilization in Medicaid populations. Although meeting each measure was associated with lower odds of ED utilization, this decrease was larger if the controller asthma medication measure was met rather than the ratio measure. Additionally, models using the controller medication measure had greater areas under the ROC curve and smaller deviances than models using the ratio measure. Both administrative measures of asthma care quality were associated with lower odds of ED utilization. The controller medication measure of asthma care quality may be better than the ratio measure in relation to emergency asthma care utilization by Medicaid beneficiaries.

A research on service quality decision-making of Chinese communications industry based on quantum game

NASA Astrophysics Data System (ADS)

Zhang, Cuihua; Xing, Peng

2015-08-01

In recent years, Chinese service industry is developing rapidly. Compared with developed countries, service quality should be the bottleneck for Chinese service industry. On the background of three major telecommunications service providers in China, the functions of customer perceived utilities are established. With the goal of consumer's perceived utility maximization, the classic Nash equilibrium solution and quantum equilibrium solution are obtained. Then a numerical example is studied and the changing trend of service quality and customer perceived utility is further analyzed by the influence of the entanglement operator. Finally, it is proved that quantum game solution is better than Nash equilibrium solution.

The impact of posttraumatic stress disorder on quality of life and health service utilization among veterans who have schizophrenia.

PubMed

Calhoun, Patrick S; Bosworth, Hayden B; Stechuchak, Karen A; Strauss, Jennifer; Butterfield, Marian I

2006-06-01

The present study examined the impact of comorbid posttraumatic stress disorder (PTSD) on health-related quality of life and objective measures of health service utilization in 165 male veterans who have primary schizophrenia. Comorbid PTSD was assessed with the PTSD Checklist. Comorbid PTSD was significantly associated with decreased quality of life and increased medical service utilization, including increased psychiatric hospitalization and increased outpatient physical health visits, even after controlling for other clinical and demographic variables among this sample of patients who had primary schizophrenia. Veterans who have schizophrenia should be screened carefully for exposure to trauma and posttraumatic stress disorder.

An Updated Meta-Analysis of Laparoscopic Versus Open Repair for Perforated Peptic Ulcer.

PubMed

Zhou, Chunhua; Wang, Weizhi; Wang, Jiwei; Zhang, Xiaoyu; Zhang, Qun; Li, Bowen; Xu, Zekuan

2015-09-09

Laparoscopic repair (LR) for perforated peptic ulcer (PPU) has been introduced since 1990. Although many studies comparing LR with open repair (OR) have been published, controversy remains regarding the clinical utility of laparoscopic techniques for the treatment of PPU. Thus, it is necessary for us to broaden our knowledge on this subject with the newly published articles. Twenty-four nonrandomized controlled studies (NRS) and five randomized controlled trails (RCTs) were included in our meta-analyses, which comprised 5,268 patients (1,890 in the LR group and 3,378 in the OR group). In the analysis of high quality NRS and RCTs, compared with OR, high quality evidence suggested that LR was associated with a lower incidence of overall postoperative complications; moderate evidence showed that the two procedures had the similar reoperation rate; based on the low quality evidence, LR had reduced hospital mortality and similar operative time; Moreover, LR was observed having the advantages of earlier resumption of oral intake, shorter hospital stay and less analgesic use, which were supported by very low evidence. All the evidences suggest that LR is better than OR for PPU, but more high-quality RCTs are still needed for further validation.

An Updated Meta-Analysis of Laparoscopic Versus Open Repair for Perforated Peptic Ulcer

PubMed Central

Zhou, Chunhua; Wang, Weizhi; Wang, Jiwei; Zhang, Xiaoyu; Zhang, Qun; Li, Bowen; Xu, Zekuan

2015-01-01

Laparoscopic repair (LR) for perforated peptic ulcer (PPU) has been introduced since 1990. Although many studies comparing LR with open repair (OR) have been published, controversy remains regarding the clinical utility of laparoscopic techniques for the treatment of PPU. Thus, it is necessary for us to broaden our knowledge on this subject with the newly published articles. Twenty-four nonrandomized controlled studies (NRS) and five randomized controlled trails (RCTs) were included in our meta-analyses, which comprised 5,268 patients (1,890 in the LR group and 3,378 in the OR group). In the analysis of high quality NRS and RCTs, compared with OR, high quality evidence suggested that LR was associated with a lower incidence of overall postoperative complications; moderate evidence showed that the two procedures had the similar reoperation rate; based on the low quality evidence, LR had reduced hospital mortality and similar operative time; Moreover, LR was observed having the advantages of earlier resumption of oral intake, shorter hospital stay and less analgesic use, which were supported by very low evidence. All the evidences suggest that LR is better than OR for PPU, but more high-quality RCTs are still needed for further validation. PMID:26350958

32 CFR 199.15 - Quality and utilization review peer review organization program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Director, OCHAMPUS. These contractors may include contractors that have exclusive functions in the area of utilization and quality review, fiscal intermediary contractors (which perform these functions along with a... functions concerning management of the delivery and financing of health care services under CHAMPUS...

MASQOT: a method for cDNA microarray spot quality control

PubMed Central

Bylesjö, Max; Eriksson, Daniel; Sjödin, Andreas; Sjöström, Michael; Jansson, Stefan; Antti, Henrik; Trygg, Johan

2005-01-01

Background cDNA microarray technology has emerged as a major player in the parallel detection of biomolecules, but still suffers from fundamental technical problems. Identifying and removing unreliable data is crucial to prevent the risk of receiving illusive analysis results. Visual assessment of spot quality is still a common procedure, despite the time-consuming work of manually inspecting spots in the range of hundreds of thousands or more. Results A novel methodology for cDNA microarray spot quality control is outlined. Multivariate discriminant analysis was used to assess spot quality based on existing and novel descriptors. The presented methodology displays high reproducibility and was found superior in identifying unreliable data compared to other evaluated methodologies. Conclusion The proposed methodology for cDNA microarray spot quality control generates non-discrete values of spot quality which can be utilized as weights in subsequent analysis procedures as well as to discard spots of undesired quality using the suggested threshold values. The MASQOT approach provides a consistent assessment of spot quality and can be considered an alternative to the labor-intensive manual quality assessment process. PMID:16223442

Comparative Analytical Utility of DNA Derived from Alternative Human Specimens for Molecular Autopsy and Diagnostics

PubMed Central

Klassen, Tara L.; von Rüden, Eva-Lotta; Drabek, Janice; Noebels, Jeffrey L.; Goldman, Alica M.

2013-01-01

Genetic testing and research have increased the demand for high-quality DNA that has traditionally been obtained by venipuncture. However, venous blood collection may prove difficult in special populations and when large-scale specimen collection or exchange is prerequisite for international collaborative investigations. Guthrie/FTA card–based blood spots, buccal scrapes, and finger nail clippings are DNA-containing specimens that are uniquely accessible and thus attractive as alternative tissue sources (ATS). The literature details a variety of protocols for extraction of nucleic acids from a singular ATS type, but their utility has not been systematically analyzed in comparison with conventional sources such as venous blood. Additionally, the efficacy of each protocol is often equated with the overall nucleic acid yield but not with the analytical performance of the DNA during mutation detection. Together with a critical in-depth literature review of published extraction methods, we developed and evaluated an all-inclusive approach for serial, systematic, and direct comparison of DNA utility from multiple biological samples. Our results point to the often underappreciated value of these alternative tissue sources and highlight ways to maximize the ATS-derived DNA for optimal quantity, quality, and utility as a function of extraction method. Our comparative analysis clarifies the value of ATS in genomic analysis projects for population-based screening, diagnostics, molecular autopsy, medico-legal investigations, or multi-organ surveys of suspected mosaicisms. PMID:22796560

[Value-based medicine in ophthalmology].

PubMed

Hirneiss, C; Neubauer, A S; Tribus, C; Kampik, A

2006-06-01

Value-based medicine (VBM) unifies costs and patient-perceived value (improvement in quality of life, length of life, or both) of an intervention. Value-based ophthalmology is of increasing importance for decisions in eye care. The methods of VBM are explained and definitions for a specific terminology in this field are given. The cost-utility analysis as part of health care economic analyses is explained. VBM exceeds evidence-based medicine by incorporating parameters of cost and benefits from an ophthalmological intervention. The benefit of the intervention is defined as an increase or maintenance of visual quality of life and can be determined by utility analysis. The time trade-off method is valid and reliable for utility analysis. The resources expended for the value gained in VBM are measured with cost-utility analysis in terms of cost per quality-adjusted life years gained (euros/QALY). Numerous cost-utility analyses of different ophthalmological interventions have been published. The fundamental instrument of VBM is cost-utility analysis. The results in cost per QALY allow estimation of cost effectiveness of an ophthalmological intervention. Using the time trade-off method for utility analysis allows the comparison of ophthalmological cost-utility analyses with those of other medical interventions. VBM is important for individual medical decision making and for general health care.

Objectives and study design of the Colville study: silviculture, ecology, utilization, and economics of small-diameter densely stocked stands.

Treesearch

R.J. Barbour; S.D. Tesch; J. McNeel; S.A. Willits; R.D. Fight; A. Mason; K.E. Skog

1997-01-01

Public land managers in the United States are increasingly interested in managing forests to provide a range of ecological and social outputs in addition to timber. These outputs might include healthy riparian areas, connected blocks of late-successional forests, habitat for threatened and endangered species, and high quality recreational opportunities. On National...

Quantitative Analysis of High-Quality Officer Selection by Commandants Career-Level Education Board

DTIC Science & Technology

2017-03-01

due to Marines being evaluated before the end of their initial service commitment. Our research utilizes quantitative variables to analyze the...not provide detailed information why. B. LIMITATIONS The photograph analysis in this research is strictly limited to a quantitative analysis in...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release. Distribution is unlimited. QUANTITATIVE

Introduction of 3D Printing Technology in the Classroom for Visually Impaired Students

ERIC Educational Resources Information Center

Jo, Wonjin; I, Jang Hee; Harianto, Rachel Ananda; So, Ji Hyun; Lee, Hyebin; Lee, Heon Ju; Moon, Myoung-Woon

2016-01-01

The authors investigate how 3D printing technology could be utilized for instructional materials that allow visually impaired students to have full access to high-quality instruction in history class. Researchers from the 3D Printing Group of the Korea Institute of Science and Technology (KIST) provided the Seoul National School for the Blind with…

A portable, low-cost flight-data measurement and recording system

NASA Technical Reports Server (NTRS)

Miller, R. J.

1982-01-01

The design of and the experience with an inexpensive, hand-portable, onboard data system used to record four parameters in the final portion of the landing approach and touchdown of an airplane are described. The system utilized a high-quality audio tape recorder and amateur photographic equipment with accessory circuitry rather than specialized instrumentation to given satisfactory results.

Two-Year College Succession Planning: Utilizing the Mission Statement for Selection of the Vice President of Human Resources

ERIC Educational Resources Information Center

Lacey-Nevitt, Lucia

2012-01-01

Colleges have a critical investment in the proper selection of key executive administrative positions with high quality leadership and character since leadership transitions can be unsettling and costly, and governing boards have a vested interest in getting it right. The problem is that two-year colleges are facing a strategic planning crisis…

Progress on genetic linkage maps, traits/QTLs, and utilization in two recombinant inbred line populations of peanuts (Arachis hypogaea L.)

USDA-ARS?s Scientific Manuscript database

Peanut, a highly nutritional crop, is used in edible products or crushed for cooking oil, and is susceptible to a range of diseases, including Tomato spotted wilt virus (TSWV), early and late leaf spot (ELS and LLS). Losses in productivity and quality are also attributable to environmental stresses ...

Reducing dislocations in semiconductors utilizing repeated thermal cycling during multistage epitaxial growth

DOEpatents

Fan, John C. C.; Tsaur, Bor-Yeu; Gale, Ronald P.; Davis, Frances M.

1992-02-25

Dislocation densities are reduced in growing semiconductors from the vapor phase by employing a technique of interrupting growth, cooling the layer so far deposited, and then repeating the process until a high quality active top layer is achieved. The method of interrupted growth, coupled with thermal cycling, permits dislocations to be trapped in the initial stages of epitaxial growth.

Reducing dislocations in semiconductors utilizing repeated thermal cycling during multistage epitaxial growth

DOEpatents

Fan, John C. C.; Tsaur, Bor-Yeu; Gale, Ronald P.; Davis, Frances M.

1986-12-30

Dislocation densities are reduced in growing semiconductors from the vapor phase by employing a technique of interrupting growth, cooling the layer so far deposited, and then repeating the process until a high quality active top layer is achieved. The method of interrupted growth, coupled with thermal cycling, permits dislocations to be trapped in the initial stages of epitaxial growth.

Overview of the dairy and food processing research conducted at the Dairy and Functional Foods Research Unit, ERRC, and research to develop sustainable food processes

USDA-ARS?s Scientific Manuscript database

The DFFRU is dedicated to solving critical problems in the utilization of milk and specialty crop byproducts by developing high-quality, value-added functional foods and consumer products. The presentation will give an overview of the research projects that will benefit human health and well-being. ...

Evaluation of Time Transfer Units for Time and Frequency Transfer in Optical Fibers Utilizing a Passive Technique Based on SONET/SDH

DTIC Science & Technology

2012-01-01

precision and accuracy. For instance, in international time metrology, two-way satellite time and frequency transfer ( TWSTFT ) (see e.g. [1] and...can act as a time transfer system that is complementary to other high quality systems such as TWSTFT and GPS. REFERENCES [1] J. Levine. “A

In-Situ Cure Monitoring of the Immidization Reaction of PMR-15

NASA Technical Reports Server (NTRS)

Cossins, Sheryl; Kellar, Jon J.; Winter, Robb M.

1997-01-01

Glass fiber reinforced polymer composites are becoming widely used in industry. With this increase in production, an in-situ method of quality control for the curing of the polymer is desirable. This would allow for the production of high-quality parts having more uniform properties.' Recently, in-situ fiber optic monitoring of polymer curing has primarily focused on epoxy resins and has been performed by Raman or fluorescence methods. In addition, some infrared (IR) investigations have been performed using transmission or ATR cells. An alternate IR approach involves using optical fibers as a sensor by utilizing evanescent wave spectroscopy.

Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan

PubMed Central

Steinhardt, Laura C; Aman, Iqbal; Pakzad, Iqbalshah; Kumar, Binay; Singh, Lakhwinder P; Peters, David H

2011-01-01

Background User fees for primary care tend to suppress utilization, and many countries are experimenting with fee removal. Studies show that additional inputs are needed after removing fees, although well-documented experiences are lacking. This study presents data on the effects of fee removal on facility quality and utilization in Afghanistan, based on a pilot experiment and subsequent nationwide ban on fees. Methods Data on utilization and observed structural and perceived overall quality of health care were compared from before-and-after facility assessments, patient exit interviews and catchment area household surveys from eight facilities where fees were removed and 14 facilities where fee levels remained constant, as part of a larger health financing pilot study from 2005 to 2007. After a national user fee ban was instituted in 2008, health facility administrative data were analysed to assess subsequent changes in utilization and quality. Results The pilot study analysis indicated that observed and perceived quality increased across facilities but did not differ by fee removal status. Difference-in-difference analysis showed that utilization at facilities previously charging both service and drug fees increased by 400% more after fee removal, prompting additional inputs from service providers, compared with facilities that previously only charged service fees or had no change in fees (P = 0.001). Following the national fee ban, visits for curative care increased significantly (P < 0.001), but institutional deliveries did not. Services typically free before the ban—immunization and antenatal care—had immediate increases in utilization but these were not sustained. Conclusion Both pilot and nationwide data indicated that curative care utilization increased following fee removal, without differential changes in quality. Concerns raised by non-governmental organizations, health workers and community leaders over the effects of lost revenue and increased utilization require continued effort to raise revenues, monitor health worker and patient perceptions, and carefully manage health facility performance. PMID:22027924

A value-based medicine analysis of ranibizumab for the treatment of subfoveal neovascular macular degeneration.

PubMed

Brown, Melissa M; Brown, Gary C; Brown, Heidi C; Peet, Jonathan

2008-06-01

To assess the conferred value and average cost-utility (cost-effectiveness) for intravitreal ranibizumab used to treat occult/minimally classic subfoveal choroidal neovascularization associated with age-related macular degeneration (AMD). Value-based medicine cost-utility analysis. MARINA (Minimally Classic/Occult Trial of the Anti-Vascular Endothelial Growth Factor Antibody Ranibizumab in the Treatment of Neovascular AMD) Study patients utilizing published primary data. Reference case, third-party insurer perspective, cost-utility analysis using 2006 United States dollars. Conferred value in the forms of (1) quality-adjusted life-years (QALYs) and (2) percent improvement in health-related quality of life. Cost-utility is expressed in terms of dollars expended per QALY gained. All outcomes are discounted at a 3% annual rate, as recommended by the Panel on Cost-effectiveness in Health and Medicine. Data are presented for the second-eye model, first-eye model, and combined model. Twenty-two intravitreal injections of 0.5 mg of ranibizumab administered over a 2-year period confer 1.039 QALYs, or a 15.8% improvement in quality of life for the 12-year period of the second-eye model reference case of occult/minimally classic age-related subfoveal choroidal neovascularization. The reference case treatment cost is $52652, and the cost-utility for the second-eye model is $50691/QALY. The quality-of-life gain from the first-eye model is 6.4% and the cost-utility is $123887, whereas the most clinically simulating combined model yields a quality-of-life gain of 10.4% and cost-utility of $74169. By conventional standards and the most commonly used second-eye and combined models, intravitreal ranibizumab administered for occult/minimally classic subfoveal choroidal neovascularization is a cost-effective therapy. Ranibizumab treatment confers considerably greater value than other neovascular macular degeneration pharmaceutical therapies that have been studied in randomized clinical trials.

A fouling monitor alarm to prevent forced outages

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

Thompson, R.E.; Hickinbotham, A.; Fang, T.C.

2000-07-01

Many utilities rely on coal blending to meet emissions and boiler performance goals, but the increased variability in coal quality can adversely impact ash deposition and soot blowing requirements. Other utilities are experimenting with lower quality coals and burner zone blending of coals fired from different bunkers as part of a deregulation strategy to reduce fuel costs. However, these strategies can lead to slagging/fouling episodes, a possible outage, or a decrease in unit availability if boiler operations are not carefully monitored. This paper summarizes the development of software to monitor boiler fouling and to provide an advanced warning to themore » control operators when a fouling episode is imminent. With adequate warming, preemptive action can be taken (e.g., soot blowing, a change in coal blend, etc.) to potentially avoid a costly outage. The software utilizes a unique combination of combustion diagnostic techniques and convective section heat adsorption analyses to identify boiler operating conditions where ash deposition rates may be high and conductive to triggering a fouling episode. The paper outlines the history of the fouling problem and the implementation of the software on Wabamun Unit 4, a tangentially-fired unit with relatively narrow reheat tube spacing. The unit had a tendency to foul when burning a high alkaline (but low ash) coal seam. The paper discusses the software development, implementation, and data acquisitions activities. Preliminary test results are provided for Wabamun 4 and for Sundance Units 1 and 2 where the software was recently installed.« less

Costs and Clinical Quality Among Medicare Beneficiaries: Associations with Health Center Penetration of Low-Income Residents

PubMed Central

Sharma, Ravi; Lebrun-Harris, Lydie A.; Ngo-Metzger, Quyen

2014-01-01

Objective Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). Data Sources Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS’ Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA’s Uniform Data System) and number of low-income residents (American Community Survey). Study Design We estimated access to primary care in each HRR by “health center penetration” (health center patients as a proportion of low-income residents). We calculated total Medicare spending (adjusted for population size, local input prices, and health risk). We assessed clinical quality by preventable hospital admissions, hospital readmissions, and emergency department visits. We sorted HRRs by health center penetration rate and compared spending and quality measures between the high- and low-penetration deciles. We also employed linear regressions to estimate spending and quality measures as a function of health center penetration. Principal Findings The high-penetration decile had 9.7% lower Medicare spending ($926 per capita, p=0.01) than the low-penetration decile, and no different clinical quality outcomes. Conclusions Compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings. Limited evidence suggests that these savings do not compromise clinical quality. PMID:25243096

High-Cost Patients: Hot-Spotters Don't Explain the Half of It.

PubMed

Lee, Natalie S; Whitman, Noah; Vakharia, Nirav; Taksler, Glen B; Rothberg, Michael B

2017-01-01

Understanding resource utilization patterns among high-cost patients may inform cost reduction strategies. To identify patterns of high-cost healthcare utilization and associated clinical diagnoses and to quantify the significance of hot-spotters among high-cost users. Retrospective analysis of high-cost patients in 2012 using data from electronic medical records, internal cost accounting, and the Centers for Medicare and Medicaid Services. K-medoids cluster analysis was performed on utilization measures of the highest-cost decile of patients. Clusters were compared using clinical diagnoses. We defined "hot-spotters" as those in the highest-cost decile with ≥4 hospitalizations or ED visits during the study period. A total of 14,855 Medicare Fee-for-service beneficiaries identified by the Medicare Quality Resource and Use Report as having received 100 % of inpatient care and ≥90 % of primary care services at Cleveland Clinic Health System (CCHS) in Northeast Ohio. The highest-cost decile was selected from this population. Healthcare utilization and diagnoses. The highest-cost decile of patients (n = 1486) accounted for 60 % of total costs. We identified five patient clusters: "Ambulatory," with 0 admissions; "Surgical," with a median of 2 surgeries; "Critically Ill," with a median of 4 ICU days; "Frequent Care," with a median of 2 admissions, 3 ED visits, and 29 outpatient visits; and "Mixed Utilization," with 1 median admission and 1 ED visit. Cancer diagnoses were prevalent in the Ambulatory group, care complications in the Surgical group, cardiac diseases in the Critically Ill group, and psychiatric disorders in the Frequent Care group. Most hot-spotters (55 %) were in the "frequent care" cluster. Overall, hot-spotters represented 9 % of the high-cost population and accounted for 19 % of their overall costs. High-cost patients are heterogeneous; most are not so-called "hot-spotters" with frequent admissions. Effective interventions to reduce costs will require a more multi-faceted approach to the high-cost population.

Factors influencing utilization of hospital services by adult sickle cell disease patients: a systematic review.

PubMed

Benenson, Irina; Jadotte, Yuri; Echevarria, Mercedes

2017-03-01

Painful vaso-occlusive crisis is a hallmark of sickle cell disease (SCD) that commonly results in utilization of hospital services. Recurrent use of hospital services by SCD patients is associated with high healthcare costs and adverse clinical outcomes. Understanding the factors influencing the pattern of utilization is a first step in improving medical care of this patient population while reducing healthcare expenditures. The primary objective of this systematic review was to determine what modifiable and non-modifiable factors influence utilization of hospital services by adult SCD patients. Adult SCD patients of both sexes who utilized hospital services for acute or emergency care. Non-modifiable and modifiable factors influencing utilization of hospital services. Prospective and retrospective cohort studies, case-control and analytical cross-sectional studies. The primary outcome of interest was high utilization of hospital services by adult SCD patients based on non-modifiable and modifiable factors measured as an odds ratio (analytical outcome). The secondary outcome was the prevalence of non-modifiable and modifiable factors among SCD patients who utilized hospital services measured as an event rate (descriptive outcome). A comprehensive multi-step search was undertaken to find both published and unpublished studies. Only studies published in the English language were included. The search was not limited by year of publication. Retrieved papers were assessed for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. Data were extracted using a researcher-developed tool. Included studies were combined in a statistical meta-analysis. The meta-analysis was based on a random effect model. For studies that did not allow statistical pooling, the findings have been presented in a narrative form. Fourteen studies were included in this review. The analysis demonstrated that male patients accounted for 40.8% (95% confidence interval [CI] 0.370-0.447) of all utilizing patients. Sickle cell disease patients who were publically insured accounted for 76.5% (95% CI 0.632-0.861) of all patients who had hospital encounters. Patients aged 25-35 years had the highest rate of utilization, and the rate of utilization declined in patients older than 50 years. High utilizing patients had more diagnoses of acute chest syndrome and sepsis than patients who were moderate or low utilizers. The majority of SCD patients who utilized hospital services were women, young people and publically insured individuals. Patients with particularly high level of utilization had more frequent diagnoses of acute chest syndrome and sepsis.

Analytical scaling relations to evaluate leakage and intrusion in intermittent water supply systems.

PubMed

Taylor, David D J; Slocum, Alexander H; Whittle, Andrew J

2018-01-01

Intermittent water supplies (IWS) deliver piped water to one billion people; this water is often microbially contaminated. Contaminants that accumulate while IWS are depressurized are flushed into customers' homes when these systems become pressurized. In addition, during the steady-state phase of IWS, contaminants from higher-pressure sources (e.g., sewers) may continue to intrude where pipe pressure is low. To guide the operation and improvement of IWS, this paper proposes an analytic model relating supply pressure, supply duration, leakage, and the volume of intruded, potentially-contaminated, fluids present during flushing and steady-state. The proposed model suggests that increasing the supply duration may improve water quality during the flushing phase, but decrease the subsequent steady-state water quality. As such, regulators and academics should take more care in reporting if water quality samples are taken during flushing or steady-state operational conditions. Pipe leakage increases with increased supply pressure and/or duration. We propose using an equivalent orifice area (EOA) to quantify pipe quality. This provides a more stable metric for regulators and utilities tracking pipe repairs. Finally, we show that the volume of intruded fluid decreases in proportion to reductions in EOA. The proposed relationships are applied to self-reported performance indicators for IWS serving 108 million people described in the IBNET database and in the Benchmarking and Data Book of Water Utilities in India. This application shows that current high-pressure, continuous water supply targets will require extensive EOA reductions. For example, in order to achieve national targets, utilities in India will need to reduce their EOA by a median of at least 90%.

Analytical scaling relations to evaluate leakage and intrusion in intermittent water supply systems

PubMed Central

Slocum, Alexander H.; Whittle, Andrew J.

2018-01-01

Intermittent water supplies (IWS) deliver piped water to one billion people; this water is often microbially contaminated. Contaminants that accumulate while IWS are depressurized are flushed into customers’ homes when these systems become pressurized. In addition, during the steady-state phase of IWS, contaminants from higher-pressure sources (e.g., sewers) may continue to intrude where pipe pressure is low. To guide the operation and improvement of IWS, this paper proposes an analytic model relating supply pressure, supply duration, leakage, and the volume of intruded, potentially-contaminated, fluids present during flushing and steady-state. The proposed model suggests that increasing the supply duration may improve water quality during the flushing phase, but decrease the subsequent steady-state water quality. As such, regulators and academics should take more care in reporting if water quality samples are taken during flushing or steady-state operational conditions. Pipe leakage increases with increased supply pressure and/or duration. We propose using an equivalent orifice area (EOA) to quantify pipe quality. This provides a more stable metric for regulators and utilities tracking pipe repairs. Finally, we show that the volume of intruded fluid decreases in proportion to reductions in EOA. The proposed relationships are applied to self-reported performance indicators for IWS serving 108 million people described in the IBNET database and in the Benchmarking and Data Book of Water Utilities in India. This application shows that current high-pressure, continuous water supply targets will require extensive EOA reductions. For example, in order to achieve national targets, utilities in India will need to reduce their EOA by a median of at least 90%. PMID:29775462

Cost-utility analysis of dasatinib and nilotinib in patients with chronic myeloid leukemia refractory to first-line treatment with imatinib in Thailand.

PubMed

Kulpeng, Wantanee; Sompitak, Sumalai; Jootar, Saengsuree; Chansung, Kanchana; Teerawattananon, Yot

2014-04-01

Recently, the second-generation tyrosine kinase inhibitors dasatinib and nilotinib have emerged as alternative treatments in patients with chronic myeloid leukemia (CML) who are resistant to or intolerant of imatinib. This article aimed to assess the cost utility and budget impact of using dasatinib or nilotinib, rather than high-dose (800-mg/d) imatinib, in patients with chronic phase (CP) CML who are resistant to standard-dose (400-mg/d) imatinib in Thailand. A Markov simulation model was developed and used to estimate the lifetime costs and outcomes of treating patients aged ≥38 years with CP-CML. The efficacy parameters were synthesized from a systematic review. Utilities using the European Quality of Life-5 Dimensions tool and costs were obtained from the Thai CML population. Costs and outcomes were compared and presented as the incremental cost-effectiveness ratio in 2011 Thai baht (THB) per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses were performed to estimate parameter uncertainty. From a societal perspective, treatment with dasatinib was found to yield more QALYs (2.13) at a lower cost (THB 1,631,331) per person than high-dose imatinib. Nilotinib treatment was also found to be more cost-effective than high-dose imatinib, producing an incremental cost-effectiveness ratio of THB 83,328 per QALY gained. This treatment option also resulted in the highest number of QALYs gained of all of the treatment options. The costs of providing dasatinib, nilotinib, and high-dose imatinib were estimated at THB 5 billion, THB 6 billion, and THB 7 billion, respectively. Treatment with dasatinib or nilotinib is likely to be more cost-effective than treatment with high-dose imatinib in CP-CML patients who do not respond positively to standard-dose imatinib in the Thai context. Dasatinib was found to be more cost-effective than nilotinib. Copyright © 2014 Elsevier HS Journals, Inc. All rights reserved.

An Efficient Framework for Compressed Sensing Reconstruction of Highly Accelerated Dynamic Cardiac MRI

NASA Astrophysics Data System (ADS)

Ting, Samuel T.

The research presented in this work seeks to develop, validate, and deploy practical techniques for improving diagnosis of cardiovascular disease. In the philosophy of biomedical engineering, we seek to identify an existing medical problem having significant societal and economic effects and address this problem using engineering approaches. Cardiovascular disease is the leading cause of mortality in the United States, accounting for more deaths than any other major cause of death in every year since 1900 with the exception of the year 1918. Cardiovascular disease is estimated to account for almost one-third of all deaths in the United States, with more than 2150 deaths each day, or roughly 1 death every 40 seconds. In the past several decades, a growing array of imaging modalities have proven useful in aiding the diagnosis and evaluation of cardiovascular disease, including computed tomography, single photon emission computed tomography, and echocardiography. In particular, cardiac magnetic resonance imaging is an excellent diagnostic tool that can provide within a single exam a high quality evaluation of cardiac function, blood flow, perfusion, viability, and edema without the use of ionizing radiation. The scope of this work focuses on the application of engineering techniques for improving imaging using cardiac magnetic resonance with the goal of improving the utility of this powerful imaging modality. Dynamic cine imaging, or the capturing of movies of a single slice or volume within the heart or great vessel region, is used in nearly every cardiac magnetic resonance imaging exam, and adequate evaluation of cardiac function and morphology for diagnosis and evaluation of cardiovascular disease depends heavily on both the spatial and temporal resolution as well as the image quality of the reconstruction cine images. This work focuses primarily on image reconstruction techniques utilized in cine imaging; however, the techniques discussed are also relevant to other dynamic and static imaging techniques based on cardiac magnetic resonance. Conventional segmented techniques for cardiac cine imaging require breath-holding as well as regular cardiac rhythm, and can be time-consuming to acquire. Inadequate breath-holding or irregular cardiac rhythm can result in completely non-diagnostic images, limiting the utility of these techniques in a significant patient population. Real-time single-shot cardiac cine imaging enables free-breathing acquisition with significantly shortened imaging time and promises to significantly improve the utility of cine imaging for diagnosis and evaluation of cardiovascular disease. However, utility of real-time cine images depends heavily on the successful reconstruction of final cine images from undersampled data. Successful reconstruction of images from more highly undersampled data results directly in images exhibiting finer spatial and temporal resolution provided that image quality is sufficient. This work focuses primarily on the development, validation, and deployment of practical techniques for enabling the reconstruction of real-time cardiac cine images at the spatial and temporal resolutions and image quality needed for diagnostic utility. Particular emphasis is placed on the development of reconstruction approaches resulting in with short computation times that can be used in the clinical environment. Specifically, the use of compressed sensing signal recovery techniques is considered; such techniques show great promise in allowing successful reconstruction of highly undersampled data. The scope of this work concerns two primary topics related to signal recovery using compressed sensing: (1) long reconstruction times of these techniques, and (2) improved sparsity models for signal recovery from more highly undersampled data. Both of these aspects are relevant to the practical application of compressed sensing techniques in the context of improving image reconstruction of real-time cardiac cine images. First, algorithmic and implementational approaches are proposed for reducing the computational time for a compressed sensing reconstruction framework. Specific optimization algorithms based on the fast iterative/shrinkage algorithm (FISTA) are applied in the context of real-time cine image reconstruction to achieve efficient per-iteration computation time. Implementation within a code framework utilizing commercially available graphics processing units (GPUs) allows for practical and efficient implementation directly within the clinical environment. Second, patch-based sparsity models are proposed to enable compressed sensing signal recovery from highly undersampled data. Numerical studies demonstrate that this approach can help improve image quality at higher undersampling ratios, enabling real-time cine imaging at higher acceleration rates. In this work, it is shown that these techniques yield a holistic framework for achieving efficient reconstruction of real-time cine images with spatial and temporal resolution sufficient for use in the clinical environment. A thorough description of these techniques from both a theoretical and practical view is provided - both of which may be of interest to the reader in terms of future work.

Skilled delivery care service utilization in Ethiopia: analysis of rural-urban differentials based on national demographic and health survey (DHS) data.

PubMed

Fekadu, Melaku; Regassa, Nigatu

2014-12-01

Despite the slight progress made on Antenatal Care (ANC) utilization, skilled delivery care service utilization in Ethiopia is still far-below any acceptable standards. Only 10% of women receive assistance from skilled birth attendants either at home or at health institutions, and as a result the country is recording a high maternal mortality ratio (MMR) of 676 per 100,000 live births (EDHS, 2011). Hence, this study aimed at identifying the rural-urban differentials in the predictors of skilled delivery care service utilization in Ethiopia. The study used the recent Ethiopian Demographic and Health Survey (EDHS 2011) data. Women who had at least one birth in the five years preceding the survey were included in this study. The data were analyzed using univariate (percentage), bivariate (chi-square) and multivariate (Bayesian logistic regression). The results showed that of the total 6,641 women, only 15.6% received skilled delivery care services either at home or at health institution. Rural women were at greater disadvantage to receive the service. Only 4.5% women in rural areas received assistance from skilled birth attendants (SBAs) compared to 64.1 % of their urban counter parts. Through Bayesian logistic regression analysis, place of residence, ANC utilization, women's education, age and birth order were identified as key predictors of service utilization. The findings highlight the need for coordinated effort from government and stakeholders to improve women's education, as well as strengthen community participation. Furthermore, the study recommended the need to scale up the quality of ANC and family planning services backed by improved and equitable access, availability and quality of skilled delivery care services.

The quality of life associated with presbyopia.

PubMed

Luo, Betsy P; Brown, Gary C; Luo, Solomon C; Brown, Melissa M

2008-04-01

To determine the health-related quality of life associated with the presbyopia. Cross-sectional, patient preference-based, time trade-off utility analysis. One hundred and ten patients with spectacle-corrected presbyopia and a best-corrected visual acuity of 20/40 or better were interviewed in a cross-sectional fashion using a standardized, validated, time trade-off utility analysis questionnaire. The mean utility associated with the health state of presbyopia in our sample was 0.980 (standard deviation, 0.086; 95% confidence interval, 0.964 to 0.996). Ten percent of the cohort had a presbyopia-associated utility of 0.95 or less. Age, gender, level of education, marital status, and the degree of presbyopia did not significantly affect the time trade-off utilities associated with presbyopia. Presbyopia corrected with glasses is associated with a nominal decrease in quality of life, similar to that of treated hypertension, for the average person with the condition. Approximately 10% of such patients theoretically may be candidates for an intervention other than spectacles to correct the condition.

Intelligent Cooperative MAC Protocol for Balancing Energy Consumption

NASA Astrophysics Data System (ADS)

Wu, S.; Liu, K.; Huang, B.; Liu, F.

To extend the lifetime of wireless sensor networks, we proposed an intelligent balanced energy consumption cooperative MAC protocol (IBEC-CMAC) based on the multi-node cooperative transmission model. The protocol has priority to access high-quality channels for reducing energy consumption of each transmission. It can also balance the energy consumption among cooperative nodes by using high residual energy nodes instead of excessively consuming some node's energy. Simulation results show that IBEC-CMAC can obtain longer network lifetime and higher energy utilization than direct transmission.

Foraging behavior by Daphnia in stoichiometric gradients of food quality.

PubMed

Schatz, Greg S; McCauley, Edward

2007-10-01

Mismatches in the elemental composition of herbivores and their resources can impact herbivore growth and reproduction. In aquatic systems, the ratio of elements, such as C, P, and N, is used to characterize the food quality of algal prey. For example, large increases in the C:P ratio of edible algae can decrease rates of growth and reproduction in Daphnia. Current theory emphasizes that Daphnia utilize only assimilation and respiration processes to maintain an optimal elemental composition, yet studies of terrestrial herbivores implicate behavioral processes in coping with local variation in food quality. We tested the ability of juvenile and adult Daphnia to locate regions of high-quality food within a spatial gradient of algal prey differing in C:P ratio, while holding food density constant over space. Both juveniles and adults demonstrated similar behavior by quickly locating (i.e., <10 min) the region of high food quality. Foraging paths were centred on regions of high food quality and these differed significantly from paths of individuals exposed to a homogeneous environment of both food density and food quality. Ingestion rate experiments on algal prey of differing stoichiometric ratio show that individuals can adjust their intake rate over fast behavioral time-scales, and we use these data to examine how individuals choose foraging locations when presented with a spatial gradient that trades off food quality and food quantity. Daphnia reared under low food quality conditions chose to forage in regions of high food quality even though they could attain the same C ingestion rate elsewhere along a spatial gradient. We argue that these aspects of foraging behavior by Daphnia have important implications for how these herbivores manage their elemental composition and our understanding of the dynamics of these herbivore-plant systems in lakes and ponds where spatial variation in food quality is present.

Evidence of clinical utility: an unmet need in molecular diagnostics for patients with cancer.

PubMed

Parkinson, David R; McCormack, Robert T; Keating, Susan M; Gutman, Steven I; Hamilton, Stanley R; Mansfield, Elizabeth A; Piper, Margaret A; Deverka, Patricia; Frueh, Felix W; Jessup, J Milburn; McShane, Lisa M; Tunis, Sean R; Sigman, Caroline C; Kelloff, Gary J

2014-03-15

This article defines and describes best practices for the academic and business community to generate evidence of clinical utility for cancer molecular diagnostic assays. Beyond analytical and clinical validation, successful demonstration of clinical utility involves developing sufficient evidence to demonstrate that a diagnostic test results in an improvement in patient outcomes. This discussion is complementary to theoretical frameworks described in previously published guidance and literature reports by the U.S. Food and Drug Administration, Centers for Disease Control and Prevention, Institute of Medicine, and Center for Medical Technology Policy, among others. These reports are comprehensive and specifically clarify appropriate clinical use, adoption, and payer reimbursement for assay manufacturers, as well as Clinical Laboratory Improvement Amendments-certified laboratories, including those that develop assays (laboratory developed tests). Practical criteria and steps for establishing clinical utility are crucial to subsequent decisions for reimbursement without which high-performing molecular diagnostics will have limited availability to patients with cancer and fail to translate scientific advances into high-quality and cost-effective cancer care. See all articles in this CCR Focus section, "The Precision Medicine Conundrum: Approaches to Companion Diagnostic Co-development." ©2014 AACR.

Neural networks with fuzzy Petri nets for modeling a machining process

NASA Astrophysics Data System (ADS)

Hanna, Moheb M.

1998-03-01

The paper presents an intelligent architecture based a feedforward neural network with fuzzy Petri nets for modeling product quality in a CNC machining center. It discusses how the proposed architecture can be used for modeling, monitoring and control a product quality specification such as surface roughness. The surface roughness represents the output quality specification manufactured by a CNC machining center as a result of a milling process. The neural network approach employed the selected input parameters which defined by the machine operator via the CNC code. The fuzzy Petri nets approach utilized the exact input milling parameters, such as spindle speed, feed rate, tool diameter and coolant (off/on), which can be obtained via the machine or sensors system. An aim of the proposed architecture is to model the demanded quality of surface roughness as high, medium or low.

Parental perception of the nutritional quality of school meals and its association with students' school lunch participation.

PubMed

Ohri-Vachaspati, Punam

2014-03-01

This study explores the association between parental perception of the nutritional quality of school meals and whether students eat lunch served at school. We use data from five low-income cities in New Jersey that have high minority populations. Students whose parents perceive the quality of school meals to be healthy have greater odds of eating meals served at school. Recent changes in guidelines for the United States Department of Agriculture's National School Lunch Program met with resistance from several fronts. Advocates for and implementers of improved school meals may benefit from partnering with parents to increase the acceptance and utilization of improved school offerings. Copyright © 2013 Elsevier Ltd. All rights reserved.

Growth and Photovoltaic Properties of High-Quality GaAs Nanowires Prepared by the Two-Source CVD Method.

PubMed

Wang, Ying; Yang, Zaixing; Wu, Xiaofeng; Han, Ning; Liu, Hanyu; Wang, Shuobo; Li, Jun; Tse, WaiMan; Yip, SenPo; Chen, Yunfa; Ho, Johnny C

2016-12-01

Growing high-quality and low-cost GaAs nanowires (NWs) as well as fabricating high-performance NW solar cells by facile means is an important development towards the cost-effective next-generation photovoltaics. In this work, highly crystalline, dense, and long GaAs NWs are successfully synthesized using a two-source method on non-crystalline SiO2 substrates by a simple solid-source chemical vapor deposition method. The high V/III ratio and precursor concentration enabled by this two-source configuration can significantly benefit the NW growth and suppress the crystal defect formation as compared with the conventional one-source system. Since less NW crystal defects would contribute fewer electrons being trapped by the surface oxides, the p-type conductivity is then greatly enhanced as revealed by the electrical characterization of fabricated NW devices. Furthermore, the individual single NW and high-density NW parallel arrays achieved by contact printing can be effectively fabricated into Schottky barrier solar cells simply by employing asymmetric Ni-Al contacts, along with an open circuit voltage of ~0.3 V. All these results indicate the technological promise of these high-quality two-source grown GaAs NWs, especially for the realization of facile Schottky solar cells utilizing the asymmetric Ni-Al contact.

The Utility of the Faces Pain Scale in the Assessment of Shoulder Pain in Turkish Stroke Patients: Its Relation with Quality of Life and Psychologic Status

ERIC Educational Resources Information Center

Dogan, Sebnem Koldas; Ay, Saime; Oztuna, Derya; Aytur, Yesim Kurtais; Evcik, Deniz

2010-01-01

This study was planned to investigate the utility of the vertical Faces Pain Scale (FPS) in the assessment of pain in stroke patients using the shoulder pain model and to assess its utility in the Turkish patient population. The secondary aim was to analyze the association of FPS with the quality of life and depression in the study population.…

Searching for a business case for quality in Medicaid managed care.

PubMed

Greene, Sandra B; Reiter, Kristin L; Kilpatrick, Kerry E; Leatherman, Sheila; Somers, Stephen A; Hamblin, Allison

2008-01-01

Despite the prevalence of evidence-based interventions to improve quality in health care systems, there is a paucity of documented evidence of a financial return on investment (ROI) for these interventions from the perspective of the investing entity. To report on a demonstration project designed to measure the business case for selected quality interventions in high-risk high-cost patient populations in 10 Medicaid managed care organizations across the United States. Using claims and enrollment data gathered over a 3-year period and data on the costs of designing, implementing, and operating the interventions, ROIs were computed for 11 discrete evidence-based quality-enhancing interventions. A complex case management program to treat adults with multiple comorbidities achieved the largest ROI of 12.21:1. This was followed by an ROI of 6.35:1 for a program which treated children with asthma with a history of high emergency room (ER) use and/or inpatient admissions for their disease. An intervention for high-risk pregnant mothers produced a 1.26:1 ROI, and a program for adult patients with diabetes resulted in a 1.16:1 return. The remaining seven interventions failed to show positive returns, although four sites came close to realizing sufficient savings to offset investment costs. Evidence-based interventions designed to improve the quality of patient care may have the best opportunity to yield a positive financial return if it is focused on high-risk high-cost populations and conditions associated with avoidable emergency and inpatient utilization. Developing the necessary tracking systems for the claims and financial investments is critical to perform accurate financial ROI analyses.

Efficient preparation of graphene liquid cell utilizing direct transfer with large-area well-stitched graphene

NASA Astrophysics Data System (ADS)

Sasaki, Yuki; Kitaura, Ryo; Yuk, Jong Min; Zettl, Alex; Shinohara, Hisanori

2016-04-01

By utilizing graphene-sandwiched structures recently developed in this laboratory, we are able to visualize small droplets of liquids in nanometer scale. We have found that small water droplets as small as several tens of nanometers sandwiched by two single-layer graphene are frequently observed by TEM. Due to the electron beam irradiation during the TEM observation, these sandwiched droplets are frequently moving from one place to another and are subjected to create small bubbles inside. The synthesis of a large area single-domain graphene of high-quality is essential to prepare the graphene sandwiched cell which safely encapsulates the droplets in nanometer size.

Standard Reference Specimens in Quality Control of Engineering Surfaces

PubMed Central

Song, J. F.; Vorburger, T. V.

1991-01-01

In the quality control of engineering surfaces, we aim to understand and maintain a good relationship between the manufacturing process and surface function. This is achieved by controlling the surface texture. The control process involves: 1) learning the functional parameters and their control values through controlled experiments or through a long history of production and use; 2) maintaining high accuracy and reproducibility with measurements not only of roughness calibration specimens but also of real engineering parts. In this paper, the characteristics, utilizations, and limitations of different classes of precision roughness calibration specimens are described. A measuring procedure of engineering surfaces, based on the calibration procedure of roughness specimens at NIST, is proposed. This procedure involves utilization of check specimens with waveform, wavelength, and other roughness parameters similar to functioning engineering surfaces. These check specimens would be certified under standardized reference measuring conditions, or by a reference instrument, and could be used for overall checking of the measuring procedure and for maintaining accuracy and agreement in engineering surface measurement. The concept of “surface texture design” is also suggested, which involves designing the engineering surface texture, the manufacturing process, and the quality control procedure to meet the optimal functional needs. PMID:28184115

A Cross-sectional Assessment of Health-related Quality of Life among Patients with Chronic Obstructive Pulmonary Disease.

PubMed

Garcia-Gordillo, Miguel Ángel; Collado-Mateo, Daniel; Olivares, Pedro Rufino; Adsuar, José Carmelo; Merellano-Navarro, Eugenio

2017-08-01

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality characterized by progressive airflow obstruction and inflammation in the airways, which has an impact on health-related quality of life. The EQ-5D-5L is one of the most used preference-based, health-related quality of life questionnaire. The objective of this study was to provide normative values of EQ-5D-5L for Spanish people suffering from COPD. Data were extracted from the Spanish National Health Survey (2011/2012). Overall, 1130 people with COPD participated in this survey. The utility index of EQ-5D-5L and the Visual Analog Scale (VAS) score were defined by gender, region, and age. Mean (SD) EQ-5D-5L utility index and VAS score for Spanish people with COPD were 0.742 (0.309) and 60.466 (21.934) respectively. In general, men reported better health status than women. Ceiling effect of the whole sample was 30.35%. The current study provides normative values of EQ-5D-5L for Spanish people affected by COPD. Ceiling effect was high and better results were observed in men compared with women.

[Evaluation of the adjusted amino acid score by digestibility for estimating the protein quality and protein available in food and diets].

PubMed

Pak, N; Vera, G; Araya, H

1985-03-01

The purpose of the present study was to evaluate the amino acid score adjusted by digestibility to estimate protein quality and utilizable protein in foods and diets, considering net protein utilization (NPU) as a biological reference method. Ten foods of vegetable origin and ten of animal origin, as well as eight mixtures of foods of vegetable and animal origin were studied. When all the foods were considered, a positive (r = 0.83) and highly significant correlation (p less than 0.001) between NPU and the amino acid score adjusted by digestibility was found. When the foods were separated according to their origin, this correlation was positive only for the foods of vegetable origin (r = 0.93) and statistically significant (p less than 0.001). Also, only in those foods were similar values found between NPU and amino acid score adjusted by digestibility, as well as in utilizable protein estimated considering both methods. Caution is required to interpret protein quality and utilizable protein values of foods of animal origin and mixtures of foods of vegetable and animal origin when the amino acid score method adjusted by digestibility, or NPU, are utilized.

Lab-on-a-Chip Based Protein Crystallization

NASA Technical Reports Server (NTRS)

vanderWoerd, Mark J.; Brasseur, Michael M.; Spearing, Scott F.; Whitaker, Ann F. (Technical Monitor)

2001-01-01

We are developing a novel technique with which we will grow protein crystals in very small volumes, utilizing chip-based, microfluidic ("LabChip") technology. This development, which is a collaborative effort between NASA's Marshall Space Flight Center and Caliper Technologies Corporation, promises a breakthrough in the field of protein crystal growth. Our initial results obtained from two model proteins, Lysozyme and Thaumatin, show that it is feasible to dispense and adequately mix protein and precipitant solutions on a nano-liter scale. The mixtures have shown crystal growth in volumes in the range of 10 nanoliters to 5 microliters. In addition, large diffraction quality crystals were obtained by this method. X-ray data from these crystals were shown to be of excellent quality. Our future efforts will include the further development of protein crystal growth with LabChip(trademark) technology for more complex systems. We will initially address the batch growth method, followed by the vapor diffusion method and the liquid-liquid diffusion method. The culmination of these chip developments is to lead to an on orbit protein crystallization facility on the International Space Station. Structural biologists will be invited to utilize the on orbit Iterative Biological Crystallization facility to grow high quality macromolecular crystals in microgravity.

Assessing the microbial quality of a tropical watershed with an urbanization gradient using traditional and alternate fecal indicators.

PubMed

Santiago-Rodriguez, Tasha M; Toranzos, Gary A; Arce-Nazario, Javier A

2016-10-01

Urbanization affects the microbial loading into tropical streams, but its impact on water quality varies across watersheds. Rainfall in tropical environments also complicates microbial dynamics due to high seasonal and annual variations. Understanding the dynamics of fecal contamination in tropical surface waters may be further hindered by limitations from the utilization of traditional microbial indicators. We measured traditional (Enterococcus spp. and Escherichia coli), as well as alternate (enterophages and coliphages) indicators of fecal contamination in a tropical watershed in Puerto Rico during a 1-year period, and examined their relationship with rainfall events across an urbanization gradient. Enterococcus spp. and E. coli concentrations were 4 to 5 logs higher in non-urbanized or pristine sites when compared to enterophages and coliphages, suggesting that traditional fecal indicator bacteria may be natural inhabitants of pristine tropical waters. All of the tested indicators were positively correlated with rainfall and urbanization, except in the most urbanized sites, where rainfall may have had a dilution effect. The present study indicates that utilizing novel indicators of microbial water quality may improve the assessment of fecal contamination and pathogen risk for tropical watersheds.

Coordinated Multiple Cadaver Use for Minimally Invasive Surgical Training

PubMed Central

Blaschko, Sarah D.; Brooks, H. Mark; Dhuy, S. Michael; Charest-Shell, Cynthia; Clayman, Ralph V.

2007-01-01

Background: The human cadaver remains the gold standard for anatomic training and is highly useful when incorporated into minimally invasive surgical training programs. However, this valuable resource is often not used to its full potential due to a lack of multidisciplinary cooperation. Herein, we propose the coordinated multiple use of individual cadavers to better utilize anatomical resources and potentiate the availability of cadaver training. Methods: Twenty-two postgraduate surgeons participated in a robot-assisted surgical training course that utilized shared cadavers. All participants completed a Likert 4-scale satisfaction questionnaire after their training session. Cadaveric tissue quality and the quality of the training session related to this material were assessed. Results: Nine participants rated the quality of the cadaveric tissue as excellent, 7 as good, 5 as unsatisfactory, and 1 as poor. Overall, 72% of participants who operated on a previously used cadaver were satisfied with their training experience and did not perceive the previous use deleterious to their training. Conclusion: The coordinated use of cadavers, which allows for multiple cadaver use for different teaching sessions, is an excellent training method that increases availability of human anatomical material for minimally invasive surgical training. PMID:18237501

Quality of reproductive healthcare for adolescents: A nationally representative survey of providers in Mexico

PubMed Central

De Castro, Filipa; Barrientos-Gutiérrez, Tonatiuh; Leyva-López, Ahideé

2017-01-01

Objective Adolescents need sexual and reproductive health services but little is known about quality-of-care in lower- and middle-income countries where most of the world’s adolescents reside. Quality-of-care has important implications as lower quality may be linked to higher unplanned pregnancy and sexually transmitted infection rates. This study sought to generate evidence about quality-of-care in public sexual and reproductive health services for adolescents. Methods This cross-sectional study had a complex, probabilistic, stratified sampling design, representative at the national, regional and rural/urban level in Mexico, collecting provider questionnaires at 505 primary care units in 2012. A sexual and reproductive quality-of-healthcare index was defined and multinomial logistic regression was utilized in 2015. Results At the national level 13.9% (95%CI: 6.9–26.0) of healthcare units provide low quality, 68.6% (95%CI: 58.4–77.3) medium quality and 17.5% (95%CI: 11.9–25.0) high quality reproductive healthcare services to adolescents. Urban or metropolitan primary care units were at least 10 times more likely to provide high quality care than those in rural areas. Units with a space specifically for counseling adolescents were at least 8 times more likely to provide high quality care. Ministry of Health clinics provided the lowest quality of service, while those from Social Security for the Underserved provided the best. Conclusions The study indicates higher quality sexual and reproductive healthcare services are needed. In Mexico and other middle- to low-income countries where quality-of-care has been shown to be a problem, incorporating adolescent-friendly, gender-equity and rights-based perspectives could contribute to improvement. Setting and disseminating standards for care in guidelines and providing tools such as algorithms could help healthcare personnel provide higher quality care. PMID:28273129

Economic evaluation of Varicella vaccination: results of a systematic review

PubMed Central

Unim, Brigid; Saulle, Rosella; Boccalini, Sara; Taddei, Cristina; Ceccherini, Vega; Boccia, Antonio; Bonanni, Paolo; La Torre, Giuseppe

2013-01-01

Introduction: The aim of the present study is to review the economic burden of varicella disease and the benefit of universal varicella vaccination in different settings pending its implementation in all Italian regions. Materials and Methods: Research was conducted using PubMed, Scopus and ISI databases. Score quality and data extraction were performed for all included studies. Results: Twenty-three articles met the criteria: 15 cost-effectiveness, 8 cost-benefit and one cost-utility analysis. Varicella vaccination could save the society from €637,762 (infant strategy) to 53 million annually (combined infant and adolescent strategy). The median and the mean quality scores resulted in 91.8% and 85.4% respectively; 11 studies were considered of high quality and 12 of low quality. Discussion: The studies are favorable to the introduction of universal varicella vaccination in Italy, being cost saving and having a positive impact on morbidity. The quality score of the studies varied greatly: recent analyses were of comparable quality to older studies. PMID:23823940

Guaranteeing the quality and integrity of pork - An Australian case study.

PubMed

Channon, H A; D'Souza, D N; Jarrett, R G; Lee, G S H; Watling, R J; Jolley, J Y C; Dunshea, F R

2018-04-27

The Australian pork industry is strongly committed to assuring the integrity of its product, with substantial research investment made over the past ten years to develop and implement systems to assure the consistency and quality of fresh pork and to enable accurate tracing of unpackaged fresh pork back to property of origin using trace elemental profiling. These initiatives are pivotal to allow Australian pork of guaranteed eating quality to be successfully positioned as higher value products, across a range of international and domestic markets, whilst managing any threats of product substitution. This paper describes the current status of the development of a predictive eating quality model for Australian pork, utilizing eating quality datasets generated from recent Australian studies. The implementation of trace elemental profiling, by Physi-Trace™, to verify and defend provenance claims and support the supply of consistently high eating quality Australian pork to its customers, is also discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

A survey of pedagogical approaches and quality mechanisms used in education programs for mental health professionals.

PubMed

McCann, Edward; Higgins, Agnes; Maguire, Gerry; Alexander, Jane; Watts, Mike; Creaner, Mary; Rani, Shobha

2012-09-01

The provision of high-quality education and training that is responsive, relevant, accessible and evidence based is critical if the vision for quality mental health services presented in recent policy initiatives in Ireland is to be fulfilled. This paper reports the findings related to pedagogical approaches and quality assurance mechanisms utilized within mental health education. The study involved canvassing all Higher Education Institutions in Ireland. A total of 227 courses in 31 educational institutes were identified and 149 questionnaires were returned from 129 Course Coordinators. Various quality processes were identified in existing programs; however, formal feedback from service providers, service users and carers was seldom reported. Ongoing evaluation and quality assurance strategies are a key element of governance and there is a need to develop strategies that explore the impact of education programs on mental health education and health outcomes. Recommendations are made in terms of future interprofessional mental health education and practice.

42 CFR 480.101 - Scope and definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs... of the problem and follow-up. Quality review study information means all documentation related to the...

Improving service uptake and quality of care of integrated maternal health services: the Kenya Kwale District improvement collaborative.

PubMed

Mwaniki, Michael K; Vaid, Sonali; Chome, Isaac Mwamuye; Amolo, Dorcas; Tawfik, Youssef

2014-09-21

Health-related millennium development goals are off track in most of the countries in the sub-Saharan African region. Lack of access to, and low utilization of essential services and high-impact interventions, together with poor quality of health services, may be partially responsible for this lack of progress. We explored whether improvement approaches can be applied to increase utilization of antenatal care (ANC), health facility deliveries, prevention of mother-to-child transmission services and adherence to ANC standards of care in a rural district in Kenya. We targeted improvement of ANC services because ANC is a vital point of entry for most high-impact interventions targeting the pregnant mother. Healthcare workers in 21 public health facilities in Kwale District, Kenya formed improvement teams that met regularly to examine performance gaps in service delivery, identify root causes of such gaps, then develop and implement change ideas to address the gaps. Data were collected and entered into routine government registers by the teams on a daily basis. Data were abstracted from the government registers monthly to evaluate 20 indicators of care quality for improvement activities. For the purposes of this study, aggregate data for the district were collected from the District Health Management Office. The number of pregnant mothers starting ANC within the first trimester and those completing at least four ANC checkups increased significantly (from 41 (8%) to 118 (24%) p=0.002 and from 186 (37%) to 316 (64%) p<0.001, respectively). The proportions of ANC visits in which provision of care adhered to the required standards increased from <40% to 80-100% within three to six months (X2 for trend 4.07, p<0.001). There was also a significant increase in the number of pregnant women delivering in health facilities each month from 164 (33%) to 259 (52%) (p=0.012). Improvement approaches can be applied in rural health care facilities in low-income settings to increase utilization of services and adherence to standards of care. Using the quality improvement methodology to target integrated health services is feasible. Longer follow-up periods are needed to gather more evidence on the sustainability of quality improvement initiatives in low-income countries.

Quality improvement in pediatrics: past, present, and future.

PubMed

Schwartz, Stephanie P; Rehder, Kyle J

2017-01-01

Almost two decades ago, the landmark report "To Err is Human" compelled healthcare to address the large numbers of hospitalized patients experiencing preventable harm. Concurrently, it became clear that the rapidly rising cost of healthcare would be unsustainable in the long-term. As a result, quality improvement methodologies initially rooted in other high-reliability industries have become a primary focus of healthcare. Multiple pediatric studies demonstrate remarkable quality and safety improvements in several domains including handoffs, catheter-associated blood stream infections, and other serious safety events. While both quality improvement and research are data-driven processes, significant differences exist between the two. Research utilizes a hypothesis driven approach to obtain new knowledge while quality improvement often incorporates a cyclic approach to translate existing knowledge into clinical practice. Recent publications have provided guidelines and methods for effectively reporting quality and safety work and improvement implementations. This review examines not only how quality improvement in pediatrics has led to improved outcomes, but also looks to the future of quality improvement in healthcare with focus on education and collaboration to ensure best practice approaches to caring for children.

Coherent scattering noise reduction method with wavelength diversity detection for holographic data storage system

NASA Astrophysics Data System (ADS)

Nakamura, Yusuke; Hoshizawa, Taku; Takashima, Yuzuru

2017-09-01

A new method, wavelength diversity detection (WDD), for improving signal quality is proposed and its effectiveness is numerically confirmed. We consider that WDD is especially effective for high-capacity systems having low hologram diffraction efficiencies. In such systems, the signal quality is primarily limited by coherent scattering noise; thus, effective improvement of the signal quality under a scattering-limited system is of great interest. WDD utilizes a new degree of freedom, the spectrum width, and scattering by molecules to improve the signal quality of the system. We found that WDD improves the quality by counterbalancing the degradation of the quality due to Bragg mismatch. With WDD, a higher-scattering-coefficient medium can improve the quality. The result provides an interesting insight into the requirements for material characteristics, especially for a large-M/# material. In general, a larger-M/# material contains more molecules; thus, the system is subject to more scattering, which actually improves the quality with WDD. We propose a pathway for a future holographic data storage system (HDSS) using WDD, which can record a larger amount of data than a conventional HDSS.

Cost-effectiveness of lobectomy versus genetic testing (Afirma®) for indeterminate thyroid nodules: Considering the costs of surveillance.

PubMed

Balentine, Courtney J; Vanness, David J; Schneider, David F

2018-01-01

We evaluated whether diagnostic thyroidectomy for indeterminate thyroid nodules would be more cost-effective than genetic testing after including the costs of long-term surveillance. We used a Markov decision model to estimate the cost-effectiveness of thyroid lobectomy versus genetic testing (Afirma®) for evaluation of indeterminate (Bethesda 3-4) thyroid nodules. The base case was a 40-year-old woman with a 1-cm indeterminate nodule. Probabilities and estimates of utilities were obtained from the literature. Cost estimates were based on Medicare reimbursements with a 3% discount rate for costs and quality-adjusted life-years. During a 5-year period after the diagnosis of indeterminate thyroid nodules, lobectomy was less costly and more effective than Afirma® (lobectomy: $6,100; 4.50 quality-adjusted life- years vs Afirma®: $9,400; 4.47 quality-adjusted life-years). Only in 253 of 10,000 simulations (2.5%) did Afirma® show a net benefit at a cost-effectiveness threshold of $100,000 per quality- adjusted life-years. There was only a 0.3% probability of Afirma® being cost saving and a 14.9% probability of improving quality-adjusted life-years. Our base case estimate suggests that diagnostic lobectomy dominates genetic testing as a strategy for ruling out malignancy of indeterminate thyroid nodules. These results, however, were highly sensitive to estimates of utilities after lobectomy and living under surveillance after Afirma®. Published by Elsevier Inc.

An evaluation of contaminated estuarine sites using sediment quality guidelines and ecological assessment methodologies.

PubMed

Fulton, M; Key, P; Wirth, E; Leight, A K; Daugomah, J; Bearden, D; Sivertsen, S; Scott, G

2006-10-01

Toxic contaminants may enter estuarine ecosystems through a variety of pathways. When sediment contaminant levels become sufficiently high, they may impact resident biota. One approach to predict sediment-associated toxicity in estuarine ecosystems involves the use of sediment quality guidelines (ERMs, ERLs) and site-specific contaminant chemistry while a second approach utilizes site-specific ecological sampling to assess impacts at the population or community level. The goal of this study was to utilize an integrated approach including chemical contaminant analysis, sediment quality guidelines and grass shrimp population monitoring to evaluate the impact of contaminants from industrial sources. Three impacted sites and one reference site were selected for study. Grass shrimp populations were sampled using a push-netting approach. Sediment samples were collected at each site and analyzed for metals, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs) and pesticides. Contaminant levels were then compared to sediment quality guidelines. In general, grass shrimp population densities at the sites decreased as the ERM quotients increased. Grass shrimp densities were significantly reduced at the impacted site that had an ERM exceedance for chromium and the highest Mean ERM quotient. Regression analysis indicated that sediment chromium concentrations were negatively correlated with grass shrimp density. Grass shrimp size was reduced at two sites with intermediate levels of contamination. These findings support the use of both sediment quality guidelines and site-specific population monitoring to evaluate the impacts of sediment-associated contaminants in estuarine systems.

KAT: a K-mer analysis toolkit to quality control NGS datasets and genome assemblies.

PubMed

Mapleson, Daniel; Garcia Accinelli, Gonzalo; Kettleborough, George; Wright, Jonathan; Clavijo, Bernardo J

2017-02-15

De novo assembly of whole genome shotgun (WGS) next-generation sequencing (NGS) data benefits from high-quality input with high coverage. However, in practice, determining the quality and quantity of useful reads quickly and in a reference-free manner is not trivial. Gaining a better understanding of the WGS data, and how that data is utilized by assemblers, provides useful insights that can inform the assembly process and result in better assemblies. We present the K-mer Analysis Toolkit (KAT): a multi-purpose software toolkit for reference-free quality control (QC) of WGS reads and de novo genome assemblies, primarily via their k-mer frequencies and GC composition. KAT enables users to assess levels of errors, bias and contamination at various stages of the assembly process. In this paper we highlight KAT's ability to provide valuable insights into assembly composition and quality of genome assemblies through pairwise comparison of k-mers present in both input reads and the assemblies. KAT is available under the GPLv3 license at: https://github.com/TGAC/KAT . bernardo.clavijo@earlham.ac.uk. Supplementary data are available at Bioinformatics online. © The Author 2016. Published by Oxford University Press.

Utility values in the visually impaired: comparing time-trade off and VisQoL.

PubMed

Gothwal, Vijaya K; Bagga, Deepak K

2013-08-01

Visual impairment (VI) negatively affects quality of life (QoL). Utilities represent a way of measuring the QoL impact associated with a particular health state, like VI, and are also useful in economic evaluations of health care interventions. Utilities can be determined either directly or indirectly. Here we determine whether the Vision and Quality of Life Index, VisQoL (indirect approach), is acceptable to use in patients with VI in an urban setting in South India; whether the VisQoL utility values, derived from an Australian sample of both visually impaired and normally sighted participants, demonstrate agreement (if any) with direct utilities, determined by time trade-off (TTO), from visually impaired South Indian patients; and determine the relationship between utilities and self-reported visual disability. Three hundred forty-nine adults with VI were administered the two-item TTO item, six-item VisQoL, and the 16-item Andhra Pradesh Eye Disease-Visual Function Questionnaire (APEDS-VFQ) in a face-to-face interview. The VisQoL utilities were derived from the utility scoring algorithm. Rasch-scaled scores of the APEDS-VFQ were obtained using the conversion scores sheets. Agreement between TTO and utilities VisQoL was assessed using the Bland-Altman method. All participants (response rate, 100%) completed the VisQoL as compared with 72% for the TTO. There was no statistically significant difference in the mean utilities from the two methods (0.65 ± 0.31 by TTO vs. 0.66 ± 0.27 by VisQoL, p = 0.67). However, the 95% limits of agreement on the Bland-Altman plot were wide (-0.65, 0.67), implying a lack of agreement between the methods. The VisQoL relates relatively strongly with APEDS-VFQ as compared with TTO (TTO vs. APEDS-VFQ, r = -0.23, VisQoL vs. APEDS-VFQ, r = -0.66, z = -6.70; p < 0.001 for both). Older participants, female, and those with less than 12 years of education had lower utilities. The direct (TTO) and indirect (VisQoL) methods of utility evaluation tend to disagree in our patients with VI. Given the high completion rates of the VisQoL as compared with the TTO, the VisQoL may be a suitable alternative for utility assessment in an Indian population.

Comparative mass spectrometry & nuclear magnetic resonance metabolomic approaches for nutraceuticals quality control analysis: a brief review.

PubMed

Farag, Mohamed A

2014-01-01

The number of botanical dietary supplements in the market has recently increased primarily due to increased health awareness. Standardization and quality control of the constituents of these plant extracts is an important topic, particularly when such ingredients are used long term as dietary supplements, or in cases where higher doses are marketed as drugs. The development of fast, comprehensive, and effective untargeted analytical methods for plant extracts is of high interest. Nuclear magnetic resonance spectroscopy and mass spectrometry are the most informative tools, each of which enables high-throughput and global analysis of hundreds of metabolites in a single step. Although only one of the two techniques is utilized in the majority of plant metabolomics applications, there is a growing interest in combining the data from both platforms to effectively unravel the complexity of plant samples. The application of combined MS and NMR in the quality control of nutraceuticals forms the major part of this review. Finally I will look at the future developments and perspectives of these two technologies for the quality control of herbal materials.

Do Health Care Delivery System Reforms Improve Value? The Jury Is Still Out.

PubMed

Korenstein, Deborah; Duan, Kevin; Diaz, Manuel J; Ahn, Rosa; Keyhani, Salomeh

2016-01-01

Widespread restructuring of health delivery systems is underway in the United States to reduce costs and improve the quality of health care. To describe studies evaluating the impact of system-level interventions (incentives and delivery structures) on the value of US health care, defined as the balance between quality and cost. We identified articles in PubMed (2003 to July 2014) using keywords identified through an iterative process, with reference and author tracking. We searched tables of contents of relevant journals from August 2014 through 11 August 2015 to update our sample. We included prospective or retrospective studies of system-level changes, with a control, reporting both quality and either cost or utilization of resources. Data about study design, study quality, and outcomes was extracted by one reviewer and checked by a second. Thirty reports of 28 interventions were included. Interventions included patient-centered medical home implementations (n=12), pay-for-performance programs (n=10), and mixed interventions (n=6); no other intervention types were identified. Most reports (n=19) described both cost and utilization outcomes. Quality, cost, and utilization outcomes varied widely; many improvements were small and process outcomes predominated. Improved value (improved quality with stable or lower cost/utilization or stable quality with lower cost/utilization) was seen in 23 reports; 1 showed decreased value, and 6 showed unchanged, unclear, or mixed results.Study limitations included variability among specific endpoints reported, inconsistent methodologies, and lack of full adjustment in some observational trials. Lack of standardized MeSH terms was also a challenge in the search. On balance, the literature suggests that health system reforms can improve value. However, this finding is tempered by the varying outcomes evaluated across studies with little documented improvement in outcome quality measures. Standardized measures of value would facilitate assessment of the impact of interventions across studies and better estimates of the broad impact of system change.

Outpatient utilization of psychopharmaceuticals in the City of Zagreb 2001-2006.

PubMed

Stimac, Danijela; Culig, Josip

2009-03-01

A comprehensive insight into drug utilization as an economic and primarily a public health issue can only be acquired in the context of overall health state of the respective population. The objectives of the study were: 1) to determine the real outpatient utilization of psychopharmaceuticals in Zagreb, 2) to determine the psychopharmaceutical prescribing quality during the study period; and 3) to propose appropriate interventions in Zagreb on the basis of the results obtained. Data on drug utilization were obtained from all Zagreb pharmacies. The number of defined daily doses (DDD) and number of DDD per 1000 inhabitants per day (DDD/1000/day) were calculated from the number of particular drug packages. The Drug Utilization 90% (DU90%) method was used as a criterion of prescribing quality. Outpatient utilization of psychopharmaceuticals showed a declining pattern from 115.40 DDD/1000/day in 2001 to 93.15 DDD/1000/day in 2006. Anxiolytics accounted for the majority of this drug group utilization in the City of Zagreb, although the anxiolytic/antidepressant ratio decreased from 7.19 in 2001 to 3.86 in 2006. The utilization of selective serotonin reuptake inhibitors showed a 2.5-fold increase and accounted for 90% of overall antidepressant utilization. A 2.5-fold decrease was recorded in the utilization of antipsychotics, while the atypical/typical antipsychotic ratio changed from 1:2 in 2001 to 1.1:1 in 2006. Despite some improvement observed in the prescribing quality, the predominance of benzodiazepines in the utilization of psychopharmaceuticals points to the need of additional rationalization in the field.

A Cost-Utility Analysis of Lung Cancer Screening and the Additional Benefits of Incorporating Smoking Cessation Interventions

PubMed Central

Villanti, Andrea C.; Jiang, Yiding; Abrams, David B.; Pyenson, Bruce S.

2013-01-01

Background A 2011 report from the National Lung Screening Trial indicates that three annual low-dose computed tomography (LDCT) screenings for lung cancer reduced lung cancer mortality by 20% compared to chest X-ray among older individuals at high risk for lung cancer. Discussion has shifted from clinical proof to financial feasibility. The goal of this study was to determine whether LDCT screening for lung cancer in a commercially-insured population (aged 50–64) at high risk for lung cancer is cost-effective and to quantify the additional benefits of incorporating smoking cessation interventions in a lung cancer screening program. Methods and Findings The current study builds upon a previous simulation model to estimate the cost-utility of annual, repeated LDCT screenings over 15 years in a high risk hypothetical cohort of 18 million adults between age 50 and 64 with 30+ pack-years of smoking history. In the base case, the lung cancer screening intervention cost $27.8 billion over 15 years and yielded 985,284 quality-adjusted life years (QALYs) gained for a cost-utility ratio of $28,240 per QALY gained. Adding smoking cessation to these annual screenings resulted in increases in both the costs and QALYs saved, reflected in cost-utility ratios ranging from $16,198 per QALY gained to $23,185 per QALY gained. Annual LDCT lung cancer screening in this high risk population remained cost-effective across all sensitivity analyses. Conclusions The findings of this study indicate that repeat annual lung cancer screening in a high risk cohort of adults aged 50–64 is highly cost-effective. Offering smoking cessation interventions with the annual screening program improved the cost-effectiveness of lung cancer screening between 20% and 45%. The cost-utility ratios estimated in this study were in line with other accepted cancer screening interventions and support inclusion of annual LDCT screening for lung cancer in a high risk population in clinical recommendations. PMID:23940744

Evaluation of portable CT scanners for otologic image-guided surgery

PubMed Central

Balachandran, Ramya; Schurzig, Daniel; Fitzpatrick, J Michael; Labadie, Robert F

2011-01-01

Purpose Portable CT scanners are beneficial for diagnosis in the intensive care unit, emergency room, and operating room. Portable fixed-base versus translating-base CT systems were evaluated for otologic image-guided surgical (IGS) applications based on geometric accuracy and utility for percutaneous cochlear implantation. Methods Five cadaveric skulls were fitted with fiducial markers and scanned using both a translating-base, 8-slice CT scanner (CereTom®) and a fixed-base, flat-panel, volume-CT (fpVCT) scanner (Xoran xCAT®). Images were analyzed for: (a) subjective quality (i.e. noise), (b) consistency of attenuation measurements (Hounsfield units) across similar tissue, and (c) geometric accuracy of fiducial marker positions. The utility of these scanners in clinical IGS cases was tested. Results Five cadaveric specimens were scanned using each of the scanners. The translating-base, 8-slice CT scanner had spatially consistent Hounsfield units, and the image quality was subjectively good. However, because of movement variations during scanning, the geometric accuracy of fiducial marker positions was low. The fixed-base, fpVCT system had high spatial resolution, but the images were noisy and had spatially inconsistent attenuation measurements; while the geometric representation of the fiducial markers was highly accurate. Conclusion Two types of portable CT scanners were evaluated for otologic IGS. The translating-base, 8-slice CT scanner provided better image quality than a fixed-base, fpVCT scanner. However, the inherent error in three-dimensional spatial relationships by the translating-based system makes it suboptimal for otologic IGS use. PMID:21779768

Joint Machine Learning and Game Theory for Rate Control in High Efficiency Video Coding.

PubMed

Gao, Wei; Kwong, Sam; Jia, Yuheng

2017-08-25

In this paper, a joint machine learning and game theory modeling (MLGT) framework is proposed for inter frame coding tree unit (CTU) level bit allocation and rate control (RC) optimization in High Efficiency Video Coding (HEVC). First, a support vector machine (SVM) based multi-classification scheme is proposed to improve the prediction accuracy of CTU-level Rate-Distortion (R-D) model. The legacy "chicken-and-egg" dilemma in video coding is proposed to be overcome by the learning-based R-D model. Second, a mixed R-D model based cooperative bargaining game theory is proposed for bit allocation optimization, where the convexity of the mixed R-D model based utility function is proved, and Nash bargaining solution (NBS) is achieved by the proposed iterative solution search method. The minimum utility is adjusted by the reference coding distortion and frame-level Quantization parameter (QP) change. Lastly, intra frame QP and inter frame adaptive bit ratios are adjusted to make inter frames have more bit resources to maintain smooth quality and bit consumption in the bargaining game optimization. Experimental results demonstrate that the proposed MLGT based RC method can achieve much better R-D performances, quality smoothness, bit rate accuracy, buffer control results and subjective visual quality than the other state-of-the-art one-pass RC methods, and the achieved R-D performances are very close to the performance limits from the FixedQP method.

Effects of variety, cropping year, location and fertilizer application on nutritive value of durum wheat straw.

PubMed

Tolera, A; Tsegaye, B; Berg, T

2008-04-01

This study was carried out to assess the effects of variety, year, location and level of fertilizer application on chemical composition and in sacco dry matter (DM) degradability of durum wheat straw as well as to understand the relationship between straw quality and agronomic traits of the crop and to assess the possibilities of selecting wheat varieties that combine high grain yield with desirable straw quality. Two local (Arendeto and Tikur sinde) and two improved (Boohai and Gerardo) varieties of durum wheat (Triticum turgidum Desf.) were used in the experiment. The four varieties were grown at two locations (Akaki and Ejere) in the years 2001/2002 and 2002/2003 in 5 x 5 m plots in three replications. Diammonium phosphate and urea fertilizers were applied at four levels (0/0, 32/23, 41/23 and 64/46 kg/ha of nitrogen/phosphorus). Straw quality was assessed based on chemical composition and in sacco DM degradability. Correlation of straw quality with grain and straw yield and with other agronomic characteristics of the crop was determined. The potential utility index (a measure that integrates grain and digestible straw yield) was used for ranking of the varieties. The local varieties had higher crude protein (CP) and lower neutral detergent fibre contents and higher digestibility than the improved varieties. The cropping year and location had significant effect on CP content and degradability of the straw, which could be due to climatic variation. However, the fertilizer level did not have any significant effect on straw quality except that the CP content of the straw tended to increase with increasing level of fertilizer application. Based on the potential utility index the varieties ranked, in a decreasing order, as Tikur sinde > Arendeto > Gerardo > Boohai and the ranking was consistent across years and locations. Except the CP content, straw quality was not negatively correlated with grain and straw yield. This indicates that there is a possibility of selecting varieties of wheat that combine high grain and straw yield with desirable straw quality.

The Urban Ecology Institute's field studies program: utilizing urban areas for experiential learning and ecological research

NASA Astrophysics Data System (ADS)

Starry, O.

2005-05-01

The Urban Ecology Institute (UEI) promotes the stewardship of healthy urban ecosystems by improving science and civic education for middle and high school youth and by working with urban communities to protect and transform natural resources. Established in 1999, UEI's field studies program engages over 1000 youth in the greater Boston area. A substantial component of this program involves water quality monitoring. We have recently adapted protocols from published leaf breakdown studies for incorporation into the UEI water quality curriculum. A 2004 pilot study of these leaf breakdown activities, conducted at four sites, compared rates of red maple breakdown to those of Norway maple, a potentially invasive urban street tree. Preliminary data from this successful pilot study suggest that leaf litter inputs from the two different tree species have varying effects on stream ecosystem function. We present this study as an example of how urban areas can be utilized for both ecological research and inclusive experiential learning through which science and mathematic knowledge can be effectively communicated.

Applications of Skylab EREP photographs to mapping landforms and environmental geomorphology in the Great Plains and Midwest

NASA Technical Reports Server (NTRS)

Morrison, R. B.; Lineback, J. A.; Fuller, H. K.; Rinkenberger, R. K.

1975-01-01

The following evaluations of Skylab photographs were undertaken: (1) the 1290 Skylab S190A and S190B photographs of Illinois, Iowa, Kansas, Missouri, Nebraska, and South Dakota were evaluated in detail in terms of coverage, cloud cover, photographic quality, endlap, detectability of roads and stereorelief, and utility for geomorphologic mapping, and (2) the utility of the Skylab photos were tested for interpretive analytic mapping of geomorphologic features over large areas representative of different parts of this region. Photointerpretative maps of analytic geomorphology were obtained for various test areas representative of the varied landscapes in the region. These maps are useful for regional land-use planning, ground-water exploration, and other environmental geomorphologic-geologic applications. Compared with LANDSAT-1 MSS images, Skylab photos afford almost as extensive overviews of large areas but in considerably greater detail, and for many SL photos, moderate stereorelief. However, repetitive multiseasonal, cloud-free coverage by high-quality photos is very limited and many areas have no coverage at all.

Silage review: Unique challenges of silages made in hot and cold regions.

PubMed

Bernardes, T F; Daniel, J L P; Adesogan, A T; McAllister, T A; Drouin, P; Nussio, L G; Huhtanen, P; Tremblay, G F; Bélanger, G; Cai, Y

2018-05-01

Silage making can be conveniently divided into field, ensiling, storage, and feed-out phases. In all of these stages, controllable and uncontrollable components can affect silage quality. For instance, silages produced in hot or cold regions are strongly influenced by uncontrollable climate-related factors. In hot regions, crops for silage are influenced by (1) high temperatures negatively affecting corn yield (whole-crop and grain) and nutritive value, (2) butyric and alcoholic fermentations in warm-season grasses (Panicum, Brachiaria, and Pennisetum genera) and sugarcane, respectively, and (3) accelerated aerobic deterioration of silages. Ensiling expertise and economic factors that limit mechanization also impair silage production and utilization in hot environments. In cold regions, a short and cool growing season often limits the use of crops sensitive to cool temperature, such as corn. The fermentation triggered by epiphytic and inoculated microorganisms can also be functionally impaired at lower temperature. Although the use of silage inoculants has increased in Northern Europe, acid-based additives are still a good option in difficult weather conditions to ensure good fermentation quality, nutritive value, and high intake potential of silages. Acid-based additives have enhanced the quality of round bale silage, which has become a common method of forage preservation in Northern Europe. Although all abiotic factors can affect silage quality, the ambient temperature is a factor that influences all stages of silage making from production in the field to utilization at the feed bunk. This review identifies challenges and obstacles to producing silages under hot and cold conditions and discusses strategies for addressing these challenges. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

42 CFR 480.136 - Disclosure to intermediaries and carriers.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs... quality review study information, a QIO must disclose to intermediaries and carriers QIO information that...

42 CFR 480.136 - Disclosure to intermediaries and carriers.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations... deliberations and quality review study information, a QIO must disclose to intermediaries and carriers QIO...

42 CFR 480.136 - Disclosure to intermediaries and carriers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations... deliberations and quality review study information, a QIO must disclose to intermediaries and carriers QIO...

42 CFR 480.136 - Disclosure to intermediaries and carriers.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs... quality review study information, a QIO must disclose to intermediaries and carriers QIO information that...

42 CFR 480.136 - Disclosure to intermediaries and carriers.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs... quality review study information, a QIO must disclose to intermediaries and carriers QIO information that...

UTILIZING SHELLFISH RESPONSES TO SET TARGET WATER QUALITY CONDITIONS FOR THE RESTORATION OF OYSTER REEFS IN THE CALOOSAHATCHEE ESTUARY, FLORIDA.

EPA Science Inventory

Volety, Aswani K., S.G. Tolley and James T. Winstead. 2002. Utilizing Shellfish Responses to Set Target Water Quality Conditions for the Restoration of Oyster Reefs in the Caloosahatchee Estuary, Florida. Presented at the International Workshop on Restoration of Benthic Invertebr...

Multiple-image hiding using super resolution reconstruction in high-frequency domains

NASA Astrophysics Data System (ADS)

Li, Xiao-Wei; Zhao, Wu-Xiang; Wang, Jun; Wang, Qiong-Hua

2017-12-01

In this paper, a robust multiple-image hiding method using the computer-generated integral imaging and the modified super-resolution reconstruction algorithm is proposed. In our work, the host image is first transformed into frequency domains by cellular automata (CA), to assure the quality of the stego-image, the secret images are embedded into the CA high-frequency domains. The proposed method has the following advantages: (1) robustness to geometric attacks because of the memory-distributed property of elemental images, (2) increasing quality of the reconstructed secret images as the scheme utilizes the modified super-resolution reconstruction algorithm. The simulation results show that the proposed multiple-image hiding method outperforms other similar hiding methods and is robust to some geometric attacks, e.g., Gaussian noise and JPEG compression attacks.

A Facile Methodology for Engineering the Morphology of CsPbX3 Perovskite Nanocrystals under Ambient Condition

NASA Astrophysics Data System (ADS)

Seth, Sudipta; Samanta, Anunay

2016-11-01

A facile and highly reproducible room temperature, open atmosphere synthesis of cesium lead halide perovskite nanocrystals of six different morphologies is reported just by varying the solvent, ligand and reaction time. Sequential evolution of the quantum dots, nanoplates and nanobars in one medium and nanocubes, nanorods and nanowires in another medium is demonstrated. These perovskite nanoparticles are shown to be of excellent crystalline quality with high fluorescence quantum yield. A mechanism of the formation of nanoparticles of different shapes and sizes is proposed. Considering the key role of morphology in nanotechnology, this simple method of fabrication of a wide range of high quality nanocrystals of different shapes and sizes of all-inorganic lead halide perovskites, whose potential is already demonstrated in light emitting and photovoltaic applications, is likely to help widening the scope and utility of these materials in optoelectronic devices.

Fabrication and transport property of artificial structure of CNTs using SPM nano-manipulation

NASA Astrophysics Data System (ADS)

Maejima, K.; Kida, M.; Yaguchi, Y.; Sudo, K.; Kawamura, T.; Morimoto, T.; Aoki, N.; Ochiai, Y.

2007-04-01

We have established a novel manipulation technique using a glass-micro capillary under a high-resolution CCD microscope so far. Two isolated multi-wall carbon nanotubes (MWNTs) are settled to form a well-aligned cross structure. Recently, we have tried to develop a fine manipulation system using a scanning probe microscope with a silicon cantilever. Therefore, thinner high-quality MWNTs (˜10 nm in diameter) can be utilized in this system. At the junction, we have observed weak localization and Fano-like-effect, zero bias anomaly whose traces were visible even at room temperature with thick MWNTs (˜100 nm in diameter). On the other hand, with thinner high-quality MWNTs (˜10 nm in diameter), we have observed also anomalous I-V characteristic and Altshuler-Aronov-Spivak-like magneto-oscillations at low temperature in the nano-space transport.

A quality by design approach to scale-up of high-shear wet granulation process.

PubMed

Pandey, Preetanshu; Badawy, Sherif

2016-01-01

High-shear wet granulation is a complex process that in turn makes scale-up a challenging task. Scale-up of high-shear wet granulation process has been studied extensively in the past with various different methodologies being proposed in the literature. This review article discusses existing scale-up principles and categorizes the various approaches into two main scale-up strategies - parameter-based and attribute-based. With the advent of quality by design (QbD) principle in drug product development process, an increased emphasis toward the latter approach may be needed to ensure product robustness. In practice, a combination of both scale-up strategies is often utilized. In a QbD paradigm, there is also a need for an increased fundamental and mechanistic understanding of the process. This can be achieved either by increased experimentation that comes at higher costs, or by using modeling techniques, that are also discussed as part of this review.

Nutritional and sensory quality evaluation of sponge cake prepared by incorporation of high dietary fiber containing mango (Mangifera indica var. Chokanan) pulp and peel flours.

PubMed

Aziah, A A Noor; Min, W Lee; Bhat, Rajeev

2011-09-01

Sponge cake prepared by partial substitution of wheat flour with mango pulp and mango peel flours (MPuF and MPeF, respectively) at different concentrations (control, 5%, 10%, 20% or 30%) were investigated for the physico-chemical, nutritional and organoleptic characteristics. Results showed sponge cake incorporated with MPuF and MPeF to have high dietary fiber with low fat, calorie, hydrolysis and predicted glycemic index compared with the control. Increasing the levels of MPuF and MPeF in sponge cake had significant impact on the volume, firmness and color. Sensory evaluation showed sponge cake formulated with 10% MPuF and 10% MPeF to be the most acceptable. MPeF and MPuF have high potential as fiber-rich ingredients and can be utilized in the preparation of cake and other bakery products to improve the nutritional qualities.

UceWeb: a web-based collaborative tool for collecting and sharing quality of life data.

PubMed

Parimbelli, E; Sacchi, L; Rubrichi, S; Mazzanti, A; Quaglini, S

2015-01-01

This work aims at building a platform where quality-of-life data, namely utility coefficients, can be elicited not only for immediate use, but also systematically stored together with patient profiles to build a public repository to be further exploited in studies on specific target populations (e.g. cost/utility analyses). We capitalized on utility theory and previous experience to define a set of desirable features such a tool should show to facilitate sound elicitation of quality of life. A set of visualization tools and algorithms has been developed to this purpose. To make it easily accessible for potential users, the software has been designed as a web application. A pilot validation study has been performed on 20 atrial fibrillation patients. A collaborative platform, UceWeb, has been developed and tested. It implements the standard gamble, time trade-off and rating-scale utility elicitation methods. It allows doctors and patients to choose the mode of interaction to maximize patients’ comfort in answering difficult questions. Every utility elicitation may contribute to the growth of the repository. UceWeb can become a unique source of data allowing researchers both to perform more reliable comparisons among healthcare interventions and build statistical models to gain deeper insight into quality of life data.

AIMING FOR THE BULL'S EYE: The Cost-Utility of Screening for Hydroxychloroquine Retinopathy.

PubMed

McClellan, Andrew J; Chang, Jonathan S; Smiddy, William E

2016-10-01

Throughout medicine, the cost of various treatments has been increasingly studied with the result that certain management guidelines might be reevaluated in their context. Cost-utility is a term referring to the expense of preventing the loss of quality of life, quantified in dollars per quality-adjusted life year. In 2002, the American Academy of Ophthalmology published hydroxychloroquine screening recommendations which were revised in 2011. The purpose of this report is to estimate the cost-utility of these recommendations. A hypothetical care model of screening for hydroxychloroquine retinopathy was formulated. The costs of screening components were calculated using 2016 Medicare fee schedules from the Centers for Medicare and Medicaid Services. The cost-utility of screening for hydroxychloroquine retinopathy with the 2011 American Academy of Ophthalmology guidelines was found to vary from 33,155 to 344,172 dollars per quality-adjusted life year depending on the type and number of objective screening tests chosen, practice setting, and the duration of hydroxychloroquine use. Screening had a more favorable cost-utility when the more sensitive and specific diagnostics were used, and for patients with an increased risk of toxicity. American Academy of Ophthalmology guidelines have a wide-ranging cost-utility. Prudent clinical judgment of risk stratification and tests chosen is necessary to optimize cost-utility without compromising the efficacy of screening.

Evaluating the Impact of Parent-Reported Medical Home Status on Children's Health Care Utilization, Expenditures, and Quality: A Difference-in-Differences Analysis with Causal Inference Methods.

PubMed

Han, Bing; Yu, Hao; Friedberg, Mark W

2017-04-01

To evaluate the effects of the parent-reported medical home status on health care utilization, expenditures, and quality for children. Medical Expenditure Panel Survey (MEPS) during 2004-2012, including a total of 9,153 children who were followed up for 2 years in the survey. We took a causal difference-in-differences approach using inverse probability weighting and doubly robust estimators to study how changes in medical home status over a 2-year period affected children's health care outcomes. Our analysis adjusted for children's sociodemographic, health, and insurance statuses. We conducted sensitivity analyses using alternative statistical methods, different approaches to outliers and missing data, and accounting for possible common-method biases. Compared with children whose parents reported having medical homes in both years 1 and 2, those who had medical homes in year 1 but lost them in year 2 had significantly lower parent-reported ratings of health care quality and higher utilization of emergency care. Compared with children whose parents reported having no medical homes in both years, those who did not have medical homes in year 1 but gained them in year 2 had significantly higher ratings of health care quality, but no significant differences in health care expenditures and utilization. Having a medical home may help improve health care quality for children; losing a medical home may lead to higher utilization of emergency care. © Health Research and Educational Trust.

Optimizing preservation protocols to extract high-quality RNA from different tissues of echinoderms for next-generation sequencing.

PubMed

Pérez-Portela, Rocío; Riesgo, Ana

2013-09-01

Transcriptomic information provides fundamental insights into biological processes. Extraction of quality RNA is a challenging step, and preservation and extraction protocols need to be adjusted in many cases. Our objectives were to optimize preservation protocols for isolation of high-quality RNA from diverse echinoderm tissues and to compare the utility of parameters as absorbance ratios and RIN values to assess RNA quality. Three different tissues (gonad, oesophagus and coelomocytes) were selected from the sea urchin Arbacia lixula. Solid tissues were flash-frozen and stored at -80 °C until processed. Four preservation treatments were applied to coelomocytes: flash freezing and storage at -80 °C, RNAlater and storage at -20 °C, preservation in TRIzol reagent and storage at -80 °C and direct extraction with TRIzol from fresh cells. Extractions of total RNA were performed with a modified TRIzol protocol for all tissues. Our results showed high values of RNA quantity and quality for all tissues, showing nonsignificant differences among them. However, while flash freezing was effective for solid tissues, it was inadequate for coelomocytes because of the low quality of the RNA extractions. Coelomocytes preserved in RNAlater displayed large variability in RNA integrity and insufficient RNA amount for further isolation of mRNA. TRIzol was the most efficient system for stabilizing RNA which resulted on high RNA quality and quantity. We did not detect correlation between absorbance ratios and RNA integrity. The best strategies for assessing RNA integrity was the visualization of 18S rRNA and 28S rRNA bands in agarose gels and estimation of RIN values with Agilent Bioanalyzer chips. © 2013 John Wiley & Sons Ltd.

A Standard Psychophysiological Preparation for Evaluating the Effects of Environmental Vibration Stress. Phase I. Development.

DTIC Science & Technology

A Standard Psychophysiological Preparation (SPP) for the evaluation of the physiological and biomechanical mechanisms responsible for performance...consumption, biomechanical parameters and performance level. The results of pilot tests (including 6-hours exposure to vibration while performing a...tracking task) verify the applicability and utility of the SPP and demonstrate that high quality, quantitative physiological and biomechanical data can

Closing the Gap: Enacting Care and Facilitating Black Students' Educational Access in the Creation of a High School College-Going Culture

ERIC Educational Resources Information Center

Knight-Diop, Michelle G.

2010-01-01

Research clearly shows the importance of obtaining a postsecondary education in terms of accessing job opportunities, higher salaries, and improved benefits for a better quality of life in the United States. Bringing together the literature on school-based caring for Black students and the literature on college preparation, I utilize notions of…

Linking Internet strategy to high-quality, cost-effective managed care.

PubMed

Beauregard, T R

2000-01-01

This article describes an experimental pilot project incorporating e-commerce and the Internet into the traditional process of health benefit negotiations through the utilization of an HMO Internet auction. The timeline and process of the auction are described, with the final auction taking place during the last week of negotiations. The results reveal an efficient and effective system to augment the traditional benefit negotiation process.

Improved Soybean Oil for Biodiesel Fuel

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

Tom Clemente; Jon Van Gerpen

2007-11-30

The goal of this program was to generate information on the utility of soybean germplasm that produces oil, high in oleic acid and low in saturated fatty acids, for its use as a biodiesel. Moreover, data was ascertained on the quality of the derived soybean meal (protein component), and the agronomic performance of this novel soybean germplasm. Gathering data on these later two areas is critical, with respect to the first, soybean meal (protein) component is a major driver for commodity soybean, which is utilized as feed supplements in cattle, swine, poultry and more recently aquaculture production. Hence, it ismore » imperative that the resultant modulation in the fatty acid profile of the oil does not compromise the quality of the derived meal, for if it does, the net value of the novel soybean will be drastically reduced. Similarly, if the improved oil trait negative impacts the agronomics (i.e. yield) of the soybean, this in turn will reduce the value of the trait. Over the course of this program oil was extruded from approximately 350 bushels of soybean designated 335-13, which produces oil high in oleic acid (>85%) and low in saturated fatty acid (<6%). As predicted improvement in cold flow parameters were observed as compared to standard commodity soybean oil. Moreover, engine tests revealed that biodiesel derived from this novel oil mitigated NOx emissions. Seed quality of this soybean was not compromised with respect to total oil and protein, nor was the amino acid profile of the derived meal as compared to the respective control soybean cultivar with a conventional fatty acid profile. Importantly, the high oleic acid/low saturated fatty acids oil trait was not impacted by environment and yield was not compromised. Improving the genetic potential of soybean by exploiting the tools of biotechnology to improve upon the lipid quality of the seed for use in industrial applications such as biodiesel will aid in expanding the market for the crop. This in turn, may lead to job creation in rural areas of the country and help stimulate the agricultural economy. Moreover, production of soybean with enhanced oil quality for biodiesel may increase the attractiveness of this renewable, environmentally friendly fuel.« less

Development of communication networks and water quality early warning detection systems at drinking water utilities in the Ohio River Valley Basin.

PubMed

Schulte, J G; Vicory, A H

2005-01-01

Source water quality is of major concern to all drinking water utilities. The accidental introduction of contaminants to their source water is a constant threat to utilities withdrawing water from navigable or industrialized rivers. The events of 11 September, 2001 in the United States have heightened concern for drinking water utility security as their source water and finished water may be targets for terrorist acts. Efforts are underway in several parts of the United States to strengthen early warning capabilities. This paper will focus on those efforts in the Ohio River Valley Basin.

Women with urinary incontinence in Spain: Health-related quality of life and the use of healthcare resources.

PubMed

Villoro, Renata; Merino, María; Hidalgo-Vega, Alvaro; Jiménez, Margarita; Martínez, Lucía; Aracil, Javier

2016-12-01

To describe Health-Related Quality of Life (HRQOL) and healthcare resource utilization in women aged 60 and over in Spain. Descriptive analysis of primary data from the Spanish National Health Survey, 2012. Utility indices were obtained through the EQ5D5L questionnaire included in the survey, and utilization rates of consultations, hospitalizations, emergency services, and medication intake. HRQOL and utilization rates were systematically compared between women diagnosed with UI, women diagnosed with other chronic conditions (OCC) and healthy women of the same age. Utility indices were 0.47 in UI women versus 0.78 and 0.96 in women diagnosed with OCC and healthy women, respectively. Each year 351,675 Quality Adjusted Life Years are lost in Spain due to UI in the population of women aged 60 and over. Resource utilization of these women was significantly higher than that of other women. UI has a larger impact on both HRQOL and healthcare consumption in women who are aged 60 and over, than OCC. Appropriate treatment of UI might entail an important gain in terms of HRQOL and a significant reduction in healthcare consumption in Spain. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Institutional deliveries weakly associated with improved neonatal survival in developing countries: evidence from 192 Demographic and Health Surveys.

PubMed

Fink, Günther; Ross, Rebecca; Hill, Kenneth

2015-12-01

Child and maternal mortality remain high in many developing countries. A principal strategy used in low- and middle-income countries is increasing the proportion of pregnancies delivered at facilities. Although this strategy is reasonable with high quality facilities, evidence for the protective effects of facility deliveries is mixed. We pooled 1.47 million birth records collected by the Demographic and Health Surveys to estimate the association between institutional deliveries and early neonatal mortality. Subsample analysis and instrumental variable estimation were used to assess and correct the extent to which mortality differentials are biased by an increased likelihood of facility attendance for high-risk deliveries. No associations between institutional deliveries and early neonatal mortality were found in the pooled sample [adjusted odds ratio (aOR) 0.995, 95% confidence interval (CI) 0.966-1.025)]. When stratified by facility type, protective effects were found for private facilities (aOR 0.876, 95% CI 0.840-0.914), but not for public hospitals or health centres. Significant protective effects were found when past behaviour was used to eliminate selection bias generated by short-term responses to medical need (aOR 0.884, 95% CI 0.814-0.961). At the community and country levels, strong positive associations were found between early neonatal mortality among facility deliveries and the prevalence of institutional deliveries. Facility deliveries have the potential to reduce early neonatal mortality in developing countries. The results presented suggest that the quality, utilization and protective effects of institutional deliveries vary widely across countries; major improvements in both utilization and quality of care will be needed to achieve further improvements in maternal and child health. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

42 CFR 475.100 - Scope and applicability.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATIONS Utilization and Quality Control Quality Improvement Organizations § 475.100 Scope and applicability. This subpart implements...

Update on value-based medicine.

PubMed

Brown, Melissa M; Brown, Gary C

2013-05-01

To update concepts in Value-Based Medicine, especially in view of the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act assures that some variant of Value-Based Medicine cost-utility analysis will play a key role in the healthcare system. It identifies the highest quality care, thereby maximizing the most efficacious use of healthcare resources and empowering patients and physicians.Standardization is critical for the creation and acceptance of a Value-Based Medicine, cost-utility analysis, information system, since 27 million different input variants can go into a cost-utility analysis. Key among such standards is the use of patient preferences (utilities), as patients best understand the quality of life associated with their health states. The inclusion of societal costs, versus direct medical costs alone, demonstrates that medical interventions are more cost effective and, in many instances, provide a net financial return-on-investment to society referent to the direct medical costs expended. Value-Based Medicine provides a standardized methodology, integrating critical, patient, quality-of-life preferences, and societal costs, to allow the highest quality, most cost-effective care. Central to Value-Based Medicine is the concept that all patients deserve the interventions that provide the greatest patient value (improvement in quality of life and/or length of life).

Paternal involvement in the management of pediatric chronic diseases: associations with adherence, quality of life, and health status.

PubMed

Wysocki, Tim; Gavin, Leslie

2006-06-01

This article reports associations among paternal involvement in pediatric chronic disease management and child outcomes. The Dads' Active Disease Support scale (DADS) and measures of treatment adherence, quality of life, health status, and health care utilization were obtained for youths with six chronic diseases, with complete data sets obtained from 190 couples. Paternal involvement was not associated with these outcomes among younger children. Among adolescents, mother-reported and father-reported DADS scores indicating more paternal involvement were associated with maintenance, rather than deterioration, of treatment adherence and more favorable quality of life. Youths' health status and health care utilization were not related significantly to paternal involvement. More paternal involvement was associated with more favorable adherence and quality of life among adolescents but not associated with health status or health care utilization. Longitudinal studies could verify whether paternal involvement merits clinical intervention.

Responding to the Pandemic of Falsified Medicines

PubMed Central

Nayyar, Gaurvika M. L.; Attaran, Amir; Clark, John P.; Culzoni, M. Julia; Fernandez, Facundo M.; Herrington, James E.; Kendall, Megan; Newton, Paul N.; Breman, Joel G.

2015-01-01

Over the past decade, the number of countries reporting falsified (fake, spurious/falsely labeled/counterfeit) medicines and the types and quantities of fraudulent drugs being distributed have increased greatly. The obstacles in combating falsified pharmaceuticals include 1) lack of consensus on definitions, 2) paucity of reliable and scalable technology to detect fakes before they reach patients, 3) poor global and national leadership and accountability systems for combating this scourge, and 4) deficient manufacturing and regulatory challenges, especially in China and India where fake products often originate. The major needs to improve the quality of the world's medicines fall into three main areas: 1) research to develop and compare accurate and affordable tools to identify high-quality drugs at all levels of distribution; 2) an international convention and national legislation to facilitate production and utilization of high-quality drugs and protect all countries from the criminal and the negligent who make, distribute, and sell life-threatening products; and 3) a highly qualified, well-supported international science and public health organization that will establish standards, drug-quality surveillance, and training programs like the U.S. Food and Drug Administration. Such leadership would give authoritative guidance for countries in cooperation with national medical regulatory agencies, pharmaceutical companies, and international agencies, all of which have an urgent interest and investment in ensuring that patients throughout the world have access to good quality medicines. The organization would also advocate strongly for including targets for achieving good quality medicines in the United Nations Millennium Development Goals and Sustainable Development Goals. PMID:25897060

Identifying role of perceived quality and satisfaction on the utilization status of the community clinic services; Bangladesh context.

PubMed

Karim, Rizwanul M; Abdullah, Mamun S; Rahman, Anisur M; Alam, Ashraful M

2016-06-24

Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 community clinics. Since most of the outcome indicators focus mainly on women and children, women having children less than 2 years of age were randomly assigned and interviewed for the study purpose. Data were collected through FGD, Key informants interview and a pretested semi- structured questionnaire. About 95 % of the respondents were Muslims and 5 % were Hindus. The average age of the respondents was 23.38 (SD 4.15) and almost all of them are home makers. The average monthly expenditure of their family was 95US $ (SD 32US$). At the beginning of the study, two psychometric research instruments; 24 items perceived quality of primary care services PQPCS scale (chronbach's α = .89) and 22 items community clinic service satisfaction CCSS scale (chronbach's α = .97), were constructed and validated. This study showed less educated, poor, landless mothers utilized the community clinic services more than their educated and wealthier counterpart. Women who lived in their own residence used the community clinic services more frequently than those who lived in a rental house. Perceptions concerning skill and competence of the health care provider and satisfaction indicating interpersonal communication and attitude of the care provider were important predictors for community clinic service utilization. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues played significant role on community clinic's services utilization. Besides parental education and income, client's perception and satisfaction played significant role in community clinic service utilization. Provider's perception of service quality should be studied. The study findings will enable policy-makers to improve quality of primary health care services, realizing providers' and patients' ideas of community clinic service quality.

Document segmentation for high-quality printing

NASA Astrophysics Data System (ADS)

Ancin, Hakan

1997-04-01

A technique to segment dark texts on light background of mixed mode color documents is presented. This process does not perceptually change graphics and photo regions. Color documents are scanned and printed from various media which usually do not have clean background. This is especially the case for the printouts generated from thin magazine samples, these printouts usually include text and figures form the back of the page, which is called bleeding. Removal of bleeding artifacts improves the perceptual quality of the printed document and reduces the color ink usage. By detecting the light background of the document, these artifacts are removed from background regions. Also detection of dark text regions enables the halftoning algorithms to use true black ink for the black text pixels instead of composite black. The processed document contains sharp black text on white background, resulting improved perceptual quality and better ink utilization. The described method is memory efficient and requires a small number of scan lines of high resolution color documents during processing.

Caregiver negative affect is a primary determinant of caregiver report of pediatric asthma quality of life.

PubMed

Price, Marcella R; Bratton, Donna L; Klinnert, Mary D

2002-12-01

Quality of life has increased in popularity as an outcome measure in health research. However, the measurement of quality of life has been questioned on methodologic grounds, as it often shows little association with objective measures of disease status. For this report we studied the determinants of pediatric asthma caregiver report of quality of life and its relationship to disease burden. Ninety-eight children who were admitted to a Pediatric Day Program for an asthma evaluation were enrolled in an outcome study. A complete set of medical records for the 2-year period before and after the admission was collected and systematically coded for health care utilization. Using the Pediatric Asthma Caregiver's Quality of Life Questionnaire, data were collected at baseline, discharge, and year after the admission. Caregiver negative affect (anxiety and depression), measured with the Brief Symptom Inventory, was also collected at baseline and discharge. Caregiver report of quality of life was unrelated to health care utilization at baseline but instead was significantly related to baseline caregiver negative affect. A significant relationship between health care utilization and quality of life was present at followup. The Emotional Function scale from the quality of life measure can account for most of the relationship between quality of life and negative affect. Caregiver affect may have a considerable influence on report of quality of life. Understanding the individual characteristics of the respondent is important when using a quality of life instrument as an outcome measure.

Distance from health facility and mothers' perception of quality related to skilled delivery service utilization in northern Ethiopia.

PubMed

Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen

2017-01-01

Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem.

Distance from health facility and mothers’ perception of quality related to skilled delivery service utilization in northern Ethiopia

PubMed Central

Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen

2017-01-01

Background Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. Subjects and methods A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). Results A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. Conclusion Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem. PMID:29042819

Integrating Hydrologic and Water Quality Models as a Decision Support Tool for Implementation of Low Impact Development in a Coastal Urban Watershed under Climate Variability and Sea Level Rise

NASA Astrophysics Data System (ADS)

Chang, N. B.

2016-12-01

Many countries concern about development and redevelopment efforts in urban regions to reduce the flood risk by considering hazards such as high-tide events, storm surge, flash floods, stormwater runoff, and impacts of sea level rise. Combining these present and future hazards with vulnerable characteristics found throughout coastal communities such as majority low-lying areas and increasing urban development, create scenarios for increasing exposure of flood hazard. As such, the most vulnerable areas require adaptation strategies and mitigation actions for flood hazard management. In addition, in the U.S., Numeric Nutrient Criteria (NNC) are a critical tool for protecting and restoring the designated uses of a waterbody with regard to nitrogen and phosphorus pollution. Strategies such as low impact development (LID) have been promoted in recent years as an alternative to traditional stormwater management and drainage to control both flooding and water quality impact. LID utilizes decentralized multifunctional site designs and incorporates on-site storm water management practices rather than conventional storm water management approaches that divert flow toward centralized facilities. How to integrate hydrologic and water quality models to achieve the decision support becomes a challenge. The Cross Bayou Watershed of Pinellas County in Tampa Bay, a highly urbanized coastal watershed, is utilized as a case study due to its sensitivity to flood hazards and water quality management within the watershed. This study will aid the County, as a decision maker, to implement its stormwater management policy and honor recent NNC state policy via demonstration of an integrated hydrologic and water quality model, including the Interconnected Channel and Pond Routing Model v.4 (ICPR4) and the BMPTRAIN model as a decision support tool. The ICPR4 can be further coupled with the ADCIRC/SWAN model to reflect the storm surge and seal level rise in coastal regions.

Cost utility of maintenance treatment of recurrent depression with sertraline versus episodic treatment with dothiepin.

PubMed

Hatziandreu, E J; Brown, R E; Revicki, D A; Turner, R; Martindale, J; Levine, S; Siegel, J E

1994-03-01

The objective of this study was to model, for patients at risk of recurrent depression, the cost-utility of maintenance therapy with sertraline compared with treatment of acute episodes with dothiepin ('episodic treatment'). Using clinical decision analysis techniques, a Markov state-transition model was constructed to estimate the lifetime costs and quality-adjusted life-years (QALYs) of the 2 therapeutic strategies. The model follows 2 cohorts of 35-year-old women at high risk for recurrent depression over their lifetimes. Model construction and relevant data (probabilities) for performing the analysis were based on existing clinical knowledge. Two physician panels were used to obtain estimates of recurrence probabilities not available in the literature, health utilities, and resource consumption. Costs were obtained from published sources. The baseline analysis showed that it costs 2172 British pounds sterling ($US3692, 1991 currency) to save an additional QALY with sertraline maintenance treatment. Sensitivity analysis showed that the incremental cost-utility ratio ranged from 557 British pounds sterling to 5260 British pounds sterling per QALY. Overall, the resulting ratios are considered to be well within the range of cost-utility ratios that support the adoption and appropriate utilisation of a technology. Based on the study assumptions, long term maintenance treatment with sertraline appears to be clinically and economically justified choice for patients at high risk of recurrent depression.

Preliminary Evaluation of Air Quality Model Performance Utilizing Measurements at the University of Houston Moody Tower and others during the TexAQS-II

NASA Astrophysics Data System (ADS)

Byun, D. W.; Rappenglueck, B.; Lefer, B.

2007-12-01

Accurate meteorological and photochemical modeling efforts are necessary to understand the measurements made during the Texas Air Quality Study (TexAQS-II). The main objective of the study is to understand the meteorological and chemical processes of high ozone and regional haze events in the Eastern Texas, including the Houston-Galveston metropolitan area. Real-time and retrospective meteorological and photochemical model simulations were performed to study key physical and chemical processes in the Houston Galveston Area. In particular, the Vertical Mixing Experiment (VME) at the University of Houston campus was performed on selected days during the TexAQS-II. Results of the MM5 meteorological model and CMAQ air quality model simulations were compared with the VME and other TexAQS-II measurements to understand the interaction of the boundary layer dynamics and photochemical evolution affecting Houston air quality.

Delay Discounting Mediates Parent-Adolescent Relationship Quality and Risky Sexual Behavior for Low Self-Control Adolescents

PubMed Central

Kahn, Rachel E.; Holmes, Christopher; Farley, Julee P.; Kim-Spoon, Jungmeen

2015-01-01

Parent-adolescent relationship quality and delay discounting may play important roles in adolescents’ sexual decision making processes, and levels of self-control during adolescence could act as a buffer within these factors. This longitudinal study included 219 adolescent (55% male; mean age = 12.66 years at Wave 1; mean age = 15.10 years at Wave 2) and primary caregiver dyads. Structural equation modeling was utilized to determine whether delay discounting mediated the association between parent-adolescent relationship quality and adolescents’ risky sexual behavior and how this mediated association may differ between those with high versus low self-control. The results revealed parent-adolescent relationship quality plays a role in the development of risky sexual behavior indirectly through levels of delay discounting, but only for adolescents with low self-control. These findings could inform sex education policies and health prevention programs that address adolescent risky sexual behavior. PMID:26202153

A systematic tale of two differing reviews: evaluating the evidence on public and private sector quality of primary care in low and middle income countries.

PubMed

Coarasa, Jorge; Das, Jishnu; Gummerson, Elizabeth; Bitton, Asaf

2017-04-12

Systematic reviews are powerful tools for summarizing vast amounts of data in controversial areas; but their utility is limited by methodological choices and assumptions. Two systematic reviews of literature on the quality of private sector primary care in low and middle income countries (LMIC), published in the same journal within a year, reached conflicting conclusions. The difference in findings reflects different review methodologies, but more importantly, a weak underlying body of literature. A detailed examination of the literature cited in both reviews shows that only one of the underlying studies met the gold standard for methodological robustness. Given the current policy momentum on universal health coverage and primary health care reform across the globe, there is an urgent need for high quality empirical evidence on the quality of private versus public sector primary health care in LMIC.

APPLICATION OF DATA QUALITY OBJECTIVES AND MEASUREMENT QUALITY OBJECTIVES TO RESEARCH PROJECTS

EPA Science Inventory

The paper assists systematic planning for research projects. It presents planning concepts in terms that have some utility for researchers. For example, measurement quality objectives are more familiar to researchers than data quality objectives because these quality criteria are...

An Empirical Study of Logistics Organization, Electronic Linkage, and Performance

DTIC Science & Technology

1993-01-01

utilization of transportation resources, and improved quality management. Researchers have proposed an information technology (IT) implementation model for...management, more efficient utilization of transportation resources, and improved quality management. Researchers have proposed an information...coordination of (1) facility structure, (2) forecasting and order management, (3) transportation , (4) inventory, and (5) warehousing and packaging. The

Industrial waste utilization in the panels production for high buildings facade and socle facing

NASA Astrophysics Data System (ADS)

Vitkalova, Irina; Torlova, Anastasiya; Pikalov, Evgeniy; Selivanov, Oleg

2018-03-01

The research presents comprehensive utilization of such industrial waste as galvanic sludge, broken window glass as functional additives for producing ceramics for facade and socle paneling in high-rise construction. The basic charge component is low-plasticity clay, which does not allow producing high-quality products if used without any functional additives. The application of the mentioned above components broadens the resource base, reduces production cost and the mass of the products in comparison with the currently used facing ceramics. The decrease of product mass helps to reduce the load on the basement and to use ceramic material in high-rise construction more effectively. Additional advantage of the developed composition is the reducing of production energy intensity due to comparatively low pressing pressure and firing temperature thus reducing the overall production cost. The research demonstrates the experimental results of determining density, compressive strength, water absorption, porosity and frost resistance of the produced ceramic material. These characteristics prove that the material can be applied for high buildings outdoor paneling. Additional research results prove ecologic safety of the produced ceramic material.

Beyond expected utility: rethinking behavioral decision research.

PubMed

Frisch, D; Clemen, R T

1994-07-01

Much research in psychology has evaluated the quality of people's decisions by comparisons with subjective expected utility (SEU) theory. This article suggests that typical arguments made for the status of utility theory as normative do not justify its use by psychologists as a standard by which to evaluate decision quality. It is argued that to evaluate decision quality, researchers need to identify those decision processes that tend to lead to desirable outcomes. It is contended that a good decision-making process must be concerned with how (and whether) decision makers evaluate potential consequences of decisions, the extent to which they accurately identify all relevant consequences, and the way in which they make final choices. Research that bears on these issues is reviewed.

Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization: A Randomized Quality Improvement Trial.

PubMed

Yoon, Jean; Chang, Evelyn; Rubenstein, Lisa V; Park, Angel; Zulman, Donna M; Stockdale, Susan; Ong, Michael K; Atkins, David; Schectman, Gordon; Asch, Steven M

2018-06-05

Primary care models that offer comprehensive, accessible care to all patients may provide insufficient resources to meet the needs of patients with complex conditions who have the greatest risk for hospitalization. To assess whether augmenting usual primary care with team-based intensive management lowers utilization and costs for high-risk patients. Randomized quality improvement trial. (ClinicalTrials.gov: NCT03100526). 5 U.S. Department of Veterans Affairs (VA) medical centers. Primary care patients at high risk for hospitalization who had a recent acute care episode. Locally tailored intensive management programs providing care coordination, goals assessment, health coaching, medication reconciliation, and home visits through an interdisciplinary team, including a physician or nurse practitioner, a nurse, and psychosocial experts. Utilization and costs (including intensive management program expenses) 12 months before and after randomization. 2210 patients were randomly assigned, 1105 to intensive management and 1105 to usual care. Patients had a mean age of 63 years and an average of 7 chronic conditions; 90% were men. Of the patients assigned to intensive management, 487 (44%) received intensive outpatient care (that is, ≥3 encounters in person or by telephone) and 204 (18%) received limited intervention. From the pre- to postrandomization periods, mean inpatient costs decreased more for the intensive management than the usual care group (-$2164 [95% CI, -$7916 to $3587]). Outpatient costs increased more for the intensive management than the usual care group ($2636 [CI, $524 to $4748]), driven by greater use of primary care, home care, telephone care, and telehealth. Mean total costs were similar in the 2 groups before and after randomization. Sites took up to several months to contact eligible patients, limiting the time between treatment and outcome assessment. Only VA costs were assessed. High-risk patients with access to an intensive management program received more outpatient care with no increase in total costs. Veterans Health Administration Primary Care Services.

Banana by-products: an under-utilized renewable food biomass with great potential.

PubMed

Padam, Birdie Scott; Tin, Hoe Seng; Chye, Fook Yee; Abdullah, Mohd Ismail

2014-12-01

Banana (Musaceae) is one of the world's most important fruit crops that is widely cultivated in tropical countries for its valuable applications in food industry. Its enormous by-products are an excellent source of highly valuable raw materials for other industries by recycling agricultural waste. This prevents an ultimate loss of huge amount of untapped biomass and environmental issues. This review discusses extensively the breakthrough in the utilization of banana by-products such as peels, leaves, pseudostem, stalk and inflorescence in various food and non-food applications serving as thickening agent, coloring and flavor, alternative source for macro and micronutrients, nutraceuticals, livestock feed, natural fibers, and sources of natural bioactive compounds and bio-fertilizers. Future prospects and challenges are the important key factors discussed in association to the sustainability and feasibility of utilizing these by-products. It is important that all available by-products be turned into highly commercial outputs in order to sustain this renewable resource and provide additional income to small scale farming industries without compromising its quality and safety in competing with other commercial products.

42 CFR 480.108 - Penalties for unauthorized disclosure.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 480.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations...