Quality measures and pediatric radiology: suggestions for the transition to value-based payment.

PubMed

Heller, Richard E; Coley, Brian D; Simoneaux, Stephen F; Podberesky, Daniel J; Hernanz-Schulman, Marta; Robertson, Richard L; Donnelly, Lane F

2017-06-01

Recent political and economic factors have contributed to a meaningful change in the way that quality in health care, and by extension value, are viewed. While quality is often evaluated on the basis of subjective criteria, pay-for-performance programs that link reimbursement to various measures of quality require use of objective and quantifiable measures. This evolution to value-based payment was accelerated by the 2015 passage of the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA). While many of the drivers of these changes are rooted in federal policy and programs such as Medicare and aimed at adult patients, the practice of pediatrics and pediatric radiology will be increasingly impacted. This article addresses issues related to the use of quantitative measures to evaluate the quality of services provided by the pediatric radiology department or sub-specialty section, particularly as seen from the viewpoint of a payer that may be considering ways to link payment to performance. The paper concludes by suggesting a metric categorization strategy to frame future work on the subject.

Value-Added Measures of Education Performance: Clearing Away the Smoke and Mirrors. Policy Brief 10-4

ERIC Educational Resources Information Center

Harris, Douglas N.

2010-01-01

In this policy brief, the author explores the problems with attainment measures when it comes to evaluating performance at the school level, and explores the best uses of value-added measures. These value-added measures, the author writes, are useful for sorting out-of-school influences from school influences or from teacher performance, giving…

Online physician ratings fail to predict actual performance on measures of quality, value, and peer review.

PubMed

Daskivich, Timothy J; Houman, Justin; Fuller, Garth; Black, Jeanne T; Kim, Hyung L; Spiegel, Brennan

2018-04-01

Patients use online consumer ratings to identify high-performing physicians, but it is unclear if ratings are valid measures of clinical performance. We sought to determine whether online ratings of specialist physicians from 5 platforms predict quality of care, value of care, and peer-assessed physician performance. We conducted an observational study of 78 physicians representing 8 medical and surgical specialties. We assessed the association of consumer ratings with specialty-specific performance scores (metrics including adherence to Choosing Wisely measures, 30-day readmissions, length of stay, and adjusted cost of care), primary care physician peer-review scores, and administrator peer-review scores. Across ratings platforms, multivariable models showed no significant association between mean consumer ratings and specialty-specific performance scores (β-coefficient range, -0.04, 0.04), primary care physician scores (β-coefficient range, -0.01, 0.3), and administrator scores (β-coefficient range, -0.2, 0.1). There was no association between ratings and score subdomains addressing quality or value-based care. Among physicians in the lowest quartile of specialty-specific performance scores, only 5%-32% had consumer ratings in the lowest quartile across platforms. Ratings were consistent across platforms; a physician's score on one platform significantly predicted his/her score on another in 5 of 10 comparisons. Online ratings of specialist physicians do not predict objective measures of quality of care or peer assessment of clinical performance. Scores are consistent across platforms, suggesting that they jointly measure a latent construct that is unrelated to performance. Online consumer ratings should not be used in isolation to select physicians, given their poor association with clinical performance.

Error Rates in Measuring Teacher and School Performance Based on Student Test Score Gains. NCEE 2010-4004

ERIC Educational Resources Information Center

Schochet, Peter Z.; Chiang, Hanley S.

2010-01-01

This paper addresses likely error rates for measuring teacher and school performance in the upper elementary grades using value-added models applied to student test score gain data. Using realistic performance measurement system schemes based on hypothesis testing, we develop error rate formulas based on OLS and Empirical Bayes estimators.…

Measuring daily Value-at-Risk of SSEC index: A new approach based on multifractal analysis and extreme value theory

NASA Astrophysics Data System (ADS)

Wei, Yu; Chen, Wang; Lin, Yu

2013-05-01

Recent studies in the econophysics literature reveal that price variability has fractal and multifractal characteristics not only in developed financial markets, but also in emerging markets. Taking high-frequency intraday quotes of the Shanghai Stock Exchange Component (SSEC) Index as example, this paper proposes a new method to measure daily Value-at-Risk (VaR) by combining the newly introduced multifractal volatility (MFV) model and the extreme value theory (EVT) method. Two VaR backtesting techniques are then employed to compare the performance of the model with that of a group of linear and nonlinear generalized autoregressive conditional heteroskedasticity (GARCH) models. The empirical results show the multifractal nature of price volatility in Chinese stock market. VaR measures based on the multifractal volatility model and EVT method outperform many GARCH-type models at high-risk levels.

Measurement-based reliability/performability models

NASA Technical Reports Server (NTRS)

Hsueh, Mei-Chen

1987-01-01

Measurement-based models based on real error-data collected on a multiprocessor system are described. Model development from the raw error-data to the estimation of cumulative reward is also described. A workload/reliability model is developed based on low-level error and resource usage data collected on an IBM 3081 system during its normal operation in order to evaluate the resource usage/error/recovery process in a large mainframe system. Thus, both normal and erroneous behavior of the system are modeled. The results provide an understanding of the different types of errors and recovery processes. The measured data show that the holding times in key operational and error states are not simple exponentials and that a semi-Markov process is necessary to model the system behavior. A sensitivity analysis is performed to investigate the significance of using a semi-Markov process, as opposed to a Markov process, to model the measured system.

Demystifying Results-Based Performance Measurement.

ERIC Educational Resources Information Center

Jorjani, Hamid

Many evaluators are convinced that Results-based Performance Measurement (RBPM) is an effective tool to improve service delivery and cost effectiveness in both public and private sectors. Successful RBPM requires self-directed and cross-functional work teams and the supporting infrastructure to make it work. There are many misconceptions and…

[Gas Concentration Measurement Based on the Integral Value of Absorptance Spectrum].

PubMed

Liu, Hui-jun; Tao, Shao-hua; Yang, Bing-chu; Deng, Hong-gui

2015-12-01

The absorptance spectrum of a gas is the basis for the qualitative and quantitative analysis of the gas by the law of the Lambert-Beer. The integral value of the absorptance spectrum is an important parameter to describe the characteristics of the gas absorption. Based on the measured absorptance spectrum of a gas, we collected the required data from the database of HIT-RAN, and chose one of the spectral lines and calculated the integral value of the absorptance spectrum in the frequency domain, and then substituted the integral value into Lambert-Beer's law to obtain the concentration of the detected gas. By calculating the integral value of the absorptance spectrum we can avoid the more complicated calculation of the spectral line function and a series of standard gases for calibration, so the gas concentration measurement will be simpler and faster. We studied the changing trends of the integral values of the absorptance spectrums versus temperature. Since temperature variation would cause the corresponding variation in pressure, we studied the changing trends of the integral values of the absorptance spectrums versus both the pressure not changed with temperature and changed with the temperature variation. Based on the two cases, we found that the integral values of the absorptance spectrums both would firstly increase, then decrease, and finally stabilize with temperature increasing, but the ranges of specific changing trend were different in the two cases. In the experiments, we found that the relative errors of the integrated values of the absorptance spectrum were much higher than 1% and still increased with temperature when we only considered the change of temperature and completely ignored the pressure affected by the temperature variation, and the relative errors of the integrated values of the absorptance spectrum were almost constant at about only 1% when we considered that the pressure were affected by the temperature variation. As the integral value

Hospital Value-Based Purchasing Performance: Do Organizational and Market Characteristics Matter?

PubMed

Spaulding, Aaron; Edwardson, Nick; Zhao, Mei

The hospital value-based purchasing (HVBP) program of the Centers for Medicare & Medicaid Services challenges hospitals to deliver high-quality care or face a reduction in Medicare payments. How do different organizational structures and market characteristics enable or inhibit successful transition to this new model of value-based care? To address that question, this study employs an institutional theory lens to test whether certain organizational structures and market characteristics mediate hospitals' ability to perform across HVBP domains.Data from the 2014 American Hospital Association Annual Survey Database, Area Health Resource File, the Medicare Hospital Compare Database, and the association between external environment and hospital performance are assessed through multiple regression analysis. Results indicate that hospitals that belong to a system are more likely than independent hospitals to score highly on the domains associated with the HVBP incentive arrangement. However, varying and sometimes counterintuitive market influences bring different dimensions to the HVBP program. A hospital's ability to score well in this new value arrangement may be heavily based on the organization's ability to learn from others, implement change, and apply the appropriate amount of control in various markets.

Linking Quality and Spending to Measure Value for People with Serious Illness.

PubMed

Ryan, Andrew M; Rodgers, Phillip E

2018-03-01

Healthcare payment is rapidly evolving to reward value by measuring and paying for quality and spending performance. Rewarding value for the care of seriously ill patients presents unique challenges. To evaluate the state of current efforts to measure and reward value for the care of seriously ill patients. We performed a PubMed search of articles related to (1) measures of spending for people with serious illness and (2) linking spending and quality measures and rewarding performance for the care of people with serious illness. We limited our search to U.S.-based studies published in English between January 1, 1960, and March 31, 2017. We supplemented this search by identifying public programs and other known initiatives that linked quality and spending for the seriously ill and extracted key program elements. Our search related to linking spending and quality measures and rewarding performance for the care of people with serious illness yielded 277 articles. We identified three current public programs that currently link measures of quality and spending-or are likely to within the next few years-the Oncology Care Model; the Comprehensive End-Stage Renal Disease Model; and Home Health Value-Based Purchasing. Models that link quality and spending consist of four core components: (1) measuring quality, (2) measuring spending, (3) the payment adjustment model, and (4) the linking/incentive model. We found that current efforts to reward value for seriously ill patients are targeted for specific patient populations, do not broadly encourage the use of palliative care, and have not closely aligned quality and spending measures related to palliative care. We develop recommendations for policymakers and stakeholders about how measures of spending and quality can be balanced in value-based payment programs.

Linking Quality and Spending to Measure Value for People with Serious Illness

PubMed Central

Rodgers, Phillip E.

2018-01-01

Abstract Background: Healthcare payment is rapidly evolving to reward value by measuring and paying for quality and spending performance. Rewarding value for the care of seriously ill patients presents unique challenges. Objective: To evaluate the state of current efforts to measure and reward value for the care of seriously ill patients. Design: We performed a PubMed search of articles related to (1) measures of spending for people with serious illness and (2) linking spending and quality measures and rewarding performance for the care of people with serious illness. We limited our search to U.S.-based studies published in English between January 1, 1960, and March 31, 2017. We supplemented this search by identifying public programs and other known initiatives that linked quality and spending for the seriously ill and extracted key program elements. Results: Our search related to linking spending and quality measures and rewarding performance for the care of people with serious illness yielded 277 articles. We identified three current public programs that currently link measures of quality and spending—or are likely to within the next few years—the Oncology Care Model; the Comprehensive End-Stage Renal Disease Model; and Home Health Value-Based Purchasing. Models that link quality and spending consist of four core components: (1) measuring quality, (2) measuring spending, (3) the payment adjustment model, and (4) the linking/incentive model. We found that current efforts to reward value for seriously ill patients are targeted for specific patient populations, do not broadly encourage the use of palliative care, and have not closely aligned quality and spending measures related to palliative care. Conclusions: We develop recommendations for policymakers and stakeholders about how measures of spending and quality can be balanced in value-based payment programs. PMID:29091529

Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing.

PubMed

French, Katy E; Albright, Heidi W; Frenzel, John C; Incalcaterra, James R; Rubio, Augustin C; Jones, Jessica F; Feeley, Thomas W

2013-12-01

The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. © 2013 Published by Elsevier Inc.

What Is the Value of Value-Based Purchasing?

PubMed

Tanenbaum, Sandra J

2016-10-01

Value-based purchasing (VBP) is a widely favored strategy for improving the US health care system. The meaning of value that predominates in VBP schemes is (1) conformance to selected process and/or outcome metrics, and sometimes (2) such conformance at the lowest possible cost. In other words, VBP schemes choose some number of "quality indicators" and financially incent providers to meet them (and not others). Process measures are usually based on clinical science that cannot determine the effects of a process on individual patients or patients with comorbidities, and do not necessarily measure effects that patients value; additionally, there is no provision for different patients valuing different things. Proximate outcome measures may or may not predict distal ones, and the more distal the outcome, the less reliably it can be attributed to health care. Outcome measures may be quite rudimentary, such as mortality rates, or highly contestable: survival or function after prostate surgery? When cost is an element of value-based purchasing, it is the cost to the value-based payer and not to other payers or patients' families. The greatest value of value-based purchasing may not be to patients or even payers, but to policy makers seeking a morally justifiable alternative to politically contested regulatory policies. Copyright © 2016 by Duke University Press.

Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System.

PubMed

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.

Evaluation of audit-based performance measures for dental care plans.

PubMed

Bader, J D; Shugars, D A; White, B A; Rindal, D B

1999-01-01

Although a set of clinical performance measures, i.e., a report card for dental plans, has been designed for use with administrative data, most plans do not have administrative data systems containing the data needed to calculate the measures. Therefore, we evaluated the use of a set of proxy clinical performance measures calculated from data obtained through chart audits. Chart audits were conducted in seven dental programs--three public health clinics, two dental health maintenance organizations (DHMO), and two preferred provider organizations (PPO). In all instances audits were completed by clinical staff who had been trained using telephone consultation and a self-instructional audit manual. The performance measures were calculated for the seven programs, audit reliability was assessed in four programs, and for one program the audit-based proxy measures were compared to the measures calculated using administrative data. The audit-based measures were sensitive to known differences in program performance. The chart audit procedures yielded reasonably reliable data. However, missing data in patient charts rendered the calculation of some measures problematic--namely, caries and periodontal disease assessment and experience. Agreement between administrative and audit-based measures was good for most, but not all, measures in one program. The audit-based proxy measures represent a complex but feasible approach to the calculation of performance measures for those programs lacking robust administrative data systems. However, until charts contain more complete diagnostic information (i.e., periodontal charting and diagnostic codes or reason-for-treatment codes), accurate determination of these aspects of clinical performance will be difficult.

Value-based medicine: evidence-based medicine and beyond.

PubMed

Brown, Gary C; Brown, Melissa M; Sharma, Sanjay

2003-09-01

Value-based medicine is the practice of medicine emphasizing the value received from an intervention. Value is measured by objectively quantifying: 1) the improvement in quality of life and/or 2) the improvement in length of life conferred by an intervention. Evidence-based medicine often measures the improvement gained in length of life, but generally ignores the importance of quality of life improvement or loss. Value-based medicine incorporates the best features of evidence-based medicine and takes evidence-based data to a higher level by incorporating the quality of life perceptions of patients with a disease in concerning the value of an intervention. Inherent in value-based medicine are the costs associated with an intervention. The resources expended for the value gained in value-based medicine is measured with cost-utility analysis in terms of the US dollars/QALY (money spent per quality-adjusted life-year gained). A review of the current status and the likely future of value-based medicine is addressed herein.

Current State of Value-Based Purchasing Programs

PubMed Central

Chee, Tingyin T.; Ryan, Andrew M.; Wasfy, Jason H.; Borden, William B.

2016-01-01

The United States healthcare system is rapidly moving toward rewarding value. Recent legislation, such as the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act (MACRA), solidified the role of value-based payment in Medicare. Many private insurers are following Medicare’s lead. Much of the policy attention has been on programs such as accountable care organizations and bundled payments; yet, value-based purchasing (VBP) or pay-for-performance, defined as providers being paid fee-for-service with payment adjustments up or down based on value metrics, remains a core element of value payment in MACRA and will likely remain so for the foreseeable future. This review article summarizes the current state of VBP programs and provides analysis of the strengths, weaknesses, and opportunities for the future. Multiple inpatient and outpatient VBP programs have been implemented and evaluated, with the impact of those programs being marginal. Opportunities to enhance the performance of VBP programs include improving the quality measurement science, strengthening both the size and design of incentives, reducing health disparities, establishing broad outcome measurement, choosing appropriate comparison targets, and determining the optimal role of VBP relative to alternative payment models. VBP programs will play a significant role in healthcare delivery for years to come, and they serve as an opportunity for providers to build the infrastructure needed for value-oriented care. PMID:27245648

Value-based care in hepatology.

PubMed

Strazzabosco, Mario; Allen, John I; Teisberg, Elizabeth O

2017-05-01

The migration from legacy fee-for-service reimbursement to payments linked to high-value health care is accelerating in the United States because of new legislation and redesign of payments from the Centers for Medicare and Medicaid Services. Because patients with chronic diseases account for substantial use of health care resources, payers and health systems are focusing on maximizing the value of care for these patients. Because chronic liver diseases impose a major health burden worldwide affecting the health and lives of many individuals and families as well as substantial costs for individuals and payers, hepatologists must understand how they can improve their practices. Hepatologists practice a high-intensity cognitive subspecialty, using complex and costly procedures and medications. High-value patient care requires multidisciplinary coordination, labor-intensive support for critically ill patients, and effective chronic disease management. Under current fee-for-service reimbursement, patient values, medical success, and financial success can all be misaligned. Many current attempts to link health outcomes to reimbursement are based on compliance with process measures, with less emphasis on outcomes that matter most to patients, thus slowing transformation to higher-value team-based care. Outcome measures that reflect the entire cycle of care are needed to assist both clinicians and administrators in improving the quality and value of care. A comprehensive set of outcome measures for liver diseases is not currently available. Numerous researchers now are attempting to fill this gap by devising and testing outcome indicators and patient-reported outcomes for the major liver conditions. These indicators will provide tools to implement a value-based approach for patients with chronic liver diseases to compare results and value of care between referral centers, to perform health technology assessment, and to guide decision-making processes for health

Measuring Distribution Performance? Benchmarking Warrants Your Attention

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

Ericson, Sean J; Alvarez, Paul

Identifying, designing, and measuring performance metrics is critical to securing customer value, but can be a difficult task. This article examines the use of benchmarks based on publicly available performance data to set challenging, yet fair, metrics and targets.

Current State of Value-Based Purchasing Programs.

PubMed

Chee, Tingyin T; Ryan, Andrew M; Wasfy, Jason H; Borden, William B

2016-05-31

The US healthcare system is rapidly moving toward rewarding value. Recent legislation, such as the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act, solidified the role of value-based payment in Medicare. Many private insurers are following Medicare's lead. Much of the policy attention has been on programs such as accountable care organizations and bundled payments; yet, value-based purchasing (VBP) or pay-for-performance, defined as providers being paid fee-for-service with payment adjustments up or down based on value metrics, remains a core element of value payment in Medicare Access and CHIP Reauthorization Act and will likely remain so for the foreseeable future. This review article summarizes the current state of VBP programs and provides analysis of the strengths, weaknesses, and opportunities for the future. Multiple inpatient and outpatient VBP programs have been implemented and evaluated; the impact of those programs has been marginal. Opportunities to enhance the performance of VBP programs include improving the quality measurement science, strengthening both the size and design of incentives, reducing health disparities, establishing broad outcome measurement, choosing appropriate comparison targets, and determining the optimal role of VBP relative to alternative payment models. VBP programs will play a significant role in healthcare delivery for years to come, and they serve as an opportunity for providers to build the infrastructure needed for value-oriented care. © 2016 American Heart Association, Inc.

What Are Error Rates for Classifying Teacher and School Performance Using Value-Added Models?

ERIC Educational Resources Information Center

Schochet, Peter Z.; Chiang, Hanley S.

2013-01-01

This article addresses likely error rates for measuring teacher and school performance in the upper elementary grades using value-added models applied to student test score gain data. Using a realistic performance measurement system scheme based on hypothesis testing, the authors develop error rate formulas based on ordinary least squares and…

76 FR 26489 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-06

...This final rule implements a Hospital Inpatient Value-Based Purchasing program (Hospital VBP program or the program) under section 1886(o) of the Social Security Act (the Act), under which value-based incentive payments will be made in a fiscal year to hospitals that meet performance standards with respect to a performance period for the fiscal year involved. The program will apply to payments for discharges occurring on or after October 1, 2012, in accordance with section 1886(o) (as added by section 3001(a) of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act)). Scoring in the Hospital VBP program will be based on whether a hospital meets or exceeds the performance standards established with respect to the measures. By adopting this program, we will reward hospitals based on actual quality performance on measures, rather than simply reporting data for those measures.

A measurement-based performability model for a multiprocessor system

NASA Technical Reports Server (NTRS)

Ilsueh, M. C.; Iyer, Ravi K.; Trivedi, K. S.

1987-01-01

A measurement-based performability model based on real error-data collected on a multiprocessor system is described. Model development from the raw errror-data to the estimation of cumulative reward is described. Both normal and failure behavior of the system are characterized. The measured data show that the holding times in key operational and failure states are not simple exponential and that semi-Markov process is necessary to model the system behavior. A reward function, based on the service rate and the error rate in each state, is then defined in order to estimate the performability of the system and to depict the cost of different failure types and recovery procedures.

Self-rated health and mortality: could clinical and performance-based measures of health and functioning explain the association?

PubMed

Lyyra, Tiina-Mari; Heikkinen, Eino; Lyyra, Anna-Liisa; Jylhä, Marja

2006-01-01

It is well established that self-rated health (SRH) predicts mortality even when other indicators of health status are taken into account. It has been suggested that SRH measures a wide array of mortality-related physiological and pathological characteristics not captured by the covariates included in the analyses. Our aim was to test this hypothesis by examining the predictive value of SRH on mortality controlling for different measurements of body structure, performance-based functioning and diagnosed diseases with a population-based, prospective study over an 18-year follow-up. Subjects consisted of 257 male residents of the city of Jyväskylä, central Finland, aged 51-55 and 71-75 years. Among the 71-75-year-olds the association between SRH and mortality was weaker over the longer compared to shorter follow-up period. In the multivariate Cox regression models with an 18-year follow-up time for middle-aged and a10-year follow-up time for older men, SRH predicted mortality even when the anthropometrics, clinical chemistry and performance-based measures of functioning were controlled for, but not when the number of chronic diseases was included. Although our results confirm the hypothesis that the predictive value of SRH can be explained by diagnosed diseases, its predictive power remained, when the clinical and performance-based measures of health and functioning were controlled.

Value-based purchasing and hospital acquired conditions: are we seeing improvement?

PubMed

Spaulding, Aaron; Zhao, Mei; Haley, D Rob

2014-12-01

To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators. This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases. Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables. The secondary data sources were merged into a single database using Stata 10. Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions. Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Performance-Based Measurement: Action for Organizations and HPT Accountability

ERIC Educational Resources Information Center

Larbi-Apau, Josephine A.; Moseley, James L.

2010-01-01

Basic measurements and applications of six selected general but critical operational performance-based indicators--effectiveness, efficiency, productivity, profitability, return on investment, and benefit-cost ratio--are presented. With each measurement, goals and potential impact are explored. Errors, risks, limitations to measurements, and a…

Comparing student performance on paper- and computer-based math curriculum-based measures.

PubMed

Hensley, Kiersten; Rankin, Angelica; Hosp, John

2017-01-01

As the number of computerized curriculum-based measurement (CBM) tools increases, it is necessary to examine whether or not student performance can generalize across a variety of test administration modes (i.e., paper or computer). The purpose of this study is to compare math fact fluency on paper versus computer for 197 upper elementary students. Students completed identical sets of probes on paper and on the computer, which were then scored for digits correct, problems correct, and accuracy. Results showed a significant difference in performance between the two sets of probes, with higher fluency rates on the paper probes. Because decisions about levels of student support and interventions often rely on measures such as these, more research in this area is needed to examine the potential differences in student performance between paper-based and computer-based CBMs.

Strategic Measures of Teacher Performance

ERIC Educational Resources Information Center

Milanowski, Anthony

2011-01-01

Managing the human capital in education requires measuring teacher performance. To measure performance, administrators need to combine measures of practice with measures of outcomes, such as value-added measures, and three measurement systems are needed: classroom observations, performance assessments or work samples, and classroom walkthroughs.…

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery.

PubMed

McLaughlin, Nancy; Upadhyaya, Pooja; Buxey, Farzad; Martin, Neil A

2014-09-01

Care providers have put significant effort into optimizing patient safety and quality of care. Value, defined as meaningful outcomes achieved per dollar spent, is emerging as a promising framework to redesign health care. Scarce data exist regarding cost measurement and containment for episodes of neurosurgical care. The authors assessed how cost measurement and strategic containment could be used to optimize the value of delivered care after the implementation and maturation of quality improvement initiatives. A retrospective study of consecutive patients undergoing microvascular decompression was performed. Group 1 comprised patients treated prior to the implementation of quality improvement interventions, and Group 2 consisted of those treated after the implementation and maturation of quality improvement processes. A third group, Group 3, represented a contemporary group studied after the implementation of cost containment interventions targeting the three most expensive activities: pre-incision time in the operating room (OR) and total OR time, intraoperative neuromonitoring (IOM), and bed assignment (and overall length of stay [LOS]). The value of care was assessed for all three groups. Forty-four patients were included in the study. Average preparation time pre-incision decreased from 73 to 65 to 45 minutes in Groups 1, 2, and 3, respectively. The average total OR time and OR cost were 434 minutes and $8513 in Group 1; 348 minutes and $7592 in Group 2; and 407 minutes and $8333 in Group 3. The average cost for IOM, excluding electrode needles, was $1557, $1585, and $1263, respectively, in Groups 1, 2, and 3. Average total cost for bed assignment was $5747, $5198, and $4535, respectively, in Groups 1, 2, and 3. The average total LOS decreased from 3.16 days in Group 1 to 2.14 days in Group 3. Complete relief of or a significant decrease in preoperative symptomatology was achieved in 42 of the 44 patients, respectively. Overall, the average cost of a surgical

A framework to measure the value of public health services.

PubMed

Jacobson, Peter D; Neumann, Peter J

2009-10-01

To develop a framework that public health practitioners could use to measure the value of public health services. Primary data were collected from August 2006 through March 2007. We interviewed (n=46) public health practitioners in four states, leaders of national public health organizations, and academic researchers. Using a semi-structured interview protocol, we conducted a series of qualitative interviews to define the component parts of value for public health services and identify methodologies used to measure value and data collected. The primary form of analysis is descriptive, synthesizing information across respondents as to how they measure the value of their services. Our interviews did not reveal a consensus on how to measure value or a specific framework for doing so. Nonetheless, the interviews identified some potential strategies, such as cost accounting and performance-based contracting mechanisms. The interviews noted implementation barriers, including limits to staff capacity and data availability. We developed a framework that considers four component elements to measure value: external factors that must be taken into account (i.e., mandates); key internal actions that a local health department must take (i.e., staff assessment); using appropriate quantitative measures; and communicating value to elected officials and the public.

Patient value: its nature, measurement, and role in real world evidence studies and outcomes-based reimbursement.

PubMed

McKenna, Stephen P; Wilburn, Jeanette

2018-05-01

The assessment of "patient value" is fundamental to clinical trials, real world evidence studies, and outcomes-based reimbursement schemes. Measures of health-related quality-of-life (HRQoL) are widely used in health research. Such measures are effective in determining the presence or absence of symptoms and functional ability. However, HRQoL measures were not intended, nor designed, to determine the value to patients of alternative health states. Functions have no intrinsic value-they are a means to fulfil human needs. However, needs can be met in a variety of ways, for example by adopting different functions or by the provision of social services. It is possible to analyze all functions in terms of the needs they satisfy. A needs model has been applied in health research since the 1990s. It is concerned with the extent to which human needs are fulfilled in the presence of disease and its treatment. It is argued that this is the major concern of the patient. Needs-based measures are patient-centric and produce a valid unidimensional index of outcome. Consequently, they provide a direct means of measuring patient value. This approach provides the possibility of evaluating health services in terms of the value they provide to consumers and payers. It also has a role to play in real-world evidence studies and outcomes-based reimbursement. It is recommended that greater attention is given in future to the development of patient-reported outcome measures that provide direct assessments of patient value.

Development of performance measures based on visibility for effective placement of aids to navigation

NASA Astrophysics Data System (ADS)

Fang, Tae Hyun; Kim, Yeon-Gyu; Gong, In-Young; Park, Sekil; Kim, Ah-Young

2015-09-01

In order to develop the challenging process of placing Aids to Navigation (AtoN), we propose performance measures which quantifies the effect of such placement. The best placement of AtoNs is that from which the navigator can best recognize the information provided by an AtoN. The visibility of AtoNs depends mostly on light sources, the weather condition and the position of the navigator. Visual recognition is enabled by achieving adequate contrast between the AtoN light source and background light. Therefore, the performance measures can be formulated through the amount of differences between these two lights. For simplification, this approach is based on the values of the human factor suggested by International Association of Marine Aids to Navigation and Lighthouse Authorities (IALA). Performance measures for AtoN placement can be evaluated through AtoN Simulator, which has been being developed by KIOST/KRISO in Korea and has been launched by Korea National Research Program. Simulations for evaluation are carried out at waterway in Busan port in Korea.

Developing a 360-degree, value-based performance review model.

PubMed

Allen, M L

1997-01-01

In healthcare, competency assessment continues to be a concern. Even the JCAHO stresses its importance, along with ongoing education for employees. Many healthcare facilities have developed specific technical-competency requirements to ensure quality of service. The leadership at the University of Kansas Hospital (UKMC) wanted to develop a value-driven performance review process that focused on values and interpersonal skills for its employees. The current set of values lacked focus on key quality, behavior and service values, and it was felt employees had not committed to these values. A task force, made up of representatives from key hospital groups, was formed to create a process that would emphasize and assess key leadership skills and values. This team discussed various review mechanisms, including Micheli's 360-degree review process, which uses various sources (supervisors, colleagues and peers, for example) to give input that will be broader and more comprehensive of employee performance. The team incorporated such key leadership expectations as visioning, empowering, modeling, communication, stewardship and self-development into the tool. Called Leadership Enhancement And Development (LEAD), the tool could be completed by a peer, supervisor, direct report or even used for self-review. Results were kept confidential through the use of numbers and letters yet could be incorporated into a spreadsheet for analysis. Starting with managers and supervisors, the process has been piloted in a few larger departments at UKMC where it has been well received. Over time, the process will be used for all employees where it will continue to stress the importance of hospital values and commitment to patients and other employees.

A knowledge based search tool for performance measures in health care systems.

PubMed

Beyan, Oya D; Baykal, Nazife

2012-02-01

Performance measurement is vital for improving the health care systems. However, we are still far from having accepted performance measurement models. Researchers and developers are seeking comparable performance indicators. We developed an intelligent search tool to identify appropriate measures for specific requirements by matching diverse care settings. We reviewed the literature and analyzed 229 performance measurement studies published after 2000. These studies are evaluated with an original theoretical framework and stored in the database. A semantic network is designed for representing domain knowledge and supporting reasoning. We have applied knowledge based decision support techniques to cope with uncertainty problems. As a result we designed a tool which simplifies the performance indicator search process and provides most relevant indicators by employing knowledge based systems.

The HackensackUMC Value-Based Care Model: Building Essentials for Value-Based Purchasing.

PubMed

Douglas, Claudia; Aroh, Dianne; Colella, Joan; Quadri, Mohammed

2016-01-01

The Affordable Care Act, 2010, and the subsequent shift from a quantity-focus to a value-centric reimbursement model led our organization to create the HackensackUMC Value-Based Care Model to improve our process capability and performance to meet and sustain the triple aims of value-based purchasing: higher quality, lower cost, and consumer perception. This article describes the basics of our model and illustrates how we used it to reduce the costs of our patient sitter program.

Performance measurement: integrating quality management and activity-based cost management.

PubMed

McKeon, T

1996-04-01

The development of an activity-based management system provides a framework for developing performance measures integral to quality and cost management. Performance measures that cross operational boundaries and embrace core processes provide a mechanism to evaluate operational results related to strategic intention and internal and external customers. The author discusses this measurement process that allows managers to evaluate where they are and where they want to be, and to set a course of action that closes the gap between the two.

Value-based management of design reuse

NASA Astrophysics Data System (ADS)

Carballo, Juan Antonio; Cohn, David L.; Belluomini, Wendy; Montoye, Robert K.

2003-06-01

Effective design reuse in electronic products has the potential to provide very large cost savings, substantial time-to-market reduction, and extra sources of revenue. Unfortunately, critical reuse opportunities are often missed because, although they provide clear value to the corporation, they may not benefit the business performance of an internal organization. It is therefore crucial to provide tools to help reuse partners participate in a reuse transaction when the transaction provides value to the corporation as a whole. Value-based Reuse Management (VRM) addresses this challenge by (a) ensuring that all parties can quickly assess the business performance impact of a reuse opportunity, and (b) encouraging high-value reuse opportunities by supplying value-based rewards to potential parties. In this paper we introduce the Value-Based Reuse Management approach and we describe key results on electronic designs that demonstrate its advantages. Our results indicate that Value-Based Reuse Management has the potential to significantly increase the success probability of high-value electronic design reuse.

Curriculum-Based Measurement, Program Development, Graphing Performance and Increasing Efficiency.

ERIC Educational Resources Information Center

Deno, Stanley L.; And Others

1987-01-01

Four brief articles look at aspects of curriculum based measurement (CBM) for academically handicapped students including procedures of CBM with examples, different approaches to graphing student performance, and solutions to the problem of making time to measure student progress frequently. (DB)

Recurrence quantity analysis based on singular value decomposition

NASA Astrophysics Data System (ADS)

Bian, Songhan; Shang, Pengjian

2017-05-01

Recurrence plot (RP) has turned into a powerful tool in many different sciences in the last three decades. To quantify the complexity and structure of RP, recurrence quantification analysis (RQA) has been developed based on the measures of recurrence density, diagonal lines, vertical lines and horizontal lines. This paper will study the RP based on singular value decomposition which is a new perspective of RP study. Principal singular value proportion (PSVP) will be proposed as one new RQA measure and bigger PSVP means higher complexity for one system. In contrast, smaller PSVP reflects a regular and stable system. Considering the advantage of this method in detecting the complexity and periodicity of systems, several simulation and real data experiments are chosen to examine the performance of this new RQA.

Mathematical values in the processing of Chinese numeral classifiers and measure words.

PubMed

Her, One-Soon; Chen, Ying-Chun; Yen, Nai-Shing

2017-01-01

A numeral classifier is required between a numeral and a noun in Chinese, which comes in two varieties, sortal classifer (C) and measural classifier (M), also known as 'classifier' and 'measure word', respectively. Cs categorize objects based on semantic attributes and Cs and Ms both denote quantity in terms of mathematical values. The aim of this study was to conduct a psycholinguistic experiment to examine whether participants process C/Ms based on their mathematical values with a semantic distance comparison task, where participants judged which of the two C/M phrases was semantically closer to the target C/M. Results showed that participants performed more accurately and faster for C/Ms with fixed values than the ones with variable values. These results demonstrated that mathematical values do play an important role in the processing of C/Ms. This study may thus shed light on the influence of the linguistic system of C/Ms on magnitude cognition.

Judging Surgical Research: How Should We Evaluate Performance and Measure Value?

PubMed Central

Souba, Wiley W.; Wilmore, Douglas W.

2000-01-01

Objective To establish criteria to evaluate performance in surgical research, and to suggest strategies to optimize research in the future. Summary Background Data Research is an integral component of the academic mission, focusing on important clinical problems, accounting for surgical advances, and providing training and mentoring for young surgeons. With constraints on healthcare resources, there is increasing pressure to generate clinical revenues at the expense of the time and effort devoted to surgical research. An approach that would assess the value of research would allow prioritization of projects. Further, alignment of high-priority research projects with clinical goals would optimize research gains and maximize the clinical enterprise. Methods The authors reviewed performance criteria applied to industrial research and modified these criteria to apply to surgical research. They reviewed several programs that align research objectives with clinical goals. Results Performance criteria were categorized along several dimensions: internal measures (quality, productivity, innovation, learning, and development), customer satisfaction, market share, and financial indices (cost and profitability). A “report card” was proposed to allow the assessment of research in an individual department or division. Conclusions The department’s business strategy can no longer be divorced from its research strategy. Alignment between research and clinical goals will maximize the department’s objectives but will create the need to modify existing hierarchical structures and reward systems. Such alignment appears to be the best way to ensure the success of surgical research in the future. PMID:10862192

Measuring Value in Internal Medicine Residency Training Hospitals Using Publicly Reported Measures.

PubMed

Schickedanz, Adam; Gupta, Reshma; Arora, Vineet M; Braddock, Clarence H

2018-03-01

Graduate medical education (GME) lacks measures of resident preparation for high-quality, cost-conscious practice. The authors used publicly reported teaching hospital value measures to compare internal medicine residency programs on high-value care training and to validate these measures against program director perceptions of value. Program-level value training scores were constructed using Centers for Medicare & Medicaid Services Value-Based Purchasing (VBP) Program hospital quality and cost-efficiency data. Correlations with Association of Program Directors in Internal Medicine Annual Survey high-value care training measures were examined using logistic regression. For every point increase in program-level VBP score, residency directors were more likely to agree that GME programs have a responsibility to contain health care costs (adjusted odds ratio [aOR] 1.18, P = .04), their faculty model high-value care (aOR 1.07, P = .03), and residents are prepared to make high-value medical decisions (aOR 1.07, P = .09). Publicly reported clinical data offer valid measures of GME value training.

Measurement uncertainty analysis techniques applied to PV performance measurements

NASA Astrophysics Data System (ADS)

Wells, C.

1992-10-01

The purpose of this presentation is to provide a brief introduction to measurement uncertainty analysis, outline how it is done, and illustrate uncertainty analysis with examples drawn from the PV field, with particular emphasis toward its use in PV performance measurements. The uncertainty information we know and state concerning a PV performance measurement or a module test result determines, to a significant extent, the value and quality of that result. What is measurement uncertainty analysis? It is an outgrowth of what has commonly been called error analysis. But uncertainty analysis, a more recent development, gives greater insight into measurement processes and tests, experiments, or calibration results. Uncertainty analysis gives us an estimate of the interval about a measured value or an experiment's final result within which we believe the true value of that quantity will lie. Why should we take the time to perform an uncertainty analysis? A rigorous measurement uncertainty analysis: Increases the credibility and value of research results; allows comparisons of results from different labs; helps improve experiment design and identifies where changes are needed to achieve stated objectives (through use of the pre-test analysis); plays a significant role in validating measurements and experimental results, and in demonstrating (through the post-test analysis) that valid data have been acquired; reduces the risk of making erroneous decisions; demonstrates quality assurance and quality control measures have been accomplished; define Valid Data as data having known and documented paths of: Origin, including theory; measurements; traceability to measurement standards; computations; uncertainty analysis of results.

Value-based metrics and Internet-based enterprises

NASA Astrophysics Data System (ADS)

Gupta, Krishan M.

2001-10-01

Within the last few years, a host of value-based metrics like EVA, MVA, TBR, CFORI, and TSR have evolved. This paper attempts to analyze the validity and applicability of EVA and Balanced Scorecard for Internet based organizations. Despite the collapse of the dot-com model, the firms engaged in e- commerce continue to struggle to find new ways to account for customer-base, technology, employees, knowledge, etc, as part of the value of the firm. While some metrics, like the Balance Scorecard are geared towards internal use, others like EVA are for external use. Value-based metrics are used for performing internal audits as well as comparing firms against one another; and can also be effectively utilized by individuals outside the firm looking to determine if the firm is creating value for its stakeholders.

An advanced look at surgical performance under Medicare's hospital-inpatient value-based purchasing program: who is winning and who is losing?

PubMed

Dupree, James M; Neimeyer, Jennifer; McHugh, Megan

2014-01-01

The Centers for Medicare and Medicaid Services (CMS) is beginning to shift from paying providers based on volume to more explicitly rewarding quality of care. The hospital value-based purchasing (VBP) program is the first in a series of mandatory programs to financially reward and penalize US hospitals based on quality measure performance. Our objective was to identify the characteristics of hospitals that perform well (and those that perform poorly) on the surgical measures in CMS' hospital VBP program. Using 2008 to 2010 performance data from CMS' Hospital Compare website and the 2009 American Hospital Association annual survey, we examined surgical measure performance for all acute care general hospitals in the US. Outcomes were determined by a composite surgical performance score indicating the percentage of eligible surgical performance points that a hospital received. There were 3,030 hospitals included in our study. Composite surgical performance scores were 15.6% lower at public hospitals than at for-profit hospitals (p < 0.01). Additionally, there were significant differences in the routes by which hospitals achieved points, with smaller hospitals, for-profit hospitals, Magnet hospitals, and NSQIP hospitals all more likely to obtain points via the achievement route. The results of our study indicate that public hospitals perform worse on the surgical measures in the hospital VBP program. This study raises important questions about the impact that this new, mandatory program will have on public hospitals, which serve an important safety-net role and appear to be disadvantaged in the hospital VBP program. This issue should continue to be investigated as these mandatory quality programs are updated in future years. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Counting missing values in a metabolite-intensity data set for measuring the analytical performance of a metabolomics platform.

PubMed

Huan, Tao; Li, Liang

2015-01-20

Metabolomics requires quantitative comparison of individual metabolites present in an entire sample set. Unfortunately, missing intensity values in one or more samples are very common. Because missing values can have a profound influence on metabolomic results, the extent of missing values found in a metabolomic data set should be treated as an important parameter for measuring the analytical performance of a technique. In this work, we report a study on the scope of missing values and a robust method of filling the missing values in a chemical isotope labeling (CIL) LC-MS metabolomics platform. Unlike conventional LC-MS, CIL LC-MS quantifies the concentration differences of individual metabolites in two comparative samples based on the mass spectral peak intensity ratio of a peak pair from a mixture of differentially labeled samples. We show that this peak-pair feature can be explored as a unique means of extracting metabolite intensity information from raw mass spectra. In our approach, a peak-pair peaking algorithm, IsoMS, is initially used to process the LC-MS data set to generate a CSV file or table that contains metabolite ID and peak ratio information (i.e., metabolite-intensity table). A zero-fill program, freely available from MyCompoundID.org , is developed to automatically find a missing value in the CSV file and go back to the raw LC-MS data to find the peak pair and, then, calculate the intensity ratio and enter the ratio value into the table. Most of the missing values are found to be low abundance peak pairs. We demonstrate the performance of this method in analyzing an experimental and technical replicate data set of human urine metabolome. Furthermore, we propose a standardized approach of counting missing values in a replicate data set as a way of gauging the extent of missing values in a metabolomics platform. Finally, we illustrate that applying the zero-fill program, in conjunction with dansylation CIL LC-MS, can lead to a marked improvement in

Performance measurement in surgery through the National Quality Forum.

PubMed

Hyder, Joseph A; Roy, Nathalie; Wakeam, Elliot; Hernandez, Roland; Kim, Simon P; Bader, Angela M; Cima, Robert R; Nguyen, Louis L

2014-11-01

Performance measurement has become central to surgical practice. We systematically reviewed all endorsed performance measures from the National Quality Forum, the national clearing house for performance measures in health care, to identify measures relevant to surgical practice and describe measure stewardship, measure types, and identify gaps in measurement. Performance measures current to June 2014 were categorized by denominator statement as either assessing surgical practice in specific or as part of a mixed medical and surgical population. Measures were further classified by surgical specialty, Donabedian measure type, patients, disease and events targeted, reporting eligibility, and measure stewards. Of 637 measures, 123 measures assessed surgical performance in specific and 123 assessed surgical performance in aggregate. Physician societies (51 of 123, 41.5%) were more common than government agencies (32 of 123, 26.0%) among measure stewards for surgical measures, in particular, the Society for Thoracic Surgery (n = 32). Outcomes measures rather than process measures were common among surgical measures (62 of 123, 50.4%) compared with aggregate medical/surgical measures (46 of 123, 37.4%). Among outcomes measures, death alone was the most commonly specified outcome (24 of 62, 38.7%). Only 1 surgical measure addressed patient-centered care and only 1 measure addressed hospital readmission. We found 7 current surgical measures eligible for value-based purchasing. Surgical society stewards and outcomes measure types, particularly for cardiac surgery, were well represented in the National Quality Forum. Measures addressing patient-centered outcomes and the value of surgical decision-making were not well represented and may be suitable targets for measure innovation. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Measuring the value of accurate link prediction for network seeding.

PubMed

Wei, Yijin; Spencer, Gwen

2017-01-01

The influence-maximization literature seeks small sets of individuals whose structural placement in the social network can drive large cascades of behavior. Optimization efforts to find the best seed set often assume perfect knowledge of the network topology. Unfortunately, social network links are rarely known in an exact way. When do seeding strategies based on less-than-accurate link prediction provide valuable insight? We introduce optimized-against-a-sample ([Formula: see text]) performance to measure the value of optimizing seeding based on a noisy observation of a network. Our computational study investigates [Formula: see text] under several threshold-spread models in synthetic and real-world networks. Our focus is on measuring the value of imprecise link information. The level of investment in link prediction that is strategic appears to depend closely on spread model: in some parameter ranges investments in improving link prediction can pay substantial premiums in cascade size. For other ranges, such investments would be wasted. Several trends were remarkably consistent across topologies.

Values taught, values learned, attitude and performance in mathematics

NASA Astrophysics Data System (ADS)

Limbaco, K. S. A.

2015-03-01

The purpose of the study was to identify, describe and find the relationship among values taught, values learned, attitude and performance in mathematics. The researcher used descriptive-correlational method of research to gather information and to describe the nature of situation. The following instruments were used in this study: Math Attitude Inventory, Inventory of Values Taught and Learned which were content validated by experts in the field of Mathematics, Values and Education. Generally, most of the values were taught by the teachers. All of the values were learned by the students. The following got the highest mean ratings for values taught: moral strength, sharing, charity, valuing life, love of God, truth and honesty, reason, alternativism and articulation. The following got highest mean ratings for values learned: patience/tolerance, sharing, charity, valuing life, faith, love of God, truth and honesty, analogical thinking, confidence and individual liberty. Majority of the respondents have moderately positive attitude towards mathematics. Positive statements in the Mathematics Attitude Inventory are "Generally true" while negative statements are "Neutral." In conclusion, values were taught by mathematics teacher, thus, learned by the students. Therefore, mathematics is very much related to life. Values can be learned and strengthened through mathematics; there is a significant relationship between values taught by the teachers and values learned by the students and attitude towards mathematics and performance in mathematics; values taught does not affect attitude towards mathematics and performance in mathematics. A student may have a positive attitude towards mathematics or have an exemplary performance in mathematics even if the mathematics teacher did not teach values; values learned does not affect attitude towards mathematics and performance in mathematics. A student may have a positive attitude towards mathematics or have an exemplary performance

Employers' use of value-based purchasing strategies.

PubMed

Rosenthal, Meredith B; Landon, Bruce E; Normand, Sharon-Lise T; Frank, Richard G; Ahmad, Thaniyyah S; Epstein, Arnold M

2007-11-21

Value-based purchasing by employers has often been portrayed as the lynchpin to quality improvement in a market-based health care system. Although a small group of the largest national employers has been actively engaged in promoting quality measurement, reporting, and pay for performance, it is unknown whether these ideas have significantly permeated employer-sponsored health benefit purchasing. To provide systematic descriptions and analyses of value-based purchasing and related efforts to improve quality of care by health care purchasers. We conducted telephone interviews with executives at 609 of the largest employers across 41 US markets between July 2005 and March 2006. The 41 randomly selected markets have at least 100,000 persons enrolled in health maintenance organizations, include approximately 91% of individuals enrolled in health maintenance organizations nationally, and represent roughly 78% of the US metropolitan population. Using the Dun & Bradstreet database of US employers, we identified the 26 largest firms in each market. Firms ranged in size from 60 to 250,000 employees. The degree to which value-based purchasing and related strategies are reported being used by employers. Percentages were weighted by number of employees. Of 1041 companies contacted, 609 employer representatives completed the survey (response rate, 64%). A large percentage of surveyed executives reported that they examine health plan quality data (269 respondents; 65% [95% confidence interval {CI}, 57%-74%]; P<.001), but few reported using it for performance rewards (49 respondents; 17% [95% CI, 7%-27%]; P=.008) or to influence employees (71 respondents; 23% [95% CI, 13%-33%]). Physician quality information is even less commonly examined (71 respondents; 16% [95% CI, 9%-23%]) or used by employers to reward performance (8 respondents; 2% [95% CI, 0%-3%]) or influence employee choice of providers (34 respondents; 8% [95% CI, 3%-12%]). Surveyed employers as a whole do not appear to

Value-Based Argumentation for Justifying Compliance

NASA Astrophysics Data System (ADS)

Burgemeestre, Brigitte; Hulstijn, Joris; Tan, Yao-Hua

Compliance is often achieved 'by design' through a coherent system of controls consisting of information systems and procedures . This system-based control requires a new approach to auditing in which companies must demonstrate to the regulator that they are 'in control'. They must determine the relevance of a regulation for their business, justify which set of control measures they have taken to comply with it, and demonstrate that the control measures are operationally effective. In this paper we show how value-based argumentation theory can be applied to the compliance domain. Corporate values motivate the selection of control measures (actions) which aim to fulfill control objectives, i.e. adopted norms (goals). In particular, we show how to formalize the dialogue in which companies justify their compliance decisions to regulators using value-based argumentation. The approach is illustrated by a case study of the safety and security measures adopted in the context of EU customs regulation.

Cultural values and performance appraisal: assessing the effects of rater self-construal on performance ratings.

PubMed

Mishra, Vipanchi; Roch, Sylvia G

2013-01-01

Much of the prior research investigating the influence of cultural values on performance ratings has focused either on conducting cross-national comparisons among raters or using cultural level individualism/collectivism scales to measure the effects of cultural values on performance ratings. Recent research has shown that there is considerable within country variation in cultural values, i.e. people in one country can be more individualistic or collectivistic in nature. Taking the latter perspective, the present study used Markus and Kitayama's (1991) conceptualization of independent and interdependent self-construals as measures of individual variations in cultural values to investigate within culture variations in performance ratings. Results suggest that rater self-construal has a significant influence on overall performance evaluations; specifically, raters with a highly interdependent self-construal tend to show a preference for interdependent ratees, whereas raters high on independent self-construal do not show a preference for specific type of ratees when making overall performance evaluations. Although rater self-construal significantly influenced overall performance evaluations, no such effects were observed for specific dimension ratings. Implications of these results for performance appraisal research and practice are discussed.

Performance of biometric quality measures.

PubMed

Grother, Patrick; Tabassi, Elham

2007-04-01

We document methods for the quantitative evaluation of systems that produce a scalar summary of a biometric sample's quality. We are motivated by a need to test claims that quality measures are predictive of matching performance. We regard a quality measurement algorithm as a black box that converts an input sample to an output scalar. We evaluate it by quantifying the association between those values and observed matching results. We advance detection error trade-off and error versus reject characteristics as metrics for the comparative evaluation of sample quality measurement algorithms. We proceed this with a definition of sample quality, a description of the operational use of quality measures. We emphasize the performance goal by including a procedure for annotating the samples of a reference corpus with quality values derived from empirical recognition scores.

Using the New Postacute Care Quality Measures to Demonstrate the Value of Occupational Therapy.

PubMed

Sandhu, Sharmila; Furniss, Jeremy; Metzler, Christina

As the health care system continues to evolve toward one based on quality not quantity, demonstrating the value of occupational therapy has never been more important. Providing high-quality services, achieving optimal outcomes, and identifying and promoting occupational therapy's distinct value are the responsibilities of all practitioners. In relation to the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, the Centers for Medicare and Medicaid Services (CMS) is implementing new functional items and related outcome performance measures across postacute care (PAC) settings. Practitioners can demonstrate the role and value of occupational therapy services through their participation in data collection and the interpretation of the resulting performance measures. In this column, we review the objectives of the IMPACT Act, introduce the new self-care and mobility items and outcome performance measures being implemented in PAC settings, and describe ways to use these new data to advocate for occupational therapy. We also discuss American Occupational Therapy Association initiatives to provide materials and guidance for occupational therapy practitioners to contribute to PAC data collection. Copyright © 2018 by the American Occupational Therapy Association, Inc.

Measurement properties of performance-based measures to assess physical function in hip and knee osteoarthritis: a systematic review.

PubMed

Dobson, F; Hinman, R S; Hall, M; Terwee, C B; Roos, E M; Bennell, K L

2012-12-01

To systematically review the measurement properties of performance-based measures to assess physical function in people with hip and/or knee osteoarthritis (OA). Electronic searches were performed in MEDLINE, CINAHL, Embase, and PsycINFO up to the end of June 2012. Two reviewers independently rated measurement properties using the consensus-based standards for the selection of health status measurement instrument (COSMIN). "Best evidence synthesis" was made using COSMIN outcomes and the quality of findings. Twenty-four out of 1792 publications were eligible for inclusion. Twenty-one performance-based measures were evaluated including 15 single-activity measures and six multi-activity measures. Measurement properties evaluated included internal consistency (three measures), reliability (16 measures), measurement error (14 measures), validity (nine measures), responsiveness (12 measures) and interpretability (three measures). A positive rating was given to only 16% of possible measurement ratings. Evidence for the majority of measurement properties of tests reported in the review has yet to be determined. On balance of the limited evidence, the 40 m self-paced test was the best rated walk test, the 30 s-chair stand test and timed up and go test were the best rated sit to stand tests, and the Stratford battery, Physical Activity Restrictions and Functional Assessment System were the best rated multi-activity measures. Further good quality research investigating measurement properties of performance measures, including responsiveness and interpretability in people with hip and/or knee OA, is needed. Consensus on which combination of measures will best assess physical function in people with hip/and or knee OA is urgently required. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

ESR concept paper on value-based radiology.

PubMed

2017-10-01

The European Society of Radiology (ESR) established a Working Group on Value-Based Imaging (VBI WG) in August 2016 in response to developments in European healthcare systems in general, and the trend within radiology to move from volume- to value-based practice in particular. The value-based healthcare (VBH) concept defines "value" as health outcomes achieved for patients relative to the costs of achieving them. Within this framework, value measurements start at the beginning of therapy; the whole diagnostic process is disregarded, and is considered only if it is the cause of errors or complications. Making the case for a new, multidisciplinary organisation of healthcare delivery centred on the patient, this paper establishes the diagnosis of disease as a first outcome in the interrelated activities of the healthcare chain. Metrics are proposed for measuring the quality of radiologists' diagnoses and the various ways in which radiologists provide value to patients, other medical specialists and healthcare systems at large. The ESR strongly believes value-based radiology (VBR) is a necessary complement to existing VBH concepts. The Society is determined to establish a holistic VBR programme to help European radiologists deal with changes in the evolution from volume- to value-based evaluation of radiological activities. Main Messages • Value-based healthcare defines value as patient's outcome over costs. • The VBH framework disregards the diagnosis as an outcome. • VBH considers diagnosis only if wrong or a cause of complications. • A correct diagnosis is the first outcome that matters to patients. • Metrics to measure radiologists' impacts on patient outcomes are key. • The value provided by radiology is multifaceted, going beyond exam volumes.

Evaluation about the Performance of E-Government Based on Interval-Valued Intuitionistic Fuzzy Set

PubMed Central

Zhang, Shuai; Wang, Yan

2014-01-01

The evaluation is an important approach to promote the development of the E-Government. Since the rapid development of E-Government in the world, the E-Government performance evaluation has become a hot issue in the academia. In this paper, we develop a new evaluation method for the development of the E-Government based on the interval-valued intuitionistic fuzzy set which is a powerful technique in expressing the uncertainty of the real situation. First, we extend the geometric Heronian mean (GHM) operator to interval-valued intuitionistic fuzzy environment and proposed the interval-valued intuitionistic fuzzy GHM (IIFGHM) operator. Then, we investigate the relationships between the IIFGHM operator and some existing ones, such as generalized interval-valued intuitionistic fuzzy HM (GIIFHM) and interval-valued intuitionistic fuzzy weighted Bonferoni mean operator. Furthermore, we validate the effectiveness of the proposed method using a real case about the E-Government evaluation in Hangzhou City, China. PMID:24707196

Evaluation about the performance of E-government based on interval-valued intuitionistic fuzzy set.

PubMed

Zhang, Shuai; Yu, Dejian; Wang, Yan; Zhang, Wenyu

2014-01-01

The evaluation is an important approach to promote the development of the E-Government. Since the rapid development of E-Government in the world, the E-Government performance evaluation has become a hot issue in the academia. In this paper, we develop a new evaluation method for the development of the E-Government based on the interval-valued intuitionistic fuzzy set which is a powerful technique in expressing the uncertainty of the real situation. First, we extend the geometric Heronian mean (GHM) operator to interval-valued intuitionistic fuzzy environment and proposed the interval-valued intuitionistic fuzzy GHM (IIFGHM) operator. Then, we investigate the relationships between the IIFGHM operator and some existing ones, such as generalized interval-valued intuitionistic fuzzy HM (GIIFHM) and interval-valued intuitionistic fuzzy weighted Bonferoni mean operator. Furthermore, we validate the effectiveness of the proposed method using a real case about the E-Government evaluation in Hangzhou City, China.

Developing a Measure of Value in Health Care.

PubMed

Ken Lee, K H; Matthew Austin, J; Pronovost, Peter J

2016-06-01

There is broad support to pay for value, rather than volume, for health care in the United States. Despite the support, practical approaches for measuring value remain elusive. Value is commonly defined as quality divided by costs, where quality reflects patient outcomes and costs are the total costs for providing care, whether these be costs related to an episode, a diagnosis, or per capita. Academicians have proposed a conceptual approach to measure value, in which we measure outcomes important to patients and costs using time-driven activity-based costing. This approach is conceptually sound, but has significant practical challenges. In our commentary, we describe how health care can use existing quality measures and cost accounting data to measure value. Although not perfect, we believe this approach is practical, valid, and scalable and can establish the foundation for future work in this area. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Teaching hospital performance: towards a community of shared values?

PubMed

Mauro, Marianna; Cardamone, Emma; Cavallaro, Giusy; Minvielle, Etienne; Rania, Francesco; Sicotte, Claude; Trotta, Annarita

2014-01-01

This paper explores the performance dimensions of Italian teaching hospitals (THs) by considering the multiple constituent model approach, using measures that are subjective and based on individual ideals and preferences. Our research replicates a study of a French TH and deepens it by adjusting it to the context of an Italian TH. The purposes of this research were as follows: to identify emerging views on the performance of teaching hospitals and to analyze how these views vary among hospital stakeholders. We conducted an in-depth case study of a TH using a quantitative survey method. The survey uses a questionnaire based on Parsons' social system action theory, which embraces the major models of organizational performance and covers three groups of internal stakeholders: physicians, caregivers and administrative staff. The questionnaires were distributed between April and September 2011. The results confirm that hospital performance is multifaceted and includes the dimensions of efficiency, effectiveness and quality of care, as well as organizational and human features. There is a high degree of consensus among all observed stakeholder groups about these values, and a shared view of performance is emerging. Our research provides useful information for defining management priorities to improve the performance of THs. Copyright © 2013 Elsevier Ltd. All rights reserved.

Patient-reported outcome measures versus inertial performance-based outcome measures: A prospective study in patients undergoing primary total knee arthroplasty.

PubMed

Bolink, S A A N; Grimm, B; Heyligers, I C

2015-12-01

Outcome assessment of total knee arthroplasty (TKA) by subjective patient reported outcome measures (PROMs) may not fully capture the functional (dis-)abilities of relevance. Objective performance-based outcome measures could provide distinct information. An ambulant inertial measurement unit (IMU) allows kinematic assessment of physical performance and could potentially be used for routine follow-up. To investigate the responsiveness of IMU measures in patients following TKA and compare outcomes with conventional PROMs. Patients with end stage knee OA (n=20, m/f=7/13; age=67.4 standard deviation 7.7 years) were measured preoperatively and one year postoperatively. IMU measures were derived during gait, sit-stand transfers and block step-up transfers. PROMs were assessed by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS). Responsiveness was calculated by the effect size, correlations were calculated with Spearman's rho correlation coefficient. One year after TKA, patients performed significantly better at gait, sit-to-stand transfers and block step-up transfers. Measures of time and kinematic IMU measures demonstrated significant improvements postoperatively for each performance-based test. The largest improvement was found in block step-up transfers (effect size=0.56-1.20). WOMAC function score and KSS function score demonstrated moderate correlations (Spearman's rho=0.45-0.74) with some of the physical performance-based measures pre- and postoperatively. To characterize the changes in physical function after TKA, PROMs could be supplemented by performance-based measures, assessing function during different activities and allowing kinematic characterization with an ambulant IMU. Copyright © 2015 Elsevier B.V. All rights reserved.

Profit-Based Model Selection for Customer Retention Using Individual Customer Lifetime Values.

PubMed

Óskarsdóttir, María; Baesens, Bart; Vanthienen, Jan

2018-03-01

The goal of customer retention campaigns, by design, is to add value and enhance the operational efficiency of businesses. For organizations that strive to retain their customers in saturated, and sometimes fast moving, markets such as the telecommunication and banking industries, implementing customer churn prediction models that perform well and in accordance with the business goals is vital. The expected maximum profit (EMP) measure is tailored toward this problem by taking into account the costs and benefits of a retention campaign and estimating its worth for the organization. Unfortunately, the measure assumes fixed and equal customer lifetime value (CLV) for all customers, which has been shown to not correspond well with reality. In this article, we extend the EMP measure to take into account the variability in the lifetime values of customers, thereby basing it on individual characteristics. We demonstrate how to incorporate the heterogeneity of CLVs when CLVs are known, when their prior distribution is known, and when neither is known. By taking into account individual CLVs, our proposed approach of measuring model performance gives novel insights when deciding on a customer retention campaign. The method is dependent on the characteristics of the customer base as is compliant with modern business analytics and accommodates the data-driven culture that has manifested itself within organizations.

Combining Time-Driven Activity-Based Costing with Clinical Outcome in Cost-Effectiveness Analysis to Measure Value in Treatment of Depression.

PubMed

El Alaoui, Samir; Lindefors, Nils

2016-01-01

A major challenge of mental health care is to provide safe and effective treatment with limited resources. The main purpose of this study was to examine a value-based approach in clinical psychiatry when evaluating a process improvement initiative. This was accomplished by using the relatively new time driven activity based costing (TDABC) method within the more widely adopted cost-effectiveness analysis framework for economic evaluation of healthcare technologies. The objective was to evaluate the cost-effectiveness of allowing psychologists to perform post-treatment assessment previously performed by psychiatrists at an outpatient clinic treating depression using internet-based cognitive-behavioral therapy (ICBT). Data was collected from 568 adult patients treated with ICBT for depression during 2013-2014. The TDABC methodology was used to estimate total healthcare costs, including development of process maps for the complete cycle of care and estimation of resource use and minute costs of staff, hospital space and materials based on their relative proportions used. Clinical outcomes were measured using the Patient Health Questionnaire depression scale (PHQ-9) before and after treatment and at 6-month follow-up. Cost-effectiveness analyses (CEA) was performed and the results presented as incremental net benefits (INB), cost-effectiveness acceptability curves (CEACs) and confidence ellipses to demonstrate uncertainty around the value of the organizational intervention. Taking into account the complete healthcare process (from referral to follow-up assessment), treatment costs decreased from $709 (SD = $130) per patient in 2013 to $659 (SD = $134) in 2014 while treatment effectiveness was maintained; 27% had achieved full remission from depression after treatment (PHQ-9 < 5) during both 2013 and 2014 and an additional 35% and 33% had achieved partial remission in 2013 and 2014, respectively. At follow-up, 42% were in full remission after treatment during both 2013

Combining Time-Driven Activity-Based Costing with Clinical Outcome in Cost-Effectiveness Analysis to Measure Value in Treatment of Depression

PubMed Central

Lindefors, Nils

2016-01-01

Background A major challenge of mental health care is to provide safe and effective treatment with limited resources. The main purpose of this study was to examine a value-based approach in clinical psychiatry when evaluating a process improvement initiative. This was accomplished by using the relatively new time driven activity based costing (TDABC) method within the more widely adopted cost-effectiveness analysis framework for economic evaluation of healthcare technologies. The objective was to evaluate the cost-effectiveness of allowing psychologists to perform post-treatment assessment previously performed by psychiatrists at an outpatient clinic treating depression using internet-based cognitive-behavioral therapy (ICBT). Methods Data was collected from 568 adult patients treated with ICBT for depression during 2013–2014. The TDABC methodology was used to estimate total healthcare costs, including development of process maps for the complete cycle of care and estimation of resource use and minute costs of staff, hospital space and materials based on their relative proportions used. Clinical outcomes were measured using the Patient Health Questionnaire depression scale (PHQ-9) before and after treatment and at 6-month follow-up. Cost-effectiveness analyses (CEA) was performed and the results presented as incremental net benefits (INB), cost-effectiveness acceptability curves (CEACs) and confidence ellipses to demonstrate uncertainty around the value of the organizational intervention. Outcomes Taking into account the complete healthcare process (from referral to follow-up assessment), treatment costs decreased from $709 (SD = $130) per patient in 2013 to $659 (SD = $134) in 2014 while treatment effectiveness was maintained; 27% had achieved full remission from depression after treatment (PHQ-9 < 5) during both 2013 and 2014 and an additional 35% and 33% had achieved partial remission in 2013 and 2014, respectively. At follow-up, 42% were in full remission

A meta-analytic review of self-reported, clinician-rated, and performance-based motivation measures in schizophrenia: Are we measuring the same "stuff"?

PubMed

Luther, Lauren; Firmin, Ruth L; Lysaker, Paul H; Minor, Kyle S; Salyers, Michelle P

2018-04-07

An array of self-reported, clinician-rated, and performance-based measures has been used to assess motivation in schizophrenia; however, the convergent validity evidence for these motivation assessment methods is mixed. The current study is a series of meta-analyses that summarize the relationships between methods of motivation measurement in 45 studies of people with schizophrenia. The overall mean effect size between self-reported and clinician-rated motivation measures (r = 0.27, k = 33) was significant, positive, and approaching medium in magnitude, and the overall effect size between performance-based and clinician-rated motivation measures (r = 0.21, k = 11) was positive, significant, and small in magnitude. The overall mean effect size between self-reported and performance-based motivation measures was negligible and non-significant (r = -0.001, k = 2), but this meta-analysis was underpowered. Findings suggest modest convergent validity between clinician-rated and both self-reported and performance-based motivation measures, but additional work is needed to clarify the convergent validity between self-reported and performance-based measures. Further, there is likely more variability than similarity in the underlying construct that is being assessed across the three methods, particularly between the performance-based and other motivation measurement types. These motivation assessment methods should not be used interchangeably, and measures should be more precisely described as the specific motivational construct or domain they are capturing. Copyright © 2018 Elsevier Ltd. All rights reserved.

Measurement of susceptibility artifacts with histogram-based reference value on magnetic resonance images according to standard ASTM F2119.

PubMed

Heinrich, Andreas; Teichgräber, Ulf K; Güttler, Felix V

2015-12-01

The standard ASTM F2119 describes a test method for measuring the size of a susceptibility artifact based on the example of a passive implant. A pixel in an image is considered to be a part of an image artifact if the intensity is changed by at least 30% in the presence of a test object, compared to a reference image in which the test object is absent (reference value). The aim of this paper is to simplify and accelerate the test method using a histogram-based reference value. Four test objects were scanned parallel and perpendicular to the main magnetic field, and the largest susceptibility artifacts were measured using two methods of reference value determination (reference image-based and histogram-based reference value). The results between both methods were compared using the Mann-Whitney U-test. The difference between both reference values was 42.35 ± 23.66. The difference of artifact size was 0.64 ± 0.69 mm. The artifact sizes of both methods did not show significant differences; the p-value of the Mann-Whitney U-test was between 0.710 and 0.521. A standard-conform method for a rapid, objective, and reproducible evaluation of susceptibility artifacts could be implemented. The result of the histogram-based method does not significantly differ from the ASTM-conform method.

High-performance multi-channel fiber-based absolute distance measuring interferometer system

NASA Astrophysics Data System (ADS)

Deck, Leslie L.

2009-08-01

I describe the principle of operation and performance of a fiber-based absolute distance measuring interferometer system with 60 independent simultaneous channels. The system was designed for demanding applications requiring passive, electrically immune sensors with an extremely long MTTF. In addition to providing better than 0.3nm measurement repeatability at 5KHz for all channels, the system demonstrated absolute distance uncertainty of less than 5nm over a 500 micron measurement range.

Development of Sensor-Based Measures of Rifle Marksmanship Skill and Performance. CRESST Report 756

ERIC Educational Resources Information Center

Espinosa, Paul D.; Nagashima, Sam O.; Chung, Gregory K. W. K.; Parks, Daniel; Baker, Eva L.

2009-01-01

Measures of rifle marksmanship skill and performance were developed using a prototype instrumented laser-based training system. Measures of performance were derived from laser strikes on a video-projected target. Measures of rifle marksmanship skill--breath control, trigger control, and muzzle wobble--were developed from shooters' breathing and…

Network analysis of surgical innovation: Measuring value and the virality of diffusion in robotic surgery.

PubMed

Garas, George; Cingolani, Isabella; Panzarasa, Pietro; Darzi, Ara; Athanasiou, Thanos

2017-01-01

Existing surgical innovation frameworks suffer from a unifying limitation, their qualitative nature. A rigorous approach to measuring surgical innovation is needed that extends beyond detecting simply publication, citation, and patent counts and instead uncovers an implementation-based value from the structure of the entire adoption cascades produced over time by diffusion processes. Based on the principles of evidence-based medicine and existing surgical regulatory frameworks, the surgical innovation funnel is described. This illustrates the different stages through which innovation in surgery typically progresses. The aim is to propose a novel and quantitative network-based framework that will permit modeling and visualizing innovation diffusion cascades in surgery and measuring virality and value of innovations. Network analysis of constructed citation networks of all articles concerned with robotic surgery (n = 13,240, Scopus®) was performed (1974-2014). The virality of each cascade was measured as was innovation value (measured by the innovation index) derived from the evidence-based stage occupied by the corresponding seed article in the surgical innovation funnel. The network-based surgical innovation metrics were also validated against real world big data (National Inpatient Sample-NIS®). Rankings of surgical innovation across specialties by cascade size and structural virality (structural depth and width) were found to correlate closely with the ranking by innovation value (Spearman's rank correlation coefficient = 0.758 (p = 0.01), 0.782 (p = 0.008), 0.624 (p = 0.05), respectively) which in turn matches the ranking based on real world big data from the NIS® (Spearman's coefficient = 0.673;p = 0.033). Network analysis offers unique new opportunities for understanding, modeling and measuring surgical innovation, and ultimately for assessing and comparing generative value between different specialties. The novel surgical innovation metrics developed may

MEASUREMENT: ACCOUNTING FOR RELIABILITY IN PERFORMANCE ESTIMATES.

PubMed

Waterman, Brian; Sutter, Robert; Burroughs, Thomas; Dunagan, W Claiborne

2014-01-01

When evaluating physician performance measures, physician leaders are faced with the quandary of determining whether departures from expected physician performance measurements represent a true signal or random error. This uncertainty impedes the physician leader's ability and confidence to take appropriate performance improvement actions based on physician performance measurements. Incorporating reliability adjustment into physician performance measurement is a valuable way of reducing the impact of random error in the measurements, such as those caused by small sample sizes. Consequently, the physician executive has more confidence that the results represent true performance and is positioned to make better physician performance improvement decisions. Applying reliability adjustment to physician-level performance data is relatively new. As others have noted previously, it's important to keep in mind that reliability adjustment adds significant complexity to the production, interpretation and utilization of results. Furthermore, the methods explored in this case study only scratch the surface of the range of available Bayesian methods that can be used for reliability adjustment; further study is needed to test and compare these methods in practice and to examine important extensions for handling specialty-specific concerns (e.g., average case volumes, which have been shown to be important in cardiac surgery outcomes). Moreover, it's important to note that the provider group average as a basis for shrinkage is one of several possible choices that could be employed in practice and deserves further exploration in future research. With these caveats, our results demonstrate that incorporating reliability adjustment into physician performance measurements is feasible and can notably reduce the incidence of "real" signals relative to what one would expect to see using more traditional approaches. A physician leader who is interested in catalyzing performance improvement

What can the national quality forum tell us about performance measurement in anesthesiology?

PubMed

Hyder, Joseph A; Niconchuk, Jonathan; Glance, Laurent G; Neuman, Mark D; Cima, Robert R; Dutton, Richard P; Nguyen, Louis L; Fleisher, Lee A; Bader, Angela M

2015-02-01

Anesthesiologists face increasing pressure to demonstrate the value of the care they provide, whether locally or nationally through public reporting and payor requirements. In this article, we describe the current state of performance measurement in anesthesia care at the national level and highlight gaps and opportunities in performance measurement for anesthesiologists. We evaluated all endorsed performance measures in the National Quality Forum (NQF), the clearinghouse for all federal performance measures, and classified all measures as follows: (1) anesthesia-specific; (2) surgery-specific; (3) jointly attributable; or (4) other. We used NQF-provided descriptors to characterize measures in terms of (1) structure, process, outcome, or efficiency; (2) patients, disease, and events targeted; (3) procedural specialty; (4) reporting eligibility; (5) measures stewards; and (6) timing in the care stream. Of the 637 endorsed performance measures, few (6, 1.0%) were anesthesia-specific. An additional 39 measures (6.1%) were surgery-specific, and 67 others (10.5%) were jointly attributable. "Anesthesia-specific" measures addressed preoperative antibiotic timing (n = 4), normothermia (n = 1), and protocol use for the placement of central venous catheter (n = 1). Jointly attributable measures included outcome measures (n = 49/67, 73.1%), which were weighted toward mortality alone (n = 24) and cardiac surgery (n = 14). Other jointly attributable measures addressed orthopedic surgery (n = 4), general surgical oncologic resections (n = 12), or nonspecified surgeries (n = 15), but none specifically addressed anesthesia care outside the operating room such as for endoscopy. Only 4 measures were eligible for value-based purchasing. No named anesthesiology professional groups were among measure stewards, but surgical professional groups (n = 33/67, 47%) were frequent measure stewards. Few NQF performance measures are specific to anesthesia practice, and none of these appears to

Value-at-risk estimation with wavelet-based extreme value theory: Evidence from emerging markets

NASA Astrophysics Data System (ADS)

Cifter, Atilla

2011-06-01

This paper introduces wavelet-based extreme value theory (EVT) for univariate value-at-risk estimation. Wavelets and EVT are combined for volatility forecasting to estimate a hybrid model. In the first stage, wavelets are used as a threshold in generalized Pareto distribution, and in the second stage, EVT is applied with a wavelet-based threshold. This new model is applied to two major emerging stock markets: the Istanbul Stock Exchange (ISE) and the Budapest Stock Exchange (BUX). The relative performance of wavelet-based EVT is benchmarked against the Riskmetrics-EWMA, ARMA-GARCH, generalized Pareto distribution, and conditional generalized Pareto distribution models. The empirical results show that the wavelet-based extreme value theory increases predictive performance of financial forecasting according to number of violations and tail-loss tests. The superior forecasting performance of the wavelet-based EVT model is also consistent with Basel II requirements, and this new model can be used by financial institutions as well.

Diagnostic colonoscopy: performance measurement study.

PubMed

Kuznets, Naomi

2002-07-01

This is the fifth of a series of best practices studies undertaken by the Performance Measurement Initiative (PMI), the centerpiece of the Institute for Quality Improvement (IQI), a not-for-profit quality improvement subsidiary of the Accreditation Association for Ambulatory Health Care (AAAHC) (Performance Measurement Initiative, 1999a, 1999b, 2000a, 2000b). The IQI was created to offer clinical performance measurement and improvement opportunities to ambulatory health care organizations and others interested in quality patient care. The purpose of the study was to provide opportunities to initiate clinical performance measurement on key processes and outcomes for this procedure and use this information for clinical quality improvement. This article provides performance measurement information on how organizations that have demonstrated and validated differences in clinical practice can have similar outcomes, but at a dramatically lower cost. The intent of the article is to provide organizations with alternatives in practice to provide a better value to their patients.

Assessing value-based health care delivery for haemodialysis.

PubMed

Parra, Eduardo; Arenas, María Dolores; Alonso, Manuel; Martínez, María Fernanda; Gamen, Ángel; Aguarón, Juan; Escobar, María Teresa; Moreno-Jiménez, José María; Alvarez-Ude, Fernando

2017-06-01

Disparities in haemodialysis outcomes among centres have been well-documented. Besides, attempts to assess haemodialysis results have been based on non-comprehensive methodologies. This study aimed to develop a comprehensive methodology for assessing haemodialysis centres, based on the value of health care. The value of health care is defined as the patient benefit from a specific medical intervention per monetary unit invested (Value = Patient Benefit/Cost). This study assessed the value of health care and ranked different haemodialysis centres. A nephrology quality management group identified the criteria for the assessment. An expert group composed of stakeholders (patients, clinicians and managers) agreed on the weighting of each variable, considering values and preferences. Multi-criteria methodology was used to analyse the data. Four criteria and their weights were identified: evidence-based clinical performance measures = 43 points; yearly mortality = 27 points; patient satisfaction = 13 points; and health-related quality of life = 17 points (100-point scale). Evidence-based clinical performance measures included five sub-criteria, with respective weights, including: dialysis adequacy; haemoglobin concentration; mineral and bone disorders; type of vascular access; and hospitalization rate. The patient benefit was determined from co-morbidity-adjusted results and corresponding weights. The cost of each centre was calculated as the average amount expended per patient per year. The study was conducted in five centres (1-5). After adjusting for co-morbidity, value of health care was calculated, and the centres were ranked. A multi-way sensitivity analysis that considered different weights (10-60% changes) and costs (changes of 10% in direct and 30% in allocated costs) showed that the methodology was robust. The rankings: 4-5-3-2-1 and 4-3-5-2-1 were observed in 62.21% and 21.55%, respectively, of simulations, when weights were varied by 60

Physician-Owned Surgical Hospitals Outperform Other Hospitals in Medicare Value-Based Purchasing Program.

PubMed

Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

2016-10-01

The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals and creates financial incentives for quality improvement and fosters increased transparency. Limited information is available comparing hospital performance across health care business models. The 2015 Hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Of 3,089 hospitals with total performance scores, categories of representative health care business models included 104 physician-owned surgical hospitals, 111 University HealthSystem Consortium, 14 US News & World Report Honor Roll hospitals, 33 Kaiser Permanente, and 124 Pioneer accountable care organization affiliated hospitals. Estimated mean total performance scores for physician-owned surgical hospitals (64.4; 95% CI, 61.83-66.38) and Kaiser Permanente (60.79; 95% CI, 56.56-65.03) were significantly higher compared with all remaining hospitals, and University HealthSystem Consortium members (36.8; 95% CI, 34.51-39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included physician-owned surgical hospitals (mean 2.32; p < 0.0001), US News & World Report honorees (mean 2.24; p = 0.0140), and University HealthSystem Consortium members (mean 1.99; p < 0.0001), and Kaiser Permanente hospitals had lower case mix value (mean 1.54; p < 0.0001). Re-estimation of total performance scores did not change the original results after adjustment for differences in hospital case mix index. The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals can guide value improvement and policy-making decisions for all Medicare Value-Based

Value management program: performance, quantification, and presentation of imaging value-added actions.

PubMed

Patel, Samir

2015-03-01

Health care is in a state of transition, shifting from volume-based success to value-based success. Hospital executives and referring physicians often do not understand the total value a radiology group provides. A template for easy, cost-effective implementation in clinical practice for most radiology groups to demonstrate the value they provide to their clients (patients, physicians, health care executives) has not been well described. A value management program was developed to document all of the value-added activities performed by on-site radiologists, quantify them in terms of time spent on each activity (investment), and present the benefits to internal and external stakeholders (outcomes). The radiology value-added matrix is the platform from which value-added activities are categorized and synthesized into a template for defining investments and outcomes. The value management program was first implemented systemwide in 2013. Across all serviced locations, 9,931.75 hours were invested. An annual executive summary report template demonstrating outcomes is given to clients. The mean and median individual value-added hours per radiologist were 134.52 and 113.33, respectively. If this program were extrapolated to the entire field of radiology, approximately 30,000 radiologists, this would have resulted in 10,641,161 uncompensated value-added hours documented in 2013, with an estimated economic value of $2.21 billion. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Measurement-to-measurement blood pressure variability is related to cognitive performance: the Maine Syracuse study.

PubMed

Crichton, Georgina E; Elias, Merrill F; Dore, Gregory A; Torres, Rachael V; Robbins, Michael A

2014-11-01

The objective was to investigate the association between variability in blood pressure (BP) and cognitive function for sitting, standing, and reclining BP values and variability derived from all 15 measures. In previous studies, only sitting BP values have been examined, and only a few cognitive measures have been used. A secondary objective was to examine associations between BP variability and cognitive performance in hypertensive individuals stratified by treatment success. Cross-sectional analyses were performed on 972 participants of the Maine Syracuse Study for whom 15 serial BP clinic measures (5 sitting, 5 recumbent, and 5 standing) were obtained before testing of cognitive performance. Using all 15 measures, higher variability in systolic and diastolic BP was associated with poorer performance on multiple measures of cognitive performance, independent of demographic factors, cardiovascular risk factors, and pulse pressure. When sitting, reclining, and standing systolic BP values were compared, only variability in standing BP was related to measures of cognitive performance. However, for diastolic BP, variability in all 3 positions was related to cognitive performance. Mean BP values were weaker predictors of cognition. Furthermore, higher overall variability in both systolic and diastolic BP was associated with poorer cognitive performance in unsuccessfully treated hypertensive individuals (with BP ≥140/90 mm Hg), but these associations were not evident in those with controlled hypertension. © 2014 American Heart Association, Inc.

Perturbing engine performance measurements to determine optimal engine control settings

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

Jiang, Li; Lee, Donghoon; Yilmaz, Hakan

Methods and systems for optimizing a performance of a vehicle engine are provided. The method includes determining an initial value for a first engine control parameter based on one or more detected operating conditions of the vehicle engine, determining a value of an engine performance variable, and artificially perturbing the determined value of the engine performance variable. The initial value for the first engine control parameter is then adjusted based on the perturbed engine performance variable causing the engine performance variable to approach a target engine performance variable. Operation of the vehicle engine is controlled based on the adjusted initialmore » value for the first engine control parameter. These acts are repeated until the engine performance variable approaches the target engine performance variable.« less

One Moon, many measurements 1: Radiance values

NASA Astrophysics Data System (ADS)

Pieters, C. M.; Boardman, J. W.; Ohtake, M.; Matsunaga, T.; Haruyama, J.; Green, R. O.; Mall, U.; Staid, M. I.; Isaacson, P. J.; Yokota, Y.; Yamamoto, S.; Besse, S.; Sunshine, J. M.

2013-09-01

Several modern optical instruments orbited the Moon during 2008 and 2009 onboard the SELENE and Chandrayaan-1 spacecraft and provided a welcomed feast of spectroscopic data to be used for scientific analyses. The different spatial and spectral resolutions of these sensors along with diverse illumination geometry during data acquisition make each set of data unique, and each instrument contributes special value to integrated science analyses. In order to provide the maximum science benefit, we have undertaken a careful cross-validation of radiance data among these orbital instruments and also a set of systematic data acquired using Earth-based telescopes. Most radiance values at 750 nm fall between 0 and 100 W/(m2 μm sr), but a small important fraction can be up to ×2 to ×3 that value, with the largest values occurring at the highest spatial resolution. All instruments are in agreement about overall spectral properties of lunar materials, but small systematic differences are documented between instruments. Lunar radiance values measured with remote sensors for landing sites are all not as high as that estimated from laboratory measurements of returned soil. This is largely because laboratory measurements of lunar soils cannot retain or duplicate the fine structure of lunar regolith found in the natural space environment.

Physician-owned Surgical Hospitals Outperform Other Hospitals in the Medicare Value-based Purchasing Program

PubMed Central

Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

2016-01-01

Background The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals while creating financial incentives for quality improvement and fostering increased transparency. Limited information is available comparing hospital performance across healthcare business models. Study Design 2015 hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Results Of 3089 hospitals with Total Performance Scores (TPS), categories of representative healthcare business models included 104 Physician-owned Surgical Hospitals (POSH), 111 University HealthSystem Consortium (UHC), 14 US News & World Report Honor Roll (USNWR) Hospitals, 33 Kaiser Permanente, and 124 Pioneer Accountable Care Organization affiliated hospitals. Estimated mean TPS for POSH (64.4, 95% CI 61.83, 66.38) and Kaiser (60.79, 95% CI 56.56, 65.03) were significantly higher compared to all remaining hospitals while UHC members (36.8, 95% CI 34.51, 39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included POSH (mean 2.32, p<0.0001), USNWR honorees (mean 2.24, p 0.0140) and UHC members (mean =1.99, p<0.0001) while Kaiser Permanente hospitals had lower case mix value (mean =1.54, p<0.0001). Re-estimation of TPS did not change the original results after adjustment for differences in hospital case mix index. Conclusions The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals may guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals. PMID:27502368

Patient Experience-based Value Sets: Are They Stable?

PubMed

Pickard, A Simon; Hung, Yu-Ting; Lin, Fang-Ju; Lee, Todd A

2017-11-01

Although societal preference weights are desirable to inform resource-allocation decision-making, patient experienced health state-based value sets can be useful for clinical decision-making, but context may matter. To estimate EQ-5D value sets using visual analog scale (VAS) ratings for patients undergoing knee replacement surgery and compare the estimates before and after surgery. We used the Patient Reported Outcome Measures data collected by the UK National Health Service on patients undergoing knee replacement from 2009 to 2012. Generalized least squares regression models were used to derive value sets based on the EQ-5D-3 level using a development sample before and after surgery, and model performance was examined using a validation sample. A total of 90,450 preoperative and postoperative valuations were included. For preoperative valuations, the largest decrement in VAS values was associated with the dimension of anxiety/depression, followed by self-care, mobility, usual activities, and pain/discomfort. However, pain/discomfort had a greater impact on VAS value decrement in postoperative valuations. Compared with preoperative health problems, postsurgical health problems were associated with larger value decrements, with significant differences in several levels and dimensions, including level 2 of mobility, level 2/3 of usual activities, level 3 of pain/discomfort, and level 3 of anxiety/depression. Similar results were observed across subgroups stratified by age and sex. Findings suggest patient experience-based value sets are not stable (ie, context such as timing matters). However, the knowledge that lower values are assigned to health states postsurgery compared with presurgery may be useful for the patient-doctor decision-making process.

The Relationship between Video Game Use and a Performance-Based Measure of Persistence

ERIC Educational Resources Information Center

Ventura, Matthew; Shute, Valerie; Zhao, Weinan

2013-01-01

An online performance-based measure of persistence was developed using anagrams and riddles. Persistence was measured by recording the time spent on unsolved anagrams and riddles. Time spent on unsolved problems was correlated to a self-report measure of persistence. Additionally, frequent video game players spent longer times on unsolved problems…

The ambiguities of performance-based governance reforms in Italy: Reviving the fortunes of evaluation and performance measurement.

PubMed

Marra, Mita

2018-08-01

Over the past two decades, Italy's administrative reforms have institutionalized evaluation to improve program effectiveness, staff productivity, and results-driven accountability against waste and corruption. Across ministries, regional governments, universities, schools and environmental protection agencies, seemingly unexpected consequences have emerged out of the implementation of performance measurement and evaluation regimes within public organizations. Formal compliance to legally binding evaluation procedures, judicially-sanctioned managerial accountability and lack of cross-agency coordination coupled with long-standing cultural separations among evaluators are some of the ambiguities associated with a performance-based governance system within Italian public administration. Building upon the 'new governane theory,' and qualitative fieldwork, I explore the political consequences of evaluation and performance measurement for possible improvements. From a normative perspective, greater integration between program evaluation and performance measurement can support organizational learning and democratic accountability both at the central and local level. Copyright © 2017 Elsevier Ltd. All rights reserved.

Network analysis of surgical innovation: Measuring value and the virality of diffusion in robotic surgery

PubMed Central

Cingolani, Isabella; Panzarasa, Pietro; Darzi, Ara; Athanasiou, Thanos

2017-01-01

Background Existing surgical innovation frameworks suffer from a unifying limitation, their qualitative nature. A rigorous approach to measuring surgical innovation is needed that extends beyond detecting simply publication, citation, and patent counts and instead uncovers an implementation-based value from the structure of the entire adoption cascades produced over time by diffusion processes. Based on the principles of evidence-based medicine and existing surgical regulatory frameworks, the surgical innovation funnel is described. This illustrates the different stages through which innovation in surgery typically progresses. The aim is to propose a novel and quantitative network-based framework that will permit modeling and visualizing innovation diffusion cascades in surgery and measuring virality and value of innovations. Materials and methods Network analysis of constructed citation networks of all articles concerned with robotic surgery (n = 13,240, Scopus®) was performed (1974–2014). The virality of each cascade was measured as was innovation value (measured by the innovation index) derived from the evidence-based stage occupied by the corresponding seed article in the surgical innovation funnel. The network-based surgical innovation metrics were also validated against real world big data (National Inpatient Sample–NIS®). Results Rankings of surgical innovation across specialties by cascade size and structural virality (structural depth and width) were found to correlate closely with the ranking by innovation value (Spearman’s rank correlation coefficient = 0.758 (p = 0.01), 0.782 (p = 0.008), 0.624 (p = 0.05), respectively) which in turn matches the ranking based on real world big data from the NIS® (Spearman’s coefficient = 0.673;p = 0.033). Conclusion Network analysis offers unique new opportunities for understanding, modeling and measuring surgical innovation, and ultimately for assessing and comparing generative value between different

Improving cluster-based missing value estimation of DNA microarray data.

PubMed

Brás, Lígia P; Menezes, José C

2007-06-01

We present a modification of the weighted K-nearest neighbours imputation method (KNNimpute) for missing values (MVs) estimation in microarray data based on the reuse of estimated data. The method was called iterative KNN imputation (IKNNimpute) as the estimation is performed iteratively using the recently estimated values. The estimation efficiency of IKNNimpute was assessed under different conditions (data type, fraction and structure of missing data) by the normalized root mean squared error (NRMSE) and the correlation coefficients between estimated and true values, and compared with that of other cluster-based estimation methods (KNNimpute and sequential KNN). We further investigated the influence of imputation on the detection of differentially expressed genes using SAM by examining the differentially expressed genes that are lost after MV estimation. The performance measures give consistent results, indicating that the iterative procedure of IKNNimpute can enhance the prediction ability of cluster-based methods in the presence of high missing rates, in non-time series experiments and in data sets comprising both time series and non-time series data, because the information of the genes having MVs is used more efficiently and the iterative procedure allows refining the MV estimates. More importantly, IKNN has a smaller detrimental effect on the detection of differentially expressed genes.

The Association of Clinic-Based Mobility Tasks and Measures of Community Performance and Risk.

PubMed

Callisaya, Michele L; Verghese, Joe

2018-01-10

Gait speed is recognized as an important predictor of adverse outcomes in older people. However, it is unknown whether other more complex mobility tasks are better predictors of such outcomes. To examine a range of clinic-based mobility tests and determine which were most strongly associated with measures of community performance and risk (CP&R). Cross-sectional study. Central Control Mobility and Aging Study, Westchester County, New York. Aged ≥65 years (n = 424). Clinic-based mobility measures included gait speed measured during normal and dual-task conditions, the Floor Maze Immediate and Delay tasks, and stair ascending and descending. CP&R measures were self-reported by the use of standardized questionnaires and classified into measures of performance (distance walked, travel outside one's home [life space], activities of daily living, and participation in cognitive leisure activities) or risk (balance confidence, fear of falling, and past falls). Linear and logistic regression were used to examine associations between the clinic-based mobility measures and CP&R measures adjusting for covariates. The mean age of the sample was 77.8 (SD 6.4) years, and 55.2% (n = 234) were female. In final models, faster normal walking speed was most strongly associated with 5 of the 7 community measures (greater distance walked, greater life space, better activities of daily living function, higher balance confidence, and less fear of falling; all P < .05). More complex tasks (walking while talking and maze immediate) were associated with cognitive leisure activity (P < .05), and ascending stairs was the only measure associated with a history of falls (P < .05). Normal walking speed is a simple and inexpensive clinic-based mobility test that is associated with a wide range of CP&R measures. In addition, poorer performance ascending stairs may assist in identifying those at risk of falls. Poorer performance in more complex mobility tasks (walking while talking and maze

Computer-Based and Paper-Based Measurement of Recognition Performance.

ERIC Educational Resources Information Center

Federico, Pat-Anthony

To determine the relative reliabilities and validities of paper-based and computer-based measurement procedures, 83 male student pilots and radar intercept officers were administered computer and paper-based tests of aircraft recognition. The subject matter consisted of line drawings of front, side, and top silhouettes of aircraft. Reliabilities…

Developing safety performance functions incorporating reliability-based risk measures.

PubMed

Ibrahim, Shewkar El-Bassiouni; Sayed, Tarek

2011-11-01

Current geometric design guides provide deterministic standards where the safety margin of the design output is generally unknown and there is little knowledge of the safety implications of deviating from these standards. Several studies have advocated probabilistic geometric design where reliability analysis can be used to account for the uncertainty in the design parameters and to provide a risk measure of the implication of deviation from design standards. However, there is currently no link between measures of design reliability and the quantification of safety using collision frequency. The analysis presented in this paper attempts to bridge this gap by incorporating a reliability-based quantitative risk measure such as the probability of non-compliance (P(nc)) in safety performance functions (SPFs). Establishing this link will allow admitting reliability-based design into traditional benefit-cost analysis and should lead to a wider application of the reliability technique in road design. The present application is concerned with the design of horizontal curves, where the limit state function is defined in terms of the available (supply) and stopping (demand) sight distances. A comprehensive collision and geometric design database of two-lane rural highways is used to investigate the effect of the probability of non-compliance on safety. The reliability analysis was carried out using the First Order Reliability Method (FORM). Two Negative Binomial (NB) SPFs were developed to compare models with and without the reliability-based risk measures. It was found that models incorporating the P(nc) provided a better fit to the data set than the traditional (without risk) NB SPFs for total, injury and fatality (I+F) and property damage only (PDO) collisions. Copyright © 2011 Elsevier Ltd. All rights reserved.

Association of Practice-Level Social and Medical Risk With Performance in the Medicare Physician Value-Based Payment Modifier Program

PubMed Central

Epstein, Arnold M.; Orav, E. John; Filice, Clara E.; Samson, Lok Wong; Joynt Maddox, Karen E.

2017-01-01

Importance Medicare recently launched the Physician Value-Based Payment Modifier (PVBM) Program, a mandatory pay-for-performance program for physician practices. Little is known about performance by practices that serve socially or medically high-risk patients. Objective To compare performance in the PVBM Program by practice characteristics. Design, Setting, and Participants Cross-sectional observational study using PVBM Program data for payments made in 2015 based on performance of large US physician practices caring for fee-for-service Medicare beneficiaries in 2013. Exposures High social risk (defined as practices in the top quartile of proportion of patients dually eligible for Medicare and Medicaid) and high medical risk (defined as practices in the top quartile of mean Hierarchical Condition Category risk score among fee-for-service beneficiaries). Main Outcomes and Measures Quality and cost z scores based on a composite of individual measures. Higher z scores reflect better performance on quality; lower scores, better performance on costs. Results Among 899 physician practices with 5 189 880 beneficiaries, 547 practices were categorized as low risk (neither high social nor high medical risk) (mean, 7909 beneficiaries; mean, 320 clinicians), 128 were high medical risk only (mean, 3675 beneficiaries; mean, 370 clinicians), 102 were high social risk only (mean, 1635 beneficiaries; mean, 284 clinicians), and 122 were high medical and social risk (mean, 1858 beneficiaries; mean, 269 clinicians). Practices categorized as low risk performed the best on the composite quality score (z score, 0.18 [95% CI, 0.09 to 0.28]) compared with each of the practices categorized as high risk (high medical risk only: z score, −0.55 [95% CI, −0.77 to −0.32]; high social risk only: z score, −0.86 [95% CI, −1.17 to −0.54]; and high medical and social risk: −0.78 [95% CI, −1.04 to −0.51]) (P < .001 across groups). Practices categorized as high social risk

Case-Mix Adjusting Performance Measures in a Veteran Population: Pharmacy- and Diagnosis-Based Approaches

PubMed Central

Liu, Chuan-Fen; Sales, Anne E; Sharp, Nancy D; Fishman, Paul; Sloan, Kevin L; Todd-Stenberg, Jeff; Nichol, W Paul; Rosen, Amy K; Loveland, Susan

2003-01-01

Objective To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy- and diagnosis-based case-mix adjustment measures. Data Sources/Study Setting The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N=126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. Study Design We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Principal Findings Rankings of predicted utilization measures across facilities vary by case-mix adjustment measure. There is greater consistency within the diagnosis-based models than between the diagnosis- and pharmacy-based models. The eight facilities were ranked differently by the diagnosis- and pharmacy-based models. Conclusions Choice of case-mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility. PMID:14596393

A value-based medicine cost-utility analysis of idiopathic epiretinal membrane surgery.

PubMed

Gupta, Omesh P; Brown, Gary C; Brown, Melissa M

2008-05-01

To perform a reference case, cost-utility analysis of epiretinal membrane (ERM) surgery using current literature on outcomes and complications. Computer-based, value-based medicine analysis. Decision analyses were performed under two scenarios: ERM surgery in better-seeing eye and ERM surgery in worse-seeing eye. The models applied long-term published data primarily from the Blue Mountains Eye Study and the Beaver Dam Eye Study. Visual acuity and major complications were derived from 25-gauge pars plana vitrectomy studies. Patient-based, time trade-off utility values, Markov modeling, sensitivity analysis, and net present value adjustments were used in the design and calculation of results. Main outcome measures included the number of discounted quality-adjusted-life-years (QALYs) gained and dollars spent per QALY gained. ERM surgery in the better-seeing eye compared with observation resulted in a mean gain of 0.755 discounted QALYs (3% annual rate) per patient treated. This model resulted in $4,680 per QALY for this procedure. When sensitivity analysis was performed, utility values varied from $6,245 to $3,746/QALY gained, medical costs varied from $3,510 to $5,850/QALY gained, and ERM recurrence rate increased to $5,524/QALY. ERM surgery in the worse-seeing eye compared with observation resulted in a mean gain of 0.27 discounted QALYs per patient treated. The $/QALY was $16,146 with a range of $20,183 to $12,110 based on sensitivity analyses. Utility values ranged from $21,520 to $12,916/QALY and ERM recurrence rate increased to $16,846/QALY based on sensitivity analysis. ERM surgery is a very cost-effective procedure when compared with other interventions across medical subspecialties.

The Development and Validation of Brief and Ultrabrief Measures of Values.

PubMed

Sandy, Carson J; Gosling, Samuel D; Schwartz, Shalom H; Koelkebeck, Tim

2017-01-01

Values are a central personality construct and the importance of studying them has been well established. To encourage researchers to integrate measures of values into their studies, brief and ultrabrief instruments were developed to recapture the 10 values measured by the 40-item Portrait Values Questionnaire (PVQ; Schwartz, 2003 ). Rigorous psychometric procedures based on separate derivation (N = 38,049) and evaluation (N = 29,143) samples yielded 10- and 20-item measures of values, which proved to be successful at capturing the patterns and magnitude of correlations associated with the original PVQ. These instruments should be useful to researchers who would like to incorporate a values scale into their study but do not have the space to administer a longer measure.

Review of the Community College System's Performance-Based Program Budgeting Measures and Incentive Fund. Report 97-49.

ERIC Educational Resources Information Center

Florida State Legislature, Tallahassee. Office of Program Policy Analysis and Government Accountability.

This report addresses the Florida Community College System's (FCCS) performance based on measures established by the General Appropriations Act. Discussed are: (1) FCCS' performance on the measures used in the performance-based budgeting (PBB) incentive fund; (2) improvements that can be made to the PBB incentive fund; and (3) changes to community…

Predictors of performance-based measures of instrumental activities of daily living in nondemented patients with Parkinson's disease.

PubMed

Pirogovsky, Eva; Martinez-Hannon, Mercedes; Schiehser, Dawn M; Lessig, Stephanie L; Song, David D; Litvan, Irene; Filoteo, J Vincent

2013-01-01

Few studies have examined instrumental activities of daily living (iADLs) in nondemented Parkinson's disease (PD), and the majority of these studies have used report-based measures, which can have limited validity. The present study had two main goals: (a) to examine the performance of nondemented PD patients on two performance-based measures of iADLs, which are considered more objective functional measures, and (b) to examine the cognitive, motor, and psychiatric correlates of iADL impairment in PD. Ninety-eight nondemented PD patients and 47 healthy older adults were administered performance-based measures that assess the ability to manage medications (Medication Management Ability Assessment) and finances (University of California, San Diego, UCSD, Performance-based Skills Assessment), the Mattis Dementia Rating Scale to assess global cognitive functioning, the Unified Parkinson's Disease Rating Scale Part III to assess motor symptom severity, and the Geriatric Depression Scale to assess depressive symptoms. Nondemented PD patients demonstrated significantly impaired scores relative to the healthy comparison group on the performance-based measure of financial management, but there were no significant group differences in medication management. Global cognitive functioning, motor severity, and depressive symptoms did not correlate with scores on either of the functional measures, except for a small correlation between depressive symptoms and financial management. The two performance-based measures of iADL functioning did not correlate with one another. These findings suggest that medication and financial management may not be predicted based on global cognitive functioning and that iADLs may not be represented by a single construct. Furthermore, these findings suggest the potential need for a multidimensional approach to assessing iADLs.

Measure-valued solutions to the complete Euler system revisited

NASA Astrophysics Data System (ADS)

Březina, Jan; Feireisl, Eduard

2018-06-01

We consider the complete Euler system describing the time evolution of a general inviscid compressible fluid. We introduce a new concept of measure-valued solution based on the total energy balance and entropy inequality for the physical entropy without any renormalization. This class of so-called dissipative measure-valued solutions is large enough to include the vanishing dissipation limits of the Navier-Stokes-Fourier system. Our main result states that any sequence of weak solutions to the Navier-Stokes-Fourier system with vanishing viscosity and heat conductivity coefficients generates a dissipative measure-valued solution of the Euler system under some physically grounded constitutive relations. Finally, we discuss the same asymptotic limit for the bi-velocity fluid model introduced by H.Brenner.

Watermarking scheme based on singular value decomposition and homomorphic transform

NASA Astrophysics Data System (ADS)

Verma, Deval; Aggarwal, A. K.; Agarwal, Himanshu

2017-10-01

A semi-blind watermarking scheme based on singular-value-decomposition (SVD) and homomorphic transform is pro-posed. This scheme ensures the digital security of an eight bit gray scale image by inserting an invisible eight bit gray scale wa-termark into it. The key approach of the scheme is to apply the homomorphic transform on the host image to obtain its reflectance component. The watermark is embedded into the singular values that are obtained by applying the singular value decomposition on the reflectance component. Peak-signal-to-noise-ratio (PSNR), normalized-correlation-coefficient (NCC) and mean-structural-similarity-index-measure (MSSIM) are used to evaluate the performance of the scheme. Invisibility of watermark is ensured by visual inspection and high value of PSNR of watermarked images. Presence of watermark is ensured by visual inspection and high values of NCC and MSSIM of extracted watermarks. Robustness of the scheme is verified by high values of NCC and MSSIM for attacked watermarked images.

Reference values for developing responsive functional outcome measures across the lifespan.

PubMed

McKay, Marnee J; Baldwin, Jennifer N; Ferreira, Paulo; Simic, Milena; Vanicek, Natalie; Burns, Joshua

2017-04-18

To generate a reference dataset of commonly performed functional outcome measures in 1,000 children and adults and investigate the influence of demographic, anthropometric, strength, and flexibility characteristics. Twelve functional outcome measures were collected from 1,000 healthy individuals aged 3-101 years: 6-minute walk test, 30-second chair stand test, timed stairs test, long jump, vertical jump, choice stepping reaction time, balance (Star Excursion Balance Test, tandem stance eyes open and closed, single-leg stance eyes closed), and dexterity (9-hole peg test, Functional Dexterity Test). Correlation and multiple regression analyses were performed to identify factors independently associated with each measure. Age- and sex-stratified reference values for functional outcome measures were generated. Functional performance increased through childhood and adolescence, plateaued during adulthood, and declined in older adulthood. While balance did not differ between the sexes, male participants generally performed better at gross motor tasks while female participants performed better at dexterous tasks. Height was the most consistent correlate of functional performance in children, while lower limb muscle strength was a major determinant in adolescents and adults. In older adults, age, lower limb strength, and joint flexibility explained up to 63% of the variance in functional measures. These normative reference values provide a framework to accurately track functional decline associated with neuromuscular disorders and assist development and validation of responsive outcome measures for therapeutic trials. © 2017 American Academy of Neurology.

Airborne and Ground-Based Measurements Using a High-Performance Raman Lidar

NASA Technical Reports Server (NTRS)

Whiteman, David N.; Rush, Kurt; Rabenhorst, Scott; Welch, Wayne; Cadirola, Martin; McIntire, Gerry; Russo, Felicita; Adam, Mariana; Venable, Demetrius; Connell, Rasheen;

Reverse engineering gene regulatory networks from measurement with missing values.

PubMed

Ogundijo, Oyetunji E; Elmas, Abdulkadir; Wang, Xiaodong

2016-12-01

Gene expression time series data are usually in the form of high-dimensional arrays. Unfortunately, the data may sometimes contain missing values: for either the expression values of some genes at some time points or the entire expression values of a single time point or some sets of consecutive time points. This significantly affects the performance of many algorithms for gene expression analysis that take as an input, the complete matrix of gene expression measurement. For instance, previous works have shown that gene regulatory interactions can be estimated from the complete matrix of gene expression measurement. Yet, till date, few algorithms have been proposed for the inference of gene regulatory network from gene expression data with missing values. We describe a nonlinear dynamic stochastic model for the evolution of gene expression. The model captures the structural, dynamical, and the nonlinear natures of the underlying biomolecular systems. We present point-based Gaussian approximation (PBGA) filters for joint state and parameter estimation of the system with one-step or two-step missing measurements . The PBGA filters use Gaussian approximation and various quadrature rules, such as the unscented transform (UT), the third-degree cubature rule and the central difference rule for computing the related posteriors. The proposed algorithm is evaluated with satisfying results for synthetic networks, in silico networks released as a part of the DREAM project, and the real biological network, the in vivo reverse engineering and modeling assessment (IRMA) network of yeast Saccharomyces cerevisiae . PBGA filters are proposed to elucidate the underlying gene regulatory network (GRN) from time series gene expression data that contain missing values. In our state-space model, we proposed a measurement model that incorporates the effect of the missing data points into the sequential algorithm. This approach produces a better inference of the model parameters and hence

Shrinkage regression-based methods for microarray missing value imputation.

PubMed

Wang, Hsiuying; Chiu, Chia-Chun; Wu, Yi-Ching; Wu, Wei-Sheng

2013-01-01

Missing values commonly occur in the microarray data, which usually contain more than 5% missing values with up to 90% of genes affected. Inaccurate missing value estimation results in reducing the power of downstream microarray data analyses. Many types of methods have been developed to estimate missing values. Among them, the regression-based methods are very popular and have been shown to perform better than the other types of methods in many testing microarray datasets. To further improve the performances of the regression-based methods, we propose shrinkage regression-based methods. Our methods take the advantage of the correlation structure in the microarray data and select similar genes for the target gene by Pearson correlation coefficients. Besides, our methods incorporate the least squares principle, utilize a shrinkage estimation approach to adjust the coefficients of the regression model, and then use the new coefficients to estimate missing values. Simulation results show that the proposed methods provide more accurate missing value estimation in six testing microarray datasets than the existing regression-based methods do. Imputation of missing values is a very important aspect of microarray data analyses because most of the downstream analyses require a complete dataset. Therefore, exploring accurate and efficient methods for estimating missing values has become an essential issue. Since our proposed shrinkage regression-based methods can provide accurate missing value estimation, they are competitive alternatives to the existing regression-based methods.

Value-Based Assessment of Radiology Reporting Using Radiologist-Referring Physician Two-Way Feedback System-a Design Thinking-Based Approach.

PubMed

Shaikh, Faiq; Hendrata, Kenneth; Kolowitz, Brian; Awan, Omer; Shrestha, Rasu; Deible, Christopher

2017-06-01

In the era of value-based healthcare, many aspects of medical care are being measured and assessed to improve quality and reduce costs. Radiology adds enormously to health care costs and is under pressure to adopt a more efficient system that incorporates essential metrics to assess its value and impact on outcomes. Most current systems tie radiologists' incentives and evaluations to RVU-based productivity metrics and peer-review-based quality metrics. In a new potential model, a radiologist's performance will have to increasingly depend on a number of parameters that define "value," beginning with peer review metrics that include referrer satisfaction and feedback from radiologists to the referring physician that evaluates the potency and validity of clinical information provided for a given study. These new dimensions of value measurement will directly impact the cascade of further medical management. We share our continued experience with this project that had two components: RESP (Referrer Evaluation System Pilot) and FRACI (Feedback from Radiologist Addressing Confounding Issues), which were introduced to the clinical radiology workflow in order to capture referrer-based and radiologist-based feedback on radiology reporting. We also share our insight into the principles of design thinking as applied in its planning and execution.

International comparison of experience-based health state values at the population level.

PubMed

Heijink, Richard; Reitmeir, Peter; Leidl, Reiner

2017-07-07

Decision makers need to know whether health state values, an important component of summary measures of health, are valid for their target population. A key outcome is the individuals' valuation of their current health. This experience-based perspective is increasingly used to derive health state values. This study is the first to compare such experience-based valuations at the population level across countries. We examined the relationship between respondents' self-rated health as measured by the EQ-VAS, and the different dimensions and levels of the EQ-5D-3 L. The dataset included almost 32,000 survey respondents from 15 countries. We estimated generalized linear models with logit link function, including country-specific models and pooled-data models with country effects. The results showed significant and meaningful differences in the valuation of health states and individual health dimensions between countries, even though similarities were present too. Between countries, coefficients correlated positively for the values of mobility, self-care and usual activities, but not for the values of pain and anxiety, thus underlining structural differences. The findings indicate that, ideally, population-specific experience-based value sets are developed and used for the calculation of health outcomes. Otherwise, sensitivity analyses are needed. Furthermore, transferring the results of foreign studies into the national context should be performed with caution. We recommend future studies to investigate the causes of differences in experience-based health state values through a single international study possibly complemented with qualitative research on the determinants of valuation.

[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.

Curriculum-Based Measurement in Science Learning: Vocabulary-Matching as an Indicator of Performance and Progress

ERIC Educational Resources Information Center

Espin, Christine A.; Busch, Todd W.; Lembke, Erica S.; Hampton, David D.; Seo, Kyounghee; Zukowski, Beth A.

2013-01-01

The technical adequacy of curriculum-based measures in the form of short and simple vocabulary-matching probes to predict students' performance and progress in science at the secondary level was investigated. Participants were 198 seventh-grade students from 10 science classrooms. Curriculum-based measurements (CBM) were 5-min vocabulary-matching…

What can the past of pay-for-performance tell us about the future of Value-Based Purchasing in Medicare?

PubMed

Ryan, Andrew M; Damberg, Cheryl L

2013-06-01

The Medicare program has implemented pay-for-performance (P4P), or Value-Based Purchasing, for inpatient care and for Medicare Advantage plans, and plans to implement a program for physicians in 2015. In this paper, we review evidence on the effectiveness of P4P and identify design criteria deemed to be best practice in P4P. We then assess the extent to which Medicare's existing and planned Value-Based Purchasing programs align with these best practices. Of the seven identified best practices in P4P program design, the Hospital Value-Based Purchasing program is strongly aligned with two of the best practices, moderately aligned with three, weakly aligned with one, and has unclear alignment with one best practice. The Physician Value-Based Purchasing Modifier is strongly aligned with two of the best practices, moderately aligned with one, weakly aligned with three, and has unclear alignment with one of the best practices. The Medicare Advantage Quality Bonus Program is strongly aligned with four of the best practices, moderately aligned with two, and weakly aligned with one of the best practices. We identify enduring gaps in P4P literature as it relates to Medicare's plans for Value-Based Purchasing and discuss important issues in the future of these implementations in Medicare. Copyright © 2013 Elsevier Inc. 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

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

Link-Based Similarity Measures Using Reachability Vectors

PubMed Central

Yoon, Seok-Ho; Kim, Ji-Soo; Ryu, Minsoo; Choi, Ho-Jin

2014-01-01

We present a novel approach for computing link-based similarities among objects accurately by utilizing the link information pertaining to the objects involved. We discuss the problems with previous link-based similarity measures and propose a novel approach for computing link based similarities that does not suffer from these problems. In the proposed approach each target object is represented by a vector. Each element of the vector corresponds to all the objects in the given data, and the value of each element denotes the weight for the corresponding object. As for this weight value, we propose to utilize the probability of reaching from the target object to the specific object, computed using the “Random Walk with Restart” strategy. Then, we define the similarity between two objects as the cosine similarity of the two vectors. In this paper, we provide examples to show that our approach does not suffer from the aforementioned problems. We also evaluate the performance of the proposed methods in comparison with existing link-based measures, qualitatively and quantitatively, with respect to two kinds of data sets, scientific papers and Web documents. Our experimental results indicate that the proposed methods significantly outperform the existing measures. PMID:24701188

The incremental value of self-reported mental health measures in predicting functional outcomes of veterans.

PubMed

Eisen, Susan V; Bottonari, Kathryn A; Glickman, Mark E; Spiro, Avron; Schultz, Mark R; Herz, Lawrence; Rosenheck, Robert; Rofman, Ethan S

2011-04-01

Research on patient-centered care supports use of patient/consumer self-report measures in monitoring health outcomes. This study examined the incremental value of self-report mental health measures relative to a clinician-rated measure in predicting functional outcomes among mental health service recipients. Participants (n = 446) completed the Behavior and Symptom Identification Scale, the Brief Symptom Inventory, and the Veterans/Rand Short Form-36 at enrollment in the study (T1) and 3 months later (T2). Global Assessment of Functioning (GAF) ratings, mental health service utilization, and psychiatric diagnoses were obtained from administrative data files. Controlling for demographic and clinical variables, results indicated that improvement based on the self-report measures significantly predicted one or more functional outcomes (i.e., decreased likelihood of post-enrollment psychiatric hospitalization and increased likelihood of paid employment), above and beyond the predictive value of the GAF. Inclusion of self-report measures may be a useful addition to performance measurement efforts.

Direct quantum process tomography via measuring sequential weak values of incompatible observables.

PubMed

Kim, Yosep; Kim, Yong-Su; Lee, Sang-Yun; Han, Sang-Wook; Moon, Sung; Kim, Yoon-Ho; Cho, Young-Wook

2018-01-15

The weak value concept has enabled fundamental studies of quantum measurement and, recently, found potential applications in quantum and classical metrology. However, most weak value experiments reported to date do not require quantum mechanical descriptions, as they only exploit the classical wave nature of the physical systems. In this work, we demonstrate measurement of the sequential weak value of two incompatible observables by making use of two-photon quantum interference so that the results can only be explained quantum physically. We then demonstrate that the sequential weak value measurement can be used to perform direct quantum process tomography of a qubit channel. Our work not only demonstrates the quantum nature of weak values but also presents potential new applications of weak values in analyzing quantum channels and operations.

Reliability of a computer-based system for measuring visual performance skills.

PubMed

Erickson, Graham B; Citek, Karl; Cove, Michelle; Wilczek, Jennifer; Linster, Carolyn; Bjarnason, Brendon; Langemo, Nathan

2011-09-01

Athletes have demonstrated better visual abilities than nonathletes. A vision assessment for an athlete should include methods to evaluate the quality of visual performance skills in the most appropriate, accurate, and repeatable manner. This study determines the reliability of the visual performance measures assessed with a computer-based system, known as the Nike Sensory Station. One hundred twenty-five subjects (56 men, 69 women), age 18 to 30, completed Phase I of the study. Subjects attended 2 sessions, separated by at least 1 week, in which identical protocols were followed. Subjects completed the following assessments: Visual Clarity, Contrast Sensitivity, Depth Perception, Near-Far Quickness, Target Capture, Perception Span, Eye-Hand Coordination, Go/No Go, and Reaction Time. An additional 36 subjects (20 men, 16 women), age 22 to 35, completed Phase II of the study involving modifications to the equipment, instructions, and protocols from Phase I. Results show no significant change in performance over time on assessments of Visual Clarity, Contrast Sensitivity, Depth Perception, Target Capture, Perception Span, and Reaction Time. Performance did improve over time for Near-Far Quickness, Eye-Hand Coordination, and Go/No Go. The results of this study show that many of the Nike Sensory Station assessments show repeatability and no learning effect over time. The measures that did improve across sessions show an expected learning effect caused by the motor response characteristics being measured. Copyright © 2011 American Optometric Association. Published by Elsevier Inc. All rights reserved.

A Measurement and Simulation Based Methodology for Cache Performance Modeling and Tuning

NASA Technical Reports Server (NTRS)

Waheed, Abdul; Yan, Jerry; Saini, Subhash (Technical Monitor)

1998-01-01

We present a cache performance modeling methodology that facilitates the tuning of uniprocessor cache performance for applications executing on shared memory multiprocessors by accurately predicting the effects of source code level modifications. Measurements on a single processor are initially used for identifying parts of code where cache utilization improvements may significantly impact the overall performance. Cache simulation based on trace-driven techniques can be carried out without gathering detailed address traces. Minimal runtime information for modeling cache performance of a selected code block includes: base virtual addresses of arrays, virtual addresses of variables, and loop bounds for that code block. Rest of the information is obtained from the source code. We show that the cache performance predictions are as reliable as those obtained through trace-driven simulations. This technique is particularly helpful to the exploration of various "what-if' scenarios regarding the cache performance impact for alternative code structures. We explain and validate this methodology using a simple matrix-matrix multiplication program. We then apply this methodology to predict and tune the cache performance of two realistic scientific applications taken from the Computational Fluid Dynamics (CFD) domain.

Developing a GPS-based truck freight performance measure platform.

DOT National Transportation Integrated Search

2010-05-01

Although trucks move the largest volume and value of goods in urban areas, relatively little is known about their travel : patterns and how the roadway network performs for trucks. Global positioning systems (GPS) used by trucking : companies to mana...

Measurement and research on the appearance of tongue board based on modification to discuss centrifugal fan air performance

NASA Astrophysics Data System (ADS)

Jwo, Ching-Song; Cheng, Tseng-Tang; Cho, Hung-Pin; Chiang, Wei-Tang; Chen, Sih-Li; Chen, Chien-Wei; Jian, Ling-You

2011-12-01

This paper presents a reduced fan noise method, with increased fan-benefit analysis of various performances. The experimental approach adopts changes in the outlet in the form of two fans (flat tongue and a V-Type tongue plate) in order to measure the noise under the two forms of value and volume of supply air fan, shaft power consumption, operating current, and static pressure. The results showed that the tongue plate and the V-plane tongue plate noise between the value of the measurement location of 6.7 in the tongue plate in the plane below the noise level is about V-tongue plate 1 ~ 1.5dB (A). Air flow rate testing showed that the flat plate and the V-Type tongue plate between the tongue plate V-Type flow rate value, the measurement location of 3.4 in the tongue plate in the plane was more than the V-Type flow rate tongue plate 5 to 5.5%. Shaft power testing of measurement model 3, and measurement model 4, showed that the tongue plate in the plane V-tongue plate was more than 8%, 5%. The measurement models 3 and 4 and 5 showed more than the V-Type plane tongue plate 1%, 2.7%, and 2.6%. The measurement models 6 and 8 showed that, the flat tongue plate is less than the V-tongue plate of 2.9% and 2.3%. Static pressure testing showed that the flat tongue plate in particular measurement models (3,4,8,9), the static value of V-tongue plate than the 11.1% higher, respectively, 9%, 4.3%, and 3.7%. The results summarized above suggest that, in the specific measurement points, when parallel to the tongue plate the V-tongue board has better performance.

[Implicit value judgments in the measurement of health inequalities].

PubMed

Harper, Sam; King, Nicholas B; Meersman, Stephen C; E Reichman, Marsha; Breen, Nancy; Lynch, John

2014-04-01

Quantitative estimates of the magnitude, direction, and rate of change of health inequalities play a crucial role in creating and assessing policies aimed at eliminating the disproportionate burden of disease in disadvantaged populations. It is generally assumed that the measurement of health inequalities is a value-neutral process, providing objective data that are then interpreted using normative judgments about whether a particular distribution of health is just, fair, or socially acceptable. We discuss five examples in which normative judgments play a role in the measurement process itself, through either the selection of one measurement strategy to the exclusion of others or the selection of the type, significance, or weight assigned to the variables being measured. Overall, we find that many commonly used measures of inequality are value laden and that the normative judgments implicit in these measures have important consequences for interpreting and responding to health inequalities. Because values implicit in the generation of health inequality measures may lead to radically different interpretations of the same underlying data,we urge researchers to explicitly consider and transparently discuss the normative judgments underlying their measures. We also urge policymakers and other consumers of health inequalities data to pay close attention to the measures on which they base their assessments of current and future health policies.

Implicit value judgments in the measurement of health inequalities.

PubMed

Harper, Sam; King, Nicholas B; Meersman, Stephen C; Reichman, Marsha E; Breen, Nancy; Lynch, John

2010-03-01

Quantitative estimates of the magnitude, direction, and rate of change of health inequalities play a crucial role in creating and assessing policies aimed at eliminating the disproportionate burden of disease in disadvantaged populations. It is generally assumed that the measurement of health inequalities is a value-neutral process, providing objective data that are then interpreted using normative judgments about whether a particular distribution of health is just, fair, or socially acceptable. We discuss five examples in which normative judgments play a role in the measurement process itself, through either the selection of one measurement strategy to the exclusion of others or the selection of the type, significance, or weight assigned to the variables being measured. Overall, we find that many commonly used measures of inequality are value laden and that the normative judgments implicit in these measures have important consequences for interpreting and responding to health inequalities. Because values implicit in the generation of health inequality measures may lead to radically different interpretations of the same underlying data, we urge researchers to explicitly consider and transparently discuss the normative judgments underlying their measures. We also urge policymakers and other consumers of health inequalities data to pay close attention to the measures on which they base their assessments of current and future health policies.

Occupational physicians' perceived value of evidence-based medicine intervention in enhancing their professional performance.

PubMed

Hugenholtz, Nathalie I R; Schaafsma, Frederieke G; Schreinemakers, Jos F; van Dijk, Frank J H; Nieuwenhuijsen, Karen

2008-06-01

This study evaluated how physicians in a nonclinical setting perceive the value of an intervention with multifaceted evidence-based medicine with regard to enhancing their professional performance. A qualitative study was conducted using focus groups and face-to-face interviews with 14 of the 48 Dutch occupational physicians who participated in the intervention. The intervention combined a didactic course in evidence-based medicine with recurrent case-method learning sessions. During the sessions, the participants were challenged to discuss their cases and to give one another feedback on how to find information on cases. Five main themes and four subthemes were identified: professional behavior and quality of care (subtheme: transparency): occupational physicians associated being up-to-date with quality of care, and evidence-based medicine was associated with improvements in professional standards; critical attitude and improved recommendations: occupational physicians asked themselves more-profound questions and searched more for information; sharing knowledge: the peer-group sessions facilitated the sharing of knowledge; communication (subthemes: colleagues, clients and other specialists): the more soundly based recommendations enhanced self-confidence positively and therefore altered interaction with medical specialists in particular; and satisfaction and barriers: the occupational physicians were especially content with the structured discussion in the peer-group sessions. However, the intervention was very time consuming. The participants regarded the intervention as a useful method for enhancing their professional performance. They stated that they became more up-to-date and more self-confident by searching for and sharing knowledge. These actions resulted in more scientifically based recommendations and improved interaction with clients and other specialists. However, time constraints remain an important barrier.

Further insight into the incremental value of new markers: the interpretation of performance measures and the importance of clinical context.

PubMed

Kerr, Kathleen F; Bansal, Aasthaa; Pepe, Margaret S

2012-09-15

In this issue of the Journal, Pencina and et al. (Am J Epidemiol. 2012;176(6):492-494) examine the operating characteristics of measures of incremental value. Their goal is to provide benchmarks for the measures that can help identify the most promising markers among multiple candidates. They consider a setting in which new predictors are conditionally independent of established predictors. In the present article, the authors consider more general settings. Their results indicate that some of the conclusions made by Pencina et al. are limited to the specific scenarios the authors considered. For example, Pencina et al. observed that continuous net reclassification improvement was invariant to the strength of the baseline model, but the authors of the present study show this invariance does not hold generally. Further, they disagree with the suggestion that such invariance would be desirable for a measure of incremental value. They also do not see evidence to support the claim that the measures provide complementary information. In addition, they show that correlation with baseline predictors can lead to much bigger gains in performance than the conditional independence scenario studied by Pencina et al. Finally, the authors note that the motivation of providing benchmarks actually reinforces previous observations that the problem with these measures is they do not have useful clinical interpretations. If they did, researchers could use the measures directly and benchmarks would not be needed.

Advanced Engineering Technology for Measuring Performance.

PubMed

Rutherford, Drew N; D'Angelo, Anne-Lise D; Law, Katherine E; Pugh, Carla M

2015-08-01

The demand for competency-based assessments in surgical training is growing. Use of advanced engineering technology for clinical skills assessment allows for objective measures of hands-on performance. Clinical performance can be assessed in several ways via quantification of an assessee's hand movements (motion tracking), direction of visual attention (eye tracking), levels of stress (physiologic marker measurements), and location and pressure of palpation (force measurements). Innovations in video recording technology and qualitative analysis tools allow for a combination of observer- and technology-based assessments. Overall the goal is to create better assessments of surgical performance with robust validity evidence. Copyright © 2015 Elsevier Inc. All rights reserved.

Organizational characteristics, financial performance measures, and funding sources of faith based organizations.

PubMed

Lampkin, Lynne; Raghavan, Kamala

2008-01-01

This study examined the impact of organizational characteristics and financial performance measures of faith based organizations (FBOS) in Pennsylvania and Ohio on the decisions of the funding sources. Organizational characteristics of size, age, and type of service, and financial performance measures such as expense, liquidity, and solvency ratios were gathered from the data on IRS form 990 for 97 FBOS for the period of 1995 to 2004. The study found that the 1996 Charitable Choice provisions and the 2001 Office of Faith-Based and Community Initiatives have led to increased government funding for FBOS. The results showed that government funding of FBOS is affected positively by age of the FBO, and negatively by its size. For smaller FBOS, savings ratio had a negative relationship to government funding and a positive relationship to direct public support. For social service FBOS government funding was positively affected by age and negatively affected by size and debt ratio, while days-cash-on-hand had a negative impact on direct public support. All of the above relationships were statistically significant.

Using Performance Measures in the Federal Budget Process

DTIC Science & Technology

1993-07-01

developed in private sector , the primary measure of perfor- three different ways. The first is by budgeting mance for an organization as a whole is...example, a mass transit agency that in the private sector . This subjectivity has led stresses efficiency as a primary value would to the development of more...Public Sector 1 Obstacles to Measuring the Performance of Federal Agencies 3 How Can Performance Measurement Affect the Budget Process? 7 Conclusion 9

Spaceport Performance Measures

NASA Technical Reports Server (NTRS)

Finger, G. Wayne

2010-01-01

Spaceports have traditionally been characterized by performance measures associated with their site characteristics. Measures such as "Latitude" (proximity to the equator), "Azimuth" (range of available launch azimuths) and "Weather" (days of favorable weather) are commonly used to characterize a particular spaceport. However, other spaceport performance measures may now be of greater value. These measures can provide insight into areas of operational differences between competing spaceports and identify areas for improving the performance of spaceports. This paper suggests Figures of Merit (FOMs) for spaceport "Capacity" (number of potential launch opportunities per year and / or potential mass' to low earth orbit (LEO) per year); "Throughput" (actual mass to orbit per year compared to capacity); "Productivity" (labor effort hours per unit mass to orbit); "Energy Efficiency" (joules expended at spaceport per unit mass to orbit); "Carbon Footprint" tons CO2 per unit mass to orbit). Additional FOMS are investigated with regards to those areas of special interest to commercial launch operators, such as "Assignment Schedule" (days required for a binding assignment of a launch site from the spaceport); "Approval Schedule" (days to complete a range safety assessment leading to an approval or disapproval of a launch vehicle); "Affordability" (cost for a spaceport to assess a new launch vehicle); "Launch Affordability" (fixed range costs per launch); "Reconfigure Time" (hours to reconfigure the range from one vehicle's launch ready configuration to another vehicle's configuration); "Turn,Around Time" (minimum range hours required between launches of an identical type launch vehicle). Available or notional data is analyzed for the KSC/CCAFS area and other spaceports. Observations regarding progress over the past few decades are made. Areas where improvement are needed or indicated are suggested.

Measures of rowing performance.

PubMed

Smith, T Brett; Hopkins, Will G

2012-04-01

Accurate measures of performance are important for assessing competitive athletes in practi~al and research settings. We present here a review of rowing performance measures, focusing on the errors in these measures and the implications for testing rowers. The yardstick for assessing error in a performance measure is the random variation (typical or standard error of measurement) in an elite athlete's competitive performance from race to race: ∼1.0% for time in 2000 m rowing events. There has been little research interest in on-water time trials for assessing rowing performance, owing to logistic difficulties and environmental perturbations in performance time with such tests. Mobile ergometry via instrumented oars or rowlocks should reduce these problems, but the associated errors have not yet been reported. Measurement of boat speed to monitor on-water training performance is common; one device based on global positioning system (GPS) technology contributes negligible extra random error (0.2%) in speed measured over 2000 m, but extra error is substantial (1-10%) with other GPS devices or with an impeller, especially over shorter distances. The problems with on-water testing have led to widespread use of the Concept II rowing ergometer. The standard error of the estimate of on-water 2000 m time predicted by 2000 m ergometer performance was 2.6% and 7.2% in two studies, reflecting different effects of skill, body mass and environment in on-water versus ergometer performance. However, well trained rowers have a typical error in performance time of only ∼0.5% between repeated 2000 m time trials on this ergometer, so such trials are suitable for tracking changes in physiological performance and factors affecting it. Many researchers have used the 2000 m ergometer performance time as a criterion to identify other predictors of rowing performance. Standard errors of the estimate vary widely between studies even for the same predictor, but the lowest

Non-invasive continuous blood pressure measurement based on mean impact value method, BP neural network, and genetic algorithm.

PubMed

Tan, Xia; Ji, Zhong; Zhang, Yadan

2018-04-25

Non-invasive continuous blood pressure monitoring can provide an important reference and guidance for doctors wishing to analyze the physiological and pathological status of patients and to prevent and diagnose cardiovascular diseases in the clinical setting. Therefore, it is very important to explore a more accurate method of non-invasive continuous blood pressure measurement. To address the shortcomings of existing blood pressure measurement models based on pulse wave transit time or pulse wave parameters, a new method of non-invasive continuous blood pressure measurement - the GA-MIV-BP neural network model - is presented. The mean impact value (MIV) method is used to select the factors that greatly influence blood pressure from the extracted pulse wave transit time and pulse wave parameters. These factors are used as inputs, and the actual blood pressure values as outputs, to train the BP neural network model. The individual parameters are then optimized using a genetic algorithm (GA) to establish the GA-MIV-BP neural network model. Bland-Altman consistency analysis indicated that the measured and predicted blood pressure values were consistent and interchangeable. Therefore, this algorithm is of great significance to promote the clinical application of a non-invasive continuous blood pressure monitoring method.

Detecting Anomalies from End-to-End Internet Performance Measurements (PingER) Using Cluster Based Local Outlier Factor

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

Ali, Saqib; Wang, Guojun; Cottrell, Roger Leslie

PingER (Ping End-to-End Reporting) is a worldwide end-to-end Internet performance measurement framework. It was developed by the SLAC National Accelerator Laboratory, Stanford, USA and running from the last 20 years. It has more than 700 monitoring agents and remote sites which monitor the performance of Internet links around 170 countries of the world. At present, the size of the compressed PingER data set is about 60 GB comprising of 100,000 flat files. The data is publicly available for valuable Internet performance analyses. However, the data sets suffer from missing values and anomalies due to congestion, bottleneck links, queuing overflow, networkmore » software misconfiguration, hardware failure, cable cuts, and social upheavals. Therefore, the objective of this paper is to detect such performance drops or spikes labeled as anomalies or outliers for the PingER data set. In the proposed approach, the raw text files of the data set are transformed into a PingER dimensional model. The missing values are imputed using the k-NN algorithm. The data is partitioned into similar instances using the k-means clustering algorithm. Afterward, clustering is integrated with the Local Outlier Factor (LOF) using the Cluster Based Local Outlier Factor (CBLOF) algorithm to detect the anomalies or outliers from the PingER data. Lastly, anomalies are further analyzed to identify the time frame and location of the hosts generating the major percentage of the anomalies in the PingER data set ranging from 1998 to 2016.« less

Detecting Anomalies from End-to-End Internet Performance Measurements (PingER) Using Cluster Based Local Outlier Factor

DOE PAGES

Ali, Saqib; Wang, Guojun; Cottrell, Roger Leslie; ...

2018-05-28

PingER (Ping End-to-End Reporting) is a worldwide end-to-end Internet performance measurement framework. It was developed by the SLAC National Accelerator Laboratory, Stanford, USA and running from the last 20 years. It has more than 700 monitoring agents and remote sites which monitor the performance of Internet links around 170 countries of the world. At present, the size of the compressed PingER data set is about 60 GB comprising of 100,000 flat files. The data is publicly available for valuable Internet performance analyses. However, the data sets suffer from missing values and anomalies due to congestion, bottleneck links, queuing overflow, networkmore » software misconfiguration, hardware failure, cable cuts, and social upheavals. Therefore, the objective of this paper is to detect such performance drops or spikes labeled as anomalies or outliers for the PingER data set. In the proposed approach, the raw text files of the data set are transformed into a PingER dimensional model. The missing values are imputed using the k-NN algorithm. The data is partitioned into similar instances using the k-means clustering algorithm. Afterward, clustering is integrated with the Local Outlier Factor (LOF) using the Cluster Based Local Outlier Factor (CBLOF) algorithm to detect the anomalies or outliers from the PingER data. Lastly, anomalies are further analyzed to identify the time frame and location of the hosts generating the major percentage of the anomalies in the PingER data set ranging from 1998 to 2016.« less

Predicting Document Retrieval System Performance: An Expected Precision Measure.

ERIC Educational Resources Information Center

Losee, Robert M., Jr.

1987-01-01

Describes an expected precision (EP) measure designed to predict document retrieval performance. Highlights include decision theoretic models; precision and recall as measures of system performance; EP graphs; relevance feedback; and computing the retrieval status value of a document for two models, the Binary Independent Model and the Two Poisson…

Clustering of reads with alignment-free measures and quality values.

PubMed

Comin, Matteo; Leoni, Andrea; Schimd, Michele

2015-01-01

The data volume generated by Next-Generation Sequencing (NGS) technologies is growing at a pace that is now challenging the storage and data processing capacities of modern computer systems. In this context an important aspect is the reduction of data complexity by collapsing redundant reads in a single cluster to improve the run time, memory requirements, and quality of post-processing steps like assembly and error correction. Several alignment-free measures, based on k-mers counts, have been used to cluster reads. Quality scores produced by NGS platforms are fundamental for various analysis of NGS data like reads mapping and error detection. Moreover future-generation sequencing platforms will produce long reads but with a large number of erroneous bases (up to 15 %). In this scenario it will be fundamental to exploit quality value information within the alignment-free framework. To the best of our knowledge this is the first study that incorporates quality value information and k-mers counts, in the context of alignment-free measures, for the comparison of reads data. Based on this principles, in this paper we present a family of alignment-free measures called D (q) -type. A set of experiments on simulated and real reads data confirms that the new measures are superior to other classical alignment-free statistics, especially when erroneous reads are considered. Also results on de novo assembly and metagenomic reads classification show that the introduction of quality values improves over standard alignment-free measures. These statistics are implemented in a software called QCluster (http://www.dei.unipd.it/~ciompin/main/qcluster.html).

Moving healthcare quality forward with nursing-sensitive value-based purchasing.

PubMed

Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth

2012-12-01

To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society. © 2012 Sigma Theta Tau International.

Moving Healthcare Quality Forward With Nursing-Sensitive Value-Based Purchasing

PubMed Central

Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth

2012-01-01

Purpose: To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Design and Methods: Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. Findings: Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. Conclusions: Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. Clinical Relevance: NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society. PMID:23066956

Measuring Recognition Performance Using Computer-Based and Paper-Based Methods.

ERIC Educational Resources Information Center

Federico, Pat-Anthony

1991-01-01

Using a within-subjects design, computer-based and paper-based tests of aircraft silhouette recognition were administered to 83 male naval pilots and flight officers to determine the relative reliabilities and validities of 2 measurement modes. Relative reliabilities and validities of the two modes were contingent on the multivariate measurement…

Financial Incentives and Physician Practice Participation in Medicare's Value-Based Reforms.

PubMed

Markovitz, Adam A; Ramsay, Patricia P; Shortell, Stephen M; Ryan, Andrew M

2017-07-26

To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. Publicly available data from Medicare's Physician Compare (n = 1,278; January 2012 to November 2013) and nationally representative physician practice data from the National Survey of Physician Organizations 3 (NSPO3; n = 907,538; 2013). We used regression analysis to examine practice-level relationships between prior exposure to performance incentives and participation in key Medicare value-based payment reforms: accountable care organization (ACO) programs, the Physician Quality Reporting System ("Physician Compare"), and the Meaningful Use of Health Information Technology program ("Meaningful Use"). Prior experience and success with financial incentives were measured as (1) the percentage of practices' revenue from financial incentives for quality or efficiency; and (2) practices' exposure to public reporting of quality measures. We linked physician participation data from Medicare's Physician Compare to the NSPO3 survey. There was wide variation in practices' exposure to performance incentives, with 64 percent exposed to financial incentives, 45 percent exposed to public reporting, and 2.2 percent of practice revenue coming from financial incentives. For each percentage-point increase in financial incentives, there was a 0.9 percentage-point increase in the probability of participating in ACOs (standard error [SE], 0.1, p < .001) and a 0.8 percentage-point increase in the probability of participating in Meaningful Use (SE, 0.1, p < .001), controlling for practice characteristics. Financial incentives were not associated with participation in Physician Compare. Among ACO participants, a 1 percentage-point increase in incentives was associated with a 0.7 percentage-point increase in the probability of being "very well" prepared to utilize cost and quality data

Exploring the Potential of Value-Added Performance Measures to Affect the Quality of the Teacher Workforce

ERIC Educational Resources Information Center

Goldhaber, Dan

2015-01-01

The past decade has seen a tremendous amount of research on the use of value-added modeling to assess individual teachers, and a significant number of states and districts are now using, or plan to use, value added as a component of a teacher's summative performance evaluation. In this article, I explore the various mechanisms through which the…

Reference value sensitivity of measures of unfair health inequality

PubMed Central

García-Gómez, Pilar; Schokkaert, Erik; Van Ourti, Tom

2014-01-01

Most politicians and ethical observers are not interested in pure health inequalities, as they want to distinguish between different causes of health differences. Measures of “unfair” inequality - direct unfairness and the fairness gap, but also the popular standardized concentration index - therefore neutralize the effects of what are considered to be “legitimate” causes of inequality. This neutralization is performed by putting a subset of the explanatory variables at reference values, e.g. their means. We analyze how the inequality ranking of different policies depends on the specific choice of reference values. We show with mortality data from the Netherlands that the problem is empirically relevant and we suggest a statistical method for fixing the reference values. PMID:24954998

Objective Situation Awareness Measurement Based on Performance Self-Evaluation

NASA Technical Reports Server (NTRS)

DeMaio, Joe

1998-01-01

The research was conducted in support of the NASA Safe All-Weather Flight Operations for Rotorcraft (SAFOR) program. The purpose of the work was to investigate the utility of two measurement tools developed by the British Defense Evaluation Research Agency. These tools were a subjective workload assessment scale, the DRA Workload Scale and a situation awareness measurement tool. The situation awareness tool uses a comparison of the crew's self-evaluation of performance against actual performance in order to determine what information the crew attended to during the performance. These two measurement tools were evaluated in the context of a test of innovative approach to alerting the crew by way of a helmet mounted display. The situation assessment data are reported here. The performance self-evaluation metric of situation awareness was found to be highly effective. It was used to evaluate situation awareness on a tank reconnaissance task, a tactical navigation task, and a stylized task used to evaluated handling qualities. Using the self-evaluation metric, it was possible to evaluate situation awareness, without exact knowledge the relevant information in some cases and to identify information to which the crew attended or failed to attend in others.

PERFORMANCE OF A COMPUTER-BASED ASSESSMENT OF COGNITIVE FUNCTION MEASURES IN TWO COHORTS OF SENIORS

PubMed Central

Espeland, Mark A.; Katula, Jeffrey A.; Rushing, Julia; Kramer, Arthur F.; Jennings, Janine M.; Sink, Kaycee M.; Nadkarni, Neelesh K.; Reid, Kieran F.; Castro, Cynthia M.; Church, Timothy; Kerwin, Diana R.; Williamson, Jeff D.; Marottoli, Richard A.; Rushing, Scott; Marsiske, Michael; Rapp, Stephen R.

2013-01-01

Background Computer-administered assessment of cognitive function is being increasingly incorporated in clinical trials, however its performance in these settings has not been systematically evaluated. Design The Seniors Health and Activity Research Program (SHARP) pilot trial (N=73) developed a computer-based tool for assessing memory performance and executive functioning. The Lifestyle Interventions and Independence for Seniors (LIFE) investigators incorporated this battery in a full scale multicenter clinical trial (N=1635). We describe relationships that test scores have with those from interviewer-administered cognitive function tests and risk factors for cognitive deficits and describe performance measures (completeness, intra-class correlations). Results Computer-based assessments of cognitive function had consistent relationships across the pilot and full scale trial cohorts with interviewer-administered assessments of cognitive function, age, and a measure of physical function. In the LIFE cohort, their external validity was further demonstrated by associations with other risk factors for cognitive dysfunction: education, hypertension, diabetes, and physical function. Acceptable levels of data completeness (>83%) were achieved on all computer-based measures, however rates of missing data were higher among older participants (odds ratio=1.06 for each additional year; p<0.001) and those who reported no current computer use (odds ratio=2.71; p<0.001). Intra-class correlations among clinics were at least as low (ICC≤0.013) as for interviewer measures (ICC≤0.023), reflecting good standardization. All cognitive measures loaded onto the first principal component (global cognitive function), which accounted for 40% of the overall variance. Conclusion Our results support the use of computer-based tools for assessing cognitive function in multicenter clinical trials of older individuals. PMID:23589390

Promoting Health Equity And Eliminating Disparities Through Performance Measurement And Payment.

PubMed

Anderson, Andrew C; O'Rourke, Erin; Chin, Marshall H; Ponce, Ninez A; Bernheim, Susannah M; Burstin, Helen

2018-03-01

Current approaches to health care quality have failed to reduce health care disparities. Despite dramatic increases in the use of quality measurement and associated payment policies, there has been no notable implementation of measurement strategies to reduce health disparities. The National Quality Forum developed a road map to demonstrate how measurement and associated policies can contribute to eliminating disparities and promote health equity. Specifically, the road map presents a four-part strategy whose components are identifying and prioritizing areas to reduce health disparities, implementing evidence-based interventions to reduce disparities, investing in the development and use of health equity performance measures, and incentivizing the reduction of health disparities and achievement of health equity. To demonstrate how the road map can be applied, we present an example of how measurement and value-based payment can be used to reduce racial disparities in hypertension among African Americans.

Value-Based Reimbursement: Impact of Curtailing Physician Autonomy in Medical Decision Making.

PubMed

Gupta, Dipti; Karst, Ingolf; Mendelson, Ellen B

2016-02-01

In this article, we define value in the context of reimbursement and explore the effect of shifting reimbursement paradigms on the decision-making autonomy of a women's imaging radiologist. The current metrics used for value-based reimbursement such as report turnaround time are surrogate measures that do not measure value directly. The true measure of a physician's value in medicine is accomplishment of better health outcomes, which, in breast imaging, are best achieved with a physician-patient relationship. Complying with evidence-based medicine, which includes data-driven best clinical practices, a physician's clinical expertise, and the patient's values, will improve our science and preserve the art of medicine.

Using organizational and clinical performance data to increase the value of mental health care.

PubMed

Schmidt, Eric M; Krahn, Dean D; McGuire, Marsden H; Tavakoli, Sara; Wright, David M; Solares, Hugo E; Lemke, Sonne; Trafton, Jodie

2017-02-01

U.S. health systems, policy makers, and patients increasingly demand high-value care that improves health outcomes at lower cost. This study describes the initial design and analysis of the Mental Health Management System (MHMS), a performance data and quality improvement tool used by the Veterans Health Administration (VHA) to increase the value of its mental health care. The MHMS evaluates access to and quality of mental health care, organizational structure and efficiency, implementation of innovative treatment options, and, in collaboration with management, resource needs for delivering care. Performance on 31 measures was calculated for all U.S. VHA facilities (N = 139). Pearson correlations revealed that better access to care was significantly associated with fewer mental health provider staffing vacancies (r = -.24) and higher staff-to-patient ratios for psychiatrists (r = .19) and other outpatient mental health providers (r = .27). Higher staff-to-patient ratios were significantly associated with higher performance on a number of patient and provider satisfaction measures (range of r = .18-.51) and continuity of care measures (range of r = .26-.43). Relationships observed between organizational and clinical performance measures suggest that the MHMS is a robust informatics and quality improvement tool that can serve as a model for health systems planning to adopt a value perspective. Future research should expand the MHMS framework to measure patient and health systems costs and psychosocial outcomes, as well as evaluate whether quality improvement solutions implemented as a result of using organizational information leads to higher-value mental health care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Reducing gender differences in performance in introductory college physics through values affirmation

NASA Astrophysics Data System (ADS)

Kost-Smith, Lauren

2011-04-01

Despite males and females being equally represented at the college level in several STEM disciplines (including biology, chemistry and mathematics), females continue to be under-represented in physics. Our research documents and addresses this participation gender gap in the introductory, calculus-based physics courses at the University of Colorado. We characterize gender differences in performance, psychological factors (including attitudes and beliefs) and retention that exist in Physics 1 and 2 [L. E. Kost, et al., Phys. Rev. ST Phys. Educ. Res. 5, 010101 (2009); L. E. Kost-Smith, et al., Phys. Rev. ST Phys. Educ. Res. 6, 020112 (2010)]. We find that the gender differences in performance can largely be accounted for by measurable differences in the physics and mathematics backgrounds and incoming attitudes and beliefs of males and females. But these background factors do not completely account for the gender gaps. We hypothesize, based on gender differences in responses to survey questions about students' sense of physics identity and confidence levels, that identity threat (the fear of confirming a negative characterization about one's identity) is playing a role in our courses. Working with researchers in psychology, we implemented an intervention where students either wrote about their most important values or not, twice at the beginning of the course [A. Miyake, et al., Science, 330, 1234 (2010)]. This ``values affirmation'' activity reduced the male-female performance difference substantially and elevated women's modal grades from the C to B range. Benefits were strongest for women who tended to endorse the stereotype that men do better than women in physics. This brief psychological intervention may be a promising way to address the gender gap in science performance.

Chaining for Flexible and High-Performance Key-Value Systems

DTIC Science & Technology

2012-09-01

store that is fault tolerant achieves high performance and availability, and offers strong data consistency? We present a new replication protocol...effective high performance data access and analytics, many sites use simpler data model “ NoSQL ” systems. ese systems store and retrieve data only by...DRAM, Flash, and disk-based storage; can act as an unreliable cache or a durable store ; and can offer strong or weak data consistency. e value of

Partial discharge measurements on 110kV current transformers. Setting the control value. Case study

NASA Astrophysics Data System (ADS)

Dan, C.; Morar, R.

2017-05-01

The case study presents a series of partial discharge measurements, reflecting the state of insulation of 110kV CURRENT TRANSFORMERS located in Sibiu county substations. Measurements were performed based on electrical method, using MPD600: an acquisition and analysis toolkit for detecting, recording, and analyzing partial discharges. MPD600 consists of one acquisition unit, an optical interface and a computer with dedicated software. The system allows measurements of partial discharge on site, even in presence of strong electromagnetic interferences because it provides synchronous acquisition from all measurement points. Therefore, measurements, with the ability to be calibrated, do render: - a value subject to interpretation according to IEC 61869-1:2007 + IEC 61869-2:2012 + IEC 61869-3:2011 + IEC 61869-5:2011 and IEC 60270: 2000; - the possibility to determine the quantitative limit of PD (a certain control value) to which the equipment can be operated safely and repaired with minimal costs (relative to the high costs implied by eliminating the consequences of a failure) identified empirically (process in which the instrument transformer subjected to the tests was completely destroyed).

A quantum inspired model of radar range and range-rate measurements with applications to weak value measurements

NASA Astrophysics Data System (ADS)

Escalante, George

2017-05-01

Weak Value Measurements (WVMs) with pre- and post-selected quantum mechanical ensembles were proposed by Aharonov, Albert, and Vaidman in 1988 and have found numerous applications in both theoretical and applied physics. In the field of precision metrology, WVM techniques have been demonstrated and proven valuable as a means to shift, amplify, and detect signals and to make precise measurements of small effects in both quantum and classical systems, including: particle spin, the Spin-Hall effect of light, optical beam deflections, frequency shifts, field gradients, and many others. In principal, WVM amplification techniques are also possible in radar and could be a valuable tool for precision measurements. However, relatively limited research has been done in this area. This article presents a quantum-inspired model of radar range and range-rate measurements of arbitrary strength, including standard and pre- and post-selected measurements. The model is used to extend WVM amplification theory to radar, with the receive filter performing the post-selection role. It is shown that the description of range and range-rate measurements based on the quantum-mechanical measurement model and formalism produces the same results as the conventional approach used in radar based on signal processing and filtering of the reflected signal at the radar receiver. Numerical simulation results using simple point scatterrer configurations are presented, applying the quantum-inspired model of radar range and range-rate measurements that occur in the weak measurement regime. Potential applications and benefits of the quantum inspired approach to radar measurements are presented, including improved range and Doppler measurement resolution.

Achieving Value in Primary Care: The Primary Care Value Model.

PubMed

Rollow, William; Cucchiara, Peter

2016-03-01

The patient-centered medical home (PCMH) model provides a compelling vision for primary care transformation, but studies of its impact have used insufficiently patient-centered metrics with inconsistent results. We propose a framework for defining patient-centered value and a new model for value-based primary care transformation: the primary care value model (PCVM). We advocate for use of patient-centered value when measuring the impact of primary care transformation, recognition, and performance-based payment; for financial support and research and development to better define primary care value-creating activities and their implementation; and for use of the model to support primary care organizations in transformation. © 2016 Annals of Family Medicine, Inc.

Development of the Computerized Model of Performance-Based Measurement System to Measure Nurses' Clinical Competence.

PubMed

Liou, Shwu-Ru; Liu, Hsiu-Chen; Tsai, Shu-Ling; Cheng, Ching-Yu; Yu, Wei-Chieh; Chu, Tsui-Ping

2016-04-01

Critical thinking skills and clinical competence are for providing quality patient care. The purpose of this study is to develop the Computerized Model of Performance-Based Measurement system based on the Clinical Reasoning Model. The system can evaluate and identify learning needs for clinical competency and be used as a learning tool to increase clinical competency by using computers. The system includes 10 high-risk, high-volume clinical case scenarios coupled with questions testing clinical reasoning, interpersonal, and technical skills. Questions were sequenced to reflect patients' changing condition and arranged by following the process of collecting and managing information, diagnosing and differentiating urgency of problems, and solving problems. The content validity and known-groups validity was established. The Kuder-Richardson Formula 20 was 0.90 and test-retest reliability was supported (r = 0.78). Nursing educators can use the system to understand students' needs for achieving clinical competence, and therefore, educational plans can be made to better prepare students and facilitate their smooth transition to a future clinical environment. Clinical nurses can use the system to evaluate their performance-based abilities and weakness in clinical reasoning. Appropriate training programs can be designed and implemented to practically promote nurses' clinical competence and quality of patient care.

Implementation of a High-Speed FPGA and DSP Based FFT Processor for Improving Strain Demodulation Performance in a Fiber-Optic-Based Sensing System

NASA Technical Reports Server (NTRS)

Farley, Douglas L.

2005-01-01

NASA's Aviation Safety and Security Program is pursuing research in on-board Structural Health Management (SHM) technologies for purposes of reducing or eliminating aircraft accidents due to system and component failures. Under this program, NASA Langley Research Center (LaRC) is developing a strain-based structural health-monitoring concept that incorporates a fiber optic-based measuring system for acquiring strain values. This fiber optic-based measuring system provides for the distribution of thousands of strain sensors embedded in a network of fiber optic cables. The resolution of strain value at each discrete sensor point requires a computationally demanding data reduction software process that, when hosted on a conventional processor, is not suitable for near real-time measurement. This report describes the development and integration of an alternative computing environment using dedicated computing hardware for performing the data reduction. Performance comparison between the existing and the hardware-based system is presented.

Practitioner Review: Do Performance-Based Measures and Ratings of Executive Function Assess the Same Construct?

ERIC Educational Resources Information Center

Toplak, Maggie E.; West, Richard F.; Stanovich, Keith E.

2013-01-01

Background: Both performance-based and rating measures are commonly used to index executive function in clinical and neuropsychological assessments. They are intended to index the same broad underlying mental construct of executive function. The association between these two types of measures was investigated in the current article. Method and…

Comparison of self-report-based and physical performance-based frailty definitions among patients receiving maintenance hemodialysis.

PubMed

Johansen, Kirsten L; Dalrymple, Lorien S; Delgado, Cynthia; Kaysen, George A; Kornak, John; Grimes, Barbara; Chertow, Glenn M

2014-10-01

A well-accepted definition of frailty includes measurements of physical performance, which may limit its clinical utility. In a cross-sectional study, we compared prevalence and patient characteristics based on a frailty definition that uses self-reported function to the classic performance-based definition and developed a modified self-report-based definition. Prevalent adult patients receiving hemodialysis in 14 centers around San Francisco and Atlanta in 2009-2011. Self-report-based frailty definition in which a score lower than 75 on the Physical Function scale of the 36-Item Short Form Health Survey (SF-36) was substituted for gait speed and grip strength in the classic definition; modified self-report definition with optimized Physical Function score cutoff points derived in a development (one-half) cohort and validated in the other half. Performance-based frailty defined as 3 of the following: weight loss, weakness, exhaustion, low physical activity, and slow gait speed. 387 (53%) patients were frail based on self-reported function, of whom 209 (29% of the cohort) met the performance-based definition. Only 23 (3%) met the performance-based definition of frailty only. The self-report definition had 90% sensitivity, 64% specificity, 54% positive predictive value, 93% negative predictive value, and 72.5% overall accuracy. Intracellular water per kilogram of body weight and serum albumin, prealbumin, and creatinine levels were highest among nonfrail individuals, intermediate among those who were frail by self-report, and lowest among those who also were frail by performance. Age, percentage of body fat, and C-reactive protein level followed an opposite pattern. The modified self-report definition had better accuracy (84%; 95% CI, 79%-89%) and superior specificity (88%) and positive predictive value (67%). Our study did not address prediction of outcomes. Patients who meet the self-report-based but not the performance-based definition of frailty may represent an

Using value-based total cost of ownership (TCO) measures to inform subsystem trade-offs

NASA Astrophysics Data System (ADS)

Radziwill, Nicole M.; DuPlain, Ronald F.

2010-07-01

Total Cost of Ownership (TCO) is a metric from management accounting that helps expose both the direct and indirect costs of a business decision. However, TCO can sometimes be too simplistic for "make vs. buy" decisions (or even choosing between competing design alternatives) when value and extensibility are more critical than total cost. A three-dimensional value-based TCO, which was developed to clarify product decisions for an observatory prior to Final Design Review (FDR), will be presented in this session. This value-based approach incorporates priority of requirements, satisfiability of requirements, and cost, and can be easily applied in any environment.

Research Frontiers in Public Sector Performance Measurement

NASA Astrophysics Data System (ADS)

Zhonghua, Cai; Ye, Wang

In "New Public Management" era, performance measurement has been widely used in managerial practices of public sectors. From the content and features of performance measurement, this paper aims to explore inspirations on Chinese public sector performance measurement, which based on a review of prior literatures including influencial factors, methods and indicators of public sector performance evaluation. In the end, arguments are presented in this paper pointed out the direction of future researches in this field.

Property Values as a Measure of Neighborhoods: An Application of Hedonic Price Theory.

PubMed

Leonard, Tammy; Powell-Wiley, Tiffany M; Ayers, Colby; Murdoch, James C; Yin, Wenyuan; Pruitt, Sandi L

2016-07-01

Researchers measuring relationships between neighborhoods and health have begun using property appraisal data as a source of information about neighborhoods. Economists have developed a rich tool kit to understand how neighborhood characteristics are quantified in appraisal values. This tool kit principally relies on hedonic (implicit) price models and has much to offer regarding the interpretation and operationalization of property appraisal data-derived neighborhood measures, which goes beyond the use of appraisal data as a measure of neighborhood socioeconomic status. We develop a theoretically informed hedonic-based neighborhood measure using residuals of a hedonic price regression applied to appraisal data in a single metropolitan area. We describe its characteristics, reliability in different types of neighborhoods, and correlation with other neighborhood measures (i.e., raw neighborhood appraisal values, census block group poverty, and observed property characteristics). We examine the association between all neighborhood measures and body mass index. The hedonic-based neighborhood measure was correlated in the expected direction with block group poverty rate and observed property characteristics. The neighborhood measure and average raw neighborhood appraisal value, but not census block group poverty, were associated with individual body mass index. We draw theoretically consistent methodology from the economics literature on hedonic price models to demonstrate how to leverage the implicit valuation of neighborhoods contained in publicly available appraisal data. Consistent measurement and application of the hedonic-based neighborhood measures in epidemiology will improve understanding of the relationships between neighborhoods and health. Researchers should proceed with a careful use of appraisal values utilizing theoretically informed methods such as this one.

Heisenberg's uncertainty principle for simultaneous measurement of positive-operator-valued measures

NASA Astrophysics Data System (ADS)

Miyadera, Takayuki; Imai, Hideki

2008-11-01

A limitation on simultaneous measurement of two arbitrary positive-operator-valued measures is discussed. In general, simultaneous measurement of two noncommutative observables is only approximately possible. Following Werner’s formulation, we introduce a distance between observables to quantify an accuracy of measurement. We derive an inequality that relates the achievable accuracy with noncommutativity between two observables. As a byproduct a necessary condition for two positive-operator-valued measures to be simultaneously measurable is obtained.

Strategic performance management: development of a performance measurement system at the Mayo Clinic.

PubMed

Curtright, J W; Stolp-Smith, S C; Edell, E S

2000-01-01

Managing and measuring performance become exceedingly complex as healthcare institutions evolve into integrated health systems comprised of hospitals, outpatient clinics and surgery centers, nursing homes, and home health services. Leaders of integrated health systems need to develop a methodology and system that align organizational strategies with performance measurement and management. To meet this end, multiple healthcare organizations embrace the performance-indicators reporting system known as a "balanced scorecard" or a "dashboard report." This discrete set of macrolevel indicators gives senior management a fast but comprehensive glimpse of the organization's performance in meeting its quality, operational, and financial goals. The leadership of outpatient operations for Mayo Clinic in Rochester, Minnesota built on this concept by creating a performance management and measurement system that monitors and reports how well the organization achieves its performance goals. Internal stakeholders identified metrics to measure performance in each key category. Through these metrics, the organization links Mayo Clinic's vision, primary value, core principles, and day-to-day operations by monitoring key performance indicators on a weekly, monthly, or quarterly basis.

Comparative values of medical school assessments in the prediction of internship performance.

PubMed

Lee, Ming; Vermillion, Michelle

2018-02-01

Multiple undergraduate achievements have been used for graduate admission consideration. Their relative values in the prediction of residency performance are not clear. This study compared the contributions of major undergraduate assessments to the prediction of internship performance. Internship performance ratings of the graduates of a medical school were collected from 2012 to 2015. Hierarchical multiple regression analyses were used to examine the predictive values of undergraduate measures assessing basic and clinical sciences knowledge and clinical performances, after controlling for differences in the Medical College Admission Test (MCAT). Four hundred eighty (75%) graduates' archived data were used in the study. Analyses revealed that clinical competencies, assessed by the USMLE Step 2 CK, NBME medicine exam, and an eight-station objective structured clinical examination (OSCE), were strong predictors of internship performance. Neither the USMLE Step 1 nor the inpatient internal medicine clerkship evaluation predicted internship performance. The undergraduate assessments as a whole showed a significant collective relationship with internship performance (ΔR 2  = 0.12, p < 0.001). The study supports the use of clinical competency assessments, instead of pre-clinical measures, in graduate admission consideration. It also provides validity evidence for OSCE scores in the prediction of workplace performance.

Precision phase estimation based on weak-value amplification

NASA Astrophysics Data System (ADS)

Qiu, Xiaodong; Xie, Linguo; Liu, Xiong; Luo, Lan; Li, Zhaoxue; Zhang, Zhiyou; Du, Jinglei

2017-02-01

In this letter, we propose a precision method for phase estimation based on the weak-value amplification (WVA) technique using a monochromatic light source. The anomalous WVA significantly suppresses the technical noise with respect to the intensity difference signal induced by the phase delay when the post-selection procedure comes into play. The phase measured precision of this method is proportional to the weak-value of a polarization operator in the experimental range. Our results compete well with the wide spectrum light phase weak measurements and outperform the standard homodyne phase detection technique.

Comparing multistate expected damages, option price and cumulative prospect measures for valuing flood protection

NASA Astrophysics Data System (ADS)

Farrow, Scott; Scott, Michael

2013-05-01

Floods are risky events ranging from small to catastrophic. Although expected flood damages are frequently used for economic policy analysis, alternative measures such as option price (OP) and cumulative prospect value exist. The empirical magnitude of these measures whose theoretical preference is ambiguous is investigated using case study data from Baltimore City. The outcome for the base case OP measure increases mean willingness to pay over the expected damage value by about 3%, a value which is increased with greater risk aversion, reduced by increased wealth, and only slightly altered by higher limits of integration. The base measure based on cumulative prospect theory is about 46% less than expected damages with estimates declining when alternative parameters are used. The method of aggregation is shown to be important in the cumulative prospect case which can lead to an estimate up to 41% larger than expected damages. Expected damages remain a plausible and the most easily computed measure for analysts.

Threshold values of physical performance tests for locomotive syndrome.

PubMed

Muramoto, Akio; Imagama, Shiro; Ito, Zenya; Hirano, Kenichi; Tauchi, Ryoji; Ishiguro, Naoki; Hasegawa, Yukiharu

2013-07-01

Our previous study determined which physical performance tests were the most useful for evaluating locomotive syndrome. Our current study establishes reference values for these major physical performance tests with regards to diagnosing and assessing risk of locomotive syndrome (LS). We measured timed-up-and-go test, one-leg standing time, back muscle strength, grip strength, 10-m gait time and maximum stride in 406 individuals (167 men, 239 women) between the ages of 60-88 years (mean 68.8 ± 6.7 years) during Yakumo Study 2011-12. The LS was defined as having a score of >16 points on the 25-Question Geriatric Locomotive Function Scale (GLFS-25). The reference value of each physical test was determined using receiver operating characteristics analysis. Women had a significantly higher prevalence of LS than men did and also scored significantly higher on the GLFS-25: women, 9.2 ± 10.3 pts; men, 6.7 ± 8.0 pts. Both genders in the non-LS group performed significantly better in all physical performance test gender except for back muscle strength in men and grip strength in both genders than those in the LS group, even after adjusting for age. The results of all the physical performance tests correlated significantly with the GLFS-25 scores of both genders even after adjusting for age except for grip strength. Reference values for TUG, one-leg standing time, back muscle strength, 10-m gait time, maximum stride and grip strength in men were 6.7 s, 21 s, 78 kg, 5.5 s and, 119 cm and 34 kg, respectively, and those for women were 7.5 s, 15 s, 40 kg, 6.2 s, 104 cm, and 22 kg, respectively. We established reference values for major physical performance tests used when assessing locomotive syndrome as defined by the GLFS-25. Our results can be used to characterize physical function and to help tailor an anti-LS training program for each individual.

Value-Based Care in the Worldwide Battle Against Cancer.

PubMed

Johansen, Niloufer J; Saunders, Christobel M

2017-02-17

Globally, an increasing and aging population is contributing to the prevalence of cancer. To be effective, cancer care needs to involve the coordination of multidisciplinary specialties, and also needs to be affordable, accessible, and capable of producing optimal patient outcomes. Porter and Teisberg (2006) have postulated that shifting current healthcare strategies from volume-based to patient-centric care redirects economic competition to providing treatments which promote the best patient outcomes while driving down costs. Therefore, the value in value-based healthcare (VBH) is defined as patient outcome per currency spent on providing care. Based on the experiences of healthcare organizations currently transitioning to the value-based system, this review details actionable guidelines to transition current cancer care practices to the value-based system in four main steps: by defining universal clinical and patient-reported measures, creating cancer-specific units that provide the full care cycle, establishing a data capture model to routinely determine the value of the care delivered, and continually improving treatment strategies through research. As healthcare providers in more developed countries move to value-based care, those located in less developed countries should also be assisted in their transition to relieve the cancer burden globally.

On set-valued functionals: Multivariate risk measures and Aumann integrals

NASA Astrophysics Data System (ADS)

Ararat, Cagin

In this dissertation, multivariate risk measures for random vectors and Aumann integrals of set-valued functions are studied. Both are set-valued functionals with values in a complete lattice of subsets of Rm. Multivariate risk measures are considered in a general d-asset financial market with trading opportunities in discrete time. Specifically, the following features of the market are incorporated in the evaluation of multivariate risk: convex transaction costs modeled by solvency regions, intermediate trading constraints modeled by convex random sets, and the requirement of liquidation into the first m ≤ d of the assets. It is assumed that the investor has a "pure" multivariate risk measure R on the space of m-dimensional random vectors which represents her risk attitude towards the assets but does not take into account the frictions of the market. Then, the investor with a d-dimensional position minimizes the set-valued functional R over all m-dimensional positions that she can reach by trading in the market subject to the frictions described above. The resulting functional Rmar on the space of d-dimensional random vectors is another multivariate risk measure, called the market-extension of R. A dual representation for R mar that decomposes the effects of R and the frictions of the market is proved. Next, multivariate risk measures are studied in a utility-based framework. It is assumed that the investor has a complete risk preference towards each individual asset, which can be represented by a von Neumann-Morgenstern utility function. Then, an incomplete preference is considered for multivariate positions which is represented by the vector of the individual utility functions. Under this structure, multivariate shortfall and divergence risk measures are defined as the optimal values of set minimization problems. The dual relationship between the two classes of multivariate risk measures is constructed via a recent Lagrange duality for set optimization. In

Cognitive Correlates of Functional Abilities in Individuals with Mild Cognitive Impairment: Comparison of Questionnaire, Direct Observation and Performance-based Measures

PubMed Central

Schmitter-Edgecombe, Maureen; Parsey, Carolyn M.

2014-01-01

The relationship between and the cognitive correlates of several proxy measures of functional status were studied in a population with mild cognitive impairment (MCI). Participants were 51 individuals diagnosed with MCI and 51 cognitively healthy older adults (OA). Participants completed performance-based functional status tests, standardized neuropsychological tests, and performed eight activities of daily living (e.g., watered plants, filled medication dispenser) while under direct observation in a campus apartment. An informant interview about everyday functioning was also conducted. Compared to the OA control group, the MCI group performed more poorly on all proxy measures of everyday functioning. The informant-report of instrumental activities of daily living (IADL) did not correlate with the two performance-based measures; however, both the informant-report IADL and the performance-based everyday problem-solving test correlated with the direct observation measure. After controlling for age and education, cognitive predictors did not explain a significant amount of variance in the performance-based measures; however, performance on a delayed memory task was a unique predictor for the informant-report IADL, and processing speed predicted unique variance for the direct observation score. These findings indicate that differing methods for evaluating functional status are not assessing completely overlapping aspects of everyday functioning in the MCI population. PMID:24766574

Cognitive correlates of functional abilities in individuals with mild cognitive impairment: comparison of questionnaire, direct observation, and performance-based measures.

PubMed

Schmitter-Edgecombe, Maureen; Parsey, Carolyn M

2014-01-01

The relationship between, and the cognitive correlates of, several proxy measures of functional status were studied in a population with mild cognitive impairment (MCI). Participants were 51 individuals diagnosed with MCI and 51 cognitively healthy older adults (OA). Participants completed performance-based functional status tests and standardized neuropsychological tests, and performed eight activities of daily living (e.g., watered plants, filled medication dispenser) while under direct observation in a campus apartment. An informant interview about everyday functioning was also conducted. Compared to the OA control group, the MCI group performed more poorly on all proxy measures of everyday functioning. The informant report of instrumental activities of daily living (IADL) did not correlate with the two performance-based measures; however, both the informant-report IADL and the performance-based everyday problem-solving test correlated with the direct observation measure. After controlling for age and education, cognitive predictors did not explain a significant amount of variance in the performance-based measures; however, performance on a delayed memory task was a unique predictor for the informant-report IADL, and processing speed predicted unique variance for the direct observation score. These findings indicate that differing methods for evaluating functional status are not assessing completely overlapping aspects of everyday functioning in the MCI population.

Performance of electrolyte measurements assessed by a trueness verification program.

PubMed

Ge, Menglei; Zhao, Haijian; Yan, Ying; Zhang, Tianjiao; Zeng, Jie; Zhou, Weiyan; Wang, Yufei; Meng, Qinghui; Zhang, Chuanbao

2016-08-01

In this study, we analyzed frozen sera with known commutabilities for standardization of serum electrolyte measurements in China. Fresh frozen sera were sent to 187 clinical laboratories in China for measurement of four electrolytes (sodium, potassium, calcium, and magnesium). Target values were assigned by two reference laboratories. Precision (CV), trueness (bias), and accuracy [total error (TEa)] were used to evaluate measurement performance, and the tolerance limit derived from the biological variation was used as the evaluation criterion. About half of the laboratories used a homogeneous system (same manufacturer for instrument, reagent and calibrator) for calcium and magnesium measurement, and more than 80% of laboratories used a homogeneous system for sodium and potassium measurement. More laboratories met the tolerance limit of imprecision (coefficient of variation [CVa]) than the tolerance limits of trueness (biasa) and TEa. For sodium, calcium, and magnesium, the minimal performance criterion derived from biological variation was used, and the pass rates for total error were approximately equal to the bias (<50%). For potassium, the pass rates for CV and TE were more than 90%. Compared with the non homogeneous system, the homogeneous system was superior for all three quality specifications. The use of commutable proficiency testing/external quality assessment (PT/EQA) samples with values assigned by reference methods can monitor performance and provide reliable data for improving the performance of laboratory electrolyte measurement. The homogeneous systems were superior to the non homogeneous systems, whereas accuracy of assigned values of calibrators and assay stability remained challenges.

Psychometric Properties of Performance-based Measurements of Functional Capacity: Test-Retest Reliability, Practice Effects, and Potential Sensitivity to Change

PubMed Central

Leifker, Feea R.; Patterson, Thomas L.; Bowie, Christopher R.; Mausbach, Brent T.; Harvey, Philip D.

2010-01-01

Performance-based measures of the ability to perform social and everyday living skills are being more widely used to assess functional capacity in people with serious mental illnesses such as schizophrenia and bipolar disorder. Since they are also being used as outcome measures in pharmacological and cognitive remediation studies aimed at cognitive impairments in schizophrenia, understanding their measurement properties and potential sensitivity to change is important. In this study, the test-retest reliability, practice effects, and reliable change indices of two different performance-based functional capacity measures, the UCSD Performance-based skills assessment (UPSA) and Social skills performance assessment (SSPA) were examined over several different retest intervals in two different samples of people with schizophrenia (n’s=238 and 116) and a healthy comparison sample (n=109). These psychometric properties were compared to those of a neuropsychological assessment battery. Test-retest reliabilities of the long form of the UPSA ranged from r=.63 to r=.80 over follow-up periods up to 36 months in people with schizophrenia, while brief UPSA reliabilities ranged from r=.66 to r=.81. Test-retest reliability of the NP performance scores ranged from r=.77 to r=.79. Test-retest reliabilities of the UPSA were lower in healthy controls, while NP performance was slightly more reliable. SSPA test-retest reliability was lower. Practice effect sizes ranged from .05 to .16 for the UPSA and .07 to .19 for the NP assessment in patients, with HC having more practice effects. Reliable change intervals were consistent across NP and both FC measures, indicating equal potential for detection of change. These performance-based measures of functional capacity appear to have similar potential to be sensitive to change compared to NP performance in people with schizophrenia. PMID:20399613

Measurement and comparison of the optical performance of an ophthalmic lens based on a Hartmann-Shack wavefront sensor in real viewing conditions.

PubMed

Zhou, Chuanqing; Wang, Weichao; Yang, Kun; Chai, Xinyu; Ren, Qiushi

2008-12-01

The spatially resolved wavefront aberrations of four types of ophthalmic lens are measured with a custom-built apparatus based on a Hartmann-Shack wavefront sensor and specially designed positioning stage. The wavefront aberrations of the progressive addition lenses (PALs) are compared. The results show that the distribution depends much on the design philosophy, although the average values of root mean square in the entire measurement areas have no significant difference. It is feasible to evaluate the optical performance through the wavefront analysis of PALs, but how to meet the customized visual needs of patients and how to minimize the unwanted aberrations in some special zones are important points that should be taken into account.

Is breast compression associated with breast cancer detection and other early performance measures in a population-based breast cancer screening program?

PubMed

Moshina, Nataliia; Sebuødegård, Sofie; Hofvind, Solveig

2017-06-01

We aimed to investigate early performance measures in a population-based breast cancer screening program stratified by compression force and pressure at the time of mammographic screening examination. Early performance measures included recall rate, rates of screen-detected and interval breast cancers, positive predictive value of recall (PPV), sensitivity, specificity, and histopathologic characteristics of screen-detected and interval breast cancers. Information on 261,641 mammographic examinations from 93,444 subsequently screened women was used for analyses. The study period was 2007-2015. Compression force and pressure were categorized using tertiles as low, medium, or high. χ 2 test, t tests, and test for trend were used to examine differences between early performance measures across categories of compression force and pressure. We applied generalized estimating equations to identify the odds ratios (OR) of screen-detected or interval breast cancer associated with compression force and pressure, adjusting for fibroglandular and/or breast volume and age. The recall rate decreased, while PPV and specificity increased with increasing compression force (p for trend <0.05 for all). The recall rate increased, while rate of screen-detected cancer, PPV, sensitivity, and specificity decreased with increasing compression pressure (p for trend <0.05 for all). High compression pressure was associated with higher odds of interval breast cancer compared with low compression pressure (1.89; 95% CI 1.43-2.48). High compression force and low compression pressure were associated with more favorable early performance measures in the screening program.

Value and Performance in the IT Society.

ERIC Educational Resources Information Center

Bryson, Jo

This paper discusses valuing information and its supporting technologies in the global environment. Different value propositions are explored from a financial, social, cultural, political, economic, corporate, and personal values perspective. Various means of measuring the relevancy of these value propositions to the individual, organization or…

Parent ratings of working memory are uniquely related to performance-based measures of secondary memory but not primary memory.

PubMed

Ralph, Kathryn J; Gibson, Bradley S; Gondoli, Dawn M

2018-03-06

Existing evidence suggests that performance- and rating-based measures of working memory (WM) correlate poorly. Although some researchers have interpreted this evidence as suggesting that these measures may be assessing distinct cognitive constructs, another possibility is that rating-based measures are related to some but not all theoretically motivated performance-based measures. The current study distinguished between performance-based measures of primary memory (PM) and secondary memory (SM), and examined the relation between each of these components of WM and parent-ratings on the WM subscale of the Behavior Rating Inventory of Executive Function (BRIEF-WM). Because SM and BRIEF-WM scores have both been associated with group differences in attention-deficit/hyperactivity disorder (ADHD), it was hypothesized that SM scores would be uniquely related to parent-rated BRIEF-WM scores. Participants were a sample of 77 adolescents with and without an ADHD diagnosis, aged 11 to 15 years, from a midwestern school district. Participant scores on verbal and spatial immediate free recall tasks were used to estimate both PM and SM capacities. Partial correlation analyses were used to evaluate the extent to which estimates of PM and SM were uniquely related parent-rated BRIEF-WM scores. Both verbal and spatial SM scores were significantly related to parent-rated BRIEF-WM scores, when corresponding PM scores were controlled. Higher verbal and spatial SM scores were associated with less frequent parent-report of WM-related failures in their child's everyday life. However, neither verbal nor spatial PM scores significantly related to parent-rated BRIEF-WM scores, when corresponding SM scores were controlled. The current study suggested that previously observed low correlations between performance- and rating-based measures of WM may result from use of performance-based WM measures that do not capture the unique contributions of PM and SM components of WM.

The high-performance electric field detector EFD for space-based measurements

NASA Astrophysics Data System (ADS)

Badoni, Davide

2016-04-01

electromagnetic emissions and more in general to investigate lithosphere-atmosphere-ionosphere EM coupling. The EFD can measure electric field in a wide band of frequencies extending from quasi-DC up to about 5 MHz. The resolution in the ULF band is better than 1μV/m with a dynamic range of 120 dB. This is a value 40 times better than that of any other recent instrument of similar quality. The sensitivity, in measuring d.o.p., in the other bands (ELF, VLF and HF) is better than 300 nV/√Hz, i.e. - by considering the boom lengths - the sensitivity in measuring electric field is of the order of 50 nV/(√Hz m). With these bandwidth and precision, the described electric field detector represents the most performing and updated device so far developed for electric field measurements in near-space applications. We present the description of the EFD instrument electronics and the results of the preliminary tests performed on the prototype in laboratory.

The Value of Performance Measurement in Promoting Improvements in Women's Health.

PubMed

Siu, Emily C Y; Levinton, Carey; Brown, Adalsteinn D

2009-11-01

To determine the factors associated with the use and impact of performance data relevant to women's health. We developed a survey on six levels of information use based on Knott and Wildavsky's (1980) policy utilization framework and used this survey to determine Ontario hospital administrators' use of women's health report indicators. We related responses to this survey to six potentially relevant organizational factors, such as women's health as a written hospital priority, a women's health program and hospital budget size, using correlation and multiple-regression analysis. Only women's health in a written hospital priority (p=0.01) and hospital budget (p=0.02, log transformed) were significantly associated with the highest level of use when all organizational factors were considered. These findings suggest that the use of women's health performance indicators is strongly related to the size of the hospital budget and to organizational commitment to women's health.

Performance measures for a dialysis setting.

PubMed

Gu, Xiuzhu; Itoh, Kenji

2018-03-01

This study from Japan extracted performance measures for dialysis unit management and investigated their characteristics from professional views. Two surveys were conducted using self-administered questionnaires, in which dialysis managers/staff were asked to rate the usefulness of 44 performance indicators. A total of 255 managers and 2,097 staff responded. Eight performance measures were elicited from dialysis manager and staff responses: these were safety, operational efficiency, quality of working life, financial effectiveness, employee development, mortality, patient/employee satisfaction and patient-centred health care. These performance measures were almost compatible with those extracted in overall healthcare settings in a previous study. Internal reliability, content and construct validity of the performance measures for the dialysis setting were ensured to some extent. As a general trend, both dialysis managers and staff perceived performance measures as highly useful, especially for safety, mortality, operational efficiency and patient/employee satisfaction, but showed relatively low concerns for patient-centred health care and employee development. However, dialysis managers' usefulness perceptions were significantly higher than staff. Important guidelines for designing a holistic hospital/clinic management system were yielded. Performance measures must be balanced for outcomes and performance shaping factors (PSF); a common set of performance measures could be applied to all the healthcare settings, although performance indicators of each measure should be composed based on the application field and setting; in addition, sound causal relationships between PSF and outcome measures/indicators should be explored for further improvement. © 2017 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Reliability of Performance-Based Clinical Measurements to Assess Shoulder Girdle Kinematics and Positioning: Systematic Review.

PubMed

D'hondt, Norman E; Kiers, Henri; Pool, Jan J M; Hacquebord, Sijmen T; Terwee, Caroline B; Veeger, Dirkjan H E J

2017-01-01

Deviant shoulder girdle movement is suggested as an eminent factor in the etiology of shoulder pain. Reliable measurements of shoulder girdle kinematics are a prerequisite for optimizing clinical management strategies. The purpose of this study was to evaluate the reliability, measurement error, and internal consistency of measurements with performance-based clinical tests for shoulder girdle kinematics and positioning in patients with shoulder pain. The MEDLINE, Embase, CINAHL, and SPORTDiscus databases were systematically searched from inception to August 2015. Articles published in Dutch, English, or German were included if they involved the evaluation of at least one of the measurement properties of interest. Two reviewers independently evaluated the methodological quality per studied measurement property with the 4-point-rating scale of the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist, extracted data, and assessed the adequacy of the measurement properties. Forty studies comprising more than 30 clinical tests were included. Actual reported measurements of the tests were categorized into: (1) positional measurement methods, (2) measurement methods to determine dynamic characteristics, and (3) tests to diagnose impairments of shoulder girdle function. Best evidence synthesis of the tests was performed per measurement for each measurement property. All studies had significant limitations, including incongruence between test description and actual reported measurements and a lack of reporting on minimal important change. In general, the methodological quality of the selected studies was fair to poor. High-quality evidence indicates that measurements obtained with the Modified Scapular Assistance Test are not reliable for clinical use. Sound recommendations for the use of other tests could not be made due to inadequate evidence. Across studies, diversity in description, performance, and interpretation of similar

A value-based medicine comparison of interventions for subfoveal neovascular macular degeneration.

PubMed

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

2007-06-01

To perform a value-based medicine analysis of clinical trials that evaluate the interventions of laser photocoagulation, intravitreal pegaptanib therapy, and photodynamic therapy (PDT) with verteporfin for the treatment of classic subfoveal choroidal neovascularization. Reference case cost-utility analysis using value-based medicine principles, which use patient-based utility values and standardized, input variable criteria. Data from participants in the Macular Photocoagulation Study, Pegaptanib for Neovascular Age-Related Macular Degeneration Study, and the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study. Visual data were converted to a value-based format using time tradeoff utility analysis values from patients with macular degeneration. Costs were obtained from 2005 Medicare data. Outcomes (quality-adjusted life-years [QALYs]) and costs were discounted at a 3% annual rate. Interventional QALYs gained, percent improvement in quality of life, and dollars spent per QALY gained. Laser photocoagulation confers a 4.4% (P = 0.03 versus pegaptanib therapy) improvement in quality of life for the reference case, whereas pegaptanib therapy confers a 5.9% improvement and PDT confers an 8.1% (P = 0.0002 versus pegaptanib therapy) improvement. The cost-utility associated with laser photocoagulation is $8179, that for pegaptanib therapy is $66978, and that for PDT is $31544. All sensitivity analyses remain within the conventional standards of cost-effectiveness. Photodynamic therapy confers greater patient value than intravitreal pegaptanib therapy and laser photocoagulation for the treatment of classic subfoveal choroidal neovascularization. Despite the fact that laser photocoagulation is the most cost-effective intervention, both PDT and pegaptanib therapy deliver greater value, and thus are both preferred over laser photocoagulation. Using an economic measure, photodynamic therapy is the preferred treatment among these 3 interventions.

Value-based health care for inflammatory bowel diseases.

PubMed

van Deen, Welmoed K; Esrailian, Eric; Hommes, Daniel W

2015-05-01

Increasing healthcare costs worldwide put the current healthcare systems under pressure. Although many efforts have aimed to contain costs in medicine, only a few have achieved substantial changes. Inflammatory bowel diseases rank among the most costly of chronic diseases, and physicians nowadays are increasingly engaged in health economics discussions. Value-based health care [VBHC] has gained a lot of attention recently, and is thought to be the way forward to contain costs while maintaining quality. The key concept behind VBHC is to improve achieved outcomes per encountered costs, and evaluate performance accordingly. Four main components need to be in place for the system to be effective: [1] accurate measurement of health outcomes and costs; [2] reporting of these outcomes and benchmarking against other providers; [3] identification of areas in need of improvement based on these data and adjusting the care delivery processes accordingly; and [4] rewarding high-performing participants. In this article we will explore the key components of VBHC, we will review available evidence focussing on inflammatory bowel diseases, and we will present our own experience as a guide for other providers. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

A Long-Term Performance Enhancement Method for FOG-Based Measurement While Drilling

PubMed Central

Zhang, Chunxi; Lin, Tie

2016-01-01

In the oil industry, the measurement-while-drilling (MWD) systems are usually used to provide the real-time position and orientation of the bottom hole assembly (BHA) during drilling. However, the present MWD systems based on magnetic surveying technology can barely ensure good performance because of magnetic interference phenomena. In this paper, a MWD surveying system based on a fiber optic gyroscope (FOG) was developed to replace the magnetic surveying system. To accommodate the size of the downhole drilling conditions, a new design method is adopted. In order to realize long-term and high position precision and orientation surveying, an integrated surveying algorithm is proposed based on inertial navigation system (INS) and drilling features. In addition, the FOG-based MWD error model is built and the drilling features are analyzed. The state-space system model and the observation updates model of the Kalman filter are built. To validate the availability and utility of the algorithm, the semi-physical simulation is conducted under laboratory conditions. The results comparison with the traditional algorithms show that the errors were suppressed and the measurement precision of the proposed algorithm is better than the traditional ones. In addition, the proposed method uses a lot less time than the zero velocity update (ZUPT) method. PMID:27483270

A Long-Term Performance Enhancement Method for FOG-Based Measurement While Drilling.

PubMed

Zhang, Chunxi; Lin, Tie

2016-07-28

In the oil industry, the measurement-while-drilling (MWD) systems are usually used to provide the real-time position and orientation of the bottom hole assembly (BHA) during drilling. However, the present MWD systems based on magnetic surveying technology can barely ensure good performance because of magnetic interference phenomena. In this paper, a MWD surveying system based on a fiber optic gyroscope (FOG) was developed to replace the magnetic surveying system. To accommodate the size of the downhole drilling conditions, a new design method is adopted. In order to realize long-term and high position precision and orientation surveying, an integrated surveying algorithm is proposed based on inertial navigation system (INS) and drilling features. In addition, the FOG-based MWD error model is built and the drilling features are analyzed. The state-space system model and the observation updates model of the Kalman filter are built. To validate the availability and utility of the algorithm, the semi-physical simulation is conducted under laboratory conditions. The results comparison with the traditional algorithms show that the errors were suppressed and the measurement precision of the proposed algorithm is better than the traditional ones. In addition, the proposed method uses a lot less time than the zero velocity update (ZUPT) method.

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.

Measuring value sensitivity in medicine.

PubMed

Ineichen, Christian; Christen, Markus; Tanner, Carmen

2017-01-28

Value sensitivity - the ability to recognize value-related issues when they arise in practice - is an indispensable competence for medical practitioners to enter decision-making processes related to ethical questions. However, the psychological competence of value sensitivity is seldom an explicit subject in the training of medical professionals. In this contribution, we outline the traditional concept of moral sensitivity in medicine and its revised form conceptualized as value sensitivity and we propose an instrument that measures value sensitivity. We developed an instrument for assessing the sensitivity for three value groups (moral-related values, values related to the principles of biomedical ethics, strategy-related values) in a four step procedure: 1) value identification (n = 317); 2) value representation (n = 317); 3) vignette construction and quality evaluation (n = 37); and 4) instrument validation by comparing nursing professionals with hospital managers (n = 48). We find that nursing professionals recognize and ascribe importance to principle-related issues more than professionals from hospital management. The latter are more likely to recognize and ascribe importance to strategy-related issues. These hypothesis-driven results demonstrate the discriminatory power of our newly developed instrument, which makes it useful not only for health care professionals in practice but for students and people working in the clinical context as well.

[Value-based medicine for glaucoma].

PubMed

Hirneiss, C; Kampik, A; Neubauer, A S

2010-03-01

The application of value-based medicine (VBM) tenets in the area of glaucoma research requires valid and reliable data concerning the quality of life with glaucoma. A multitude of instruments for measuring quality of life of patients with glaucoma have been employed in the past. Any instrument used would need to capture peripheral vision loss and its influence on patient-reported quality of life as this is one of the hallmarks of this disease. Cost-utility analyses can then be based on the reported quality of life and the cost of glaucoma therapy. Several cost-utility analyses have been applied in the field of glaucoma screening as well as treating ocular hypertension and based on this a recommendation regarding population subgroups which can be treated cost efficiently can be made.

Can Value-Added Measures of Teacher Performance Be Trusted?

ERIC Educational Resources Information Center

Guarino, Cassandra M.; Reckase, Mark D.; Wooldridge, Jeffrey M.

2015-01-01

We investigate whether commonly used value-added estimation strategies produce accurate estimates of teacher effects under a variety of scenarios. We estimate teacher effects in simulated student achievement data sets that mimic plausible types of student grouping and teacher assignment scenarios. We find that no one method accurately captures…

Value-based genomics.

PubMed

Gong, Jun; Pan, Kathy; Fakih, Marwan; Pal, Sumanta; Salgia, Ravi

2018-03-20

Advancements in next-generation sequencing have greatly enhanced the development of biomarker-driven cancer therapies. The affordability and availability of next-generation sequencers have allowed for the commercialization of next-generation sequencing platforms that have found widespread use for clinical-decision making and research purposes. Despite the greater availability of tumor molecular profiling by next-generation sequencing at our doorsteps, the achievement of value-based care, or improving patient outcomes while reducing overall costs or risks, in the era of precision oncology remains a looming challenge. In this review, we highlight available data through a pre-established and conceptualized framework for evaluating value-based medicine to assess the cost (efficiency), clinical benefit (effectiveness), and toxicity (safety) of genomic profiling in cancer care. We also provide perspectives on future directions of next-generation sequencing from targeted panels to whole-exome or whole-genome sequencing and describe potential strategies needed to attain value-based genomics.

Value-based genomics

PubMed Central

Gong, Jun; Pan, Kathy; Fakih, Marwan; Pal, Sumanta; Salgia, Ravi

2018-01-01

Advancements in next-generation sequencing have greatly enhanced the development of biomarker-driven cancer therapies. The affordability and availability of next-generation sequencers have allowed for the commercialization of next-generation sequencing platforms that have found widespread use for clinical-decision making and research purposes. Despite the greater availability of tumor molecular profiling by next-generation sequencing at our doorsteps, the achievement of value-based care, or improving patient outcomes while reducing overall costs or risks, in the era of precision oncology remains a looming challenge. In this review, we highlight available data through a pre-established and conceptualized framework for evaluating value-based medicine to assess the cost (efficiency), clinical benefit (effectiveness), and toxicity (safety) of genomic profiling in cancer care. We also provide perspectives on future directions of next-generation sequencing from targeted panels to whole-exome or whole-genome sequencing and describe potential strategies needed to attain value-based genomics. PMID:29644010

Experimental realization of generalized qubit measurements based on quantum walks

NASA Astrophysics Data System (ADS)

Zhao, Yuan-yuan; Yu, Neng-kun; Kurzyński, Paweł; Xiang, Guo-yong; Li, Chuan-Feng; Guo, Guang-Can

2015-04-01

We report an experimental implementation of a single-qubit generalized measurement scenario, the positive-operator valued measure (POVM), based on a quantum walk model. The qubit is encoded in a single-photon polarization. The photon performs a quantum walk on an array of optical elements, where the polarization-dependent translation is performed via birefringent beam displacers and a change of the polarization is implemented with the help of wave plates. We implement: (i) trine POVM, i.e., the POVM elements uniformly distributed on an equatorial plane of the Bloch sphere; (ii) symmetric-informationally-complete (SIC) POVM; and (iii) unambiguous discrimination of two nonorthogonal qubit states.

A Scaled-Projective Measure of Interpersonal Values

ERIC Educational Resources Information Center

Kilmann, Ralph H.

1975-01-01

The Kilmann Insight Test is a measure of the interpersonal value constructs. That is how the individual perceives and interprets the desirable and undesirable features of interpersonal behavior. The validity of the test is investigated by explaining its relationship to a self-report measure assessing similar values. (DEP)

Enhancing performance of next generation FSO communication systems using soft computing-based predictions.

PubMed

Kazaura, Kamugisha; Omae, Kazunori; Suzuki, Toshiji; Matsumoto, Mitsuji; Mutafungwa, Edward; Korhonen, Timo O; Murakami, Tadaaki; Takahashi, Koichi; Matsumoto, Hideki; Wakamori, Kazuhiko; Arimoto, Yoshinori

2006-06-12

The deterioration and deformation of a free-space optical beam wave-front as it propagates through the atmosphere can reduce the link availability and may introduce burst errors thus degrading the performance of the system. We investigate the suitability of utilizing soft-computing (SC) based tools for improving performance of free-space optical (FSO) communications systems. The SC based tools are used for the prediction of key parameters of a FSO communications system. Measured data collected from an experimental FSO communication system is used as training and testing data for a proposed multi-layer neural network predictor (MNNP) used to predict future parameter values. The predicted parameters are essential for reducing transmission errors by improving the antenna's accuracy of tracking data beams. This is particularly essential for periods considered to be of strong atmospheric turbulence. The parameter values predicted using the proposed tool show acceptable conformity with original measurements.

Performance Measures for Student Success, 2016

ERIC Educational Resources Information Center

North Carolina Community College System, 2016

2016-01-01

The Performance Measures for Student Success Report is the North Carolina Community College System's major accountability document. This annual performance report is based on data compiled from the previous year and serves to inform colleges and the public on the performance of our 58 community colleges. In 1993, the State Board of Community…

Performance Measures for Student Success, 2013

ERIC Educational Resources Information Center

North Carolina Community College System, 2013

2013-01-01

The Performance Measures for Student Success Report is the North Carolina Community College System's major accountability document. This annual performance report is based on data compiled from the previous year and serves to inform colleges and the public on the performance of North Carolina's 58 community colleges. In 2010, President Scott Ralls…

Performance Measures for Student Success, 2014

ERIC Educational Resources Information Center

North Carolina Community College System, 2014

2014-01-01

The Performance Measures for Student Success Report is the North Carolina Community College System's major accountability document. This annual performance report is based on data compiled from the previous year and serves to inform colleges and the public on the performance of North Carolina's 58 community colleges. In 2010, President Scott Ralls…

Using Publicly Available Data to Construct a Transparent Measure of Health Care Value: A Method and Initial Results.

PubMed

Weeks, William B; Kotzbauer, Gregory R; Weinstein, James N

2016-06-01

Using publicly available Hospital Compare and Medicare data, we found a substantial range of hospital-level performance on quality, expenditure, and value measures for 4 common reasons for admission. Hospitals' ability to consistently deliver high-quality, low-cost care varied across the different reasons for admission. With the exception of coronary artery bypass grafting, hospitals that provided the highest-value care had more beds and a larger average daily census than those providing the lowest-value care. Transparent data like those we present can empower patients to compare hospital performance, make better-informed treatment decisions, and decide where to obtain care for particular health care problems. In the United States, the transition from volume to value dominates discussions of health care reform. While shared decision making might help patients determine whether to get care, transparency in procedure- and hospital-specific value measures would help them determine where to get care. Using Hospital Compare and Medicare expenditure data, we constructed a hospital-level measure of value from a numerator composed of quality-of-care measures (satisfaction, use of timely and effective care, and avoidance of harms) and a denominator composed of risk-adjusted 30-day episode-of-care expenditures for acute myocardial infarction (1,900 hospitals), coronary artery bypass grafting (884 hospitals), colectomy (1,252 hospitals), and hip replacement surgery (1,243 hospitals). We found substantial variation in aggregate measures of quality, cost, and value at the hospital level. Value calculation provided additional richness when compared to assessment based on quality or cost alone: about 50% of hospitals in an extreme quality- (and about 65% more in an extreme cost-) quintile were in the same extreme value quintile. With the exception of coronary artery bypass grafting, higher-value hospitals were larger and had a higher average daily census than lower-value

The Surprisingly Low Motivational Power of Future Rewards: Comparing Conventional Money-Based Measures of Discounting with Motivation-Based Measures

ERIC Educational Resources Information Center

Ebert, Jane E. J.

2010-01-01

Temporal discount rates are often poor predictors of behaviors that we expect will be motivated by the future. The current research suggests this may be because conventional discounting measures are poor measures of the motivational value of future rewards. In six studies, I develop motivation-based measures of the present value (PV) of future…

Overstating values: medical facts, diverse values, bioethics and values-based medicine.

PubMed

Parker, Malcolm

2013-02-01

Fulford has argued that (1) the medical concepts illness, disease and dysfunction are inescapably evaluative terms, (2) illness is conceptually prior to disease, and (3) a model conforming to (2) has greater explanatory power and practical utility than the conventional value-free medical model. This 'reverse' model employs Hare's distinction between description and evaluation, and the sliding relationship between descriptive and evaluative meaning. Fulford's derivative 'Values Based Medicine' (VBM) readjusts the imbalance between the predominance of facts over values in medicine. VBM allegedly responds to the increased choices made available by, inter alia, the progress of medical science itself. VBM attributes appropriate status to evaluative meaning, where strong consensus about descriptive meaning is lacking. According to Fulford, quasi-legal bioethics, while it can be retained as a kind of deliberative framework, is outcome-based and pursues 'the right answer', while VBM approximates a democratic, process-oriented method for dealing with diverse values, in partnership with necessary contributions from evidence-based medicine (EBM). I support the non-cognitivist underpinnings of VBM, and its emphasis on the importance of values in medicine. But VBM overstates the complexity and diversity of values, misrepresents EBM and VBM as responses to scientific and evaluative complexity, and mistakenly depicts 'quasi-legal bioethics' as a space of settled descriptive meaning. Bioethical reasoning can expose strategies that attempt to reduce authentic values to scientific facts, illustrating that VBM provides no advantage over bioethics in delineating the connections between facts and values in medicine. © 2011 Blackwell Publishing Ltd.

A Framework for Measuring Low-Value Care.

PubMed

Miller, George; Rhyan, Corwin; Beaudin-Seiler, Beth; Hughes-Cromwick, Paul

2018-04-01

It has been estimated that more than 30% of health care spending in the United States is wasteful, and that low-value care, which drives up costs unnecessarily while increasing patient risk, is a significant component of wasteful spending. To address the need for an ability to measure the magnitude of low-value care nationwide, identify the clinical services that are the greatest contributors to waste, and track progress toward eliminating low-value use of these services. Such an ability could provide valuable input to the efforts of policymakers and health systems to improve efficiency. We reviewed existing methods that could contribute to measuring low-value care and developed an integrated framework that combines multiple methods to comprehensively estimate and track the magnitude and principal sources of clinical waste. We also identified a process and needed research for implementing the framework. A comprehensive methodology for measuring and tracking low-value care in the United States would provide an important contribution toward reducing waste. Implementation of the framework described in this article appears feasible, and the proposed research program will allow moving incrementally toward full implementation while providing a near-term capability for measuring low-value care that can be enhanced over time. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Measuring Values in Environmental Research: A Test of an Environmental Portrait Value Questionnaire

PubMed Central

Bouman, Thijs; Steg, Linda; Kiers, Henk A. L.

2018-01-01

Four human values are considered to underlie individuals’ environmental beliefs and behaviors: biospheric (i.e., concern for environment), altruistic (i.e., concern for others), egoistic (i.e., concern for personal resources) and hedonic values (i.e., concern for pleasure and comfort). These values are typically measured with an adapted and shortened version of the Schwartz Value Survey (SVS), to which we refer as the Environmental-SVS (E-SVS). Despite being well-validated, recent research has indicated some concerns about the SVS methodology (e.g., comprehensibility, self-presentation biases) and suggested an alternative method of measuring human values: The Portrait Value Questionnaire (PVQ). However, the PVQ has not yet been adapted and applied to measure values most relevant to understand environmental beliefs and behaviors. Therefore, we tested the Environmental-PVQ (E-PVQ) – a PVQ variant of E-SVS –and compared it with the E-SVS in two studies. Our findings provide strong support for the validity and reliability of both the E-SVS and E-PVQ. In addition, we find that respondents slightly preferred the E-PVQ over the E-SVS (Study 1). In general, both scales correlate similarly to environmental self-identity (Study 1), energy behaviors (Studies 1 and 2), pro-environmental personal norms, climate change beliefs and policy support (Study 2). Accordingly, both methodologies show highly similar results and seem well-suited for measuring human values underlying environmental behaviors and beliefs. PMID:29743874

Negative measurement sensitivity values of planar capacitive imaging probes

NASA Astrophysics Data System (ADS)

Yin, Xiaokang; Chen, Guoming; Li, Wei; Hutchins, David

2014-02-01

The measurement sensitivity distribution of planar capacitive imaging (CI) probes describes how effectively each region in the sensing area is contributing to the measured charge signal on the sensing electrode. It can be used to determine the imaging ability of a CI probe. It is found in previous work that, there are regions in the sensing area where the change of the charge output and the change of targeting physical parameter are of opposite trends. This opposite correlation implies that the measurement sensitivity values in such regions are negative. In this work, the cause of negative sensitivity is discussed. Experiments are also designed and performed so as to verify the existence of negative sensitivity and study the factors that may affect the negative sensitivity distributions.

Transportation performance measures for outcome based system management and monitoring.

DOT National Transportation Integrated Search

2014-09-01

The Oregon Department of Transportation (ODOT) is mature in its development and use of : performance measures, however there was not a standard approach for selecting measures nor : evaluating if existing ones were used to inform decision-making. Thi...

Application of online measures to monitor and evaluate multiplatform fusion performance

NASA Astrophysics Data System (ADS)

Stubberud, Stephen C.; Kowalski, Charlene; Klamer, Dale M.

1999-07-01

A primary concern of multiplatform data fusion is assessing the quality and utility of data shared among platforms. Constraints such as platform and sensor capability and task load necessitate development of an on-line system that computes a metric to determine which other platform can provide the best data for processing. To determine data quality, we are implementing an approach based on entropy coupled with intelligent agents. To determine data quality, we are implementing an approach based on entropy coupled with intelligent agents. Entropy measures quality of processed information such as localization, classification, and ambiguity in measurement-to-track association. Lower entropy scores imply less uncertainty about a particular target. When new information is provided, we compuete the level of improvement a particular track obtains from one measurement to another. The measure permits us to evaluate the utility of the new information. We couple entropy with intelligent agents that provide two main data gathering functions: estimation of another platform's performance and evaluation of the new measurement data's quality. Both functions result from the entropy metric. The intelligent agent on a platform makes an estimate of another platform's measurement and provides it to its own fusion system, which can then incorporate it, for a particular target. A resulting entropy measure is then calculated and returned to its own agent. From this metric, the agent determines a perceived value of the offboard platform's measurement. If the value is satisfactory, the agent requests the measurement from the other platform, usually by interacting with the other platform's agent. Once the actual measurement is received, again entropy is computed and the agent assesses its estimation process and refines it accordingly.

Independent Analysis of Real-Time, Measured Performance Data From Microcogenerative Fuel Cell Systems Installed in Buildings

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

Dillon, Heather E.; Colella, Whitney G.

2015-06-01

Pacific Northwest National Laboratory (PNNL) is working with industry to independently monitor up to 15 distinct 5 kW-electric (kWe) combined heat and power (CHP) high temperature (HT) proton exchange membrane (PEM) fuel cell systems (FCSs) installed in light commercial buildings. This research paper discusses an evaluation of the first six months of measured performance data acquired at a 1 s sampling rate from real-time monitoring equipment attached to the FCSs at building sites. Engineering performance parameters are independently evaluated. Based on an analysis of the first few months of measured operating data, FCS performance is consistent with manufacturer-stated performance. Initialmore » data indicate that the FCSs have relatively stable performance and a long-term average production of about 4.57 kWe of power. This value is consistent with, but slightly below, the manufacturer's stated rated electric power output of 5 kWe. The measured system net electric efficiency has averaged 33.7%, based on the higher heating value (HHV) of natural gas fuel. This value, also, is consistent with, but slightly below, the manufacturer's stated rated electric efficiency of 36%. The FCSs provide low-grade hot water to the building at a measured average temperature of about 48.4 degrees C, lower than the manufacturer's stated maximum hot water delivery temperature of 65 degrees C. The uptime of the systems is also evaluated. System availability can be defined as the quotient of total operating time compared to time since commissioning. The average values for system availability vary between 96.1 and 97.3%, depending on the FCS evaluated in the field. Performance at rated value for electrical efficiency (PRVeff) can be defined as the quotient of the system time operating at or above the rated electric efficiency and the time since commissioning. The PRVeff varies between 5.6% and 31.6%, depending on the FCS field unit evaluated. Performance at rated value for electrical

High-Performance Sensors Based on Resistance Fluctuations of Single-Layer-Graphene Transistors.

PubMed

Amin, Kazi Rafsanjani; Bid, Aveek

2015-09-09

One of the most interesting predicted applications of graphene-monolayer-based devices is as high-quality sensors. In this article, we show, through systematic experiments, a chemical vapor sensor based on the measurement of low-frequency resistance fluctuations of single-layer-graphene field-effect-transistor devices. The sensor has extremely high sensitivity, very high specificity, high fidelity, and fast response times. The performance of the device using this scheme of measurement (which uses resistance fluctuations as the detection parameter) is more than 2 orders of magnitude better than a detection scheme in which changes in the average value of the resistance is monitored. We propose a number-density-fluctuation-based model to explain the superior characteristics of a noise-measurement-based detection scheme presented in this article.

Measuring Incompatible Observables by Exploiting Sequential Weak Values.

PubMed

Piacentini, F; Avella, A; Levi, M P; Gramegna, M; Brida, G; Degiovanni, I P; Cohen, E; Lussana, R; Villa, F; Tosi, A; Zappa, F; Genovese, M

2016-10-21

One of the most intriguing aspects of quantum mechanics is the impossibility of measuring at the same time observables corresponding to noncommuting operators, because of quantum uncertainty. This impossibility can be partially relaxed when considering joint or sequential weak value evaluation. Indeed, weak value measurements have been a real breakthrough in the quantum measurement framework that is of the utmost interest from both a fundamental and an applicative point of view. In this Letter, we show how we realized for the first time a sequential weak value evaluation of two incompatible observables using a genuine single-photon experiment. These (sometimes anomalous) sequential weak values revealed the single-operator weak values, as well as the local correlation between them.

Measuring Incompatible Observables by Exploiting Sequential Weak Values

NASA Astrophysics Data System (ADS)

Piacentini, F.; Avella, A.; Levi, M. P.; Gramegna, M.; Brida, G.; Degiovanni, I. P.; Cohen, E.; Lussana, R.; Villa, F.; Tosi, A.; Zappa, F.; Genovese, M.

2016-10-01

One of the most intriguing aspects of quantum mechanics is the impossibility of measuring at the same time observables corresponding to noncommuting operators, because of quantum uncertainty. This impossibility can be partially relaxed when considering joint or sequential weak value evaluation. Indeed, weak value measurements have been a real breakthrough in the quantum measurement framework that is of the utmost interest from both a fundamental and an applicative point of view. In this Letter, we show how we realized for the first time a sequential weak value evaluation of two incompatible observables using a genuine single-photon experiment. These (sometimes anomalous) sequential weak values revealed the single-operator weak values, as well as the local correlation between them.

Accuracy of apparent diffusion coefficient value measurement on PACS workstation: A comparative analysis.

PubMed

El Kady, Reem M; Choudhary, Arabinda Kumar; Tappouni, Rafel

2011-03-01

The purpose of this article is to evaluate the accuracy of apparent diffusion coefficient (ADC) measurements made with a PACS workstation compared with measurements made with a dedicated workstation, which is currently considered the reference standard. A retrospective review was performed in liver lesions from 79 patients using three MRI platforms. The final diagnosis was established by liver biopsy in 31 patients and by dynamic MRI and follow-up, both clinical and radiologic as indicated, in 48 patients. Each lesion that was clearly demonstrable on the ADC map was measured with a commercial dedicated postprocessing workstation and again with a PACS system. A two-sample t test was used to determine the statistically significant differences between the two ADC measurements. A total of 79 patients with 120 liver lesions were included. ADC values measured on the workstation were 0.4-4.38 × 10(-3) mm(2)/s. The ADC values measured on the PACS were 0.42-4.35 × 10(-3) mm(2)/s. The T value was -1.113, with 119 degrees of freedom, and the significance level was 0.268, which implies no significant difference between the two different measuring systems for all pathologic abnormalities and MRI scanners used. ADC values measured on a routine PACS workstation are as accurate as the values obtained on a dedicated specialized workstation. ADC value measurement on the routine PACS will save time and lead to increased utilization, which, in turn, will lead to an improved understanding of the different disease processes and their clinical management.

Analysis of performance measurement at HR-GR Department using the balance scorecard method

NASA Astrophysics Data System (ADS)

Vienni; Bachtiar, M.

2017-12-01

PT. X is a company engaged in logistics service in Indonesia. Every company will certainly face a dynamic business environment. Competitors not only from domestic but also from overseas. To be successful in achieving its objectives, company should have a comprehensive measurement system as a strategy feedback that will drive the performance of company. HR-GA department is department that coordinate directly with company’s management. Company through departments expect development goals in individual and also support of infrastructure will run smoothly. In 2015, company has taken steps to conduct a balanced scorecard as performance measurement. Nevertheless, a number of factors so it cannot run optimally. This study aims to analyse the current system and provided suggestions in order to give an overview to department related to its current performance. The results of data processing show that there are 8 objective strategies that have been formulated with 9 key performance indicators. Based on the results of scorecard, obtained values of 4.44 for customer perspective, 4.32 for internal business process perspective & 5.00 for learning and growth perspective. It concludes that performance based on perspectives are categorized very well

Airborne and Ground-Based Measurements Using a High-Performance Raman Lidar. Part 2; Ground Based

NASA Technical Reports Server (NTRS)

Whiteman, David N.; Cadirola, Martin; Venable, Demetrius; Connell, Rasheen; Rush, Kurt; Leblanc, Thierry; McDermid, Stuart

2009-01-01

The same RASL hardware as described in part I was installed in a ground-based mobile trailer and used in a water vapor lidar intercomparison campaign, hosted at Table Mountain, CA, under the auspices of the Network for the Detection of Atmospheric Composition Change (NDACC). The converted RASL hardware demonstrated high sensitivity to lower stratospheric water vapor indicating that profiling water vapor at those altitudes with sufficient accuracy to monitor climate change is possible. The measurements from Table Mountain also were used to explain the reason, and correct , for sub-optimal airborne aerosol extinction performance during the flight campaign.

Quantum Standard Teleportation Based on the Generic Measurement Bases

NASA Astrophysics Data System (ADS)

Hao, San-Ru; Hou, Bo-Yu; Xi, Xiao-Qiang; Yue, Rui-Hong

2003-10-01

We study the quantum standard teleportation based on the generic measurement bases. It is shown that the quantum standard teleportation does not depend on the explicit expression of the measurement bases. We have given the correspondence relation between the measurement performed by Alice and the unitary transformation performed by Bob. We also prove that the single particle unknown states and the two-particle unknown cat-like states can be exactly transmitted by means of the generic measurement bases and the correspondence unitary transformations. The project supported in part by National Natural Science Foundation of China, the Hunan Provincial Natural Science Foundation of China, and the Scientific Research Fund of Hunan Provincial Education Department

Value redefined for inflammatory bowel disease patients: a choice-based conjoint analysis of patients' preferences.

PubMed

van Deen, Welmoed K; Nguyen, Dominic; Duran, Natalie E; Kane, Ellen; van Oijen, Martijn G H; Hommes, Daniel W

2017-02-01

Value-based healthcare is an upcoming field. The core idea is to evaluate care based on achieved outcomes divided by the costs. Unfortunately, the optimal way to evaluate outcomes is ill-defined. In this study, we aim to develop a single, preference based, outcome metric, which can be used to quantify overall health value in inflammatory bowel disease (IBD). IBD patients filled out a choice-based conjoint (CBC) questionnaire in which patients chose preferable outcome scenarios with different levels of disease control (DC), quality of life (QoL), and productivity (Pr). A CBC analysis was performed to estimate the relative value of DC, QoL, and Pr. A patient-centered composite score was developed which was weighted based on the stated preferences. We included 210 IBD patients. Large differences in stated preferences were observed. Increases from low to intermediate outcome levels were valued more than increases from intermediate to high outcome levels. Overall, QoL was more important to patients than DC or Pr. Individual outcome scores were calculated based on the stated preferences. This score was significantly different from a score not weighted based on patient preferences in patients with active disease. We showed the feasibility of creating a single outcome metric in IBD which incorporates patients' values using a CBC. Because this metric changes significantly when weighted according to patients' values, we propose that success in healthcare should be measured accordingly.

Value Based Care and Patient-Centered Care: Divergent or Complementary?

PubMed

Tseng, Eric K; Hicks, Lisa K

2016-08-01

Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care.

Construction Performance Optimization toward Green Building Premium Cost Based on Greenship Rating Tools Assessment with Value Engineering Method

NASA Astrophysics Data System (ADS)

Latief, Yusuf; Berawi, Mohammed Ali; Basten, Van; Riswanto; Budiman, Rachmat

2017-07-01

Green building concept becomes important in current building life cycle to mitigate environment issues. The purpose of this paper is to optimize building construction performance towards green building premium cost, achieving green building rating tools with optimizing life cycle cost. Therefore, this study helps building stakeholder determining building fixture to achieve green building certification target. Empirically the paper collects data of green building in the Indonesian construction industry such as green building fixture, initial cost, operational and maintenance cost, and certification score achievement. After that, using value engineering method optimized green building fixture based on building function and cost aspects. Findings indicate that construction performance optimization affected green building achievement with increasing energy and water efficiency factors and life cycle cost effectively especially chosen green building fixture.

Value-based formulas for purchasing. Does managed care offer value to society?

PubMed

Priester, R

1997-01-01

To assess whether managed care is, all things considered, a good investment for our society, we can measure its performance relative to five essential health care goals: promote efficiency; expand access; improve quality; preserve freedom of choice; and protect patient advocacy. These goals, which have shaped and continue to shape health care policy, define what is important to us in our health care system. Concerns about managed care's ability to advance these goals and thus to offer value are heightened if recently observed trends continue.

Biometric identification based on novel frequency domain facial asymmetry measures

NASA Astrophysics Data System (ADS)

Mitra, Sinjini; Savvides, Marios; Vijaya Kumar, B. V. K.

2005-03-01

In the modern world, the ever-growing need to ensure a system's security has spurred the growth of the newly emerging technology of biometric identification. The present paper introduces a novel set of facial biometrics based on quantified facial asymmetry measures in the frequency domain. In particular, we show that these biometrics work well for face images showing expression variations and have the potential to do so in presence of illumination variations as well. A comparison of the recognition rates with those obtained from spatial domain asymmetry measures based on raw intensity values suggests that the frequency domain representation is more robust to intra-personal distortions and is a novel approach for performing biometric identification. In addition, some feature analysis based on statistical methods comparing the asymmetry measures across different individuals and across different expressions is presented.

The Business Value of Superior Energy Performance

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

McKane, Aimee; Scheihing, Paul; Evans, Tracy

Industrial facilities participating in the U.S. Department of Energy’s (US DOE) Superior Energy Performance (SEP) program are finding that it provides them with significant business value. This value starts with the implementation of ISO 50001-Energy management system standard, which provides an internationally-relevant framework for integration of energy management into an organization’s business processes. The resulting structure emphasizes effective use of available data and supports continual improvement of energy performance. International relevance is particularly important for companies with a global presence or trading interests, providing them with access to supporting ISO standards and a growing body of certified companies representing themore » collective knowledge of communities of practice. This paper examines the business value of SEP, a voluntary program that builds on ISO 50001, inviting industry to demonstrate an even greater commitment through third-party verification of energy performance improvement to a specified level of achievement. Information from 28 facilities that have already achieved SEP certification will illustrate key findings concerning both the value and the challenges from SEP/ISO 50001 implementation. These include the facilities’ experience with implementation, internal and external value of third-party verification of energy performance improvement; attractive payback periods and the importance of SEP tools and guidance. US DOE is working to bring the program to scale, including the Enterprise-Wide Accelerator (SEP for multiple facilities in a company), the Ratepayer-Funded Program Accelerator (supporting tools for utilities and program administrators to include SEP in their program offerings), and expansion of the program to other sectors and industry supply chains.« less

Measuring Individual Performance with Comprehensive Bibliometric Reports as an Alternative to h-Index Values

PubMed Central

2018-01-01

The h-index is frequently used to measure the performance of single scientists in Korea (and beyond). No single indicator alone, however, is able to provide a stable and complete assessment of performance. The Stata command bibrep.ado is introduced which automatically produces bibliometric reports for single researchers (senior researchers working in the natural or life sciences). The user of the command receives a comprehensive bibliometric report which can be used in research evaluation instead of the h-index. PMID:29713257

Association of Body Mass Index With Self-Report and Performance-Based Measures of Balance and Mobility

PubMed Central

Wert, David M.; Hile, Elizabeth S.; Studenski, Stephanie A.; Brach, Jennifer S.

2011-01-01

Background The incidence of obesity is increasing in older adults, with associated worsening in the burden of disability. Little is known about the impact of body mass index (BMI) on self-report and performance-based balance and mobility measures in older adults. Objective The purposes of this study were (1) to examine the association of BMI with measures of balance and mobility and (2) to explore potential explanatory factors. Design This was a cross-sectional, observational study. Methods Older adults (mean age=77.6 years) who participated in an ongoing observational study (N=120) were classified as normal weight (BMI=18.5–24.9 kg/m2), overweight (BMI=25.0–29.9 kg/m2), moderately obese (BMI=30.0–34.9 kg/m2), or severely obese (BMI≥35 kg/m2). Body mass index data were missing for one individual; thus, data for 119 participants were included in the analysis. Mobility and balance were assessed using self-report and performance-based measures and were compared among weight groups using analysis of variance and chi-square analysis for categorical data. Multiple linear regression analysis was used to examine the association among BMI, mobility, and balance after controlling for potential confounding variables. Results Compared with participants who were of normal weight or overweight, those with moderate or severe obesity were less likely to report their mobility as very good or excellent (52%, 55%, 39%, and 6%, respectively); however, there was no difference in self-report of balance among weight groups. Participants with severe obesity (n=17) had the lowest levels of mobility on the performance-based measures, followed by those who were moderately obese (n=31), overweight (n=42), and of normal weight (n=29). There were no differences on performance-based balance measures among weight groups. After controlling for age, sex, minority status, physical activity level, education level, and comorbid conditions, BMI still significantly contributed to mobility (�

Estimating SPT-N Value Based on Soil Resistivity using Hybrid ANN-PSO Algorithm

NASA Astrophysics Data System (ADS)

Nur Asmawisham Alel, Mohd; Ruben Anak Upom, Mark; Asnida Abdullah, Rini; Hazreek Zainal Abidin, Mohd

2018-04-01

Standard Penetration Resistance (N value) is used in many empirical geotechnical engineering formulas. Meanwhile, soil resistivity is a measure of soil’s resistance to electrical flow. For a particular site, usually, only a limited N value data are available. In contrast, resistivity data can be obtained extensively. Moreover, previous studies showed evidence of a correlation between N value and resistivity value. Yet, no existing method is able to interpret resistivity data for estimation of N value. Thus, the aim is to develop a method for estimating N-value using resistivity data. This study proposes a hybrid Artificial Neural Network-Particle Swarm Optimization (ANN-PSO) method to estimate N value using resistivity data. Five different ANN-PSO models based on five boreholes were developed and analyzed. The performance metrics used were the coefficient of determination, R2 and mean absolute error, MAE. Analysis of result found that this method can estimate N value (R2 best=0.85 and MAEbest=0.54) given that the constraint, Δ {\\bar{l}}ref, is satisfied. The results suggest that ANN-PSO method can be used to estimate N value with good accuracy.

Measuring relative performance of an EDS detector using a NiO standard.

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

Sugar, Joshua Daniel; Kotula, Paul Gabriel

2013-09-01

A method for measuring the relative performance of energy dispersive spectrometers (EDS) on a TEM is discussed. A NiO thin-film standard fabricated at Sandia CA is used. A performance parameter,, is measured and compared to values on several TEM systems.

A National Trial on Differences in Cerebral Perfusion Pressure Values by Measurement Location.

PubMed

McNett, Molly M; Bader, Mary Kay; Livesay, Sarah; Yeager, Susan; Moran, Cristina; Barnes, Arianna; Harrison, Kimberly R; Olson, DaiWai M

2018-04-01

Cerebral perfusion pressure (CPP) is a key parameter in management of brain injury with suspected impaired cerebral autoregulation. CPP is calculated by subtracting intracranial pressure (ICP) from mean arterial pressure (MAP). Despite consensus on importance of CPP monitoring, substantial variations exist on anatomical reference points used to measure arterial MAP when calculating CPP. This study aimed to identify differences in CPP values based on measurement location when using phlebostatic axis (PA) or tragus (Tg) as anatomical reference points. The secondary study aim was to determine impact of differences on patient outcomes at discharge. This was a prospective, repeated measures, multi-site national trial. Adult ICU patients with neurological injury necessitating ICP and CPP monitoring were consecutively enrolled from seven sites. Daily MAP/ICP/CPP values were gathered with the arterial transducer at the PA, followed by the Tg as anatomical reference points. A total of 136 subjects were enrolled, resulting in 324 paired observations. There were significant differences for CPP when comparing values obtained at PA and Tg reference points (p < 0.000). Differences remained significant in repeated measures model when controlling for clinical factors (mean CPP-PA = 80.77, mean CPP-Tg = 70.61, p < 0.000). When categorizing CPP as binary endpoint, 18.8% of values were identified as adequate with PA values, yet inadequate with CPP values measured at the Tg. Findings identify numerical differences for CPP based on anatomical reference location and highlight importance of a standard reference point for both clinical practice and future trials to limit practice variations and heterogeneity of findings.

Performance measurement and modeling of component applications in a high performance computing environment : a case study.

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

Armstrong, Robert C.; Ray, Jaideep; Malony, A.

2003-11-01

We present a case study of performance measurement and modeling of a CCA (Common Component Architecture) component-based application in a high performance computing environment. We explore issues peculiar to component-based HPC applications and propose a performance measurement infrastructure for HPC based loosely on recent work done for Grid environments. A prototypical implementation of the infrastructure is used to collect data for a three components in a scientific application and construct performance models for two of them. Both computational and message-passing performance are addressed.

Curriculum-Based Measurement Performance Indicators: A Tool for Undergraduate Calculus Students to Inform and Direct Their Learning Behavior

ERIC Educational Resources Information Center

Sturges, Linda W.

2010-01-01

The present study investigated the extent to which providing students with individualized performance feedback informed and directed their learning behavior. Individualized performance feedback was delivered to students using curriculum-based measurement progress indicators, either as a visual representation of ongoing performance in the form of a…

Metrix Matrix: A Cloud-Based System for Tracking Non-Relative Value Unit Value-Added Work Metrics.

PubMed

Kovacs, Mark D; Sheafor, Douglas H; Thacker, Paul G; Hardie, Andrew D; Costello, Philip

2018-03-01

In the era of value-based medicine, it will become increasingly important for radiologists to provide metrics that demonstrate their value beyond clinical productivity. In this article the authors describe their institution's development of an easy-to-use system for tracking value-added but non-relative value unit (RVU)-based activities. Metrix Matrix is an efficient cloud-based system for tracking value-added work. A password-protected home page contains links to web-based forms created using Google Forms, with collected data populating Google Sheets spreadsheets. Value-added work metrics selected for tracking included interdisciplinary conferences, hospital committee meetings, consulting on nonbilled outside studies, and practice-based quality improvement. Over a period of 4 months, value-added work data were collected for all clinical attending faculty members in a university-based radiology department (n = 39). Time required for data entry was analyzed for 2 faculty members over the same time period. Thirty-nine faculty members (equivalent to 36.4 full-time equivalents) reported a total of 1,223.5 hours of value-added work time (VAWT). A formula was used to calculate "value-added RVUs" (vRVUs) from VAWT. VAWT amounted to 5,793.6 vRVUs or 6.0% of total work performed (vRVUs plus work RVUs [wRVUs]). Were vRVUs considered equivalent to wRVUs for staffing purposes, this would require an additional 2.3 full-time equivalents, on the basis of average wRVU calculations. Mean data entry time was 56.1 seconds per day per faculty member. As health care reimbursement evolves with an emphasis on value-based medicine, it is imperative that radiologists demonstrate the value they add to patient care beyond wRVUs. This free and easy-to-use cloud-based system allows the efficient quantification of value-added work activities. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Diversifying natural resources value measurements: The Trinity River study

USGS Publications Warehouse

Taylor, J.G.; Douglas, A.J.

1999-01-01

An interdisciplinary team set out to establish the economic and social values of the Trinity River in northern California. This information was intended to support the Secretary of the Interior's decision on allocation of Trinity River flows. This team set out to measure the values of Trinity River flows, fishery resources, and recreation amenities in several different ways. A survey was mailed to users of the Trinity River. This single instrument included economic measures (willingness-to-pay and costs incurred in visiting) and social-psychological measures (importance, satisfaction, and water allocation preferences). A closely related survey measured several of these same values among west coast regional households. The results of these surveys were compiled, and the measured economic and social values were compared. We found that integrating economic and social value information provides a greater depth of understanding of the resource's value. In addition, this integration provides a more in-depth understanding through the quantitative and qualitative results that emerge.

MEthods of ASsessing blood pressUre: identifying thReshold and target valuEs (MeasureBP): a review & study protocol.

PubMed

Blom, Kimberly C; Farina, Sasha; Gomez, Yessica-Haydee; Campbell, Norm R C; Hemmelgarn, Brenda R; Cloutier, Lyne; McKay, Donald W; Dawes, Martin; Tobe, Sheldon W; Bolli, Peter; Gelfer, Mark; McLean, Donna; Bartlett, Gillian; Joseph, Lawrence; Featherstone, Robin; Schiffrin, Ernesto L; Daskalopoulou, Stella S

2015-04-01

Despite progress in automated blood pressure measurement (BPM) technology, there is limited research linking hard outcomes to automated office BPM (OBPM) treatment targets and thresholds. Equivalences for automated BPM devices have been estimated from approximations of standardized manual measurements of 140/90 mmHg. Until outcome-driven targets and thresholds become available for automated measurement methods, deriving evidence-based equivalences between automated methods and standardized manual OBPM is the next best solution. The MeasureBP study group was initiated by the Canadian Hypertension Education Program to close this critical knowledge gap. MeasureBP aims to define evidence-based equivalent values between standardized manual OBPM and automated BPM methods by synthesizing available evidence using a systematic review and individual subject-level data meta-analyses. This manuscript provides a review of the literature and MeasureBP study protocol. These results will lay the evidenced-based foundation to resolve uncertainties within blood pressure guidelines which, in turn, will improve the management of hypertension.

Bayes' theorem application in the measure information diagnostic value assessment

NASA Astrophysics Data System (ADS)

Orzechowski, Piotr D.; Makal, Jaroslaw; Nazarkiewicz, Andrzej

2006-03-01

The paper presents Bayesian method application in the measure information diagnostic value assessment that is used in the computer-aided diagnosis system. The computer system described here has been created basing on the Bayesian Network and is used in Benign Prostatic Hyperplasia (BPH) diagnosis. The graphic diagnostic model enables to juxtapose experts' knowledge with data.

An automated A-value measurement tool for accurate cochlear duct length estimation.

PubMed

Iyaniwura, John E; Elfarnawany, Mai; Ladak, Hanif M; Agrawal, Sumit K

2018-01-22

There has been renewed interest in the cochlear duct length (CDL) for preoperative cochlear implant electrode selection and postoperative generation of patient-specific frequency maps. The CDL can be estimated by measuring the A-value, which is defined as the length between the round window and the furthest point on the basal turn. Unfortunately, there is significant intra- and inter-observer variability when these measurements are made clinically. The objective of this study was to develop an automated A-value measurement algorithm to improve accuracy and eliminate observer variability. Clinical and micro-CT images of 20 cadaveric cochleae specimens were acquired. The micro-CT of one sample was chosen as the atlas, and A-value fiducials were placed onto that image. Image registration (rigid affine and non-rigid B-spline) was applied between the atlas and the 19 remaining clinical CT images. The registration transform was applied to the A-value fiducials, and the A-value was then automatically calculated for each specimen. High resolution micro-CT images of the same 19 specimens were used to measure the gold standard A-values for comparison against the manual and automated methods. The registration algorithm had excellent qualitative overlap between the atlas and target images. The automated method eliminated the observer variability and the systematic underestimation by experts. Manual measurement of the A-value on clinical CT had a mean error of 9.5 ± 4.3% compared to micro-CT, and this improved to an error of 2.7 ± 2.1% using the automated algorithm. Both the automated and manual methods correlated significantly with the gold standard micro-CT A-values (r = 0.70, p < 0.01 and r = 0.69, p < 0.01, respectively). An automated A-value measurement tool using atlas-based registration methods was successfully developed and validated. The automated method eliminated the observer variability and improved accuracy as compared to manual

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).

Sex estimation based on tooth measurements using panoramic radiographs.

PubMed

Capitaneanu, Cezar; Willems, Guy; Jacobs, Reinhilde; Fieuws, Steffen; Thevissen, Patrick

2017-05-01

Sex determination is an important step in establishing the biological profile of unidentified human remains. The aims of the study were, firstly, to assess the degree of sexual dimorphism in permanent teeth, based on digital tooth measurements performed on panoramic radiographs. Secondly, to identify sex-related tooth position-specific measurements or combinations of such measurements, and to assess their applicability for potential sex determination. Two hundred digital panoramic radiographs (100 males, 100 females; age range 22-34 years) were retrospectively collected from the dental clinic files of the Dentomaxillofacial Radiology Center of the University Hospitals Leuven, Belgium, and imported in image enhancement software. Tooth length- and width-related variables were measured on all teeth in upper and lower left quadrant, and ratios of variables were calculated. Univariate and multivariate analyses were performed to quantify the sex discriminative value of the tooth position-specific variables and their combinations. The mandibular and maxillary canine showed the greatest sexual dimorphism, and tooth length variables had the highest discriminative potential. Compared to single variables, combining variables or ratios of variables did not improve substantially the discrimination between males and females. Considering that the discriminative ability values (area under the curve (AUC)) were not higher than 0.80, it is not advocated to use the currently studied dental variables for accurate sex estimation in forensic practice.

Singular value description of a digital radiographic detector: Theory and measurements

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

Kyprianou, Iacovos S.; Badano, Aldo; Gallas, Brandon D.

The H operator represents the deterministic performance of any imaging system. For a linear, digital imaging system, this system operator can be written in terms of a matrix, H, that describes the deterministic response of the system to a set of point objects. A singular value decomposition of this matrix results in a set of orthogonal functions (singular vectors) that form the system basis. A linear combination of these vectors completely describes the transfer of objects through the linear system, where the respective singular values associated with each singular vector describe the magnitude with which that contribution to the objectmore » is transferred through the system. This paper is focused on the measurement, analysis, and interpretation of the H matrix for digital x-ray detectors. A key ingredient in the measurement of the H matrix is the detector response to a single x ray (or infinitestimal x-ray beam). The authors have developed a method to estimate the 2D detector shift-variant, asymmetric ray response function (RRF) from multiple measured line response functions (LRFs) using a modified edge technique. The RRF measurements cover a range of x-ray incident angles from 0 deg. (equivalent location at the detector center) to 30 deg. (equivalent location at the detector edge) for a standard radiographic or cone-beam CT geometric setup. To demonstrate the method, three beam qualities were tested using the inherent, Lu/Er, and Yb beam filtration. The authors show that measures using the LRF, derived from an edge measurement, underestimate the system's performance when compared with the H matrix derived using the RRF. Furthermore, the authors show that edge measurements must be performed at multiple directions in order to capture rotational asymmetries of the RRF. The authors interpret the results of the H matrix SVD and provide correlations with the familiar MTF methodology. Discussion is made about the benefits of the H matrix technique with regards to

Establishing values-based leadership and value systems in healthcare organizations.

PubMed

Graber, David R; Kilpatrick, Anne Osborne

2008-01-01

The importance of values in organizations is often discussed in management literature. Possessing strong or inspiring values is increasingly considered to be a key quality of successful leaders. Another common theme is that organizational values contribute to the culture and ultimate success of organizations. These conceptions or expectations are clearly applicable to healthcare organizations in the United States. However, healthcare organizations have unique structures and are subject to societal expectations that must be accommodated within an organizational values system. This article describes theoretical literature on organizational values. Cultural and religious influences on Americans and how they may influence expectations from healthcare providers are discussed. Organizational cultures and the training and socialization of the numerous professional groups in healthcare also add to the considerable heterogeneity of value systems within healthcare organizations. These contribute to another challenge confronting healthcare managers--competing or conflicting values within a unit or the entire organization. Organizations often fail to reward members who uphold or enact the organization's values, which can lead to lack of motivation and commitment to the organization. Four key elements of values-based leadership are presented for healthcare managers who seek to develop as values-based leaders. 1) Recognize your personal and professional values, 2) Determine what you expect from the larger organization and what you can implement within your sphere of influence, 3) Understand and incorporate the values of internal stakeholders, and 4) Commit to values-based leadership.

The Utility of Curriculum-Based Measurement within a Multitiered Framework: Establishing Cut Scores as Predictors of Student Performance on the Alaska Standards-Based Assessment

ERIC Educational Resources Information Center

Legg, David E.

2013-01-01

The purpose of this study was to explore the relationship between student performance on Reading Curriculum-based Measures (R-CBM) and student performance on the Alaska's standards based assessment (SBA) administered to students in Studied School District (SSD) Grade 3 through Grade 5 students in the Studied School District as required by…

Redox potential - field measurements - meassured vs. expected values

NASA Astrophysics Data System (ADS)

Stavělová, Monika; Kovář, Martin

2016-04-01

Oxidation and reduction (redox) potential is an important and theoretically very well defined parameter and can be calculated accurately. Its value is determinative for management of many electrochemical processes, chemical redox technologies as well as biotechnologies. To measure the redox value that would correspond with the accuracy level of theoretical calculations in field or operational conditions is however nearly impossible. Redox is in practice measured using combined argentochloride electrode with subsequent value conversion to standard hydrogen electrode (EH). Argentochloride electrode does not allow for precise calibration. Prior to the measurement the accuracy of measurement of particular electrode can only be verified in comparative/control solution with value corresponding with oxic conditions (25°C: +220 mV argentochloride electrode, i.e.. +427 mV after conversion to EH). A commercial product of stabile comparative solution for anoxic conditions is not available and therefore not used in every day practice - accuracy of negative redox is not verified. In this presentation results of two tests will be presented: a) monitoring during dynamic groundwater sampling from eight monitoring wells at a site contaminated by chlorinated ethenes (i.e. post-oxic to anoxic conditions) and b) laboratory test of groundwater contaminated by arsenic from two sites during reaction with highly oxidized compounds of iron (ferrates) - i.e. strongly oxic conditions. In both tests a simultaneous measurement by four argentochloride electrodes was implemented - all four electrodes were prior to the test maintained expertly. The redox values of testing electrodes in a comparative solution varied by max. 6 mV. The redox values measured by four electrodes in both anoxic and oxic variant varied by tens to a hundred mV, while with growing time of test the variance of measured redox values increased in both oxic and anoxic variant. Therefore the interpretation of measured redox

Performance assessment of Vita Easy Shade spectrophotometer on colour measurement of aesthetic dental materials.

PubMed

AlGhazali, N; Burnside, G; Smith, R W; Preston, A J; Jarad, F D

2011-12-01

Four different shades were used to produce 20 samples of resin-based composite and 20 samples of porcelain to evaluate the performance ability of an intra oral test spectrophotometer compared to a reference spectrophotometer. The absolute colour coordinates CIELAB values measured with both spectrophotometers were significantly different (p < 0.001). However, a high correlation was found (p < 0.001) despite the low concordance noticed. The colour difference deltaE* values calculated between different shades also were significantly different between both spectrophotometers (p < 0.05). Therefore, the Easy Shade can be used in dental practice and dental research with some limitations.

Physiological and Performance Measures for Baseline Concussion Assessment.

PubMed

Dobney, Danielle M; Thomas, Scott G; Taha, Tim; Keightley, Michelle

2017-05-17

Baseline testing is a common strategy for concussion assessment and management. Research continues to evaluate novel measures for potential to improve baseline testing methods. The primary objective was to; 1) determine the feasibility of including physiological, neuromuscular and mood measures as part of baseline concussion testing protocol, 2) describe typical values in a varsity athlete sample, and 3) estimate the influence of concussion history on these baseline measures. Prospective observational study. University Athletic Therapy Clinic. 100 varsity athletes. Frequency and domain measures of heart rate variability (HRV), blood pressure (BP), grip strength, Profile of Mood States and the Sport Concussion Assessment Tool-2. Physiological, neuromuscular performance and mood measures were feasible at baseline. Participants with a history of two or more previous concussions displayed significantly higher diastolic blood pressure. Females reported higher total mood disturbance compared to males. Physiological and neuromuscular performance measures are safe and feasible as baseline concussion assessment outcomes. History of concussion may have an influence on diastolic blood pressure.

Neurocognitive mechanisms underlying value-based decision-making: from core values to economic value

PubMed Central

Brosch, Tobias; Sander, David

2013-01-01

Value plays a central role in practically every aspect of human life that requires a decision: whether we choose between different consumer goods, whether we decide which person we marry or which political candidate gets our vote, we choose the option that has more value to us. Over the last decade, neuroeconomic research has mapped the neural substrates of economic value, revealing that activation in brain regions such as ventromedial prefrontal cortex (VMPFC), ventral striatum or posterior cingulate cortex reflects how much an individual values an option and which of several options he/she will choose. However, while great progress has been made exploring the mechanisms underlying concrete decisions, neuroeconomic research has been less concerned with the questions of why people value what they value, and why different people value different things. Social psychologists and sociologists have long been interested in core values, motivational constructs that are intrinsically linked to the self-schema and are used to guide actions and decisions across different situations and different time points. Core value may thus be an important determinant of individual differences in economic value computation and decision-making. Based on a review of recent neuroimaging studies investigating the neural representation of core values and their interactions with neural systems representing economic value, we outline a common framework that integrates the core value concept and neuroeconomic research on value-based decision-making. PMID:23898252

40 CFR 600.206-08 - Calculation and use of FTP-based and HFET-based fuel economy values for vehicle configurations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... fuel economy values from the tests performed using gasoline or diesel test fuel. (ii) Calculate the city, highway, and combined fuel economy values from the tests performed using alcohol or natural gas test fuel. (b) If only one equivalent petroleum-based fuel economy value exists for an electric...

40 CFR 600.206-08 - Calculation and use of FTP-based and HFET-based fuel economy values for vehicle configurations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... fuel economy values from the tests performed using gasoline or diesel test fuel. (ii) Calculate the city, highway, and combined fuel economy values from the tests performed using alcohol or natural gas test fuel. (b) If only one equivalent petroleum-based fuel economy value exists for an electric...

U50: A New Metric for Measuring Assembly Output Based on Non-Overlapping, Target-Specific Contigs.

PubMed

Castro, Christina J; Ng, Terry Fei Fan

2017-11-01

Advances in next-generation sequencing technologies enable routine genome sequencing, generating millions of short reads. A crucial step for full genome analysis is the de novo assembly, and currently, performance of different assembly methods is measured by a metric called N 50 . However, the N 50 value can produce skewed, inaccurate results when complex data are analyzed, especially for viral and microbial datasets. To provide a better assessment of assembly output, we developed a new metric called U 50 . The U 50 identifies unique, target-specific contigs by using a reference genome as baseline, aiming at circumventing some limitations that are inherent to the N 50 metric. Specifically, the U 50 program removes overlapping sequence of multiple contigs by utilizing a mask array, so the performance of the assembly is only measured by unique contigs. We compared simulated and real datasets by using U 50 and N 50 , and our results demonstrated that U 50 has the following advantages over N 50 : (1) reducing erroneously large N 50 values due to a poor assembly, (2) eliminating overinflated N 50 values caused by large measurements from overlapping contigs, (3) eliminating diminished N 50 values caused by an abundance of small contigs, and (4) allowing comparisons across different platforms or samples based on the new percentage-based metric UG 50 %. The use of the U 50 metric allows for a more accurate measure of assembly performance by analyzing only the unique, non-overlapping contigs. In addition, most viral and microbial sequencing have high background noise (i.e., host and other non-targets), which contributes to having a skewed, misrepresented N 50 value-this is corrected by U 50 . Also, the UG 50 % can be used to compare assembly results from different samples or studies, the cross-comparisons of which cannot be performed with N 50 .

United States Population-Based Estimates of Patient-Reported Outcomes Measurement Information System Symptom and Functional Status Reference Values for Individuals With Cancer.

PubMed

Jensen, Roxanne E; Potosky, Arnold L; Moinpour, Carol M; Lobo, Tania; Cella, David; Hahn, Elizabeth A; Thissen, David; Smith, Ashley Wilder; Ahn, Jaeil; Luta, George; Reeve, Bryce B

2017-06-10

Purpose To estimate cancer population-based reference values in the United States for eight PROMIS (Patient-Reported Outcomes Measurement Information System) domains by age and stage of disease. Patients and Methods For the Measuring Your Health (MY-Health) study, persons newly diagnosed with cancer (prostate, colorectal, non-small-cell lung, non-Hodgkin lymphoma, breast, uterine, or cervical) from 2010 to 2012 (N = 5,284) were recruited through the National Cancer Institute's SEER Program. Participants were mailed surveys 6 to 13 months after diagnosis. Raking by race/ethnicity, age, and stage generated weighted average PROMIS scores for pain interference, fatigue, anxiety, depression, sleep disturbance, physical function, ability to participate in social roles, and cognitive function. PROMIS measures are standardized to a T-score metric, with a score of 50 representing the general US population mean. Clinically meaningful differences were defined as a 3-point difference in scores. Results Several reference values (means) for patients with cancer were worse than the general United States population norms of 50. These include pain interference (52.4), fatigue (52.2), and physical function (44.1). Reference values were highest (ie, showed greatest symptom burden) in lung cancer (pain interference, 55.5; fatigue, 57.3; depression, 51.4) and cervical cancer (anxiety, 53.2; sleep disturbance, 53.4). Reference values for patients age 65 to 84 years reported lower sleep disturbance, anxiety, and depression, and better cognitive function than younger patients. Cancer reference values were poorer among those with advanced disease compared with patients with limited or no evidence of disease, specifically physical function (41.1 v 46.6, respectively), fatigue (55.8 v 50.2, respectively), and pain interference (55.2 v 50.9, respectively). Conclusion In a large, population-based sample of patients with recently diagnosed cancer, we observed symptom severity and functional

Outlier Removal in Model-Based Missing Value Imputation for Medical Datasets.

PubMed

Huang, Min-Wei; Lin, Wei-Chao; Tsai, Chih-Fong

2018-01-01

Many real-world medical datasets contain some proportion of missing (attribute) values. In general, missing value imputation can be performed to solve this problem, which is to provide estimations for the missing values by a reasoning process based on the (complete) observed data. However, if the observed data contain some noisy information or outliers, the estimations of the missing values may not be reliable or may even be quite different from the real values. The aim of this paper is to examine whether a combination of instance selection from the observed data and missing value imputation offers better performance than performing missing value imputation alone. In particular, three instance selection algorithms, DROP3, GA, and IB3, and three imputation algorithms, KNNI, MLP, and SVM, are used in order to find out the best combination. The experimental results show that that performing instance selection can have a positive impact on missing value imputation over the numerical data type of medical datasets, and specific combinations of instance selection and imputation methods can improve the imputation results over the mixed data type of medical datasets. However, instance selection does not have a definitely positive impact on the imputation result for categorical medical datasets.

Calculating meal glycemic index by using measured and published food values compared with directly measured meal glycemic index.

PubMed

Dodd, Hayley; Williams, Sheila; Brown, Rachel; Venn, Bernard

2011-10-01

Glycemic index (GI) testing is normally based on individual foods, whereas GIs for meals or diets are based on a formula using a weighted sum of the constituents. The accuracy with which the formula can predict a meal or diet GI is questionable. Our objective was to compare the GI of meals, obtained by using the formula and by using both measured food GI and published values, with directly measured meal GIs. The GIs of 7 foods were tested in 30 healthy people. The foods were combined into 3 meals, each of which provided 50 g available carbohydrate, including a staple (potato, rice, or spaghetti), vegetables, sauce, and pan-fried chicken. The mean (95% CI) meal GIs determined from individual food GI values and by direct measurement were as follows: potato meal [predicted, 63 (56, 70); measured, 53 (46, 62)], rice meal [predicted, 51 (45, 56); measured, 38 (33, 45)], and spaghetti meal [predicted, 54 (49, 60); measured, 38 (33, 44)]. The predicted meal GIs were all higher than the measured GIs (P < 0.001). The extent of the overestimation depended on the particular food, ie, 12, 15, and 19 GI units (or 22%, 40%, and 50%) for the potato, rice, and spaghetti meals, respectively. The formula overestimated the GI of the meals by between 22% and 50%. The use of published food values also overestimated the measured meal GIs. Investigators using the formula to calculate a meal or diet GI should be aware of limitations in the method. This trial is registered with the Australian and New Zealand Clinical Trials Registry as ACTRN12611000210976.

The Impact of Nursing Home Pay-for-Performance on Quality and Medicare Spending: Results from the Nursing Home Value-Based Purchasing Demonstration.

PubMed

Grabowski, David C; Stevenson, David G; Caudry, Daryl J; O'Malley, A James; Green, Lisa H; Doherty, Julia A; Frank, Richard G

2017-08-01

To evaluate the impact of the Nursing Home Value-Based Purchasing demonstration on quality of care and Medicare spending. Administrative and qualitative data from Arizona, New York, and Wisconsin nursing homes over the base-year (2008-2009) and 3-year (2009-2012) demonstration period. Nursing homes were randomized to the intervention in New York, while the comparison facilities were constructed via propensity score matching in Arizona and Wisconsin. We used a difference-in-difference analysis to compare outcomes across the base-year relative to outcomes in each of the three demonstration years. To provide context and assist with interpretation of results, we also interviewed staff members at participating facilities. Medicare savings were observed in Arizona in the first year only and Wisconsin for the first 2 years; no savings were observed in New York. The demonstration did not systematically impact any of the quality measures. Discussions with nursing home administrators suggested that facilities made few, if any, changes in response to the demonstration, leading us to conclude that the observed savings likely reflected regression to the mean rather than true savings. The Federal nursing home pay-for-performance demonstration had little impact on quality or Medicare spending. © Health Research and Educational Trust.

The performance evaluation model of mining project founded on the weight optimization entropy value method

NASA Astrophysics Data System (ADS)

Mao, Chao; Chen, Shou

2017-01-01

According to the traditional entropy value method still have low evaluation accuracy when evaluating the performance of mining projects, a performance evaluation model of mineral project founded on improved entropy is proposed. First establish a new weight assignment model founded on compatible matrix analysis of analytic hierarchy process (AHP) and entropy value method, when the compatibility matrix analysis to achieve consistency requirements, if it has differences between subjective weights and objective weights, moderately adjust both proportions, then on this basis, the fuzzy evaluation matrix for performance evaluation. The simulation experiments show that, compared with traditional entropy and compatible matrix analysis method, the proposed performance evaluation model of mining project based on improved entropy value method has higher accuracy assessment.

Performance-based measures associate with frailty in patients with end-stage liver disease

PubMed Central

Lai, Jennifer C.; Volk, Michael L; Strasburg, Debra; Alexander, Neil

2016-01-01

Background Physical frailty, as measured by the Fried Frailty Index, is increasingly recognized as a critical determinant of outcomes in cirrhotics. However, its utility is limited by the inclusion of self-reported components. We aimed to identify performance-based measures associated with frailty in patients with cirrhosis. Methods Cirrhotics ≥50 years underwent: 6-minute walk test (6MWT, cardiopulmonary endurance), chair stands in 30 seconds (muscle endurance), isometric knee extension (lower extremity strength), unipedal stance time (static balance), and maximal step length (dynamic balance/coordination). Linear regression associated each physical performance test with frailty. Principal components exploratory factor analysis evaluated the inter-relatedness of frailty and the 5 physical performance tests. Results Of forty cirrhotics, with a median age of 64 years and Model for End-stage Liver Disease (MELD) MELD of 12,10 (25%) were frail by Fried Frailty Index ≥3. Frail cirrhotics had poorer performance in 6MWT distance (231 vs. 338 meters), 30 second chair stands (7 vs. 10), isometric knee extension (86 vs. 122 Newton meters), and maximal step length (22 vs. 27 inches) [p≤0.02 for each]. Each physical performance test was significantly associated with frailty (p<0.01), even after adjustment for MELD or hepatic encephalopathy. Principal component factor analysis demonstrated substantial, but unique, clustering of each physical performance test to a single factor – frailty. Conclusion Frailty in cirrhosis is a multi-dimensional construct that is distinct from liver dysfunction and incorporates endurance, strength, and balance. Our data provide specific targets for prehabilitation interventions aimed at reducing frailty in cirrhotics in preparation for liver transplantation. PMID:27495749

Performance-Based Measures Associate With Frailty in Patients With End-Stage Liver Disease.

PubMed

Lai, Jennifer C; Volk, Michael L; Strasburg, Debra; Alexander, Neil

2016-12-01

Physical frailty, as measured by the Fried Frailty Index, is increasingly recognized as a critical determinant of outcomes in patients with cirrhosis. However, its utility is limited by the inclusion of self-reported components. We aimed to identify performance-based measures associated with frailty in patients with cirrhosis. Patients with cirrhosis, aged 50 years or older, underwent: 6-minute walk test (cardiopulmonary endurance), chair stands in 30 seconds (muscle endurance), isometric knee extension (lower extremity strength), unipedal stance time (static balance), and maximal step length (dynamic balance/coordination). Linear regression associated each physical performance test with frailty. Principal components exploratory factor analysis evaluated the interrelatedness of frailty and the 5 physical performance tests. Of 40 patients with cirrhosis, with a median age of 64 years and Model for End-stage Liver Disease (MELD) MELD of 12.10 (25%) were frail by Fried Frailty Index ≥3. Frail patients with cirrhosis had poorer performance in 6-minute walk test distance (231 vs 338 m), 30-second chair stands (7 vs 10), isometric knee extension (86 vs 122 Newton meters), and maximal step length (22 vs 27 in. (P ≤ 0.02 for each). Each physical performance test was significantly associated with frailty (P < 0.01), even after adjustment for MELD or hepatic encephalopathy. Principal component factor analysis demonstrated substantial, but unique, clustering of each physical performance test to a single factor-frailty. Frailty in cirrhosis is a multidimensional construct that is distinct from liver dysfunction and incorporates endurance, strength, and balance. Our data provide specific targets for prehabilitation interventions aimed at reducing frailty in patients with cirrhosis in preparation for liver transplantation.

Employee Perceptions and Value of Performance Appraisals

ERIC Educational Resources Information Center

Bagnell, Rhea

2012-01-01

Performance appraisals traditionally have been studied quantitatively, from the manager's point of view, without considering their value or lack of value to workers. The absence of this information indicates that workers' perceptions and feelings have not always been considered. Therefore, the purpose of this phenomenological study was…

Performance testing accountability measurements

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

Oldham, R.D.; Mitchell, W.G.; Spaletto, M.I.

The New Brunswick Laboratory (NBL) provides assessment support to the DOE Operations Offices in the area of Material Control and Accountability (MC and A). During surveys of facilities, the Operations Offices have begun to request from NBL either assistance in providing materials for performance testing of accountability measurements or both materials and personnel to do performance testing. To meet these needs, NBL has developed measurement and measurement control performance test procedures and materials. The present NBL repertoire of performance tests include the following: (1) mass measurement performance testing procedures using calibrated and traceable test weights, (2) uranium elemental concentration (assay)more » measurement performance tests which use ampulated solutions of normal uranyl nitrate containing approximately 7 milligrams of uranium per gram of solution, and (3) uranium isotopic measurement performance tests which use ampulated uranyl nitrate solutions with enrichments ranging from 4% to 90% U-235. The preparation, characterization, and packaging of the uranium isotopic and assay performance test materials were done in cooperation with the NBL Safeguards Measurements Evaluation Program since these materials can be used for both purposes.« less

40 CFR 600.206-08 - Calculation and use of FTP-based and HFET-based fuel economy values for vehicle configurations.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., highway, and combined fuel economy values from the tests performed using gasoline or diesel test fuel. (ii) Calculate the city, highway, and combined fuel economy values from the tests performed using alcohol or natural gas test fuel. (b) If only one equivalent petroleum-based fuel economy value exists for an...

Measuring surgical performance: A risky game?

PubMed

Kiernan, F; Rahman, F

2015-08-01

Interest in performance measurement has been driven by increased demand for better indicators of hospital quality of care. This is due in part to policy makers wishing to benchmark standards of care and implement quality improvements, and also by an increased demand for transparency and accountability. We describe the role of performance measurement, which is not only about quality improvement, but also serves as a guide in allocating resources within health systems, and between health, education, and social welfare systems. As hospital based healthcare is responsible for the most cost within the healthcare system, and treats the most severely ill of patients, it is no surprise that performance measurement has focused attention on hospital based care, and in particular on surgery, as an important means of improving quality and accountability. We are particularly concerned about the choice of mortality as an outcome measure in surgery, as this choice assumes that all mortality in surgery is preventable. In reality, as a low quality indicator of care it risks both gaming, and cream-skimming, unless accurate risk adjustment exists. Further concerns relate to the public reporting of this outcome measure. As mortality rates are an imperfect measure of quality, the reputation of individual surgeons will be threatened by the public release of this data. Significant effort should be made to communicate the results to the public in an appropriate manner. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

A New Method for the Evaluation and Prediction of Base Stealing Performance.

PubMed

Bricker, Joshua C; Bailey, Christopher A; Driggers, Austin R; McInnis, Timothy C; Alami, Arya

2016-11-01

Bricker, JC, Bailey, CA, Driggers, AR, McInnis, TC, and Alami, A. A new method for the evaluation and prediction of base stealing performance. J Strength Cond Res 30(11): 3044-3050, 2016-The purposes of this study were to evaluate a new method using electronic timing gates to monitor base stealing performance in terms of reliability, differences between it and traditional stopwatch-collected times, and its ability to predict base stealing performance. Twenty-five healthy collegiate baseball players performed maximal effort base stealing trials with a right and left-handed pitcher. An infrared electronic timing system was used to calculate the reaction time (RT) and total time (TT), whereas coaches' times (CT) were recorded with digital stopwatches. Reliability of the TGM was evaluated with intraclass correlation coefficients (ICCs) and coefficient of variation (CV). Differences between the TGM and traditional CT were calculated with paired samples t tests Cohen's d effect size estimates. Base stealing performance predictability of the TGM was evaluated with Pearson's bivariate correlations. Acceptable relative reliability was observed (ICCs 0.74-0.84). Absolute reliability measures were acceptable for TT (CVs = 4.4-4.8%), but measures were elevated for RT (CVs = 32.3-35.5%). Statistical and practical differences were found between TT and CT (right p = 0.00, d = 1.28 and left p = 0.00, d = 1.49). The TGM TT seems to be a decent predictor of base stealing performance (r = -0.49 to -0.61). The authors recommend using the TGM used in this investigation for athlete monitoring because it was found to be reliable, seems to be more precise than traditional CT measured with a stopwatch, provides an additional variable of value (RT), and may predict future performance.

Reference Values for Human Posture Measurements Based on Computerized Photogrammetry: A Systematic Review.

PubMed

Macedo Ribeiro, Ana Freire; Bergmann, Anke; Lemos, Thiago; Pacheco, Antônio Guilherme; Mello Russo, Maitê; Santos de Oliveira, Laura Alice; de Carvalho Rodrigues, Erika

The main objective of this study was to review the literature to identify reference values for angles and distances of body segments related to upright posture in healthy adult women with the Postural Assessment Software (PAS/SAPO). Electronic databases (BVS, PubMed, SciELO and Scopus) were assessed using the following descriptors: evaluation, posture, photogrammetry, physical therapy, postural alignment, postural assessment, and physiotherapy. Studies that performed postural evaluation in healthy adult women with PAS/SAPO and were published in English, Portuguese and Spanish, between the years 2005 and 2014 were included. Four studies met the inclusion criteria. Data from the included studies were grouped to establish the statistical descriptors (mean, variance, and standard deviation) of the body angles and distances. A total of 29 variables were assessed (10 in the anterior views, 16 in the lateral right and left views, and 3 in the posterior views), and its respective mean and standard deviation were calculated. Reference values for the anterior and posterior views showed no symmetry between the right and left sides of the body in the frontal plane. There were also small differences in the calculated reference values for the lateral view. The proposed reference values for quantitative evaluation of the upright posture in healthy adult women estimated in the present study using PAS/SAPO could guide future studies and help clinical practice. Copyright © 2017. Published by Elsevier Inc.

Values-based recruitment in health care.

PubMed

Miller, Sam Louise

2015-01-27

Values-based recruitment is a process being introduced to student selection for nursing courses and appointment to registered nurse posts. This article discusses the process of values-based recruitment and demonstrates why it is important in health care today. It examines the implications of values-based recruitment for candidates applying to nursing courses and to newly qualified nurses applying for their first posts in England. To ensure the best chance of success, candidates should understand the principles and process of values-based recruitment and how to prepare for this type of interview.

Added Value of Physical Performance Measures in Predicting Adverse Health-Related Events: Results from the Health, Aging, and Body Composition Study

PubMed Central

Cesari, Matteo; Kritchevsky, Stephen B; Newman, Anne B; Simonsick, Eleanor M; Harris, Tamara B; Penninx, Brenda W; Brach, Jennifer S; Tylavsky, Frances A; Satterfield, Suzanne; Bauer, Doug C; Rubin, Susan M; Visser, Marjolein; Pahor, Marco

2009-01-01

Objectives To determine how three different physical performance measures (PPM) combine for added utility in predicting adverse health events in elders. Design Prospective cohort study. Setting Health, Aging, and Body Composition Study. Participants 3,024 well-functioning older persons (mean age 73.6 years). Measurements Timed gait, repeated chair stands and balance (semi- and full-tandem, and single leg stands each held for 30 seconds) tests were administered at baseline. Usual gait speed was categorized to distinguish high and low risk participants using the previously established 1 m/sec cut-point. The same population-percentile (21.3%) was used to identify cut-points for repeated chair stands (17.05 sec) and balance (53 sec) tests. Cox proportional hazard analyses were performed to evaluate the added value of PPM in predicting mortality, hospitalization, and (severe) mobility limitation events over 6.9 years of follow-up. Results Risk estimates for developing adverse health-related events were similarly large for each of the three high risk groups considered separately. A greater number of PPM scores at the high risk level was associated with a greater risk of developing adverse health-related events. When all three PPMs were considered, having only one poor performance was sufficient to indicate a highly significant higher risk of (severe) lower extremity and mortality events. Conclusion Although gait speed is considered the most important predictor of adverse health events, these findings demonstrate that poor performance on other tests of lower extremity function are equally prognostic. This suggests that chair stand and standing balance performance may be adequate substitutes when gait speed is unavailable. PMID:19207142

Factors influencing the robustness of P-value measurements in CT texture prognosis studies

NASA Astrophysics Data System (ADS)

McQuaid, Sarah; Scuffham, James; Alobaidli, Sheaka; Prakash, Vineet; Ezhil, Veni; Nisbet, Andrew; South, Christopher; Evans, Philip

2017-07-01

Several studies have recently reported on the value of CT texture analysis in predicting survival, although the topic remains controversial, with further validation needed in order to consolidate the evidence base. The aim of this study was to investigate the effect of varying the input parameters in the Kaplan-Meier analysis, to determine whether the resulting P-value can be considered to be a robust indicator of the parameter’s prognostic potential. A retrospective analysis of the CT-based normalised entropy of 51 patients with lung cancer was performed and overall survival data for these patients were collected. A normalised entropy cut-off was chosen to split the patient cohort into two groups and log-rank testing was performed to assess the survival difference of the two groups. This was repeated for varying normalised entropy cut-offs and varying follow-up periods. Our findings were also compared with previously published results to assess robustness of this parameter in a multi-centre patient cohort. The P-value was found to be highly sensitive to the choice of cut-off value, with small changes in cut-off producing substantial changes in P. The P-value was also sensitive to follow-up period, with particularly noisy results at short follow-up periods. Using matched conditions to previously published results, a P-value of 0.162 was obtained. Survival analysis results can be highly sensitive to the choice in texture cut-off value in dichotomising patients, which should be taken into account when performing such studies to avoid reporting false positive results. Short follow-up periods also produce unstable results and should therefore be avoided to ensure the results produced are reproducible. Previously published findings that indicated the prognostic value of normalised entropy were not replicated here, but further studies with larger patient numbers would be required to determine the cause of the different outcomes.

Benchmarking: your performance measurement and improvement tool.

PubMed

Senn, G F

2000-01-01

Many respected professional healthcare organizations and societies today are seeking to establish data-driven performance measurement strategies such as benchmarking. Clinicians are, however, resistant to "benchmarking" that is based on financial data alone, concerned that it may be adverse to the patients' best interests. Benchmarking of clinical procedures that uses physician's codes such as Current Procedural Terminology (CPTs) has greater credibility with practitioners. Better Performers, organizations that can perform procedures successfully at lower cost and in less time, become the "benchmark" against which other organizations can measure themselves. The Better Performers' strategies can be adopted by other facilities to save time or money while maintaining quality patient care.

Value-based medicine: concepts and application.

PubMed

Bae, Jong-Myon

2015-01-01

Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research.

Value-based medicine: concepts and application

PubMed Central

Bae, Jong-Myon

2015-01-01

Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research. PMID:25773441

Montana Department of Transportation Research Peer Exchange : Implementation, Performance Measures, and the Value of Research

DOT National Transportation Integrated Search

2018-01-01

The Montana Department of Transportation (MDT) Research Program hosted a peer exchange in Helena, Montana, from September 12-14, 2017. The objective for the peer exchange was to explore best practices on implementation, performance measures, and the ...

Investigation of the mediating effects of IT governance-value delivery on service quality and ERP performance

NASA Astrophysics Data System (ADS)

Tsai, Wen-Hsien; Chou, Yu-Wei; Leu, Jun-Der; Chao Chen, Der; Tsaur, Tsen-Shu

2015-02-01

This study aimed to explore the mediating effects of IT governance (ITG)-value delivery in the relationships among the quality of vendor service, the quality of consultant services, ITG-value delivery and enterprise resource planning (ERP) performance. The sampling of this research was acquired from a questionnaire survey concerning ERP implementations in Taiwan. In this survey, 4366 questionnaires were sent to manufacturing and service companies listed in the TOP 5000: The Largest Corporations in Taiwan 2009. The results showed that an ERP system will exhibit a decreased error rate and improved performance if ERP system vendors and consultants provide good service quality. The results also demonstrated that significant relationships exist among the quality of vendor service, the quality of consultant services and value delivery. The contribution of this article is twofold. First, it found that value delivery provides an effective measure of ERP performance under an ITG framework. Second, it provides evidence of the partial mediating effects of value delivery between service quality and ERP performance. In other words, if enterprises want to improve ERP performance, they need to consider factors such as value delivery and the quality of a vendor/consultant's service.

DSN 70-meter antenna microwave optics design and performance improvements. Part 2: Comparison with measurements

NASA Technical Reports Server (NTRS)

Bathker, D. A.; Slobin, S. D.

1989-01-01

The measured Deep Space Network (DSN) 70-meter antenna performance at S- and X-bands is compared with the design expectations. A discussion of natural radio-source calibration standards is given. New estimates of DSN 64-meter antenna performance are given, based on improved values of calibration source flux and size correction. A comparison of the 64- and 70-meter performances shows that average S-band peak gain improvement is 1.94 dB, compared with a design expectation of 1.77 dB. At X-band, the average peak gain improvement is 2.12 dB, compared with the (coincidentally similar) design expectation of 1.77 dB. The average measured 70-meter S-band peak gain exceeds the nominal design-expected gain by 0.02 dB; the average measured 70-meter X-band peak gain is 0.14 dB below the nominal design-expected gain.

Relationship between touch sensation of the affected hand and performance of valued activities in individuals with chronic stroke.

PubMed

Hill, Valerie A; Fisher, Thomas; Schmid, Arlene A; Crabtree, Jeffrey; Page, Stephen J

2014-01-01

To investigate the association between touch sensation of the affected hand and performance and satisfaction with performance of valued activities in individuals with chronic stroke. Using a cross-sectional study design, this study correlated factors related to hand sensation and activity performance in individuals with chronic stroke. The Touch Test Evaluators and Canadian Occupational Performance Measure (COPM) were used. Correlations were used to determine the relationships between touch sensation of the affected hand and individuals' performance and satisfaction with performance of valued activities. There was a good to excellent relationship between sensation and performance and satisfaction with performance of valued activities for individuals with intact touch sensation of the affected hand who scored higher on the COPM. There was little to no relationship between touch sensation of the affected hand and performance of valued activities for individuals with impaired sensation. This is the first study to relate touch sensation of the affected hand and performance and satisfaction with performance of valued activities in individuals with stroke. The findings suggest that rehabilitation therapists need to continue to address sensory function in evaluation and intervention as it relates to performance in valued activities. This study serves as a foundation for future research in sensation and performance of valued activities in individuals with chronic stroke.

Cognitive performance modeling based on general systems performance theory.

PubMed

Kondraske, George V

2010-01-01

General Systems Performance Theory (GSPT) was initially motivated by problems associated with quantifying different aspects of human performance. It has proved to be invaluable for measurement development and understanding quantitative relationships between human subsystem capacities and performance in complex tasks. It is now desired to bring focus to the application of GSPT to modeling of cognitive system performance. Previous studies involving two complex tasks (i.e., driving and performing laparoscopic surgery) and incorporating measures that are clearly related to cognitive performance (information processing speed and short-term memory capacity) were revisited. A GSPT-derived method of task analysis and performance prediction termed Nonlinear Causal Resource Analysis (NCRA) was employed to determine the demand on basic cognitive performance resources required to support different levels of complex task performance. This approach is presented as a means to determine a cognitive workload profile and the subsequent computation of a single number measure of cognitive workload (CW). Computation of CW may be a viable alternative to measuring it. Various possible "more basic" performance resources that contribute to cognitive system performance are discussed. It is concluded from this preliminary exploration that a GSPT-based approach can contribute to defining cognitive performance models that are useful for both individual subjects and specific groups (e.g., military pilots).

Smith machine counterbalance system affects measures of maximal bench press throw performance.

PubMed

Vingren, Jakob L; Buddhadev, Harsh H; Hill, David W

2011-07-01

Equipment with counterbalance weight systems is commonly used for the assessment of performance in explosive resistance exercise movements, but it is not known if such systems affect performance measures. The purpose of this study was to determine the effect of using a counterbalance weight system on measures of smith machine bench press throw performance. Ten men and 14 women (mean ± SD: age, 25 ± 4 years; height, 173 ± 10 cm; weight, 77.7 ± 18.3 kg) completed maximal smith machine bench press throws under 4 different conditions (2 × 2; counterbalance × load): with or without a counterbalance weight system and using 'light' or 'moderate' net barbell loads. Performance variables (peak force, peak velocity, and peak power) were measured using a linear accelerometer attached to the barbell. The counterbalance weight system resulted in significant (p < 0.001) reductions in measures of peak force (mean difference ± standard error: light: -112 ± 20 N; moderate: -140 ± 23 N), peak velocity (light: -0.49 ± 0.10 m·s; moderate: -0.33 ± 0.07 m·s), and peak power (light: -220 ± 43 W; moderate: -143 ± 28 W) compared with no counterbalance system for both load conditions. Load condition did not affect absolute or percentage reductions from the counterbalance weight system for any variable. In conclusion, the use of a counterbalance weight system reduces accelerometer-based performance measures for the bench press throw exercise at light and moderate loads. This reduction in measures is likely because of an increase in the external resistance during the movement, which results in a discrepancy between the manually input and the actual value for external load. A counterbalance weight system should not be used when measuring performance in explosive resistance exercises with an accelerometer.

Performance measurement: A tool for program control

NASA Technical Reports Server (NTRS)

Abell, Nancy

1994-01-01

Performance measurement is a management tool for planning, monitoring, and controlling as aspects of program and project management--cost, schedule, and technical requirements. It is a means (concept and approach) to a desired end (effective program planning and control). To reach the desired end, however, performance measurement must be applied and used appropriately, with full knowledge and recognition of its power and of its limitations--what it can and cannot do for the project manager. What is the potential of this management tool? What does performance measurement do that a traditional plan vs. actual technique cannot do? Performance measurement provides an improvement over the customary comparison of how much money was spent (actual cost) vs. how much was planned to be spent based on a schedule of activities (work planned). This commonly used plan vs. actual comparison does not allow one to know from the numerical data if the actual cost incurred was for work intended to be done.

Performance of a lookup table-based approach for measuring tissue optical properties with diffuse optical spectroscopy

NASA Astrophysics Data System (ADS)

Nichols, Brandon S.; Rajaram, Narasimhan; Tunnell, James W.

2012-05-01

Diffuse optical spectroscopy (DOS) provides a powerful tool for fast and noninvasive disease diagnosis. The ability to leverage DOS to accurately quantify tissue optical parameters hinges on the model used to estimate light-tissue interaction. We describe the accuracy of a lookup table (LUT)-based inverse model for measuring optical properties under different conditions relevant to biological tissue. The LUT is a matrix of reflectance values acquired experimentally from calibration standards of varying scattering and absorption properties. Because it is based on experimental values, the LUT inherently accounts for system response and probe geometry. We tested our approach in tissue phantoms containing multiple absorbers, different sizes of scatterers, and varying oxygen saturation of hemoglobin. The LUT-based model was able to extract scattering and absorption properties under most conditions with errors of less than 5 percent. We demonstrate the validity of the lookup table over a range of source-detector separations from 0.25 to 1.48 mm. Finally, we describe the rapid fabrication of a lookup table using only six calibration standards. This optimized LUT was able to extract scattering and absorption properties with average RMS errors of 2.5 and 4 percent, respectively.

Development of minimum standards for event-based data collection loggers and performance measure definitions for signalized intersections.

DOT National Transportation Integrated Search

2017-01-01

The arterial traffic signal performance measures were not used to their fullest potential in the past. The development of traffic signal controllers with event-based, high-resolution data logging capabilities enabled the advances in derivation and vi...

Effects of Goal Line Feedback on Level, Slope, and Stability of Performance within Curriculum-Based Measurement.

ERIC Educational Resources Information Center

Fuchs, Lynn S.; And Others

1991-01-01

Nineteen special educators implemented Curriculum-Based Measurement with a total of 36 learning-disabled math pupils in grades 2-8 to examine the effects of goal line feedback. Results indicated comparable levels and slopes of student performance across treatment conditions, although goal line feedback was associated with greater performance…

Small-time Scale Network Traffic Prediction Based on Complex-valued Neural Network

NASA Astrophysics Data System (ADS)

Yang, Bin

2017-07-01

Accurate models play an important role in capturing the significant characteristics of the network traffic, analyzing the network dynamic, and improving the forecasting accuracy for system dynamics. In this study, complex-valued neural network (CVNN) model is proposed to further improve the accuracy of small-time scale network traffic forecasting. Artificial bee colony (ABC) algorithm is proposed to optimize the complex-valued and real-valued parameters of CVNN model. Small-scale traffic measurements data namely the TCP traffic data is used to test the performance of CVNN model. Experimental results reveal that CVNN model forecasts the small-time scale network traffic measurement data very accurately

Ranking streamflow model performance based on Information theory metrics

NASA Astrophysics Data System (ADS)

Martinez, Gonzalo; Pachepsky, Yakov; Pan, Feng; Wagener, Thorsten; Nicholson, Thomas

2016-04-01

The accuracy-based model performance metrics not necessarily reflect the qualitative correspondence between simulated and measured streamflow time series. The objective of this work was to use the information theory-based metrics to see whether they can be used as complementary tool for hydrologic model evaluation and selection. We simulated 10-year streamflow time series in five watersheds located in Texas, North Carolina, Mississippi, and West Virginia. Eight model of different complexity were applied. The information-theory based metrics were obtained after representing the time series as strings of symbols where different symbols corresponded to different quantiles of the probability distribution of streamflow. The symbol alphabet was used. Three metrics were computed for those strings - mean information gain that measures the randomness of the signal, effective measure complexity that characterizes predictability and fluctuation complexity that characterizes the presence of a pattern in the signal. The observed streamflow time series has smaller information content and larger complexity metrics than the precipitation time series. Watersheds served as information filters and and streamflow time series were less random and more complex than the ones of precipitation. This is reflected the fact that the watershed acts as the information filter in the hydrologic conversion process from precipitation to streamflow. The Nash Sutcliffe efficiency metric increased as the complexity of models increased, but in many cases several model had this efficiency values not statistically significant from each other. In such cases, ranking models by the closeness of the information-theory based parameters in simulated and measured streamflow time series can provide an additional criterion for the evaluation of hydrologic model performance.

Complex Fuzzy Set-Valued Complex Fuzzy Measures and Their Properties

PubMed Central

Ma, Shengquan; Li, Shenggang

2014-01-01

Let F*(K) be the set of all fuzzy complex numbers. In this paper some classical and measure-theoretical notions are extended to the case of complex fuzzy sets. They are fuzzy complex number-valued distance on F*(K), fuzzy complex number-valued measure on F*(K), and some related notions, such as null-additivity, pseudo-null-additivity, null-subtraction, pseudo-null-subtraction, autocontionuous from above, autocontionuous from below, and autocontinuity of the defined fuzzy complex number-valued measures. Properties of fuzzy complex number-valued measures are studied in detail. PMID:25093202

VCSEL-based fiber optic link for avionics: implementation and performance analyses

NASA Astrophysics Data System (ADS)

Shi, Jieqin; Zhang, Chunxi; Duan, Jingyuan; Wen, Huaitao

2006-11-01

A Gb/s fiber optic link with built-in test capability (BIT) basing on vertical-cavity surface-emitting laser (VCSEL) sources for military avionics bus for next generation has been presented in this paper. To accurately predict link performance, statistical methods and Bit Error Rate (BER) measurements have been examined. The results show that the 1Gb/s fiber optic link meets the BER requirement and values for link margin can reach up to 13dB. Analysis shows that the suggested photonic network may provide high performance and low cost interconnections alternative for future military avionics.

Choice and Change of Measures in Performance-Measurement Models

DTIC Science & Technology

2005-05-01

associated costs . 3 Discussions of many current accounting and performance-measurement issues can be...change: an exploratory study. Accounting , Organizations, and Society, 24(3), 189-204. Adimando, C., Butler, R., Malley, S ., Ravid, S . A., Shepro, R...impact of contextual and process factors on the evaluation of activity-based costing systems. Accounting , Organizations and Society, 24, 525-559. Antle

Comparison of methodologies for calculating quality measures based on administrative data versus clinical data from an electronic health record system: implications for performance measures.

PubMed

Tang, Paul C; Ralston, Mary; Arrigotti, Michelle Fernandez; Qureshi, Lubna; Graham, Justin

2007-01-01

New reimbursement policies and pay-for-performance programs to reward providers for producing better outcomes are proliferating. Although electronic health record (EHR) systems could provide essential clinical data upon which to base quality measures, most metrics in use were derived from administrative claims data. We compared commonly used quality measures calculated from administrative data to those derived from clinical data in an EHR based on a random sample of 125 charts of Medicare patients with diabetes. Using standard definitions based on administrative data (which require two visits with an encounter diagnosis of diabetes during the measurement period), only 75% of diabetics determined by manually reviewing the EHR (the gold standard) were identified. In contrast, 97% of diabetics were identified using coded information in the EHR. The discrepancies in identified patients resulted in statistically significant differences in the quality measures for frequency of HbA1c testing, control of blood pressure, frequency of testing for urine protein, and frequency of eye exams for diabetic patients. New development of standardized quality measures should shift from claims-based measures to clinically based measures that can be derived from coded information in an EHR. Using data from EHRs will also leverage their clinical content without adding burden to the care process.

Method and apparatus for real-time measurement of fuel gas compositions and heating values

DOEpatents

Zelepouga, Serguei; Pratapas, John M.; Saveliev, Alexei V.; Jangale, Vilas V.

2016-03-22

An exemplary embodiment can be an apparatus for real-time, in situ measurement of gas compositions and heating values. The apparatus includes a near infrared sensor for measuring concentrations of hydrocarbons and carbon dioxide, a mid infrared sensor for measuring concentrations of carbon monoxide and a semiconductor based sensor for measuring concentrations of hydrogen gas. A data processor having a computer program for reducing the effects of cross-sensitivities of the sensors to components other than target components of the sensors is also included. Also provided are corresponding or associated methods for real-time, in situ determination of a composition and heating value of a fuel gas.

The Impact of IT Capability on Employee Capability, Customer Value, Customer Satisfaction, and Business Performance

ERIC Educational Resources Information Center

Chae, Ho-Chang

2009-01-01

This study empirically examines the impact of IT capability on firms' performance and evaluates whether firms' IT capabilities play a role in improving employee capability, customer value, customer satisfaction, and ultimately business performance. The results were based on comparing the business performance of the IT leader companies with that of…

Evaluation of analytical performance based on partial order methodology.

PubMed

Carlsen, Lars; Bruggemann, Rainer; Kenessova, Olga; Erzhigitov, Erkin

2015-01-01

Classical measurements of performances are typically based on linear scales. However, in analytical chemistry a simple scale may be not sufficient to analyze the analytical performance appropriately. Here partial order methodology can be helpful. Within the context described here, partial order analysis can be seen as an ordinal analysis of data matrices, especially to simplify the relative comparisons of objects due to their data profile (the ordered set of values an object have). Hence, partial order methodology offers a unique possibility to evaluate analytical performance. In the present data as, e.g., provided by the laboratories through interlaboratory comparisons or proficiency testings is used as an illustrative example. However, the presented scheme is likewise applicable for comparison of analytical methods or simply as a tool for optimization of an analytical method. The methodology can be applied without presumptions or pretreatment of the analytical data provided in order to evaluate the analytical performance taking into account all indicators simultaneously and thus elucidating a "distance" from the true value. In the present illustrative example it is assumed that the laboratories analyze a given sample several times and subsequently report the mean value, the standard deviation and the skewness, which simultaneously are used for the evaluation of the analytical performance. The analyses lead to information concerning (1) a partial ordering of the laboratories, subsequently, (2) a "distance" to the Reference laboratory and (3) a classification due to the concept of "peculiar points". Copyright © 2014 Elsevier B.V. All rights reserved.

Value-based medicine and vitreoretinal diseases.

PubMed

Brown, Melissa M; Brown, Gary C; Sharma, Sanjay

2004-06-01

The purpose of the review is to examine the role of value-based medicine and its impact, or potential impact, on vitreoretinal interventions. Value-based medicine integrates evidence-based data from clinical trials with the patient-perceived improvement in quality of life conferred by an intervention. Cost-utility analysis, the healthcare economic instrument used to create a value-based medicine database, is being increasingly used to study the cost-effectiveness of vitreoretinal interventions. Vitreoretinal interventions are generally cost-effective because of the great value they impart to patients. Laser surgical procedures, such as for diabetic retinopathy, threshold retinopathy of prematurity, and exudative macular degeneration appear to be especially cost-effective as a group.

Machine learning classifiers for glaucoma diagnosis based on classification of retinal nerve fibre layer thickness parameters measured by Stratus OCT.

PubMed

Bizios, Dimitrios; Heijl, Anders; Hougaard, Jesper Leth; Bengtsson, Boel

2010-02-01

To compare the performance of two machine learning classifiers (MLCs), artificial neural networks (ANNs) and support vector machines (SVMs), with input based on retinal nerve fibre layer thickness (RNFLT) measurements by optical coherence tomography (OCT), on the diagnosis of glaucoma, and to assess the effects of different input parameters. We analysed Stratus OCT data from 90 healthy persons and 62 glaucoma patients. Performance of MLCs was compared using conventional OCT RNFLT parameters plus novel parameters such as minimum RNFLT values, 10th and 90th percentiles of measured RNFLT, and transformations of A-scan measurements. For each input parameter and MLC, the area under the receiver operating characteristic curve (AROC) was calculated. There were no statistically significant differences between ANNs and SVMs. The best AROCs for both ANN (0.982, 95%CI: 0.966-0.999) and SVM (0.989, 95% CI: 0.979-1.0) were based on input of transformed A-scan measurements. Our SVM trained on this input performed better than ANNs or SVMs trained on any of the single RNFLT parameters (p < or = 0.038). The performance of ANNs and SVMs trained on minimum thickness values and the 10th and 90th percentiles were at least as good as ANNs and SVMs with input based on the conventional RNFLT parameters. No differences between ANN and SVM were observed in this study. Both MLCs performed very well, with similar diagnostic performance. Input parameters have a larger impact on diagnostic performance than the type of machine classifier. Our results suggest that parameters based on transformed A-scan thickness measurements of the RNFL processed by machine classifiers can improve OCT-based glaucoma diagnosis.

Relevance of methods and standards for the assessment of measurement system performance in a High-Value Manufacturing Industry

NASA Astrophysics Data System (ADS)

Loftus, Pete; Giudice, Seb

2014-08-01

Measurements underpin the engineering decisions that allow products to be designed, manufactured, operated, and maintained. Therefore, the quality of measured data needs to be systematically assured to allow decision makers to proceed with confidence. The use of standards is one way of achieving this. This paper explores the relevance of international documentary standards to the assessment of measurement system capability in High Value Manufacturing (HVM) Industry. An internal measurement standard is presented which supplements these standards and recommendations are made for a cohesive effort to develop the international standards to provide consistency in such industrial applications.

Development and validation of a measurement procedure based on ultra-high performance liquid chromatography-tandem mass spectrometry for simultaneous measurement of β-lactam antibiotic concentration in human plasma.

PubMed

Rigo-Bonnin, Raül; Ribera, Alba; Arbiol-Roca, Ariadna; Cobo-Sacristán, Sara; Padullés, Ariadna; Murillo, Òscar; Shaw, Evelyn; Granada, Rosa; Pérez-Fernández, Xosé L; Tubau, Fe; Alía, Pedro

2017-05-01

The administration of β-lactam antibiotics in continuous infusion could let optimize the pharmacokinetic/pharmacodynamic parameters, especially in the treatment of serious bacterial infections. In this context, and also due to variability in their plasmatic concentrations, therapeutic drug monitoring (TDM) may be useful to optimize dosing and, therefore, be useful for the clinicians. We developed and validated a measurement procedure based on ultra-high performance liquid chromatography-tandem mass spectrometry for simultaneous measurement of amoxicillin, ampicillin, cloxacillin, piperacillin, cefepime, ceftazidime, cefuroxime, aztreonam and meropenem concentrations in plasma. The chromatographic separation was achieved using an Acquity®-UPLC® BEH™ (2.1×100mm id, 1.7μm) reverse-phase C 18 column, with a water/acetonitrile linear gradient containing 0.1% formic acid at a 0.4mL/min flow rate. β-Lactam antibiotics and their internal standards were detected by electrospray ionization mass spectrometry in multiple reaction monitoring mode. Chromatography run time was 7.0min and β-lactam antibiotics eluted at retention times ranging between 1.08 and 1.91min. The lower limits of quantification were between 0.50 and 1.00mg/L. Coefficients of variation and relative bias absolute values were <13.3% and 14.7%, respectively. Recovery values ranged from 55.7% to 84.8%. Evaluation of the matrix effect showed ion enhancement for all antibiotics. No interferences or carry-over were observed. Our measurement procedure could be applied to daily clinical laboratory practice to measure the concentration of β-lactam antibiotics in plasma, for instance in patients with bone and joint infections and critically ill patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Spectral dilation of L(B,H)-valued measures and its application to stationary dilation for Banach space valued processes

NASA Technical Reports Server (NTRS)

Miamee, A. G.

1988-01-01

Let B be a Banach space and H and K two Hilbert spaces. The spectral dilation of L(B,H)-valued measures is studied and it is shown that the recent results of Makagon and Salehi (1986) and Rosenberg (1982) on the dilation of L(K,H)-valued measures can be extended to hold for the general Banach space setting of L(B,H)-valued measures. These L(B,H)-valued measures are closely connected to the Banach space valued processes. This connection is recalled and as application of spectral dilation of L(B,H)-valued measures the well known stationary dilation results for scalar valued processes is extended to the case of Banach space valued processes.

Anomalous weak values and the violation of a multiple-measurement Leggett-Garg inequality

NASA Astrophysics Data System (ADS)

Avella, Alessio; Piacentini, Fabrizio; Borsarelli, Michelangelo; Barbieri, Marco; Gramegna, Marco; Lussana, Rudi; Villa, Federica; Tosi, Alberto; Degiovanni, Ivo Pietro; Genovese, Marco

2017-11-01

Quantum mechanics presents peculiar properties that, on the one hand, have been the subject of several theoretical and experimental studies about its very foundations and, on the other hand, provide tools for developing new technologies, the so-called quantum technologies. The nonclassicality pointed out by Leggett-Garg inequalities has represented, with Bell inequalities, one of the most investigated subjects. In this article we study the connection of Leggett-Garg inequalities with a new emerging field of quantum measurement, the weak values in the case of a series of sequential measurements on a single object. In detail, we perform an experimental study of the four-time-correlator Leggett-Garg test, by exploiting single and sequential weak measurements performed on heralded single photons.

FPGA-Based X-Ray Detection and Measurement for an X-Ray Polarimeter

NASA Technical Reports Server (NTRS)

Gregory, Kyle; Hill, Joanne; Black, Kevin; Baumgartner, Wayne

2013-01-01

This technology enables detection and measurement of x-rays in an x-ray polarimeter using a field-programmable gate array (FPGA). The technology was developed for the Gravitational and Extreme Magnetism Small Explorer (GEMS) mission. It performs precision energy and timing measurements, as well as rejection of non-x-ray events. It enables the GEMS polarimeter to detect precisely when an event has taken place so that additional measurements can be made. The technology also enables this function to be performed in an FPGA using limited resources so that mass and power can be minimized while reliability for a space application is maximized and precise real-time operation is achieved. This design requires a low-noise, charge-sensitive preamplifier; a highspeed analog to digital converter (ADC); and an x-ray detector with a cathode terminal. It functions by computing a sum of differences for time-samples whose difference exceeds a programmable threshold. A state machine advances through states as a programmable number of consecutive samples exceeds or fails to exceed this threshold. The pulse height is recorded as the accumulated sum. The track length is also measured based on the time from the start to the end of accumulation. For track lengths longer than a certain length, the algorithm estimates the barycenter of charge deposit by comparing the accumulator value at the midpoint to the final accumulator value. The design also employs a number of techniques for rejecting background events. This innovation enables the function to be performed in space where it can operate autonomously with a rapid response time. This implementation combines advantages of computing system-based approaches with those of pure analog approaches. The result is an implementation that is highly reliable, performs in real-time, rejects background events, and consumes minimal power.

Study of ultrasonic thermometry based on ultrasonic time-of-flight measurement

NASA Astrophysics Data System (ADS)

Jia, Ruixi; Xiong, Qingyu; Wang, Lijie; Wang, Kai; Shen, Xuehua; Liang, Shan; Shi, Xin

2016-03-01

Ultrasonic thermometry is a kind of acoustic pyrometry and it has been evolving as a new temperature measurement technology for various environment. However, the accurate measurement of the ultrasonic time-of-flight is the key for ultrasonic thermometry. In this paper, we study the ultrasonic thermometry technique based on ultrasonic time-of-flight measurement with a pair of ultrasonic transducers for transmitting and receiving signal. The ultrasonic transducers are installed in a single path which ultrasonic travels. In order to validate the performance of ultrasonic thermometry, we make a contrast about the absolute error between the measured temperature value and the practical one. With and without heater source, the experimental results indicate ultrasonic thermometry has high precision of temperature measurement.

NHS constitution values for values-based recruitment: a virtue ethics perspective.

PubMed

Groothuizen, Johanna Elise; Callwood, Alison; Gallagher, Ann

2018-05-17

Values-based recruitment is used in England to select healthcare staff, trainees and students on the basis that their values align with those stated in the Constitution of the UK National Health Service (NHS). However, it is unclear whether the extensive body of existing literature within the field of moral philosophy was taken into account when developing these values. Although most values have a long historical tradition, a tendency to assume that they have just been invented, and to approach them uncritically, exists within the healthcare sector. Reflection is necessary. We are of the opinion that selected virtue ethics writings, which are underpinned by historical literature as well as practical analysis of the healthcare professions, provide a helpful framework for evaluation of the NHS Constitution values, to determine whether gaps exist and improvements can be made. Based on this evaluation, we argue that the definitions of certain NHS Constitution values are ambiguous. In addition to this, we argue that 'integrity' and 'practical wisdom', two important concepts in the virtue ethics literature, are not sufficiently represented within the NHS Constitution values. We believe that the NHS Constitution values could be strengthened by providing clearer definitions, and by integrating 'integrity' and 'practical wisdom'. This will benefit values-based recruitment strategies. Should healthcare policy-makers in other countries wish to develop a similar values-based recruitment framework, we advise that they proceed reflectively, and take previously published virtue ethics literature into consideration. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Improving the performance of a filling line based on simulation

NASA Astrophysics Data System (ADS)

Jasiulewicz-Kaczmarek, M.; Bartkowiak, T.

2016-08-01

The paper describes the method of improving performance of a filling line based on simulation. This study concerns a production line that is located in a manufacturing centre of a FMCG company. A discrete event simulation model was built using data provided by maintenance data acquisition system. Two types of failures were identified in the system and were approximated using continuous statistical distributions. The model was validated taking into consideration line performance measures. A brief Pareto analysis of line failures was conducted to identify potential areas of improvement. Two improvements scenarios were proposed and tested via simulation. The outcome of the simulations were the bases of financial analysis. NPV and ROI values were calculated taking into account depreciation, profits, losses, current CIT rate and inflation. A validated simulation model can be a useful tool in maintenance decision-making process.

High Performance Photodiode Based on p-Si/Copper Phthalocyanine Heterojunction.

PubMed

Zhong, Junkang; Peng, Yingquan; Zheng, Tingcai; Lv, Wenli; Ren, Qiang; Fobao, Huang; Ying, Wang; Chen, Zhen; Tang, Ying

2016-06-01

Hybrid organic-inorganic (HOI) photodiodes have both advantages of organic and inorganic materials, including compatibility of traditional Si-based semiconductor technology, low cost, high photosensitivity and high reliability, showing tremendous value in application. Red light sensitive HOI photodiodes based on the p-Si/copper phthalocyanine (CuPc) hetrojunction were fabricated and characterized. The effects of CuPc layer thickness on the performance were investigated, and an optimal layer thickness of around 30 nm was determined. An analytical expression is derived to describe the measured thickness dependence of the saturation photocurrent. For the device with optimal CuPc layer thickness, a photoresponsivity of 0.35 A/W and external quantum efficiency of 70% were obtained at 9 V reverse voltage bias and 655 nm light illumination of 0.451 mW. Furthermore, optical power dependent performances were investigated.

Operational Risk Measurement of Chinese Commercial Banks Based on Extreme Value Theory

NASA Astrophysics Data System (ADS)

Song, Jiashan; Li, Yong; Ji, Feng; Peng, Cheng

The financial institutions and supervision institutions have all agreed on strengthening the measurement and management of operational risks. This paper attempts to build a model on the loss of operational risks basing on Peak Over Threshold model, emphasizing on weighted least square, which improved Hill’s estimation method, while discussing the situation of small sample, and fix the sample threshold more objectively basing on the media-published data of primary banks loss on operational risk from 1994 to 2007.

Predicting the Performance of Chain Saw Machines Based on Shore Scleroscope Hardness

NASA Astrophysics Data System (ADS)

Tumac, Deniz

2014-03-01

Shore hardness has been used to estimate several physical and mechanical properties of rocks over the last few decades. However, the number of researches correlating Shore hardness with rock cutting performance is quite limited. Also, rather limited researches have been carried out on predicting the performance of chain saw machines. This study differs from the previous investigations in the way that Shore hardness values (SH1, SH2, and deformation coefficient) are used to determine the field performance of chain saw machines. The measured Shore hardness values are correlated with the physical and mechanical properties of natural stone samples, cutting parameters (normal force, cutting force, and specific energy) obtained from linear cutting tests in unrelieved cutting mode, and areal net cutting rate of chain saw machines. Two empirical models developed previously are improved for the prediction of the areal net cutting rate of chain saw machines. The first model is based on a revised chain saw penetration index, which uses SH1, machine weight, and useful arm cutting depth as predictors. The second model is based on the power consumed for only cutting the stone, arm thickness, and specific energy as a function of the deformation coefficient. While cutting force has a strong relationship with Shore hardness values, the normal force has a weak or moderate correlation. Uniaxial compressive strength, Cerchar abrasivity index, and density can also be predicted by Shore hardness values.

Presenting Cost and Efficiency Measures That Support Consumers to Make High-Value Health Care Choices.

PubMed

Greene, Jessica; Sacks, Rebecca M

2018-02-25

To identify approaches to presenting cost and resource use measures that support consumers in selecting high-value hospitals. Survey data were collected from U.S. employees of Analog Devices (n = 420). In two online experiments, participants viewed comparative data on four hospitals. In one experiment, participants were randomized to view one of five versions of the same comparative cost data, and in the other experiment they viewed different versions of the same readmissions data. Bivariate and multivariate analyses examined whether presentation approach was related to selecting the high-value hospital. Consumers were approximately 16 percentage points more likely to select a high-value hospital when cost data were presented using actual dollar amounts or using the word "affordable" to describe low-cost hospitals, compared to when the Hospital Compare spending ratio was used. Consumers were 33 points more likely to select the highest performing hospital when readmission performance was shown using word icons rather than percentages. Presenting cost and resource use measures effectively to consumers is challenging. This study suggests using actual dollar amounts for cost, but presenting performance on readmissions using evaluative symbols. © Health Research and Educational Trust.

Telerobotic system performance measurement - Motivation and methods

NASA Technical Reports Server (NTRS)

Kondraske, George V.; Khoury, George J.

1992-01-01

A systems performance-based strategy for modeling and conducting experiments relevant to the design and performance characterization of telerobotic systems is described. A developmental testbed consisting of a distributed telerobotics network and initial efforts to implement the strategy described is presented. Consideration is given to the general systems performance theory (GSPT) to tackle human performance problems as a basis for: measurement of overall telerobotic system (TRS) performance; task decomposition; development of a generic TRS model; and the characterization of performance of subsystems comprising the generic model. GSPT employs a resource construct to model performance and resource economic principles to govern the interface of systems to tasks. It provides a comprehensive modeling/measurement strategy applicable to complex systems including both human and artificial components. Application is presented within the framework of a distributed telerobotics network as a testbed. Insight into the design of test protocols which elicit application-independent data is described.

A robust indicator based on singular value decomposition for flaw feature detection from noisy ultrasonic signals

NASA Astrophysics Data System (ADS)

Cui, Ximing; Wang, Zhe; Kang, Yihua; Pu, Haiming; Deng, Zhiyang

2018-05-01

Singular value decomposition (SVD) has been proven to be an effective de-noising tool for flaw echo signal feature detection in ultrasonic non-destructive evaluation (NDE). However, the uncertainty in the arbitrary manner of the selection of an effective singular value weakens the robustness of this technique. Improper selection of effective singular values will lead to bad performance of SVD de-noising. What is more, the computational complexity of SVD is too large for it to be applied in real-time applications. In this paper, to eliminate the uncertainty in SVD de-noising, a novel flaw indicator, named the maximum singular value indicator (MSI), based on short-time SVD (STSVD), is proposed for flaw feature detection from a measured signal in ultrasonic NDE. In this technique, the measured signal is first truncated into overlapping short-time data segments to put feature information of a transient flaw echo signal in local field, and then the MSI can be obtained from the SVD of each short-time data segment. Research shows that this indicator can clearly indicate the location of ultrasonic flaw signals, and the computational complexity of this STSVD-based indicator is significantly reduced with the algorithm proposed in this paper. Both simulation and experiments show that this technique is very efficient for real-time application in flaw detection from noisy data.

Measuring Performance with Library Automated Systems.

ERIC Educational Resources Information Center

OFarrell, John P.

2000-01-01

Investigates the capability of three library automated systems to generate some of the datasets necessary to form the ISO (International Standards Organization) standard on performance measurement within libraries, based on research in Liverpool John Moores University (United Kingdom). Concludes that the systems are weak in generating the…

The Resource-Based View and Value: The Customer-Based View of the Firm

ERIC Educational Resources Information Center

Clulow, Val; Barry, Carol; Gerstman, Julie

2007-01-01

Purpose: The resource-based view (RBV) explores the role of key resources, identified as intangible assets and capabilities, in creating competitive advantage and superior performance. To a great extent the conceptual analysis and empirical research within the RBV has focused on the firm's perspective of key resources and the value to the firm of…

An Evaluation of Empirical Bayes' Estimation of Value- Added Teacher Performance Measures. Working Paper #31. Revised

ERIC Educational Resources Information Center

Guarino, Cassandra M.; Maxfield, Michelle; Reckase, Mark D.; Thompson, Paul; Wooldridge, Jeffrey M.

2014-01-01

Empirical Bayes' (EB) estimation is a widely used procedure to calculate teacher value-added. It is primarily viewed as a way to make imprecise estimates more reliable. In this paper we review the theory of EB estimation and use simulated data to study its ability to properly rank teachers. We compare the performance of EB estimators with that of…

40 CFR 1065.205 - Performance specifications for measurement instruments.

Code of Federal Regulations, 2014 CFR

2014-07-01

... are all determined with the same collected data, as described in § 1065.305, and based on absolute... meters to allow noise to be measured at the lowest calibrated value instead of zero flow rate. [79 FR...

[Balanced scorecard for performance measurement of a nursing organization in a Korean hospital].

PubMed

Hong, Yoonmi; Hwang, Kyung Ja; Kim, Mi Ja; Park, Chang Gi

2008-02-01

The purpose of this study was to develop a balanced scorecard (BSC) for performance measurement of a Korean hospital nursing organization and to evaluate the validity and reliability of performance measurement indicators. Two hundred fifty-nine nurses in a Korean hospital participated in a survey questionnaire that included 29-item performance evaluation indicators developed by investigators of this study based on the Kaplan and Norton's BSC (1992). Cronbach's alpha was used to test the reliability of the BSC. Exploratory and confirmatory factor analysis with a structure equation model (SEM) was applied to assess the construct validity of the BSC. Cronbach's alpha of 29 items was .948. Factor analysis of the BSC showed 5 principal components (eigen value >1.0) which explained 62.7% of the total variance, and it included a new one, community service. The SEM analysis results showed that 5 components were significant for the hospital BSC tool. High degree of reliability and validity of this BSC suggests that it may be used for performance measurements of a Korean hospital nursing organization. Future studies may consider including a balanced number of nurse managers and staff nurses in the study. Further data analysis on the relationships among factors is recommended.

The Utility of Curriculum-Based Measurement and Performance Assessment as Alternatives to Traditional Intelligence and Achievement Tests.

ERIC Educational Resources Information Center

Elliott, Stephen N.; Fuchs, Lynn S.

1997-01-01

Curriculum-based measurement and performance assessments can provide valuable data for making special-education eligibility decisions. Reviews applied research on these assessment approaches and discusses the practical context of treatment validation and decisions about instructional services for students with diverse academic needs. (Author/JDM)

Changes in experienced value of everyday occupations after nature-based vocational rehabilitation.

PubMed

Pálsdóttir, Anna María; Grahn, Patrik; Persson, Dennis

2014-01-01

The aim of this study was to describe and assess changes in participants' experiences of everyday occupations after nature-based vocational rehabilitation (NBVR), to assess changes regarding symptoms of severe stress and the rate of return to work and possible association with experiencing the occupational value of everyday occupations. The NBVR was carried out by a transdisciplinary rehabilitation team and took place in a specially designed rehabilitation garden. The study had a longitudinal and mixed-method approach. Data concerning experiences of everyday occupations (Oval-pd), self-assessed occupational competence (OSA-F), health status (EQ-VAS, SCI-93), and sense of coherence (SOC-13) were collected before and after the intervention, and a one-year follow-up was carried out regarding returning to work. Semi-structured interviews were performed 12 weeks after the intervention. Significant changes were measured regarding perceived occupational values in daily life, symptoms of severe stress, and returning to work. Both the return to work rate and symptoms of severe stress were significantly associated with changed experience of everyday occupation. In the interviews, participants explained that they now had a slower pace of everyday life and that everyday occupations were more often related to nature and creativity. This could be interpreted as nature-based rehabilitation inducing changes through meaningful occupations in restorative environments, leading to a positive change in perceived values of everyday occupations.

Subsonic Longitudinal Performance Coefficient Extraction from Shuttle Flight Data: an Accuracy Assessment for Determination of Data Base Updates

NASA Technical Reports Server (NTRS)

Findlay, J. T.; Kelly, G. M.; Mcconnell, J. G.; Compton, H. R.

1983-01-01

Longitudinal performance comparisons between flight derived and predicted values are presented for the first five NASA Space Shuttle Columbia flights. Though subsonic comparisons are emphasized, comparisons during the transonic and low supersonic regions of flight are included. Computed air data information based on the remotely sensed atmospheric measurements as well as in situ Orbiter Air Data System (ADS) measurements were incorporated. Each air data source provides for comparisons versus the predicted values from the LaRC data base. Principally, L/D, C sub L, and C sub D, comparisons are presented, though some pitching moment results are included. Similarities in flight conditions and spacecraft configuration during the first five flights are discussed. Contributions from the various elements of the data base are presented and the overall differences observed between the flight and predicted values are discussed in terms of expected variations. A discussion on potential data base updates is presented based on the results from the five flights to date.

Assessment of pilot workload - Converging measures from performance based, subjective and psychophysiological techniques

NASA Technical Reports Server (NTRS)

Kramer, Arthur F.; Sirevaag, Erik J.; Braune, Rolf

1986-01-01

This study explores the relationship between the P300 component of the event-related brain potential (ERP) and the processing demands of a complex real-world task. Seven male volunteers enrolled in an Instrument Flight Rule (IFR) aviation course flew a series of missions in a single engine fixed-based simulator. In dual task conditions subjects were also required to discriminate between two tones differing in frequency. ERPs time-locked to the tones, subjective effort ratings and overt performance measures were collected during two 45 min flights differing in difficulty (manipulated by varying both atmospheric conditions and instrument reliability). The more difficult flight was associated with poorer performance, increased subjective effort ratings, and smaller secondary task P300s. Within each flight, P300 amplitude was negatively correlated with deviations from command headings indicating that P300 amplitude was a sensitive workload metric both between and within the flight missions.

Ultrasound guided FNA of thyroid performed by cytopathologists enhances Bethesda diagnostic value.

PubMed

Wu, Maoxin; Choi, YoonSun; Zhang, Zesong; Si, Quisheng; Salem, Fadi; Szporn, Arnold; Zhang, David; Burstein, David; Teng, Marita; Miles, Brett A; Genden, Eric

2016-10-01

Ultrasound (US) guided fine needle aspiration (FNA) biopsy of thyroid are examined and reported by cytopathologists based usually on The Bethesda System for Reporting Thyroid Cytopathology (BTC) regardless of the procedure's performers. This study is designed to determine whether there is any performer-dependent difference. Six hundred and fifty-one thyroid US-FNAs in correlation with surgical follow-up (SFU) were studied. The statistical analysis was performed using the surgical pathology diagnosis as the gold standard. Among the 283 cases performed by cytopathologists, there were 8 (2.8%) nondiagnostic (BTC I), 197 (69.6%) benign (BTC II), 31 (11%) atypical (BTC III), 14 (5%) suspicious for follicular neoplasm (BTC IV), 12 (4.2%) suspicious for malignancy (BTC V), and 21 (7.4%) positive for malignancy (BTC VI), and there were 55 (19.4%) cases with SFU. The 368 cases performed by others showed 76 (21%) BTC I, 238 (65%) BTC II, 26 (7%) BTC III, 10 (3%) BTC IV, 9 (2.5%) BTC V 5, and 9 (2.5%) BTC VI, and there were 26 (7%) cases with SFU. The cytopathologist group achieved better sensitivity (91.3 vs.78%); slightly better specificity (83.3 vs. 82%); better positive predictive value (87.5 vs. 70%); similar negative predictive value (88.2 vs. 88%); and better overall accuracy (87.8 vs. 81%) compared with the non-cytopathologist group. Overall the difference for all statistical values is significant different (P = 0.041). US-FNA performed by cytopathologists showed a lower unsatisfactory rate and significantly better overall statistical values. Cytopathologists may play an important role in thyroid patient care. Diagn. Cytopathol. 2016;44:787-791. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Measuring comparative hospital performance.

PubMed

Griffith, John R; Alexander, Jeffrey A; Jelinek, Richard C

2002-01-01

Leading healthcare provider organizations now use a "balanced scorecard" of performance measures, expanding information reviewed at the governance level to include financial, customer, and internal performance information, as well as providing an opportunity to learn and grow to provide better strategic guidance. The approach, successfully used by other industries, uses competitor data and benchmarks to identify opportunities for improved mission achievement. This article evaluates one set of nine multidimensional hospital performance measures derived from Medicare reports (cash flow, asset turnover, mortality, complications, length of inpatient stay, cost per case, occupancy, change in occupancy, and percent of revenue from outpatient care). The study examines the content validity, reliability and sensitivity, validity of comparison, and independence and concludes that seven of the nine measures (all but the two occupancy measures) represent a potentially useful set for evaluating most U.S. hospitals. This set reflects correctable differences in performance between hospitals serving similar populations, that is, the measures reflect relative performance and identify opportunities to make the organization more successful.

Event- and interval-based measurement of stuttering: a review.

PubMed

Valente, Ana Rita S; Jesus, Luis M T; Hall, Andreia; Leahy, Margaret

2015-01-01

Event- and interval-based measurements are two different ways of computing frequency of stuttering. Interval-based methodology emerged as an alternative measure to overcome problems associated with reproducibility in the event-based methodology. No review has been made to study the effect of methodological factors in interval-based absolute reliability data or to compute the agreement between the two methodologies in terms of inter-judge, intra-judge and accuracy (i.e., correspondence between raters' scores and an established criterion). To provide a review related to reproducibility of event-based and time-interval measurement, and to verify the effect of methodological factors (training, experience, interval duration, sample presentation order and judgment conditions) on agreement of time-interval measurement; in addition, to determine if it is possible to quantify the agreement between the two methodologies The first two authors searched for articles on ERIC, MEDLINE, PubMed, B-on, CENTRAL and Dissertation Abstracts during January-February 2013 and retrieved 495 articles. Forty-eight articles were selected for review. Content tables were constructed with the main findings. Articles related to event-based measurements revealed values of inter- and intra-judge greater than 0.70 and agreement percentages beyond 80%. The articles related to time-interval measures revealed that, in general, judges with more experience with stuttering presented significantly higher levels of intra- and inter-judge agreement. Inter- and intra-judge values were beyond the references for high reproducibility values for both methodologies. Accuracy (regarding the closeness of raters' judgements with an established criterion), intra- and inter-judge agreement were higher for trained groups when compared with non-trained groups. Sample presentation order and audio/video conditions did not result in differences in inter- or intra-judge results. A duration of 5 s for an interval appears to be

Performance in wild ungulates: measuring population density and condition of individuals

Treesearch

John G. Kie

1988-01-01

Measures of performance in wild ungulates can include characteristics indicative of condition and health such as body weights, fat reserves, blood values, reproductive rates, and parasite loads. Performance may also be inferred from habitat-related factors, such as diet and nutritional intake. However, these parameters interact with population density to form a...

Integrated Campaign Probabilistic Cost, Schedule, Performance, and Value for Program Office Support

NASA Technical Reports Server (NTRS)

Cornelius, David; Sasamoto, Washito; Daugherty, Kevin; Deacon, Shaun

2012-01-01

This paper describes an integrated assessment tool developed at NASA Langley Research Center that incorporates probabilistic analysis of life cycle cost, schedule, launch performance, on-orbit performance, and value across a series of planned space-based missions, or campaign. Originally designed as an aid in planning the execution of missions to accomplish the National Research Council 2007 Earth Science Decadal Survey, it utilizes Monte Carlo simulation of a series of space missions for assessment of resource requirements and expected return on investment. Interactions between simulated missions are incorporated, such as competition for launch site manifest, to capture unexpected and non-linear system behaviors. A novel value model is utilized to provide an assessment of the probabilistic return on investment. A demonstration case is discussed to illustrate the tool utility.

[From evidence-based medicine to value-based medicine].

PubMed

Zhang, Shao-dan; Liang, Yuan-bo; Li, Si-zhen

2006-11-01

Evidence base medicine (EBM) is based on objective evidence, which provides best available knowledge for physicians to scientifically make medical and therapeutic decisions for the care of all individual patients in order to improve the effectiveness of treatment and to prolong the life of patients. EBM has made a significant progress in clinical practice. But medical therapies cannot always bring a better life quality and clinically, patients' preference should be always taken into account. Value-based medicine medicine (VBM) is the practice of medicine that emphasizes the value received from an intervention. It takes evidence-based data to a higher level by combining the parameters of patient-perceived value with the cost of an intervention. The fundamental instrument of VBM is cost-utility analysis. VBM will provide a better practice model to evaluate the therapeutic package and cost effectiveness for individual and general health care.

PERFORMANCE MEASUREMENT IN TRIBAL HOME VISITING: CHALLENGES AND OPPORTUNITIES.

PubMed

Morales, Julie R; Ferron, Cathy; Whitmore, Corrie; Reifel, Nancy; Geary, Erin; Anderson, Cyndi; Mcdaniel, Judy

2018-05-01

Over the last several decades, performance measurement has become an increasingly prevalent requirement among human services agencies for demonstrating program progress and achieving outcomes. In the Tribal Maternal, Infant, and Early Childhood Home Visiting Program (Tribal MIECHV), performance measurement was one of the central components of the Administration for Children and Families' cooperative agreements to tribes, urban Indian organizations, and tribal organizations. Since the inception of the Tribal MIECHV Program in 2010, the benchmark requirement was intended to be a mechanism to systematically monitor program progress and performance toward improving the quality of home-visiting programs that serve vulnerable American Indian or Alaska Native families. In this article, we examine performance measurement in the context of Tribal MIECHV, providing an overview of performance measurement, the Tribal MIECHV requirement, and how grantees experienced the requirement; we describe the existing literature on performance measurement challenges and benefits, and the specific challenges and advantages experienced by tribal grantees; and provide recommendations for performance measurement in tribal home-visiting contexts based on grantees' own experiences. This article contributes to the literature by examining performance measurement challenges and opportunities in the context of tribal communities, and provides recommendations that may inform future policy on performance measurement design and implementation in tribal communities. © 2018 Michigan Association for Infant Mental Health.

What Value "Value Added"?

ERIC Educational Resources Information Center

Richards, Andrew

2015-01-01

Two quantitative measures of school performance are currently used, the average points score (APS) at Key Stage 2 and value-added (VA), which measures the rate of academic improvement between Key Stage 1 and 2. These figures are used by parents and the Office for Standards in Education to make judgements and comparisons. However, simple…

The case of value-based healthcare for people living with complex long-term conditions.

PubMed

Elf, Marie; Flink, Maria; Nilsson, Marie; Tistad, Malin; von Koch, Lena; Ytterberg, Charlotte

2017-01-11

There is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient's experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions. Achieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient's individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation. The shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient's perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.

SEM based overlay measurement between resist and buried patterns

NASA Astrophysics Data System (ADS)

Inoue, Osamu; Okagawa, Yutaka; Hasumi, Kazuhisa; Shao, Chuanyu; Leray, Philippe; Lorusso, Gian; Baudemprez, Bart

2016-03-01

With the continuous shrink in pattern size and increased density, overlay control has become one of the most critical issues in semiconductor manufacturing. Recently, SEM based overlay of AEI (After Etch Inspection) wafer has been used for reference and optimization of optical overlay (both Image Based Overlay (IBO) and Diffraction Based Overlay (DBO)). Overlay measurement at AEI stage contributes monitor and forecast the yield after formation by etch and calibrate optical measurement tools. however those overlay value seems difficult directly for feedback to a scanner. Therefore, there is a clear need to have SEM based overlay measurements of ADI (After Develop Inspection) wafers in order to serve as reference for optical overlay and make necessary corrections before wafers go to etch. Furthermore, to make the corrections as accurate as possible, actual device like feature dimensions need to be measured post ADI. This device size measurement is very unique feature of CDSEM , which can be measured with smaller area. This is currently possible only with the CD-SEM. This device size measurement is very unique feature of CD-SEM , which can be measured with smaller area. In this study, we assess SEM based overlay measurement of ADI and AEI wafer by using a sample from an N10 process flow. First, we demonstrate SEM based overlay performance at AEI by using dual damascene process for Via 0 (V0) and metal 1 (M1) layer. We also discuss the overlay measurements between litho-etch-litho stages of a triple patterned M1 layer and double pattern V0. Second, to illustrate the complexities in image acquisition and measurement we will measure overlay between M1B resist and buried M1A-Hard mask trench. Finally, we will show how high accelerating voltage can detect buried pattern information by BSE (Back Scattering Electron). In this paper we discuss the merits of this method versus standard optical metrology based corrections.

Experimental Demonstration of Higher Precision Weak-Value-Based Metrology Using Power Recycling

NASA Astrophysics Data System (ADS)

Wang, Yi-Tao; Tang, Jian-Shun; Hu, Gang; Wang, Jian; Yu, Shang; Zhou, Zong-Quan; Cheng, Ze-Di; Xu, Jin-Shi; Fang, Sen-Zhi; Wu, Qing-Lin; Li, Chuan-Feng; Guo, Guang-Can

2016-12-01

The weak-value-based metrology is very promising and has attracted a lot of attention in recent years because of its remarkable ability in signal amplification. However, it is suggested that the upper limit of the precision of this metrology cannot exceed that of classical metrology because of the low sample size caused by the probe loss during postselection. Nevertheless, a recent proposal shows that this probe loss can be reduced by the power-recycling technique, and thus enhance the precision of weak-value-based metrology. Here we experimentally realize the power-recycled interferometric weak-value-based beam-deflection measurement and obtain the amplitude of the detected signal and white noise by discrete Fourier transform. Our results show that the detected signal can be strengthened by power recycling, and the power-recycled weak-value-based signal-to-noise ratio can surpass the upper limit of the classical scheme, corresponding to the shot-noise limit. This work sheds light on higher precision metrology and explores the real advantage of the weak-value-based metrology over classical metrology.

The Relationship Between Hospital Value-Based Purchasing Program Scores and Hospital Bond Ratings.

PubMed

Rangnekar, Anooja; Johnson, Tricia; Garman, Andrew; O'Neil, Patricia

2015-01-01

Tax-exempt hospitals and health systems often borrow long-term debt to fund capital investments. Lenders use bond ratings as a standard metric to assess whether to lend funds to a hospital. Credit rating agencies have historically relied on financial performance measures and a hospital's ability to service debt obligations to determine bond ratings. With the growth in pay-for-performance-based reimbursement models, rating agencies are expanding their hospital bond rating criteria to include hospital utilization and value-based purchasing (VBP) measures. In this study, we evaluated the relationship between the Hospital VBP domains--Clinical Process of Care, Patient Experience of Care, Outcome, and Medicare Spending per Beneficiary (MSPB)--and hospital bond ratings. Given the historical focus on financial performance, we hypothesized that hospital bond ratings are not associated with any of the Hospital VBP domains. This was a retrospective, cross-sectional study of all hospitals that were rated by Moody's for fiscal year 2012 and participated in the Centers for Medicare & Medicaid Services' VBP program as of January 2014 (N = 285). Of the 285 hospitals in the study, 15% had been assigned a bond rating of Aa, and 46% had been assigned an A rating. Using a binary logistic regression model, we found an association between MSPB only and bond ratings, after controlling for other VBP and financial performance scores; however, MSPB did not improve the overall predictive accuracy of the model. Inclusion of VBP scores in the methodology used to determine hospital bond ratings is likely to affect hospital bond ratings in the near term.

Weak measurements and quantum weak values for NOON states

NASA Astrophysics Data System (ADS)

Rosales-Zárate, L.; Opanchuk, B.; Reid, M. D.

2018-03-01

Quantum weak values arise when the mean outcome of a weak measurement made on certain preselected and postselected quantum systems goes beyond the eigenvalue range for a quantum observable. Here, we propose how to determine quantum weak values for superpositions of states with a macroscopically or mesoscopically distinct mode number, that might be realized as two-mode Bose-Einstein condensate or photonic NOON states. Specifically, we give a model for a weak measurement of the Schwinger spin of a two-mode NOON state, for arbitrary N . The weak measurement arises from a nondestructive measurement of the two-mode occupation number difference, which for atomic NOON states might be realized via phase contrast imaging and the ac Stark effect using an optical meter prepared in a coherent state. The meter-system coupling results in an entangled cat-state. By subsequently evolving the system under the action of a nonlinear Josephson Hamiltonian, we show how postselection leads to quantum weak values, for arbitrary N . Since the weak measurement can be shown to be minimally invasive, the weak values provide a useful strategy for a Leggett-Garg test of N -scopic realism.

Measurement Invariance of Expectancy-Value Questionnaire in Physical Education

ERIC Educational Resources Information Center

Zhu, Xihe; Sun, Haichun; Chen, Ang; Ennis, Catherine

2012-01-01

Expectancy-Value Questionnaire (EVQ) measures student expectancy beliefs and task values of the domain content (Eccles & Wigfield, 1995). In this study the authors examine measurement invariance of EVQ in the domain of physical education between elementary and middle-school students. Participants included 811 students (3rd-5th grades) from 13…

Cultural Values Predicting Acculturation Orientations: Operationalizing a Quantitative Measure

ERIC Educational Resources Information Center

Ehala, Martin

2012-01-01

This article proposes that acculturation orientations are related to two sets of cultural values: utilitarianism (Ut) and traditionalism (Tr). While utilitarian values enhance assimilation, traditional values support language and identity maintenance. It is proposed that the propensity to either end of this value opposition can be measured by an…

Value of eddy-covariance data for individual-based, forest gap models

NASA Astrophysics Data System (ADS)

Roedig, Edna; Cuntz, Matthias; Huth, Andreas

2014-05-01

Individual-based forest gap models simulate tree growth and carbon fluxes on large time scales. They are a well established tool to predict forest dynamics and successions. However, the effect of climatic variables on processes of such individual-based models is uncertain (e.g. the effect of temperature or soil moisture on the gross primary production (GPP)). Commonly, functional relationships and parameter values that describe the effect of climate variables on the model processes are gathered from various vegetation models of different spatial scales. Though, their accuracies and parameter values have not been validated for the specific model scales of individual-based forest gap models. In this study, we address this uncertainty by linking Eddy-covariance (EC) data and a forest gap model. The forest gap model FORMIND is applied on the Norwegian spruce monoculture forest at Wetzstein in Thuringia, Germany for the years 2003-2008. The original parameterizations of climatic functions are adapted according to the EC-data. The time step of the model is reduced to one day in order to adapt to the high resolution EC-data. The FORMIND model uses functional relationships on an individual level, whereas the EC-method measures eco-physiological responses at the ecosystem level. However, we assume that in homogeneous stands as in our study, functional relationships for both methods are comparable. The model is then validated at the spruce forest Waldstein, Germany. Results show that the functional relationships used in the model, are similar to those observed with the EC-method. The temperature reduction curve is well reflected in the EC-data, though parameter values differ from the originally expected values. For example at the freezing point, the observed GPP is 30% higher than predicted by the forest gap model. The response of observed GPP to soil moisture shows that the permanent wilting point is 7 vol-% lower than the value derived from the literature. The light

Value-based insurance design: embracing value over cost alone.

PubMed

Fendrick, A Mark; Chernew, Michael E; Levi, Gary W

2009-12-01

The US healthcare system is in crisis, with documented gaps in quality, safety, access, and affordability. Many believe the solution to unsustainable cost increases is increased patient cost-sharing. From an overall cost perspective, reduced consumption of certain essential services may yield short-term savings but lead to worse health and markedly higher costs down the road--in complications, hospitalizations, and increased utilization. Value-based insurance design (VBID) can help plug the inherent shortfalls in "across-the-board" patient cost-sharing. Instead of focusing on cost or quality alone, VBID focuses on value, aligning the financial and nonfinancial incentives of the various stakeholders and complementing other current initiatives to improve quality and subdue costs, such as high-deductible consumer-directed health plans, pay-for-performance programs, and disease management. Mounting evidence, both peer-reviewed and empirical, indicates not only that VBID can be implemented, but also leads to desired changes in behavior. For all its documented successes and recognized promise, VBID is in its infancy and is not a panacea for the current healthcare crisis. However, the available research and documented experiences indicate that as an overall approach, and in its fully evolved and widely adopted form, VBID will promote a healthier population and therefore support cost-containment efforts by producing better health at any price point.

The Effect of Self-Reported and Performance-Based Functional Impairment on Future Hospital Costs of Community-Dwelling Older Persons

ERIC Educational Resources Information Center

Reuben, David B.; Seeman, Teresa E.; Keeler, Emmett; Hayes, Risa P.; Bowman, Lee; Sewall, Ase; Hirsch, Susan H.; Wallace, Robert B.; Guralnik, Jack M.

2004-01-01

Purpose: We determined the prognostic value of self-reported and performance-based measurement of function, including functional transitions and combining different measurement approaches, on utilization. Design and Methods: Our cohort study used the 6th, 7th, and 10th waves of three sites of the Established Populations for Epidemiologic Studies…

Lithium target performance evaluation for low-energy accelerator-based in vivo measurements using gamma spectroscopy.

PubMed

Aslam; Prestwich, W V; McNeill, F E

2003-03-01

The operating conditions at McMaster KN Van de Graaf accelerator have been optimized to produce neutrons via the (7)Li(p, n)(7)Be reaction for in vivo neutron activation analysis. In a number of earlier studies (development of an accelerator based system for in vivo neutron activation analysis measurements of manganese in humans, Ph.D. Thesis, McMaster University, Hamilton, ON, Canada; Appl. Radiat. Isot. 53 (2000) 657; in vivo measurement of some trace elements in human Bone, Ph.D. Thesis. McMaster University, Hamilton, ON, Canada), a significant discrepancy between the experimental and the calculated neutron doses has been pointed out. The hypotheses formulated in the above references to explain the deviation of the experimental results from analytical calculations, have been tested experimentally. The performance of the lithium target for neutron production has been evaluated by measuring the (7)Be activity produced as a result of (p, n) interaction with (7)Li. In contradiction to the formulated hypotheses, lithium target performance was found to be mainly affected by inefficient target cooling and the presence of oxides layer on target surface. An appropriate choice of these parameters resulted in neutron yields same as predicated by analytical calculations.

Measuring value for low-acuity care across settings.

PubMed

Morgan, Sofie Rahman; Smith, Meaghan A; Pitts, Stephen R; Shesser, Robert; Uscher-Pines, Lori; Ward, Michael J; Pines, Jesse M

2012-09-01

Increasing healthcare costs have created an emphasis on improving value, defined as how invested time, money, and resources improve health. The role of emergency departments (EDs) within value-driven health systems is still undetermined. Often questioned is the value of an ED visit for conditions that could be reasonably treated elsewhere such as office-based, urgent, and retail clinics. This paper presents a conceptual approach to assess the value of these low-acuity visits. It adapts an existing analytic model to highlight specific factors that impact key stakeholders' (patients, insurers, and society) assessments of the value of ED-based care compared with care in alternative settings. These factors are presented in 3 equations, 1 for each stakeholder, emphasizing how tangible and intangible benefits of care weigh against direct and indirect costs and how each perspective influences value. Aligning value among groups could allow stakeholders to influence each other and could guide rational change in the delivery of acute medical care for low-acuity conditions.

StakeMeter: value-based stakeholder identification and quantification framework for value-based software systems.

PubMed

Babar, Muhammad Imran; Ghazali, Masitah; Jawawi, Dayang N A; Bin Zaheer, Kashif

2015-01-01

Value-based requirements engineering plays a vital role in the development of value-based software (VBS). Stakeholders are the key players in the requirements engineering process, and the selection of critical stakeholders for the VBS systems is highly desirable. Based on the stakeholder requirements, the innovative or value-based idea is realized. The quality of the VBS system is associated with the concrete set of valuable requirements, and the valuable requirements can only be obtained if all the relevant valuable stakeholders participate in the requirements elicitation phase. The existing value-based approaches focus on the design of the VBS systems. However, the focus on the valuable stakeholders and requirements is inadequate. The current stakeholder identification and quantification (SIQ) approaches are neither state-of-the-art nor systematic for the VBS systems. The existing approaches are time-consuming, complex and inconsistent which makes the initiation process difficult. Moreover, the main motivation of this research is that the existing SIQ approaches do not provide the low level implementation details for SIQ initiation and stakeholder metrics for quantification. Hence, keeping in view the existing SIQ problems, this research contributes in the form of a new SIQ framework called 'StakeMeter'. The StakeMeter framework is verified and validated through case studies. The proposed framework provides low-level implementation guidelines, attributes, metrics, quantification criteria and application procedure as compared to the other methods. The proposed framework solves the issues of stakeholder quantification or prioritization, higher time consumption, complexity, and process initiation. The framework helps in the selection of highly critical stakeholders for the VBS systems with less judgmental error.

StakeMeter: Value-Based Stakeholder Identification and Quantification Framework for Value-Based Software Systems

PubMed Central

Babar, Muhammad Imran; Ghazali, Masitah; Jawawi, Dayang N. A.; Zaheer, Kashif Bin

2015-01-01

Value-based requirements engineering plays a vital role in the development of value-based software (VBS). Stakeholders are the key players in the requirements engineering process, and the selection of critical stakeholders for the VBS systems is highly desirable. Based on the stakeholder requirements, the innovative or value-based idea is realized. The quality of the VBS system is associated with the concrete set of valuable requirements, and the valuable requirements can only be obtained if all the relevant valuable stakeholders participate in the requirements elicitation phase. The existing value-based approaches focus on the design of the VBS systems. However, the focus on the valuable stakeholders and requirements is inadequate. The current stakeholder identification and quantification (SIQ) approaches are neither state-of-the-art nor systematic for the VBS systems. The existing approaches are time-consuming, complex and inconsistent which makes the initiation process difficult. Moreover, the main motivation of this research is that the existing SIQ approaches do not provide the low level implementation details for SIQ initiation and stakeholder metrics for quantification. Hence, keeping in view the existing SIQ problems, this research contributes in the form of a new SIQ framework called ‘StakeMeter’. The StakeMeter framework is verified and validated through case studies. The proposed framework provides low-level implementation guidelines, attributes, metrics, quantification criteria and application procedure as compared to the other methods. The proposed framework solves the issues of stakeholder quantification or prioritization, higher time consumption, complexity, and process initiation. The framework helps in the selection of highly critical stakeholders for the VBS systems with less judgmental error. PMID:25799490

Operationalizing value-based pricing of medicines : a taxonomy of approaches.

PubMed

Sussex, Jon; Towse, Adrian; Devlin, Nancy

2013-01-01

The UK Government is proposing a novel form of price regulation for branded medicines, which it has dubbed 'value-based pricing' (VBP). The specifics of how VBP will work are unclear. We provide an account of the possible means by which VBP of medicines might be operationalized, and a taxonomy to describe and categorize the various approaches. We begin with a brief discussion of the UK Government's proposal for VBP and proceed to define a taxonomy of approaches to VBP. The taxonomy has five main dimensions: (1) what is identified as being of value, (2) how each element is measured, (3) how it is valued, (4) how the different elements of value are aggregated, and (5) how the result is then used to determine the price of a medicine. We take as our starting point that VBP will include a measure of health gain and that, as proposed by the UK Government, this will be built on the QALY. Our principal interest is in the way criteria other than QALYs are taken into account, including severity of illness, the extent of unmet need, and wider societal considerations such as impacts on carers. We set out to: (1) identify and describe the full range of alternative means by which 'value' might be measured and valued, (2) identify and describe the options available for aggregating the different components of value to establish a maximum price, and (3) note the challenges and relative advantages associated with these approaches. We review the means by which aspects of VBP are currently operationalized in a selection of countries and place these, and proposals for the UK, in the context of our taxonomy. Finally, we give an initial assessment of the challenges, pros and cons of each approach. We conclude that identifying where VBP should lie on each of the five dimensions entails value judgements: there are no simple 'right or wrong' solutions. If a wider definition of value than incremental QALYs gained is adopted, as is desirable, then a pragmatic way to aggregate the different

An official American thoracic society workshop report: developing performance measures from clinical practice guidelines.

PubMed

Kahn, Jeremy M; Gould, Michael K; Krishnan, Jerry A; Wilson, Kevin C; Au, David H; Cooke, Colin R; Douglas, Ivor S; Feemster, Laura C; Mularski, Richard A; Slatore, Christopher G; Wiener, Renda Soylemez

2014-05-01

Many health care performance measures are either not based on high-quality clinical evidence or not tightly linked to patient-centered outcomes, limiting their usefulness in quality improvement. In this report we summarize the proceedings of an American Thoracic Society workshop convened to address this problem by reviewing current approaches to performance measure development and creating a framework for developing high-quality performance measures by basing them directly on recommendations from well-constructed clinical practice guidelines. Workshop participants concluded that ideally performance measures addressing care processes should be linked to clinical practice guidelines that explicitly rate the quality of evidence and the strength of recommendations, such as the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. Under this framework, process-based performance measures would only be developed from strong recommendations based on high- or moderate-quality evidence. This approach would help ensure that clinical processes specified in performance measures are both of clear benefit to patients and supported by strong evidence. Although this approach may result in fewer performance measures, it would substantially increase the likelihood that quality-improvement programs based on these measures actually improve patient care.

Optimal Tuner Selection for Kalman Filter-Based Aircraft Engine Performance Estimation

NASA Technical Reports Server (NTRS)

Simon, Donald L.; Garg, Sanjay

2010-01-01

A linear point design methodology for minimizing the error in on-line Kalman filter-based aircraft engine performance estimation applications is presented. This technique specifically addresses the underdetermined estimation problem, where there are more unknown parameters than available sensor measurements. A systematic approach is applied to produce a model tuning parameter vector of appropriate dimension to enable estimation by a Kalman filter, while minimizing the estimation error in the parameters of interest. Tuning parameter selection is performed using a multi-variable iterative search routine which seeks to minimize the theoretical mean-squared estimation error. This paper derives theoretical Kalman filter estimation error bias and variance values at steady-state operating conditions, and presents the tuner selection routine applied to minimize these values. Results from the application of the technique to an aircraft engine simulation are presented and compared to the conventional approach of tuner selection. Experimental simulation results are found to be in agreement with theoretical predictions. The new methodology is shown to yield a significant improvement in on-line engine performance estimation accuracy

Value-based resource management: a model for best value nursing care.

PubMed

Caspers, Barbara A; Pickard, Beth

2013-01-01

With the health care environment shifting to a value-based payment system, Catholic Health Initiatives nursing leadership spearheaded an initiative with 14 hospitals to establish best nursing care at a lower cost. The implementation of technology-enabled business processes at point of care led to a new model for best value nursing care: Value-Based Resource Management. The new model integrates clinical patient data from the electronic medical record and embeds the new information in care team workflows for actionable real-time decision support and predictive forecasting. The participating hospitals reported increased patient satisfaction and cost savings in the reduction of overtime and improvement in length of stay management. New data generated by the initiative on nursing hours and cost by patient and by population (Medicare severity diagnosis-related groups), and patient health status outcomes across the acute care continuum expanded business intelligence for a value-based population health system.

Effect-based trigger values for in vitro bioassays: Reading across from existing water quality guideline values.

PubMed

Escher, Beate I; Neale, Peta A; Leusch, Frederic D L

2015-09-15

Cell-based bioassays are becoming increasingly popular in water quality assessment. The new generations of reporter-gene assays are very sensitive and effects are often detected in very clean water types such as drinking water and recycled water. For monitoring applications it is therefore imperative to derive trigger values that differentiate between acceptable and unacceptable effect levels. In this proof-of-concept paper, we propose a statistical method to read directly across from chemical guideline values to trigger values without the need to perform in vitro to in vivo extrapolations. The derivation is based on matching effect concentrations with existing chemical guideline values and filtering out appropriate chemicals that are responsive in the given bioassays at concentrations in the range of the guideline values. To account for the mixture effects of many chemicals acting together in a complex water sample, we propose bioanalytical equivalents that integrate the effects of groups of chemicals with the same mode of action that act in a concentration-additive manner. Statistical distribution methods are proposed to derive a specific effect-based trigger bioanalytical equivalent concentration (EBT-BEQ) for each bioassay of environmental interest that targets receptor-mediated toxicity. Even bioassays that are indicative of the same mode of action have slightly different numeric trigger values due to differences in their inherent sensitivity. The algorithm was applied to 18 cell-based bioassays and 11 provisional effect-based trigger bioanalytical equivalents were derived as an illustrative example using the 349 chemical guideline values protective for human health of the Australian Guidelines for Water Recycling. We illustrate the applicability using the example of a diverse set of water samples including recycled water. Most recycled water samples were compliant with the proposed triggers while wastewater effluent would not have been compliant with a few

Pressure Measurement Based on Thermocouples

NASA Astrophysics Data System (ADS)

Thomsen, K.

2010-12-01

Measuring gas pressures reliably in a harsh radiation environment was confirmed to be tricky during operation of the liquid spallation target of MEGAPIE at the Paul Scherrer Institute (PSI). Severe drift of calibration and the loss of a sensor were experienced. At the same time, the only instrumentation that worked flawlessly in the system were thermocouples. Motivated by this experience, a novel pressure sensor for application in high radiation fields has been developed, which is based on temperature measurement. The new sensor takes advantage of the fact that the thermal conductivity over a mechanical joint exhibits a strong dependence on the contact pressure. In the novel sensor heating is applied at one point and temperatures are measured at different specific locations of the pressure gage; in particular, the temperatures on the two sides of a mechanical contact are monitored. From the observed temperature distribution the gas pressure can be derived. By choosing specific mechanical details in the lay-out, it is possible to tailor the useful measurement range. In addition to yielding pressure values, the new sensor concept admits for obtaining a measure for the accuracy of the result. This is done by continuous self monitoring of the device. The health status and based thereupon the plausibility of the indicated pressure value can be deducted by comparing sensed temperatures to expectation values for any given heating power. Malfunctioning of the pressure gage is reliably detected from the diverse readings of only one device; this can be seen as providing internal redundancy while at the same time immunity to common mode failure. After some analytical and finite element studies to verify the concept in principle, a first prototype of such a novel pressure sensor has been built at PSI. Initial measurement campaigns demonstrated the correct operation of the device as anticipated. Further potential for optimization, like designing a gage for high temperature

Calibration of Smartphone-Based Weather Measurements Using Pairwise Gossip.

PubMed

Zamora, Jane Louie Fresco; Kashihara, Shigeru; Yamaguchi, Suguru

2015-01-01

Accurate and reliable daily global weather reports are necessary for weather forecasting and climate analysis. However, the availability of these reports continues to decline due to the lack of economic support and policies in maintaining ground weather measurement systems from where these reports are obtained. Thus, to mitigate data scarcity, it is required to utilize weather information from existing sensors and built-in smartphone sensors. However, as smartphone usage often varies according to human activity, it is difficult to obtain accurate measurement data. In this paper, we present a heuristic-based pairwise gossip algorithm that will calibrate smartphone-based pressure sensors with respect to fixed weather stations as our referential ground truth. Based on actual measurements, we have verified that smartphone-based readings are unstable when observed during movement. Using our calibration algorithm on actual smartphone-based pressure readings, the updated values were significantly closer to the ground truth values.

Psychological collectivism: a measurement validation and linkage to group member performance.

PubMed

Jackson, Christine L; Colquitt, Jason A; Wesson, Michael J; Zapata-Phelan, Cindy P

2006-07-01

The 3 studies presented here introduce a new measure of the individual-difference form of collectivism. Psychological collectivism is conceptualized as a multidimensional construct with the following 5 facets: preference for in-groups, reliance on in-groups, concern for in-groups, acceptance of in-group norms, and prioritization of in-group goals. Study 1 developed and tested the new measure in a sample of consultants. Study 2 cross-validated the measure using an alumni sample of a Southeastern university, assessing its convergent validity with other collectivism measures. Study 3 linked scores on the measure to 4 dimensions of group member performance (task performance, citizenship behavior, counterproductive behavior, and withdrawal behavior) in a computer software firm and assessed discriminant validity using the Big Five. The results of the studies support the construct validity of the measure and illustrate the potential value of collectivism as a predictor of group member performance. ((c) 2006 APA, all rights reserved).

Social value and individual choice: The value of a choice-based decision-making process in a collectively funded health system.

PubMed

Espinoza, Manuel Antonio; Manca, Andrea; Claxton, Karl; Sculpher, Mark

2018-02-01

Evidence about cost-effectiveness is increasingly being used to inform decisions about the funding of new technologies that are usually implemented as guidelines from centralized decision-making bodies. However, there is also an increasing recognition for the role of patients in determining their preferred treatment option. This paper presents a method to estimate the value of implementing a choice-based decision process using the cost-effectiveness analysis toolbox. This value is estimated for 3 alternative scenarios. First, it compares centralized decisions, based on population average cost-effectiveness, against a decision process based on patient choice. Second, it compares centralized decision based on patients' subgroups versus an individual choice-based decision process. Third, it compares a centralized process based on average cost-effectiveness against a choice-based process where patients choose according to a different measure of outcome to that used by the centralized decision maker. The methods are applied to a case study for the management of acute coronary syndrome. It is concluded that implementing a choice-based process of treatment allocation may be an option in collectively funded health systems. However, its value will depend on the specific health problem and the social values considered relevant to the health system. Copyright © 2017 John Wiley & Sons, Ltd.

Development and Performance Evaluation of Image-Based Robotic Waxing System for Detailing Automobiles

PubMed Central

Hsu, Bing-Cheng

2018-01-01

Waxing is an important aspect of automobile detailing, aimed at protecting the finish of the car and preventing rust. At present, this delicate work is conducted manually due to the need for iterative adjustments to achieve acceptable quality. This paper presents a robotic waxing system in which surface images are used to evaluate the quality of the finish. An RGB-D camera is used to build a point cloud that details the sheet metal components to enable path planning for a robot manipulator. The robot is equipped with a multi-axis force sensor to measure and control the forces involved in the application and buffing of wax. Images of sheet metal components that were waxed by experienced car detailers were analyzed using image processing algorithms. A Gaussian distribution function and its parameterized values were obtained from the images for use as a performance criterion in evaluating the quality of surfaces prepared by the robotic waxing system. Waxing force and dwell time were optimized using a mathematical model based on the image-based criterion used to measure waxing performance. Experimental results demonstrate the feasibility of the proposed robotic waxing system and image-based performance evaluation scheme. PMID:29757940

Development and Performance Evaluation of Image-Based Robotic Waxing System for Detailing Automobiles.

PubMed

Lin, Chi-Ying; Hsu, Bing-Cheng

2018-05-14

Waxing is an important aspect of automobile detailing, aimed at protecting the finish of the car and preventing rust. At present, this delicate work is conducted manually due to the need for iterative adjustments to achieve acceptable quality. This paper presents a robotic waxing system in which surface images are used to evaluate the quality of the finish. An RGB-D camera is used to build a point cloud that details the sheet metal components to enable path planning for a robot manipulator. The robot is equipped with a multi-axis force sensor to measure and control the forces involved in the application and buffing of wax. Images of sheet metal components that were waxed by experienced car detailers were analyzed using image processing algorithms. A Gaussian distribution function and its parameterized values were obtained from the images for use as a performance criterion in evaluating the quality of surfaces prepared by the robotic waxing system. Waxing force and dwell time were optimized using a mathematical model based on the image-based criterion used to measure waxing performance. Experimental results demonstrate the feasibility of the proposed robotic waxing system and image-based performance evaluation scheme.

Developing Effective Performance Measures

DTIC Science & Technology

2014-10-14

University When Performance Measurement Goes Bad Laziness Vanity Narcissism Too Many Pettiness Inanity 52 Developing Effective...Kasunic, October 14, 2014 © 2014 Carnegie Mellon University Narcissism Measuring performance from the organization’s point of view, rather than from

Precise Penning trap measurements of double β-decay Q-values

NASA Astrophysics Data System (ADS)

Redshaw, M.; Brodeur, M.; Bollen, G.; Bustabad, S.; Eibach, M.; Gulyuz, K.; Izzo, C.; Lincoln, D. L.; Novario, S. J.; Ringle, R.; Sandler, R.; Schwarz, S.; Valverde, A. A.

2015-10-01

The double β-decay (ββ -decay) Q-value, defined as the mass difference between parent and daughter atoms, is an important parameter for both two-neutrino ββ -decay (2 νββ) and neutrinoless ββ -decay (0 νββ) experiments. The Q-value enters into the calculation of the phase space factors, which relate the measured ββ -decay half-life to the nuclear matrix element and, in the case of 0 νββ , the effective Majorana mass of the neutrino. In addition, the Q-value defines the total kinetic energy of the two electrons emitted in 0 νββ , corresponding to the location of the single peak that is the sought after signature of 0 νββ . Hence, it is essential to have a precise and accurate Q-value determination. Over the last decade, the Penning trap mass spectrometry community has made a significant effort to provide precise ββ -decay Q-value determinations. Here we report on recent measurements with the Low Energy Beam and Ion Trap (LEBIT) facility at the National Superconducting Cyclotron Laboratory (NSCL) of the 48Ca, 82Se, and 96Zr Q-values. These measurements complete the determination of ββ -decay Q-values for the 11 ``best'' candidates (those with Q >2 MeV). We also report on a measurement of the 78Kr double electron capture (2EC) Q-value and discuss ongoing Penning trap measurements relating to ββ -decay and 2EC. Support from NSF Contract No. PHY-1102511, and DOE Grant No. 03ER-41268.