[Clinical examples of professor LI Zhi-dao's "tonifying three qi" acupuncture method].

PubMed

Li, Rui-Chao; Li, Yan; Fu, Yuan-Xin; Zhao, Xiang-Fei; Sun, Jing; Li, Lan-Yuan

2014-08-01

Professor LI Zhi-dao, according to acupoint selection of syndrome differentiation in TCM basic theory, concluded a new therapy, namely "tonifying three qi" that is mainly based on three acupoints in the Conception Vessel. This method is consisted of Danzhong (CV 17), Zhongwan (CV 12) and Qihai (CV 6) in the Conception Vessel, which could successively nourish clear qi, stomach qi and original qi. In clinic, according to the severity of symptoms of three qi, the acupoints are selected flexibly, which could respectively treat deficiency of heart-lung qi, deficiency of stomach-spleen qi and deficiency of original qi. Some examples are also given in the article.

Phenotypic analysis of separation-of-function alleles of MEI-41, Drosophila ATM/ATR.

PubMed Central

Laurençon, Anne; Purdy, Amanda; Sekelsky, Jeff; Hawley, R Scott; Su, Tin Tin

2003-01-01

ATM/ATR kinases act as signal transducers in eukaryotic DNA damage and replication checkpoints. Mutations in ATM/ATR homologs have pleiotropic effects that range from sterility to increased killing by genotoxins in humans, mice, and Drosophila. Here we report the generation of a null allele of mei-41, Drosophila ATM/ATR homolog, and the use of it to document a semidominant effect on a larval mitotic checkpoint and methyl methanesulfonate (MMS) sensitivity. We also tested the role of mei-41 in a recently characterized checkpoint that delays metaphase/anaphase transition after DNA damage in cellular embryos. We then compare five existing mei-41 alleles to the null with respect to known phenotypes (female sterility, cell cycle checkpoints, and MMS resistance). We find that not all phenotypes are affected equally by each allele, i.e., the functions of MEI-41 in ensuring fertility, cell cycle regulation, and resistance to genotoxins are genetically separable. We propose that MEI-41 acts not in a single rigid signal transduction pathway, but in multiple molecular contexts to carry out its many functions. Sequence analysis identified mutations, which, for most alleles, fall in the poorly characterized region outside the kinase domain; this allowed us to tentatively identify additional functional domains of MEI-41 that could be subjected to future structure-function studies of this key molecule. PMID:12807779

Basic Theory of Fractional Conformal Invariance of Mei Symmetry and its Applications to Physics

NASA Astrophysics Data System (ADS)

Luo, Shao-Kai; Dai, Yun; Yang, Ming-Jing; Zhang, Xiao-Tian

2018-04-01

In this paper, we present a basic theory of fractional dynamics, i.e., the fractional conformal invariance of Mei symmetry, and find a new kind of conserved quantity led by fractional conformal invariance. For a dynamical system that can be transformed into fractional generalized Hamiltonian representation, we introduce a more general kind of single-parameter fractional infinitesimal transformation of Lie group, the definition and determining equation of fractional conformal invariance are given. And then, we reveal the fractional conformal invariance of Mei symmetry, and the necessary and sufficient condition whether the fractional conformal invariance would be the fractional Mei symmetry is found. In particular, we present the basic theory of fractional conformal invariance of Mei symmetry and it is found that, using the new approach, we can find a new kind of conserved quantity; as a special case, we find that an autonomous fractional generalized Hamiltonian system possesses more conserved quantities. Also, as the new method's applications, we, respectively, find the conserved quantities of a fractional general relativistic Buchduhl model and a fractional Duffing oscillator led by fractional conformal invariance of Mei symmetry.

MiR-144 regulates hematopoiesis and vascular development by targeting meis1 during zebrafish development.

PubMed

Su, Zhenhong; Si, Wenxia; Li, Lei; Zhou, Bisheng; Li, Xiuchun; Xu, Yan; Xu, Chengqi; Jia, Haibo; Wang, Qing K

2014-04-01

Hematopoiesis is a dynamic process by which peripheral blood lineages are developed. It is a process tightly regulated by many intrinsic and extrinsic factors, including transcriptional factors and signaling molecules. However, the epigenetic regulation of hematopoiesis, for example, regulation via microRNAs (miRNAs), remains incompletely understood. Here we show that miR-144 regulates hematopoiesis and vascular development in zebrafish. Overexpression of miR-144 inhibited primitive hematopoiesis as demonstrated by a reduced number of circulating blood cells, reduced o-dianisidine staining of hemoglobin, and reduced expression of hbαe1, hbβe1, gata1 and pu.1. Overexpression of miR-144 also inhibited definitive hematopoiesis as shown by reduced expression of runx1 and c-myb. Mechanistically, miR-144 regulates hematopoiesis by repressing expression of meis1 involved in hematopoiesis. Both real-time RT-PCR and Western blot analyses showed that overexpression of miR-144 repressed expression of meis1. Bioinformatic analysis predicts a target binding sequence for miR-144 at the 3'-UTR of meis1. Deletion of the miR-144 target sequence eliminated the repression of meis1 expression mediated by miR-144. The miR-144-mediated abnormal phenotypes were partially rescued by co-injection of meis1 mRNA and could be almost completely rescued by injection of both meis1 and gata1 mRNA. Finally, because meis1 is involved in vascular development, we tested the effect of miR-144 on vascular development. Overexpression of miR-144 resulted in abnormal vascular development of intersegmental vessels in transgenic zebrafish with Flk1p-EGFP, and the defect was rescued by co-injection of meis1 mRNA. These findings establish miR-144 as a novel miRNA that regulates hematopoiesis and vascular development by repressing expression of meis1. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mechanism of Torrential Rain Associated with the Mei-yu Development during SCSMEX-98

NASA Technical Reports Server (NTRS)

Qian, Jian-Hua; Tao, Wei-Kuo; Lau, K.-M.; Starr, David OC. (Technical Monitor)

2002-01-01

A case of torrential precipitation process in the Mei-yu front, an Asian monsoon system east to the Tibetan Plateau, is studied with the coupled Penn State University/NCAR MM5 and NASA/GSFC PLACE (Parameterization for Land - Atmosphere - Cloud Exchange) models. Remote and local impacts of water vapor on the location and intensity of Mei-yu precipitation are studied by numerical experiments. Results demonstrate that the water vapor source for this heavy precipitation case in Yangtze river basin is derived mostly from the Bay of Bengal, transported by the southwesterly low-level Jet (LLJ) southeast to the Tibetan Plateau. The moist convection is a critical process in the development and maintenance of the front. The meridional and zonal secondary circulations resulted from Mei-yu condensation heating both act to increase the wind speed in the LLJ. The condensation induced local circulation strengthens the moisture transport in the LLJ, providing a positive feedback to sustain the Mei-yu precipitation system. It is found that local precipitation recycling shifts heavy rain toward the warm side of the Mei-yu front. This shift of rainfall location is due to the pronounced increase of atmospheric moisture and decrease of surface temperature over the warm side of the front.

Arginine Methylation Regulates MEIS2 Nuclear Localization to Promote Neuronal Differentiation of Adult SVZ Progenitors.

PubMed

Kolb, Jasmine; Anders-Maurer, Marie; Müller, Tanja; Hau, Ann-Christin; Grebbin, Britta Moyo; Kallenborn-Gerhardt, Wiebke; Behrends, Christian; Schulte, Dorothea

2018-04-10

Adult neurogenesis is regulated by stem cell niche-derived extrinsic factors and cell-intrinsic regulators, yet the mechanisms by which niche signals impinge on the activity of intrinsic neurogenic transcription factors remain poorly defined. Here, we report that MEIS2, an essential regulator of adult SVZ neurogenesis, is subject to posttranslational regulation in the SVZ olfactory bulb neurogenic system. Nuclear accumulation of MEIS2 in adult SVZ-derived progenitor cells follows downregulation of EGFR signaling and is modulated by methylation of MEIS2 on a conserved arginine, which lies in close proximity to nested binding sites for the nuclear export receptor CRM1 and the MEIS dimerization partner PBX1. Methylation impairs interaction with CRM1 without affecting PBX1 dimerization and thereby allows MEIS2 nuclear accumulation, a prerequisite for neuronal differentiation. Our results describe a form of posttranscriptional modulation of adult SVZ neurogenesis whereby an extrinsic signal fine-tunes neurogenesis through posttranslational modification of a transcriptional regulator of cell fate. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Meis3 synergizes with Pbx4 and Hoxb1b in promoting hindbrain fates in the zebrafish.

PubMed

Vlachakis, N; Choe, S K; Sagerström, C G

2001-04-01

Many Hox proteins are thought to require Pbx and Meis co-factors to specify cell identity during embryogenesis. Here we demonstrate that Meis3 synergizes with Pbx4 and Hoxb1b in promoting hindbrain fates in the zebrafish. We find that Hoxb1b and Pbx4 act together to induce ectopic hoxb1a expression in rhombomere 2 of the hindbrain. In contrast, Hoxb1b and Pbx4 acting together with Meis3 induce hoxb1a, hoxb2, krox20 and valentino expression rostrally and cause extensive transformation of forebrain and midbrain fates to hindbrain fates, including differentiation of excess rhombomere 4-specific Mauthner neurons. This synergistic effect requires that Hoxb1b and Meis3 have intact Pbx-interaction domains, suggesting that their in vivo activity is dependent on binding to Pbx4. In the case of Meis3, binding to Pbx4 is also required for nuclear access. Our results are consistent with Hoxb1b and Meis3 interacting with Pbx4 to form complexes that regulate hindbrain development during zebrafish embryogenesis.

Genome-Wide Characterization and Linkage Mapping of Simple Sequence Repeats in Mei (Prunus mume Sieb. et Zucc.)

PubMed Central

Sun, Lidan; Yang, Weiru; Zhang, Qixiang; Cheng, Tangren; Pan, Huitang; Xu, Zongda; Zhang, Jie; Chen, Chuguang

2013-01-01

Because of its popularity as an ornamental plant in East Asia, mei (Prunus mume Sieb. et Zucc.) has received increasing attention in genetic and genomic research with the recent shotgun sequencing of its genome. Here, we performed the genome-wide characterization of simple sequence repeats (SSRs) in the mei genome and detected a total of 188,149 SSRs occurring at a frequency of 794 SSR/Mb. Mononucleotide repeats were the most common type of SSR in genomic regions, followed by di- and tetranucleotide repeats. Most of the SSRs in coding sequences (CDS) were composed of tri- or hexanucleotide repeat motifs, but mononucleotide repeats were always the most common in intergenic regions. Genome-wide comparison of SSR patterns among the mei, strawberry (Fragaria vesca), and apple (Malus×domestica) genomes showed mei to have the highest density of SSRs, slightly higher than that of strawberry (608 SSR/Mb) and almost twice as high as that of apple (398 SSR/Mb). Mononucleotide repeats were the dominant SSR motifs in the three Rosaceae species. Using 144 SSR markers, we constructed a 670 cM-long linkage map of mei delimited into eight linkage groups (LGs), with an average marker distance of 5 cM. Seventy one scaffolds covering about 27.9% of the assembled mei genome were anchored to the genetic map, depending on which the macro-colinearity between the mei genome and Prunus T×E reference map was identified. The framework map of mei constructed provides a first step into subsequent high-resolution genetic mapping and marker-assisted selection for this ornamental species. PMID:23555708

Thermography applied acupuncture and qi-gong

NASA Astrophysics Data System (ADS)

Qin, Yuwen; Ji, Hong-Wei; Chen, Jin-Long; Li, Hong-Qi

1997-04-01

Thermographic technique can be used to measure temperature distribution of body surface in real-time, non-contact and full-field, which has been successfully used in medical diagnosis, remote sensing, and NDT, etc. The authors have developed a thermographic experiment that can be applied to inspect the effect of action of acupuncture and qi-gong (a system of deep breathing exercises) by measuring the temperature of hand and arm. The observation is performed respectively by thermography for the dynamic changes of temperature of the arm and hand after acupuncture therapy and qi-gong therapy. Thermographic results show that the temperature on the collateral channels increases markedly. In the meantime, it can be seen that the above therapies of Chinese medicine can stimulate the channel collateral system. This also contributes a new basis to the effect of action of the therapies of Chinese medicine. The work shows that thermographic technique is a powerful tool for research in Chinese medicine. In this paper, some thermal images are obtained from the persons treated with acupuncture and qi- gong.

[Comparative analysis on the biological basis of blood stasis syndrome induced by qi-stagnation and qi-deficiency in patients with unstable angina pectoris].

PubMed

Ren, Jian-xun; Liu, Jian-xun; Lin, Cheng-ren

2010-04-01

To comparatively analyse the objective characteristics of different syndrome types of qi-disturbance-induced blood stasis syndrome (QDBS) in the pathogenetic evolution of unstable angina coronary heart disease (UA-CHD). Seventy-eight patients with UA-CHD of QDBS were differentiated into 2 groups: 55 in the qi-deficiency-induced blood-stasis syndrome group (A) and 23 in the qi-stagnation-induced blood-stasis syndrome group (B). The comparative analysis on them was carried out through comparing their blood pressure, glucose and lipid metabolisms, coagulation function, thyroid function and inflammation reaction changes, etc. In the pathogenetic process of qi-disturbance induced blood stasis, the initiating age, levels of HbA1c, TSH, PT and APTT between the two groups were significantly different (P < 0.05). Levels of TNF-alpha and LN were higher and levels of sIgA lower in patients than those in healthy subjects (P < 0.05). Inflammation immune reaction may play an important role in the pathogenetic process of blood-stasis syndrome, and the functional disturbance of hypothalamus, pituitary and endocrinal secretion induced by emotional stress is possibly the essence of qi-stagnation induced blood stasis syndrome.

[Professor Xu Fu-song's traditional Chinese medicine protocols for male diseases: A descriptive analysis].

PubMed

Liu, Cheng-yong; Xu, Fu-song

2015-04-01

To analyze the efficacy and medication principles of Professor Xu Fu-songs traditional Chinese medicine (TCM) protocols for male diseases. We reviewed and descriptively analyzed the unpublished complete medical records of 100 male cases treated by Professor Xu Fu-song with his TCM protocols from 1978 to 1992. The 100 cases involved 32 male diseases, most of which were difficult and complicated cases. The drug compliance was 95%. Each prescription was made up of 14 traditional Chinese drugs on average. The cure rate was 32% , and the effective rate was 85%. Professor Xu Fu-song advanced and proved some new theories and therapeutic methods. Professor Xu Fu-song's TCM protocols can be applied to a wide range of male diseases, mostly complicated, and are characterized by accurate differentiation of symptoms and signs, high drug compliance, and excellent therapeutic efficacy.

Genome-wide DNA polymorphisms in two cultivars of mei (Prunus mume sieb. et zucc.).

PubMed

Sun, Lidan; Zhang, Qixiang; Xu, Zongda; Yang, Weiru; Guo, Yu; Lu, Jiuxing; Pan, Huitang; Cheng, Tangren; Cai, Ming

2013-10-06

Mei (Prunus mume Sieb. et Zucc.) is a famous ornamental plant and fruit crop grown in East Asian countries. Limited genetic resources, especially molecular markers, have hindered the progress of mei breeding projects. Here, we performed low-depth whole-genome sequencing of Prunus mume 'Fenban' and Prunus mume 'Kouzi Yudie' to identify high-quality polymorphic markers between the two cultivars on a large scale. A total of 1464.1 Mb and 1422.1 Mb of 'Fenban' and 'Kouzi Yudie' sequencing data were uniquely mapped to the mei reference genome with about 6-fold coverage, respectively. We detected a large number of putative polymorphic markers from the 196.9 Mb of sequencing data shared by the two cultivars, which together contained 200,627 SNPs, 4,900 InDels, and 7,063 SSRs. Among these markers, 38,773 SNPs, 174 InDels, and 418 SSRs were distributed in the 22.4 Mb CDS region, and 63.0% of these marker-containing CDS sequences were assigned to GO terms. Subsequently, 670 selected SNPs were validated using an Agilent's SureSelect solution phase hybridization assay. A subset of 599 SNPs was used to assess the genetic similarity of a panel of mei germplasm samples and a plum (P. salicina) cultivar, producing a set of informative diversity data. We also analyzed the frequency and distribution of detected InDels and SSRs in mei genome and validated their usefulness as DNA markers. These markers were successfully amplified in the cultivars and in their segregating progeny. A large set of high-quality polymorphic SNPs, InDels, and SSRs were identified in parallel between 'Fenban' and 'Kouzi Yudie' using low-depth whole-genome sequencing. The study presents extensive data on these polymorphic markers, which can be useful for constructing high-resolution genetic maps, performing genome-wide association studies, and designing genomic selection strategies in mei.

A critical courier role of volatile oils from Dalbergia odorifera for cardiac protection in vivo by QiShenYiQi.

PubMed

Yu, Jiahui; Zhang, Wen; Zhang, Yiqian; Wang, Yadong; Zhang, Boli; Fan, Guanwei; Zhu, Yan

2017-08-04

Component-based Chinese medicine (CCM) is derived from traditional Chinese medicine but produced with modern pharmaceutical standard and clearer clinical indications. However, it still faces challenges of defining individual component contribution in the complex formula. Using QiShenYiQi (QSYQ) as a model CCM, we investigated the role of Dalbergia odorifera (DO), an herbal component, in preventing myocardial damage. We showed that in vitro, QSYQ exerted considerable protective activities on cardiomyocytes from H 2 O 2 -induced mitochondrial dysfunction with or without DO. However, in isolated rat hearts, myocardial protection by QSYQ was significantly weakened without DO. In everted gut sac model, DO significantly enhanced absorption of the major QSYQ ingredients in different regions of rat intestine. Finally, in in vivo mouse model of doxorubicin (DOX)-induced myocardial damage, only QSYQ, but not QiShenYiQi without DO (QSYQ-DO), exerted a full protection. Taken together, our results showed that instead of directly contributing to the myocardial protection, Dalbergia odorifera facilitates the major active ingredients absorption and increases their efficacy, eventually enhancing the in vivo potency of QSYQ. These findings may shed new lights on our understanding of the prescription compatibility theory, as well as the impacts of "courier herbs" in component-based Chinese medicine.

Loss of the transcription factor Meis1 prevents sympathetic neurons target-field innervation and increases susceptibility to sudden cardiac death

PubMed Central

Bouilloux, Fabrice; Thireau, Jérôme; Ventéo, Stéphanie; Farah, Charlotte; Karam, Sarah; Dauvilliers, Yves; Valmier, Jean; Copeland, Neal G; Jenkins, Nancy A; Richard, Sylvain; Marmigère, Frédéric

2016-01-01

Although cardio-vascular incidents and sudden cardiac death (SCD) are among the leading causes of premature death in the general population, the origins remain unidentified in many cases. Genome-wide association studies have identified Meis1 as a risk factor for SCD. We report that Meis1 inactivation in the mouse neural crest leads to an altered sympatho-vagal regulation of cardiac rhythmicity in adults characterized by a chronotropic incompetence and cardiac conduction defects, thus increasing the susceptibility to SCD. We demonstrated that Meis1 is a major regulator of sympathetic target-field innervation and that Meis1 deficient sympathetic neurons die by apoptosis from early embryonic stages to perinatal stages. In addition, we showed that Meis1 regulates the transcription of key molecules necessary for the endosomal machinery. Accordingly, the traffic of Rab5+ endosomes is severely altered in Meis1-inactivated sympathetic neurons. These results suggest that Meis1 interacts with various trophic factors signaling pathways during postmitotic neurons differentiation. DOI: http://dx.doi.org/10.7554/eLife.11627.001 PMID:26857994

Retinoic acid-independent expression of Meis2 during autopod patterning in the developing bat and mouse limb.

PubMed

Mason, Mandy K; Hockman, Dorit; Curry, Lyle; Cunningham, Thomas J; Duester, Gregg; Logan, Malcolm; Jacobs, David S; Illing, Nicola

2015-01-01

The bat has strikingly divergent forelimbs (long digits supporting wing membranes) and hindlimbs (short, typically free digits) due to the distinct requirements of both aerial and terrestrial locomotion. During embryonic development, the morphology of the bat forelimb deviates dramatically from the mouse and chick, offering an alternative paradigm for identifying genes that play an important role in limb patterning. Using transcriptome analysis of developing Natal long-fingered bat (Miniopterus natalensis) fore- and hindlimbs, we demonstrate that the transcription factor Meis2 has a significantly higher expression in bat forelimb autopods compared to hindlimbs. Validation by reverse transcriptase and quantitative polymerase chain reaction (RT-qPCR) and whole mount in situ hybridisation shows that Meis2, conventionally known as a marker of the early proximal limb bud, is upregulated in the bat forelimb autopod from CS16. Meis2 expression is localised to the expanding interdigital webbing and the membranes linking the wing to the hindlimb and tail. In mice, Meis2 is also expressed in the interdigital region prior to tissue regression. This interdigital Meis2 expression is not activated by retinoic acid (RA) signalling as it is present in the retained interdigital tissue of Rdh10 (trex/trex) mice, which lack RA. Additionally, genes encoding RA-synthesising enzymes, Rdh10 and Aldh1a2, and the RA nuclear receptor Rarβ are robustly expressed in bat fore- and hindlimb interdigital tissues indicating that the mechanism that retains interdigital tissue in bats also occurs independently of RA signalling. Mammalian interdigital Meis2 expression, and upregulation in the interdigital webbing of bat wings, suggests an important role for Meis2 in autopod development. Interdigital Meis2 expression is RA-independent, and retention of interdigital webbing in bat wings is not due to the suppression of RA-induced cell death. Rather, RA signalling may play a role in the thinning

Transcriptional activation by MEIS1A in response to protein kinase A signaling requires the transducers of regulated CREB family of CREB co-activators.

PubMed

Goh, Siew-Lee; Looi, Yvonne; Shen, Hui; Fang, Jun; Bodner, Caroline; Houle, Martin; Ng, Andy Cheuk-Him; Screaton, Robert A; Featherstone, Mark

2009-07-10

The transcription factor encoded by the murine ecotropic integration site 1 gene (MEIS1) is a partner of HOX and PBX proteins. It has been implicated in embryonic patterning and leukemia, and causally linked to restless legs syndrome. The MEIS1A C terminus harbors a transcriptional activation domain that is stimulated by protein kinase A (PKA) in a manner dependent on the co-activator of cAMP response element-binding protein (CREB), CREB-binding protein (CBP). We explored the involvement of another mediator of PKA-inducible transcription, namely the CREB co-activators transducers of regulated CREB activity (TORCs). Overexpression of TORC1 or TORC2 bypassed PKA for activation by MEIS1A. Co-immunoprecipitation experiments demonstrated a physical interaction between MEIS1 and TORC2 that is dependent on the MEIS1A C terminus, whereas chromatin immunoprecipitation revealed PKA-inducible recruitment of MEIS1, PBX1, and TORC2 on the MEIS1 target genes Hoxb2 and Meis1. The MEIS1 interaction domain on TORC1 was mapped to the N-terminal coiled-coil region, and TORC1 mutants lacking this domain attenuated the response to PKA on a natural MEIS1A target enhancer. Thus, TORCs physically cooperate with MEIS1 to achieve PKA-inducible transactivation through the MEIS1A C terminus, suggesting a concerted action in developmental and oncogenic processes.

Transcriptional Activation by MEIS1A in Response to Protein Kinase A Signaling Requires the Transducers of Regulated CREB Family of CREB Co-activators*

PubMed Central

Goh, Siew-Lee; Looi, Yvonne; Shen, Hui; Fang, Jun; Bodner, Caroline; Houle, Martin; Ng, Andy Cheuk-Him; Screaton, Robert A.; Featherstone, Mark

2009-01-01

The transcription factor encoded by the murine ecotropic integration site 1 gene (MEIS1) is a partner of HOX and PBX proteins. It has been implicated in embryonic patterning and leukemia, and causally linked to restless legs syndrome. The MEIS1A C terminus harbors a transcriptional activation domain that is stimulated by protein kinase A (PKA) in a manner dependent on the co-activator of cAMP response element-binding protein (CREB), CREB-binding protein (CBP). We explored the involvement of another mediator of PKA-inducible transcription, namely the CREB co-activators transducers of regulated CREB activity (TORCs). Overexpression of TORC1 or TORC2 bypassed PKA for activation by MEIS1A. Co-immunoprecipitation experiments demonstrated a physical interaction between MEIS1 and TORC2 that is dependent on the MEIS1A C terminus, whereas chromatin immunoprecipitation revealed PKA-inducible recruitment of MEIS1, PBX1, and TORC2 on the MEIS1 target genes Hoxb2 and Meis1. The MEIS1 interaction domain on TORC1 was mapped to the N-terminal coiled-coil region, and TORC1 mutants lacking this domain attenuated the response to PKA on a natural MEIS1A target enhancer. Thus, TORCs physically cooperate with MEIS1 to achieve PKA-inducible transactivation through the MEIS1A C terminus, suggesting a concerted action in developmental and oncogenic processes. PMID:19473990

Technology for the production of Zero Q.I pitch from coal tar

NASA Astrophysics Data System (ADS)

Karthik, K.; Kumar, K. Rajesh; Rao, C. V. Nageswara; Kumar, B. Vinod; Murty, J. V. S.

2013-06-01

Zero Quinoline Insolubles (Q.I) pitch is a special type of pitch obtained from pre-treatment of coal tar, which is converted into pitch. This is used for impregnation of electrodes for improving the strength, electrical properties and also used as a pre-cursor for Mesophase pitch for producing Mesophase pitch based carbon fibers, carbon foam, and Meso carbon micro beads. This paper discusses the technology of Q.I separation from Coal Tar by using decantation of Coal Tar mixed with Heavy Creosote Oil (HC Oil) at different temperatures. By this method we were able to produce the Zero Q.I pitch with a Q.I value of 0.1%.

ACAS-Xu Initial Self-Separation Flight Tests

NASA Technical Reports Server (NTRS)

Marston, Mike; Baca, Gabe

2015-01-01

The purpose of this flight test report is to document and report the details of the ACAS Xu (Airborne Collision Avoidance System For Unmanned Aircraft) / Self-Separation flight test series performed at Edwards AFB from November to December of 2014. Included in this document are details about participating aircraft, aircrew, mission crew, system configurations, flight data, flight execution, flight summary, test results, and lessons learned.

A tale of TALE, PREP1, PBX1, and MEIS1: Interconnections and competition in cancer.

PubMed

Blasi, Francesco; Bruckmann, Chiara; Penkov, Dmitry; Dardaei, Leila

2017-05-01

We report the latest structural information on PREP1 tumor suppressor, the specific "oncogene" and "tumor suppressive" signatures of MEIS1 and PREP1, the molecular rules regulating PREP1 and MEIS1 binding to DNA, and how these can change depending on the interaction with PBX1, cell-type, neoplastic transformation, and intracellular concentration. As both PREP1 and MEIS1 interact with PBX1 they functionally compete with each other. PREP1, PBX1, and MEIS1 TALE-class homeodomain transcription factors act in an interdependent and integrated way in experimental tumorigenesis. We also pool together the plethora of data available in human cancer databanks and connect them with the available molecular information. The emerging picture suggests that a similarly basic approach might be used to better dissect and define other oncogenes and suppressors and better understand human cancer. © 2017 The Authors. BioEssays Published by WILEY Periodicals, Inc.

SPring-8 BL41XU, a high-flux macromolecular crystallography beamline

PubMed Central

Hasegawa, Kazuya; Shimizu, Nobutaka; Okumura, Hideo; Mizuno, Nobuhiro; Baba, Seiki; Hirata, Kunio; Takeuchi, Tomoyuki; Yamazaki, Hiroshi; Senba, Yasunori; Ohashi, Haruhiko; Yamamoto, Masaki; Kumasaka, Takashi

2013-01-01

SPring-8 BL41XU is a high-flux macromolecular crystallography beamline using an in-vacuum undulator as a light source. The X-rays are monochromated by a liquid-nitrogen-cooling Si double-crystal monochromator, and focused by Kirkpatrick–Baez mirror optics. The focused beam size at the sample is 80 µm (H) × 22 µm (V) with a photon flux of 1.1 × 1013 photons s−1. A pinhole aperture is used to collimate the beam in the range 10–50 µm. This high-flux beam with variable size provides opportunities not only for micro-crystallography but also for data collection effectively making use of crystal volume. The beamline also provides high-energy X-rays covering 20.6–35.4 keV which allows ultra-high-resolution data to be obtained and anomalous diffraction using the K-edge of Xe and I. Upgrade of BL41XU for more rapid and accurate data collection is proceeding. Here, details of BL41XU are given and an outline of the upgrade project is documented. PMID:24121338

[Qi as a materialist concept on the level of medical philosophy].

PubMed

Su, Zhan-Qing

2005-03-01

This paper has made a distinction between the materialist concept of qi on the medical philosophical level and its substantial existence, and illustrated the materiality and multiplicity of qi. Materiality refers to the objective reality, a summation of various things or phenomena related to human beings; while multiplicity refers to diversity of specific substances, each holding its individual essence. Based on two essential conceptions "xiang" and "xiangji", and combining the theories of traditional Chinese medicine and Western medicine, this paper has also made a preliminary study on the substantial existence of qi at macro- and micro-levels, and on physiological (normal) and pathological (abnormal) aspects. It is the author's argument that studies of the substantial existence of qi from different aspects, micro-dimension in particular, will push the syndrome differentiation of traditional Chinese medicine to a more subtle sphere.

The complete chloroplast genome of Sinopodophyllum hexandrum Ying (Berberidaceae).

PubMed

Meng, Lihua; Liu, Ruijuan; Chen, Jianbing; Ding, Chenxu

2017-05-01

The complete nucleotide sequence of the Sinopodophyllum hexandrum Ying chloroplast genome (cpDNA) was determined based on next-generation sequencing technologies in this study. The genome was 157 203 bp in length, containing a pair of inverted repeat (IRa and IRb) regions of 25 960 bp, which were separated by a large single-copy (LSC) region of 87 065 bp and a small single-copy (SSC) region of 18 218 bp, respectively. The cpDNA contained 148 genes, including 96 protein-coding genes, 8 ribosomal RNA genes, and 44 tRNA genes. In these genes, eight harbored a single intron, and two (ycf3 and clpP) contained a couple of introns. The cpDNA AT content of S. hexandrum cpDNA is 61.5%.

Restless legs syndrome-associated intronic common variant in Meis1 alters enhancer function in the developing telencephalon.

PubMed

Spieler, Derek; Kaffe, Maria; Knauf, Franziska; Bessa, José; Tena, Juan J; Giesert, Florian; Schormair, Barbara; Tilch, Erik; Lee, Heekyoung; Horsch, Marion; Czamara, Darina; Karbalai, Nazanin; von Toerne, Christine; Waldenberger, Melanie; Gieger, Christian; Lichtner, Peter; Claussnitzer, Melina; Naumann, Ronald; Müller-Myhsok, Bertram; Torres, Miguel; Garrett, Lillian; Rozman, Jan; Klingenspor, Martin; Gailus-Durner, Valérie; Fuchs, Helmut; Hrabě de Angelis, Martin; Beckers, Johannes; Hölter, Sabine M; Meitinger, Thomas; Hauck, Stefanie M; Laumen, Helmut; Wurst, Wolfgang; Casares, Fernando; Gómez-Skarmeta, Jose Luis; Winkelmann, Juliane

2014-04-01

Genome-wide association studies (GWAS) identified the MEIS1 locus for Restless Legs Syndrome (RLS), but causal single nucleotide polymorphisms (SNPs) and their functional relevance remain unknown. This locus contains a large number of highly conserved noncoding regions (HCNRs) potentially functioning as cis-regulatory modules. We analyzed these HCNRs for allele-dependent enhancer activity in zebrafish and mice and found that the risk allele of the lead SNP rs12469063 reduces enhancer activity in the Meis1 expression domain of the murine embryonic ganglionic eminences (GE). CREB1 binds this enhancer and rs12469063 affects its binding in vitro. In addition, MEIS1 target genes suggest a role in the specification of neuronal progenitors in the GE, and heterozygous Meis1-deficient mice exhibit hyperactivity, resembling the RLS phenotype. Thus, in vivo and in vitro analysis of a common SNP with small effect size showed allele-dependent function in the prospective basal ganglia representing the first neurodevelopmental region implicated in RLS.

[Professor GAO Yuchun's experience on "sequential acupuncture leads to smooth movement of qi"].

PubMed

Wang, Yanjun; Xing, Xiao; Cui, Linhua

2016-01-01

Professor GAO Yuchun is considered as the key successor of GAO's academic school of acupuncture and moxibustion in Yanzhao region. Professor GAO's clinical experience of, "sequential acupuncture" is introduced in details in this article. In Professor GAO's opinions, appropriate acupuncture sequence is the key to satisfactory clinical effects during treatment. Based on different acupoints, sequential acupuncture can achieve the aim of qi following needles and needles leading qi; based on different symptoms, sequential acupuncture can regulate qi movement; based on different body positions, sequential acupuncture can harmonize qi-blood and reinforcing deficiency and reducing excess. In all, according to the differences of disease condition and constitution, based on the accurate acupoint selection and appropriate manipulation, it is essential to capture the nature of diseases and make the order of acupuncture, which can achieve the aim of regulating qi movement and reinforcing deficiency and reducing excess.

Endophytic Fungus from Sinopodophyllum emodi (Wall.) Ying that Produces Podophyllotoxin.

PubMed

Liang, Zizhen; Zhang, Jia; Zhang, Xuan; Li, Jinjie; Zhang, Xiaoqian; Zhao, Changqi

2016-02-01

The aryltetralin lactone podophyllotoxin, which exhibits pronounced antineoplastic activity, is used as the precursor of the following three clinical anticancer drugs: Etoposide™, Etopophos™ and Teniposide™. The natural occurrence of this arylnaphthalene lignan is scarce and unable to meet the ever-rising demand in the medical industry. Thus, developing alternative sources for the production of podophyllotoxin is extremely urgent. This is the first report of the production of podophyllotoxin from endophytic Alternaria tenuissima isolated from Sinopodophyllum emodi (Wall.) Ying. The identification of podophyllotoxin was performed using high-performance liquid chromatography and liquid chromatography-mass spectrometry (MS)-MS and confirmed by comparison with authentic standards. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Study on qi deficiency syndrome distribution and quality of life in patients with advanced non-small cell lung cancer].

PubMed

Yuan, Lin; Zhang, Pei-tong; Yang, Zong-yan

2011-07-01

To study the qi deficiency syndrome distribution and quality of life (QOL) of patients with advanced non-small cell lung cancer (NSCLC). A questionnaire survey was conducted in 120 patients with advanced NSCLC using the QOL scale "Functional Assessment of Cancer Therapy" (FACT-L) (Version 4.0). Meanwhile, syndrome typing was performed. On the basis of results of syndrome typing, patients of different syndrome types were grouped and compared, thus studying the distribution of advanced NSCLC patients of qi deficiency syndrome and qi deficiency syndrome correlated QOL features. Qi deficiency, blood stasis, yin deficiency, phlegm and dampness dominated in syndrome types of the 120 patients with advanced NSCLC. Of syndrome types accounting for larger ratios in 112 patients, pure qi deficiency syndrome accounted for 30.36% (34 cases), qi deficiency and blood stasis syndrome for 18. 75% (21 cases), both qi and yin deficiency syndrome for 10. 71% (12 cases). There was no correlation between the appearance of qi deficiency syndrome and patients' age, sex, pathological typing (adenocarcinoma/squamous carcinoma), or the disease duration. NSCLC patients in phase IV were mostly complicated with qi deficiency syndrome (P<0.05). Scores of physical states, emotional states, functional states, and total scores in the FACT-L scale were lower in those complicated with qi deficiency syndrome (89 cases) than in those without complicated qi deficiency syndrome (31 cases), showing statistical difference (P<0.01, P<0.05). The scores of the lung cancer specific module (additional concerns) in the FACT-L scale showed statistical difference, sequenced as qi deficiency and blood stasis syndrome > pure qi deficiency syndrome > both qi and yin deficiency syndrome (P<0.05). Qi deficiency syndrome is the main syndrome of advanced NSCLC. The QOL of advanced NSCLC patients complicated with qi deficiency syndrome was poorer than those without complicated qi deficiency syndrome. Besides, along with

Making cognitive decision support work: Facilitating adoption, knowledge and behavior change through QI.

PubMed

Weir, Charlene; Brunker, Cherie; Butler, Jorie; Supiano, Mark A

2017-07-01

This paper evaluates the role of facilitation in the successful implementation of Computerized Decision Support (CDS). Facilitation processes include education, specialized computerized decision support, and work process reengineering. These techniques, as well as modeling and feedback enhance self-efficacy, which we propose is one of the factors that mediate the effectiveness of any CDS. In this study, outpatient clinics implemented quality improvement (QI) projects focused on improving geriatric care. Quality Improvement is the systematic process of improving quality through continuous measurement and targeted actions. The program, entitled "Advancing Geriatric Education through Quality Improvement" (AGE QI), consisted of a 6-month, QI based, intervention: (1) 2h didactic session, (2) 1h QI planning session, (3) computerized decision support design and implementation, (4) QI facilitation activities, (5) outcome feedback, and (6) 20h of CME. Specifically, we examined the impact of the QI based program on clinician's perceived self-efficacy in caring for older adults and the relationship of implementation support and facilitation on perceived success. The intervention was implemented at 3 institutions, 27 community healthcare system clinics, and 134 providers. This study reports the results of pre/post surveys for the forty-nine clinicians who completed the full CME program. Self-efficacy ratings for specific clinical behaviors related to care of older adults were assessed using a Likert based instrument. Self-ratings of efficacy improved across the following domains (depression, falls, end-of-life, functional status and medication management) and specifically in QI targeted domains and were associated with overall clinic improvements. Published by Elsevier Inc.

Weaker cognitive control abilities of Pi (Spleen) qi-deficient individuals supported Chinese medicine diagnosis.

PubMed

Lin, Hui-Yan; Zhao, Yan-Ping; Xu, Gui-Ping; Li, Yun-Si; Xie, Wei-Yun; Bai, Li-Hua; Jin, Hua

2017-07-28

To investigate whether Pi (Spleen) qi-deficiency affected psychological and neural responses in relevance to cognitive control. Pi qi-deficient and balanced participants were asked to perform the Stroop task, a classical cognitive control paradigm. In this paradigm, participants had to judge the color of the prompted word. The word's meaning indicated the color (the consistent condition) or not (the inconsistent condition), or were unrelated to the color (the neutral condition). Electroencephalograph (EEG) was recorded during the task. Event-related potential (ERP) results showed that Pi qi-deficient individuals failed to exhibit a normal Stroop effect as Balanced individuals did, such as the accuracy differences between the consistent and the inconsistent conditions as well as the N450 effect (P>0.05). Meanwhile, Pi qi-deficient individuals displayed larger P2 and P3 amplitudes than balanced individuals did during performing the cognitive control task (P<0.05). Pi qi-deficiency had psychological and neural basis at least in cognitive control aspect.

Malaysian Education Index (MEI): An Online Indexing and Repository System

ERIC Educational Resources Information Center

Kabilan, Muhammad Kamarul; Ismail, Hairul Nizam; Yaakub, Rohizani; Yusof, Najeemah Mohd; Idros, Sharifah Noraidah Syed; Umar, Irfan Naufal; Arshad, Muhammad Rafie Mohd.; Idrus, Rosnah; Rahman, Habsah Abdul

2010-01-01

This "Project Sheet" describes an on-going project that is being carried out by a group of educational researchers, computer science researchers and librarians from Universiti Sains Malaysia, Penang. The Malaysian Education Index (MEI) has two main functions--(1) Online Indexing System, and (2) Online Repository System. In this brief…

Traditional Chinese medicine formula Bi-Qi capsule alleviates rheumatoid arthritis-induced inflammation, synovial hyperplasia, and cartilage destruction in rats.

PubMed

Wang, Kai; Zhang, Dongmei; Liu, Yan; Wang, Xuan; Zhao, Jiantong; Sun, Tingting; Jin, Tingting; Li, Baoli; Pathak, Janak L

2018-03-14

Traditional Chinese medicine (TCM) formula Bi-Qi capsule (Bi-Qi) is a commonly prescribed drug to treat rheumatoid arthritis (RA). However, the mechanism of Bi-Qi-mediated amelioration of RA pathogenesis is still a mystery. Collagen induced arthritis (CIA) in rats is an established model that shares many similarities with RA in humans. In this study we investigated the effect of Bi-Qi on the pathogenesis of CIA in rats. CIA was developed in Sprague-Dawley (S.D) rats (n = 60, female) and used as a model resembling RA in humans. Rats were treated with a high or moderate dose of Bi-Qi, or methotrexate (MTX). Effects of the treatment on local joint and systemic inflammation, synovial hyperplasia, cartilage destruction, and other main features in the pathogenesis of CIA were analyzed. Inflamed and swollen ankles and joints were observed in arthritic rats, while Bi-Qi or MTX treatment alleviated these symptoms. Only the Bi-Qi moderate dose decreased RA-induced serum levels of tumor necrosis factor-alpha (TNF-α). Both Bi-Qi and MTX reduced the interleukin (IL)-18 serum level. Protein levels of cartilage oligomeric matrix protein and osteopontin in serum, synovium, and cartilage were elevated in arthritic rats, while Bi-Qi alleviated these effects. Synovial hyperplasia, inflammatory cell infiltration in synovium and a high degree of cartilage degradation was observed in RA, and Bi-Qi or MTX alleviated this effect. Bi-Qi at the moderate dose was the most effective in mitigating CIA-related clinical complications. Our findings showed that Bi-Qi alleviates CIA-induced inflammation, synovial hyperplasia, cartilage destruction, and the other main features in the pathogenesis of CIA. This provides fundamental evidence for the anti-arthritic properties of Bi-Qi and corroborates the use of Bi-Qi TCM formula for the treatment of RA.

A study of formation and development of one kind of cyclone on the mei-yu (Baiu) front

NASA Astrophysics Data System (ADS)

Zhang, Feng; Zhao, Sixiong

2004-10-01

The paper presents one diagnosis of baroclinity and the coupling of jets during the developing process of a cyclone that occurred on the mei-yu (Baiu) front around the end of the second stage of the mei-yu (Baiu) in 1998. Results have shown that: (1) The advantageous changes of upper-level large-scale circulation caused the appearance and maintenance of the coupling between the upper-level jet (ULJ) and lower-level jet (LLJ) over the cyclone’s area. The coupling of jets in this case possesses some different characteristics from previous cases. Moreover, the coupling between the ULJ and LLJ caused the intensification of both lower-level convergence and upper-level divergence, which was favorable for the development of this cyclone. (2) From the analysis of the voricity budget, the role of lower-level convergence in the development of the cyclone was emphasized. Divergent wind in the lower troposphere was a direct contributor to the development of the cyclone. (3) During the development of the cyclone, cold air and warm air were active over the cyclone’s domain. Although this cyclone occurred at the mei-yu (Baiu) front, its development assumed baroclinity to a certain extent, which was just the main difference between this kind of cyclone and the first kind of low which is usually barotropic (or quasi-barotropic). (4) In recent years, studies on mei-yu front lows have paid more attention to the lower troposphere. In this paper, the analysis of the energy budget further supports this point: the certain effect of baroclinity forcing in the upper troposphere on mei-yu front lows cannot be ignored.

Dan-Qi prescription ameliorates insulin resistance through overall corrective regulation of glucose and fat metabolism.

PubMed

Xie, Zhishen; Loi Truong, Thanh; Zhang, Pei; Xu, Fengguo; Xu, Xiaojun; Li, Ping

2015-08-22

Danshen and Sanqi Prescription (Dan-Qi) is commonly used to treat cardiovascular diseases (CVD) in China. Since Danshen and Sanqi are reported to ameliorate lipid metabolism disorders at treatment of cardiovascular diseases. Meanwhile, it is reported that co-administration of Danshen and Sanqi exhibited significant pharmacokinetic herb-herb interactions. We reasoned that Danshen and Sanqi combination could be potentially function synergistically in treating diet induced insulin resistance. Using high calori food induced Drosophila and mice models, we assessed Danshen and Sanqi treatment for their anti-diabetic effects. The combination of Danshen and Sanqi (Dan-Qi) effectively improved fat and glucose metabolism of the high-sugar and high-fat diet fed fruit flies. More importantly, Dan-Qi significantly ameliorated hyperlipidemia and hyperglycemia phenotype caused in high-fat diet induced obesity (DIO) mouse model. The Dan-Qi treated DIO mice showed lower fasting insulin, triglycerides, total and low-density lipoprotein cholesterol (LDL-C) levels in plasma, much better than Danshen or Sanqi treated alone. It was shown that Dan-Qi prescription reduced fat accumulation in the liver with Sanqi playing the major role. Interestingly, it was not Danshen or Sanqi alone, but the combination markedly increased glycogen deposition in mice liver. Quantitative RT-PCR showed Dan-Qi increased liver glycogen synthesis gene like Glut-1, GK, and Glut-4, reduced fat and cholesterol anabolism genes such as SREBP-1c, ACC, ATP-CL, ACS. Meanwhilpose tissues and muscle tissues, the glucose and fat metabolism genes are changed accordingly to pro-catabolism status. Notably, endogenous plasma metabolites of Dan-Qi treated mice displayed much better overral rectifying effects than the Danshen or Sanqi alone. Our data demonstrated that Danshen and Sanqi combination exerted significant anti-diabetic efficacy, and Dan-Qi prescription could be potentially considered as a therapeutic application in

Vasa promotes Drosophila germline stem cell differentiation by activating mei-P26 translation by directly interacting with a (U)-rich motif in its 3' UTR.

PubMed

Liu, Niankun; Han, Hong; Lasko, Paul

2009-12-01

Vasa (Vas) is a DEAD-box RNA-binding protein required in Drosophila at several steps of oogenesis and for primordial germ cell (PGC) specification. Vas associates with eukaryotic initiation factor 5B (eIF5B), and this interaction has been implicated in translational activation of gurken mRNA in the oocyte. Vas is expressed in all ovarian germline cells, and aspects of the vas-null phenotype suggest a function in regulating the balance between germline stem cells (GSCs) and their fate-restricted descendants. We used a biochemical approach to recover Vas-associated mRNAs and obtained mei-P26, whose product represses microRNA activity and promotes GSC differentiation. We found that vas and mei-P26 mutants interact, and that mei-P26 translation is substantially reduced in vas mutant cells. In vitro, Vas protein bound specifically to a (U)-rich motif in the mei-P26 3' untranslated region (UTR), and Vas-dependent regulation of GFP-mei-P26 transgenes in vivo was dependent on the same (U)-rich 3' UTR domain. The ability of Vas to activate mei-P26 expression in vivo was abrogated by a mutation that greatly reduces its interaction with eIF5B. Taken together, our data support the conclusion that Vas promotes germ cell differentiation by directly activating mei-P26 translation in early-stage committed cells.

QI2S - Quick Image Interpretation System

NASA Astrophysics Data System (ADS)

Naghmouchi, Jamin; Aviely, Peleg; Ginosar, Ran; Ober, Giovanna; Bischoff, Ole; Nadler, Ron; Guiser, David; Citroen, Meira; Freddi, Riccardo; Berekovic, Mladen

2015-09-01

The evolution of the Earth Observation mission will be driven by many factors, and the deveploment of new processing paradigms to facilitate data downlink, handling and storage will be a key factor. Next generation EO satellites will generate a great amount of data at a very high data rate, both radar and optical. Real-time onboard processing can be the solution to reduce data downlink and management on ground. Radiometric, geometric, and atmospheric corrections of EO data as well as material/object detection in addition to the well-known needs for image compression and signal processing can be performed directly on board and the aim of QI2S project is to demonstrate this. QI2S, a concept prototype system for novel onboard image processing and image interpretation which has been designed, developed and validated in the framework of an EU FP7 project, targets these needs and makes a significant step towards exceeding current roadmaps of leading space agencies for future payload processors. The QI2S system features multiple chip components of the RC64, a novel rad-hard 64-core signal processing chip, which targets DSP performance of 75 GMACs (16bit), 150 GOPS and 38 single precision GFLOPS while dissipating less than 10 Watts. It integrates advanced DSP cores with a multibank shared memory and a hardware scheduler, also supporting DDR2/3 memory and twelve 3.125 Gbps full duplex high-speed serial links using SpaceFibre and other protocols. The processor is being developed within the European FP7 Framework Program and will be qualified to the highest space standards.

Impact of Qi-invigorating traditional Chinese medicines on intestinal flora: A basis for rational choice of prebiotics.

PubMed

Wang, Xiao-Meng; Li, Xiao-Bo; Peng, Ying

2017-04-01

According to the theory of traditional Chinese medicine (TCM), Qi (vital energy) is regarded as a driving force of biological activities in human body, including both nutrient substances and organ functions. Qi-invigorating TCMs are widely used to treat various symptoms and disorders, such as fatigue, obesity, immunosuppression, intestinal flora imbalance, and gastrointestinal diseases, in which Qi is considered to be reduced or depleted. Interestingly, abundant clinical evidences suggest that these disorders are associated with the alternation of intestinal flora, which directly affects disease status. Herein we review the interaction between gut microbiota and Qi-invigorating TCMs under healthy and disease conditions and discuss the mechanisms of action and applications of Qi-invigorating TCMs in enhancing health status through microbial alternation. A better understanding of the role of Qi-invigorating TCMs in modulating microbial composition and the association between intestinal microbiota and diseases would help reveal the clinical consequences of microbiota alteration and explore opportunities to harness this symbiotic relationship to improve public health. Copyright © 2017 China Pharmaceutical University. Published by Elsevier B.V. All rights reserved.

Ultra-high Strength Nanostructured Mg

DTIC Science & Technology

2014-03-31

27709-2211 Nanostructured Mg and Mg alloys, Mg metallic glass, Cryomilling, Powder consolidation, Spark plasma sintering , Deformation mechanisms REPORT...mechanically milled powder and high pressure on spark plasma sintering of Mg-Cu-Gd metallic glasses; (9) microstructure and mechanical behavior of Mg-10Li-3Al...pressure on spark plasma sintering of Mg– Cu–Gd metallic glasses, Acta Materialia , (07 2013): 4414. doi: Baolong Zheng, Ying Li, Weizong Xu

Binuclear cyclometalated organoplatinum complexes containing 1,1'-bis(diphenylphosphino)ferrocene as spacer ligand: kinetics and mechanism of MeI oxidative addition.

PubMed

Jamali, Sirous; Nabavizadeh, S Masoud; Rashidi, Mehdi

2008-06-16

The binuclear complex [Pt2Me2(ppy)2(mu-dppf)], 1, in which ppy = deprotonated 2-phenylpyridyl and dppf = 1,1'-bis(diphenylphosphino)ferrocene, was synthesized by the reaction of [PtMe(SMe2)(ppy)] with 0.5 equiv of dppf at room temperature. In this reaction when 1 equiv of dppf was used, the dppf chelating complex 2, [PtMe(dppf)(ppy-kappa1C)], was obtained. The reaction of Pt(II)-Pt(II) complex 1 with excess MeI gave the Pt(IV)-Pt(IV) complex [Pt2I2Me4(ppy)2(mu-dppf)], 3. When the reaction was performed with 1 equiv of MeI, a mixture containing unreacted complex 1, a mixed-valence Pt(II)-Pt(IV) complex [PtMe(ppy)(mu-dppf)PtIMe2(ppy)], 4, and complex 3 was obtained. In a comparative study, the reaction of [PtMe(SMe2)(ppy)] with 1 equiv of monodentate phosphine PPh3 gave [PtMe(ppy)(PPh3)], A. MeI was reacted with A to give the platinum(IV) complex [PtMe2I(ppy)(PPh3)], C. All the complexes were fully characterized using multinuclear (1H, 31P, 13C, and 195Pt) NMR spectroscopy, and complex 2 was further identified by single crystal X-ray structure determination. The reaction of binuclear Pt(II)-Pt(II) complex 1 with excess MeI was monitored by low temperature 31P NMR spectroscopy and further by 1H NMR spectroscopy, and the kinetics of the reaction was studied by UV-vis spectroscopy. On the basis of the data, a mechanism has been suggested for the reaction which overall involved stepwise oxidative addition of MeI to the two Pt(II) centers. In this suggested mechanism, the reaction proceeded through a number of Pt(II)-Pt(IV) and Pt(IV)-Pt(IV) intermediates. Although MeI in each step was trans oxidatively added to one of the Pt(II) centers, further trans to cis isomerizations of Me and I groups were also identified. A comparative kinetic study of the reaction of monomeric platinum(II) complex A with MeI was also performed. The rate of reaction of MeI with complex 1 was some 3.5 times faster than that with complex A, indicating that dppf in the complex 1, as compared with

Qi-Dan Fang ameliorates adriamycin-induced nephrotic syndrome rat model by enhancing renal function and inhibiting podocyte injury.

PubMed

Wu, Jun-Biao; Ye, Shu-Fang; Liang, Chun-Ling; Li, Yu-Cui; Yu, Ying-Jia; Lai, Jie-Mei; Lin, Hui; Zheng, Jie; Zhou, Jiu-Yao

2014-02-12

Nephrotic syndrome (NS) is a clinical syndrome with a variety of causes, mainly characterized by heavy proteinuria. Podocyte injury plays a key role in proteinuria, one of the principal means for the control of NS is to prevent podocyte injury. Qi-Dan Fang consists of two of the most extensively applied herbal remedies among Traditional Chinese Medicine (TCM) (Radix Astragali Mongolici and Radix Salviae Miltiorrhizae, with a weight ratio of 5:1) which are specifically used for the treatment of various kidney diseases. In previous studies, we found that Qi-Dan Fang provides improvement to patients with adriamycin-induced nephrotic syndrome by alleviating proteinuria and serum lipid. The aim of this study is to study the efficiency of Qi-Dan Fang on NS model rat with renal dysfunction and podocyte injury, something which has not been carried out yet. The rats were divided into Normal, Model, Jin Gui Shen Qi Pill (4.12 g/kg), Qi-Dan Fang (3.09, 6.17 and 12.34 g/kg/d) groups, they were each given a single tail intravenous injection of Adriamycin (6.0 mg/kg) except for the Normal group and were orally administered dosages of Qi-Dian Fang and Jin Gui Shen Qi pills once daily for 7 weeks. Following the treatment, the content of cystation C (CysC), blood urea nitrogen (BUN), serum creatinine (Scr) were measured with an autobiochemical analyser. The pathomorphological changes to the glomeruli, the mRNA expressions of nephrin, podocin, CD2AP genes and p53, bax, bcl-2 proteins expressions were also carried out to probe the effects of Qi-Dan Fang. (1) Qi-Dan Fang treatment raised the level of CysC in blood serum while lowering the content of BUN and Scr in the adriamycin-induced nephrotic syndrome rat model; (2) Long-term administration of Qi-Dan Fang was able to ameliorate pathomorphological change of glomeruli and repair the organization structure of Glomerulus; (3) Qi-Dan Fang could increase the mRNA expression of nephrin, podocin and CD2AP genes, down-regulate the

[Guiding-qi acupuncture for dry eye syndrome].

PubMed

Xie, Wenzhang; Zeng, Liang; Tao, Ying; Zhou, Yingfan; Zhao, Ran; Huang, Xinyun; Hou, Wenguang; Zhang, Ren; Zong, Lei

2018-02-12

To observe the clinical efficacy differences between different needling methods for dry eye syndrome. Sixty patients of dry eye syndrome were randomly divided into an observation group and a control group, 30 cases (60 eyes) in each group. Shangjingming (Extra), Xiajingming (Extra), Tongziliao (GB 1), Cuanzhu (BL 2), Fengchi (GB 20), Hegu (LI 4), Sanyinjiao (SP 6), Taixi (KI 3) and Taichong (LR 3) were selected in the two groups. The control group was treated with conventional acupuncture, while the observation group was treated with guiding- qi acupuncture. Electroacupuncture (EA) was used at bilateral Tongziliao (GB1) and Cuanzhu (BL 2), 30 min per treatment. The treatment was given three times per week. Totally 1-month treatment (12 treatments) was given. The eye symptom score, breakup time of tear film (BUT), Schirmer Ⅰ test (SⅠT) and visual analogue scale (VAS) score were compared before and after treatment in the two groups. The clinical efficacy was compared between the two groups. Compared before treatment, the eye symptom score, BUT, SⅠT and VAS score were improved after treatment in the two groups (all P <0.001); the improvements of eye symptom score and SⅠT in the observation group were superior to those in the control group (both P <0.05). The differences of BUT and VSA score between the two groups were not significant (both P >0.05). The total effective rate was 86.7% (52/60) in the observation group, which was superior to 73.3% (44/60) in the control group ( P <0.05). . The conventional EA and guiding- qi acupuncture combined with EA are both effective for dry eye syndrome, and the efficacy of guiding- qi acupuncture combined with EA is superior to that of conventional EA.

Effect and Mechanism of QiShenYiQi Pill on Experimental Autoimmune Myocarditis Rats.

PubMed

Lv, Shichao; Wu, Meifang; Li, Meng; Wang, Qiang; Xu, Ling; Wang, Xiaojing; Zhang, Junping

2016-03-06

To observe the effect of QiShenYiQi pill (QSYQ) on experimental autoimmune myocarditis rats, and to explore its mechanism of action. Lewis rats underwent the injection of myocardial myosin mixed with Freund's complete adjuvant were randomized into 3 groups: model, valsartan, and QSYQ groups. Rats injected with phosphate-buffered saline (PBS) mixed with Freund's complete adjuvant were used as the control group. Rats were euthanized at 4 and 8 weeks, and we weighed rat body mass, heart mass, and left ventricular mass. Myocardium sections were stained with hematoxylin and eosin (H&E) and Masson trichrome. Myocardial TGF-β1 and CTGF protein expression was detected by immunohistochemistry, and myocardial TGF-β1 and CTGF mRNA expression was detected by real-time qPCR. QSYQ reduced HMI and LVMI, as well as the histological score of hearts and CVF, which further decreased over time, and its effect was significantly greater than that of valsartan at 4 and 8 weeks. After 4 weeks, QSYQ inhibited the protein and mRNA expression of TGF-β1 and CTGF, and its effect on lowering CTGF was significantly greater than that of valsartan. In addition, after 8 weeks, QSYQ also inhibited the protein and mRNA expression of CTGF, whereas there was no significant difference in the expression of myocardial TGF-β1. This study provides evidence that QSYQ can improve cardiac remodeling of experimental autoimmune myocarditis rats. It also effectively improved the degree of myocardial fibrosis, which is related to the mechanism of regulation of TGF-β1 CTGF.

A second soundly sleeping dragon: new anatomical details of the Chinese troodontid Mei long with implications for phylogeny and taphonomy.

PubMed

Gao, Chunling; Morschhauser, Eric M; Varricchio, David J; Liu, Jinyuan; Zhao, Bo

2012-01-01

A second nearly complete, articulated specimen of the basal troodontid Mei long (DNHM D2154) is reported from the Early Cretaceous (Hauterivian-Valanginian) lower Yixian Formation, Liaoning Province, China. New diagnostic features of Mei long are identified, including: a uniquely shaped maxilla, low with small, low maxillary fenestra; sacrum with an extremely wide caudal portion and elongate 4(th) and 5(th) sacral processes; and a large distal articular surface on the tibiotarsus which continues caudally on the tibia. A phylogenetic analysis including new data from the second specimen recovered Mei as a basal troodontid, in keeping with previous analyses. Although the skeleton exhibits several juvenile-like features including free cervical ribs, unfused frontals and nasals, and a short snouted skull, other attributes, full fusion of all neurocentral synostoses and the sacrum, and dense exteriors to cortical bone, suggest a small, mature individual. Microscopic examination of tibia and fibula histology confirms maturity and suggests an individual greater than two years old with slowed growth. Despite being one of the smallest dinosaurs, Mei long exhibits multi-year growth and cortical bone consisting largely of fibro-lamellar tissue marked by lines of arrested growth as in much larger and more basal theropods. This Mei long specimen lies in a similar but mirrored sleeping position to that of the holotype, strengthening the hypothesis that both specimens were preserved in a stereotypical life position. Like many Liaoning specimens, the new specimen also lacks extensive taphonomic and stratigraphic data, making further behavioral inference problematic.

A Second Soundly Sleeping Dragon: New Anatomical Details of the Chinese Troodontid Mei long with Implications for Phylogeny and Taphonomy

PubMed Central

Gao, Chunling; Morschhauser, Eric M.; Varricchio, David J.; Liu, Jinyuan; Zhao, Bo

2012-01-01

A second nearly complete, articulated specimen of the basal troodontid Mei long (DNHM D2154) is reported from the Early Cretaceous (Hauterivian-Valanginian) lower Yixian Formation, Liaoning Province, China. New diagnostic features of Mei long are identified, including: a uniquely shaped maxilla, low with small, low maxillary fenestra; sacrum with an extremely wide caudal portion and elongate 4th and 5th sacral processes; and a large distal articular surface on the tibiotarsus which continues caudally on the tibia. A phylogenetic analysis including new data from the second specimen recovered Mei as a basal troodontid, in keeping with previous analyses. Although the skeleton exhibits several juvenile-like features including free cervical ribs, unfused frontals and nasals, and a short snouted skull, other attributes, full fusion of all neurocentral synostoses and the sacrum, and dense exteriors to cortical bone, suggest a small, mature individual. Microscopic examination of tibia and fibula histology confirms maturity and suggests an individual greater than two years old with slowed growth. Despite being one of the smallest dinosaurs, Mei long exhibits multi-year growth and cortical bone consisting largely of fibro-lamellar tissue marked by lines of arrested growth as in much larger and more basal theropods. This Mei long specimen lies in a similar but mirrored sleeping position to that of the holotype, strengthening the hypothesis that both specimens were preserved in a stereotypical life position. Like many Liaoning specimens, the new specimen also lacks extensive taphonomic and stratigraphic data, making further behavioral inference problematic. PMID:23028847

Feasibility of a virtual learning collaborative to implement an obesity QI project in 29 pediatric practices.

PubMed

John, Tamara; Morton, Michaela; Weissman, Mark; O'Brien, Ellen; Hamburger, Ellen; Hancock, Yolandra; Moon, Rachel Y

2014-04-01

Quality improvement (QI) activities are required to maintain board certification in pediatrics. However, because of lack of training and resources, pediatricians may feel overwhelmed by the need to implement QI activities. Pediatricians also face challenges when caring for overweight and obese children. To create a virtual (online) QI learning collaborative through which pediatric practices could easily develop and implement a continuous QI process. Prospective cohort. Pediatric practices that were part of the Children's National Health Network were invited to participate, with the option to receive continuing medical education and maintenance of certification credits. s) Practices conducted baseline and monthly chart audits, participated in educational webinars and selected monthly practice changes, using Plan-Do-Study-Act cycles. Practices reported activities monthly and periodic feedback was provided to practices about their performance. s) Improvement in (i) body mass index (BMI) percentile documentation, (ii) appropriate nutritional and activity counseling and (iii) follow-up management for high-risk patients. Twenty-nine practices (120 providers) participated, and 24 practices completed all program activities. Monthly chart audits demonstrated continuous improvement in documentation of BMI, abnormal weight diagnosis, nutrition and activity screening and counseling, weight-related health messages and follow-up management of overweight and obese patients. Impact of QI activities on visit duration and practice efficiency was minimal. A virtual learning collaborative was successful in providing a framework for pediatricians to implement a continuous QI process and achieve practice improvements. This format can be utilized to address multiple health issues.

The Chinese Herb Yi-Qi-Huo-Xue Protects Cardiomyocyte Function in Diabetic Cardiomyopathy.

PubMed

Wang, Xiangsheng; Huang, Jing; Wang, Shengyi; Ni, Qing

2018-01-01

Aims. To study the effect of the Chinese herb Yi-qi-huo-xue on cardiomyopathy in diabetic rats. Methods . Rats were fed a high fat and high glucose diet and injected with 50 ml/kg streptozotocin (STZ) to induce diabetic cardiomyopathy (DCM), followed by treatment with Yi-qi-huo-xue for 4 weeks. We measured the rats' heart weight index, observed the myocardial morphology using hematoxylin eosin (HE) staining, and determined the content of collagen types I and III in the myocardium using enzyme-linked immunosorbent assay (ELISA). We determined Bcl-2, Bax, and P53 protein expression by Western blot analysis and the cardiomyocyte apoptosis rate via a flow cytometry assay. Results. Compared with the rats in the control group, the diabetic rats gained weight and had increased blood sugar levels, an enhanced heart weight index, and increased myocardial pathophysiological damage. There was a decrease in their Bcl-2 expression, and their Bax and P53 expression increased. The Bcl-2/Bax ratio was enhanced, and there was an increase in the content of collagen types I and III in the myocardium. After treatment with Yi-qi-huo-xue, all levels listed above returned to normal. Conclusion. The Chinese herb Yi-qi-huo-xue degraded the myocardial interstitial collagen types I and III to protect the myocardium of the diabetic rats, thus delaying the role of myocardial fibrosis. Yi-qi-huo-xue could play an important role in protecting the myocardium of DCM rats by enhancing the expression of the Bcl-2 protein, inhibiting the expression of the Bax and P53 proteins, increasing the ratio of Bcl-2/Bax, and inhibiting the apoptosis of cardiomyocytes.

Some properties of the Catalan-Qi function related to the Catalan numbers.

PubMed

Qi, Feng; Mahmoud, Mansour; Shi, Xiao-Ting; Liu, Fang-Fang

2016-01-01

In the paper, the authors find some properties of the Catalan numbers, the Catalan function, and the Catalan-Qi function which is a generalization of the Catalan numbers. Concretely speaking, the authors present a new expression, asymptotic expansions, integral representations, logarithmic convexity, complete monotonicity, minimality, logarithmically complete monotonicity, a generating function, and inequalities of the Catalan numbers, the Catalan function, and the Catalan-Qi function. As by-products, an exponential expansion and a double inequality for the ratio of two gamma functions are derived.

CREB, NF-Y and MEIS1 conserved binding sites are essential to balance Myostatin promoter/enhancer activity during early myogenesis.

PubMed

Grade, Carla Vermeulen Carvalho; Mantovani, Carolina Stefano; Fontoura, Marina Alves; Yusuf, Faisal; Brand-Saberi, Beate; Alvares, Lúcia Elvira

2017-10-01

Myostatin (MSTN) is a strong inhibitor of skeletal muscle growth in human and other vertebrates. Its transcription is controlled by a proximal promoter/enhancer (Mstn P/E) containing a TATA box besides CREB, NF-Y, MEIS1 and FXR transcription factor binding sites (TFBSs), which are conserved throughout evolution. The aim of this work was to investigate the role of these TFBSs on Mstn P/E activity and evaluate the potential of their putative ligands as Mstn trans regulators. Mstn P/E mutant constructs were used to establish the role of conserved TFBSs using dual-luciferase assays. Expression analyses were performed by RT-PCR and in situ hybridization in C2C12 myoblasts and E10.5 mouse embryos, respectively. Our results revealed that CREB, NF-Y and MEIS1 sites are required to balance Mstn P/E activity, keeping Mstn transcription within basal levels during myoblast proliferation. Furthermore, our data showed that NF-Y site is essential, although not sufficient, to mediate Mstn P/E transcriptional activity. In turn, CREB and MEIS1 binding sites seem to depend on the presence of NF-Y site to induce Mstn P/E. FXR appears not to confer any effect on Mstn P/E activity, except in the absence of all other conserved TFBS. Accordingly, expression studies pointed to CREB, NF-Y and MEIS1 but not to FXR factors as possible regulators of Mstn transcription in the myogenic context. Altogether, our findings indicated that CREB, NF-Y and MEIS1 conserved sites are essential to control basal Mstn transcription during early myogenesis, possibly by interacting with these or other related factors.

Effect and Mechanism of QiShenYiQi Pill on Experimental Autoimmune Myocarditis Rats

PubMed Central

Lv, Shichao; Wu, Meifang; Li, Meng; Wang, Qiang; Xu, Ling; Wang, Xiaojing; Zhang, Junping

2016-01-01

Background To observe the effect of QiShenYiQi pill (QSYQ) on experimental autoimmune myocarditis rats, and to explore its mechanism of action. Material/methods Lewis rats underwent the injection of myocardial myosin mixed with Freund’s complete adjuvant were randomized into 3 groups: model, valsartan, and QSYQ groups. Rats injected with phosphate-buffered saline (PBS) mixed with Freund’s complete adjuvant were used as the control group. Rats were euthanized at 4 and 8 weeks, and we weighed rat body mass, heart mass, and left ventricular mass. Myocardium sections were stained with hematoxylin and eosin (H&E) and Masson trichrome. Myocardial TGF-β1 and CTGF protein expression was detected by immunohistochemistry, and myocardial TGF-β1 and CTGF mRNA expression was detected by real-time qPCR. Results QSYQ reduced HMI and LVMI, as well as the histological score of hearts and CVF, which further decreased over time, and its effect was significantly greater than that of valsartan at 4 and 8 weeks. After 4 weeks, QSYQ inhibited the protein and mRNA expression of TGF-β1 and CTGF, and its effect on lowering CTGF was significantly greater than that of valsartan. In addition, after 8 weeks, QSYQ also inhibited the protein and mRNA expression of CTGF, whereas there was no significant difference in the expression of myocardial TGF-β1. Conclusions This study provides evidence that QSYQ can improve cardiac remodeling of experimental autoimmune myocarditis rats. It also effectively improved the degree of myocardial fibrosis, which is related to the mechanism of regulation of TGF-β1 CTGF. PMID:26946470

[Discussion on relationship between "living alone with closed windows and doors" and depression].

PubMed

Liu, Fengfeng; Li, Rui

2018-03-12

"Living alone with closed windows and doors"was mentioned in the pathological manifestations of stomach meridian of foot- yangming in Neijing ( The Inner Canon of Huangdi ), which is similar to the symptoms of depression. Currently the treatment of depression is mostly based on"spirit being stored in five organs"theory, and little attention is paid on stomach meridian of foot- yangming . From the pathological manifestations of"living alone with closed windows and doors"in stomach meridian of foot- yangming , the relationship between stomach meridian and depression is discussed from ying-yang and qi -blood. In addition, the close relationship between the stomach meridian and qi -blood, qi movement of five organs, heart and brain is discussed to explore the mechanism of treating depression. In conclusion, the literature and modern research regarding treating depression from stomach meridian are summarized, hoping to provide more clinical methods for the treatment of depression.

Xu Bing, Ed Pien and Gu Xiong: Lost and Found in Translation

ERIC Educational Resources Information Center

Mahon, Patrick

2008-01-01

The works of contemporary artists Xu Bing, Ed Pien and Gu Xiong are involved in bringing to light some of the factors inherent in social, cultural and linguistic translation. In doing so, each artist is also engaged in the nuanced activity of moving between historical and contemporary aesthetic strategies in order to interrogate the way meaning is…

Evaluation of medical students using the "qi, blood, and fluid" system of Kampo medicine.

PubMed

Arai, Makoto; Arai, Katsuhiko; Hioki, Chizuko; Takashi, Masanori; Matsumoto, Kaori; Honda, Masamitsu; Izumi, Shun-ichiro

2013-04-20

Although "qi, blood, and fluid" (QBF) is the most important concept for patients in Kampo medicine, there are few studies about the conditions of the QBF system among healthy populations. We used QBF pattern scores to determine whether or not medical students, presumed to be healthy, had any potentially pathological conditions. Six consecutive fourth-year classes totaling 652 medical students evaluated their own QBF conditions using Terasawa's QBF pattern scores. The six conditions: "qi deficiency" (QD), "qi stagnation" (QS), "qi counterflow" (QC), "blood deficiency" (BD), "blood stasis" (BS), and "fluid disturbance" (FD), were categorized according to Terasawa's criteria. The Mann-Whitney U test was used to compare the score differences between the genders, Chi-square test was used to examine gender differences in the QBF diagnoses, and the Spearman's rank-order correlation coefficient analysis was used to analyze the correlation between each category of QBF. In all, 44.6% of the students met at least one diagnostic criterion in the QBF system. QC, BD, BS, and FD were established more in females, and QD and QS were established without gender differences. Most students who were presumed to be healthy were revealed to have some potentially pathological conditions using the QBF system.

The Role of Rumination and Stressful Life Events in the Relationship between the Qi Stagnation Constitution and Depression in Women: A Moderated Mediation Model.

PubMed

Liu, Mingfan; Jiang, Ying; Wang, Xiumei; Liu, Qiaosheng; Wu, Hou

2017-01-01

The qi stagnation constitution is associated with depression in traditional Chinese medicine. It is unclear how rumination and stressful life events affect the relationship between the qi stagnation constitution and depression. The Qi Stagnation Constitution Scale, Ruminative Response Scale, Center for Epidemiologic Studies Depression Scale, and Adolescent Self-Rating Life Events Checklist were used to assess this association in 1200 female college students. The results revealed that the qi stagnation constitution was positively associated with depression. Furthermore, rumination was a partial mediator of the relationship between the qi stagnation constitution and depression. In addition, stressful life events moderated the direct effect and mediating effect of the qi stagnation constitution on depression. These findings indicate that rumination and stressful life events may affect the relationship between the qi stagnation constitution and depression in women.

The Role of Rumination and Stressful Life Events in the Relationship between the Qi Stagnation Constitution and Depression in Women: A Moderated Mediation Model

PubMed Central

Liu, Qiaosheng

2017-01-01

The qi stagnation constitution is associated with depression in traditional Chinese medicine. It is unclear how rumination and stressful life events affect the relationship between the qi stagnation constitution and depression. The Qi Stagnation Constitution Scale, Ruminative Response Scale, Center for Epidemiologic Studies Depression Scale, and Adolescent Self-Rating Life Events Checklist were used to assess this association in 1200 female college students. The results revealed that the qi stagnation constitution was positively associated with depression. Furthermore, rumination was a partial mediator of the relationship between the qi stagnation constitution and depression. In addition, stressful life events moderated the direct effect and mediating effect of the qi stagnation constitution on depression. These findings indicate that rumination and stressful life events may affect the relationship between the qi stagnation constitution and depression in women. PMID:28757889

The effects of Qi exercise on maternal/fetal interaction and maternal well-being during pregnancy.

PubMed

Ji, Eun Sun; Han, Hae-Ra

2010-01-01

To investigate the effects of Qi exercise on maternal outcomes during pregnancy. A prospective, two-group, quasi-experimental, pretest/post test design was used. A convenience sample was recruited from one women's wellness center and one women's health clinic in Seoul, Korea. Participants were healthy pregnant women at more than 18 weeks gestation. A total of 70 women were included in the final analysis. Qi exercise was carried out for 90 minutes, twice a week for 12 weeks. Study outcomes were measured by the Intrapersonal Communication Questionnaire (Talking to Your Baby), Zung's Self-rating Depression Scale (ZSDS), the State Trait Anxiety Inventory (STAI), and the Pregnancy Mild Discomfort Index. Analysis of covariance was used to compare outcomes between groups, after adjusting for baseline scores. The Qi exercise group had higher post test maternal/fetal interaction and lower maternal depressive symptoms and physical discomfort scores than the control group. There was no difference in anxiety. The findings suggest that the holistic approach of Qi exercise may positively influence maternal/fetal interaction and mother's health. Whether these beneficial effects can be sustained throughout pregnancy requites additional research.

Construction and Commissioning of BL37XU at SPring-8

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

Terada, Yasuko; Goto, Shunji; Takimoto, Naoki

2004-05-12

Trace element analysis beamline (BL37XU) at SPring-8 was designed for application to various X-ray fluorescence analyses such as XRF imaging, XAFS, TXRF and XRF holography. The beamline has of two branches, one being a SPring-8 standard undulator-beamline optics branch (Branch A) and the other a high-energy branch (Branch B). In the experimental hutches, several kinds of experimental device are equipped. The end-stations have been opened to public use since November 2002, and various experiments have been carried out.

On an instability exhibited by the ballistic-diffusive heat conduction model of Xu and Hu

DOE PAGES

Christov, I. C.; Jordan, P. M.

2013-11-13

We show that the constitutive relation for the thermal flux proposed by Xu & Hu (2011) admits an unconditional instability. We also highlight the difference between mathematical models containing delay and those that include relaxation effects.

BCQ+: a body constitution questionnaire to assess Yang-Xu. Part I: establishment of a first final version through a Delphi process.

PubMed

Su, Yi-Chang; Chen, Li-Li; Lin, Jun-Dai; Lin, Jui-Shan; Huang, Yi-Chia; Lai, Jim-Shoung

2008-12-01

Assessing an individual's level of Yang deficiency (Yang-Xu) by its manifestations is a frequent issue in traditional Chinese medicine (TCM) clinical trials. To this end, an objective, reliable and rigorous diagnostic tool is required. This study aimed to develop a first final version of the Yang-Xu Constitution Questionnaire. We conducted 3 steps to develop such an objective measurement tool: 1) the research team was formed and a panel of 26 experts was selected for the Delphi process; 2) items for the questionnaire were generated by literature review and a Delphi process; items were reworded into colloquial questions; face and content validity of the items were evaluated through a Delphi process again; 3) the difficulty of the questionnaire was evaluated in a pilot study with 81 subjects aged 20-60 years. The literature review retrieved 35 relevant items which matched the definition of 'constitution' and 'Yang-Xu'. After a first Delphi process, 22 items were retained and translated into colloquial questions. According to the second part of the Delphi process, the content validity index of each of the 22 questions ranged between 0.85-1. These 22 questions were evaluated by 81 subjects, 2 questions that were hard to tell the difference were combined; 3 questions were modified after the research team had discussed the participants' feedback. Finally, the questionnaire was established with 21 questions. This first final version of a questionnaire to assess Yang-Xu constitution with considerable face and content validity may serve as a basis to develop an advanced Yang-Xu questionnaire. 2008 S. Karger AG, Basel.

Requirement of histidine 217 for ubiquinone reductase activity (Qi site) in the cytochrome bc1 complex.

PubMed

Gray, K A; Dutton, P L; Daldal, F

1994-01-25

Folding models suggest that the highly conserved histidine 217 of the cytochrome b subunit from the cytochrome bc1 complex is close to the quinone reductase (Qi) site. This histidine (bH217) in the cytochrome b polypeptide of the photosynthetic bacterium Rhodobacter capsulatus has been replaced with three other residues, aspartate (D), arginine (R), and leucine (L). bH217D and bH217R are able to grow photoheterotrophically and contain active cytochrome bc1 complexes (60% of wild-type activity), whereas the bH217L mutant is photosynthetically incompetent and contains a cytochrome bc1 complex that has only 10% of the wild-type activity. Single-turnover flash-activated electron transfer experiments show that cytochrome bH is reduced via the Qo site with near native rates in the mutant strains but that electron transfer between cytochrome bH and quinone bound at the Qi site is greatly slowed. These results are consistent with redox midpoint potential (Em) measurements of the cytochrome b subunit hemes and the Qi site quinone. The Em values of cyt bL and bH are approximately the same in the mutants and wild type, although the mutant strains have a larger relative concentration of what may be the high-potential form of cytochrome bH, called cytochrome b150. However, the redox properties of the semiquinone at the Qi site are altered significantly. The Qi site semiquinone stability constant of bH217R is 10 times higher than in the wild type, while in the other two strains (bH217D and bH217L) the stability constant is much lower than in the wild type. Thus H217 appears to have major effects on the redox properties of the quinone bound at the Qi site. These data are incorporated into a suggestion that H217 forms part of the binding pocket of the Qi site in a manner reminiscent of the interaction between quinone bound at the Qb site and H190 of the L subunit of the bacterial photosynthetic reaction center.

External Qi therapy to treat symptoms of Agent Orange Sequelae in Korean combat veterans of the Vietnam War.

PubMed

Lee, Myeong Soo; Woo, Won-Hong; Lim, Hyun-Ja; Hong, Sung-Soo; Kim, Hye-Jung; Moon, Sun-Rock

2004-01-01

We investigated the efficacy of Qi therapy as a non-pharmacological treatment for various symptoms presented by Korean combat veterans of the Vietnam War with Agent Orange Sequelae. Nine subjects volunteered to receive 30 minutes of Qi therapy, twice per day for 7 days. There was marked improvement in 89% of the patients with impaired physical activity, 86% of those with psychological disorder, 78% of those with heavy drug use, and 67% of those with fatigue, indigestion and high blood glucose levels. This data suggests that Qi therapy combined with conventional treatment has positive effects in reducing and managing the pain, psychosomatic disorders, and substance abuse in patients with Agent Orange Sequelae. We cannot completely discount the possible influence of the placebo effect, and more objective, clinical measures are needed to study the long-term effects of Qi therapy.

[Carving and spread of Xu Shuwei's medical books in the Southern Song Dynasty].

PubMed

Zhang, Haipeng

2015-09-01

Xu Shuwei's Pu ji ben shi fang (Moxibustion in Prescription for Universal Relief) was carved for several times and disseminated to Hubei, Hunan, Zhejiang, Jiangsu, Fujian, Sichuan Provinces and the areas under the rule of the Jin ethnic minority group. While Shang han bai zheng ge (Poets of Syndrome of Exo-pathogenic Cold disease), Shang han fa wei lun (Discourse on Elucidation of Exo-pathogenic Cold Disease), and Shang han jiu shi lun (90 Discourses on Exo-pathogenic Disease) were scarcely carved or spread in its copying form with very limited distribution. Hence, Pu ji ben shi fang exerts greater influence in the Southern Song Dynasty. When analysing the citations from the Pu ji ben sgiu fang in the books of the Southern Song Dynasty, very few texts were cited from Pu ji ben shi fang. Thus, in terms of knowledge on exo-pathogenic cold disease in the Southern Song Dynasty, Xu's influence was quite limited even though he himself had deep insight into this art of disease.

Mei-P26 Cooperates with Bam, Bgcn and Sxl to Promote Early Germline Development in the Drosophila Ovary

PubMed Central

Li, Yun; Zhang, Qiao; Carreira-Rosario, Arnaldo; Maines, Jean Z.; McKearin, Dennis M.; Buszczak, Michael

2013-01-01

In the Drosophila female germline, spatially and temporally specific translation of mRNAs governs both stem cell maintenance and the differentiation of their progeny. However, the mechanisms that control and coordinate different modes of translational repression within this lineage remain incompletely understood. Here we present data showing that Mei-P26 associates with Bam, Bgcn and Sxl and nanos mRNA during early cyst development, suggesting that this protein helps to repress the translation of nanos mRNA. Together with recently published studies, these data suggest that Mei-P26 mediates both GSC self-renewal and germline differentiation through distinct modes of translational repression depending on the presence of Bam. PMID:23526974

Integrated analysis of DNA methylation, immunohistochemistry and mRNA expression, data identifies a Methylation Expression Index (MEI) robustly associated with survival of ER-positive breast cancer patients

PubMed Central

Garcia-Closas, Montserrat; Davis, Sean; Meltzer, Paul; Lissowska, Jolanta; Horne, Hisani N.; Sherman, Mark E.; Lee, Maxwell

2015-01-01

Identification of prognostic gene expression signatures may enable improved decisions about management of breast cancer. To identify a prognostic signature for breast cancer, we performed DNA methylation profiling and identified methylation markers that were associated with expression of ER, PR, HER2, CK5/6 and EGFR proteins. Methylation markers that were correlated with corresponding mRNA expression levels were identified using 208 invasive tumors from a population-based case-control study conducted in Poland. Using this approach, we defined the Methylation Expression Index (MEI) signature that was based on a weighted sum of mRNA levels of 57 genes. Classification of cases as low or high MEI scores were related to survival using Cox regression models. In the Polish study, women with ER-positive low MEI cancers had reduced survival at a median of 5.20 years of follow-up, HR=2.85 95%CI=1.25-6.47. Low MEI was also related to decreased survival in four independent datasets totaling over 2500 ER-positive breast cancers. These results suggest that integrated analysis of tumor expression markers, DNA methylation, and mRNA data can be an important approach for identifying breast cancer prognostic signatures. Prospective assessment of MEI along with other prognostic signatures should be evaluated in future studies. PMID:25773928

SPring-8 BL44XU, beamline designed for structure analysis of large biological macromolecular assemblies

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

Higashiura, Akifumi, E-mail: hgsur-a@protein.osaka-u.ac.jp; Yamashita, Eiki; Yoshimura, Masato

2016-07-27

Beamline BL44XU at SPring-8 is operated by the Institute for Protein Research of Osaka University. The beamline is designed for X-ray crystallography of large biological macromolecular assemblies. Here we show its detailed performances, results, and the ongoing upgrade plans.

Education in Quality Improvement for Pediatric Practice: an online program to teach clinicians QI.

PubMed

Bundy, David G; Morawski, Lori F; Lazorick, Suzanne; Bradbury, Scott; Kamachi, Karen; Suresh, Gautham K

2014-01-01

Education in Quality Improvement for Pediatric Practice (EQIPP) is an online program designed to improve evidence-based care delivery by teaching front-line clinicians quality improvement (QI) skills. Our objective was to evaluate EQIPP data to characterize 1) participant enrollment, use patterns, and demographics; 2) changes in performance in clinical QI measures from baseline to follow-up measurement; and 3) participant experience. We conducted an observational study of EQIPP participants utilizing 1 of 3 modules (asthma, immunizations, gastroesophageal reflux disease) from 2009 to 2013. Enrollment and use, demographic, and quality measure data were extracted directly from the EQIPP system; participant experience was assessed via an optional online survey. Study participants (n = 3501) were diverse in their gender, age, and race; most were board certified. Significant quality gaps were observed across many of the quality measures at baseline; sizable improvements were observed across most quality measures at follow-up. Participants were generally satisfied with their experience. The most influential module elements were collecting and analyzing data, creating and implementing aim statements and improvement plans, and completing "QI Basics." Online educational programs, such as EQIPP, hold promise for front-line clinicians to learn QI. The sustainability of the observed improvements in care processes and their linkage to improvements in health outcomes are unknown and are an essential topic for future study. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Micro-focusing System of the Taiwan Contract Beamline BL12XU at SPring-8 for IXS Experiments under High Pressure

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

Huang, C.-Y.; Cai, Y.-Q.; Chung, S.-C.

The Taiwan Contract Beamline BL12XU at SPring-8 is designed for inelastic X-ray scattering (IXS) experiments. DCS is a powerful technique capable of probing the dynamic behavior and electronic structure of materials under high pressure. The state-of-the-arts technology to generate static high pressure up to mega-bar range uses diamond anvil cells (DAC). The allowed volume of the sample in DAC scales inversely with the pressure and is limited to the order of 1 x 10-3 mm3. In order to utilize such a device to explore the interesting phenomena under high pressure, we have designed a micro-focusing system using a set ofmore » KB mirrors, which is compatible with the existing optical system of BL12XU. Realistic ray-tracing results indicate that the system can achieve a focus of 10 {mu}m x 5.3 {mu}m(H x V) with a total efficiency of about 86%. The improved focus is expected to substantially enhance the experimental capability of BL12XU for high-pressure research.« less

78 FR 43857 - Order Relating to Yaming Nina Qi Hanson

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-22

... the procedures that apply to this matter. \\2\\ 50 U.S.C. app. 2401-2420 (2000). Since August 21, 2001... provided her with $75,000 to purchase the autopilots from the Canadian seller. Qi Hanson knew at the time... XiangYu Aviation Technical Group of Xian, China, had given her money to finance the entire purchase. In...

[Analysis in pulmonary ventilatory function from 100 patients with ano-rectal diseases caused by deficiency of qi].

PubMed

Wang, W

1999-03-01

To explore the pathogenesis of ano-rectal diseases caused by deficiency of Qi, which is correlated with obstruction of pulmonary ventilation. The pulmonary ventilatory function was measured in 100 patients with the internal piles, the interno-external hemorrhoid and prolapse of rectum, the prolapse of anus was the principal symptom of them. Data from the 100 patients showed that 67% of them were diagnosed with the obstruction of pulmonary ventilation, the ratio was far less in the health control group. FEV 1.0 (mean +/- s) (2011.65 +/- 875) ml, MMF (1.84 +/- 1.24) L/s and PEF (2.34 +/- 1.51) L/s in male patients, (1551.54 +/- 514) ml, (1.57 +/- 0.62) L/s and (1.85 +/- 0.92) L/s in female patients, but those values were higher in the control than in the patients. The statistical analysis was performed and the difference was significant between patients and the control group (P < 0.01). The patients with ano-rectal diseases caused by deficiency of Qi accompanied with obstruction of pulmonary ventilation in different degree and varied sorts, it confirmed that the pathogenesis of ano-rectal diseases caused by deficiency of Qi is related with "sinking of pectoral Qi".

Influence of de qi on the immediate analgesic effect of SP6 acupuncture in patients with primary dysmenorrhoea and cold and dampness stagnation: a multicentre randomised controlled trial.

PubMed

Zhao, Min-Yi; Zhang, Peng; Li, Jing; Wang, Lin-Peng; Zhou, Wei; Wang, Yan-Xia; She, Yan-Fen; Ma, Liang-Xiao; Wang, Pei; Hu, Ni-Juan; Lin, Chi; Hu, Shang-Qin; Wu, Gui-Wen; Wang, Ya-Feng; Sun, Jun-Jun; Jiang, Si-Zhu; Zhu, Jiang

2017-10-01

The aim of this multicentre randomised controlled trial was to investigate the contribution of de qi to the immediate analgesic effect of acupuncture in patients with primary dysmenorrhoea and the specific traditional Chinese medicine diagnosis cold and dampness stagnation . Eighty-eight patients with primary dysmenorrhoea and cold and dampness stagnation were randomly assigned to de qi (n=43) or no de qi (n=45) groups and underwent 30 min of SP6 acupuncture. The de qi group received deep needling at SP6 with manipulation using thick needles; the no de qi group received shallow needling with no manipulation using thin needles. In both groups the pain scores and actual de qi sensation were evaluated using a visual analogue scale for pain (VAS-P) and the acupuncture de qi clinical assessment scale (ADCAS), respectively. Both groups showed reductions in VAS-P, with no signficant differences between groups. ADCAS scores showed 43/43 and 25/45 patients in de qi and no de qi groups, respectively, actually experienced de qi sensation. Independent of original group allocation, VAS-P reductions associated with actual de qi (n=68) were greater than those without (28.4±18.19 mm vs 14.6±12.28 mm, p=0.008). This study showed no significant difference in VAS-P scores in patients with primary dysmenorrhoea and cold and dampness stagnation immediately after SP6 acupuncture designed to induce or avoid de qi sensation. Both treatments significantly reduced VAS-P relative to baseline. Irrespective of group allocation, patients experiencing actual de qi sensation demonstrated larger reductions in pain score relative to those without, suggesting greater analgesic effects. Chinese Clinical Trial Registry (ChiCTR-TRC-13003086); Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Professor Shi Qi's experience of applying herbal paste for treating chronic musculoskeletal conditions].

PubMed

Li, Xiao-feng; Wang, Yong-jun; Ye, Xiu-lan; Zhou, Chong-jian

2012-06-01

Professor Shi Qi is a famous traditional Chinese medicine doctor specializing in orthopaedics and traumatology, who has formatted a set of systematic protocols for the diagnosis and treatment of chronic musculoskeletal conditions. When it is time for using tonics in winter, he advocates applying herbal paste for treating chronic musculoskeletal diseases. This paper introduces Professor Shi Qi's commonly used prescription for treating chronic musculoskeletal conditions and puts forward demands and understandings in concocting herbal paste, experience in herbal paste for treating chronic musculoskeletal diseases such as cervical spondylosis, lumbar disc herniation, lumbar spinal stenosis, lumbar muscle strain, ankylosing spondylitis, osteoporosis, knee osteoarthritis and avascular necrosis of femoral head, and the advantages of herbal paste for treating chronic musculoskeletal conditions as opposed to alternative treatments.

Differential expression of Meis2, Mab21l2 and Tbx3 during limb development associated with diversification of limb morphology in mammals.

PubMed

Dai, Mengyao; Wang, Yao; Fang, Lu; Irwin, David M; Zhu, Tengteng; Zhang, Junpeng; Zhang, Shuyi; Wang, Zhe

2014-01-01

Bats are the only mammals capable of self-powered flight using wings. Differing from mouse or human limbs, four elongated digits within a broad wing membrane support the bat wing, and the foot of the bat has evolved a long calcar that spread the interfemoral membrane. Our recent mRNA sequencing (mRNA-Seq) study found unique expression patterns for genes at the 5' end of the Hoxd gene cluster and for Tbx3 that are associated with digit elongation and wing membrane growth in bats. In this study, we focused on two additional genes, Meis2 and Mab21l2, identified from the mRNA-Seq data. Using whole-mount in situ hybridization (WISH) we validated the mRNA-Seq results for differences in the expression patterns of Meis2 and Mab21l2 between bat and mouse limbs, and further characterize the timing and location of the expression of these two genes. These analyses suggest that Meis2 may function in wing membrane growth and Mab21l2 may have a role in AP and DV axial patterning. In addition, we found that Tbx3 is uniquely expressed in the unique calcar structure found in the bat hindlimb, suggesting a role for this gene in calcar growth and elongation. Moreover, analysis of the coding sequences for Meis2, Mab21l2 and Tbx3 showed that Meis2 and Mab21l2 have high sequence identity, consistent with the functions of genes being conserved, but that Tbx3 showed accelerated evolution in bats. However, evidence for positive selection in Tbx3 was not found, which would suggest that the function of this gene has not been changed. Together, our findings support the hypothesis that the modulation of the spatiotemporal expression patterns of multiple functional conserved genes control limb morphology and drive morphological change in the diversification of mammalian limbs.

Differential Expression of Meis2, Mab21l2 and Tbx3 during Limb Development Associated with Diversification of Limb Morphology in Mammals

PubMed Central

Fang, Lu; Irwin, David M.; Zhu, Tengteng; Zhang, Junpeng; Zhang, Shuyi; Wang, Zhe

2014-01-01

Bats are the only mammals capable of self-powered flight using wings. Differing from mouse or human limbs, four elongated digits within a broad wing membrane support the bat wing, and the foot of the bat has evolved a long calcar that spread the interfemoral membrane. Our recent mRNA sequencing (mRNA-Seq) study found unique expression patterns for genes at the 5′ end of the Hoxd gene cluster and for Tbx3 that are associated with digit elongation and wing membrane growth in bats. In this study, we focused on two additional genes, Meis2 and Mab21l2, identified from the mRNA-Seq data. Using whole-mount in situ hybridization (WISH) we validated the mRNA-Seq results for differences in the expression patterns of Meis2 and Mab21l2 between bat and mouse limbs, and further characterize the timing and location of the expression of these two genes. These analyses suggest that Meis2 may function in wing membrane growth and Mab21l2 may have a role in AP and DV axial patterning. In addition, we found that Tbx3 is uniquely expressed in the unique calcar structure found in the bat hindlimb, suggesting a role for this gene in calcar growth and elongation. Moreover, analysis of the coding sequences for Meis2, Mab21l2 and Tbx3 showed that Meis2 and Mab21l2 have high sequence identity, consistent with the functions of genes being conserved, but that Tbx3 showed accelerated evolution in bats. However, evidence for positive selection in Tbx3 was not found, which would suggest that the function of this gene has not been changed. Together, our findings support the hypothesis that the modulation of the spatiotemporal expression patterns of multiple functional conserved genes control limb morphology and drive morphological change in the diversification of mammalian limbs. PMID:25166052

Craniometric examination of Longxian and Qi Li Cun archaeological sites to assess population continuity in ancient northern China.

PubMed

Gibbon, Victoria E; Porter, Tarun A; Wu, Xiujie; Liu, Wu

2016-10-01

In this paper, population continuity and discontinuity in northern China are explored using craniometric analyses from two archaeological sites, Longxian (Warring States) and Qi Li Cun (Han Dynasty). Neither population has been previously studied. Artefactual evidence shows the individuals from Qi Li Cun were Xianbei, descendants from Mongolia. Longxian is from further south in the central plains at an earlier time, thus, we expect to observe variability between these groups. In total, 24 cranial measurements were obtained on 66 crania from these sites. Howells's cranial measurements on Anyang (42 crania) and Hainan (83 crania) Chinese samples were included for comparative purposes. Less variability is expected between Longxian and Howells's Chinese data due to geographic and temporal similarity. With closer geographic and temporal affinity with Anyang, the expectation is for Longxian and Anyang to be similar. Few statistical differences exist between Longxian and Qi Li Cun; this was supported by the similarity found through principal components analysis (PCA). Regardless of sex, canonical discriminant analysis shows clustering of Longxian and Qi Li Cun separate from those of Anyang and Hainan. Their similarity indicates the people from Longxian and Qi Li Cun likely share Mongolian ancestry. Our results, supported by other studies, suggest that despite temporal differences, Mongolians living in China during the Warring States and Han dynasty retained their cultural and genetic Mongolian identity. These data add valuable bioarchaeological information regarding the peopling of northern China during a crucial period of cultural and political change in the Early Bronze Age and Iron Age. Copyright © 2016 Elsevier GmbH. All rights reserved.

Effectiveness of De Qi during acupuncture for the treatment of tinnitus: study protocol for a randomized controlled trial.

PubMed

Xie, Hui; Li, Xinrong; Lai, Jiaqin; Zhou, Yanan; Wang, Caiying; Liang, Jiao

2014-10-15

Acupuncture has been used in China to treat tinnitus for a long time. There is debate as to whether or not De Qi is a key factor in achieving the efficacy of acupuncture. However, there is no sufficient evidence obtained from randomized controlled trials to confirm the role of De Qi in the treatment of acupuncture for tinnitus. This study aims to identify the effect of De Qi for patients who receive acupuncture to alleviate tinnitus by a prospective, double-blind, randomized, sham-controlled trial. This study compares two acupuncture groups (with or without manipulation) in 292 patients with a history of subjective tinnitus. The trial will be conducted in the Teaching Hospital of Chengdu University of Traditional Chinese Medicine. In the study, the patients will be randomly assigned into two groups according to a computer-generated randomization list and assessed prior to treatment. Then, they will receive 5 daily sessions of 30 minutes each time for 4 consecutive weeks and undergo a 12-week follow-up phase. The administration of acupuncture follows the guidelines for clinical research on acupuncture (WHO Regional Publication, Western Pacific Series Number 15, 1995), and is performed double-blind by physicians well-trained in acupuncture. The measures of outcome include the subjective symptoms scores and quantitative sensations of De Qi evaluated by Visual Analog Scales (VAS) and the Chinese version of the 'modified' Massachusetts General Hospital Acupuncture Sensation Scale (C-MMASS). Furthermore, adverse events are recorded and analyzed. If any subjects are withdrawn from the trial, intention-to-treat analysis (ITT) and per-protocol (PP) analysis will be performed. The key features of this trial include the randomization procedures, large sample and the standardized protocol to evaluate De Qi qualitatively and quantitatively in the treatment of acupuncture for tinnitus. The trial will be the first study with a high evidence level in China to assess the efficacy

Traces and echoes of De Architectura by Marcus Vitruvius Pollio in the work of Xu Guangqi in 17th century China

NASA Astrophysics Data System (ADS)

Cigola, Michela; Fang, Yibing

2016-03-01

This study aims to investigate the role played by Xu Guangqi (1562-1633), minister of the Ming Dynasty, in the development of European scientific and technical knowledge in China between the 16th and 17th centuries by analyzing a book of Western technology that he wrote, namely, Taixi Shuifa ( On Western Hydraulics). Several Western books related to machine knowledge are searched to trace the source of the illustrations in Taixi Shuifa. We found that Archimedes' screw and Ctesibius' machine, which are included in Vitruvius' De Architectura volumes, also appear in the work of Xu Guangqi.

A comment on "The interaction of X2 (X = F, Cl, and Br) with active sites of graphite" [Xu et al., Chem. Phys. Lett., 418, 413 (2006)

NASA Astrophysics Data System (ADS)

Lechner, Christoph; Baranek, Philippe; Vach, Holger

2018-04-01

In their article, Xu et al. (2006) present the adsorption energies for the chemisorption of the three halogens F2 , Cl2 , and Br2 on the active sites of graphite. The three investigated systems are the three most stable surfaces, (0 0 1), (1 0 0), and (1 1 0); the latter two are also called zigzag and armchair surface, respectively. Due to some inconsistencies in their article, we re-evaluated the results of Xu et al. in order to investigate the impact on the adsorption energies of the halogens. For the (0 0 1) surface, our results agree with Xu et al. However, for the other two surfaces we find major differences. Contrary to Xu et al., we find that the halogens adsorb the strongest on the zigzag surface. The second strongest adsorption is found on the armchair surface for the symmetric configurations, the third strongest for the asymmetric configurations. Several reasons are given which explain this discrepancy. The most striking source of error in the work of Xu et al. is due to the fact that they did not choose the correct spin multiplicities for the model systems which means that they performed the calculations in excited states. This leads to errors between 50 and 600% for the zigzag surface and 3-42% for the armchair surface.

[Post-stroke constipation treated with acupuncture therapy of regulating qi circulation of fu-organ].

PubMed

Ren, Zhen; Wu, Qing-Ming; Li, Dan-Dan; Liu, Wei-Ai; Li, Xiang-Rong; Lin, Xu-Ming

2013-10-01

To compare the difference in the efficacy on post-stroke constipation between acupuncture therapy of regulating qi circulation of fe-organ and Shengxue Tongbian Capsules. Seventy-five patients of post-stroke constipation were randomized into an acupuncture group (39 cases) and a Chinese medicine group (36 cases). The unit mode comprehensive therapy of stroke was adopted as basic treatment in the two groups. In the acupuncture group, acupuncture therapy of regulating qi circulation of fu-organ was added at Tianshu (ST 25), Zhigou (TE 6), Qihai (CV 6) and Zusanli (ST 36), once every day. In the Chinese medicine group, Shengrue Tongbian Capsules were supplemented for oral administration, once every day, 10 g each time. The clinical symptom score of constipation was observed before treatment, after 1 and 2 weeks treatment in the two groups, respectively. The efficacy in 1 week and 2 weeks of treatment and the adverse reaction were observed. In 1 and 2 weeks of treatment, the clinical symptom score of constipation was reduced significantly as compared with that before treatment in the two groups (all P < 0.05). The improvements in the acupuncture group were significant than those in the Chinese medicine group in 2 weeks of treatment (8.03 +/- 2.38 vs 9.20 +/- 2.45, P < 0.05). Concerning to the occurrence of adverse reaction, there was 1 case of local bruises in needling local site in the acupuncture group; and there were 1 case of abdominal pain, 3 cases of diarrhea and 2 cases of nausea and vomiting in the Chinese medicine group. Both the acupuncture therapy of regulating qi circulation of fu-organ and Shengxue Tongbian Capsules achieve the significant efficacy on post-stroke constipation. The efficacy of the acupuncture therapy of regulating qi circulation of fe-organ is better and the adverse reaction is less after long-term persistent treatment.

Fire-Heat and Qi Deficiency Syndromes as Predictors of Short-term Prognosis of Acute Ischemic Stroke

PubMed Central

Cheng, Shu-Chen; Lin, Chien-Hsiung; Chang, Yeu-Jhy; Lee, Tsong-Hai; Ryu, Shan-Jin; Chen, Chun-Hsien; Chang, Her-Kun; Chang, Chee-Jen

2013-01-01

Abstract Objectives To explore the relationships between traditional Chinese medicine (TCM) syndromes and disease severity and prognoses after ischemic stroke, such as neurologic deficits and decline in activities of daily living (ADLs). Methods The study included 211 patients who met the inclusion criteria of acute ischemic stroke based on clinical manifestations, computed tomography or magnetic resonance imaging findings, and onset of ischemic stroke within 72 hours with clear consciousness. To assess neurologic function and ADLs in patients with different TCM syndromes, the TCM Syndrome Differentiation Diagnostic Criteria for Apoplexy scale (containing assessments of wind, phlegm, blood stasis, fire-heat, qi deficiency, and yin deficiency with yang hyperactivity syndromes) was used within 72 hours of stroke onset, and Western medicine–based National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) assessments were performed at both admission and discharge. Results The most frequent TCM syndromes associated with acute ischemic stroke were wind syndrome, phlegm syndrome, and blood stasis syndrome. Improvement according to the BI at discharge and days of admission were significantly different between patients with and those without fire-heat syndrome. Patients with qi deficiency syndrome had longer hospital stays and worse NIHSS and BI assessments at discharge than patients without qi deficiency syndrome. All the reported differences reached statistical significance. Conclusions These results provide evidence that fire-heat syndrome and qi deficiency syndrome are essential elements that can predict short-term prognosis of acute ischemic stroke. PMID:23600945

Serum metabolomics strategy for understanding pharmacological effects of ShenQi pill acting on kidney yang deficiency syndrome.

PubMed

Nan, Yang; Zhou, Xiaohang; Liu, Qi; Zhang, Aihua; Guan, Yu; Lin, Shanhua; Kong, Ling; Han, Ying; Wang, Xijun

2016-07-15

Kidney yang deficiency syndrome, a diagnostic pattern in Chinese medicine, is similar with clinical features of the glucocorticoid withdrawal syndrome. The aim of this present study was to explore low molecular mass differentiating metabolites between control group and model group of kidney yang deficiency rats induced with corticosterone as well as the therapeutic effect of Shen Qi Pill, a classic traditional Chinese medicine formula for treating Kidney yang deficiency syndrome in China. This study utilized ultra-performance liquid chromatography coupled with electrospray ionization synapt quadrupole time-of-flight high definition mass spectrometry (UPLC/ESI-SYNAPT-QTOF-HDMS) to identify the underlying biomarkers for clarifying mechanism of Shen Qi Pill in treating Kidney yang deficiency syndrome based on metabolite profiling of the serum samples and in conjunction with multivariate and pathway analysis. Meanwhile, blood biochemistry assay and histopathology were examined to identify specific changes in the model group rats. Distinct changes in the pattern of metabolites were observed by UPLC-HDMS. The changes in metabolic profiling were restored to their baseline values after treatment with Shen Qi Pill according to the combined with a principal component analysis (PCA) score plots. Altogether, the current metabolomics approach based on UPLC-HDMS and orthogonal projection to latent structures discriminate analysis (OPLS-DA) demonstrated 27 ions (18 in the negative mode, 9 in the positive mode, 17 ions restored by Shen Qi Pill). These results indicated that effectiveness of Shen Qi Pill in Kidney yang deficiency syndrome rats induced a substantial change in the metabolic profiles by regulating the biomarkers and adjusting the metabolic disorder. It suggested that the metabolomics approach was a powerful approach for elucidation of pathologic changes of Chinese medicine syndrome and action mechanisms of traditional Chinese medicine. Copyright © 2015 Elsevier B

A QI Initiative to Reduce Hospitalization for Children With Isolated Skull Fractures.

PubMed

Lyons, Todd W; Stack, Anne M; Monuteaux, Michael C; Parver, Stephanie L; Gordon, Catherine R; Gordon, Caroline D; Proctor, Mark R; Nigrovic, Lise E

2016-06-01

Although children with isolated skull fractures rarely require acute interventions, most are hospitalized. Our aim was to safely decrease the hospitalization rate for children with isolated skull fractures. We designed and executed this multifaceted quality improvement (QI) initiative between January 2008 and July 2015 to reduce hospitalization rates for children ≤21 years old with isolated skull fractures at a single tertiary care pediatric institution. We defined an isolated skull fracture as a skull fracture without intracranial injury. The QI intervention consisted of 2 steps: (1) development and implementation of an evidence-based guideline, and (2) dissemination of a provider survey designed to reinforce guideline awareness and adherence. Our primary outcome was hospitalization rate and our balancing measure was hospital readmission within 72 hours. We used standard statistical process control methodology to assess change over time. To assess for secular trends, we examined admission rates for children with an isolated skull fracture in the Pediatric Health Information System administrative database. We identified 321 children with an isolated skull fracture with a median age of 11 months (interquartile range 5-16 months). The baseline admission rate was 71% (179/249, 95% confidence interval, 66%-77%) and decreased to 46% (34/72, 95% confidence interval, 35%-60%) after implementation of our QI initiative. No child was readmitted after discharge. The admission rate in our secular trend control group remained unchanged at 78%. We safely reduced the hospitalization rate for children with isolated skull fractures without an increase in the readmissions. Copyright © 2016 by the American Academy of Pediatrics.

Revision of the Oriental genus Holophris Mocsáry, 1890 and description of the genus Leptopareia Rosa & Xu, gen. nov. (Hymenoptera, Chrysididae).

PubMed

Rosa, Paolo; Wei, Na-Sen; Notton, David; Xu, Zai-Fu

2016-02-19

Two Oriental genera of the tribe Elampini (Chrysidinae) are here discussed. The genus Holophris Mocsáry, 1890 is redescribed, and the genus Leptopareia Rosa & Xu, gen. nov. (type species Hedychrum borneanum Cameron, 1908) is established. Two new species are described: Holophris thailandica Rosa, Wei, Notton & Xu, sp. nov. (Thailand), and Leptopareia luzonensis Rosa, Wei, Notton & Xu, sp. nov. (Philippines, Luzon). The lectotype of Hedychrum borneanum Cameron, 1908 is designated. New combinations are proposed for L. borneana (Cameron, 1908), comb. nov., L. purpurea (Smith, 1860), comb. nov., L. abyssinica (Mocsáry, 1914), comb. nov., L. confusa (Kimsey, 1988), comb. nov., L. congoensis (du Buysson, 1900), comb. nov., and L. kalliopsis (Zimmermann, 1961), comb. nov. (all are from Holophris Mocsáry). Holophris marginella (Mocsáry, 1890) is newly recorded from China and Thailand; H. taiwana (Tsuneki, 1970) from India, Indonesia and Laos; and Leptopareia borneana (Cameron, 1908) from Thailand. Keys to Oriental genera of the tribe Elampini and to Oriental species of the two genera are provided.

Miserere colic (Miserere mei). Contribution on etymology and clinical features; hypothesis on its appearance in medical literature during centuries 17th-18th.

PubMed

Acea Nebril, B

2001-03-01

The definition of ileus has undergone deep changes over the last three millennia. The term ileus was originally used in Classic Greece to describe a common cause of intestinal obstruction, and subsequently the Romans would often translate it into the Latin word volvulus. During the Renaissance, ileus, volvulus and intussusception became synonymous with a vulgar term--Miserere Mei or Miserere colic--whose origin and evolution are still much of a mystery. This paper provides some historical investigation on the Miserere Mei or Miserere colic, with the aim of discussing its evolution within medical literature during the 17th and 18th centuries.

A Disorder of Qi: Breathing Exercise as a Cure for Neurasthenia in Japan, 1900–1945

PubMed Central

Wu, Yu-Chuan

2016-01-01

Neurasthenia became a common disease and caused widespread concern in Japan at the turn of the twentieth century, whereas only a couple of decades earlier the term “nerve” had been unfamiliar, if not unknown, to many Japanese. By exploring the theories and practices of breathing exercise—one of the most popular treatments for neurasthenia at the time—this paper attempts to understand how people who practiced breathing exercises for their nervous ills perceived, conceived, and accordingly cared for their nerves. It argues that they understood “nerve” based on their existing conceptions of qi. Neurasthenia was for them a disorder of qi, although the qi had assumed modern appearances as blood and nervous current. The paper hopes to contribute to the understanding of how the concept of nerves has been accepted and assimilated in East Asia. It also points out the need to understand the varied cultures of nerves not only at the level of concept and metaphor, but also at the level of perception and experience. PMID:26363046

Caramel colour and process contaminants in foods and beverages: Part II - Occurrence data and exposure assessment of 2-acetyl-4-(1,2,3,4-tetrahydroxybutyl)imidazole (THI) and 4-methylimidazole (4-MEI) in Belgium.

PubMed

Fierens, T; Van Holderbeke, M; Cornelis, C; Jacobs, G; Sioen, I; De Maeyer, M; Vinkx, C; Vanermen, G

2018-07-30

In Europe, 2-acetyl-4-(1,2,3,4-tetrahydroxybutyl)imidazole (THI) and 4-methylimidazole (4-MEI) are - to a certain level - allowed to be present in the food colours ammonia caramel (E 150c) and sulphite ammonia caramel (E 150d). Besides their presence in food colours, exposure to these contaminants may also include other dietary sources. This study describes the occurrence of THI and 4-MEI in a wide variety of food products (n = 522) purchased from the Belgian market and their dietary intake in Belgian consumers from 15 years old onwards. THI was found to be present in 22.4% of the investigated foods at a level up to 551 µg/kg. For 4-MEI (57.7% quantifiable), concentrations up to 2,835 µg/kg were observed. The average dietary intake amounted to 0.02-0.36 µg kg -1  bw -1  day for THI and 0.4-3.7 µg kg -1  bw -1  day for 4-MEI. Coffee, cola and beer were contributing most to the dietary THI and 4-MEI intake in Belgium. Copyright © 2018 Elsevier Ltd. All rights reserved.

Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability-An Emerging Framework.

PubMed

Holve, Erin

2013-01-01

Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four "pillars" of sustainability are discussed based on the experiences of EDM Forum grantees and other research and QI networks. These include trust and value, governance, management, and financial and administrative support. Two "foundational considerations," adaptive capacity and policy levers, are also discussed.

Assessment of Electromagnetic Interference with Active Cardiovascular Implantable Electronic Devices (CIEDs) Caused by the Qi A13 Design Wireless Charging Board

PubMed Central

Seckler, Tobias; Jagielski, Kai; Stunder, Dominik

2015-01-01

Electromagnetic interference is a concern for people wearing cardiovascular implantable electronic devices (CIEDs). The aim of this study was to assess the electromagnetic compatibility between CIEDs and the magnetic field of a common wireless charging technology. To do so the voltage induced in CIEDs by Qi A13 design magnetic fields were measured and compared with the performance limits set by ISO 14117. In order to carry this out a measuring circuit was developed which can be connected with unipolar or bipolar pacemaker leads. The measuring system was positioned at the four most common implantation sites in a torso phantom filled with physiological saline solution. The phantom was exposed by using Helmholtz coils from 5 µT to 27 µT with 111 kHz sine-bursts or by using a Qi A13 design wireless charging board (Qi-A13-Board) in two operating modes “power transfer” and “pinging”. With the Helmholtz coils the lowest magnetic flux density at which the performance limit was exceeded is 11 µT. With the Qi-A13-Board in power transfer mode 10.8% and in pinging mode 45.7% (2.2% at 10 cm distance) of the performance limit were reached at maximum. In neither of the scrutinized cases, did the voltage induced by the Qi-A13-Board exceed the performance limits. PMID:26024360

Effect of QiShenYiQi pill on myocardial collagen metabolism in experimental autoimmune myocarditis rats.

PubMed

Lv, Shi-Chao; Wu, Meifang; Li, Meng; Wang, Qiang; Wang, Xiao-Jing; Zhang, Ao; Xu, Ling; Zhang, Jun-Ping

2017-04-01

To observe the effect of QiShenYiQi pill (QSYQ) on myocardial collagen metabolism in experimental autoimmune myocarditis rats, and to explore its mechanism of action. Lewis rats underwent the injection of myocardial myosin mixed with freund's complete adjuvant were randomized into three groups: model, valsartan and QSYQ groups. And we treated rats which were injected phosphate buffered saline (PBS) mixed with freund's complete adjuvant as control group. Rats were intervened and euthanized at 4 and 8 weeks. We use alkaline hydrolysis to detect the content of myocardial hydroxyproline (HYP), and ELISA to detect the level of serum procollagen type I carboxyterminal peptide (PICP), procollagen type III amino-terminal peptide (PIIINP), and collagen C telopeptide type I (CTX-I). Myocardial MMP-1 and TIMP-1 protein expression was detected by immunohistochemistry, and myocardial MMP-1 and TIMP-1 mRNA expression was detected by real-time qPCR. QSYQ reduced the content of myocardial HYP, and this reduction was greater over time. QSYQ also reduced the serum concentration of PICP, PIIINP, CTX-I and the PICP/PIIINP ratio, which further reduced over time, whereas its effect on lowering PICP was significantly greater than that of valsartan at 4 and 8 weeks, and lowering CTX-I was significantly greater than that of valsartan at 8 weeks. In addition, after 4 weeks, QSYQ enhanced the protein and mRNA expression of MMP-1 and TIMP-1, and its effect on highering TIMP-1 was significantly greater than that of valsartan, whereas there was no significant difference in the expression of myocardial MMP-1 or TIMP-1 at 8 weeks. QSYQ reduced the ratio of MMP-1/TIMP-1, which further reduced over time, and the effect of QYSQ was significantly greater than that of valsartan after 4 weeks. This study provides evidence that QSYQ can reduce the rate of myocardial collagen synthesis and degradation. It also effectively improved the degree of myocardial fibrosis in experimental autoimmune myocarditis

Efficacy of an integrated continuing medical education (CME) and quality improvement (QI) program on radiation oncologist (RO) clinical practice

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

Leong, Cheng Nang; Shakespeare, Thomas Philip; North Coast Cancer Institute, Coffs Harbour

2006-12-01

Purpose: There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. Methods and Materials: The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scoresmore » were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. Results: Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. Conclusion: An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence.« less

VizieR Online Data Catalog: Follow-up of probable young star ASASSN-15qi (Herczeg+, 2016)

NASA Astrophysics Data System (ADS)

Herczeg, G. J.; Dong, S.; Shappee, B. J.; Chen, P.; Hillenbrand, L. A.; Jose, J.; Kochanek, C. S.; Prieto, J. L.; Stanek, K. Z.; Kaplan, K.; Holoien, T.-S.; Mairs, S.; Johnstone, D.; Gully-Santiago, M.; Zhu, Z.; Smith, M. C.; Bersier, D.; Mulders, G. D.; Filippenko, A. V.; Ayani, K.; Brimacombe, J.; Brown, J. S.; Connelley, M.; Harmanen, J.; Itoh, R.; Kawabata, K. S.; Maehara, H.; Takata, K.; Yuk, H.; Zheng, W.

2017-02-01

The outburst of ASASSN-15qi (2MASS J22560882+5831040) occurred on JD2457298 (2015 October 2; UTC dates are used herein). The All-Sky Automated Survey for Supernovae (ASAS-SN) is an all-sky V-band transient survey with a limiting magnitude of ~17. ASAS-SN photometry of ASASSN-15qi was obtained from two different telescopes on Haleakala, Hawaii with intervals of one to three days. ASAS-SN photometry is listed in Table 2. Archival photometry, ground-based optical photometry with Las Cumbres Observatory Global Telescope Network (LCOGT) 1m telescope at McDonald Observatory between 2015 October 23 and December 23 and at the Liverpool Telescope on 2016 April 26 and June 11, Swift/UVOT photometry on 2015 October 12 (ID 00034098001) and 2015 December 27 (ID 00034098002), NIR photometry with the NOTCam camera at the Nordic Optical Telescope (NOT) on 2015 December 22 and Spitzer/IRAC MIR photometry on 2006 December 29 (Program ID 30734, PI Donald Figer) and James Clerk Maxwell Telescope (JCMT) SCUBA2 submillimeter observations of ASASSN-15qi on 2015 November 5 and optical and NIR spectroscopy observations are also described in section 2. (1 data file).

The CCR4 Deadenylase Acts with Nanos and Pumilio in the Fine-Tuning of Mei-P26 Expression to Promote Germline Stem Cell Self-Renewal

PubMed Central

Joly, Willy; Chartier, Aymeric; Rojas-Rios, Patricia; Busseau, Isabelle; Simonelig, Martine

2013-01-01

Summary Translational regulation plays an essential role in Drosophila ovarian germline stem cell (GSC) biology. GSC self-renewal requires two translational repressors, Nanos (Nos) and Pumilio (Pum), which repress the expression of differentiation factors in the stem cells. The molecular mechanisms underlying this translational repression remain unknown. Here, we show that the CCR4 deadenylase is required for GSC self-renewal and that Nos and Pum act through its recruitment onto specific mRNAs. We identify mei-P26 mRNA as a direct and major target of Nos/Pum/CCR4 translational repression in the GSCs. mei-P26 encodes a protein of the Trim-NHL tumor suppressor family that has conserved functions in stem cell lineages. We show that fine-tuning Mei-P26 expression by CCR4 plays a key role in GSC self-renewal. These results identify the molecular mechanism of Nos/Pum function in GSC self-renewal and reveal the role of CCR4-NOT-mediated deadenylation in regulating the balance between GSC self-renewal and differentiation. PMID:24286029

The CCR4 deadenylase acts with Nanos and Pumilio in the fine-tuning of Mei-P26 expression to promote germline stem cell self-renewal.

PubMed

Joly, Willy; Chartier, Aymeric; Rojas-Rios, Patricia; Busseau, Isabelle; Simonelig, Martine

2013-01-01

Translational regulation plays an essential role in Drosophila ovarian germline stem cell (GSC) biology. GSC self-renewal requires two translational repressors, Nanos (Nos) and Pumilio (Pum), which repress the expression of differentiation factors in the stem cells. The molecular mechanisms underlying this translational repression remain unknown. Here, we show that the CCR4 deadenylase is required for GSC self-renewal and that Nos and Pum act through its recruitment onto specific mRNAs. We identify mei-P26 mRNA as a direct and major target of Nos/Pum/CCR4 translational repression in the GSCs. mei-P26 encodes a protein of the Trim-NHL tumor suppressor family that has conserved functions in stem cell lineages. We show that fine-tuning Mei-P26 expression by CCR4 plays a key role in GSC self-renewal. These results identify the molecular mechanism of Nos/Pum function in GSC self-renewal and reveal the role of CCR4-NOT-mediated deadenylation in regulating the balance between GSC self-renewal and differentiation.

Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability—An Emerging Framework

PubMed Central

Holve, Erin

2013-01-01

Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four “pillars” of sustainability are discussed based on the experiences of EDM Forum grantees and other research and QI networks. These include trust and value, governance, management, and financial and administrative support. Two “foundational considerations,” adaptive capacity and policy levers, are also discussed. PMID:25848557

Cardioprotective Effects of QiShenYiQi Dripping Pills on Transverse Aortic Constriction-Induced Heart Failure in Mice.

PubMed

Ruan, Guoran; Ren, Haojin; Zhang, Chi; Zhu, Xiaogang; Xu, Chao; Wang, Liyue

2018-01-01

QiShenYiQi dripping pills (QSYQ), a traditional Chinese medicine, are commonly used to treat coronary heart disease, and QSYQ was recently approved as a complementary treatment for ischemic heart failure in China. However, only few studies reported on whether QSYQ exerts a protective effect on heart failure induced by pressure overload. In this study, we explored the role of QSYQ in a mouse model of heart failure induced by transverse aortic constriction (TAC). Twenty-eight C57BL/6J mice were divided into four groups: Sham + NS group, Sham + QSYQ group, TAC + NS group, and TAC + QSYQ group. QSYQ dissolved in normal saline (NS) was administered intragastrically (3.5 mg/100 g/day) in the Sham + QSYQ and TAC + QSYQ groups. In the Sham + NS and TAC + NS groups, NS was provided every day intragastrically. Eight weeks after TAC, echocardiography, and cardiac catheterization were performed to evaluate the cardiac function, and immunofluorescent staining with anti-actinin2 antibody was performed to determine the structure of the myocardial fibers. Moreover, TUNEL staining and Masson trichrome staining were employed to assess the effects of QSYQ on cardiac apoptosis and cardiac fibrosis. Western blots and real-time polymerase chain reaction (PCR) were used to measure the expression levels of vascular endothelial growth factor (VEGF) in the heart, and immunohistochemical staining with anti-CD31 antibody was performed to explore the role of QSYQ in cardiac angiogenesis. Results showed that TAC-induced cardiac dysfunction and disrupted structure of myocardial fibers significantly improved after QSYQ treatment. Moreover, QSYQ treatment also significantly improved cardiac apoptosis and cardiac fibrosis in TAC-induced heart failure, which was accompanied by an increase in VEGF expression levels and maintenance of microvessel density in the heart. In conclusion, QSYQ exerts a protective effect on TAC-induced heart failure, which could be attributed to enhanced cardiac angiogenesis

BVRI photometry of ASASSN-15qi using the Tautenburg Schmidt telescope

NASA Astrophysics Data System (ADS)

Stecklum, Bringfried; Eisloeffel, Jochen; Scholz, Alexander

2015-10-01

We report on photometric observations of the optical transient ASASSN-15qi performed at the Th & uuml;ringer Landessternwarte Tautenburg. The brightening of this source was discovered by the All-Sky Automated Survey for Supernovae (ASAS-SN, Shappee et al. 2014, ApJ, 788, 48). The object is located west of the HII region SH2-148 and a likely member of the star forming region.

Out of Sorts? Some Remedies for Theories of Object Concepts: A Reply to Rhemtulla and Xu (2007)

ERIC Educational Resources Information Center

Blok, Sergey V.; Newman, George E.; Rips, Lance J.

2007-01-01

Responds to comments made by Rhemtulla and Xu on the current authors' original paper Concepts of individual objects (e.g., a favorite chair or pet) include knowledge that allows people to identify these objects, sometimes after long stretches of time. In an earlier article, the authors set out experimental findings and mathematical modeling to…

Unmanned Aircraft Systems (UAS) Integration in the National Airspace System (NAS) Project: Advanced Collision Avoidance System for UAS (ACAS Xu) Interoperability White Paper Presentation

NASA Technical Reports Server (NTRS)

Fern, Lisa

2017-01-01

The Phase 1 DAA Minimum Operational Performance Standards (MOPS) provided requirements for two classes of DAA equipment: equipment Class 1 contains the basic DAA equipment required to assist a pilot in remaining well clear, while equipment Class 2 integrates the Traffic Alert and Collision Avoidance (TCAS) II system. Thus, the Class 1 system provides RWC functionality only, while the Class 2 system is intended to provide both RWC and Collision Avoidance (CA) functionality, in compliance with the Minimum Aviation System Performance (MASPS) for the Interoperability of Airborne Collision Avoidance Systems. The FAAs TCAS Program Office is currently developing Airborne Collision Avoidance System X (ACAS X) to support the objectives of the Federal Aviation Administrations (FAA) Next Generation Air Transportation System Program (NextGen). ACAS X has a suite of variants with a common underlying design that are intended to be optimized for their intended airframes and operations. ACAS Xu being is designed for UAS and allows for new surveillance technologies and tailored logic for platforms with different performance characteristics. In addition to Collision Avoidance (CA) alerting and guidance, ACAS Xu is being tuned to provide RWC alerting and guidance in compliance with the SC 228 DAA MOPS. With a single logic performing both RWC and CA functions, ACAS Xu will provide industry with an integrated DAA solution that addresses many of the interoperability shortcomings of Phase I systems. While the MOPS for ACAS Xu will specify an integrated DAA system, it will need to show compliance with the RWC alerting thresholds and alerting requirements defined in the DAA Phase 2 MOPS. Further, some functional components of the ACAS Xu system such as the remote pilots displayed guidance might be mostly references to the corresponding requirements in the DAA MOPS. To provide a seamless, integrated, RWC-CA system to assist the pilot in remaining well clear and avoiding collisions, several

[Textual research on the time of completion of XU Shuwei' books on exo-pathogenic cold diseases].

PubMed

Lu, Mingxin

2015-11-01

Shang han bai zheng ge (Poets of Syndromes of Exo-pathogenic Cold Disease), Shang han fa wei lun (Discourse on Elucidation of Exo-pathogenic Cold Disease), Shang han jiu shi lun (90 Discourses on Exo-pathogenic Cold Disease) were the three extant books on exo-pathogenic cold disease written by Xu Shuwei among his other works of its kind. Although there were carved editions of the Yuan and Ming Dynasties, these books were gradually paid attention for citations by other physicians till the Qing Dynasty. Through comparison of its texts, it can be found that the title of Shang han bai zheng ge was mentioned in his other medical works. While Shang han fa wei lun and Shang han jiu shi lun contained some overlapping contents, some even carrying concept contradictory to each other. According to historical materials, Xu Shuwei began to write the above-mentioned 3 books in the Northern Song Dynasty. In the several early years of the Southern Song Dynasty after crossing the Yangtze River, he collected the remained manuscripts and continued to write. Among them, Shang han bai zheng ge was completed first, followed by Shang han fa wei lun, with Shang han jiu shi lun came as the last.

An RRM-containing mei2-like MCT1 plays a negative role in the seed germination and seedling growth of Arabidopsis thaliana in the presence of ABA.

PubMed

Gu, Lili; Jung, Hyun Ju; Kwak, Kyung Jin; Dinh, Sy Nguyen; Kim, Yeon-Ok; Kang, Hunseung

2016-12-01

Despite an increasing understanding of the essential role of the Mei2 gene encoding an RNA-binding protein (RBP) in premeiotic DNA synthesis and meiosis in yeasts and animals, the functional roles of the mei2-like genes in plant growth and development are largely unknown. Contrary to other mei2-like RBPs that contain three RNA-recognition motifs (RRMs), the mei2 C-terminal RRM only (MCT) is unique in that it harbors only the last C-terminal RRM. Although MCTs have been implicated to play important roles in plants, their functional roles in stress responses as well as plant growth and development are still unknown. Here, we investigated the expression and functional role of MCT1 (At1g37140) in plant response to abscisic acid (ABA). Confocal analysis of MCT1-GFP-expressing plants revealed that MCT1 is localized to the nucleus. The transcript level of MCT1 was markedly increased upon ABA treatment. Analysis of MCT1-overexpressing transgenic Arabidopsis plants and artificial miRNA-mediated mct1 knockdown mutants demonstrated that MCT1 inhibited seed germination and cotyledon greening of Arabidopsis plants under ABA. The transcript levels of ABA signaling-related genes, such as ABI3, ABI4, and ABI5, were markedly increased in the MCT1-overexpressing transgenic plant. Collectively, these results suggest that ABA-upregulated MCT1 plays a negative role in Arabidopsis seed germination and seedling growth under ABA by modulating the expression of ABA signaling-related genes. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Progress of projection computed tomography by upgrading of the beamline 37XU of SPring-8

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

Terada, Yasuko, E-mail: yterada@spring8.or.jp; Suzuki, Yoshio; Uesugi, Kentaro

2016-01-28

Beamline 37XU at SPring-8 has been upgraded for nano-focusing applications. The length of the beamline has been extended to 80 m. By utilizing this length, the beamline has advantages for experiments such as X-ray focusing, X-ray microscopic imaging and X-ray computed tomography. Projection computed tomography measurements were carried out at experimental hutch 3 located 80 m from the light source. CT images of a microcapsule have been successfully obtained with a wide X-ray energy range.

The Harvard case of Xu Xiping: exploitation of the people, scientific advance, or genetic theft?

PubMed

Sleeboom, Margaret

2005-04-01

A unique history and make-up of a population may make it an attractive research target for population geneticists and pharmaco-genomic investors. The promise of pharmaceutical profits and advances in medical knowledge attracted Harvard researchers and the company Millennium Pharmaceuticals to remote areas in Anhui Province, Central China, leading to international diplomatic disagreements about issues such as the ownership of genetic material and informed consent (IC). This article discusses the role of genomics and genetic sampling in China, the way it is related to population policies (the new eugenics), the national importance of genetic materials and the conflicts it led to between the Chinese government and Harvard University. Here many consider the Xu Xiping case as textbook example of ruthless Western exploitation of development countries, illustrating the cold rationality of science in the process of globalisation. Ten perspectives on this case show that this view is simplistic and contributes little to an understanding of bioethical issues important to the population actually donating the samples. Viewing the Xu Xiping case as the nexus of the intertwinement of international, transnational, national, and local interest groups shows how different interest groups make use of different units of analysis. It also clarifies why the same practice of genetic sampling continues under a different regime, and why the discussion about genetic sampling has shifted from a concern with health care of the poor to an issue of international exploitation, terrorism and development.

Atomistic determinants of co-enzyme Q reduction at the Qi-site of the cytochrome bc1 complex

NASA Astrophysics Data System (ADS)

Postila, Pekka A.; Kaszuba, Karol; Kuleta, Patryk; Vattulainen, Ilpo; Sarewicz, Marcin; Osyczka, Artur; Róg, Tomasz

2016-09-01

The cytochrome (cyt) bc1 complex is an integral component of the respiratory electron transfer chain sustaining the energy needs of organisms ranging from humans to bacteria. Due to its ubiquitous role in the energy metabolism, both the oxidation and reduction of the enzyme’s substrate co-enzyme Q has been studied vigorously. Here, this vast amount of data is reassessed after probing the substrate reduction steps at the Qi-site of the cyt bc1 complex of Rhodobacter capsulatus using atomistic molecular dynamics simulations. The simulations suggest that the Lys251 side chain could rotate into the Qi-site to facilitate binding of half-protonated semiquinone - a reaction intermediate that is potentially formed during substrate reduction. At this bent pose, the Lys251 forms a salt bridge with the Asp252, thus making direct proton transfer possible. In the neutral state, the lysine side chain stays close to the conserved binding location of cardiolipin (CL). This back-and-forth motion between the CL and Asp252 indicates that Lys251 functions as a proton shuttle controlled by pH-dependent negative feedback. The CL/K/D switching, which represents a refinement to the previously described CL/K pathway, fine-tunes the proton transfer process. Lastly, the simulation data was used to formulate a mechanism for reducing the substrate at the Qi-site.

China Report, Red Flag, No. 13, 1 July 1983.

DTIC Science & Technology

1983-09-13

Jianying , Li Fuchun, Li Xiannian, Xu Xiangqian and Nie Rongzhen strongly criticized the errors of the "Cultural Revolution." But these were smeared as...22) ( Li Qi) 26 The Significance of Life Lies in Making Contributions and Not Making Demands—On Zhang Haidi’s Communist Outlook on Life (pp 23-27...Duxiu^, and Comrades Qu Qiubai^ and Li Lisan^ did not engage in conspiracies. Luo Zhanglong? tried to split the party by setting up another central

Broadband enhanced transmission of acoustic waves through serrated metal gratings

NASA Astrophysics Data System (ADS)

Qi, Dong-Xiang; Fan, Ren-Hao; Deng, Yu-Qiang; Peng, Ru-Wen; Wang, Mu; Jiangnan University Collaboration

In this talk, we present our studies on broadband properties of acoustic waves through metal gratings. We have demonstrated that serrated metal gratings, which introduce gradient coatings, can give rise to broadband transmission enhancement of acoustic waves. Here, we have experimentally and theoretically studied the acoustic transmission properties of metal gratings with or without serrated boundaries. The average transmission is obviously enhanced for serrated metal gratings within a wide frequency range, while the Fabry-Perot resonance is significantly suppressed. An effective medium hypothesis with varying acoustic impedance is proposed to analyze the mechanism, which was verified through comparison with finite-element simulation. The serrated boundary supplies gradient mass distribution and gradient normal acoustic impedance, which could efficiently reduce the boundary reflection. Further, by increasing the region of the serrated boundary, we present a broadband high-transmission grating for wide range of incident angle. Our results may have potential applications to broadband acoustic imaging, acoustic sensing and new acoustic devices. References: [1] Dong-Xiang Qi, Yu-Qiang Deng, Di-Hu Xu, Ren-Hao Fan, Ru-Wen Peng, Ze-Guo Chen, Ming-Hui Lu, X. R. Huang and Mu Wang, Appl. Phys. Lett. 106, 011906 (2015); [2] Dong-Xiang Qi, Ren-Hao Fan, Ru-Wen Peng, Xian-Rong Huang, Ming-Hui Lu, Xu Ni, Qing Hu, and Mu Wang, Applied Physics Letters 101, 061912 (2012).

The effectiveness of a multidisciplinary QI activity for accidental fall prevention: Staff compliance is critical

PubMed Central

2012-01-01

Background Accidental falls among inpatients are a substantial cause of hospital injury. A number of successful experimental studies on fall prevention have shown the importance and efficacy of multifactorial intervention, though success rates vary. However, the importance of staff compliance with these effective, but often time-consuming, multifactorial interventions has not been fully investigated in a routine clinical setting. The purpose of this observational study was to describe the effectiveness of a multidisciplinary quality improvement (QI) activity for accidental fall prevention, with particular focus on staff compliance in a non-experimental clinical setting. Methods This observational study was conducted from July 2004 through December 2010 at St. Luke’s International Hospital in Tokyo, Japan. The QI activity for in-patient falls prevention consisted of: 1) the fall risk assessment tool, 2) an intervention protocol to prevent in-patient falls, 3) specific environmental safety interventions, 4) staff education, and 5) multidisciplinary healthcare staff compliance monitoring and feedback mechanisms. Results The overall fall rate was 2.13 falls per 1000 patient days (350/164331) in 2004 versus 1.53 falls per 1000 patient days (263/172325) in 2010, representing a significant decrease (p = 0.039). In the first 6 months, compliance with use of the falling risk assessment tool at admission was 91.5% in 2007 (3998/4368), increasing to 97.6% in 2010 (10564/10828). The staff compliance rate of implementing an appropriate intervention plan was 85.9% in 2007, increasing to 95.3% in 2010. Conclusion In our study we observed a substantial decrease in patient fall rates and an increase of staff compliance with a newly implemented falls prevention program. A systematized QI approach that closely involves, encourages, and educates healthcare staff at multiple levels is effective. PMID:22788785

[Correlation between spirit-qi acupuncture and lifting-thrusting twirling method for spirit in Huangdi Neijing].

PubMed

Wang, Feng; Qin, Yuge; Qin, Yuheng; Li, Li; Li, Mei

2016-03-01

By analyzing the articles in Huangdi Neijing (Inner Canon of Yellow Emperor), combined with the verification of consciousness in vitro in clinic and modern science, it is found Huangdi Neijing has made special requirements of treating spirit for physicians using spirit-qi acupuncture. The physicians consciously use different methods to motivate the spirit of physician and patients, especially patients, to transform it to the physiological effect of patients, which could minimize the psychological factors that make negative influence on treatment; also the psychotherapy is considered as the most important principle of treating spirit. The reinforcing and reducing methods in later generations, mainly lifting-thrusting twirling method, unintentionally lead patients into a basic or strong status of treating spirit or keeping spirit during the process of achieving stimulation and needle sensation. To partially perform the special role of treating spirit for physicians in Huangdi Neijing on patients could cause the chages including patient-based using spirit to move qi. It not only inspires the body's natural resistance to disease and self-healing, but also motivates the self-protection mechanism of keeping spirit.

[Analysis on content of serum monoamine neurotransmitters in macaques with anger-in-induced premenstrual syndrome and liver-qi depression syndrome].

PubMed

Wei, Sheng; Hou, Jin-Liang; Chao, Yu-Bin; Du, Xi-Yang; Zong, Shao-Bo

2012-08-01

To observe the changes in content of monoamine neurotransmitters in the serum of rhesus macaques, and explore the role of serum monoamine neurotransmitters in premenstrual syndrome (PMS) and liver-qi depression induced by anger-in emotion. Social level pressure was applied on 24 female macaques to induce the angry emotional reaction, and then nine of the low-status macaques with anger-in emotional reaction were screened out and were divided into anger-in emotion group, PMS and liver-qi depression group (model group) and Jingqianshu Granule group. Macaques in the last two groups were suffered extruding in a pack cage for inducing PMS liver-qi depression. After 5 d of extruding, experimental animals were evaluated according to the emotional evaluation scale, meanwhile, macaque serum of follicular phase and middle-late luteal phase was collected to analyze the content of serum norepinephrine, dopamine, and 5-hydroxytryptamine. Compared with the normal control group, the scores of depression of the model group and the anger-in emotion group evaluated with emotional evaluation scale were significantly increased (P<0.01, P<0.05); while the score of the model group was significantly higher than that of the anger-in emotion group (P<0.05), and it returned to normal after Jingqianshu Granule treatment. As compared to the normal control group, serum monoamine neurotransmitter levels of the model group and the anger-in emotion group were increased (P<0.05, P<0.01), and the serum monoamine neurotransmitter levels of the model group were significantly higher than those of the anger-in emotion group (P<0.05), while there was no significant difference when compared with the normal control group after the treatment. Anger-in emotion can induce liver-qi depression syndrome which is related to the changes in monoamine neurotransmitters.

Roles of the µ-opioid receptor and its related signaling pathways in the pathogenesis of premenstrual syndrome liver-qi stagnation

PubMed Central

Song, Chunhong; Xue, Ling

2017-01-01

The present study aimed to investigate the roles of the µ-opioid receptor (MOR) and its related signaling pathways in the pathogenesis of premenstrual syndrome (PMS) liver-qi stagnation, along with the therapeutic effects of the Shu-Yu capsule in treating the condition. A PMS liver-qi stagnation rat model was established using a chronic restraint stress method. The protein expression level of MOR within rat hippocampal tissue was detected via western blot analysis and cyclic adenosine monophosphate (cAMP) levels within the supernatant of a rat hippocampal cell culture were determined by ELISA. The western blot analysis indicated that the hippocampal expression level of MOR was significantly elevated in the PMS liver-qi stagnation model group. However, subsequent treatment with a Shu-Yu capsule was found to significantly decrease the level of MOR expression. In addition, in vitro experiments were performed, whereby primary hippocampal neurons were treated with model rat serum. It was observed that the level of MOR expression was significantly elevated, while brain-derived neurotrophic factor (BDNF) and cAMP levels in the culture supernatant were significantly decreased. These effects were reversed by treatment with serum from the Shu-Yu capsule-treated rats. Furthermore, when treated with the MOR activator DAMGO, the following were significantly decreased in the primary neurons: Phosphorylation levels of cAMP response element binding protein and extracellular signal-regulated protein kinases (ERK); BDNF expression; and cAMP content in the culture supernatant. These effects were reversed in primary neurons treated with DAMGO and Shu-Yu-containing rat serum. Collectively, the data suggest that increased MOR expression and activation of the cAMP/ERK signaling pathway in the hippocampus may be involved in the pathogenesis of PMS liver-qi stagnation. Furthermore, the efficacy of the Shu-Yu capsule in treating the condition may be via its regulation of MOR receptor

The Effects of Yin, Yang and Qi in the Skin on Pain.

PubMed

Adams, James David

2016-01-29

The most effective and safe treatment site for pain is in the skin. This chapter discusses the reasons to treat pain in the skin. Pain is sensed in the skin through transient receptor potential cation channels and other receptors. These receptors have endogenous agonists (yang) and antagonists (yin) that help the body control pain. Acupuncture works through modulation of these receptor activities (qi) in the skin; as do moxibustion and liniments. The treatment of pain in the skin has the potential to save many lives and improve pain therapy in most patients.

The Effects of Yin, Yang and Qi in the Skin on Pain

PubMed Central

Adams, James David

2016-01-01

The most effective and safe treatment site for pain is in the skin. This chapter discusses the reasons to treat pain in the skin. Pain is sensed in the skin through transient receptor potential cation channels and other receptors. These receptors have endogenous agonists (yang) and antagonists (yin) that help the body control pain. Acupuncture works through modulation of these receptor activities (qi) in the skin; as do moxibustion and liniments. The treatment of pain in the skin has the potential to save many lives and improve pain therapy in most patients. PMID:28930115

[Xu Ren's Zhen jiu jing yan fang (Experiential recipe on acupuncture and moxibustion) and its spread].

PubMed

Wang, Zongxin

2002-07-01

The book, Zhen jiu jing yan fang (Experiential Recipe on Acupuncture and Moxibustion), written by Xu Ren, an imperial physician of Korea was completed in the 4th year of Renzu emperor (1644), and was an important work for the history of Korean acupuncture and moxibustion. However, there were mistakes on its writing date as described in the books of acu - moxibustion history in former reports. The portion of Mian xue tang zhen jiu ji cheng (Mianxuetang's Complete Work of Acupuncture and Moxibustion) universally recognized to be unique, was plagiarized from Zhen jiu jing yan fang.

An intermediate luminosity optical transient (ILOTs) model for the young stellar object ASASSN-15qi

NASA Astrophysics Data System (ADS)

Kashi, Amit; Soker, Noam

2017-07-01

We construct a scenario where the outburst of the young stellar object ASASSN-15qi is an intermediate luminosity optical transient (ILOT). In this scenario, a sub-Jupiter young planet was tidally destructed on to a young main-sequence (MS) star. The system is young, and therefore the radius of the planet is larger than its final value; consequently, its density is smaller. The lower density allows the tidal destruction of the young Saturn-like planet on to the MS star of mass ≈2.4 M⊙, resulting in the formation of a disc and a gravitationally powered ILOT. Unlike the case of the more energetic ILOT V838 Mon, the mass of the destructed planet is too low to inflate a giant envelope, and hence the merger remnant remains hot. If our suggested model holds, this ILOT possesses two interesting properties: (I) its luminosity and total energy are below those of novae; (II) it is not as red as other ILOTs. The unusual outburst of ASASSN-15qi - if indeed is an ILOT - further increases the diversity of the already heterogeneous group of ILOTs. We mark the region on the energy-time diagram occupied by such young ILOTs.

Recent progress of hard x-ray imaging microscopy and microtomography at BL37XU of SPring-8

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

Suzuki, Yoshio, E-mail: yoshio@spring8.or.jp; Takeuchi, Akihisa; Terada, Yasuko

2016-01-28

A hard x-ray imaging microscopy and microtomography system is now being developed at the beamline 37XU of SPring-8. In the latest improvement, a spatial resolution of about 50 nm is achieved in two-dimensional imaging at 6 keV x-ray energy using a Fresnel zone plate objective with an outermost zone width of 35 nm. In the tomographic measurement, a spatial resolution of about 100 nm is achieved at 8 keV using an x-ray guide tube condenser optic and a Fresnel zone plate objective with an outermost zone width of 50 nm.

[Question discussion on Theories of Different Schools of Acupuncture and Moxibustion, "the twelfth five-year plan" teaching material].

PubMed

Yin, Zhen-Jin

2014-02-01

The several questions in Theories of Acupuncture and Moxibustion of Different Schools, "the twelfth five-year plan" teaching material, are analyzed and discussed. The expression of DOU Han-qing on "playing a role of meridians, collaterals, qi and blood" is not so accurate, which is suggested to modify as "attaching the importance to needles". "Theory of heaven, human being and earth" "theory of acupuncture on qi regulation" and "the eight therapeutic methods in treatment of disease" in Jinzhenfu (Ode to Golden Needles) are valuable academically and suggested to be supplemented. The expression of XI Hong on "reinforcing and reducing technique by following or against the running course of meridian" and the expression of XU Feng on "the magic turtle eight techniques" are not concrete. It is required to elaborate them in detail. These questions are put forward and needed to discuss with the editors so as to perfect the teaching material.

Toyota beamline (BL33XU) at SPring-8

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

Nonaka, T., E-mail: nonaka@mosk.tytlabs.co.jp; Dohmae, K.; Hayashi, Y.

2016-07-27

The Toyota beamline (BL33XU) at SPring-8 is an undulator beamline developed to assist in the study of various automotive-related materials. The light source is a tapered in-vacuum undulator that provides a variable energy band width as well as a high brilliance X-ray beam. Two different optical arrangements are available: Optics 1 and Optics 2. Optics 1 is dedicated to time-resolved X-ray absorption spectroscopy (XAFS), and consists of two channel-cut crystal monochromators and four water-cooled flat Si mirrors. The Si(111) and Si(220) monochromator crystals cover an energy range of 4.0–46.0 keV and are driven by high-speed AC servo motors. These monochromators,more » in conjunction with the tapered undulator, enable high-quality XAFS data acquisition with a temporal resolution of 10 ms. Optics 2 is optimized for X-ray diffraction, scattering and imaging and includes a recently installed double crystal monochromator, two water-cooled flat Si mirrors and Kirkpatrick-Baez (KB) focusing mirrors. The monochromator incorporates parallel mounted Si(111) and Si(311) crystals and covers an energy range of 4.5–70 keV. The beamline provides two experimental stations: Exp. Hutch 2 and Exp. Hutch 3. The gas supply system and mass spectrometers installed in Exp. Hutch 2 allow in-operando measurements under various atmospheres. The scanning three-dimensional X-ray diffraction (scanning 3DXRD) microscopy instrumentation developed and installed in Exp. Hutch 3 enables non-destructive orientation and stress mapping of 1 mm-thick steel specimens using a high energy microbeam.« less

Chemically Resolved Interface Structure of Epitaxial Graphene on SiC(0001)

DTIC Science & Technology

2013-11-19

Phys. Rev. B 76, 235416 (2007). [22] W . Chen, H. Xu, L. Liu, X.Y. Gao, D. C. Qi, G.W. Peng, S. C. Tan, Y. P. Feng, K. P. Loh, and A. T. S. Wee, Surf...J. Hass, J. E. Millan-Otoya, P. N. First, and E.H. Conrad, Phys. Rev. B 78, 205424 (2008). [27] J. Borysiuk, R. Bozek, W . Strupinski, A. Wysmolek, K...to the X-ray polarization FIG. S1: Experimental geometries for both (a) conventional XPS (α ~78°) used for survey scans and ( b ) highly surface

Perception of Therapeutic Qi, a Nonmechanical, Nonpsychological Factor in Acupuncture That Originates from the Therapist.

PubMed

Hochstrasser, Raphael J; Endler, P Christian; Klein, Sabine D

2015-08-01

So far, most research attempts to explain the mechanism of the action of acupuncture have focused mostly on mechanically-triggered active factors and have produced inconclusive findings. In this study, we investigate whether acupuncture might also involve nonmechanical, nonpsychological active factors originating in the therapist. In 30 individuals, an acupuncture needle was inserted in the acupoint PC6 using a special device without touching the needle. A second device was used to fix the needle rigidly in place, excluding any mechanical transmission of movement from the handle to the needle's tip. Each participant was exposed in random order to a control and a stimulation phase. During the stimulation phase, the free needle's end was held by the therapist to allow the transmission of Qi; during the control phase, it was left untouched. Participants' subjective sensations during the stimulation phase and the control phase were recorded using a questionnaire. Twenty-two of 28 (79%; p = 0.003) test participants believed that they had received stimulation when it had actually been performed, and 26 (93%; p < 0.001) sensed differences between the two experimental phases. Thus, participants were able to sense the transmission of therapeutic Qi in the absence of mechanical or psychological factors. Copyright © 2015. Published by Elsevier B.V.

78 FR 56264 - Big Bear Mining Corp., Four Rivers BioEnergy, Inc., Mainland Resources, Inc., QI Systems Inc...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-12

... SECURITIES AND EXCHANGE COMMISSION [File No. 500-1] Big Bear Mining Corp., Four Rivers BioEnergy, Inc., Mainland Resources, Inc., QI Systems Inc., South Texas Oil Co., and Synova Healthcare Group, Inc... concerning the securities of Four Rivers BioEnergy, Inc. because it has not filed any periodic reports since...

Urban renewal based wind environment at pedestrian level in high-density and high-rise urban areas in Sai Ying Pun, Hong Kong

NASA Astrophysics Data System (ADS)

Yao, J. W.; Zheng, J. Y.; Zhao, Y.; Shao, Y. H.; Yuan, F.

2017-11-01

In high-density and high-rise urban areas, pedestrian level winds contribute to improve comfort, safety and diffusion of heat in urban areas. Outdoor wind study is extremely vital and a prerequisite in high-density cities considering that the immediate pedestrian level wind environment is fundamentally impacted by the presence of a series of high-rise buildings. In this paper, the research site of Sai Ying Pun in Hong Kong will be analysed in terms of geography, climate and urban morphology, while the surrounding natural ventilation has also been simulated by the wind tunnel experiment Computational Fluid Dynamics (CFD). It has found that, the existing problems in this district are the contradiction between planning control and commercial interests, which means some areas around tall buildings are not benefit to the residents because of the unhealthy wind environment. Therefore, some recommendation of urban renewal strategy has been provided.

PREFACE: International Conference on Quantum Optics and Quantum Information (icQoQi) 2013

NASA Astrophysics Data System (ADS)

2014-11-01

Quantum Information can be understood as being naturally derived from a new understanding of information theory when quantum systems become information carriers and quantum effects become non negligible. Experiments and the realization of various interesting phenomena in quantum information within the established field of quantum optics have been reported, which has provided a very convenient framework for the former. Together, quantum optics and quantum information are among the most exciting areas of interdisciplinary research in modern day science which cover a broad spectrum of topics, from the foundations of quantum mechanics and quantum information science to the introduction of new types of quantum technologies and metrology. The International Conference on Quantum Optics and Quantum Information (icQoQi) 2013 was organized by the Faculty of Science, International Islamic University Malaysia with the objective of bringing together leading academic scientists, researchers and scholars in the domain of interest from around the world to share their experiences and research results about all aspects of quantum optics and quantum information. While the event was organized on a somewhat modest scale, it was in fact a rather fruitful meeting for established researchers and students as well, especially for the local scene where the field is relatively new. We would therefore, like to thank the organizing committee, our advisors and all parties for having made this event successful and last but not least would extend our sincerest gratitude to IOP for publishing these selected papers from icQoQi2013 in Journal of Physics: Conference Series.

Construction of the vessel-collateral theory and its guidance for prevention and treatment of vasculopathy.

PubMed

Wu, Yiling

2011-06-01

According to the self-discipline of traditional Chinese medicine, vessel-collateral theory was constructed systematically, which was important to improving prevention and treatment level of vasculopathy. The hypothesis of "homeostasis (Cheng), compensatory auto-adaptation (Zhi), regulation (Tiao) and equilibrium (Ping)" based on the "qi-yin-yang-five elements" coupled with the ying (nutrients)-wei (defense) theory, has become the core content of the vessel-collateral theory. Clinical and laboratory trials have been developed to further confirm the scientific connotations of the hypothesis, such as Tong Xin Luo capsule, as the representative drugs of vessel collateral theory, showed good efficacy in protecting the vascular endothelium, stabilizing the vulnerable plaque and reducing the blood vessel spasm. "Sou, ti, shu, tong" was the characteristics of Tong Xin Luo capsule in treating "microvascular damage" as the core mechanism of acute myocardial infarction, cerebral infarction and microvascular complications of diabetes. Shen Song Yang Xin capsules in the treatment of arrhythmia have made integrated adjustment advantage. Qi Li Qiang Xin capsules have been made treating both manifestation and root cause of chronic heart failure. These research have improved prevention and treatment level of major vascular system diseases.

Optical Design and Performance of the Taiwan Inelastic X-Ray Scattering Beamline (BL12XU) at SPring-8

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

Cai, Y.Q.; Chow, P.; Chen, C.C.

2004-05-12

As part of the Taiwan x-ray facility at SPring-8, we have designed, constructed and commissioned a dedicated Inelastic X-ray Scattering (IXS) beamline (BL12XU) for both resonant and non-resonant experiments on electronic excitations in correlated electron systems with energy resolution from 10-1000 meV. At the Si(555) near-backscattering energy of 9.886 keV, a total energy resolution of 70 meV has been achieved with flux of 1.5x1011 phs/sec/50meV. The optical design and performance of the beamline are presented and discussed with selected results from recent commissioning experiments.

Periodic Leg Movements during Sleep Are Associated with Polymorphisms in BTBD9, TOX3/BC034767, MEIS1, MAP2K5/SKOR1, and PTPRD

PubMed Central

Moore, Hyatt; Winkelmann, Juliane; Lin, Ling; Finn, Laurel; Peppard, Paul; Mignot, Emmanuel

2014-01-01

Study Objectives: To examine association between periodic leg movements (PLM) and 13 single nucleotide polymorphisms (SNPs) in 6 loci known to increase risk of restless legs syndrome (RLS). Setting: Stanford Center for Sleep Sciences and Medicine and Clinical Research Unit of University of Wisconsin Institute for Clinical and Translational Research. Patients: Adult participants (n = 1,090, mean age = 59.7 years) from the Wisconsin Sleep Cohort (2,394 observations, 2000-2012). Design and Interventions: A previously validated automatic detector was used to measure PLMI. Thirteen SNPs within BTBD9, TOX3/BC034767, MEIS1 (2 unlinked loci), MAP2K5/SKOR1, and PTPRD were tested. Analyses were performed using a linear model and by PLM category using a 15 PLM/h cutoff. Statistical significance for loci was Bonferroni corrected for 6 loci (P < 8.3 × 10-3). RLS symptoms were categorized into four groups: likely, possible, no symptoms, and unknown based on a mailed survey response. Measurements and Results: Prevalence of PLMI ≥ 15 was 33%. Subjects with PLMs were older, more likely to be male, and had more frequent RLS symptoms, a shorter total sleep time, and higher wake after sleep onset. Strong associations were found at all loci except one. Highest associations for PLMI > 15/h were obtained using a multivariate model including age, sex, sleep disturbances, and the best SNPs for each loci, yielding the following odds ratios (OR) and P values: BTBD9 rs3923809(A) OR = 1.65, P = 1.5×10-8; TOX3/BC034767 rs3104788(T) OR = 1.35, P = 9.0 × 10-5; MEIS1 rs12469063(G) OR = 1.38, P = 2.0 × 10-4; MAP2K5/SKOR1 rs6494696(G) OR = 1.24, P = 1.3×10-2; and PTPRD(A) rs1975197 OR = 1.31, P = 6.3×10-3. Linear regression models also revealed significant PLM effects for BTBD9, TOX3/BC034767, and MEIS1. Co-varying for RLS symptoms only modestly reduced the genetic associations. Conclusions: Single nucleotide polymorphisms demonstrated to increase risk of RLS are strongly linked to increased

[Efficacy of Qilin Pills combined with sertraline in the treatment of secondary non-consolidated kidney qi premature ejaculation].

PubMed

Li, Jian-xin; Lu, Qing-ge

2015-05-01

To observe the clinical effectiveness of Qilin Pills combined with sertraline in the treatment of secondary non-consolidated kidney qi premature ejaculation (PE). A total of 120 patients with secondary non-consolidated kidney qi PE were randomly assigned to groups A (aged [35.5 ± 5.4] yr), B (aged [36.2 ± 5.7] yr), and C (aged [35.2 ± 5.3] yr) in the ratio of 1:1:1 to receive Qilin Pills (once 6 g, bid), sertraline (once 50 mg, qd), and Qilin Pills plus sertraline, respectively, all for 4 weeks. The intravaginal ejaculatory latency time (IELT) and PE diagnostic tool (PEDT) scores were obtained before and after medication and at 1 month after drug withdrawal, and comparative analyses were made among the three groups of patients. The IELT was dramatically prolonged in groups A, B, and C after treatment ([3.23 ± 1.84], [3.87 ± 2.43], and [5.92 ± 3.11] min) and at 1 month after drug withdrawal ([1.85 ± 1.27], [1.52 ± 1.06], and [ 4.26 ± 1.88 ] min) as compared with the baseline ([0.88 ± 0.45], [0.84 ± 0.47], and [0.85 ± 0.50] min) (P < 0.01), even longer in group C than in A and B (P < 0.01). The PEDT scores of the three groups were 5.1 ± 1.8, 4.9 ± 1.7, and 3.8 ± 1.2 after treatment and 8.2 ± 2.4, 8.1 ± 2.4, and 6.5 ± 2.1 at 1 month after drug withdrawal, significantly improved in comparison with 13.2 ± 3.2, 12.8 ± 3.1, and 13.1 ± 3.4 before treatment (P < 0.01), even more significantly in group C than in A and B (P < 0.01). Qilin Pills combined with sertraline has a definite efficacy in the treatment of secondary non-consolidated kidney qi PE and therefore deserves wide clinical application.

Hard x-ray photoelectron spectroscopy equipment developed at beamline BL46XU of SPring-8 for industrial researches

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

Yasuno, Satoshi, E-mail: yasuno@spring8.or.jp; Koganezawa, Tomoyuki; Watanabe, Takeshi

Hard X-ray photoelectron spectroscopy (HAXPES) is a powerful tool for investigating the chemical and electronic states of bulk and buried interface in a non-destructive manner due to the large probing depth of this technique. At BL46XU of SPring-8, there are two HAXPES systems equipped with different electron spectrometers, which can be utilized appropriately according to the purpose in various industrial researches. In this article, these systems are outlined, and two typical examples of HAXPES studies performed by them are presented, which focus on the silicidation at Ni/SiC interface and the energy distribution of interface states at SiO{sub 2}/a-InGaZnO.

Protective effect of a Chinese Medicine formula He-Ying-Qing-Re Formula on diabetic retinopathy.

PubMed

Wang, Leilei; Wang, Ning; Tan, Hor-yue; Zhang, Yinjian; Feng, Yibin

2015-07-01

He-Ying-Qing-Re Formula (HF) is a formula modified from "Si-Miao-Yong-An Decoction", a traditional Chinese medical classic emerged in the Qing dynasty and has been reported for treatment of vascular diseases. HF, containing 8 herbs, has been used in local hospital for decades as a complementary method for diabetic retinopathy (DR) with retinal vascular dysfunction. Clinical reports revealed HF could ameliorate vision defects, microaneurysms, hemorrhages and macular edema. The aim of this study is to investigate the anti-DR action of HF and its underlying mechanism experimentally. Chromatographic fingerprinting of HF and rodent model of DR were established; hypoglycemic effect of HF was measured by fasting, random blood glucose and glucose tolerance test; vascular degeneration was measured by retinal digestion; blood-retina-barrier (BRB) permeability was assessed with Evans Blue leakage assay. Advanced glycation end products (AGEs) were measured in vitro and in vivo level; Migration of retinal vascular endothelial cells were determined by wound healing and transwell chamber assays; permeability of endothelial monolayer was monitored with dextran transport. AGEs-related proteins and signaling were measured with immunoblotting and immunohistochemistry. Chlorogenic acid, ferulic acid and arctin were identified as major components in HF; HF suppresses retinal vasculature degeneration and BRB permeability damage without significant inhibition on hyperglycemia; HF reduces in vitro and in vivo formation of AGEs and AGEs-induced migration as well as permeability of retinal vascular endothelial cells. Expression of tight junction proteins Zo-1 and Claudin-1 was increased while activation of AGEs receptor and downstream signaling Akt were suppressed upon HF treatment. HF exhibits protective effect against diabetic retinopathy, which may be associated with inhibition on AGEs and recovery on endothelial dysfunction via modulation of tight junction and AGEs downstream signaling

[Analysis of on medication rules for Qi-deficiency and blood-stasis syndrome of chronic heart failure based on data mining technology].

PubMed

Wang, Qian; Yao, Geng-Zhen; Pan, Guang-Ming; Huang, Jing-Yi; An, Yi-Pei; Zou, Xu

2017-01-01

To analyze the medication features and the regularity of prescriptions of traditional Chinese medicine in treating patients with Qi-deficiency and blood-stasis syndrome of chronic heart failure based on modern literature. In this article, CNKI Chinese academic journal database, Wanfang Chinese academic journal database and VIP Chinese periodical database were all searched from January 2000 to December 2015 for the relevant literature on traditional Chinese medicine treatment for Qi-deficiency and blood-stasis syndrome of chronic heart failure. Then a normalized database was established for further data mining and analysis. Subsequently, the medication features and the regularity of prescriptions were mined by using traditional Chinese medicine inheritance support system(V2.5), association rules, improved mutual information algorithm, complex system entropy clustering and other mining methods. Finally, a total of 171 articles were included, involving 171 prescriptions, 140 kinds of herbs, with a total frequency of 1 772 for the herbs. As a result, 19 core prescriptions and 7 new prescriptions were mined. The most frequently used herbs included Huangqi(Astragali Radix), Danshen(Salviae Miltiorrhizae Radix et Rhizoma), Fuling(Poria), Renshen(Ginseng Radix et Rhizoma), Tinglizi(Semen Lepidii), Baizhu(Atractylodis Macrocephalae Rhizoma), and Guizhi(Cinnamomum Ramulus). The core prescriptions were composed of Huangqi(Astragali Radix), Danshen(Salviae Miltiorrhizae Radix et Rhizoma) and Fuling(Poria), etc. The high frequent herbs and core prescriptions not only highlight the medication features of Qi-invigorating and blood-circulating therapy, but also reflect the regularity of prescriptions of blood-circulating, Yang-warming, and urination-promoting therapy based on syndrome differentiation. Moreover, the mining of the new prescriptions provide new reference and inspiration for clinical treatment of various accompanying symptoms of chronic heart failure. In conclusion

Efficacy of modified LiuJunZi decoction on functional dyspepsia of spleen-deficiency and qi-stagnation syndrome: a randomized controlled trial

PubMed Central

2013-01-01

Background Chinese herbal medicine (CHM) has been used in China and some other countries for the treatment of patients with functional dyspepsia (FD). However, controlled studies supporting the efficacy of such treatments in patients with FD are lacking. In this trial, we aimed to assess the efficacy and safety of modified LiuJunZi decoction in patients with FD of spleen-deficiency and qi-stagnation syndrome. Methods We performed a randomized, double-blind, placebo-controlled trial with patients from five centers. Patients with FD of spleen-deficiency and qi-stagnation syndrome (n = 160) were randomly assigned to groups given CHM modified LiuJunZi decoction or placebo in a 2:1 ratio. Herbal or placebo granules were dissolved in 300 ml of boiled water cooled to 70°C. Patients in both groups were administered 150 ml (50°C) twice daily. The trial included a 4-week treatment period and a 4-week follow-up period. The primary outcomes were dyspepsia symptom scores, measured by the total dyspepsia symptom scale and the single dyspepsia symptom scale at weeks 0, 1, 2, 3, 4 and 8. The secondary outcome was the change of radiopaque barium markers emptied from the stomach between week 0 and week 4 of treatment. Results Compared with patients in the placebo group, patients in the CHM group showed significant improvements according to the scores of total dyspepsia symptoms and single dyspepsia symptoms obtained from patients (P < 0.01) and investigators (P < 0.01). They also showed an improvement in the number of radiopaque barium markers emptied from the stomach (P < 0.05). Conclusions CHM modified LiuJunZi decoction appears to offer symptomatic improvement in patients with FD of spleen-deficiency and qi-stagnation syndrome. Trial registration Chinese Clinical Trial Registry (ChiCTR): http://ChiCTR-TRC-10001074 PMID:23453018

[Thunder-fire Moxibustion for Qi Deficiency-induced Fatigue in Breast Cancer Patients Under-going Chemotherapy].

PubMed

Lu, Lu; Li, Wei-Han; Guo, Xiao-Chuan; Fu, Wen-Bin

2018-02-25

To observe the clinical effect of thunder-fire moxibustion in the treatment of qi deficiency-induced fatigue in breast cancer patients undergoing chemotherapy. Sixty breast cancer patients undergoing chemotherapy were randomly divided into thunder-fire moxibustion (Moxi) and conventional nursing (nursing) groups ( n ＝30 in each group). Patients in the Moxi group were treated with thunder-fire moxibustion applied to the back part of body from Pishu (BL 20) to Qihaishu (BL 24) on the bilateral sides and to the abdominal part from Zhongwan (CV 12) to Guanyuan (CV 4) for 30 min, once a day for 14 days. Patients in the nursing group were treated with health education and conventional nursing care. The simple fatigue scale, traditional Chinese medicine (TCM) syndrome score, clinical curative effect were observed before and after the treatment, and white blood cell (WBC) count was observed 5 days ofter chemotherapy and after the treatment respectively. After the treatment, the simple fatigue scales and TCM syndrome scores were significantly decreased and WBC counts were significantly increased in both groups relevant to their individual pre-treatment ( P <0.01). The therapeutic effect of the Moxi group was appa-rently superior to that of the nursing group in lowering the simple fatigue scale and TCM syndrome score and in up-regulating WBC count ( P <0.01, P <0.05). The total effective rate of the Moxi group was significantly higher than that of the nursing group (83.3%[25/30]vs 36.7% [11/30], P <0.01). Thunder-fire moxibustion can effectively relieve the degree of fatigue and the symptoms of qi deficiency in breast cancer patients undergoing chemotherapy.

[Metabonomic phenotype of "formula corresponding to pattern types" based on "qi and yin deficiency pattern" of myocardial ischemia rat model].

PubMed

Yan, Bei; A, Ji-Ye; Hao, Hai-Ping; Wang, Guang-Ji; Liu, Lin-Sheng; Zha, Wei-Bin; Zhang, Ying; Gu, Sheng-Hua

2011-08-01

In order to explore the scientific connotation of "Fangzhengduiying (formula corresponding to pattern types)", "Qiyinliangxuzheng (Qi and Yin deficiency pattern)" of myocardial ischemia rat model and GC-TOF/MS based metabonomic method were used for comparing the effects of Sheng-mai injection, Salvia injection and propranolol in the present study. After data processing and pattern recognition, Sheng-mai injection showed better efficacy than the other two drugs in accordance with not only visual observation from PLS-DA scores plots but also the number of abnormal endogenous compounds restored to the normal level. Further studies showed that Sheng-mai injection could normalize the level of plasma endothelin-1, the index related to cardiovascular diseases and sleep disorders, which verified the results of metabonomics. Finally, the regulated metabolites and related metabolic pathways were analyzed, and it was supposed that the effects of Sheng-mai injection involved in the alternation of energy metabolism, lipid metabolism, amino acids metabolism, and so on. These findings provided scientific evidence to Shengmai "Fang" used for "Qi and Yin deficiency pattern" correspondingly, indicating that metabonomics has great potential in traditional Chinese medical research, which provides a novel approach and way to modernization of traditional Chinese medicine.

mei-41 and bub1 block mitosis at two distinct steps in response to incomplete DNA replication in Drosophila embryos.

PubMed

Garner, M; van Kreeveld, S; Su, T T

2001-10-16

Drosophila double park encodes a homolog of Cdt1 that functions in initiation of DNA replication in fission yeast and Xenopus. dup mutants complete the first 15 embryonic cell cycles, presumably via maternal dup products, and show defects in the 16(th) S phase (S16). Cells carrying dup(a1) allele forgo S16 altogether but enter mitosis 16 (M16). We find that the timing of entry into M16 is similar in dup(a1) and heterozygous or wild-type (wt) controls. In contrast, we find that mutant cells carrying another allele, dup(a3), undergo a partial S16 and delay the entry into M16. Thus, initiation of S16 appears necessary for delaying M16. This delay is absent in double mutants of dup(a3) and mei-41 (Drosophila ATR), indicating that a mei-41-dependent checkpoint acts to delay the entry into mitosis in response to incomplete DNA replication. dup(a3) and dup(a1) mutant cells that enter M16 become arrested in M16. We find that mitotic cyclins are stabilized and that a spindle checkpoint protein, Bub1, localizes onto chromosomes during mitotic arrest in dup mutants. These features suggest an arrest prior to metaphase-anaphase transition. dup(a3) bub1 double mutant cells exit M16, indicating that a bub1-mediated checkpoint acts to block mitotic exit in dup mutants. To our knowledge, this is the first report of (1) incomplete DNA replication affecting both the entry into and the exit from mitosis in a single cell cycle via different mechanisms and (2) the role of bub1 in regulating mitotic exit in response to incomplete DNA replication.

The changes in quality ingredients of Qi chrysanthemum flowers treated with elevated UV-B radiation at different growth stages.

PubMed

Yao, Xiaoqin; Chu, Jianzhou; He, Xueli; Ma, Chunhui; Han, Chao; Shen, Haiyu

2015-05-01

The paper mainly reported the changes in quality ingredients of Qi chrysanthemum flowers treated with elevated UV-B radiation at different growth stages. The experiment included two levels of UV-B radiation (ambient UV-B, a 10% increase in ambient UV-B). Elevated UV-B radiation was carried out for 10-days during seedling, vigorous growth, bud and flower stages of Qi chrysanthemum, respectively. Elevated UV-B treatments applied during four development stages did not significantly affect flower yield, the rate of superoxide radical production and malondialdehyde concentration in flowers, while increased free amino acid concentration. The amino acid concentration induced by elevated UV-B radiation applied during bud stage was higher than that during the other stages. Elevated UV-B radiation applied during vigorous growth (except for flavone), bud and flower stages of chrysanthemum significantly increased hydrogen peroxide concentration, phenylalanine ammonia lyase enzyme activity, vitamin C, chlorogenic acid and flavone concentrations in flowers. These results suggested that active and nutritional ingredients in flowers of chrysanthemum could be increased by elevated UV-B radiation applied during the later growth stages of chrysanthemum. The paper supplied a simple and environmental-friendly method to improve quality of medicinal plants. Copyright © 2015 Elsevier B.V. All rights reserved.

Imaging Complex Fault Slip of the 2016 MeiNong and Kumamoto Earthquakes with Sentinel-1 InSAR and Other Geodetic and Seismic Data

NASA Astrophysics Data System (ADS)

Fielding, E. J.; Huang, M. H.; Liang, C.; Yue, H.; Agram, P. S.; Simons, M.; Fattahi, H.; Tung, H.; Hu, J. C.; Huang, C.

2016-12-01

We map complex fault ruptures of the February 2016 MeiNong earthquake in Taiwan and the April 2016 Kumamoto earthquake sequence in Japan by analysis of Synthetic Aperture Radar (SAR) data from the Copernicus Sentinel-1A (S1A) satellite operated by the European Space Agency and the Advanced Land Observation Satellite-2 (ALOS-2) satellite operated by the Japanese Aerospace Exploration Agency (JAXA). Our analysis shows that the MeiNong main rupture at lower crustal depth triggered slip on another fault at upper crustal depth and shallow slip on several faults in the upper few km. The Kumamoto earthquake sequence ruptured two major fault systems over two days and triggered shallow slip on a large number of shallow faults. We combine less precise analysis of large scale displacements from the SAR images of the two satellites by pixel offset tracking or sub-pixel correlation, including the along-track component of surface motion, with the more precise SAR interferometry (InSAR) measurements in the radar line-of-sight direction to estimate all three components of the surface displacement for the events. Data was processed with customized workflows based on modules in the InSAR Scientific Computing Environment (ISCE). Joint inversion of S1A and ALOS-2 InSAR, GPS, and strong motion seismograms for the Mw6.4 MeiNong earthquake shows that the main thrust rupture with N61°W strike and 15° dip at 15-20 km depth explains nearly all of the seismic waveforms but leaves a substantial uplift residual in the InSAR and GPS offsets estimated 4 hours after the earthquake. We model this residual with slip on a N8°E-trending thrust fault dipping 30° at depths between 5-10 km. This fault strike is parallel to surface faults and we interpret it as fault slip within a mid-crustal duplex that was triggered by the main rupture within 4 hours of the mainshock. In addition, InSAR shows sharp discontinuities at many locations that are likely due to shallow triggered slip, but the timing of

Chinese medicine patterns in patients with post-stroke dementia.

PubMed

Tang, Nou-Ying; Liu, Chung-Hsiang; Liu, Hsu-Jan; Li, Tsai-Chung; Liu, Jui-Chen; Chen, Ping-Kun; Hsieh, Ching-Liang

2012-04-01

A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP). Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychiatric Association, as well as the National Institute of Neurological Disorders and Stroke-Association International pour Ia Recherche et I'Enseignement en Neurosciences vascular dementia diagnostic criteria of post-stroke dementia. 100 patients (99.0%) were KEDP (kidney essence deficiency pattern, shèn jīng kuī xū zhèng, ), 83 patients were AHLYP (ascendant hyperactivity of liver yang pattern, gān yáng shàng kàng zhèng, ), 83 patients were QBDP (qi-blood deficiency pattern, qì xuè kuī xū zhèng, ), 81 patients were SBOCP (static blood obstructing the collaterals pattern, yū xuè zǔ luò zhèng, ), 72 patients were BSTRP (bowels stagnation turbidity retention pattern, fǔ zhì zhuó liú zhèng, ), 50 patients were FHIEP (fire heat interior excess pattern, huǒ rè nèi sheng zhèng, ), and 39 participants (38.6%) were PTOOP (phlegm turbidity obstructing the orifices pattern, tán zhuó zǔ qiào zhèng, ); one to 31 patients have at least 2 CMPs simultaneously. In conclusion, the most CMP is KEDP CMP in the post-stroke dementia patients, and one patient may have one or at least 2 CMPs simultaneously.

[Experimental study on the treatment of serious soft tissue injuries with strengthening the spleen and replenishing qi].

PubMed

Chen, Xun-wen; Zhu, Yong-zhan; Chen, Zhi-wei; Wu, Zheng-jie; He, Li-lei

2008-09-01

To study the effects of Chinese drugs based on strengthening the spleen and replenishing qi treatment rule on neoformative capillaries and fibroblast during the soft tissue repair after serious trauma in rats, so as to explore the biological basis of the TCM theory "the spleen dominate extremities and muscles" applied to the treatment of soft tissue injuries. The model rats were established by bleeding from femoral artery and lancing method, and the rats were randomly divided into the control group, strengthening the spleen group and activating blood and resolving stasis group. The samples were got from the tissue of the wounded area at the 5th, 10th and 15th days after oral administration of the traditional Chinese medicine. After fixation and section, the tissues were stained by CD31 and PCNA staining. The amount of the capillaries and fibroblasts in the tissue of the wounded area were observed through multi-purpose microscope (ZEISS Axioskop2). Quantitative analysis was carried out on Image-ProPlus image analyzer. The amount of the capillaries and fibroblasts in the wounded tissue in the strengthening the spleen group were larger than that in the control group at the 5th, 10th and 15th day. And the proliferation speed of capillaries and fibroblasts was faster than those in the control group or the activating blood and resolving stasis group. The Chinese drugs according to strengthening the spleen and replenishing qi treatment rule were effective to promote growth of the granulation tissue and facilitate healing of the wounded area. And it has better effect than the treatment of promoting blood circulation and removing stasis.

On the qi deficiency in traditional Chinese medicine.

PubMed

Chiang, Hui-Chu; Chang, Hen-Hong; Huang, Po-Yu; Hsu, Mutsu

2014-09-01

Qi deficiency (QD), one of the most common disorders in Traditional Chinese medicine (TCM), is relevant to many disorders in obstetrics and gynecology. This study aimed to identify the common processes and criteria for diagnosing QD among contemporary proficient TCM practitioners. Steps of decision tree analysis and modified Delphi method were merged together into four-round postal questionnaires to collect qualitative and quantitative data. Open-ended questions and content analysis were used to explore the proficient TCM practitioners' cognitive activities used for diagnosis. The statements obtained from the qualitative responses were used to develop the items for subsequent questionnaires. Based on the TCM practitioners' responses, the diagnostic processes and criteria for making diagnosis were generated. Twenty-eight out of the 30 participants completed all four questionnaires from June 2007 to January 2010. The 11 diagnostic procedures identified in the returned first round of questionnaires were used as the alternatives to select and rank for all the steps to diagnose QD. After three more rounds of postal surveys, an algorithm with a five-stage diagnostic process as well as sets of decision criteria were identified. Although the priorities of procedures and descriptions of reasoning were varied, the content revealed the major themes in the model. The criteria to differentiate signs and symptoms (S/S) included five principles for correlating S/S with QD, and 17 S/S should be differentiated carefully. The results demonstrate that the TCM practitioners precisely diagnosed QD using a number of specific procedures and criteria that could be used as a reference to understand women complaining of S/S that could be similar to QD. Copyright © 2014. Published by Elsevier B.V.

[Health assessment of Qi'ao Island mangrove wetland ecosystem in Pearl River Estuary].

PubMed

Wang, Shu-Gong; Zheng, Yao-Hui; Peng, Yi-Sheng; Chen, Gui-Zhu

2010-02-01

Based on the theories of wetland ecosystem health and by using "Pressure-State-Response" model, a health assessment indicator system for Qi' ao Island mangrove wetland ecosystem in Pearl River Estuary was built, and the assessment indices, assessment criteria, indices weighted values, assessment grades, and assessment methods were established to assess the health state of this ecosystem. In 2008, the overall health index of this ecosystem was 0.6580, health level was of grade II (healthy), and the pressure, state, and response indices were 0.3469, 0.8718, and 0.7754, respectively, suggesting that this ecosystem was good in state and response, but still had definite pressure. As a provincial nature reserve, this ecosystem was to be further improved in its health level. However, the research on the health assessment of mangrove wetland ecosystem was still young. Further studies should be made on the selection of assessment indices, long-term oriented monitoring of these indices, and quantification of the relations between ecosystem health level and ecosystem services.

Dmc1 catalyzes interhomolog joint molecule formation in meiosis with Rad51 and Mei5-Sae3 as accessory factors

PubMed Central

Cloud, Veronica; Chan, Yuen-Ling; Grubb, Jennifer; Budke, Brian; Bishop, Douglas K.

2014-01-01

Meiotic recombination in budding yeast requires two RecA-related proteins, Rad51 and Dmc1, both of which form filaments on DNA capable of directing homology search and catalyzing formation of homologous joint molecules (JMs) and strand exchange. Using a separation-of-function mutant form of Rad51, that retains filament-forming but not JM forming activity, we show that the JM activity of Rad51 is fully dispensable for meiotic recombination. The corresponding mutation in Dmc1 causes a profound recombination defect, demonstrating Dmc1’s JM activity alone is responsible for meiotic recombination. We further provide biochemical evidence that Rad51 acts with Mei5-Sae3 as a Dmc1 accessory factor. Thus, Rad51 is a multifunctional protein that catalyzes recombination directly in mitosis and indirectly, via Dmc1, during meiosis. PMID:22955832

The effects of UV-B radiation intensity on biochemical parameters and active ingredients in flowers of Qi chrysanthemum and Huai chrysanthemum.

PubMed

Yao, Xiao-Qin; Chu, Jian-Zhou; He, Xue-Li; Si, Chao

2014-01-01

The article studied UV-B effects on biochemical parameters and active ingredients in flowers of Qi chrysanthemum and Huai chrysanthemum during the bud stage. The experiment included four UV-B radiation levels (CK, ambient UV-B; T1, T2 and T3 indicated a 5%, 10% and 15% increase in ambient UV-BBE, respectively) to determine the optimal UV-B radiation intensity in regulating active ingredients level in flowers of two chrysanthemum varieties. Flower dry weight of two cultivars was not affected by UV-B radiation under experimental conditions reported here. UV-B treatments significantly increased the rate of superoxide radical production, hydrogen peroxide (H2O2) (except for T1) and malondialdehyde concentration in flowers of Huai chrysanthemum and H2O2 concentration in flowers of Qi chrysanthemum. T2 and T3 treatments induced a significant increase in phenylalanine ammonia lyase enzyme (PAL) activity, anthocyanins, proline, ascorbic acid, chlorogenic acid and flavone content in flowers of two chrysanthemum varieties, and there were no significant differences in PAL activity, ascorbic acid, flavone and chlorogenic acid content between the two treatments. These results indicated that appropriate UV-B radiation intensity did not result in the decrease in flower yield, and could regulate PAL activity and increase active ingredients content in flowers of two chrysanthemum varieties. © 2014 The American Society of Photobiology.

Assessment of Electromagnetic Interference with Active Cardiovascular Implantable Electronic Devices (CIEDs) Caused by the Qi A13 Design Wireless Charging Board.

PubMed

Seckler, Tobias; Jagielski, Kai; Stunder, Dominik

2015-05-27

Electromagnetic interference is a concern for people wearing cardiovascular implantable electronic devices (CIEDs). The aim of this study was to assess the electromagnetic compatibility between CIEDs and the magnetic field of a common wireless charging technology. To do so the voltage induced in CIEDs by Qi A13 design magnetic fields were measured and compared with the performance limits set by ISO 14117. In order to carry this out a measuring circuit was developed which can be connected with unipolar or bipolar pacemaker leads. The measuring system was positioned at the four most common implantation sites in a torso phantom filled with physiological saline solution. The phantom was exposed by using Helmholtz coils from 5 µT to 27 µT with 111 kHz sine‑bursts or by using a Qi A13 design wireless charging board (Qi‑A13‑Board) in two operating modes "power transfer" and "pinging". With the Helmholtz coils the lowest magnetic flux density at which the performance limit was exceeded is 11 µT. With the Qi‑A13‑Board in power transfer mode 10.8% and in pinging mode 45.7% (2.2% at 10 cm distance) of the performance limit were reached at maximum. In neither of the scrutinized cases, did the voltage induced by the Qi‑A13‑Board exceed the performance limits.

Lipidomics study of plasma phospholipid metabolism in early type 2 diabetes rats with ancient prescription Huang-Qi-San intervention by UPLC/Q-TOF-MS and correlation coefficient.

PubMed

Wu, Xia; Zhu, Jian-Cheng; Zhang, Yu; Li, Wei-Min; Rong, Xiang-Lu; Feng, Yi-Fan

2016-08-25

Potential impact of lipid research has been increasingly realized both in disease treatment and prevention. An effective metabolomics approach based on ultra-performance liquid chromatography/quadrupole-time-of-flight mass spectrometry (UPLC/Q-TOF-MS) along with multivariate statistic analysis has been applied for investigating the dynamic change of plasma phospholipids compositions in early type 2 diabetic rats after the treatment of an ancient prescription of Chinese Medicine Huang-Qi-San. The exported UPLC/Q-TOF-MS data of plasma samples were subjected to SIMCA-P and processed by bioMark, mixOmics, Rcomdr packages with R software. A clear score plots of plasma sample groups, including normal control group (NC), model group (MC), positive medicine control group (Flu) and Huang-Qi-San group (HQS), were achieved by principal-components analysis (PCA), partial least-squares discriminant analysis (PLS-DA) and orthogonal partial least-squares discriminant analysis (OPLS-DA). Biomarkers were screened out using student T test, principal component regression (PCR), partial least-squares regression (PLS) and important variable method (variable influence on projection, VIP). Structures of metabolites were identified and metabolic pathways were deduced by correlation coefficient. The relationship between compounds was explained by the correlation coefficient diagram, and the metabolic differences between similar compounds were illustrated. Based on KEGG database, the biological significances of identified biomarkers were described. The correlation coefficient was firstly applied to identify the structure and deduce the metabolic pathways of phospholipids metabolites, and the study provided a new methodological cue for further understanding the molecular mechanisms of metabolites in the process of regulating Huang-Qi-San for treating early type 2 diabetes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Studies on the psychosomatic functioning of ill-health according to eastern and Western medicine. 2. Anxiety-affinitive constitution associated with qi, blood, and body fluid--diagnostic and therapeutic methods.

PubMed

Takeichi, M; Sato, T; Takefu, M

1999-01-01

The objective of this investigation was to identify characteristics of psychosomatic function in medical students (N = 62, mean age, 23.3, SD, 1.7 years) whose ill-health was related to unbalanced qi, blood, and body fluid, and to develop a diagnosis and treatment method for these conditions. Our study revealed complicated characteristics. At the psychological level, these characteristics are stress-related emotional disturbances, including anxiety, insomnia and anergy, and the lowering of social function. At the physiological level, these characteristics are associated with high complexity of fractal dimension of eye (horizontal) and respiratory (thoracic) movements correlated to STA1-trait anxiety. Thus, the three psychosomatic characteristics related to unbalanced qi, blood, and body fluid suggest the concept of an anxiety-affinitive constitution, also described as the equivalent of ill-health. This indicates that diagnosis and treatment of this type of constitution has the potential to be useful for both the prevention of stress-related and life-style disease, and the treatment of current disease.

To compare the efficacy of two kinds of Zhizhu pills in the treatment of functional dyspepsia of spleen-deficiency and qi-stagnation syndrome:a randomized group sequential comparative trial

PubMed Central

2011-01-01

Background In Traditional Chinese Medicine (TCM) theory, functional dyspepsia (FD) can be divided into different syndromes according to different clinical symptoms and signs, and the most common one is spleen-deficiency and qi-stagnation syndrome that can be treated by Chinese traditional patent medicine ---- two kinds of Zhizhu pills, between which the primary difference in ingredients is that one contains immature orange fruit of Citrus aurantium L.(IFCA) and the other contains that of Citrus sinensis Osbeck (IFCS). The trial's objective was to compare the efficacy of two kinds of Zhizhu pills on symptom changes in patients with FD of spleen-deficiency and qi-stagnation syndrome. Methods A randomized, group sequential, double-blinded, multicenter trial was conducted in patients with FD of spleen-deficiency and qi-stagnation syndrome at 3 hospitals in Beijing between June 2003 and May 2005. Participants were randomly allocated into two groups (IFCA group and IFCS group) in a 1:1 ratio, and respectively took one of the two kinds of Zhizhu pills orally, 6 g each time, 3 times a day, for 4 weeks. Statistical analysis was performed with use of a group sequential method, the triangular test (TT). Results A total of 163 patients were randomized, and 3 patients were excluded from analysis because of early dropouts, leaving 160 patients (IFCA group: n = 82; IFCS group: n = 78) for statistical analysis. Three interim analyses were done after 62, 116, and 160 patients had completed their 4-week treatment, respectively. At the third interim analysis, the sample path crossed the upper boundary and the trial was stopped, the cure-markedly effective rates were 45% for IFCS group and 67% for IFCA group, respectively, the one-sided p-value was 0.0036, the median unbiased estimate of the odds ratio (OR) for the benefit of IFCA relative to IFCS was 2.91 with 95%CI: 1.40 to 6.06. No adverse events were observed in the two groups. Conclusions Zhizhu pills containing IFCA was superior

THE ERUPTION OF THE CANDIDATE YOUNG STAR ASASSN-15QI

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

Herczeg, Gregory J.; Dong, Subo; Chen, Ping

Outbursts on young stars are usually interpreted as accretion bursts caused by instabilities in the disk or the star–disk connection. However, some protostellar outbursts may not fit into this framework. In this paper, we analyze optical and near-infrared spectra and photometry to characterize the 2015 outburst of the probable young star ASASSN-15qi. The ∼3.5 mag brightening in the V band was sudden, with an unresolved rise time of less than one day. The outburst decayed exponentially by 1 mag for 6 days and then gradually back to the pre-outburst level after 200 days. The outburst is dominated by emission frommore » ∼10,000 K gas. An explosive release of energy accelerated matter from the star in all directions, seen in a spectacular cool, spherical wind with a maximum velocity of 1000 km s{sup −1}. The wind and hot gas both disappeared as the outburst faded and the source returned to its quiescent F-star spectrum. Nebulosity near the star brightened with a delay of 10–20 days. Fluorescent excitation of H{sub 2} is detected in emission from vibrational levels as high as v = 11, also with a possible time delay in flux increase. The mid-infrared spectral energy distribution does not indicate the presence of warm dust emission, though the optical photospheric absorption and CO overtone emission could be related to a gaseous disk. Archival photometry reveals a prior outburst in 1976. Although we speculate about possible causes for this outburst, none of the explanations are compelling.« less

Mesozoic intracontinental underthrust in the SE margin of the North China Block: Insights from the Xu-Huai thrust-and-fold belt

NASA Astrophysics Data System (ADS)

Shu, Liangshu; Yin, Hongwei; Faure, Michel; Chen, Yan

2017-06-01

The Xu-Huai thrust-and-fold belt, located in the southeastern margin of the North China Block, consists mainly of thrust and folded pre-Mesozoic strata. Its geodynamic evolution and tectonic setting are topics of long debate. This paper provides new evidence from geological mapping, structural analysis, and making balance cross-sections, with restoration of cross-sections. Results suggest that this belt was subjected to two-phase deformation, including an early-phase regional-scale NW-ward thrust and fold, and a late-phase extension followed by the emplacement of dioritic, monzodioritic porphyrites dated at 131-135 Ma and locally strike-slip shearing. According to the mapping, field observations and drill-hole data, three structural units were distinguished, namely, (1) the pre-Neoproterozoic crystalline basement in the eastern segment, (2) the nappe unit or the thrust-and-fold zone in the central segment, which is composed of Neoproterozoic to Ordovician carbonate rocks and Carboniferous-Permian coal-bearing rocks, about 2600 m thick, and (3) the western frontal zone. A major decollement fault has also been identified in the base of the nappe unit, on which dozen-meter to km-scale thrust-and-fold bodies were commonly developed. All pre-Mesozoic depositional sequences were involved into a widespread thrust and fold event. Six uncompetent-rock layers with biostratigraphic ages (Nanjing University, 1996) have been recognized, and each uncompetent-rock layer occurred mainly in the top of the footwall, playing an important role in the development of the Xu-Huai thrust-and-fold belt. Geometry of the major decollement fault suggests that the nappe unit of this belt was rooted in its eastern side, near the Tan-Lu Fault Zone. Two geological cross-sections were chosen for structural balancing and restoration. From the balanced cross-sections, ramp-flat and imbricated faults as well as fault-related folds were identified. A shortening of 20.6-29.6 km was obtained from

Modeling Aggressive Medulloblastoma Using Human-Induced Pluripotent Stem Cells

DTIC Science & Technology

2015-07-01

Mingyao Ying, Ph.D. CONTRACTING ORGANIZATION: Hugo W. Moser Research Institute at Kennedy Krieger , Inc., Baltimore, MD 21205 REPORT DATE...Cells W81XWH-14-1-0176 Mingyao Ying, Ph.D. Ying@kennedykrieger.org Hugo W. Moser Research Institute at Kennedy Krieger , Inc. Baltimore, MD 21205...medulloblastoma model derived from human induced pluripotent stem cells. Jonathan Sagal1, Charles G. Eberhart2, Mingyao Ying1. 1Kennedy Krieger

Phylogenetic characterisation of circulating, clinical influenza isolates from Bali, Indonesia: preliminary report from the BaliMEI project.

PubMed

Adisasmito, W; Budayanti, S N; Aisyah, D N; Gallo Cassarino, T; Rudge, J W; Watson, S J; Kozlakidis, Z; Smith, G J D; Coker, R

2017-08-23

Human influenza represents a major public health concern, especially in south-east Asia where the risk of emergence and spread of novel influenza viruses is particularly high. The BaliMEI study aims to conduct a five year active surveillance and characterisation of influenza viruses in Bali using an extensive network of participating healthcare facilities. Samples were collected during routine diagnostic treatment in healthcare facilities. In addition to standard clinical and molecular methods for influenza typing, next generation sequencing and subsequent de novo genome assembly were performed to investigate the phylogeny of the collected patient samples. The samples collected are characteristic of the seasonally circulating influenza viruses with indications of phylogenetic links to other samples characterised in neighbouring countries during the same time period. There were some strong phylogenetic links with sequences from samples collected in geographically proximal regions, with some of the samples from the same time-period resulting to small clusters at the tree-end points. However this work, which is the first of its kind completely performed within Indonesia, supports the view that the circulating seasonal influenza in Bali reflects the strains circulating in geographically neighbouring areas as would be expected to occur within a busy regional transit centre.

Cupping therapy: A prudent remedy for a plethora of medical ailments.

PubMed

Mehta, Piyush; Dhapte, Vividha

2015-07-01

Since ancient times, complementary and alternative medicine (CAM; bǔ chōng yǔ tì dài yī xué) have played an important role in human health and welfare. Many therapeutic approaches in healthcare outside the realm of conventional medicine persist in various parts of the world. There is considerable scientific and commercial potential in CAM, which needs to be explored precisely. Cupping therapy ( bá guàn liáo fǎ), one of the CAM, is practiced across the world. This therapy is believed to act by correcting imbalances in the internal bio field, such as by restoring the flow of "Qi (qì)". Cupping involves applying a heated cup to generate a partial vacuum that mobilizes the blood flow and promotes effective healing. This review outlines various tools and techniques of cupping therapy.

Influence of ecological factors on the production of active substances in the anti-cancer plant Sinopodophyllum hexandrum (Royle) T.S. Ying.

PubMed

Liu, Wei; Liu, Jianjun; Yin, Dongxue; Zhao, Xiaowen

2015-01-01

The quality of traditional Chinese herbal medicine, which plays a very important role in the health system of China, is determined by the active substances produced by the plants. The type, content, and proportion of these substances may vary depending on ecological factors in areas where the plants are grown. Sinopodophyllum hexandrum (Royle) T.S. Ying, an endangered plant species with great medical value, was investigated in eight production locations representative of its natural geographical distribution range in China. The correlation between the contents of the active ingredients extracted from the roots and rhizomes of S. hexandrum and the ecological factors were evaluated step-by-step using a series of computational biology methodologies. The results showed that ecological factors had significant effects on the contents but not on the types of the active ingredients in eight production locations. The primary ecological factors influencing the active substances included the annual average precipitation, July mean temperature, frost-free period, sunshine duration, soil pH, soil organic matter, and rapidly available potassium in the soil. The annual average precipitation was the most important determinant factor and was significantly and negatively correlated with the active ingredient contents (P < 0.001). In contrast, organic matter was the most important limiting factor and was significantly and positively correlated with the active substances. These ecological factors caused 98.13% of the total geographical variation of the active ingredient contents. The climate factors contributed more to the active ingredient contents than did the soil factors. It was concluded that from the view of the contents of the secondary metabolites and ecological factors of each growing location, in Jingyuan, Ningxia Province, and Yongdeng, Gansu Province, conditions were favorable to the production of podophyllotoxin and lignans, whereas in Shangri-La, Yunnan Province, and

Influence of Ecological Factors on the Production of Active Substances in the Anti-Cancer Plant Sinopodophyllum hexandrum (Royle) T.S. Ying

PubMed Central

Liu, Wei; Liu, Jianjun; Yin, Dongxue; Zhao, Xiaowen

2015-01-01

The quality of traditional Chinese herbal medicine, which plays a very important role in the health system of China, is determined by the active substances produced by the plants. The type, content, and proportion of these substances may vary depending on ecological factors in areas where the plants are grown. Sinopodophyllum hexandrum (Royle) T.S. Ying, an endangered plant species with great medical value, was investigated in eight production locations representative of its natural geographical distribution range in China. The correlation between the contents of the active ingredients extracted from the roots and rhizomes of S. hexandrum and the ecological factors were evaluated step-by-step using a series of computational biology methodologies. The results showed that ecological factors had significant effects on the contents but not on the types of the active ingredients in eight production locations. The primary ecological factors influencing the active substances included the annual average precipitation, July mean temperature, frost-free period, sunshine duration, soil pH, soil organic matter, and rapidly available potassium in the soil. The annual average precipitation was the most important determinant factor and was significantly and negatively correlated with the active ingredient contents (P < 0.001). In contrast, organic matter was the most important limiting factor and was significantly and positively correlated with the active substances. These ecological factors caused 98.13% of the total geographical variation of the active ingredient contents. The climate factors contributed more to the active ingredient contents than did the soil factors. It was concluded that from the view of the contents of the secondary metabolites and ecological factors of each growing location, in Jingyuan, Ningxia Province, and Yongdeng, Gansu Province, conditions were favorable to the production of podophyllotoxin and lignans, whereas in Shangri-La, Yunnan Province, and

MS-QI: A Modulation Spectrum-Based ECG Quality Index for Telehealth Applications.

PubMed

Tobon V, Diana P; Falk, Tiago H; Maier, Martin

2016-08-01

As telehealth applications emerge, the need for accurate and reliable biosignal quality indices has increased. One typical modality used in remote patient monitoring is the electrocardiogram (ECG), which is inherently susceptible to several different noise sources, including environmental (e.g., powerline interference), experimental (e.g., movement artifacts), and physiological (e.g., muscle and breathing artifacts). Accurate measurement of ECG quality can allow for automated decision support systems to make intelligent decisions about patient conditions. This is particularly true for in-home monitoring applications, where the patient is mobile and the ECG signal can be severely corrupted by movement artifacts. In this paper, we propose an innovative ECG quality index based on the so-called modulation spectral signal representation. The representation quantifies the rate of change of ECG spectral components, which are shown to be different from the rate of change of typical ECG noise sources. The proposed modulation spectral-based quality index, MS-QI, was tested on 1) synthetic ECG signals corrupted by varying levels of noise, 2) single-lead recorded data using the Hexoskin garment during three activity levels (sitting, walking, running), 3) 12-lead recorded data using conventional ECG machines (Computing in Cardiology 2011 dataset), and 4) two-lead ambulatory ECG recorded from arrhythmia patients (MIT-BIH Arrhythmia Database). Experimental results showed the proposed index outperforming two conventional benchmark quality measures, particularly in the scenarios involving recorded data in real-world environments.

Negative regulation of G2-M by ATR (mei-41)/Chk1(Grapes) facilitates tracheoblast growth and tracheal hypertrophy in Drosophila.

PubMed

Kizhedathu, Amrutha; Bagul, Archit V; Guha, Arjun

2018-04-16

Imaginal progenitors in Drosophila are known to arrest in G2 during larval stages and proliferate thereafter. Here we investigate the mechanism and implications of G2 arrest in progenitors of the adult thoracic tracheal epithelium (tracheoblasts). We report that tracheoblasts pause in G2 for ~48-56 h and grow in size over this period. Surprisingly, tracheoblasts arrested in G2 express drivers of G2-M like Cdc25/String (Stg). We find that mechanisms that prevent G2-M are also in place in this interval. Tracheoblasts activate Checkpoint Kinase 1/Grapes (Chk1/Grp) in an ATR/mei-41-dependent manner. Loss of ATR/Chk1 led to precocious mitotic entry ~24-32 h earlier. These divisions were apparently normal as there was no evidence of increased DNA damage or cell death. However, induction of precocious mitoses impaired growth of tracheoblasts and the tracheae they comprise. We propose that ATR/Chk1 negatively regulate G2-M in developing tracheoblasts and that G2 arrest facilitates cellular and hypertrophic organ growth. © 2018, Kizhedathu et al.

Quantum Material Properties of 4d and 5d Transition Metal Oxides and Potential Applications

DTIC Science & Technology

2015-05-26

11 2009): 0. doi: 10.1103/PhysRevB.80.184505 Y. Liu, I. G. Deac, P. Khalifah, R. J. Cava, Y. A. Ying, P. Schiffer , K. D. Nelson. Possible observation...Yiqun A. Ying, Karl Nelson, Iosef G. Deac, Peter Schiffer , Peter Khalifah, Robert J. Cava, and Ying Liu, "Magneto electrical transport properties and

[metabonomics research on coronary heart disease patients of phlegm turbidity syndrome and qi deficiency syndrome].

PubMed

Cheng, Peng; Chen, Ze-qi; Wang, Dong-sheng

2015-02-01

To study the correlation between Chinese medical types of coronary heart disease (CHD) [i.e., phlegm turbidity syndrome (PTS) and qi deficiency syndrome (QDS)] and their metabolites. Recruited were 65 CHD patients including 37 cases of PTS and 28 cases of QDS. Serum endogenous metabolites in the two syndrome types were determined by gas chromatograph-mass spectrometer-computer (GC/MS), and their differences between their metabolic profiles analyzed. More than 100 chromatographic peaks were totally scanned. Chromatograms obtained was matched with mass spectrum bank, and finally we got the category contribution value of 46 kinds of substances. Results of MCTree analysis showed patients of PTS and patients of QDS could be effectively distinguished. Compounds contributing to identify the two syndromes were sequenced as serine, valine, 2 hydroxy propionic acid. Comparison of metabolites showed contents of serine and 2 hydroxy propionic acid were higher in patients of PTS than in patients of QDS (P<0.05). The differences in the metabonomics of CHD TCM syndrome types could provide material bases for TCM syndrome differentiation of CHD, indicating that metabonomics technologies might become a new research method for TCM syndrome typing.

Masked syllable priming effects in word and picture naming in Chinese.

PubMed

You, Wenping; Zhang, Qingfang; Verdonschot, Rinus G

2012-01-01

Four experiments investigated the role of the syllable in Chinese spoken word production. Chen, Chen and Ferrand (2003) reported a syllable priming effect when primes and targets shared the first syllable using a masked priming paradigm in Chinese. Our Experiment 1 was a direct replication of Chen et al.'s (2003) Experiment 3 employing CV (e.g., ,/ba2.ying2/, strike camp) and CVG (e.g., ,/bai2.shou3/, white haired) syllable types. Experiment 2 tested the syllable priming effect using different syllable types: e.g., CV (,/qi4.qiu2/, balloon) and CVN (,/qing1.ting2/, dragonfly). Experiment 3 investigated this issue further using line drawings of common objects as targets that were preceded either by a CV (e.g., ,/qi3/, attempt), or a CVN (e.g., ,/qing2/, affection) prime. Experiment 4 further examined the priming effect by a comparison between CV or CVN priming and an unrelated priming condition using CV-NX (e.g., ,/mi2.ni3/, mini) and CVN-CX (e.g., ,/min2.ju1/, dwellings) as target words. These four experiments consistently found that CV targets were named faster when preceded by CV primes than when they were preceded by CVG, CVN or unrelated primes, whereas CVG or CVN targets showed the reverse pattern. These results indicate that the priming effect critically depends on the match between the structure of the prime and that of the first syllable of the target. The effect obtained in this study was consistent across different stimuli and different tasks (word and picture naming), and provides more conclusive and consistent data regarding the role of the syllable in Chinese speech production.

Development and Validation of an UPLC-MS/MS Method for Pharmacokinetic Comparison of Five Alkaloids from JinQi Jiangtang Tablets and Its Monarch Drug Coptidis Rhizoma

PubMed Central

Sun, Lili; Ding, Feifei; You, Guangjiao; Liu, Han; Wang, Meng; Ren, Xiaoliang; Deng, Yanru

2017-01-01

JinQi Jiangtang (JQJT) tablets, a Chinese patent medicine approved by the State Food and Drug Administration, are composed of Coptidis Rhizoma, Astragali Radix, and Lonicerae Japonicae Flos, and have a significant effect on diabetes. Coptidis Rhizoma is monarch drug in the prescription. The aim of the present study was to investigate and compare the pharmacokinetics of multiple ingredients from JQJT tablets and Coptidis Rhizoma extract (CRE) following oral administration in rats. Five alkaloids: coptisine chloride, epiberberine chloride, berberine chloride, jatrorrhizine chloride, and palmatine chloride, were simultaneously determined in rat plasma using established and validated ultra-high performance liquid chromatography mass spectrometry (UPLC-MS/MS). Significant pharmacokinetic differences were observed for the five alkaloids after a single administration of CRE and JQJT tablets. Compared with CRE, the Cmax values of palmatine chloride and jatrorrhizine chloride were decreased significantly, the AUC0–t values of four alkaloids (all except jatrorrhizine chloride) were notably decreased, and the mean residence times of all five alkaloids were significantly decreased after administration of JQJT tablets. The results indicated that the absorption characteristics of the five alkaloids from Coptidis Rhizoma would be influenced by the compatibility of Astragali Radix or Lonicerae Japonicae Flos from JQJT tablets, such that absorption was inhibited and elimination was accelerated. In conclusion, the developed strategy was suitable for the comparison of five alkaloids from JinQi Jiangtang tablets and its monarch drug, which could be valuable for compatibility studies of traditional Chinese medicines. PMID:29286316

The modified Yi qi decoction protects cardiac ischemia-reperfusion induced injury in rats.

PubMed

Yu, Xiao; Zhao, Xiao-Dong; Bao, Rong-Qi; Yu, Jia-Yu; Zhang, Guo-Xing; Chen, Jing-Wei

2017-06-21

To investigate the effects and involved mechanisms of the modified Yi Qi decoction (MYQ) in cardiac ischemia-reperfusion (IR) induced injury. Male Sprague-Dawley rats were subjected to a 30-min coronary arterial occlusion followed by reperfusion, low or high dose decoction of MYQ was administrated orally for 1 week or 1 month. Both in 1 week and 1 month IR rat groups, cardiac function indexes were significantly impaired compared with sham group rats, accompanied with higher ratio of infarct size to risk size, decreased expressions of sodium calcium exchanger (NCX1) and sarcoplasmic reticulum Ca 2+ -ATPase (Serca2a), and different expressions of autophagic proteins, Beclin-1 and LC3. Treatment with MYQ (low or high dose) for 1 week showed no marked beneficial effects on cardiac function and cardiac injury (ratio of infarct size to risk size), although expressions of anti-apoptotic protein, Bcl-2, NCX1 and Serca2a were increased. Treatment with MYQ (low or high dose) for 1 month showed significantly improved effects on cardiac function and cardiac injury (ratio of infarct size to risk size), accompanied with increase of Bcl-2, NCX1 and Serca2a expressions, and decrease of Bax (a pro-apoptotic protein) and Beclin-1 expressions. The results show that MYQ have potential therapeutic effects on IR-induced cardiac injury, which may be through regulation of apoptotic proteins, cytosolic Ca 2+ handling proteins and autophagic proteins signal pathways.

The Mobile Element Locator Tool (MELT): population-scale mobile element discovery and biology

PubMed Central

Gardner, Eugene J.; Lam, Vincent K.; Harris, Daniel N.; Chuang, Nelson T.; Scott, Emma C.; Pittard, W. Stephen; Mills, Ryan E.; Devine, Scott E.

2017-01-01

Mobile element insertions (MEIs) represent ∼25% of all structural variants in human genomes. Moreover, when they disrupt genes, MEIs can influence human traits and diseases. Therefore, MEIs should be fully discovered along with other forms of genetic variation in whole genome sequencing (WGS) projects involving population genetics, human diseases, and clinical genomics. Here, we describe the Mobile Element Locator Tool (MELT), which was developed as part of the 1000 Genomes Project to perform MEI discovery on a population scale. Using both Illumina WGS data and simulations, we demonstrate that MELT outperforms existing MEI discovery tools in terms of speed, scalability, specificity, and sensitivity, while also detecting a broader spectrum of MEI-associated features. Several run modes were developed to perform MEI discovery on local and cloud systems. In addition to using MELT to discover MEIs in modern humans as part of the 1000 Genomes Project, we also used it to discover MEIs in chimpanzees and ancient (Neanderthal and Denisovan) hominids. We detected diverse patterns of MEI stratification across these populations that likely were caused by (1) diverse rates of MEI production from source elements, (2) diverse patterns of MEI inheritance, and (3) the introgression of ancient MEIs into modern human genomes. Overall, our study provides the most comprehensive map of MEIs to date spanning chimpanzees, ancient hominids, and modern humans and reveals new aspects of MEI biology in these lineages. We also demonstrate that MELT is a robust platform for MEI discovery and analysis in a variety of experimental settings. PMID:28855259

Cupping therapy: A prudent remedy for a plethora of medical ailments

PubMed Central

Mehta, Piyush; Dhapte, Vividha

2015-01-01

Since ancient times, complementary and alternative medicine (CAM; 補充與替代醫學 bǔ chōng yǔ tì dài yī xué) have played an important role in human health and welfare. Many therapeutic approaches in healthcare outside the realm of conventional medicine persist in various parts of the world. There is considerable scientific and commercial potential in CAM, which needs to be explored precisely. Cupping therapy (拔罐療法 bá guàn liáo fǎ), one of the CAM, is practiced across the world. This therapy is believed to act by correcting imbalances in the internal bio field, such as by restoring the flow of “Qi (氣qì)”. Cupping involves applying a heated cup to generate a partial vacuum that mobilizes the blood flow and promotes effective healing. This review outlines various tools and techniques of cupping therapy. PMID:26151023

Caryotricha minuta (Xu et al., 2008) nov. comb., a unique marine ciliate (Protista, Ciliophora, Spirotrichea), with phylogenetic analysis of the ambiguous genus Caryotricha inferred from the small-subunit rRNA gene sequence.

PubMed

Miao, Miao; Shao, Chen; Jiang, Jiamei; Li, Liqiong; Stoeck, Thorsten; Song, Weibo

2009-02-01

A population of Kiitricha minuta Xu et al., 2008, a small kiitrichid ciliate, was isolated from a brackish water sample in Jiaozhou Bay, Qingdao, northern China. After comparison of its morphology and infraciliature, it is believed that this morphotype should be assigned to the genus Caryotricha; hence, a new combination is suggested, Caryotricha minuta (Xu et al., 2008) nov. comb. The small-subunit (SSU) rRNA gene sequence was determined in order to elucidate the phylogenetic position of this poorly known, ambiguous genus. The organism can be clearly separated from its congener, Caryotricha convexa Kahl, 1932, by the extremely shortened ventral cirral rows in the posterior ends. Based on the data available, an improved diagnosis is given for the genus: marine Kiitrichidae with prominent buccal field; two highly developed undulating membranes; non-grouped, uniform cirral rows on both ventral and dorsal sides; enlarged transverse cirri present, which are the only differentiated cirri; marginal cirri not present; one short migratory row located posterior to buccal field; structure of dorsal kineties generally in Kiitricha pattern. The sequence of the SSU rRNA gene of C. minuta differs by 13 % from that of Kiitricha marina. Molecular phylogenetic analyses (Bayesian inference, least squares, neighbour joining, maximum parsimony) indicate that Caryotricha, together with Kiitricha, diverges at a deep level from all other spirotrichs. Its branching position is between Phacodiniidia and Licnophoridia. The results strongly support the distinct separation of the Kiitricha-Caryotricha clade, which always branches basal to the Stichotrichia-Hypotrichia-Oligotrichia-Choreotrichia assemblage. These results also confirm the previous hypothesis that the Kiitricha-Caryotricha group, long assumed to be a close relation to the euplotids, represents a taxon at subclass level within the spirotrichs.

Ting Xu

Science.gov Websites

California, Berkeley tingxu@berkeley.edu 510-642-1632 Research profile » A U.S. Department of Energy National Laboratory Operated by the University of California UC logo Questions & Comments * Privacy Computational Study of Excited-State Phenomena in Energy Materials Center for X-ray Optics MSD Facilities Ion

Implementation of a programme to market a complementary food supplement (Ying Yang Bao) and impacts on anaemia and feeding practices in Shanxi, China.

PubMed

Sun, Jing; Dai, Yaohua; Zhang, Shuaiming; Huang, Jian; Yang, Zhenyu; Huo, Junsheng; Chen, Chunming

2011-10-01

In China, a full fat soy powder mixed with multiple micronutrient powders (Ying Yang Bao (YYB)) was developed, and the efficacy of YYB was shown in controlling anaemia and improving child growth and development. However, prior to 2008, there was no sustainable way to provide YYB to vulnerable populations, except through free distribution by the government. This study was to test the concept of public-private partnership (PPP) to deliver YYB and to evaluate the effectiveness of marketing YYB through PPP. Programme activities included development of a complementary food supplement (CFS) national standard, product concept test, product development and marketing, behavior change communication, monitoring and evaluation. Baseline and end-line surveys were used to evaluate product awareness, purchasing and the impacts of the project on anaemia and feeding practices. A Chinese CFS standard was approved. Caregivers and their 6- to-24-month-old children participated in the baseline (n=226) and the end-line survey (n=221). A concept test at the baseline survey showed that 78% of caregivers were willing to buy YYB at 0.1 USD. After developing the product and implementing the intervention for 8 months, 59.6% of surveyed caregivers purchased YYB. While not significant, the prevalence of anaemia was marginally lower at the end line (28.8%) than at the baseline (36.2%). For those purchasing YYB, the risk of anaemia was significantly reduced by 87% of odds (P<0.009). The end-line survey found that feeding practices had improved significantly following the intervention. An enabling policy and regulatory environment in which CFSs are defined and parameters for appropriate marketing are identified as a prerequisite for marketing YYB or other nutritious CFS. Public and private advocacy and marketing could successfully increase awareness of YYB and access and use through market channels. The YYB project may be effective for reducing anaemia and improving feeding practices. © 2011

The cost-effectiveness analysis of JinQi Jiangtang tablets for the treatment on prediabetes: a randomized, double-blind, placebo-controlled, multicenter design.

PubMed

Sun, Xiao; Guo, Liping; Shang, Hongcai; Ren, Ming; Wang, Yue; Huo, Da; Lei, Xiang; Wang, Hui; Zhai, Jingbo

2015-11-03

reduced the incidence of diabetes mellitus and enhanced reversion rate. compared with the control group (p< 0.05); the scores of SF-36 of two groups had no significant difference P> 0.05); finally the compliance of participants between the two groups had no significant difference. The cost-effectiveness analysis outcomes:in the intervention period of 12 months,on the aspect of reversion rate, the treatment group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio;on the aspect of the incidence of diabetes, the control group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio; in the follow-up period of 24 months, on the aspect of reversion rate, the treatment group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio, on the aspect of the incidence of diabetes, the control group had better economic advantage by using cost-effectivenes ratio and the incremental cost-effectiveness ratio.At the same time, these outcomes remained the same by sensitivity analysis. Assuming that prices and resident incomes rose 5%, the sensitiveness analysis shows that the two group affected by the paremeters changed little. The importance and effectiveness of lifestyle education and JinQi Jiangtang tablets was proven. In both the intervention period and follow-up, JinQi Jiangtang tablets combined with lifestyle education had a greater cost advantage effect than the lifestyle education alone on the reversion rate; the lifestyle education had a greater cost advantage effect than the JinQi Jiangtang tablets combined with lifestyle education on the incidence of diabetes. Chinese Clinical Trials ChiCTR-TRC-09000401 ) , registered on 25 May 2009.

A distal 594 bp ECR specifies Hmx1 expression in pinna and lateral facial morphogenesis and is regulated by the Hox-Pbx-Meis complex

DOE PAGES

Rosin, Jessica M.; Li, Wenjie; Cox, Liza L.; ...

2016-07-19

Hmx1 encodes a homeodomain transcription factor expressed in the developing lateral craniofacial mesenchyme, retina and sensory ganglia. Mutation or mis-regulation of Hmx1 underlies malformations of the eye and external ear in multiple species. Deletion or insertional duplication of an evolutionarily conserved region (ECR) downstream of Hmx1 has recently been described in rat and cow, respectively. Here, we demonstrate that the impact of Hmx1 loss is greater than previously appreciated, with a variety of lateral cranioskeletal defects, auriculofacial nerve deficits, and duplication of the caudal region of the external ear. Using a transgenic approach, we demonstrate that a 594 bp sequencemore » encompassing the ECR recapitulates specific aspects of the endogenous Hmx1 lateral facial expression pattern. Moreover, we show that Hoxa2, Meis and Pbx proteins act cooperatively on the ECR, via a core 32 bp sequence, to regulate Hmx1 expression. In conclusion, these studies highlight the conserved role for Hmx1 in BA2-derived tissues and provide an entry point for improved understanding of the causes of the frequent lateral facial birth defects in humans.« less

A distal 594 bp ECR specifies Hmx1 expression in pinna and lateral facial morphogenesis and is regulated by the Hox-Pbx-Meis complex

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

Rosin, Jessica M.; Li, Wenjie; Cox, Liza L.

Hmx1 encodes a homeodomain transcription factor expressed in the developing lateral craniofacial mesenchyme, retina and sensory ganglia. Mutation or mis-regulation of Hmx1 underlies malformations of the eye and external ear in multiple species. Deletion or insertional duplication of an evolutionarily conserved region (ECR) downstream of Hmx1 has recently been described in rat and cow, respectively. Here, we demonstrate that the impact of Hmx1 loss is greater than previously appreciated, with a variety of lateral cranioskeletal defects, auriculofacial nerve deficits, and duplication of the caudal region of the external ear. Using a transgenic approach, we demonstrate that a 594 bp sequencemore » encompassing the ECR recapitulates specific aspects of the endogenous Hmx1 lateral facial expression pattern. Moreover, we show that Hoxa2, Meis and Pbx proteins act cooperatively on the ECR, via a core 32 bp sequence, to regulate Hmx1 expression. In conclusion, these studies highlight the conserved role for Hmx1 in BA2-derived tissues and provide an entry point for improved understanding of the causes of the frequent lateral facial birth defects in humans.« less

Volatile organic compounds sources and sinks in a wheat canopy. Analysis based on combined eddy-covariance fluxes, in-canopy profiles and chamber measurements with a PTR-TOF-Qi-MS

NASA Astrophysics Data System (ADS)

Loubet, Benjamin; Gonzaga, Lais; Buysse, Pauline; Ciuraru, Raluca; Lafouge, Florence; Decuq, Céline; Zurfluh, Olivier; Fortineau, Alain; Fanucci, Olivier; Sarda-Esteve, Roland; Zannoni, Nora; Truong, Francois; Boissard, Christophe; Gros, Valérie

2017-04-01

Volatile organic compounds (VOC) are essential drivers of atmospheric chemistry. Many VOCs are emitted from and deposited to ecosystems. While forests and grasslands have already been substantially studied, exchanges of VOCs with crops are less known, although these ecosystems represent more than 50% of the surface in France. In this study, we analyze sources and sinks of VOCs in a wheat field (at the ICOS FR-GRI site near Paris) at anthesis based on measurements of fluxes, concentration profiles and branch chambers. The VOCs were measured using a PTR-TOF-Qi-MS (where Qi stands for Quad Ion guide). Air was successively sampled through lines located at different heights within and above the canopy, of which one was used for Eddy Covariance and located near a sonic anemometer. Additional measurements included the standard ICOS meteorological data as well as leaf area index profiles and photosynthesis curves at several heights in the canopy. We report fluxes and profiles for more than 500 VOCs. The deposition velocities of depositing compounds are compared to the maximum exchange velocity and the ozone deposition velocity. The sources and sinks location and magnitude are evaluated by inverse Lagrangian modelling assuming no reaction and simple reaction schemes in the canopy. The sources and sinks of VOC in the canopy are interpreted in terms crop phenology and the potential for reaction with ozone and NOx is evaluated. This study takes place in the ADEME CORTEA COV3ER French project (http://www6.inra.fr/cov3er).

The efficacy and safety of Jiedu Tongluo granules for treating post-stroke depression with qi deficiency and blood stasis syndrome: study protocol for a randomized controlled trial.

PubMed

Zhao, Ai-Mei; Qiu, Wen-Ran; Mao, Li-Jun; Ren, Jun-Guo; Xu, Li; Yao, Ming-Jiang; Bilinksi, Kellie; Chang, Dennis; Liu, Jian-Xun

2018-05-10

Post-stroke depression (PSD) is the most common psychiatric complication after a stroke. The most frequently used antidepressants are selective serotonin receptor inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), however, these exhibit a series of side effects. Traditional Chinese medicine has been used to treat PSD with few side effects. The aim of this study is to evaluate the efficacy and safety of Jiedu Tongluo granules for treating PSD with qi deficiency and blood stasis syndrome. The planned study is a double-blind, randomized, placebo-controlled pilot trial. Eighty participants will be randomly assigned to receive either treatment or placebo. The treatment group will receive Jiedu Tongluo granules (JDTLG) with conventional treatment, and the placebo group will receive placebo with conventional treatment for 8 weeks. The primary outcome is the effectiveness of JDTLG on depression after 8 weeks treatment, which is defined as a decrease of 50% or more in 17-item Hamilton Depression Scale (HAMD-17) score or clinical recovery (score < 7). Secondary outcomes are improvement in neurological function, degree of independence, activities of daily living, and TCM syndrome at each visit, which will be measured with National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Barthel Index (BI) and TCM scale, respectively. Interleukin (IL)-6, IL-8, and small-molecule metabolites will be monitored to explore the mechanism of action of JDTLG on PSD. Safety measures include vital signs, results of electrocardiography, laboratory index (full blood count, kidney and liver function tests) and adverse events. The purpose of this trial is to evaluate the therapeutic effects and safety of JDTLG in individuals with PSD with concomitant qi deficiency and blood stasis syndrome. If successful, the outcome of this trial will provide a viable treatment option for PSD patients. ClinicalTrials.gov ID: NCT03147053 . Registered on

Electronic structure of the ingredient planes of Bi2Sr2CaCu2O8 + δ and Bi2Sr2CuO6 + δ superconductors

NASA Astrophysics Data System (ADS)

Ma, Xucun

Understanding the mechanism of high transition temperature superconductivity in cuprates has been hindered by the apparent complexity of their multilayered crystal structure. Using a cryogenic scanning tunneling microscopy (STM), we report on layer-by-layer probing of the electronic structures of the ingredient planes (BiO, SrO, CuO2) of Bi2Sr2CaCu2O8 + δ (Bi-2212) and Bi2Sr2CuO6 + δ (Bi-2201) superconductors prepared by argon-ion bombardment and annealing (IBA) technique. We show that the well-known pseudogap (PG) feature observed by STM is inherently a property of the charge reservoir planes and thus irrelevant directly to Cooper pairing. The CuO2 planes are exclusively characterized by a small gap inside the PG. The small gap becomes invisible near Tc, which we identify as the superconducting gap. The results constitute severe constraints on any microscopic model for high Tc superconductivity in cuprates. Contributors: Yan-Feng Lv, Wen-Lin Wang, Hao Ding, Yang Wang, Yong Zhong, Ying Ding, Ruidan Zhong, John Schneeloch, Gen-Da Gu, Lili Wang, Ke He, Shuai-Hua Ji, Lin Zhao, Xing-Jiang Zhou Can-Li Song, and Qi-Kun Xue. NSF and MOST of China.

The summer snow cover anomaly over the Tibetan Plateau and its association with simultaneous precipitation over the mei-yu-baiu region

NASA Astrophysics Data System (ADS)

Liu, Ge; Wu, Renguang; Zhang, Yuanzhi; Nan, Sulan

2014-07-01

The summer snow anomalies over the Tibetan Plateau (TP) and their effects on climate variability are often overlooked, possibly due to the fact that some datasets cannot properly capture summer snow cover over high terrain. The satellite-derived Equal-Area Scalable Earth grid (EASE-grid) dataset shows that snow still exists in summer in the western part and along the southern flank of the TP. Analysis demonstrates that the summer snow cover area proportion (SCAP) over the TP has a significant positive correlation with simultaneous precipitation over the mei-yu-baiu (MB) region on the interannual time scale. The close relationship between the summer SCAP and summer precipitation over the MB region could not be simply considered as a simultaneous response to the Silk Road pattern and the SST anomalies in the tropical Indian Ocean and tropical central-eastern Pacific. The SCAP anomaly has an independent effect and may directly modulate the land surface heating and, consequently, vertical motion over the western TP, and concurrently induce anomalous vertical motion over the North Indian Ocean via a meridional vertical circulation. Through a zonal vertical circulation over the tropics and a Kelvin wave-type response, anomalous vertical motion over the North Indian Ocean may result in an anomalous high over the western North Pacific and modulate the convective activity in the western Pacific warm pool, which stimulates the East Asia-Pacific (EAP) pattern and eventually affects summer precipitation over the MB region.

The Utilization during Mitotic Cell Division of Loci Controlling Meiotic Recombination and Disjunction in DROSOPHILA MELANOGASTER

PubMed Central

Baker, Bruce S.; Carpenter, Adelaide T. C.; Ripoll, P.

1978-01-01

To inquire whether the loci identified by recombination-defective and disjunction-defective meiotic mutants in Drosophila are also utilized during mitotic cell division, the effects of 18 meiotic mutants (representing 13 loci) on mitotic chromosome stability have been examined genetically. To do this, meiotic-mutant-bearing flies heterozygous for recessive somatic cell markers were examined for the frequencies and types of spontaneous clones expressing the cell markers. In such flies, marked clones can arise via mitotic recombination, mutation, chromosome breakage, nondisjunction or chromosome loss, and clones from these different origins can be distinguished. In addition, meiotic mutants at nine loci have been examined for their effects on sensitivity to killing by UV and X rays.—Mutants at six of the seven recombination-defective loci examined (mei-9, mei-41, c(3)G, mei-W68, mei-S282, mei-352, mei-218) cause mitotic chromosome instability in both sexes, whereas mutants at one locus (mei-218) do not affect mitotic chromosome stability. Thus many of the loci utilized during meiotic recombination also function in the chromosomal economy of mitotic cells.—The chromosome instability produced by mei-41 alleles is the consequence of chromosome breakage, that of mei-9 alleles is primarily due to chromosome breakage and, to a lesser extent, to an elevated frequency of mitotic recombination, whereas no predominant mechanism responsible for the instability caused by c(3)G alleles is discernible. Since these three loci are defective in their responses to mutagen damage, their effects on chromosome stability in nonmutagenized cells are interpreted as resulting from an inability to repair spontaneous lesions. Both mei-W68 and mei-S282 increase mitotic recombination (and in mei-W68, to a lesser extent, chromosome loss) in the abdomen but not the wing. In the abdomen, the primary effect on chromosome stability occurs during the larval period when the abdominal histoblasts

Review of Cycadophila Xu, Tang & Skelley (Coleoptera: Erotylidae: Pharaxonothinae) inhabiting Cycas (Cycadaceae) in Asia, with descriptions of a new subgenus and thirteen new species.

PubMed

Skelley, Paul; Xu, Guang; Tang, William; Lindström, Anders J; Marler, Thomas; Khuraijam, Jibankumar Singh; Singh, Rita; Radha, P; Rich, Stephen

2017-05-12

The genus Cycadophila Xu, Tang & Skelley (Coleoptera: Erotylidae: Pharaxonothinae) associated with Cycas L. (Cycadacaeae) in Asia is reviewed. Strobilophila, new subgenus, with five species is described: Cycadophila (Strobilophila) assamensis new species, C. (S.) hiepi new species, C. (S.) kwaiensis new species, C. (S.) tansachai new species and C. (S.) yangi new species, all associated with Cycas. For the nominate subgenus Cycadophila eight new species are described, Cycadophila (Cycadophila) abyssa new species, C. (C.) collina new species,C. (C.) samara new species, C. (C.) convexa new species, C. (C.) cyclochasma new species, C. (C.) eurynota new species, C. (C.) papua new species, and C. (C.) torquata new species and four new generic combinations are proposed: C. (C.) vittata (Arrow) new combination, C. (C.) discimaculata (Mader) new combination, C. (C.) intermedia (Chûjô) new combination, and C. (C.) lata (Grouvelle) new combination. Only the first three listed species of the nominate subgenus have known associations with Cycas. Species are distinguished on the basis of morphology and/or by analysis of 16S rRNA gene sequences. The larva of subgenus Strobilophila is described based on individuals collected together with adults and matched with analysis of 16S rRNA gene sequences. Keys to subgenera and species of known adults and larvae are provided.

Antiproliferative effect of a food coloring on colon cancer cell line.

PubMed

Norizadeh Tazehkand, M

2017-01-01

4-MEI (4-Methylimidazole) is used as a chemical intermediate, crude material or component in the manufacture of pharmaceuticals, photographic and photothermographic chemicals, dyes and pigments and agricultural chemicals. 4-MEI is unintentionally found in our food. Caramel colour (which is the most used beverage colouring and food), dark beers and common brands of cola drinks may comprise more than 100 μg of this compound per 12-ounce serving. 4-MEI is widely used by people and colon cancer is common in our countries. So, it was decided to do in vitro analysis of anti-cancer effect of 4-MEI by MTT test using htc-116 cell line.In this study, mouse Htc-116 cell line was treated with 4-MEI concentrations of 300, 450, 600 and 750 µg/mL for 24 hours and 48 hours periods, after that antiproliferative effect of the 4-MEI was studied by MTT assay. In this study 4-MEI at highest concentration of 24h and at all concentration for 48 h treatment time significantly inhibited cell proliferation when it was compared to control. Also, exposing to the 4-MEI for 48 hours led to a decrease in cells proliferation by concentration dependent manner. This result showed that 4-MEI had anticancer effect in htc-116 cells. However, it has to be evaluated with different new studies (Tab. 1, Fig. 4, Ref. 19).

Identification of a New Isoindole-2-yl Scaffold as a Qo and Qi Dual Inhibitor of Cytochrome bc 1 Complex: Virtual Screening, Synthesis, and Biochemical Assay.

PubMed

Azizian, Homa; Bagherzadeh, Kowsar; Shahbazi, Sophia; Sharifi, Niusha; Amanlou, Massoud

2017-09-18

Respiratory chain ubiquinol-cytochrome (cyt) c oxidoreductase (cyt bc 1 or complex III) has been demonstrated as a promising target for numerous antibiotics and fungicide applications. In this study, a virtual screening of NCI diversity database was carried out in order to find novel Qo/Qi cyt bc 1 complex inhibitors. Structure-based virtual screening and molecular docking methodology were employed to further screen compounds with inhibition activity against cyt bc 1 complex after extensive reliability validation protocol with cross-docking method and identification of the best score functions. Subsequently, the application of rational filtering procedure over the target database resulted in the elucidation of a novel class of cyt bc 1 complex potent inhibitors with comparable binding energies and biological activities to those of the standard inhibitor, antimycin.

[Impacts on chronic fatigue syndrome of qi deficiency syndrome and T cell subgroups in patients treated with acupuncture at selective time].

PubMed

Ling, Jia-Yan; Shen, Lin; Liu, Qing; Wang, Ling-Yun

2013-12-01

To verify the clinical efficacy on chronic fatigue syndrome of qi deficiency syndrome treated with acupuncture at selective time and explore the effect mechanism. Eighty patients were randomized into a selective-time-acupuncture group and an acupuncture group, 40 cases in each one. Qihai (CV 6), Guanyuan (CV 4), Hegu (LI 4), Taichong (LR 3), Sanyinjiao (SP 6) and Zusanli (ST 36) were selected in the two groups. In the selective-time-acupuncture group, acupuncture was used at 9:00am to 11:00am. In the acupuncture group, acupuncture was used at any time except in the range from 9:00am to 11:00am. No any manipulation was applied after the arrival of needling sensation. The treatment was given once every day, 10 day treatment made one session and two sessions of treatment were required. The fatigue scale was adopted to evaluate the efficacy before and after treatment in the patients of the two groups. The ratios among CD3+, CD4+ and CD8+ T cells in the peripheral blood were detected before ad b a after treatment. In the acupuncture group, the total score of fatigue and the score of physical fatigue were reduced after treatment as compared with those before treatment (all P<0.05). In the selective-time -acupuncture group, the total score of fatigue, the s core of physical fatigue and the score of mental fatigue after treatment were reduced obviously as compared with those hefore treatment (all P<0. 01). The improvements in the scores of the selective-time-acupuncture group were superior to the acupuncture group (all P<0. 05). The ratio of CD3+ and CD8+ T cells was increased obviously after treatment in the two groups (all P<0. 05) and the ratio of CD4+ and CD8+ T cells was reduced obviously in the selective-time-acupuncture group (P<0. 05), which was better than that in the acupuncture group (all P<0.05). The total effective rate was 95.0% (38/40) in the selective-time-acupuncture group, which was better than 80.0% (32/40) in the acupuncture group (P<0.05). The

Pharmacist leadership in ICU quality improvement: coordinating spontaneous awakening and breathing trials.

PubMed

Stollings, Joanna L; Foss, Julie J; Ely, E Wesley; Ambrose, Anna M; Rice, Todd W; Girard, Timothy D; Wheeler, Arthur P

2015-08-01

Coordinating efforts across disciplines in the intensive care unit is a key component of quality improvement (QI) efforts. Spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) are considered key components of guidelines, yet unfortunately are often not done or coordinated properly. To determine if a pharmacist-driven awakening and breathing coordination (ABC) QI program would improve compliance (ie, process measures) as compared with the previous protocol, which did not involve pharmacists. The QI program included pharmacist-led education, daily discussion on rounds, and weekly performance reports to staff. Using a pre-QI versus during-QI versus post-QI intervention design, we compared data from 500 control ventilator-days (pre-QI period) versus 580 prospective ventilator-days (during-QI period). We then evaluated the sustainability of the QI program in 216 ventilator-days in the post-QI period. SAT safety screens were performed on only 20% pre-QI patient-days versus 97% of during-QI patient-days (P < 0.001) and 100% of post-QI patient-days (P = 0.25). The rates of passing the SAT safety screen in pre-QI and during-QI periods were 63% versus 78% (P = 0.03) and 81% in the post-QI period (P = 0.86). The rates of SATs among eligible patients on continuous infusions were only 53% in the pre-QI versus 85% in the during-QI (P = 0.0001) and 87% in the post-QI (P = 1) periods. In this QI initiative, a pharmacist-driven, interdisciplinary ABC protocol significantly improved process measures compliance, comparing the pre-QI versus during-QI rates of screening, performing, and coordinating SAT and SBTs, and these results were sustained in the 8-month follow-up period post-QI program. © The Author(s) 2015.

Measurements of VOC fluxes by Eddy-covariance with a PTR-Qi-TOF-MS over a mature wheat crop near Paris: Evaluation of data quality and uncertainties.

NASA Astrophysics Data System (ADS)

Buysse, Pauline; Loubet, Benjamin; Ciuraru, Raluca; Lafouge, Florence; Zurfluh, Olivier; Gonzaga-Gomez, Lais; Fanucci, Olivier; Gueudet, Jean-Christophe; Decuq, Céline; Gros, Valérie; Sarda, Roland; Zannoni, Nora

2017-04-01

The quantification of volatile organic compounds (VOC) fluxes exchanged by terrestrial ecosystems is of large interest because of their influence on the chemistry and composition of the atmosphere including aerosols and oxidants. Latest developments in the techniques for detecting, identifying and measuring VOC fluxes have considerably improved the abilities to get reliable estimates. Among these, the eddy-covariance (EC) methodology constitutes the most direct approach, and relies on both well-established principles (Aubinet et al. 2000) and a sound continuously worldwide improving experience. The combination of the EC methodology with the latest proton-transfer-reaction mass spectrometer (PTR-MS) device, the PTR-Qi-TOF-MS, which allows the identification and quantification of more than 500 VOC at high frequency, now provides a very powerful and precise tool for an accurate quantification of VOC fluxes on various types of terrestrial ecosystems. The complexity of the whole methodology however demands that several data quality requirements are fulfilled. VOC fluxes were measured by EC with a PTR-Qi-TOF-MS (national instrument within the ANAEE-France framework) for one month and a half over a mature wheat crop near Paris (FR-GRI ICOS site). Most important emissions (by descending order) were observed from detected compounds with mass-over-charge (m/z) ratios of 33.033 (methanol), 45.033 (acetaldehyde), 93.033 (not identified yet), 59.049 (acetone), and 63.026 (dimethyl sulfide or DMS). Emissions from higher-mass compounds, which might be due to pesticide applications at the beginning of our observation period, were also detected. Some compounds were also seen to deposit (e.g. m/z 47.013, 71.085, 75.044, 83.05) while others exhibited bidirectional fluxes (e.g. m/z 57.07, 69.07). Before analyzing VOC flux responses to meteorological and crop development drivers, a data quality check was performed which included (i) uncertainty analysis of mass and concentration

Accelerated degradation of methyl iodide by agrochemicals.

PubMed

Zheng, Wei; Papiernik, Sharon K; Guo, Mingxin; Yates, Scott R

2003-01-29

The fumigant methyl iodide (MeI, iodomethane) is considered a promising alternative to methyl bromide (MeBr) for soil-borne pest control in high-cash-value crops. However, the high vapor pressure of MeI results in emissions of a significant proportion of the applied mass into the ambient air, and this may lead to pollution of the environment. Integrating the application of certain agrochemicals with soil fumigation provides a novel approach to reduce excessive fumigant emissions. This study investigated the potential for several agrochemicals that are commonly used in farming operations, including fertilizers and nitrification inhibitors, to transform MeI in aqueous solution. The pseudo-first-order hydrolysis half-life (t(1/2)) of MeI was approximately 108 d, while the transformation of MeI in aqueous solutions containing selected agrochemicals was more rapid, with t(1/2) < 100 d (t(1/2) < 0.5 d in some solutions containing nitrification inhibitors). The influence of these agrochemicals on the rate of MeI degradation in soil was also determined. Adsorption to soil apparently reduced the availability of some nitrification inhibitors in the soil aqueous phase and lowered the degradation rate in soil. In contrast, addition of the nitrification inhibitors thiourea and allylthiourea to soil significantly accelerated the degradation of MeI, possibly due to soil surface catalysis. The t(1/2) of MeI was <20 h in thiourea- and allylthiourea-amended soil, considerably less than that in unamended soil (t(1/2) > 300 h).

Caramel Color in Soft Drinks and Exposure to 4-Methylimidazole: A Quantitative Risk Assessment

PubMed Central

Smith, Tyler J. S.; Wolfson, Julia A.; Jiao, Ding; Crupain, Michael J.; Rangan, Urvashi; Sapkota, Amir; Bleich, Sara N.; Nachman, Keeve E.

2015-01-01

Caramel color is added to many widely-consumed beverages as a colorant. Consumers of these beverages can be exposed to 4-methylimidazole (4-MEI), a potential carcinogen formed during its manufacture. California’s Proposition 65 law requires that beverages containing 4-MEI concentrations corresponding to exposures that pose excess cancer risks > 1 case per 100,000 exposed persons (29 μg 4-MEI/day) carry warning labels. Using ultrahigh-performance liquid chromatography-tandem mass spectrometry, we assessed 4-MEI concentrations in 12 beverages purchased in California and a geographically distant metropolitan area (New York) in which warning labels are not required. In addition, we characterized beverage consumption by age and race/ethnicity (using weighted means calculated from logistic regressions) and assessed 4-MEI exposure and resulting cancer risks and US population cancer burdens attributable to beverage consumption. Data on beverage consumption were obtained from the National Health and Nutrition Examination Survey, dose-response data for 4-MEI were obtained from the California Environmental Protection Agency Office of Environmental Health Hazards Assessment, and data on population characteristics were obtained from the U.S. Census Bureau. Of the 12 beverages, Malta Goya had the highest 4-MEI concentration (915.8 to 963.3μg/L), lifetime average daily dose (LADD - 8.04x10-3 mg/kgBW-day), lifetime excess cancer risk (1.93x10-4) and burden (5,011 cancer cases in the U.S. population over 70 years); Coca-Cola had the lowest value of each (4-MEI: 9.5 to 11.7μg/L; LADD: 1.01x10-4 mg/kgBW-day; risk: 1.92x10-6; and burden: 76 cases). 4-MEI concentrations varied considerably by soda and state/area of purchase, but were generally consistent across lots of the same beverage purchased in the same state/area. Routine consumption of certain beverages can result in 4-MEI exposures > 29 μg/day. State regulatory standards appear to have been effective in reducing exposure

Caramel color in soft drinks and exposure to 4-methylimidazole: a quantitative risk assessment.

PubMed

Smith, Tyler J S; Wolfson, Julia A; Jiao, Ding; Crupain, Michael J; Rangan, Urvashi; Sapkota, Amir; Bleich, Sara N; Nachman, Keeve E

2015-01-01

Caramel color is added to many widely-consumed beverages as a colorant. Consumers of these beverages can be exposed to 4-methylimidazole (4-MEI), a potential carcinogen formed during its manufacture. California's Proposition 65 law requires that beverages containing 4-MEI concentrations corresponding to exposures that pose excess cancer risks > 1 case per 100,000 exposed persons (29 μg 4-MEI/day) carry warning labels. Using ultrahigh-performance liquid chromatography-tandem mass spectrometry, we assessed 4-MEI concentrations in 12 beverages purchased in California and a geographically distant metropolitan area (New York) in which warning labels are not required. In addition, we characterized beverage consumption by age and race/ethnicity (using weighted means calculated from logistic regressions) and assessed 4-MEI exposure and resulting cancer risks and US population cancer burdens attributable to beverage consumption. Data on beverage consumption were obtained from the National Health and Nutrition Examination Survey, dose-response data for 4-MEI were obtained from the California Environmental Protection Agency Office of Environmental Health Hazards Assessment, and data on population characteristics were obtained from the U.S. Census Bureau. Of the 12 beverages, Malta Goya had the highest 4-MEI concentration (915.8 to 963.3μg/L), lifetime average daily dose (LADD - 8.04x10-3 mg/kgBW-day), lifetime excess cancer risk (1.93x10-4) and burden (5,011 cancer cases in the U.S. population over 70 years); Coca-Cola had the lowest value of each (4-MEI: 9.5 to 11.7μg/L; LADD: 1.01x10-4 mg/kgBW-day; risk: 1.92x10-6; and burden: 76 cases). 4-MEI concentrations varied considerably by soda and state/area of purchase, but were generally consistent across lots of the same beverage purchased in the same state/area. Routine consumption of certain beverages can result in 4-MEI exposures > 29 μg/day. State regulatory standards appear to have been effective in reducing exposure to

Quality improvement for patient safety: project-level versus program-level learning.

PubMed

Rivard, Peter E; Parker, Victoria A; Rosen, Amy K

2013-01-01

Improving quality and patient safety is of increasing strategic importance to health care organizations. However, simply increasing the volume of quality improvement (QI) activity does not necessarily improve patient outcomes. There is a need for greater understanding of QI success factors. This study looked for differences in QI implementation across hospitals with a range of performance on Patient Safety Indicators. We conducted an exploratory comparative case study of 4 Veterans Health Administration hospitals including site visits and interviews with leaders and staff. Two themes emerged. Project-level QI learning is assessing and modifying specific QI projects relative to expectations. Program-level QI learning is assessing and modifying the overall QI endeavor. The nature of project-level QI learning was similar across sites, whereas we identified qualitative differences across organizations in program-level QI learning. The highest performing organization was evaluating and refining its overall approach to QI, whereas the others were learning how to build and control QI programs. Program-level QI learning may be key if a QI program is to succeed in improving patient outcomes. This type of organizational learning entails a big-picture, organization-wide view of QI. It also entails second-order organizational learning based on assessment not only of whether QI is being done correctly but also whether the right QI activities are being done, for the right reasons. The organization is "learning to learn." In addition to gaining mastery and control of QI, leaders regularly engage with staff in rethinking QI and experimenting with new approaches. Leaders also assess how QI activity fits in the organization's developmental journey and how it supports realization of strategy.

Pediatrics Residents' Confidence and Performance Following a Longitudinal Quality Improvement Curriculum.

PubMed

Courtlandt, Cheryl; Noonan, Laura; Koricke, Maureen Walsh; Zeskind, Philip Sanford; Mabus, Sarah; Feld, Leonard

2016-02-01

Quality improvement (QI) training is an integral part of residents' education. Understanding the educational value of a QI curriculum facilitates understanding of its impact. The purpose of this study was to evaluate the effects of a longitudinal QI curriculum on pediatrics residents' confidence and competence in the acquisition and application of QI knowledge and skills. Three successive cohorts of pediatrics residents (N = 36) participated in a longitudinal curriculum designed to increase resident confidence in QI knowledge and skills. Key components were a succession of progressive experiential projects, QI coaching, and resident team membership culminating in leadership of the project. Residents completed precurricular and postcurricular surveys and demonstrated QI competence by performance on the pediatric QI assessment scenario. Residents participating in the Center for Advancing Pediatric Excellence QI curriculum showed significant increases in pre-post measures of confidence in QI knowledge and skills. Coaching and team leadership were ranked by resident participants as having the most educational value among curriculum components. A pediatric QI assessment scenario, which correlated with resident-perceived confidence in acquisition of QI skills but not QI knowledge, is a tool available to test pediatrics residents' QI knowledge. A 3-year longitudinal, multimodal, experiential QI curriculum increased pediatrics residents' confidence in QI knowledge and skills, was feasible with faculty support, and was well-accepted by residents.

Degradation of the unbiodegradable particulate fraction (XU) from different activated sludges during batch digestion tests at ambient temperature.

PubMed

Habermacher, Jonathan; Benetti, Antonio Domingues; Derlon, Nicolas; Morgenroth, Eberhard

2016-07-01

One strategy for the management of excess sludge in small wastewater treatment plants (WWTPs) consists in minimizing the excess sludge production by operating the WWTP at very long solids retention times (SRTs > 30 days). A number of recent studies have suggested that sludge minimization at very long SRT results from the degradation of the unbiodegradable particulate fraction (XU) (influent unbiodegradable compounds and endogenous decay products). But the biodegradability of the unbiodegradable particulate fraction has only been evaluated during batch digestion test performed at ambient temperature with sludge fed with synthetic wastewaters. It is not clear to what extent observations made for sludge fed with synthetic influents can be transposed to sludge fed with real influent. The current study thus focused on evaluating the biodegradability of the unbiodegradable particulate fraction for sludge fed with real wastewater. Batch digestion tests (400 days, ambient temperature) were conducted with three different sludges fed with either synthetic or real influents and exposed to aerobic or intermittent aeration conditions. Our results indicate that volatile suspended solids (VSS) decreased even after complete decay of the active biomass (i.e., after 30 days of aerobic batch digestion) indicating that the unbiodegradable particulate fraction is biodegradable. However, very low degradation rates of the unbiodegradable particulate fraction were monitored after day 30 of digestion (0.7-1.7·10(-3) d(-1)). These values were in the lower range of previously published values for synthetic wastewaters (1-7.5·10(-3) d(-1)). The low values determined in our study indicate that the rate could decrease over time or that sludge composition influences the degradability of the unbiodegradable particulate fraction. But our results also demonstrate that extracellular polymeric substances (EPS) have a minor impact on the biodegradability of the unbiodegradable particulate

Process-induced formation of imidazoles in selected foods.

PubMed

Mottier, Pascal; Mujahid, Claudia; Tarres, Adrienne; Bessaire, Thomas; Stadler, Richard H

2017-08-01

The presence of 4-methylimidazole (4-MEI), 2-methylimidazole (2-MEI) and 2-acetyl-4-tetrahydroxybutylimidazole (THI) in some foods may result from the usage of caramel colorants E150c and E150d as food additives. This study demonstrates that alkylimidazoles are also byproducts formed from natural constituents in foods during thermal processes. A range of heat-processed foods that are known not to contain caramel colorants were analyzed by isotope dilution LC-MS/MS to determine the contamination levels. Highest 4-MEI concentrations (up to 466µg/kg) were observed in roasted barley, roasted malt and cocoa powders, with the concomitant presence of 2-MEI and/or THI in some cases, albeit at significantly lower levels. Low amounts of 4-MEI (<20µg/kg) were also detected in cereal-based foods such as breakfast cereals and bread toasted to a brown color (medium toasted). The occurrence of 4-MEI in certain processed foods is therefore not a reliable indicator of the presence of the additives E150c or E150d. Copyright © 2017 Elsevier Ltd. All rights reserved.

An exploratory analysis of the model for understanding success in quality.

PubMed

Kaplan, Heather C; Froehle, Craig M; Cassedy, Amy; Provost, Lloyd P; Margolis, Peter A

2013-01-01

Experience suggests that differences in context produce variability in the effectiveness of quality improvement (QI) interventions. However, little is known about which contextual factors affect success or how they exert influence. Using the Model for Understanding Success in Quality (MUSIQ), we perform exploratory quantitative tests of the role of context in QI success. We used a cross-sectional design to survey individuals participating in QI projects in three settings: a pediatric hospital, hospitals affiliated with a state QI collaborative, and organizations sponsoring participants in an improvement advisor training program. Individuals participating in QI projects completed a questionnaire assessing contextual factors included in MUSIQ and measures of perceived success. Path analysis was used to test the direct, indirect, and total effects of context variables on QI success as hypothesized in MUSIQ. In the 74 projects studied, most contextual factors in MUSIQ were found to be significantly related to at least one QI project performance outcome. Contextual factors exhibiting significant effects on two measures of perceived QI success included resource availability, QI team leadership, team QI skills, microsystem motivation, microsystem QI culture, and microsystem QI capability. There was weaker evidence for effects of senior leader project sponsors, organizational QI culture, QI team decision-making, and microsystem QI leadership. These initial tests add to the validity of MUSIQ as a tool for identifying which contextual factors affect improvement success and understanding how they exert influence. Using MUSIQ, managers and QI practitioners can begin to identify aspects of context that must be addressed before or during the execution of QI projects and plan strategies to modify context for increased success. Additional work by QI researchers to improve the theory, refine measurement approaches, and validate MUSIQ as a predictive tool in a wider range of QI

Association between hospital size and quality improvement for pharmaceutical services.

PubMed

Nau, David P; Garber, Mathew C; Lipowski, Earlene E; Stevenson, James G

2004-01-15

The relationship between hospital size and quality improvement (QI) for pharmaceutical services was studied. A questionnaire on QI was sent to hospital pharmacy directors in Michigan and Florida in 2002. The questionnaire included items on QI lead-team composition, QI tools, QI training, and QI culture. Usable responses were received from 162 (57%) of 282 pharmacy directors. Pharmacy QI lead teams were present in 57% of institutions, with larger teams in large hospitals (> or = 300 patients). Only two QI tools were used by a majority of hospitals: root-cause analysis (62%) and flow charts (66%). Small hospitals (< 50 patients) were less likely than medium-sized hospitals (50-299 patients) and large hospitals to use several QI tools, including control charts, cause-and-effect diagrams, root-cause analysis, flow charts, and histograms. Large hospitals were more likely than small and medium-sized hospitals to use root-cause analysis and control charts. There was no relationship between hospital size and the frequency with which physician or patient satisfaction with pharmaceutical services was measured. There were no differences in QI training or QI culture across hospital size categories. A survey suggested that a majority of hospital pharmacies in Michigan and Florida have begun to adopt QI techniques but that most are not using rigorous QI tools. Pharmacies in large hospitals had more QI lead-team members and were more likely to use certain QI tools, but there was no relationship between hospital size and satisfaction measurements, QI training, or QI culture.

Faculty-Resident "Co-learning": A Longitudinal Exploration of an Innovative Model for Faculty Development in Quality Improvement.

PubMed

Wong, Brian M; Goldman, Joanne; Goguen, Jeannette M; Base, Christian; Rotteau, Leahora; Van Melle, Elaine; Kuper, Ayelet; Shojania, Kaveh G

2017-08-01

To examine the effectiveness of co-learning, wherein faculty and trainees learn together, as a novel approach for building quality improvement (QI) faculty capacity. From July 2012 through September 2015, the authors conducted 30 semistructured interviews with 23 faculty participants from the Co-Learning QI Curriculum of the Department of Medicine, Faculty of Medicine, University of Toronto, and collected descriptive data on faculty participation and resident evaluations of teaching effectiveness. Interviewees were from 13 subspecialty residency programs at their institution. Of the 56 faculty participants, the Co-Learning QI Curriculum trained 29 faculty mentors, 14 of whom taught formally. Faculty leads with an academic QI role, many of whom had prior QI training, reinforced their QI knowledge while also developing QI mentorship and teaching skills. Co-learning elements that contributed to QI teaching skills development included seeing first how the QI content is taught, learning through project mentorship, building experience longitudinally over time, a graded transition toward independent teaching, and a supportive program lead. Faculty with limited QI experience reported improved QI knowledge, skills, and project facilitation but were ambivalent about assuming a teacher role. Unplanned outcomes for both groups included QI teaching outside of the curriculum, applying QI principles to other work, networking, and strengthening one's QI professional role. The Co-Learning QI Curriculum was effective in improving faculty QI knowledge and skills and increased faculty capacity to teach and mentor QI. Findings suggest that a combination of curriculum and contextual factors were critical to realizing the curriculum's full potential.

Simple and Fast Sample Preparation Followed by Gas Chromatography-Tandem Mass Spectrometry (GC-MS/MS) for the Analysis of 2- and 4-Methylimidazole in Cola and Dark Beer.

PubMed

Choi, Sol Ji; Jung, Mun Yhung

2017-04-01

We have developed a simple and fast sample preparation technique in combination with a gas chromatography-tandem mass spectrometry (GC-MS/MS) for the quantification of 2-methylimidazole (2-MeI) and 4-methylimidazole (4-MeI) in colas and dark beers. Conventional sample preparation technique for GC-MS requires laborious and time-consuming steps consisting of sample concentration, pH adjustment, ion pair extraction, centrifugation, back-extraction, centrifugation, derivatization, and extraction. Our sample preparation technique consists of only 2 steps (in situ derivation and extraction) which requires less than 3 min. This method provided high linearity, low limit of detection and limit of quantification, high recovery, and high intra- and interday repeatability. It was found that internal standard method with diluted stable isotope (4-MeI-d 6 ) and 2-ethylimidazole (2-EI) could not correctly compensate the matrix effects. Thus, standard addition technique was used for the quantification of 2- and 4-MeI. The established method was successfully applied to colas and dark beers for the determination of 2-MeI and 4-MeI. The 4-MeI contents in colas and dark beers ranged from 8 to 319 μg/L and from trace to 417 μg/L, respectively. Small quantity (0 to 8 μg/L) of 2-MeI was found only in dark beers. The contents of 4-MeI (22 μg/L) in colas obtained from fast food restaurants were significantly lower than those (177 μg/L) in canned or bottled colas. © 2017 Institute of Food Technologists®.

Metabolomic profiles illuminate the efficacy of Chinese herbal Da-Cheng-Qi decoction on acute pancreatitis in rats.

PubMed

Li, Juan; Zhu, Shi-Feng; Zhao, Xian-Lin; Liu, Yi-Xia; Wan, Mei-Hua; Guo, Hui; Liu, Yi-Ling; Gong, Han-Lin; Chen, Guang-Yuan; Tang, Wen-Fu

2015-01-01

Chinese herbal drug Da-Cheng-Qi decoction (DCQD) has been widely used for decades to treat acute pancreatitis (AP). Previous trials are mostly designed to state the potential mechanisms of the therapeutic effects rather than to detect its whole effect on metabolism. This study aimed to investigate the efficacy of DCQD on metabolism in AP. Twenty-two male adult Sprague-Dawley rats were randomized into three groups. AP was induced by retrograde ductal infusion of 3.5% sodium taurocholate solution in DCQD and AP group, while 0.9% saline solution was used in sham operation (SO) group. Blood samples were obtained 12 h after drug administration and a 600 MHz superconducting Nuclear Magnetic Resonance (NMR) spectrometer was used to detected plasma metabolites. Principal Components Analysis (PCA) and Partial Least Squares-Discriminant Analysis after Orthogonal Signal Correction (OSC-PLS-DA) were applied to analyze the Longitudinal Eddy-delay (LED) and Carr-Purcell-Meiboom-Gill (CPMG) spectra. Differences in concentrations of metabolites among the three groups were detected by OSC-PLS-DA of 1HNMR spectra (both LED and CPMG). Compared with SO group, DCQD group had higher levels of plasma glycerol, glutamic acid, low density lipoprotein (LDL), saturated fatty acid (FA) and lower levels of alanine and glutamine, while the metabolic changes were reversed in the AP group. Our results demonstrated that DCQD was capable of altering the changed concentrations of metabolites in rats with AP and 1HNMR-based metabolomic approach provided a new methodological cue for systematically investigating the efficacies and mechanisms of DCQD in treating AP. Copyright © 2015 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Measuring input prices for physicians: The revised Medicare Economic Index

PubMed Central

Freeland, Mark S.; Chulis, George S.; Arnett, Ross H.; Brown, Aaron P.

1991-01-01

Medicare payments for physician services under Part B were historically restrained by capping prevailing charges using the Medicare Economic Index (MEI). The MEI, an input price index for physician services that incorporates an adjustment for economywide labor productivity, has not undergone a major revision since 1975. The MEI is an important determinant of the annual volume performance standard that will be used to set aggregate increases in the revised system for paying physicians under Medicare beginning in 1992. The MEI will also be used in establishing the annual changes to the payment conversion factors under the new payment system. PMID:10170807

Comparison of practice based research network based quality improvement technical assistance and evaluation to other ongoing quality improvement efforts for changes in agency culture.

PubMed

Livingood, William C; Peden, Angela H; Shah, Gulzar H; Marshall, Nandi A; Gonzalez, Ketty M; Toal, Russell B; Alexander, Dayna S; Wright, Alesha R; Woodhouse, Lynn D

2015-07-31

Public health agencies in the USA are increasingly challenged to adopt Quality Improvement (QI) strategies to enhance performance. Many of the functional and structural barriers to effective use of QI can be found in the organizational culture of public health agencies. The purpose of this study was to assess the impact of public health practice based research network (PBRN) evaluation and technical assistance for QI interventions on the organizational culture of public health agencies in Georgia, USA. An online survey of key informants in Georgia's districts and county health departments was used to compare perceptions of characteristics of organizational QI culture between PBRN supported QI districts and non-PBRN supported districts before and after the QI interventions. The primary outcomes of concern were number and percentage of reported increases in characteristics of QI culture as measured by key informant responses to items assessing organizational QI practices from a validated instrument on QI Collaboratives. Survey results were analyzed using Multi-level Mixed Effects Logistic Model, which accounts for clustering/nesting. Increases in QI organizational culture were consistent for all 10- items on a QI organizational culture survey related to: leadership support, use of data, on-going QI, and team collaboration. Statistically significant odds ratios were calculated for differences in increased QI organizational culture between PBRN-QI supported districts compared to Non-PBRN supported districts for 5 of the 10 items, after adjusting for District clustering of county health departments. Agency culture, considered by many QI experts as the main goal of QI, is different than use of specific QI methods, such as Plan-Do-Study-Act (PDSA) cycles or root-cause analyses. The specific use of a QI method does not necessarily reflect culture change. Attempts to measure QI culture are newly emerging. This study documented significant improvements in characteristics of

YiQiFuMai Powder Injection Attenuates Ischemia/Reperfusion-Induced Myocardial Apoptosis Through AMPK Activation.

PubMed

Li, Fang; Zheng, Xianjie; Fan, Xiaoxue; Zhai, Kefeng; Tan, Yisha; Kou, Junping; Yu, Boyang

2016-12-01

The YiQiFuMai powder injection (YQFM), a traditional Chinese medicine (TCM) prescription re-developed based on the well-known TCM formula Sheng-maisan, showed a wide range of pharmacological activities in cardiovascular diseases in clinics. However, its role in protection against myocardial ischemia/reperfusion (MI/R) injury has not been elucidated. The present study not only evaluated the cardioprotective effect of YQFM from MI/R injury but also investigated the potential molecular mechanisms both in vivo and in vitro. The myocardium infarct size, production of lactate dehydrogenase (LDH), creatine kinase (CK), cardiac function, TUNEL staining, and caspase-3 activity were measured. Cell viability was determined, and cell apoptosis was measured by Hoechst 33342 staining and flow cytometry. Mitochondrial membrane potential (ΔΨm) was measured, and ATP content was quantified by bioluminescent assay. Expression of apoptosis-related proteins, including Caspase-3, Bcl-2, Bax, AMPKα, and phospho-AMPKα, was analyzed by western blotting. AMPKα siRNA transfection was also applied to the mechanism elucidation. YQFM at a concentration of 1.06 g/kg significantly reduced myocardium infarct size and the production of LDH, CK in serum, improved the cardiac function, and also produced a significant decrease of apoptotic index. Further, combined treatment with compound C partly attenuated the anti-apoptotic effect of YQFM. In addition, pretreatment with YQFM ranging from 25 to 400 μg/mL markedly improved cell viability and decreased LDH release. Moreover, YQFM inhibited H9c2 apoptosis, blocked the expression of caspase-3, and modulated Bcl-2 and Bax proteins, leading to an increased mitochondrial membrane potential and cellular ATP content. Mechanistically, YQFM activated AMP-activated protein kinase (AMPK) signaling pathways whereas pretreatment with AMPK inhibitor Compound C and application of transfection with AMPKα siRNA attenuated the anti-apoptotic effect of YQFM

"It Feels Like a Lot of Extra Work": Resident Attitudes About Quality Improvement and Implications for an Effective Learning Health Care System.

PubMed

Butler, Jorie M; Anderson, Katherine A; Supiano, Mark A; Weir, Charlene R

2017-07-01

The learning health care system promotes development and application of evidence generated within the health care system to enhance the quality of patient care. The purpose of this study was to understand resident attitudes about quality improvement (QI) in Accreditation Council for Graduate Medical Education-approved programs. Four focus groups were conducted with 45 residents at the University of Utah School of Medicine during September and October 2014. Residents discussed the perceived value of QI and their experiences with QI. Qualitative analysis was conducted iteratively, resulting in a set of constructs that were then consolidated into overarching themes. Five themes emerged from the qualitative analysis. Four of these represented QI participation barriers: challenges with understanding the vision of QI, confusion about basic aspects of QI, a sense that resident contributions to QI are not valued/valuable to the QI process, and challenges with prioritizing responsibilities relating to QI compared with other responsibilities. One theme represented a facilitator of successful QI: factors that make QI work successfully (e.g., clear goals and a sense of being on the "same page"). If resident attitudes about QI do not improve, the culture of the learning health care system is threatened. An important step in enhancing the perceived value of QI is resolving the perceived tension between providing excellent patient care and satisfying other goals. Involving residents more effectively in QI may result in improved attitudes and promote development of a better-functioning learning health care system.

Effects of levomilnacipran extended-release on motivation/energy and functioning in adults with major depressive disorder.

PubMed

Thase, Michael E; Gommoll, Carl; Chen, Changzheng; Kramer, Kenneth; Sambunaris, Angelo

2016-11-01

The objective of this post-hoc analysis was to investigate the relationship between motivation/energy and functional impairment in patients with major depressive disorder (MDD). Data were taken from a phase 3 trial of levomilnacipran extended-release (ER) in adults with MDD (NCT01034462; N=429) that used the 18-item Motivation and Energy Inventory (MEI) to assess motivation/energy. Two subgroups with lower and higher motivation/energy were defined using baseline MEI total scores (≤28 and >28, respectively). Change from baseline in the Sheehan Disability Scale (SDS) total score was analyzed in the intent-to-treat (ITT) population and both subgroups. Path analyses were carried out in the ITT population and a lower MEI subgroup to assess the direct and indirect effects of levomilnacipran ER on SDS total score change. In the ITT population and the lower MEI subgroup, significant differences were found between levomilnacipran ER and placebo for changes in the SDS total score (-2.6 and -3.9, both P<0.01), but not in the higher MEI subgroup. The indirect effect of levomilnacipran ER on SDS total score improvement, as mediated by MEI total score change, was 79.9% in the lower MEI subgroup and 67.2% in the ITT population. Levomilnacipran ER was previously shown to improve motivation/energy in adults with MDD. The current analysis indicates that improvements in functional impairment were considerably mediated by improvements in motivation/energy, particularly in patients with lower motivation/energy at baseline.

Strategies for addressing barriers to publishing pediatric quality improvement research.

PubMed

Van Cleave, Jeanne; Dougherty, Denise; Perrin, James M

2011-09-01

Advancing the science of quality improvement (QI) requires dissemination of the results of QI. However, the results of few QI interventions reach publication. To identify barriers to publishing results of pediatric QI research and provide practical strategies that QI researchers can use to enhance publishability of their work. We reviewed and summarized a workshop conducted at the Pediatric Academic Societies 2007 meeting in Toronto, Ontario, Canada, on conducting and publishing QI research. We also interviewed 7 experts (QI researchers, administrators, journal editors, and health services researchers who have reviewed QI manuscripts) about common reasons that QI research fails to reach publication. We also reviewed recently published pediatric QI articles to find specific examples of tactics to enhance publishability, as identified in interviews and the workshop. We found barriers at all stages of the QI process, from identifying an appropriate quality issue to address to drafting the manuscript. Strategies for overcoming these barriers included collaborating with research methodologists, creating incentives to publish, choosing a study design to include a control group, increasing sample size through research networks, and choosing appropriate process and clinical quality measures. Several well-conducted, successfully published QI studies in pediatrics offer guidance to other researchers in implementing these strategies in their own work. Specific, feasible approaches can be used to improve opportunities for publication in pediatric, QI, and general medical journals.

Sustaining a quality improvement culture in local health departments applying for accreditation.

PubMed

Verma, Pooja; Moran, John W

2014-01-01

This article focuses on local health departments (LHDs) that are advanced in accreditation and quality improvement (QI) efforts and the barriers and facilitators associated with sustaining improvements and building an organizational culture of QI. To understand the barriers and facilitators associated with building and sustaining progress toward a QI culture in LHDs. Quantitative data from a self-reporting survey and qualitative data from telephone interviews. Twenty-two LHDs across the United States responded to the survey. Ten of the 22 LHD respondents participated in telephone interviews. QI lead staff at LHDs that are advanced in accreditation preparation and QI. Self-reported LHD survey ratings against indicators for a QI culture, and the identified barriers and facilitators around sustaining QI initiatives. Of the 6 domains of a QI culture measured in the survey, the percentages of respondents that scored themselves highly to at least 1 indicator in each domain are as follows: leadership commitment (100%); employee empowerment (100%); teamwork and collaboration (100%); continuous process improvement (86%); customer focus (72%); and QI infrastructure (64%). Qualitative data from 10 telephone interviews revealed that key barriers to sustaining progress around QI included staff turnover, budget cuts, and major crises or events that arise as priority. Key facilitators included leadership commitment, accreditation, and dedication of resources and staff time to QI. When engaging in QI, LHDs should consider investing efforts in gaining leadership support and dedicating staff time early in the QI journey to ensure that QI efforts and initiatives are sustained. Local health departments interested in developing a QI culture should also consider pursuing accreditation, as it provides a structured framework for continuous improvement. They should also actively develop QI knowledge and skills among all staff members to minimize the negative impact of staff turnover.

Poly(Dopamine)-Assisted Immobilization of Xu Duan on 3D Printed Poly(Lactic Acid) Scaffolds to Up-Regulate Osteogenic and Angiogenic Markers of Bone Marrow Stem Cells.

PubMed

Yeh, Chia-Hung; Chen, Yi-Wen; Shie, Ming-You; Fang, Hsin-Yuan

2015-07-14

Three-dimensional printing is a versatile technique to generate large quantities of a wide variety of shapes and sizes of polymer. The aim of this study is to develop functionalized 3D printed poly(lactic acid) (PLA) scaffolds and use a mussel-inspired surface coating and Xu Duan (XD) immobilization to regulate cell adhesion, proliferation and differentiation of human bone-marrow mesenchymal stem cells (hBMSCs). We prepared PLA scaffolds and coated with polydopamine (PDA). The chemical composition and surface properties of PLA/PDA/XD were characterized by XPS. PLA/PDA/XD controlled hBMSCs' responses in several ways. Firstly, adhesion and proliferation of hBMSCs cultured on PLA/PDA/XD were significantly enhanced relative to those on PLA. In addition, the focal adhesion kinase (FAK) expression of cells was increased and promoted cell attachment depended on the XD content. In osteogenesis assay, the osteogenesis markers of hBMSCs cultured on PLA/PDA/XD were significantly higher than seen in those cultured on a pure PLA/PDA scaffolds. Moreover, hBMSCs cultured on PLA/PDA/XD showed up-regulation of the ang-1 and vWF proteins associated with angiogenic differentiation. Our results demonstrate that the bio-inspired coating synthetic PLA polymer can be used as a simple technique to render the surfaces of synthetic scaffolds active, thus enabling them to direct the specific responses of hBMSCs.

Poly(Dopamine)-Assisted Immobilization of Xu Duan on 3D Printed Poly(Lactic Acid) Scaffolds to Up-Regulate Osteogenic and Angiogenic Markers of Bone Marrow Stem Cells

PubMed Central

Yeh, Chia-Hung; Chen, Yi-Wen; Shie, Ming-You; Fang, Hsin-Yuan

2015-01-01

Three-dimensional printing is a versatile technique to generate large quantities of a wide variety of shapes and sizes of polymer. The aim of this study is to develop functionalized 3D printed poly(lactic acid) (PLA) scaffolds and use a mussel-inspired surface coating and Xu Duan (XD) immobilization to regulate cell adhesion, proliferation and differentiation of human bone-marrow mesenchymal stem cells (hBMSCs). We prepared PLA scaffolds and coated with polydopamine (PDA). The chemical composition and surface properties of PLA/PDA/XD were characterized by XPS. PLA/PDA/XD controlled hBMSCs’ responses in several ways. Firstly, adhesion and proliferation of hBMSCs cultured on PLA/PDA/XD were significantly enhanced relative to those on PLA. In addition, the focal adhesion kinase (FAK) expression of cells was increased and promoted cell attachment depended on the XD content. In osteogenesis assay, the osteogenesis markers of hBMSCs cultured on PLA/PDA/XD were significantly higher than seen in those cultured on a pure PLA/PDA scaffolds. Moreover, hBMSCs cultured on PLA/PDA/XD showed up-regulation of the ang-1 and vWF proteins associated with angiogenic differentiation. Our results demonstrate that the bio-inspired coating synthetic PLA polymer can be used as a simple technique to render the surfaces of synthetic scaffolds active, thus enabling them to direct the specific responses of hBMSCs. PMID:28793441

MO-E-12A-01: Quantitative Imaging: Techniques, Applications, and Challenges

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

Jackson, E; Jeraj, R; McNitt-Gray, M

The first symposium in the Quantitative Imaging Track focused on the introduction of quantitative imaging (QI) by illustrating the potential of QI in diagnostic and therapeutic applications in research and patient care, highlighting key challenges in implementation of such QI applications, and reviewing QI efforts of selected national and international agencies and organizations, including the FDA, NCI, NIST, and RSNA. This second QI symposium will focus more specifically on the techniques, applications, and challenges of QI. The first talk of the session will focus on modalityagnostic challenges of QI, beginning with challenges of the development and implementation of QI applicationsmore » in single-center, single-vendor settings and progressing to the challenges encountered in the most general setting of multi-center, multi-vendor settings. The subsequent three talks will focus on specific QI challenges and opportunities in the modalityspecific settings of CT, PET/CT, and MR. Each talk will provide information on modality-specific QI techniques, applications, and challenges, including current efforts focused on solutions to such challenges. Learning Objectives: Understand key general challenges of QI application development and implementation, regardless of modality. Understand selected QI techniques and applications in CT, PET/CT, and MR. Understand challenges, and potential solutions for such challenges, for the applications presented for each modality.« less

A mindful eating intervention: A theory-guided randomized anti-obesity feasibility study with adolescent Latino females.

PubMed

Daly, Patricia; Pace, Thaddeus; Berg, Judith; Menon, Usha; Szalacha, Laura A

2016-10-01

While pediatric anti-obesity lifestyle interventions have received considerable attention, few show sustained impact on body mass index (BMI). Using the Information-Motivation-Behavioral Skills Theory as a framework, we examined the effects of a satiety-focused mindful eating intervention (MEI) on BMI, weight and mindful awareness. Utilizing a two-group, repeated measures design, 37 adolescent females with a BMI >90th percentile, recruited from a public high school in a Latino community in the Southwestern United States, were randomized 2:1, one third to the group receiving a 6-week MEI and two thirds to the comparison group (CG) receiving the usual care (nutrition and exercise information). During six weekly 90-min after school MEI group sessions, the behavioral skills of slow intentional eating were practiced with foci on satiety cues and triggers to overeat. Feasibility and acceptability were measured as participant retention (goal ≥55%) and evaluative comments from those in the MEI group, respectively. BMI and mindful awareness were measured on site at baseline, immediately post intervention, and at 4-week follow-up (week 10). Fifty-seven and 65% of those in the MEI and CG were retained throughout the study, respectively. MEI participants showed significantly lowered BMI compared with CG participants, whose weight increased (p<0.001). At six weeks, the MEI group BMI decreased by 1.1kg/m(2) (BMI continued to decline to 1.4kg/m(2) by week 10); while CG BMI increased by 0.7kg/m(2) (consistent with BMI >90th percentile standard growth projections). Initial and sustained decline of BMI in the MEI group supports further study of this theory-guided approach, and the value of practicing satiety-focused mindful eating behavioral skills to facilitate health behavior change. Copyright © 2016 Elsevier Ltd. All rights reserved.

Documentation of quality improvement exposure by internal medicine residency applicants.

PubMed

Kolade, Victor O; Sethi, Anuradha

2016-01-01

Quality improvement (QI) has become an essential component of medical care in the United States. In residency programs, QI is a focus area of the Clinical Learning Environment Review visits conducted by the Accreditation Council for Graduate Medical Education. The readiness of applicants to internal medicine residency to engage in QI on day one is unknown. To document the reporting of QI training or experience in residency applications. Electronic Residency Application Service applications to a single internal medicine program were reviewed individually looking for reported QI involvement or actual projects in the curriculum vitae (CVs), personal statements (PSs), and letters of recommendation (LORs). CVs were also reviewed for evidence of education in QI such as completion of Institute for Healthcare Improvement (IHI) modules. Of 204 candidates shortlisted for interview, seven had QI items on their CVs, including one basic IHI certificate. Three discussed their QI work in their PSs, and four had recommendation letters describing their involvement in QI. One applicant had both CV and LOR evidence, so that 13 (6%) documented QI engagement. Practice of or instruction in QI is rarely mentioned in application documents of prospective internal medicine interns.

Team dynamics within quality improvement teams: a scoping review.

PubMed

Rowland, Paula; Lising, Dean; Sinclair, Lynne; Baker, G Ross

2018-03-31

This scoping review examines what is known about the processes of quality improvement (QI) teams, particularly related to how teams impact outcomes. The aim is to provide research-informed guidance for QI leaders and to inform future research questions. Databases searched included: MedLINE, EMBASE, CINAHL, Web of Science and SCOPUS. Eligible publications were written in English, published between 1999 and 2016. Articles were included in the review if they examined processes of the QI team, were related to healthcare QI and were primary research studies. Studies were excluded if they had insufficient detail regarding QI team processes. Descriptive detail extracted included: authors, geographical region and health sector. The Integrated (Health Care) Team Effectiveness Model was used to synthesize findings of studies along domains of team effectiveness: task design, team process, psychosocial traits and organizational context. Over two stages of searching, 4813 citations were reviewed. Of those, 48 full-text articles are included in the synthesis. This review demonstrates that QI teams are not immune from dysfunction. Further, a dysfunctional QI team is not likely to influence practice. However, a functional QI team alone is unlikely to create change. A positive QI team dynamic may be a necessary but insufficient condition for implementing QI strategies. Areas for further research include: interactions between QI teams and clinical microsystems, understanding the role of interprofessional representation on QI teams and exploring interactions between QI team task, composition and process.

Simultaneous determination of ethyl carbamate and 4-(5-)methylimidazole in yellow rice wine and soy sauce by gas chromatography with mass spectrometry.

PubMed

Wu, Pinggu; Zhang, Liqun; Wang, Liyuan; Zhang, Jing; Tan, Ying; Tang, Jun; Ma, Bingjie; Pan, Xiaodong; Jiang, Wei

2014-08-01

We developed a new method, based on alkaline diatomite solid-phase extraction followed by gas chromatography with mass spectrometry, for the simultaneous determination of the toxic contaminants ethyl carbamate (EC) and 4-(5-)methylimidazole (4-MEI) in yellow rice wine and soy sauce. The optimal extraction conditions were defined. With the application of alkaline diatomite solid-phase extraction, damage to the capillary column by organic acids was greatly reduced. With deuterated EC used as the internal standard, the linearity of the calibration curves for EC and 4-MEI was good with correlation coefficient above 0.99. In a spiked experiment with EC and 4-MEI in yellow rice wine and soy sauce, recovery of the added EC was 80.5-102.5% and that of 4-MEI was 78.3-92.8%. The limit of quantification and limit of detection for EC were 6.0 and 2.0 μg/kg, respectively, and for 4-MEI were 15.0 and 5.0 μg/kg, respectively. The validation results demonstrate that the method is fast, simple, and selective, and therefore is suitable for simultaneously determining the presence of EC and 4-MEI in fermented food. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Clinical Utility of Quantitative Imaging

PubMed Central

Rosenkrantz, Andrew B; Mendiratta-Lala, Mishal; Bartholmai, Brian J.; Ganeshan, Dhakshinamoorthy; Abramson, Richard G.; Burton, Kirsteen R.; Yu, John-Paul J.; Scalzetti, Ernest M.; Yankeelov, Thomas E.; Subramaniam, Rathan M.; Lenchik, Leon

2014-01-01

Quantitative imaging (QI) is increasingly applied in modern radiology practice, assisting in the clinical assessment of many patients and providing a source of biomarkers for a spectrum of diseases. QI is commonly used to inform patient diagnosis or prognosis, determine the choice of therapy, or monitor therapy response. Because most radiologists will likely implement some QI tools to meet the patient care needs of their referring clinicians, it is important for all radiologists to become familiar with the strengths and limitations of QI. The Association of University Radiologists Radiology Research Alliance Quantitative Imaging Task Force has explored the clinical application of QI and summarizes its work in this review. We provide an overview of the clinical use of QI by discussing QI tools that are currently employed in clinical practice, clinical applications of these tools, approaches to reporting of QI, and challenges to implementing QI. It is hoped that these insights will help radiologists recognize the tangible benefits of QI to their patients, their referring clinicians, and their own radiology practice. PMID:25442800

Are quality improvement methods a fashion for hospitals in Taiwan?

PubMed

Chung, Kuo-Piao; Yu, Tsung-Hsien

2012-08-01

This study reviews the rise and fall of the quality improvement (QI) methods implemented by hospitals in Taiwan, and examines the factors related to these methods. Cross-sectional, questionnaire-based survey. One hundred and thirty-nine district teaching hospitals, regional hospitals and medical centers. Directors or the persons in charge of implementing QI methods. s) None. s) Breadth and depth of the 18 QI methods. Seventy-two hospitals responded to the survey, giving a response rate of 52%. In terms of breadth based on the hospitals' self-reporting, the average number of QI methods adopted per hospital was 11.78 (range: 7-17). More than 80% of the surveyed hospitals had implemented eight QI methods, and >50% had implemented five QI methods. The QI methods adopted by over 80% of the surveyed hospitals had been implemented for a period of ∼7 years. On the basis of the authors' classification, seven of the eight QI methods (except for QI team in total quality management) had an implementation depth of almost 70% or higher in the surveyed hospitals. This study provides a snapshot of the QI methods implemented by hospitals in Taiwan. The results show that the average breadth of the QI methods adopted was 11.78; however, only 8.83 were implemented deeply. The hospitals' accreditation level was associated with the breadth and depth of QI method implementation.

Quality Improvement and Performance Management Benefits of Public Health Accreditation: National Evaluation Findings.

PubMed

Siegfried, Alexa; Heffernan, Megan; Kennedy, Mallory; Meit, Michael

To identify the quality improvement (QI) and performance management benefits reported by public health departments as a result of participating in the national, voluntary program for public health accreditation implemented by the Public Health Accreditation Board (PHAB). We gathered quantitative data via Web-based surveys of all applicant and accredited public health departments when they completed 3 different milestones in the PHAB accreditation process. Leadership from 324 unique state, local, and tribal public health departments in the United States. Public health departments that have achieved PHAB accreditation reported the following QI and performance management benefits: improved awareness and focus on QI efforts; increased QI training among staff; perceived increases in QI knowledge among staff; implemented new QI strategies; implemented strategies to evaluate effectiveness and quality; used information from QI processes to inform decision making; and perceived achievement of a QI culture. The reported implementation of QI strategies and use of information from QI processes to inform decision making was greater among recently accredited health departments than among health departments that had registered their intent to apply but not yet undergone the PHAB accreditation process. Respondents from health departments that had been accredited for 1 year reported higher levels of staff QI training and perceived increases in QI knowledge than those that were recently accredited. PHAB accreditation has stimulated QI and performance management activities within public health departments. Health departments that pursue PHAB accreditation are likely to report immediate increases in QI and performance management activities as a result of undergoing the PHAB accreditation process, and these benefits are likely to be reported at a higher level, even 1 year after the accreditation decision.

Effects of levomilnacipran extended-release on motivation/energy and functioning in adults with major depressive disorder

PubMed Central

Gommoll, Carl; Chen, Changzheng; Kramer, Kenneth; Sambunaris, Angelo

2016-01-01

The objective of this post-hoc analysis was to investigate the relationship between motivation/energy and functional impairment in patients with major depressive disorder (MDD). Data were taken from a phase 3 trial of levomilnacipran extended-release (ER) in adults with MDD (NCT01034462; N=429) that used the 18-item Motivation and Energy Inventory (MEI) to assess motivation/energy. Two subgroups with lower and higher motivation/energy were defined using baseline MEI total scores (≤28 and >28, respectively). Change from baseline in the Sheehan Disability Scale (SDS) total score was analyzed in the intent-to-treat (ITT) population and both subgroups. Path analyses were carried out in the ITT population and a lower MEI subgroup to assess the direct and indirect effects of levomilnacipran ER on SDS total score change. In the ITT population and the lower MEI subgroup, significant differences were found between levomilnacipran ER and placebo for changes in the SDS total score (−2.6 and −3.9, both P<0.01), but not in the higher MEI subgroup. The indirect effect of levomilnacipran ER on SDS total score improvement, as mediated by MEI total score change, was 79.9% in the lower MEI subgroup and 67.2% in the ITT population. Levomilnacipran ER was previously shown to improve motivation/energy in adults with MDD. The current analysis indicates that improvements in functional impairment were considerably mediated by improvements in motivation/energy, particularly in patients with lower motivation/energy at baseline. PMID:27455513

Impact of a competency based curriculum on quality improvement among internal medicine residents.

PubMed

Fok, Mark C; Wong, Roger Y

2014-11-28

Teaching quality improvement (QI) principles during residency is an important component of promoting patient safety and improving quality of care. The literature on QI curricula for internal medicine residents is limited. We sought to evaluate the impact of a competency based curriculum on QI among internal medicine residents. This was a prospective, cohort study over four years (2007-2011) using pre-post curriculum comparison design in an internal medicine residency program in Canada. Overall 175 post-graduate year one internal medicine residents participated. A two-phase, competency based curriculum on QI was developed with didactic workshops and longitudinal, team-based QI projects. The main outcome measures included self-assessment, objective assessment using the Quality Improvement Knowledge Assessment Tool (QIKAT) scores to assess QI knowledge, and performance-based assessment via presentation of longitudinal QI projects. Overall 175 residents participated, with a response rate of 160/175 (91%) post-curriculum and 114/175 (65%) after conducting their longitudinal QI project. Residents' self-reported confidence in making changes to improve health increased and was sustained at twelve months post-curriculum. Self-assessment scores of QI skills improved significantly from pre-curriculum (53.4 to 69.2 percent post-curriculum [p-value 0.002]) and scores were sustained at twelve months after conducting their longitudinal QI projects (53.4 to 72.2 percent [p-value 0.005]). Objective scores using the QIKAT increased post-curriculum from 8.3 to 10.1 out of 15 (p-value for difference <0.001) and this change was sustained at twelve months post-project with average individual scores of 10.7 out of 15 (p-value for difference from pre-curriculum <0.001). Performance-based assessment occurred via presentation of all projects at the annual QI Project Podium Presentation Day. The competency based curriculum on QI improved residents' QI knowledge and skills during residency

What infusion flow should be used for mid-dilution hemodiafiltration?

PubMed

Maduell, Francisco; Arias, Marta; Fontseré, Néstor; Vera, Manel; Masso, Elisabeth; Garro, Julia; Barros, Xoana; Martina, Maria N; Elena, Montserrat; Bergadá, Eduardo; Cases, Aleix; Bedini, Jose Luis; Campistol, Josep M

2010-01-01

There is still no consensus on the optimal infusion flow (Qi) in mid-dilution hemodiafiltration. The aim of this study was to compare mid-dilution with varying Qi. Prospective study in 25 patients who underwent seven hemodialysis sessions with a Qi of 0, 50, 100, 150, 200, 250 and 300 ml/min. All sessions were well tolerated except Qi 300 ml/min. No significant differences in urea, creatinine, alpha(1)-microglobulin or alpha(1)-acid glycoprotein reduction ratios were observed. beta(2)-Microglobulin, myoglobin and prolactin reduction ratios were higher with Qi 150, 200, 250 and 300 ml/min in comparison with Qi of 0, 50 and 100 ml/min. There were no differences in the removal of small or larger molecules when Qi was 150 ml/min or higher. Optimal Qi in mid-dilution appears to be in the range of 150-250 ml/min since good clinical outcomes, similar efficiency and no technical complications up to a Qi of 250 ml/min were observed.

Attitudes of Pulmonary and Critical Care Training Program Directors toward Quality Improvement Education.

PubMed

Kahn, Jeremy M; Feemster, Laura C; Fruci, Carolyn M; Hyzy, Robert C; Savant, Adrienne P; Siner, Jonathan M; Weiss, Curtis H; Patel, Bela

2015-04-01

Quality improvement (QI) is a required component of fellowship training in pulmonary, critical care, and sleep medicine. However, little is known about how training programs approach QI education. We sought to understand the perceptions of pulmonary, critical care, and sleep medicine training program directors toward QI education. We developed and fielded an internet survey of pulmonary, critical care, and sleep medicine training program directors during 2013. Survey domains included program characteristics, the extent of trainee and faculty involvement in QI, attitudes toward QI education, and barriers to successful QI education in their programs. A total of 75 program directors completed the survey (response rate = 45.2%). Respondents represented both adult (n = 43, 57.3%) and pediatric (n = 32, 42.7%) programs. Although the majority of directors (n = 60, 80.0%) reported substantial fellow involvement in QI, only 19 (26.0%) reported having a formal QI education curriculum. QI education was primarily based around faculty mentoring (n = 46, 61.3%) and lectures (n = 38, 50.7%). Most directors agreed it is an important part of fellowship training (n = 63, 84.0%). However, fewer reported fellows were well integrated into ongoing QI activities (n = 45, 60.0%) or graduating fellows were capable of carrying out independent QI (n = 28, 50.7%). Key barriers to effective QI education included lack of qualified faculty, lack of interest among fellows, and lack of time. Training program directors in pulmonary, critical care, and sleep medicine value QI education but face substantial challenges to integrating it into fellowship training.

Role of Arcuate Nucleus in the Regulation of Feeding Behavior in the Process of Altitude Acclimatization in Rats.

PubMed

Liu, Xiang-Wen; Yin, Jie; Ma, Qi-Sheng; Qi, Chu-Chu; Mu, Ji-Ying; Zhang, Lang; Gao, Li-Ping; Jing, Yu-Hong

2017-09-01

Liu, Xiang-Wen, Jie Yin, Qi-Sheng Ma, Chu-Chu Qi, Ji-Ying Mu, Lang Zhang, Li-Ping Gao, and Yu-Hong Jing. Role of arcuate nucleus in the regulation of feeding behavior in the process of altitude acclimatization in rats. High Alt Med Biol. 18:234-241, 2017.-Highly efficient energy utilization and metabolic homeostasis maintenance rely on neuromodulation. Altitude exposure is known to stimulate neuroendocrine systems to respond to acute hypoxia and adaptive acclimatization. However, limited data on how the adaptive regulation of the arcuate nucleus performs in the process of altitude acclimatization are available. In the present study, male Sprague Dawley rats were transported to Huashixia, Qinghai (with an altitude of 4400 m) from Xian (with an altitude of 300 m) by air; rats were consistently raised in Xian as control. Food uptake and body weight were measured consecutively after being subjected to high-altitude condition. Contents of plasma leptin and ghrelin were analyzed by the Enzyme Linked Immunosorbent Assay (ELISA) Kits. Brain coronal sections were obtained, and neuropeptide Y (NPY), proopiomelanocotin (POMC), and c-fos immunoreactivity in arcuate nucleus were observed. Arcuate nucleus was isolated from the hypothalamus, and the mRNA of NPY and POMC were measured by quantitative real-time polymerase chain reaction. Our results showed both food consumption and body weight decreased in the high plateau compared with rats raised in the low-altitude condition. Plasma leptin increased at the early stage, and ghrelin decreased at a later stage after reaching the high plateau. The peak of c-fos immunoreactivity in the arcuate nucleus was at day 3 after reaching the high plateau. The expression level of NPY increased, and POMC decreased in the arcuate nucleus at day 7 after reaching the high plateau compared with the plain control group. These results indicate that the arcuate nucleus of hypothalamus performs an important function in regulating feeding behavior

Key Characteristics of Rehabilitation Quality Improvement Publications: Scoping Review From 2010 to 2016.

PubMed

Jesus, Tiago S; Papadimitriou, Christina; Pinho, Cátia S; Hoenig, Helen

2018-06-01

To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation. Five electronic databases were searched for English-language articles from 2010 to 2016. Keywords for QI and safety management were searched for in combination with keywords for rehabilitation content and journals. Secondary searches (eg, references-list scanning) were also performed. Two reviewers independently selected articles using working definitions of rehabilitation and QI study types; of 1016 references, 112 full texts were assessed for eligibility. Reported study characteristics including study focus, study setting, use of inferential statistics, stated limitations, and use of improvement cycles and theoretical models were extracted by 1 reviewer, with a second reviewer consulted whenever inferences or interpretation were involved. Fifty-nine empirical rehabilitation QI studies were found: 43 reporting on local QI activities, 7 reporting on QI effectiveness research, 8 reporting on QI facilitators or barriers, and 1 systematic review of a specific topic. The number of publications had significant yearly growth between 2010 and 2016 (P=.03). Among the 43 reports on local QI activities, 23.3% did not explicitly report any study limitations; 39.5% did not used inferential statistics to measure the QI impact; 95.3% did not cite/mention the appropriate reporting guidelines; only 18.6% reported multiple QI cycles; just over 50% reported using a model to guide the QI activity; and only 7% reported the use of a particular theoretical model. Study sites and focuses were diverse; however, nearly a third (30.2%) examined early mobilization in intensive care units. The number of empirical, peer-reviewed rehabilitation QI publications is growing but remains a tiny fraction of rehabilitation research publications. Rehabilitation QI studies could be strengthened by greater use of extant models and theory to guide the QI work, consistent reporting of study limitations, and use of

Community Sourced Knowledge: Solving the Maintenance Problem

DTIC Science & Technology

2012-05-01

The end-user doesn’t need further assistance. KPI – Key Performance Indicator KPI -1 = Relayed solution to the end-user. KPI -2 = Trouble ticket is...created for the end-user and escalated for further review. KPI -3 = Trouble ticket is created for the end-user. KPI -4 = End of Call. Start of Process...14i KPI -1 KPI -2 KPI -3 KPI -4 QI-2QI-3 QI-4 QI-5 QI-6 Does the analyst understand the end- user’s rqst. Yes No 7 QI-1 Inform KMT. Legend KMT

Towards a better classification of unclear eruptive variables: the cases of V2492 Cyg, V350 Cep, and ASASSN-15qi

NASA Astrophysics Data System (ADS)

Jurdana-Šepić, R.; Munari, U.; Antoniucci, S.; Giannini, T.; Lorenzetti, D.

2018-06-01

Context. Eruptive variables are young stars that show episodic variations of brightness: EXors/FUors variations are commonly associated with enhanced accretion outbursts occurring at intermittent cadence of months/years (EXors) and decades/centuries (FUors). Variations that can be ascribed to a variable extinction along their line of sight are instead classified as UXors. Aims: We aim at investigating the long-term photometric behaviour of three sources classified as eruptive variables. We present data from the archival plates of the Asiago Observatory relative to the fields where the targets are located. For the sake of completeness we have also analysed the Harvard plates of the same regions that cover a much longer historical period, albeit at a lower sensitivity, however we are only able to provide upper limits. Methods: A total of 273 Asiago plates were investigated, providing a total of more than 200 magnitudes for the three stars, which cover a period of about 34 yr between 1958 and 1991. We have compared our data with more recently collected literature data. Results: Our plates analysis of V2492 Cyg provides historical upper limits that seem not to be compatible with the level of the activity monitored during the last decade. Therefore, recently observed accretion phenomena could be associated with the outbursting episodes, more than repetitive obscuration. While a pure extinction does not seem the only mechanism responsible for the ASASSN-15qi fluctuations, it can account quite reasonably for the recent V350 Cep variations.

National variation in coronary angiography rates and timing after an acute coronary syndrome in New Zealand (ANZACS-QI 6).

PubMed

Williams, Michael J A; Harding, Scott A; Devlin, Gerard; Nunn, Chris; El-Jack, Sief; Scott, Tony; Lee, Mildred; Kerr, Andrew J

2016-01-08

The New Zealand Cardiac Clinical Network and the Ministry of Health recommend a "3-day door-to-catheter target" for acute coronary syndromes (ACS) admissions, requiring that at least 70% of ACS patients referred for invasive coronary angiography (ICA) undergo this within 3 days of hospital admission. We assessed the variability in use of ICA, timing of ICA, and duration of hospital admission across New Zealand District Health Boards (DHBs). All patients admitted to all New Zealand public hospitals with suspected ACS undergoing ICA over 1 year ending November 2014 had demographic, risk factor, and diagnostic data collected prospectively using the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. Complete datasets were available in 7,988 (98.4%) patients. DHBs were categorised as those able to perform percutaneous coronary intervention on-site (intervention-capable) or not. There was a near two-fold variation between DHBs in the age standardised rate (ASR) of ICA ranging from 16.8 per 10,000 to 34.1 per 10,000 population (New Zealand rate; 27.9 per 10,000). Patients in intervention-capable DHBs had a 30% higher ASR of ICA. The proportion of ACS patients meeting the 3-day target ranged from 56.7% to 92.9% (New Zealand; 76.4%). Those in intervention-capable DHBs were more likely to meet the target (78.7% vs 68.0%, p<0.0001) and spent 0.84 days (p<.0001) less in hospital. There is a considerable variation in the rate and timing of ICA in New Zealand. Patients with ACS admitted to DHBs without interventional-capability are disadvantaged. New initiatives to correct this discrepancy are needed.

Exercise is an effective treatment for positive valence symptoms in major depression.

PubMed

Toups, Marisa; Carmody, Thomas; Greer, Tracy; Rethorst, Chad; Grannemann, Bruce; Trivedi, Madhukar H

2017-02-01

Measurement of symptoms domains and their response to treatment in relative isolation from diagnosed mental disorders has gained new urgency, as reflected by the National Institute of Mental Health's introduction of the Research Domain Criteria (RDoC). The Snaith Hamilton Pleasure Scale (SHAPS) and the Motivation and Energy Inventory (MEI) are two scales measuring positive valence symptoms. We evaluated the effect of exercise on positive valence symptoms of Major Depressive Disorder (MDD). Subjects in the Treatment with Exercise Augmentation for Depression (TREAD) study completed self-reported SHAPS and MEI during 12 weeks of exercise augmentation for depression. We evaluated the effect of exercise on SHAPS and MEI scores, and whether the changes were related to overall MDD severity measured with the Quick Inventory of Depression Symptomatology (QIDS). SHAPS and MEI scores significantly improved with exercise. MEI score change had larger effect size and greater correlation with change in QIDS score. MEI also showed significant moderator and mediator effects of exercise in MDD. Generalizability to other treatments is limited. This study lacked other bio-behavioral markers that would enhance understanding of the relationship of RDoC and the measures used. Positive valence symptoms improve with exercise treatment for depression, and this change correlates well with overall outcome. Motivation and energy may be more clinically relevant to outcome of exercise treatment than anhedonia. Copyright © 2016. Published by Elsevier B.V.

A national study of nurse leadership and supports for quality improvement in rural hospitals.

PubMed

Paez, Kathryn; Schur, Claudia; Zhao, Lan; Lucado, Jennifer

2013-01-01

This study assessed the perceptions and actions of rural hospital nurse executives with regard to patient safety and quality improvement (QI). A national sample of rural hospital nurse executives (n = 300) completed a survey measuring 4 domains related to patient safety and QI: (a) patient "Safety Culture," (b) adequacy of QI "Resources," (c) "Barriers" related to QI, and (d) "Nurse Leader Engagement" in activities supporting QI. Perceptions of Safety Culture were strong but 47% of the Resources needed to carry out QI were inadequate, 29% of Barriers were moderate to major, and 25% of Nurse Leader Engagement activities were performed infrequently. Nurse Leader Engagement in quality-related activities was less frequent among nurses in isolated and small rural town hospitals compared with large rural city hospitals. To further QI, rural nurse executives may need to use their communications and actions to raise the visibility of QI.

Teaching Quality Improvement in Graduate Medical Education: An Experiential and Team-Based Approach to the Acquisition of Quality Improvement Competencies.

PubMed

Hall Barber, Karen; Schultz, Karen; Scott, Abigail; Pollock, Emily; Kotecha, Jyoti; Martin, Danyal

2015-10-01

An emerging priority in medical education is the need to facilitate learners' acquisition of quality improvement (QI) competencies. Accreditation bodies in both Canada and the United States have included QI and patient safety in their core competencies. In 2010, the Department of Family Medicine at Queen's University designed a graduate medical education curriculum to engage residents in a clinical QI program that would meet accreditation requirements. Monthly didactic sessions were combined with an experiential, team-based QI project that aligned with existing clinic priorities. The curriculum spans the first year of residency and is divided into three stages: (1) Engaging, (2) Understanding, and (3) Improving and translating. In Stage 1, teams of residents select a clinical QI topic, engage stakeholders, and collect baseline data related to their topic. In Stage 2, they focus on understanding their problem, interpreting their results, and applying QI tools. In Stage 3, they develop change ideas, translate their knowledge, and prepare to hand over their project. This QI curriculum aided residents in effectively acquiring QI competencies and allowed them to experience real-world challenges, such as securing project buy-in, negotiating with peers, and developing solutions to problems. Unlike in many QI programs, residents learned how to improve quality rather than about QI; thus, they formed the necessary foundation to carry out QI work in the future. The curriculum will be evaluated using a knowledge assessment and satisfaction tool and postproject resident interviews. Facilitators will focus more on improving faculty develop ment in QI.

Practical Implications for an Effective Radiology Residency Quality Improvement Program for Milestone Assessment.

PubMed

Leddy, Rebecca; Lewis, Madelene; Ackerman, Susan; Hill, Jeanne; Thacker, Paul; Matheus, Maria; Tipnis, Sameer; Gordon, Leonie

2017-01-01

Utilization of a radiology resident-specific quality improvement (QI) program and curriculum based on the Accreditation Council for Graduate Medical Education (ACGME) milestones can enable a program's assessment of the systems-based practice component and prepare residents for QI implementation post graduation. This article outlines the development process, curriculum, QI committee formation, and resident QI project requirements of one institution's designated radiology resident QI program. A method of mapping the curriculum to the ACGME milestones and assessment of resident competence by postgraduate year level is provided. Sample projects, challenges to success, and lessons learned are also described. Survey data of current trainees and alumni about the program reveal that the majority of residents and alumni responders valued the QI curriculum and felt comfortable with principles and understanding of QI. The most highly valued aspect of the program was the utilization of a resident education committee. The majority of alumni responders felt the residency quality curriculum improved understanding of QI, assisted with preparation for the American Board of Radiology examination, and prepared them for QI in their careers. In addition to the survey results, outcomes of resident project completion and resident scholarly activity in QI are evidence of the success of this program. It is hoped that this description of our experiences with a radiology resident QI program, in accordance with the ACGME milestones, may facilitate the development of successful QI programs in other diagnostic radiology residencies. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Relationships between tuna catch and variable frequency oceanographic conditions

NASA Astrophysics Data System (ADS)

Ormaza-González, Franklin Isaac; Mora-Cervetto, Alejandra; María Bermúdez-Martínez, Raquel

2016-08-01

Skipjack (Katsuwunus pelamis), yellow fin (Thunnus albacares) and albacore (Thunnus alulunga) tunas landed in the Eastern Pacific Ocean (EPO) countries and Ecuador were correlated to the Indexes Oceanic El Niño (ONI) and Multivariate Enso Index (MEI). The temporal series 1983-2012, and 1977-1999 (warm Pacific Decadal Oscillation, PDO), and 2000-2012 (cold PDO) were analyzed. Linear correlation showed that at least 11 % of the total landings were associated with the MEI, with a slightly negative gradient from cold to warm conditions. When non-linear regression (n = 6), the R2 was higher up to 0.304 (MEI, r = 0.551). The correlation shows high spread from -0.5 to +0.5 for both MEI/ONI; the highest landings occurred at 0.34-0.45; both indexes suggested that at extreme values < -1.0 and > 1.1 total landings tend to decrease. Landings were associated up to 21.9 % (MEI) in 2000-2012, 1983-1999 rendered lower R2 (< 0.09); i.e., during cold PDO periods there was a higher association between landings and oceanographic conditions. For the non-linear regression (n = 6) a R2 of 0.374 (MEI) and 0.408 (ONI) were registered, for the 2000-2012, a higher R2 was observed in 1983-1999, 0.443 and 0.711 for MEI and ONI respectively, suggesting that is better to analyze split series (1983-1999, 2000-2012) than as a whole (1983-2012), due to noise produced by the transition from hot to cold PDOs. The highest landings were in the range -0.2 to 0.5 for MEI/ONI. The linear regression of skipjack landings in Ecuador gave an R2 of 0.140 (MEI) and 0.066 (ONI) and the non-linear were 0.440 and 0.183 respectively. Total landings in the EPO associated to oceanographic events of high and low frequencies could be used somehow as predictors of the high El Niño o La Niña. There is a clear evidence that tuna fish biomass are at higher levels when the PDO is on cold phase (2000-2030) and vice versa on warm phase (1980-1999). The analysis of the skipjack catch per unit effort (CPUE) on floating

Simultaneous determination of naringenin and hesperetin in rats after oral administration of Da-Cheng-Qi decoction by high-performance liquid chromatography-tandem mass spectrometry.

PubMed

Liu, Ying; Xu, Fengguo; Zhang, Zunjian; Song, Rui; Tian, Yuan

2008-07-01

To quantify naringenin and hesperetin in rat plasma after oral administration of Da-Cheng-Qi decoction, a famous purgative traditional Chinese medicine, a high-performance liquid chromatography-tandem mass spectrometry method was developed and validated. The HPLC separation was carried out on a Zorbax SB-C(18) column using 0.1% formic acid-methanol as mobile phase and estazolam as internal standard after the sample of rat plasma had been cleaned up with one-step protein precipitation using methanol. Atmospheric pressure chemical ionization in the positive ion mode and selected reaction monitoring method was developed to determine the active components. This method was validated in terms of recovery, linearity, accuracy and precision (intra- and inter-batch variation). The recoveries of naringenin and hesperetin were 72.8-76.6 and 75.7-77.2%, respectively. Linearity in rat plasma was observed over the range of 0.5-250 ng/mL (r2 > 0.99) for both naringenin and hesperetin. The accuracy and precision were well within the acceptable range and the relative standard deviation of the measured rat plasma samples was less than 15% (n = 5). The validated method was successfully applied for the evaluation of the pharmacokinetics of naringenin and hesperetin administered to six rats.

Positivity-preserving High Order Finite Difference WENO Schemes for Compressible Euler Equations

DTIC Science & Technology

2011-07-15

the WENO reconstruction. We assume that there is a polynomial vector qi(x) = (ρi(x), mi(x), Ei(x)) T with degree k which are (k + 1)-th order accurate...i+ 1 2 = qi(xi+ 1 2 ). The existence of such polynomials can be established by interpolation for WENO schemes. For example, for the fifth or- der...WENO scheme, there is a unique vector of polynomials of degree four qi(x) satisfying qi(xi− 1 2 ) = w+ i− 1 2 , qi(xi+ 1 2 ) = w− i+ 1 2 and 1 ∆x ∫ Ij qi

Healthcare quality improvement work: a professional employee perspective.

PubMed

Gadolin, Christian; Andersson, Thomas

2017-06-12

Purpose The purpose of this paper is to describe and analyze conditions that influence how employees engage in healthcare quality improvement (QI) work. Design/methodology/approach Qualitative case study based on interviews ( n=27) and observations ( n=10). Findings The main conditions that influence how employees engage in healthcare QI work are professions, work structures and working relationships. These conditions can both prevent and facilitate healthcare QI. Professions and work structures may cement existing institutional logics and thus prevent employees from engaging in healthcare QI work. However, attempts to align QI with professional logics, together with work structures that empower employees, can make these conditions increase employee engagement, which can be accomplished through positive working relationships that foster institutional work, which bridge different competing institutional logics, making it possible to overcome barriers that professions and work structures may constitute. Practical implications Understanding the conditions that influence how employees engage in healthcare QI work will make initiatives more likely to succeed. Originality/value Healthcare QI has mainly been studied from an implementer perspective, and employees have either been neglected or seen as passive resisters. Weak employee perspectives make healthcare QI research incomplete. In our research, healthcare QI work is studied closely at the actor level to understand healthcare QI from an employee perspective.

Evaluating investment in quality improvement capacity building: a systematic review.

PubMed

Mery, Gustavo; Dobrow, Mark J; Baker, G Ross; Im, Jennifer; Brown, Adalsteinn

2017-02-20

Leading health systems have invested in substantial quality improvement (QI) capacity building, but little is known about the aggregate effect of these investments at the health system level. We conducted a systematic review to identify key steps and elements that should be considered for system-level evaluations of investment in QI capacity building. We searched for evaluations of QI capacity building and evaluations of QI training programmes. We included the most relevant indexed databases in the field and a strategic search of the grey literature. The latter included direct electronic scanning of 85 relevant government and institutional websites internationally. Data were extracted regarding evaluation design and common assessment themes and components. 48 articles met the inclusion criteria. 46 articles described initiative-level non-economic evaluations of QI capacity building/training, while 2 studies included economic evaluations of QI capacity building/training, also at the initiative level. No system-level QI capacity building/training evaluations were found. We identified 17 evaluation components that fit within 5 overarching dimensions (characteristics of QI training; characteristics of QI activity; individual capacity; organisational capacity and impact) that should be considered in evaluations of QI capacity building. 8 key steps in return-on-investment (ROI) assessments in QI capacity building were identified: (1) planning-stakeholder perspective; (2) planning-temporal perspective; (3) identifying costs; (4) identifying benefits; (5) identifying intangible benefits that will not be included in the ROI estimation; (6) discerning attribution; (7) ROI calculations; (8) sensitivity analysis. The literature on QI capacity building evaluation is limited in the number and scope of studies. Our findings, summarised in a Framework to Guide Evaluations of QI Capacity Building , can be used to start closing this knowledge gap. Published by the BMJ Publishing

A scoping review of online repositories of quality improvement projects, interventions and initiatives in healthcare.

PubMed

Bytautas, Jessica P; Gheihman, Galina; Dobrow, Mark J

2017-04-01

Quality improvement (QI) is becoming an important focal point for health systems. There is increasing interest among health system stakeholders to learn from and share experiences on the use of QI methods and approaches in their work. Yet there are few easily accessible, online repositories dedicated to documenting QI activity. We conducted a scoping review of publicly available, web-based QI repositories to (i) identify current approaches to sharing information on QI practices; (ii) categorise these approaches based on hosting, scope and size, content acquisition and eligibility, content format and search, and evaluation and engagement characteristics; and (iii) review evaluations of the design, usefulness and impact of their online QI practice repositories. The search strategy consisted of traditional database and grey literature searches, as well as expert consultation, with the ultimate aim of identifying and describing QI repositories of practices undertaken in a healthcare context. We identified 13 QI repositories and found substantial variation across the five categories. The QI repositories used different terminology (eg, practices vs case studies) and approaches to content acquisition, and varied in terms of primary areas of focus. All provided some means for organising content according to categories or themes and most provided at least rudimentary keyword search functionality. Notably, none of the QI repositories included evaluations of their impact. With growing interest in sharing and spreading best practices and increasing reliance on QI as a key contributor to health system performance, the role of QI repositories is likely to expand. Designing future QI repositories based on knowledge of the range and type of features available is an important starting point for improving their usefulness and impact. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Quality Improvement Practices in Academic Emergency Medicine: Perspectives from the Chairs

PubMed Central

DelliFraine, Jami; Langabeer, James; King, Brent

2010-01-01

Objective To assess academic emergency medicine (EM) chairs’ perceptions of quality improvement (QI) training programs. Methods A voluntary anonymous 20 item survey was distributed to a sample of academic chairs of EM through the Association of Academic Chairs of Emergency Medicine. Data was collected to assess the percentage of academic emergency physicians who had received QI training, the type of training they received, their perception of the impact of this training on behavior, practice and outcomes, and any perceived barriers to implementing QI programs in the emergency department. Results The response rate to the survey was 69% (N = 59). 59.3% of respondents report that their hospital has a formal QI program for physicians. Chairs received training in a variety of QI programs. The type of QI program used by respondents was perceived as having no impact on goals achieved by QI (χ2 = 12.382; p = 0.260), but there was a statistically significant (χ2 = 14.383; p = 0.006) relationship between whether or not goals were achieved and academic EM chairs’ perceptions about return on investment for QI training. Only 22% of chairs responded that they have already made changes as a result of the QI training. 78.8% of EM chairs responded that quality programs could have a significant positive impact on their practice and the healthcare industry. Chairs perceived that QI programs had the most potential value in the areas of understanding and reducing medical errors and improving patient flow and throughput. Other areas of potential value of QI include improving specific clinical indicators and standardizing physician care. Conclusion Academic EM chairs perceived that QI programs were an effective way to drive needed improvements. The results suggest that there is a high level of interest in QI but a low level of adoption of training and implementation. PMID:21293770

Evaluating investment in quality improvement capacity building: a systematic review

PubMed Central

Mery, Gustavo; Dobrow, Mark J; Baker, G Ross; Im, Jennifer; Brown, Adalsteinn

2017-01-01

Purpose Leading health systems have invested in substantial quality improvement (QI) capacity building, but little is known about the aggregate effect of these investments at the health system level. We conducted a systematic review to identify key steps and elements that should be considered for system-level evaluations of investment in QI capacity building. Methods We searched for evaluations of QI capacity building and evaluations of QI training programmes. We included the most relevant indexed databases in the field and a strategic search of the grey literature. The latter included direct electronic scanning of 85 relevant government and institutional websites internationally. Data were extracted regarding evaluation design and common assessment themes and components. Results 48 articles met the inclusion criteria. 46 articles described initiative-level non-economic evaluations of QI capacity building/training, while 2 studies included economic evaluations of QI capacity building/training, also at the initiative level. No system-level QI capacity building/training evaluations were found. We identified 17 evaluation components that fit within 5 overarching dimensions (characteristics of QI training; characteristics of QI activity; individual capacity; organisational capacity and impact) that should be considered in evaluations of QI capacity building. 8 key steps in return-on-investment (ROI) assessments in QI capacity building were identified: (1) planning—stakeholder perspective; (2) planning—temporal perspective; (3) identifying costs; (4) identifying benefits; (5) identifying intangible benefits that will not be included in the ROI estimation; (6) discerning attribution; (7) ROI calculations; (8) sensitivity analysis. Conclusions The literature on QI capacity building evaluation is limited in the number and scope of studies. Our findings, summarised in a Framework to Guide Evaluations of QI Capacity Building, can be used to start closing this knowledge

78 FR 27238 - Ocean Transportation Intermediary License Applicants

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-09

... President (QI), Charles H. Fischer III, President, Application Type: QI Change. CNC Worldwide, Inc. (NVO), 5343 W. Imperial Highway, Suite 300, Los Angeles, CA 90045, Officers: Eric Cheon, Secretary (QI), Henry...), 446 Cloverleaf Drive, Baldwin Park, CA 91706, Officers: Alexander C. Sahagun, President (QI), Julian L...

A multi-state assessment of employer-sponsored quality improvement education for early-career registered nurses.

PubMed

Djukic, Maja; Kovner, Christine T; Brewer, Carol S; Fatehi, Farida K; Seltzer, Joanna R

2013-01-01

Increasing participation of registered nurses (RNs) in quality improvement (QI) is a promising strategy to close the health care quality chasm. For RNs to participate effectively in hospital QI, they must have adequate QI knowledge and skills. This descriptive study assessed employer-sponsored QI education and RNs' preparedness across a wide range of QI steps and processes. RNs from 15 U.S. states who were employed in hospitals and were initially licensed to practice in 2007 to 2008 were surveyed. Fewer than one third of respondents reported being very prepared across all measured QI topics. More than half reported receiving zero hours of training in these same topics in the last year. Lack of educational offerings on the topic was the top reason respondents gave for not obtaining QI training. The QI education offered by employers to RNs could be substantially improved. Nurse educators play a critical role in making these improvements. Copyright 2013, SLACK Incorporated.

Prospects and Problems of Transferring Quality-Improvement Methods from Health Care to Social Services: Two Case Studies

PubMed Central

Neubeck, Truls; Elg, Mattias; Schneider, Thomas; Andersson-Gäre, Boel

2014-01-01

Introduction: This study examines the use of quality-improvement (QI) methods in social services. Particularly the key aspects—generalizable knowledge, interprofessional teamwork, and measurements—are studied in projects from the QI program Forum for Values in Sweden. Methods: This is a mixed-method case study. Two projects using standard QI methods and tools as used in health care were chosen as critical cases to highlight some problems and prospects with the use of QI in social services. The cases were analyzed through documented results and qualitative interviews with participants one year after the QI projects ended. Results: The social service QI projects led to measurable improvements when they used standard methods and tools for QI in health care. One year after the projects, the improvements were either not continuously measured or not reported in any infrastructure for measurements. The study reveals that social services differ from health care regarding the availability and use of evidence, the role of professional expertise, and infrastructure for measurements. Conclusions: We argue that QI methods as used in health care are applicable in social services and can lead to measurable improvements. The study gives valuable insights for QI, not only in social services but also in health care, on how to assess and sustain improvements when infrastructures for measurements are lacking. In addition, when one forms QI teams, the focus should be on functions instead of professions, and QI methods can be used to support implementation of evidence-based practice. PMID:24867549

Comparative diagnostics of allergy using quantitative immuno-PCR and ELISA.

PubMed

Simonova, Maria A; Pivovarov, Victor D; Ryazantsev, Dmitry Y; Dolgova, Anna S; Berzhets, Valentina M; Zavriev, Sergei K; Svirshchevskaya, Elena V

2018-05-01

Estimation of specific IgE is essential for the prevention of allergy progression. Quantitative immuno-PCR (qiPCR) can increase the sensitivity of IgE detection. We aimed to develop qiPCR and compare it to the conventional ELISA in identification of IgE to Alt a 1 and Fel d 1 allergens. Single stranded 60-mer DNA conjugated to streptavidin was used to detect antigen-IgE-biotin complex by qiPCR. In semi-logarithmic scale qiPCR data were linear in a full range of serum dilutions resulting in three- to ten-times higher sensitivity of qiPCR in comparison with ELISA in IgE estimation in low titer sera. Higher sensitivity of qiPCR in identification of low titer IgE is a result of a higher linearity of qiPCR data.

Has Voluntary Public Health Accreditation Impacted Health Department Perceptions and Activities in Quality Improvement and Performance Management?

PubMed

Beitsch, Leslie M; Kronstadt, Jessica; Robin, Nathalie; Leep, Carolyn

The Public Health Accreditation Board (PHAB) is now in its 10th year, making it an ideal time to study the impact of PHAB accreditation on local health departments (LHDs). To examine whether applying for PHAB accreditation affects perceptions and activities regarding quality improvement (QI) and performance management (PM) within LHDs. Data from the National Association of County & City Health Officials' 2010, 2013, and 2016 National Profile of Local Health Departments and associated QI modules were linked to PHAB-applicant data collected in e-PHAB in a cross-sectional and longitudinal approach examining self-reported QI/PM activities. Local health departments responding to National Association of County & City Health Officials Profile questionnaires and QI modules in 2010, 2013, and 2016. Implementation of formal QI program within agency, numbers of formal QI projects in the past year, presence of elements indicating formal QI program implementation, and changes over time by accreditation status as of June 2017. Accredited and in-process LHDs showed greater gains over time in all of the outcome measures than LHDs not registered in e-PHAB. Results of logistic regression controlling for population served and governance type found accredited LHDs more likely to report formal QI programs agency-wide (odds ratio: [OR] = 27.0; P < .001) and have implemented 6 to 8 elements of formal QI (OR = 27.0; P < .001) in 2016, compared with nonaccreditation-seeking LHDs. Between 2013 and 2016, LHDs that responded to both survey waves that were registered in e-PHAB or accredited were significantly more likely than nonaccreditation-seeking LHDs to report any increase in overall level of QI implementation (OR = 4.89; P = .006) and increase in number of elements of formal QI (OR = 16.1; P < .001). Local health departments accredited by June 2017 and those in process reported more formal QI activities and showed greater improvements with QI/PM implementation over time than LHDs not

Improving Culture, One Quality Improvement Project at a Time.

PubMed

Vander Schaaf, Emily B; Cornett, Amanda C; Randolph, Greg D

A culture of quality improvement (QI) values collaboration, transparency, and staff empowerment. Organizations exhibiting a culture of QI are more likely to engage in QI. We examined whether local health departments' (LHDs') participation in a longitudinal, experiential QI training program changes QI culture. Prior to and following participation in a QI training program, all employees of participating LHDs were asked to complete an 8-item survey assessing components of QI culture on a 5-point scale. From 2010 to 2015, multidisciplinary teams from North Carolina LHDs participated in sequential cohorts of a 6-month QI training program, during which the teams completed a QI project. We dichotomized culture survey responses, with 4 or 5 being "Supportive." We compared adjusted proportions, using linear regression, clustering at LHD, and controlling for cohort. Data from 42 LHDs were included. At baseline, 7.8% responded that their LHD had a supportive culture for all 8 components, compared with 12% at follow-up (P < .001), adjusted for cohort and clustering by LHD. At follow-up, the percentage of employees responding that their LHDs had supportive cultures increased for all components of culture including communication by 4.1% (95% CI: 2.0%-6.2%), problem solving by 2.9% (95% CI: 1.6%-5.5%), team work by 5.2% (95% CI: 2.5%-7.8%), vision by 4.3% (95% CI: 1.1%-7.5%), performance measures by 5.6% (95% CI: 1.6%-9.6%), recognition by 4.7% (95% CI: 1.4%-8.0%), for conflict by 5.5% (95% CI: 1.7%-9.4%), and alignment by 5.8% (95% CI: 2.3%-9.2%). Engagement with structured QI training programs-and perhaps simply completing QI projects-can cause small, but important changes in organizations' cultures, thus increasing engagement in future QI and improving overall care and services. The article demonstrates that when LHDs participate in a longitudinal, experiential QI training program, their cultures of QI improve. Local health departments participating in similar training

Research on major antitumor active components in Zi-Cao-Cheng-Qi decoction based on hollow fiber cell fishing with high performance liquid chromatography.

PubMed

Li, Miaomiao; Hu, Shuang; Chen, Xuan; Wang, Runqin; Bai, Xiaohong

2018-02-05

Hollow fiber cell fishing (HFCF) based on hepatoma HepG-2 cells, human renal tubular ACHN cells or human cervical carcinoma HeLa cells, coupled with high-performance liquid chromatography (HPLC), was developed and employed to research the major active components in Zi-Cao-Cheng-Qi decoction both in vitro and in vivo. The research showed that the active components, such as hesperidin, magnolol, honokiol, shikonin, emodin and β,β'-dimethylacrylshikonin were screened out by HFCF based on the cancer cells in vitro, furthermore they can be absorbed into blood and reach in the target organ, and some of the active components can be fished by the cells and maintain effective concentrations. Before application of HFCF with HPLC, cell growth state, cell survival rate, positive effect on screening results binding between active centers on the fiber and target components, repeatability of retention times and relative peak areas of the target analytes were analysed and investigated. In short, HFCF with HPLC is a simple, inexpensive, effective, and reliable method that can be used in researching active components from traditional Chinese medicine (TCM) and its formula both in vitro and in vivo, elucidating preliminarily the TCM characteristics of multiple components and multiple targets, laying a foundation for expounding the antitumor efficacy material basis in TCM. Copyright © 2017 Elsevier B.V. All rights reserved.

The Educational Toolbox: Kick Start Your Educational Program in Quality Improvement.

PubMed

Hoffman, Rebecca L; Medbery, Rachel L; Vandermeer, Thomas J; Morris, Jon B; Kelz, Rachel R

2015-01-01

To disseminate materials and learning from the proceedings of the Association of Program Directors 2014 Annual Meeting workshop on the integration of quality improvement (QI) education into the existing educational infrastructure. Modern surgical practice demands an understanding of QI methodology. Yet, today׳s surgeons are not formally educated in QI methodology. Therefore, it is hard to follow the historical mantra of "see one, do one, teach one" in the quality realm. Participants were given a brief introduction to QI approaches. A number of concrete examples of how to incorporate QI education into training programs were presented, followed by a small group session focused on the identification of barriers to incorporation. Participants were provided with a worksheet to help navigate the initial incorporation of QI education in 3 steps. Participants were representative of all types of training programs, with differing levels of existing QI integration. Barriers to QI education included lack of resident interest/buy-in, concerns over the availability of educational resources (i.e., limited time to devote to QI), and a limited QI knowledge among surgical educators. The 3 steps to kick starting the educational process included (1) choosing a specific method of QI education, (2) incorporation via barrier, infrastructure, and stakeholder identification, and (3) implementation and ongoing assessment. Recent changes in the delivery of surgical care along with the new accreditation system have necessitated the development of QI education programs for use in surgical education. To continue to make surgery safer and ensure optimal patient outcomes, surgical educators must teach each resident to adopt quality science methodology in a meaningful way. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The Emergence of Probabilistic Reasoning in Very Young Infants: Evidence from 4.5- and 6-Month-Olds

ERIC Educational Resources Information Center

Denison, Stephanie; Reed, Christie; Xu, Fei

2013-01-01

How do people make rich inferences from such sparse data? Recent research has explored this inferential ability by investigating probabilistic reasoning in infancy. For example, 8- and 11-month-old infants can make inferences from samples to populations and vice versa (Denison & Xu, 2010a; Xu & Denison, 2009; Xu & Garcia, 2008a). The…

Chief of Residents for Quality Improvement and Patient Safety: A Recipe for a New Role in Graduate Medical Education.

PubMed

Ferraro, Kelly; Zernzach, Randall; Maturo, Stephen; Nagy, Christopher; Barrett, Rebecca

2017-03-01

The San Antonio Uniformed Services Health Education Consortium (SAUSHEC) is the largest group of residency programs in the Department of Defense. In an effort to provide improved Quality Improvement and Patient Safety (QI/PS) training for its residents, SAUSHEC created the position of Chief of QI/PS for Residents in the academic year 2014-2015. The Chief of QI/PS for Residents was based in the Internal Medicine residency program but also assisted with SAUSHEC-wide QI/PS projects. This is the first such job in the Department of Defense. Here, we detail the accomplishments during this first academic year, including the alignment of the job with the stated QI/PS-related goals of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review. Efforts focused within the Internal Medicine residency program included QI/PS curriculum development, improvement upon monthly morbidity and mortality (M&M) conferences, and facilitating resident participation in QI projects. The 2014-2015 academic year Internal Medicine residency QI/PS project focused on increasing comfort and discussions with patients regarding advance directives; this also served to emphasize the humanistic side of potential QI/PS projects. The Chief of QI/PS for Residents also spearheaded hospital-wide initiatives, including the creation of a quarterly hospital-wide M&M conference, coordinating resident involvement in QI/PS-related committees, and facilitating feedback of patient safety report responses to trainees. We focus on the portion of the QI/PS curriculum involving the presentation of a mock Root Cause Analysis (RCA) and provide the results of a pre- and postpresentation survey of resident knowledge of RCAs. In order to quantify the efforts over the entire academic year, we also report the results of a resident self-assessment of QI/PS aptitude and competencies, including changes in these measures over the academic year. Finally, we discuss challenges faced and outline

Trimeric association of Hox and TALE homeodomain proteins mediates Hoxb2 hindbrain enhancer activity.

PubMed

Jacobs, Y; Schnabel, C A; Cleary, M L

1999-07-01

Pbx/exd proteins modulate the DNA binding affinities and specificities of Hox proteins and contribute to the execution of Hox-dependent developmental programs in arthropods and vertebrates. Pbx proteins also stably heterodimerize and bind DNA with Meis and Pknox1-Prep1, additional members of the TALE (three-amino-acid loop extension) superclass of homeodomain proteins that function on common genetic pathways with a subset of Hox proteins. In this study, we demonstrated that Pbx and Meis bind DNA as heterotrimeric complexes with Hoxb1 on a genetically defined Hoxb2 enhancer, r4, that mediates the cross-regulatory transcriptional effects of Hoxb1 in vivo. The DNA binding specificity of the heterotrimeric complex for r4 is mediated by a Pbx-Hox site in conjunction with a distal Meis site, which we showed to be required for ternary complex formation and Meis-enhanced transcription. Formation of heterotrimeric complexes in which all three homeodomains bind their cognate DNA sites is topologically facilitated by the ability of Pbx and Meis to interact through their amino termini and bind DNA without stringent half-site orientation and spacing requirements. Furthermore, Meis site mutation in the Hoxb2 enhancer phenocopies Pbx-Hox site mutation to abrogate enhancer-directed expression of a reporter transgene in the murine embryonic hindbrain, demonstrating that DNA binding by all three proteins is required for trimer function in vivo. Our data provide in vitro and in vivo evidence for the combinatorial regulation of Hox and TALE protein functions that are mediated, in part, by their interdependent DNA binding activities as ternary complexes. As a consequence, Hoxb1 employs Pbx and Meis-related proteins, as a pair of essential cofactors in a higher-order molecular complex, to mediate its transcriptional effects on an endogenous Hox response element.

Trimeric Association of Hox and TALE Homeodomain Proteins Mediates Hoxb2 Hindbrain Enhancer Activity

PubMed Central

Jacobs, Yakop; Schnabel, Catherine A.; Cleary, Michael L.

1999-01-01

Pbx/exd proteins modulate the DNA binding affinities and specificities of Hox proteins and contribute to the execution of Hox-dependent developmental programs in arthropods and vertebrates. Pbx proteins also stably heterodimerize and bind DNA with Meis and Pknox1-Prep1, additional members of the TALE (three-amino-acid loop extension) superclass of homeodomain proteins that function on common genetic pathways with a subset of Hox proteins. In this study, we demonstrated that Pbx and Meis bind DNA as heterotrimeric complexes with Hoxb1 on a genetically defined Hoxb2 enhancer, r4, that mediates the cross-regulatory transcriptional effects of Hoxb1 in vivo. The DNA binding specificity of the heterotrimeric complex for r4 is mediated by a Pbx-Hox site in conjunction with a distal Meis site, which we showed to be required for ternary complex formation and Meis-enhanced transcription. Formation of heterotrimeric complexes in which all three homeodomains bind their cognate DNA sites is topologically facilitated by the ability of Pbx and Meis to interact through their amino termini and bind DNA without stringent half-site orientation and spacing requirements. Furthermore, Meis site mutation in the Hoxb2 enhancer phenocopies Pbx-Hox site mutation to abrogate enhancer-directed expression of a reporter transgene in the murine embryonic hindbrain, demonstrating that DNA binding by all three proteins is required for trimer function in vivo. Our data provide in vitro and in vivo evidence for the combinatorial regulation of Hox and TALE protein functions that are mediated, in part, by their interdependent DNA binding activities as ternary complexes. As a consequence, Hoxb1 employs Pbx and Meis-related proteins, as a pair of essential cofactors in a higher-order molecular complex, to mediate its transcriptional effects on an endogenous Hox response element. PMID:10373562

Carotid dual-energy CT angiography: Evaluation of low keV calculated monoenergetic datasets by means of a frequency-split approach for noise reduction at low keV levels.

PubMed

Riffel, Philipp; Haubenreisser, Holger; Meyer, Mathias; Sudarski, Sonja; Morelli, John N; Schmidt, Bernhard; Schoenberg, Stefan O; Henzler, Thomas

2016-04-01

Calculated monoenergetic ultra-low keV datasets did not lead to improved contrast-to-noise ratio (CNR) due to the dramatic increase in image noise. The aim of the present study was to evaluate the objective image quality of ultra-low keV monoenergetic images (MEIs) calculated from carotid DECT angiography data with a new monoenergetic imaging algorithm using a frequency-split technique. 20 patients (12 male; mean age 53±17 years) were retrospectively analyzed. MEIs from 40 to 120 keV were reconstructed using the monoenergetic split frequency approach (MFSA). Additionally MEIs were reconstructed for 40 and 50 keV using a conventional monoenergetic (CM) software application. Signal intensity, noise, signal-to-noise ratio (SNR) and CNR were assessed in the basilar, common, internal carotid arteries. Ultra-low keV MEIs at 40 keV and 50 keV demonstrated highest vessel attenuation, significantly greater than those of the polyenergetic images (PEI) (all p-values <0.05). The highest SNR level and CNR level was found at 40 keV and 50 keV (all p-values <0.05). MEIs with MFSA showed significantly lower noise levels than those processed with CM (all p-values <0.05) and no significant differences in vessel attenuation (p>0.05). Thus MEIs with MFSA showed significantly higher SNR and CNR compared to MEIs with CM. Combining the lower spatial frequency stack for contrast at low keV levels with the high spatial frequency stack for noise at high keV levels (frequency-split technique) leads to improved image quality of ultra-low keV monoenergetic DECT datasets when compared to previous monoenergetic reconstruction techniques without the frequency-split technique. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Prognostic value of major extracranial injury in traumatic brain injury: an individual patient data meta-analysis in 39,274 patients.

PubMed

van Leeuwen, Nikki; Lingsma, Hester F; Perel, Pablo; Lecky, Fiona; Roozenbeek, Bob; Lu, Juan; Shakur, Haleema; Weir, James; Steyerberg, Ewout W; Maas, Andrew I R

2012-04-01

Major extracranial injury (MEI) is common in traumatic brain injury (TBI) patients, but the effect on outcome is controversial. To assess the prognostic value of MEI on mortality after TBI in an individual patient data meta-analysis of 3 observational TBI studies (International Mission on Prognosis and Clinical Trial Design in TBI [IMPACT]), a randomized controlled trial (Corticosteroid Randomization After Significant Head Injury [CRASH]), and a trauma registry (Trauma Audit and Research Network [TARN]). MEI (extracranial injury with an Abbreviated Injury Scale ≥ 3 or requiring hospital admission) was related to mortality with logistic regression analysis, adjusted for age, Glasgow Coma Scale motor score, and pupil reactivity and stratified by TBI severity. We pooled odds ratios (ORs) with random-effects meta-analysis. We included 39,274 patients. Mortality was 25%, and 32% had MEI. MEI was a strong predictor for mortality in TARN, with adjusted odds ratios of 2.81 (95% confidence interval [CI], 2.44-3.23) in mild, 2.18 (95% CI, 1.80-2.65) in moderate, and 2.14 (95% CI, 1.95-2.35) in severe TBI patients. The prognostic effect was smaller in IMPACT and CRASH, with pooled adjusted odds ratios of 2.14 (95% CI, 0.93-4.91) in mild, 1.46 (95% CI, 1.14-1.85) in moderate, and 1.18 (95% CI, 1.03-1.55) in severe TBI. When patients who died within 6 hours after injury were excluded from TARN, the effect of MEI was comparable with IMPACT and CRASH. MEI is an important prognostic factor for mortality in TBI patients. However, the effect varies by population, which explains the controversy in the literature. The strength of the effect is smaller in patients with more severe brain injury and depends on time of inclusion in a study.

Systematic review of middle ear implants: do they improve hearing as much as conventional hearing AIDS?

PubMed

Tysome, James R; Moorthy, Ram; Lee, Ambrose; Jiang, Dan; O'Connor, Alec Fitzgerald

2010-12-01

A systematic review to determine whether middle ear implants (MEIs) improve hearing as much as hearing aids. Databases included MEDLINE, EMBASE, DARE, and Cochrane searched with no language restrictions from 1950 or the start date of each database. Initial search found 644 articles, of which 17 met the inclusion criteria of MEI in adults with a sensorineural hearing loss, where hearing outcomes and patient-reported outcome measures (PROMs) compared MEI with conventional hearing aids (CHAs). Study quality assessment included whether ethical approval was gained, the study was prospective, eligibility criteria specified, a power calculation made and appropriate controls, outcome measures, and analysis performed. Middle ear implant outcome analysis included residual hearing, complications, and comparison to CHA in terms of functional gain, speech perception in quiet and in noise, and validated PROM questionnaires. Because of heterogeneity of outcome measures, comparisons were made by structured review. The quality of studies was moderate to poor with short follow-up. The evidence supports the use of MEI because, overall, they do not decrease residual hearing, result in a functional gain in hearing comparable to CHA, and may improve perception of speech in noise and sound quality. We recommend the publication of long-term results comparing MEI with CHA, reporting a minimum of functional gain, speech perception in quiet and in noise, complications, and a validated PROM to guide the engineering of the new generation of MEI in the future.

Laboratory determination of the carbon kinetic isotope effects (KIEs) for reactions of methyl halides with various nucleophiles in solution

USGS Publications Warehouse

Baesman, S.M.; Miller, L.G.

2005-01-01

Large carbon kinetic isotope effects (KIEs) were measured for reactions of methyl bromide (MeBr), methyl chloride (MeCl), and methyl iodide (MeI) with various nucleophiles at 287 and 306 K in aqueous solutions. Rates of reaction of MeBr and MeI with H2O (neutral hydrolysis) or Cl- (halide substitution) were consistent with previous measurements. Hydrolysis rates increased with increasing temperature or pH (base hydrolysis). KIEs for hydrolysis were 51 ?? 6??? for MeBr and 38 ?? 8??? for MeI. Rates of halide substitution increased with increasing temperature and greater reactivity of the attacking nucleophile, with the fastest reaction being that of MeI with Br-. KIEs for halide substitution were independent of temperature but varied with the reactant methyl halide and the attacking nucleophile. KIEs were similar for MeBr substitution with Cl- and MeCl substitution with Br- (57 ?? 5 and 60 ?? 9??? respectively). The KIE for halide exchange of MeI was lower overall (33 ?? 8??? and was greater for substitution with Br- (46 ?? 6???) than with Cl- (29 ?? 6???). ?? Springer Science + Business Media, Inc. 2005.

Cryo-banking of Prunus mume pollen and its application in cross-breeding.

PubMed

Zhang, Ya-Li; Chen, Rui-Dan; Huang, Cui-Juan; Liu, Yan

2009-01-01

The Mei (Prunus mume Sieb. et Zucc.) is one of the most widely used landscape plants and important germplasm resources in China. The study of pollen cryopreservation and the construction of a pollen cryo-bank have great importance in Mei research. From 2003 to 2007 we cryopreserved pollen from 51 Mei cultivars. In vitro germination of cryopreserved pollen was not significantly different from that of fresh pollen, even after four years of storage in liquid nitrogen. Cryopreserved pollen of 19 cultivars was used successfully for intraspecific hybridizations at Wuhan and Beijing in 2005 and 2006.

Meeting the Challenge of Practice Quality Improvement: A Study of Seven Family Medicine Residency Training Practices

PubMed Central

Chase, Sabrina M.; Miller, William L.; Shaw, Eric; Looney, Anna; Crabtree, Benjamin F.

2011-01-01

Purpose Incorporating quality improvement (QI) into resident education and clinical care is challenging. This report explores key characteristics shaping the relative success or failure of QI efforts in seven primary care practices serving as family medicine residency training sites. Method The authors used data from the 2002–2008 Using Learning Teams for Reflective Adaptation (ULTRA) study to conduct a comparative case analysis. This secondary data analysis focused on seven residency training practices' experiences with RAP (reflective adaptive process), a 12-week intensive QI process. Field notes, meeting notes, and audiotapes of RAP meetings were used to construct case summaries. A matrix comparing key themes across practices was used to rate practices' QI progress during RAP on a scale of 0 to 3. Results Three practices emerged as unsuccessful (scores of 0–1) and four as successful (scores of 2–3). Larger practices with previous QI experience, faculty with extensive exposure to QI literature, and an office manager, residency director, or medical director who advocated for the process made substantial progress during RAP, succeeding at QI. Smaller practices without these characteristics were unable to do so. Successful practices also engaged residents in the QI process and identified serious problems as potential crises; unsuccessful practices did not. Conclusions Larger residency training practices are more likely to have the resources and characteristics that permit them to create a QI-supportive culture leading to QI success. The authors suggest, however, that smaller practices may increase their chances of success by adopting a developmental approach to QI. PMID:22030767

Importance of Performance Measurement and MCH Epidemiology Leadership to Quality Improvement Initiatives at the National, State and Local Levels

PubMed Central

Rankin, Kristin M.; Gavin, Loretta; Moran, John W.; Kroelinger, Charlan D.; Vladutiu, Catherine J.; Goodman, David A.; Sappenfield, William M.

2018-01-01

Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists’ contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes. PMID:27423235

Importance of Performance Measurement and MCH Epidemiology Leadership to Quality Improvement Initiatives at the National, State and Local Levels.

PubMed

Rankin, Kristin M; Gavin, Loretta; Moran, John W; Kroelinger, Charlan D; Vladutiu, Catherine J; Goodman, David A; Sappenfield, William M

2016-11-01

Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists' contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes.

The influence of corporate structure and quality improvement activities on outcome improvement in residential care homes.

PubMed

Winters, S; Kool, R B; Klazinga, N S; Huijsman, R

2014-08-01

To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships between corporate structure, QI activities and performance improvements on indicators. In total, 169 residential care homes for the elderly in the Netherlands. Change between 2007 and 2009 in client-reported and professional indicators. A middle-size corporate structure was associated with QI. The QI activity 'multidisciplinary team meetings' was positively correlated with the indicator 'safety environment' for somatic and psycho-geriatric care. The QI activities 'educational material' and 'direct work instructions' were associated negatively with the indicator 'availability of personnel' for somatic clients, but positively for psycho-geriatric clients. QI activities such as 'health plan activities', 'clinical lessons' and 'financial activities' had no relationship to improved performance. For psycho-geriatric clients mainly organizational QI activities were positively associated with QI. The mediating role of the corporate structure for performing QI activities appeared stronger for the change in client-reported than for professional indicators. This study reveals associations between QI activities and corporate structure and changes in indicator performance. A corporate structure was associated with improvement in client-reported indicators, but less on professional indicators, which assumes a central policy at corporate level with impact on client-reported indicators, in contrast to a more local level approach towards activities that result in QI on professional indicators. Tailoring QI activities at the right managerial level may be important to achieve improvement. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in

Trauma quality improvement in low and middle income countries of the Asia-Pacific region: a mixed methods study.

PubMed

Stelfox, Henry Thomas; Joshipura, Manjul; Chadbunchachai, Witaya; Ellawala, Ranjith N; O'Reilly, Gerard; Nguyen, Thai Son; Gruen, Russell L

2012-08-01

Quality Improvement (QI) programs have been shown to be a valuable tool to strengthen care of severely injured patients, but little is known about them in low and middle income countries (LMIC). We sought to explore opportunities to improve trauma QI activities in LMIC, focusing on the Asia-Pacific region. We performed a mixed methods research study using both inductive thematic analysis of a meeting convened at the Royal Australasian College of Surgeons, Melbourne, Australia, November 21-22, 2010 and a pre-meeting survey to explore experiences with trauma QI activities in LMIC. Purposive sampling was employed to invite participants with demonstrated leadership in trauma care to provide diverse representation of organizations and countries within Asia-Pacific. A total of 22 experts participated in the meeting and reported that trauma QI activities varied between countries and organizations: morbidity and mortality conferences (56 %), monitoring complications (31 %), preventable death studies (25 %), audit filters (19 %), and statistical methods for analyzing morbidity and mortality (6 %). Participants identified QI gaps to include paucity of reliable/valid injury data, lack of integrated trauma QI activities, absence of standards of care, lack of training in QI methods, and varying cultures of quality and safety. The group highlighted barriers to QI: limited engagement of leaders, organizational diversity, limited resources, heavy clinical workload, and medico-legal concerns. Participants proposed establishing the Asia-Pacific Trauma Quality Improvement Network (APTQIN) as a tool to facilitate training and dissemination of QI methods, injury data management, development of pilot QI projects, and advocacy for quality trauma care. Our study provides the first description of trauma QI practices, gaps in existing practices, and barriers to QI in LMIC of the Asia-Pacific region. In this study we identified opportunities for addressing these challenges, and that work

How do hospital boards govern for quality improvement? A mixed methods study of 15 organisations in England

PubMed Central

Pomeroy, Linda; Burnett, Susan; Anderson, Janet E; Fulop, Naomi J

2017-01-01

Background Health systems worldwide are increasingly holding boards of healthcare organisations accountable for the quality of care that they provide. Previous empirical research has found associations between certain board practices and higher quality patient care; however, little is known about how boards govern for quality improvement (QI). Methods We conducted fieldwork over a 30-month period in 15 healthcare provider organisations in England as part of a wider evaluation of a board-level organisational development intervention. Our data comprised board member interviews (n=65), board meeting observations (60 hours) and documents (30 sets of board meeting papers, 15 board minutes and 15 Quality Accounts). We analysed the data using a framework developed from existing evidence of links between board practices and quality of care. We mapped the variation in how boards enacted governance of QI and constructed a measure of QI governance maturity. We then compared organisations to identify the characteristics of those with mature QI governance. Results We found that boards with higher levels of maturity in relation to governing for QI had the following characteristics: explicitly prioritising QI; balancing short-term (external) priorities with long-term (internal) investment in QI; using data for QI, not just quality assurance; engaging staff and patients in QI; and encouraging a culture of continuous improvement. These characteristics appeared to be particularly enabled and facilitated by board-level clinical leaders. Conclusions This study contributes to a deeper understanding of how boards govern for QI. The identified characteristics of organisations with mature QI governance seemed to be enabled by active clinical leadership. Future research should explore the biographies, identities and work practices of board-level clinical leaders and their role in organisation-wide QI. PMID:28689191

Development of a Quality Improvement Curriculum in Physician Assistant Studies.

PubMed

Kindratt, Tiffany B; Orcutt, Venetia L

2017-06-01

The purpose of this project was to develop and evaluate a curriculum for physician assistant (PA) students addressing knowledge, skills, and attitudes (KSA) toward quality improvement (QI). Students (N = 77) completed a pretest rating their KSA. A curriculum was developed to improve KSA among didactic and clinical students. Two department-wide QI projects were developed for student participation. Students completed a posttest after completing curriculum components and changes in KSA had been measured. Postcurriculum implementation, QI knowledge, and skills increased significantly in most areas. Large improvements were seen in knowledge of Plan, Do, Study, Act models and life cycles of QI projects (p < .0001). Seven students (20%) participated in department-wide projects. Our curriculum model (1) was effective at improving students' QI knowledge and skills; (2) allowed students to participate in community-based QI projects; and (3) can be used by other PA programs looking to enhance their QI curriculum.

The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement.

PubMed

Kaplan, Heather C; Provost, Lloyd P; Froehle, Craig M; Margolis, Peter A

2012-01-01

BACKGROUND Quality improvement (QI) efforts have become widespread in healthcare, however there is significant variability in their success. Differences in context are thought to be responsible for some of the variability seen. To develop a conceptual model that can be used by organisations and QI researchers to understand and optimise contextual factors affecting the success of a QI project. 10 QI experts were provided with the results of a systematic literature review and then participated in two rounds of opinion gathering to identify and define important contextual factors. The experts subsequently met in person to identify relationships among factors and to begin to build the model. The Model for Understanding Success in Quality (MUSIQ) is organised based on the level of the healthcare system and identifies 25 contextual factors likely to influence QI success. Contextual factors within microsystems and those related to the QI team are hypothesised to directly shape QI success, whereas factors within the organisation and external environment are believed to influence success indirectly. The MUSIQ framework has the potential to guide the application of QI methods in healthcare and focus research. The specificity of MUSIQ and the explicit delineation of relationships among factors allows a deeper understanding of the mechanism of action by which context influences QI success. MUSIQ also provides a foundation to support further studies to test and refine the theory and advance the field of QI science.

Evaluation of respiratory parameters in rats and rabbits exposed to methyl iodide.

PubMed

DeLorme, Michael P; Himmelstein, Mathew W; Kemper, Raymond A; Kegelman, Thomas A; Gargas, Michael L; Kinzell, John H

2009-05-01

Laboratory animals exposed to methyl iodide (MeI) have previously demonstrated lesions of the olfactory epithelium that were associated with local metabolism in the nasal tissues. Interactions of MeI in the nasal passage may, therefore, alter systemic toxicokinetics. The current study used unrestrained plethysmographs to determine the MeI effect on the breathing frequency and minute volume (MV) in rats and rabbits. Groups of 4 rats each were exposed to 0, 25, or 100 ppm and groups of 4 rabbits each were exposed to 0 and 20 ppm MeI for 6 h. Breathing frequency and MV were measured and recorded during the exposure. Blood samples were collected for inorganic serum iodide and the globin adduct S-methylcysteine (SMC) as biomarkers of systemic kinetics immediately following exposure. No significant reductions in breathing frequency were observed for either rats or rabbits. Significant changes in minute volume were demonstrated by both rats and rabbits; however, the changes observed in rats were not concentration dependent. The MeI-induced changes in MV resulted in significant differences in the total volume of test substance atmosphere inhaled over the 6-h period. Rats demonstrated a concentration-dependent increase in both inorganic serum iodide and SMC. Rabbits exposed to 20 ppm MeI demonstrated a significant increase of inorganic serum iodide; SMC was also increased but was not statistically significant. The results of this study are consistent with previous kinetic studies with MeI, and the data presented here can be integrated into a computational fluid dynamics physiologically based pharmacokinetic model for both rats and rabbits.

78 FR 59359 - Ocean Transportation Intermediary License Applicants

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-26

... (QI), Gregory M. Hinton, Operating Manager, Application Type: QI Change. Safe Movers, Inc. dba Isaac's..., Treasurer (QI), Ami Joseph, President, Application Type: Change Trade Name to Isaac's Moving & Storage. U.S...

OCCURRENCE OF VANCOMYCIN RESISTANT ENTEROCOCCI IN ANIMAL FECES

EPA Science Inventory

A survey was conducted to determine the occurrence of vancomycin resistant Enterococci (VRE) in animal and human fecal samples. A selective agar mEI, and mEI supplemented with 4 micrograms/ml vancomycin was used in a membrane filtration procedure to determine quantitative levels ...

78 FR 60673 - Airworthiness Directives; The Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-02

...-140, 1200 New Jersey Avenue SE., Washington, DC 20590. FOR FURTHER INFORMATION CONTACT: Ray Mei...) Related Information For more information about this AD, contact Ray Mei, Aerospace Engineer, Systems and...://www.myboeingfleet.com . (4) You may view this service information at FAA, Transport Airplane...

[Studies of the repair of radiation-induced genetic damage in Drosophila]. Final progress report

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

Hawley, R.S.

1998-11-01

This research focuses on the structure of the mei-41 gene and elucidation of the role the mei-41 gene product plays in both recombination and repair. Genetic and molecular studies are continuing on the mus308 locus and the mus312 and mei-9 genes. The author views mus312 as a very likely candidate for a gene required for both chromosome pairing/synopsis and for double strand break repair. A thorough genetic study has been initiated of this locus and of the cytology of the meiotic and mitotic defects of mutations at this locus.

RN-to-BSN Students' Quality Improvement Knowledge, Skills, Confidence, and Systems Thinking.

PubMed

Trent, Peggy; Dolansky, Mary A; DeBrew, Jacqueline Kayler; Petty, Gayle M

2017-12-01

Little evidence demonstrates that RN-to-baccalaureate nursing (BSN) graduates have met The Essentials of Baccalaureate Education for Professional Nursing Practice-specifically, evidence of the graduates' organizational and systems leadership related to quality care and patient safety. This BSN Essentials reflects the QSEN quality improvement (QI) competency. The purpose of this pilot study was to develop and test an assessment strategy to measure RN-to BSN students' QI competence and their perception of QI knowledge and skills. Students (N = 59) from six RN-to-BSN programs participated in a Qualtrics survey e-mailed during the last semester of their program. The majority of students (60%) reported that they did not experience QI content in their program. Scores on QI knowledge, skills, and systems thinking were low, yet the students self-reported that they were confident in their ability to perform QI. This pilot study provides an assessment strategy to measure students' competence related to QI. Nursing education has an opportunity to integrate and measure QI competence to ensure that nurses have the knowledge and skills to continually improve patient care. [J Nurs Educ. 2017;56(12):737-740.]. Copyright 2017, SLACK Incorporated.

Quality improvement primer part 1: Preparing for a quality improvement project in the emergency department.

PubMed

Chartier, Lucas B; Cheng, Amy H Y; Stang, Antonia S; Vaillancourt, Samuel

2018-01-01

Emergency medicine (EM) providers work in a fast-paced and often hectic environment that has a high risk for patient safety incidents and gaps in the quality of care. These challenges have resulted in opportunities for frontline EM providers to play a role in quality improvement (QI) projects. QI has developed into a mature field with methodologies that can dramatically improve the odds of having a successful project with a sustainable impact. However, this expertise is not yet commonly taught during professional training. In this first of three articles meant as a QI primer for EM clinicians, we will introduce QI methodology and strategic planning using a fictional case study as an example. We will review how to identify a QI problem, define components of an effective problem statement, and identify stakeholders and core change team members. We will also describe three techniques used to perform root cause analyses-Ishikawa diagrams, Pareto charts and process mapping-and how they relate to preparing for a QI project. The next two papers in this series will focus on the execution of the QI project itself using rapid-cycle testing and on the evaluation and sustainability of QI projects.

A Microbeam Small-Angle X-ray Scattering Study on Enamel Crystallites in Subsurface Lesion

NASA Astrophysics Data System (ADS)

Yagi, N.; Ohta, N.; Matsuo, T.; Tanaka, T.; Terada, Y.; Kamasaka, H.; Kometani, T.

2010-10-01

The early caries lesion in bovine tooth enamel was studied by two different X-ray diffraction systems at the SPring-8 third generation synchrotron radiation facility. Both allowed us simultaneous measurement of the small and large angle regions. The beam size was 6μm at BL40XU and 50μm at BL45XU. The small-angle scattering from voids in the hydroxyapatite crystallites and the wide-angle diffraction from the hydroxyapatite crystals were observed simultaneously. At BL40XU an X-ray image intensifier was used for the small-angle and a CMOS flatpanel detector for the large-angle region. At BL45XU, a large-area CCD detector was used to cover both regions. A linear microbeam scan at BL40XU showed a detailed distribution of voids and crystals and made it possible to examine the structural details in the lesion. The two-dimensional scan at BL45XU showed distribution of voids and crystals in a wider region in the enamel. The simultaneous small- and wide-angle measurement with a microbeam is a powerful tool to elucidate the mechanisms of demineralization and remineralization in the early caries lesion.

Quantification of 4-Methylimidazole in soft drinks, sauces and vinegars of Greek market using two liquid chromatography techniques.

PubMed

Tzatzarakis, Manolis N; Vakonaki, Elena; Moti, Sofia; Alegakis, Athanasios; Tsitsimpikou, Christina; Tsakiris, Ioannis; Goumenou, Marina; Nosyrev, Alexander E; Rizos, Apostolos K; Tsatsakis, Aristidis M

2017-09-01

The substance 4-methylimidazole (4-MEI) has raised several concerns regarding its toxicity to humans, although no harmonized classification has yet been decided. The regulatory limits for food products set by various authorities in Europe and the USA differ considerably. The purpose of the present study is to compare two liquid chromatography techniques in order to determine the levels of 4-MEI in food products from the Greek market and roughly estimate the possible exposure and relevant health risk for the consumers. A total of thirty-four samples (soft drinks, beers, balsamic vinegars, energy drinks and sauces) were collected and analyzed. The quality parameters for both analytical methodologies (linearity, accuracy, inter day precision, recovery) are presented. No detectable levels of 4-MEI are found in beers and soft drink samples, other than cola type. On the other hand, 4-MEI was detected in all cola type soft drinks (15.8-477.0 ng/ml), energy drinks (57.1%, 6.6-22.5 ng/ml) and vinegar samples (66.7%, 9.7-3034.7 ng/ml), while only one of the sauce samples was found to have a detectable level of 17.5 ng/ml 4-MEI. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Observation and analysis on the meridian-collateral running track-related anatomical structure in the human body].

PubMed

Xie, Hao-ran; Li, Fang-chun; Zhang, Wei-bo

2009-06-01

In the present paper the authors analyze the anatomical structure of the meridian running track by using the dialectical thought and comprehensive analysis of the integrated Chinese and western medicine. It has been observed that the "Qi-passages" of the 14 meridians of Chinese medicine are located in the connective tissue among the interspace of the muscles, etc. distributing longitudinally. The "Qi-passages" of the 15 Luomai (collaterals of the meridians) are located in the connective tissue among the interspace of the muscles, etc. distributing transversally, while those of the small branches of the meridian collaterals are located in the interspace mesenchyme of the muscle bundles distributing in the whole body. The "Qi-passages" of the tiny branches of the meridian collaterals are located in the mesenchyme of the intracellular space, such as the muscle fibers in the whole body. The authors hold that the so-called "Mai Qi" of the meridian-collaterals is the liquid-Qi flowing in the vertical and horizontal tissue interspaces. The "Qi-passage" of the meridian-collaterals of Chinese medicine is the pathway of the liquid-Qi of the tissue interspaces. The structure of the meridian-collaterals is the tissue interspace. The meridian-collateral system is a regulation-control system in the human body where the Qi-passages communicate with each other, and is, in fact, the protoplasm, the liquid-Qi circulating in the tissue interspaces.

Validation of a method for assessing resident physicians' quality improvement proposals.

PubMed

Leenstra, James L; Beckman, Thomas J; Reed, Darcy A; Mundell, William C; Thomas, Kris G; Krajicek, Bryan J; Cha, Stephen S; Kolars, Joseph C; McDonald, Furman S

2007-09-01

Residency programs involve trainees in quality improvement (QI) projects to evaluate competency in systems-based practice and practice-based learning and improvement. Valid approaches to assess QI proposals are lacking. We developed an instrument for assessing resident QI proposals--the Quality Improvement Proposal Assessment Tool (QIPAT-7)-and determined its validity and reliability. QIPAT-7 content was initially obtained from a national panel of QI experts. Through an iterative process, the instrument was refined, pilot-tested, and revised. Seven raters used the instrument to assess 45 resident QI proposals. Principal factor analysis was used to explore the dimensionality of instrument scores. Cronbach's alpha and intraclass correlations were calculated to determine internal consistency and interrater reliability, respectively. QIPAT-7 items comprised a single factor (eigenvalue = 3.4) suggesting a single assessment dimension. Interrater reliability for each item (range 0.79 to 0.93) and internal consistency reliability among the items (Cronbach's alpha = 0.87) were high. This method for assessing resident physician QI proposals is supported by content and internal structure validity evidence. QIPAT-7 is a useful tool for assessing resident QI proposals. Future research should determine the reliability of QIPAT-7 scores in other residency and fellowship training programs. Correlations should also be made between assessment scores and criteria for QI proposal success such as implementation of QI proposals, resident scholarly productivity, and improved patient outcomes.

Mixed-Methods Assessment of Trauma and Acute Care Surgical Quality Improvement Programs in Peru.

PubMed

LaGrone, Lacey N; Fuhs, Amy K; Egoavil, Eduardo Huaman; Rodriguez Castro, Manuel J A; Valderrama, Roberto; Isquith-Dicker, Leah N; Herrera-Matta, Jaime; Mock, Charles N

2017-04-01

Evidence for the positive impact of quality improvement (QI) programs on morbidity, mortality, patient satisfaction, and cost is strong. Data regarding the status of QI programs in low- and middle-income countries, as well as in-depth examination of barriers and facilitators to their implementation, are limited. This cross-sectional, descriptive study employed a mixed-methods design, including distribution of an anonymous quantitative survey and individual interviews with healthcare providers who participate in the care of the injured at ten large hospitals in Lima, Peru. Key areas identified for improvement in morbidity and mortality (M&M) conferences were the standardization of case selection, incorporation of evidence from the medical literature into case presentation and discussion, case documentation, and the development of a clear plan for case follow-up. The key barriers to QI program implementation were a lack of prioritization of QI, lack of sufficient human and administrative resources, lack of political support, and lack of education on QI practices. A national program that makes QI a required part of all health providers' professional training and responsibilities would effectively address a majority of identified barriers to QI programs in Peru. Specifically, the presence of basic QI elements, such as M&M conferences, should be required at hospitals that train pre-graduate physicians. Alternatively, short of this national-level organization, efforts that capitalize on local examples through apprenticeships between institutions or integration of QI into continuing medical education would be expected to build on the facilitators for QI programs that exist in Peru.

Using Public Reports of Patient Satisfaction for Hospital Quality Improvement

PubMed Central

Barr, Judith K; Giannotti, Tierney E; Sofaer, Shoshanna; Duquette, Cathy E; Waters, William J; Petrillo, Marcia K

2006-01-01

Objective To explore the impact of statewide public reporting of hospital patient satisfaction on hospital quality improvement (QI), using Rhode Island (RI) as a case example. Data Source Primary data collected through semi-structured interviews between September 2002 and January 2003. Study Design The design is a retrospective study of hospital executives at all 11 general and two specialty hospitals in RI. Respondents were asked about hospital QI activities at several points throughout the public reporting process, as well as about hospital structure and processes to accomplish QI. Qualitative analysis of the interview data proceeded through an iterative process to identify themes and categories in the data. Principal Findings Data from the standardized statewide patient satisfaction survey process were used by hospitals to identify and target new QI initiatives, evaluate performance, and monitor progress. While all hospitals fully participated in the public reporting process, they varied in the stage of development of their QI activities and adoption of the statewide standardized survey for ongoing monitoring of their QI programs. Most hospitals placed responsibility for QI within each department, with results reported to top management, who were perceived as giving strong support for QI. The external environment facilitated QI efforts. Conclusion Public reporting of comparative data on patient views can enhance and reinforce QI efforts in hospitals. The participation of key stakeholders facilitated successful implementation of statewide public reporting. This experience in RI offers lessons for other states or regions as they move to public reporting of hospital quality data. PMID:16704506

Do relationships exist between the scope and intensity of quality improvement activities and hospital operation performance? A 10-year observation in Taiwan.

PubMed

Chung, Kuo-Piao; Yu, Tsung-Hsien

2015-08-14

The relationship between the scope and intensity of quality improvement (QI) activities and hospital performance remains unclear. This study investigated the relationship between performance, external environment, and the scope and intensity of QI activities in hospitals. The study used a longitudinal observation. Data regarding the scope and intensity of QI activities were collected using a questionnaire survey among the administrative deputy superintendents / directors of quality management center in 139 hospitals. Hospital performance indicators were abstracted from the 2000-2009 national hospitals profiles. We adopted year 2000 as the baseline, and divided the study period into three 3-year periods. The Generalized Estimating Equations (GEE) model was used for the statistical analysis. Seventy-two hospitals responded to the survey, giving a response rate of 52%. The results showed a significant increase in the scope and intensity of QI activities between 2000 and 2009. The results also showed that the scope and intensity of a hospital's QI activities were associated with the scope and intensity of its competitors' QI activities in the previous period and its own prior performance. The scope of QI activities in the previous period was not significantly related to the selected hospital performance measures. However, the intensity of QI activities in the previous period showed a significant and positive relationship with the number of inpatients and the turnover of beds. The study demonstrates that the intensity of QI activities is associated with the external environment and the hospital's own performance in the previous period. Furthermore, some performance measures are associated with the intensity of the QI activities in the previous period.

Anti-inflammatory and antinociceptive effects of Chinese medicine SQ gout capsules and its modulation of pro-inflammatory cytokines focusing on gout arthritis.

PubMed

Kodithuwakku, Nandani Darshika; Pan, Min; Zhu, Yi-lin; Zhang, Yan-yan; Feng, Yi-dong; Fang, Wei-rong; Li, Yun-man

2013-12-12

Shuang-Qi gout capsule is a traditional Chinese medicine prescription, which has been used in the treatment of joint pain, inflammation and gout arthritis. This study evaluates anti-inflammatory and antinociceptive effects of Shuang-Qi gout capsule and its modulation of pro-inflammatory cytokines with special reference to gout arthritis. Anti-inflammatory effect of Shuang-Qi gout capsule was investigated bymice tail-flick response, acetic acid induced writhing response, Xylene-induced auricle inflammation and the hind paw volume of the monosodium urate (MSU) crystal induced rats with different time durations. To investigate the effects on gout arthritis, ankle joint of rats induced by MSU crystals and assessed for edema and histopathological changes. In vitro, prepared serum was incubated with urate crystal induced HUVE cells and the release of TNF-α and IL-1β determined by ELISA. Shuang-Qi gout capsule showed significant and dose dependent anti-inflammatory effect via reducing edema and pain, throughout all the models. The high dose of Shuang-Qi gout capsule and Indomethacin significantly attenuated the edema. Histopathological results showed that high and medium dose of Shuang-Qi gout capsule and Indomethacin reduced gouty joint inflammatory features, while the high dose of Shuang-Qi gout capsule showed a better therapeutic effect. High and medium dose of Shuang-Qi gout capsule significantly reduced the release of TNF-α and IL-1β (p<0.05). Shuang-Qi gout capsule can effectively inhibit the inflammation, analgesia, through the modulation of emission of pro-inflammatory cytokines and the curative effect is dose dependent. Conversely, these MSU induced in vivo and in vitro studies of Shuang-Qi gout capsule suggest that, Shuang-Qi gout capsule may be a potential agent for treatment in gouty arthritis. © 2013 Published by Elsevier Ireland Ltd.

MO-C-12A-01: Quantitative Imaging Initiatives: Why, Who, What, and How?

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

Sullivan, D; Jackson, E; Clarke, L

Over the past decade, there has been an increasing focus on quantitative imaging (QI), which, according to one definition, is “the extraction of quantifiable features from medical images for the assessment of normal or the severity, degree of change, or status of a disease, injury, or chronic condition relative to normal” ( www.rsna.org/QIBA ). To achieve the goals of QI requires the development and standardization of data acquisition, data analysis, and data display techniques, as well as appropriate reporting structures. As such, successful implementation of QI relies heavily on expertise from the fields of medical physics, radiology, statistics, and informaticsmore » as well as collaboration from vendors of imaging acquisition, analysis, and reporting systems. When successfully implemented, QI techniques will provide image-derived metrics with known bias and variance that can be validated with anatomically and physiologically relevant measures, including treatment response, and the heterogeneity of that response, and outcome. Such non-invasive measures can then be used effectively in clinical and translational research as well as patient care. In addition to modality-specific QI efforts implemented by individual scientific organizations, national and international organizations, including the NCI, RSNA, FDA, and NIST, appreciating the tremendous potential of QI but also understanding the associated challenges, have become increasingly involved. This symposium session will focus on 1) introducing QI and illustrating why it is important, even though challenging, in both research and clinical applications, and 2) providing overviews of QI efforts from national and international organizations, including the RSNA, NCI, FDA, and NIST. Learning Objectives: Understand the importance and potential of QI in research and clinical applications. Understand key challenges of QI and current barriers to implementation. Understand the current QI efforts of several national

Longitudinal Evaluation of Quality Improvement and Public Health Accreditation Readiness in Nebraska Local Health Departments, 2011-2016.

PubMed

Chen, Li-Wu; Gregg, Abbey; Palm, David

Public health accreditation is intended to improve the performance of public health departments, and quality improvement (QI) is an important component of the Public Health Accreditation Board process. The objective of this study was to evaluate the QI maturity and accreditation readiness of local health departments (LHDs) in Nebraska during a 6-year period that included several statewide initiatives to progress readiness, including funding and technical assistance. We used a mixed-methods approach that consisted of both online surveys and key informant interviews to assess QI maturity and accreditation readiness. Nineteen of Nebraska's 21 LHDs completed the survey in 2011 and 2013, 20 of 20 LHDs completed the survey in 2015, and 19 of 20 LHDs completed the survey in 2016. We facilitated a large group discussion with staff members from 16 LHDs in 2011, and we conducted key informant interviews with staff members from 4 LHDs in 2015. Both QI maturity and accreditation readiness improved from 2011 to 2016. In 2011, of 19 LHDs, only 6 LHD directors agreed that their LHD had a culture that focused on QI, but this number increased every year up to 12 in 2016. The number of LHDs that had a high capacity to engage in QI efforts improved from 3 in 2011 to 8 in 2016. The number of LHDs with a QI plan increased from 3 in 2011 to 10 in 2016. The number of LHDs that were confident in their ability to obtain Public Health Accreditation Board accreditation improved from 6 in 2011 to 13 in 2016. Although their QI maturity generally increased over time, LHDs interviewed in 2015 still faced challenges adopting a formal QI system. External financial and technical support helped LHDs build their QI maturity and accreditation readiness. Funding and technical assistance can improve LHDs' QI maturity and accreditation readiness. Improvement takes time and sustained efforts by LHDs, and support from external partners (eg, state health departments) helps build LHDs' QI maturity and

Increased Adoption of Quality Improvement Interventions to Implement Evidence-Based Practices for Pressure Ulcer Prevention in U.S. Academic Medical Centers.

PubMed

Padula, William V; Mishra, Manish K; Makic, Mary Beth F; Wald, Heidi L; Campbell, Jonathan D; Nair, Kavita V; Valuck, Robert J

2015-12-01

In 2008, the U.S. Centers for Medicare and Medicaid Services enacted a nonpayment policy for stage III and IV hospital-acquired pressure ulcers (HAPUs), which incentivized hospitals to improve prevention efforts. In response, hospitals looked for ways to support implementation of evidence-based practices for HAPU prevention, such as adoption of quality improvement (QI) interventions. The objective of this study was to quantify adoption patterns of QI interventions for supporting evidence-based practices for HAPU prevention. This study surveyed wound care specialists working at hospitals within the University HealthSystem Consortium. A questionnaire was used to retrospectively describe QI adoption patterns according to 25 HAPU-specific QI interventions into four domains: leadership, staff, information technology (IT), and performance and improvement. Respondents indicated QI interventions implemented between 2007 and 2012 to the nearest quarter and year. Descriptive statistics defined patterns of QI adoption. A t-test and statistical process control chart established statistically significant increase in adoption following nonpayment policy enactment in October 2008. Increase are described in terms of scope (number of QI domains employed) and scale (number of QI interventions within domains). Fifty-three of the 55 hospitals surveyed reported implementing QI interventions for HAPU prevention. Leadership interventions were most frequent, increasing in scope from 40% to 63% between 2008 and 2012; "annual programs to promote pressure ulcer prevention" showed the greatest increase in scale. Staff interventions increased in scope from 32% to 53%; "frequent consult driven huddles" showed the greatest increase in scale. IT interventions increased in scope from 31% to 55%. Performance and improvement interventions increased in scope from 18% to 40%, with "new skin care products . . ." increasing the most. Academic medical centers increased adoption of QI interventions

The Effects of Conditional Discrimination Instruction and Verbal Behavior on the Establishment of Hierarchical Responding

ERIC Educational Resources Information Center

Barnes, Clarissa S.

2013-01-01

This investigation evaluated the use of conditional discrimination (CD) instruction and multiple exemplar instruction (MEI) to establish derived relational responding in accordance with hierarchical frames with school aged children. The first experiment used a multiple probe design to evaluate the effectiveness of MEI to teach participants to…

The first ever Cochrane event in Russia and Russian speaking countries - Cochrane Russia Launch - Evidence-based medicine: Achievements and barriers (QiQUM 2015) International Conference, Kazan, December 7-8, 2015.

PubMed

Ziganshina, Liliya Eugenevna; Jørgensen, Karsten Juhl

2016-01-01

Kazan hosted Russia's second International Conference QiQUM 2015 on Cochrane evidence for health policy, which was entirely independent of the pharmaceutical or other health industry, bringing together 259 participants from 11 countries and 13 regions of the Russian Federation. The Conference was greeted and endorsed by world leaders in Evidence-based medicine, health and pharmaceutical information, policy and regulation, and the World Health Organization. Participants discussed the professional and social problems arising from biased health information, unethical pharmaceutical promotion, misleading reporting of clinical trials with consequent flaws in health care delivery and the role of Cochrane evidence for informed decisions and better health. The first in history Cochrane workshop, facilitated jointly by experts from Cochrane and the WHO, with 40 participants from Kazakhstan, Kyrgyzstan, Tajikistan and Russia introduced the concept of Cochrane systematic review and the Use of Cochrane evidence in WHO policy setting. Websites document conference materials and provide interface for future collaboration: http://kpfu.ru/biology-medicine/struktura-instituta/kafedry/kfikf/konferenciya/mezhdunarodnaya-konferenciya-39dokazatelnaya.html and http://russia.cochrane.org/news/international-conference.

The emergence of autoclitic frames in atypically and typically developing children as a function of multiple exemplar instruction.

PubMed

Luke, Nicole; Greer, R Douglas; Singer-Dudek, Jessica; Keohane, Dolleen-Day

2011-01-01

In two experiments, we tested the effect of multiple exemplar instruction (MEI) for training sets on the emergence of autoclitic frames for spatial relations for novel tacts and mands. In Experiment 1, we used a replicated pre- and post-intervention probe design with four students with significant learning disabilities to test for acquisition of four autoclitic frames with novel tacts and mands before and after MEI. The untaught topographies emerged for all participants. In Experiment 2, we used a multiple probe design to test the effects of the MEI procedures on the same responses in four typically developing, bilingual students. The novel usage emerged for all participants. In the latter experiment, the children demonstrated untaught usage of mand or tact frames regardless of whether they were taught to respond in either listener or speaker functions alone or across listener and speaker functions. The findings are discussed in terms of the role of MEI in the formation of abstractions.

Human HOX Proteins Use Diverse and Context-Dependent Motifs to Interact with TALE Class Cofactors.

PubMed

Dard, Amélie; Reboulet, Jonathan; Jia, Yunlong; Bleicher, Françoise; Duffraisse, Marilyne; Vanaker, Jean-Marc; Forcet, Christelle; Merabet, Samir

2018-03-13

HOX proteins achieve numerous functions by interacting with the TALE class PBX and MEIS cofactors. In contrast to this established partnership in development and disease, how HOX proteins could interact with PBX and MEIS remains unclear. Here, we present a systematic analysis of HOX/PBX/MEIS interaction properties, scanning all paralog groups with human and mouse HOX proteins in vitro and in live cells. We demonstrate that a previously characterized HOX protein motif known to be critical for HOX-PBX interactions becomes dispensable in the presence of MEIS in all except the two most anterior paralog groups. We further identify paralog-specific TALE-binding sites that are used in a highly context-dependent manner. One of these binding sites is involved in the proliferative activity of HOXA7 in breast cancer cells. Together these findings reveal an extraordinary level of interaction flexibility between HOX proteins and their major class of developmental cofactors. Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

78 FR 24200 - Ocean Transportation Intermediary License Applicants

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-24

...: Hsiao-Ling Chen, President (QI), Application Type: QI Change Matus International, Inc. (NVO & OFF), 411 N. Oak Street, Inglewood, CA 90302, Officers: Anthony S. Pineda, Treasurer (QI), Allan J. Matus...] BILLING CODE 6730-01-P ...

The thermodynamic and dynamical features of double front structures during 21 31 July 1998 in China

NASA Astrophysics Data System (ADS)

Zhou, Yushu; Deng, Guo; Lei, Ting; Ju, Jianhua

2005-11-01

The daily 1° × 1° data of the Aviation (AVN) model, the black body temperature (TBB) data of cloud top, and cloud images by geostationary meteorological satellite (GMS) are used to identify a dew-point front near the periphery of the western Pacific subtropical high (WPSH). The results clearly demonstrate the existence of the dew-point front, and its thermodynamic and dynamic structural characteristics are analyzed in detail. The dew-point front is a transitional belt between the moist southwest monsoon flow and the dry adiabatic sinking flow near the WPSH, manifested by a large horizontal moisture gradient in the mid-lower troposphere and conjugated with the mei-yu front to form a predominant double-front structure associated with intense rainfall in the mei-yu period. The mei-yu front is located between 30° and 35°N, vertically extends from the ground level to the upper level and shifts northward. The dew-point front is to the south of the mei-yu front and lies up against the periphery of the WPSH. Generally, it is located between 850 hPa and 500 hPa. On the dew-point front side, the southwesterly prevails at the lower level and the northeasterly at the upper level; this wind distribution is different from that on the mei-yu front side. Vertical ascending motion exists between the two fronts, and there are descending motions on the north side of the mei-yu front and on the south side of the dew-point front, which form a secondary circulation. The dynamics of the double fronts also have some interesting features. At the lower level, positive vertical vorticity and obvious convergence between the two fronts are clearly identified. At the mid-lower level, negative local change of the divergence (corresponding to increasing convergence) is often embedded in the two fronts or against the mei-yu front. Most cloud clusters occur between the two fronts and propagate down stream in a wave-like manner.

77 FR 26553 - Medicare Program; Meeting of the Medicare Economic Index Technical Advisory Panel-May 21, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-04

...] Medicare Program; Meeting of the Medicare Economic Index Technical Advisory Panel--May 21, 2012 AGENCY... announces that a public meeting of the Medicare Economic Index Technical Advisory Panel (``the Panel'') will... Economic Index (MEI). This first meeting will focus on MEI inputs and input weights. This meeting is open...

77 FR 61548 - Airworthiness Directives; The Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-10

.... Comments will be available in the AD docket shortly after receipt. FOR FURTHER INFORMATION CONTACT: Ray Mei..., views, or arguments about this proposal. Send your comments to an address listed under the ADDRESSES... office. (j) Related Information (1) For more information about this AD, contact Ray Mei, Aerospace...

78 FR 42727 - Airworthiness Directives; the Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-17

... available in the AD docket shortly after receipt. FOR FURTHER INFORMATION CONTACT: Ray Mei, Aerospace... . SUPPLEMENTARY INFORMATION: Comments Invited We invite you to send any written relevant data, views, or arguments... about this AD, contact Ray Mei, Aerospace Engineer, Systems and Equipment Branch, ANM-130S, FAA, Seattle...

Algorithms to qualify respiratory data collected during the transport of trauma patients.

PubMed

Chen, Liangyou; McKenna, Thomas; Reisner, Andrew; Reifman, Jaques

2006-09-01

We developed a quality indexing system to numerically qualify respiratory data collected by vital-sign monitors in order to support reliable post-hoc mining of respiratory data. Each monitor-provided (reference) respiratory rate (RR(R)) is evaluated, second-by-second, to quantify the reliability of the rate with a quality index (QI(R)). The quality index is calculated from: (1) a breath identification algorithm that identifies breaths of 'typical' sizes and recalculates the respiratory rate (RR(C)); (2) an evaluation of the respiratory waveform quality (QI(W)) by assessing waveform ambiguities as they impact the calculation of respiratory rates and (3) decision rules that assign a QI(R) based on RR(R), RR(C) and QI(W). RR(C), QI(W) and QI(R) were compared to rates and quality indices independently determined by human experts, with the human measures used as the 'gold standard', for 163 randomly chosen 15 s respiratory waveform samples from our database. The RR(C) more closely matches the rates determined by human evaluation of the waveforms than does the RR(R) (difference of 3.2 +/- 4.6 breaths min(-1) versus 14.3 +/- 19.3 breaths min(-1), mean +/- STD, p < 0.05). Higher QI(W) is found to be associated with smaller differences between calculated and human-evaluated rates (average differences of 1.7 and 8.1 breaths min(-1) for the best and worst QI(W), respectively). Establishment of QI(W) and QI(R), which ranges from 0 for the worst-quality data to 3 for the best, provides a succinct quantitative measure that allows for automatic and systematic selection of respiratory waveforms and rates based on their data quality.

Integrating Quality Improvement and Continuing Professional Development: A Model From the Mental Health Care System.

PubMed

Sockalingam, Sanjeev; Tehrani, Hedieh; Lin, Elizabeth; Lieff, Susan; Harris, Ilene; Soklaridis, Sophie

2016-04-01

To explore the perspectives of leaders in psychiatry and continuing professional development (CPD) regarding the relationship, opportunities, and challenges in integrating quality improvement (QI) and CPD. In 2013-2014, the authors interviewed 18 participants in Canada: 10 psychiatrists-in-chief, 6 CPD leaders in psychiatry, and 2 individuals with experience integrating these domains in psychiatry who were identified through snowball sampling. Questions were designed to identify participants' perspectives about the definition, relationship, and integration of QI and CPD in psychiatry. Interviews were recorded and transcribed. An iterative, inductive method was used to thematically analyze the transcripts. To ensure the rigor of the analysis, the authors performed member checking and sampling until theoretical saturation was achieved. Participants defined QI as a concept measured at the individual, hospital, and health care system levels and CPD as a concept measured predominantly at the individual and hospital levels. Four themes related to the relationship between QI and CPD were identified: challenges with QI training, adoption of QI into the mental health care system, implementation of QI in CPD, and practice improvement outcomes. Despite participants describing QI and CPD as mutually beneficial, they expressed uncertainty about the appropriateness of aligning these domains within a mental health care context because of the identified challenges. This study identified challenges with aligning QI and CPD in psychiatry and yielded a framework to inform future integration efforts. Further research is needed to determine the generalizability of this framework to other specialties and health care professions.

Utilizing Quality Improvement Methods to Improve Patient Care Outcomes in a Pediatric Residency Program

PubMed Central

Akins, Ralitsa B.; Handal, Gilbert A.

2009-01-01

Objective Although there is an expectation for outcomes-oriented training in residency programs, the reality is that few guidelines and examples exist as to how to provide this type of education and training. We aimed to improve patient care outcomes in our pediatric residency program by using quality improvement (QI) methods, tools, and approaches. Methods A series of QI projects were implemented over a 3-year period in a pediatric residency program to improve patient care outcomes and teach the residents how to use QI methods, tools, and approaches. Residents experienced practice-based learning and systems-based assessment through group projects and review of their own patient outcomes. Resident QI experiences were reviewed quarterly by the program director and were a mandatory part of resident training portfolios. Results Using QI methodology, we were able to improve management of children with obesity, to achieve high compliance with the national patient safety goals, improve the pediatric hotline service, and implement better patient flow in resident continuity clinic. Conclusion Based on our experiences, we conclude that to successfully implement QI projects in residency programs, QI techniques must be formally taught, the opportunities for resident participation must be multiple and diverse, and QI outcomes should be incorporated in resident training and assessment so that they experience the benefits of the QI intervention. The lessons learned from our experiences, as well as the projects we describe, can be easily deployed and implemented in other residency programs. PMID:21975995

Improving the completion of Quality Improvement projects amongst psychiatry core trainees.

PubMed

Ewins, Liz

2015-01-01

Quality Improvement (QI) projects are seen increasingly as more valuable and effective in developing services than traditional audit. However, the development of this methodology has been slower in the mental health field and QI projects are new to most psychiatrists. This project describes a way of engaging trainees across Avon and Wiltshire Mental Health Partnership (AWP) Trust and the Severn School of Psychiatry in QI projects, using QI methodology itself. Through the implementation and development of training sessions and simple, low cost and sustainable interventions over a 10 month period, two thirds of core trainees and over a half of the advanced psychiatry trainees in the School are now participating in 28 individual QI projects and QI project methodology is to become embedded in the core psychiatry training course. As an additional positive outcome, specialty doctors, consultants, foundation doctors, GP trainees, medical students, as well as the wider multidisciplinary team, have all become engaged in QI projects alongside trainees, working with service users and their families to identify problems to tackle and ideas to test.

Epidemiological Distribution and Subtype Analysis of Premenstrual Dysphoric Disorder Syndromes and Symptoms Based on TCM Theories

PubMed Central

Wang, Haijun; Zhan, Xianghong; Liu, Hongqi; Wang, Xiaoyun; Li, Xia; Wang, Xiaoru; Wu, Jibiao

2017-01-01

We performed an epidemiological investigation of subjects with premenstrual dysphoric disorder (PMDD) to identify the clinical distribution of the major syndromes and symptoms. The pathogenesis of PMDD mainly involves the dysfunction of liver conveyance and dispersion. Excessive liver conveyance and dispersion are associated with liver-qi invasion syndrome, while insufficient liver conveyance and dispersion are expressed as liver-qi depression syndrome. Additionally, a nonconditional logistic regression was performed to analyze the symptomatic features of liver-qi invasion and liver-qi depression. As a result of this analysis, two subtypes of PMDD are proposed, namely, excessive liver conveyance and dispersion (liver-qi invasion syndrome) and insufficient liver conveyance and dispersion (liver-qi depression syndrome). Our findings provide an epidemiological foundation for the clinical diagnosis and treatment of PMDD based on the identification of different types. PMID:28698873

Applying Bayesian Item Selection Approaches to Adaptive Tests Using Polytomous Items

ERIC Educational Resources Information Center

Penfield, Randall D.

2006-01-01

This study applied the maximum expected information (MEI) and the maximum posterior-weighted information (MPI) approaches of computer adaptive testing item selection to the case of a test using polytomous items following the partial credit model. The MEI and MPI approaches are described. A simulation study compared the efficiency of ability…

[Effects of Chinese herbal compound for supplementing qi and activating blood circulation on actin, Cx43 expressions and gap junctional intercellular communication functions of myocardial cells in patients with Coxsackie virus B 3 viral myocarditis].

PubMed

Zhang, Ming-xue; He, Wei; Gu, Ping

2010-08-01

To observe the effect of Chinese herbal compound for supplementing qi and activating blood circulation (CHC) on the gap junctional intercellular communication (GJIC) function of myocardial cells in patients with Coxsackie virus B 3 (CVB3) viral myocarditis. Expressions of actin and connexin43 (Cx43) in myocardial cells of patients arranged in three groups (the normal control group, the viral infected group and the CHC treated group) were detected by immunohistochemical method; the fluorescence photobleaching recovery rate of cells was detected by laser scanning confocal microscope. As compared with the viral infected group, the expressions of actin and Cx43 were increased and the GJIC function was improved in the CHC treated group. CHC could antagonize viral injury on skeleton protein, and repair the structure of gap junction channel to improve the GJIC function of myocardial cells after being attacked by CVB3.

Assessing the Organizational Characteristics Influencing Quality Improvement Implementation in Saudi Hospitals.

PubMed

Shamsuddin Alaraki, Mohammad

The health care system in Saudi Arabia has serious problems with quality and safety that can be reduced through systematic quality improvement (QI) activities. Despite the use of different QI models to improve health care in Saudi hospitals during the last 2 decades, consistent improvements have not yet been achieved and the results are still far below expectations. This may reflect a problem in introducing and implementing the QI models in the local contexts. The objective of this study is to assess the extent of QI implementation in Saudi hospitals and to identify the organizational characteristics that make Saudi hospitals particularly challenging for QI. Understanding these characteristics can inform efforts to improve them and may lead to more successful implementation. A mixed-methods approach was conducted using 2 data collection tools: questionnaires and interviews. The quantitative phase (questionnaires) aimed to uncover the current level of QI implementation in Saudi hospital as measured by 7 critical dimensions adapted from the literature. The qualitative phase (interviews) aimed to understand the organizational characteristics that impede or underpin QI in Saudi hospitals. The QI implementation was found to be significantly poor across the 7 dimensions with average score ranging between 22.80 ± 0.57 and 2.11 ± 0.69 on a 5-point Likert scale and with P value of less than .05. We also found that the current level of QI implementation helped Saudi hospitals neither to improve "customer satisfaction" nor to achieve measurable improvements in "quality results" scoring significantly low at 2.11 ± 0.69 with P value of .000 and 2.47 ± 0.57 with P value of .000, respectively. Our study confirms the presence of a multitude of organizational barriers that impede QI in Saudi hospitals. These are related to organizational culture, human resources management, processes and systems, and structure. These 4 were found to have the strongest impact on QI in Saudi

Introducing quality improvement methods into local public health departments: structured evaluation of a statewide pilot project.

PubMed

Riley, William; Parsons, Helen; McCoy, Kim; Burns, Debra; Anderson, Donna; Lee, Suhna; Sainfort, François

2009-10-01

To test the feasibility and assess the preliminary impact of a unique statewide quality improvement (QI) training program designed for public health departments. One hundred and ninety-five public health employees/managers from 38 local health departments throughout Minnesota were selected to participate in a newly developed QI training program and 65 of those engaged in and completed eight expert-supported QI projects over a period of 10 months from June 2007 through March 2008. As part of the Minnesota Quality Improvement Initiative, a structured distance education QI training program was designed and deployed in a first large-scale pilot. To evaluate the preliminary impact of the program, a mixed-method evaluation design was used based on four dimensions: learner reaction, knowledge, intention to apply, and preliminary outcomes. Subjective ratings of three dimensions of training quality were collected from participants after each of the scheduled learning sessions. Pre- and post-QI project surveys were administered to collect participant reactions, knowledge, future intention to apply learning, and perceived outcomes. Monthly and final QI project reports were collected to further inform success and preliminary outcomes of the projects. The participants reported (1) high levels of satisfaction with the training sessions, (2) increased perception of the relevance of the QI techniques, (3) increased perceived knowledge of all specific QI methods and techniques, (4) increased confidence in applying QI techniques on future projects, (5) increased intention to apply techniques on future QI projects, and (6) high perceived success of, and satisfaction with, the projects. Finally, preliminary outcomes data show moderate to large improvements in quality and/or efficiency for six out of eight projects. QI methods and techniques can be successfully implemented in local public health agencies on a statewide basis using the collaborative model through distance training and

Introduction of a quality improvement curriculum in the Department of Internal Medicine, Lincoln Medical Center.

PubMed

Venugopal, Usha; Kasubhai, Moiz; Paruchuri, Vikram

2017-01-01

Community hospitals with limited resources struggle to engage physicians in Quality improvement initiatives. We introduced Quality Improvement (QI) curriculum for residents in response to ACGME requirements and surveyed the residents understanding of QI and their involvement in QI projects before and after the introduction of the curriculum. The current article describes our experiences with the process, the challenges and possible solutions to have a successful resident led QI initiative in a community hospital. Methods: A formal QI curriculum was introduced in the Department of Internal Medicine from September to October 2015 using the Model for Improvement from Institute for Health care Improvement (IHI). Learners were expected to read the online modules, discuss in small group sessions and later encouraged to draft their QI projects using the Charter form and PDSA form available on the HI website. Online surveys were conducted a week prior and 3 months after completion of the curriculum Results: 80% (100/117) of residents completed the pre-curriculum survey and 52% (61/117) completed the survey post curriculum. 96.7% of residents report that physicians should lead QI projects and training rather than the hospital administrators. Residents had 20% increase in understanding and confidence in leading quality improvement projects post curriculum once initiated. Most Residents (72%) feel QI should be taught during residency. Active involvement of residents with interest was seen after the initiation of Open School Institute of health improvement (IHI) curriculum as compared to Institutional led QI's. The resident interventions, pitfalls with change processes with an example of PDSA cycle are discussed. Conclusion: A Dedicated QI curriculum is necessary to prepare the physicians deliver quality care in an increasing complex health care delivery system. The strength of the curriculum is the ease of understanding the material, easily available to all, and can be easily

Educational gaps and solutions for early-career nurse managers' education and participation in quality improvement.

PubMed

Djukic, Maja; Kovner, Christine T; Brewer, Carol S; Fatehi, Farida; Jun, Jin

2015-04-01

The objective of this study was to examine early-career frontline nurse managers' (FLNMs') reported educational preparedness and participation in quality improvement (QI). Frontline nurse managers are vitally important for leading QI. However, it is not well known if they have adequate knowledge and skills to lead this important function. We examined cross-sectional survey data from 42 FLNMs using descriptive statistics. About 30% of FLNMs reported being very prepared across 12 measured QI skills by schools or employers and 35% reported participating in a specific clinical effort to improve patient care on their unit more than once a month. More than 50% reported having good organizational support for QI, but only about 30% reported being rewarded for their contributions to QI. Our study highlights opportunities for development in QI for FLNMs and offers some solutions for nurse executives that can bridge the educational gaps.

Decreasing the Use of Damage Control Laparotomy in Trauma: A Quality Improvement Project.

PubMed

Harvin, John A; Kao, Lillian S; Liang, Mike K; Adams, Sasha D; McNutt, Michelle K; Love, Joseph D; Moore, Laura J; Wade, Charles E; Cotton, Bryan A; Holcomb, John B

2017-08-01

Our institution has published damage control laparotomy (DCL) rates of 30% and documented the substantial morbidity associated with the open abdomen. The purpose of this quality improvement (QI) project was to decrease the rate of DCL at a busy, Level I trauma center in the US. A prospective cohort of all emergent trauma laparotomies from November 2013 to October 2015 (QI group) was followed. The QI intervention was multifaceted and included audit and feedback for every DCL case. Morbidity and mortality of the QI patients were compared with those from a published control (control group: emergent laparotomy from January 2011 to October 2013). A significant decrease was observed immediately on beginning the QI project, from a 39% DCL rate in the control period to 23% in the QI group (p < 0.001). This decrease was sustained over the 2-year study period. There were no differences in demographics, Injury Severity Score, or transfusions between the groups. No differences organ/space infection (control 16% vs QI 12%; p = 0.15), fascial dehiscence (6% vs 8%; p = 0.20), unplanned relaparotomy (11% vs 10%; p = 0.58), or mortality (9% vs 10%; p = 0.69) were observed. The reduction in use resulted in a decrease of 68 DCLs over the 2-year period. There was a further reduction in the rate of DCL to 17% after completion of the QI project. A QI initiative rapidly changed the use of DCL and improved quality of care by decreasing resource use without an increase morbidity or mortality. This decrease was sustained during the QI period and further improved upon after its completion. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Effectiveness of strengthened stimulation during acupuncture for the treatment of Bell palsy: a randomized controlled trial

PubMed Central

Xu, Sha-bei; Huang, Bo; Zhang, Chen-yan; Du, Peng; Yuan, Qi; Bi, Gui-juan; Zhang, Gui-bin; Xie, Min-jie; Luo, Xiang; Huang, Guang-ying; Wang, Wei

2013-01-01

Background: The traditional Chinese theory of acupuncture emphasizes that the intensity of acupuncture must reach a threshold to generate de qi, which is necessary to achieve the best therapeutic effect. De qi is an internal compound sensation of soreness, tingling, fullness, aching, cool, warmth and heaviness, and a radiating sensation at and around the acupoints. However, the notion that de qi must be achieved for maximum benefit has not been confirmed by modern scientific evidence. Methods: We performed a prospective multicentre randomized controlled trial involving patients with Bell palsy. Patients were randomly assigned to the de qi (n = 167) or control (n = 171) group. Both groups received acupuncture: in the de qi group, the needles were manipulated manually until de qi was reached, whereas in the control group, the needles were inserted without any manipulation. All patients received prednisone as a basic treatment. The primary outcome was facial nerve function at month 6. We also assessed disability and quality of life 6 months after randomization. Results: After 6 months, patients in the de qi group had better facial function (adjusted odds ratio [OR] 4.16, 95% confidence interval [CI] 2.23–7.78), better disability assessment (differences of least squares means 9.80, 95% CI 6.29–13.30) and better quality of life (differences of least squares means 29.86, 95% CI 22.33–37.38). Logistic regression analysis showed a positive effect of the de qi score on facial-nerve function (adjusted OR 1.07, 95% CI 1.04–1.09). Interpretation: Among patients with Bell palsy, acupuncture with strong stimulation that elicited de qi had a greater therapeutic effect, and stronger intensity of de qi was associated with the better therapeutic effects. Trial registration: Clinicaltrials.gov no. NCT00685789. PMID:23439629

Effectiveness of strengthened stimulation during acupuncture for the treatment of Bell palsy: a randomized controlled trial.

PubMed

Xu, Sha-bei; Huang, Bo; Zhang, Chen-yan; Du, Peng; Yuan, Qi; Bi, Gui-juan; Zhang, Gui-bin; Xie, Min-jie; Luo, Xiang; Huang, Guang-ying; Wang, Wei

2013-04-02

The traditional Chinese theory of acupuncture emphasizes that the intensity of acupuncture must reach a threshold to generate de qi, which is necessary to achieve the best therapeutic effect. De qi is an internal compound sensation of soreness, tingling, fullness, aching, cool, warmth and heaviness, and a radiating sensation at and around the acupoints. However, the notion that de qi must be achieved for maximum benefit has not been confirmed by modern scientific evidence. We performed a prospective multicentre randomized controlled trial involving patients with Bell palsy. Patients were randomly assigned to the de qi (n = 167) or control (n = 171) group. Both groups received acupuncture: in the de qi group, the needles were manipulated manually until de qi was reached, whereas in the control group, the needles were inserted without any manipulation. All patients received prednisone as a basic treatment. The primary outcome was facial nerve function at month 6. We also assessed disability and quality of life 6 months after randomization. After 6 months, patients in the de qi group had better facial function (adjusted odds ratio [OR] 4.16, 95% confidence interval [CI] 2.23-7.78), better disability assessment (differences of least squares means 9.80, 95% CI 6.29-13.30) and better quality of life (differences of least squares means 29.86, 95% CI 22.33-37.38). Logistic regression analysis showed a positive effect of the de qi score on facial-nerve function (adjusted OR 1.07, 95% CI 1.04-1.09). Among patients with Bell palsy, acupuncture with strong stimulation that elicited de qi had a greater therapeutic effect, and stronger intensity of de qi was associated with the better therapeutic effects. Clinicaltrials.gov no. NCT00685789.

Evaluating the state of quality-improvement science through evidence synthesis: insights from the closing the quality gap series.

PubMed

McDonald, Kathryn M; Schultz, Ellen M; Chang, Christine

2013-01-01

The Closing the Quality Gap series from the Agency for Healthcare Research and Quality summarizes evidence for eight high-priority health care topics: outcomes used in disability research, bundled payment programs, public reporting initiatives, health care disparities, palliative care, the patient-centered medical home, prevention of health care-associated infections, and medication adherence. To distill evidence from this series and provide insight into the "state of the science" of quality improvement (QI). We provided common guidance for topic development and qualitatively synthesized evidence from the series topic reports to identify cross-topic themes, challenges, and evidence gaps as related to QI practice and science. Among topics that examined effectiveness of QI interventions, we found improvement in some outcomes but not others. Implementation context and potential harms from QI activities were not widely evaluated or reported, although market factors appeared important for incentive-based QI strategies. Patient-focused and systems-focused strategies were generally more effective than clinician-focused strategies, although the latter approach improved clinician adherence to infection prevention strategies. Audit and feedback appeared better for targeting professionals and organizations, but not patients. Topic reviewers observed heterogeneity in outcomes used for QI evaluations, weaknesses in study design, and incomplete reporting. Synthesizing evidence across topics provided insight into the state of the QI field for practitioners and researchers. To facilitate future evidence synthesis, consensus is needed around a smaller set of outcomes for use in QI evaluations and a framework and lexicon to describe QI interventions more broadly, in alignment with needs of decision makers responsible for improving quality.

Sustaining quality improvement and patient safety training in graduate medical education: lessons from social theory.

PubMed

Wong, Brian M; Kuper, Ayelet; Hollenberg, Elisa; Etchells, Edward E; Levinson, Wendy; Shojania, Kaveh G

2013-08-01

Despite an official mandate to incorporate formal quality improvement (QI) and patient safety (PS) training into graduate medical education, many QI/PS curricular efforts face implementation challenges and are not sustained. Educators are increasingly turning to sociocultural theories to address issues such as curricular uptake in medical education. The authors conducted a case study using Bourdieu's concepts of "field" and "habitus" to identify theoretically derived strategies that can promote sustained implementation of QI/PS curricula. From October 2010 through May 2011, the authors conducted semistructured interviews with principal authors of studies included in a systematic review of QI/PS curricula and with key informants (identified by study participants) who did not publish on their QI/PS curricular efforts. The authors purposively sampled to theoretical saturation and analyzed data concurrently with iterative data gathering within Bourdieu's theoretical framework. The study included 16 participants representing six specialties in the United States and Canada. Data analysis revealed that academic physicians belong to, and compete for legitimate forms of capital within, two separate but related fields associated with QI/PScurricular implementation: the "academic field" and the "health care delivery field." Respondents used specific strategies toexploit and/or redefine the prevailingforms of legitimate capital in each field to encourage changes inacademic physicians' habitus that would legitimizeQI/PS. Situating study findings in a sociocultural theory enables articulation of concrete strategies that can legitimize QI/PS in the academic and health care delivery fields. These strategies can promote sustained QI/PS curricula in graduate medical education.

Incorporating discrete event simulation into quality improvement efforts in health care systems.

PubMed

Rutberg, Matthew Harris; Wenczel, Sharon; Devaney, John; Goldlust, Eric Jonathan; Day, Theodore Eugene

2015-01-01

Quality improvement (QI) efforts are an indispensable aspect of health care delivery, particularly in an environment of increasing financial and regulatory pressures. The ability to test predictions of proposed changes to flow, policy, staffing, and other process-level changes using discrete event simulation (DES) has shown significant promise and is well reported in the literature. This article describes how to incorporate DES into QI departments and programs in order to support QI efforts, develop high-fidelity simulation models, conduct experiments, make recommendations, and support adoption of results. The authors describe how DES-enabled QI teams can partner with clinical services and administration to plan, conduct, and sustain QI investigations. © 2013 by the American College of Medical Quality.

77 FR 9657 - Ocean Transportation Intermediary License Applicants

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-17

..., President/Treasurer/Secretary, (Qualifying Individual), Application Type: Trade Name Change/QI Change...), Christopher Dale, Director/President/CEO, Application Type: Trade Name Change/QI Change. Dated: February 13...), Application Type: QI Change/Add OFF Service. Eagle Van Lines, Inc. (NVO & OFF), 5041 Beech Place, Temple Hills...

The Influence of Context on Quality Improvement Success in Health Care: A Systematic Review of the Literature

PubMed Central

Kaplan, Heather C; Brady, Patrick W; Dritz, Michele C; Hooper, David K; Linam, W Matthew; Froehle, Craig M; Margolis, Peter

2010-01-01

Context: The mixed results of success among QI initiatives may be due to differences in the context of these initiatives. Methods: The business and health care literature was systematically reviewed to identify contextual factors that might influence QI success; to categorize, summarize, and synthesize these factors; and to understand the current stage of development of this research field. Findings: Forty-seven articles were included in the final review. Consistent with current theories of implementation and organization change, leadership from top management, organizational culture, data infrastructure and information systems, and years involved in QI were suggested as important to QI success. Other potentially important factors identified in this review included: physician involvement in QI, microsystem motivation to change, resources for QI, and QI team leadership. Key limitations in the existing literature were the lack of a practical conceptual model, the lack of clear definitions of contextual factors, and the lack of well-specified measures. Conclusions: Several contextual factors were shown to be important to QI success, although the current body of literature lacks adequate definitions and is characterized by considerable variability in how contextual factors are measured across studies. Future research should focus on identifying and developing measures of context tied to a conceptual model that examines context across all levels of the health care system and explores the relationships among various aspects of context. PMID:21166868

Development of Team Action Projects in Surgery (TAPS): a multilevel team-based approach to teaching quality improvement.

PubMed

Waits, Seth A; Reames, Bradley N; Krell, Robert W; Bryner, Benjamin; Shih, Terry; Obi, Andrea T; Henke, Peter K; Minter, Rebecca M; Englesbe, Michael J; Wong, Sandra L

2014-01-01

To meet the Accreditation Council for Graduate Medical Education core competency in Practice-Based Learning and Improvement, educational curricula need to address training in quality improvement (QI). We sought to establish a program to train residents in the principles of QI and to provide practical experiences in developing and implementing improvement projects. We present a novel approach for engaging students, residents, and faculty in QI efforts-Team Action Projects in Surgery (TAPS). Large academic medical center and health system. Multiple teams consisting of undergraduate students, medical students, surgery residents, and surgery faculty were assembled and QI projects developed. Using "managing to learn" Lean principles, these multilevel groups approached each project with robust data collection, development of an A3, and implementation of QI activities. A total of 5 resident led QI projects were developed during the TAPS pilot phase. These included a living kidney donor enhanced recovery protocol, consult improvement process, venous thromboembolism prophylaxis optimization, Clostridium difficile treatment standardization, and understanding variation in operative duration of laparoscopic cholecystectomy. Qualitative and quantitative assessment showed significant value for both the learner and stakeholders of QI related projects. Through the development of TAPS, we demonstrate a novel approach to addressing the increasing focus on QI within graduate medical education. Efforts to expand this multilevel team based approach would have value for teachers and learners alike. Copyright © 2014. Published by Elsevier Inc.

The influence of context on quality improvement success in health care: a systematic review of the literature.

PubMed

Kaplan, Heather C; Brady, Patrick W; Dritz, Michele C; Hooper, David K; Linam, W Matthew; Froehle, Craig M; Margolis, Peter

2010-12-01

The mixed results of success among QI initiatives may be due to differences in the context of these initiatives. The business and health care literature was systematically reviewed to identify contextual factors that might influence QI success; to categorize, summarize, and synthesize these factors; and to understand the current stage of development of this research field. Forty-seven articles were included in the final review. Consistent with current theories of implementation and organization change, leadership from top management, organizational culture, data infrastructure and information systems, and years involved in QI were suggested as important to QI success. Other potentially important factors identified in this review included: physician involvement in QI, microsystem motivation to change, resources for QI, and QI team leadership. Key limitations in the existing literature were the lack of a practical conceptual model, the lack of clear definitions of contextual factors, and the lack of well-specified measures. Several contextual factors were shown to be important to QI success, although the current body of literature lacks adequate definitions and is characterized by considerable variability in how contextual factors are measured across studies. Future research should focus on identifying and developing measures of context tied to a conceptual model that examines context across all levels of the health care system and explores the relationships among various aspects of context. © 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

Susceptible genes of restless legs syndrome in migraine.

PubMed

Fuh, Jong-Ling; Chung, Ming-Yi; Yao, Shu-Chih; Chen, Ping-Kun; Liao, Yi-Chu; Hsu, Chia-Lin; Wang, Po-Jen; Wang, Yen-Feng; Chen, Shih-Pin; Fann, Cathy S-J; Kao, Lung-Sen; Wang, Shuu-Jiun

2016-10-01

Objective Several genetic variants have been found to increase the risk of restless legs syndrome (RLS). The aim of the present study was to determine if these genetic variants were also associated with the comorbidity of RLS and migraine in patients. Methods Thirteen single-nucleotide polymorphisms (SNPs) at six RLS risk loci ( MEIS1, BTBD9, MAP2K5, PTPRD, TOX3, and an intergenic region on chromosome 2p14) were genotyped in 211 migraine patients with RLS and 781 migraine patients without RLS. Association analyses were performed for the overall cohort, as well as for the subgroups of patients who experienced migraines with and without aura and episodic migraines (EMs) vs. chronic migraines (CMs). In order to verify which genetic markers were potentially related to the incidence of RLS in migraine patients, multivariate regression analyses were also performed. Results Among the six tested loci, only MEIS1 was significantly associated with RLS. The most significant SNP of MEIS1, rs2300478, increased the risk of RLS by 1.42-fold in the overall cohort ( p = 0.0047). In the subgroup analyses, MEIS1 augmented the risk of RLS only in the patients who experienced EMs (odds ratio (OR) = 1.99, p = 0.0004) and not those experiencing CMs. Multivariate regression analyses further showed that rs2300478 in MEIS1 (OR = 1.39, p = 0.018), a CM diagnosis (OR = 1.52, p = 0.022), and depression (OR = 1.86, p = 0.005) were independent predictors of RLS in migraine. Conclusions MEIS1 variants were associated with an increased risk of RLS in migraine patients. It is possible that an imbalance in iron homeostasis and the dopaminergic system may represent a link between RLS incidence and migraines.

Seasonal Transitions and the Westerly Jet in the Holocene East Asian Summer Monsoon

NASA Astrophysics Data System (ADS)

Chiang, J. C. H.; Kong, W.; Swenson, L. M.

2016-12-01

The Holocene East Asian Summer Monsoon (EASM) evolution was previously characterized as a trend towards weaker monsoon intensity paced by orbital insolation. We argue that this evolution is more accurately characterized as changes in the transition timing and duration of the EASM seasonal stages (Spring, pre Mei-Yu, Mei-Yu, Midsummer), and tied to the north-south displacement of the westerlies relative to Tibet. To this end, we employ atmospheric general circulation model time-slice simulations across the Holocene, and objectively identify the transition timing and duration of the EASM seasonal stages. Compared to the late Holocene, we find an earlier onset of Mei-Yu and an earlier transition from Mei-Yu to Summer in the early-mid Holocene, resulting in a shortened Mei-Yu and prolonged Summer stage. These changes are accompanied by an earlier northward positioning of the westerlies relative to Tibet. Our hypothesis provides a more satisfactory explanation for two key observations of Holocene East Asian climate: the `asynchronous Holocene optimum', and changes to East Asian dustiness. Our results highlight a key difference in the way that the East Asian monsoon dynamically responds to precessional insolation changes compared to the other monsoons. For other monsoon systems, changes to the land-ocean contrast drive changes to monsoon intensity. While this also occurs for the East Asian monsoon, more importantly changes to the meridional position of the westerlies relative to the Tibetan Plateau determine the timing of seasonal transitions; a northward shift triggers earlier seasonal rainfall transitions and in particular a shorter Mei-Yu and longer Midsummer stage. By similar reasoning, changes to obliquity also strongly affect East Asian summer monsoon seasonality, with a larger tilt resulting in earlier northward shift of the westerlies.

Genetic control of juvenile growth and botanical architecture in an ornamental woody plant, Prunus mume Sieb. et Zucc. as revealed by a high-density linkage map.

PubMed

Sun, Lidan; Wang, Yaqun; Yan, Xiaolan; Cheng, Tangren; Ma, Kaifeng; Yang, Weiru; Pan, Huitang; Zheng, Chengfei; Zhu, Xuli; Wang, Jia; Wu, Rongling; Zhang, Qixiang

2014-01-01

Mei, Prunus mume Sieb. et Zucc., is an ornamental plant popular in East Asia and, as an important member of genus Prunus, has played a pivotal role in systematic studies of the Rosaceae. However, the genetic architecture of botanical traits in this species remains elusive. This paper represents the first genome-wide mapping study of quantitative trait loci (QTLs) that affect stem growth and form, leaf morphology and leaf anatomy in an intraspecific cross derived from two different mei cultivars. Genetic mapping based on a high-density linkage map constricted from 120 SSRs and 1,484 SNPs led to the detection of multiple QTLs for each trait, some of which exert pleiotropic effects on correlative traits. Each QTL explains 3-12% of the phenotypic variance. Several leaf size traits were found to share common QTLs, whereas growth-related traits and plant form traits might be controlled by a different set of QTLs. Our findings provide unique insights into the genetic control of tree growth and architecture in mei and help to develop an efficient breeding program for selecting superior mei cultivars.

77 FR 64991 - Ocean Transportation Intermediary License Applicants

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-24

... & OFF), 8579 NW 72nd Street, Miami, FL 33166. Officers: Greta E. Suarez, Manager (QI), Hector E. Escobar, Manager/Member. Application Type: New NVO & OFF License. Hospitality Logistics International LLC (NVO..., FL 33122. Officers: Luis G. Leal-Perez, Manager (QI), Doris Rodriguez, Manager. Application Type: QI...

78 FR 8534 - Ocean Transportation Intermediary License Applicants

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

... (QI), Reinhard Eckhoff, Chairman, Application Type: QI Change M E Dey Cargo Corporation dba Orient Grace Container Line (NVO & OFF), 510 Plaza Drive, Suite 1210, Atlanta, GA 30349, Officers: John Davis, Secretary (QI), Debra A. Watmore, President, Application Type: Name Change to Dey Cargo Corporation, dba...

Just-in-Time Training: A Novel Approach to Quality Improvement Education.

PubMed

Knutson, Allison; Park, Nesha D; Smith, Denise; Tracy, Kelly; Reed, Danielle J W; Olsen, Steven L

2015-01-01

Just-in-time training (JITT) is accepted in medical education as a training method for newer concepts or seldom-performed procedures. Providing JITT to a large nursing staff may be an effective method to teach quality improvement (QI) initiatives. We sought to determine if JITT could increase knowledge of a specific nutrition QI initiative. Members of the nutrition QI team interviewed staff using the Frontline Contextual Inquiry to assess knowledge regarding the specific QI project. The inquiry was completed pre- and post-JITT. A JITT educational cart was created, which allowed trainers to bring the educational information to the bedside for a short, small group educational session. The results demonstrated a marked improvement in the knowledge of the frontline staff regarding our Vermont Oxford Network involvement and the specifics of the nutrition QI project. Just-in-time training can be a valuable and effective method to disseminate QI principles to a large audience of staff members.

Combating Obesity at Community Health Centers (COACH): A Quality Improvement Collaborative for Weight Management Programs

PubMed Central

Wilkes, Abigail E.; John, Priya M.; Vable, Anusha M.; Campbell, Amanda; Heuer, Loretta; Schaefer, Cynthia; Vinci, Lisa; Drum, Melinda L.; Chin, Marshall H.; Quinn, Michael T.; Burnet, Deborah L.

2013-01-01

Community health centers (CHCs) seek effective strategies to address obesity. MidWest Clinicians’ Network partnered with [an academic medical center] to test feasibility of a weight management quality improvement (QI) collaborative. MidWest Clinicians’ Network members expressed interest in an obesity QI program. This pilot study aimed to determine whether the QI model can be feasibly implemented with limited resources at CHCs to improve weight management programs. Five health centers with weight management programs enrolled with CHC staff as primary study participants; this study did not attempt to measure patient outcomes. Participants attended learning sessions and monthly conference calls to build QI skills and share best practices. Tailored coaching addressed local needs. Topics rated most valuable were patient recruitment/retention strategies, QI techniques, evidence-based weight management, motivational interviewing. Challenges included garnering provider support, high staff turnover, and difficulty tracking patient-level data. This paper reports practical lessons about implementing a weight management QI collaborative in CHCs. PMID:23727964

Teaching a Systems Approach: An Innovative Quality Improvement Project.

PubMed

Hamrin, Vanya; Vick, Rose; Brame, Cynthia; Simmons, Megan; Smith, Letizia; Vanderhoef, Dawn

2016-04-01

Nurse practitioners are required to navigate complex health care systems. Quality improvement (QI) projects provide the opportunity for nurse practitioner students to learn systems knowledge and improve health care outcomes in patient populations. A gap in the literature exists around how to systematically teach, apply, and measure QI curricular objectives at the master's level. Six faculty evaluated the QI project for the psychiatric nurse practitioner master's program by identifying the most challenging QI concepts for students to apply, revising their teaching strategies to address gaps, and retrospectively evaluating the outcomes of these curriculum changes by comparing student outcomes before and after the curricular changes. A significant difference was noted on QI project performance between students in the 2014 and 2015 graduating classes, measured by the scores earned on students' final papers (t[92] = 1.66, p = .05, d = .34, r(2) = .0289). Theoretical principles of adult and cooperative learning were used to inform curricular changes to enhance student's acquisition of QI skills. Copyright 2016, SLACK Incorporated.

[Studies of the repair of radiation-induced genetic damage in Drosophila]. Annual progress report, February 1, 1993--November 1, 1994

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

Hawley, R.S.

This research focuses on two repair deficient mutations in Drosophila melanogaster, namely mei-9, mei-41. In addition, the authors propose to extend this study to include the mus-312 mutation. They expect these studies to provide substantial insights into both the molecular mechanisms of DNA repair in Drosophila and the role these genes play in normal biological processes.

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Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-28

.... Application Type: QI Change. Efrinsa Global Logistics Inc. (NVO & OFF), 8441 NW 68th Street, Miami, FL 33166... (QI), Sheila E. Lawrence, President. Application Type: New OFF License. MMC Logistics, LLC (OFF), 2853 Henderson Mill Road, Atlanta, GA 30341. Officer: John S. Chihade, Manager (QI). Application Type: New OFF...

The Selection and Protection of Optical Astronomical Observing Sites in China

NASA Astrophysics Data System (ADS)

Wenjing, Jin; Bai, Jinming; Yao, Yongqiang

2015-03-01

Before 1950 there are two observatories, Shanghai and Purple Mountain Astronomical Observatories (SHAO and PMO), and two observing stations, Qingdao and Kunming stations in China. With the requirements of astronomical research, two observatories, Beijing and Shaanxi Astronomical Observatories (BAO and SXAO) and two artificial satellite stations, Urumqi and Changchun, were established about 1960. Based on the current management, now there are 4 observatories, SHAO, PMO, NAOC(National Astronomical Observatories), which was grouped from BAO, YNAO and 2 others, as well as XAO (Xinjiang Astronomical Observatory). The optical 1-2 m class telescopes are being operated at former four observatories. SXAO is changed as National Time Service Center. Because of city expansion as well as the traveling and economic developments, these observatories are suffered severe light pollution. For example, Zo Ce is located at the suburb of Shanghai city. A 40 cm double astrograph was installed in 1900 and a 1.56 m optical reflector have been operated since November 1987. In 1994 the seeing is better than 1 and the night sky brightness in V is about 19 mag/arcsec 2, stars fainter than 20 mag with CCD are visibles. In 2007 a large playground was built in Zô Cè area. The light pollution is severe gradually. The night sky brightness has been increased to 15.8 mag/arcsec 2. The other observatories have similar situation. New site surveys and found new stations to solve the problem. Except the solar and radio stations of each Astronomical Observatory, now there are 3 optical observing sites at PMO (Hong-He, Xu-Yi and Yaoan), 2 at SHAO (Zô Cè and Tian Huang Ping) and 2 at YNAO (Kunming and Gao-Mei-Gu) as well as 1 optical observing site at BAO (Xing-Long). The best observing site is Gao-Mei-Gu, which is selected as the optical observing site of YNAO and where atmospheric turbulence distribution is 0.11 near ground with heights from 6.5m to 2.7m during night. Sky brightness in B and V band

Evaluating the State of Quality-Improvement Science through Evidence Synthesis: Insights from the Closing the Quality Gap Series

PubMed Central

McDonald, Kathryn M; Schultz, Ellen M; Chang, Christine

2013-01-01

Context: The Closing the Quality Gap series from the Agency for Healthcare Research and Quality summarizes evidence for eight high-priority health care topics: outcomes used in disability research, bundled payment programs, public reporting initiatives, health care disparities, palliative care, the patient-centered medical home, prevention of health care-associated infections, and medication adherence. Objective: To distill evidence from this series and provide insight into the “state of the science” of quality improvement (QI). Methods: We provided common guidance for topic development and qualitatively synthesized evidence from the series topic reports to identify cross-topic themes, challenges, and evidence gaps as related to QI practice and science. Results: Among topics that examined effectiveness of QI interventions, we found improvement in some outcomes but not others. Implementation context and potential harms from QI activities were not widely evaluated or reported, although market factors appeared important for incentive-based QI strategies. Patient-focused and systems-focused strategies were generally more effective than clinician-focused strategies, although the latter approach improved clinician adherence to infection prevention strategies. Audit and feedback appeared better for targeting professionals and organizations, but not patients. Topic reviewers observed heterogeneity in outcomes used for QI evaluations, weaknesses in study design, and incomplete reporting. Conclusions: Synthesizing evidence across topics provided insight into the state of the QI field for practitioners and researchers. To facilitate future evidence synthesis, consensus is needed around a smaller set of outcomes for use in QI evaluations and a framework and lexicon to describe QI interventions more broadly, in alignment with needs of decision makers responsible for improving quality. PMID:24079357

Advancing Quality Improvement in Public Health Departments Through a Statewide Training Program.

PubMed

Davis, Mary V; Cornett, Amanda; Mahanna, Elizabeth; See, Claire; Randolph, Greg

2016-01-01

To examine the effectiveness of an ongoing statewide public health quality improvement training program (PH QI 101) among 4 cohorts of training participants. We conducted a mixed-method evaluation of the PH QI 101 training program that included measures of participants' satisfaction, learning, behavior change, and participants' translation and spread to their organizations what was learned. Data analysis included descriptive quantitative statistics and qualitative reviews. The Mann-Whitney U test was used to examine changes in participants' confidence to conduct a QI project from pre- to posttraining and 6 months posttraining. Two hundred two staff members from 37 North Carolina local health departments. An 8-month experiential learning process in which participants learn to use QI methods by applying them to a specific project. More than 90% of participants reported satisfaction with the program. Median scores on perceived self-confidence to conduct a QI project significantly increased for all training waves. At least 85% of participants reported spreading QI tools to coworkers posttraining. Two-thirds of participants in 3 waves reported that the QI project conducted during the training was at the sustaining results stage. Most participants in 3 of the training waves reported initiating new QI projects at their health department following training. Facilitators to implementation included interest and support from managers and leaders. Lack of interest and competing priorities among other staff were key barriers to implementation. This program successfully trained 4 waves of public health professionals in QI tools and methods. Leader training and involvement was a key addition to the adapted model. This statewide approach may serve as a model to other states as they seek to achieve national accreditation standards.

Retinoid-xenobiotic interactions: the Ying and the Yang

PubMed Central

2015-01-01

The literature provides compelling evidence pointing to tight metabolic interactions between retinoids and xenobiotics. These are extensive and important for understanding xenobiotic actions in the body. Within the body, retinoids affect xenobiotic metabolism and actions and conversely, xenobiotics affect retinoid metabolism and actions. This article summarizes data that establish the importance of retinoid-dependent metabolic pathways for sustaining the body’s responses to xenobiotic exposure, including the roles of all-trans- and 9-cis-retinoic acid for protecting mammals from harmful xenobiotic effects and for ensuring xenobiotic elimination from the body. This review will also consider molecular mechanisms underlying xenobiotic toxicity focusing on how this may contribute to retinoid deficiency and disruption of normal retinoid homeostasis. Special attention is paid to xenobiotic molecular targets (nuclear receptors, regulatory proteins, enzymes, and transporters) which affect retinoid metabolism and signaling. PMID:26311625

Quality indicators for Transfusion Medicine in Spain: a survey among hospital transfusion services.

PubMed

Romon, Iñigo; Lozano, Miguel

2017-05-01

Transfusion services in the European Union must implement quality management systems to improve quality. Quality indicators (QI) play a key role in quality management because they can supply important information about the performance of the transfusion service, which can then be used for benchmarking. However, little is known about the actual use of QI in hospitals. We tried to ascertain the use and characteristics of QI in Spanish hospital transfusion services. We performed a survey among transfusion services in order to learn which QI they use. We classified indicators into categories and concepts, according to the steps of the transfusion process or the activities the indicators referred to. Seventy-six hospitals (17.9% of the hospitals actively transfusing in the country) reported 731 QI. Twenty-two of them (29%) were tertiary level hospitals. The number of indicators per hospital and by activity varied greatly. QI were assigned to some basic categories: transfusion process (23% of indicators), transfusion activity and stock management (22%), haemovigilance (20%), stem cell transplantation (9%), transfusion laboratory (9%), quality management system (8%), blood donation (3.4%), apheresis and therapeutic activities (2.5%) and immunohaematology of pregnancy (2%). Although most hospitals use QI in their quality management system and share a core group of indicators, we found a great dispersion in the number and characteristics of the indicators used. The use of a commonly agreed set of QI could be an aid to benchmarking among hospitals and to improving the transfusion process.

Quality improvement education incorporated as an integral part of critical care fellows training at the Mayo Clinic.

PubMed

Kashani, Kianoush B; Ramar, Kannan; Farmer, J Christopher; Lim, Kaiser G; Moreno-Franco, Pablo; Morgenthaler, Timothy I; Dankbar, Gene C; Hale, Curt W

2014-10-01

The Accreditation Council for Graduate Medical Education emphasizes quality improvement (QI) education in residency/fellowship training programs. The Mayo Clinic Combined Critical Care Fellowship (CCF) program conducted a pilot QI education program to incorporate QI training as a required curriculum for the 2010-2011 academic year. CCF collaborated with the Mayo Quality Academy to customize and teach the existing Mayo Quality Fellows curriculum to the CCF fellows with the help of two quality coaches over five months starting July 2010. All fellows were to achieve Bronze and Silver certification prior to graduation. Silver required passing four written exams and submitting a health care QI project. Five projects were selected on the basis of the Impact-Effort Prioritization matrix, and DMAIC (Define, Measure, Analyze, Improve, and Control) methodology was used to complete the projects. The primary outcome was to assess learners' satisfaction, knowledge, and skill transfer. All 20 fellows were Bronze certified, and 14 (70%) were Silver certified by the time of graduation. All five QI projects were completed and showed positive impacts on patient safety and care. Surveys showed improved learner satisfaction. Graduates felt the QI training improved their QI skills and employment and career advancement. The QI curriculum had appropriate content and teaching pace and did not significantly displace other important clinical core curriculum topics. The pilot was successfully implemented in the CCF program and now is in the fourth academic year as an established and integral part of the fellowship core curriculum.

The Search for Perpetual Motion: Fatigue, Friction, and Drag in Quality Improvement.

PubMed

Cumbler, Ethan; Pierce, Read

Most people who have worked on continuous quality improvement (QI) with teams in the clinical microsystem have experienced "change fatigue." Application of the "Limit-to-Growth" system archetype to QI teams within health care can be used to understand negative feedback loops generated by successful QI that can limit future progress. Awareness of these factors can result in actions designed to reduce drag on forward momentum. Leaders in health care QI can anticipate and minimize negative feedback loops that accumulate to slow subsequent progress of highly functioning improvement teams within clinical microsystems.

Can small pelagic fish landings be used as predictors of high-frequency oceanographic fluctuations in the 1-2 El Niño region?

NASA Astrophysics Data System (ADS)

Ormaza-González, Franklin Isaac; Mora-Cervetto, Alejandra; María Bermúdez-Martínez, Raquel; Hurtado-Domínguez, Mario Armando; Raúl Peralta-Bravo, Manuel; Mariuxi Jurado-Maldonado, Viviana

2016-08-01

A group of small pelagic fish captured between 1981 and 2012 within El Niño area 1-2 by the Ecuadorian fleet was correlated with the oceanographic Multivariate ENSO Index (MEI), and the Oceanographic El Niño Index (ONI) referred to El Niño region 3-4. For the period 1981-2012, total landings correlated poorly with the indexes, but during 2000-2012 (cold PDO) they proved to have a 14-29 % association with both indexes; the negative slope of the curves suggested higher landing during cold events (La Niña) and also indicated a tendency to decrease at extreme values ( > 0.5 and < -1.0). Round herring (Etrumeus teres) fourth-quarter (Q4) landings were related to the MEI in a nonlinear analysis by up to 80 %. During moderate or strong La Niña events landings noticeably increased. Bullet tuna (Auxis spp.) catches showed a negative gradient from cold to warm episodes with an R2 of 0.149. For Chilean jack mackerel (Trachurus murphyi) irregular landings between 2003 and 2007 were observed and were poorly correlated (R2 < 0.1) with ONI or MEI. Anchovy (Engraulis ringens) captured in Ecuadorian waters since 2000 had an R2 of 0.302 and 0.156 for MEI and ONI, respectively, but showed a higher correlation with the cold Pacific Decadal Oscillation (PDO). South American pilchard (Sardinops sagax) was higher than -0.5 for the ONI and MEI, and landings dramatically decreased; however, Q4 landings correlated with ONI and MEI, with R2 of 0.109 and 0.225, respectively (n = 3). Linear correlation of Q4 indexes against the following year's Q1 landings had a linkage of up to 22 %; this species could therefore be considered a predictor of El Niño. Chub mackerel (Scomber japonicus) landings did not have a significant linear correlation with the indexes for 1981-2012 and therefore could not be considered a valid predictor. Chuhueco (Cetengraulis mysticetus) is a local species with high landings during El Niño years and, conversely, remarkably low landings during La Ni

Nursing Home Administrator Quality Improvement Self-Efficacy Scale.

PubMed

Siegel, Elena O; Zisberg, Anna; Bakerjian, Debra; Zysberg, Leehu

Nursing home (NH) quality improvement (QI) is challenging. The critical role of NH leaders in successful QI is well established; however, current options for assessing the QI capabilities of leaders such as the licensed NH administrator are limited. This article presents the development and preliminary validation of an instrument to measure NH administrator self-efficacy in QI. We used a mixed-methods cross-sectional design to develop and test the measure. For item generation, 39 NH leaders participated in qualitative interviews. Item reduction and content validity were established with a sample of eight subject matter experts. A random sample of 211 administrators from NHs with the lowest and highest Centers for Medicare and Medicaid Services Five-Star Quality ratings completed the measure. We conducted exploratory and confirmatory factor analyses and tested the measure for internal reliability and convergent, discriminant, and known group validity. The final measure included five subscales and 32 items. Confirmatory factor analysis reaffirmed the factorial structure with good fit indices. The new measure's subscales correlated with valid measures of self-efficacy and locus of control, supporting the measure's convergent and discriminant validity. Significant differences in most of the subscales were found between the objective (Centers for Medicare and Medicaid Services Five-Star Quality rating) and subjective (Self-Rated Facility QI Index) quality outcomes, supporting the measure's known group validity. The instrument has usefulness to both NH organizations and individual NH administrators as a diagnostic tool to identify administrators with higher/lower chances of successfully implementing QI. Organizations and individuals can use this diagnostic to identify the administrator's professional development needs for QI, in general, and specific to the instrument's five subscales, informing directions for in-house training, mentoring, and outside professional

Creating a Quality Improvement Course for Undergraduate Medical Education: Practice What You Teach.

PubMed

Bradham, Tamala S; Sponsler, Kelly C; Watkins, Scott C; Ehrenfeld, Jesse M

2018-05-02

More than half of U.S. medical schools have implemented curricula addressing quality improvement (QI); however, the evidence on which pedagogical methods are most effective is limited. As of January 2015, students at Vanderbilt University School of Medicine are required to take a QI course consisting of three 1-month-long (4 hours per week) blocks during their third or fourth year, in which student-identified faculty sponsors are paired with highly trained QI professionals from Vanderbilt University Medical Center. The three blocks of the QI course include didactic instruction using Institute for Healthcare Improvement Open School modules, readings, weekly assignments, and experiential learning activities (i.e., students develop and implement a QI project with two Plan-Do-Study-Act cycles using a systematic approach that employs the principles of improvement science, which they present as a poster on the last day of the third block). From January 2015 to January 2017, 132 students completed all three blocks, resulting in 110 completed QI projects. On evaluations (distributed after each completed block), a majority of students rated the clinical relevance of the blocks highly (191/273, 70%), agreed the blocks contributed to their development as a physician (192/273, 70%), and reported the blocks motivated them to continue to learn more about QI (168/273, 62%). The authors have applied QI tools and methods to improve the QI course and will aim to measure and assess the sustainability of the course by tracking clinical outcomes related to the projects and students' ongoing involvement in QI after graduation.Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a "work of the United States Government" for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.

Bu-Zhong-Yi-Qi Decoction, the Water Extract of Chinese Traditional Herbal Medicine, Enhances Cisplatin Cytotoxicity in A549/DDP Cells through Induction of Apoptosis and Autophagy

PubMed Central

Xiong, Ying

2017-01-01

Cisplatin is one of the most active cytotoxic agents for non-small cell lung cancer (NSCLC) treatment. However, the development of cisplatin resistance is common. Bu-Zhong-Yi-Qi decoction (BZYQD), a Chinese traditional herbal medicine, is widely used for the enhancement of antitumor effect in other medications. In this study, we evaluated the effect and drug-resistance reversal mechanism of BZYQD combined with cisplatin on cisplatin-resistant A549/DDP cells. Our results showed that BZYQD exhibited direct cytotoxic and chemosensitizing effects. Cotreatment with BZYQD and cisplatin induced intrinsic apoptotic pathways which were measured by condensed nuclear chromatin, Annexin V/PI apoptosis assay, and apoptosis related proteins expression. In addition, cotreatment with BZYQD and cisplatin also activated autophagy, as indicated by an increase in LC3 puncta, classical autophagosomes and/or autolysosomes, and an accumulation of LC3-II and ATG7 protein. Finally, cotreatment with BZYQD and cisplatin resulted in the generation of ROS and scavenging ROS by NAC almost completely suppressing cell death. These results suggest that cotreatment with BZYQD and cisplatin might reverse cisplatin resistance by inducing ROS accumulation, which activates apoptosis and autophagy by oxidative stress. The combination of BZYQD and cisplatin may represent a novel approach in treatment for NSCLC and thus offer a new target for chemotherapy. PMID:28154825

What is needed to implement a web-based audit and feedback intervention with outreach visits to improve care quality: A concept mapping study among cardiac rehabilitation teams.

PubMed

van Engen-Verheul, Mariëtte M; Peek, Niels; Haafkens, Joke A; Joukes, Erik; Vromen, Tom; Jaspers, Monique W M; de Keizer, Nicolette F

2017-01-01

Evidence on successful quality improvement (QI) in health care requires quantitative information from randomized clinical trials (RCTs) on the effectiveness of QI interventions, but also qualitative information from professionals to understand factors influencing QI implementation. Using a structured qualitative approach, concept mapping, this study determines factors identified by cardiac rehabilitation (CR) teams on what is needed to successfully implement a web-based audit and feedback (A&F) intervention with outreach visits to improve the quality of CR care. Participants included 49 CR professionals from 18 Dutch CR centres who had worked with the A&F system during a RCT. In three focus group sessions participants formulated statements on factors needed to implement QI successfully. Subsequently, participants rated all statements for importance and feasibility and grouped them thematically. Multi dimensional scaling was used to produce a final concept map. Forty-two unique statements were formulated and grouped into five thematic clusters in the concept map. The cluster with the highest importance was QI team commitment, followed by organisational readiness, presence of an adequate A&F system, access to an external quality assessor, and future use and functionalities of the A&F system. Concept mapping appeared efficient and useful to understand contextual factors influencing QI implementation as perceived by healthcare teams. While presence of a web-based A&F system and external quality assessor were seen as instrumental for gaining insight into performance and formulating QI actions, QI team commitment and organisational readiness were perceived as essential to actually implement and carry out these actions. These two sociotechnical factors should be taken into account when implementing and evaluating the success of QI implementations in future research. Copyright © 2016. Published by Elsevier Ireland Ltd.

Cytochrome b6 arginine 214 of Synechococcus sp. PCC 7002, a key residue for quinone-reductase site function and turnover of the cytochrome bf complex.

PubMed

Nelson, Matthew E; Finazzi, Giovanni; Wang, Qing Jun; Middleton-Zarka, Kelly A; Whitmarsh, John; Kallas, Toivo

2005-03-18

Quinone-reductase (Q(i)) domains of cyanobacterial/chloroplast cytochrome bf and bacterial/mitochondrial bc complexes differ markedly, and the cytochrome bf Q(i) site mechanism remains largely enigmatic. To investigate the bf Q(i) domain, we constructed the mutation R214H, which substitutes histidine for a conserved arginine in the cytochrome b(6) polypeptide of the cyanobacterium Synechococcus sp. SPCC 7002. At high light intensity, the R214H mutant grew approximately 2.5-fold more slowly than the wild type. Slower growth arose from correspondingly slower overall turnover of the bf complex. Specifically, as shown in single flash turnover experiments of cytochrome b(6) reduction and oxidation, the R214H mutation partially blocked electron transfer to the Q(i) site, mimicking the effect of the Q(i) site inhibitor 2-N-4-hydroxyquinoline-N-oxide. The kinetics of cytochrome b(6) oxidation were largely unaffected by hydrogen-deuterium exchange in the mutant but were slowed considerably in the wild type. This suggests that although protonation events influenced the kinetics of cytochrome b(6) oxidation at the Q(i) site in the wild type, electron flow limited this reaction in the R214H mutant. Redox titration of membranes revealed midpoint potentials (E(m,7)) of the two b hemes similar to those in the wild type. Our data define cytochrome b(6) Arg(214) as a key residue for Q(i) site catalysis and turnover of the cytochrome bf complex. In the recent cytochrome bf structures, Arg(214) lies near the Q(i) pocket and the newly discovered c(i) or x heme. We propose a model for Q(i) site function and a role for Arg(214) in plastoquinone binding.

MO-G-12A-01: Quantitative Imaging Metrology: What Should Be Assessed and How?

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

Giger, M; Petrick, N; Obuchowski, N

The first two symposia in the Quantitative Imaging Track focused on 1) the introduction of quantitative imaging (QI) challenges and opportunities, and QI efforts of agencies and organizations such as the RSNA, NCI, FDA, and NIST, and 2) the techniques, applications, and challenges of QI, with specific examples from CT, PET/CT, and MR. This third symposium in the QI Track will focus on metrology and its importance in successfully advancing the QI field. While the specific focus will be on QI, many of the concepts presented are more broadly applicable to many areas of medical physics research and applications. Asmore » such, the topics discussed should be of interest to medical physicists involved in imaging as well as therapy. The first talk of the session will focus on the introduction to metrology and why it is critically important in QI. The second talk will focus on appropriate methods for technical performance assessment. The third talk will address statistically valid methods for algorithm comparison, a common problem not only in QI but also in other areas of medical physics. The final talk in the session will address strategies for publication of results that will allow statistically valid meta-analyses, which is critical for combining results of individual studies with typically small sample sizes in a manner that can best inform decisions and advance the field. Learning Objectives: Understand the importance of metrology in the QI efforts. Understand appropriate methods for technical performance assessment. Understand methods for comparing algorithms with or without reference data (i.e., “ground truth”). Understand the challenges and importance of reporting results in a manner that allows for statistically valid meta-analyses.« less

Design and measurement of quality improvement indicators in ambulatory pulmonary care: creating a "culture of quality" in an academic pulmonary division.

PubMed

Roberts, David H; Gilmartin, Geoffrey S; Neeman, Naama; Schulze, Joanne E; Cannistraro, Sabrina; Ngo, Long H; Aronson, Mark D; Weiss, J Woodrow

2009-10-01

Quality improvement (QI) measures often are cited as goals for individual practices and medical centers and may someday form a component of reimbursement guidelines. Relatively few QI metrics relevant to ambulatory pulmonary medicine have been published. We describe the development and implementation of a QI program in an academic pulmonary division, including progress to date and lessons learned. Metrics for the pulmonary QI Dashboard were developed based on an extensive literature review. Patients were identified through International Classification of Diseases-based billing databases, and results data were obtained from a manual and automated review of the electronic medical record. The performance of the division was monitored and presented in regular faculty meetings. Quarterly, confidential, individual scorecards gave each clinician feedback about his or her performance and compared the feedback to that of the faculty of the entire division. Significant improvements were found in many QI measures during a 2-year period. The number of patients with asthma who received appropriately prescribed inhaled corticosteroids increased from a baseline of 76 to 92% to 98%. Flu shot and pneumococcal vaccine administration documentation for patients with COPD increased from baseline values of 11 to 32% and 11 to 34%, respectively, to 90% and 93%, respectively. The COPD Global Initiative for Obstructive Lung Disease pharmacotherapy guidelines adherence increased substantially for patients with all disease stages. Chest CT scan results notification documentation improved from a baseline of 67 to 76% to 98%. Comparison between baseline and QI periods yielded statistically significant increases for these indicators. QI measures for an ambulatory pulmonary practice can be designed, implemented, and monitored. Key components include a well-structured electronic medical record, measurable outcomes, strong QI leadership, and specific interventions, such as providing feedback

Role of Medicinal Plants for Liver-Qi Regulation Adjuvant Therapy in Post-stroke Depression: A Systematic Review of Literature.

PubMed

Zeng, Ling-Feng; Cao, Ye; Wang, Lu; Dai, Yun-Kai; Hu, Ling; Wang, Qi; Zhu, Li-Ting; Bao, Wen-Hu; Zou, Yuan-Ping; Chen, Yun-Bo; Xu, Wei-Hua; Liang, Wei-Xiong; Wang, Ning-Sheng

2017-01-01

Current evidence demonstrated certain beneficial effects of medicinal herbs as an adjuvant therapy for post-stroke depression (PSD) in China; Chai-hu (Chinese Thorowax Root, Radix Bupleuri) is an example of a medicinal plant for Liver-Qi regulation (MPLR) in the treatment of PSD. Despite several narrative reports on the antidepressant properties of MPLR, it appears that there are no systematic reviews to summarize its outcome effects. Therefore, the aim of this review was to assess the effectiveness and safety of MPLR adjuvant therapy in patients with PSD. Seven databases were extensively searched from January 2000 until July 2016. Randomized control trials (RCTs) involving patients with PSD that compared treatment with and without MPLR were taken into account. The pooled effect estimates were calculated based on Cochrane Collaboration's software RevMan 5.3. Finally, 42 eligible studies with 3612 participants were included. Overall, MPLR adjuvant therapy showed a significantly higher effective rate (RR = 1.23; 95% CI = 1.19, 1.27; p < 0.00001) compared to those without. Moreover, the administration of MPLR was superior to abstainers regarding Hamilton Depression Scale (HAMD) score changes after 3 weeks (WMD = -4.83; 95% CI = -6.82, -2.83; p < 0.00001), 4 weeks (WMD = -3.25; 95% CI = -4.10, -2.40; p < 0.00001), 6 weeks (WMD = -4.04; 95% CI = -5.24, -2.84; p < 0.00001), 8 weeks (WMD = -4.72; 95% CI = -5.57, -3.87; p < 0.00001), and 12 weeks (WMD = -3.07; 95% CI = -4.05, -2.09; p < 0.00001). In addition, there were additive benefits in terms of response changes for the National Institutes of Health Stroke Scale (NIHSS) and other self-rating scores. No frequently occurring or serious adverse events were reported. We concluded that there is supporting evidence that adjuvant therapy with MPLR is effective in reducing the depressive symptoms and enhancing quality of life for patients with

75 FR 63856 - In the Matter of Certain Liquid Crystal Display Devices, Including Monitors, Televisions, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-18

... Science Park, Miaoli County 350, Taiwan. Innolux Corporation, 2525 Brockton Drive, Suite 300, Austin, TX... Shan-Ying Road, Gueishan, Taoyuan 333, Taiwan. Qisda America Corporation, 8941 Research Drive, Suite...

A house officer-sponsored quality improvement initiative: leadership lessons and liabilities.

PubMed

Weingart, S N

1998-07-01

House officers play an important role in the care of hospitalized patients, yet they are infrequent participants in quality improvement (QI) activities. A grassroots QI initiative among medical house officers was implemented at Beth Israel Deaconess Medical Center's East Campus in Boston from 1995 through 1997. A group of house officer volunteers completed five of nine projects, including a survey that demonstrated frequent failures of cardiac monitor-defibrillators in the emergency room. Reaching out to key administrators produced several quick fixes. Developing effective, ongoing partnerships with clinical departments and QI professionals proved more problematic. Residency training programs that provide experience in QI give house officers a potentially valuable skill and an additional means to improve the quality of patient care. Yet many obstacles work against house officers' participation in QI initiatives, including long hours and the daily demands of patient care, rotating monthly assignments, and clinical leaders' assumption that they have little interest in QI. The organizers of the officer problem-solving group over-estimated the hospital resources at their disposal and failed to build mechanisms to ensure the initiative's continuation into its second year, when their own interest waned and no new group of leaders emerged to take their place. House officers represent an underused resource for QI. They are skilled at identifying problems but have difficulty executing sustained and complex QI initiatives. Peer leadership is a potent means to mobilize resident-physician participation but may require faculty or staff involvement and support to guarantee its continuity.

Leveraging the Continuum: A Novel Approach to Meeting Quality Improvement and Patient Safety Competency Requirements Across a Large Department of Medicine.

PubMed

Myers, Jennifer S; Bellini, Lisa M

2018-05-22

Quality improvement (QI) and patient safety (PS) are now core competencies across the medical education continuum. A major challenge to developing and implementing these new curricular requirements is the lack of faculty expertise. In 2015, the authors developed a centralized, vertically integrated, competency-based approach to meet the educational requirements in QI/PS across the continuum of graduate medical education in the Department of Medicine, Perelman School of Medicine, University of Pennsylvania. By leveraging the QI/PS expertise of one individual, the authors identified and trained core QI/PS faculty members and sequentially deployed QI/PS activities that were tailored to the learner level and specialty. The curriculum includes PS event reporting, systems thinking and root cause analysis skills, adverse event disclosure, and a QI workshop series and project. PS event reporting, an indication of engagement in PS culture, increased by 186% among interns, 384% among PGY 2 and 3 residents, and 613% among fellows between AYs 2013-2014 and 2016-2017. In AY 2017-2018, 9 faculty members and 40 fellows from 9 fellowships participated in the QI workshop series, and 53 fellows from 7 fellowships participated in the adverse event disclosure simulation activity. All educational activities were rated highly. The authors are expanding the adverse event disclosure activity to include residents and the remaining fellowship programs, identifying fellowships to pilot curricular efforts related to clinical quality metrics, developing introductory activities in basic QI/PS concepts for medical students, and evaluating the impact of efforts on the participating faculty members.

Factors predicting training transfer in health professionals participating in quality improvement educational interventions.

PubMed

Eid, Ahmed; Quinn, Doris

2017-01-31

Predictors of quality improvement (QI) training transfer are needed. This study aimed to identify these predictors among health professionals who participated in a QI training program held at a large hospital in the United States between 2005 and 2014. It also aimed to determine how these predictive factors facilitated or impeded QI training transfer. Following the Success Case Method, we used a screening survey to identify trainees with high and low levels of training transfer. We then conducted semistructured interviews with a sample of the survey respondents to document how training transfer was achieved and how lack of training transfer could be explained. The survey's response rate was 43%, with a Cronbach alpha of 0.89. We then conducted a thematic analysis of the interview transcripts of 16 physicians. The analysis revealed 3 categories of factors influencing the transfer of QI training: trainee characteristics, training course, and work environment. Relevant trainee characteristics included attitude toward change, motivation, mental processing skills, interpersonal skills, and the personality characteristics curiosity, humility, conscientiousness, resilience, wisdom, and positivity. The training project, team-based learning, and lectures were identified as relevant aspects of the training course. Work culture, work relationships, and resources were subthemes of the work environment category. We identified several QI training transfer predictors in our cohort of physicians. We hypothesize that some of these predictors may be more relevant to QI training transfer. Our results will help organizational leaders select trainees who are most likely to transfer QI training and to ensure that their work environments are conducive to QI training transfer.

A merged model of quality improvement and evaluation: maximizing return on investment.

PubMed

Woodhouse, Lynn D; Toal, Russ; Nguyen, Trang; Keene, DeAnna; Gunn, Laura; Kellum, Andrea; Nelson, Gary; Charles, Simone; Tedders, Stuart; Williams, Natalie; Livingood, William C

2013-11-01

Quality improvement (QI) and evaluation are frequently considered to be alternative approaches for monitoring and assessing program implementation and impact. The emphasis on third-party evaluation, particularly associated with summative evaluation, and the grounding of evaluation in the social and behavioral science contrast with an emphasis on the integration of QI process within programs or organizations and its origins in management science and industrial engineering. Working with a major philanthropic organization in Georgia, we illustrate how a QI model is integrated with evaluation for five asthma prevention and control sites serving poor and underserved communities in rural and urban Georgia. A primary foundation of this merged model of QI and evaluation is a refocusing of the evaluation from an intimidating report card summative evaluation by external evaluators to an internally engaged program focus on developmental evaluation. The benefits of the merged model to both QI and evaluation are discussed. The use of evaluation based logic models can help anchor a QI program in evidence-based practice and provide linkage between process and outputs with the longer term distal outcomes. Merging the QI approach with evaluation has major advantages, particularly related to enhancing the funder's return on investment. We illustrate how a Plan-Do-Study-Act model of QI can (a) be integrated with evaluation based logic models, (b) help refocus emphasis from summative to developmental evaluation, (c) enhance program ownership and engagement in evaluation activities, and (d) increase the role of evaluators in providing technical assistance and support.

Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross‐sectional survey

PubMed Central

Phung, Viet‐Hai; Essam, Nadya; Asghar, Zahid; Spaight, Anne

2015-01-01

Abstract Rationale, aims and objectives Clinical leadership and organizational culture are important contextual factors for quality improvement (QI) but the relationship between these and with organizational change is complex and poorly understood. We aimed to explore the relationship between clinical leadership, culture of innovation and clinical engagement in QI within a national ambulance QI Collaborative (QIC). Methods We used a self‐administered online questionnaire survey sent to front‐line clinicians in all 12 English ambulance services. We conducted a cross‐sectional analysis of quantitative data and qualitative analysis of free‐text responses. Results There were 2743 (12% of 22 117) responses from 11 of the 12 participating ambulance services. In the 3% of responders that were directly involved with the QIC, leadership behaviour was significantly higher than for those not directly involved. QIC involvement made no significant difference to responders' perceptions of the culture of innovation in their organization, which was generally considered poor. Although uptake of QI methods was low overall, QIC members were significantly more likely to use QI methods, which were also significantly associated with leadership behaviour. Conclusions Despite a limited organizational culture of innovation, clinical leadership and use of QI methods in ambulance services generally, the QIC achieved its aims to significantly improve pre‐hospital care for acute myocardial infarction and stroke. We postulate that this was mediated through an improvement subculture, linked to the QIC, which facilitated large‐scale improvement by stimulating leadership and QI methods. Further research is needed to understand success factors for QI in complex health care environments. PMID:26303398

Partnering health disparities research with quality improvement science in pediatrics.

PubMed

Lion, K Casey; Raphael, Jean L

2015-02-01

Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction. Copyright © 2015 by the American Academy of Pediatrics.

Comparison of reactivity of Pt(II) center in the mononuclear and binuclear organometallic diimineplatinum complexes toward oxidative addition of methyl iodide

NASA Astrophysics Data System (ADS)

Hashemi, Majid

2016-01-01

The reactivities of Pt(II) center in a series of organometallic mononuclear Pt(II), binuclear Pt(II) and binuclear mixed-valence Pt(II)-Pt(IV) complexes toward oxidative addition of MeI have been compared from a theoretical point of view. The nucleophilicity index and electron-donation power were calculated for each of these complexes. The energies of HOMO and dZ2 orbital were determined for these complexes. Very good correlations were found between logk2 (k2 is the experimentally determined second order rate constant for the oxidative addition of MeI on these complexes) and nucleophilicity index or electron-donation power for these complexes. The correlation between logk2 and the energy of HOMO or the energy of dZ2 orbital were also very good. The condensed-to-atom Fukui functions for electrophilic attack on these complexes showed that the Pt(II) center is the preferred site for the oxidative addition of MeI. All of these observations are in agreement with the proposed SN2 type mechanism in the oxidative addition of MeI on the Pt(II) center in these complexes.

How to use concept mapping to identify barriers and facilitators of an electronic quality improvement intervention.

PubMed

van Engen-Verheul, Mariëtte; Peek, Niels; Vromen, Tom; Jaspers, Monique; de Keizer, Nicolette

2015-01-01

Systematic quality improvement (QI) interventions are increasingly used to change complex health care systems. Results of randomized clinical trials can provide quantitative evidence whether QI interventions were effective but they do not teach us why and how QI was (not) achieved. Qualitative research methods can answer these questions but typically involve only a small group of respondents against high resources. Concept mapping methodology overcomes these drawbacks by integrating results from qualitative group sessions with multivariate statistical analysis to represent ideas of diverse stakeholders visually on maps in an efficient way. This paper aims to describe how to use concept mapping to qualitatively gain insight into barriers and facilitators of an electronic QI intervention and presents experiences with the method from an ongoing case study to evaluate a QI system in the field of cardiac rehabilitation in the Netherlands.

Impact of a highly detailed emission inventory on modeling accuracy

NASA Astrophysics Data System (ADS)

Taghavi, M.; Cautenet, S.; Arteta, J.

2005-03-01

During Expérience sur Site pour COntraindre les Modèles de Pollution atmosphérique et de Transport d'Emissions (ESCOMPTE) campaign (June 10 to July 14, 2001), two pollution events observed during an intensive measurement period (IOP2a and IOP2b) have been simulated. The comprehensive Regional Atmospheric Modeling Systems (RAMS) model, version 4.3, coupled online with a chemical module including 29 species is used to follow the chemistry of a polluted zone over Southern France. This online method takes advantage of a parallel code and use of the powerful computer SGI 3800. Runs are performed with two emission inventories: the Emission Pre Inventory (EPI) and the Main Emission Inventory (MEI). The latter is more recent and has a high resolution. The redistribution of simulated chemical species (ozone and nitrogen oxides) is compared with aircraft and surface station measurements for both runs at regional scale. We show that the MEI inventory is more efficient than the EPI in retrieving the redistribution of chemical species in space (three-dimensional) and time. In surface stations, MEI is superior especially for primary species, like nitrogen oxides. The ozone pollution peaks obtained from an inventory, such as EPI, have a large uncertainty. To understand the realistic geographical distribution of pollutants and to obtain a good order of magnitude in ozone concentration (in space and time), a high-resolution inventory like MEI is necessary. Coupling RAMS-Chemistry with MEI provides a very efficient tool able to simulate pollution plumes even in a region with complex circulations, such as the ESCOMPTE zone.

HOXA1 and TALE proteins display cross-regulatory interactions and form a combinatorial binding code on HOXA1 targets

PubMed Central

De Kumar, Bony; Parker, Hugo J.; Paulson, Ariel; Parrish, Mark E.; Pushel, Irina; Singh, Narendra Pratap; Zhang, Ying; Slaughter, Brian D.; Unruh, Jay R.; Florens, Laurence; Zeitlinger, Julia; Krumlauf, Robb

2017-01-01

Hoxa1 has diverse functional roles in differentiation and development. We identify and characterize properties of regions bound by HOXA1 on a genome-wide basis in differentiating mouse ES cells. HOXA1-bound regions are enriched for clusters of consensus binding motifs for HOX, PBX, and MEIS, and many display co-occupancy of PBX and MEIS. PBX and MEIS are members of the TALE family and genome-wide analysis of multiple TALE members (PBX, MEIS, TGIF, PREP1, and PREP2) shows that nearly all HOXA1 targets display occupancy of one or more TALE members. The combinatorial binding patterns of TALE proteins define distinct classes of HOXA1 targets, which may create functional diversity. Transgenic reporter assays in zebrafish confirm enhancer activities for many HOXA1-bound regions and the importance of HOX-PBX and TGIF motifs for their regulation. Proteomic analyses show that HOXA1 physically interacts on chromatin with PBX, MEIS, and PREP family members, but not with TGIF, suggesting that TGIF may have an independent input into HOXA1-bound regions. Therefore, TALE proteins appear to represent a wide repertoire of HOX cofactors, which may coregulate enhancers through distinct mechanisms. We also discover extensive auto- and cross-regulatory interactions among the Hoxa1 and TALE genes, indicating that the specificity of HOXA1 during development may be regulated though a complex cross-regulatory network of HOXA1 and TALE proteins. This study provides new insight into a regulatory network involving combinatorial interactions between HOXA1 and TALE proteins. PMID:28784834

The science of quality improvement implementation: developing capacity to make a difference.

PubMed

Alexander, Jeffrey A; Hearld, Larry R

2011-12-01

Quality improvement (QI) holds promise to improve quality of care; however, organizations often struggle with its implementation. It has been recommended that practitioners, managers, and researchers attempt to increase systematic understanding of the structure, practices, and context of organizations that facilitate or impede the implementation of QI innovations. To critically review the empirical research on QI implementation in health care organizations. A literature review of 107 studies that examined the implementation of QI innovations in health care organizations. Studies were classified into 4 groups based on the types of predictors that were assumed to affect implementation (content of QI innovation, organizational processes, internal context, and external context). Internal context and organizational processes were the most frequently studied categories. External context and organizational process categories exhibited the highest rate of positive effects on QI implementation. The review revealed several important gaps in the QI implementation literature. Studies often lacked clear conceptual frameworks to guide the research, which may hinder efforts to compare relationships across studies. Studies also tended to adopt designs that were narrowly focused on independent effects of predictors and did not include holistic frameworks to capture interactions among the many factors involved in implementation. Other design limitations included the use of cross-sectional designs, single-source data collection, and potential selection bias among study participants.

JPRS Report. Environmental Issues.

DTIC Science & Technology

1991-06-11

the aspects of management of raising, artificial repro- duction, artificial insemination , raising of the young, male reproduction capability...method of fresh sperm artificial insemination to impreg- nate pandas. In 1980 Mei Mei, a panda in the Chengdu Zoo, success- fully gave birth to a... insemination for panda reproduction. Beginning in 1980, in 10 years of artificially raising giant pandas, the Chengdu Zoo has had 15 pregnancies

Genetic background in partitioning of metabolizable energy efficiency in dairy cows.

PubMed

Mehtiö, T; Negussie, E; Mäntysaari, P; Mäntysaari, E A; Lidauer, M H

2018-05-01

The main objective of this study was to assess the genetic differences in metabolizable energy efficiency and efficiency in partitioning metabolizable energy in different pathways: maintenance, milk production, and growth in primiparous dairy cows. Repeatability models for residual energy intake (REI) and metabolizable energy intake (MEI) were compared and the genetic and permanent environmental variations in MEI were partitioned into its energy sinks using random regression models. We proposed 2 new feed efficiency traits: metabolizable energy efficiency (MEE), which is formed by modeling MEI fitting regressions on energy sinks [metabolic body weight (BW 0.75 ), energy-corrected milk, body weight gain, and body weight loss] directly; and partial MEE (pMEE), where the model for MEE is extended with regressions on energy sinks nested within additive genetic and permanent environmental effects. The data used were collected from Luke's experimental farms Rehtijärvi and Minkiö between 1998 and 2014. There were altogether 12,350 weekly MEI records on 495 primiparous Nordic Red dairy cows from wk 2 to 40 of lactation. Heritability estimates for REI and MEE were moderate, 0.33 and 0.26, respectively. The estimate of the residual variance was smaller for MEE than for REI, indicating that analyzing weekly MEI observations simultaneously with energy sinks is preferable. Model validation based on Akaike's information criterion showed that pMEE models fitted the data even better and also resulted in smaller residual variance estimates. However, models that included random regression on BW 0.75 converged slowly. The resulting genetic standard deviation estimate from the pMEE coefficient for milk production was 0.75 MJ of MEI/kg of energy-corrected milk. The derived partial heritabilities for energy efficiency in maintenance, milk production, and growth were 0.02, 0.06, and 0.04, respectively, indicating that some genetic variation may exist in the efficiency of using

Quality Index Tables for Some Eastern Hardwood Species Based on Lumber Prices from 1970 to 1974

Treesearch

Joseph J. Mendel; Margaret K. Peirsol

1977-01-01

Revised quality index (QI) tables for white ash, beech, black cherry, birch, hard maple, soft maple, red oak, white oak, and yellow-poplar are based on 1970-74 lumber prices for the Appalachian and northeastern marketing areas. Changes in QI since 1964-68 were greatest for white oak; there also were significant changes in QI for red oak, white ash, and yellow-poplar....

Performance and carcass characteristics of steers fed with two levels of metabolizable energy intake during summer and winter season.

PubMed

Arias, R A; Keim, J P; Gandarillas, M; Velásquez, A; Alvarado-Gilis, C; Mader, T L

2018-05-22

Climate change is producing an increase on extreme weather events around the world such as flooding, drought and extreme ambient temperatures impacting animal production and animal welfare. At present, there is a lack of studies addressing the effects of climatic conditions associated with energy intake in finishing cattle in South American feed yards. Therefore, two experiments were conducted to assess the effects of environmental variables and level of metabolizable energy intake above maintenance requirements (MEI) on performance and carcass quality of steers. In each experiment (winter and summer), steers were fed with 1.85 or 2.72 times of their requirements of metabolizable energy of maintenance. A total of 24 crossbred steers per experiment were used and located in four pens (26.25 m2/head) equipped with a Calan Broadbent Feeding System. Animals were fed with the same diet within each season, varying the amount offered to adjust the MEI treatments. Mud depth, mud scores, tympanic temperature (TT), environmental variables, average daily gain, respiration rates and carcass characteristics plus three thermal comfort indices were collected. Data analysis considered a factorial arrangement (Season and MEI). In addition, a repeated measures analysis was performed for TT and respiration rate. Mean values of ambient temperature, solar radiation and comfort thermal indices were greater in the summer experiment as expected (P<0.005). The mean values of TT were higher in steers fed with higher MEI and also in the summer season. The average daily gain was greater during summer v. winter (1.10±0.11 v. 0.36±0.06) kg/day, also when steers were fed 2.72 v. 1.85 MEI level (0.89±0.12 v. 0.57±0.10) kg/day. In summer, respiration rate increased in 41.2% in the afternoon. In winter, muddy conditions increased with time of feeding, whereas wind speed and rainfall had significant effects on TT and average daily gain. We conclude that MEI and environmental variables have direct

Protective effect of Bu-zhong-yi-qi decoction, the water extract of Chinese traditional herbal medicine, on 5-fluorouracil-induced renal injury in mice.

PubMed

Xiong, Ying; Shang, Bingzhen; Xu, Siying; Zhao, Ran; Gou, He; Wang, Chun

2016-09-01

Drug-induced renal injury is a serious toxic side effect of 5-fluorouracil (5-FU) treatment. Bu-zhong-yi-qi decoction (BZYQD), a water extract of Chinese traditional herbal medicine, is widely used in Asia as an alternative treatment to reduce the side effects of chemotherapy and also improve cancer survival. However, the mechanism is unknown. This study is designed to investigate the protective effect of BZYQD on 5-FU-induced renal injury in mice. Mice were divided into four groups: the control, 5-FU, 5-FU + low, and high BZYQD group. Mice in the three latter groups were administered 5-FU (100 mg/kg/day, intraperitoneally) for six days, and in the 5-FU + low and high BZYQD groups were given BZYQD (1 or 2 g raw herb/kg/day, intragastrically) beginning four days before 5-FU and continuing until the termination of the experiment. The right kidney fixed in formalin for histological examination and the left was homogenized to measure the levels of apoptosis-related proteins and activities of oxidative stress-related biomarkers. Blood samples were collected for measuring renal function-related biochemical indices. Renal morphology injury, increased urea nitrogen and creatinine concentration, and decreased SOD, CAT, and GSH-Px were all observed in 5-FU-administrated mice. However, BZYQD almost reversed the morphological injury as well as renal function-related indices and antioxidant enzyme activity. These results suggest that BZYQD inhibits 5-FU-induced renal injury, possibly through the reduction of apoptosis and necrosis in renal tubular epithelial cells via the antioxidant mechanism. Henceforth, BZYQD may be a potential antioxidant against drug-induced oxidative stress.

Monitoring and evaluating the adherence to a complementary food supplement (Ying Yang Bao) among young children in rural Qinghai, China: a mixed methods evaluation study

PubMed Central

Wu, Qiong; Zhang, Yanfeng; Chang, Suying; Wang, Wei; Helena van Velthoven, Michelle; Han, Huijun; Xing, Min; Chen, Li; Du, Xiaozhen; Scherpbier, Robert W

2017-01-01

Background Large investments are currently made in community–based complementary food supplement (Ying Yang Bao, YYB) programs to improve nutrition of young children in rural areas in China. However, there is a lack of knowledge about the experience and challenges of implementing YYB programs in China. We aimed to: 1) monitor distribution of YYB; 2) assess children’s adherence to and acceptability of YYB; and 3) evaluate community–based strategies to improve the program. Methods This mixed methods evaluation study combined data from surveys and focus groups that took place during a controlled interventional evaluation trial. The trial aimed to evaluate the effectiveness of community–based YYB distribution on improving children's health status in rural areas in China. We conducted five cross–sectional surveys with caregivers of children aged 6–23 months (baseline survey (N = 1804) in August 2012 and four follow–up cross–sectional surveys: 1) N = 494 in January 2013; 2) N = 2187 in August 2013; 3) N = 504 in January 2014; and 4) N = 2186 in August 2014) in one rural county in Qinghai Province. We used a two–stage cluster sampling technique to select mothers with eligible children for each survey. Information was collected from caregivers on household characteristics, YYB consumption and acceptability in the surveys. High adherence in each survey was defined as children who consumed at least four YYB sachets during the previous week. A logistic regression model was developed to obtain odds ratios (OR) with 95% confidence intervals of factors associated with high adherence. Also, we conducted 10 focus groups with73 caregivers and health workers involved in the YYB distribution. Content analysis was used to explore qualitative findings, which were used to gain deeper insight into the quantitative results. Results Around 90% of caregivers had ever received YYB and more than 80% of children ever took YYB. Caregivers mainly knew about

Monitoring and evaluating the adherence to a complementary food supplement (Ying Yang Bao) among young children in rural Qinghai, China: a mixed methods evaluation study.

PubMed

Wu, Qiong; Zhang, Yanfeng; Chang, Suying; Wang, Wei; Helena van Velthoven, Michelle; Han, Huijun; Xing, Min; Chen, Li; Du, Xiaozhen; Scherpbier, Robert W

2017-06-01

Large investments are currently made in community-based complementary food supplement (Ying Yang Bao, YYB) programs to improve nutrition of young children in rural areas in China. However, there is a lack of knowledge about the experience and challenges of implementing YYB programs in China. We aimed to: 1) monitor distribution of YYB; 2) assess children's adherence to and acceptability of YYB; and 3) evaluate community-based strategies to improve the program. This mixed methods evaluation study combined data from surveys and focus groups that took place during a controlled interventional evaluation trial. The trial aimed to evaluate the effectiveness of community-based YYB distribution on improving children's health status in rural areas in China. We conducted five cross-sectional surveys with caregivers of children aged 6-23 months (baseline survey (N = 1804) in August 2012 and four follow-up cross-sectional surveys: 1) N = 494 in January 2013; 2) N = 2187 in August 2013; 3) N = 504 in January 2014; and 4) N = 2186 in August 2014) in one rural county in Qinghai Province. We used a two-stage cluster sampling technique to select mothers with eligible children for each survey. Information was collected from caregivers on household characteristics, YYB consumption and acceptability in the surveys. High adherence in each survey was defined as children who consumed at least four YYB sachets during the previous week. A logistic regression model was developed to obtain odds ratios (OR) with 95% confidence intervals of factors associated with high adherence. Also, we conducted 10 focus groups with73 caregivers and health workers involved in the YYB distribution. Content analysis was used to explore qualitative findings, which were used to gain deeper insight into the quantitative results. Around 90% of caregivers had ever received YYB and more than 80% of children ever took YYB. Caregivers mainly knew about YYB through their village doctors. High

[Distribution characteristics of basic syndromes of chronic functional constipation and its related factors analysis].

PubMed

Zhao, Lei; Liao, Xiu-jun; Yang, Guan-gen; Mao, Wei-ming; Zhang, Xiu-feng; Deng, Qun; Wu, Wen-jing

2014-10-01

To explore the distribution characteristics of basic syndromes and its related factors in patients with chronic functional constipation (CFC). The complete data of 538 patients with CFC were collected and initial database was established with Epidata 3. 0. TCM syndrome typing was performed. The distribution characteristics of basic syndromes were analyzed using SPSS 17. 0 Software. The univariate and multivariate Logistic regression analyses were performed with SPSS 17. 0 Software to determine basic syndrome related factors such as age, engaged professionals, sleep quality, depression, mental stress, interpersonal relations, work fatigue, stimulating beverage, exercise conditions, Western medicine type of constipation, and so on. The TCM syndrome frequency of CFC patients was sequenced from high to low as qi deficiency syndrome (380 cases, 70.6%), qi stagnation syndrome (337 cases, 62.6%), blood deficiency syndrome (234 cases, 43.5%), yin deficiency syndrome (220 cases, 40.9%), yang deficiency syndrome (197 cases, 36.6%), and others(58 cases, 10. 8%) . Most patients were complicated with complex syndromes, and the most common complex syndromes were qi deficiency complicated qi stagnation syndrome (275 cases, 51.1%) and qi deficiency complicated blood deficiency syndrome (222 cases, 41.3%). Aging, work fatigue, and exercise conditions were main related factors for qi deficiency syndrome (P <0. 01, P <0. 05). Poor emotional (depression and anxiety tendencies), mental stress, interpersonal relations, defecation barriers constipation were main related factors for qi stagnation syndrome (P <0.01). Sleep quality and poor emotional (depression and anxiety tendencies) were main related factors for blood deficiency syndrome (P <0. 01, P < 0.05). Stimulating beverages were main related factor for yin deficiency syndrome (P <0.05). Engaged in mental work and slow transit constipation were main related factors for yang deficiency syndrome (P < 0. 01, P <0. 05). CFC is featured

Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project.

PubMed

Hoyer, Erik H; Friedman, Michael; Lavezza, Annette; Wagner-Kosmakos, Kathleen; Lewis-Cherry, Robin; Skolnik, Judy L; Byers, Sherrie P; Atanelov, Levan; Colantuoni, Elizabeth; Brotman, Daniel J; Needham, Dale M

2016-05-01

To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS). Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables. Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P < 0.001), and patients with improved JH-HLM mobility scores between admission and discharge increased from 32% to 45% (P < 0.001). For all patients, the QI project was associated with an adjusted median LOS reduction of 0.40 (95% confidence interval [CI]: -0.57 to -0.21, P < 0.001) days compared to 12 months prior. A subgroup of patients expected to have a longer LOS (expected LOS >7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P < 0.001) days. Increased mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73). Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved

One size does not fit all: a qualitative content analysis of the importance of existing quality improvement capacity in the implementation of Releasing Time to Care: the Productive Ward™ in Saskatchewan, Canada.

PubMed

Hamilton, Jessica; Verrall, Tanya; Maben, Jill; Griffiths, Peter; Avis, Kyla; Baker, G Ross; Teare, Gary

2014-12-19

Releasing Time to Care: The Productive Ward™ (RTC) is a method for conducting continuous quality improvement (QI). The Saskatchewan Ministry of Health mandated its implementation in Saskatchewan, Canada between 2008 and 2012. Subsequently, a research team was developed to evaluate its impact on the nursing unit environment. We sought to explore the influence of the unit's existing QI capacity on their ability to engage with RTC as a program for continuous QI. We conducted interviews with staff from 8 nursing units and asked them to speak about their experience doing RTC. Using qualitative content analysis, and guided by the Organizing for Quality framework, we describe the existing QI capacity and impact of RTC on the unit environment. The results focus on 2 units chosen to highlight extreme variation in existing QI capacity. Unit B was characterized by a strong existing environment. RTC was implemented in an environment with a motivated manager and collaborative culture. Aided by the structural support provided by the organization, the QI capacity on this unit was strengthened through RTC. Staff recognized the potential of using the RTC processes to support QI work. Staff on unit E did not have the same experience with RTC. Like unit B, they had similar structural supports provided by their organization but they did not have the same existing cultural or political environment to facilitate the implementation of RTC. They did not have internal motivation and felt they were only doing RTC because they had to. Though they had some success with RTC activities, the staff did not have the same understanding of the methods that RTC could provide for continuous QI work. RTC has the potential to be a strong tool for engaging units to do QI. This occurs best when RTC is implemented in a supporting environment. One size does not fit all and administrative bodies must consider the unique context of each environment prior to implementing large-scale QI projects. Use of an

Management and Long-Term Outcome of Acute Coronary Syndrome Patients Presenting with Heart Failure in a Contemporary New Zealand Cohort (ANZACS-QI 4).

PubMed

Kueh, Shaw Hua Anthony; Devlin, Gerry; Lee, Mildred; Doughty, Rob N; Kerr, Andrew J

2016-08-01

Acute heart failure (HF) associated with an acute coronary syndrome (ACS) predicts adverse outcome. There have been important recent improvements in ACS management. Our aim was to describe the management and outcomes in those with and without HF in a contemporary ACS cohort. Consecutive patients presenting with ACS between 2007 and 2011 were enrolled in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. Outcomes and medication dispensing were obtained using anonymised linkage to national data sets. A summary pharmacotherapy measure of "quadruple therapy" was defined as dispensing of at least one agent from each of the four evidence-based classes - anti-platelet, statin, angiotensin converting enzyme inhibitor/angiotensin receptor blocker and beta blocker. Of 3743 ACS patients 14% had acute HF. Acute heart failure patients were older (69.2±12.6 vs 62.3±12.8 years, p<0.001), less likely to have coronary angiography (66% vs 86%, p<0.001) and revascularisation (46% vs 62%, p<0.001). Immediate post-discharge quadruple therapy was higher for those with than without HF (61% vs 55%, p=0.02) but fell to similar levels by one-year (45% vs 53%, p=0.55). At four years follow-up nearly half of those presenting with ACS and HF had died. After adjustment, HF remained a strong predictor of death within 28 days (OR 2.9, 95%CI 1.5 - 5.5) and beyond 28 days (HR 1.8, 95%CI 1.5 - 2.3). Acute heart failure complicating ACS is associated with heightened risk of short-term and long-term mortality. One in three ACS patients with HF did not have coronary angiography and less than half received quadruple therapy a year after presentation. Copyright © 2016. Published by Elsevier B.V.

Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross-sectional survey.

PubMed

Phung, Viet-Hai; Essam, Nadya; Asghar, Zahid; Spaight, Anne; Siriwardena, Aloysius N

2016-02-01

Clinical leadership and organizational culture are important contextual factors for quality improvement (QI) but the relationship between these and with organizational change is complex and poorly understood. We aimed to explore the relationship between clinical leadership, culture of innovation and clinical engagement in QI within a national ambulance QI Collaborative (QIC). We used a self-administered online questionnaire survey sent to front-line clinicians in all 12 English ambulance services. We conducted a cross-sectional analysis of quantitative data and qualitative analysis of free-text responses. There were 2743 (12% of 22 117) responses from 11 of the 12 participating ambulance services. In the 3% of responders that were directly involved with the QIC, leadership behaviour was significantly higher than for those not directly involved. QIC involvement made no significant difference to responders' perceptions of the culture of innovation in their organization, which was generally considered poor. Although uptake of QI methods was low overall, QIC members were significantly more likely to use QI methods, which were also significantly associated with leadership behaviour. Despite a limited organizational culture of innovation, clinical leadership and use of QI methods in ambulance services generally, the QIC achieved its aims to significantly improve pre-hospital care for acute myocardial infarction and stroke. We postulate that this was mediated through an improvement subculture, linked to the QIC, which facilitated large-scale improvement by stimulating leadership and QI methods. Further research is needed to understand success factors for QI in complex health care environments. © 2016 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Mapping mental health service access: achieving equity through quality improvement.

PubMed

Green, Stuart A; Poots, Alan J; Marcano-Belisario, Jose; Samarasundera, Edgar; Green, John; Honeybourne, Emmi; Barnes, Ruth

2013-06-01

Improving access to psychological therapies (IAPTs) services deliver evidence-based care to people with depression and anxiety. A quality improvement (QI) initiative was undertaken by an IAPT service to improve referrals providing an opportunity to evaluate equitable access. QI methodologies were used by the clinical team to improve referrals to the service. The collection of geo-coded data allowed referrals to be mapped to small geographical areas according to deprivation. A total of 6078 patients were referred to the IAPT service during the period of analysis and mapped to 120 unique lower super output areas (LSOAs). The average weekly referral rate rose from 17 during the baseline phase to 43 during the QI implementation phase. Spatial analysis demonstrated all 15 of the high deprivation/low referral LSOAs were converted to high deprivation/high or medium referral LSOAs following the QI initiative. This work highlights the importance of QI in developing clinical services aligned to the needs of the population through the analysis of routine data matched to health needs. Mapping can be utilized to communicate complex information to inform the planning and organization of clinical service delivery and evaluate the progress and sustainability of QI initiatives.

Estimating costs of quality improvement for outpatient healthcare organisations: a practical methodology.

PubMed

Brown, Sydney E S; Chin, Marshall H; Huang, Elbert S

2007-08-01

Outpatient healthcare organisations worldwide participate in quality improvement (QI) programmes. Despite the importance of understanding the financial impact of such programmes, there are no established standard methods for empirically assessing QI programme costs and their consequences for small outpatient healthcare organisations. The costs and cost consequences were evaluated for a diabetes QI programme implemented throughout the USA in federally qualified community health centres. For five case study centres, survey instruments and methods for data analysis were developed. Two types of cost/revenue were evaluated. Direct costs/revenues, such as personnel time, items purchased and grants received, were evaluated using self-administered surveys. Cost/revenue consequences, which were cost/revenue changes that may have occurred due to changes in patient utilisation or physician behaviour, were evaluated using electronic billing data. Other methods for evaluating cost/revenue consequences if electronic billing data are not available are also discussed. This paper describes a practical taxonomy and method for assessing the costs and revenues of QI programmes for outpatient organisations. Results of such analyses will be useful for healthcare organisations implementing QI programmes and also for policy makers designing incentives for QI participation.

A retrospective evaluation of the Perfecting Patient Care University training program for health care organizations.

PubMed

Morganti, Kristy Gonzalez; Lovejoy, Susan; Beckjord, Ellen Burke; Haviland, Amelia M; Haas, Ann C; Farley, Donna O

2014-01-01

This study evaluated how the Perfecting Patient Care (PPC) University, a quality improvement (QI) training program for health care leaders and clinicians, affected the ability of organizations to improve the health care they provide. This training program teaches improvement methods based on Lean concepts and principles of the Toyota Production System and is offered in several formats. A retrospective evaluation was performed that gathered data on training, other process factors, and outcomes after staff completed the PPC training. A majority of respondents reported gaining QI competencies and cultural achievements from the training. Organizations had high average scores for the success measures of "outcomes improved" and "sustainable monitoring" but lower scores for diffusion of QI efforts. Total training dosage was significantly associated with the measures of QI success. This evaluation provides evidence that organizations gained the PPC competencies and cultural achievements and that training dosage is a driver of QI success.

Linking Community Hospital Initiatives With Osteopathic Medical Students' Quality Improvement Training: A Pilot Program.

PubMed

Brannan, Grace D; Russ, Ronald; Winemiller, Terry R; Mast, Eric

2016-01-01

Quality improvement (QI) continues to be a health care challenge, and the literature indicates that osteopathic medical students need more training. To qualify for portions of managed care reimbursement, hospitals are required to meet measures intended to improve quality of care and patient satisfaction, which may be challenging for small community hospitals with limited resources. Because osteopathic medical training is grounded on community hospital experiences, an opportunity exists to align the outcomes needs of hospitals and QI training needs of students. In this pilot program, 3 sponsoring hospitals recruited and mentored 1 osteopathic medical student each through a QI project. A mentor at each hospital identified a project that was important to the hospital's patient care QI goals. This pilot program provided osteopathic medical students with hands-on QI training, created opportunities for interprofessional collaboration, and contributed to hospital initiatives to improve patient outcomes.

Developing an Interdisciplinary, Team-Based Quality Improvement Leadership Training Program for Clinicians: The Partners Clinical Process Improvement Leadership Program.

PubMed

Rao, Sandhya K; Carballo, Victoria; Cummings, Brian M; Millham, Frederick; Jacobson, Joseph O

Although there has been tremendous progress in quality improvement (QI) education for students and trainees in recent years, much less has been published regarding the training of active clinicians in QI. The Partners Clinical Process Improvement Leadership Program (CPIP) is a 6-day experiential program. Interdisciplinary teams complete a QI project framed by didactic sessions, interactive exercises, case-based problem sessions, and a final presentation. A total of 239 teams composed of 516 individuals have graduated CPIP. On completion, participant satisfaction scores average 4.52 (scale 1-5) and self-reported understanding of QI concepts improved. At 6 months after graduation, 66% of survey respondents reported sustained QI activity. Three opportunities to improve the program have been identified: (1) increasing faculty participation through online and tiered course offerings, (2) integrating the faculty-focused program with the trainee curriculum, and (3) developing a postgraduate curriculum to address the challenges of sustained improvement.

Call to action: Better care, better health, and greater value in college health.

PubMed

Ciotoli, Carlo; Smith, Allison J; Keeling, Richard P

2018-03-05

It is time for action by leaders across higher education to strengthen quality improvement (QI) in college health, in pursuit of better care, better health, and increased value - goals closely linked to students' learning and success. The size and importance of the college student population; the connections between wellbeing, and therefore QI, and student success; the need for improved standards and greater accountability; and the positive contributions of QI to employee satisfaction and professionalism all warrant a widespread commitment to building greater capacity and capability for QI in college health. This report aims to inspire, motivate, and challenge college health professionals and their colleagues, campus leaders, and national entities to take both immediate and sustainable steps to bring QI to the forefront of college health practice - and, by doing so, to elevate care, health, and value of college health as a key pathway to advancing student success.

76 FR 61076 - Initiation of Antidumping and Countervailing Duty Administrative Reviews and Requests for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-03

... Ying Printing & Dyeing CLO Shanghai GBR Group International Co. Shanghai Holiday Import & Export Co... determine, consistent with FAG Italia v. United States, 291 F.3d 806 (Fed Cir. 2002), as appropriate...

78 FR 72630 - Initiation of Antidumping and Countervailing Duty Administrative Reviews and Request for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-03

... Ding Ying Printing & Dyeing Co. Ltd..... Shanghai Guoxing Metal Products Co. Ltd Shanghai Jianhai... of initiation of the review, will determine, consistent with FAG Italia v. United States, 291 F.3d...

Capacity and readiness for quality improvement among home and community-based service providers.

PubMed

Abrahamson, Kathleen; Myers, Jaclyn; Arling, Greg; Davila, Heather; Mueller, Christine; Abery, Brian; Cai, Yun

2016-01-01

The objective of this study was to explore home and community-based service (HCBS) providers' perspectives of organizational readiness for quality improvement (QI). Data were obtained from a survey of participants (N = 56) in a state-sponsored HCBS QI initiative. Quality improvement challenges included lack of time and resources, staff apprehension or resistance, resistance from consumers and families, and project sustainability. Support from leadership was viewed as an important factor in participating organizations' decision to engage in QI. Internal resources available to support QI varied widely between participating organizations, with differences observed between smaller and larger agencies, as well as between provider types and populations served.

Quantum interference in DNA bases probed by graphene nanoribbons

NASA Astrophysics Data System (ADS)

Jeong, Heejeong; Seul Kim, Han; Lee, Sung-Hoon; Lee, Dongho; Hoon Kim, Yong; Huh, Nam

2013-07-01

Based on first-principles nonequilibrium Green's function calculations, we demonstrate quantum interference (QI) effects on the tunneling conductance of deoxyribonucleic acid bases placed between zigzag graphene nanoribbon electrodes. With the analogy of QI in hydrocarbon ring structures, we hypothesize that QI can be well preserved in the π-π coupling between the carbon-based electrode and a single DNA base. We demonstrate indications of QI, such as destructively interfered anti-resonance or Fano-resonance, that affect the variation of tunneling conductance depending on the orientation of a base. We find that guanine, with a 10-fold higher transverse conductance, can be singled out from the other bases.

Observations of ozone and carbon monoxide at Mei-Feng mountain site (2269 m a.s.l.) in Central Taiwan: seasonal variations and influence of Asian continental outflow.

PubMed

Lin, Yu Chi; Lin, Chuan Yao; Lin, Po Hsiung; Engling, Guenter; Lan, Yung-Yao; Kuo, Ten-Ho; Hsu, Wei Ting; Ting, Chia-Chun

2011-07-15

Continuous measurements of ozone (O(3)) and carbon monoxide (CO) were carried out at Mei-Feng (24.05°N, 120.10°E, 2269 m above sea level), a remote mountain site in central Taiwan, to investigate the influence of long-range transported air pollution on O(3) and CO variations in the subtropical Pacific region. Data collected from March 2009 to September 2010 revealed average mixing ratios of 37±14 ppb for O(3) and 188±82 ppb for CO at this remote site. Diurnal variations for both O(3) and CO were observed as well in all seasons. The higher levels for O(3) and CO in the afternoon were attributed to transport of boundary layer pollution to the site during daytime upslope flow. Monthly means of both O(3) and CO showed maxima in spring and in the continental air masses from Southeast Asia, coastal China, and Korea/Japan. On the contrary, the lower O(3) and CO levels found in summer were due to the marine air masses originating from the Philippine Sea and Pacific Ocean. The relationship between O(3) and CO was analyzed, using nighttime data to minimize any local influence. The results showed a fairly good correlation between O(3) and CO from March to September. The contribution of CO from the Asian outflow reached a maximum in spring (88 ppb) and had a minimum in summer (27 ppb). The photochemical buildup of O(3) resulting from anthropogenic emissions in continental Asia was estimated to be 15 ppb in spring, while its production was insignificant, with an average of 4 ppb, in summer. A positive correlation between O(3) and CO plus high ozone levels in springtime suggested that the enhancements of O(3) were likely due to O(3) which was photochemically produced over this region. Copyright © 2011 Elsevier B.V. All rights reserved.

31 The quality improvement QIP - improving multidisciplinary staff engagement with quality improvement in the RVH emergency department.

PubMed

Bannon, Olly; Greenwood, Emma

2017-12-01

: In recent years the RVH Emergency Department (ED) had been under intense pressure and public scrutiny. This led to a demoralised workforce who had become disengaged with quality improvement (QI). QI projects had become an exercise in data collection with little focus on improving care for patients.Two consultants undertook training in QI and then decided to develop a QI project aiming to empower staff and embed QI as daily practice. An ED QI steering group of interested multidisciplinary members was formed and devised an improvement plan to increase staff engagement with QI.The steering group secured funding for a subscription to the Institute of Healthcare Improvement (IHI) online open school. This was made available to 50 staff and was used to increase knowledge of QI methodology. An aim of 250 open school modules completed by August 2017 was set. This total was surpassed in June 2017, amounting to over 330 hours of QI training undertaken in staff's own time. To date 13 staff members have achieved IHI Certificates in Quality and Safety.We designed a series of projects which were linked with the Trust Improvement plan. The QI teams are all multidisciplinary with medical and nursing staff from different grades involved in each as well as input from other professionals such as pharmacy, physio and clerical/admin staff.emermed;34/12/A880-a/F1F1F1Figure 1Through the delivery of this project the ED team's enthusiasm for QI has been reinvigorated. We have demonstrated improvements in clinical standards such as pain management where a project was undertaken, which has seen a 4 fold increase in the number of patient's who sustain a fractured hip receiving the gold standard treatment of fascia iliaca nerve block.We have shown improvements in communication with the 'Unfinished Symphony' project demonstrating significantly better ED/GP written handover correspondance and the 'What's in a name' project decreasing inter-specialty conflict during the referral process. We

[Stratified analysis of the relationship between traditional Chinese medicine constitutional types and health status in the general population based on data of 8,448 cases].

PubMed

Zhu, Yan-bo; Wang, Qi; Chen, Ke-fan; Wu, Yu-e; Hong, Wei-li; Liu, Li

2011-04-01

To examine the relationship between traditional Chinese medicine (TCM) constitutional types and health status among groups of different age or gender in the general population of China. Data of 8 448 cases were randomly sampled from a database of 21 948 cases of a cross-sectional survey on the TCM constitutional types and health status which was carried out in 9 provinces or municipalities of China (Jiangsu, Anhui, Gansu, Qinghai, Fujian, Beijing, Jilin, Jiangxi and Henan) according to gender and age structure of the Chinese population in 2005. Scores of health-related quality of life scale--the Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-36)--were analyzed by Nemenyi test to compare the health status of individuals with different constitutional types. Compared with the gentleness type, the MOS SF-36 scores of the 8 types of pathological constitution were significantly low (P<0.05) among groups of different age or gender. The MOS SF-36 score was the lowest in men of the qi-deficiency, qi-depression and blood-stasis types, while it was the lowest in women of the phlegm-dampness, qi-depression and qi-deficiency types. For the age group of 15 to 34, the special diathesis, qi-depression and blood-stasis types had the lowest MOS SF-36 scores; for the age group of 35 to 59, the qi-deficiency, qi-depression and blood-stasis types had the lowest MOS SF-36 scores; for the age group of over 60, the qi-deficiency, qi-depression and phlegm-dampness types had the lowest MOS SF-36 scores. In groups of different gender or age, the MOS SF-36 scores of the 8 types of pathological constitution were significantly lower than that of the gentleness type, indicating a deficient health status. The health status of different types of constitution showed different characteristics in groups of different gender or age.

An evaluation of methods used to teach quality improvement to undergraduate healthcare students to inform curriculum development within preregistration nurse education: a protocol for systematic review and narrative synthesis.

PubMed

Armstrong, Lorraine; Lauder, William; Shepherd, Ashley

2015-01-14

Despite criticism, quality improvement (QI) continues to drive political and educational priorities within health care. Until recently, QI educational interventions have varied, targeting mainly postgraduates, middle management and the medical profession. However, there is now consensus within the UK, USA and beyond to integrate QI explicitly into nurse education, and faculties may require redesign of their QI curriculum to achieve this. Whilst growth in QI preregistration nurse education is emerging, little empirical evidence exists to determine such effects. Furthermore, previous healthcare studies evaluating QI educational interventions lend little in the way of support and have instead been subject to criticism. They reveal methodological weakness such as no reporting of theoretical underpinnings, insufficient intervention description, poor evaluation methods, little clinical or patient impact and lack of sustainability. This study aims therefore to identify, evaluate and synthesise teaching methods used within the undergraduate population to aid development of QI curriculum within preregistration nurse education. A systematic review of the literature will be conducted. Electronic databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (PsychINFO), Education Resources Information Centre (ERIC), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Applied Social Sciences Index and Abstracts (ASSIA), will be searched alongside reference list scanning and a grey literature search. Peer-reviewed studies from 2000-2014 will be identified using key terms quality improvement, education, curriculum, training, undergraduate, teaching methods, students and evaluation. Studies describing a QI themed educational intervention aimed at undergraduate healthcare students will be included and data extracted using a modified version of the Reporting of Primary Studies in Education (REPOSE) Guidelines. Studies will

Quality Improvement Implementation in the Nursing Home

PubMed Central

Berlowitz, Dan R; Young, Gary J; Hickey, Elaine C; Saliba, Debra; Mittman, Brian S; Czarnowski, Elaine; Simon, Barbara; Anderson, Jennifer J; Ash, Arlene S; Rubenstein, Lisa V; Moskowitz, Mark A

2003-01-01

Objective To examine quality improvement (QI) implementation in nursing homes, its association with organizational culture, and its effects on pressure ulcer care. Data Sources/Study Settings Primary data were collected from staff at 35 nursing homes maintained by the Department of Veterans Affairs (VA) on measures related to QI implementation and organizational culture. These data were combined with information obtained from abstractions of medical records and analyses of an existing database. Study Design A cross-sectional analysis of the association among the different measures was performed. Data Collection/Extraction Methods Completed surveys containing information on QI implementation, organizational culture, employee satisfaction, and perceived adoption of guidelines were obtained from 1,065 nursing home staff. Adherence to best practices related to pressure ulcer prevention was abstracted from medical records. Risk-adjusted rates of pressure ulcer development were calculated from an administrative database. Principal Findings Nursing homes differed significantly (p<.001) in their extent of QI implementation with scores on this 1 to 5 scale ranging from 2.98 to 4.08. Quality improvement implementation was greater in those nursing homes with an organizational culture that emphasizes innovation and teamwork. Employees of nursing homes with a greater degree of QI implementation were more satisfied with their jobs (a 1-point increase in QI score was associated with a 0.83 increase on the 5-point satisfaction scale, p<.001) and were more likely to report adoption of pressure ulcer clinical guidelines (a 1-point increase in QI score was associated with a 28 percent increase in number of staff reporting adoption, p<.001). No significant association was found, though, between QI implementation and either adherence to guideline recommendations as abstracted from records or the rate of pressure ulcer development. Conclusions Quality improvement implementation is most

Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project.

PubMed

Zgierska, Aleksandra E; Vidaver, Regina M; Smith, Paul; Ales, Mary W; Nisbet, Kate; Boss, Deanne; Tuan, Wen-Jan; Hahn, David L

2018-06-05

Systematic implementation of guidelines for opioid therapy management in chronic non-cancer pain can reduce opioid-related harms. However, implementation of guideline-recommended practices in routine care is subpar. The goal of this quality improvement (QI) project is to assess whether a clinic-tailored QI intervention improves the implementation of a health system-wide, guideline-driven policy on opioid prescribing in primary care. This manuscript describes the protocol for this QI project. A health system with 28 primary care clinics caring for approximately 294,000 primary care patients developed and implemented a guideline-driven policy on long-term opioid therapy in adults with opioid-treated chronic non-cancer pain (estimated N = 3980). The policy provided multiple recommendations, including the universal use of treatment agreements, urine drug testing, depression and opioid misuse risk screening, and standardized documentation of the chronic pain diagnosis and treatment plan. The project team drew upon existing guidelines, feedback from end-users, experts and health system leadership to develop a robust QI intervention, targeting clinic-level implementation of policy-directed practices. The resulting multi-pronged QI intervention included clinic-wide and individual clinician-level educational interventions. The QI intervention will augment the health system's "routine rollout" method, consisting of a single educational presentation to clinicians in group settings and a separate presentation for staff. A stepped-wedge design will enable 9 primary care clinics to receive the intervention and assessment of within-clinic and between-clinic changes in adherence to the policy items measured by clinic-level electronic health record-based measures and process measures of the experience with the intervention. Developing methods for a health system-tailored QI intervention required a multi-step process to incorporate end-user feedback and account for the needs of

78 FR 60834 - Initiation of Antidumping and Countervailing Duty Administrative Reviews and Request for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-02

.... Shanghai Colour Nail Co., Ltd. Shanghai Curvet Hardware Products Co., Ltd. Shanghai Ding Ying Printing... of initiation of the review, will determine, consistent with FAG Italia v. United States, 291 F.3d...

Initial Benchmarking of the Quality of Medical Care of Childhood-Onset Systemic Lupus Erythematosus

PubMed Central

Mina, Rina; Harris, Julia G.; Klein-Gitelman, Marisa S.; Appenzeller, Simone; Centeville, Maraisa; Eskra, Diane; Huggins, Jennifer L.; Johnson, Anne L.; Khubchandani, Raju; Khandekar, Prachi; Lee, Jiha; Liu, HaiMei; Pendl, Joshua D.; Silva, Clovis A.; Silva, Marco F.; Zaal, Ahmad I.; DeWitt, Esi Morgan; Ardoin, Stacy P.; Brunner, Hermine I.

2015-01-01

Objective To assess the quality of medical care in childhood-onset systemic lupus erythematosus (cSLE) at tertiary pediatric rheumatology centers as measured by observance cSLE quality indicators (cSLE-QI). Methods International consensus has been achieved for cSLE-QI (Hollander et al. Arthritis Care & Research, 2013) capturing medical care provision in nine domains: diagnostic testing, education of cardiovascular (CV) risk and lifestyles, lupus nephritis (LN), medication management, bone health, ophthalmological surveillance, transition, pregnancy and vaccination. Using medical record information, the level of performance these cSLE-QI was assessed in cSLE populations treated at four tertiary pediatric rheumatology centers in the U.S, two in Brazil, and one center in India. Results A total of 483 cSLE patients were assessed. Care for the 310 U.S. patients differed markedly for cSLE-QI addressing LN, bone health, vaccinations, education on CV risk, and transition planning. Performance of safety blood testing for medications was high at all centers. Despite often similar performance on the cSLE-QI, access to kidney biopsies was lower in Brazil than in the U.S. Irrespective of country of practice, larger centers tended to meet the cSLE-QI more often than smaller centers. Conclusions The cSLE-QI, evidence based minimum standards of medical care, are not consistently met in the U.S. or some other countries outside the U.S. This has the potential to contribute to suboptimal cSLE outcomes. PMID:26219749

Applying a Theory-Driven Framework to Guide Quality Improvement Efforts in Nursing Homes: The LOCK Model.

PubMed

Mills, Whitney L; Pimentel, Camilla B; Palmer, Jennifer A; Snow, A Lynn; Wewiorski, Nancy J; Allen, Rebecca S; Hartmann, Christine W

2018-05-08

Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning. We adapted these concepts to QI in the nursing home setting, creating the "LOCK" framework. The LOCK framework is currently being disseminated across the Veterans Health Administration. The LOCK framework has five tenets: (a) Look for the bright spots, (b) Observe, (c) Collaborate in huddles, (d) Keep it bite-sized, and (e) facilitation. Each tenet is described. We also present a case study documenting how a fictional nursing home can implement the LOCK framework as part of a QI effort to improve engagement between staff and residents. The case study describes sample observations, processes, and outcomes. We also discuss practical applications for nursing home staff, the adaptability of LOCK for different QI projects, the specific role of facilitation, and lessons learned. The proposed framework complements national efforts to improve quality of care and quality of life for nursing home residents and may be valuable across long-term care settings and QI project types.

Does lean muddy the quality improvement waters? A qualitative study of how a hospital management team understands lean in the context of quality improvement.

PubMed

Savage, Carl; Parke, Louise; von Knorring, Mia; Mazzocato, Pamela

2016-10-19

Health care has experimented with many different quality improvement (QI) approaches with greater variation in name than content. This has been dubbed pseudoinnovation. However, it could also be that the subtleties and differences are not clearly understood. To explore this further, the purpose of this study was to explore how hospital managers perceive lean in the context of QI. We used a qualitative study design with semi-structured interviews to explore twelve top managers' perceptions of the relationship between lean and quality improvement (QI) at a university-affiliated hospital. Managers described that QI and lean shared the same overall purpose: focus on patient needs and improve efficiency and effectiveness. Employee involvement was emphasized in both strategies, as well as the support offered by managers of staff initiatives. QI was perceived as a strategy that could support structural changes at the organizational level whereas lean was seen as applicable at the operational level. Moreover, lean carried a negative connotation, lacked the credibility of QI, and was perceived as a management fad. Aspects of QI and lean were misunderstood. In a context where lean remains an abstract term, and staff associate lean with automotive applications and cost reduction, it may be fruitful for managers to invest time and resources to develop a strategy for continual improvement and utilize vocabulary that resonates with health care staff. This could reduce the risk that improvement efforts are rejected out of hand.

Early Experiences After Adopting a Quality Improvement Portfolio Into the Academic Advancement Process.

PubMed

Sehgal, Niraj L; Neeman, Naama; King, Talmadge E

2017-01-01

Academic medical centers (AMCs) and their academic departments are increasingly assuming leadership in the education, science, and implementation of quality improvement (QI) and patient safety efforts. Fostering, recognizing, and promoting faculty leading these efforts is challenging using traditional academic metrics for advancement. The authors adapted a nationally developed QI portfolio, adopted it into their own department's advancement process in 2012, and tracked its utilization and impact over the first two years of implementation. Sixty-seven QI portfolios were submitted with 100% of faculty receiving their requested academic advancement. Women represented 60% of the submitted portfolios, while the Divisions of General Internal Medicine and Hospital Medicine accounted for 60% of the submissions. The remaining 40% were from faculty in 10 different specialty divisions. Faculty attitudes about the QI portfolio were overwhelmingly positive, with 83% agreeing that it "was an effective tool for helping to better recognize faculty contributions in QI work" and 85% agreeing that it "was an effective tool for elevating the importance of QI work in our department." The QI portfolio was one part of a broader effort to create opportunities to recognize and support faculty involved in improvement work. Further adapting the tool to ensure that it complements-rather than duplicates-other elements of the advancement process is critical for continued utilization by faculty. This will also drive desired dissemination to other departments locally and other AMCs nationally who are similarly committed to cultivating faculty career paths in systems improvement.

HOXA1 and TALE proteins display cross-regulatory interactions and form a combinatorial binding code on HOXA1 targets.

PubMed

De Kumar, Bony; Parker, Hugo J; Paulson, Ariel; Parrish, Mark E; Pushel, Irina; Singh, Narendra Pratap; Zhang, Ying; Slaughter, Brian D; Unruh, Jay R; Florens, Laurence; Zeitlinger, Julia; Krumlauf, Robb

2017-09-01

Hoxa1 has diverse functional roles in differentiation and development. We identify and characterize properties of regions bound by HOXA1 on a genome-wide basis in differentiating mouse ES cells. HOXA1-bound regions are enriched for clusters of consensus binding motifs for HOX, PBX, and MEIS, and many display co-occupancy of PBX and MEIS. PBX and MEIS are members of the TALE family and genome-wide analysis of multiple TALE members (PBX, MEIS, TGIF, PREP1, and PREP2) shows that nearly all HOXA1 targets display occupancy of one or more TALE members. The combinatorial binding patterns of TALE proteins define distinct classes of HOXA1 targets, which may create functional diversity. Transgenic reporter assays in zebrafish confirm enhancer activities for many HOXA1-bound regions and the importance of HOX-PBX and TGIF motifs for their regulation. Proteomic analyses show that HOXA1 physically interacts on chromatin with PBX, MEIS, and PREP family members, but not with TGIF, suggesting that TGIF may have an independent input into HOXA1-bound regions. Therefore, TALE proteins appear to represent a wide repertoire of HOX cofactors, which may coregulate enhancers through distinct mechanisms. We also discover extensive auto- and cross-regulatory interactions among the Hoxa1 and TALE genes, indicating that the specificity of HOXA1 during development may be regulated though a complex cross-regulatory network of HOXA1 and TALE proteins. This study provides new insight into a regulatory network involving combinatorial interactions between HOXA1 and TALE proteins. © 2017 De Kumar et al.; Published by Cold Spring Harbor Laboratory Press.

Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration.

PubMed

Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A

2016-01-01

This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation. © The Author(s) 2014.

[Profound meaning of acupuncture taboos in Internal Classic based on the fault of reinforcing and reducing technique by mind conduction of acupuncture therapy].

PubMed

Qin, Yuge; Wang, Feng; Qin, Yuheng; Li, Li; Li, Mei

2016-05-01

By analyzing the acupuncture taboos in Neijing (Internal Classic) on clinical application of mind conduction of acupuncture therapy in going against the actual situation, astronomy and others, it is found that the relevant acupuncture taboo implies many subtle mysteries of human body, qi, mind and astronomy, which have not been discovered yet in modern science and are very significant in qi protection. In Neijing, the acupuncture physicians have been highly required in the mind treatment, in which, accurately regulating qi circulation is the target in the treatment. The mind conduction is used for qi circulation to accomplish accurately the reinforcing or reducing in the deficiency or excess condition. All of the taboos are provided to normalize the accuracy of reinforcing and reducing technique of acupuncture therapy and avoid the damage of qi in human body. Hence, those taboos must be obeyed so as to prevent from serious consequence and ensure the safety of this acupuncture therapy.

Climate Variability and Phytoplankton in the Pacific Ocean

NASA Technical Reports Server (NTRS)

Rousseaux, Cecile

2012-01-01

The effect of climate variability on phytoplankton communities was assessed for the tropical and sub-tropical Pacific Ocean between 1998 and 2005 using an established biogeochemical assimilation model. The phytoplankton communities exhibited wide range of responses to climate variability, from radical shifts in the Equatorial Pacific, to changes of only a couple of phytoplankton groups in the North Central Pacific, to no significant changes in the South Pacific. In the Equatorial Pacific, climate variability dominated the variability of phytoplankton. Here, nitrate, chlorophyll and all but one of the 4 phytoplankton types (diatoms, cyanobacteria and coccolithophores) were strongly correlated (p<0.01) with the Multivariate El Nino Southern Oscillation Index (MEI). In the North Central Pacific, MEI and chlorophyll were significantly (p<0.01) correlated along with two of the phytoplankton groups (chlorophytes and coccolithophores). Ocean biology in the South Pacific was not significantly correlated with MEI. During La Nina events, diatoms increased and expanded westward along the cold tongue (correlation with MEI, r=-0.81), while cyanobacteria concentrations decreased significantly (r=0.78). El Nino produced the reverse pattern, with cyanobacteria populations increasing while diatoms plummeted. The diverse response of phytoplankton in the different major basins of the Pacific suggests the different roles climate variability can play in ocean biology.

The Effect of ENSO on Phytoplankton Composition in the Pacific Ocean

NASA Technical Reports Server (NTRS)

Rousseaux, Cecile

2012-01-01

The effect of climate variability on phytoplankton communities was assessed for the tropical and sub-tropical Pacific Ocean between 1998 and 2005 using an established biogeochemical assimilation model. The phytoplankton communities exhibited wide range of responses to climate variability, from radical shifts in the Equatorial Pacific, to changes of only a couple of phytoplankton groups in the North Central Pacific, to no significant changes in the South Pacific. In the Equatorial Pacific, climate variability dominated the variability of phytoplankton. Here, nitrate, chlorophyll and all but one of the 4 phytoplankton types (diatoms, cyanobacteria and coccolithophores) were strongly correlated (p less than 0.01) with the Multivariate El Nino Southern Oscillation Index (MEI). In the North Central Pacific, MEI and chlorophyll were significantly (p<0.01) correlated along with two of the phytoplankton groups (chlorophytes and coccolithophores). Ocean biology in the South Pacific was not significantly correlated with MEI. During La Ni a events, diatoms increased and expanded westward along the cold tongue (correlation with MEI, r=-0.81), while cyanobacteria concentrations decreased significantly (r=0.78). El Nino produced the reverse pattern, with cyanobacteria populations increasing while diatoms plummeted. The diverse response of phytoplankton in the different major basins of the Pacific suggests the different roles climate variability can play in ocean biology.

Methyl halide production associated with kelp

NASA Technical Reports Server (NTRS)

Dastoor, Minoo N.; Manley, Steven L.

1985-01-01

Methyl halides (MeX) are important trace constituents of the atmosphere because they, mostly MeCl, have a major impact on the atmospheric ozone layer. Also, MeCl may account for 5 pct. of the total Cl budget and MeI may have a central role in the biogeochemical cycling of iodine. High MeI concentrations were found in seawater from kelp beds and it has been suggested that MeI is produced by kelps and that MeI and MeBr along with numerous other halocarbons were released by non-kelp marine macroalgae. The objective was to determine if kelps (and other seaweeds) are sources of MeX and to assess their contribution to the estimated global source strength (EGSS) of MeX. Although the production of MeX appears to be associated with kelp, microbes involved with kelp degradation also produce MeX. Microbial MeX production may be of global significance. The microbial MeX production potential, assuming annual kelp production equals kelp degradation and 100 pct. conversion of kelp halides to MeX, is approx. 2 x the EGSS. This is not achieved but indicates that microbial production of MeX may be of global significance.

Evaluation of a novel mentor program to improve surgical care for US hospitals.

PubMed

Berian, Julia R; Thomas, Juliana M; Minami, Christina A; Farrell, Paula R; O'Leary, Kevin J; Williams, Mark V; Prachand, Vivek N; Halverson, Amy L; Bilimoria, Karl Y; Johnson, Julie K

2017-04-01

To evaluate a novel mentor program for 27 US surgeons, charged with improving quality at their respective hospitals, having been paired 1:1 with 27 surgeon mentors through a state-wide quality improvement (QI) initiative. Mixed-methods utilizing quantitative surveys and in-depth semi-structured interviews. The Illinois Surgical Quality Improvement Collaborative (ISQIC) utilized a novel Mentor Program to guide surgeons new to QI. All mentor-mentee pairs received the survey (n = 27). Purposive sampling identified a subset of mentors (n = 8) and mentees (n = 4) for in-depth semi-structured interviews. Surgeons with expertise in QI mentored surgeons new to QI. (i) Quantitative: self-reported satisfaction with the mentor program; (ii) Qualitative: key themes suggesting actions and strategies to facilitate mentorship in QI. Mentees expressed satisfaction with the mentor program (n = 24, 88.9%) and agreed that mentorship is vital to ISQIC (n = 24, 88.9%). Analysis of interview data revealed four key themes: (i) nuances of data management, (ii) culture of quality and safety, (iii) mentor-mentee relationship and (iv) logistics. Strategies from these key themes include: utilize raw data for in-depth QI understanding, facilitate presentations to build QI support, identify opportunities for in-person meetings and establish scheduled conference calls. The mentor's role required sharing experiences and acting as a resource. The mentee's role required actively bringing questions and identifying barriers. Mentorship plays a vital role in advancing surgeon knowledge and engagement with QI in ISQIC. Key themes in mentorship reflect strategies to best facilitate mentorship, which may serve as a guide to other collaboratives. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Patterns of Energy Imbalance of the Meridians in Patients with Temporomandibular Dysfunction.

PubMed

Rasera Zotelli, Vera L; Grillo, Cássia M; Bressiani Gil, Maria L; Wada, Ronaldo S; Sato, Jorge E; de Sousa, Maria da Luz R

2018-02-01

Temporomandibular dysfunction (TMD) is a set of changes that affects the muscles of mastication, temporomandibular joint, teeth, and associated periodontal and orofacial structures. According to Traditional Chinese Medicine, the imbalance of energy (Qi) circulating in the acupuncture meridians is always the primary etiologic cause of any physical manifestation. The aim of this study was to describe the patterns of Qi imbalance in patients with TMD by means of an objective measurement. The clinical study was conducted at the Piracicaba Dental School (FOP/Unicamp), in Piracicaba-SP, Brazil. We evaluated 40 adult volunteers with TMD. The Qi measurement was carried out by the researcher using the Ryodoraku method using 24 points representing the 12 acupuncture meridians: LU9 (Taiyuan), PC7 (Daling), HT7 (Shemen), SI5 (Yanggu), TE4 (Yangchi), LI5 (Yangxi), SP3 (Taibai), LR3 (Taichong), KI3 (Taixi), BL64 (Jinggu), GB40 (Qiuxu), and ST42 (Chongyang). The average total Qi of 40 volunteers (21.7 μA ± 1.5), was below the normal range (40-60 μA) and was classified as deficiency of Qi (empty). The coupled meridians that showed the highest Qi imbalance were the kidney (29.4 μA ± 2.8) and bladder (13.8 μA ± 1). The Qi planes with greatest imbalance were the Shao Yang and Shao Yin. In conclusion, volunteers with TMD presented a pattern of Qi deficiency, and the most prevalent imbalance patterns identified were in the kidney and bladder coupled meridians and in the energetic planes Shao Yin (heart/kidney) and Shao Yang (triple energizer/gall bladder). Copyright © 2017. Published by Elsevier B.V.

Process Evaluation of a Quality Improvement Project to Decrease Hospital Readmissions From Skilled Nursing Facilities.

PubMed

Meehan, Thomas P; Qazi, Daniel J; Van Hoof, Thomas J; Ho, Shih-Yieh; Eckenrode, Sheila; Spenard, Ann; Pandolfi, Michelle; Johnson, Florence; Quetti, Deborah

2015-08-01

To describe and evaluate the impact of quality improvement (QI) support provided to skilled nursing facilities (SNFs) by a Quality Improvement Organization (QIO). Retrospective, mixed-method, process evaluation of a QI project intended to decrease preventable hospital readmissions from SNFs. Five SNFs in Connecticut. SNF Administrators, Directors of Nursing, Assistant Directors of Nursing, Admissions Coordinators, Registered Nurses, Certified Nursing Assistants, Receptionists, QIO Quality Improvement Consultant. QIO staff provided training and technical assistance to SNF administrative and clinical staff to establish or enhance QI infrastructure and implement an established set of QI tools [Interventions to Reduce Acute Care Transfers (INTERACT) tools]. Baseline SNF demographic, staffing, and hospital readmission data; baseline and follow-up SNF QI structure (QI Committee), processes (general and use of INTERACT tools), and outcome (30-day all-cause hospital readmission rates); details of QIO-provided training and technical assistance; QIO-perceived barriers to quality improvement; SNF leadership-perceived barriers, accomplishments, and suggestions for improvement of QIO support. Success occurred in establishing QI Committees and targeting preventable hospital readmissions, as well as implementing INTERACT tools in all SNFs; however, hospital readmission rates decreased in only 2 facilities. QIO staff and SNF leaders noted the ongoing challenge of engaging already busy SNF staff and leadership in QI activities. SNF leaders reported that they appreciated the training and technical assistance that their institutions received, although most noted that additional support was needed to bring about improvement in readmission rates. This process evaluation documented mixed clinical results but successfully identified opportunities to improve recruitment of and provision of technical support to participating SNFs. Recommendations are offered for others who wish to conduct

Using Quality Improvement Tools to Reduce Chronic Lung Disease.

PubMed

Picarillo, Alan Peter; Carlo, Waldemar

2017-09-01

Rates of chronic lung disease (CLD) in very low birthweight infants have not decreased at the same pace as other neonatal morbidities over the past 20 years. Multifactorial causes of CLD make this common morbidity difficult to reduce, although there have been several successful quality improvement (QI) projects in individual neonatal intensive care units. QI projects have become a mainstay of neonatal care over the past decade, with an increasing number of publications devoted to this topic. A specific QI project for CLD must be based on best available evidence in the medical literature, expert recommendations, or based on work by previous QI initiatives. Copyright © 2017 Elsevier Inc. All rights reserved.

PREFACE International Symposium on Spintronic Devices and Commercialization 2010

NASA Astrophysics Data System (ADS)

Du, You-wei; Judy, Jack; Qian, Zhenghong; Wang, Jianping

2011-01-01

very successful indeed. We are also grateful to the Advisory Committee, the Conference Chairs, the Excutive Chairs, the Academic Committee, the Organization Committee and the Secretariat for their fruitful work. We would especially like to thank all the organizers listed below for their support in all aspects of the conference. We would like to express our thanks to all the authors for their time and genuine efforts, and to the reviewers for their fruitful comments during the preparation of this volume. ISSDC'2010 ORGANIZATION Advisory Committee Chialing Chien, USAJunhao Chu, ChinaBernard Dieny, FranceKoichiro Inomata, Japan Liangmo Mei, ChinaJohn Sivertsen, USAMingjing Tu, ChinaDingsheng Wang, China Zhanguo Wang, ChinaQikun Xue, ChinaWenshan Zhan, China Conference Chairs Jack Judy, USAYouwei Du, China Executive Chairs Zhenghong Qian, USAJianping Wang, USA Organization Committee ChairJiyan Luo, China Vice ChairsGuilin Duan, ChinaLingling Sun, ChinaBaogen Shen, China MembersTiecheng Lu, ChinaDa Ma, ChinaYe Tian, China Jinsong Xu, ChinaQiuling XuChangmao Yang, China Guanghua Yu, ChinaYi Yan, China Academic Committee ChairsZhenghong Qian, USAYongbing Xu, UK Vice ChairsSeongtae Bae, SingaporeYong Jiang, ChinaDexin Wang, USA Huaiwu Zhang, ChinaJianhua Zhao, China MembersJianwang Cai, ChinaXiangdong Chen, ChinaHaifeng Ding, China Chunhong Hou, USAGunther Baubock, USABin Hu, USA Jungchun Huang, TaiwanDexuan Huo, ChinaYoon H Jeong, Korea Chihuang Lai, TaiwanRunwei Li, ChinaWei Liu, China Jing Shi, USAYasushi Takemura, JapanMark Tondra, USA Shan X Wang, USADi Wu, ChinaDesheng Xue, China Minglang Yan, USAShishen Yan, ChinaXiaofei Yang, China Chun Yeol You, KoreaWei Zhao, ChinaShiming Zhou, China Jianguo Zhu, China Secretariat Secretary-generalChangmao Yang, China Vice Secretary-generalJunli Wang, ChinaJinsong Xu, ChinaYe Tian, China MembersRu Bai, ChinaHongliang Zhan, China ISSDC' 2010 Organizers Department of Science and Technology, CSIC, China SpinIC Inc., China Hangzhou

Inflation in DoD Medical Care.

DTIC Science & Technology

1997-07-01

cataract surgery , to the outpatient setting); • 1.4%, trends in medical practice in place prior to PPS; • 0.0%, aging of the Medicare population...HFCA’s Medicare Economic Index.17 The MEI is used to update payments for physician services under Medicare Part B. The MEI is oriented toward care... physician services industry.l% [emphasis added] Table III-3. Medicare Economic Index: Expense Categories, Expenditure Weights, and Price Proxies

Development of a Multi-Domain Assessment Tool for Quality Improvement Projects.

PubMed

Rosenbluth, Glenn; Burman, Natalie J; Ranji, Sumant R; Boscardin, Christy K

2017-08-01

Improving the quality of health care and education has become a mandate at all levels within the medical profession. While several published quality improvement (QI) assessment tools exist, all have limitations in addressing the range of QI projects undertaken by learners in undergraduate medical education, graduate medical education, and continuing medical education. We developed and validated a tool to assess QI projects with learner engagement across the educational continuum. After reviewing existing tools, we interviewed local faculty who taught QI to understand how learners were engaged and what these faculty wanted in an ideal assessment tool. We then developed a list of competencies associated with QI, established items linked to these competencies, revised the items using an iterative process, and collected validity evidence for the tool. The resulting Multi-Domain Assessment of Quality Improvement Projects (MAQIP) rating tool contains 9 items, with criteria that may be completely fulfilled, partially fulfilled, or not fulfilled. Interrater reliability was 0.77. Untrained local faculty were able to use the tool with minimal guidance. The MAQIP is a 9-item, user-friendly tool that can be used to assess QI projects at various stages and to provide formative and summative feedback to learners at all levels.

Evaluation of an on-line methodology for measuring volatile organic compounds (VOC) fluxes by eddy-covariance with a PTR-TOF-Qi-MS

NASA Astrophysics Data System (ADS)

Loubet, Benjamin; Buysse, Pauline; Lafouge, Florence; Ciuraru, Raluca; Decuq, Céline; Zurfluh, Olivier

2017-04-01

Field scale flux measurements of volatile organic compounds (VOC) are essential for improving our knowledge of VOC emissions from ecosystems. Many VOCs are emitted from and deposited to ecosystems. Especially less known, are crops which represent more than 50% of French terrestrial surfaces. In this study, we evaluate a new on-line methodology for measuring VOC fluxes by Eddy Covariance with a PTR-Qi-TOF-MS. Measurements were performed at the ICOS FR-GRI site over a crop using a 30 m long high flow rate sampling line and an ultrasonic anemometer. A Labview program was specially designed for acquisition and on-line covariance calculation: Whole mass spectra ( 240000 channels) were acquired on-line at 10 Hz and stored in a temporary memory. Every 5 minutes, the spectra were mass-calibrated and normalized by the primary ion peak integral at 10 Hz. The mass spectra peaks were then retrieved from the 5-min averaged spectra by withdrawing the baseline, determining the resolution and using a multiple-peak detection algorithm. In order to optimize the peak detection algorithm for the covariance, we determined the covariances as the integrals of the peaks of the vertical-air-velocity-fluctuation weighed-averaged-spectra. In other terms, we calculate , were w is the vertical component of the air velocity, Sp is the spectra, t is time, lag is the decorrelation lag time and <.> denotes an average. The lag time was determined as the decorrelation time between w and the primary ion (at mass 21.022) which integrates the contribution of all reactions of VOC and water with the primary ion. Our algorithm was evaluated by comparing the exchange velocity of water vapor measured by an open path absorption spectroscopy instrument and the water cluster measured with the PTRQi-TOF-MS. The influence of the algorithm parameters and lag determination is discussed. This study was supported by the ADEME-CORTEA COV3ER project (http://www6.inra.fr/cov3er).

A National Study of Differences between Online and Classroom-Only Community College Students in Time to First Associate Degree Attainment, Transfer, and Dropout

ERIC Educational Resources Information Center

Shea, Peter; Bidjerano, Temi

2016-01-01

Previous research indicates that online learning at the community college level results in higher rates of withdrawal, failure, and dropout compared to classroom-based education (Xu & Smith Jaggars, 2011; Smith-Jaggars & Xu, 2010). The primary goal of the current study was to examine national data (US Dept. of Ed. Beginning Postsecondary…

Methods for the guideline-based development of quality indicators--a systematic review

PubMed Central

2012-01-01

Background Quality indicators (QIs) are used in many healthcare settings to measure, compare, and improve quality of care. For the efficient development of high-quality QIs, rigorous, approved, and evidence-based development methods are needed. Clinical practice guidelines are a suitable source to derive QIs from, but no gold standard for guideline-based QI development exists. This review aims to identify, describe, and compare methodological approaches to guideline-based QI development. Methods We systematically searched medical literature databases (Medline, EMBASE, and CINAHL) and grey literature. Two researchers selected publications reporting methodological approaches to guideline-based QI development. In order to describe and compare methodological approaches used in these publications, we extracted detailed information on common steps of guideline-based QI development (topic selection, guideline selection, extraction of recommendations, QI selection, practice test, and implementation) to predesigned extraction tables. Results From 8,697 hits in the database search and several grey literature documents, we selected 48 relevant references. The studies were of heterogeneous type and quality. We found no randomized controlled trial or other studies comparing the ability of different methodological approaches to guideline-based development to generate high-quality QIs. The relevant publications featured a wide variety of methodological approaches to guideline-based QI development, especially regarding guideline selection and extraction of recommendations. Only a few studies reported patient involvement. Conclusions Further research is needed to determine which elements of the methodological approaches identified, described, and compared in this review are best suited to constitute a gold standard for guideline-based QI development. For this research, we provide a comprehensive groundwork. PMID:22436067

Identifying priorities for quality improvement at an emergency Department in Ghana.

PubMed

DeWulf, Annelies; Otchi, Elom H; Soghoian, Sari

2017-08-30

Healthcare quality improvement (QI) is a global priority, and understanding the perspectives of frontline healthcare workers can help guide sustainable and meaningful change. We report a qualitative investigation of emergency department (ED) staff priorities for QI at a tertiary care hospital in Ghana. The aims of the study were to educate staff about the World Health Organization's (WHO) definition of quality in healthcare, and to identify an initial focus for building a departmental QI program. Semi-structured interviews were conducted with ED staff using open-ended questions to probe their understanding and valuation of the six dimensions of quality defined by the WHO. Participants were then asked to rank the dimensions in order of importance for QI. Qualitative responses were thematically analyzed, and ordinal rank-order was determined for quantitative data regarding QI priorities. Twenty (20) members of staff of different cadres participated, including ED physicians, nurses, orderlies, a security officer, and an accountant. A majority of participants (61%) ranked access to emergency healthcare as high priority for QI. Two recurrent themes - financial accessibility and hospital bed availability - accounted for the majority of discussions, each linked to all the dimensions of healthcare quality. ED staff related all of the WHO quality dimensions to their work, and prioritized access to emergency care as the most important area for improvement. Participants expressed a high degree of motivation to improve healthcare quality, and the study helped with the development of a departmental QI program focused on the broad topic of access to ED services.

Measuring reflection on participation in quality improvement activities for maintenance of certification.

PubMed

Wittich, Christopher M; Reed, Darcy A; Ting, Henry H; Berger, Richard A; Nowicki, Kelly M; Blachman, Morris J; Mandrekar, Jayawant N; Beckman, Thomas J

2014-10-01

To validate a measure of reflection on participation in quality improvement (QI) activities and to identify associations with characteristics of QI projects, participants, and teams. This was a prospective validation study of all Mayo Clinic team participants who submitted QI projects for maintenance of certification (MOC) credit from 2010 to 2012. The authors developed a measure of reflection on participation in QI activities and explored associations between participants' overall reflection scores and characteristics of projects, participants, and teams. A total of 922 participants (567 physicians) on 118 teams completed QI projects and reflections. Factor analysis revealed a two-dimensional model with good internal consistency reliabilities (Cronbach alpha) for high (0.85) and low (0.81) reflection. Reflection scores (mean [standard deviation]) were associated with projects that changed practice (yes: 4.30 [0.51]; no: 3.71 [0.57]; P < .0001), changed the health care system (yes: 4.25 [0.54]; no: 4.03 [0.62]; P < .0001), and impacted patient safety (P < .0001). Physicians' reflection scores (4.27 [0.57]) were higher than support staff scores (4.07 [0.55]; P = .0005). A positive association existed between reflection scores and the number of QI roles per participant (P < .0001). There were no associations with participant gender, team size, or team diversity. The authors identified associations between participant reflection and the impact of QI projects, participants' professional roles, and participants' involvement with projects. With further study, the authors anticipate that the new measure of reflection will be useful for determining meaningful engagement in MOC.

A paradigm shift toward systemwide quality improvement education: meeting the needs of a rapidly changing health care environment: meeting the needs of a rapidly changing health care environment.

PubMed

Brownlee, Katherine; Minnier, Tamra E; Martin, Susan Christie; Greenhouse, Pamela K

2013-01-01

Widespread changes in the health care landscape require a paradigm shift from an educational model where quality improvement (QI) expertise is centralized to a model where foundational and functional QI knowledge is widespread through all levels of a health care organization. To support a new educational structure prioritizing QI education as a stand-alone priority, a 6-month educational course was introduced for operational leaders (requiring completion of a real-life improvement project) and a second, introductory QI education set of 5 stand-alone classes was introduced for managers and frontline staff; the latter is provided at centralized sites, on-site, and via webinars. Additional QI courses have been introduced for board members. Sixty operational leaders attended the first 2 offerings of the 6-month course and completed 50 associated QI projects, as of July 2012; nearly 1500 participants have attended the "Just-in-Time" classes, representing 13 University of Pittsburgh Medical Center hospitals and affiliated facilities. Eighty-three percent of recent participants rated the 6-month course a 4 or 5 in terms of efficacy. Two-thirds of participants from both 6-month series reported that they continued to work on their project once the class was over. The number of course attendees and their feedback regarding efficacy of this educational approach, as well as the volume of associated completed projects, indicate success in providing greater numbers of staff at all levels of the organization with QI education and tools. This educational format shows promise for further refinement and replicability.

Establishing a portfolio of quality-improvement projects in pediatric surgery through advanced improvement leadership systems.

PubMed

Gerrein, Betsy T; Williams, Christina E; Von Allmen, Daniel

2013-01-01

Formal quality-improvement (QI) projects require that participants are educated in QI methods to provide them with the capability to carry out successful, meaningful work. However, orchestrating a portfolio of projects that addresses the strategic mission of the institution requires an extension of basic QI training to provide the division or business unit with the capacity to successfully develop and manage the portfolio. Advanced Improvement Leadership Systems is a program to help units create a meaningful portfolio. This program, used by the Division of Pediatric General and Thoracic Surgery at Cincinnati Children's Hospital Medical Center, helped establish a portfolio of targeted QI projects designed to achieve outstanding outcomes at competitive costs in multiple clinical areas aligned with the institution's strategic goals (improve disease-based outcomes, patient safety, flow, and patient and family experience). These objectives are addressed in an institutional strategic plan built around 5 core areas: Safety, Productivity, Care Coordination and Outcomes, Patient and Family Experience, and Value. By combining the portfolio of QI projects with improvements in the divisional infrastructure, effective improvement efforts were realized throughout the division. In the 9 months following the program, divisional capability resulted in a 16.5% increase (5.7% to 22.2%) of formally trained staff working on 10 QI teams. Concurrently, a leadership team, designed to coordinate projects, remove barriers, and provide technical support, provided the capacity to pursue this ongoing effort. The Advanced Improvement Leadership Systems program increased the Division's efficiency and effectiveness in pursing the QI mission that is integral at our hospital.

Clinical and Educational Outcomes of an Integrated Inpatient Quality Improvement Curriculum for Internal Medicine Residents.

PubMed

Ogrinc, Greg; Cohen, Emily S; van Aalst, Robertus; Harwood, Beth; Ercolano, Ellyn; Baum, Karyn D; Pattison, Adam J; Jones, Anne C; Davies, Louise; West, Al

2016-10-01

Integrating teaching and hands-on experience in quality improvement (QI) may increase the learning and the impact of resident QI work. We sought to determine the clinical and educational impact of an integrated QI curriculum. This clustered, randomized trial with early and late intervention groups used mixed methods evaluation. For almost 2 years, internal medicine residents from Dartmouth-Hitchcock Medical Center on the inpatient teams at the White River Junction VA participated in the QI curriculum. QI project effectiveness was assessed using statistical process control. Learning outcomes were assessed with the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) and through self-efficacy, interprofessional care attitudes, and satisfaction of learners. Free text responses by residents and a focus group of nurses who worked with the residents provided information about the acceptability of the intervention. The QI projects improved many clinical processes and outcomes, but not all led to improvements. Educational outcome response rates were 65% (68 of 105) at baseline, 50% (18 of 36) for the early intervention group at midpoint, 67% (24 of 36) for the control group at midpoint, and 53% (42 of 80) for the late intervention group. Composite QIKAT-R scores (range, 0-27) increased from 13.3 at baseline to 15.3 at end point ( P  < .01), as did the self-efficacy composite score ( P  < .05). Satisfaction with the curriculum was rated highly by all participants. Learning and participating in hands-on QI can be integrated into the usual inpatient work of resident physicians.

Establishing a Portfolio of Quality-Improvement Projects in Pediatric Surgery through Advanced Improvement Leadership Systems

PubMed Central

Gerrein, Betsy T; Williams, Christina E; von Allmen, Daniel

2013-01-01

Formal quality-improvement (QI) projects require that participants are educated in QI methods to provide them with the capability to carry out successful, meaningful work. However, orchestrating a portfolio of projects that addresses the strategic mission of the institution requires an extension of basic QI training to provide the division or business unit with the capacity to successfully develop and manage the portfolio. Advanced Improvement Leadership Systems is a program to help units create a meaningful portfolio. This program, used by the Division of Pediatric General and Thoracic Surgery at Cincinnati Children’s Hospital Medical Center, helped establish a portfolio of targeted QI projects designed to achieve outstanding outcomes at competitive costs in multiple clinical areas aligned with the institution’s strategic goals (improve disease-based outcomes, patient safety, flow, and patient and family experience). These objectives are addressed in an institutional strategic plan built around 5 core areas: Safety, Productivity, Care Coordination and Outcomes, Patient and Family Experience, and Value. By combining the portfolio of QI projects with improvements in the divisional infrastructure, effective improvement efforts were realized throughout the division. In the 9 months following the program, divisional capability resulted in a 16.5% increase (5.7% to 22.2%) of formally trained staff working on 10 QI teams. Concurrently, a leadership team, designed to coordinate projects, remove barriers, and provide technical support, provided the capacity to pursue this ongoing effort. The Advanced Improvement Leadership Systems program increased the Division’s efficiency and effectiveness in pursing the QI mission that is integral at our hospital. PMID:24361020

Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States.

PubMed

Padula, William V; Makic, Mary Beth F; Mishra, Manish K; Campbell, Jonathan D; Nair, Kavita V; Wald, Heidi L; Valuck, Robert J

2015-06-01

Prevention of pressure ulcers, one of the hospital-acquired conditions (HACs) targeted by the 2008 nonpayment policy of the Centers for Medicare & Medicaid Services (CMS), is a critical issue. This study was conducted to determine the comparative effectiveness of quality improvement (QI) interventions associated with reduced hospital-acquired pressure ulcer (HAPU) rates. In an quasi-experimental design, interrupted time series analyses were conducted to determine the correlation between HAPU incidence rates and adoption of QI interventions. Among University HealthSystem Consortium hospitals, 55 academic medical centers were surveyed from September 2007 through February 2012 for adoption patterns of QI interventions for pressure ulcer prevention, and hospital-level data for 5,208 pressure ulcer cases were analyzed. Between- and within-hospital reduction significance was tested with t-tests post-CMS policy intervention. Fifty-three (96%) of the 55 hospitals used QI interventions for pressure ulcer prevention. The effect size analysis identified five effective interventions that each reduced pressure ulcer rates by greater than 1 case per 1,000 patient discharges per quarter: leadership initiatives, visual tools, pressure ulcer staging, skin care, and patient nutrition. The greatest reductions in rates occurred earlier in the adoption process (p<.05). Five QI interventions had clinically meaningful associations with reduced stage III and IV HAPU incidence rates in 55 academic medical centers. These QI interventions can be used in support of an evidence-based prevention protocol for pressure ulcers. Hospitals can not only use these findings from this study as part of a QI bundle for preventing HAPUs.

Managed care and total quality management: a necessary integration.

PubMed

Phoon, J; Corder, K; Barter, M

1996-01-01

The process of quality improvement/total quality management (QI/TQM) plays a key role in the delivery of health care in a managed care system. The concepts and ideas surrounding QI/TQM and managed care are interrelated, and the success of health care delivery depends on the integration and coexistence of these two philosophies. In looking more closely at these concepts, it becomes clear that the principles of QI/TQM must underlie strategic decisions involved in the implementation of a managed care system. Nurses play a key role in the success of this integration as nurse case managers, nurse practitioners, and nurse administrators. They have a direct impact on the many variables and goals of both QI/TQM and managed care.

Using evidence-based practice to create a venous access team: the Venous Access Task Force of the Children's Hospital of Denver.

PubMed

MacPhee, Maura

2002-12-01

The following article is an example of evidence-based practice applied to an institutional Quality Improvement (QI) project. QI originated in the 1980s and is best associated with the work of W. Deming (1986). It is also known as Continuous Quality Improvement, because a major principle of this approach is constant improvement of services or products. This improvement process contains other critical components: scientific method, employee participation and teamwork, accountable leadership, appropriate training and ongoing education, and client focus (Demming, 1986). QI has been globally successful and has helped transform American industry, including health care services. The following clinically based project illustrates the application of QI concepts and evidence-based practice to enhance outcomes. Copyright 2002, Elsevier Science (USA). All rights reserved.

Quality and safety training in primary care: making an impact.

PubMed

Byrne, John M; Hall, Susan; Baz, Sam; Kessler, Todd; Roman, Maher; Patuszynski, Mark; Thakkar, Kruti; Kashner, T Michael

2012-12-01

Preparing residents for future practice, knowledge, and skills in quality improvement and safety (QI/S) is a requisite element of graduate medical education. Despite many challenges, residency programs must consider new curricular innovations to meet the requirements. We report the effectiveness of a primary care QI/S curriculum and the role of the chief resident in quality and patient safety in facilitating it. Through the Veterans Administration Graduate Medical Education Enhancement Program, we added a position for a chief resident in quality and patient safety, and 4 full-time equivalent internal medicine residents, to develop the Primary Care Interprofessional Patient-Centered Quality Care Training Curriculum. The curriculum includes a first-or second-year, 1-month block rotation that serves as a foundational experience in QI/S and interprofessional care. The responsibilities of the chief resident in quality and patient safety included organizing and teaching the QI/S curriculum and mentoring resident projects. Evaluation included prerotation and postrotation surveys of self-assessed QI/S knowledge, abilities, skills, beliefs, and commitment (KASBC); an end-of-the-year KASBC; prerotation and postrotation knowledge test; and postrotation and faculty surveys. Comparisons of prerotation and postrotation KASBC indicated significant self-assessed improvements in 4 of 5 KASBC domains: knowledge (P < .001), ability (P < .001), skills (P < .001), and belief (P < .03), which were sustained on the end-of-the-year survey. The knowledge test demonstrated increased QI/S knowledge (P  =  .002). Results of the postrotation survey indicate strong satisfaction with the curriculum, with 76% (25 of 33) and 70% (23 of 33) of the residents rating the quality and safety curricula as always or usually educational. Most faculty members acknowledged that the chief resident in quality and patient safety enhanced both faculty and resident QI/S interest and

Development of a core set of quality indicators for paediatric primary care practices in Europe, COSI-PPC-EU.

PubMed

Ewald, Dominik A; Huss, Gottfried; Auras, Silke; Caceres, Juan Ruiz-Canela; Hadjipanayis, Adamos; Geraedts, Max

2018-06-01

Paediatric ambulatory healthcare systems in Europe are, because of historical reasons, diverse and show strikingly different outcomes. All across Europe, the benchmarking of structures, processes and outcomes could reveal opportunities for improving Paediatric Primary Care (PPC). The aim of this study was to develop a set of Quality Indicators (QIs) to assess and monitor PPC in Europe. In a three-step process, we used the available external evidence and European expert consensus in a modified RAND/UCLA Appropriateness Method (RAM) to develop an indicator set. (1) A broad literature and online research of published QI and guidelines yielded an inventory of 1516 QI. (2) A collaborative panel of paediatric senior experts from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) from 15 European countries participated in a first consensus process to reduce the initial indicator inventory by eliminating not PPC-focused indicators and duplicates. (3) In a second consensus process, the panel rated the QI regarding validity and feasibility. The final QI set "COSI-PPC-EU" consists of 42 indicators in five categories of PPC: (A) health promotion/prevention/screening (13 QI), (B) acute care (9 QI), (C) chronic care (8 QI), (D) practice management (3 QI) and (E) patient safety (9 QI). COSI-PPC-EU represents a consented set of a limited number of valid quality indicators for the application in paediatric primary care in different healthcare systems throughout Europe. What is Known: • Paediatric ambulatory healthcare systems in Europe are diverse and show strikingly different outcomes. • There are known gaps in quality performance measures of paediatric primary care in Europe. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. What is New: • A set of 42 quality indicators for primary paediatric care in Europe was developed in a multi

Towards DNA-Based Programmable Matter

DTIC Science & Technology

2012-02-28

optics. Nature 2003, 424, 824–830. (2) Xu, H. X.; Bjerneld, E. J.; Kall , M.; Borjesson, L. Spectroscopy of single hemoglobin molecules by surface...Brenner, M. P.; Manoharan, V. N. The Free-energy Landscape of Clusters of Attractive Hard Spheres. Science 2010, 327, 560–563. (35) Xu, H. X.; Kall , M

Chemomic and chemometric approach based on ultra-fast liquid chromatography with ion trap time-of-flight mass spectrometry to reveal the difference in the chemical composition between Da-Cheng-Qi decoction and its three constitutional herbal medicines.

PubMed

Wang, Mengru; Li, Yuanyuan; Huang, Yin; Tian, Yuan; Xu, Fengguo; Zhang, Zunjian

2014-05-01

Da-Cheng-Qi decoction (DCQT) is a traditional purgative Chinese decoction with a history of 2000 years. To study the effect of interactions between the ingredients on the overall chemical composition of DCQT, a chemomic and chemometric approach based on ultra-fast liquid chromatography with ion trap time-of-flight mass spectrometry was developed and validated. After mixing and decocting all four ingredients to make the DCQT, the concentrations of some chemicals are significantly different from those in single herb decoction and 24 of them were identified and tentatively characterized by comparing their data with those of standard compounds or literature data. No new chemicals were formed during mixing and decoction. Our findings indicated that there are interactions between these natural medicines during the mixing and preparation process. The 24 identified chemicals could be used as chemical markers for optimizing prescription and evaluation of consistent quality, and the strategy in the present study could be applied for other multiherb formulae. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Correction: Shell-isolated nanoparticle-enhanced Raman spectroscopy study of the adsorption behaviour of DNA bases on Au(111) electrode surfaces.

PubMed

Wen, Bao-Ying; Jin, Xi; Li, Yue; Wang, Ya-Hao; Li, Chao-Yu; Liang, Miao-Miao; Panneerselvam, Rajapandiyan; Xu, Qing-Chi; Wu, De-Yin; Yang, Zhi-Lin; Li, Jian-Feng; Tian, Zhong-Qun

2016-06-21

Correction for 'Shell-isolated nanoparticle-enhanced Raman spectroscopy study of the adsorption behaviour of DNA bases on Au(111) electrode surfaces' by Bao-Ying Wen et al., Analyst, 2016, DOI: 10.1039/c6an00180g.

Role of UDP-Glucuronosyltransferase (UGT) 2B2 in Metabolism of Triiodothyronine: Effect of Microsomal Enzyme Inducers in Sprague Dawley and UGT2B2-Deficient Fischer 344 Rats

PubMed Central

Richardson, Terrilyn A.; Klaassen, Curtis D.

2010-01-01

Microsomal enzyme inducers (MEI) that increase UDP-glucuronosyltransferases (UGTs) can impact thyroid hormone homeostasis in rodents. Increased glucuronidation can result in reduction of serum thyroid hormone and a concomitant increase in thyroid-stimulating hormone (TSH). UGT2B2 is thought to glucuronidate triiodothyronine (T3). The purposes of this study were to determine the role of UGT2B2 in T3 glucuronidation and whether increased T3 glucuronidation mediates the increased TSH observed after MEI treatment. Sprague Dawley (SD) and UGT2B2-deficient Fischer 344 (F344) rats were fed a control diet or diet containing pregnenolone-16α-carbonitrile (PCN; 800 ppm), 3-methylcholanthrene (3-MC; 200 ppm), or Aroclor 1254 (PCB; 100 ppm) for 7 days. Serum thyroxine (T4), T3, and TSH concentrations, hepatic androsterone/T4/T3 glucuronidation, and thyroid follicular cell proliferation were determined. In both SD and F344 rats, MEI treatments decreased serum T4, whereas serum T3 was maintained (except with PCB treatment). Hepatic T4 glucuronidation increased significantly after MEI in both rat strains. Compared with the other MEI, only PCN treatment significantly increased T3 glucuronidation (281 and 497%) in both SD and UGT2B2-deficient F344 rats, respectively, and increased both serum TSH and thyroid follicular cell proliferation. These data demonstrate an association among increases in T3 glucuronidation, TSH, and follicular cell proliferation after PCN treatment, suggesting that T3 is glucuronidated by other PCN-inducible UGTs in addition to UGT2B2. These data also suggest that PCN (rather than 3-MC or PCB) promotes thyroid tumors through excessive TSH stimulation of the thyroid gland. PMID:20421340

Quality improvement--boon or boondoggle?

PubMed

Paterson, M A; Wendel, J

1994-01-01

Is quality improvement (QI) reducing healthcare costs while improving patient care? Researchers find that QI has improved employee satisfaction and morale, but it was designed to do more. One solution is to use problem-solving techniques to help teams identify the level at which they want to address a problem, whether that be the subinstitutional, institutional, or system level. If QI is to fulfill its promise, skilled managers must create effective teams capable of defining and solving complex problems.

The Development of High Order Methods for Real World Applications

DTIC Science & Technology

2015-12-03

current method has been applied to aerodynamic problems. Numerical tests show that significant savings in the number of DOFs can be achieved through... current element Vi, and the normal flux Fn(Qi) at the interface is Fn(Qi) = ~F (Qi) · ~n. In order to eliminate the test function, the boundary integral...provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently

The Development of High-Order Methods for Real World Applications

DTIC Science & Technology

2015-12-03

current method has been applied to aerodynamic problems. Numerical tests show that significant savings in the number of DOFs can be achieved through... current element Vi, and the normal flux Fn(Qi) at the interface is Fn(Qi) = ~F (Qi) · ~n. In order to eliminate the test function, the boundary integral...provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently

78 FR 38336 - Ocean Transportation Intermediary License Applicants

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-26

..., President (QI), Stephen B. Schwark, Treasurer, Application Type: License Transfer to EFL Container Lines...., Suite K, Mobile, AL 36609, Officers: Thomas (Mac) H. McPhillips IV, Assistant Vice President (QI), Oscar...

Prescription pattern of Chinese herbal products for heart failure in Taiwan: A population-based study.

PubMed

Tsai, Ming-Yen; Hu, Wen-Long; Lin, Che-Chen; Lee, Yi-Chiao; Chen, Shih-Yu; Hung, Yu-Chiang; Chen, Yung-Hsiang

2017-02-01

Certain Chinese herbal products (CHPs) may protect against the progression of heart failure (HF). However, there is a lack of research regarding the use of CHPs in patients with HF. The aims of this study were to analyze CHPs usage patterns in patients with HF and to identify the frequency and combination of CHPs most commonly used for HF. This retrospective, nationwide, population-based cohort study was conducted using a randomly sampled cohort of one million patients selected from the National Health Insurance Research Database (NHIRD) for the years 2000-2010 in Taiwan. CHP use and the top ten most frequently prescribed formulae and single herbs for treating HF were assessed, including total formulae number and average and frequency of prescriptions. Demographic characteristics, including sex and age at diagnosis of HF, were examined, together with existing comorbidities. The cohort included 19,988 newly diagnosed AD patients, who were given CHP treatment for HF between 2000 and 2010. Among them, female patients (53.3%) and those over 65years old (63.9%) were more likely to use CM. After adjusting for demographic factors, HF patients suffering from coronary artery disease (CAD) were more likely to seek traditional Chinese medicine (TCM) treatment than those with non-TCM users (57.6% vs. 52.6%). Zhi-Gan-Cao-Tang (4.07%) and Danshen (5.13%) were the most frequent formula CHP and single CHP prescribed by TCM practitioners for treating HF, respectively. Most people with HF who consumed CHPs used CHPs to supplement Yang-Qi, nourish the Ying-blood, and strengthen the heart spirit as complementary medicines to relieve HF-related symptoms, in addition to using standard anti-HF treatments. Further large-scale, randomized clinical trials are warranted in order to determine the effectiveness and safety of these herbal medicines. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A story of success: continuous quality improvement in cystic fibrosis care in the USA.

PubMed

Quon, Bradley S; Goss, Christopher H

2011-12-01

Continuous quality improvement (CQI) in healthcare can be described as a reiterative approach to improving processes to reduce unexpected variation in health outcomes. CQI represents one model to achieve quality improvement (QI) and has long been recognized as a key to success in the manufacturing industry with companies like Toyota leading the way. Healthcare, and specifically pulmonary, critical care and sleep medicine represent ideal settings for the application of CQI. This opinion piece will describe QI and CQI initiatives in the US Cystic fibrosis (CF) population. QI in CF care in the United States has been ongoing since inception of the US CF Foundation (CFF) in 1955. This effort has included work to improve the quality of clinical care provided at CF centers and work to improve clinical outcomes in CF. More recently, QI methods have been applied to the conduct of clinical research. The CF community has become a leader in the area of QI and has pointed out the opportunities for others to follow in the area of lung diseases.

Using quality improvement to promote breast-feeding in a local health department.

PubMed

Wright, Sarah S; Lea, C Suzanne; Holloman, Roxanne; Cornett, Amanda; Harrison, Lisa Macon; Randolph, Greg D

2012-01-01

In 2008, breast-feeding initiation and continuation rates in Beaufort County, North Carolina, were lower than statewide rates. A quality improvement (QI) project was initiated to increase breast-feeding rates by enhancing the overall environment that supports breast-feeding at the Beaufort County Health Department. This case study describes one of the first QI initiatives implemented through the North Carolina Center for Public Health Quality QI training program, conducted in 2009. The aim of this project was to improve the health and wellness of mothers and infants in Beaufort County by promoting breast-feeding among Beaufort County Health Department Women, Infants and Children (WIC) clients. Using QI tools, 4 new approaches to breast-feeding promotion were tested and implemented: creating a nurturing location to breast-feed while at the health department, actively telephoning new mothers to provide breast-feeding support, incentivizing adoption of educational messages by providing a breast-feeding tote bag, and promoting new WIC food packages. These enhancements involved staff in QI planning and implementation and correlated with improved breast-feeding initiation for WIC clients during the year following project completion.

The Association of Organizational Culture and Quality Improvement Implementation With Neonatal Outcomes in the NICU.

PubMed

Mahl, Sukhy; Lee, Shoo K; Baker, G Ross; Cronin, Catherine M G; Stevens, Bonnie; Ye, Xiang Y

2015-01-01

Studies of adult patient populations suggest that organizational culture is associated with quality improvement (QI) implementation, as well as patient outcomes. However, very little research on organizational culture has been performed in neonatal patient populations. This combined cross-sectional survey and retrospective cohort study assessed employee perceptions of organizational culture and QI implementation within 18 Canadian neonatal intensive care units. The associations between these data and neonatal outcomes in extremely preterm infants (born at < 29 weeks' gestation) were then assessed using multivariable analyses. Perceptions of unit culture and QI implementation varied according to occupation and age. Higher hierarchical culture was associated with increased survival without major morbidities (odds ratio, 1.04; 95% confidence interval, 1.01-1.06), as were higher QI implementation scores (odds ratio range, 1.20-1.36 by culture type). Our data suggest that organizational culture, particularly hierarchical culture, and level of QI implementation may play a role in neonatal outcomes. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Developing Quality Improvement capacity and capability across the Children in Fife partnership.

PubMed

Morris, Craig; Alexander, Ingrid

2016-01-01

A Project Manager from the Fife Early Years Collaborative facilitated a large-scale Quality Improvement (herein QI) project to build organisational capacity and capability across the Children in Fife partnership through three separate, eight month training cohorts. This 18 month QI project enabled 32 practitioners to increase their skills, knowledge, and experiences in a variety of QI tools including the Model for Improvement which then supported the delivery of high quality improvement projects and improved outcomes for children and families. Essentially growing the confidence and capability of practitioners to deliver sustainable QI. 27 respective improvement projects were delivered, some leading to service redesign, reduced waiting times, increased uptake of health entitlements, and improved accessibility to front-line health services. 13 improvement projects spread or scaled beyond the initial site and informal QI mentoring took place with peers in respective agencies. Multiple PDSA cycles were conducted testing the most efficient and effective support mechanisms during and post training, maintaining regular contact, and utilising social media to share progress and achievements.

Improving Warfighters’ Sustainment and Performance in Extreme Environmental Conditions

DTIC Science & Technology

2008-02-18

Physiol, 485 ( Pt 2) (1995) 525-530. 9. Puchowicz,M.A., Xu,K., Sun,X., Ivy,A., Emancipator,D., and LaManna,J.C., Diet-induced ketosis increases...2002) 1131-1139. 27. Puchowicz,M.A., Xu,K., Sun,X., Ivy,A., Emancipator,D., and LaManna,J.C., Diet-induced ketosis increases capillary density

Hierarchical and Complex System Entropy Clustering Analysis Based Validation for Traditional Chinese Medicine Syndrome Patterns of Chronic Atrophic Gastritis.

PubMed

Zhang, Yin; Liu, Yue; Li, Yannan; Zhao, Xia; Zhuo, Lin; Zhou, Ajian; Zhang, Li; Su, Zeqi; Chen, Cen; Du, Shiyu; Liu, Daming; Ding, Xia

2018-03-22

Chronic atrophic gastritis (CAG) is the precancerous stage of gastric carcinoma. Traditional Chinese Medicine (TCM) has been widely used in treating CAG. This study aimed to reveal core pathogenesis of CAG by validating the TCM syndrome patterns and provide evidence for optimization of treatment strategies. This is a cross-sectional study conducted in 4 hospitals in China. Hierarchical clustering analysis (HCA) and complex system entropy clustering analysis (CSECA) were performed, respectively, to achieve syndrome pattern validation. Based on HCA, 15 common factors were assigned to 6 syndrome patterns: liver depression and spleen deficiency and blood stasis in the stomach collateral, internal harassment of phlegm-heat and blood stasis in the stomach collateral, phlegm-turbidity internal obstruction, spleen yang deficiency, internal harassment of phlegm-heat and spleen deficiency, and spleen qi deficiency. By CSECA, 22 common factors were assigned to 7 syndrome patterns: qi deficiency, qi stagnation, blood stasis, phlegm turbidity, heat, yang deficiency, and yin deficiency. Combination of qi deficiency, qi stagnation, blood stasis, phlegm turbidity, heat, yang deficiency, and yin deficiency may play a crucial role in CAG pathogenesis. In accord with this, treatment strategies by TCM herbal prescriptions should be targeted to regulating qi, activating blood, resolving turbidity, clearing heat, removing toxin, nourishing yin, and warming yang. Further explorations are needed to verify and expand the current conclusions.

Hospital accreditation: staff experiences and perceptions.

PubMed

Bogh, Søren Bie; Blom, Ane; Raben, Ditte Caroline; Braithwaite, Jeffrey; Thude, Bettina; Hollnagel, Erik; Plessen, Christian von

2018-06-11

Purpose The purpose of this paper is to understand how staff at various levels perceive and understand hospital accreditation generally and in relation to quality improvement (QI) specifically. Design/methodology/approach In a newly accredited Danish hospital, the authors conducted semi-structured interviews to capture broad ranging experiences. Medical doctors, nurses, a quality coordinator and a quality department employee participated. Interviews were audio recorded and subjected to framework analysis. Findings Staff reported that The Danish Healthcare Quality Programme affected management priorities: office time and working on documentation, which reduced time with patients and on improvement activities. Organisational structures were improved during preparation for accreditation. Staff perceived that the hospital was better prepared for new QI initiatives after accreditation; staff found disease specific requirements unnecessary. Other areas benefited from accreditation. Interviewees expected that organisational changes, owing to accreditation, would be sustained and that the QI focus would continue. Practical implications Accreditation is a critical and complete hospital review, including areas that often are neglected. Accreditation dominates hospital agendas during preparation and surveyor visits, potentially reducing patient care and other QI initiatives. Improvements are less likely to occur in areas that other QI initiatives addressed. Yet, accreditation creates organisational foundations for future QI initiatives. Originality/value The authors study contributes new insights into how hospital staff at different organisational levels perceive and understand accreditation.

[Talk about nomenclature of twelve meridians from quantitative yin-yang theory].

PubMed

Zhao, Xi-xin; Wang, Xue-xia; Zhao, Zhao; Ran, Peng-fei; Lü, Xiao-rui

2009-03-01

Based on leads provided by Neijing and other literature, analyze origins of the three-yin and the three-yang and the their respective contents of yin and yang, indicating the principle that the order of yang-qi from more to less is Yang ming, Tai yang, Shao yang, and the order of yin-qi is Tai yin, Shao yin, Jue yin. According to the location of five (six) zang-organs, respective yin-qi content is defined, and according to the principle of more yin-qi matches more, and less yin-qi matches less, five (six) zang-organs match each other. The zang-organs above the diaphragm joints with The Hand-Channels and the zang-organs below the diaphragm with The Foot-Channels, completing the nomenclature of twelve meridians. The names of the six yang-channels correspond to the yin-channels of the exterior-interior relationship, the yin-channels link with hands (feet), and the yang-channels also link with hands (feet), and the amount of yin-qi of the zang-organs corresponding to the yin-channels and the amount of yang-qi of the fu-organs corresponding to yang-channels are in a state of balance. Based on this principle, nomenclature of six channels are completed. Emphasize that the nomenclature of twelve meridians contains profound TCM theories, especially, TCM, by yin-yang, three-yin and three- yang, illustrates living phenomena from the whole to the system and organ level in human body, and the scientific principle "yin-yang can be unlimitedly divided" and its significance, which must guide the studies on living phenomena with modern life sciences from the whole to the molecular level.

Quality improvement and accreditation readiness in state public health agencies.

PubMed

Madamala, Kusuma; Sellers, Katie; Beitsch, Leslie M; Pearsol, Jim; Jarris, Paul

2012-01-01

There were 3 specific objectives of this study. The first objective was to examine the progress of state/territorial health assessment, health improvement planning, performance management, and quality improvement (QI) activities at state/territorial health agencies and compare findings to the 2007 findings when available. A second objective was to examine respondent interest and readiness for national voluntary accreditation. A final objective was to explore organizational factors (eg, leadership and capacity) that may influence QI or accreditation readiness. Cross-sectional study. State and Territorial Public Health Agencies. Survey respondents were organizational leaders at State and Territorial Public Health Agencies. Sixty-seven percent of respondents reported having a formal performance management process in place. Approximately 77% of respondents reported a QI process in place. Seventy-three percent of respondents agreed or strongly agreed that they would seek accreditation and 36% agreed or strongly agreed that they would seek accreditation in the first 2 years of the program. In terms of accreditation prerequisites, a strategic plan was most frequently developed, followed by a state/territorial health assessment and health improvement plan, respectively. Advancements in the practice and applied research of QI in state public health agencies are necessary steps for improving performance. In particular, strengthening the measurement of the QI construct is essential for meaningfully assessing current practice patterns and informing future programming and policy decisions. Continued QI training and technical assistance to agency staff and leadership is also critical. Accreditation may be the pivotal factor to strengthen both QI practice and research. Respondent interest in seeking accreditation may indicate the perceived value of accreditation to the agency.

Developing a Benchmarking Process in Perfusion: A Report of the Perfusion Downunder Collaboration

PubMed Central

Baker, Robert A.; Newland, Richard F.; Fenton, Carmel; McDonald, Michael; Willcox, Timothy W.; Merry, Alan F.

2012-01-01

Abstract: Improving and understanding clinical practice is an appropriate goal for the perfusion community. The Perfusion Downunder Collaboration has established a multi-center perfusion focused database aimed at achieving these goals through the development of quantitative quality indicators for clinical improvement through benchmarking. Data were collected using the Perfusion Downunder Collaboration database from procedures performed in eight Australian and New Zealand cardiac centers between March 2007 and February 2011. At the Perfusion Downunder Meeting in 2010, it was agreed by consensus, to report quality indicators (QI) for glucose level, arterial outlet temperature, and pCO2 management during cardiopulmonary bypass. The values chosen for each QI were: blood glucose ≥4 mmol/L and ≤10 mmol/L; arterial outlet temperature ≤37°C; and arterial blood gas pCO2 ≥ 35 and ≤45 mmHg. The QI data were used to derive benchmarks using the Achievable Benchmark of Care (ABC™) methodology to identify the incidence of QIs at the best performing centers. Five thousand four hundred and sixty-five procedures were evaluated to derive QI and benchmark data. The incidence of the blood glucose QI ranged from 37–96% of procedures, with a benchmark value of 90%. The arterial outlet temperature QI occurred in 16–98% of procedures with the benchmark of 94%; while the arterial pCO2 QI occurred in 21–91%, with the benchmark value of 80%. We have derived QIs and benchmark calculations for the management of several key aspects of cardiopulmonary bypass to provide a platform for improving the quality of perfusion practice. PMID:22730861

Improvement of "Novel Multiparty Quantum Key Agreement Protocol with GHZ States"

NASA Astrophysics Data System (ADS)

Gu, Jun; Hwang, Tzonelih

2017-10-01

Quantum key agreement (QKA) protocol is a method for negotiating a fair and secure key among mutually untrusted participants. Recently, Xu et al. (Quantum Inf. Process. 13:2587-2594, 2014) proposed a multi-party QKA protocol based on Greenberger-Horne-Zeilinger (GHZ) states. However, this study points out that Xu et al.'s protocol cannot provide the fairness property. That is, the last involved participant in the protocol can manipulate the final shared secret key without being detected by the other participants. Moreover, according to Yu et al.'s research (2015), Xu et al.'s protocol cannot avoid the public discussion attack too. To avoid these weaknesses, an improved QKA protocol is proposed.

Multiscale Mathematics for Nano-Particle-Endowed Active Membranes and Films

DTIC Science & Technology

2016-08-03

Formation in Biofilms ,” Contemporary Mathematics (586), 2013, 105-116. 2. Yi Sun and Qi Wang, “Modeling and Simulations of Multicellular Aggregate Self...6402. 21. Hua Jiang, Hao Yang, Jun Zeng, Zhiyuan Zhou, Jin Peng, Qi Wang, Analytic Oncology, Electron J Metab Nutr Cancer ，Jun. 2015，Vol. 2， No. 2, 26...30. 22. Chen Chen, Dacheng Ren, Mingming Ren and Qi Wang, “3-D Spatial-Temporal Structures of Biofilms in A Water Channel,” Mathematical Methods

Applying ethnography to the study of context in healthcare quality and safety.

PubMed

Leslie, Myles; Paradis, Elise; Gropper, Michael A; Reeves, Scott; Kitto, Simon

2014-02-01

Translating and scaling healthcare quality improvement (QI) and patient safety interventions remains a significant challenge. Context has been identified as a major factor in this. QI and patient safety research have begun to focus on context, with ethnography seen as a promising methodology for understanding the professional, organisational and cultural aspects of context. While ethnography is used to investigate the context of a variety of QI and safety interventions, the challenges inherent in effectively importing a qualitative methodology and its social science practitioners into this work have been largely unexamined. We explain ethnography as a research practice grounded in theory and dependent on observations gathered and interpreted in particular ways. We then review the approach of health services literature to evaluating this sort of qualitative research. Although the study of context is an interest shared by both social scientists and healthcare QI and safety researchers, we identify three key points at which those 'exporting' ethnography as a methodology and those 'importing' it to deal with QI and safety challenges may diverge. We describe perspectival divergences on the methodology's mission, form and scale. At the level of mission we demonstrate how ethnography has been adapted to a 'describe and feed back' role in the service of QI. At the level of form, we show how the long-term embedded observation at the heart of ethnography can be adapted only so far to accommodate QI interests if both data quality and ethical standards are to be upheld. Finally, at the level of scale, we demonstrate one ethnographic study design that balances breadth of exposure with depth of experience in its observations and so generates a particular type of scalable findings. The effective export of ethnography into QI and safety research requires discussion and negotiation between social scientific and health services research perspectives, as well as creative approaches

Spatially-Resolved Characterization Techniques to Investigate Impact Damage in Ultra-High Performance Concretes

DTIC Science & Technology

2013-04-01

Concretes G eo te ch n ic al a n d S tr u ct u re s La b or at or y Robert D. Moser, Paul G. Allison, and Mei Q. Chandler April 2013 Approved...Impact Damage in Ultra-High Performance Concretes Robert D. Moser, Paul G. Allison, and Mei Q. Chandler Geotechnical and Structures Laboratory US...Portland Cement concrete (OPC) and Ultra-High Performance Concretes (UHPCs) under high-strain impact and penetration loads at lower length scales

Improving operative flow during pediatric airway evaluation: a quality-improvement initiative.

PubMed

Prager, Jeremy D; Ruiz, Amanda G; Mooney, Kristin; Gao, Dexiang; Szolnoki, Judit; Shah, Rahul K

2015-03-01

Microlaryngoscopy and bronchoscopy procedures (MLBs) are short-duration, high-acuity procedures that carry risk. Poor case flow and communication exacerbate such potential risk. Efficient operative flow is critical for patient safety and resource expenditure. To identify areas for improvement and evaluate the effectiveness of a multidisciplinary quality-improvement (QI) initiative. A QI project using the "Plan-Do-Study-Act" (PDSA) cycle was implemented to assess MLBs performed on pediatric patients in a tertiary academic children's hospital. Forty MLBs were audited using a QI evaluation tool containing 144 fields. Each MLB was evaluated for flow, communication, and timing. Opportunities for improvement were identified. Subsequently, QI interventions were implemented in an iterative cycle, and 66 MLBs were audited after the intervention. Specific QI interventions addressed issues of personnel frequently exiting the operating room (OR) and poor preoperative preparation, identified during QI audit as areas for improvement. Interventions included (1) conducting "huddles" between surgeon and OR staff to discuss needed equipment; (2) implementing improvements to surgeon case ordering and preference cards review; (3) posting an OR door sign to limit traffic during airway procedures; and (4) discouraging personnel breaks during airway procedures. Operating room exiting behavior of OR personnel, preoperative preparation, and case timing were assessed and compared before and after the QI intervention. Personnel exiting the OR during the MLB was identified as a preintervention issue, with the surgical technologist, circulator, or surgeon exiting the room in 55% of cases (n = 22). The surgical technologist and circulator left the room to retrieve equipment in 40% of cases (n = 16), which indicated the need for increased preoperative preparation to improve case timing and operative flow. The QI interventions implemented to address these concerns included education

Defining and Assessing Quality Improvement Outcomes: A Framework for Public Health

PubMed Central

Nawaz, Saira; Thomas, Craig; Young, Andrea

2015-01-01

We describe an evidence-based framework to define and assess the impact of quality improvement (QI) in public health. Developed to address programmatic and research-identified needs for articulating the value of public health QI in aggregate, this framework proposes a standardized set of measures to monitor and improve the efficiency and effectiveness of public health programs and operations. We reviewed the scientific literature and analyzed QI initiatives implemented through the Centers for Disease Control and Prevention’s National Public Health Improvement Initiative to inform the selection of 5 efficiency and 8 effectiveness measures. This framework provides a model for identifying the types of improvement outcomes targeted by public health QI efforts and a means to understand QI’s impact on the practice of public health. PMID:25689185

The Efficacy and Safety of Shen Guo Lao Nian Granule for Common Cold of Qi-Deficiency Syndrome: Study Protocol for a Randomized, Double-Blind, Placebo-Controlled, Multicenter, Phase II Clinical Trial

PubMed Central

Fu, Juanjuan; Ding, Hong; Yang, Haimiao; Huang, Yuhong

2017-01-01

Background Common cold is one of the most frequently occurring illnesses in primary healthcare services and represents considerable disease burden. Common cold of Qi-deficiency syndrome (CCQDS) is an important but less addressed traditional Chinese medicine (TCM) pattern. We designed a protocol to explore the efficacy, safety, and optimal dose of Shen Guo Lao Nian Granule (SGLNG) for treating CCQDS. Methods/Design This is a multicenter, randomized, double-blind, placebo-controlled, phase II clinical trial. A total of 240 eligible patients will be recruited from five centers. Patients are randomly assigned to high-dose group, middle-dose group, low-dose group, or control group in a 1 : 1 : 1 : 1 ratio. All drugs are required to be taken 3 times daily for 5 days with a 5-day follow-up period. Primary outcomes are duration of all symptoms, total score reduction on Jackson's scale, and TCM symptoms scale. Secondary outcomes include every single TCM symptom duration and score reduction, TCM main symptoms disappearance rate, curative effects, and comparison between Jackson's scale and TCM symptom scale. Ethics and Trial Registration This study protocol was approved by the Ethics Committee of Clinical Trials and Biomedicine of West China Hospital of Sichuan University (number IRB-2014-12) and registered with the Chinese Clinical Trial Registry (ChiCTR-IPR-15006349). PMID:29430253

78 FR 40519 - Proposal Review Panel for Materials Research; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-05

... NATIONAL SCIENCE FOUNDATION Proposal Review Panel for Materials Research; Notice of Meeting In... Foundation announces the following meeting: Name: Site visit review of the Materials Research Science and...: Part open Contact Person: Dr. Charles Ying, Program Director, Materials Research Science and...

75 FR 17927 - Kevin Xu: Debarment Order

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-08

... products that bore the trademarks ZYPREXA, TAMIFLU, CASODEX, PLAVIX, and ARICEPT without the authorization... States various blister strips containing counterfeit TAMIFLU, CASODEX, ZYPREXA, and PLAVIX. On or about... of drugs that were misbranded, namely a shipment containing blister strips of PLAVIX pills that were...

The representation of vulnerable populations in quality improvement studies.

PubMed

Rolnitsky, Asaph; Kirtsman, Maksim; Goldberg, Hanna R; Dunn, Michael; Bell, Chaim M

2018-05-01

A mapping review to quantify representation of vulnerable populations, who suffer from disparity and often inequitable healthcare, in quality improvement (QI) research. Studies published in 2004-2014 inclusive from Medline, Embase and Cochrane databases for English language research with the terms 'quality improvement' or 'quality control' or 'QI' and 'plan-do-study-act' or 'PDSA' in the years 2004-2014 inclusively. Published clinical research that was a QI-themed, as identified by its declared search terms, MESH terms, abstract or title. Three reviewers identified the eligible studies independently. Excluded were publications that were not trials, evaluations or analyses. Of 2039 results, 1660 were eligible for inclusion. There were 586 (33.5%) publications that targeted a specific vulnerable population: children (184, 10.54%), mental health patients (125, 7.16%), the elderly (100, 5.73%), women (57, 3.27%), the poor (30, 1.72%), rural residents (29, 1.66%), visible minorities (27, 1.55%), the terminally ill (17, 0.97%), adolescents (16, 0.92%) and prisoners (1 study). Seventy-four articles targeted two or more vulnerable populations, and 11 targeted three population categories. On average, there were 158 QI research studies published per year, increasing from 69 in 2004 to 396 in 2014 (R2 = 0.7, P < 0.001). The relative representation of vulnerable populations had a mean of 33.58% and was stable over the time period (standard deviation (SD) = 5.9%, R2 = 0.001). Seven countries contributed to over 85% of the publications targeting vulnerable populations, with the USA contributing 62% of the studies. Over 11 years, there has been a marked increase in QI publications. Roughly one-third of all published QI research is on vulnerable populations, a stable proportion over time. Nevertheless, some vulnerable populations are under-represented. Increased education, resources and attention are encouraged to improve the health of vulnerable populations through focused QI

Integrated clinical and quality improvement coaching in Son La Province, Vietnam: a model of building public sector capacity for sustainable HIV care delivery.

PubMed

Cosimi, Lisa A; Dam, Huong V; Nguyen, Thai Q; Ho, Huyen T; Do, Phuong T; Duc, Duat N; Nguyen, Huong T; Gardner, Bridget; Libman, Howard; Pollack, Todd; Hirschhorn, Lisa R

2015-07-17

The global scale-up of antiretroviral therapy included extensive training and onsite support to build the capacity of HIV health care workers. However, traditional efforts aimed at strengthening knowledge and skills often are not successful at improving gaps in the key health systems required for sustaining high quality care. We trained and mentored existing staff of the Son La provincial health department and provincial HIV clinic to work as a provincial coaching team (PCT) to provide integrated coaching in clinical HIV skills and quality improvement (QI) to the HIV clinics in the province. Nine core indicators were measured through chart extraction by clinic and provincial staff at baseline and at 6 month intervals thereafter. Coaching from the team to each of the clinics, in both QI and clinical skills, was guided by results of performance measurements, gap analyses, and resulting QI plans. After 18 months, the PCT had successfully spread QI activities, and was independently providing regular coaching to the provincial general hospital clinic and six of the eight district clinics in the province. The frequency and type of coaching was determined by performance measurement results. Clinics completed a mean of five QI projects. Quality of HIV care was improved throughout all clinics with significant increases in seven of the indicators. Overall both the PCT activities and clinic performance were sustained after integration of the model into the Vietnam National QI Program. We successfully built capacity of a team of public sector health care workers to provide integrated coaching in both clinical skills and QI across a province. The PCT is a feasible and effective model to spread and sustain quality activities and improve HIV care services in a decentralized rural setting.

Postgraduate Education in Quality Improvement Methods: Initial Results of the Fellows' Applied Quality Training (FAQT) Curriculum.

PubMed

Winchester, David E; Burkart, Thomas A; Choi, Calvin Y; McKillop, Matthew S; Beyth, Rebecca J; Dahm, Phillipp

2016-06-01

Training in quality improvement (QI) is a pillar of the next accreditation system of the Accreditation Committee on Graduate Medical Education and a growing expectation of physicians for maintenance of certification. Despite this, many postgraduate medical trainees are not receiving training in QI methods. We created the Fellows Applied Quality Training (FAQT) curriculum for cardiology fellows using both didactic and applied components with the goal of increasing confidence to participate in future QI projects. Fellows completed didactic training from the Institute for Healthcare Improvement's Open School and then designed and completed a project to improve quality of care or patient safety. Self-assessments were completed by the fellows before, during, and after the first year of the curriculum. The primary outcome for our curriculum was the median score reported by the fellows regarding their self-confidence to complete QI activities. Self-assessments were completed by 23 fellows. The majority of fellows (15 of 23, 65.2%) reported no prior formal QI training. Median score on baseline self-assessment was 3.0 (range, 1.85-4), which was significantly increased to 3.27 (range, 2.23-4; P = 0.004) on the final assessment. The distribution of scores reported by the fellows indicates that 30% were slightly confident at conducting QI activities on their own, which was reduced to 5% after completing the FAQT curriculum. An interim assessment was conducted after the fellows completed didactic training only; median scores were not different from the baseline (mean, 3.0; P = 0.51). After completion of the FAQT, cardiology fellows reported higher self-confidence to complete QI activities. The increase in self-confidence seemed to be limited to the applied component of the curriculum, with no significant change after the didactic component.

Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales

PubMed Central

Cooper, Andrew; Gray, Jonathon; Willson, Alan; Lines, Chris; McCannon, Joe; McHardy, Karina

2015-01-01

Introduction Effective communication is critical to successful large-scale change. Yet, in our experience, communications strategies are not formally incorporated into quality improvement (QI) frameworks. The 1000 Lives Campaign (‘Campaign’) was a large-scale national QI collaborative that aimed to save an additional 1000 lives and prevent 50 000 episodes of harm in Welsh health care over a 2-year period. We use the Campaign as a case study to describe the development, application, and impact of a communications strategy embedded in a large-scale QI initiative. Methods A comprehensive communications strategy guided communications work during the Campaign. The main aims of the communications strategy were to engage the hearts and minds of frontline National Health Service (NHS) staff in the Campaign and promote their awareness and understanding of specific QI interventions and the wider patient safety agenda. We used qualitative and quantitative measures to monitor communications outputs and assess how the communications strategy influenced awareness and knowledge of frontline NHS staff. Results The communications strategy facilitated clear and consistent framing of Campaign messages and allowed dissemination of information related to the range of QI interventions. It reaffirmed the aim and value of the Campaign to frontline staff, thereby promoting sustained engagement with Campaign activities. The communications strategy also built the profile of the Campaign both internally with NHS organizations across Wales and externally with the media, and played a pivotal role in improving awareness and understanding of the patient safety agenda. Ultimately, outcomes from the communications strategy could not be separated from overall Campaign outcomes. Conclusion and recommendations Systematic and structured communications can support and enhance QI initiatives. From our experience, we developed a ‘communications bundle’ consisting of six core components. We

Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales.

PubMed

Cooper, Andrew; Gray, Jonathon; Willson, Alan; Lines, Chris; McCannon, Joe; McHardy, Karina

2015-03-01

Effective communication is critical to successful large-scale change. Yet, in our experience, communications strategies are not formally incorporated into quality improvement (QI) frameworks. The 1000 Lives Campaign ('Campaign') was a large-scale national QI collaborative that aimed to save an additional 1000 lives and prevent 50 000 episodes of harm in Welsh health care over a 2-year period. We use the Campaign as a case study to describe the development, application, and impact of a communications strategy embedded in a large-scale QI initiative. A comprehensive communications strategy guided communications work during the Campaign. The main aims of the communications strategy were to engage the hearts and minds of frontline National Health Service (NHS) staff in the Campaign and promote their awareness and understanding of specific QI interventions and the wider patient safety agenda. We used qualitative and quantitative measures to monitor communications outputs and assess how the communications strategy influenced awareness and knowledge of frontline NHS staff. The communications strategy facilitated clear and consistent framing of Campaign messages and allowed dissemination of information related to the range of QI interventions. It reaffirmed the aim and value of the Campaign to frontline staff, thereby promoting sustained engagement with Campaign activities. The communications strategy also built the profile of the Campaign both internally with NHS organizations across Wales and externally with the media, and played a pivotal role in improving awareness and understanding of the patient safety agenda. Ultimately, outcomes from the communications strategy could not be separated from overall Campaign outcomes. Systematic and structured communications can support and enhance QI initiatives. From our experience, we developed a 'communications bundle' consisting of six core components. We recommend that communications bundles be incorporated into existing QI

Quality Improvement Strategies in Accountable Care Organization Hospitals.

PubMed

Mora, Arthur M; Walker, Daniel

2016-01-01

Accountable Care Organizations (ACOs) are hoped to lower costs and improve health care quality. However, hospitals remain unsure how to bring about the quality improvement (QI) required to increase financial viability. This success may hinge on the use of sophisticated measurement tracking and the use of multiple QI tools. This study aims to assess the current approaches that ACO hospitals are using to improve quality and to compare their strategies with non-ACO hospitals. The 2013 American Hospital Association's Annual Survey and the Survey of Care Systems and Payment data were merged to identify ACO and non-ACO hospitals. ACO and non-ACO hospital rates of reported use of multiple QI tools and the ability to detect and track readmissions across organizational boundaries were compared. ACO hospitals were significantly less likely to use only 1 QI tool (43.5% vs 65.2%; P < .001) and more likely to use 2 (36.4% vs 28.1%; P < .05), 3 (12.1% vs 6.5%; P < .001), or 4 (8.0% vs 0.2%; P < .001) QI tools. ACO hospitals were significantly more likely to have the capability to detect readmissions (34.1% vs 22.8%; P < .001) and track readmissions (90.5% vs 85.7%; P < .05). Results suggest that ACO hospitals are incorporating more sophisticated measurements and combinations of QI tools than non-ACO hospitals. It remains to be seen whether this leads to accelerated changes across the quality domains in ACO hospitals.

Correlation Analysis between Traditional Chinese Medicine Syndromes and Gastrointestinal Bleeding after Percutaneous Coronary Intervention

PubMed Central

Huang, Chaolian; Wang, Mingming; Kong, Xiaolin; Liu, Guannan

2018-01-01

Objective To explore the characters of traditional Chinese medicine (TCM) syndromes after percutaneous coronary intervention (PCI) and to provide syndrome study theoretical evidence for TCM differentiation treatment after PCI through retrospective study. Methods Patients with coronary heart disease (CHD) who underwent PCI in Cardiovascular Intervention Center of Wangjing Hospital during Dec. 2012 to Dec. 2014 and met the inclusion criteria were enrolled. Retrospective study was then conducted based on patients' clinical document and angiography data to explore the distribution pattern of TCM syndromes. Results 801 patients were recruited in the study. TCM syndromes in descending order of their incidence were Qi deficiency and blood stasis syndrome, heart blood stasis syndrome, Qi and Yin deficiency syndrome, phlegm and blood stasis syndrome, Qi stagnation and blood stasis syndrome, Yang asthenia syndrome, heart and kidney yin deficiency syndrome to cold congeal, and blood stasis syndrome in a more to less order. Qi deficiency and blood stasis syndrome was in the most (occurring in 298 patients, 37.20%); Qi and Yin deficiency syndrome occurred in 163 patients (20.35%); heart blood stasis syndrome was shown in 126 patients (15.73%); phlegm and blood stasis syndrome was shown in 95 patients (11.86%). Conclusion Qi deficiency and blood stasis syndrome was closely associated with post-PCI bleeding, implying that this syndrome might serve as a powerful predictor of GI bleeding as well as a potential supplement to the current predicting and scoring system of bleeding such as CRUSADE.

Building Systemwide Improvement Capability: Does an Organization's Strategy for Quality Improvement Matter?

PubMed

Babich, Lauren P; Charns, Martin P; McIntosh, Nathalie; Lerner, Barbara; Burgess, James F; Stolzmann, Kelly L; VanDeusen Lukas, Carol

2016-01-01

Health care organizations have used different strategies to implement quality improvement (QI) programs but with only mixed success in implementing and spreading QI organization-wide. This suggests that certain organizational strategies may be more successful than others in developing an organization's improvement capability. To investigate this, our study examined how the primary focus of grant-funded QI efforts relates to (1) key measures of grant success and (2) organization-level measures of success in QI and organizational learning. Using a mixed-methods design, we conducted one-way analyses of variance to relate Veterans Affairs administrative survey data to data collected as part of a 3.5-year evaluation of 29 health care organization grant recipients. We then analyzed qualitative evidence from the evaluation to explain our results. We found that hospitals that focused on developing organizational infrastructure to support QI implementation compared with those that focused on training or conducting projects rated highest (at α = .05) on all 4 evaluation measures of grant success and all 3 systemwide survey measures of QI and organizational learning success. This study adds to the literature on developing organizational improvement capability and has practical implications for health care leaders. Focusing on either projects or staff training in isolation has limited value. Organizations are more likely to achieve systemwide transformation of improvement capability if their strategy emphasizes developing or strengthening organizational systems, structures, or processes to support direct improvement efforts.

Operationalizing quality improvement in a pediatric surgical practice.

PubMed

Arca, Marjorie J; Enters, Jessica; Christensen, Melissa; Jeziorczak, Paul; Sato, Thomas T; Thielke, Robert; Oldham, Keith T

2014-01-01

Quality improvement (QI) is critical to enhancing patient care. It is necessary to prioritize which QI initiatives are relevant to one's institution and practice, as implementation is resource-intensive. We have developed and implemented a streamlined process to identify QI opportunities in our practice. We designed a web-based Pediatric and Infant Case Log and Outcomes (PICaLO) instrument using Research Electronic Data Capture (REDCap™) to record all surgical procedures for our practice. At the time of operation, a surgeon completes a case report form. An administrative assistant enters the data in PICaLO within 5-7days. Outcomes such as complications, deaths, and "occurrences" (readmissions, reoperations, transfers to ICU, ER visit, additional clinic visits) are recorded at the time of encounter, during M & M Conferences, and during follow-up clinic visits. Variables were chosen and defined based on national standards from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), and Patient Based Learning Log. Occurrences are queried for potential QI initiatives. In 2012, 3597 patients were entered, totaling 5177 procedures. There were 220 complications, 278 occurrences, and 16 deaths. Specific QI opportunities were identified and put into place. Data on procedures and outcomes can be collected effectively in a pediatric surgery practice to delineate pertinent QI initiatives. PICaLO is recognized by the American Board of Surgery as a mechanism to meet Maintenance of Certification 4 criteria. © 2014.

Engaging Australian physicians in evidence-based medicine: a representative national survey.

PubMed

Toulkidis, V; Donnelly, N J; Ward, J E

2005-01-01

To assess Australian adult physicians' views about evidence-based medicine (EBM) and quality improvement (QI). Cross-sectional postal survey of two hundred and forty-four randomly selected Australian physicians (78.5% response rate). Physicians' views about the promotion of EBM and QI and their impact on patient care, strategies to support better clinical practice and self-reported understanding of EBM terms. Sixty-eight per cent (95% confidence interval (CI): 62-74%) of physicians had a positive view of the current promotion of EBM in Australia. Significantly fewer (45%; 95% CI: 38-51%) were so positive about QI (P <0.001). Although 74% (95% CI: 68-79%) indicated that EBM improves patient care, significantly fewer (46%; 95% CI: 40-53%) held this view with respect to QI (P <0.001). Although 70% (95% CI: 64-76%) of physicians agreed they had adequate skills to search for evidence, significantly fewer (21%; 95% CI: 17-27%) agreed they had sufficient time to do so (P <0.001). EBM skills were positively associated with involvement in teaching. Physicians were significantly more positive about approaches exclusive to themselves compared with those involving other disciplines. Although Australian physicians have positive views of EBM, QI appears less well regarded. Initiatives to improve quality and safety that incorporate principles and language of EBM will likely be received better by physicians than isolated QI. Further enhancement of EBM requires concomitant attention to physician training, workplace infrastructure and supportive professional development.

Chai-Qin-Cheng-Qi Decoction and Carbachol Improve Intestinal Motility by Regulating Protein Kinase C-Mediated Ca2+ Release in Colonic Smooth Muscle Cells in Rats with Acute Necrotising Pancreatitis

PubMed Central

Zhang, Chen-Long; Lin, Zi-Qi; Zhang, Xiao-Xin; Guo, Jia; Wu, Wei; Shi, Na; Deng, Li-Hui; Chen, Wei-Wei; Zhang, Xiao-Ying; Bharucha, Shameena; Huang, Wei; Sutton, Robert; Windsor, John A.

2017-01-01

Chai-Qin-Cheng-Qi decoction (CQCQD) improves intestinal motility in acute pancreatitis (AP), but the mechanism(s) require elucidation. We investigated the effects of CQCQD and carbachol, a prokinetic agent, on colonic smooth muscle cells (SMCs) in L-arginine-induced necrotising AP model in rats. In treatment groups, intragastric CQCQD (20 g/kg, 2 hourly × 3 doses) or intraperitoneal carbachol (60 μg/kg) was given 24 hours after induction of AP. Both CQCQD and carbachol decreased the severity of pancreatic and colonic histopathology (all P < 0.05). Both CQCQD and carbachol reduced serum intestinal fatty acid binding protein, vasoactive intestinal peptide, and substance P and increased motility levels. CQCQD upregulated SMC phospholipase C-beta 1 (PLC-β1) mRNA and PLC protein (both P < 0.05), while both treatments upregulated protein kinase C-alpha (PKC-α) mRNA and PKC protein and downregulated adenylate cyclase (AC) mRNA and protein compared with no treatment (all P < 0.05). Neither treatment significantly altered L-arginine-induced PKC-β1 and PKC-ε mRNA reduction. Both treatments significantly increased fluorescence intensity of SMC intracellular calcium concentration [Ca2+]i (3563.5 and 3046.9 versus 1086.9, both P < 0.01). These data suggest CQCQD and carbachol improve intestinal motility in AP by increasing [Ca2+]i in colonic SMCs via upregulating PLC, PKC and downregulating AC. PMID:28529530

Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

PubMed

Jeffs, Lianne P; Lo, Joyce; Beswick, Susan; Campbell, Heather

2013-01-01

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

Performance Contracting and Quality Improvement in Outpatient Treatment: Effects on Waiting Time and Length of Stay

PubMed Central

Stewart, Maureen T.; Horgan, Constance M.; Garnick, Deborah W.; Ritter, Grant; McLellan, A. Thomas

2012-01-01

We evaluate effects of a performance contract (PC) implemented in Delaware in 2001 and participation in quality improvement (QI) programs on waiting time for treatment and length of stay (LOS) using client treatment episode level data from Delaware (n = 12,368) and Maryland (n = 147,151) for 1998 – 2006. Results of difference-in-difference analyses indicate waiting time declined 13 days following the PC, after controlling for client characteristics and historical trends. Participation in the PC and a formal QI program was associated with a decrease of 20 days. LOS increased 22 days under the PC and 24 days under the PC and QI programs, after controlling for client characteristics. The PC and QI program were associated with improvements in LOS and waiting time, although we cannot determine which aspects of the programs (incentives, training, monitoring) resulted in these changes. PMID:22445031

Improving the Context Supporting Quality Improvement in a Neonatal Intensive Care Unit Quality Collaborative: An Exploratory Field Study.

PubMed

Grooms, Heather R; Froehle, Craig M; Provost, Lloyd P; Handyside, James; Kaplan, Heather C

Successful quality improvement (QI) requires a supportive context. The goal was to determine whether a structured curriculum could help QI teams improve the context supporting their QI work. An exploratory field study was conducted of 43 teams participating in a neonatal intensive care unit QI collaborative. Using a curriculum based on the Model for Understanding Success in Quality, teams identified gaps in their context and tested interventions to modify context. Surveys and self-reflective journals were analyzed to understand how teams developed changes to modify context. More than half (55%) targeted contextual improvements within the microsystem, focusing on motivation and culture. "Information sharing" interventions to communicate information about the project as a strategy to engage more staff were the most common interventions tested. Further study is needed to determine if efforts to modify context consistently lead to greater outcome improvements.

Stochastic Analysis and Design of Systems

DTIC Science & Technology

2011-09-14

measures is described by the Frobenius - Perron operator corresponding to the map T (qi, ., .). This is the unique operator [Pi] such that∫ A [Pi]µ(x...ξi(k)) are non-linear, the Frobenius - Perron operators are linear operators, but infinite-dimensional. For more details on the theory of these...given by the Frobenius - Perron operator corresponding to the map R(qi, qj , ., .). This is given as ∫ A [Mi,j ]µ(x)dx = Eηj ∫ Rn µ(x).χA(R(qi, qj , x

Quality improvement nursing facilities: a nursing leadership perspective.

PubMed

Adams-Wendling, Linda; Lee, Robert

2005-11-01

The purposes of this study were to characterize the state of quality improvement (QI) in nursing facilities and to identify barriers to improvement from nursing leaders' perspectives. The study employed a non-experimental descriptive design, using closed- and open-ended survey questions in a sample of 51 nursing facilities in a midwestern state. Only two of these facilities had active QI programs. Furthermore, turnover and limited training among these nursing leaders represented major barriers to rapid implementation of such programs. This study is consistent with earlier findings that QI programs are limited in nursing homes.

Influence of climate variability on anchovy reproductive timing off northern Chile

NASA Astrophysics Data System (ADS)

Contreras-Reyes, Javier E.; Canales, T. Mariella; Rojas, Pablo M.

2016-12-01

We investigated the relationship between environmental variables and the Gonadosomatic Monthly Mean (GMM) index of anchovy (Engraulis ringens) to understand how the environment affects the dynamics of anchovy reproductive timing. The data examined corresponds to biological information collected from samples of the landings off northern Chile (18°21‧S, 24°00‧S) during the period 1990-2010. We used the Humboldt Current Index (HCI) and the Multivariate ENSO Index (MEI), which combine several physical-oceanographic factors in the Tropical and South Pacific regions. Using the GMM index, we studied the dynamics of anchovy reproductive timing at different intervals of length, specifically females with a length between 11.5 and 14 cm (medium class) and longer than 14 cm (large class). Seasonal Autoregressive Integrated Mobile Average (SARIMA) was used to predict missing observations. The trends of the environment and reproductive indexes were explored via the Breaks For Additive Season and Trend (BFAST) statistical technique and the relationship between these indexes via cross-correlation functions (CCF) analysis. Our results showed that the habitat of anchovy switched from cool to warm condition, which also influenced gonad development. This was revealed by two and three significant changes (breaks) in the trend of the HCI and MEI indexes, and two significant breaks in the GMM of each time series of anchovy females (medium and large). Negative cross-correlation between the MEI index and GMM of medium and large class females was found, indicating that as the environment gets warmer (positive value of MEI) a decrease in the reproductive activity of anchovy can be expected. Correlation between the MEI index and larger females was stronger than with medium females. Additionally, our results indicate that the GMM index of anchovy for both length classes reaches two maximums per year; the first from August to September and the second from December to January. The

α -decay chains of the superheavy nuclei Rg-350255

NASA Astrophysics Data System (ADS)

Santhosh, K. P.; Nithya, C.

2017-05-01

The decay modes and half-lives of 96 isotopes of the superheavy element roentgenium (Rg) within the range of 255 ≤A ≤350 come under investigation in the present paper. The isotopes which lie beyond the proton drip line are identified by calculating the one-proton and two-proton separation energies. The α -decay half-lives are calculated using the Coulomb and proximity potential model for deformed nuclei (CPPMDN). For a theoretical comparison the α half-lives are also evaluated using the Viola-Seaborg semiempirical relation, the universal curve of Poenaru et al., the analytical formula of Royer, and the universal decay law of Qi et al. Spontaneous fission half-lives are computed with the shell-effect-dependent formula of Santhosh and Nithya and the semiempirical formula of Xu et al. The decay modes are predicted by comparing the α -decay half-lives within the CPPMDN with the corresponding spontaneous fission half-lives computed by the shell-effect-dependent formula of Santhosh and Nithya. In our paper it is seen that the isotopes 255-271,273Rg lie beyond the proton drip line and hence decay through proton emission. The isotopes 272,274-277Rg exhibit long α chains. Three α chains are predicted from the isotopes Rg-282278. The isotopes Rg-345283 decay through spontaneous fission. The isotopes Rg-350346 are found to be stable against α decay. The theoretical results are compared with the available experimental results and are seen to be matching well. We hope that our predictions will be useful in future experimental investigations.

Evaluation of a multiple-encounter in situ simulation for orientation of staff to a new paediatric emergency service: a single-group pretest/post-test study.

PubMed

Davison, Michelle; Kinnear, Frances B; Fulbrook, Paul

2017-10-01

To assess the utility of a multiple-encounter in-situ (MEIS) simulation as an orientation tool for multidisciplinary staff prior to opening a new paediatric emergency service. A single-group pretest/post-test study was conducted. During the MEIS simulation, multidisciplinary staff with participant or observer roles managed eight children (mannequins) who attended triage with their parent/guardians (clinical facilitators) for a range of emergency presentations (structured scenarios designed to represent the expected range of presentations plus test various clinical pathways/systems). Participants were debriefed to explore clinical, systems and crisis-resource management issues. Participants also completed a pre-intervention and post-intervention questionnaire comprising statements about role confidence and orientation adequacy. Pre-test and post-test results were analysed using t-test and Wilcoxon signed rank test. Eighty-nine staff participated in the MEIS simulation, with the majority completing the pre-simulation and post-simulation questionnaire. There was a significant improvement in post-intervention versus pre-intervention Likert scores for role confidence and orientation adequacy (p=0.001 and <0.001, respectively); effect sizes suggested the greatest impact was on orientation adequacy. Nearly all scenarios resulted in significant increases in participants' confidence levels. The MEIS simulation was of utility in orientation of staff, at least with respect to self-reported role confidence and orientation adequacy. Its effectiveness in practice or compared with other orientation techniques was not assessed, but it did identify several flaws in planned systems allowing remediation prior to opening.

Epigenetic Therapy of Hematopoietic Malignancies: Novel Approaches for Tissue-Specific and Global Inhibition of EZH2 Enzymatic Activities

DTIC Science & Technology

2017-10-01

at cis-regulatory elements such as enhancers to facilitate gene transcription. CRISPR /Cas9- mediated ablation of a putative Meis1 enhancer carrying...Tables S4 and S5. 10 Cancer Cell 30, 1–16, July 11, 2016the CRISPR /Cas9-based genomic editing technology. Cas9 and a pair of single guide RNAs (sgRNA... CRISPR /Cas9-mediated deletio sgMeis1, a pair of sgRNAs that target the DMR boundaries. (N) Sequencing of the genomic PCR products from F2/R2 primers shows

Targeting the Mevalonate Pathway to Reduce Mortality from Ovarian Cancer

DTIC Science & Technology

2017-12-01

at cis-regulatory elements such as enhancers to facilitate gene transcription. CRISPR /Cas9- mediated ablation of a putative Meis1 enhancer carrying...Tables S4 and S5. 10 Cancer Cell 30, 1–16, July 11, 2016the CRISPR /Cas9-based genomic editing technology. Cas9 and a pair of single guide RNAs (sgRNA... CRISPR /Cas9-mediated deletio sgMeis1, a pair of sgRNAs that target the DMR boundaries. (N) Sequencing of the genomic PCR products from F2/R2 primers shows

Factors influencing the long-term sustainment of quality improvements made in addiction treatment facilities: a qualitative study.

PubMed

Stumbo, Scott P; Ford, James H; Green, Carla A

2017-11-01

A greater understanding of the factors that influence long-term sustainment of quality improvement (QI) initiatives is needed to promote organizational ability to sustain QI practices over time, help improve future interventions, and increase the value of QI investments. We approached 83 of 201 executive sponsors or change leaders at addiction treatment organizations that participated in the 2007-2009 NIATx200 QI intervention. We completed semi-structured interviews with 33 individuals between November 2015 and April 2016. NIATx200 goals were to decrease wait time, increase admissions and improve retention in treatment. Interviews sought to understand factors that either facilitated or impeded long-term sustainment of organizational QI practices made during the intervention. We used thematic analysis to organize the data and group patterns of responses. We assessed available quantitative outcome data and intervention engagement data to corroborate qualitative results. We used narrative analysis to group four important themes related to long-term sustainment of QI practices: (1) finding alignment between business- and client-centered practices; (2) staff engagement early in QI process added legitimacy which facilitated sustainment; (3) commitment to integrating data into monitoring practices and the identification of a data champion; and (4) adequate organizational human resources devoted to sustainment. We found four corollary factors among agencies which did not sustain practices: (1) lack of evidence of impact on business practices led to discontinuation; (2) disengaged staff and lack of organizational capacity during implementation period led to lack of sustainment; (3) no data integration into overall business practices and no identified data champion; and (4) high staff turnover. In addition, we found that many agencies' current use of NIATx methods and tools suggested a legacy effect that might improve quality elsewhere, even absent overall sustainment of

Beyond coverage: improving the quality of antenatal care delivery through integrated mentorship and quality improvement at health centers in rural Rwanda.

PubMed

Manzi, Anatole; Nyirazinyoye, Laetitia; Ntaganira, Joseph; Magge, Hema; Bigirimana, Evariste; Mukanzabikeshimana, Leoncie; Hirschhorn, Lisa R; Hedt-Gauthier, Bethany

2018-02-23

Inadequate antenatal care (ANC) can lead to missed diagnosis of danger signs or delayed referral to emergency obstetrical care, contributing to maternal mortality. In developing countries, ANC quality is often limited by skill and knowledge gaps of the health workforce. In 2011, the Mentorship, Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) program was implemented to strengthen providers' ANC performance at 21 rural health centers in Rwanda. We evaluated the effect of MESH-QI on the completeness of danger sign assessments. Completeness of danger sign assessments was measured by expert nurse mentors using standardized observation checklists. Checklists completed from October 2010 to May 2011 (n = 330) were used as baseline measurement and checklists completed between February and November 2012 (12-15 months after the start of MESH-QI implementation) were used for follow-up. We used a mixed-effects linear regression model to assess the effect of the MESH-QI intervention on the danger sign assessment score, controlling for potential confounders and the clustering of effect at the health center level. Complete assessment of all danger signs improved from 2.1% at baseline to 84.2% after MESH-QI (p <  0.001). Similar improvements were found for 20 of 23 other essential ANC screening items. After controlling for potential confounders, the improvement in danger sign assessment score was significant. However, the effect of the MESH-QI was different by intervention district and type of observed ANC visit. In Southern Kayonza District, the increase in the danger sign assessment score was 6.28 (95% CI: 5.59, 6.98) for non-first ANC visits and 5.39 (95% CI: 4.62, 6.15) for first ANC visits. In Kirehe District, the increase in danger sign assessment score was 4.20 (95% CI: 3.59, 4.80) for non-first ANC visits and 3.30 (95% CI: 2.80, 3.81) for first ANC visits. Assessment of critical danger signs improved under MESH-QI, even when controlling for

Uncovering the Role of BMP Signaling in Melanocyte Development and Melanoma Tumorigenesis

DTIC Science & Technology

2015-06-01

Graduate Program Nicola Kearns, UMass Medical School, Interdisciplinary Graduate Program Qualifying examination committees: Christopher Clark, UMass...Dutta, UMass Medical School, Interdisciplinary Graduate Program Nicola Kearns, UMass Medical School, Interdisciplinary Graduate Program Hsi-Ju Chen...Pigment Cell Melanoma Research, 24, 378-81. 13. Lian, C.G., Xu. Y., Ceol, C.J., Wu, F., Larson, A., Dresser, K., Xu, W., Tan , L., Zhan, Q., Lee, C., Hu, D

NESHAP Area-Specific Dose-Release Factors for Potential Onsite Member-of-the-Public Locations at SRS using CAP88-PC Version 4.0

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

Trimor, P.

The Environmental Protection Agency (EPA) requires the use of the computer model CAP88-PC to estimate the total effective doses (TED) for demonstrating compliance with 40 CFR 61, Subpart H (EPA 2006), the National Emission Standards for Hazardous Air Pollutants (NESHAP) regulations. As such, CAP88 Version 4.0 was used to calculate the receptor dose due to routine atmospheric releases at the Savannah River Site (SRS). For estimation, NESHAP dose-release factors (DRFs) have been supplied to Environmental Compliance and Area Closure Projects (EC&ACP) for many years. DRFs represent the dose to a maximum receptor exposed to 1 Ci of a specified radionuclidemore » being released into the atmosphere. They are periodically updated to include changes in the CAP88 version, input parameter values, site meteorology, and location of the maximally exposed individual (MEI). In this report, the DRFs were calculated for potential radionuclide atmospheric releases from 13 SRS release points. The three potential onsite MEI locations to be evaluated are B-Area, Three Rivers Landfill (TRL), and Savannah River Ecology Lab Conference Center (SRELCC) with TRL’s onsite workers considered as members-of-the-public, and the potential future constructions of dormitories at SRELCC and Barracks at B-Area. Each MEI location was evaluated at a specified compass sector with different area to receptor distances and was conducted for both ground-level and elevated release points. The analysis makes use of area-specific meteorological data (Viner 2014). The resulting DRFs are compared to the 2014 NESHAP offsite MEI DRFs for three operational areas; A-Area, H-Area, and COS for a release rate of 1 Ci of tritium oxide at 0 ft. elevation. CAP88 was executed again using the 2016 NESHAP MEI release rates for 0 and 61 m stack heights to determine the radionuclide dose at TRL from the center-of-site (COS).« less

Technical Knowledge, Cultural Practices and Social Boundaries: Wan-Nan Scholars and the Recasting of Jesuit Astronomy, 1600-1800

NASA Astrophysics Data System (ADS)

Chu, Ping-Yi.

Taking four Wan-nan Confucian scholars--Yang Kuang -hsien, Mei Wen-ting, Chiang Yung and Tai Chen--as examples, this dissertation studies how an immigrant Jesuit scientific community built and defended itself in a specialized institutional niche located at the Ch'ing court and how a defeated Chinese scientific tradition successfully survived by occupying a broader cultural space, with the Manchu emperor in between. Special attention is paid to how these four Confucian scholars constructed social boundaries between the Chinese and the Westerners in their astronomical discourses and how they domesticated Western astronomy in order to fit the Chinese cultural conditions situated in the power structure built by the Manchus. This inquiry begins with a brief introduction of Wan-nan and the Wan-nan school. I then discuss how the Jesuits legitimated their knowledge during the Ming -Ch'ing transition, and how Jesuit astronomy was situated within the power nexus between the Confucian literati and the emperors. The next chapter focuses on Yang Kuang-hsien and his challenges to the Jesuits. I examine his strategies and the power structure in which Yang carried out his challenge to the Jesuits. The fourth and fifth chapters investigate how Mei Wen-ting restructured the relationship between Confucianism and astronomy. The former chapter focuses on Mei's social networking and his ambivalence towards the Ming and Ch'ing dynasties, on the one hand, and towards Chinese and Western learning on the other. The latter chapter deals with how Mei Wen-ting recast Chinese astronomical tradition and Confucianism. In the sixth chapter, I will compare the fame of Chiang Yung and Tai Chen in order to demonstrate how astronomy was practiced in evidential studies after Mei Wen-ting, and how evidential studies itself conveyed an ideological construction of the other. Through integrating Western astronomy with indigenous tradition while exorcising the otherness contained within the cultural package

Two-dimensional lift-up problem for a rigid porous bed

NASA Astrophysics Data System (ADS)

Chang, Y.; Huang, L. H.; Yang, F. P. Y.

2015-05-01

The present study analytically reinvestigates the two-dimensional lift-up problem for a rigid porous bed that was studied by Mei, Yeung, and Liu ["Lifting of a large object from a porous seabed," J. Fluid Mech. 152, 203 (1985)]. Mei, Yeung, and Liu proposed a model that treats the bed as a rigid porous medium and performed relevant experiments. In their model, they assumed the gap flow comes from the periphery of the gap, and there is a shear layer in the porous medium; the flow in the gap is described by adhesion approximation [D. J. Acheson, Elementary Fluid Dynamics (Clarendon, Oxford, 1990), pp. 243-245.] and the pore flow by Darcy's law, and the slip-flow condition proposed by Beavers and Joseph ["Boundary conditions at a naturally permeable wall," J. Fluid Mech. 30, 197 (1967)] is applied to the bed interface. In this problem, however, the gap flow initially mainly comes from the porous bed, and the shear layer may not exist. Although later the shear effect becomes important, the empirical slip-flow condition might not physically respond to the shear effect, and the existence of the vertical velocity affects the situation so greatly that the slip-flow condition might not be appropriate. In contrast, the present study proposes a more general model for the problem, applying Stokes flow to the gap, the Brinkman equation to the porous medium, and Song and Huang's ["Laminar poroelastic media flow," J. Eng. Mech. 126, 358 (2000)] complete interfacial conditions to the bed interface. The exact solution to the problem is found and fits Mei's experiments well. The breakout phenomenon is examined for different soil beds, mechanics that cannot be illustrated by Mei's model are revealed, and the theoretical breakout times obtained using Mei's model and our model are compared. The results show that the proposed model is more compatible with physics and provides results that are more precise.

Factors influencing suspended solids concentrations in activated sludge settling tanks.

PubMed

Kim, Y; Pipes, W O

1999-05-31

A significant fraction of the total mass of sludge in an activated sludge process may be in the settling tanks if the sludge has a high sludge volume index (SVI) or when a hydraulic overload occurs during a rainstorm. Under those conditions, an accurate estimate of the amount of sludge in the settling tanks is needed in order to calculate the mean cell residence time or to determine the capacity of the settling tanks to store sludge. Determination of the amount of sludge in the settling tanks requires estimation of the average concentration of suspended solids in the layer of sludge (XSB) in the bottom of the settling tanks. A widely used reference recommends averaging the concentrations of suspended solids in the mixed liquor (X) and in the underflow (Xu) from the settling tanks (XSB=0. 5{X+Xu}). This method does not take into consideration other pertinent information available to an operator. This is a report of a field study which had the objective of developing a more accurate method for estimation of the XSB in the bottom of the settling tanks. By correlation analysis, it was found that only 44% of the variation in the measured XSB is related to sum of X and Xu. XSB is also influenced by the SVI, the zone settling velocity at X and the overflow and underflow rates of the settling tanks. The method of averaging X and Xu tends to overestimate the XSB. A new empirical estimation technique for XSB was developed. The estimation technique uses dimensionless ratios; i.e., the ratio of XSB to Xu, the ratio of the overflow rate to the sum of the underflow rate and the initial settling velocity of the mixed liquor and sludge compaction expressed as a ratio (dimensionless SVI). The empirical model is compared with the method of averaging X and Xu for the entire range of sludge depths in the settling tanks and for SVI values between 100 and 300 ml/g. Since the empirical model uses dimensionless ratios, the regression parameters are also dimensionless and the model can be

Developing a caries risk registry to support caries risk assessment and management for children: A quality improvement initiative.

PubMed

Ruff, Jesley C; Herndon, Jill Boylston; Horton, Roger A; Lynch, Julie; Mathwig, Dawn C; Leonard, Audra; Aravamudhan, Krishna

2017-10-27

Health registries are commonly used in medicine to support public health activities and are increasingly used in quality improvement (QI) initiatives. Illustrations of dental registries and their QI applications are lacking. Within dentistry, caries risk assessment implementation and documentation are vital to optimal patient care. The purpose of this article is to describe the processes used to develop a caries risk assessment registry as a QI initiative to support clinical caries risk assessment, caries prevention, and disease management for children. Developmental steps reflected Agency for Healthcare Research and Quality recommendations for planning QI registries and included engaging "champions," defining the project, identifying registry features, defining performance dashboard indicators, and pilot testing with participant feedback. We followed Standards for Quality Improvement Reporting Excellence guidelines. Registry eligibility is patients aged 0-17 years. QI tools include prompts to register eligible patients; decision support tools grounded in evidence-based guidelines; and performance dashboard reports delivered at the provider and aggregated levels at regular intervals. The registry was successfully piloted in two practices with documented caries risk assessment increasing from 57 percent to 92 percent and positive feedback regarding the potential to improve dental practice patient centeredness, patient engagement and education, and quality of care. The caries risk assessment registry demonstrates how dental registries may be used in QI efforts to promote joint patient and provider engagement, foster shared decision making, and systematically collect patient information to generate timely and actionable data to improve care quality and patient outcomes at the individual and population levels. © 2017 American Association of Public Health Dentistry.

Improving Tanzanian childbirth service quality.

PubMed

Jaribu, Jennie; Penfold, Suzanne; Green, Cathy; Manzi, Fatuma; Schellenberg, Joanna

2018-04-16

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

Improving chronic care delivery and outcomes: the impact of the cystic fibrosis Care Center Network.

PubMed

Mogayzel, Peter J; Dunitz, Jordan; Marrow, Laura C; Hazle, Leslie A

2014-04-01

Cystic fibrosis (CF) is a multisystem, life-shortening genetic disease that requires complex care. To facilitate this expert, multidisciplinary care, the CF Foundation established a Care Center Network and accredited the first care centres in 1961. This model of care brings together physicians and specialists from other disciplines to provide care, facilitate basic and clinical research, and educate the next generation of providers. Although the Care Center Network has been invaluable in achieving substantial gains in survival and quality of life, additional opportunities for improvements in CF care exist. In 1999, analysis of data from the CF Foundation's Patient Registry detected variation in care practices and outcomes across centres, identifying opportunities for improvement. In 2002, the CF Foundation launched a comprehensive quality improvement (QI) initiative to enhance care by assembling national experts to develop a strategic plan to disseminate QI training and processes throughout the Care Center Network. The QI strategies included developing leadership (nationally and within each care centre), identifying best CF care practices, and incorporating people with CF and their families into improvement efforts. The goal was to improve the care for every person with CF in the USA. Multiple tactics were undertaken to implement the strategic plan and disseminate QI training and tools throughout the Care Center Network. In addition, strategies to foster collaboration between care centre staff and individuals with CF and their families became a cornerstone of QI efforts. Today it is clear that the application of QI principles within the CF Care Center Network has improved adherence to clinical guidelines and achievement of important health outcomes.

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

PubMed

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

2018-05-30

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