Investigation of the therapy targets of Yi-Qi-Yang-Yin-Hua-Tan-Qu-Yu recipe on type 2 diabetes by serum proteome labeled with iTRAQ.

PubMed

Zhao, Jing; Xie, Ming; Liu, Jin-Na; Wang, Bang-Zhong

2018-04-11

Ethnopharmacology relevance Based on basic theories of Chinese medicine, Yi-Qi-Yang-Yin-Hua-Tan-Qu-Yu (YQYYHTQY) recipe was constituted by eleven kinds of Chinese herbs and effective in treatment of type 2 diabetes (T2DM). But the therapy target was unclear. In this study, we used the serum proteome labeled by iTRAQ to find therapy target of YQYYHTQY recipe on T2DM. The rat model was induced by high-fat diet (HFD) and streptozotocin (STZ, 30mg/kg). Drugs were administered to rats once daily for 14 days. Related laboratory parameters were observed. Serum proteome were compared between T2DM and YQYYHTQY group using the iTRAQ labeling quantitative proteomics technique. Functional differential proteins were analysis by STRING software. Target proteins were confirmed by ELISA kits. Hyperglycemia, hyperinsulinemia, insulin resistance, decrease of glucose transporter, depilation, less activity, flock together, depression, ecchymosis of tongue and tail appearance, the typical diabetic patients "a little more than three" symptoms, as well as the decrease of grip strength, serum cyclic adenosine monophosphate (cAMP)/ cyclic guanosine monophosphate (cGMP) ratio, serum high density lipoprotein-cholesterol (HDL-C) and the increase of serum triglyceride (TG), total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), thromboxane B 2 (TXB 2 )/ 6-keto prostaglandin F1α (6-keto PGF1α) ratio, endothelin-1 (ET-1) levels were found in T2DM group. After drugs treatment, all the above indexes almost were improved in different degrees and effect of YQYYHTQY recipe was superior to pioglitazone hydrochloride. In addition, there were 23 differential proteins, 5 up-regulated and 18 down-regulated proteins. Of them, there were 4 proteins related with diabetes, blood and behavior. Cell division control protein 42 homolog (CDC42) and Ras homolog gene family member A (RhoA) were the therapy targets of YQYYHTQY recipe on T2DM. YQYYHTQY recipe showed therapy effect on T2DM. CDC42 and

Yi Guo | NREL

Science.gov Websites

Yi is dedicated to research and development in dynamic modeling, reliability analysis, vibro systems and has published numerous impactful journal publications. Prior to NREL, she pursued her Ph.D . research at Ohio State University with specialization in dynamics, vibration, and acoustics of wind turbine

Prediction of anaerobic power values from an abbreviated WAnT protocol.

PubMed

Stickley, Christopher D; Hetzler, Ronald K; Kimura, Iris F

2008-05-01

The traditional 30-second Wingate anaerobic test (WAnT) is a widely used anaerobic power assessment protocol. An abbreviated protocol has been shown to decrease the mild to severe physical discomfort often associated with the WAnT. Therefore, the purpose of this study was to determine whether a 20-second WAnT protocol could be used to accurately predict power values of a standard 30-second WAnT. In 96 college females, anaerobic power variables were assessed using a standard 30-second WAnT protocol. Maximum power values as well as instantaneous power at 10, 15, and 20 seconds were recorded. Based on these results, stepwise regression analysis was performed to determine the accuracy with which mean power, minimum power, 30-second power, and percentage of fatigue for a standard 30-second WAnT could be predicted from values obtained during the first 20 seconds of testing. Mean power values showed the highest level of predictability (R2 = 0.99) from the 20-second values. Minimum power, 30-second power, and percentage of fatigue also showed high levels of predictability (R2 = 0.91, 0.84, and 0.84, respectively) using only values obtained during the first 20 seconds of the protocol. An abbreviated (20-second) WAnT protocol appears to effectively predict results of a standard 30-second WAnT in college-age females, allowing for comparison of data to published norms. A shortened test may allow for a decrease in unwanted side effects associated with the traditional WAnT protocol.

Genetic polymorphisms of pharmacogenomic VIP variants in the Yi population from China.

PubMed

Yan, Mengdan; Li, Dianzhen; Zhao, Guige; Li, Jing; Niu, Fanglin; Li, Bin; Chen, Peng; Jin, Tianbo

2018-03-30

Drug response and target therapeutic dosage are different among individuals. The variability is largely genetically determined. With the development of pharmacogenetics and pharmacogenomics, widespread research have provided us a wealth of information on drug-related genetic polymorphisms, and the very important pharmacogenetic (VIP) variants have been identified for the major populations around the world whereas less is known regarding minorities in China, including the Yi ethnic group. Our research aims to screen the potential genetic variants in Yi population on pharmacogenomics and provide a theoretical basis for future medication guidance. In the present study, 80 VIP variants (selected from the PharmGKB database) were genotyped in 100 unrelated and healthy Yi adults recruited for our research. Through statistical analysis, we made a comparison between the Yi and other 11 populations listed in the HapMap database for significant SNPs detection. Two specific SNPs were subsequently enrolled in an observation on global allele distribution with the frequencies downloaded from ALlele FREquency Database. Moreover, F-statistics (Fst), genetic structure and phylogenetic tree analyses were conducted for determination of genetic similarity between the 12 ethnic groups. Using the χ2 tests, rs1128503 (ABCB1), rs7294 (VKORC1), rs9934438 (VKORC1), rs1540339 (VDR) and rs689466 (PTGS2) were identified as the significantly different loci for further analysis. The global allele distribution revealed that the allele "A" of rs1540339 and rs9934438 were more frequent in Yi people, which was consistent with the most populations in East Asia. F-statistics (Fst), genetic structure and phylogenetic tree analyses demonstrated that the Yi and CHD shared a closest relationship on their genetic backgrounds. Additionally, Yi was considered similar to the Han people from Shaanxi province among the domestic ethnic populations in China. Our results demonstrated significant differences on

The Therapeutic Effect of Zuogui Wan in Gestational Diabetes Mellitus Rats

PubMed Central

Feng, Qianjin; Niu, Xin; Liu, Xinshe; Xu, Kaixia; Yang, Xiangzhu; Wang, Huifeng

2014-01-01

In this experiment, we established an animal model of gestational diabetes mellitus rats using streptozotocin. Using the rat model of GDM, the pregnant rats in 1-19d were divided into three groups: (1) Zuogui Wan gestational diabetes mellitus group (group I, n = 12), (2) gestational diabetes mellitus rats as the control group (group II, n = 11), and (3) rats of normal pregnancy group (group III, n = 11). Compared with gestational diabetes mellitus rats as the control group, Zuogui Wan can change the indexes of fasting blood glucose, body weight, total cholesterol, insulin, and metabolism cage index significantly in Zuogui Wan gestational diabetes mellitus group. We can conclude that Zuogui Wan has the therapeutic effect on gestational diabetes mellitus. PMID:25136475

[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.

[Collation between Za Liao of Qian Jin Yi Fang and Xin Xiu Ben Cao].

PubMed

Liang, Fei; Jiang, Li-Sheng; Li, Jian; Zhang, Wei; Zhang, Rui-Xian

2012-10-01

To analyze specific content of Za Liao of Qian Jin Yi Fang, this essay compares its content with related content of Xin Xiu Ben Cao, finding that Za Liao of Qian Jin Yi Fang is derived from the part of Jin An of Xin Xiu Ben Cao, which complements with herbal chapters from volume II to IV of Qian Jin Yi Fang. The texts in Za Liao can verify and collate part of Jin An, and thereby showing important literature value and great help for further studies on traditional Chinese medicines of Tang dynasty.

Prescription Pattern of Chinese Herbal Products for Diabetes Mellitus in Taiwan: A Population-Based Study

PubMed Central

Huang, Chung-Yu; Lai, Jung-Nien; Hsu, Feng-Lin

2013-01-01

Background. Traditional Chinese medicine (TCM), when given as a therapy for symptom relief, has gained widespread popularity among diabetic patients. The aim of this study is to analyze the utilization of TCM among type 2 diabetic patients in Taiwan. Methods. The use of TCM for type 2 diabetic patients were evaluated using a randomly sampled cohort of 1,000,000 beneficiaries recruited from the National Health Insurance Research Database. Results. Overall, 77.9% (n = 31,289) of type 2 diabetic patients utilized TCM and 13.9% (n = 4,351) of them used TCM for the treatment of type 2 diabetes. Among the top ten most frequently prescribed herbal formulae, four remedies, Zhi-Bo-Di-Huang-Wan, Qi-Ju-Di-Huang-Wan, Ji-Sheng-Shen-Qi-Wan and Ba-Wei-Di-Huang-Wan are derivative formulae of Liu-Wei-Di-Huang-Wan. In other words, Liu-Wei-Di-Huang-Wan and its derivatives were found to be the most common herbal formulae prescribed by TCM doctors for the treatment of diabetes in Taiwan. Conclusion. Although some evidence does support the use TCM to treat diabetes, the results from the current study may have been confounded by placebo effect, which emphasize the need for well conducted, double-blind, randomized, placebo-controlled studies in order to further evaluate the efficacy of Liu-Wei-Di-Huang-Wan on patients with type 2 diabetes. PMID:23843864

Yi-gan san restores behavioral alterations and a decrease of brain glutathione level in a mouse model of schizophrenia.

PubMed

Makinodan, Manabu; Yamauchi, Takahira; Tatsumi, Kouko; Okuda, Hiroaki; Noriyama, Yoshinobu; Sadamatsu, Miyuki; Kishimoto, Toshifumi; Wanaka, Akio

2009-01-01

The traditional Chinese herbal medicine yi-gan san has been used to cure neuropsychological disorders. Schizophrenia can be one of the target diseases of yi-gan san. We aimed at evaluating the possible use of yi-gan san in improving the schizophrenic symptoms of an animal model. Yi-gan san or distilled water was administered to mice born from pregnant mice injected with polyinosinic-polycytidilic acid or phosphate buffered saline. The former is a model of schizophrenia based on the epidemiological data that maternal infection leads to psychotic disorders including schizophrenia in the offspring. Prepulse inhibition and sensitivity to methamphetamine in open field tests were analyzed and the total glutathione content of whole brains was measured. Yi-gan san reversed the decrease in prepulse inhibition, hypersensitivity to methamphetamine and cognitive deficits found in the model mice to the level of control mice. Total glutathione content in whole brains was reduced in the model mice but was restored to normal levels by yi-gan san treatment. These results suggest that yi-gan san may have ameliorating effects on the pathological symptoms of schizophrenia.

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.

State of the Art in LP-WAN Solutions for Industrial IoT Services.

PubMed

Sanchez-Iborra, Ramon; Cano, Maria-Dolores

2016-05-17

The emergence of low-cost connected devices is enabling a new wave of sensorization services. These services can be highly leveraged in industrial applications. However, the technologies employed so far for managing this kind of system do not fully cover the strict requirements of industrial networks, especially those regarding energy efficiency. In this article a novel paradigm, called Low-Power Wide Area Networking (LP-WAN), is explored. By means of a cellular-type architecture, LP-WAN-based solutions aim at fulfilling the reliability and efficiency challenges posed by long-term industrial networks. Thus, the most prominent LP-WAN solutions are reviewed, identifying and discussing the pros and cons of each of them. The focus is also on examining the current deployment state of these platforms in Spain. Although LP-WAN systems are at early stages of development, they represent a promising alternative for boosting future industrial IIoT (Industrial Internet of Things) networks and services.

Enhancing LoRaWAN Security through a Lightweight and Authenticated Key Management Approach.

PubMed

Sanchez-Iborra, Ramon; Sánchez-Gómez, Jesús; Pérez, Salvador; Fernández, Pedro J; Santa, José; Hernández-Ramos, José L; Skarmeta, Antonio F

2018-06-05

Luckily, new communication technologies and protocols are nowadays designed considering security issues. A clear example of this can be found in the Internet of Things (IoT) field, a quite recent area where communication technologies such as ZigBee or IPv6 over Low power Wireless Personal Area Networks (6LoWPAN) already include security features to guarantee authentication, confidentiality and integrity. More recent technologies are Low-Power Wide-Area Networks (LP-WAN), which also consider security, but present initial approaches that can be further improved. An example of this can be found in Long Range (LoRa) and its layer-two supporter LoRa Wide Area Network (LoRaWAN), which include a security scheme based on pre-shared cryptographic material lacking flexibility when a key update is necessary. Because of this, in this work, we evaluate the security vulnerabilities of LoRaWAN in the area of key management and propose different alternative schemes. Concretely, the application of an approach based on the recently specified Ephemeral Diffie⁻Hellman Over COSE (EDHOC) is found as a convenient solution, given its flexibility in the update of session keys, its low computational cost and the limited message exchanges needed. A comparative conceptual analysis considering the overhead of different security schemes for LoRaWAN is carried out in order to evaluate their benefits in the challenging area of LP-WAN.

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

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%.

Neuroprotective effects of an herbal medicine, Yi-Gan San on MPP+/MPTP-induced cytotoxicity in vitro and in vivo.

PubMed

Doo, Ah-Reum; Kim, Seung-Nam; Park, Ji-Yeon; Cho, Ki Ho; Hong, Jongki; Eun-Kyung, Kim; Moon, Sang Kwan; Jung, Woo Sang; Lee, Hyejung; Jung, Jae Han; Park, Hi-Joon

2010-09-15

A traditional herb, Yi-Gan San, has been widely used for the management of neurodegenerative disorders in traditional East Asian Medicine. The present study investigated the neuroprotective effects of Yi-Gan San in 1-methyl-4-phenylpyridine/1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced cytotoxicity in vitro and in vivo and sought to clarify its underlying mechanisms. The effect of Yi-Gan San on 1-methyl-4-phenylpyridine was measured in terms of 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assays, caspase-3 activity, and western blot analysis of phosphorylated Akt, one of the survival-related signaling proteins in SH-SY5Y cells. The effects of Yi-Gan San were also confirmed in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced Parkinsonian mouse model using a rotarod test and tyrosine hydroxylase-immunohistochemistry. Pretreatment of Yi-Gan San with 1-methyl-4-phenylpyridine showed a significant protective effect on SH-SY5Y cells and significantly decreased the level of caspase-3 activity compared to the values for the 1-methyl-4-phenylpyridine-treated cells. This process increased the protein expressions of phosphorylated Akt, and an inhibitor of phosphatidylinositol 3-kinase (PI3K)/Akt, LY294002, significantly decreased this protective effect of Yi-Gan San. In the mouse Parkinson's disease model, treatment with Yi-Gan San also significantly improved motor functioning and prevented dopaminergic loss related to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine challenge. Using both in vitro and in vivo methods, this study revealed that Yi-Gan San has neuroprotective effects and rescues dopaminergic neurons from 1-methyl-4-phenylpyridine/1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine toxicity, possibly via the PI3K/Akt pathway. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

The genetic admixture in Tibetan-Yi Corridor.

PubMed

Yao, Hong-Bing; Tang, Senwei; Yao, Xiaotian; Yeh, Hui-Yuan; Zhang, Wanhu; Xie, Zhiyan; Du, Qiajun; Ma, Liying; Wei, Shuoyun; Gong, Xue; Zhang, Zilong; Li, Quanfang; Xu, Bingying; Zhang, Hu-Qin; Chen, Gang; Wang, Chuan-Chao

2017-11-01

The Tibetan-Yi Corridor located on the eastern edge of Tibetan Plateau is suggested to be the key region for the origin and diversification of Tibeto-Burman speaking populations and the main route of the peopling of the Plateau. However, the genetic history of the populations in the Corridor is far from clear due to limited sampling in the northern part of the Corridor. We collected blood samples from 10 Tibetan and 10 Han Chinese individuals from Gansu province and genotyped about 600,000 genome-wide single nucleotide polymorphisms (SNPs). Our data revealed that the populations in the Corridor are all admixed on a genetic cline of deriving ancestry from Tibetans on the Plateau and surrounding lowland East Asians. The Tibetan and Han Chinese groups in the north of the Plateau show significant evidence of low-level West Eurasian admixture that could be probably traced back to 600∼900 years ago. We conclude that there have been huge population migrations from surrounding lowland onto the Tibetan Plateau via the Tibetan-Yi Corridor since the initial formation of Tibetans probably in Neolithic Time, which leads to the current genetic structure of Tibeto-Burman speaking populations. © 2017 Wiley Periodicals, Inc.

[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.

Forensic evaluation and population genetic study of 30 insertion/deletion polymorphisms in a Chinese Yi group.

PubMed

Zhang, Yu-Dang; Shen, Chun-Mei; Jin, Rui; Li, Ya-Ni; Wang, Bo; Ma, Li-Xia; Meng, Hao-Tian; Yan, Jiang-Wei; Dan Wang, Hong-; Yang, Ze-Long; Zhu, Bo-Feng

2015-05-01

Insertion/deletion polymorphisms have become a research hot spot in forensic science due to their tremendous potential in recent years. In the present study, we investigated 30 indel loci in a Chinese Yi ethnic group. The allele frequencies of the short allele of the 30 indel loci were in the range of 0.1025-0.9221. The power of discrimination values were observed ranging from to 0.2630 (HLD111 locus) to 0.6607 (HLD70 locus) and probability of exclusion values ranged from 0.0189 (HLD111 locus) to 0.2343 (HLD56 locus). The combined power of discrimination and power of exclusion for 30 loci in the studied Yi group were 0.99999999995713 and 0.97746, respectively, which showed tremendous potential for forensic personal identification in the Yi group. Moreover, the DA distances, phylogenetic tree, principal component analysis, and cluster analysis showed the Yi group had close genetic relationships with the Tibetan, South Korean, Chinese Han, and She groups. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

[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.

Current temporal asymmetry and the role of tides: Nan-Wan Bay vs. the Gulf of Elat

NASA Astrophysics Data System (ADS)

Ashkenazy, Yosef; Fredj, Erick; Gildor, Hezi; Gong, Gwo-Ching; Lee, Hung-Jen

2016-05-01

Nan-Wan Bay in Taiwan and the Gulf of Elat in Israel are two different coastal environments, and as such, their currents are expected to have different statistical properties. While Nan-Wan Bay is shallow, has three open boundaries, and is directly connected to the open ocean, the Gulf of Elat is deep, semi-enclosed, and connected to the Red Sea via the Straits of Tiran. Surface currents have been continuously measured with fine temporal (less than or equal to 1 h) and spatial resolution (less than or equal to 1 km) for more than a year in both environments using coastal radars (CODARs) that cover a domain of roughly 10 × 10 km. These measurements show that the currents in Nan-Wan Bay are much stronger than those in the Gulf of Elat and that the mean current field in Nan-Wan Bay exhibits cyclonic circulation, which is stronger in the summer; in the Gulf of Elat, the mean current field is directed southward and is also stronger during the summer. We have compared the statistical properties of the current speeds in both environments and found that both exhibit large spatial and seasonal variations in the shape parameter of the Weibull distribution. However, we have found fundamental and significant differences when comparing the temporal asymmetry of the current speed (i.e., the ratio between the time during which the current speed increases and the total time). While the Nan-Wan Bay currents are significantly asymmetric, those of the Gulf of Elat are not. We then extracted the tidal component of the Nan-Wan Bay currents and found that it is strongly asymmetric, while the asymmetry of tidally filtered currents is much weaker. We thus conclude that the temporal asymmetry of the Nan-Wan Bay currents reported here is due to the strong tides in the region. We show that the asymmetry ratio in Nan-Wan Bay varies spatially and seasonally: (i) the currents increase rapidly and decay slowly in the northern part of the domain and vice versa in the southern part, and (ii) the

Current temporal asymmetry and the role of tides: Nan-Wan Bay vs. the Gulf of Elat

NASA Astrophysics Data System (ADS)

Ashkenazy, Y.; Fredj, E.; Gildor, H.; Gong, G. C.; Lee, H. J.; Wu, C. R.

2016-02-01

Nan-Wan Bay in Taiwan and the Gulf of Elat in Israel are two different coastal environments and as such are expected to have different statistical properties of their currents. While the Nan-Wan Bay is shallow, has three open boundaries, and directly connected to the open ocean, the Gulf of Elat is deep, semi-enclosed, and connected to the Red Sea via the Straits of Tiran. High temporal (less or equal one hour) and spatial (less or equal one km) surface currents have been measured continuously for more than a year in both environments using Coastal Radars (CODARs) that cover a domain of roughly 10×10 kms. These measurements show that the currents in Nan-Wan Bay are much stronger than those in the Gulf of Elat and that the mean current field in Nan-Wan Bay exhibits cyclonic circulation, which is stronger in the summer; in the Gulf of Elat the mean current field is directed to south and is stronger during the summer. We have compared the statistical properties of the CODAR current speeds in both environments and found that both exhibit large spatial and seasonal variations in the shape parameter of the Weibull distribution. However, we have found fundamental and significant differences when comparing the temporal asymmetry of the current speed (i.e., the ratio between the time during which the current speed is increasing to the total time). While the Nan-Wan Bay currents are significantly asymmetric, those of the Gulf of Elat are not significantly asymmetric. We then extracted the tidal component of the Nan-Wan Bay currents and found that it is strongly asymmetric while the asymmetry of tidally-filtered currents is much weaker. We thus conclude that the temporal asymmetry of the Nan-Wan Bay currents reported here is due to the strong tides in the region. We show that the asymmetry ratio in the Nan-Wan Bay is varied spatially and seasonally: (i) currents increase rapidly and decay slowly in the northern part of the domain and vice versa in the southern part, and that

The Preventive Effect of Zuogui Wan on Offspring Rats' Impaired Glucose Tolerance Whose Mothers Had Gestational Diabetes Mellitus

PubMed Central

Feng, Qianjin; Niu, Xin; Xu, Kaixia; Wang, Yingli; Wang, Jinlong; Mao, Yingqiu; Gao, Shuangrong

2016-01-01

In this experiment, we used streptozotocin (STZ) to establish a model of gestational diabetes mellitus (GDM) rats, where Zuogui Wan was given to GDM rats. After pregnancy, offspring rats were divided into 4 groups: control group, high fat and sugar as the control group, GDM group, and Zuogui Wan GDM group. Rats in high fat and sugar as the control group, GDM group, and Zuogui Wan GDM group were fed with high fat and sugar diet. Rats in control group were fed the basic diet. The means of 2hPG were higher than 7.8 mmol·L−1 and lower than 11.1 mmol·L−1 on the rats of GDM group on week 15, and IGT models were successful. Body weight, abdominal fat weight, the ratio of abdominal fat weight and body weight, fasting plasma glucose, 2hPG, insulin, leptin, total cholesterol, and low density lipoprotein (LDL) of Zuogui Wan GDM group were significantly lower than GDM group. The level of adiponectin in Zuogui Wan GDM group was significantly higher than GDM group. And we concluded that giving Zuogui Wan to GDM rats can have a preventive effect on the offsprings' IGT induced by high fat and sugar diet. PMID:27034700

[Experimental study on therapeutic effect of Dabuyin Wan on true precocious puberty in female rats].

PubMed

Cheng, Min; Ye, Xiao-Di; Miao, Yun-Ping; Chen, Ai-Ying; Zheng, Gao-Li

2013-02-01

To study the therapeutic effect of Dabuyin Wan on true precocious puberty of female rats and its possible mechanism. Twenty-two-day-old female SD rats were subcutaneously injected with 40 mg x kg(-1) N-methyl-DL-aspartic acid (NMA) at 14:00 and 16:00 every day; meanwhile, the rats were given Dabuyin Wan for intervention. Visual inspection was conducted for the time of vaginal opening. The first estrus was observed by yaginal smear test. Their ovaries and uterus were weighed to calculate organ coefficients. Conventional pathological slices were made to observe morphological changes in ovaries and uterus and calculate the thickness of uterine walls and the number of corpus luteums. The level of E2 in serum was detected to assess the therapeutic effect of Dabuyin Wan on NMA precocious puberty in rats. expressions of GnRH, GPR54 and Kiss-1 mRNA in hypothalamus were measured by semi-quantitative RT-PCR to investigate the possible mechanism of Dabuyin Wan. Dabuyin Wan at 3.24 g x kg(-1) and 1.62 g x kg(-1) significantly decreased the organ coefficients in rats with precocious puberty (P < 0.05), decrease the number of vaginal openings in rats (P < 0.01) and the thickness of uterine walls and the number of corpus luteums (P < 0.05), and notably down-regulated expressions of GnRH, GPR54 and Kiss-1 mRNA in hypothalamus (P < 0.05), without significant impact on E2 in serum. Dabuyin Wan may inhibit GnRH synthesis and release as well as startup of hypothalamic-pituitary-gonadal axis by down-regulating Kiss-1/GPR54 mRNA expression in hypothalamus, in order to realize the therapeutic effect on true precocious puberty.

[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.

State of the Art in LP-WAN Solutions for Industrial IoT Services

PubMed Central

Sanchez-Iborra, Ramon; Cano, Maria-Dolores

2016-01-01

The emergence of low-cost connected devices is enabling a new wave of sensorization services. These services can be highly leveraged in industrial applications. However, the technologies employed so far for managing this kind of system do not fully cover the strict requirements of industrial networks, especially those regarding energy efficiency. In this article a novel paradigm, called Low-Power Wide Area Networking (LP-WAN), is explored. By means of a cellular-type architecture, LP-WAN–based solutions aim at fulfilling the reliability and efficiency challenges posed by long-term industrial networks. Thus, the most prominent LP-WAN solutions are reviewed, identifying and discussing the pros and cons of each of them. The focus is also on examining the current deployment state of these platforms in Spain. Although LP-WAN systems are at early stages of development, they represent a promising alternative for boosting future industrial IIoT (Industrial Internet of Things) networks and services. PMID:27196909

[A population survey of the Yi nationality in Meigu County, Sichuan Province].

PubMed

Wang, D; Zhang, G

1984-01-29

In 1980, 95.35% of the 129,819 inhabitants of Meigu County in Faxin District of the Jinshan Yi autonomous district, Sichuan Province, were of Yi nationality. Agriculture is the primary mode of production and animal husbandry is an important secondary industry. Prior to Liberation, slavery was an integral part of Yi society. The standard of living was low, mortality high, and population growth slow. After Liberation from 1956-1980, the population grew 47.1%, 90% of which was a natural increase. The primary reason for the growth was a post-1960s annual average birth rate of 46/1000 and a mortality rate that fell from 35/1000 before Liberation to 13.3/1000 in 1976. The age structure also became younger. The average age in 1964 was 24 years, with a median age of 21.8 years, as compared to a 1980 average age of 23.8 years and a median age of 17 years. 47.2% of the population were aged from birth to 14 years; 2.9% were over 65 years. At the same time, 28% of the female population were of childbearing age. By 2000 Meigu County's population will reach 259,000. Although the primary reasons for the relatively rapid population increase are due to the destruction of the slave system and a higher standard of living, factors peculiar to Yi society are also significant: 1) the destruction of the slave system permitted the population to grow without the restraints of strict codes of class stratification; 2) the high value placed on having many offsprings, and of favoring male children still prevails; 3) the attitude of early marriage and the custom of widows marrying a relative of her deceased husband still prevail; 4) and infant mortality and the mortality rate of fertile women have declined. Elements which influence the population development of Meigu County include economic factors such as the need to support the old and the young, or the inability to produce enough food to keep up with the needs of an expanding population.

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.

[Clinical observation on idiopathic tinnitus treated with acupuncture, buzhong yiqi tang and cizhu wan].

PubMed

Chen, Surong; Tan, Xuming; Fei, Lanbo; Xiang, Xiande

2018-04-12

To observe the differences in the clinical therapeutic effects on idiopathic tinnitus between the combined therapy with acupuncture and the modified formula of buzhong yiqi tang and cizhu wan and the simple administration of the modified formula of buzhong yiqi tang and cizhu wan . A total of 60 patients were randomized into a combined treatment group and an herbal medicine group, 30 cases in each one and 2 cases dropped out in the herbal medicine group. In the combined treatment group, acupuncture was given at the local acupoints for tinnitus, such as Yifeng (TE 17), penetrating needling technique from Ermen (TE 21) to Tinggong (SI 19) and Tinghui (GB 2) combined with the scalp acupuncture [the vertigo-auditory area, Baihui (GV 20)] and the oral administration of the modified formula of buzhong yiqi tang and cizhu wan . In the herbal medicine group, the oral administration of the modified formula of buzhong yiqi tang and cizhu wan was only applied. The treatment was given once a day in each group, 5 times a week for acupuncture and 7 times a week for the oral administration of herbal medicine. Totally, the treatment for 6 weeks was required in the two groups. Before and after treatment, the tinnitus severity score (TSS) and the score of tinnitus handicap inventory (THI) were observed and the clinical therapeutic effects were compared between the two groups. After treatment, the TSS and THI scores reduced as compared with those before treatment in the two groups (all P <0.05). The scores in the combined treatment group were lower than those in the herbal medicine group (both P <0.05). The total effective rate in the combined treatment group was 93.3% (28/30), better than 67.9% (19/28) in the herbal medicine group ( P <0.05). The combined treatment with scalp acupuncture, acupuncture around the ear and the modified formula of buzhong yiqi tang and cizhu wan achieve the superior therapeutic effects on idiopathic tinnitus as compared with the simple oral

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.

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

Association among activities of daily living, instrumental activities of daily living and health-related quality of life in elderly Yi ethnic minority.

PubMed

Ran, Lingyun; Jiang, Xiaodong; Li, Baogang; Kong, Hongqian; Du, Mengqi; Wang, Xiaolan; Yu, Hua; Liu, Qin

2017-03-22

The health-related quality of life (HRQoL) of the elderly population of Yi ethnic minority, which is the seventh largest nationality in China, has been rarely reported. This study was designed to explore the HRQoL of the elderly Yi ethnicity and association between their HRQOL and functional abilities. A total of 291 Yi ethnic residents were randomly recruited from 12 rural counties in Yunnan province and divided into different age groups. Local residents in Yunnan province and the elderly from Hangzhou were enrolled as controls. The MOS 36-Item Short Form Health Survey (SF-36), activities of daily living (ADL), instrumental activities of daily living (IADL) scales were utilized to evaluate the HRQoL and functional ability. One-way ANOVA was used to statistically compare the ADL and IADL among different age groups. The influential variables on HRQOL were analyzed by multiple linear regression analysis. Pearson correlation analysis was used to analyze the association among HRQoL, ADL and IADL. The HRQoL of the elderly Yi minority was significantly lower than those of local residents in Yunnan province and the elderly counterparts in Hangzhou. The IADL ability of the elderly Yi minority was low, whereas they could perform most items of ADL. ADL, IADL, and education level were positively associated with HRQoL, whereas age, chronic diseases, and the frequency of medication use were negatively correlated with HRQoL. The HRQoL and functional capacity of the elderly Yi ethnic minority were lower compared with their counterparts in Yunnan province and Hangzhou. The low level of IADL indicated that the elderly Yi participants had a high risk of cognitive impairment. Much attention should be diverted to influential factors of the HRQoL.

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.

Correlation between renin-angiotensin system gene polymorphisms and essential hypertension in the Chinese Yi ethnic group.

PubMed

Yang, Yu-Ling; Mo, Yan-Ping; He, Yong-Shu; Yang, Fang; Xu, Yan; Li, Cheng-Cheng; Wang, Jiao; Reng, Hao-Ming; Long, Li

2015-12-01

The renin-angiotensin system (RAS) has been considered to play an important role in the regulation of blood pressure. This study aimed to investigate the correlation between RAS gene polymorphisms and essential hypertension (EH) in the Chinese Yi ethnic group. A total of 244 EH subjects and 185 normotensive individuals from the Chinese Yi ethnic group were genotyped for AGT M235T (rs699), AT1R A1166C (rs5186), ACE I/D (rs4340) and ACE G2350A (rs4343) polymorphisms by the polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) method. Significant differences in the allele and genotype frequency of ACE G2350A were observed between the EH cases and controls (p=0.001, 0.002). After being grouped by gender, significant differences in the allele and genotype frequency of ACE G2350A and AT1R A1166C were observed between females of the EH cases and controls (ACE G2350A: p=0.000, 0.002; AT1R A1166C: p=0.008, 0.011). After excluding the influence of multifactorial interactions, the ACE G2350A polymorphism is significantly associated with the pathogenesis of EH in the Chinese Yi ethnic group (odds ratio (OR)=1.656, 95% confidence interval (CI) 1.807-2.524, p=0.019). The RAS-related ACE G2350A polymorphism is associated with the pathogenesis of EH in the Chinese Yi ethnic group. © The Author(s) 2015.

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.

[Effect of Xinling Wan in treatment of stable angina pectoris: a randomized, double-blinded, placebo parallel-controlled, multicenter trial].

PubMed

Gao, Jian-Wei; Gao, Xue-Min; Zou, Ting; Zhao, Tian-Meng; Wang, Dong-Hua; Wu, Zong-Gui; Ren, Chang-Jie; Wang, Xing; Geng, Nai-Zhi; Zhao, Ming-Jun; Liang, Qiu-Ming; Feng, Xing; Yang, Bai-Song; Shi, Jun-Ling; Hua, Qi

2018-03-01

To evaluate the effectiveness and safety of Xinling Wan on patients with stable angina pectoris, a randomized, double-blinded, placebo parallel-controlled, multicenter clinical trial was conducted. A total of 232 subjects were enrolled and randomly divided into experiment group and placebo group. The experiment group was treated with Xinling Wan (two pills each time, three times daily) for 4 weeks, and the placebo group was treated with placebo. The effectiveness evaluation showed that Xinling Wan could significantly increase the total duration of treadmill exercise among patients with stable angina pectoris. FAS analysis showed that the difference value of the total exercise duration was between experiment group (72.11±139.32) s and placebo group (31.25±108.32) s. Xinling Wan could remarkably increase the total effective rate of angina pectoris symptom score, and the analysis showed that the total effective rate was 78.95% in experiment group and 42.61% in placebo group. The reduction of nitroglycerin dose was (2.45±2.41) tablets in experiment group and (0.50±2.24) tablets in placebo group on the basis of FAS analysis. The decrease of symptom integral was (4.68±3.49) in experiment group and (3.19±3.31) in placebo group based on FAS analysis. Besides, Xinling Wan could decrease the weekly attack time and the duration of angina pectoris. PPS analysis results were similar to those of FAS analysis. In conclusion, Xinling Wan has an obvious therapeutic effect in treating stable angina pectoris, with a good safety and a low incidence of adverse event and adverse reaction in experiment group. Copyright© by the Chinese Pharmaceutical Association.

[Analysis of HLA-B locus gene polymorphism in Sichuan Yi ethnic group and Xinjiang Uygur ethnic group].

PubMed

Xu, Ming-Yan; Hong, Kun-Xue; Ma, Jun; Deng, Xiao-Ling; Li, Jun; Peng, Hong; Ruan, Yu-Hua; Qin, Guan-Ming; Zhang, Yuan-Zhi; Xing, Hui; Xu, Xiao-Hu; Shao, Yi-Ming

2006-08-01

The polymorphism of HLA-B alleles in Sichuan Yi and Xinjiang Uygur population was investigated using the PCR-SSP method. Twenty one alleles were detected in HLA-B loci in 106 Sichuan unrelated Yi healthy subjects. Of them, B*40, B*15 and B*51 were the most common alleles with an allele frequency of 0.1981, 0.1368, 0.1274, respectively; while B*47, B*44, B*18, B*57 and B*78 were the rare alleles with an allele frequency of 0.0189, 0.0142, 0.0094, 0.0047 and 0.0047, respectively. The distribution of HLA-B allele frequencies in Sichuan Yis was between Southern Han and Northern Han. In 110 Xinjiang unrelated healthy Uygur subjects, 27 alleles were detected in HLA-B loci. Of them, B*35 and B*51 were the most common alleles with an allele frequency of 0.1136 and 0.1136, respectively; while B*41, B*56 and B*78 were the rare alleles with a frequency of 0.0045, 0.0045 and 0.0091, respectively. Frequencies of "Caucasoid origin" HLA alleles such as B*08, B*35 and B*50 in Xinjiang Uygurs were higher than other ethnic groups in China. The result of chi2 tests showed that the distributions of HLA-B alleles in Yi and Uygur ethnic groups were in Hardy-Weinberg equilibrium. Heterozygosity (H), discrimination power (DP) and probability of paternity exclusion (EP) of HLA-B locus from Sichuan Yi ethnic group were computed to be 0.8977, 0.9661 and 0.8009; and those from Xinjiang Uygur ethnic group were 0.9372, 0.9857 and 0.8732. The data obtained in this study on the distributions of HLA-B alleles in the Sichuan Yi and Xinjiang Uygur population provide important group genetics information for forensic and paternity tests to estimate the frequency of a DNA profile in these two populations, and can be used in transplant matching, anthropological and disease association studies.

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

Patterns of Chinese medicine use in prescriptions for treating Alzheimer's disease in Taiwan.

PubMed

Lin, Shun-Ku; Yan, Sui-Hing; Lai, Jung-Nien; Tsai, Tung-Hu

2016-01-01

Certain Chinese medicine (CM) herbs and acupuncture may protect against Alzheimer's disease (AD). However, there is a lack of research regarding the use of CM in patients with AD. The aim of this study was to investigate CM usage patterns in patients with AD, and identify the Chinese herbal formulae most commonly used for AD. 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 between 1997 and 2008 in Taiwan. CM use and the top ten most frequently prescribed formulae for treating AD were assessed, including average formulae dose and frequency of prescriptions. Demographic characteristics, including sex, age and insurance level were examined, together with geographic location. Existing medical conditions with the behavioral and psychological symptoms of dementia, and medications associated with CM were also examined. Factors associated with CM use were analyzed by multiple logistic regressions. The cohort included 1137 newly diagnosed AD patients, who were given conventional treatment for AD between 1997 and 2008. Among them, 78.2 % also used CM treatments, including Chinese herbal remedies, acupuncture and massage manipulation. Female patients (aOR 1.57 with 95 % CI 1.16-2.13) and those living in urban areas (aOR 3.00 with 95 % CI 1.83-4.90 in the middle of Taiwan) were more likely to use CM. After adjusting for demographic factors, AD patients suffering from the behavioral and psychological symptoms of dementia were more likely to seek CM treatment than those with no symptoms (aOR 2.26 with 95 % CI 1.48-3.43 in patients suffering more than three symptoms). Bu-Zhong-Yi-Qi-Tang and Ji-Sheng-Shen-Qi-Wan were the two formulae most frequently prescribed by CM practitioners for treating AD. Most people with AD who consumed herbal products used supplement qi, nourish the blood, and quiet the heart spirit therapy as

[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.

IsoWAN: A NASA Science and Engineering Information and Services Framework

NASA Technical Reports Server (NTRS)

Korsmeyer, David J.; Chow, Edward T.; Conroy, Michael P.; Swanson, Keith (Technical Monitor)

2000-01-01

We believe that the next evolutionary step in supporting wide-area application and services delivery to customers is a network framework that provides for collocation of applications and services at distinct sites in the network, an interconnection between these sites that is performance optimized for these applications, and value-added services for applications. We use the term IsoWAN to describe an advanced, isolated network interconnect services framework that will enable applications to be more secure, and able to access and be in use in both local and remote environments. The main functions of an IsoWAN are virtual localization of application services, an application service interface, coordinated delivery of applications and associated data to the customer, and supporting collaborative application development for customers. An initial pilot network between three NASA Centers: Ames Research Center, the Jet Propulsion Laboratory, and Marshall Space Flight Center, has been built and its properties will be discussed.

Forensic characteristics and phylogenetic analyses of the Chinese Yi population via 19 X-chromosomal STR loci.

PubMed

He, GuangLin; Li, Ye; Zou, Xing; Li, Ping; Chen, PengYu; Song, Feng; Gao, Tianzhen; Liao, Miao; Yan, Jing; Wu, Jin

2017-09-01

The demographic characteristics and genetic polymorphism data of 56 Chinese nationalities or 31 administrative divisions in Chinese mainland have repeatedly been the genetic research hotspots. While most genetic studies focused on some particular Chinese populations based on autosomal or Y-chromosomal genetic markers, the forensic characteristics and phylogenetic analyses of the seventh largest Chinese population (Yi ethnicity) on the X-chromosomal genetic markers are scarce. Here, allele frequencies and forensic statistical parameters for 19 X-chromosomal short tandem repeat loci (DXS7424-DXS101, DXS6789-DXS6809, DXS7423-DXS10134, DXS10103-HPRTB-DXS10101, DXS10159-DXS10162-DXS10164, DXS10148-DXS10135-DXS8378, and DXS7132-DXS10079-DXS10074-DXS10075) of 331 Chinese Yi individuals were obtained. All 19 X-chromosomal short tandem repeat (STR) loci in females were consistent with the Hardy-Weinberg equilibrium test. A total of 214 alleles were identified with the corresponding allele frequencies spanned from 0.0019 to 0.6106. The combined PE, PDF, and PDM were 0.9999999214, 0.9999999999999999999993, and 0.9999999999998, respectively. The high combined MEC Krüger , MEC Kishida , MEC Desmarais , and MEC Desmarais Duo were achieved as 0.9999999617638, 0.9999999999971, 0.9999999999971, and 0.9999999931538, respectively. The findings suggested that the panel of 19 X-STR loci is highly polymorphic and informative in the Yi ethnic population and can be considered to be a powerful tool in forensic complex kinship identification. Population differentiation analyses among 12 populations indicated that significant differences in genetic structure were observed in between the Yi ethnicity and the Chinese Uyghur as well as Kazakh, and genetic homogeneity existed in similar ethno-origin or geographic origin populations.

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.

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.

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.

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.

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.

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...

Optimizing the ASC WAN: evaluating network performance tools for comparing transport protocols.

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

Lydick, Christopher L.

2007-07-01

The Advanced Simulation & Computing Wide Area Network (ASC WAN), which is a high delay-bandwidth network connection between US Department of Energy National Laboratories, is constantly being examined and evaluated for efficiency. One of the current transport-layer protocols which is used, TCP, was developed for traffic demands which are different from that on the ASC WAN. The Stream Control Transport Protocol (SCTP), on the other hand, has shown characteristics which make it more appealing to networks such as these. Most important, before considering a replacement for TCP on any network, a testing tool that performs well against certain criteria needsmore » to be found. In order to try to find such a tool, two popular networking tools (Netperf v.2.4.3 & v.2.4.6 (OpenSS7 STREAMS), and Iperf v.2.0.6) were tested. These tools implement both TCP and SCTP and were evaluated using four metrics: (1) How effectively can the tool reach a throughput near the bandwidth? (2) How much of the CPU does the tool utilize during operation? (3) Is the tool freely and widely available? And, (4) Is the tool actively developed? Following the analysis of those tools, this paper goes further into explaining some recommendations and ideas for future work.« less

[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.

Design and Smartphone-Based Implementation of a Chaotic Video Communication Scheme via WAN Remote Transmission

NASA Astrophysics Data System (ADS)

Lin, Zhuosheng; Yu, Simin; Li, Chengqing; Lü, Jinhu; Wang, Qianxue

This paper proposes a chaotic secure video remote communication scheme that can perform on real WAN networks, and implements it on a smartphone hardware platform. First, a joint encryption and compression scheme is designed by embedding a chaotic encryption scheme into the MJPG-Streamer source codes. Then, multiuser smartphone communications between the sender and the receiver are implemented via WAN remote transmission. Finally, the transmitted video data are received with the given IP address and port in an Android smartphone. It should be noted that, this is the first time that chaotic video encryption schemes are implemented on such a hardware platform. The experimental results demonstrate that the technical challenges on hardware implementation of secure video communication are successfully solved, reaching a balance amongst sufficient security level, real-time processing of massive video data, and utilization of available resources in the hardware environment. The proposed scheme can serve as a good application example of chaotic secure communications for smartphone and other mobile facilities in the future.

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

[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.

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

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

A remarkable new species of Nemoura (Plecoptera: Nemouridae) from Chuxiong Yi Autonomous Prefecture of Yunnan Province, China.

PubMed

Qian, Yu-Han; Xiao, Qian; Chen, Zhi-Teng; Du, Yu-Zhou

2018-01-24

A new species of the genus Nemoura, N. latilongispina sp. nov. from Chuxiong Yi Autonomous Prefecture of Yunnan Province, southwestern China is described and illustrated. The new species is characterized by ventral sclerite of epiproct extended laterally, forming upcurved plates fringed with long spines along upper margin, and by the strongly sclerotized, fork-shaped cercus.

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.

Partial AZFc duplications not deletions are associated with male infertility in the Yi population of Yunnan Province, China.

PubMed

Ye, Jun-jie; Ma, Li; Yang, Li-juan; Wang, Jin-huan; Wang, Yue-li; Guo, Hai; Gong, Ning; Nie, Wen-hui; Zhao, Shu-hua

2013-09-01

There are many reports on associations between spermatogenesis and partial azoospermia factor c (AZFc) deletions as well as duplications; however, results are conflicting, possibly due to differences in methodology and ethnic background. The purpose of this study is to investigate the association of AZFc polymorphisms and male infertility in the Yi ethnic population, residents within Yunnan Province, China. A total of 224 infertile patients and 153 fertile subjects were selected in the Yi ethnic population. The study was performed by sequence-tagged site plus/minus (STS+/-) analysis followed by gene dosage and gene copy definition analysis. Y haplotypes of 215 cases and 115 controls were defined by 12 binary markers using single nucleotide polymorphism on Y chromosome (Y-SNP) multiplex assays based on single base primer extension technology. The distribution of Y haplotypes was not significantly different between the case and control groups. The frequencies of both gr/gr (7.6% vs. 8.5%) and b2/b3 (6.3% vs. 8.5%) deletions do not show significant differences. Similarly, single nucleotide variant (SNV) analysis shows no significant difference of gene copy definition between the cases and controls. However, the frequency of partial duplications in the infertile group (4.0%) is significantly higher than that in the control group (0.7%). Further, we found a case with sY1206 deletion which had two CDY1 copies but removed half of DAZ genes. Our results show that male infertility is associated with partial AZFc duplications, but neither gr/gr nor b2/b3 deletions, suggesting that partial AZFc duplications rather than deletions are risk factors for male infertility in Chinese-Yi population.

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

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).

[A Study on the quotations in the Wu xing da yi (The Gist of Five Phases) cited from Nei jing (Inner Canon)].

PubMed

Wang, Zheng-Shan; Zhang, Qi-Cheng

2013-07-01

In the Wu xing da yi (The Gist of Five Phases), written by Xiao Ji of the Sui Dynasty, there were 9 quotations cited from Huang di nei jing (Inner Canon of Huangdi). By comparison with current version of Huang di nei jing, most of the descriptions are similar, yet still with some differences, such as yin-yang nature of the five zang visceras, the liver being the root of "pi ji", the spleen being the root of "cang lin" etc. Wu xing da yi epitomizes the books about yin-yang and five phases before the Sui Dynasty, while Xiao Ji's quotations from Huang di nei jing interpreted from the views of yin-yang and five phases, are different from the annotations of later ages.

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

[Research on maternal health behaviors for Yi-nationality women in poor rural areas based on the theory of reasoned action].

PubMed

Wu, Yuju; Hao, Gang; Sun, Shuai; Chen, Yuehui; Zhang, Rui; Liu, Qiaolan; Yang, Yang; Zhou, Huan

2015-08-01

To analyze the status of maternal health behaviors and it's risk factors for Yi-nationality women in poor rural areas of Sichuan province. In 2012, multi-stage stratified cluster sampling method was used to select 14 villages of two poor counties in Liangshan Yi-nationality autonomous prefecture Sichuan province. At least 10 women who have infants aged 0-12 months were selected in each simple villages, a total of 284. The structured questionnaire was developed on the basis of the theory of reasoned action. Yi-nationality female college students were trained as investigators. Research indicators included prenatal care rate, hospital delivery rate, postpartum examination rate, socio-demographic characteristics, maternal health care knowledge. χ² test was used to compare the differences of above indicators among different groups. The structural equation model were used to statistical analyze. In the 284 subject women, 51.7% (147/284) women owned more than 2 children, 41.6% (118/284) women were more than 30 years old, 87.3% (248/284) women were illiteracy. The prenatal care rate was 69.7% (197/284), the hospital delivery rate was 26.8% (76/284), and the postnatal check rate was 22.9% (65/284). The influence factors of maternal health behaviors included the number of children, age and education (χ² were 10.92, 13.24, 9.58; P values were 0.027, 0.004, 0.008, respectively).The structural equation model analysis results showed that the maternal health behaviors were directly or indirectly affected by subjective norms (β = 0.236, P < 0.001), women's cognition (β = 0.226, P = 0.020) and women's attitudes on maternal health behavior (β = 0.157, P = 0.001). Among subjective norms, women have high compliance to their husbands (β = 0.850, P < 0.001), their peers (β = 0.708, P < 0.001), and their mothers-in-law (β = 0.636, P < 0.001). There were still serious problems in maternal health behaviors for Yi-nationality women in poor rural areas. The main factors included

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.

Can Medical Herbs Stimulate Regeneration or Neuroprotection and Treat Neuropathic Pain in Chemotherapy-Induced Peripheral Neuropathy?

PubMed Central

Schröder, Sven; Beckmann, Kathrin; Franconi, Giovanna; Greten, Henry Johannes; Rostock, Matthias; Efferth, Thomas

2013-01-01

Chemotherapy-induced neuropathy (CIPN) has a relevant impact on the quality of life of cancer patients. There are no curative conventional treatments, so further options have to be investigated. We conducted a systematic review in English and Chinese language databases to illuminate the role of medical herbs. 26 relevant studies on 5 single herbs, one extract, one receptor-agonist, and 8 combinations of herbs were identified focusing on the single herbs Acorus calamus rhizoma, Cannabis sativa fructus, Chamomilla matricaria, Ginkgo biloba, Salvia officinalis, Sweet bee venom, Fritillaria cirrhosae bulbus, and the herbal combinations Bu Yang Huan Wu, modified Bu Yang Huan Wu plus Liuwei Di Huang, modified Chai Hu Long Gu Mu Li Wan, Geranii herba plus Aconiti lateralis praeparata radix , Niu Che Sen Qi Wan (Goshajinkigan), Gui Zhi Jia Shu Fu Tang (Keishikajutsubuto), Huang Qi Wu Wu Tang (Ogikeishigomotsuto), and Shao Yao Gan Cao Tang (Shakuyakukanzoto). The knowledge of mechanism of action is still limited, the quality of clinical trials needs further improvement, and studies have not yielded enough evidence to establish a standard practice, but a lot of promising substances have been identified. While CIPN has multiple mechanisms of neuronal degeneration, a combination of herbs or substances might deal with multiple targets for the aim of neuroprotection or neuroregeneration in CIPN. PMID:23983777

Evaluation of symptom, clinical chemistry and metabolomics profiles during Rehmannia six formula (R6) treatment: an integrated and personalized data analysis approach.

PubMed

van Wietmarschen, Herman A; van der Greef, Jan; Schroën, Yan; Wang, Mei

2013-12-12

Rehmannia Six Formula (R6, Chinese name is Liu Wei Di Huang Wan) is one of the most important classic Chinese medicine formula used to treat metabolic disorders related to aging. It was first reported in the Chinese medicine book titled 'Xiao Er Yao Zheng Zhi Jue by Qian Yi' (Chinese Song dynasty: 1035-1117). In modern times it is therefore often used to treat diabetes, pre-diabetes, fatigue and people with metabolic syndrome. The aim of this study is to measure changes in symptoms, clinical parameters and serum metabolite profiles during R6 treatment of human subjects with features of metabolic syndrome. Symptoms, clinical parameters and serum metabolites were measured before and after 4 and 8 weeks of R6 treatment. Nonlinear Principal Component Analysis was applied for the first time to conduct an integrated analysis of the three data sets. Correlation structures were compared before treatment and after 4 and 8 weeks of treatment. Additionally, a State Space Grid approach was used to study personalized changes in symptom profiles. The symptoms 'hectic fever' and 'spontaneous sweating' were found to be most relieved during R6 treatment. Most of the symptoms were less correlated with other variables after 8 weeks of R6 treatment. LDL-C, total cholesterol, systolic blood pressure and waist size were found to decrease during R6 treatment. Additionally, 10 of the 15 measured phosphatidylcholines were found to decrease. Personalized symptom profiles as described by Chinese medical terms show that most Yin deficiencies are addressed first by R6 treatment. However, in subjects with reduced or less Yin deficiency but which do have a substantial Qi deficiency a reduction of Qi deficiency is subsequently observed. R6 treatment was shown to improve the lipid profile indicating a reduction of cardiovascular risk. Additionally, the changes observed in correlation structure indicate a different angle of looking at treatment effects. Less strong correlations between symptoms and

Developments and applications of accelerator system at the Wakasa Wan Energy Research Center

NASA Astrophysics Data System (ADS)

Hatori, S.; Kurita, T.; Hayashi, Y.; Yamada, M.; Yamada, H.; Mori, J.; Hamachi, H.; Kimura, S.; Shimoda, T.; Hiroto, M.; Hashimoto, T.; Shimada, M.; Yamamoto, H.; Ohtani, N.; Yasuda, K.; Ishigami, R.; Sasase, M.; Ito, Y.; Hatashita, M.; Takagi, K.; Kume, K.; Fukuda, S.; Yokohama, N.; Kagiya, G.; Fukumoto, S.; Kondo, M.

2005-12-01

At the Wakasa Wan Energy Research Center (WERC), an accelerator system with a 5 MV tandem accelerator and a 200 MeV proton synchrotron is used for ion beam analyses and irradiation experiments. The study of cancer therapy with a proton beam is also performed. Therefore, the stable operation and efficient sharing of beam time of the system are required, based on the treatment standard. Recent developments and the operation status of the system put stress on the tandem accelerator operation, magnifying the problems.

Chinese herbal medicine (Ma Zi Ren Wan) for functional constipation: study protocol for a prospective, double-blinded, double-dummy, randomized controlled trial

PubMed Central

2013-01-01

Background Functional constipation is a common clinical complaint. Although the effectiveness of Ma Zi Ren Wan for alleviating functional constipation symptoms has been proven in a previous randomized placebo-controlled study, further evidence is needed to make clinical recommendations about Chinese herbal medicine. In particular, a comparison with conventional western medicine for functional constipation patients is needed. Methods/Design This is a prospective, double-blinded, double dummy, randomized, controlled trial. After a 2-week run-in period, eligible patients (Rome III) with excessive traditional Chinese medicine syndrome will randomly be assigned to the Chinese medicine arm (Ma Zi Ren Wan and western medicine placebo), western medicine arm (senna and Chinese medicine placebo) or placebo arm (Chinese medicine placebo and western medicine placebo). Patients will undergo an 8-week treatment and an 8-week follow-up. The primary outcome is the responder rate for complete spontaneous bowel movement (CSBM) during treatment. Patients with a mean increase of CSBM ≧1/week in comparison with their baselines are defined as responders. The secondary outcomes include responder rate during follow-up, changes of colonic transit as measured with radio-opaque markers, individual and global symptom assessments, and reported adverse effects. Discussion This study is the first study to compare a Chinese Herbal Medicine (Ma Zi Ren Wan) with a laxative that is commonly used in the clinical practice of western medicine, and with a placebo. This study will complete the investigation of Ma Zi Ren Wan for functional constipation, and should, therefore, suggest recommendations for clinical practice. Furthermore, the process of first conducting a systematic review, then implementing a dose determination study followed by a placebo-control trial, and finally, comparing traditional Chinese medicine with an active conventional medicine in a controlled trial can be a reference to other

Chinese herbal medicine (Ma Zi Ren Wan) for functional constipation: study protocol for a prospective, double-blinded, double-dummy, randomized controlled trial.

PubMed

Zhong, Linda L D; Cheng, Chung Wah; Chan, Yawen; Chan, King Hong; Lam, Ting Wa; Chen, Xiao Rui; Wong, Chi Tak; Wu, Justin C Y; Bian, Zhao Xiang

2013-11-04

Functional constipation is a common clinical complaint. Although the effectiveness of Ma Zi Ren Wan for alleviating functional constipation symptoms has been proven in a previous randomized placebo-controlled study, further evidence is needed to make clinical recommendations about Chinese herbal medicine. In particular, a comparison with conventional western medicine for functional constipation patients is needed. This is a prospective, double-blinded, double dummy, randomized, controlled trial. After a 2-week run-in period, eligible patients (Rome III) with excessive traditional Chinese medicine syndrome will randomly be assigned to the Chinese medicine arm (Ma Zi Ren Wan and western medicine placebo), western medicine arm (senna and Chinese medicine placebo) or placebo arm (Chinese medicine placebo and western medicine placebo). Patients will undergo an 8-week treatment and an 8-week follow-up. The primary outcome is the responder rate for complete spontaneous bowel movement (CSBM) during treatment. Patients with a mean increase of CSBM ≧1/week in comparison with their baselines are defined as responders. The secondary outcomes include responder rate during follow-up, changes of colonic transit as measured with radio-opaque markers, individual and global symptom assessments, and reported adverse effects. This study is the first study to compare a Chinese Herbal Medicine (Ma Zi Ren Wan) with a laxative that is commonly used in the clinical practice of western medicine, and with a placebo. This study will complete the investigation of Ma Zi Ren Wan for functional constipation, and should, therefore, suggest recommendations for clinical practice. Furthermore, the process of first conducting a systematic review, then implementing a dose determination study followed by a placebo-control trial, and finally, comparing traditional Chinese medicine with an active conventional medicine in a controlled trial can be a reference to other researches on Chinese medicine

Comparative effects of Yi Jin Jing versus Tai Chi exercise training on benign prostatic hyperplasia-related outcomes in older adults: study protocol for a randomized controlled trial.

PubMed

Liu, XiangYun; Huang, Guoyuan; Chen, Peijie; Li, Yong; Xiang, JiuLin; Chen, Ting; Wang, Ru

2016-07-16

Benign prostatic hyperplasia (BPH) and its associated lower urinary tract symptoms (LUTS) occur very commonly in older men. BPH and LUTS cause substantial physical and psychological impairment that could seriously affect the quality of late life and greatly cost the health-care systems. Current surgical and pharmacological therapies are expensive, may not effectively improve prostate function and health but cause adverse effects. There is an urgent need to find new and effective non-pharmacological preventions and treatments. Yi Jin Jing and Tai Chi are two common traditional Chinese mind-body exercises with different movements and techniques, but both emphasize regulating functional homeostasis and keeping whole body harmony. Yi Jin Jing and Tai Chi have not been studied much for potentially use in the treatment of BPH-related problems. The primary purpose of this protocol is to assess the effectiveness of Yi Jin Jing versus Tai Chi on the monographic and functional changes of prostate in older men. A prospective single-center randomized controlled trial will be conducted. A total of 150 old men (60-70 years old) will be recruited from the urban tertiary of Shanghai, China. Of these, 50 eligible participants will be randomly assigned to a control group and two intervention groups with either Yi Jin Jing or Tai Chi exercise training. They will undergo 30 minutes for each exercise for five times a week for 6 months. The primary outcomes are changes of signs and symptoms in BPH and lower urinary tract from baseline to post-intervention. The main secondary outcomes are exercise-induced effects on the circulating levels of estrogen and androgen. All the outcome measures will be assessed at baseline, immediately after the 6-month intervention, and at the 3-month post-intervention follow-up. This proposed study will be the first comparative randomized clinical trial to evaluate the effectiveness of Yi Jin Jing versus Tai Chi exercise on prostate health among older

Effects of electroacupuncture and electroacupuncture plus Tao Hong Si Wu Wan in treating primary dysmenorrhea.

PubMed

Miao, Edwin Yong; Miao, Miranda Yi-mo; Kildea, Daniel George; Lao, Yi-Wen

2014-02-01

This study investigated the efficacies of electroacupuncture and electroacupuncture combined with Tao Hong Si Wu Wan in treating primary dysmenorrhea and compared the results with those obtained using conventional medical treatment. One treatment group, group 1, was administered Tao Hong Si Wu Wan (2625 mg) while the other, group 2, was administered a placebo (2625 mg) twice daily for 3 months. Electroacupuncture was used in both treatment groups: two sessions per menstrual cycle for three menstrual cycles. The reference group, group 3, was administered ibuprofen, 600 mg, twice daily, for five menstrual cycles. Uses of the herb, placebo and ibuprofen were blinded. A ridit analysis was used for testing and interpreting the effects of treatment. Pain intensity was determined using a qualitative grading method in a blinded manner. The ridit scores in groups 1 and 2 were significantly higher than those in reference group immediately after treatment and three months later. Twelve months after the treatment, group 1 had a higher ridit score than group 2. In comparison to the reference group, groups 1 and 2 achieved better menstrual pain relief both immediately and 3 months after treatment. In addition, group 1 had better long-term pain relief than group 2. Copyright © 2014. Published by Elsevier B.V.

The Use and the Prescription Pattern of Traditional Chinese Medicine Among Urolithiasis Patients in Taiwan: A Population-Based Study.

PubMed

Lin, Po-Hung; Lin, Shun-Ku; Hsu, Ren-Jun; Cheng, Kuan-Chen; Liu, Jui-Ming

2016-01-01

To investigate the pattern of Traditional Chinese Medicine (TCM) usage for urolithiasis patients in Taiwan and to determine the most common Chinese herbal products used for urolithiasis. Retrospective review of urolithiasis patients treated with TCM treatment. One million randomly selected samples in the Taiwanese National Health Insurance Research Database between 1997 and 2008. Eighty-two thousand five hundred and fifty-one newly diagnosed urolithiasis patients. The correlation between TCM treatment, demographic factors, or medical conditions. A total of 62.6% of urolithiasis patients use TCM treatment. A younger age, female gender, polypharmacy, multiple comorbidities, and stone in the lower urinary tract result in a greater tendency to use TCM, after adjusting for demographic factors. Jia-Wei-Xiao-Yao-San Extract Powder and Ji-Sheng-Shen-Qi-Wan Extract Powder are the most frequently prescribed Chinese medicine formulae. This is the first study to examine the use of and the prescription pattern for TCM in urolithiasis patients using a random, national population-based sample. More than 62% of urolithiasis patients use TCM, and patients with polypharmacy, multiple comorbidities, and stone in the ureter are more likely to use TCM. The most frequently prescribed Chinese medicine formulae were Jia-Wei-Xiao-Yao-San Extract Powder and Ji-Sheng-Shen-Qi-Wan Extract Powder, which were reported to retard the progression of renal failure and alleviate flank pain or tenderness.

Guidelines on common cold for traditional Chinese medicine based on pattern differentiation.

PubMed

Jiao, Yang; Liu, Jianping; Jiang, Liangduo; Liu, Qingquan; Li, Xiaoli; Zhang, Shunan; Zhao, Baixiao; Wang, Tianfang

2013-08-01

To establish the guidelines on common cold treated with Traditional Chinese Medicine (TCM) in terms of pattern identification. The guidelines were formulated by using the basic patterns common cold in China Pharmacopeia integrated with findings from systematic literature review and the experts' consensus on the issue in question. Common cold was divided into four patterns in the guidelines. The medications were recommended respectively: Ganmaoqingre granule for wind-cold exterior syndrome, Yinqiaojiedu granule for wind-heat exterior syndrome, Huoxiangzhengqi Wan for summer-heat dampness exterior syndrome and Shensu Wan for wind-cold exterior syndrome accompanied with Qi deficiency. The guidelines were primarily derived from the practice experience of TCM and the experts' consensus. The process was not strictly evidence-based because of lacking enough clinical studies. Further refinement of the guidelines should be needed as more studies are available.

CoralWatch Data Analysis at Hoi Ha Wan Marine Park, Hong Kong

NASA Astrophysics Data System (ADS)

Lau, A.; Hodgson, P.

2015-12-01

CoralWatch is a conservation organization that is based at the University of Queensland in Australia. Their development of the "Coral Health Chart" standardized the colour of corals for the further investigation of coral health and bleaching. The location of this project is in the NE part of Hong Kong in New Territories. The location faces ShenZhen, a heavily industrialized city, which is known for its pollution of the Pearl River. This area is protected by the Hong Kong Government and the WWF since 1996.Human activities have caused large amounts of greenhouse gasses to be released into the atmosphere. Carbon dioxide has caused the global temperature to rise and made ocean waters more acidic due to ocean respiration. The ocean is a carbon sink for mankind and the effect of severe acidification is negatively affecting marine life. The increase of temperature diminishes the amount of diversity of marine life; the decreasing acidity of the water has eliminated many species of shellfish and sea anemone; the increase of marine exploitation has decreased the diversity of marine life. The release of toxic waste, mainly mercury, waste and plastic products has also polluted the oceans which negatively impact coral reefs and endanger marine life.The data has been collected by observing the colours and discolouration (bleaching) of the corals of approximately 40 colonies per month. The species of coral in Hoi Ha Wan include, Favites flexuosa, Goniopora columna,Leptastrea purpurea, Lithophyllon undulatum, Pavona decussata. and Platygyra acuta (AFCD,1). The evaluation of four years of coralwatch data has shown the bleaching of hard boulder corals in Hoi Ha Wan, Hong Kong, has halted and the reefs are being to show signs of regeneration. Local marine biologists credited the improved situation of the corals to protected status of the area.

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.

[Applying the Methodology and Practice of Microhistory: The Diary of a Confucian Doctor, Yi Mun-gǒn (1495-1567)].

PubMed

Shin, Dongwon

2015-08-01

Since microhistory's approach to the past is based on an understanding of and a sympathy for the concrete details of human lives, its area of interests overlaps with the history of medicine and medical humanities, which examine illness and health. If we put a specific region and society in a specific period under a microscope and increase the magnifying power, we can understand the numerous network connections among the body, illness management, and medicine and how multilayered were the knowledge and power applied to them. And this approach of using microhistory to illuminate medical history can be more effective than any other historical approach. This article focuses on Yi Mun-gǒn's extensive volumes of Mukchaeilgi (Mukchae's diary) in approaching medical history from the perspective of microhistory. Simply defined, this work is a Confucian scholar-doctor's diary. Its author, Yi Mun-gǒn, played the role of a Confucian doctor, although not professionally, during his 23-year exile, after serving in a high governmental office on the senior grade of the third court rank. Thanks to this extensive and detailed diary, we can now get adetailed andthorough picture of his medical practice in the Sǒngju region, 270 kilometers southeast of Seoul, where he was exiled. This article aims to understand the state of medical practice in the Sǒngju region in the 16thcentury through the"zoom-in" method adopted by microhistory. In particular, I will focus on the following three aspects:1) Yi Mun-gǒn's motivation for and method of medical study, 2)the character of Yi Mun-gǒn'spatient treatment as hwarin (the act of life-saving), and 3) the plural existence of various illness management methods, including pyǒngjǒm (divination of illness), sutra-chanting, exorcism, and ch'oje (ritual toward Heaven). All three aspects are closely related to Confucianism. First, Yi Mun-gǒn decided to acquire professional-level medical knowledge in order to practice the Confucian virtue of filial

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.

An Evaluation of Traffic Management at ISF Academy on Kong Sin Wan Road

NASA Astrophysics Data System (ADS)

Lu, M.

2016-12-01

The ISF Academy, a school with 1500 students, is located on Kong Sin Wan Road. The majority of students from the academy commute to school every morning by private cars, school buses and other public transportation. For the past few years, the school management team has been imposing traffic management regulations to alleviate and minimize traffic congestion in the nearby area. In spite of that, traffic management on Kong Sin Wan Road is fairly limited and inadequate, resulting in congestion at the start and finish of the school day. As a school, we are dedicated to reduce and mitigate the number of private cars and school buses, as well as to control carbon dioxide emissions from the variety of vehicles. In order to implement strategies to make improvements to the current traffic management system, we, as a school, aim to establish a systematic approach to calculate and model the number of private cars, EV cars, plug-in hybrids and school buses flowing near the ISF campus every day, and the number of students on each vehicle. According to the U.S Environmental Protection Agency (EPA), the average annual carbon dioxide emission for a typical passenger vehicle is 4.7 metric tons. By multiplying the average carbon dioxide emission by the number of cars coming to campus every morning, we will gain a better understanding of the amount of carbon dioxide emitted from school vehicles. To extend the research, we will design a survey to investigate and encourage carpooling between families and students who live close, in order to combat and relieve rising traffic congestion and minimize cars crowding the roads. The traffic study project will not only help the school community create a more environment-friendly campus, but also improve the traffic congestion around the school area.

An Enhanced LoRaWAN Security Protocol for Privacy Preservation in IoT with a Case Study on a Smart Factory-Enabled Parking System.

PubMed

You, Ilsun; Kwon, Soonhyun; Choudhary, Gaurav; Sharma, Vishal; Seo, Jung Taek

2018-06-08

The Internet of Things (IoT) utilizes algorithms to facilitate intelligent applications across cities in the form of smart-urban projects. As the majority of devices in IoT are battery operated, their applications should be facilitated with a low-power communication setup. Such facility is possible through the Low-Power Wide-Area Network (LPWAN), but at a constrained bit rate. For long-range communication over LPWAN, several approaches and protocols are adopted. One such protocol is the Long-Range Wide Area Network (LoRaWAN), which is a media access layer protocol for long-range communication between the devices and the application servers via LPWAN gateways. However, LoRaWAN comes with fewer security features as a much-secured protocol consumes more battery because of the exorbitant computational overheads. The standard protocol fails to support end-to-end security and perfect forward secrecy while being vulnerable to the replay attack that makes LoRaWAN limited in supporting applications where security (especially end-to-end security) is important. Motivated by this, an enhanced LoRaWAN security protocol is proposed, which not only provides the basic functions of connectivity between the application server and the end device, but additionally averts these listed security issues. The proposed protocol is developed with two options, the Default Option (DO) and the Security-Enhanced Option (SEO). The protocol is validated through Burrows⁻Abadi⁻Needham (BAN) logic and the Automated Validation of Internet Security Protocols and Applications (AVISPA) tool. The proposed protocol is also analyzed for overheads through system-based and low-power device-based evaluations. Further, a case study on a smart factory-enabled parking system is considered for its practical application. The results, in terms of network latency with reliability fitting and signaling overheads, show paramount improvements and better performance for the proposed protocol compared with the two

[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

Casual sex and concurrent sexual partnerships among young people from an Yi community with a high prevalence of HIV in China

PubMed Central

Yang, Yi; Luan, Rong-Sheng; Liu, Peng; Wu, Chun-Lin; Zhou, Ying; Chen, Wen

2012-01-01

Liangshan Prefecture in Sichuan province, China, has a high prevalence of HIV infection, which is reflective of a change in the mode of transmission from injection drug use (IDU) to heterosexual intercourse. However, few studies focus on HIV-related heterosexual risk behaviours among the majority Yi population. The objectives of this study were to explore the characteristics of an egocentric sexual network and estimate the prevalence of casual sexual behaviour. Yi villagers (n=108), aged 15–35 years, who reported having had sex within the previous year were interviewed as to their sexual behaviours and networks. In-depth interviews and focus group discussions provided supplementary information on sexual norms. Logistic regression analysis was used to calculate unadjusted odds ratios (ORs) and 95% confidence intervals (CIs). Most of the respondents reported having had casual sex at some time in their life, and 66.7% reported multiple sexual partnerships. Only 21.3% reported ever having used a condom. During the study year, a total of 137 partners were involved in 153 sexual partnerships. Among the reported sexual partnerships, 67.3% originated from a casual sexual relationship. For network members in components of size ≥3, 56.9% were involved in concurrent sexual partnerships. Having never been married (OR: 2.11; 95% CI: 1.03–4.33) and younger age (OR: 0.89; 95% CI: 0.83–0.95) were both associated with being in a component of size ≥3. Size (OR: 2.99; 95% CI: 1.17–7.66), pair (OR: 0.54; 95% CI: 0.39–0.74), the number of weak components of the egocentric sexual network (OR: 30.04; 95% CI: 6.47–139.46) and gender (OR: 0.19; 95% CI: 0.06–0.67) were all associated with being in concurrent sexual partnerships. HIV-related interventions for the Yi ethnic minority in Sichuan province must therefore address concurrent sexual partnerships and promote condom use. PMID:22683999

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

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.

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...

Prescription patterns of Chinese herbal products for post-surgery colon cancer patients in Taiwan.

PubMed

Chao, Te-Hsin; Fu, Pin-Kuei; Chang, Chiung-Hung; Chang, Shih-Ni; Chiahung Mao, Frank; Lin, Ching-Heng

2014-08-08

Traditional Chinese medicine (TCM) is commonly provided to cancer patients, however, the patterns of prescriptions for this type of medicine in Taiwan are unclear. This study aimed to evaluate the use of traditional Chinese medicine products in colon cancer patients post-surgery in Taiwan and to research patterns of TCM. This was a cross-sectional study of newly diagnosed colon cancer patients who received surgery between 2004 and 2008 identified from the National Health Insurance Research Database of Taiwan. The prescription patterns and reasons for the use of TCM for colon cancer were analyzed. The results showed that "symptoms, signs and ill-defined conditions" (23.3%) and diseases of the digestive system (16.9%) were the most common reasons for using Chinese herbal medicine. Xiang-sha-liu-jun-zi-tang (7.1%), Bu-zhong-yi-qi-tang (4.3%), Jia-wei-xiao-yao-san (4.1%), Shen-Ling-Bai-Zhu-San (3.7%), Ban-Xia-Xie-Xin-Tang (3.4%), Gui-pi-tang (2.4%), Ping-Wei-San (2.4%), Gan-Lu-Yin (2.0%), Bao-He-Wan (1.9%), and Zhen-Ren-Huo-Ming-Yin (1.8%) were the most commonly prescribed single Chinese herbal formulae (CHF) for colon cancer patients post-surgery. Hedyotis diffusa Willd (Bai Hua She She Cao) (5.1%) and Scutellaria barbata (Ban Zhi Lian )(4.8%) were the most commonly prescribed single Chinese herbs. This study identified patterns of TCM use in colon cancer patients post-surgery in Taiwan. The herbal ingredients were most commonly used for stimulate ghrelin secretion to increase food intake and had potential anti-tumor effect. However, further research is required to evaluate any beneficial effects which could identify leads for the development of new treatment strategies using TCM. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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.

[Plasma metabonomics of Guifu Dihuang Wan in the treatment of yang deficiency].

PubMed

Xiao, Ya; Jing, Yuan; Chen, Jie-Yu; Li, Fei; Cheng, Jing-Ru; Bi, Jian-Lu; Luo, Ren; Zhao, Xiao-Shan

2016-11-20

To assess the effect of Guifu Dihuang Wan (GFDHW) in the treatment of yang deficiency and explore the underlying molecular mechanism. Sixty-two participants without diseases were randomized into control group (n=31) and experimental group (n=31) and were given lifestyle intervention additional GFDHW treatment for a month. NMR technology was used for metabonomics analysis. Intervention with GFDHW resulted in significantly decreased conversion scores of yang deficiency in the experimental group compared with the control group (P<0.005). The concentrations of lactate, valine, proline, arginine and 3-hydroxybutyrate were increased in the plasma of yang-deficient subjects after lifestyle intervention. GFDHW treatment with lifestyle intervention significantly increased the concentrations of lactate, valine, proline, arginine and 3-hydroxybutyrate and also the levels of alanine, glutamine, alpha glucose, isoleucine, betaine and propylene glycol. GFDHW treatment improves yang deficiency possibly by increasing the concentrations of alanine, glutamine, alpha glucose, isoleucine, betaine and propylene glycol and promoting energy metabolism of the body.

Prevalence, awareness, medication, control, and risk factors associated with hypertension in Yi ethnic group aged 50 years and over in rural China: the Yunnan minority eye study.

PubMed

Chen, Lixing; Zong, Yuan; Wei, Tao; Sheng, Xun; Shen, Wei; Li, Jun; Niu, Zhiqiang; Zhou, Hua; Zhang, Yang; Yuan, Yuansheng; Chen, Qin; Zhong, Hua

2015-04-15

Hypertension is an important public health issue in China, but there are few studies examining hypertension in ethnic groups in Yunnan, China. This study, Yunnan Minority Eye Study (YMES), was initially designed to determine the prevalence and impact of eye diseases, including hypertension and diabetes mellitus. As a part of YMES, the prevalence, awareness, treatment, and control of hypertension and the associated risk factors among the Yi ethnic population in rural China are reported. A population-based survey was conducted in 2012 with adult participants over 50 from rural communities in Shilin Yi Autonomous County, Yunnan Province, located in southwest China. A random cluster sampling method was used to select a representative sample. The participants' blood pressure, height, weight, and waist circumference were measured. Hypertension was defined as mean systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, and/or current use of antihypertensive medications. A total of 2208 adults were assessed. The prevalence of hypertension was 38.5%, and the age- and gender-adjusted prevalence was 37.0%. The proportion of patients who were aware of their hypertension among those diagnosed with hypertension was 24.8%. Of those aware of having hypertension, 23.6% took antihypertensive drugs. Among all hypertensive patients, only 7.2% had controlled their hypertension (<140/90 mmHg). Risk factors for hypertension were older age, smoking, alcohol consumption, family history of high blood pressure, overweight, and obesity. Protective factors included being slim and higher education. Hypertension was highly prevalent among this population of the Yi ethnic group in China. The ratio of awareness, treatment, and control of hypertension were considerately low. Hypertension education and screening programs in rural China are recommended to improve the health status of this population.

[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.

RuHe DuiDai WanMei ZhuYi De XueSheng (Working with Perfectionist Students). ERIC Digest.

ERIC Educational Resources Information Center

Brophy, Jere

Perfectionist students are not satisfied with merely doing well or even with doing better than their peers. They are satisfied only if they have done a job perfectly. Problems associated with forms of perfectionism that focus on seeking success are relatively minor, but problems associated with forms of perfectionism that focus on avoiding failure…

Traditional Chinese medicine for stable angina pectoris via TCM pattern differentiation and TCM mechanism: study protocol of a randomized controlled trial.

PubMed

Zhang, Zhe; Zhang, Fan; Wang, Yang; Du, Yi; Zhang, Huiyong; Kong, Dezhao; Liu, Yue; Yang, Guanlin

2014-10-30

Stable angina pectoris is experienced as trans-sternal or retro-sternal pressure or pain that may radiate to the left arm, neck or back. Although available evidence relating to its effectiveness and mechanism are weak, traditional Chinese medicine is used as an alternative therapy for stable angina pectoris. We report a protocol of a randomized controlled trial using traditional Chinese medicine to investigate the effectiveness, mechanism and safety for patients with stable angina pectoris. This is a north-east Chinese, multi-center, multi-blinded, placebo-controlled and superiority randomized trail. A total of 240 patients with stable angina pectoris will be randomly assigned to three groups: two treatment groups and a control group. The treatment groups will receive Chinese herbal medicine consisting of Yi-Qi-Jian-Pi and Qu-Tan-Hua-Zhuo granule and Yi-Qi-Jian-Pi and Qu-Tan-Hua-Yu granule, respectively, and conventional medicine. The control group will receive placebo medicine in addition to conventional medicine. All 3 groups will undergo a 12-week treatment and 2-week follow-up. Four visits in sum will be scheduled for each subject: 1 visit each in week 0, week 4, week 12 and week 14. The primary outcomes include: the frequency of angina pectoris attack; the dosage of nitroglycerin; body limited dimension of Seattle Angina Questionnaire. The secondary outcomes include: except for the body limited dimension of SAQ, traditional Chinese medicine pattern questionnaire and so on. Therapeutic mechanism outcomes, safety outcomes and endpoint outcomes will be also assessed. The primary aim of this trial is to develop a standard protocol to utilize high-quality EBM evidence for assessing the effectiveness and safety of SAP via TCM pattern differentiation as well as exploring the efficacy mechanism and regulation with the molecular biology and systems biology. ChiCTR-TRC-13003608, registered 18 June 2013.

[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

[The innovation of warm disease theory in the Ming Dynasty before Wen yi lun On Pestilence].

PubMed

Zhang, Zhi-bin

2008-10-01

Some doctors of the Ming dynasty raised subversive doubts against the traditional viewpoints of "exogenous cold disease is warm-heat" before the emergence of Wen yi lun (On Pestilence), holding that warm-heat disease "is contracted in different seasons instead of being transformed from cold to warm and/or heat". The conception of the separation of warm-heat disease and exogenous cold disease had changed from obscure to clear. As the idea became clear, the recognition on the new affection of warm, heat, summer-heat, pestilent pathogen was formed, and the idea that the pathogens of summer-heat and warm entered the human body through the mouth and nostrils was put forward. The six-channel syndrome differentiation of warm disease and the five sweat-resolving methods in pestilence raised by the doctors of this period are the aspects of the differential diagnosis of syndrome and treatment in warm diseases, and deserve to be paid attention to.

[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.

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.

[Design and establishment of modern literature database about acupuncture Deqi].

PubMed

Guo, Zheng-rong; Qian, Gui-feng; Pan, Qiu-yin; Wang, Yang; Xin, Si-yuan; Li, Jing; Hao, Jie; Hu, Ni-juan; Zhu, Jiang; Ma, Liang-xiao

2015-02-01

A search on acupuncture Deqi was conducted using four Chinese-language biomedical databases (CNKI, Wan-Fang, VIP and CBM) and PubMed database and using keywords "Deqi" or "needle sensation" "needling feeling" "needle feel" "obtaining qi", etc. Then, a "Modern Literature Database for Acupuncture Deqi" was established by employing Microsoft SQL Server 2005 Express Edition, introducing the contents, data types, information structure and logic constraint of the system table fields. From this Database, detailed inquiries about general information of clinical trials, acupuncturists' experience, ancient medical works, comprehensive literature, etc. can be obtained. The present databank lays a foundation for subsequent evaluation of literature quality about Deqi and data mining of undetected Deqi knowledge.

PLA Naval Aviation Training and Operations

DTIC Science & Technology

2017-12-20

cr aft Ty p es,” Re n mi n H aij u n , 1 6 A pril 2 0 1 3, p. 3. 3 3 I bi d. 3 4 K o u Yo n g qi a n g, Li Yi mi n, a n d Li X u ef e n g, “ Ta k e...6 a e 4 d 0 d 6 c 1.s ht ml. C h e n Z h e, Z h u Weij u n, a n d Z h u Ya, “ Yo u n g Offi c ers a n d E nlist e d Pers o n n el i n a N ort h S e a...ct o b er 2 0 1 4 , p. 3. MI S SI O N S, O R G A NI Z A TI O N A L S T R U C T U R E, A N D T R AI NI N G ( 2 0 1 3- 1 5) 8 5 K o u Yo n g qi a n g

TaiWan Ionospheric Model (TWIM) prediction based on time series autoregressive analysis

NASA Astrophysics Data System (ADS)

Tsai, L. C.; Macalalad, Ernest P.; Liu, C. H.

2014-10-01

As described in a previous paper, a three-dimensional ionospheric electron density (Ne) model has been constructed from vertical Ne profiles retrieved from the FormoSat3/Constellation Observing System for Meteorology, Ionosphere, and Climate GPS radio occultation measurements and worldwide ionosonde foF2 and foE data and named the TaiWan Ionospheric Model (TWIM). The TWIM exhibits vertically fitted α-Chapman-type layers with distinct F2, F1, E, and D layers, and surface spherical harmonic approaches for the fitted layer parameters including peak density, peak density height, and scale height. To improve the TWIM into a real-time model, we have developed a time series autoregressive model to forecast short-term TWIM coefficients. The time series of TWIM coefficients are considered as realizations of stationary stochastic processes within a processing window of 30 days. These autocorrelation coefficients are used to derive the autoregressive parameters and then forecast the TWIM coefficients, based on the least squares method and Lagrange multiplier technique. The forecast root-mean-square relative TWIM coefficient errors are generally <30% for 1 day predictions. The forecast TWIM values of foE and foF2 values are also compared and evaluated using worldwide ionosonde data.

Recognition of dementia in ancient China.

PubMed

Liu, Jia; Wang, Lu-Ning; Tian, Jin-Zhou

2012-12-01

A search of previous records in the literatures was done to summarize the opinions for dementia in ancient China. The earliest description of dementia was traced in the Yellow emperor's internal classic, a book written 2000 years ago. Hua Tuo (AD 140-208) in Han Dynasty first denominated "dementia" in the book, Hua Tuo Shen Yi Mi Zhuan. The pathogenesis of dementia could be generalized as the insufficiency of Qi, a flowing energy; the stagnation of phlegm, a harmful liquid substance in the body; and the blood stasis, which were also regarded as therapeutic targets. Therefore, we can conclude that dementia has been recognized and investigated in traditional Chinese medicine, which is definitely before the industrial civilization era. Copyright © 2012 Elsevier Inc. All rights reserved.

[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.

The investigation of anti-inflammatory activity of Yi Guanjian decoction by serum metabonomics approach.

PubMed

Shui, Sufang; Cai, Xiaorong; Huang, Rongqing; Xiao, Bingkun; Yang, Jianyun

2017-01-30

Yi Guanjian (YGJ), one of the Chinese herbal medicines most commonly used in western countries, reported to possess significant anti-inflammatary effects that inhibit the process of inflammation. However, the mechanisms underlying its anti-inflammation effects remain largely unresolved. This study was aimed to investigate the anti-inflammatory activity of YGJ and to explore its potential anti-inflammatory mechanisms by serum metabonomics approach. An xylene-induced mouse right-ear-edema model was used as an inflammatory response in vivo model. Ear edema, prostaglandin E2 (PGE 2 ) and Tumor-Necrosis-Factor-alpha (TNF-α) were detected. Then, serum metabolic profiling was analyzed and pathway analysis performed on the biomarkers reversed after YGJ administration and further integration of metabolic networks. The results showed that YGJ alleviated ear edema and decreased serum PGE 2 and TNF-α levels. Fourteen biomarkers were screened, and the levels were all reversed to different degrees after YGJ administration. These biomarkers were mainly related to linoleic acid metabolism, taurine and hypotaurine metabolism, glyoxylate and dicarboxylate metabolism, glycine, serine and threonine metabolism and citrate cycle (TCA cycle). In metabolic networks, glycine and pyruvate were node molecules. This indicated that YGJ could significantly inhibit inflammatory response triggered by acute local stimulation and exerted anti-inflammatory activity mainly by regulating node molecules. Copyright © 2016 Elsevier B.V. All rights reserved.

NanoSIMS U-Pb dating of hydrothermally altered monazite: Constraints on the Timing of LaoZaiWan Carlin-type gold deposit in the golden triangle region, SW China

NASA Astrophysics Data System (ADS)

PI, Q.

2017-12-01

Abstract: Direct dating of Carlin-type Au deposits was restricted due to the absence of a geochronometer. Back-scattered electron (BSE) imaging and X-ray element mapping of monazite in gold-rich ore samples from the LaoZaiWan Au deposit in SW China, reveal the presence of distinct, high-Th cores surrounded by low-Th, inclusion-rich rims. The monazite grain is considered to be the product of fluid-aided coupled dissolution-reprecipitation during Au mineralization via prograde metamorphic reactions. We present results of in situ NonSIMS U-Pb dating applied to the rims of monazite . NonSIMS U-Pb age of hydrothermal monazite gave ages of 228 ± 9 Ma(2σ) and 230 ± 16 Ma(2σ) for LaoZaiWan Au deposit. These ages are interpreted as Au mineralization ages, which consistent with the Re-Os age of arsenopyite for JinYa Au deposit, the U-Pb age of rutile for and 40Ar-39Ar age of sericite for Zhesang Au deposit. We postulate that the formation of the Carlin-type Au deposits in the Golden Triangle region was triggered by the Indosinian Orogen, related to collision of the Indochina Block with South China Block.

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.

Screening bioactive quality control markers of QiShenYiQi dripping pills based on the relationship between the ultra-high performance liquid chromatography fingerprint and vascular protective activity.

PubMed

Zhuo, Limeng; Peng, Jingjing; Zhao, Yunli; Li, Dongxiang; Xie, Xiuman; Tong, Ling; Yu, Zhiguo

2017-10-01

Traditional Chinese medicine consists of complex phytochemical constituents. Selecting appropriate analytical markers of traditional Chinese medicine is a critical step in quality control. Currently, the combination of fingerprinting and efficacy evaluation is considered as a useful method for screening active ingredients in complex mixtures. This study was designed to develop an orthogonal partial least squares model for screening bioactive quality control markers of QishenYiqi dripping pills based on the fingerprint-efficacy relationship. First, the chemical fingerprints of 49 batches of QishenYiqi dripping pill samples were established by ultra-high performance liquid chromatography coupled with a photodiode array detector. Second, ultra-high performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry was exploited to systematically investigate the 36 copossessing fingerprint components in QishenYiqi dripping pills. The vascular protective activity of QishenYiqi dripping pills was determined by using a cell counting kit-8 assay. Finally, fingerprint-efficacy relationship was established by orthogonal partial least squares model. The results indicated that ten components exhibited strong correlation with vascular protective activity, and these were preliminarily screened as quality control markers. The present study provided a novel idea for the study of the pharmacodynamic material basis and quality evaluation of QishenYiqi dripping pills. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

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.

Effect of the traditional Chinese medicines Chan Su, Lu-Shen-Wan, Dan Shen, and Asian ginseng on serum digoxin measurement by Tina-quant (Roche) and Synchron LX system (Beckman) digoxin immunoassays.

PubMed

Chow, Leonard; Johnson, Myrtle; Wells, Alice; Dasgupta, Amitava

2003-01-01

Chan Su, Lu-Shen-Wan, Dan Shen, and Asian ginseng are traditionally used to treat a number of conditions, including cardiovascular disease. All of these traditional Chinese medicines exhibit cardioactive properties. Digoxin is a cardioactive drug with a narrow therapeutic range (0.8-1.9 ng/mL). A patient taking digoxin may also take these Chinese medicines for their cardiotonic effects. Moreover, the active components of these medicines that are responsible for cardiotonic effects bear structural similarities to digoxin. Therefore, we studied the potential interference of these Chinese medicines with two digoxin immunoassays--the Tina-quant (Roche Diagnostics) and the Beckman (Synchron LX system)--and compared the values with the fluorescence polarization immunoassay (FPIA; Abbott Laboratories). When very small amounts (2-5 microL) of aqueous extract of Chan Su or Lu-Shen-Wan were added to drug-free serum, we observed high digoxin-like immunoreactivity with the FPIA. In contrast, when ethyl acetate extract of Dan Shen or microliter amounts of ginseng extract were added to drug-free serum, we observed modest digoxin-like immunoreactivity with the FPIA, but no apparent digoxin activity with the Roche and Beckman digoxin immunoassays. When aliquots of a digoxin pool prepared from patients receiving digoxin were supplemented with these Chinese medicines, we observed the most significant interference with the FPIA. The presence of endogenous digoxin-like immunoreactive substances can have additive effects with these Chinese medicines and falsely increase apparent digoxin levels by the FPIA. On the other hand, the Roche and Beckman assays were free from interference from DLIS but showed significant interference from Chan Su and Lu-Shen-Wan. We conclude that the FPIA showed the most significant interference from all four of the Chinese medicines we studied. However, the Roche and Beckman assays showed no interference from two (Dan Shen and Asian ginseng) of the four

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.

Analysis of Chemical Constituents in Wuzi-Yanzong-Wan by UPLC-ESI-LTQ-Orbitrap-MS.

PubMed

Zou, Dixin; Wang, Jinfeng; Zhang, Bo; Xie, Suhua; Wang, Qing; Xu, Kexin; Lin, Ruichao

2015-12-01

Wuzi-Yanzong-Wan (WZYZW), a classical traditional Chinese medicine (TCM) prescription containing Fructus Lych, Semen Cuscutae (fried), Fructus Rubi, Fructus Schisandrae chinensis (steamed) and Semen Plantaginis (fried with salt), is widely used to treat impotence, sterility, spermatorrhea, premature ejaculation, lumbago and post-micturation dribble. However, the chemical profile of WZYZW has not been established yet. In this work, a rapid and sensitive method for systematically screening and identifying the chemical constituents of WZYZW in both positive and negative ion modes using Ultra-Performance LC coupled with ESI-linear ion trap-Orbitrap tandem mass spectrometry (UPLC-ESI-LTQ-Orbitrap-MS) has been developed. Based on the chromatographic and spectrometric data, and referring to the literature, we could tentatively identify 106 compounds, including organic acids, flavonoids, phenylpropanoids, alkaloids and terpenoids. Fourteen ingredients from Fructus Lych were identified, while 10 ingredients were from Semen Cuscutae (fried), 33 ingredients were from Fructus Rubi, 37 ingredients were from Fructus Schisandrae chinensis (steamed), and 20 ingredients were from Semen Plantaginis (fried with salt). The results may provide essential data for further quality control, pharmacological research and clinical evaluation of WZYZW. Furthermore, this study indicates the developed approach based on UPLC-ESI-LTQ-Orbitrap-MS is suitable for characterizing the chemical profiles of TCM prescriptions. This is the first report to provide a comprehensive analysis of the chemical constituents of WZYZW.

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

YI Kwang Su's Love and history records of modern hospital under the japanese colonial period.

PubMed

Lee, Byoung Hoon

2016-12-01

This article aims to evaluate and analyze the description of the modern hospital as history record, which appeared in YI Kwang Su's novel Love. This novel has mentioned in detail western style clinic, Bukgando Catholic hospital, tuberculosis sanitarium as its main space. Modern hospitals are depicted in the novel has a great significance in historical aspect as well as in literary aspect. The most data on modern hospital is laws, statistics and newspaper archives. These materials are a great help to understand the history and status of the modern hospital. Literary description here is important materials, that specific to reconstruct the appearance of the modern hospital at that time. Literary representations infuse life into the history record. In this regard, Love has special meaning in the history of Korean modern literature. Before anything else, doctor AN Bin's clinic as a first space of the novel vividly shows the reality of the Western style clinic and a general practitioner under the colonial period. The establishment of the hospital was based on 「Rules on private hospital」 declared by the Japanese Government General of Korea in 1919. According to this Rules, a private clinic's founder had to submit the documents to the director of police affairs, in which all the details were written. It included name of hospital, site location and size, floor plan of a nearby building, each size of patient's rooms, number of steps and emergency exit, bath, toilet, disinfecting room. AN Bin's clinic was a private hospital with the requirements in the rules. The descriptions of this clinic re-created real situation of private hospitals, specifically scale of hospital, interior space, conditions of patient's room at the time. The second modern hospital in the novel is Bukgando Catholic hospital. There is a lot more materials on medical activity and hospital of protestant churches than we thought. But we do not have a lot of information on catholic church's medical

Global Application of TaiWan Ionospheric Model to Single-Frequency GPS Positioning

NASA Astrophysics Data System (ADS)

Macalalad, E.; Tsai, L. C.; Wu, J.

2012-04-01

Ionospheric delay is one the major sources of error in GPS positioning and navigation. This error in both pseudorange and phase ranges vary depending on the location of observation, local time, season, solar cycle and geomagnetic activity. For single-frequency receivers, this delay is usually removed using ionospheric models. Two of them are the Klobuchar, or broadcast, model and the global ionosphere map (GIM) provided by the International GNSS Service (IGS). In this paper, a three dimensional ionospheric electron (ne) density model derived from FormoSat3/COSMIC GPS Radio Occultation measurements, called the TaiWan Ionosphere Model, is used. It was used to calculate the slant total electron content (STEC) between receiver and GPS satellites to correct the pseudorange single-frequency observations. The corrected pseudorange for every epoch was used to determine a more accurate position of the receiver. Observations were made in July 2, 2011(Kp index = 0-2) in five randomly selected sites across the globe, four of which are IGS stations (station ID: cnmr, coso, irkj and morp) while the other is a low-cost single-frequency receiver located in Chungli City, Taiwan (ID: isls). It was illustrated that TEC maps generated using TWIM exhibited a detailed structure of the ionosphere, whereas Klobuchar and GIM only provided the basic diurnal and geographic features of the ionosphere. Also, it was shown that for single-frequency static point positioning TWIM provides more accurate and more precise positioning than the Klobuchar and GIM models for all stations. The average %error of the corrections made by Klobuchar, GIM and TWIM in DRMS are 3.88%, 0.78% and 17.45%, respectively. While the average %error in VRMS for Klobuchar, GIM and TWIM are 53.55%, 62.09%, 66.02%, respectively. This shows the capability of TWIM to provide a good global 3-dimensional ionospheric model.

The Use of Herbal Medicine in Alzheimer's Disease—A Systematic Review

PubMed Central

dos Santos-Neto, Leopoldo Luiz; de Vilhena Toledo, Maria Alice; Medeiros-Souza, Patrícia; de Souza, Gustavo Almeida

2006-01-01

The treatments of choice in Alzheimer's disease (AD) are cholinesterase inhibitors and NMDA-receptor antagonists, although doubts remain about the therapeutic effectiveness of these drugs. Herbal medicine products have been used in the treatment of Behavioral and Psychological Symptoms of Dementia (BPSD) but with various responses. The objective of this article was to review evidences from controlled studies in order to determine whether herbs can be useful in the treatment of cognitive disorders in the elderly. Randomized controlled studies assessing AD in individuals older than 65 years were identified through searches of MEDLINE, LILACS, Cochrane Library, dissertation Abstract (USA), ADEAR (Alzheimer's Disease Clinical Trials Database), National Research Register, Current Controlled trials, Centerwatch Trials Database and PsychINFO Journal Articles. The search combined the terms Alzheimer disease, dementia, cognition disorders, Herbal, Phytotherapy. The crossover results were evaluated by the Jadad's measurement scale. The systematic review identified two herbs and herbal formulations with therapeutic effects for the treatment of AD: Melissa officinalis, Salvia officinalis and Yi-Gan San and BDW (Ba Wei Di Huang Wan). Ginkgo biloba was identified in a meta-analysis study. All five herbs are useful for cognitive impairment of AD. M. officinalis and Yi-Gan San are also useful in agitation, for they have sedative effects. These herbs and formulations have demonstrated good therapeutic effectiveness but these results need to be compared with those of traditional drugs. Further large multicenter studies should be conducted in order to test the cost-effectiveness of these herbs for AD and the impact in the control of cognitive deterioration. PMID:17173107

A prototype Infrastructure for Cloud-based distributed services in High Availability over WAN

NASA Astrophysics Data System (ADS)

Bulfon, C.; Carlino, G.; De Salvo, A.; Doria, A.; Graziosi, C.; Pardi, S.; Sanchez, A.; Carboni, M.; Bolletta, P.; Puccio, L.; Capone, V.; Merola, L.

2015-12-01

In this work we present the architectural and performance studies concerning a prototype of a distributed Tier2 infrastructure for HEP, instantiated between the two Italian sites of INFN-Romal and INFN-Napoli. The network infrastructure is based on a Layer-2 geographical link, provided by the Italian NREN (GARR), directly connecting the two remote LANs of the named sites. By exploiting the possibilities offered by the new distributed file systems, a shared storage area with synchronous copy has been set up. The computing infrastructure, based on an OpenStack facility, is using a set of distributed Hypervisors installed in both sites. The main parameter to be taken into account when managing two remote sites with a single framework is the effect of the latency, due to the distance and the end-to-end service overhead. In order to understand the capabilities and limits of our setup, the impact of latency has been investigated by means of a set of stress tests, including data I/O throughput, metadata access performance evaluation and network occupancy, during the life cycle of a Virtual Machine. A set of resilience tests has also been performed, in order to verify the stability of the system on the event of hardware or software faults. The results of this work show that the reliability and robustness of the chosen architecture are effective enough to build a production system and to provide common services. This prototype can also be extended to multiple sites with small changes of the network topology, thus creating a National Network of Cloud-based distributed services, in HA over WAN.

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.

[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.

The Core Pattern Analysis on Chinese Herbal Medicine for Sjögren's syndrome: A Nationwide Population-Based Study

PubMed Central

Chang, Ching-Mao; Chu, Hsueh-Ting; Wei, Yau-Huei; Chen, Fang-Pey; Wang, Shengwen; Wu, Po-Chang; Yen, Hung-Rong; Chen, Tzeng-Ji; Chang, Hen-Hong

2015-01-01

This large-scale survey aimed to evaluate frequencies and patterns of Chinese herbal medicine (CHM) used for Sjögren's syndrome (SS) in Taiwan by analyzing the National Health Insurance Research Database (NHIRD) for cases in which CHM was used as an alternative therapy to Western medicine for improving patients' discomforts. We analyzed cases of SS principal diagnosis (ICD-9:710.2) with a catastrophic illness certificate (CIC) in traditional Chinese medicine (TCM) outpatient clinics from three cohorts of the Longitudinal Health Insurance Database (LHID) in the NHIRD between 2002 and 2011. CHM prescription patterns for SS were evaluated from claimed visitation files and corresponding prescription files. There were 15,914 SS patients with CIC (SS/CIC), and we found only 130 SS/CIC cases visiting TCM clinics in LHID2000, 133 in LHID2005, and 126 in LHID2010. After removing duplicate data, 366 SS/CIC and 4,867 visits were analyzed. The 50–59 year age group showed the highest ratio (29.51%) in both women and men. “Qi-Ju-Di-Huang-Wan” and “Xuan-Shen” (Scrophularia ningpoensis Hemsl.) was the most commonly used formula and single herb, respectively. “Qi-Ju-Di-Huang-Wan, Gan-Lu-Yin, Xuan-Shen, Mai-Men-Dong (Ophiopogon japonicus (L. f.) Ker-Gawl.), and Sheng-Di-Huang (raw Rehmannia glutinosa Libosch)” were the core pattern prescriptions in treating SS/CIC. PMID:25923413

[Textual criticism and discrimination on the naming of"Five-abstention Soup of Medical Professional"from the Han-tomb of the Marquis of Haihun].

PubMed

Wang, Y R; Yuan, Y; Xu, C Q; Cao, L J; Wang, Y L; Huang, L Q

2017-05-28

A lacquer vessel with the inscription of Yi gong wu jin tang (Five-abstention Soup of Medical Profession) has been unearthed from the Han-tomb of Marquis of Haihun, in which"Five abstentions"is related to the incantations and abstention therapies prevalent in the Qin and Han Dynasties. The"Five-abstention Law"is the five rituals and methods during the process of practicing incantations and abstentions therapies including"keeping one's thinking ( cun si )","holding the breath( bi qi )","twirling eyes ( nian mu )","stepping after Yu's sample ( yu bu )"and"incanting and blessing ( zhou zhu )". The"Five-abstention Law"uses the medium"soup"to achieve the purpose of treatment."Soup"refers either to"decoction"or to"magic water". The lacquer vessel with the inscription"Five-abstention Soup of Medical professional"could be an instrument for implementing the process of practising the"Five-abstention Law", reflecting the historical facts that Liu He, the Marquis Haihun did accept the incantations and abstention therapies.

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

[Research on whole blending end-point evaluation method of Angong Niuhuang Wan based on QbD concept].

PubMed

Liu, Xiao-Na; Zheng, Qiu-Sheng; Che, Xiao-Qing; Wu, Zhi-Sheng; Qiao, Yan-Jiang

2017-03-01

The blending end-point determination of Angong Niuhuang Wan (AGNH) is a key technology problem. The control strategy based on quality by design (QbD) concept proposes a whole blending end-point determination method, and provides a methodology for blending the Chinese materia medica containing mineral substances. Based on QbD concept, the laser induced breakdown spectroscopy (LIBS) was used to assess the cinnabar, realgar and pearl powder blending of AGNH in a pilot-scale experiment, especially the whole blending end-point in this study. The blending variability of three mineral medicines including cinnabar, realgar and pearl powder, was measured by moving window relative standard deviation (MWRSD) based on LIBS. The time profiles of realgar and pearl powder did not produce consistent results completely, but all of them reached even blending at the last blending stage, so that the whole proposal blending end point was determined. LIBS is a promising Process Analytical Technology (PAT) for process control. Unlike other elemental determination technologies such ICP-OES, LIBS does not need an elaborate digestion procedure, which is a promising and rapid technique to understand the blending process of Chinese materia medica (CMM) containing cinnabar, realgar and other mineral traditional Chinese medicine. This study proposed a novel method for the research of large varieties of traditional Chinese medicines.. Copyright© by the Chinese Pharmaceutical Association.

Marine environmental impact assessment of abalone, Haliotis discus hannai, cage farm in Wan-do, Republic of Korea

NASA Astrophysics Data System (ADS)

Oh, Hyun-Taik; Jung, Rae-Hong; Cho, Yoon-Sik; Hwang, Dong-Woon; Yi, Yong-Min

2015-12-01

To assess the marine environmental impacts of abalone, Haliotis discus hannai, cage farms in Wan-do, we monitored the benthic environment on top of the sediment underneath cage farm stations and reference stations. We applied two methods for this assessment. One was the A- and B-investigation of the MOM system (Modeling-On fish farm-Monitoring) developed in Norway. The other was a general environmental monitoring method which is widely used. In this study, we found benthic animals in all samples that belonged to condition 1 which were based on group 1(presence of macrofauna) of the B-investigation method. The values of redox potential (group 2-pH, redox potential) in all samples were above +65 mV belonging to condition 1. Based on sensory results (group 3-gas, color, odor, thickness of deposits), five out of seven experiment samples showed condition 1 while stations 2 and 7 showed condition 2, which have been cultured for 10 years in semi-closed waters. As group 2 takes precedence over group 3, the level of the conditions for B-investigation results consequently showed condition 1 in all stations. We found that pollutants and trace metals in the sediment underneath cage farms were lower than the pollution standard. This led us to conclude that the environmental impacts of the cage farms in this study were not significant.

Uncovering the Mechanisms of Chinese Herbal Medicine (MaZiRenWan) for Functional Constipation by Focused Network Pharmacology Approach.

PubMed

Huang, Tao; Ning, Ziwan; Hu, Dongdong; Zhang, Man; Zhao, Ling; Lin, Chengyuan; Zhong, Linda L D; Yang, Zhijun; Xu, Hongxi; Bian, Zhaoxiang

2018-01-01

MaZiRenWan (MZRW, also known as Hemp Seed Pill) is a Chinese Herbal Medicine which has been demonstrated to safely and effectively alleviate functional constipation (FC) in a randomized, placebo-controlled clinical study with 120 subjects. However, the underlying pharmacological actions of MZRW for FC, are still largely unknown. We systematically analyzed the bioactive compounds of MZRW and mechanism-of-action biological targets through a novel approach called "focused network pharmacology." Among the 97 compounds identified by UPLC-QTOF-MS/MS in MZRW extract, 34 were found in rat plasma, while 10 were found in rat feces. Hierarchical clustering analysis suggest that these compounds can be classified into component groups, in which compounds are highly similar to each other and most of them are from the same herb. Emodin, amygdalin, albiflorin, honokiol, and naringin were selected as representative compounds of corresponding component groups. All of them were shown to induce spontaneous contractions of rat colonic smooth muscle in vitro . Network analysis revealed that biological targets in acetylcholine-, estrogen-, prostaglandin-, cannabinoid-, and purine signaling pathways are able to explain the prokinetic effects of representative compounds and corresponding component groups. In conclusion, MZRW active components enhance colonic motility, possibly by acting on multiple targets and pathways.

Uncovering the Mechanisms of Chinese Herbal Medicine (MaZiRenWan) for Functional Constipation by Focused Network Pharmacology Approach

PubMed Central

Huang, Tao; Ning, Ziwan; Hu, Dongdong; Zhang, Man; Zhao, Ling; Lin, Chengyuan; Zhong, Linda L. D.; Yang, Zhijun; Xu, Hongxi; Bian, Zhaoxiang

2018-01-01

MaZiRenWan (MZRW, also known as Hemp Seed Pill) is a Chinese Herbal Medicine which has been demonstrated to safely and effectively alleviate functional constipation (FC) in a randomized, placebo-controlled clinical study with 120 subjects. However, the underlying pharmacological actions of MZRW for FC, are still largely unknown. We systematically analyzed the bioactive compounds of MZRW and mechanism-of-action biological targets through a novel approach called “focused network pharmacology.” Among the 97 compounds identified by UPLC-QTOF-MS/MS in MZRW extract, 34 were found in rat plasma, while 10 were found in rat feces. Hierarchical clustering analysis suggest that these compounds can be classified into component groups, in which compounds are highly similar to each other and most of them are from the same herb. Emodin, amygdalin, albiflorin, honokiol, and naringin were selected as representative compounds of corresponding component groups. All of them were shown to induce spontaneous contractions of rat colonic smooth muscle in vitro. Network analysis revealed that biological targets in acetylcholine-, estrogen-, prostaglandin-, cannabinoid-, and purine signaling pathways are able to explain the prokinetic effects of representative compounds and corresponding component groups. In conclusion, MZRW active components enhance colonic motility, possibly by acting on multiple targets and pathways. PMID:29632490

Improved Survival With Integration of Chinese Herbal Medicine Therapy in Patients With Acute Myeloid Leukemia: A Nationwide Population-Based Cohort Study.

PubMed

Fleischer, Tom; Chang, Tung-Ti; Chiang, Jen-Huai; Sun, Mao-Feng; Yen, Hung-Rong

2017-06-01

Acute myeloid leukemia (AML) is the most deadly subtype of leukemia, and many patients with this disease seek other complementary therapies, one of which is Chinese medicine. We set out to provide reliable data regarding the benefit of Chinese herbal medicine (CHM) for AML patients, using mortality as the main outcome measure. We also characterized the herbal prescriptions of patients. Using the Taiwanese National Health Insurance Research Database, we performed a nationwide population-based cohort study among AML patients from 1997 to 2010. The Cox regression model was used to adjust for comorbidities and other variables, and the hazard ratios (HRs) of CHM users and non-CHM users were compared. After 1:1 matching, 498 patients were included into the study. The HR of the CHM group was 0.41 (95% CI = 0.26-0.65; P = .0001) compared with the non-CHM group. This decrease in HR was also shown to be dose dependent ( P < .001). The 3 single-herbs most commonly prescribed were Salvia miltiorrhiza (Dan Shen), Astragalus membranaceus (Huang Qi), and Spatholobus suberectus (Ji Xue Teng). The 3 mutli-herb products most commonly prescribed were Jia Wei Xiao Yao San, Gui Pi Tang, and Qi Ju Di Huang Wan. Prospective controlled clinical data is still needed, however, this study provides real-world data regarding the benefit AML patients may have from CHM. This study suggests that all AML patients, regardless of age or other prognostic factors, may achieve longer survival times when receiving CHM in addition to standard therapy.

Evaluation of the feasibility of security technologies in teleradiology as biometric fingerprint scanners for data exchange over a satellite WAN

NASA Astrophysics Data System (ADS)

Soegner, Peter I.; Helweg, Gernot; Holzer, Heimo; zur Nedden, Dieter

2000-05-01

We evaluated the feasibility of fingerprint-scanners in combination with smart cards for personal identification and transmission of encrypted TCP/IP-data-packages via satellite between the university-hospital of Innsbruck and the rural hospital of Reutte. The aim of our study was the proof of the userfriendliness of the SkymedTM technology for security purpose in teleradiology. We examined the time of the personal identification process, the time for the necessary training and the personal satisfaction. The images were sent from the local PACS in Reutte via a Data-Encryption-and-Transmission- Box via satellite from Reutte to Innsbruck. We used an asymmetric bandwidth of 512 kbit/s from Reutte to Innsbruck and 128 kbit/s in the opposite direction. Window NT 4.0- operating PCs were used for the electronical patient record, the medical inquiry of the referring physician and the final report of the radiologist. The images were reported on an UNIX-PACS viewing station. After identification through fingerprint-scanners in combination with the smart card the radiologist was able to open the electronic patient record (EPR) from Reutte and sign with his digital signature his confirmed final report before it was send back to Reutte. The used security technology enables encrypted communication over a WAN, which fulfill data-protection.

Variations in Volatile Oil Yield and Composition of "Xin-yi" (Magnolia biondii Pamp. Flower Buds) at Different Growth Stages.

PubMed

Hu, Mingli; Bai, Mei; Ye, Wei; Wang, Yaling; Wu, Hong

2018-06-01

Dried flower buds of Magnolia biondii Pamp. are the main ingredient in "Xin-yi" in China, and the volatile oils of M. biondii flower buds are the principal medicinal component. Gas chromatographymass spectrometry (GC-MS) and microscopic techniques were employed to detect the volatile yields of M. biondii flowers at various growth stages. The volatile oil yields of M. biondii flowers differed significantly at different growth stages and were closely related to flower dry weight, oil cell density and degree of oil accumulation. In February 2016, flower buds had the highest dry weight, the maximum percentage of oil cells at the oil saturation stage and the highest density of oil cells, which coincided with the highest oil yield. In March 2016, flower buds had a lower dry weight, a higher percentage of oil cells at the oil-degrading stage and the lowest oil cell density, resulting in decreased oil yields. The total amounts of the major medicinal components in the M. biondii flower also showed regular changes at different growth stages. In January and February of 2016, M. biondii flowers had a higher dry weight, volatile oil yield and total content of medicinal ingredients, which was the best time for harvesting high-quality medicinal components. Our study reveals that volatile oil content and chemical composition are closely related to the growth stage of M. biondii flower buds. The results provide a scientific morphology and composition index for evaluating the medicinal value and harvesting of high-quality M. biondii medicinal herbs.

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.

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).

Treatment of Goiter with Traditional Chinese Medicine Regimen Xing Qi Hua Ying Tang: A Clinical Study on 72 Patients with Multinodular and Diffuse Goiter.

PubMed

Yang, Ming-Li; Lu, Bo

2018-04-01

The present work aimed to further explore the therapeutic potential of Xing Qi Hua Ying Tang (XQHYT) by conducting a systemic clinical study in patients with goiter. Seventy-two patients with either multinodular or diffuse goiter were enrolled and randomly assigned into treatment group receiving XQHYT (n = 36) and control group receiving Hai Zao Yu Hu Tang (n = 36). Traditional Chinese Medicine Hospital of Shanxi. Patients were diagnosed multinodular goiter or diffuse goiter resulting from Qi stagnation. All patients took the extract twice a day (100 mL each time) for two courses of treatment, of which a single course lasted for 3 months. Before the treatment was commenced and after the completion of the treatment, general body checks, thyroid function test, and goiter size examination were performed. Scoring of the clinical symptoms using Chinese medicine symptomatology was also done. The symptom score of the treatment group was significantly lower than that of the control group (treatment group, 8.26 ± 2.62; control group, 10.02 ± 2.62; p < 0.05). Substantial reduction in goiter size was seen in 82.3% of XQHYT-treated patients, whereas in the control group only 67.7% of patients exhibited constricted goiter. When assessed by both the Chinese medicine criteria and goiter size, the overall effective rate of the treatment group was 91.2%, whereas that of the control group was only 67.7%. The difference was statistically significant (p < 0.05). XQHYT did not affect the normal functions of liver, kidney, and heart. For both groups of patients, their levels of thyroid-stimulating hormone, free T4 and free T3 were normal before the treatment, and were not affected by the treatment. XQHYT was shown to be a promising therapeutic regimen for the treatment of goiter. The herbal regimen ameliorated clinical symptoms of patients that were accompanied with reduction in the size of goiter.

[Textual research on Guang dong xin yu (New Sayings of Guangdong) quoted in Ben cao gang mu shi yi (Supplements to Compendium of Materia Medica].

PubMed

Zhang, Ruixian; Zhang, Wei; Li, Jian; Liang, Fei

2014-05-01

Altogether 15 terms for Guang dong xin yu (New Sayings of Guangdong) were used in Ben cao gang mu shi yi (Supplements to Compendium of Materia Medica), including Yue yu (Cantonese sayings), Chong yu (Sayings from Insect Drug), Jie yu (Sayings from Crustacean Drug), Xin yu (New Sayings), Yue hai xiang yu (Fragrant Sayings from Cantonese Region), Yue zhi mu yu (Sayings from Plants in Cantonese Annals), Guang dong suo yu (Trivial Sayings from Guangdong), Yue shan lu (Records of Cantonese Mountains), Yue lu (Cantonese Records), Jiao guang lu (Joint Guangdong Records), Yue cao zhi (Records of Cantonese Grasses), Guang guo lu (Records of Guangdong Fruits), Nan yue suo ji (Trivial Records of Southern Canton), Guang zhi (Guangdong Records), Yue zhi (Cantonese Records) etc. dealing with 57 sorts of drugs (with individual overlapping ones), the author of Xin yu was Qu Dajun, a surviving fogy of the Ming Dynasty actively involved in the activities to restore the old dynasty and resist the Qing Dynasty, and was persecuted in the literary inquisition in which his works were burnt so that Zhao Xuemin, when quoting his texts, had to go in a roundabout way.

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

Searching for Synergistic Bronchodilators and Novel Therapeutic Regimens for Chronic Lung Diseases from a Traditional Chinese Medicine, Qingfei Xiaoyan Wan

PubMed Central

Hou, Yuanyuan; Cheng, Binfeng; Zhou, Mengge; Fang, Runping; Jiang, Min; Hou, Wenbin; Bai, Gang

2014-01-01

Classical Chinese pharmacopeias describe numerous excellent herbal formulations, and each prescription is an outstanding pool of effective compounds for drug discovery. Clarifying the bioactivity of the combined mechanisms of the ingredients in complex traditional Chinese medicine formulas is challenging. A classical formula known as Qingfei Xiaoyan Wan, used clinically as a treatment for prevalent chronic lung disease, was investigated in this work. A mutually enhanced bioactivity-guided ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC/Q-TOF-MS) characterization system was proposed, coupled with a dual-luciferase reporter assay for β2AR-agonist cofactor screening. Arctiin, arctigenin, descurainoside and descurainolide B, four lignin compounds that showed synergistic bronchodilation effects with ephedrine, were revealed. The synergistic mechanism of arctigenin with the β2ARagonist involved with the reduction of free Ca2+ was clarified by a dual-luciferase reporter assay for intracellular calcium and the Ca2+ indicator fluo-4/AM to monitor changes in the fluorescence. The relaxant and contractile responses of airway smooth muscle are regulated by crosstalk between the intracellular cAMP and calcium signaling pathways. Our data indicated the non-selective βAR agonist ephedrine as the principal bronchodilator of the formula, whereas the lignin ingredients served as adjuvant ingredients. A greater understanding of the mechanisms governing the control of these pathways, based on conventional wisdom, could lead to the identification of novel therapeutic targets or new agents for the treatment of asthma and COPD. PMID:25397687

Identification of the chemical constituents of Chinese medicine Yi-Xin-Shu capsule by molecular feature orientated precursor ion selection and tandem mass spectrometry structure elucidation.

PubMed

Wang, Hong-ping; Chen, Chang; Liu, Yan; Yang, Hong-Jun; Wu, Hong-Wei; Xiao, Hong-Bin

2015-11-01

The incomplete identification of the chemical components of traditional Chinese medicinal formula has been one of the bottlenecks in the modernization of traditional Chinese medicine. Tandem mass spectrometry has been widely used for the identification of chemical substances. Current automatic tandem mass spectrometry acquisition, where precursor ions were selected according to their signal intensity, encounters a drawback in chemical substances identification when samples contain many overlapping signals. Compounds in minor or trace amounts could not be identified because most tandem mass spectrometry information was lost. Herein, a molecular feature orientated precursor ion selection and tandem mass spectrometry structure elucidation method for complex Chinese medicine chemical constituent analysis was developed. The precursor ions were selected according to their two-dimensional characteristics of retention times and mass-to-charge ratio ranges from herbal compounds, so that all precursor ions from herbal compounds were included and more minor chemical constituents in Chinese medicine were identified. Compared to the conventional automatic tandem mass spectrometry setups, the approach is novel and can overcome the drawback for chemical substances identification. As an example, 276 compounds from the Chinese Medicine of Yi-Xin-Shu capsule were identified. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

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

Extractable organic matter in PM10 from LiWan district of Guangzhou City, PR China.

PubMed

Bi, Xinhui; Sheng, Guoying; Peng, Peng an; Zhang, Zhiqiang; Fu, Jiamo

2002-12-02

PM10 (particulate matter with aerodynamic diameter <10 microm) samples were collected at LiWan District of Guangzhou, PR China during April and July 2001 using a high volume air sampler to determine the distributions of homologous compounds and biomarkers. Polycyclic aromatic hydrocarbons (PAHs) including non-alkylated PAHs, methyl-alkylated PAHs, and some PAHs containing S/O atoms and n-alkanes were measured using gas chromatography/mass spectrometry analysis. The sigma(n)-alkane and sigmaPAHs ranged from 26.4 to 719.2 ng/m3 and 7.4 to 159.4 ng/m3, respectively. A seasonal fluctuation was clearly evident with higher concentrations occurring during the colder months (April). In addition, some compositional differences are observed for the organic compounds in samples collected from different heights above ground level. Higher sites had a significant contribution from vascular plant wax. The presence of petroleum products with no carbon number preference, pristane, phytane and a significant unresolved complex mixture (UCM) with unresolved to resolved components ratio (U/R) of 6.2-13.2 confirm the petroleum component. The relative distribution of n-alkanes and the values of molecular diagnostic ratio, such as carbon preference index (CPI) values ranging from 1.0 to 1.4 (for the whole range of n-alkanes), indicated the importance of petroleum and diesel residues and gasoline emissions, as well as the minor contribution of n-alkanes emitted directly from epicuticular waxes. Indeed, the percent contribution of leaf 'wax' n-alkanes (5.2-19.4%) indicated a low contribution of biogenic sources. The fossil fuel biomarkers, hopanes and steranes were observed in the PM10 samples, which indicate a petroleum origin. The distribution pattern of PAHs was characteristic of anthropogenic emissions. Coupling carbon number maximum (Cmax), CPI, U/R values, molecular marker and molecular diagnostic ratios for alkanes and PAHs revealed a classification of natural biogenic and

Sensitive and reliable multianalyte quantitation of herbal medicine in rat plasma using dynamic triggered multiple reaction monitoring.

PubMed

Yan, Zhixiang; Li, Tianxue; Lv, Pin; Li, Xiang; Zhou, Chen; Yang, Xinghao

2013-06-01

There is a growing need both clinically and experimentally to improve the determination of the blood levels of multiple chemical constituents in herbal medicines. The conventional multiple reaction monitoring (cMRM), however, is not well suited for multi-component determination and could not provide qualitative information for identity confirmation. Here we apply a dynamic triggered MRM (DtMRM) algorithm for the quantification of 20 constituents in an herbal prescription Bu-Zhong-Yi-Qi-Tang (BZYQT) in rat plasma. Dynamic MRM (DMRM) dramatically reduced the number of concurrent MRM transitions that are monitored during each MS scan. This advantage has been enhanced with the addition of triggered MRM (tMRM) for simultaneous confirmation, which maximizes the dwell time in the primary MRM quantitation phase, and also acquires sufficient MRM data to create a composite product ion spectrum. By allowing optimized collision energy for each product ion and maximizing dwell times, tMRM is significantly more sensitive and reliable than conventional product ion scanning. The DtMRM approach provides much higher sensitivity and reproducibility than cMRM. Copyright © 2013 Elsevier B.V. All rights reserved.

Urine metabolic profile changes of CCl4-liver fibrosis in rats and intervention effects of Yi Guan Jian Decoction using metabonomic approach

PubMed Central

2013-01-01

Background Yi Guan Jian Decoction (YGJD), a famous Chinese prescription, has long been employed clinically to treat liver fibrosis. However, as of date, there is no report on the effects of YGJD from a metabonomic approach. In this study, a urine metabonomic method based on gas chromatography coupled with mass spectrometry (GC/MS) was employed to study the protective efficacy and metabolic profile changes caused by YGJD in carbon tetrachloride (CCl4)-induced liver fibrosis. Methods Urine samples from Wistar rats of three randomly divided groups (control, model, and YGJD treated) were collected at various time-points, and the metabolic profile changes were analyzed by GC/MS with principal component analysis (PCA) and partial least squares-discriminate analysis (PLS-DA). Furthermore, histopathology and biochemical examination were also carried out to ensure the success of CCl4-induced liver fibrosis model. Results Urine metabolic profile studies suggested distinct clustering of the three groups, and YGJD group was much closer to the control group by showing a tendency of recovering towards the control group. Fourteen significantly changed metabolites were found, and YGJD treatment could reverse the levels of these metabolites to normal levels or close to normal levels. Conclusions The current study indicates that the YGJD has significant anti-fibrotic effects on CCl4-induced liver fibrosis in rats, which might be by regulating the dysfunction of energy metabolism, amino acid metabolism, tryptophan metabolism, cytochrome P450 metabolism, and gut microflora metabolism. The metabonomic approach can be recommended to study the pharmacological effect and mechanism of complex Chinese medicines. PMID:23725349

Contamination and Human Health Risk Assessment of Polycyclic Aromatic Hydrocarbons (PAHs) in Oysters After the Wu Yi San Oil Spill in Korea.

PubMed

Loh, Andrew; Yim, Un Hyuk; Ha, Sung Yong; An, Joon Geon; Kim, Moonkoo

2017-07-01

After the collision of the Singapore-registered oil tanker M/V Wu Yi San into the oil terminal of Yeosu, Korea on January 31, 2014, approximately 900 m 3 of oil and oil mixture were released from the ruptured pipelines. The oil affected more than 10 km of coastline along Gwangyang Bay. Emergency oil spill responses recovered bulk oil at sea and cleaned up the stranded oil on shore. As part of an emergency environmental impact assessment, region-wide monitoring of oil contamination in oyster had been conducted for 2 months. Highly elevated concentrations of polycyclic aromatic hydrocarbons (PAHs) were detected at most of the spill affected sites. Four days after the spill, the levels of PAHs in oysters increased dramatically to 627-81,000 ng/g, the average of which was 20 times higher than those found before the spill (321-4040 ng/g). The level of PAHs in these oysters increased until 10 days after the spill and then decreased. Due to the strong tidal current and easterly winter winds, the eastern part of the Bay-the Namhae region-was heavily contaminated compared with other regions. The accumulation and depuration of spilled oil in oyster corresponded with the duration and intensity of the cleanup activities, which is the first field observation in oil spill cases. Human health risk assessments showed that benzo[a]pyrene equivalent concentrations exceeded levels of concern in the highly contaminated sites, even 60 days after the spill.

Frederick Yi-Tung Cho (1939-2011) : His PhD days in Biophysics, the Photosynthesis Lab, and his patents in engineering physics.

PubMed

Govindjee; Munday, John C; Papageorgiou, George C

2017-06-01

We present here a Tribute to Frederick Yi-Tung Cho (1939-2011), an innovative and ingenious biophysicist and an entrepreneur. He was one of the 4 earliest PhD students [see: Cederstrand (1965)-Carl Nelson Cederstrand; coadvisor: Eugene Rabinowitch; Papageorgiou (1968)-George C. Papageorgiou (coauthor of this paper); and Munday (1968)-John C. Munday Jr. (also a coauthor of this paper)] of one of us (Govindjee) in Biophysics at the University of Illinois at Urbana-Champaign (UIUC) during the late 1960s (1963-1968). Fred was best known, in the photosynthesis circle for his pioneering work on low temperature (down to liquid helium temperature, 4 K) absorption and fluorescence spectroscopy of photosynthetic systems; he showed temperature independence of excitation energy transfer from (i) chlorophyll (Chl) b to Chl a and (ii) from Chl a 670 to Chl a 678; and temperature dependence of energy transfer from the phycobilins to Chl a and from Chl a 678 to its suggested trap. After doing research in biophysics of photosynthesis, Fred shifted to do research in solid-state physics/engineering in the Government Electronics Division (Group) of the Motorola Company, Scottsdale, Arizona, from where he published research papers in that area and had several patents granted. We focus mainly on his days at the UIUC in context of the laboratory in which he worked. We also list some of his papers and most of his patents in engineering physics. His friends and colleagues have correctly described him as an innovator and an ingenious scientist of the highest order. On the personal side, he was a very easy-going and amiable individual.

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

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.

YiXin-Shu, a ShengMai-San-based traditional Chinese medicine formula, attenuates myocardial ischemia/reperfusion injury by suppressing mitochondrial mediated apoptosis and upregulating liver-X-receptor α.

PubMed

Zhao, Yichao; Xu, Longwei; Qiao, Zhiqing; Gao, Lingchen; Ding, Song; Ying, Xiaoying; Su, Yuanyuan; Lin, Nan; He, Ben; Pu, Jun

2016-03-11

Positive evidence from clinical trials has fueled growing acceptance of traditional Chinese medicine (TCM) for the treatment of cardiac diseases; however, little is known about the underlying mechanisms. Here, we investigated the nature and underlying mechanisms of the effects of YiXin-Shu (YXS), an antioxidant-enriched TCM formula, on myocardial ischemia/reperfusion (MI/R) injury. YXS pretreatment significantly reduced infarct size and improved viable myocardium metabolism and cardiac function in hypercholesterolemic mice. Mechanistically, YXS attenuated myocardial apoptosis by inhibiting the mitochondrial mediated apoptosis pathway (as reflected by inhibition of mitochondrial swelling, cytochrome c release and caspase-9 activity, and normalization of Bcl-2 and Bax levels) without altering the death receptor and endoplasmic reticulum-stress death pathways. Moreover, YXS reduced oxidative/nitrative stress (as reflected by decreased superoxide and nitrotyrosine content and normalized pro- and anti-oxidant enzyme levels). Interestingly, YXS upregulated endogenous nuclear receptors including LXRα, PPARα, PPARβ and ERα, and in-vivo knockdown of cardiac-specific LXRα significantly blunted the cardio-protective effects of YXS. Collectively, these data show that YXS is effective in mitigating MI/R injury by suppressing mitochondrial mediated apoptosis and oxidative stress and by upregulating LXRα, thereby providing a rationale for future clinical trials and clinical applications.

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.

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.

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

Comparison of conventional medicine, TCM treatment, and combination of both conventional medicine and TCM treatment for patients with chronic obstructive pulmonary disease: study protocol of a randomized comparative effectiveness research trial.

PubMed

Li, Jian-Sheng; Xie, Yang; Li, Su-Yun; Yu, Xue-Qing

2014-05-01

Chronic obstructive pulmonary disease (COPD) affects millions worldwide. Although many therapies exist and are being developed to relieve symptoms and reduce mortality, few data are available to understand which of the therapeutic alternatives is the most cost-effective for COPD patients in everyday clinical practice, especially for traditional Chinese medicine (TCM). Comparative effectiveness research can help patients, clinicians, and decision-makers make best informed treatment decisions where such evidence was previously lacking. This study aims to compare the effectiveness and economic evaluation of three treatments: (1) conventional Western medicine; (2) TCM treatments, which have been evaluated and have certain effect; and (3) a combination of both conventional Western medicine and TCM treatments, and then determine which treatment is the most suitable for COPD patients. A multicenter, pragmatic, randomized, controlled trial is adopted. A total of 360 patients will be recruited and randomly assigned to one of the three treatments group, with 120 in each group. Patients in the conventional Western medicine group will be given Salbutamol, Formoterol, Salmeterol/fluticasone, respectively, according to the guidelines. For the TCM group, patients will be given Bufei granule, Bu-Fei Jian-Pi granule, Bu-Fei Yi-Shen granule, and Yi-Qi Zi-Shen granule based on their corresponding TCM syndrome patterns, respectively. For the combination of conventional medicine and TCM treatments group, patients will be given a combination of conventional Western medicine and TCM granules. Treatments in each group are recognized as a whole comprehensive intervention. After the 26-week treatment, another 26 weeks will be followed up. The outcome measures including the frequency and duration of acute exacerbations, lung function, dyspnea, exercise capacity, quality of life, and economic evaluation will be assessed. It is hypothesized that each of the three treatments will have

"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.

Concurrent administration of anticancer chemotherapy drug and herbal medicine on the perspective of pharmacokinetics.

PubMed

Cheng, Yung-Yi; Hsieh, Chen-Hsi; Tsai, Tung-Hu

2018-04-01

With an increasing number of cancer patients seeking an improved quality of life, complementary and alternative therapies are becoming more common ways to achieve such improvements. The potential risks of concurrent administration are serious and must be addressed. However, comprehensive evidence for the risks and benefits of combining anticancer drugs with traditional herbs is rare. Pharmacokinetic investigations are an efficient way to understand the influence of concomitant remedies. Therefore, this study aimed to collect the results of pharmacokinetic studies relating to the concurrent use of cancer chemotherapy and complementary and alternative therapies. According to the National Health Insurance (NHI) database in Taiwan and several publications, the three most commonly prescribed formulations for cancer patients are Xiang-Sha-Liu-Jun-Zi-Tang, Jia-Wei-Xiao-Yao-San and Bu-Zhong-Yi-Qi-Tang. The three most commonly prescribed single herbs for cancer patients are Hedyotis diffusa, Scutellaria barbata, and Astragalus membranaceus. Few studies have discussed herb-drug interactions involving these herbs from a pharmacokinetics perspective. Here, we reviewed Jia-Wei-Xiao-Yao-San, Long-Dan-Xie-Gan-Tang, Curcuma longa and milk thistle to provide information based on pharmacokinetic evidence for healthcare professionals to use in educating patients about the risks of the concomitant use of various remedies. Copyright © 2018. Published by Elsevier B.V.

Differences in Visual-Spatial Input May Underlie Different Compression Properties of Firing Fields for Grid Cell Modules in Medial Entorhinal Cortex

DTIC Science & Technology

2015-11-19

cortex. These features can be described through the plane equation (nx, ny, nz )(Xi, Yi, Zi) T − d = 0 with the normal vector (nx, ny, nz ) the point...operator. Using Eq 2 and Eq 3 we find the following expression for the distance Di ¼ d nx sin yi cosi þ ny sini þ nz cos yi cosi : ð5Þ Plugging in

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.

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

Allometric Scaling of Wingate Anaerobic Power Test Scores in Women

ERIC Educational Resources Information Center

Hetzler, Ronald K.; Stickley, Christopher D.; Kimura, Iris F.

2011-01-01

In this study, we developed allometric exponents for scaling Wingate anaerobic test (WAnT) power data that are reflective in controlling for body mass (BM) and lean body mass (LBM) and established a normative WAnT data set for college-age women. One hundred women completed a standard WAnT. Allometric exponents and percentile ranks for peak (PP)…

quantifying and Predicting Reactive Transport

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

Peter C. Burns, Department of Civil Engineering and Geological Sciences, University of Notre Dame

2009-12-04

This project was led by Dr. Jiamin Wan at Lawrence Berkeley National Laboratory. Peter Burns provided expertise in uranium mineralogy and in identification of uranium minerals in test materials. Dr. Wan conducted column tests regarding uranium transport at LBNL, and samples of the resulting columns were sent to Dr. Burns for analysis. Samples were analyzed for uranium mineralogy by X-ray powder diffraction and by scanning electron microscopy, and results were provided to Dr. Wan for inclusion in the modeling effort. Full details of the project can be found in Dr. Wan's final reports for the associated effort at LBNL.

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.

[Experimental study of active ingredients group in liver protection from erzhi wan on acute hepatic injury induced by CCl4 in mice].

PubMed

Yan, Bing; Cai, Xiujiang; Yao, Weifeng; Zhang, Li; Huang, Meiyan; Ding, Anwei

2012-05-01

To study the active ingredients in liver protection from Erzhi Wan (AIEP) on acute hepatic injury induced by carbon tetrachloride (CCl4) in mice. Sixty Kunming mice were randomly divided into six groups: the normal group, the model group, bifendate group (150 mg x kg(-1)), high AIEP group (19.8 g x kg(-1)), middle AIEP group (13.2 g x kg(-1)) and low AIEP group (6.6 g x kg(-1)). The treatment groups were orally administered once per day for 7 d separately, whereas the normal and model groups were orally administered with saline. Except normal rats, all the other rats were injected intraperitoneally CCl4 20 mL x kg(-1) once. The rats were sacrificed 16 h after CCl4 administration. Serum and liver samples were collected for analysis. The acute hepatic injury model was prepared by CCl4 injected intraperitoneally. Then, the therapeutic effects of AIEP on the model were evaluated by the activity determination of serum alanine aminotransferase and aspirate aminotransferase (ALT and AST), superoxide dismutase (SOD) and the content of malondialdehyde (MDA) in liver,and the hepatic pathohistological changes following the treatment. The activities of ALT and AST and the MDA content in liver was significantly increased and the activity of SOD was largely inhibited in the animals of modeling group. Following the treatment with AIEP, ALT and AST activities and MDA content were significantly reduced and SOD activity was obviously increased in the mice of treatment group. Furthermore, AIEP could ameliorate the hepatic pathological changes. AIEP have protective effects on acute hepatic injury induced by CCL4 in mice, and are the effect of the liver protecting active sites.

Qingfei Xiaoyan Wan, a traditional Chinese medicine formula, ameliorates Pseudomonas aeruginosa–induced acute lung inflammation by regulation of PI3K/AKT and Ras/MAPK pathways

PubMed Central

Hou, Yuanyuan; Nie, Yan; Cheng, Binfeng; Tao, Jin; Ma, Xiaoyao; Jiang, Min; Gao, Jie; Bai, Gang

2016-01-01

Gram-negative pathogen–induced nosocomial infections and resistance are a most serious menace to global public health. Qingfei Xiaoyan Wan (QF), a traditional Chinese medicine (TCM) formula, has been used clinically in China for the treatment of upper respiratory tract infections, acute or chronic bronchitis and pulmonary infection. In this study, the effects of QF on Pseudomonas aeruginosa–induced acute pneumonia in mice were evaluated. The mechanisms by which four typical anti-inflammatory ingredients from QF, arctigenin (ATG), cholic acid (CLA), chlorogenic acid (CGA) and sinapic acid (SPA), regulate anti-inflammatory signaling pathways and related targets were investigated using molecular biology and molecular docking techniques. The results showed that pretreatment with QF significantly inhibits the release of cytokines (TNF-α and IL-6) and chemokines (IL-8 and RANTES), reduces leukocytes recruitment into inflamed tissues and ameliorates pulmonary edema and necrosis. In addition, ATG was identified as the primary anti-inflammatory agent with action on the PI3K/AKT and Ras/MAPK pathways. CLA and CGA enhanced the actions of ATG and exhibited synergistic NF-κB inactivation effects possibly via the Ras/MAPK signaling pathway. Moreover, CLA is speculated to target FGFR and MEK firstly. Overall, QF regulated the PI3K/AKT and Ras/MAPK pathways to inhibit pathogenic bacterial infections effectively. PMID:27175332

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.

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.

Validity and Reliability of the 30-s Continuous Jump for Anaerobic Power and Capacity Assessment in Combat Sport

PubMed Central

Čular, Drazen; Ivančev, Vladimir; Zagatto, Alessandro M.; Milić, Mirjana; Beslija, Tea; Sellami, Maha; Padulo, Johnny

2018-01-01

Cycling test such Wingate anaerobic test (WAnT) is used to measure anaerobic power (AP), but not anaerobic capacity (AC, i.e., the metabolic energy demand). However, in sports that do not involve cycling movements (Karate), the continuous jump for 30 s (vertical jumps for 30 s) has been extensively used to measure anaerobic performance in all young athletes. Limited information’s are available concerning its validity and reliability especially in children. As such, the current study aimed to test validity and reliability of a continuous jumps test (the CJ30s), using WAnT as a reference. Thirteen female Karate kids (age: 11.07 ± 1.32 years; mass: 41.76 ± 15.32 kg; height: 152 ± 11.52 cm; training experience: 4.38 ± 2.14 years) were tested on three separate sessions. The first and second sessions were used to assess the reliability using Intra-class correlation coefficient (ICC) of CJ30s, whereas on the third session WAnT was administered. Following CJ30s and WAnT, we assessed AP (1/CJ30s, as jump height [JH], fatigue index [FI], and blood lactate [BL]; 2/WAnT, as mechanical power [P], FI, and BL) and AC as the excess post-exercise oxygen consumption (EPOC). Large/highly significant correlations were found between CJ30s and WAnT EPOCs (r = 0.730, P = 0.003), and BLs (r = 0.713, P = 0.009). Moderate/significant correlations were found between CJ30s and WAnT FIs (r = 0.640, P = 0.014), CJ30s first four jumps mean JH and WAnT peak P (r = 0.572, P = 0.032), and CJ30s mean JH and WAnT mean P (r = 0.589, P = 0.021). CJ30s showed excellent and moderate reliability (ICC) for AP (maximal JH 0.884, mean JH 0.742, FI 0.657, BL 0.653) and AC (EPOC 0.788), respectively. Correlations observed especially in terms of AC between CJ30s and WAnT provide evidence that former may adequately assess anaerobic performance for the young combat athlete. CJ30 is a reliable test and allow an easy assessment of AP and AC in karate children. PMID:29867580

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.

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

A Two-Dimensional Fourth-Order CESE Method for the Euler Equations on Triangular Unstructured Meshes (Post-Print)

DTIC Science & Technology

2012-01-12

include area code) 661 275-5649 Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std. 239.18 A Two-Dimensional Fourth-Order CESE Method for the...remark that Eq. (4) is a special case of Eq. (5) with A = N . Similarly, the Taylor expansion of fluxes can be expressed as ∂ Cfx ,yi ∂xI∂yJ∂tK (x, y, t) = A...x2′ , y2′) and within t n − 1/2 ≤ t ≤ tn, the flux fx,yi can be expressed as (fx,yi ) ∗ = A ∑ a=0 A−a ∑ b=0 A−a−b ∑ c=0 ∂a+b+ cfx ,yi ∂xa∂yb∂tc ∆xa∆yb

A metabolic profiling analysis of the acute hepatotoxicity and nephrotoxicity of Zhusha Anshen Wan compared with cinnabar in rats using (1)H NMR spectroscopy.

PubMed

Wang, Haifeng; Bai, Jiao; Chen, Gang; Li, Wen; Xiang, Rongwu; Su, Guangyue; Pei, Yuehu

2013-03-27

Zhusha Anshen Wan (ZSASW), a traditional Chinese medicine (TCM) prescription, composed of cinnabar (cinnabaris), Coptidis Rhizoma (Coptis chinensis French.), Angelicae Sinensis Radix (Angelica sinensis (oliv.) Diels), uncooked Rehmanniae Radix (Rehmannia glutinosa Libosch.), honey fried Glycyrrhizae Radix Et Rhizoma (Glycyrrhiza uralensis Fisch.), has been widely used for sedative therapy. Cinnabar, the chief component of ZSASW, has been proved to possess the toxicities. In this study, a metabonomics approach based on high-resolution (1)H nuclear magnetic resonance spectroscopy was applied to investigate the protective effects of ZSASW on the toxic effects induced by cinnabar alone. Male Wistar rats were divided into three groups: control group, ZSASW group and cinnabar group. Partial least squares-discriminant analysis (PLS-DA) was performed to identify different metabolic profiles of urine and serum from rats. Liver and kidney histopathology examinations and serum clinical chemistry analysis were also performed. The significant difference in metabolic profiling of urine and serum of the rats was observed between cinnabar treated group, control group, and the changes of endogenous metabolites related to the toxicities were identified. The results were also certified by the liver and kidney histopathology examinations and biochemical analysis of blood. Our results suggested that the four combined herbal medicines of ZSASW had the effects of protecting from the toxicity induced by cinnabar alone. This work showed that the NMR-based metabonomics approach might be a promising approach to study detoxification of Chinese medicines and reasonable combination of TCM prescriptions. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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.

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.

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

Yi min Zhang | NREL

Science.gov Websites

Volkswagen Automotive Company, Ltd. Shanghai, China (1990-1996) Featured Publications Vimmerstedt, L., A . NREL/JA-5100-61691. doi:10.1002/bbb.1434 Chum, H. L., Y. Zhang, J. Hill, D.G. Tiffany, R.V. Morey, A.G -60059. Warner, E., D. Inman, B. Kunstman, B. Bush, L. Vimmerstedt, S. Peterson, J. Macknick, and Y

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.

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

Molecular analysis of a novel Toll/interleukin-1 receptor (TIR)-domain containing virulence protein of Y. pseudotuberculosis among Far East scarlet-like fever serotype I strains.

PubMed

Nörenberg, Dominik; Wieser, Andreas; Magistro, Giuseppe; Hoffmann, Christiane; Meyer, Christian; Messerer, Maxim; Schubert, Sören

2013-12-01

Pathogenicity of Yersinia pseudotuberculosis is determined by an arsenal of virulence factors. Particularly, the Yersinia outer proteins (Yops) and the Type III secretion system (T3SS) encoded on the pYV virulence plasmid are required for Yersinia pathogenicity. A specific group of Y. pseudotuberculosis, responsible for the clinical syndrome described as Far East scarlet-like fever (FESLF), is known to have an altered virulence gene cluster. Far East strains cause unique clinical symptoms for which the pYV virulence plasmid plays apparently a rather secondary role. Here, we characterize a previously unknown protein of Y. pseudotuberculosis serotype I strains (TcpYI) which can be found particularly among the FESLF strain group. The TcpYI protein shares considerable sequence homology to members of the Toll/IL-1 receptor family. Bacterial TIR domain containing proteins (Tcps) interact with the innate immune system by TIR-TIR interactions and subvert host defenses via individual, multifaceted mechanisms. In terms of virulence, it appears that the TcpYI protein of Y. pseudotuberculosis displays its own virulence phenotype compared to the previously characterized bacterial Tcps. Our results clearly demonstrate that TcpYI increases the intracellular survival of the respective strains in vitro. Furthermore, we show here that the intracellular survival benefit of the wild-type strain correlates with an increase in tcpYI gene expression inside murine macrophages. In support of this, we found that TcpYI enhances the survival inside the spleens of mice in a mouse model of peritonitis. Our results may point toward involvement of the TcpYI protein in inhibition of phagocytosis, particularly in distinct Y. pseudotuberculosis strains of the FESLF strain group where the pYV virulence plasmid is absent. Copyright © 2013 Elsevier GmbH. All rights reserved.

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 effects of Jiao-Tai-Wan on sleep, inflammation and insulin resistance in obesity-resistant rats with chronic partial sleep deprivation.

PubMed

Zou, Xin; Huang, Wenya; Lu, Fuer; Fang, Ke; Wang, Dingkun; Zhao, Shuyong; Jia, Jiming; Xu, Lijun; Wang, Kaifu; Wang, Nan; Dong, Hui

2017-03-23

Jiao-Tai-Wan (JTW), composed of Rhizome Coptidis and Cortex Cinnamomi, is a classical traditional Chinese prescription for treating insomnia. Several in vivo studies have concluded that JTW could exert its therapeutical effect in insomnia rats. However, the specific mechanism is still unclear. The present study aimed to explore the effect of JTW on sleep in obesity-resistant (OR) rats with chronic partial sleep deprivation (PSD) and to clarify its possible mechanism. JTW was prepared and the main components contained in the granules were identified by 3D-High Performance Liquid Chromatography (3D-HPLC) assay. The Male Sprague-Dawley (SD) rats underwent 4 h PSD by environmental noise and the treatment with low and high doses of JTW orally for 4 weeks, respectively. Then sleep structure was analyzed by electroencephalographic (EEG). Inflammation markers including high-sensitivity C reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were examined in the rat plasma. Meanwhile, metabolic parameters as body weight increase rate, fasting plasma glucose (FPG), fasting insulin (FINS) levels and insulin resistance index (HOMA-IR) were measured. The expressions of clock gene cryptochromes (Cry1 and Cry2) and inflammation gene nuclear factor-κB (NF-κB) in peripheral blood monocyte cells (PBMC) were also determined. The result showed that the administration of JTW significantly increased total sleep time and total slow wave sleep (SWS) time in OR rats with PSD. Furthermore, the treatment with JTW reversed the increase in the markers of systemic inflammation and insulin resistance caused by sleep loss. These changes were also associated with the up-regulation of Cry1 mRNA and Cry 2 mRNA and the down-regulation of NF-κB mRNA expression in PBMC. This study suggests that JTW has the beneficial effects of improving sleep, inflammation and insulin sensitivity. The mechanism appears to be related to the modulation of circadian clock and

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

Accumulation of Arsenic Speciation and In Vivo Toxicity Following Oral Administration of a Chinese Patent Medicine Xiao-Er-Zhi-Bao-Wan in Rats

PubMed Central

Luo, Jiaoyang; Han, Xu; Dou, Xiaowen; Zhang, Lei; Yang, Shihai; Yang, Meihua

2017-01-01

Realgar-containing traditional Chinese medicines such as Xiao-Er-Zhi-Bao-Wan (XEZBW), have been widely used for thousands of years. However, events associated with arsenic-induced ailments have increasingly become a public concern. To address the toxicity of XEZBW, we studied the histopathology and blood biochemistry of rats exposed to XEZBW using technology like high-performance liquid chromatography-inductively coupled mass spectrometry to determine arsenic speciation. Our results demonstrated that dimethylarsinic acid (DMA) increased from 18.57 ± 7.45 to 22.74 ± 7.45 ng/g in rat kidney after oral administration for 7 and 14 days, which was 10-fold higher than the levels observed in controls. Trivalent arsenite As(III) showed a large increase on day 7 (26.99 ± 1.98 ng/g), followed by a slight decrease on day 14 (13.67 ± 6.48 ng/g). Total arsenic levels on day 7 (185.52 ± 24.56 ng/g) and day 14 (198.57 ± 26.26 ng/g) were nearly twofold higher than that in the control group (92.77 ± 14.98 ng/g). Histopathological analysis showed mild injury in the liver and kidney of rats subjected to oral administration of realgar for 14 days. As in the XEZBW groups, a mild injury in these organs was observed after administration for 14 days. This study inferred that the toxicity of arsenic was concentration- and time-dependent. The accumulation of DMA, a byproduct of choline metabolism, was responsible for inducing higher toxicity. Therefore, we concluded that measuring the levels of DMA, instead of total arsenic, might be more suitable for evaluating the toxicity of realgar-containing traditional Chinese medicines. PMID:28790918

A galenical produced from Ba-Wei-Die-Huang-Wan (THC-002) provides resistance to the cold stress-induced detrusor overactivity in conscious rats.

PubMed

Imamura, Tetsuya; Ishizuka, Osamu; Sudha, Gautam Silwal; Lei, Zhang; Hosoda, Tomoka; Noguchi, Wataru; Yamagishi, Takahiro; Yokoyama, Hitoshi; Kurizaki, Yoshiki; Nishizawa, Osamu

2013-06-01

We determined if THC-002, a galenical produced from Ba-Wei-Die-Huang-Wan, could increase skin temperature and inhibit detrusor overactivity induced by sudden whole body cooling. Further, we determined if THC-002 could decrease expression of transient receptor potential melastatin 8 (TRPM8) channels associated with the cold responses. Hind leg skin temperature of female 10-week-old Sprague-Dawley rats was measured by thermal imaging. Experimental rats (n = 12) were given oral 100 mg/kg THC-002 daily for one week, and controls (n = 12) were similarly treated with THC-002-free solution. Afterwards, thermal imaging and cystometric investigations of the freely moving conscious rats were performed at room temperature (RT, 27 ± 2°C) for 20 min. The rats were then transferred to a low temperature (LT, 4 ± 2°C) environment during which thermal imaging and cystometric measurements were taken at 5, 10, 20, 30, and 40 min. Afterward, the skin tissues were harvested to estimate expression levels of TRPM8 channels by immunohistochemistry and real-time reverse-transcription polymerase chain reaction. The RT skin temperature of THC-002-treated rats was significantly higher than controls. During the first 20 min under LT, the control rats exhibited cold stress-induced detrusor overactivity such as decreased voiding interval and bladder capacity. THC-002 partially inhibited the detrusor overactivity patterns. During the second 20 min, skin temperature was relatively stable, and the detrusor overactivity of both groups slowly disappeared. THC-002 significantly reduced expression of TRPM8 channel protein and mRNA. THC-002 inhibited cold stress-induced detrusor overactivity resulting from decreasing skin temperature. Therefore, THC-002 might provide resistance to cold stress-exacerbated lower urinary tract symptoms. Copyright © 2012 Wiley Periodicals, Inc.

Nonlabens antarcticus sp. nov., a psychrophilic bacterium isolated from glacier ice, and emended descriptions of Nonlabens marinus Park et al. 2012 and Nonlabens agnitus Yi and Chun 2012.

PubMed

Kwon, Yong Min; Yang, Sung-Hyun; Kwon, Kae Kyoung; Kim, Sang-Jin

2014-02-01

A Gram-negative, proteorhodopsin-containing, orange pigmented, rod-shaped and strictly aerobic bacterium, designated strain AKS622(T), was isolated from a glacier core collected from the coast of King George Island, Antarctica. 16S rRNA gene sequence analysis revealed that strain AKS622(T) was affiliated to the genus Nonlabens of the family Flavobacteriaceae and showed highest similarity to Nonlabens marinus S1-08(T) (97.9%). The level of DNA-DNA relatedness between strain AKS622(T) and N. marinus S1-08(T) was 46%. Optimal growth of strain AKS622(T) was observed at pH 7.0, at 15 °C and with 2.0% NaCl. The predominant cellular fatty acids were anteiso-C(15 : 0), iso-C(16 : 0), iso-C(16 : 0) 3-OH, C17:0 2-OH and summed feature 3 (comprising C(16 : 1)ω7c and/or C(16 : 1)ω6c). The DNA G+C content was 37.9 mol%. The major respiratory quinone was MK-6. Phosphatidylethanolamine, four unidentified glycolipids, three unidentified aminolipids and one unidentified lipid were detected as major polar lipids. On the basis of the data from this polyphasic taxonomic study, it was concluded that strain AKS622(T) represents a novel species within the genus Nonlabens, for which the name Nonlabens antarcticus sp. nov. is proposed. The type strain is AKS622(T) ( = KCCM 43019(T) = JCM 14068(T)). Emended descriptions of N. marinus Park et al. 2012 and Nonlabens agnitus Yi and Chun 2012 are given.

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.

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...

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.

[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

Vertical Jumping Tests versus Wingate Anaerobic Test in Female Volleyball Players: The Role of Age

PubMed Central

Nikolaidis, Pantelis Theodoros; Afonso, Jose; Clemente-Suarez, Vicente Javier; Alvarado, Jose Rafael Padilla; Driss, Tarak; Knechtle, Beat; Torres-Luque, Gema

2016-01-01

Single and continuous vertical jumping tests, as well as the Wingate anaerobic test (WAnT), are commonly used to assess the short-term muscle power of female volleyball players; however, the relationship among these tests has not been studied adequately. Thus, the aim of the present study was to examine the relationship of single and continuous vertical jumps with the WAnT in female volleyball players. Seventy adolescent (age 16.0 ± 1.0 years, body mass 62.5 ± 7.1 kg, height 170.4 ± 6.1 cm, body fat 24.2% ± 4.3%) and 108 adult female volleyball players (age 24.8 ± 5.2 years, body mass 66.5 ± 8.7 kg, height 173.2 ± 7.4 cm, body fat 22.0% ± 5.1%) performed the squat jump (SJ), countermovement jump (CMJ), Abalakov jump (AJ), 30 s Bosco test and WAnT (peak power, Ppeak; mean power, Pmean). Mean power in the Bosco test was correlated (low to large magnitude) with Pmean of the WAnT (r = 0.27, p = 0.030 in adolescents versus r = 0.56, p < 0.001 in adults). SJ, CMJ and AJ also correlated with Ppeak (0.28 ≤ r ≤ 0.46 in adolescents versus 0.58 ≤ r ≤ 0.61 in adults) and with Pmean (0.43 ≤ r ≤ 0.51 versus 0.67 ≤ r ≤ 0.71, respectively) of the WAnT (p < 0.05). In summary, the impact of the Bosco test and WAnT on muscle power varied, especially in the younger age group. Single jumping tests had larger correlations with WAnT in adults than in adolescent volleyball players. These findings should be taken into account by volleyball coaches and fitness trainers during the assessment of short-term muscle power of their athletes.

The ACTN3 R577X polymorphism is associated with muscle power in male Japanese athletes.

PubMed

Kikuchi, Naoki; Nakazato, Koichi; Min, Seok-ki; Ueda, Dai; Igawa, Shoji

2014-07-01

In this study, we investigated whether the ACTN3 R577X polymorphism is associated with muscular power in Japanese collegiate athletes by analyzing the mean and peak power results of a 30-second Wingate anaerobic test (WAnT) with respect to the ACTN3 R577X genotype in 253 Japanese athletes (144 men and 109 women). Each athlete performed a 30-second WAnT with a resistance equal to 7.5% of his or her body weight. Genotyping for the ACTN3 R577X (rs1815739) polymorphism was performed using the TaqMan approach. The ACTN3 R577X genotypes exhibited a Hardy-Weinberg equilibrium distribution in our population. The relative and absolute mean power results of the 30-second WAnT did not differ significantly among the genotypes. However, the relative peak power result of the WAnT was significantly higher in the R-allele-dominant model groups than in the XX group in male but not female athletes. These results suggest that the ACTN3 R allele is associated with the relative peak power during the WAnT in male Japanese collegiate athletes.

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.

A pilot study for the integration of cytometry reports in digital cytology telemedicine applications.

PubMed

Giansanti, Daniele; Cerroni, Fabio; Amodeo, Rachele; Filoni, Marco; Giovagnoli, Maria Rosaria

2010-01-01

Up to date, tele-pathology in the three different forms of application, "dynamic", "static" and "virtual microscopy" has been mainly based on tele-hystology remote consulting. Today the diffusion of specialized WAN connections is guiding the research of new applications of tele-pathology. A specific analysis has been conducted, focused on digital cytology, in the biomedical laboratory of Sant'Andrea Hospital to investigate the technologies potentially useful to integrate in the LAN/WAN for telemedicine applications. Among the possible tools useful to be integrated in the LAN/WAN for telemedicine applications, the cytometry equipment available in the technical unity of cytometry has been considered important. The study finally provides a proposal for a tele-consulting architecture for the integration of cytometry reports both in the hospital LAN and the WAN for possible cooperative diagnosis and second opinion support.

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 ...

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

[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

The Acute Effects of Static Stretching Compared to Dynamic Stretching with and without an Active Warm up on Anaerobic Performance.

PubMed

Kendall, Bradley J

2017-01-01

The Wingate Anaerobic Test (WAnT) has been used in many studies to determine anaerobic performance. However, there has been poor reporting of warm-up protocols and limited consistency between warm-up methods that have been used. With the WAnT being such a commonly-used test, consistency in warm-up methods is essential in order to compare results across studies. Therefore, this study was designed to compare how static stretching, dynamic stretching, and an active warm-up affect WAnT performance. Ten recreationally active participants (5 males, 5 females) with a mean (SD) age of 23.3 (0.7) volunteered for this study. Subjects were randomized to a specific order of five warm-up protocols, which were performed on individual days followed by a WAnT. Peak power, mean power, power drop, and fatigue index were compared for each trial using a repeated measures ANOVA. For peak power, results revealed that warm-up protocol had a significant effect, F (4,36) = 3.90, p = .01, partial η 2 = .302. It was hypothesized that the dynamic stretching would lead to greater peak power than the static stretching protocol. However, results of post hoc analyses failed to detect a significant difference (p =.065). For the other measured variables no significant differences were found. The findings from this study suggest that warm-up protocols may have significantly different impacts on peak power during the WAnT. Additional research should use larger sample sizes and further explore these warm-up protocols. Developing a standardized warm-up protocol for the WAnT may improve consistency between studies.

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.

No Improvement in Sprint Performance With a Neuromuscular Fitted Dental Splint.

PubMed

Fischer, Henrike; Weber, Daniel; Beneke, Ralph

2017-03-01

Mouth guards protect against orofacial and dental injuries in sports. However, special fitted dental splints have been claimed to improve strength and speed and, therefore, to enhance athletic performance. To test the effects of a neuromuscular fitted dental splint in comparison with a habitual verticalizing splint and a no-splint condition on cycling sprint performance in the Wingate Anaerobic Test (WAnT). Twenty-three men (26.0 ± 2.0 y, 1.82 ± 0.06 m, 79.4 ± 7.7 kg) performed 3 WAnTs, 1 with the neuromuscular fitted splint, 1 with a habitual verticalized dental splint of the same height and material, and 1 under control conditions without any mouth guard, in randomized order separated by 1 wk. No differences between any splint conditions were found in any aspect of WAnT performance (time to peak power, peak power, minimum power, power drop, and average power). Moderate to nearly perfect correlations between all splint conditions in all WAnT outcomes with coefficients of variation between 1.3% and 6.6% were found. Irrespective of habitual verticalization or myocentric positioning, dental splints have no effects on any aspect of WAnT performance. Results are comparable to those of test-retest experiments.

Intermittent Theta Burst Over M1 May Increase Peak Power of a Wingate Anaerobic Test and Prevent the Reduction of Voluntary Activation Measured with Transcranial Magnetic Stimulation

PubMed Central

Giboin, Louis-Solal; Thumm, Patrick; Bertschinger, Raphael; Gruber, Markus

2016-01-01

Despite the potential of repetitive transcranial magnetic stimulation (rTMS) to improve performances in patients suffering from motor neuronal afflictions, its effect on motor performance enhancement in healthy subjects during a specific sport task is still unknown. We hypothesized that after an intermittent theta burst (iTBS) treatment, performance during the Wingate Anaerobic Test (WAnT) will increase and supraspinal fatigue following the exercise will be lower in comparison to a control treatment. Ten subjects participated in two randomized experiments consisting of a WAnT 5 min after either an iTBS or a control treatment. We determined voluntary activation (VA) of the right knee extensors with TMS (VATMS) and with peripheral nerve stimulation (VAPNS) of the femoral nerve, before and after the WAnT. T-tests were applied to the WAnT results and a two way within subject ANOVA was applied to VA results. The iTBS treatment increased the peak power and the maximum pedalling cadence and suppressed the reduction of VATMS following the WAnT compared to the control treatment. No behavioral changes related to fatigue (mean power and fatigue index) were observed. These results indicate for the first time that iTBS could be used as a potential intervention to improve anaerobic performance in a sport specific task. PMID:27486391

Intermittent Theta Burst Over M1 May Increase Peak Power of a Wingate Anaerobic Test and Prevent the Reduction of Voluntary Activation Measured with Transcranial Magnetic Stimulation.

PubMed

Giboin, Louis-Solal; Thumm, Patrick; Bertschinger, Raphael; Gruber, Markus

2016-01-01

Despite the potential of repetitive transcranial magnetic stimulation (rTMS) to improve performances in patients suffering from motor neuronal afflictions, its effect on motor performance enhancement in healthy subjects during a specific sport task is still unknown. We hypothesized that after an intermittent theta burst (iTBS) treatment, performance during the Wingate Anaerobic Test (WAnT) will increase and supraspinal fatigue following the exercise will be lower in comparison to a control treatment. Ten subjects participated in two randomized experiments consisting of a WAnT 5 min after either an iTBS or a control treatment. We determined voluntary activation (VA) of the right knee extensors with TMS (VATMS) and with peripheral nerve stimulation (VAPNS) of the femoral nerve, before and after the WAnT. T-tests were applied to the WAnT results and a two way within subject ANOVA was applied to VA results. The iTBS treatment increased the peak power and the maximum pedalling cadence and suppressed the reduction of VATMS following the WAnT compared to the control treatment. No behavioral changes related to fatigue (mean power and fatigue index) were observed. These results indicate for the first time that iTBS could be used as a potential intervention to improve anaerobic performance in a sport specific task.

Metabolomics-based evidence of the hypoglycemic effect of Ge-Gen-Jiao-Tai-Wan in type 2 diabetic rats via UHPLC-QTOF/MS analysis.

PubMed

Wang, Wenbo; Zhao, Linlin; He, Zhenyu; Wu, Ning; Li, Qiuxia; Qiu, Xinjian; Zhou, Lu; Wang, Dongsheng

2018-06-12

Ge-Gen-Jiao-Tai-Wan (GGJTW) formula, derived from traditional Chinese herbal medicine, is composed of Pueraria montana var. lobata (Willd.) Sanjappa & Pradeep (Ge-Gen in Chinese), Coptis chinensis Franch (Huang-Lian), and Cinnamomum cassia (L.) J. Presl (Rou-Gui). GGJTW is used for treatment of diabetes in China, reflecting the potent hypoglycemic effect of its ingredients. However, little is known of the hypoglycemic effect of GGJTW and the underlying metabolic mechanism. This study aimed to investigate the hypoglycemic effect of GGJTW in type 2 diabetic rats and the metabolic mechanism of action. Ultra high-performance liquid chromatography coupled with quadrupole-time-of-flight tandem mass spectrometry (UHPLC-QTOF/MS)-based metabolomics approach was used for monitoring hyperglycaemia induced by high-sugar high-fat fodder and streptozotocin (STZ), and the protective effect of GGJTW. Dynamic fasting blood glucose (FBG) levels, body weight, and biochemical parameters, including lipid levels, hepatic-renal function, and hepatic histopathology were used to confirm the hyperglycaemic toxicity and attenuation effects. An orthogonal partial least squared-discriminant analysis (OPLS-DA) approach highlighted significant differences in the metabolome of the healthy control, diabetic, and drug-treated rats. The metabolomics pathway analysis (MetPA) and Kyoto encyclopedia of genes and genomes (KEGG) database were used to investigate the underlying metabolic pathways. Metabolic profiling revealed 37 metabolites as the most potential biomarker metabolites distinguishing GGJTW-treated rats from model rats. Most of the metabolites were primarily associated with bile acid metabolism and lipid metabolism. The most critical pathway was primary bile acid biosynthesis pathway involving the up-regulation of the levels of cholic acid (CA), chenodeoxycholic acid (CDCA), taurocholic acid (TCA), glycocholic acid (GCA), taurochenodesoxycholic acid (TCDCA), and taurine. The significantly

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.

North Korean Civil-Military Trends: Military-First Politics to a Point

DTIC Science & Technology

2006-09-01

to the Great Leader. Yi Yong Mu. The NDC’s impact on the formal leadership lineup was made clear by 2001, when Yi Yong Mu, vice chairman of the NDC...to be restricted, as are career bonds that could come about between officers through sequential appointments to same commands. • First time

76 FR 82268 - Initiation of Antidumping and Countervailing Duty Administrative Reviews and Request for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-30

... Trading Corp. China Metallurgical Import and Export Liaoning Company Hunan Valin Xiangtan Iron & Steel Co...., Ltd. Zhejiang Wanli Tools Group Co., Ltd. Wanli Tools Group Zhenjiang Inter-China Import & Export Co... on Fresh Garlic from the People's Republic of China for one exporter. All deadlines for the...

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...

Wingate Anaerobic Test peak power and anaerobic capacity classifications for men and women intercollegiate athletes.

PubMed

Zupan, Michael F; Arata, Alan W; Dawson, Letitia H; Wile, Alfred L; Payn, Tamara L; Hannon, Megan E

2009-12-01

The Wingate Anaerobic Test (WAnT) has been established as an effective tool in measuring both muscular power and anaerobic capacity in a 30-second time period; however, there are no published normative tables by which to compare WAnT performance in men and women intercollegiate athletics. The purpose of this study was to develop a classification system for anaerobic peak power and anaerobic capacity for men and women National Collegiate Athletic Association (NCAA) Division I college athletes using the WAnT. A total of 1,585 (1,374 men and 211 women) tests were conducted on athletes ranging from the ages of 18 to 25 years using the WAnT. Absolute and relative peak power and anaerobic capacity data were recorded. One-half standard deviations were used to set up a 7-tier classification system (poor to elite) for these assessments. These classifications can be used by athletes, coaches, and practitioners to evaluate anaerobic peak power and anaerobic capacity in their athletes.

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.

Predictors of high-intensity running capacity in collegiate women during a soccer game.

PubMed

McCormack, William P; Stout, Jeffrey R; Wells, Adam J; Gonzalez, Adam M; Mangine, Gerald T; Fragala, Maren S; Hoffman, Jay R

2014-04-01

The purpose of this investigation was to determine which physiological assessments best predicted high-intensity running (HIR) performance during a women's collegiate soccer game. A secondary purpose was to examine the relationships among physiological performance measures including muscle architecture on soccer performance (distance covered, HIR, and sprints during the game) during a competitive collegiate women's soccer game. Ten National Collegiate Athletic Association (NCAA) Division I women soccer players performed physiological assessments within a 2-week period before a competitive regulation soccer game performed during the spring season. Testing consisted of height, body mass, ultrasound measurement of dominant (DOMleg), and nondominant leg (NDOMleg) vastus lateralis for muscle thickness (MT) and pennation angle (PA), VO2max, running economy, and Wingate anaerobic test (WAnT) for peak power (PP), mean power (MP), and fatigue rate (FR). During the game, distance run, HIR, and sprints were measured using a 10-Hz global positioning system. Stepwise regression revealed that VO2max, dominant leg thickness, and dominant leg PA were the strongest predictors of HIR distance during the game (R = 0.989, SEE = 115.5 m, p = 0.001). V[Combining Dot Above]O2max was significantly correlated with total distance run (r = 0.831; p = 0.003), HIR (r = 0.755; p = 0.012), WAnTPP (r = -0.737; p = 0.015), WAnTPP·kg (r = -0.706; p = 0.022), and WAnTFR (r = -0.713; p = 0.021). DOMlegMT was significantly correlated with WAnTFR (r = 0.893; p = 0.001). DOMlegPA was significantly correlated with WAnTFR (r = 0.740; p = 0.023). The NDOMlegPA was significantly correlated to peak running velocity (r = 0.781; p = 0.013) and WAnT MP·kg (r = 0.801; p = 0.01). Results of this study indicate that V[Combining Dot Above]O2max and muscle architecture are important characteristics of NCAA Division I women soccer players and may predict HIR distance during a competitive contest.

Effect of voluntary hypocapnic hyperventilation on the metabolic response during Wingate anaerobic test.

PubMed

Fujii, Naoto; Tsuchiya, Sho-Ichiro; Tsuji, Bun; Watanabe, Kazuhito; Sasaki, Yosuke; Nishiyasu, Takeshi

2015-09-01

We evaluated whether hypocapnia achieved through voluntary hyperventilation diminishes the increases in oxygen uptake elicited by short-term (e.g., ~30 s) all-out exercise without affecting exercise performance. Nine subjects performed 30-s Wingate anaerobic tests (WAnT) in control and hypocapnia trials on separate days in a counterbalanced manner. During the 20-min rest prior to the 30-s WAnT, the subjects in the hypocapnia trial performed voluntary hyperventilation (minute ventilation = 31 L min(-1)), while the subjects in the control trial continued breathing spontaneously (minute ventilation = 14 L min(-1)). The hyperventilation in the hypocapnia trial reduced end-tidal CO2 pressure from 34.8 ± 2.5 mmHg at baseline rest to 19.3 ± 1.0 mmHg immediately before the 30-s WAnT. In the control trial, end-tidal CO2 pressure at baseline rest (35.9 ± 2.5 mmHg) did not differ from that measured immediately before the 30-s WAnT (35.9 ± 3.3 mmHg). Oxygen uptake during the 30-s WAnT was lower in the hypocapnia than the control trial (1.55 ± 0.52 vs. 1.95 ± 0.44 L min(-1)), while the postexercise peak blood lactate concentration was higher in the hypocapnia than control trial (10.4 ± 1.9 vs. 9.6 ± 1.9 mmol L(-1)). In contrast, there was no difference in the 5-s peak (842 ± 111 vs. 850 ± 107 W) or mean (626 ± 74 vs. 639 ± 80 W) power achieved during the 30-s WAnT between the control and hypocapnia trials. These results suggest that during short-period all-out exercise (e.g., 30-s WAnT), hypocapnia induced by voluntary hyperventilation reduces the aerobic metabolic rate without affecting exercise performance. This implies a compensatory elevation in the anaerobic metabolic rate.

Trilingual Education in China: Perspectives from a University Programme for Minority Students

ERIC Educational Resources Information Center

Liu, Jie; Edwards, Viv

2017-01-01

Attention to trilingual education programmes in China has tended to focus on basic education; there had been little attention to date on the higher education sector. This paper will attempt to bridge this gap by exploring a Yi-English-Chinese trilingual education programme through case studies of three Yi students, using the "River of…

77 FR 76483 - Ocean Transportation Intermediary License Applicants The Commission gives notice that the...

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...

A Higher-Order Conservation Element Solution Element Method for Solving Hyperbolic Differential Equations on Unstructured Meshes

DTIC Science & Technology

2014-03-01

Unclassified c. THIS PAGE Unclassified SAR 232 19b. TELEPHONE NO (include area code) 661 275-5649 Standard Form 298 (Rev. 8-98) Prescribed by ANSI ...34 # ∂ Cfx ,yi ∗ (x, y, t) ∂xI∂yJ∂tK = A∑ a=0 A−a∑ b=0 A−a−b∑ c=0 ( ∂Bfx,yi ∂xI+a∂yJ+b∂tK+c )n j Δxa a...A−a∑ b=0 A−a−b∑ c=0 ( ∂a+b+ cfx ,yi ∂xa∂yb∂tc )n−1/2 1′× (x− x1′×) a (y − y1′×) b ( t− tn−1/2 )c a!b!c

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.

The Acute Effects of Static Stretching Compared to Dynamic Stretching with and without an Active Warm up on Anaerobic Performance

PubMed Central

KENDALL, BRADLEY J.

2017-01-01

The Wingate Anaerobic Test (WAnT) has been used in many studies to determine anaerobic performance. However, there has been poor reporting of warm-up protocols and limited consistency between warm-up methods that have been used. With the WAnT being such a commonly-used test, consistency in warm-up methods is essential in order to compare results across studies. Therefore, this study was designed to compare how static stretching, dynamic stretching, and an active warm-up affect WAnT performance. Ten recreationally active participants (5 males, 5 females) with a mean (SD) age of 23.3 (0.7) volunteered for this study. Subjects were randomized to a specific order of five warm-up protocols, which were performed on individual days followed by a WAnT. Peak power, mean power, power drop, and fatigue index were compared for each trial using a repeated measures ANOVA. For peak power, results revealed that warm-up protocol had a significant effect, F(4,36) = 3.90, p = .01, partial η2 = .302. It was hypothesized that the dynamic stretching would lead to greater peak power than the static stretching protocol. However, results of post hoc analyses failed to detect a significant difference (p =.065). For the other measured variables no significant differences were found. The findings from this study suggest that warm-up protocols may have significantly different impacts on peak power during the WAnT. Additional research should use larger sample sizes and further explore these warm-up protocols. Developing a standardized warm-up protocol for the WAnT may improve consistency between studies. PMID:28479947

A CoAP-Based Network Access Authentication Service for Low-Power Wide Area Networks: LO-CoAP-EAP.

PubMed

Garcia-Carrillo, Dan; Marin-Lopez, Rafael; Kandasamy, Arunprabhu; Pelov, Alexander

2017-11-17

The Internet-of-Things (IoT) landscape is expanding with new radio technologies. In addition to the Low-Rate Wireless Personal Area Network (LR-WPAN), the recent set of technologies conforming the so-called Low-Power Wide Area Networks (LP-WAN) offers long-range communications, allowing one to send small pieces of information at a reduced energy cost, which promotes the creation of new IoT applications and services. However, LP-WAN technologies pose new challenges since they have strong limitations in the available bandwidth. In general, a first step prior to a smart object being able to gain access to the network is the process of network access authentication. It involves authentication, authorization and key management operations. This process is of vital importance for operators to control network resources. However, proposals for managing network access authentication in LP-WAN are tailored to the specifics of each technology, which could introduce interoperability problems in the future. In this sense, little effort has been put so far into providing a wireless-independent solution for network access authentication in the area of LP-WAN. To fill this gap, we propose a service named Low-Overhead CoAP-EAP (LO-CoAP-EAP), which is based on previous work designed for LR-WPAN. LO-CoAP-EAP integrates the use of Authentication, Authorization and Accounting (AAA) infrastructures and the Extensible Authentication Protocol (EAP) protocol. For this integration, we use the Constrained Application Protocol (CoAP) to design a network authentication service independent of the type of LP-WAN technology. LO-CoAP-EAP represents a trade-off between flexibility, wireless technology independence, scalability and performance in LP-WAN.

A CoAP-Based Network Access Authentication Service for Low-Power Wide Area Networks: LO-CoAP-EAP

PubMed Central

Garcia-Carrillo, Dan; Marin-Lopez, Rafael; Kandasamy, Arunprabhu; Pelov, Alexander

2017-01-01

The Internet-of-Things (IoT) landscape is expanding with new radio technologies. In addition to the Low-Rate Wireless Personal Area Network (LR-WPAN), the recent set of technologies conforming the so-called Low-Power Wide Area Networks (LP-WAN) offers long-range communications, allowing one to send small pieces of information at a reduced energy cost, which promotes the creation of new IoT applications and services. However, LP-WAN technologies pose new challenges since they have strong limitations in the available bandwidth. In general, a first step prior to a smart object being able to gain access to the network is the process of network access authentication. It involves authentication, authorization and key management operations. This process is of vital importance for operators to control network resources. However, proposals for managing network access authentication in LP-WAN are tailored to the specifics of each technology, which could introduce interoperability problems in the future. In this sense, little effort has been put so far into providing a wireless-independent solution for network access authentication in the area of LP-WAN. To fill this gap, we propose a service named Low-Overhead CoAP-EAP (LO-CoAP-EAP), which is based on previous work designed for LR-WPAN. LO-CoAP-EAP integrates the use of Authentication, Authorization and Accounting (AAA) infrastructures and the Extensible Authentication Protocol (EAP) protocol. For this integration, we use the Constrained Application Protocol (CoAP) to design a network authentication service independent of the type of LP-WAN technology. LO-CoAP-EAP represents a trade-off between flexibility, wireless technology independence, scalability and performance in LP-WAN. PMID:29149040

Relationship Between Blood Flow and Performance Recovery: A Randomized, Placebo-Controlled Study.

PubMed

Borne, Rachel; Hausswirth, Christophe; Bieuzen, François

2017-02-01

To investigate the effect of different limb blood-flow levels on cycling-performance recovery, blood lactate concentration, and heart rate. Thirty-three high-intensity intermittent-trained athletes completed two 30-s Wingate anaerobic test sessions, 3 × 30-s (WAnT 1-3) and 1 × 30-s (WAnT 4), on a cycling ergometer. WAnT 1-3 and WAnT 4 were separated by a randomly assigned 24-min recovery intervention selected from among blood-flow restriction, passive rest, placebo stimulation, or neuromuscular electrical-stimulation-induced blood flow. Calf arterial inflow was measured by venous occlusion plethysmography at regular intervals throughout the recovery period. Performance was measured in terms of peak and mean power output during WAnT 1 and WAnT 4. After the recovery interventions, a large (r = .68 [90% CL .42; .83]) and very large (r = .72 (90% CL .49; .86]) positive correlation were observed between the change in calf arterial inflow and the change in mean and peak power output, respectively. Calf arterial inflow was significantly higher during the neuromuscular-electrical-stimulation recovery intervention than with the blood-flow-restriction, passive-rest, and placebo-stimulation interventions (P < .001). This corresponds to the only intervention that allowed performance recovery (P > .05). No recovery effect was linked to heart rate or blood lactate concentration levels. For the first time, these data support the existence of a positive correlation between an increase in blood flow and performance recovery between bouts of high-intensity exercise. As a practical consideration, this effect can be obtained by using neuromuscular electrical stimulation-induced blood flow since this passive, simple strategy could be easily applied during short-term recovery.

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.

Ethnic Variations in Pterygium in a Rural Population in Southwestern China: The Yunnan Minority Eye Studies.

PubMed

Zhong, Hua; Chen, Qin; Li, Jun; Shen, Wei; Sheng, Xun; Niu, Zhiqiang; Zhou, Hua; Wei, Tao; Yuan, Yuansheng; Pan, Chen-Wei

2016-01-01

To determine the prevalence and associations of pterygium in a multiethnic adult population in rural China and to examine potential ethnic differences Methods: A total of 6418 adults (2133 ethnic Bai, 2130 ethnic Yi, and 2155 ethnic Han) aged 50 years or older participated in the study. Anterior segment examination was performed without pupil dilation using a slit lamp. Pterygium was defined as a raised fleshy triangular fibrovascular tissue growth of the conjunctiva encroaching onto a clear cornea. Pterygium was least prevalent among adults of Yi ethnicity (29.5%) compared with Bai (39.0%, p < 0.001) or Han (39.5%, p < 0.001) ethnicities. Those of Bai ethnicity were most likely to be affected by severe pterygium (7.5%), while Yi were least likely to be affected (3.8%). Multivariate analysis revealed that increasing age (odds ratio, OR, 1.017), female sex (OR 1.53), lower educational level (OR 1.25), higher blood pressure levels (OR 1.002), and greater time spent outdoors per day (OR 1.09) were significantly associated with a higher prevalence of pterygium, while Yi ethnicity (OR 0.65, comparing Yi with Han) and wearing brimmed hats outdoors (OR 0.82) were protective factors. Ethnicity was significantly associated with prevalence of pterygium. Our findings may be applicable to many other countries located within the "pterygium belt" for health resource allocation among different ethnic groups.

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.

The worldwide airline network and the dispersal of exotic species: 2007–2010

PubMed Central

Tatem, Andrew J

2009-01-01

International air travel has played a significant role in driving recent increases in the rates of biological invasion and spread of infectious diseases. By providing high speed, busy transport links between spatially distant, but climatically similar regions of the world, the worldwide airline network (WAN) increases the risks of deliberate or accidental movements and establishment of climatically sensitive exotic organisms. With traffic levels continuing to rise and climates changing regionally, these risks will vary, both seasonally and year-by-year. Here, detailed estimates of air traffic trends and climate changes for the period 2007–2010 are used to examine the likely directions and magnitudes of changes in climatically sensitive organism invasion risk across the WAN. Analysis of over 144 million flights from 2007–2010 shows that by 2010, the WAN is likely to change little overall in terms of connecting regions with similar climates, but anticipated increases in traffic and local variations in climatic changes should increase the risks of exotic species movement on the WAN and establishment in new areas. These overall shifts mask spatially and temporally heterogenous changes across the WAN, where, for example, traffic increases and climatic convergence by July 2010 between parts of China and northern Europe and North America raise the likelihood of exotic species invasions, whereas anticipated climatic shifts may actually reduce invasion risks into much of eastern Europe. PMID:20300170

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

Improved ultra-performance liquid chromatography with electrospray ionization quadrupole-time-of-flight high-definition mass spectrometry method for the rapid analysis of the chemical constituents of a typical medical formula: Liuwei Dihuang Wan.

PubMed

Wang, Ping; Lv, Hai tao; Zhang, Ai hua; Sun, Hui; Yan, Guang li; Han, Ying; Wu, Xiu hong; Wang, Xi jun

2013-11-01

Liuwei Dihuang Wan (LDW), a classic Chinese medicinal formula, has been used to improve or restore declined functions related to aging and geriatric diseases, such as impaired mobility, vision, hearing, cognition, and memory. It has attracted increasing attention as one of the most popular and valuable herbal medicines. However, the systematic analysis of the chemical constituents of LDW is difficult and thus has not been well established. In this paper, a rapid, sensitive, and reliable ultra-performance LC with ESI quadrupole TOF high-definition MS method with automated MetaboLynx analysis in positive and negative ion mode was established to characterize the chemical constituents of LDW. The analysis was performed on a Waters UPLC™ HSS T3 using a gradient elution system. MS/MS fragmentation behavior was proposed for aiding the structural identification of the components. Under the optimized conditions, a total of 50 peaks were tentatively characterized by comparing the retention time and MS data. It is concluded that a rapid and robust platform based on ultra-performance LC with ESI quadrupole TOF high-definition MS has been successfully developed for globally identifying multiple constituents of traditional Chinese medicine prescriptions. This is the first report on the systematic analysis of the chemical constituents of LDW. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

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

Expedition 17 Pre-launch Images from Kazakhstan

NASA Image and Video Library

2008-04-07

JSC2008-E-032248 (7 April 2008) --- At their crew quarters in Baikonur, Kazakhstan, Expedition 17 Commander Sergei Volkov (center), Flight Engineer Oleg Kononenko (right) and South Korean spaceflight participant So-yeon Yi clasp hands for photographers on April 7, 2008, the eve of their launch to the International Space Station. Volkov, Kononenko and Yi are scheduled to launch to the station on the Soyuz TMA-12 spacecraft from the Baikonur Cosmodrome on April 8 and arrive at the ISS on April 10 to begin what will be six months in space for Volkov and Kononenko. Yi will be in space nine days on the complex, returning to Earth with two of the Expedition 16 crewmembers currently on the station. Photo Credit: NASA /Victor Zelentsov

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.

Enhancement on Wingate Anaerobic Test Performance With Hyperventilation.

PubMed

Leithäuser, Renate M; Böning, Dieter; Hütler, Matthias; Beneke, Ralph

2016-07-01

Relatively long-lasting metabolic alkalizing procedures such as bicarbonate ingestion have potential for improving performance in long-sprint to middle-distance events. Within a few minutes, hyperventilation can induce respiratory alkalosis. However, corresponding performance effects are missing or equivocal at best. To test a potential performance-enhancing effect of respiratory alkalosis in a 30-s Wingate Anaerobic Test (WAnT). 10 men (mean ± SD age 26.6 ± 4.9 y, height 184.4 ± 6.1 cm, body-mass test 1 80.7 ± 7.7 kg, body-mass test 2 80.4 ± 7.2 kg, peak oxygen uptake 3.95 ± 0.43 L/min) performed 2 WAnTs, 1 with and 1 without a standardized 15-min hyperventilation program pre-WAnT in randomized order separated by 1 wk. Compared with the control condition, hyperventilation reduced (all P < .01) pCO2 (40.5 ± 2.8 vs 22.5 ± 1.6 mm Hg) and HCO3 - (25.5 ± 1.7 vs 22.7 ± 1.6 mmol/L) and increased (all P < .01) pH (7.41 ± 0.01 vs 7.61 ± 0.03) and actual base excess (1.4 ± 1.4 vs 3.2 ± 1.6 mmol/L) pre-WAnT with an ergogenic effect on WAnT average power (681 ± 41 vs 714 ± 44 W) and total metabolic energy (138 ± 12 vs. 144 ± 13 kJ) based on an increase in glycolytic energy (81 ± 13 vs 88 ± 13 kJ). Hyperventilation-induced respiratory alkalosis can enhance WAnT cycling sprint performance well in the magnitude of what is seen after successful bicarbonate ingestion.

Comparison of Sprint and Run Times with Performance on the Wingate Anaerobic Test.

ERIC Educational Resources Information Center

Tharp, Gerald D.; And Others

1985-01-01

Male volunteers were studied to examine the relationship between the Wingate Anaerobic Test (WAnT) and sprint-run times and to determine the influence of age and weight. Results indicate the WAnT is a moderate predictor of dash and run times but becomes a stronger predictor when adjusted for body weight. (Author/MT)

The missing link between submarine volcano and promising geothermal potential in Jinshan, Northern Taiwan

NASA Astrophysics Data System (ADS)

Wang, S. C.; Hutchings, L.; Chang, C. C.; Lee, C. S.

2017-12-01

The Tatun volcanic group (TVG) and the Keelung submarine volcano (KSV) are active volcanoes and surrounding three nuclear plant sites in north Taiwan. The famous Jinshan-Wanli hot springs locates between TVG and KSV, moreover, the geochemical anomalies of acidic boiling springs on the seacoast infer that the origin is from magmatic fluids, sea water and meteoric water mixture, strongly implying that mantle fluids ascends into the shallow crust. The evidence for a magma chamber, submarine volcano, and boiling springs have a close spatial relationship. Based on UNECE specifications to Geothermal Energy Resources (2016), the Jinshan-Wanli geothermal area could be classified as Known Geothermal Energy Source for geothermal direct use and Potential Geothermal Energy Source for conventional geothermal system. High resolution reservoir exploration and modeling in Jinshan-Wanli geothermal area is developing for drilling risk mitigation. The geothermal team of National Taiwan Ocean University and local experts are cooperating for further exploration drilling and geothermal source evaluation. Keywords: geothermal resource evaluation, Jinshan-Wanli geothermal area, submarine volcano

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.

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.

Efficacy of MaZiRenWan, a Chinese Herbal Medicine, in Patients With Functional Constipation in a Randomized Controlled Trial.

PubMed

Zhong, Linda L D; Cheng, Chung-Wah; Kun, Wai; Dai, Liang; Hu, Dong-Dong; Ning, Zi-Wan; Xiao, Hai-Tao; Lin, Cheng-Yuan; Zhao, Ling; Huang, Tao; Tian, Ke; Chan, King-Hong; Lam, Ting-Wa; Chen, Xiao-Rui; Wong, Chi-Tak; Li, Min; Lu, Ai-Ping; Wu, Justin C Y; Bian, Zhao-Xiang

2018-04-12

The Chinese herbal medicine, MaZiRenWan (MZRW), has been used for more than 2000 years to treat constipation, but it has not been tested in a randomized controlled trial. We performed a trial to evaluate the efficacy and safety of MZRW, compared with the stimulant laxative senna or placebo, for patients with functional constipation (FC). We performed a double-blind, double-dummy, trial of 291 patients with FC based on Rome III criteria, seen at 8 clinics in Hong Kong from June 2013 through August 2015. Patients were observed for 2 weeks and then assigned randomly (1:1:1) to groups given MZRW (7.5 g, twice daily), senna (15 mg daily), or placebo for 8 weeks. Patients were then followed for 8 weeks and evaluated at baseline and weeks 4, 8 (end of treatment), and 16 (end of follow up). Participants recorded information on stool form and frequency, feeling of complete evacuation, and research medication taken. Data on individual bowel symptoms, global symptom improvement, and adverse events were collected. A complete response was defined as an increase ≥1 complete spontaneous bowel movement (CSBM)/week from baseline (the primary outcome). Secondary outcomes included response during the follow-up period, colonic transit, individual and global symptom assessments, quality of life measured with 36-item short form Chinese version, and adverse events. Although there was no statistically significant difference in proportions of patients with a complete response to MZRW (68%) vs. senna (57.7%) (P = .14) at week 8, there was a statistically significant difference vs. placebo (33.0%) (P < .005). At the 16-week timepoint (after the 8-week follow-up period), 47.4% of patients had a complete response to MZRW, 20.6% had a complete response to senna, and 17.5% had a complete response to placebo (P < .005 for MZRW vs. placebo). The group that received MZRW group also had significant increases in colonic transit and reduced severity of constipation, straining, incomplete evacuation

High Intensity Cycling Performances of Boys with and without Intellectual Disability.

ERIC Educational Resources Information Center

Chia, Y. H. M.; Lee, K. S.; Teo-Koh, S. M.

2002-01-01

Boys with (n=16) and without (n=18) intellectual disability (ID) performed the Wingate Anaerobic Test (WAnT) on two separate occasions. Comparable levels of reliability and agreement were found on the WAnT for both groups. However, the performances of boys with ID were more variable, less powerful, and resulted in lower post-exercise blood lactose…

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....

Comparison on conjunctival sac bacterial flora of the seniors with dry eye in Ganzi autonomous prefecture

PubMed Central

Zhang, Yue; Liu, Zhi-Rong; Chen, Hui; Fan, Ying-Chuan; Duo, Ji; Zheng, Hong; Wang, Guang-Jin; Li, Yu-Chan; Jiachu, Dan-Ba; Zewang, Ge-Ma

2013-01-01

AIM To compare the bacterial flora in palpebral conjunctiva of xerophthalmia seniors of Tibetan, Yi and Han, and analyze the differences and similarities of the bacteria. METHODS The test subjects were selected from 2 Tibetan, 2 Yi and 3 Han populated places, respectively. Total 222 seniors (444 eyes) with dry eye were examined. Secretion was collected from the palpebral conjunctiva of the subjects and then inoculated onto a blood agar plate. After 48h of incubation, the bacteria were examined for the differences and similarities between different ethnics. RESULTS There was no significant difference (P>0.05) of Gram stain characterization, dominant bacteria and number of the bacterial species present in oxrophthalmia patients among Tibetan, Yi and Han nationalities. The bacteria presented in all groups include staphylococcus epidermidis, corynebacterium, micrococcus luteu, intracellular bacteria sphingomonas, pseudomonas aeruginosa. The bacteria detected from the two of three ethnic groups were staphylococcus aureus, staphylococcus haemolyticus, escherichia coli, kytococcus sedentarius, streptococcus angina, micrococcus lylae, and staphylococcus heads. The incidence rate of bacteria-associated dry eye in Tibetan population was significantly lower than that of Han and Yi population. CONCLUSION There is no significant difference in the bacteria flora of palpebral conjunctiva observed among dry eye elder populations of Tibetan, Yi and Han people. All of staphylococcus epidermidis, corynebacterium, micrococcus luteu, intracellular bacteria sphingomonas, pseudomonas aeruginosa, staphylococcus aureus, staphylococcus haemolyticus, escherichia coli, kytococcus sedentarius, streptococcus angina, micrococcus lylae and staphylococcus heads are common bacteria flora of the three nationalities inhibiting in this area. PMID:23991377

Validity of the Wingate anaerobic test for the evaluation of elite runners.

PubMed

Legaz-Arrese, Alejandro; Munguía-Izquierdo, Diego; Carranza-García, Luis E; Torres-Dávila, Celeste G

2011-03-01

This study aimed to determine performance differences, based on the Wingate anaerobic test (WAnT), between homogeneous groups of elite male and female runners competing at distances ranging from 100 m to the marathon. We also attempted to establish a link between running ability and performance as measured by the WAnT. In total, 116 world-class runners (86 men and 30 woman) volunteered to participate in our study. Subjects were tested for peak power (PP, 5-second output) and mean power (MP, 30-second output) using WAnT procedures. Runners were classified into groups according to their best performances times. For male runners, PP and MP outputs decreased with increasing distance (p < 0.001). This trend was also true for female runners (p < 0.005). However, for both sexes, there were no significant differences in the PP values among 100-, 400-, and 800-m runners, and there were also no differences in the MP values for subjects that ran distances of 100 m compared with the values for subjects that ran distances of 400 and 800 m. In addition, no significant differences were observed in the PP and MP values between subjects that ran distances of 800, 1,500, and 3,000 m. Performance in the WAnT was not significantly associated with running performance in any distance event. The results of this study indicate that the WAnT is not a useful tool for the evaluation of elite runners.

An ab initio density functional study of the optical functions of 9-Methyl-3-Thiophen-2-YI-Thieno [3,2e] [1,2,4] Thriazolo [4,3c] Pyrimidine-8-Carboxylic Acid Ethyl Ester crystals.

PubMed

Reshak, Ali H; Kityk, I V; Khenata, R; Al-Douri, Y; Auluck, S

2012-09-01

An ab initio investigation of the optical constants of 9-Methyl-3-Thiophen-2-YI-Thieno [3,2e] [1,2,4] Thriazolo [4,3c] Pyrimidine-8-Carboxylic Acid Ethyl Ester crystal is performed within a framework of local density approximation (LDA), and the Engel-Vosko generalized gradient approximation (EV-GGA) exchange correlation potentials. It is established that there are two independent molecules (A and B) exhibiting different intra-molecular interactions: C-H⋯O (A) and C-H⋯N (B). These intra-molecular interactions favor stabilization of the crystal structure for molecules A and B. It should be emphasized that there exist remarkable π-π interactions between the pyrimidine rings of the two neighbors B molecules giving extra strengths and stabilizations to the superamolecular structure. These different intra-molecular interactions C-H⋯O (A) and C-H⋯N (B) and the π-π interaction between the pyrimidine rings of the two neighbors B molecules give principal contribution to dispersion of optical properties. With a view to seek deeper insight into the electronic structure, the optical properties were investigated. Our calculations show that the optical constants are very anisotropic. The EVGGA calculation shows a blue spectral shift of around 0.024 eV with significant changes in the spectra compared to the LDA calculation. The observed spectral shifts are in agreement with the calculated band structure and corresponding electron density of states. Copyright © 2012 Elsevier B.V. All rights reserved.

[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.

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.

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

Solar Energy Investigation Activities for Primary Pupils: Experience Sharing from a Teacher of a Solar Energy School in Hong Kong

ERIC Educational Resources Information Center

Cho, Kit Fan

2005-01-01

CCC Kei Wai Primary School (Ma Wan) is a 30-classroom 7-story primary school located at Ma Wan Island. The campus was completed in 2003. There are three arrays of photovoltaic modules installed on the roof with an expected annual yield of 5600 kWh a.c. electricity. This system is supported by a research project called "Building Integrated…

[Comparison of green coffee beans volatiles chemical composition of Hainan main area].

PubMed

Hu, Rong-Suo; Chu, Zhong; Gu, Feng-Lin; Lu, Min-Quan; Lu, Shao-Fang; Wu, Gui-Ping; Tan, Le-He

2013-02-01

Chemical component of Hainan green coffee beans was analyzed with solid phase microextraction-gas chromatography-mass spectrometry, and the discrepancy between two green coffee beans was differentiated through the spectrum database retrieval and retention index of compound characterization. The experimental results show that: the chemical composition of Wanning coffee beans and Chengmai coffee beans is basically the same. The quantity of analyzed compound in Wanning area coffee is 91, and in Chengmai area coffee is 106, the quantity of the same compound is 66, and the percent of the same component is 75.52%. The same compounds accounted for 89.86% of the total content of Wanning area coffee, and accounted for 85.70% of the total content of Chengmai area coffee.

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.

Expedition 16 Soyuz TMA-11 Lands

NASA Image and Video Library

2008-04-18

A Russian search and rescue helicopter flies over the burning Kazakh steppe after Expedition 16 Commander Peggy Whitson, Flight Engineer and Soyuz Commander Yuri Malenchenko and South Korean spaceflight participant So-yeon Yi landed their Soyuz TMA-11 spacecraft, Friday, April 19, 2008, in central Kazakhstan to complete 192 days in space for Whitson and Malenchenko and 11 days in orbit for Yi. Photo Credit: (NASA/Reuters/Pool)

Preemptive Approach to Improving Survival in Epithelial Ovarian Cancer

DTIC Science & Technology

2012-06-01

Metab 2008;93:3471–7. 692[87] Cho JH, Lee JG, Yang YI, Kim JH, Ahn JH, Baek NI, Lee KT, Choi JH. Eupatilin, a die- 693tary flavonoid , induces G2/M cell...Metab 2008;93:3471–7. 692[87] Cho JH, Lee JG, Yang YI, Kim JH, Ahn JH, Baek NI, Lee KT, Choi JH. Eupatilin, a die- 693tary flavonoid , induces G2/M

Organo-Soluble Porphyrin Mixed Monolayer-Protected Gold Nanorods with Intercalated Fullerenes

DTIC Science & Technology

2012-03-16

Mixed Monolayer- Protected Gold Nanorods with Intercalated Fullerenes Chenming Xue, Yongqian Xu, Yi Pang, Dingshan Yu, Liming Dai, Min Gao, Augustine...Protected Gold Nanorods with Intercalated Fullerenes 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT... Fullerenes Chenming Xue, † Yongqian Xu, ‡ Yi Pang, ‡ Dingshan Yu, § Liming Dai, § Min Gao, † Augustine Urbas ± and Quan

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.

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

Correlations between polymorphisms in the uridine diphosphate-glucuronosyltransferase 1A and C-C motif chemokine receptor 5 genes and infection with the hepatitis B virus in three ethnic groups in China.

PubMed

Zhang, Chan; He, Yan; Shan, Ke-Ren; Tan, Kui; Zhang, Ting; Wang, Chan-Juan; Guan, Zhi-Zhong

2018-02-01

Objective To determine whether genetic polymorphisms in the uridine diphosphate-glucuronosyltransferase 1A ( UGT1A) and the C-C motif chemokine receptor 5 ( CCR5) genes are associated with hepatitis B virus (HBV) infection in Yi, Yao and Han ethnic groups in the Guizhou Province of China. Methods The study enrolled subjects with and without HBV infection. Whole blood was used for DNA genotyping using standard techniques. The study determined the frequencies of several polymorphic alleles ( UGT1A6 [rs2070959], UGT1A1 [rs8175347], CCR5-59029 [rs1799987] and CCR5Δ32 [rs333]) and then characterized their relationship with HBV infection. Results A total of 404 subjects were enrolled in the study: 138 from the Yao group, 101 from the Yi group and 165 from the Han group. There was a significant difference in the frequency of UGT1A1 rs8175347 polymorphisms among the three groups. The rates of 7TA carriers of UGT1A1 rs8175347 in all three groups were significantly higher than the other genotypes. Individuals with genotype AA of UGT1A6 rs2070959 in the Yi group had a higher risk for HBV infection than in the Yao and Han groups. The frequency of genotype GG in CCR5-59029 in the Yao group was significantly higher than in the Yi group. The genotypes of CCR5Δ32 were not associated with HBV infection. Conclusion These findings provide genetic and epidemiological evidence for an association of UGT1A and CCR5-59029 polymorphisms with HBV infection in Chinese Yi and Yao populations.

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.

String Scale Gauge Coupling Unification with Vector-Like Exotics and Noncanonical U(1)Y Normalization

NASA Astrophysics Data System (ADS)

Barger, V.; Jiang, Jing; Langacker, Paul; Li, Tianjun

We use a new approach to study string scale gauge coupling unification systematically, allowing both the possibility of noncanonical U(1)Y normalization and the existence of vector-like particles whose quantum numbers are the same as those of the Standard Model (SM) fermions and their Hermitian conjugates and the SM adjoint particles. We first give all the independent sets (Yi) of particles that can be employed to achieve SU(3)C and SU(2)L string scale gauge coupling unification and calculate their masses. Second, for a noncanonical U(1)Y normalization, we obtain string scale SU(3)C ×SU(2)L ×U(1)Y gauge coupling unification by choosing suitable U(1)Y normalizations for each of the Yi sets. Alternatively, for the canonical U(1)Y normalization, we achieve string scale gauge coupling unification by considering suitable combinations of the Yi sets or by introducing additional independent sets (Zi), that do not affect the SU(3)C ×SU(2)L unification at tree level, and then choosing suitable combinations, one from the Yi sets and one from the Zi sets. We also briefly discuss string scale gauge coupling unification in models with higher Kac-Moody levels for SU(2)L or SU(3)C.

Performance Evaluation of LoRa Considering Scenario Conditions.

PubMed

Sanchez-Iborra, Ramon; Sanchez-Gomez, Jesus; Ballesta-Viñas, Juan; Cano, Maria-Dolores; Skarmeta, Antonio F

2018-03-03

New verticals within the Internet of Things (IoT) paradigm such as smart cities, smart farming, or goods monitoring, among many others, are demanding strong requirements to the Radio Access Network (RAN) in terms of coverage, end-node's power consumption, and scalability. The technologies employed so far to provide IoT scenarios with connectivity, e.g., wireless sensor network and cellular technologies, are not able to simultaneously cope with these three requirements. Thus, a novel solution known as Low Power - Wide Area Network (LP-WAN) has emerged as a promising alternative to provide with low-cost and low-power-consumption connectivity to end-nodes spread in a wide area. Concretely, the Long-Range Wide Area Network (LoRaWAN) technology is one of the LP-WAN platforms that is receiving greater attention from both the industry and the academia. For that reason, in this work, a comprehensive performance evaluation of LoRaWAN under different environmental conditions is presented. The results are obtained from three real scenarios, namely, urban, suburban, and rural, considering both dynamic and static conditions, hence a discussion about the most proper LoRaWAN physical-layer configuration for each scenario is provided. Besides, a theoretical coverage study is also conducted by the use of a radio planning tool considering topographic maps and a precise propagation model. From the attained results, it can be concluded that it is necessary to evaluate the propagation conditions of the deployment scenario prior to the system implantation in order to reach a compromise between the robustness of the network and the transmission data-rate.

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).

High-Speed Optical Wide-Area Data-Communication Network

NASA Technical Reports Server (NTRS)

Monacos, Steve P.

1994-01-01

Proposed fiber-optic wide-area network (WAN) for digital communication balances input and output flows of data with its internal capacity by routing traffic via dynamically interconnected routing planes. Data transmitted optically through network by wavelength-division multiplexing in synchronous or asynchronous packets. WAN implemented with currently available technology. Network is multiple-ring cyclic shuffle exchange network ensuring traffic reaches its destination with minimum number of hops.

Successful approaches. Educating through entertainment, theatre and AIDS.

PubMed

1996-01-01

The South Pacific Commission (SPC) has published a booklet about how young people in theater and drama entertain and educate the community about AIDS, help development efforts, and develop the youth's creativity and self-esteem. The most successful theater troupes in the Pacific are Wan Smolbag in Vanuatu and Youth to Youth in Health in the Marshall Islands. Such groups are an effective means of communicating messages about AIDS to youth. The involvement of youth in all aspects of the production of theater fosters self-confidence and -esteem and affords them an opportunity to learn about development issues affecting their lives and the welfare of their communities. Wan Smolbag's role has expanded from community-based theater to community and social development work. The UK has provided assistance for a three-year project for Wan Smolbag to help set up theater groups in other Pacific Island countries. SPC's AIDS program's Small Grants Project has contributed funds to foster the skills of youth working in theater to Women's Action for Change in Fiji, the Sei Group of the Solomon Islands Development Trust, and Malabo theater group in Papua New Guinea (PNG). The grant made to Malabo allowed the group to tour the provinces to spread the message about AIDS. A question and answer session led by troupe members and/or a health worker follows each performance. Theater is most likely the only way of communicating with PNG's population since there are more than 800 languages and illiteracy is common. Wan Smolbag conducted workshops for health workers and high school students at the South Pacific Arts Festival in the Cook Islands in 1992. These Wan Smolbag-led workshops resulted in a video production entitled Fading Away. This video has since been used to increase knowledge about some AIDS-related issues. Wan Smolbag/SPC video Like Any Other Lovers still wins world recognition as an effective tool for AIDS education. The next South Pacific Arts Festival is scheduled for

A Comparison Between the PLM and the MC68020 as Prolog Processors

DTIC Science & Technology

1988-01-01

Continnt &OII P0111ter CP Memory X6_ofset(MP) A11ument Register 6 A6 Memory X7_ofset(MP) A11ument Register 7 A7 Memory X6_ofaet(MP) Tempor&ry Register 6...get_vuia.ble_Y iaput. Permeunt nria.ble Yi &Dd &rgumeat ~Jl8ler XJ output: fuDctioD move the content of Xj iato Yi get_va.na.ble_Y: move.! Xi.·4

Korean Affairs Report, Number 258

DTIC Science & Technology

1983-01-03

because of the affect they will have on the overall political situation. Recently, Yu Han-yol, the DKP secretary general, said: Unless physically...establishment of laws." A law’s objective can be more fruit - fully accomplished when those who manage the law have good intentions and a sense of...joint commission was signed by Korean Foreign Minister Yi Pom-sok and his Gabonese counterpart Martin Bongo on August 24, 1982 when Yi accompanied

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

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.

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...

Early Rockets

NASA Image and Video Library

2004-04-15

According to one ancient legend, a Chinese official named Wan Hoo attempted a flight to the moon using a large wicker chair to which were fastened 47 large rockets. Forty seven assistants, each armed with a torch, rushed forward to light the fuses. In a moment, there was a tremendous roar accompanied by billowing clouds of smoke. When the smoke cleared, the flying chair and Wan Hoo were gone.

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.

North Korean Policy Elites

DTIC Science & Technology

2004-06-01

far the largest and covers almost the entire nation. Its programming includes news, educational, and entertainment shows; however, it mimics the print...Kim Chong-il, Head, Cadres of 5th Section (Female Entertainers ) Yi Myong-che Secretary to Kim Chong-il. Provides policy recommendations and oversees...for his table to Japanese jet skis and Sony home electronics.9 Likewise, the account of Yi Nam-oak (Li Nam-ok), who grew up as a companion to Kim’s

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.

Performance Evaluation of LoRa Considering Scenario Conditions

PubMed Central

Sanchez-Gomez, Jesus; Ballesta-Viñas, Juan

2018-01-01

New verticals within the Internet of Things (IoT) paradigm such as smart cities, smart farming, or goods monitoring, among many others, are demanding strong requirements to the Radio Access Network (RAN) in terms of coverage, end-node’s power consumption, and scalability. The technologies employed so far to provide IoT scenarios with connectivity, e.g., wireless sensor network and cellular technologies, are not able to simultaneously cope with these three requirements. Thus, a novel solution known as Low Power - Wide Area Network (LP-WAN) has emerged as a promising alternative to provide with low-cost and low-power-consumption connectivity to end-nodes spread in a wide area. Concretely, the Long-Range Wide Area Network (LoRaWAN) technology is one of the LP-WAN platforms that is receiving greater attention from both the industry and the academia. For that reason, in this work, a comprehensive performance evaluation of LoRaWAN under different environmental conditions is presented. The results are obtained from three real scenarios, namely, urban, suburban, and rural, considering both dynamic and static conditions, hence a discussion about the most proper LoRaWAN physical-layer configuration for each scenario is provided. Besides, a theoretical coverage study is also conducted by the use of a radio planning tool considering topographic maps and a precise propagation model. From the attained results, it can be concluded that it is necessary to evaluate the propagation conditions of the deployment scenario prior to the system implantation in order to reach a compromise between the robustness of the network and the transmission data-rate. PMID:29510524

[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

Impacts of You Gui Wan on the expression of estrogen receptors and angiogenic factors in OVX‑rat vagina: a possible mechanism for the trophic effect of the formula on OVX‑induced vaginal atrophy.

PubMed

Yin, Qiao-Zhi; Lu, Hua; Li, Li-Min; Yie, Shang-Mian; Hu, Xiang; Liu, Zhi-Bin; Zheng, Xiao; Cao, Sheng; Yao, Zou-Ying

2013-11-01

The administration of You Gui Wan (YGW) decoction has been observed to improve vaginal atrophy induced by ovariectomy (OVX) in rats. The aim of the current study was to explore the possible mechanisms underlying this effect. Following OVX, 37 Sprague Dawley female rats were randomly divided into three groups which were orally administered with YGW decoction, saline or estrogen for 11 weeks. In parallel with this, 19 normal and 17 rats with sham-surgery were used as controls. The effects of these treatments on estrogen receptors (ER) and various angiogenic factors, including vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor-1 (VEGFR-1), angiopoietin (Ang)1 and 2 and basic fibroblast growth factor (bFGF) in the vagina were compared using immunohistochemistry or quantitative polymerase chain reaction (qPCR). OVX was found to induce significant vaginal atrophy and decrease the expression of ER and various angiogenic factors when compared with the normal and sham-surgery animals (all P<0.05). Estrogen replacement and the administration of YGW decoction reversed the vaginal atrophic process. The hormonal replacement and YGW treatment recovered the protein expression of ER-α and -β, VEGF and VEGFR-1 and the mRNA levels of ER-α, VEGF, VEGFR-1, Ang1 and 2, and bFGF when compared with OVX-rats with saline, normal and sham-surgery treatments (all P<0.05). Thus, it may be concluded that a possible mechanism underlying the effect of YGW on OVX-induced vaginal atrophy may be the upregulated expression of ER and various angiogenic factors in the vaginal tissue.

Climatic similarity and biological exchange in the worldwide airline transportation network

PubMed Central

Tatem, Andrew J; Hay, Simon I

2007-01-01

Recent increases in the rates of biological invasion and spread of infectious diseases have been linked to the continued expansion of the worldwide airline transportation network (WAN). Here, the global structure of the WAN is analysed in terms of climatic similarity to illuminate the risk of deliberate or accidental movements of climatically sensitive organisms around the world. From over 44 000 flight routes, we show, for each month of an average year, (i) those scheduled routes that link the most spatially distant but climatically similar airports, (ii) the climatically best-connected airports, and (iii) clusters of airports with similar climatic features. The way in which traffic volumes alter these findings is also examined. Climatic similarity across the WAN is skewed (most geographically close airports are climatically similar) but heavy-tailed (there are considerable numbers of geographically distant but climatically similar airports), with climate similarity highest in the June–August period, matching the annual peak in air traffic. Climatically matched, geographically distant airports form subnetworks within the WAN that change throughout the year. Further, the incorporation of passenger and freight traffic data highlight at greater risk of invasion those airports that are climatically well connected by numerous high capacity routes. PMID:17426013

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

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

Extending the Ground Force Network: Aerial Layer Networking

DTIC Science & Technology

2013-04-25

Additionally aerial layer networks are envisioned to augment the Global Information Grid ( GIG ) access, which is currently provided by the surface...frequencies such as HF, VHF, and UHF. This enabled ground forces to establish tactical wide area networks (WAN) and permitted entry to the GIG ...PRC-117G. Both systems are unique in their overall mission sets, but both provide tactical users access to the WAN and GIG . Self-forming and self

A Decision Analysis Perspective on Multiple Response Robust Optimization

DTIC Science & Technology

2012-03-01

the utility function in question is monotonically increasing and is twice differentiable . If γ(y) = 0, the utility function is describing risk neutral...twice differentiable , the risk aversion function with respect to a single attribute, yi, i = 1, . . . , n, is given in Equation 2.9, γUyi = − U ′′yi U...UV (V (y1, y2)) and fol- lowing the chain rule of differentiation , Matheson and Abbas [31] show that the risk aversion with respect to a single

Targeting histone abnormality in triple negative breast cancer

DTIC Science & Technology

2017-08-01

ELEMENT NUMBER N/A 6. AUTHOR(S) 5d. PROJECT NUMBER N/A Yi Huang, M.D., Ph.D. 5e. TASK NUMBER N/A E -Mail:huangy2@upmc.edu 5f. WORK UNIT NUMBER...prevention. This funded Breast Cancer Breakthrough Award is initially a partnership between Dr. Yi Huang (initiating PI) and Dr. Nancy E . Davidson...partner PI). During the current funding period, Dr. Nancy E . Davidson moved to University of Washington at Seattle and transferred the Partnering PI to

A representative prescription for emotional disease, Ding-Zhi-Xiao-Wan restores 5-HT system deficit through interfering the synthesis and transshipment in chronic mild stress-induced depressive rats.

PubMed

Dong, Xian-Zhe; Li, Zhao-Liang; Zheng, Xiao-Li; Mu, Li-Hua; Zhang, Gang-qiang; Liu, Ping

2013-12-12

Ding-Zhi-Xiao-Wan (DZ, also known as Kai-Xin-San) is a famous traditional Chinese medicine used for the treatment of emotional disease. Previously, we have found that in a variety of animal models of depression (such as tail suspension model, model of chronic fatigue and forced swimming model) DZ demonstrated significant antidepressant behavior and promoted the production of 5-hydroxytryptamine (5-HT). However, the mechanisms of 5-HT regulation are still unclear. Therefore, the current study is designed to further investigate the antidepressant effect of DZ by observing its influence on 5-HT synthesis, metabolism, transport and other key links, so as to clarify the molecular mechanism of its 5-HT regulation. Solitary rising combined with the chronic unpredictable mild stress (CMS) was used to establish the rat model of depression. The rats were given DZ for 3 weeks, the behavior change and the following items in hippocampus and prefrontal cortex were detected simultaneously: 5-HT, 5-hydroxyindoleacetic acid (5-HIAA), tryptophan hydroxylase (TPH), aromatic amino acid decarboxylase (AADC), monoamine oxidase (MAO) and 5-HT transporter (5-HTT) were observed. Our results showed that treatment with the DZ significantly improved the behavior and simultaneously increased the 5-HT level in the hippocampus, prefrontal cortex tissues and hippocampus extracellular of depressive rats. In future studies revealed that DZ could significantly increase the protein and mRNA expression of the key enzymes TPH during the 5-HT synthesis process in the hippocampus and prefrontal cortex of the depressed rats, and suppress the expression of 5-HTT protein and mRNA at the same time. But it had no effects on MAO-A and MAO-B activities. We believe that antidepressant effect of DZ is caused by the increase of 5-HT synthesis and reduction of 5-HT re-uptake, and eventually increase the content of 5-HT in the brain and the synaptic gaps. © 2013 Published by Elsevier Ireland Ltd.

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.

JPRS Report, East Asia, Southeast Asia

DTIC Science & Technology

1988-05-25

seek employment is expected to lighten Malaysia’s unemployment problem. Deputy Labor Min- ister Datuk Wan Abu Bakar pointed out today that if they can...680,000 people. The deputy minister of labor, Datuk Wan Abu Bakar , is fully aware of this projection, and is encouraging our citizens to seek...autonomy to both the Muslims and Christians in Mindanao similar to a federal system as in the United States and Malaysia. Sultan Macapanton Abbas Jr

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.

Kansas squat test: a reliable indicator of short-term anaerobic power.

PubMed

Fry, Andrew C; Kudrna, Rebecca A; Falvo, Michael J; Bloomer, Richard J; Moore, Christopher A; Schilling, Brian K; Weiss, Lawrence W

2014-03-01

The purposes of this study were to establish stability reliability of a measure of lower-body anaerobic power, the Kansas squat test (KST), and to compare the KST with the commonly used Wingate anaerobic test (WAnT) for lower-body power. Fourteen resistance-trained men (mean ± SD; age = 24.2 ± 3.6 years) performed both the KST and the WAnT twice on separate occasions. The KST consisted of using an external dynamometer to measure mean repetition power while performing 15 repetitions of speed squats using 70% of 1 repetition maximum system mass (barbell + body mass), initiating each repetition at 6-second intervals. Repetition power, mean power for all 15 repetitions, and % fatigue for the KST were all reliable (intraclass correlation coefficient = 0.754-0.937; p ≤ 0.05). There were no differences between tests for the mean power for all repetitions or relative fatigue (p ≤ 0.05) and no significant differences between tests for any individual repetition (test × repetition interaction, p < 0.05). Although absolute values were different (p > 0.05), significant correlations were found between the KST and WAnT for mean (r = 0.752) and maximum (r = 0.775) test powers but not for relative fatigue (r = 0.174). Lactate (HLa) responses were greater for the WAnT compared with the KST. These data indicate that the KST is reliable for resistance-trained men, and that measures of maximum and mean test powers for the KST are highly correlated to those values for the WAnT, but fatigue rates and HLa responses were not correlated. It appears that the KST is a lifting-specific anaerobic power and power endurance test that emphasizes phosphagen metabolism and may be used to assess training-induced changes in lower-body power.

Korean Affairs Report

DTIC Science & Technology

1986-03-26

with the "outrageous" measures recently taken by the police to block its headquarters, Floor leader Kim Tong- yong of the party said that he expects the... Kims on the party as a precondition, is too wide. In the wake of his recent meetings with Kim Yong -sam, Yi Min-u, and Kim Sang- hyon, Cho is...Initial police investigation showed that Yi was hit by a 50cm-long wooden bar carried by Yim Yong -chol, 23, a junior. Police apprehended Yim, Miss Kim

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

JPRS Report China

DTIC Science & Technology

1988-11-07

in charge of technology, and their success in this election put them in a favorable position in future cabinet reshuffles. Kuo Wan- jung [6753 1238...very high, Kuo Wan- jung , as the first female executive official, still has the opportunity to scale new heights. Party Organs Party organs won a... Kuo Shu-min 6753 3219 2404, Hsu Li-chuan 6079 7787 1227, Li Chi-kuang 2621 1323 0342, and Chang Hui-chen 1728 1979 3791: "The Structure of the New

Achyranthis bidentatae radix enhanced articular distribution and anti-inflammatory effect of berberine in Sanmiao Wan using an acute gouty arthritis rat model.

PubMed

Wu, Juan; Li, Jingya; Li, Wei; Sun, Bei; Xie, Jin; Cheng, Wenming; Zhang, Qunlin

2018-07-15

Sanmiao Wan (SMW) has been a basic prescription employed for the treatment for gout in the clinic since Yuan dynasty. Achyranthis bidentatae radix (ABR) is designed as a lower-guiding drug in SMW to augment the articular accumulation of active ingredients and improve the anti-inflammatory effect. Present study was undertaken to investigate the dose-response relationship of berberine in SMW between the articular concentration and anti-inflammatory effect in the knee joint under the lower-guiding of ABR. Rats were divided into control group, model group and SMW without or with low, medium and high doses of ABR groups. Rat model of acute gouty arthritis (AGA) was established by intra-articular injection of 0.2 mL monosodium urate crystal (20 mg/mL) inside knee joint cavity on day 2 during drug treatment slots. Knee joint swelling, synovial hyperplasia and inflammatory cell infiltration were investigated for anti-inflammatory study. The concentrations of berberine in rat plasma and tissues were determined by UPLC-MS/MS method. The effect of ABR on the expression levels of P-glycoprotein (P-gp) and MDR1 mRNA in the synovial tissues of knee joints in AGA rats was examined by Western blot and RT-qPCR assay, respectively. The distribution of berberine increased by 6.53%, 44.31% and 212.96% in the knee joint and 474.93%, 631.01% and 1063.3% in the ankle for SMW with low, medium and high doses of ABR groups, compared with SMW without ABR group. Similarly, the plasma level of berberine increased by 19.81%, 143.4% and 681.13%. On the contrary, the distribution of berberine evidently decreased 3.23, 10.61 and 46.21-fold in heart and 3.68, 6.74 and 24.78-fold in lung. SMW with different doses of ABR groups exhibited better efficiency than SMW without ABR group on ameliorating knee joint swelling, inhibiting synovial hyperplasia and alleviating inflammatory cell infiltration of AGA rats. The treatment with ABR could down-regulate the MDR1 mRNA and P-gp expressions of synovial

Two Enhancements of the Logarithmic Least-Squares Method for Analyzing Subjective Comparisons

DTIC Science & Technology

1989-03-25

error term. 1 For this model, the total sum of squares ( SSTO ), defined as n 2 SSTO = E (yi y) i=1 can be partitioned into error and regression sums...of the regression line around the mean value. Mathematically, for the model given by equation A.4, SSTO = SSE + SSR (A.6) A-4 where SSTO is the total...sum of squares (i.e., the variance of the yi’s), SSE is error sum of squares, and SSR is the regression sum of squares. SSTO , SSE, and SSR are given

Translations on North Korea No. 495

DTIC Science & Technology

1976-12-02

Yun Ch’i-ho Hwang Ch’ol-san Kim Yong -yon comrade, KPA general, political committee member, and DPRK minister of peoples armed forces colonel...t’ae " So Kwan-hi functionary of the sector concerned Chong Song-nam Kim Sok-chin So Nam-sin Han Pyong- yong Wang Kyong-hak Ch’oe Sang-muk...Chin-t’ae Kim Sok-ki Yi Chong-mok Ch’oe Tu-kwang Han Su-kil Yi Yong -ch’ang [Pyongyang NODONG SINMUN in Korean 8 Oct 76 p 3] LOYALTY OATH

Regulation & Development of Membrane Transport Processes.

DTIC Science & Technology

1985-05-15

221, 733-741. 30. Liu, A. Y. C. and Greengard, P. (1974) Proc. Nall. Acad. Sci. USA, 71, 3869-3873. 31. MacKnight, A. D. C., DiBona , D. R., and Leaf...However, DiBona and Sachs and their collaborators 2. IXO(YI’(YI’IC INSEITION OF OTHER TANSPORT SYSTEMS 155 have challenged this view, suggesting that...the U.S. Public Health Service. REFERENCES I. DiBona , D. R., Ito, S., Berglindh, T.. and Sachs, G. (1979) Proc. Nall. Acad. Sci. USA, 76, 6689-6693. 2

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.

Competition in collaborative clothing: a qualitative case study of influences on collaborative quality improvement in the ICU.

PubMed

Dainty, Katie N; Scales, Damon C; Sinuff, Tasnim; Zwarenstein, Merrick

2013-04-01

Multiorganisational quality improvement (QI) collaborative networks are promoted for improving quality within healthcare. Recently, several large-scale QI initiatives have been conducted in the intensive care unit (ICU) environment with successful quantitative results. However, the mechanisms through which such networks lead to QI success remain uncertain. We aim to understand ICU staff perspectives on collaborative QI based on involvement in a multiorganisational improvement network and hypothesise about theoretical constructs that might explain the effect of collaboration in such networks. Qualitative study using a modified grounded theory approach. Key informant interviews were conducted with staff from 12 community hospital ICUs that participated in a cluster randomized control trial (RCT) of a QI intervention using a collaborative approach between 2006 and 2008. Data analysis followed the standard procedure for grounded theory using constant comparative methodology. The collaborative network was perceived to promote increased intrateam cooperation over interorganisational cooperation, but friendly competition with other ICUs appeared to be a prominent driver of behaviour change. Bedsides, clinicians reported that belonging to a collaborative network provided recognition for the high-quality patient care that they already provided. However, the existing communication structure was perceived to be ineffective for staff engagement since it was based on a hierarchical approach to knowledge transfer and project awareness. QI collaborative networks may promote behaviour change by improving intrateam communication, fostering competition with other institutions, and increasing recognition for providing high-quality care. Other commonly held assumptions about their potential impact, for instance, increasing interorganisational legitimisation, communication and collaboration, may be less important.

Improving the Quality of Care for Patients Diagnosed With Glioma During the Perioperative Period

PubMed Central

Riblet, Natalie B.V.; Schlosser, Evelyn M.; Homa, Karen; Snide, Jennifer A.; Jarvis, Lesley A.; Simmons, Nathan E.; Sargent, David H.; Mason, Linda P.; Cooney, Tobi J.; Kennedy, Nancy L.; Fadul, Camilo E.

2014-01-01

Purpose: Although there is agreement on the oncologic management of patients with glioma, few guidelines exist to standardize other aspects of care, including supportive care. Methods: A quality improvement (QI) project was chartered to improve the care provided to patients with glioma. A multidisciplinary team was convened and identified 10 best-practice measures. Using a plan-do-study-act framework, the team brainstormed and implemented various improvement interventions between June 2011 and October 2012. Statistical process control charts were used to evaluate progress. A dashboard of quality measures was generated to allow for ongoing measurement and reporting. Results: The retrospective assessment phase consisted of 43 patients with diagnosis of glioma. A manual medical record review for these patients showed that compliance with 10 best-practice measures ranged from 23% to 100%. Several factors contributed to less-than-ideal process performance, including poor communication among disciplines and lack of familiarity with the larger system of care. After implementing improvement interventions, performance was measured in 96 consecutive patients with glioma. The proportion of patients who met criteria for 10 practice measures significantly improved (pre-QI work, 63%; post-QI work, 85%; P = .003). The largest improvement was observed in the measure assessing for preoperative notification of the neuro-oncology program (pre-QI work, 39%; post-QI work, 97%; P < .001). Conclusion: QI principles were used by a multidisciplinary team to improve the quality of care for patients with glioma during the perioperative period. Leadership involvement, ongoing dialogue across departments, and reporting of system performance were important for sustaining process improvements. PMID:25294392

The effect of different calculation methods of flywheel parameters on the Wingate Anaerobic Test.

PubMed

Coleman, S G; Hale, T

1998-08-01

Researchers compared different methods of calculating kinetic parameters of friction-braked cycle ergometers, and the subsequent effects on calculating power outputs in the Wingate Anaerobic Test (WAnT). Three methods of determining flywheel moment of inertia and frictional torque were investigated, requiring "run-down" tests and segmental geometry. Parameters were used to calculate corrected power outputs from 10 males in a 30-s WAnT against a load related to body mass (0.075 kg.kg-1). Wingate Indices of maximum (5 s) power, work, and fatigue index were also compared. Significant differences were found between uncorrected and corrected power outputs and between correction methods (p < .05). The same finding was evident for all Wingate Indices (p < .05). Results suggest that WAnT must be corrected to give true power outputs and that choosing an appropriate correction calculation is important. Determining flywheel moment of inertia and frictional torque using unloaded run-down tests is recommended.

Analysis of genetic correlations of hip height with selection indices and mature weight in Nelore cattle.

PubMed

Boligon, A A; Carvalheiro, R; Ayres, D R; Albuquerque, L G

2013-02-01

Body size is directly related to the productive and reproductive performance of beef cattle raised under free-range conditions. In an attempt to better plan selection criteria, avoiding extremes in body size, this study estimated the heritabilities and genetic correlations of yearling hip height (YH) and mature hip height (MH) with selection indices obtained at weaning (WI) and yearling (YI) and mature weight (MW). Data from 102,373 Nelore animals born between 1984 and 2010, which belong to 263 farms that participate in genetic evaluation programmes of beef cattle conducted in Brazil and Paraguay, were used. The (co)variance components and genetic parameters were estimated by Bayesian inference in multi-trait analysis using an animal model. The mean heritabilities for YH, MH and MW were 0.56 ± 0.06, 0.47 ± 0.02 and 0.42 ± 0.02, respectively. The genetic correlation of YH with WI (0.13 ± 0.01) and YI (0.11 ± 0.01) was practically zero, whereas a higher correlation was observed with MW (0.22 ± 0.03). Positive genetic correlations of medium magnitude were estimated between MH and WI and YI (0.23 ± 0.01 and 0.43 ± 0.02, respectively). On the other hand, a high genetic correlation (0.68 ± 0.03) was observed between the indicator traits of mature body size (MH and MW). Considering the top 20 % of sire (896 sires) in terms of breeding values for the yearling index, the rank sire correlations between breeding values for MH and MW was 0.62. In general, the results indicate that selection based on WI and YI should not lead to important changes in YH. However, an undesired correlated response in mature cow height is expected, particularly when selection is performed using YI. Therefore, changes in the body structure of Nelore females can be obtained when MH and MW is used as a selection criterion for cows.

The traditional Chinese medicine prescription patterns for migraine patients in Taiwan: a population-based study.

PubMed

Chang, Yu-Yun; Tsai, Yueh-Ting; Lai, Jung-Nien; Yeh, Chia-Hao; Lin, Shun-Ku

2014-02-12

Traditional Chinese medicine (TCM), when given for symptom relief, has gained widespread popularity among migraine patients. The aim of this study is to analyze the utilization of TCM among migraine patients in Taiwan. The usage, frequency of service, and the Chinese herbal products prescribed for migraine were evaluated using a representative sample of one million subjects selected at random from the 22 million beneficiaries of the National Health Insurance scheme of Taiwan. Overall, 89.3% (N=12,827) migraine patients utilized TCM and 24.2% of them sought TCM with the intention of treating their migraine-related symptoms. Migraine patients who are living in urban area and those with an episodic migraine pattern (<15 days/month) (aOR=3.18, 95% CI: 2.75-3.67) were more likely to be TCM users than those living in a rural area and those who suffered from chronic migraine (≥15 days/month) (aOR=1.00). Overall, 81.2% of TCM visits involved the prescription of a Chinese herbal remedy or remedies and Chuan-Xiong-Cha-Tiao-San, Jia-Wei-Xiao-Yao-San, Ge-Gen-Tang, Xue-Fu-Zhu-Yu-Tang, Ban-Xia-Bai-Zhu-Tian-Ma-Tang, Qing-Shang-Juan-Tong-Tang, Xiao-Chai-Hu-Tang, Tian-Ma-Gou-Teng-Yin, Bu-Zhong-Yi-Qi-Tang, and Tian-Wang-Bu-Xin-Dan were the ten most frequently prescribed formula for treating migraine based on syndrome differentiation. Chuan-Xiong-Cha-Tiao-San, which contains sedative and anti-inflammatory agents, is the most commonly prescribed Chinese herbal formula for the treatment of migraine-related phenomena. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

YangXue QingNao Wan and Silibinin Capsules, the Two Chinese Medicines, Attenuate Cognitive Impairment in Aged LDLR (+/-) Golden Syrian Hamsters Involving Protection of Blood Brain Barrier

PubMed Central

Gu, You-Yu; Huang, Ping; Li, Quan; Liu, Yu-Ying; Liu, George; Wang, Yu-Hui; Yi, Ming; Yan, Li; Wei, Xiao-Hong; Yang, Lei; Hu, Bai-He; Zhao, Xin-Rong; Chang, Xin; Sun, Kai; Pan, Chun-Shui; Cui, Yuan-Chen; Chen, Qing-Fang; Wang, Chuan-She; Fan, Jing-Yu; Ma, Zhi-Zhong; Han, Jing-Yan

2018-01-01

The purpose of the study was to explore the effect and the underlying mechanism of YangXue QingNao Wan (YXQNW) and Silibinin Capsules (SC), the two Chinese medicines, on cognitive impairment in older people with familial hyperlipidaemia. Fourteen month-old female LDLR (+/-) golden Syrian hamsters were used with their wild type as control. YXQNW (0.5 g/kg/day), SC (0.1 g/kg/day), or YXQNW (0.5 g/kg/day) + SC (0.1 g/kg/day) were administrated orally for 30 days. To assess the effects of the two drugs on plasma lipid content and cognitive ability, plasma TC, TG, LDL-C, and HDL-C were measured, and Y maze task was carried out both before and after administration. After administering of the drugs for 30 days, to evaluate the effect of the two drugs on disturbed blood flow caused by hyperlipidemia, the cerebral blood flow (CBF) was measured. To assess blood–brain barrier integrity, albumin leakage in middle cerebral artery (MCA) area was determined. To evaluate the effect of the drugs on impaired microvessels, the number and morphology of microvessels were assessed in hippocampus area. To further evaluate the ultrastructure of microvessels in hippocampus, transmission electron microscopy (TEM) and scanning electron microscopy (SEM) were carried out. To assess the profiles of claudin-5 and occludin in hippocampus, we performed immunofluorescence. Finally, to assess the expression of claudin-5, JAM-1, occludin and ZO-1 in hippocampus, western blot was carried out. The results showed that YXQNW, SC, and YXQNW + SC improved cognitive impairment of aged LDLR (+/-) golden Syrian hamsters without lowering plasma TC and LDL-C. YXQNW, SC, and YXQNW + SC attenuated albumin leakage in MCA area and neuronal damage in hippocampus, concomitant with an increase in CBF, a decrease of perivascular edema and an up-regulated expression of claudin-5, occludin and ZO-1. In conclusion, YXQNW, SC, and YXQNW + SC are able to improve cognitive ability in aged LDLR (+/-) golden Syrian hamsters

Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change.

PubMed

McAlearney, Ann Scheck; Terris, Darcey; Hardacre, Jeanne; Spurgeon, Peter; Brown, Claire; Baumgart, Andre; Nyström, Monica E

2013-01-01

We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

Describing methods and interventions: a protocol for the systematic analysis of the perioperative quality improvement literature.

PubMed

Jones, Emma; Lees, Nicholas; Martin, Graham; Dixon-Woods, Mary

2014-09-05

Quality improvement (QI) methods are widely used in surgery in an effort to improve care, often using techniques such as Plan-Do-Study-Act cycles to implement specific interventions. Explicit definition of both the QI method and quality intervention is necessary to enable the accurate replication of effective interventions in practice, facilitate cumulative learning, reduce research waste and optimise benefits to patients. This systematic review aims to assess quality of reporting of QI methods and quality interventions in perioperative care. Studies reporting on quality interventions implemented in perioperative care settings will be identified. Searches will be conducted in the Ovid SP version of Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organisation of Care database and the related articles function of PubMed. The journal BMJ Quality will be searched separately. Search strategy terms will relate to (i) surgery, (ii) QI and (iii) evaluation methods. Explicit exclusion and inclusion criteria will be applied. Data from studies will be extracted using a data extraction form. The Template for Intervention Description and Replication (TIDieR) checklist will be used to evaluate quality of reporting, together with additional items aimed at assessing QI methods specifically. PROSPERO http://CRD42014012845.

Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change.

PubMed

McAlearney, Ann Scheck; Terris, Darcey; Hardacre, Jeanne; Spurgeon, Peter; Brown, Claire; Baumgart, Andre; Nyström, Monica E

2014-01-01

We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

Educating fellows in practice-based learning and improvement and systems-based practice: The value of quality improvement in clinical practice.

PubMed

Carey, William A; Colby, Christopher E

2013-02-01

In 1999, the Accreditation Council for Graduate Medical Education identified 6 general competencies in which all residents must receive training. In the decade since these requirements went into effect, practice-based learning and improvement (PBLI) and systems-based practice (SBP) have proven to be the most challenging competencies to teach and assess. Because PBLI and SBP both are related to quality improvement (QI) principles and processes, we developed a QI-based curriculum to teach these competencies to our fellows. This experiential curriculum engaged our fellows in our neonatal intensive care unit's (NICU's) structured QI process. After identifying specific patient outcomes in need of improvement, our fellows applied validated QI methods to develop evidence-based treatment protocols for our neonatal intensive care unit. These projects led to immediate and meaningful improvements in patient care and also afforded our fellows various means by which to demonstrate their competence in PBLI and SBP. Our use of portfolios enabled us to document our fellows' performance in these competencies quite easily and comprehensively. Given the clinical and educational structures common to most intensive care unit-based training programs, we believe that a QI-based curriculum such as ours could be adapted by others to teach and assess PBLI and SBP. Copyright © 2013 Elsevier Inc. All rights reserved.

Patient-reported quality indicators for osteoarthritis: a patient and public generated self-report measure for primary care.

PubMed

Blackburn, Steven; Higginbottom, Adele; Taylor, Robert; Bird, Jo; Østerås, Nina; Hagen, Kåre Birger; Edwards, John J; Jordan, Kelvin P; Jinks, Clare; Dziedzic, Krysia

2016-01-01

People with osteoarthritis desire high quality care, support and information. However, the quality of care for people with OA in general practice is not routinely collected. Quality Indicators can be used to benefit patients by measuring whether minimum standards of quality care are being met from a patient perspective. The aim of this study was to describe how a Research User Group (RUG) worked alongside researchers to co-produce a set of self-reported quality indicators for people with osteoarthritis when visiting their general practitioner or practice nurse (primary care). These were required in the MOSAICS study, which developed and evaluated a new model of supported self-management of OA to implement the NICE quality standards for OA. This article describes the public involvement in the MOSAICS study. This was 1) the co-development by RUG members and researchers of an Osteoarthritis Quality Indicators United Kingdom (OA QI (UK)) questionnaire for use in primary care, and 2) the comparison of the OA QI (UK) with a similar questionnaire developed in Norway. This study shows how important and effective a research user group can be in working with researchers in developing quality care indicators for osteoarthritis for use in a research study and, potentially, routine use in primary care. The questionnaire is intended to benefit patients by enabling the assessment of the quality of primary care for osteoarthritis from a patient's perspective. The OA QI (UK) has been used to examine differences in the quality of osteoarthritis care in four European countries. Background People with osteoarthritis (OA) desire high quality care, support and information about OA. However, the quality of care for people with OA in general practice is not routinely collected. Quality Indicators (QI) can be used to benefit patients by measuring whether minimum standards of quality care (e.g. NICE quality standards) are being met from a patient perspective. A Research User Group (RUG

Metabolic Regulation of Caspase 2 in Breast Cancer

DTIC Science & Technology

2009-04-01

Darbandi, Sook-Young Yoon, Judy Q. Wu, Yuko J. Miyamoto2 Jennifer A. Gibbon, Josh L. Andersen, Christopher D. Freel, Wanli Tang, Changli He, Manabu...Darbandi1, Sook-Young Yoon3, Judy Q. Wu1, Yuko J. Miyamoto2, Jennifer A. Gibbon1, Josh L. Andersen1, Christopher D. Freel1, Wanli Tang1, Changli He3...Altman, B.J., Coloff, J.L., Herman, C.E., Jacobs, S.R., Wieman, H.L., Wofford , J.A., Dimascio, L.N., Ilkayeva, O., Kelekar, A., et al. (2007

78 FR 14792 - Ocean Transportation Intermediary License Applicants

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-07

...: Mohamed Y. Ali, Manager (QI); Abdul S. Mohamed, Member. Application Type: Add Trade Name Compass Logistics... Ugueto, Secretary. Application Type: New NVO & OFF License American Forwarding & Logistics, LLC (NVO & OFF), 1919 NW 19th Street, Unit 624, Ft. Lauderdale, FL 33311. Officers: Gabriele Awada, Manager (QI...

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Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

...), 18311 Railroad Street, City of Industry, CA 91748, Officer:, Lang Zhang, President (QI), Application..., Oklahoma City, OK 73112, Officers: Thomas W. Young, Vice President (QI), Gregory P. Roush, Manager/Member, Application Type: Add Trade Name Smart Lines Worldwide Feiliks Global Logistics Corporation (NVO), 176-20 S...

78 FR 75345 - Ocean Transportation Intermediary License Applicants

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-11

... License. TOP Since Logistics, Inc. (NVO & OFF), 1255 Corporate Center Drive, Suite 210, Monterey Park, CA..., President (QI). Application Type: New NVO License. American Forwarding & Logistics, LLC (NVO & OFF), 3330 NW... Stachow, Managing Member. Application Type: QI Change. Cromarti Logistics LLC (NVO), 2810 Grants Lake Blvd...

Learning to Collaborate: A Case Study of Performance Improvement CME

ERIC Educational Resources Information Center

Shershneva, Marianna B.; Mullikin, Elizabeth A.; Loose, Anne-Sophie; Olson, Curtis A.

2008-01-01

Introduction: Performance Improvement Continuing Medical Education (PI CME) is a mechanism for joining quality improvement (QI) in health care to continuing medical education (CME) systems together. Although QI practices and CME approaches have been recognized for years, what emerges from their integration is largely unfamiliar, because it…

Quality improvement "201": context-relevant quality improvement leadership training for the busy clinician-educator.

PubMed

Stille, Christopher J; Savageau, Judith A; McBride, Jeanne; Alper, Eric J

2012-01-01

Development of quality improvement (QI) skills and leadership for busy clinician-educators in academic medical centers is increasingly necessary, although it is challenging given limited resources. In response, the authors developed the Quality Scholars program for primary care teaching faculty. They conducted a needs assessment, evaluated existing internal and national resources, and developed a 9-month, 20-session project-based curriculum that combines didactic and hands-on techniques with facilitated project discussion. They also conducted pre-post tests of knowledge and attitudes, and evaluations of each session, scholars' projects, and program sustainability and costs. In all, 10 scholars from all 3 generalist disciplines comprised the first class. A wide spectrum of previous experiences enhanced collaboration. QI knowledge increased slightly, and reported self-readiness to lead QI projects increased markedly. Protected time for project work and group discussion of QI topics was seen as essential. All 10 scholars completed projects and presented results. Institutional leadership agreed to sustain the program using institutional funds.

Creating a quality-improvement dialogue: utilizing knowledge from frontline staff, managers, and experts to foster health care quality improvement.

PubMed

Parker, Louise E; Kirchner, JoAnn E; Bonner, Laura M; Fickel, Jacqueline J; Ritchie, Mona J; Simons, Carol E; Yano, Elizabeth M

2009-02-01

There is a growing consensus that a hybrid of two common approaches to quality improvement (QI), local participatory QI and expert QI, might be the best method for achieving quality care. Achieving such a hybrid requires that content experts establish an ongoing dialogue with both frontline staff members and managers. In this study we examined frontline staff members' and managers' preferences regarding how to conduct such a dialogue, and we provide practical suggestions for implementation. The two groups shared a number of preferences (e.g., verbal face-to-face exchanges, discussions focused on quality of care). There were also some differences. For example, although managers were interested in discussions of business aspects (e.g., costs), frontline staff members were concerned with workload issues. Finally, although informants acknowledged that engaging in a QI dialogue was time consuming, they also believed it was essential if health care organizations are to improve the quality of care they provide.

Entanglement-enhanced Neyman-Pearson target detection using quantum illumination

NASA Astrophysics Data System (ADS)

Zhuang, Quntao; Zhang, Zheshen; Shapiro, Jeffrey H.

2017-08-01

Quantum illumination (QI) provides entanglement-based target detection---in an entanglement-breaking environment---whose performance is significantly better than that of optimum classical-illumination target detection. QI's performance advantage was established in a Bayesian setting with the target presumed equally likely to be absent or present and error probability employed as the performance metric. Radar theory, however, eschews that Bayesian approach, preferring the Neyman-Pearson performance criterion to avoid the difficulties of accurately assigning prior probabilities to target absence and presence and appropriate costs to false-alarm and miss errors. We have recently reported an architecture---based on sum-frequency generation (SFG) and feedforward (FF) processing---for minimum error-probability QI target detection with arbitrary prior probabilities for target absence and presence. In this paper, we use our results for FF-SFG reception to determine the receiver operating characteristic---detection probability versus false-alarm probability---for optimum QI target detection under the Neyman-Pearson criterion.

Use of Quality Indicators in Nursing Homes in Victoria, Australia: A Cross-Sectional Descriptive Survey.

PubMed

Ibrahim, Joseph E; Chadwick, Liam; MacPhail, Aleece; McAuliffe, Linda; Koch, Susan; Wells, Yvonne

2014-08-01

This study aimed to characterize the use of mandated quality indicators (QIs) in public sector nursing homes by describing their adherence to established principles of measurement and whether nursing homes respond to QI data to improve care. Data were collected from a descriptive cross-sectional quantitative study using a confidential survey questionnaire distributed electronically to senior staff in all public sector nursing homes in Victoria, Australia. Staff from 113 of 196 facilities completed the survey (58%). Adherence to principles of measurement was suboptimal, with variation in applying QI definitions and infrequent random audits of data (n = 54, 48%). QI data triggered reviews of individual residents (62%-79%), staff practice (44%-65%), and systems of care (45%-55%). Most facilities (58%-75%) reported that beneficial changes in care occurred as a result of using QIs. QI performance data are positively received and used to improve care. Standardization of data collection, analysis, and reporting should strengthen the program's utility. © The Author(s) 2014.

Physician Perceptions of Performance Feedback in a Quality Improvement Activity.

PubMed

Eden, Aimee R; Hansen, Elizabeth; Hagen, Michael D; Peterson, Lars E

Physician performance and peer comparison feedback can affect physician care quality and patient outcomes. This study aimed to understand family physician perspectives of the value of performance feedback in quality improvement (QI) activities. This study analyzed American Board of Family Medicine open-ended survey data collected between 2004 and 2014 from physicians who completed a QI module that provided pre- and post-QI project individual performance data and peer comparisons. Physicians made 3480 comments in response to a question about this performance feedback, which were generally positive in nature (86%). Main themes that emerged were importance of accurate feedback data, enhanced detail in the content of feedback, and ability to customize peer comparison groups to compare performance to peers with similar patient populations or practice characteristics. Meaningful and tailored performance feedback may be an important tool for physicians to improve their care quality and should be considered an integral part of QI project design.

Tai Chi and Qi Gong

MedlinePlus

... Iversen MD, McAlindon T, et al. Assessing the comparative effectiveness of tai chi versus physical therapy for knee osteoarthritis: design and rationale for a randomized trial. BMC Complementary ...

Methods for estimation of radiation risk in epidemiological studies accounting for classical and Berkson errors in doses.

PubMed

Kukush, Alexander; Shklyar, Sergiy; Masiuk, Sergii; Likhtarov, Illya; Kovgan, Lina; Carroll, Raymond J; Bouville, Andre

2011-02-16

With a binary response Y, the dose-response model under consideration is logistic in flavor with pr(Y=1 | D) = R (1+R)(-1), R = λ(0) + EAR D, where λ(0) is the baseline incidence rate and EAR is the excess absolute risk per gray. The calculated thyroid dose of a person i is expressed as Dimes=fiQi(mes)/Mi(mes). Here, Qi(mes) is the measured content of radioiodine in the thyroid gland of person i at time t(mes), Mi(mes) is the estimate of the thyroid mass, and f(i) is the normalizing multiplier. The Q(i) and M(i) are measured with multiplicative errors Vi(Q) and ViM, so that Qi(mes)=Qi(tr)Vi(Q) (this is classical measurement error model) and Mi(tr)=Mi(mes)Vi(M) (this is Berkson measurement error model). Here, Qi(tr) is the true content of radioactivity in the thyroid gland, and Mi(tr) is the true value of the thyroid mass. The error in f(i) is much smaller than the errors in ( Qi(mes), Mi(mes)) and ignored in the analysis. By means of Parametric Full Maximum Likelihood and Regression Calibration (under the assumption that the data set of true doses has lognormal distribution), Nonparametric Full Maximum Likelihood, Nonparametric Regression Calibration, and by properly tuned SIMEX method we study the influence of measurement errors in thyroid dose on the estimates of λ(0) and EAR. The simulation study is presented based on a real sample from the epidemiological studies. The doses were reconstructed in the framework of the Ukrainian-American project on the investigation of Post-Chernobyl thyroid cancers in Ukraine, and the underlying subpolulation was artificially enlarged in order to increase the statistical power. The true risk parameters were given by the values to earlier epidemiological studies, and then the binary response was simulated according to the dose-response model.

Quality improvement in medical education: current state and future directions.

PubMed

Wong, Brian M; Levinson, Wendy; Shojania, Kaveh G

2012-01-01

During the last decade, there has been a drive to improve the quality of patient care and prevent the occurrence of avoidable errors. This review describes current efforts to teach or engage trainees in patient safety and quality improvement (QI), summarises progress to date, as well as successes and challenges, and lists our recommendations for the next steps that will shape the future of patient safety and QI in medical education. Trainees encounter patient safety and QI through three main groups of activity. First are formal curricula that teach concepts or methods intended to facilitate trainees' participation in QI activities. These curricula increase learner knowledge and may improve clinical processes, but demonstrate limited capacity to modify learner behaviours. Second are educational activities that impart specific skills related to safety or quality which are considered to represent core doctor competencies (e.g. effective patient handover). These are frequently taught effectively, but without emphasis on the general safety or quality principles that inform the relevant skills. Third are real-life QI initiatives that involve trainees as active or passive participants. These innovative approaches expose trainees to safety and quality by integrating QI activities into trainees' day-to-day work. However, this integration can be challenging and can sometimes result in tension with broader educational goals. To prepare the next generation of doctors to make meaningful contributions to the quality mission, we propose the following call to action. Firstly, a major effort to build faculty capacity, especially among teachers of QI, should be instigated. Secondly, accreditation standards and assessment methods, both during training and at end-of-training certification examinations, should explicitly target these competencies. Finally, and perhaps most importantly, we must refocus our attention at all levels of training and instil fundamental, collaborative, open

Effectiveness of teaching quality improvement to clinicians: a systematic review.

PubMed

Boonyasai, Romsai T; Windish, Donna M; Chakraborti, Chayan; Feldman, Leonard S; Rubin, Haya R; Bass, Eric B

2007-09-05

Accreditation requirements mandate teaching quality improvement (QI) concepts to medical trainees, yet little is known about the effectiveness of teaching QI. To perform a systematic review of the effectiveness of published QI curricula for clinicians and to determine whether teaching methods influence the effectiveness of such curricula. The electronic literature databases of MEDLINE, EMBASE, CINAHL, and ERIC were searched for English-language articles published between January 1, 1980, and April 30, 2007. Experts in the field of QI were queried about relevant studies. Two independent reviewers selected studies for inclusion if the curriculum taught QI principles to clinicians and the evaluation used a comparative study design. Information about the features of each curriculum, its use of 9 principles of adult learning, and the type of educational and clinical outcomes were extracted. The relationship between the outcomes and the number of educational principles used was assessed. Of 39 studies that met eligibility criteria, 31 described team-based projects; 37 combined didactic instruction with experiential learning. The median number of adult learning principles used was 7 (range, 2-8). Evaluations included 22 controlled trials (8 randomized and 14 nonrandomized) and 17 pre/post or time series studies. Fourteen studies described educational outcomes (attitudes, knowledge, or skills or behaviors) and 28 studies described clinical process or patient outcomes. Nine of the 10 studies that evaluated knowledge reported only positive effects but only 2 of these described a validated assessment tool. The 6 assessments of attitudes found mixed results. Four of the 6 studies on skill or behavior outcomes reported only positive effects. Eight of the 28 studies of clinical outcomes reported only beneficial effects. Controlled studies were more likely than other studies to report mixed or null effects. Only 4 studies evaluated both educational and clinical outcomes

Society and Ecosystem Carbon Budget through Life Cycle Assessment: Results from Asian Drylands

NASA Astrophysics Data System (ADS)

Chen, J.

2017-12-01

Land use, land cover changes, and ecosystem-specific management practices are recognized for their roles in mediating the climatic effects on ecosystem structure and function. A major challenge is that our understanding and forecasting of ecosystem functions, such as C fluxes, cannot rely solely on conventional biophysical regulations from the local ecosystem to the global scale. A second challenge lies in quantifying the magnitude of the C fluxes from managed ecosystems and landscapes over the lifetime of the C cycle, and to deduct the various energy inputs during management. Our specific challenge here is to quantify the landscape-scale C footprint of both managed agricultural-forest landscapes and people - the societal input and engagement in ecosystem studies. Using the East Asia Drylands (Chen et al., 2013) and an agricultural watershed in southwestern Michigan as a test bed, the mechanisms (carbon as an example) from both human activities and biophysical changes on ecosystem C dynamics at different temporal and spatial scales are proposed to be explored by modeling total net ecosystem C production (physical and social C fluxes), performing a spatially-explicit life cycle assessment (LCA) on the total C production. Remote sensing technology, available geospatial data, records of management practices, surveys of historical practices, a land surface model, and in situ measurements of C fluxes are all needed to achieve our objectives. Our case study calls for direct involvement of society as both the driver and beneficiary of ecosystem dynamics. Reference Chen, J., Wan, S., Henebry, G., Qi, J., Gutman, G., Sun, G., and Kappas, M. (Eds.) 2013. Dryland East Asia (DEA): Land Dynamics Amid Social And Climate Change. HEP and De Gruyter, 470 pp.

78 FR 48435 - Ocean Transportation Intermediary License Applicants

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-08

... & OFF), 370 S. Crenshaw Blvd., Suite E202A, Torrance, CA 90503, Officers: Charles W. Dobeck, Member (QI...), Hoboken Business Center, 50 Harrison Street, Suite 301, Hoboken, NJ 07030, Officers: Jose L. Ramirez..., President (QI), Sean W. Kim, Director, Application Type: New NVO & OFF License. In Motion Logistics, LLC...

An Evaluation of the Technical Adequacy of a Revised Measure of Quality Indicators of Transition

ERIC Educational Resources Information Center

Morningstar, Mary E.; Lee, Hyunjoo; Lattin, Dana L.; Murray, Angela K.

2016-01-01

This study confirmed the reliability and validity of the Quality Indicators of Exemplary Transition Programs Needs Assessment-2 (QI-2). Quality transition program indicators were identified through a systematic synthesis of transition research, policies, and program evaluation measures. To verify reliability and validity of the QI-2, we…

78 FR 48435 - Ocean Transportation Intermediary License Applicants

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-08

... Change. Ever Line Logistics Inc. (NVO & OFF), 147-35 Farmers Blvd., Suite 208, Jamaica, NY 11434, Officer: Caihong Yang, President (QI), Application Type: Name Change to Bona Logistics US Inc. Global Container.... (OFF), 2018 Park Row Drive, Suite 6765, Katy, TX 77449, Officers: Frederick D. Coker, President (QI...

78 FR 5441 - Ocean Transportation Intermediary License Applicants

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-25

... Trade Name Blu Logistics. Brutos International Corp. (NVO & OFF), 428 S. Atlantic Blvd., Suite 203, Monterey Park, CA 91754, Officers: Janet Li, Secretary (QI), Jesse Wu, CEO/CFO, Application Type: New NVO..., President (QI), Olen D. Woods, Director, Application Type: New NVO License. Global Logistics New Jersey, LLC...

Comparison of two anaerobic water polo-specific tests with the Wingate test.

PubMed

Bampouras, Theodoros M; Marrin, Kelly

2009-01-01

The purpose of the current study was to compare 2 water polo-specific tests-the 14 x 25-m swims (SWIM) and the 30-second crossbar jumps (30CJ)-with a laboratory-based test of anaerobic power, the Wingate Anaerobic Test (WAnT). Thirteen elite women's water polo players (mean +/- SD: age 22.0 +/- 4.4 years, height 168.7 +/- 7.9 cm, body mass 65.9 +/- 6.1 kg, body fat 23.6 +/- 3.5 %, maximum oxygen uptake 51.4 +/- 4.5 mlxkgxmin) participated in the study. The SWIM involved 14 repeated "all-out" sprints every 30 seconds. Swimming time was recorded, and sprint velocity, mean velocity (Vmean), and the gradient of the linear regression equation (GRADIENT) were calculated. The 30CJ involved repeated in-water water polo jumps and touching the goal crossbar with both hands. The number of touches in 30 seconds was recorded. Additionally, the subjects completed a 30-second WAnT, and mean power (Mp) and fatigue index (FI) were calculated. Kendall tau (tau) rank correlation was used to examine for correlation between ranks. Significance level was set at p WAnT and the 2 sport-specific tests. It was suggested that the WAnT may not be an appropriate evaluation tool for anaerobic power assessment of water polo players, stressing the importance of sport-specific tests.