Upgrades, Current Capabilities and Near-Term Plans of the NASA ARC Mars Climate

Science.gov (United States)

Hollingsworth, J. L.; Kahre, Melinda April; Haberle, Robert M.; Schaeffer, James R.

2012-01-01

We describe and review recent upgrades to the ARC Mars climate modeling framework, in particular, with regards to physical parameterizations (i.e., testing, implementation, modularization and documentation); the current climate modeling capabilities; selected research topics regarding current/past climates; and then, our near-term plans related to the NASA ARC Mars general circulation modeling (GCM) project.

Coordination between Fault-Ride-Through Capability and Over-current Protection of DFIG Generators for Wind Farms

DEFF Research Database (Denmark)

Bak-Jensen, Birgitte; Kawady, T.A.; Abdel-Rahman, Mansour Hassan

2010-01-01

is investigated. Simulation test cases using MATLAB-Simulink are implemented on a 365-MW wind farm in AL-Zaafarana, Egypt. The simulation results show the influence of the FRT capability on the protective relaying coordination in wind farms, showing that the FRT may work in situations where is were expected......Fault Ride-Through (FRT) capabilities set up according to the grid codes may affect the performance of related protective elements during fault periods. Therefore, in this paper the coordination between the FRT capability and over-current protection of DFIG Wind Generators in MV networks...... not to work, and then disabling the over-current protection, which should have worked in this situation....

An Exploration of the Benefits of an Animallike Robot Companion with More Advanced Touch Interaction Capabilities for Dementia Care

Directory of Open Access Journals (Sweden)

Merel M. Jung

2017-06-01

Full Text Available Animallike robot companions such as robotic seal Paro are increasingly used in dementia care due to the positive effects that interaction with these robots can have on the well-being of these patients. Touch is one of the most important interaction modalities for patients with dementia and can be a natural way to interact with animallike robots. To advance the development of animallike robots, we explored in what ways people with dementia could benefit from interaction with an animallike robot with more advanced touch recognition capabilities and which touch gestures would be important in their interaction with Paro. In addition, we explored which other target groups might benefit from interaction with animallike robots with more advanced interaction capabilities. In this study, we administered a questionnaire and conducted interviews with two groups of health-care providers who all worked in a geriatric psychiatry department. One group used Paro in their work (i.e., the expert group; n = 5 while the other group had no experience with the use of animallike robot (i.e., the layman group; n = 4. The results showed that health-care providers perceived Paro as an effective intervention to improve the well-being of people with dementia. Examples of usages for Paro that were mentioned were providing distraction, interrupting problematic behaviors, and stimulating communication. Furthermore, the care providers indicated that people with dementia (would use mostly positive forms of touch and speech to interact with Paro. Paro’s auditory responses were criticized because they can overstimulate the patients. In addition, the care providers argued that social interactions with Paro are currently limited and therefore the robot does not meet the needs of a broader audience such as healthy elderly people who still live in their own homes. The development of robot pets with more advanced social capabilities such as touch and speech recognition might

U.S. Sodium Fast Reactor Codes and Methods: Current Capabilities and Path Forward

Energy Technology Data Exchange (ETDEWEB)

Brunett, A. J.; Fanning, T. H.

2017-06-26

The United States has extensive experience with the design, construction, and operation of sodium cooled fast reactors (SFRs) over the last six decades. Despite the closure of various facilities, the U.S. continues to dedicate research and development (R&D) efforts to the design of innovative experimental, prototype, and commercial facilities. Accordingly, in support of the rich operating history and ongoing design efforts, the U.S. has been developing and maintaining a series of tools with capabilities that envelope all facets of SFR design and safety analyses. This paper provides an overview of the current U.S. SFR analysis toolset, including codes such as SAS4A/SASSYS-1, MC2-3, SE2-ANL, PERSENT, NUBOW-3D, and LIFE-METAL, as well as the higher-fidelity tools (e.g. PROTEUS) being integrated into the toolset. Current capabilities of the codes are described and key ongoing development efforts are highlighted for some codes.

Development and validation of a score for evaluating comprehensive stroke care capabilities: J-ASPECT Study

OpenAIRE

Kada, Akiko; Nishimura, Kunihiro; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Suzuki, Akifumi; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru

2017-01-01

Background Although the Brain Attack Coalition recommended establishing centers of comprehensive care for stroke and cerebrovascular disease patients, a scoring system for such centers was lacking. We created and validated a comprehensive stroke center (CSC) score, adapted to Japanese circumstances. Methods Of the selected 1369 certified training institutions in Japan, 749 completed an acute stroke care capabilities survey. Hospital performance was determined using a 25-item score, evaluating...

High-voltage integrated linear regulator with current sinking capabilities for portable ultrasound scanners

DEFF Research Database (Denmark)

Pausas, Guifre Vendrell; Llimos Muntal, Pere; Jørgensen, Ivan Harald Holger

2017-01-01

This paper presents a high-voltage integrated regulator capable of sinking current for driving pulse-triggered level shifters in drivers for ultrasound applications. The regulator utilizes a new topology with a feedback loop and a current sinking circuit to satisfy the requirements of the portable....... The proposed design has been implemented in high-voltage 0.18 μm process whithin an area of 0.11 mm2 and it is suitable for system-on-chip integration due to its low component count and the fully integrated design....

Reforming health care in Canada: current issues

Directory of Open Access Journals (Sweden)

Baris Enis

1998-01-01

Full Text Available This paper examines the current health care reform issues in Canada. The provincial health insurance plans of the 1960s and 1970s had the untoward effects of limiting the federal government's clout for cost control and of promoting a system centered on inpatient and medical care. Recently, several provincial commissions reported that the current governance structures and management processes are outmoded in light of new knowledge, new fiscal realities and the evolution of power among stake-holders. They recommend decentralized governance and restructuring for better management and more citizen participation. Although Canada's health care system remains committed to safeguarding its guiding principles, the balance of power may be shifting from providers to citizens and "technocrats". Also, all provinces are likely to increase their pressure on physicians by means of salary caps, by exploring payment methods such as capitation, limiting access to costly technology, and by demanding practice changes based on evidence of cost-effectiveness.

The informatics capability maturity of integrated primary care centres in Australia.

Science.gov (United States)

Liaw, Siaw-Teng; Kearns, Rachael; Taggart, Jane; Frank, Oliver; Lane, Riki; Tam, Michael; Dennis, Sarah; Walker, Christine; Russell, Grant; Harris, Mark

2017-09-01

Integrated primary care requires systems and service integration along with financial incentives to promote downward substitution to a single entry point to care. Integrated Primary Care Centres (IPCCs) aim to improve integration by co-location of health services. The Informatics Capability Maturity (ICM) describes how well health organisations collect, manage and share information; manage eHealth technology, implementation, change, data quality and governance; and use "intelligence" to improve care. Describe associations of ICM with systems and service integration in IPCCs. Mixed methods evaluation of IPCCs in metropolitan and rural Australia: an enhanced general practice, four GP Super Clinics, a "HealthOne" (private-public partnership) and a Community Health Centre. Data collection methods included self-assessed ICM, document review, interviews, observations in practice and assessment of electronic health record data. Data was analysed and compared across IPCCs. The IPCCs demonstrated a range of funding models, ownership, leadership, organisation and ICM. Digital tools were used with varying effectiveness to collect, use and share data. Connectivity was problematic, requiring "work-arounds" to communicate and share information. The lack of technical, data and software interoperability standards, clinical coding and secure messaging were barriers to data collection, integration and sharing. Strong leadership and governance was important for successful implementation of robust and secure eHealth systems. Patient engagement with eHealth tools was suboptimal. ICM is positively associated with integration of data, systems and care. Improved ICM requires a health workforce with eHealth competencies; technical, semantic and software standards; adequate privacy and security; and good governance and leadership. Copyright © 2017 Elsevier B.V. All rights reserved.

Communication between office-based primary care providers and nurses working within patients' homes: an analysis of process data from CAPABLE.

Science.gov (United States)

Smith, Patrick D; Boyd, Cynthia; Bellantoni, Julia; Roth, Jill; Becker, Kathleen L; Savage, Jessica; Nkimbeng, Manka; Szanton, Sarah L

2016-02-01

To examine themes of communication between office-based primary care providers and nurses working in private residences; to assess which methods of communication elicit fruitful responses to nurses' concerns. Lack of effective communication between home health care nurses and primary care providers contributes to clinical errors, inefficient care delivery and decreased patient safety. Few studies have described best practices related to frequency, methods and reasons for communication between community-based nurses and primary care providers. Secondary analysis of process data from 'Community Aging in Place: Advancing Better Living for Elders (CAPABLE)'. Independent reviewers analysed nurse documentation of communication (phone calls, letters and client coaching) initiated for 70 patients and analysed 45 letters to primary care providers to identify common concerns and recommendations raised by CAPABLE nurses. Primary care providers responded to 86% of phone calls, 56% of letters and 50% of client coaching efforts. Primary care providers addressed 86% of concerns communicated by phone, 34% of concerns communicated by letter and 41% of client-raised concerns. Nurses' letters addressed five key concerns: medication safety, pain, change in activities of daily living, fall safety and mental health. In letters, CAPABLE nurses recommended 58 interventions: medication change; referral to a specialist; patient education; and further diagnostic evaluation. Effective communication between home-based nurses and primary care providers enhances care coordination and improves outcomes for home-dwelling elders. Various methods of contact show promise for addressing specific communication needs. Nurses practicing within patients' homes can improve care coordination by using phone calls to address minor matters and written letters for detailed communication. Future research should explore implementation of Situation, Background, Assessment and Recommendation in home care to promote

Assessment of CFD capability for prediction of hypersonic shock interactions

Science.gov (United States)

Knight, Doyle; Longo, José; Drikakis, Dimitris; Gaitonde, Datta; Lani, Andrea; Nompelis, Ioannis; Reimann, Bodo; Walpot, Louis

2012-01-01

The aerothermodynamic loadings associated with shock wave boundary layer interactions (shock interactions) must be carefully considered in the design of hypersonic air vehicles. The capability of Computational Fluid Dynamics (CFD) software to accurately predict hypersonic shock wave laminar boundary layer interactions is examined. A series of independent computations performed by researchers in the US and Europe are presented for two generic configurations (double cone and cylinder) and compared with experimental data. The results illustrate the current capabilities and limitations of modern CFD methods for these flows.

Fault Ride-through Capability Enhancement of Voltage Source Converter-High Voltage Direct Current Systems with Bridge Type Fault Current Limiters

Directory of Open Access Journals (Sweden)

Md Shafiul Alam

2017-11-01

Full Text Available This paper proposes the use of bridge type fault current limiters (BFCLs as a potential solution to reduce the impact of fault disturbance on voltage source converter-based high voltage DC (VSC-HVDC systems. Since VSC-HVDC systems are vulnerable to faults, it is essential to enhance the fault ride-through (FRT capability with auxiliary control devices like BFCLs. BFCL controllers have been developed to limit the fault current during the inception of system disturbances. Real and reactive power controllers for the VSC-HVDC have been developed based on current control mode. DC link voltage control has been achieved by a feedback mechanism such that net power exchange with DC link capacitor is zero. A grid-connected VSC-HVDC system and a wind farm integrated VSC-HVDC system along with the proposed BFCL and associated controllers have been implemented in a real time digital simulator (RTDS. Symmetrical three phase as well as different types of unsymmetrical faults have been applied in the systems in order to show the effectiveness of the proposed BFCL solution. DC link voltage fluctuation, machine speed and active power oscillation have been greatly suppressed with the proposed BFCL. Another significant feature of this work is that the performance of the proposed BFCL in VSC-HVDC systems is compared to that of series dynamic braking resistor (SDBR. Comparative results show that the proposed BFCL is superior over SDBR in limiting fault current as well as improving system fault ride through (FRT capability.

Anesthesia for day-care surgeries: Current perspectives

Directory of Open Access Journals (Sweden)

Sukhminder Jit Singh Bajwa

2017-01-01

Full Text Available Day-care surgery has become a popular modality of surgical intervention throughout the globe. Numerous factors including the economic and financial issues are driving this therapeutic modality to a widespread acceptance among surgeons and anesthesiologists. Advancements in anesthesia and surgical techniques as well as availability of newer drugs are largely responsible for the progress of day-care surgeries. Numerous challenges are still faced by anesthesiologists and surgeons in carrying out day-care surgeries, especially in spite of these advancements, at resource-limited setups. The first right step in successfully delivering the day-care surgical services includes proper selection of the patients. The preanesthetic evaluation is highly essential in determining the suitability of the patient for day-care anesthesia and surgery as well as the formulation of various anesthetic plans and strategies. The current review is intended to highlight inherent challenges and probable solutions to them for this rapidly progressing anesthesia.

Conceptualizing innovation capabilities: A contingency perspective

Directory of Open Access Journals (Sweden)

Tor Helge Aas

2017-01-01

Full Text Available Empirical research has confirmed that a positive relationship exists between the implementation of innovation activities and the future performance of organizations. Firms utilize resources and capabilities to develop innovations in the form of new products, services or processes. Some firms prove to be better at reproducing innovation success than others, and the capacity to do so is referred to as innovation capability. However, the term innovation capability is ambiguously treated in extant literature. There are several different definitions of the concept and the distinction between innovation capabilities and other types of capabilities, such as dynamic capabilities, is neither explicitly stated, nor is the relationship between the concept and other resource- and capability-based concepts within strategy theory established. Although innovation is increasingly identified as crucial for a firm’s sustainable competitiveness in contemporary volatile and complex markets, the strategy-innovation link is underdeveloped in extant research. To overcome this challenge this paper raises the following research question: What type of innovation capabilities are required to innovate successfully? Due to the status of the extant research, we chose a conceptual research design to answer our research question and the paper contributes with a conceptual framework to discuss what innovation capabilities firms need to reproduce innovation success. Based on careful examination of current literature on innovation capability specifically, and the strategy-innovation link in general, we suggest that innovation capability must be viewed along two dimensions – innovation novelty and market characteristics. This framework enables the identification of four different contexts for innovation capabilities in a two-bytwo matrix. We discuss the types of innovation capabilities necessary within the four different contexts. This novel framework contributes to the

The critical care air transport program.

Science.gov (United States)

Beninati, William; Meyer, Michael T; Carter, Todd E

2008-07-01

The critical care air transport team program is a component of the U.S. Air Force Aeromedical Evacuation system. A critical care air transport team consists of a critical care physician, critical care nurse, and respiratory therapist along with the supplies and equipment to operate a portable intensive care unit within a cargo aircraft. This capability was developed to support rapidly mobile surgical teams with high capability for damage control resuscitation and limited capacity for postresuscitation care. The critical care air transport team permits rapid evacuation of stabilizing casualties to a higher level of care. The aeromedical environment presents important challenges for the delivery of critical care. All equipment must be tested for safety and effectiveness in this environment before use in flight. The team members must integrate the current standards of care with the limitation imposed by stresses of flight on their patient. The critical care air transport team capability has been used successfully in a range of settings from transport within the United States, to disaster response, to support of casualties in combat.

An Overview of Current and Future Stratospheric Balloon Mission Capabilities

Science.gov (United States)

Smith, Michael

The modern stratospheric balloon has been used for a variety of missions since the late 1940's. Capabilities of these vehicles to carry larger payloads, fly to higher altitudes, and fly for longer periods of time have increased dramatically over this time. In addition to these basic performance metrics, reliability statistics for balloons have reached unprecedented levels in recent years. Balloon technology developed in the United States in the last decade has the potential to open a new era in economical space science using balloons. As always, the advantage of the balloon platform is the fact that missions can be carried out at a fraction of the cost and schedule of orbital missions. A secondary advantage is the fact that instruments can be re-flown numerous times while upgrading sensor and data processing technologies from year to year. New mission capabilities now have the potential for enabling ground breaking observations using balloons as the primary platform as opposed to a stepping stone to eventual orbital observatories. The limit of very high altitude balloon missions will be explored with respect to the current state of the art of balloon materials and fabrication. The same technological enablers will also be applied to possibilities for long duration missions at mid latitudes with payloads of several tons. The balloon types and their corresponding mission profiles will be presented in a performance matrix that will be useful for potential scientific users in planning future research programs.

IntelliTable: Inclusively-Designed Furniture with Robotic Capabilities.

Science.gov (United States)

Prescott, Tony J; Conran, Sebastian; Mitchinson, Ben; Cudd, Peter

2017-01-01

IntelliTable is a new proof-of-principle assistive technology system with robotic capabilities in the form of an elegant universal cantilever table able to move around by itself, or under user control. We describe the design and current capabilities of the table and the human-centered design methodology used in its development and initial evaluation. The IntelliTable study has delivered robotic platform programmed by a smartphone that can navigate around a typical home or care environment, avoiding obstacles, and positioning itself at the user's command. It can also be configured to navigate itself to pre-ordained places positions within an environment using ceiling tracking, responsive optical guidance and object-based sonar navigation.

Current and future impact of osteoarthritis on health care

DEFF Research Database (Denmark)

Turkiewicz, A; Petersson, I F; Björk, J

2014-01-01

OBJECTIVE: To estimate the current and future (to year 2032) impact of osteoarthritis (OA) health care seeking. METHOD: Population-based study with prospectively ascertained data from the Skåne Healthcare Register (SHR), Sweden, encompassing more than 15 million person-years of primary and specia......OBJECTIVE: To estimate the current and future (to year 2032) impact of osteoarthritis (OA) health care seeking. METHOD: Population-based study with prospectively ascertained data from the Skåne Healthcare Register (SHR), Sweden, encompassing more than 15 million person-years of primary...

Music therapy in palliative care: current perspectives.

Science.gov (United States)

O'Kelly, Julian

2002-03-01

As the music therapy profession has developed internationally over the last 25 years, so has its role in palliative care. Music is a highly versatile and dynamic therapeutic modality, lending itself to a variety of music therapy techniques used to benefit both those living with life-threatening illnesses and their family members and caregivers. This article will give a broad overview of the historical roots of music therapy and introduce the techniques that are employed in current practice. By combining a review of mainstream music therapy practice involving musical improvisation, song-writing and receptive/recreational techniques with case material from my own experience, this article aims to highlight the potential music therapy holds as an effective holistic practice for palliative care, whatever the care setting.

Adding navigation, artificial audition and vital sign monitoring capabilities to a telepresence mobile robot for remote home care applications.

Science.gov (United States)

Laniel, Sebastien; Letourneau, Dominic; Labbe, Mathieu; Grondin, Francois; Polgar, Janice; Michaud, Francois

2017-07-01

A telepresence mobile robot is a remote-controlled, wheeled device with wireless internet connectivity for bidirectional audio, video and data transmission. In health care, a telepresence robot could be used to have a clinician or a caregiver assist seniors in their homes without having to travel to these locations. Many mobile telepresence robotic platforms have recently been introduced on the market, bringing mobility to telecommunication and vital sign monitoring at reasonable costs. What is missing for making them effective remote telepresence systems for home care assistance are capabilities specifically needed to assist the remote operator in controlling the robot and perceiving the environment through the robot's sensors or, in other words, minimizing cognitive load and maximizing situation awareness. This paper describes our approach adding navigation, artificial audition and vital sign monitoring capabilities to a commercially available telepresence mobile robot. This requires the use of a robot control architecture to integrate the autonomous and teleoperation capabilities of the platform.

Simplified tools for measuring retention in care in antiretroviral treatment program in Ethiopia: cohort and current retention in care.

Science.gov (United States)

Assefa, Yibeltal; Worku, Alemayehu; Wouters, Edwin; Koole, Olivier; Haile Mariam, Damen; Van Damme, Wim

2012-01-01

Patient retention in care is a critical challenge for antiretroviral treatment programs. This is mainly because retention in care is related to adherence to treatment and patient survival. It is therefore imperative that health facilities and programs measure patient retention in care. However, the currently available tools, such as Kaplan Meier, for measuring retention in care have a lot of practical limitations. The objective of this study was to develop simplified tools for measuring retention in care. Retrospective cohort data were collected from patient registers in nine health facilities in Ethiopia. Retention in care was the primary outcome for the study. Tools were developed to measure "current retention" in care during a specific period of time for a specific "ART-age group" and "cohort retention" in care among patients who were followed for the last "Y" number of years on ART. "Probability of retention" based on the tool for "cohort retention" in care was compared with "probability of retention" based on Kaplan Meier. We found that the new tools enable to measure "current retention" and "cohort retention" in care. We also found that the tools were easy to use and did not require advanced statistical skills. Both "current retention" and "cohort retention" are lower among patients in the first two "ART-age groups" and "ART-age cohorts" than in subsequent "ART-age groups" and "ART-age cohorts". The "probability of retention" based on the new tools were found to be similar to the "probability of retention" based on Kaplan Meier. The simplified tools for "current retention" and "cohort retention" will enable practitioners and program managers to measure and monitor rates of retention in care easily and appropriately. We therefore recommend that health facilities and programs start to use these tools in their efforts to improve retention in care and patient outcomes.

Simplified tools for measuring retention in care in antiretroviral treatment program in Ethiopia: cohort and current retention in care.

Directory of Open Access Journals (Sweden)

Yibeltal Assefa

Full Text Available INTRODUCTION: Patient retention in care is a critical challenge for antiretroviral treatment programs. This is mainly because retention in care is related to adherence to treatment and patient survival. It is therefore imperative that health facilities and programs measure patient retention in care. However, the currently available tools, such as Kaplan Meier, for measuring retention in care have a lot of practical limitations. The objective of this study was to develop simplified tools for measuring retention in care. METHODS: Retrospective cohort data were collected from patient registers in nine health facilities in Ethiopia. Retention in care was the primary outcome for the study. Tools were developed to measure "current retention" in care during a specific period of time for a specific "ART-age group" and "cohort retention" in care among patients who were followed for the last "Y" number of years on ART. "Probability of retention" based on the tool for "cohort retention" in care was compared with "probability of retention" based on Kaplan Meier. RESULTS: We found that the new tools enable to measure "current retention" and "cohort retention" in care. We also found that the tools were easy to use and did not require advanced statistical skills. Both "current retention" and "cohort retention" are lower among patients in the first two "ART-age groups" and "ART-age cohorts" than in subsequent "ART-age groups" and "ART-age cohorts". The "probability of retention" based on the new tools were found to be similar to the "probability of retention" based on Kaplan Meier. CONCLUSION: The simplified tools for "current retention" and "cohort retention" will enable practitioners and program managers to measure and monitor rates of retention in care easily and appropriately. We therefore recommend that health facilities and programs start to use these tools in their efforts to improve retention in care and patient outcomes.

ICU nurses' oral-care practices and the current best evidence.

Science.gov (United States)

DeKeyser Ganz, Freda; Fink, Naomi Farkash; Raanan, Ofra; Asher, Miriam; Bruttin, Madeline; Nun, Maureen Ben; Benbinishty, Julie

2009-01-01

The purpose of this study was to describe the oral-care practices of ICU nurses, to compare those practices with current evidence-based practice, and to determine if the use of evidence-based practice was associated with personal demographic or professional characteristics. A national survey of oral-care practices of ICU nurses was conducted using a convenience sample of 218 practicing ICU nurses in 2004-05. The survey instrument included questions about demographic and professional characteristics and a checklist of oral-care practices. Nurses rated their perceived level of priority concerning oral care on a scale from 0 to 100. A score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the current best evidence. This score was then statistically analyzed using ANOVA to determine differences of EBP based on demographic and professional characteristics. The most commonly used equipment was gauze pads (84%), followed by tongue depressors (55%), and toothbrushes (34%). Chlorhexidine was the most common solution used (75%). Less than half (44%) reported brushing their patients' teeth. The majority performed an oral assessment before beginning oral care (71%); however, none could describe what assessment tool was used. Only 57% of nurses reported documenting their oral care. Nurses rated oral care of intubated patients with a priority of 67+/-27.1. Wide variations were noted within and between units in terms of which techniques, equipment, and solutions were used. No significant relationships were found between the use of an evidence-based protocol and demographic and professional characteristics or with the priority given to oral care. While nurses ranked oral care a high priority, many did not implement the latest evidence into their current practice. The level of research utilization was not related to personal or professional characteristics. Therefore attempts should be made to encourage all

Emergency Care Capabilities in North East Haiti: A Cross-sectional Observational Study.

Science.gov (United States)

De Wulf, Annelies; Aluisio, Adam R; Muhlfelder, Dana; Bloem, Christina

2015-12-01

The North East Department is a resource-limited region of Haiti. Health care is provided by hospitals and community clinics, with no formal Emergency Medical System and undefined emergency services. As a paucity of information exists on available emergency services in the North East Department of Haiti, the objective of this study was to assess systematically the existing emergency care resources in the region. This cross-sectional observational study was carried out at all Ministry of Public Health and Population (MSPP)-affiliated hospitals in the North East Department and all clinics within the Fort Liberté district. A modified version of the World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care and Generic Essential Emergency Equipment Lists were completed for each facility. Three MSPP hospitals and five clinics were assessed. Among hospitals, all had a designated emergency ward with 24 hour staffing by a medical doctor. All hospitals had electricity with backup generators and access to running water; however, none had potable water. All hospitals had x-ray and ultrasound capabilities. No computed tomography scanners existed in the region. Invasive airway equipment and associated medications were not present consistently in the hospitals' emergency care areas, but they were available in the operating rooms. Pulse oximetry was unavailable uniformly. One hospital had intermittently functioning defibrillation equipment, and two hospitals had epinephrine. Basic supplies for managing obstetrical and traumatic emergencies were available at all hospitals. Surgical services were accessible at two hospitals. No critical care services were available in the region. Clinics varied widely in terms of equipment availability. They uniformly had limited emergency medical equipment. The clinics also had inconsistent access to basic assessment tools (sphygmomanometers 20% and stethoscopes 60%). A protocol for transferring

The ESA River & Lake System: Current Capabilities and Future Potential

DEFF Research Database (Denmark)

Smith, Richard G.; Salloway, Mark; Berry, Philippa A. M.

Measuring the earth's river and lake resources using satellite radar altimetry offers a unique global monitoring capability, which complements the detailed measurements made by the steadily decreasing number of in-situ gauges. To exploit this unique remote monitoring capability, a global pilot...

Enhancing the capabilities of eddy current techniques for non-destructive evaluation of austenitic stainless steels

International Nuclear Information System (INIS)

Rao, B.P.C.; Thirunavukkarasu, S.; Sasi, B.; Jayakumar, T.; Baldev Raj

2010-01-01

Eddy current non-destructive evaluation (NDE) techniques find many applications during fabrication and in-service inspection of components made of stainless steel. In recent years, concurrent developments in electromagnetic field detection sensors such as giant magneto-resistive (GMR), giant-magneto impedance (GMI) and SQUIDs sensors, computers, microelectronics, and incorporating advanced signal and image processing techniques, have paved the way for enhancing the capabilities of existing eddy current (EC) techniques for examination of austenitic stainless steel (SS) plates, tubes and other geometries and several innovative methodologies have been developed. This paper highlights a few such applications in EC testing to austenitic stainless steel components used in fast reactors. (author)

Current status of palliative care--clinical implementation, education, and research.

Science.gov (United States)

Grant, Marcia; Elk, Ronit; Ferrell, Betty; Morrison, R Sean; von Gunten, Charles F

2009-01-01

Palliative and end-of-life care is changing in the United States. This dynamic field is improving care for patients with serious and life-threatening cancer through creation of national guidelines for quality care, multidisciplinary educational offerings, research endeavors, and resources made available to clinicians. Barriers to implementing quality palliative care across cancer populations include a rapidly expanding population of older adults who will need cancer care and a decrease in the workforce available to give care. Methods of integrating current palliative care knowledge into care of patients include multidisciplinary national education and research endeavors, and clinician resources. Acceptance of palliative care as a recognized medical specialty provides a valuable resource for improvement of care. Although compilation of evidence for the importance of palliative care specialities is in its initial stages, national research grants have provided support to build the knowledge necessary for appropriate palliative care. Opportunities are available to clinicians for understanding and applying appropriate palliative and end-of-life care to patients with serious and life-threatening cancers. (c) 2009 American Cancer Society, Inc.

Rationing critical care medicine: recent studies and current trends.

Science.gov (United States)

Ward, Nicholas S

2005-12-01

This paper reviews the literature on the rationing of critical care resources. Although much has been written about the concept of rationing, there have been few scientific studies as to its prevalence. A recent meta-analysis reviewed all previously published studies on rationing access to intensive care units but little is known about practices within the intensive care unit. Much literature in the past few years has focused on the growing use of critical care resources and projections for the future. Several authors suggest there may be a crisis in financial or personnel resources if some rationing does not take place. Other papers have argued that the methods of rationing critical care previously proposed, such as limiting the care of dying patients or using cost-effectiveness analysis to determine care, may not be effective or viewed as ethical by some. Finally, several recent papers review how critical care is practiced and allocated in India and Asian countries that already practice open rationing in their health care systems. There is currently no published evidence that overt rationing is taking place in critical care medicine. There is growing evidence that in the future, the need for critical care may outstrip financial resources unless some form of rationing takes place. It is also clear from the literature that choosing how to ration critical care will be a difficult task.

Exploration Medical Capability - Technology Watch

Science.gov (United States)

Krihak, Michael; Watkins, Sharmila; Barr, Yael; Barsten, Kristina; Fung, Paul; Baumann, David

2011-01-01

The objectives of the Technology Watch process are to identify emerging, high-impact technologies that augment current ExMC development efforts, and to work with academia, industry, and other government agencies to accelerate the development of medical care and research capabilities for the mitigation of potential health issues that could occur during space exploration missions. The establishment of collaborations with these entities is beneficial to technology development, assessment and/or insertion. Such collaborations also further NASA s goal to provide a safe and healthy environment for human exploration. The Tech Watch project addresses requirements and capabilities identified by knowledge and technology gaps that are derived from a discrete set of medical conditions that are most likely to occur on exploration missions. These gaps are addressed through technology readiness level assessments, market surveys, collaborations and distributed innovation opportunities. Ultimately, these gaps need to be closed with respect to exploration missions, and may be achieved through technology development projects. Information management is a key aspect to this process where Tech Watch related meetings, research articles, collaborations and partnerships are tracked by the HRP s Exploration Medical Capabilities (ExMC) Element. In 2011, ExMC will be introducing the Tech Watch external website and evidence wiki that will provide access to ExMC technology and knowledge gaps, technology needs and requirements documents.

Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention.

Science.gov (United States)

Anestis, Michael D; Law, Keyne C; Jin, Hyejin; Houtsma, Claire; Khazem, Lauren R; Assavedo, Brittney L

2017-10-01

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence-based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population-level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability-centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population-level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence-based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt. © 2016 The American Association of Suicidology.

Current practice of preconception care by primary caregivers in the Netherlands

NARCIS (Netherlands)

S.F. van Voorst (Sabine); S. Plasschaert (Sophie); L.C. de Jong-Potjer (L.); E.A.P. Steegers (Eric); S. Denktaş (Semiha)

2016-01-01

textabstractObjectives: Over the past decade the value of preconception care (PCC) consultations has been acknowledged. Investments have been made to promote delivery and uptake of PCC consultations in the Dutch primary care setting. We assessed current activities, perceptions and prerequisites for

THE IDEA IS TO USEMODIS IN CONJUNCTION WITH THE CURRENT LIMITED LANDSAT CAPABILITY, COMMERCIAL SATELLITES, ANDUNMANNED AERIAL VEHICLES (UAV), IN A MULTI-STAGE APPROACH TO MEET EPA INFORMATION NEEDS.REMOTE SENSING OVERVIEW: EPA CAPABILITIES, PRIORITY AGENCY APPLICATIONS, SENSOR/AIRCRAFT CAPABILITIES, COST CONSIDERATIONS, SPECTRAL AND SPATIAL RESOLUTIONS, AND TEMPORAL CONSIDERATIONS

Science.gov (United States)

EPA remote sensing capabilities include applied research for priority applications and technology support for operational assistance to clients across the Agency. The idea is to use MODIS in conjunction with the current limited Landsat capability, commercial satellites, and Unma...

Fault Ride Through Capability Enhancement of a Large-Scale PMSG Wind System with Bridge Type Fault Current Limiters

Directory of Open Access Journals (Sweden)

ALAM, M. S.

2018-02-01

Full Text Available In this paper, bridge type fault current limiter (BFCL is proposed as a potential solution to the fault problems of permanent magnet synchronous generator (PMSG based large-scale wind energy system. As PMSG wind system is more vulnerable to disturbances, it is essential to guarantee the stability during severe disturbances by enhancing the fault ride through capability. BFCL controller has been designed to insert resistance and inductance during the inception of system disturbances in order to limit fault current. Constant capacitor voltage has been maintained by the grid voltage source converter (GVSC controller while current extraction or injection has been achieved by machine VSC (MVSC controller. Symmetrical and unsymmetrical faults have been applied in the system to show the effectiveness of the proposed BFCL solution. PMSG wind system, BFCL and their controllers have been implemented by real time hardware in loop (RTHIL setup with real time digital simulator (RTDS and dSPACE. Another significant feature of this work is that the performance of the proposed BFCL is compared with that of series dynamic braking resistor (SDBR. Comparative RTHIL implementation results show that the proposed BFCL is very efficient in improving system fault ride through capability by limiting the fault current and outperforms SDBR.

The Orphee reactor current status and proposed enhancement of experimental capabilities

International Nuclear Information System (INIS)

Breant, P.

1990-01-01

This report provides a description of the Orphee reactor, together with a rapid assessment of its experimental and research capabilities. The plans for enhancing the reactor's experimental capabilities are also presented. (author)

The impact of antenatal mental distress on functioning and capabilities: views of health care providers and service users in Cape Town, South Africa.

Science.gov (United States)

Mall, Sumaya; Honikman, Simone; Evans, Bronwyn; Swartz, Leslie; Lund, Crick

2014-01-01

Antenatal mental distress has disabling consequences. It affects functioning and participation in daily activities and can lead to postnatal depression. This study employs the International Classification of Functioning Disability and Health (ICF), to explore the experiences of pregnant women with mental distress attending the Perinatal Mental Health Project (PMHP). The analysis also adopts Amartya Sen's capabilities approach to provide suggestions for appropriate interventions. We conducted in-depth interviews with seven pregnant women experiencing antenatal mental distress, three postnatal women who had experienced antenatal mental distress and seven health care providers all affiliated with the PMHP. We used an open-ended interview guide employing domains from the ICF as well as from the capabilities approach. Participants attributed their antenatal mental distress to a range of environmental factors. Difficulties in functioning were reported by participants including difficulties at work and caring for children. Participants stated that services provided by the PMHP have a positive impact on functioning and capabilities. The study suggests that the ICF is useful for exploring the impact of antenatal mental distress on functioning. It is well complemented by the capabilities approach to inform interventions. Implications for Rehabilitation Antenatal mental distress is a significant public health issue that impacts on women's functioning and participation exacerbated by social factors such as poverty and exposure to violence. This study explored restrictions in functioning and participation faced by women with antenatal mental distress including the ability to care for children, find meaningful employment and sustain relationships. Counselling services can play a role in restoring functioning and capabilities for women experiencing antenatal mental distress. Counselling services have the ability to discuss restrictions in functioning caused by antenatal mental

Current practice and views of neurologists on the transition from pediatric to adult care.

Science.gov (United States)

Oskoui, Maryam; Wolfson, Christina

2012-12-01

To describe the current practice and views of neurologists on transitioning patients from pediatric to adult care, a cross-sectional study of all pediatric and adult neurologists in the province of Quebec, Canada, was conducted. The response rate was 73% for pediatric and 49% for adult neurologists. Most pediatric neurologists do not have a patient transition program or policy in place. Although a transfer summary is commonly provided, critical information is often lacking. Nearly half of neurologists believed that patients experience a gap in care during the transition process, and most agreed that the transition process is often poorly coordinated, highlighting patient, family, and health care factors. Current practice does not follow existing consensus statements for transition of care with respect to timing, communication, and preparation, and many pediatric neurologists experience difficulty in finding an appropriate adult health care provider for their patients. Neurologists reported many challenges in the current transition of care process.

Acute Care Referral Systems in Liberia: Transfer and Referral Capabilities in a Low-Income Country.

Science.gov (United States)

Kim, Jimin; Barreix, Maria; Babcock, Christine; Bills, Corey B

2017-12-01

referral exist and could serve as the basis for a more robust system. Well-integrated acute care referral systems in low-income countries, like Liberia, may help to mitigate future public health crises by augmenting a country's capacity for emergency preparedness. Kim J , Barreix M , Babcock C , Bills CB . Acute care referral systems in Liberia: transfer and referral capabilities in a low-income country. Prehosp Disaster Med. 2017;32(6):642-650.

Space Logistics: Launch Capabilities

Science.gov (United States)

Furnas, Randall B.

1989-01-01

The current maximum launch capability for the United States are shown. The predicted Earth-to-orbit requirements for the United States are presented. Contrasting the two indicates the strong National need for a major increase in Earth-to-orbit lift capability. Approximate weights for planned payloads are shown. NASA is studying the following options to meet the need for a new heavy-lift capability by mid to late 1990's: (1) Shuttle-C for near term (include growth versions); and (2) the Advanced Lauching System (ALS) for the long term. The current baseline two-engine Shuttle-C has a 15 x 82 ft payload bay and an expected lift capability of 82,000 lb to Low Earth Orbit. Several options are being considered which have expanded diameter payload bays. A three-engine Shuttle-C with an expected lift of 145,000 lb to LEO is being evaluated as well. The Advanced Launch System (ALS) is a potential joint development between the Air Force and NASA. This program is focused toward long-term launch requirements, specifically beyond the year 2000. The basic approach is to develop a family of vehicles with the same high reliability as the Shuttle system, yet offering a much greater lift capability at a greatly reduced cost (per pound of payload). The ALS unmanned family of vehicles will provide a low end lift capability equivalent to Titan IV, and a high end lift capability greater than the Soviet Energia if requirements for such a high-end vehicle are defined.In conclusion, the planning of the next generation space telescope should not be constrained to the current launch vehicles. New vehicle designs will be driven by the needs of anticipated heavy users.

Focus group reflections on the current and future state of cognitive assessment tools in geriatric health care

Directory of Open Access Journals (Sweden)

Whitehead JC

2015-06-01

Full Text Available Jocelyne C Whitehead,1 Sara A Gambino,1 Jeffrey D Richter,2 Jennifer D Ryan1,3,41Rotman Research Institute, Baycrest, 2Independent Human Factors Consultant, Toronto, ON, Canada; 3Department of Psychology, 4Department of Psychiatry, University of Toronto, Toronto, ON, CanadaObjective: This study provides insight into the thoughts and opinions of geriatric health-care professionals toward cognitive assessments and the use of emerging technologies, such as eye-tracking, to supplement current tools.Methods: Two focus group sessions were conducted with nurses and physicians who routinely administer neurocognitive assessments to geriatric populations. Video recordings of the focus group sessions were transcribed and a thematic analysis was performed.Results: Participants reported the need for assessment and diagnostic tools that are accessible and efficient, and that are capable of accommodating the rapid growth in the aging population. The prevalence of more complex ailments experienced by older adults has had repercussions in the quality of care that the clients receive, and has contributed to lengthy wait times and resource shortages. Health-care professionals stated that they are hampered by the disjointed structure of the health-care system and that they would benefit from a more efficient allocation of responsibilities made possible through tools that did not require extensive training or certification. Eyetracking-based cognitive assessments were thought to strongly complement this system, yet it was thought that difficulty would be faced in gaining the support and increased uptake by health-care professionals due to the nonintuitive relationship between eyetracking and cognition.Conclusion: The findings suggest that health-care professionals are receptive to the use of eyetracking technology to assess for cognitive health as it would conserve resources by allowing frontline staff to administer assessments with minimal training

Human Exploration Systems and Mobility Capability Roadmap Progress Review

Science.gov (United States)

Culbert, Chris; Taylor, Jeff

2005-01-01

Contents include the following: Capability Roadmap Team. Capability Description and Capability Breakdown Structure. Benefits of the Human Systems and Mobility Capability. Roadmap Process and Approach. Drivers and Assumptions for the whole team. Current State-of-the-Art, Assumptions and Requirements will be covered in the appropriate sections. Capability Presentations by Leads under Roadmap (Repeated for each capability under roadmap). Capability Description, Benefits, Current State-of-the-Art. Capability Requirements and Assumptions. Roadmap for Capability. Capability Readiness Level. Technology Readiness Level. Figures of Merit. Summary of Top Level Capability. Significant Technical Challenges. Summary and Forward Work.

Transformer-based asymmetrical embedded Z-source neutral point clamped inverters with continuous input current and enhanced voltage boost capability

DEFF Research Database (Denmark)

Mo, W.; Loh, Poh Chiang; Blaabjerg, Frede

2013-01-01

Z-source Neutral Point Clamped (NPC) inverters were introduced to integrate both the advantages of Z-source inverters and NPC inverters. However, traditional Z-source inverters suffer from high voltage stress and chopping input current. This paper proposes six types transformer-based impedance-so......-source NPC inverters which have enhanced voltage boost capability and continuous input current by utilizing of transformer and embedded dc source configuration. Experimental results are presented to verify the theory validation....

Exploration Medical Capability (ExMC) Projects

Science.gov (United States)

Wu, Jimmy; Watkins, Sharmila; Baumann, David

2010-01-01

During missions to the Moon or Mars, the crew will need medical capabilities to diagnose and treat disease as well as for maintaining their health. The Exploration Medical Capability Element develops medical technologies, medical informatics, and clinical capabilities for different levels of care during space missions. The work done by team members in this Element is leading edge technology, procedure, and pharmacological development. They develop data systems that protect patient's private medical information, aid in the diagnosis of medical conditions, and act as a repository of relevant NASA life sciences experimental studies. To minimize the medical risks to crew health the physicians and scientists in this Element develop models to quantify the probability of medical events occurring during a mission. They define procedures to treat an ill or injured crew member who does not have access to an emergency room and who must be cared for in a microgravity environment where both liquids and solids behave differently than on Earth. To support the development of these medical capabilities, the Element manages the development of medical technologies that prevent, monitor, diagnose, and treat an ill or injured crewmember. The Exploration Medical Capability Element collaborates with the National Space Biomedical Research Institute (NSBRI), the Department of Defense, other Government-funded agencies, academic institutions, and industry.

Current Allergic Rhinitis Experiences Survey (CARES): Health-care practitioners' awareness, attitudes and practices.

Science.gov (United States)

Blaiss, Michael S; Fromer, Leonard M; Jacob-Nara, Juby A; Long, Randall M; Mannion, Karen M; Lauersen, Lori A

2014-01-01

Allergic rhinitis (AR) is a common health problem in the United States, with significant comorbidities and impairment of quality of life despite the availability of many prescription (Rx) and over-the-counter (OTC) medications. The health-care practitioners (HCPs) arm of the Current Allergic Rhinitis Experiences Survey (CARES) assessed HCPs' perceptions about the current management of AR. This U.S.-based national survey included 375 primary care physicians and 375 nurse practitioners/physician assistants. Participants were screened to ensure that they treat ≥15 AR sufferers per month during allergy season. The majority of HCPs (86%) agreed that AR patients can easily recognize allergy symptoms after diagnosis and that 57% of their patients come to them self-recognizing their symptoms. A total of 82% strongly agreed that AR sufferers are primarily diagnosed via history and physical and do not typically undergo diagnostic testing until after pharmacologic intervention. HCPs reported that 63-77% of AR sufferers can easily manage AR once treatment is established. According to surveyed HCPs, OTC medication should precede an Rx medication for AR management. A total of 82% HCPs considered intranasal steroids (INSs) to be the gold standard AR treatment and have minimal safety concerns about INS use. HCPs perceive that patients can easily recognize and self-manage their AR symptoms. Patient history/symptoms and physical examination are the primary methods of AR diagnosis. INSs are considered the gold standard for treatment of AR. However, most HCPs feel OTC medication should be tried before Rx medication for AR management.

Technical Study on Improvement of Endurance Capability of Limit Short-circuit Current of Charge Control SMART Meter

Science.gov (United States)

Li, W. W.; Du, Z. Z.; Yuan, R. m.; Xiong, D. Z.; Shi, E. W.; Lu, G. N.; Dai, Z. Y.; Chen, X. Q.; Jiang, Z. Y.; Lv, Y. G.

2017-10-01

Smart meter represents the development direction of energy-saving smart grid in the future. The load switch, one of the core parts of smart meter, should be of high reliability, safety and endurance capability of limit short-circuit current. For this reason, this paper discusses the quick simulation of relationship between attraction and counterforce of load switch without iteration, establishes dual response surface model of attraction and counterforce and optimizes the design scheme of load switch for charge control smart meter, thus increasing electromagnetic attraction and spring counterforce. In this way, this paper puts forward a method to improve the withstand capacity of limit short-circuit current.

ADVANCED SIMULATION CAPABILITY FOR ENVIRONMENTAL MANAGEMENT- CURRENT STATUS AND PHASE II DEMONSTRATION RESULTS

Energy Technology Data Exchange (ETDEWEB)

Seitz, R.

2013-02-26

The U.S. Department of Energy (USDOE) Office of Environmental Management (EM), Office of Soil and Groundwater, is supporting development of the Advanced Simulation Capability for Environmental Management (ASCEM). ASCEM is a state-of-the-art scientific tool and approach for understanding and predicting contaminant fate and transport in natural and engineered systems. The modular and open source high-performance computing tool facilitates integrated approaches to modeling and site characterization that enable robust and standardized assessments of performance and risk for EM cleanup and closure activities. The ASCEM project continues to make significant progress in development of computer software capabilities with an emphasis on integration of capabilities in FY12. Capability development is occurring for both the Platform and Integrated Toolsets and High-Performance Computing (HPC) Multiprocess Simulator. The Platform capabilities provide the user interface and tools for end-to-end model development, starting with definition of the conceptual model, management of data for model input, model calibration and uncertainty analysis, and processing of model output, including visualization. The HPC capabilities target increased functionality of process model representations, toolsets for interaction with Platform, and verification and model confidence testing. The Platform and HPC capabilities are being tested and evaluated for EM applications in a set of demonstrations as part of Site Applications Thrust Area activities. The Phase I demonstration focusing on individual capabilities of the initial toolsets was completed in 2010. The Phase II demonstration completed in 2012 focused on showcasing integrated ASCEM capabilities. For Phase II, the Hanford Site deep vadose zone (BC Cribs) served as an application site for an end-to-end demonstration of capabilities, with emphasis on integration and linkages between the Platform and HPC components. Other demonstrations

Putting Role 1 first: the Role 1 capability review.

Science.gov (United States)

Hodgetts, T J; Findlay, S

2012-09-01

To quantify the risk for delivering care at Role 1 in the Land Environment (point of wounding to hospital care) on current operations and set the conditions for systematic change to enhance future capability. UK, US and Danish Army Role 1 Subject Matter Experts (SMEs) (1) Questionnaire study ofUK SMEs to determine capability gaps; (2) Questionnaire study of US and Danish SMEs to benchmark UK capability; (3) Semi-structured interviews of UK SMEs; (4) In-theatre evaluation of deployed Role 1. Thirty two SMEs completed the questionnaire (68% response rate), comprising 25 medical officers (20 in clinical appointments; five in command and staff appointments), six nurses and one medical support officer. Results of the entire review were collated as a cross-Defence Lines of Development analysis, separating the specific experience of 1 Medical Regiment's Hybrid Foundation Training (HFT), Mission Specific Training (MST) and deployment cycle from the analysis gained from questionnaire studies, SME consultation and documentary evidence. The review generated 77 recommendations and 38 sub-recommendations. The top six messages of the review were (1) To balance the expressed desire to increase the ratio of trained Team Medics with the reality of generating credible instructors with clinical experience; (2) To recognise that inadequate experience for Combat Medical Technicians in Primary Healthcare in the Firm Base undermines their operational preparedness; (3) To recognise that Current Regimental Aid Post (RAP) at contingency without power lacks the rudimentary infrastructure of a modern Medical Treatment Facility; (4) To recognise that inappropriate deployment of personnel with chronic disease or acutely limiting conditions is a consistent trend for 20 years that highlights continuing system weaknesses in applying protective medical grading; (5) To accept that General Practitioner manning requires re-evaluating as an Operational Pinch Point, reviewing all options to maintain

Quantifying the Global Fresh Water Budget: Capabilities from Current and Future Satellite Sensors

Science.gov (United States)

Hildebrand, Peter; Zaitchik, Benjamin

2007-01-01

The global water cycle is complex and its components are difficult to measure, particularly at the global scales and with the precision needed for assessing climate impacts. Recent advances in satellite observational capabilities, however, are greatly improving our knowledge of the key terms in the fresh water flux budget. Many components of the of the global water budget, e.g. precipitation, atmospheric moisture profiles, soil moisture, snow cover, sea ice are now routinely measured globally using instruments on satellites such as TRMM, AQUA, TERRA, GRACE, and ICESat, as well as on operational satellites. New techniques, many using data assimilation approaches, are providing pathways toward measuring snow water equivalent, evapotranspiration, ground water, ice mass, as well as improving the measurement quality for other components of the global water budget. This paper evaluates these current and developing satellite capabilities to observe the global fresh water budget, then looks forward to evaluate the potential for improvements that may result from future space missions as detailed by the US Decadal Survey, and operational plans. Based on these analyses, and on the goal of improved knowledge of the global fresh water budget under the effects of climate change, we suggest some priorities for the future, based on new approaches that may provide the improved measurements and the analyses needed to understand and observe the potential speed-up of the global water cycle under the effects of climate change.

Physician capability to electronically exchange clinical information, 2011.

Science.gov (United States)

Patel, Vaishali; Swain, Matthew J; King, Jennifer; Furukawa, Michael F

2013-10-01

To provide national estimates of physician capability to electronically share clinical information with other providers and to describe variation in exchange capability across states and electronic health record (EHR) vendors using the 2011 National Ambulatory Medical Care Survey Electronic Medical Record Supplement. Survey of a nationally representative sample of nonfederal office-based physicians who provide direct patient care. The survey was administered by mail with telephone follow-up and had a 61% weighted response rate. The overall sample consisted of 4326 respondents. We calculated estimates of electronic exchange capability at the national and state levels, and applied multivariate analyses to examine the association between the capability to exchange different types of clinical information and physician and practice characteristics. In 2011, 55% of physicians had computerized capability to send prescriptions electronically; 67% had the capability to view lab results electronically; 42% were able to incorporate lab results into their EHR; 35% were able to send lab orders electronically; and, 31% exchanged patient clinical summaries with other providers. The strongest predictor of exchange capability is adoption of an EHR. However, substantial variation exists across geography and EHR vendors in exchange capability, especially electronic exchange of clinical summaries. In 2011, a majority of office-based physicians could exchange lab and medication data, and approximately one-third could exchange clinical summaries with patients or other providers. EHRs serve as a key mechanism by which physicians can exchange clinical data, though physicians' capability to exchange varies by vendor and by state.

Defining Medical Capabilities for Exploration Missions

Science.gov (United States)

Hailey, M.; Antonsen, E.; Blue, R.; Reyes, D.; Mulcahy, R.; Kerstman, E.; Bayuse, T.

2018-01-01

Exploration-class missions to the moon, Mars and beyond will require a significant change in medical capability from today's low earth orbit centric paradigm. Significant increases in autonomy will be required due to differences in duration, distance and orbital mechanics. Aerospace medicine and systems engineering teams are working together within ExMC to meet these challenges. Identifying exploration medical system needs requires accounting for planned and unplanned medical care as defined in the concept of operations. In 2017, the ExMC Clinicians group identified medical capabilities to feed into the Systems Engineering process, including: determining what and how to address planned and preventive medical care; defining an Accepted Medical Condition List (AMCL) of conditions that may occur and a subset of those that can be treated effectively within the exploration environment; and listing the medical capabilities needed to treat those conditions in the AMCL. This presentation will discuss the team's approach to addressing these issues, as well as how the outputs of the clinical process impact the systems engineering effort.

The current state of Lean implementation in health care: literature review.

Science.gov (United States)

Poksinska, Bozena

2010-01-01

The purpose of this article is to discuss the current state of implementation of Lean production in health care. The study focuses on the definition of Lean in health care and implementation process, barriers, challenges, enablers, and outcomes of implementing Lean production methods in health care. A comprehensive search of the literature concerning the implementation of Lean production in health care was used to generate a synthesis of the literature around the chosen research questions. Lean production in health care is mostly used as a process improvement approach and focuses on 3 main areas: (1) defining value from the patient point of view, (2) mapping value streams, and (3) eliminating waste in an attempt to create continuous flow. Value stream mapping is the most frequently applied Lean tool in health care. The usual implementation steps include conducting Lean training, initiating pilot projects, and implementing improvements using interdisciplinary teams. One of the barriers is lack of educators and consultants who have their roots in the health care sector and can provide support by sharing experience and giving examples from real-life applications of Lean in health care. The enablers of Lean in health care seem not to be different from the enablers of any other change initiative. The outcomes can be divided into 2 broad areas: the performance of the health care system and the development of employees and work environment.

Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

OpenAIRE

Jarrar, Mu?taman; Rahman, Hamzah Abdul; Don, Mohammad Sobri

2015-01-01

Background and Objective: Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia. Design: Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patie...

DDP-516 Computer Graphics System Capabilities

Science.gov (United States)

1972-06-01

This report describes the capabilities of the DDP-516 Computer Graphics System. One objective of this report is to acquaint DOT management and project planners with the system's current capabilities, applications hardware and software. The Appendix i...

Current pulse: can a production system reduce medical errors in health care?

Science.gov (United States)

Printezis, Antonios; Gopalakrishnan, Mohan

2007-01-01

One of the reasons for rising health care costs is medical errors, a majority of which result from faulty systems and processes. Health care in the past has used process-based initiatives such as Total Quality Management, Continuous Quality Improvement, and Six Sigma to reduce errors. These initiatives to redesign health care, reduce errors, and improve overall efficiency and customer satisfaction have had moderate success. Current trend is to apply the successful Toyota Production System (TPS) to health care since its organizing principles have led to tremendous improvement in productivity and quality for Toyota and other businesses that have adapted them. This article presents insights on the effectiveness of TPS principles in health care and the challenges that lie ahead in successfully integrating this approach with other quality initiatives.

Personalized health care: from theory to practice.

Science.gov (United States)

Snyderman, Ralph

2012-08-01

The practice of medicine stands at the threshold of a transformation from its current focus on the treatment of disease events to an emphasis on enhancing health, preventing disease and personalizing care to meet each individual's specific health needs. Personalized health care is a new and strategic approach that is driven by personalized health planning empowered by personalized medicine tools, which are facilitated by advances in science and technology. These tools improve the capability to predict health risks, to determine and quantify the dynamics of disease development, and to target therapeutic approaches to the needs of the individual. Personalized health care can be implemented today using currently available technologies and know-how and thereby provide a market for the rational introduction of new personalized medicine tools. The need for early adoption of personalized health care stems from the necessity to reduce the egregious and wasteful burden of preventable chronic diseases, which is not effectively addressed by our current approach to care. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

The impact of managed care and current governmental policies on an urban academic health care center.

Science.gov (United States)

Rodriguez, J L; Peterson, D J; Muehlstedt, S G; Zera, R T; West, M A; Bubrick, M P

2001-10-01

Managed care and governmental policies have restructured hospital reimbursement. We examined reimbursement trends in trauma care to assess the impact of this market driven change on an urban academic health center. Patients injured between January 1997 and December 1999 were analyzed for Injury Severity Score (ISS), length of hospital stay, hospital cost, payer, and reimbursement. Between 1997 and 1999, the volume of patients with an ISS less than 9 increased and length of stay decreased. In addition, overall cost, payment, and profit margin increased. Commercially insured patients accounted for this margin increase, because the margins of managed care and government insured patients experienced double-digit decreases. Patients with ISS of 9 or greater also experienced a volume increase and a reduction in length of stay; however, costs within this group increased greater than payments, thereby reducing profit margin. Whereas commercially insured patients maintained their margin, managed care and government insured patients did not (double- and triple-digit decreases). Managed care and current governmental policies have a negative impact on urban academic health center reimbursement. Commercial insurers subsidize not only the uninsured but also the government insured and managed care patients as well. National awareness of this issue and policy action are paramount to urban academic health centers and may also benefit commercial insurers.

[Physiotherapeutic care marketing research: current state-of-the art].

Science.gov (United States)

Babaskin, D V

2011-01-01

Successful introduction of modern technologies into the national health care systems strongly depends on the current pharmaceutical market situation. The present article is focused on the peculiarities of marketing research with special reference to physiotherapeutic services and commodities. Analysis of the structure and sequence of marketing research processes is described along with the methods applied for the purpose including their support by the use of Internet resources and technologies.

[Reimbursement of intensive care services in the German DRG system : Current problems and possible solutions].

Science.gov (United States)

Riessen, R; Hermes, C; Bodmann, K-F; Janssens, U; Markewitz, A

2018-02-01

The reimbursement of intensive care and nursing services in the German health system is based on the diagnosis-related groups (G-DRG) system. Due to the lack of a central hospital planning, the G‑DRG system has become the most important influence on the development of the German health system. Compared to other countries, intensive care in Germany is characterized by a high number of intensive care beds, a low nurse-to-patient ratio, no official definition of the level of care, and a minimal available data set from intensive care units (ICUs). Under the given circumstances, a shortage of qualified intensive care nurses and physicians is currently the largest threat for intensive care in Germany. To address these deficiencies, we suggest the following measures: (1) Integration of ICUs into the levels of care which are currently developed for emergency centers at hospitals. (2) Mandatory collection of structured data sets from all ICUs including quality criteria. (3) A reform of intensive care and nursing reimbursement under consideration of adequate staffing in the individual ICU. (4) Actions to improve ICU staffing and qualification.

Review of current capabilities for the measurement of stress, displacement, and in situ deformation modulus

International Nuclear Information System (INIS)

Schrauf, T.W.; Pratt, H.R.

1979-12-01

Current capabilities for the measurement of stress, displacement, and in situ deformation modulus in rock masses are reviewed as to their accuracy, sensitivity, advantages, and limitations. Consideration is given to both the instruments themselves and the measurement technique. Recommendations concerning adaptation of existing measurement techniques to repository monitoring are also discussed. These recommendations include: (1) development of a modified borehole deformation gage with improved long-term stability and reliability and reduced thermal sensitivity; (2) development of a downhole transducer type of extensometer; (3) development of a rigid inclusion type gage; (4) development of an improved vibrating wire stressmeter with greater accuracy and simplified calibration and installation requirements; and (5) modification of standard rod extensometers to improve their sensitivity

Advanced Simulation Capability for Environmental Management - Current Status and Phase II Demonstration Results - 13161

Energy Technology Data Exchange (ETDEWEB)

Seitz, Roger R.; Flach, Greg [Savannah River National Laboratory, Savannah River Site, Bldg 773-43A, Aiken, SC 29808 (United States); Freshley, Mark D.; Freedman, Vicky; Gorton, Ian [Pacific Northwest National Laboratory, MSIN K9-33, P.O. Box 999, Richland, WA 99352 (United States); Dixon, Paul; Moulton, J. David [Los Alamos National Laboratory, MS B284, P.O. Box 1663, Los Alamos, NM 87544 (United States); Hubbard, Susan S.; Faybishenko, Boris; Steefel, Carl I.; Finsterle, Stefan [Lawrence Berkeley National Laboratory, 1 Cyclotron Road, MS 50B-4230, Berkeley, CA 94720 (United States); Marble, Justin [Department of Energy, 19901 Germantown Road, Germantown, MD 20874-1290 (United States)

2013-07-01

The U.S. Department of Energy (US DOE) Office of Environmental Management (EM), Office of Soil and Groundwater, is supporting development of the Advanced Simulation Capability for Environmental Management (ASCEM). ASCEM is a state-of-the-art scientific tool and approach for understanding and predicting contaminant fate and transport in natural and engineered systems. The modular and open source high-performance computing tool facilitates integrated approaches to modeling and site characterization that enable robust and standardized assessments of performance and risk for EM cleanup and closure activities. The ASCEM project continues to make significant progress in development of computer software capabilities with an emphasis on integration of capabilities in FY12. Capability development is occurring for both the Platform and Integrated Tool-sets and High-Performance Computing (HPC) Multi-process Simulator. The Platform capabilities provide the user interface and tools for end-to-end model development, starting with definition of the conceptual model, management of data for model input, model calibration and uncertainty analysis, and processing of model output, including visualization. The HPC capabilities target increased functionality of process model representations, tool-sets for interaction with Platform, and verification and model confidence testing. The Platform and HPC capabilities are being tested and evaluated for EM applications in a set of demonstrations as part of Site Applications Thrust Area activities. The Phase I demonstration focusing on individual capabilities of the initial tool-sets was completed in 2010. The Phase II demonstration completed in 2012 focused on showcasing integrated ASCEM capabilities. For Phase II, the Hanford Site deep vadose zone (BC Cribs) served as an application site for an end-to-end demonstration of capabilities, with emphasis on integration and linkages between the Platform and HPC components. Other demonstrations

Advanced Simulation Capability for Environmental Management - Current Status and Phase II Demonstration Results - 13161

International Nuclear Information System (INIS)

Seitz, Roger R.; Flach, Greg; Freshley, Mark D.; Freedman, Vicky; Gorton, Ian; Dixon, Paul; Moulton, J. David; Hubbard, Susan S.; Faybishenko, Boris; Steefel, Carl I.; Finsterle, Stefan; Marble, Justin

2013-01-01

The U.S. Department of Energy (US DOE) Office of Environmental Management (EM), Office of Soil and Groundwater, is supporting development of the Advanced Simulation Capability for Environmental Management (ASCEM). ASCEM is a state-of-the-art scientific tool and approach for understanding and predicting contaminant fate and transport in natural and engineered systems. The modular and open source high-performance computing tool facilitates integrated approaches to modeling and site characterization that enable robust and standardized assessments of performance and risk for EM cleanup and closure activities. The ASCEM project continues to make significant progress in development of computer software capabilities with an emphasis on integration of capabilities in FY12. Capability development is occurring for both the Platform and Integrated Tool-sets and High-Performance Computing (HPC) Multi-process Simulator. The Platform capabilities provide the user interface and tools for end-to-end model development, starting with definition of the conceptual model, management of data for model input, model calibration and uncertainty analysis, and processing of model output, including visualization. The HPC capabilities target increased functionality of process model representations, tool-sets for interaction with Platform, and verification and model confidence testing. The Platform and HPC capabilities are being tested and evaluated for EM applications in a set of demonstrations as part of Site Applications Thrust Area activities. The Phase I demonstration focusing on individual capabilities of the initial tool-sets was completed in 2010. The Phase II demonstration completed in 2012 focused on showcasing integrated ASCEM capabilities. For Phase II, the Hanford Site deep vadose zone (BC Cribs) served as an application site for an end-to-end demonstration of capabilities, with emphasis on integration and linkages between the Platform and HPC components. Other demonstrations

Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions.

Science.gov (United States)

Jarrar, Mu'taman; Abdul Rahman, Hamzah; Don, Mohammad Sobri

2015-10-20

Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia. Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) Malaysia and the MOH Malaysia Annual Reports were reviewed. The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10th Malaysia Health Plan promotes the theme "1 Care for 1 Malaysia" in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH Malaysia is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors. There is no single intervention for optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.

Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

Science.gov (United States)

Jarrar, Mu’taman; Rahman, Hamzah Abdul; Don, Mohammad Sobri

2016-01-01

Background and Objective: Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia. Design: Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) Malaysia and the MOH Malaysia Annual Reports were reviewed. Results: The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10th Malaysia Health Plan promotes the theme “1 Care for 1 Malaysia” in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH Malaysia is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors. Conclusions: There is no single intervention for optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia. PMID:26755459

Overview of current RFSP-code capabilities for CANDU core analysis

International Nuclear Information System (INIS)

Rouben, B.

1996-01-01

RFSP (Reactor Fuelling Simulation Program) is the major finite-reactor computer code in use at the Atomic Energy of Canada Limited for the design and analysis of CANDU reactor cores. An overview is given of the major computational capabilities available in RFSP. (author) 11 refs., 29 figs

Networking capability and new product development

NARCIS (Netherlands)

Mu, J.; Di Benedetto, A.C.

2012-01-01

Current research on network theory remains largely focused on structures and outcomes without exploring the capability that firms need to build efficient and effective networks to their advantage. In this paper, we take a networking capability view in studying inter-firm relationships. We assume

The Cuban health care system and factors currently undermining it.

Science.gov (United States)

Nayeri, K

1995-08-01

This paper explores the dynamics of health and health care in Cuba during a period of severe crisis by placing it within its economic, social, and political context using a comparative historical approach. It outlines Cuban achievements in health care as a consequence of the socialist transformations since 1959, noting the full commitment by the Cuban state, the planned economy, mass participation, and a self-critical, working class perspective as crucial factors. The roles of two external factors, the U.S. economic embargo and the Council of Mutual Economic Cooperation (CMEA), are explored in shaping the Cuban society and economy, including its health care system. It is argued that the former has hindered health efforts in Cuba. The role of the latter is more complex. While the CMEA was an important source for economic growth, Cuban relations with the Soviet bloc had a damaging effect on the development of socialism in Cuba. The adoption of the Soviet model of economic development fostered bureaucracy and demoralization of Cuban workers. As such, it contributed to two internal factors that have undermined further social progress including in health care: low productivity of labor and the growth of bureaucracy. While the health care system is still consistently supported by public policy and its structure is sound, economic crisis undermines its material and moral foundations and threatens its achievements. The future of the current Cuban health care system is intertwined with the potentials for its socialist development.

Why Health Matters to Justice: A Capability Theory Perspective

DEFF Research Database (Denmark)

Nielsen, Lasse

2015-01-01

The capability approach, originated by Amartya Sen is among the most comprehensive and influential accounts of justice that applies to issues of health and health care. However, although health is always presumed as an important capability in Sen’s works, he never manages to fully explain why...

Acute care patient portals: a qualitative study of stakeholder perspectives on current practices.

Science.gov (United States)

Collins, Sarah A; Rozenblum, Ronen; Leung, Wai Yin; Morrison, Constance Rc; Stade, Diana L; McNally, Kelly; Bourie, Patricia Q; Massaro, Anthony; Bokser, Seth; Dwyer, Cindy; Greysen, Ryan S; Agarwal, Priyanka; Thornton, Kevin; Dalal, Anuj K

2017-04-01

To describe current practices and stakeholder perspectives of patient portals in the acute care setting. We aimed to: (1) identify key features, (2) recognize challenges, (3) understand current practices for design, configuration, and use, and (4) propose new directions for investigation and innovation. Mixed methods including surveys, interviews, focus groups, and site visits with stakeholders at leading academic medical centers. Thematic analyses to inform development of an explanatory model and recommendations. Site surveys were administered to 5 institutions. Thirty interviews/focus groups were conducted at 4 site visits that included a total of 84 participants. Ten themes regarding content and functionality, engagement and culture, and access and security were identified, from which an explanatory model of current practices was developed. Key features included clinical data, messaging, glossary, patient education, patient personalization and family engagement tools, and tiered displays. Four actionable recommendations were identified by group consensus. Design, development, and implementation of acute care patient portals should consider: (1) providing a single integrated experience across care settings, (2) humanizing the patient-clinician relationship via personalization tools, (3) providing equitable access, and (4) creating a clear organizational mission and strategy to achieve outcomes of interest. Portals should provide a single integrated experience across the inpatient and ambulatory settings. Core functionality includes tools that facilitate communication, personalize the patient, and deliver education to advance safe, coordinated, and dignified patient-centered care. Our findings can be used to inform a "road map" for future work related to acute care patient portals. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

The Greater Sekhukhune-CAPABILITY outreach project.

Science.gov (United States)

Gregersen, Nerine; Lampret, Julie; Lane, Tony; Christianson, Arnold

2013-07-01

The Greater Sekhukhune-CAPABILITY Outreach Project was undertaken in a rural district in Limpopo, South Africa, as part of the European Union-funded CAPABILITY programme to investigate approaches for capacity building for the translation of genetic knowledge into care and prevention of congenital disorders. Based on previous experience of a clinical genetic outreach programme in Limpopo, it aimed to initiate a district clinical genetic service in Greater Sekhukhune to gain knowledge and experience to assist in the implementation and development of medical genetic services in South Africa. Implementing the service in Greater Sekhukhune was impeded by a developing staff shortage in the province and pressure on the health service from the existing HIV/AIDS and TB epidemics. This situation underscores the need for health needs assessment for developing services for the care and prevention of congenital disorders in middle- and low-income countries. However, these impediments stimulated the pioneering of innovate ways to offer medical genetic services in these circumstances, including tele-teaching of nurses and doctors, using cellular phones to enhance clinical care and adapting and assessing the clinical utility of a laboratory test, QF-PCR, for use in the local circumstances.

Resource-Based Capability on Development Knowledge Management Capabilities of Coastal Community

Science.gov (United States)

Teniwut, Roberto M. K.; Hasyim, Cawalinya L.; Teniwut, Wellem A.

2017-10-01

Building sustainable knowledge management capabilities in the coastal area might face a whole new challenge since there are many intangible factors involved from openness on new knowledge, access and ability to use the latest technology to the various local wisdom that still in place. The aimed of this study was to identify and analyze the resource-based condition of coastal community in this area to have an empirical condition of tangible and intangible infrastructure on developing knowledge management capability coastal community in Southeast Maluku, Indonesia. We used qualitative and quantitative analysis by depth interview and questionnaire for collecting the data with multiple linear regression as our analysis method. The result provided the information on current state of resource-based capability of a coastal community in this Southeast Maluku to build a sustainability model of knowledge management capabilities especially on utilization marine and fisheries resources. The implication of this study can provide an empirical information for government, NGO and research institution to dictate on how they conducted their policy and program on developing coastal community region.

Towards a dynamic concept of alliance capability

OpenAIRE

SLUYTS, Kim; MARTENS, Rudy; MATTHYSSENS, Paul

2008-01-01

This paper has a threefold purpose. First, we offer a literature review on alliance capability based on strategic and competence based management literature. Second, we extend existing literature on alliance capability by breaking this concept down into five sub capabilities, which are each linked to a stage of the alliance life cycle. Finally, we suggest how firms can support these capabilities through structural, technological and people-related tools and techniques. We argue that current l...

Long-term care over an uncertain future: what can current retirees expect?

Science.gov (United States)

Kemper, Peter; Komisar, Harriet L; Alecxih, Lisa

The leading edge of the baby boom generation is nearing retirement and facing uncertainty about its need for long-term care (LTC). Using a microsimulation model, this analysis projected that people currently turning age 65 will need LTC for three years on average. An important share of needed care will be covered by public programs and some private insurance, but much of the care will be an uninsured private responsibility of individuals and their families--a responsibility that will be distributed unequally. While over a third of those now turning 65 are projected to never receive family care, three out of 10 will rely on family care for more than two years. Similarly, half of people turning 65 will have no private out-of-pocket expenditures for LTC, while more than one in 20 are projected to spend $100,000 or more of their own money (in present discounted value). Policy debate that focuses only on income security and acute care--and the corresponding Social Security and Medicare programs--misses the third, largely private, risk that retirees face: that of needing LTC.

In-vitro diagnostic devices introduction to current point-of-care diagnostic devices

CERN Document Server

Cheng, Chao-Min; Chen, Chien-Fu

2016-01-01

Addressing the origin, current status, and future development of point-of-care diagnostics, and serving to integrate knowledge and tools from Analytical Chemistry, Bioengineering, Biomaterials, and Nanotechnology, this book focusses on addressing the collective and combined needs of industry and academia (including medical schools) to effectively conduct interdisciplinary research. In addition to summarizing and detailing developed diagnostic devices, this book will attempt to point out the possible future trends of development for point-of-care diagnostics using both scientifically based research and practical engineering needs with the aim to help novices comprehensively understand the development of point-of-care diagnostics. This includes demonstrating several common but critical principles and mechanisms used in point-of-care diagnostics that address practical needs (e.g., disease or healthcare monitoring) using two well-developed examples so far: 1) blood glucose meters (via electrochemistry); and, 2) p...

Analytical Chemistry Core Capability Assessment - Preliminary Report

International Nuclear Information System (INIS)

Barr, Mary E.; Farish, Thomas J.

2012-01-01

The concept of 'core capability' can be nebulous one. Even at a fairly specific level, where core capability equals maintaining essential services, it is highly dependent upon the perspective of the requestor. Samples are submitted to analytical services because the requesters do not have the capability to conduct adequate analyses themselves. Some requests are for general chemical information in support of R and D, process control, or process improvement. Many analyses, however, are part of a product certification package and must comply with higher-level customer quality assurance requirements. So which services are essential to that customer - just those for product certification? Does the customer also (indirectly) need services that support process control and improvement? And what is the timeframe? Capability is often expressed in terms of the currently utilized procedures, and most programmatic customers can only plan a few years out, at best. But should core capability consider the long term where new technologies, aging facilities, and personnel replacements must be considered? These questions, and a multitude of others, explain why attempts to gain long-term consensus on the definition of core capability have consistently failed. This preliminary report will not try to define core capability for any specific program or set of programs. Instead, it will try to address the underlying concerns that drive the desire to determine core capability. Essentially, programmatic customers want to be able to call upon analytical chemistry services to provide all the assays they need, and they don't want to pay for analytical chemistry services they don't currently use (or use infrequently). This report will focus on explaining how the current analytical capabilities and methods evolved to serve a variety of needs with a focus on why some analytes have multiple analytical techniques, and what determines the infrastructure for these analyses. This information will be

Human factors and ergonomics in home care: Current concerns and future considerations for health information technology

Science.gov (United States)

Or, Calvin K.L.; Valdez, Rupa S.; Casper, Gail R.; Carayon, Pascale; Burke, Laura J.; Brennan, Patricia Flatley; Karsh, Ben-Tzion

2010-01-01

Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home dwelling patient, that can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-monitoring and self-management. Currently, a variety of health information technologies (HITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This paper reviews the HFE considerations for information access, communication, and patients self-monitoring and self-management, discusses how HIT can potentially mitigate current problems, and explains how the design and implementation of HIT itself requires careful HFE attention. PMID:19713630

Liberalism, Humanism, and Feminism in Nussbaum's Capabilities ...

African Journals Online (AJOL)

A purely theoretical analysis of Martha Nussbaum's basis of the capabilities ... Since even a capabilities approach rooted in feminist justice is itself radical and must ... rhetoric of sex and social justice that has already been embraced by current

Study on Application of New Approach of Fault Current Limiters in Fault Ride through Capability Improvement of DFIG Based Wind Turbine

DEFF Research Database (Denmark)

Naderi, Seyed Behzad; Davari, Pooya; Zhou, Dao

2018-01-01

Due to salient advantages, Doubly-Fed Induction Generator (DFIG) has more application in power network compared to Fixed Speed Wind Turbine. Because of employing back-to-back converters, one of the important studies regarding new grid code requirements is Fault Ride-Through (FRT) capability....... The proposed FCL can insert a controllable resistance in fault current pass to not only restrict fault current level and compensate voltage sag in the stator but also consume pre-fault output active power of the DFIG regarding wind speed variation. Simulation results and analytics are presented to prove...

Occupational Therapists’ Perceived Relevance of Nussbaum’s Central Capabilities to Client-centered Practice

Directory of Open Access Journals (Sweden)

Tahmineh Mousavi

2015-10-01

Full Text Available Background: Client-centered practice is highly valued in occupational therapy. Nussbaum’s Capabilities Approach focuses on the individual person and functional autonomy by encompassing 10 functional capabilities that could provide a framework for the systematic implementation of client-centered care. Method: To explore the perceived relevance of Nussbaum’s 10 capabilities with respect to client-centered practice, semi-structured interviews with 14 occupational therapists in British Columbia, Canada, were conducted and thematically analyzed. Results: Nussbaum’s Central Human Functional Capabilities approach provides a broad perspective, encompassing the range of settings of occupational therapy practice. Nussbaum’s 10 capabilities were viewed as being particularly aligned with the established tenets of client-centered practice. Conclusion: Nussbaum’s Capabilities Approach has several compelling attributes for consideration by occupational therapists that warrant further exploration as a novel basis for systematically implementing client-centered care.

Current models of care for disorders of sex development

DEFF Research Database (Denmark)

Kyriakou, Andreas; Dessens, Arianne; Bryce, Jillian

2016-01-01

BACKGROUND: To explore the current models of practice in centres delivering specialist care for children with disorders of sex development (DSD), an international survey of 124 clinicians, identified through DSDnet and the I-DSD Registry, was performed in the last quarter of 2014. RESULTS: A total...... by 14 (19 %) centres. In addition to complex biochemistry and molecular genetic investigations, 40 clinicians (51 %) also had access to next generation sequencing. A genetic test was reported to be more preferable than biochemical tests for diagnosing 5-alpha reductase deficiency and 17-beta...

Do social networks and technological capabilities help knowledge management?

Directory of Open Access Journals (Sweden)

Encarnación García-Sánchez

2017-12-01

Full Text Available Dynamic capabilities are currently becoming an important extension of the theory of resources and capabilities that enables companies to adapt better in the current competitive environment. This paper examines how knowledge management, a dynamic function related to management or administration of a set of knowledge flows, develops thanks to the greater dynamism of social networks. It then shows how this relationship is especially strengthened by different technological capabilities. To achieve these goals, the paper examines the main tools that permit companies to develop an ability to achieve competitive advantage relative to the technological capabilities of managers and workers, social networks and knowledge management.

A Strategic Approach to Medical Care for Exploration Missions

Science.gov (United States)

Canga, Michael A.; Shah, Ronak V.; Mindock, Jennifer A.; Antonsen, Erik L.

2016-01-01

Exploration missions will present significant new challenges to crew health, including effects of variable gravity environments, limited communication with Earth-based personnel for diagnosis and consultation for medical events, limited resupply, and limited ability for crew return. Providing health care capabilities for exploration class missions will require system trades be performed to identify a minimum set of requirements and crosscutting capabilities, which can be used in design of exploration medical systems. Medical data, information, and knowledge collected during current space missions must be catalogued and put in formats that facilitate querying and analysis. These data are used to inform the medical research and development program through analysis of risk trade studies between medical care capabilities and system constraints such as mass, power, volume, and training. Medical capability as a quantifiable variable is proposed as a surrogate risk metric and explored for trade space analysis that can improve communication between the medical and engineering approaches to mission design. The resulting medical system design approach selected will inform NASA mission architecture, vehicle, and subsystem design for the next generation of spacecraft.

Care pathways for dementia: current perspectives

Directory of Open Access Journals (Sweden)

Samsi K

2014-11-01

Full Text Available Kritika Samsi, Jill ManthorpeSocial Care Workforce Research Unit, King’s College London, London, UKAbstract: Uncertainty appears to typify the experience of living with dementia. With an uncertain illness trajectory and unpredictable levels of deterioration and stability in symptoms, people with a diagnosis of dementia may live with uncertainty and anxiety and find it hard to make plans or decisions for their future. People with memory problems and caregivers seeking a diagnosis of dementia may also potentially find themselves navigating a labyrinth-like maze of services, practitioners, assessments, and memory tests, with limited understanding of test scores and little information about what support is available. In this context of uncertainty, the apparent clarity and certainty of a “dementia care pathway” may be attractive. However, the term “dementia care pathway” has multiple and overlapping meanings, which can potentially give rise to further confusion if these are ill-defined or a false consensus is presumed. This review distinguishes four meanings: 1 a mechanism for the management and containment of uncertainty and confusion, useful for the professional as well as the person with dementia; 2 a manual for sequencing care activities; 3 a guide to consumers, indicating eligibility for care activities, or a guide to self-management for dementia dyads, indicating the appropriateness of care activities; and 4 a manual for “walking with” the person. Examples of these approaches are presented from UK dementia services with illustrations of existing care pathways and associated time points, specifically focusing on: 1 early symptom identification and first service encounters, 2 assessment process, 3 diagnostic disclosure, 4 postdiagnostic support, and 5 appropriate interventions. We review the evidence around these themes, as well as discuss service pathways and referral routes used by some services in England and internationally. We

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

Directory of Open Access Journals (Sweden)

Monique Venter

2016-11-01

Full Text Available Background. Critical care transfers (CCT refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft of patients who are of high acuity. In South Africa (SA, advanced life support (ALS paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods. A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample (n=7, consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results. After three rounds, consensus was obtained in 70% (57/81 of procedures and medications. Many of these items are not currently within the scope of paramedics’ training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion. Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners.

Promoting practical clinical management learning: the current situation about Information and Communications Technology capability development in student nurses.

Science.gov (United States)

Willmer, Marian

2005-11-01

This paper is about work-based learning in information management for student nurses. It seeks, through a literature review, to make a case for and promote Information and Communications Technology capability development in student nurses within their clinical environment. The profession of nursing, like many other jobs, is facing the increasing usage of information technology in day-to-day operations. Admission and discharges of patients have been held on computer databases since at least the 1980s. With the new Labour Government in 1997, increasing focus was placed on the effectiveness of the National Health Service and using computers as one way to assist in achieving greater effectiveness. Nurse education therefore needed to reflect this need and support trainee nurses to acquire skills in Information and Communications Technology. This paper is part of an ongoing professional doctorate inquiry into Information and Communications Technology capability development in student nurses. A literature search was conducted on teaching information and technology skills via Cumulative Index to Nursing and Allied Health Literature. Most of the available studies were neither based on the UK nor were they about student nurses. As there is a dearth of published work in this specific area, relevant, related and tangential literature was reviewed. It is argued that current practice and published work on Information and Communications Technology capability development by student nurses hardly exists. The literature confirmed that success in this area requires sound change management, an understanding of National Health Service culture, and effective people leadership skills. Nurse educators and managers need to pay more attention to understand how organizations work, particularly organizations where student nurses carry out their work. As the search revealed a significant gap in the literature in this area, a practical conceptual framework to fully analyse, develop and

The current implementation status of the integration of sports and physical activity into Dutch rehabilitation care.

Science.gov (United States)

Hoekstra, Femke; Hettinga, Florentina J; Alingh, Rolinde A; Duijf, Marjo; Dekker, Rienk; van der Woude, Lucas H V; van der Schans, Cees P

2017-01-01

To describe the current status of the nationwide implementation process of a sports and physical activity stimulation programme to gain insight into how sports and physical activity were integrated into Dutch rehabilitation care. The current implementation status of a sports and physical activity stimulation programme in 12 rehabilitation centres and 5 hospitals with a rehabilitation department was described by scoring fidelity and satisfaction. Seventy-one rehabilitation professionals filled out a questionnaire on how sports and physical activity, including stimulation activities, were implemented into rehabilitation care. Total fidelity scores (in %) were calculated for each organization. Professionals' satisfaction was rated on a scale from 1 to 10. In most organizations sports and physical activity were to some extent integrated during and after rehabilitation (fidelity scores: median = 54%, IQR = 23%). Physical activity stimulation was not always embedded as standard component of a rehabilitation treatment. Professionals' satisfaction rated a median value of 8.0 (IQR = 0.0) indicating high satisfaction rates. The fidelity outcome showed that activities to stimulate sports and physical activity during and after rehabilitation were integrated into rehabilitation care, but not always delivered as standardized component. These findings have emphasized the importance to focus on integrating these activities into routines of organizations. Implications for Rehabilitation Components of an evidence-based programme to stimulate sports and physical activity during and after rehabilitation can be used to measure the current status of the integration of sports and physical activity in rehabilitation care in a structural and effective way. The method described in the current study can be used to compare the content of the rehabilitation care regarding the integration of sports and physical activity among organizations both on a national and international level

Does a trade-off between current reproductive success and survival affect the honesty of male signalling in species with male parental care?

Science.gov (United States)

Kelly, N B; Alonzo, S H

2010-11-01

Recent theory predicted that male advertisement will reliably signal investment in paternal care in species where offspring survival requires paternal care and males allocate resources between advertisement and care. However, the predicted relationship between care and advertisement depended on the marginal gains from investment in current reproductive traits. Life history theory suggests that these fitness gains are also subject to a trade-off between current and future reproduction. Here, we investigate whether male signalling remains a reliable indicator of parental care when males allocate resources between current advertisement, paternal care and survival to future reproduction. We find that advertisement is predicted to remain a reliable signal of male care but that advertisement may cease to reliably indicate male quality because low-quality males are predicted to invest in current reproduction, whereas higher-quality males are able to invest in both current reproduction and survival to future reproduction. © 2010 The Authors. Journal Compilation © 2010 European Society For Evolutionary Biology.

Current End-of-Life Care Needs and Care Practices in Acute Care Hospitals

Directory of Open Access Journals (Sweden)

Amy J. Thurston

2011-01-01

Full Text Available A descriptive-comparative study was undertaken to examine current end-of-life care needs and practices in hospital. A chart review for all 1,018 persons who died from August 1, 2008 through July 31, 2009 in two full-service Canadian hospitals was conducted. Most decedents were elderly (73.8% and urbanite (79.5%, and cancer was the most common diagnosis (36.2%. Only 13.8% had CPR performed at some point during this hospitalization and 8.8% had CPR immediately preceding death, with 87.5% having a DNR order and 30.8% providing an advance directive. Most (97.3% had one or more life-sustaining technologies in use at the time of death. These figures indicate, when compared to those in a similar mid-1990s Canadian study, that impending death is more often openly recognized and addressed. Technologies continue to be routinely but controversially used. The increased rate of end-stage CPR from 2.9% to 8.8% could reflect a 1994+ shift of expected deaths out of hospital.

Evolution, current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization.

Science.gov (United States)

Heilmann, Rachel M F; Campbell, Stephanie M; Kroner, Beverly A; Proksel, Jenel R; Billups, Sarah J; Witt, Daniel M; Helling, Dennis K

2013-01-01

The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.

Factors related to intention to stay in the current workplace among long-term care nurses: A nationwide survey.

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Eltaybani, Sameh; Noguchi-Watanabe, Maiko; Igarashi, Ayumi; Saito, Yumiko; Yamamoto-Mitani, Noriko

2018-04-01

Keeping long-term care nurses employed is necessary to sustain the current and future demand for high-quality long-term care services. Understanding the factors relating to intention to stay among long-term care nurses is limited by the scarcity of studies in long-term care settings, lack of investigation of multiple factors, and the weakness of existing explanatory models. To identify the factors associated with long-term care nurses' intention to stay in their current workplace. A cross-sectional questionnaire survey. Two hundred and fifty-seven hospitals with long-term care wards across Japan. A total of 3128 staff nurses and 257 nurse managers from the long-term care wards of the participating hospitals. The questionnaire assessed nurses' intention to continue working in the current workplace as well as potential related factors, including individual factors (demographic data, reason for choosing current workplace, burnout, work engagement, somatic symptom burden) and unit factors (unit size, nurse-manager-related data, patients' medical acuity, average number of overtime hours, recreational activities, social support, perceived quality of care process, educational opportunities, feeling of loneliness, and ability to request days off). Multilevel logistic regression analysis was used to determine which variables best explained nurses' intention to stay in their workplace. Only 40.1% of the respondents reported wanting to continue working at their current workplace. The regression analysis revealed that long-term care nurses' intention to stay was positively associated with nurses' age (odds ratio [95% confidence interval]: 1.02 [1.01-1.03]), work engagement (1.24 [1.14-1.35]), getting appropriate support from nurse managers (2.78 [1.60-4.82]), perceived quality of care process (1.04 [1.01-1.06]), educational opportunities (1.06 [1.0-1.13]), and various specific reasons for choosing their workplace (e.g., a good workplace atmosphere, being interested in

Effects of comprehensive stroke care capabilities on in-hospital mortality of patients with ischemic and hemorrhagic stroke: J-ASPECT study.

Science.gov (United States)

Iihara, Koji; Nishimura, Kunihiro; Kada, Akiko; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Miyamoto, Yoshihiro; Suzuki, Akifumi; Ishikawa, Koichi B; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru

2014-01-01

The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type.

Trainers’ Attitudes towards Cardiopulmonary Resuscitation, Current Care Guidelines, and Training

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M. Mäkinen

2016-01-01

Full Text Available Objectives. Studies have shown that healthcare personnel hesitate to perform defibrillation due to individual or organisational attitudes. We aimed to assess trainers’ attitudes towards cardiopulmonary resuscitation and defibrillation (CPR-D, Current Care Guidelines, and associated training. Methods. A questionnaire was distributed to CPR trainers attending seminars in Finland (N=185 focusing on the updated national Current Care Guidelines 2011. The questions were answered using Likert scale (1 = totally disagree, 7 = totally agree. Factor loading of the questionnaire was made using maximum likelihood analysis and varimax rotation. Seven scales were constructed (Hesitation, Nurse’s Role, Nontechnical Skill, Usefulness, Restrictions, Personal, and Organisation. Cronbach’s alphas were 0.92–0.51. Statistics were Student’s t-test, ANOVA, stepwise regression analysis, and Pearson Correlation. Results. The questionnaire was returned by 124/185, 67% CPR trainers, of whom two-thirds felt that their undergraduate training in CPR-D had not been adequate. Satisfaction with undergraduate defibrillation training correlated with the Nontechnical Skills scale (p<0.01. Participants scoring high on Hesitation scale (p<0.01 were less confident about their Nurse’s Role (p<0.01 and Nontechnical Skills (p<0.01. Conclusion. Quality of undergraduate education affects the work of CPR trainers and some feel uncertain of defibrillation. The train-the-trainers courses and undergraduate medical education should focus more on practical scenarios with defibrillators and nontechnical skills.

Long-Term Care Workforce Issues: Practice Principles for Quality Dementia Care.

Science.gov (United States)

Gilster, Susan D; Boltz, Marie; Dalessandro, Jennifer L

2018-01-18

This article is one in a series of articles in this supplement addressing best practice for quality dementia care. The Alzheimer's Association, in revising their Dementia Care Practice Recommendations for 2017 has identified staff across the long-term care spectrum as a distinct and important determinant of quality dementia care. The purpose of this article is to highlight areas for developing and supporting a dementia-capable workforce. The Alzheimer's Association Principles For Advocacy To Assure Quality Dementia Care Across Settings provide a framework to examine interventions to support the dementia care workforce in long-term care settings. Evidence-based approaches that represent these principles are discussed: (a) staffing, (b) staff training, (c) compensation, (d) supportive work environments, (e) career growth and retention, and (f) engagement with family. Although not all settings currently require attention to the principles described, this article proposes these principles as best practice recommendations. Recommendations and future research considerations to further improve the lives of those who live and work in nursing homes, assisted living, hospice, and home care, are proposed. Additional areas to improve the quality of a dementia care workforce person-centered care information, communication and interdepartmental teamwork, and ongoing evaluation are discussed. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Pain care in Austrian health care centers: Questionnaire study on the current status of Austrian pain clinics].

Science.gov (United States)

Szilagyi, I-S; Bornemann-Cimenti, H; Messerer, B; Vittinghoff, M; Sandner-Kiesling, A

2015-12-01

Pain clinics provide interdisciplinary therapy to treat chronic pain patients and to increase the return-to-work rate. In recent years and due to increased economic pressure in health care, a change in the management of pain in Austrian health care centers has been observed. For the analysis of the current situation, two surveys addressing all Austrian pain clinics were performed. In total, 133 heads of Austrian Anesthesia Departments were interviewed online and personally. The data from the first interview were confirmed by an additional telephone survey that was performed by one anesthetist per Austrian state (n = 9). Currently, 44 Austrian pain clinics are active. During the last 5 years, 9 pain clinics closed. Adding the current active pain clinics together, they represent a total of 17.5 full-time-operated clinics. The most common reasons for closing the pain clinics were lack of personnel (47%), lack of time resources (26%), lack of space resources (11%), and financial difficulties (11%). A reduction of >50% of operating hours during the last 3 years was reported by 9 hospitals. The reasons for not running a pain clinic were lack of personnel (36%), lack of time (25%) and department too small (16%). Estimates between actual and required clinics indicate that 49.5 full-time-operating pain clinics are lacking in Austria, resulting in 74% of the Austrian chronic pain patients not receiving interdisciplinary pain management. Our survey confirmed the closure of 9 pain clinics during the last 5 years due to lack of personnel and time. Pain clinics appear to provide the simplest economic saving potential. This development is a major concern. Although running a pain clinic seems to be expensive at the first sight, it reduces pain, sick leave, complications, and potential legal issues against health care centers, while simultaneously increasing the hospital's competitiveness. Our results show that 74% of Austrian chronic pain patients do not have access to an

Organizational Learning Capability: An Example of University Hospital

Directory of Open Access Journals (Sweden)

Yasin UZUNTARLA

2015-06-01

Full Text Available In health care institutions aiming healthy society by the way protecting and promoting human health, reaching information has a vital importance. This descriptive research purposed an evaluation of organizational learning capability of 396 employees working in Gülhane Military Medical Academy Hospital. A questionnaire including socio-demographic characteristics was used along with Organizational Learning Capability scale designed by Ricardo CHIVA and His Friends. Data acquired was analyzed with SPSS 15.0 program. Participants’ Organizational Learning Capability and its subscales means were assessed in terms of their sociodemographic characteristics. Assessing participants’ answers in terms of 5 subscales which are experimentation, risk taking, interaction with the external environment, dialogue and participatory decision-making; for education level and professional groups, statistical significant differences was found between Organizational Learning Capability and its subscales means.

Cholesterol Point-of-Care Testing for Community Pharmacies: A Review of the Current Literature.

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Haggerty, Lauren; Tran, Deanna

2017-08-01

To summarize the literature on cholesterol point-of-care tests (POCTs). This article would serve as a resource to assist community pharmacists in developing cholesterol point-of-care (POC) pharmacy services. A literature search was performed in MEDLINE Ovid, PubMed, EMBASE, and Cochrane database using the following medical subject headings (MeSH) terms: point-of-care test, cholesterol, blood chemical analysis, rapid testing, collaborative practice, community pharmacy, and ambulatory care. Additional resources including device manufacturer web sites were summarized to supplement the current literature. All human research articles, review articles, meta-analyses, and abstracts published in English through September 1, 2014, were considered. A total of 36 articles were applicable for review. Information was divided into the following categories to be summarized: devices, pharmacists' impact, and operational cost for the pharmacy. The current literature suggests that POCTs in community pharmacies assist with patient outcomes by providing screenings and referring patients with dyslipidemia for further evaluation. The majority of studies on cholesterol POC devices focused on accuracy, revealing the need for further studies to develop best practices and practice models with successful reimbursement. Accuracy, device specifications, required supplies, and patient preference should be considered when selecting a POC device for purchase.

Current funding and financing issues in the Australian hospice and palliative care sector.

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Gordon, Robert; Eagar, Kathy; Currow, David; Green, Janette

2009-07-01

This article overviews current funding and financing issues in the Australian hospice and palliative care sector. Within Australia, the major responsibilities for managing the health care system are shared between two levels of government. Funding arrangements vary according to the type of care. The delivery of palliative care services is a State/Territory responsibility. Recently, almost all States/Territories have developed overarching frameworks to guide the development of palliative care policies, including funding and service delivery structures. Palliative care services in Australia comprise a mix of specialist providers, generalist providers, and support services in the public, nongovernment, and private sectors. The National Palliative Care Strategy is a joint strategy of the Commonwealth and States that commenced in 2002 and includes a number of major issues. Following a national study in 1996, the Australian National Subacute and Nonacute Patient (AN-SNAP) system was endorsed as the national casemix classification for subacute and nonacute care. Funding for palliative care services varies depending on the type of service and the setting in which it is provided. There is no national model for funding inpatient or community services, which is a State/Territory responsibility. A summary of funding arrangements is provided in this article. Palliative care continues to evolve at a rapid rate in Australia. Increasingly flexible evidence-based models of care delivery are emerging. This article argues that it will be critical for equally flexible funding and financing models to be developed. Furthermore, it is critical that palliative care patients can be identified, classified, and costed. Casemix classifications such as AN-SNAP represent an important starting point but further work is required.

Facility Interface Capability Assessment (FICA) project report

International Nuclear Information System (INIS)

Pope, R.B.; MacDonald, R.R.; Viebrock, J.M.; Mote, N.

1995-09-01

The US Department of Energy's (DOE) Office of Civilian Radioactive Waste Management (OCRWM) is responsible for developing the Civilian Radioactive Waste Management System (CRWMS) to accept spent nuclear fuel from commercial facilities. The objective of the Facility Interface Capability Assessment (FICA) project was to assess the capability of each commercial spent nuclear fuel (SNF) storage facility, at which SNF is stored, to handle various SNF shipping casks. The purpose of this report is to present and analyze the results of the facility assessments completed within the FICA project. During Phase 1, the data items required to complete the facility assessments were identified and the database for the project was created. During Phase 2, visits were made to 122 facilities on 76 sites to collect data and information, the database was updated, and assessments of the cask-handling capabilities at each facility were performed. Each assessment of cask-handling capability contains three parts: the current capability of the facility (planning base); the potential enhanced capability if revisions were made to the facility licensing and/or administrative controls; and the potential enhanced capability if limited physical modifications were made to the facility. The main conclusion derived from the planning base assessments is that the current facility capabilities will not allow handling of any of the FICA Casks at 49 of the 122 facilities evaluated. However, consideration of potential revisions and/or modifications showed that all but one of the 49 facilities could be adapted to handle at least one of the FICA Casks. For this to be possible, facility licensing, administrative controls, and/or physical aspects of the facility would need to be modified

Facility Interface Capability Assessment (FICA) project report

Energy Technology Data Exchange (ETDEWEB)

Pope, R.B. [ed.] [Oak Ridge National Lab., TN (United States); MacDonald, R.R. [ed.] [Civilian Radioactive Waste Management System, Vienna, VA (United States); Viebrock, J.M.; Mote, N. [Nuclear Assurance Corp., Norcross, GA (United States)

1995-09-01

The US Department of Energy`s (DOE) Office of Civilian Radioactive Waste Management (OCRWM) is responsible for developing the Civilian Radioactive Waste Management System (CRWMS) to accept spent nuclear fuel from commercial facilities. The objective of the Facility Interface Capability Assessment (FICA) project was to assess the capability of each commercial spent nuclear fuel (SNF) storage facility, at which SNF is stored, to handle various SNF shipping casks. The purpose of this report is to present and analyze the results of the facility assessments completed within the FICA project. During Phase 1, the data items required to complete the facility assessments were identified and the database for the project was created. During Phase 2, visits were made to 122 facilities on 76 sites to collect data and information, the database was updated, and assessments of the cask-handling capabilities at each facility were performed. Each assessment of cask-handling capability contains three parts: the current capability of the facility (planning base); the potential enhanced capability if revisions were made to the facility licensing and/or administrative controls; and the potential enhanced capability if limited physical modifications were made to the facility. The main conclusion derived from the planning base assessments is that the current facility capabilities will not allow handling of any of the FICA Casks at 49 of the 122 facilities evaluated. However, consideration of potential revisions and/or modifications showed that all but one of the 49 facilities could be adapted to handle at least one of the FICA Casks. For this to be possible, facility licensing, administrative controls, and/or physical aspects of the facility would need to be modified.

Productivity and quality improvements in health care through airboss mobile messaging services.

Science.gov (United States)

Shah, P J; Martinez, R; Cooney, E

1997-01-01

The US health care industry is in the midst of revolutionary changes. Under tremendous pressures from third-party payers and managed care programs to control costs while providing high quality medical services, health care entities are now looking at information technologies to help them achieve their goals. These goals typically include improved productivity, efficiency and decision-making capabilities among staff members. Moreover, hospitals and other health care facilities that provide a broad and integrated range of inpatient and outpatient care, wellness and home care services are in the best position to offer comprehensive packages to managed care and private insurers. Many health care providers and administrators are considered mobile employees. This mobility can range from intra-building and intra-campus to multi-site and metropolitan areas. This group often relies on a variety of information technologies such as personal computers, communicating laptops, pagers, cellular phones, wireline phones, cordless phones and fax machines to stay in touch and handle information needs. These health care professionals require mobile information access and messaging tools to improve communications, control accessibility and enhance decision-making capabilities. AirBoss mobile messaging services could address the health care industry's need for improved messaging capabilities for its mobile employees. The AirBoss family of services supports integrated voice services, data messaging, mobile facsimile and customized information delivery. This paper describes overview of the current mobile data networking capability, the AirBoss architecture, the health care-related applications it addresses and long-term benefits. In addition, a prototype application for mobile home health care workers is illustrated. This prototype application provides integrated e-mail, information services, web access, real-time access and update of patient records from wireline or wireless networks

Arctic Observing Network Data Management: Current Capabilities and Their Promise for the Future

Science.gov (United States)

Collins, J.; Fetterer, F.; Moore, J. A.

2008-12-01

CADIS (the Cooperative Arctic Data and Information Service) serves as the data management, discovery and delivery component of the Arctic Observing Network (AON). As an International Polar Year (IPY) initiative, AON comprises 34 land, atmosphere and ocean observation sites, and will acquire much of the data coming from the interagency Study of Environmental Arctic Change (SEARCH). CADIS is tasked with ensuring that these observational data are managed for long term use by members of the entire Earth System Science community. Portions of CADIS are either in use by the community or available for testing. We now have an opportunity to evaluate the feedback received from our users, to identify any design shortcomings, and to identify those elements which serve their purpose well and will support future development. This presentation will focus on the nuts-and-bolts of the CADIS development to date, with an eye towards presenting lessons learned and best practices based on our experiences so far. The topics include: - How did we assess our users' needs, and how are those contributions reflected in the end product and its capabilities? - Why did we develop a CADIS metadata profile, and how does it allow CADIS to support preservation and scientific interoperability? - How can we shield the user from metadata complexities (especially those associated with various standards) while still obtaining the metadata needed to support an effective data management system? - How can we bridge the gap between the data storage formats considered convenient by researchers in the field, and those which are necessary to provide data interoperability? - What challenges have been encountered in our efforts to provide access to federated data (data stored outside of the CADIS system)? - What are the data browsing and visualization needs of the AON community, and which tools and technologies are most promising in terms of supporting those needs? A live demonstration of the current

Effects of Comprehensive Stroke Care Capabilities on In-Hospital Mortality of Patients with Ischemic and Hemorrhagic Stroke: J-ASPECT Study

Science.gov (United States)

Iihara, Koji; Nishimura, Kunihiro; Kada, Akiko; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Miyamoto, Yoshihiro; Suzuki, Akifumi; Ishikawa, Koichi B.; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru

2014-01-01

Background The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. Methods and Results Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. Conclusions CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type. PMID:24828409

Effects of comprehensive stroke care capabilities on in-hospital mortality of patients with ischemic and hemorrhagic stroke: J-ASPECT study.

Directory of Open Access Journals (Sweden)

Koji Iihara

Full Text Available BACKGROUND: The effectiveness of comprehensive stroke center (CSC capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. METHODS AND RESULTS: Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH, and 28.1% for patients with subarachnoid hemorrhage (SAH. Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. CONCLUSIONS: CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type.

[Current Status of Home Visit Programs: Activities and Barriers of Home Care Nursing Services].

Science.gov (United States)

Oh, Eui Geum; Lee, Hyun Joo; Kim, Yukyung; Sung, Ji Hyun; Park, Young Su; Yoo, Jae Yong; Woo, Soohee

2015-10-01

The purpose of this study was to examine the current status of home care nursing services provided by community health nurses and to identify barriers to the services. A cross-sectional survey was conducted with three types of community health care nurses. Participants were 257 nurses, 46 of whom were hospital based home care nurses, 176 were community based visiting nurses, and 35 were long term care insurance based visiting nurses. A structured questionnaire on 7 domains of home care nursing services with a 4-point Likert scale was used to measure activities and barriers to care. Data were analyzed using SPSS WIN 21.0 program. Hospital based home care nurses showed a high level of service performance activity in the domain of clinical laboratory tests, medications and injections, therapeutic nursing, and education. Community based visiting nurses had a high level of service performance in the reference domain. Long term care insurance based visiting nurses showed a high level of performance in the service domains of fundamental nursing and counseling. The results show that although health care service provided by the three types of community health nurse overlapped, the focus of the service is differentiated. Therefore, these results suggest that existing home care services will need to be utilized efficiently in the development of a new nursing care service for patients living in the community after hospital discharge.

Health information exchange in the wild: the association between organizational capability and perceived utility of clinical event notifications in ambulatory and community care.

Science.gov (United States)

Vest, Joshua R; Ancker, Jessica S

2017-01-01

Event notifications are real-time, electronic, automatic alerts to providers of their patients' health care encounters at other facilities. Our objective was to examine the effects of organizational capability and related social/organizational issues upon users' perceptions of the impact of event notifications on quality, efficiency, and satisfaction. We surveyed representatives (n = 49) of 10 organizations subscribing to the Bronx Regional Health Information Organization's event notification services about organizational capabilities, notification information quality, perceived usage, perceived impact, and organizational and respondent characteristics. The response rate was 89%. Average item scores were used to create an individual domain summary score. The association between the impact of event notifications and organizational characteristics was modeled using random-intercept logistic regression models. Respondents estimated that organizations followed up on the majority (83%) of event notifications. Supportive organizational policies were associated with the perception that event notifications improved quality of care (odds ratio [OR] = 2.12; 95% CI, = 1.05, 4.45), efficiency (OR = 2.06; 95% CI = 1.00, 4.21), and patient satisfaction (OR = 2.56; 95% CI = 1.13, 5.81). Higher quality of event notification information was also associated with a perceived positive impact on quality of care (OR = 2.84; 95% CI = 1.31, 6.12), efficiency (OR = 3.04; 95% CI = 1.38, 6.69), and patient satisfaction (OR = 2.96; 95% CI = 1.25, 7.03). Health care organizations with appropriate processes, workflows, and staff may be better positioned to use event notifications. Additionally, information quality remains critical in users' assessments and perceptions. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

An eHealth Capabilities Framework for Graduates and Health Professionals: Mixed-Methods Study

Science.gov (United States)

McGregor, Deborah; Keep, Melanie; Janssen, Anna; Spallek, Heiko; Quinn, Deleana; Jones, Aaron; Tseris, Emma; Yeung, Wilson; Togher, Leanne; Solman, Annette; Shaw, Tim

2018-01-01

Background The demand for an eHealth-ready and adaptable workforce is placing increasing pressure on universities to deliver eHealth education. At present, eHealth education is largely focused on components of eHealth rather than considering a curriculum-wide approach. Objective This study aimed to develop a framework that could be used to guide health curriculum design based on current evidence, and stakeholder perceptions of eHealth capabilities expected of tertiary health graduates. Methods A 3-phase, mixed-methods approach incorporated the results of a literature review, focus groups, and a Delphi process to develop a framework of eHealth capability statements. Results Participants (N=39) with expertise or experience in eHealth education, practice, or policy provided feedback on the proposed framework, and following the fourth iteration of this process, consensus was achieved. The final framework consisted of 4 higher-level capability statements that describe the learning outcomes expected of university graduates across the domains of (1) digital health technologies, systems, and policies; (2) clinical practice; (3) data analysis and knowledge creation; and (4) technology implementation and codesign. Across the capability statements are 40 performance cues that provide examples of how these capabilities might be demonstrated. Conclusions The results of this study inform a cross-faculty eHealth curriculum that aligns with workforce expectations. There is a need for educational curriculum to reinforce existing eHealth capabilities, adapt existing capabilities to make them transferable to novel eHealth contexts, and introduce new learning opportunities for interactions with technologies within education and practice encounters. As such, the capability framework developed may assist in the application of eHealth by emerging and existing health care professionals. Future research needs to explore the potential for integration of findings into workforce development

Delivery of care consistent with the psychosocial standards in pediatric cancer: Current practices in the United States.

Science.gov (United States)

Scialla, Michele A; Canter, Kimberly S; Chen, Fang Fang; Kolb, E Anders; Sandler, Eric; Wiener, Lori; Kazak, Anne E

2018-03-01

With published evidence-based Standards for Psychosocial Care for Children with Cancer and their Families, it is important to know the current status of their implementation. This paper presents data on delivery of psychosocial care related to the Standards in the United States. Pediatric oncologists, psychosocial leaders, and administrators in pediatric oncology from 144 programs completed an online survey. Participants reported on the extent to which psychosocial care consistent with the Standards was implemented and was comprehensive and state of the art. They also reported on specific practices and services for each Standard and the extent to which psychosocial care was integrated into broader medical care. Participants indicated that psychosocial care consistent with the Standards was usually or always provided at their center for most of the Standards. However, only half of the oncologists (55.6%) and psychosocial leaders (45.6%) agreed or strongly agreed that their psychosocial care was comprehensive and state of the art. Types of psychosocial care provided included evidence-based and less established approaches but were most often provided when problems were identified, rather than proactively. The perception of state of the art care was associated with practices indicative of integrated psychosocial care and the extent to which the Standards are currently implemented. Many oncologists and psychosocial leaders perceive that the delivery of psychosocial care at their center is consistent with the Standards. However, care is quite variable, with evidence for the value of more integrated models of psychosocial services. © 2017 Wiley Periodicals, Inc.

Current prevention and control of health care-associated infections in long-term care facilities for the elderly in Japan.

Science.gov (United States)

Kariya, Naoko; Sakon, Naomi; Komano, Jun; Tomono, Kazunori; Iso, Hiroyasu

2018-05-01

Residents of long-term care facilities for the elderly are vulnerable to health care-associated infections. However, compared to medical institutions, long-term care facilities for the elderly lag behind in health care-associated infection control and prevention. We conducted a epidemiologic study to clarify the current status of infection control in long-term care facilities for the elderly in Japan. A questionnaire survey on the aspects of infection prevention and control was developed according to SHEA/APIC guidelines and was distributed to 617 long-term care facilities for the elderly in the province of Osaka during November 2016 and January 2017. The response rate was 16.9%. The incidence rates of health care-associated infection outbreaks and residents with health care-associated infections were 23.4 per 100 facility-years and 0.18 per 1,000 resident-days, respectively. Influenza and acute gastroenteritis were reported most frequently. Active surveillance to identify the carrier of multiple drug-resistant organisms was not common. The overall compliance with 21 items selected from the SHEA/APIC guidelines was approximately 79.2%. All facilities had infection control manuals and an assigned infection control professional. The economic burdens of infection control were approximately US$ 182.6 per resident-year during fiscal year 2015. Importantly, these data implied that physicians and nurses were actively contributed to higher SHEA/APIC guideline compliance rates and the advancement of infection control measures in long-term care facilities for the elderly. Key factors are discussed to further improve the infection control in long-term care facilities for the elderly, particularly from economic and social structural standpoints. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence

Science.gov (United States)

Hill, Jonathan C.; Foster, Nadine E.; Protheroe, Joanne

2017-01-01

Background & aims Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care. Methods A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach. Results Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options. Conclusion This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most

The current implementation status of the integration of sports and physical activity into Dutch rehabilitation care

NARCIS (Netherlands)

Hoekstra, Femke; Hettinga, Florentina J; Alingh, Rolinde A; Duijf, Marjo; Dekker, Rienk; van der Woude, Lucas H V; van der Schans, Cees P

PURPOSE: To describe the current status of the nationwide implementation process of a sports and physical activity stimulation programme to gain insight into how sports and physical activity were integrated into Dutch rehabilitation care. METHODS: The current implementation status of a sports and

Mental health care in Nepal: current situation and challenges for development of a district mental health care plan.

Science.gov (United States)

Luitel, Nagendra P; Jordans, Mark Jd; Adhikari, Anup; Upadhaya, Nawaraj; Hanlon, Charlotte; Lund, Crick; Komproe, Ivan H

2015-01-01

Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal. A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records. Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry

Antenatal care among currently married women in Rajasthan, India

Directory of Open Access Journals (Sweden)

Alok Chauhan

2012-10-01

Full Text Available Objective: To assess the utilization of antenatal care (ANC services among currently married women in Rajasthan. Methods: The data have been extracted from District Level Household and Facility Survey (DLHS-3 which was conducted during 2007-2008, all over India. A total of 12 458 currently married women in the age group of 15-49 were taken as the sample for the study. Cross tabulation and binary logistic regression method were applied to determine the factors influencing ANC. Results: Out of 12 458 respondents, 43.4 percent women not received even a single ANC during their pregnancy period. 45.1 percent of the women not received tetanus toxoid injection and 13.0 percent of the women not received Iron folic acid tablets during their pregnancy period. Only 6.6 percent of women fulfilled the minimum recommendation with regard ANC services. Conclusions: The study points to the avenues through which policy makers can formulate and implement policies on a realistic basis by identifying critical variables and target groups for effective utilisation of ANC.

Battlefield Tourniquets: Lessons Learned in Moving Current Care Toward Best Care in an Army Medical Department at War.

Science.gov (United States)

Kragh, John F; Dubick, Michael A

2016-01-01

Bleeding prevention and control by tourniquet use by out-of-hospital caregivers is a major breakthrough in military medicine of current wars. The present review documents developments in tourniquet practices since 2001 among the US military services for aid in improving doctrine, policy, and especially care in wars to come. Tourniquets are an adjunct for resuscitation in self-care and buddy aid and today are issued to all military servicepersons who deploy into a combat zone. In the US Army, virtually every Soldier is trained in first aid tourniquet use; since 2009 they are instructed early and often to use them early and often. Despite substantial knowledge gains among the services in tourniquet use and resulting improvements in casualty survival, current evidence shows persistent difficulties in achieving best care with tourniquet use for individual trauma patients. Nevertheless, contemporary tourniquet use incorporates key lessons learned over the last 14 years of war that include: (1) tourniquet use reliably stops bleeding from limb wounds and prevents mortality in prehospital settings; and (2) brief tourniquet use appears to be safe. These 2 lessons have become so evident that civilian emergency medical systems have begun using them, albeit unevenly. Collection and interpretation of data of casualties with tourniquet use have showed that such intervention has lifesaving benefit through 2 mechanisms: control of both ongoing hemorrhage and shock severity. The next generation of interventions in bleeding control involves developing the skill sets, education, and standards of tourniquet users which may improve hemorrhage control in wars to come.

Physician Rating Websites: What Aspects Are Important to Identify a Good Doctor, and Are Patients Capable of Assessing Them? A Mixed-Methods Approach Including Physicians' and Health Care Consumers' Perspectives.

Science.gov (United States)

Rothenfluh, Fabia; Schulz, Peter J

2017-05-01

Physician rating websites (PRWs) offer health care consumers the opportunity to evaluate their doctor anonymously. However, physicians' professional training and experience create a vast knowledge gap in medical matters between physicians and patients. This raises ethical concerns about the relevance and significance of health care consumers' evaluation of physicians' performance. To identify the aspects physician rating websites should offer for evaluation, this study investigated the aspects of physicians and their practice relevant for identifying a good doctor, and whether health care consumers are capable of evaluating these aspects. In a first step, a Delphi study with physicians from 4 specializations was conducted, testing various indicators to identify a good physician. These indicators were theoretically derived from Donabedian, who classifies quality in health care into pillars of structure, process, and outcome. In a second step, a cross-sectional survey with health care consumers in Switzerland (N=211) was launched based on the indicators developed in the Delphi study. Participants were asked to rate the importance of these indicators to identify a good physician and whether they would feel capable to evaluate those aspects after the first visit to a physician. All indicators were ordered into a 4×4 grid based on evaluation and importance, as judged by the physicians and health care consumers. Agreement between the physicians and health care consumers was calculated applying Holsti's method. In the majority of aspects, physicians and health care consumers agreed on what facets of care were important and not important to identify a good physician and whether patients were able to evaluate them, yielding a level of agreement of 74.3%. The two parties agreed that the infrastructure, staff, organization, and interpersonal skills are both important for a good physician and can be evaluated by health care consumers. Technical skills of a doctor and outcomes

Management of Pediatric Delirium in Pediatric Cardiac Intensive Care Patients: An International Survey of Current Practices.

Science.gov (United States)

Staveski, Sandra L; Pickler, Rita H; Lin, Li; Shaw, Richard J; Meinzen-Derr, Jareen; Redington, Andrew; Curley, Martha A Q

2018-06-01

The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery. Descriptive self-report survey. A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society. Pediatric cardiac intensive care clinicians (physicians and nurses). None. One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia. Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.

The Current Landscape of Transitions of Care Practice Models: A Scoping Review.

Science.gov (United States)

Rochester-Eyeguokan, Charmaine D; Pincus, Kathleen J; Patel, Roshni S; Reitz, Shirley J

2016-01-01

Transitions of care (TOC) are a set of actions to ensure patient coordination and continuity of care as patients transfer between different locations or levels. During transitions associated with chronic or acute illness, vulnerable patients may be placed at risk with fragmented systems compromising their health and safety. In addition, poor care transitions also have an enormous impact on health care spending. The primary objective of this scoping review is to summarize the current landscape of practice models that deliver TOC services in the United States. The secondary objective is to use the information to characterize the current state of best practice models. A search of the PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, International Pharmaceutical Abstracts, National Center for Biotechnology Information at the U.S. National Library of Medicine, and Cochrane Library databases (January 1, 2000-April 13, 2015) for articles pertaining to TOC models, limited to U.S. studies published in the English language with human subjects, gleaned 1362 articles. An additional 26 articles were added from the gray literature. Articles meeting inclusion criteria underwent a second review and were categorized into four groups: background information, original TOC research articles not evaluating practice model interventions, original TOC research articles describing practice models, and systematic or Cochrane reviews. The reviewers met weekly to discuss the challenges and resolve disagreements regarding literature reviews with consensus before progressing. A total of 188 articles describing TOC practice models met the inclusion criteria. Despite the strengths of several quality TOC models, none satisfied all the components recommended by leading experts. Multimodal interventions by multidisciplinary teams appear to represent a best practice model for TOC to improve patient outcomes and reduce readmissions, but one size does not fit all

End-of-Life Care in Nunavik, Quebec: Inuit Experiences, Current Realities, and Ways Forward.

Science.gov (United States)

Hordyk, Shawn Renee; Macdonald, Mary Ellen; Brassard, Paul

2017-06-01

Increasing longevity for Inuit living in Nunavik, northern Quebec, has resulted in heightened rates of cancers and chronic diseases necessitating complex treatments. Consequently, end-of-life (EOL) care, once the domain of Inuit families and communities, has come to include professionalized healthcare providers with varying degrees of awareness of factors to consider in providing care to Inuit populations. To better understand the factors shaping EOL care in Nunavik to support the development of a sustainable model of care. Using focused ethnography, we conducted participant observations and informal and semistructured interviews with 103 participants (community members, healthcare practitioners, and administrators) across Nunavik and in Montreal, the affiliated tertiary care center. Data domains included the following: care trajectories; patient and family experiences receiving and providing EOL care; local and urban resources and challenges; and ways forward. Sociocultural, historical, and geographic factors shape EOL care in Nunavik, presenting a complex set of challenges for Inuit patients, families, and healthcare providers. A sustainable model of EOL care requires building on shared initiatives, capitalizing on the existing strengths in communities, and attending to the multiple bereavement needs in the region. Building a sustainable model of EOL care requires respectful collaboration among governing structures, healthcare institutions, and community members. It must centrally value local knowledge and initiatives. To ensure Inuit families and patients are supported throughout the dying process, future initiatives must centrally include local stakeholders in both the design and evaluation of any changes to the current healthcare system.

Recurrent glioblastoma: Current patterns of care in an Australian population.

Science.gov (United States)

Parakh, Sagun; Thursfield, Vicky; Cher, Lawrence; Dally, Michael; Drummond, Katharine; Murphy, Michael; Rosenthal, Mark A; Gan, Hui K

2016-02-01

This retrospective population-based survey examined current patterns of care for patients with recurrent glioblastoma (rGBM) who had previously undergone surgery and post-operative therapy at original diagnosis. The patients were identified from the Victorian Cancer Registry (VCR) from 2006 to 2008. Patient demographics, tumour characteristics and oncological management were extracted using a standardised survey by the treating clinicians/VCR staff and results analysed by the VCR. Kaplan-Meier estimates of overall survival (OS) at diagnosis and progression were calculated. A total of 95 patients (48%) received treatment for first recurrence; craniotomy and post-operative treatment (38), craniotomy only (34) and non-surgical treatment (23). Patients receiving treatment at first progression had a higher median OS than those who did not (7 versus 3 months, ppattern of care survey of treatment for rGBM in an era where post-operative "Stupp" chemo-radiation is standard. First and second line therapy for rGBM is common and associated with significant benefit. Treatment generally includes re-resection and/or systemic therapy. Copyright © 2015 Elsevier Ltd. All rights reserved.

Smartphone apps and the nutrition care process: Current perspectives and future considerations.

Science.gov (United States)

Chen, Juliana; Gemming, Luke; Hanning, Rhona; Allman-Farinelli, Margaret

2018-04-01

To provide dietitians with practical guidance on incorporating smartphone applications (apps) in the nutrition care process (NCP) to optimize patient education and counseling. The current evidence-base for mobile health (mHealth) apps was searched using PubMed and Google Scholar. Where and how apps could be implemented by dietitians across the four steps of the NCP is discussed. With functionality to automatically convert patient dietary records into nutrient components, nutrition assessment can be streamlined using nutrition apps, allowing more time for dietitians to deliver education and nutrition counseling. Dietitians could prescribe apps to provide patients with education on nutrition skills and in counseling for better adherence to behavior change. Improved patient-provider communication is also made possible through the opportunity for real-time monitoring and evaluation of patient progress via apps. A practical framework termed the 'Mobile Nutrition Care Process Grid' provides dietitians with best-practice guidance on how to use apps. Including apps into dietetic practice could enhance the efficiency and quality of nutrition care and counseling delivered by dietitians. Apps should be considered an adjunct to enable dietetic counseling and care, rather than to replace the expertise, social support and accountability provided by dietitians. Copyright © 2017 Elsevier B.V. All rights reserved.

A framework for current public mental health care practice in South Africa.

Science.gov (United States)

Janse Van Rensburg, A B

2007-11-01

One of the main aims of the new Mental Health Care Act, Act No. 17 of 2002 (MHCA) is to promote the human rights of people with mental disabilities in South Africa. However, the upholding of these rights seems to be subject to the availability of resources. Chapter 2 of the MHCA clarifies the responsibility of the State to provide infrastructure and systems. Chapters 5, 6 and 7 of the Act define and regulate the different categories of mental health care users, clarify the procedures around these categories and spell out mental health practitioners' roles and responsibilities in this regard. Also according to the National Health Act No. 61 of 2003, the State remains the key role player in mental health care provision, being responsible for adequate mental health infrastructure and resource allocation. Due to "limited resources" practitioners however often work in environments where staff ratios may be fractional of what should be expected and in units of which the physical structure and security is totally inadequate. The interface between professional responsibility of clinical workers versus the inadequacy of clinical interventions resulting from infrastructure and staffing constraints needs to be defined. This paper considered recent legislation currently relevant to mental health care practice in order to delineate the legal, ethical and labour framework in which public sector mental health practitioners operate as state employees. These included the Mental Health Care Act, No.17 of 2002; the National Health Act, No. 61 of 2003 and the proposed Traditional Health Practitioners Act, No. 35 of 2004. Formal legal review of and advice on this legislation as it pertains to public sector mental health practitioners as state employees, is necessary and should form the basis of the principles and standards for care endorsed by organized mental health care practitioner groups such as the South African Society of Psychiatrists (SASOP).

National power grid simulation capability : need and issues

Energy Technology Data Exchange (ETDEWEB)

Petri, Mark C. [Argonne National Lab. (ANL), Argonne, IL (United States)

2009-06-02

On December 9 and 10, 2008, the Department of Homeland Security (DHS) Science and Technology Directorate sponsored a national workshop at Argonne National Laboratory to explore the need for a comprehensive modeling and simulation capability for the national electric power grid system. The workshop brought together leading electric power grid experts from federal agencies, the national laboratories, and academia to discuss the current state of power grid science and engineering and to assess if important challenges are being met. The workshop helped delineate gaps between grid needs and current capabilities and identify issues that must be addressed if a solution is to be implemented. This report is a result of the workshop and highlights power grid modeling and simulation needs, the barriers that must be overcome to address them, and the benefits of a national power grid simulation capability.

Graphical Visualization of Human Exploration Capabilities

Science.gov (United States)

Rodgers, Erica M.; Williams-Byrd, Julie; Arney, Dale C.; Simon, Matthew A.; Williams, Phillip A.; Barsoum, Christopher; Cowan, Tyler; Larman, Kevin T.; Hay, Jason; Burg, Alex

2016-01-01

of planned future work to modify the computer program to include additional data and of alternate capability roadmap formats currently under consideration.

Technological capability at the Brazilian official pharmaceutical laboratories

Directory of Open Access Journals (Sweden)

José Vitor Bomtempo Martins

2008-10-01

Full Text Available This paper studies the technological capability in the Brazilian Official Pharmaceutical Laboratories [OPL]. The technological capability analysis could contribute to organization strategies and governmental actions in order to improve OPL basic tasks as well to incorporate new ones, particularly concerning the innovation management. Inspired in Figueiredo (2000, 2003a, 2003b and Figueiredo and Ariffin (2003, a framework was drawn and adapted to pharmaceutical industry characteristics and current sanitary and health legislation. The framework allows to map different dimensions of the technological capability (installations, processes, products, equipments, organizational capability and knowledge management and the level attained by OPL (ordinary or innovating capability. OPL show a good development of ordinary capabilities, particularly in Product and Processes. Concerning the other dimensions, OPL are quite diverse. In general, innovating capabilities are not much developed. In the short term, it was identified a dispersion in the capacitating efforts. Considering their present level and the absorption efforts, good perspectives can be found in Installations, Processes and Organizational Capability. A lower level of efforts in Products and Knowledge Management could undermine these capabilities in the future.

Recent Investments by NASA's National Force Measurement Technology Capability

Science.gov (United States)

Commo, Sean A.; Ponder, Jonathan D.

2016-01-01

The National Force Measurement Technology Capability (NFMTC) is a nationwide partnership established in 2008 and sponsored by NASA's Aeronautics Evaluation and Test Capabilities (AETC) project to maintain and further develop force measurement capabilities. The NFMTC focuses on force measurement in wind tunnels and provides operational support in addition to conducting balance research. Based on force measurement capability challenges, strategic investments into research tasks are designed to meet the experimental requirements of current and future aerospace research programs and projects. This paper highlights recent and force measurement investments into several areas including recapitalizing the strain-gage balance inventory, developing balance best practices, improving calibration and facility capabilities, and researching potential technologies to advance balance capabilities.

Qualitative ergonomics/human factors research in health care: Current state and future directions.

Science.gov (United States)

Valdez, Rupa Sheth; McGuire, Kerry Margaret; Rivera, A Joy

2017-07-01

The objective of this systematic review was to understand the current state of Ergonomics/Human Factors (E/HF) qualitative research in health care and to draw implications for future efforts. This systematic review identified 98 qualitative research papers published between January 2005 and August 2015 in the seven journals endorsed by the International Ergonomics Association with an impact factor over 1.0. The majority of the studies were conducted in hospitals and outpatient clinics, were focused on the work of formal health care professionals, and were classified as cognitive or organizational ergonomics. Interviews, focus groups, and observations were the most prevalent forms of data collection. Triangulation and data archiving were the dominant approaches to ensuring rigor. Few studies employed a formal approach to qualitative inquiry. Significant opportunities remain to enhance the use of qualitative research to advance systems thinking within health care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Preconception care of women with diabetes: a review of current guideline recommendations

Directory of Open Access Journals (Sweden)

Mazza Danielle

2010-01-01

Full Text Available Abstract Background The prevalence of type 2 diabetes mellitus (T2DM continues to rise worldwide. More women from developing countries who are in the reproductive age group have diabetes resulting in more pregnancies complicated by T2DM, and placing both mother and foetus at higher risk. Management of these risks is best achieved through comprehensive preconception care and glycaemic control, both prior to, and during pregnancy. The aim of this review was to compare the quality and content of current guidelines concerned with the preconception care of women with diabetes and to develop a summary of recommendations to assist in the management of diabetic women contemplating pregnancy. Methods Relevant clinical guidelines were identified through a search of several databases (MEDLINE, SCOPUS and The Cochrane Library and relevant websites. Five guidelines were identified. Each guideline was assessed for quality using the AGREE instrument. Guideline recommendations were extracted, compared and contrasted. Results All guidelines were assessed as being of high quality and strongly recommended for use in practice. All were consistent in counselling about the risk of congenital malformation related to uncontrolled blood sugar preconceptionally, ensuring adequate contraception until glycaemic control is achieved, use of HBA1C to monitor metabolic control, when to commence insulin and switching from ACE inhibitors to other antihypertensives. Major differences were in the targets recommended for optimal metabolic control and opinion regarding the usage of metformin as an adjunct or alternative treatment before or during pregnancy. Conclusions International guidelines for the care of women with diabetes who are contemplating pregnancy are consistent in their recommendations; however some are more comprehensive than others. Having established current standards for the preconception care of diabetic women, there is now a need to focus on guideline

Upgrading of TREAT experimental capabilities

International Nuclear Information System (INIS)

Dickerman, C.E.; Rose, D.; Bhattacharyya, S.K.

1982-01-01

The TREAT facility at the Argonne National Laboratory site in the Idaho National Engineering Laboratory is being upgraded to provide capabilities for fast-reactor-safety transient experiments not possible at any other experimental facility. Principal TREAT Upgrade (TU) goal is provision for 37-pin size experiments on energetics of core-disruptive accidents (CDA) in fast breeder reactor cores with moderate sodium void coefficients. this goal requires a significant enhancement of the capabilities of the TREAT facility, specifically including reactor control, hardened neutron spectrum incident on the test sample, and enlarged building. The upgraded facility will retain the capability for small-size experiments of the types currently being performed in TREAT. Reactor building and crane upgrading have been completed. TU schedules call for the components of the upgraded reactor system to be finished in 1984, including upgraded TREAT fuel and control system, and expanded coverage by the hodoscope fuel-motion diagnostics system

Current Status of Multidisciplinary Care in Psoriatic Arthritis in Spain: NEXUS 2.0 Project.

Science.gov (United States)

Queiro, Rubén; Coto, Pablo; Joven, Beatriz; Rivera, Raquel; Navío Marco, Teresa; de la Cueva, Pablo; Alvarez Vega, Jose Luis; Narváez Moreno, Basilio; Rodriguez Martínez, Fernando José; Pardo Sánchez, José; Feced Olmos, Carlos; Pujol, Conrad; Rodríguez, Jesús; Notario, Jaume; Pujol Busquets, Manel; García Font, Mercè; Galindez, Eva; Pérez Barrio, Silvia; Urruticoechea-Arana, Ana; Hergueta, Merce; López Montilla, M Dolores; Vélez García-Nieto, Antonio; Maceiras, Francisco; Rodríguez Pazos, Laura; Rubio Romero, Esteban; Rodríguez Fernandez Freire, Lourdes; Luelmo, Jesús; Gratacós, Jordi

2018-02-26

1) To analyze the implementation of multidisciplinary care models in psoriatic arthritis (PsA) patients, 2) To define minimum and excellent standards of care. A survey was sent to clinicians who already performed multidisciplinary care or were in the process of undertaking it, asking: 1) Type of multidisciplinary care model implemented; 2) Degree, priority and feasibility of the implementation of quality standards in the structure, process and result for care. In 6 regional meetings the results of the survey were presented and discussed, and the ultimate priority of quality standards for care was defined. At a nominal meeting group, 11 experts (rheumatologists and dermatologists) analyzed the results of the survey and the regional meetings. With this information, they defined which standards of care are currently considered as minimum and which are excellent. The simultaneous and parallel models of multidisciplinary care are those most widely implemented, but the implementation of quality standards is highly variable. In terms of structure it ranges from 22% to 74%, in those related to process from 17% to 54% and in the results from 2% to 28%. Of the 25 original quality standards for care, 9 were considered only minimum, 4 were excellent and 12 defined criteria for minimum level and others for excellence. The definition of minimum and excellent quality standards for care will help achieve the goal of multidisciplinary care for patients with PAs, which is the best healthcare possible. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Child and Adolescent Mental Health Care in Iran: Current Status and Future Directions.

Science.gov (United States)

Sharifi, Vandad; Mojtabai, Ramin; Shahrivar, Zahra; Alaghband-Rad, Javad; Zarafshan, Hadi; Wissow, Lawrence

2016-11-01

The need for mental health care among children and adolescents in Iran, as in other low and middle income countries (LAMIC) remains mostly unmet. In this paper, we sought to provide an overview of the extent of unmet need and mental health services in Iran. We also aimed to propose approaches to address this gap. We reviewed the published epidemiologic studies of child and adolescent mental and behavioral health problems in Iran. We also examined the current status of child mental health services and the gaps between current needs and available services based on published literature that included papers published in scientific journals, as well as governmental and other administrative reports. The contextual issues relevant to child mental health care were also explored, as well as the possibilities to introduce new or scale up promising services. Child and adolescent mental and behavioral health problems are highly prevalent in Iran. Different studies have estimated that 16.7% to 36.4% of children and adolescents suffer from one or more mental health problems. However, there is a serious scarcity of resources to meet this need. Available services are delivered by independent public organizations (e.g., Ministry of Health, Welfare Organization, and Ministry of Education) or private sector with inefficient communication and collaboration among them and no mandatory national mental health policy. Available specialized child and adolescent services are mostly confined to small inpatient units and university outpatient facilities in larger cities, and there is a scarce evidence for  the effectiveness of the available services. Expansion of primary care's role in timely detection and management of child and adolescent mental health problems, implementation of task-shifting and -sharing initiatives, as well as improved collaboration among responsible governmental and non-governmental sectors are some of the most promising future venues to improve mental health care for

Emergency care capabilities in the Kingdom of Swaziland, Africa

Directory of Open Access Journals (Sweden)

Erika Phindile Chowa

2017-03-01

Discussion: Swaziland ECs were predominantly contiguous and running at overcapacity, with high patient volumes and limited resources. The limited access to technology and specialists are major challenges. We believe that these data support greater resource allocation by the Swaziland government to the emergency care sector.

Maximizing Health or Sufficient Capability in Economic Evaluation? A Methodological Experiment of Treatment for Drug Addiction.

Science.gov (United States)

Goranitis, Ilias; Coast, Joanna; Day, Ed; Copello, Alex; Freemantle, Nick; Frew, Emma

2017-07-01

Conventional practice within the United Kingdom and beyond is to conduct economic evaluations with "health" as evaluative space and "health maximization" as the decision-making rule. However, there is increasing recognition that this evaluative framework may not always be appropriate, and this is particularly the case within public health and social care contexts. This article presents a methodological case study designed to explore the impact of changing the evaluative space within an economic evaluation from health to capability well-being and the decision-making rule from health maximization to the maximization of sufficient capability. Capability well-being is an evaluative space grounded on Amartya Sen's capability approach and assesses well-being based on individuals' ability to do and be the things they value in life. Sufficient capability is an egalitarian approach to decision making that aims to ensure everyone in society achieves a normatively sufficient level of capability well-being. The case study is treatment for drug addiction, and the cost-effectiveness of 2 psychological interventions relative to usual care is assessed using data from a pilot trial. Analyses are undertaken from a health care and a government perspective. For the purpose of the study, quality-adjusted life years (measured using the EQ-5D-5L) and years of full capability equivalent and years of sufficient capability equivalent (both measured using the ICECAP-A [ICEpop CAPability measure for Adults]) are estimated. The study concludes that different evaluative spaces and decision-making rules have the potential to offer opposing treatment recommendations. The implications for policy makers are discussed.

An eHealth Capabilities Framework for Graduates and Health Professionals: Mixed-Methods Study.

Science.gov (United States)

Brunner, Melissa; McGregor, Deborah; Keep, Melanie; Janssen, Anna; Spallek, Heiko; Quinn, Deleana; Jones, Aaron; Tseris, Emma; Yeung, Wilson; Togher, Leanne; Solman, Annette; Shaw, Tim

2018-05-15

The demand for an eHealth-ready and adaptable workforce is placing increasing pressure on universities to deliver eHealth education. At present, eHealth education is largely focused on components of eHealth rather than considering a curriculum-wide approach. This study aimed to develop a framework that could be used to guide health curriculum design based on current evidence, and stakeholder perceptions of eHealth capabilities expected of tertiary health graduates. A 3-phase, mixed-methods approach incorporated the results of a literature review, focus groups, and a Delphi process to develop a framework of eHealth capability statements. Participants (N=39) with expertise or experience in eHealth education, practice, or policy provided feedback on the proposed framework, and following the fourth iteration of this process, consensus was achieved. The final framework consisted of 4 higher-level capability statements that describe the learning outcomes expected of university graduates across the domains of (1) digital health technologies, systems, and policies; (2) clinical practice; (3) data analysis and knowledge creation; and (4) technology implementation and codesign. Across the capability statements are 40 performance cues that provide examples of how these capabilities might be demonstrated. The results of this study inform a cross-faculty eHealth curriculum that aligns with workforce expectations. There is a need for educational curriculum to reinforce existing eHealth capabilities, adapt existing capabilities to make them transferable to novel eHealth contexts, and introduce new learning opportunities for interactions with technologies within education and practice encounters. As such, the capability framework developed may assist in the application of eHealth by emerging and existing health care professionals. Future research needs to explore the potential for integration of findings into workforce development programs. ©Melissa Brunner, Deborah Mc

[Chapter 1. Beyond the reification of vulnerability, thinking vulnerability as the subject capability

Science.gov (United States)

Botbol-Baum, Mylène

2016-12-29

In this introduction I will draw an overview of theories associated with the notion of care from feminist studies to clinical theory by articulating the concept of vulnerability to that of capability in Amartya Sen and showing the roots of capability theory in Aristotle and anti-utilitarian theories.

The Interface of IT Capabilities and Disruptive Innovations

DEFF Research Database (Denmark)

Baiyere, Abayomi

2017-01-01

The occurrence of disruptive innovations tends to challenge the fabric, structure and capability that define firms facing their threat. Prior research indicates that the capacity of a firm to restructure and reconfigure its resources to face/leverage such turbulent situations is dependent on how...... well it can orchestrate its capabilities. Although IT capability has been identified as one of the essential capability of today’s organisations, managers as well as researchers are yet to uncover the dynamics through which an organisation’s IT capability can be leveraged in disruptive innovation...... situations. This paper contributes to our understanding in this direction by conceptually exploring the different roles of an organisation's IT capabilitiy in disruptive innovation scenarios. The paper provides a synthesis of the current state of knowledge about both concepts and extends this to highlight...

Accelerator and Electrodynamics Capability Review

International Nuclear Information System (INIS)

Jones, Kevin W.

2010-01-01

Los Alamos National Laboratory (LANL) uses capability reviews to assess the science, technology and engineering (STE) quality and institutional integration and to advise Laboratory Management on the current and future health of the STE. Capability reviews address the STE integration that LANL uses to meet mission requirements. The Capability Review Committees serve a dual role of providing assessment of the Laboratory's technical contributions and integration towards its missions and providing advice to Laboratory Management. The assessments and advice are documented in reports prepared by the Capability Review Committees that are delivered to the Director and to the Principal Associate Director for Science, Technology and Engineering (PADSTE). Laboratory Management will use this report for STE assessment and planning. LANL has defined fifteen STE capabilities. Electrodynamics and Accelerators is one of the seven STE capabilities that LANL Management (Director, PADSTE, technical Associate Directors) has identified for review in Fiscal Year (FY) 2010. Accelerators and electrodynamics at LANL comprise a blend of large-scale facilities and innovative small-scale research with a growing focus on national security applications. This review is organized into five topical areas: (1) Free Electron Lasers; (2) Linear Accelerator Science and Technology; (3) Advanced Electromagnetics; (4) Next Generation Accelerator Concepts; and (5) National Security Accelerator Applications. The focus is on innovative technology with an emphasis on applications relevant to Laboratory mission. The role of Laboratory Directed Research and Development (LDRD) in support of accelerators/electrodynamics will be discussed. The review provides an opportunity for interaction with early career staff. Program sponsors and customers will provide their input on the value of the accelerator and electrodynamics capability to the Laboratory mission.

Accelerator and electrodynamics capability review

Energy Technology Data Exchange (ETDEWEB)

Jones, Kevin W [Los Alamos National Laboratory

2010-01-01

Los Alamos National Laboratory (LANL) uses capability reviews to assess the science, technology and engineering (STE) quality and institutional integration and to advise Laboratory Management on the current and future health of the STE. Capability reviews address the STE integration that LANL uses to meet mission requirements. The Capability Review Committees serve a dual role of providing assessment of the Laboratory's technical contributions and integration towards its missions and providing advice to Laboratory Management. The assessments and advice are documented in reports prepared by the Capability Review Committees that are delivered to the Director and to the Principal Associate Director for Science, Technology and Engineering (PADSTE). Laboratory Management will use this report for STE assessment and planning. LANL has defined fifteen STE capabilities. Electrodynamics and Accelerators is one of the seven STE capabilities that LANL Management (Director, PADSTE, technical Associate Directors) has identified for review in Fiscal Year (FY) 2010. Accelerators and electrodynamics at LANL comprise a blend of large-scale facilities and innovative small-scale research with a growing focus on national security applications. This review is organized into five topical areas: (1) Free Electron Lasers; (2) Linear Accelerator Science and Technology; (3) Advanced Electromagnetics; (4) Next Generation Accelerator Concepts; and (5) National Security Accelerator Applications. The focus is on innovative technology with an emphasis on applications relevant to Laboratory mission. The role of Laboratory Directed Research and Development (LDRD) in support of accelerators/electrodynamics will be discussed. The review provides an opportunity for interaction with early career staff. Program sponsors and customers will provide their input on the value of the accelerator and electrodynamics capability to the Laboratory mission.

Current state of information technology use in a US primary care practice-based research network.

Science.gov (United States)

Andrews, James E; Pearce, Kevin A; Sydney, Carey; Ireson, Carol; Love, Margaret

2004-01-01

To examine the current levels of information technology (IT) use in a primary care practice-based research network (PBRN) in order to inform future development of its infrastructure. Every primary care practitioner who is a member of the Kentucky Ambulatory Network (KAN),as well as the office managers of each practice. Practitioners included family practitioners, general practitioners, nurse practitioners and physician assistants. A cross-sectional study using two survey instruments: one for office managers and one for practitioners. The office manager survey included questions related to the current state of IT within the practice, plans for enhancement and general IT issues from the perspective of managing a practice. The practitioner survey was designed to measure current IT use and attitudes of primary care practitioners. Response rates for the surveys were 46% (n = 68) for the office managers and 51% (n = 116) for practitioners. All but one practice had internet access; however, 43% had only dial-up service. Only 21% of practitioners use an electronic medical record (EMR), with dollar cost being the barrier reported most frequently (58%). More than half of the office managers were either 'somewhat interested' (45%) or 'very interested' (17%) in a low-cost, standardised EMR that was, at the time, to be sponsored by the American Academy of Family Physicians. For practitioners, 71% were either 'somewhat' or 'very' interested in such a system. Responses to other IT issues are reported. While interest in enabling information technologies was high in KAN, adoption was variable, with use of several key technologies reported as low.The results suggest that research in this network that would be dependent on or enhanced by IT might be impeded and, generally, greater attention should be given to enhancing the IT infrastructure in primary care.

PALLIATIVE CARE IN GERIATRICS: CURRENT ISSUES AND PROSPECTS

Directory of Open Access Journals (Sweden)

I. P. Рonomareva

2016-01-01

Full Text Available The purpose of the study is to identify the main problems and prospects of development of palliative care in geriatrics at the present stage. Method of research was to analyze the printed and electronic databases that meet the stated issues. The results of the study highlight the problems of the development of palliative care in geriatric practice: the lack of a developed procedure of rendering palliative care and adequate elderly patient selection criteria, the lack of trained professional staff. The main prospects-association of palliative practices and concepts of modern geriatrics required specialized geriatric assessment and the provision of clinical, medical, social and socio-psychological geriatric syndromes. While promising option for the development of palliative care geriatrics is the integration into the existing health care system, acceptance of the fact that it is a part of the specialized geriatric care. This requires the involvement and training of not only specialists with medical education, but also persons without medical training from among social workers and volunteers working in palliative care. Therefore, the obtained data allowed to conclude that topical is the development of palliative care in geriatrics, taking into account not only clinical but medico-social, socio-psychological features.

Preparing nursing students for enhanced roles in primary care: The current state of prelicensure and RN-to-BSN education.

Science.gov (United States)

Wojnar, Danuta M; Whelan, Ellen Marie

With the current emphasis on including registered nurses (RNs) on the primary care teams, it is essential that nursing programs prepare students for employment in these settings. This study explored the current state of prelicensure and RN-to-Bachelor of Science in Nursing (BSN) online education regarding the implementation of primary care content in the curricula. A sample of 1,409 schools and/or colleges from across the United States was invited to participate in an online survey. About 529 surveys were returned for an overall response rate of 37.5%. Summative content analysis was used to analyze survey data. Although most respondents have implemented some primary care content, some found it challenging and others have demurred from incorporating primary care content altogether. Nursing leaders and faculty in academia must collaborate with clinical partners to design and expand didactic and clinical learning experiences that emphasize primary care content in the prelicensure and RN-to-BSN education. Copyright © 2016 Elsevier Inc. All rights reserved.

Cutaneous wound healing: Current concepts and advances in wound care

Directory of Open Access Journals (Sweden)

Kenneth C Klein

2014-01-01

Full Text Available A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care. [1] It is a snapshot of a patient′s total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors. [2] The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT, as used at our institution (CAMC, and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society may vary widely from country to country and payment system. [3] In the USA, CMS (Centers for Medicare and Medicaid Services approved indications for HBOT vary from that of the UHMS for logistical reasons. [1] We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise.

Cutaneous wound healing: Current concepts and advances in wound care

Science.gov (United States)

Klein, Kenneth C; Guha, Somes Chandra

2014-01-01

A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care.[1] It is a snapshot of a patient's total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors.[2] The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT), as used at our institution (CAMC), and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society) may vary widely from country to country and payment system.[3] In the USA, CMS (Centers for Medicare and Medicaid Services) approved indications for HBOT vary from that of the UHMS for logistical reasons.[1] We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise. PMID:25593414

Structural Capability of an Organization toward Innovation Capability

DEFF Research Database (Denmark)

Nielsen, Susanne Balslev; Momeni, Mostafa

2016-01-01

The scholars in the field of strategic management have developed two major approaches for attainment of competitive advantage: an approach based on environmental opportunities, and another one based on internal capabilities of an organization. Some investigations in the last two decades have...... indicated that the advantages relying on the internal capabilities of organizations may determine the competitive position of organizations better than environmental opportunities do. Characteristics of firms shows that one of the most internal capabilities that lead the organizations to the strongest...... competitive advantage in the organizations is the innovation capability. The innovation capability is associated with other organizational capabilities, and many organizations have focused on the need to identify innovation capabilities.This research focuses on recognition of the structural aspect...

The Virtual Ship - A New Capability in Support of Maritime Forces

National Research Council Canada - National Science Library

Best, John

1999-01-01

...) systems, weapons and the platform itself. There is currently a gap in the capability to rigorously study these integration requirements in a laboratory environment Additionally, the capability is lacking to comprehensively investigate...

Accountable Care Organizations: The National Landscape.

Science.gov (United States)

Shortell, Stephen M; Colla, Carrie H; Lewis, Valerie A; Fisher, Elliott; Kessell, Eric; Ramsay, Patricia

2015-08-01

There are now more than seven hundred accountable care organizations (ACOs) in the United States. This article describes some of their most salient characteristics including the number and types of contracts involved, organizational structures, the scope of services offered, care management capabilities, and the development of a three-category taxonomy that can be used to target technical assistance efforts and to examine performance. The current evidence on the performance of ACOs is reviewed. Since California has the largest number of ACOs (N=67) and a history of providing care under risk-bearing contracts, some additional assessments of quality and patient experience are made between California ACOs and non-ACO provider organizations. Six key issues likely to affect future ACO growth and development are discussed, and some potential "diagnostic" indicators for assessing the likelihood of potential antitrust violations are presented. Copyright © 2015 by Duke University Press.

Developing a Current Capability Design for Manufacture Framework in the Aerospace Industry

OpenAIRE

Whiteside, A.; Shehab, Essam; Beadle, C.; Percival, M.

2009-01-01

Organised by: Cranfield University During progressive product design and development in the aerospace industry, a lack of effective communication between the sequential functions of design, manufacturing and assembly often causes delays and setbacks whereby production capabilities are unable to realise design intent in high-complexity product models. As a result, there is a need to formalise the progressive release of an engineering model to production functions during New Prod...

Current and emerging occupational safety and health (OSH) issues in the healthcare sector, including home and community care

NARCIS (Netherlands)

Jong, T. de; Bos, E.; Pawlowska-Cyprysiak, K.; Hildt-Ciupinska, K.; Malinska, M.; Nicolescu, G.; Trifu, A.

2014-01-01

This report gives an overview of the current and emerging OSH issues for health- and social care workers and how these affect their safety and health at work and influence the quality of care they provide. It combines a literature review and the responses received to a questionnaire sent to OSH

Effectiveness of direct-current cardioversion for treatment of supraventricular tachyarrhythmias, in particular atrial fibrillation, in surgical intensive care patients.

Science.gov (United States)

Mayr, Andreas; Ritsch, Nicole; Knotzer, Hans; Dünser, Martin; Schobersberger, Wolfgang; Ulmer, Hanno; Mutz, Norbert; Hasibeder, Walter

2003-02-01

To evaluate primary success rate and effectiveness of direct-current cardioversion in postoperative critically ill patients with new-onset supraventricular tachyarrhythmias. Prospective intervention study. Twelve-bed surgical intensive care unit in a university teaching hospital. Thirty-seven consecutive, adult surgical intensive care unit patients with new-onset supraventricular tachyarrhythmias without previous history of tachyarrhythmias. Direct-current cardioversion using a monophasic, damped sinus-wave defibrillator. Energy levels used were 50, 100, 200, and 300 J for regular supraventricular tachyarrhythmias (n = 6) and 100, 200, and 360 J for irregular supraventricular tachyarrhythmias (n = 31). None of the patients was hypoxic, hypokalemic, or hypomagnesemic at onset of supraventricular tachyarrhythmia. Direct-current cardioversion restored sinus rhythm in 13 of 37 patients (35% primary responders). Most patients responded to the first or second direct-current cardioversion shock. Only one of 25 patients requiring more than two direct-current cardioversion shocks converted into sinus rhythm. Primary responders were significantly younger and demonstrated significant differences in arterial Po2 values at onset of supraventricular tachyarrhythmias compared with nonresponders. At 24 and 48 hrs, only six (16%) and five (13.5%) patients remained in sinus rhythm, respectively. In contrast to recent literature, direct-current cardioversion proved to be an ineffective method for treatment of new-onset supraventricular tachyarrhythmias and, in particular, atrial fibrillation with a rapid ventricular response in surgical intensive care unit patients.

Toward Vision Oriented Organization through Foresight Capability Development

Directory of Open Access Journals (Sweden)

Gianita BLEOJU

2014-11-01

Full Text Available Dealing with complexity is becoming increasingly difficult for organizations, due to limited replicable abilities, once management performance was remunerated by successful decisions on the marketplace. The competitive advantage, based upon current documented organizational management expertise, deployed into patterns of competitive behavior, prove to be unsustainable. Therefore, we assist to a relative emergency of strategic intelligence adjustment framework, to channel the managerial capability mechanisms, from current detective orientation capabilities toward anticipatory ones. Based upon exploitation of an organizational profiling database, we try our contribution to this challenging debate, by formulating recommendations for strategic adjustment and prototype testing of the potential solutions, through a designed transition matrix from market oriented to vision oriented organizations.

Post Irradiation Capabilities at the Idaho National Laboratory

International Nuclear Information System (INIS)

Schulthess, J.L.; Rosenberg, K.E.

2011-01-01

The U.S. Department of Energy (DOE), Office of Nuclear Energy (NE) oversees the efforts to ensure nuclear energy remains a viable option for the United States. A significant portion of these efforts are related to post-irradiation examinations (PIE) of highly activated fuel and materials that are subject to the extreme environment inside a nuclear reactor. As the lead national laboratory, Idaho National Laboratory (INL) has a rich history, experience, workforce and capabilities for performing PIE. However, new advances in tools and techniques for performing PIE now enable understanding the performance of fuels and materials at the nano-scale and smaller level. Examination at this level is critical since this is the scale at which irradiation damage occurs. The INL is on course to adopt these advanced tools and techniques to develop a comprehensive nuclear fuels and materials characterization capability that is unique in the world. Because INL has extensive PIE capabilities currently in place, a strong foundation exist to build upon as new capabilities are implemented and work load increases. In the recent past, INL has adopted significant capability to perform advanced PIE characterization. Looking forward, INL is planning for the addition of two facilities that will be built to meet the stringent demands of advanced tools and techniques for highly activated fuels and materials characterization. Dubbed the Irradiated Materials Characterization Laboratory (IMCL) and Advanced Post Irradiation Examination Capability, these facilities are next generation PIE laboratories designed to perform the work of PIE that cannot be performed in current DOE facilities. In addition to physical capabilities, INL has recently added two significant contributors to the Advanced Test Reactor-National Scientific User Facility (ATR-NSUF), Oak Ridge National Laboratory and University of California, Berkeley.

System Reliability Analysis Capability and Surrogate Model Application in RAVEN

Energy Technology Data Exchange (ETDEWEB)

Rabiti, Cristian [Idaho National Lab. (INL), Idaho Falls, ID (United States); Alfonsi, Andrea [Idaho National Lab. (INL), Idaho Falls, ID (United States); Huang, Dongli [Idaho National Lab. (INL), Idaho Falls, ID (United States); Gleicher, Frederick [Idaho National Lab. (INL), Idaho Falls, ID (United States); Wang, Bei [Idaho National Lab. (INL), Idaho Falls, ID (United States); Adbel-Khalik, Hany S. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Pascucci, Valerio [Idaho National Lab. (INL), Idaho Falls, ID (United States); Smith, Curtis L. [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2015-11-01

This report collect the effort performed to improve the reliability analysis capabilities of the RAVEN code and explore new opportunity in the usage of surrogate model by extending the current RAVEN capabilities to multi physics surrogate models and construction of surrogate models for high dimensionality fields.

The development of capability measures in health economics: opportunities, challenges and progress.

Science.gov (United States)

Coast, Joanna; Kinghorn, Philip; Mitchell, Paul

2015-04-01

Recent years have seen increased engagement amongst health economists with the capability approach developed by Amartya Sen and others. This paper focuses on the capability approach in relation to the evaluative space used for analysis within health economics. It considers the opportunities that the capability approach offers in extending this space, but also the methodological challenges associated with moving from the theoretical concepts to practical empirical applications. The paper then examines three 'families' of measures, Oxford Capability instruments (OxCap), Adult Social Care Outcome Toolkit (ASCOT) and ICEpop CAPability (ICECAP), in terms of the methodological choices made in each case. The paper concludes by discussing some of the broader issues involved in making use of the capability approach in health economics. It also suggests that continued exploration of the impact of different methodological choices will be important in moving forward.

Methodological Individualism and the Organizational Capabilities Approach

DEFF Research Database (Denmark)

Felin, Teppo; Foss, Nicolai Juul

2004-01-01

AbstractDuring the last decade, strategy scholars have increasingly converged on organizationalcapabilities as a key construct in strategy research. We explicate some of the underlying,unstated assumptions of current capabilities-based work by drawing on seminal work in thephilosophy of social...... critical individual-levelconsiderations, including individual action and heterogeneity. In this note we do not denyor reject the notion of routines or capabilities per se, but rather call for an increasedemphasis on how these collective structures originate and change as a result of individualactions...

Atmospheric Release Advisory Capability

International Nuclear Information System (INIS)

Dickerson, M.H.; Gudiksen, P.H.; Sullivan, T.J.

1983-02-01

The Atmospheric Release Advisory Capability (ARAC) project is a Department of Energy (DOE) sponsored real-time emergency response service available for use by both federal and state agencies in case of a potential or actual atmospheric release of nuclear material. The project, initiated in 1972, is currently evolving from the research and development phase to full operation. Plans are underway to expand the existing capability to continuous operation by 1984 and to establish a National ARAC Center (NARAC) by 1988. This report describes the ARAC system, its utilization during the past two years, and plans for its expansion during the next five to six years. An integral part of this expansion is due to a very important and crucial effort sponsored by the Defense Nuclear Agency to extend the ARAC service to approximately 45 Department of Defense (DOD) sites throughout the continental US over the next three years

Evaluation of Resources Necessary for Provision of Trauma Care in Botswana: An Initiative for a Local System.

Science.gov (United States)

Mwandri, Michael B; Hardcastle, Timothy C

2018-06-01

Developing countries face the highest incidence of trauma, and on the other hand, they do not have resources for mitigating the scourge of these injuries. The World Health Organization through the Essential Trauma Care (ETC) project provides recommendations for improving management of the injured and building up of systems that are effective in low-middle-income countries (LMICs). This study uses ETC project recommendations and other trauma-care guidelines to evaluate the current status of the resources and organizational structures necessary for optimal trauma care in Botswana; an African country with relatively good health facilities network, subsidized public hospital care and a functioning Motor Vehicle Accident fund covering road traffic collision victims. A cross-sectional descriptive design employed convenience sampling for recruiting high-volume trauma hospitals and selecting candidates. A questionnaire, checklist, and physical verification of resources were utilized to evaluate resources, staff knowledge, and organization-of-care and hospital capabilities. Results are provided in plain descriptive language to demonstrate the findings. Necessary consumables, good infrastructure, adequate numbers of personnel and rehabilitation services were identified all meeting or exceeding ETC recommendations. Deficiencies were noted in staff knowledge of initial trauma care, district hospital capability to provide essential surgery, and the organization of trauma care. The good level of resources available in Botswana may be used to improve trauma care: To further this process, more empowering of high-volume trauma hospitals by adopting trauma-care recommendations and inclusive trauma-system approaches are desirable. The use of successful examples on enhanced surgical skills and capabilities, effective trauma-care resource management, and leadership should be encouraged.

Finite element analysis of ageing reinforced and prestressed concrete structures in nuclear plant - An international review of current capabilities and priorities for future developments

International Nuclear Information System (INIS)

2002-01-01

Nuclear plants contain a variety of concrete structures whose structural performance is essential to the safety of the plant. There is a requirement to demonstrate the robustness of these structures during normal operating and extreme accident conditions, throughout their life. During this time, the concrete may degrade due to the effects of ageing. This degradation must be accounted for during the assessment of their performance. Finite Element Analysis (FEA) techniques have tremendous potential for providing valuable insight into the behaviour of these aged concrete structures under a range of different loading conditions. Advanced FEA techniques currently enjoy widespread use within the nuclear industry for the non-linear analysis of concrete. Many practitioners within the nuclear industry are at the forefront of the industrial application of these methods. However, in some areas, the programs that are commercially available lag behind the best information available from research. This document is an international review of current capabilities and priorities for future development relating to non-linear finite element analysis of reinforced and prestressed concrete in the nuclear industry in the various member states. Particular attention is paid to the analysis of degraded or ageing structures. This report: 1. Summarises the needs for FEA of aged concrete nuclear structures; 2. Details the existing capabilities, not just in terms of what the software is capable of, but also in terms of the current practices employed by those in industry; 3. Looks at how engineers, within the nuclear industry, working in this field would like to see methods improved, and identifies the factors that are limiting current practice; 4. Summarises ongoing research that may provide beneficial technological advances; 5. Assigns priorities to the different development requests; 6. Selects those developments that are felt to be of greatest benefit to industry and provides a qualitative

SuperMAG: Present and Future Capabilities

Science.gov (United States)

Hsieh, S. W.; Gjerloev, J. W.; Barnes, R. J.

2009-12-01

SuperMAG is a global collaboration that provides ground magnetic field perturbations from a long list of stations in the same coordinate system, identical time resolution and with a common baseline removal approach. This unique high quality dataset provides a continuous and nearly global monitoring of the ground magnetic field perturbation. Currently, only archived data are available on the website and hence it targets basic research without any operational capabilities. The existing SuperMAG software can be easily adapted to ingest real-time or near real-time data and provide a now-casting capability. The SuperDARN program has a long history of providing near real-time maps of the northern hemisphere electrostatic potential and as both SuperMAG and SuperDARN share common software it is relatively easy to adapt these maps for global magnetic perturbations. Magnetometer measurements would be assimilated by the SuperMAG server using a variety of techniques, either by downloading data at regular intervals from remote servers or by real-time streaming connections. The existing SuperMAG analysis software would then process these measurements to provide the final calibrated data set using the SuperMAG coordinate system. The existing plotting software would then be used to produce regularly updated global plots. The talk will focus on current SuperMAG capabilities illustrating the potential for now-casting and eventually forecasting.

[Out-of-hours primary care in Germany: general practitioners' views on the current situation].

Science.gov (United States)

Frankenhauser-Mannuß, J; Goetz, K; Scheuer, M; Szescenyi, J; Leutgeb, R

2014-07-01

The aim of this study was to explore views, experiences und perspectives of German GPs related to current out-of-hours service provision covering both urban and rural settings. In the context of the international project EurOOHnet (European Research Network for Out-of-Hours Primary Health Care) the German members (of EurOOHnet) developed a questionnaire about organisational structures, infrastructure requirements and the procedures of information flow between regular care and out-of-hours care in 2011. This questionnaire was adopted in every participating country. A comprehensive postal questionnaire was sent to 410 feneral practice cooperatives in Germany. Qualitative content analysis and an inductive reasoning process, supported by the use of Atlas.ti, were used to identify key themes from responses to open-ended questions in the survey. Results were grouped into 3 overarching categories and each of these were grouped into 3 sub-categories. The questionnaire response rate was 44% (181/410). The analysis identified organisational issues (e. g., financing) and infrastructure barriers (e. g., lack of motivated GPs for out-of-hours care) as key themes. Significantly, different priorities between rural and urban GPs were identified. In particular, rural GPs highlighted shortages of GPs and distance between the GP practice and patients' residence as concerning factors impacting on out-of-hours care. Based on reported views from survey respondents, urban and rural primary care service needs vary significantly and, therefore, different solutions are needed to improve out-of-hours primary care and optimise service quality. © Georg Thieme Verlag KG Stuttgart · New York.

When the body is past fixing: caring for bodies, caring for people.

Science.gov (United States)

Melia, Kath M

2014-03-01

To discuss the social context within which end-of-life nursing care takes place and to consider palliative options of last resort and the differences between societal and professional views on these. The distinction between life and death is not so straightforward as was once the case. Resuscitation and the increasing capability of intensive care to 'save' patients have implications for nursing practice in a society where there is an increasing demand that individuals should be able to choose the time of their death. This is a discursive paper. There are differences between the professional view on end-of-life options and the societal debates calling for a more libertarian approach. The problem for professionals is that the call for choice of the individual involves a different approach to end-of-life care, an approach that does not sit well with current professional ethics. One way forward might be a gradual reconsidering of what end-of-life care might reasonably encompass. Nurses are the healthcare workers who have the most prolonged and intimate contact with bodies. The way in which we conceptualise the body is central to much of the work carried out in the transition between life and death and is an important part of nursing. © 2013 John Wiley & Sons Ltd.

Pulse Power Capability Estimation of Lithium Titanate Oxide-based Batteries

DEFF Research Database (Denmark)

Stroe, Ana-Irina; Swierczynski, Maciej Jozef; Stroe, Daniel Loan

2016-01-01

The pulse power capability (PPC) represents one of the parameters that describe the performance behavior of Lithium-ion batteries independent on the application. Consequently, extended information about the Li-ion battery PPC and its dependence on the operating conditions become necessary. Thus......, this paper analyzes the power capability characteristic of a 13Ah high power Lithium Titanate Oxide-based battery and its dependence on temperature, load current and state-of-charge. Furthermore, a model to predict the discharging PPC of the battery cell at different temperatures and load currents for three...

The new MCNP6 depletion capability

International Nuclear Information System (INIS)

Fensin, M. L.; James, M. R.; Hendricks, J. S.; Goorley, J. T.

2012-01-01

The first MCNP based in-line Monte Carlo depletion capability was officially released from the Radiation Safety Information and Computational Center as MCNPX 2.6.0. Both the MCNP5 and MCNPX codes have historically provided a successful combinatorial geometry based, continuous energy, Monte Carlo radiation transport solution for advanced reactor modeling and simulation. However, due to separate development pathways, useful simulation capabilities were dispersed between both codes and not unified in a single technology. MCNP6, the next evolution in the MCNP suite of codes, now combines the capability of both simulation tools, as well as providing new advanced technology, in a single radiation transport code. We describe here the new capabilities of the MCNP6 depletion code dating from the official RSICC release MCNPX 2.6.0, reported previously, to the now current state of MCNP6. NEA/OECD benchmark results are also reported. The MCNP6 depletion capability enhancements beyond MCNPX 2.6.0 reported here include: (1) new performance enhancing parallel architecture that implements both shared and distributed memory constructs; (2) enhanced memory management that maximizes calculation fidelity; and (3) improved burnup physics for better nuclide prediction. MCNP6 depletion enables complete, relatively easy-to-use depletion calculations in a single Monte Carlo code. The enhancements described here help provide a powerful capability as well as dictate a path forward for future development to improve the usefulness of the technology. (authors)

The New MCNP6 Depletion Capability

International Nuclear Information System (INIS)

Fensin, Michael Lorne; James, Michael R.; Hendricks, John S.; Goorley, John T.

2012-01-01

The first MCNP based inline Monte Carlo depletion capability was officially released from the Radiation Safety Information and Computational Center as MCNPX 2.6.0. Both the MCNP5 and MCNPX codes have historically provided a successful combinatorial geometry based, continuous energy, Monte Carlo radiation transport solution for advanced reactor modeling and simulation. However, due to separate development pathways, useful simulation capabilities were dispersed between both codes and not unified in a single technology. MCNP6, the next evolution in the MCNP suite of codes, now combines the capability of both simulation tools, as well as providing new advanced technology, in a single radiation transport code. We describe here the new capabilities of the MCNP6 depletion code dating from the official RSICC release MCNPX 2.6.0, reported previously, to the now current state of MCNP6. NEA/OECD benchmark results are also reported. The MCNP6 depletion capability enhancements beyond MCNPX 2.6.0 reported here include: (1) new performance enhancing parallel architecture that implements both shared and distributed memory constructs; (2) enhanced memory management that maximizes calculation fidelity; and (3) improved burnup physics for better nuclide prediction. MCNP6 depletion enables complete, relatively easy-to-use depletion calculations in a single Monte Carlo code. The enhancements described here help provide a powerful capability as well as dictate a path forward for future development to improve the usefulness of the technology.

Researching pharmacist managerial capability: philosophical perspectives and paradigms of inquiry.

Science.gov (United States)

Woods, Phillip; Gapp, Rod; King, Michelle A

2015-01-01

In successful community pharmacy business enterprises suitably responsive actions to meet ever-increasing change require capable pharmacy managers who readily learn and adapt. Capability as a concept is generally understood to be the ability of a manager to identify and act to solve unfamiliar problems in unfamiliar situations. Capability is characterized by adaptability and flexibility. However, different understandings of the concept 'capability' and what it means to be 'capable' are indirect and incomplete. This paper aims to clarify current theories regarding the concept of 'capability' at the level of the individual, and through this to make more explicit what is known about the phenomenon, but more particularly, how we know what we know. The analysis includes the concept of 'competence' because explanations of capability include competence, and the two concepts are not clearly separated in the literature. By probing the epistemological origins of current theory concerning both concepts, the limiting taken for granted assumptions are revealed. Assumptions about context and time, and the psychological theory through which individuals are assumed to perceive, know and learn, are illuminated. The analysis, in connection with the literature, shows how the interpretive philosophic research approach may reveal a different and useful theoretical perspective for explaining capability as a dynamic performance. It is suggested that such a perspective may narrow the gap between the theory of capability and its practice. The interpretive perspective holds potential to reveal how capability, as performed by successful community pharmacy managers, might be further researched and strengthened. This paper supports the challenging suggestion that pharmacy social research needs to rebalance the dominance of purely empirical research by exploring interpretive methodologies to better understand human actions and relations in the context of pharmacy. Crown Copyright © 2015

Materials capability review Los Alamos National Laboratory, May 3-6, 2010

Energy Technology Data Exchange (ETDEWEB)

Taylor, Antoinette [Los Alamos National Laboratory

2010-01-01

The 2010 'Capability Review' process at LANL significantly differs from the Division reviews of prior years. The Capabilities being reviewed (some 4-8 per year) are deliberately chosen to be crosscutting over the Laboratory, and therefore will include not only several experimental, theoretical and simulation disciplines, but also contributions from multiple line organizations. This approach is consistent with the new Laboratory organizational structure, focusing on agile and integrated capabilities applied to present national security missions, and also nurtured to be available for rapid application to future missions. The overall intent is that the Committee assess the quality of the science, engineering, and technology identified in the agenda, and advise the LANS Board of Governors and Laboratory management. Specifically, the Committees will: (1) Assess the quality of science, technology and engineering within the Capability in the areas defined in the agenda. Identify issues to develop or enhance the core competencies within this capability. (2) Evaluate the integration of this capability across the Laboratory organizations that are listed in the agenda in terms of joint programs, projects, proposals, and/or publications. Describe the integration of this capability in the wider scientific community using the recognition as a leader within the community, ability to set research agendas, and attraction and retention of staff. (3) Assess the quality and relevance of this capability's science, technology and engineering contributions to current and emerging Laboratory programs, including Nuclear Weapons, Threat Reduction/Homeland Security, and Energy Security. (4) Advise the Laboratory Director/Principal Associate Director for Science, Technology and Engineering on the health of the Capability including the current and future (5 year) science, technology and engineering staff needs, mix of research and development activities, program opportunities

Location estimation of approaching objects is modulated by the observer's inherent and momentary action capabilities

NARCIS (Netherlands)

Kandula, Manasa; Hofman, Dennis; Dijkerman, H Chris

2016-01-01

Action capability may be one of the factors that can influence our percept of the world. A distinction can be made between momentary action capability (action capability at that particular moment) and inherent action capability (representing a stable action capability). In the current study, we

Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization.

Science.gov (United States)

Moaddab, Amirhossein; McCullough, Laurence B; Chervenak, Frank A; Fox, Karin A; Aagaard, Kjersti Marie; Salmanian, Bahram; Raine, Susan P; Shamshirsaz, Alireza A

2015-06-01

Tubal sterilization during the immediate postpartum period is 1 of the most common forms of contraception in the United States. This time of the procedure has the advantage of 1-time hospitalization, which results in ease and convenience for the woman. The US Collaborative Review of Sterilization Study indicates the high efficacy and effectiveness of postpartum tubal sterilization. Oral and written informed consent is the ethical and legal standard for the performance of elective tubal sterilization for permanent contraception for all patients, regardless of source of payment. Current health care policy and practice regarding elective tubal sterilization for Medicaid beneficiaries places a unique requirement on these patients and their obstetricians: a mandatory waiting period. This requirement originates in decades-old legislation, which we briefly describe. We then introduce the concept of health care justice in professional obstetric ethics and explain how it originates in the ethical concepts of medicine as a profession and of being a patient and its deontologic and consequentialist dimensions. We next identify the implications of health care justice for the current policy of a mandatory 30-day waiting period. We conclude that Medicaid policy allocates access to elective tubal sterilization differently, based on source of payment and gender, which violates health care justice in both its deontologic and consequentialist dimensions. Obstetricians should invoke health care justice in women's health care as the basis for advocacy for needed change in law and health policy, to eliminate health care injustice in women's access to elective tubal sterilization. Copyright © 2015 Elsevier Inc. All rights reserved.

Off-Gas Adsorption Model Capabilities and Recommendations

Energy Technology Data Exchange (ETDEWEB)

Lyon, Kevin L. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Welty, Amy K. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Law, Jack [Idaho National Lab. (INL), Idaho Falls, ID (United States); Ladshaw, Austin [Georgia Inst. of Technology, Atlanta, GA (United States); Yiacoumi, Sotira [Georgia Inst. of Technology, Atlanta, GA (United States); Tsouris, Costas [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

2016-03-01

Off-gas treatment is required to reduce emissions from aqueous fuel reprocessing. Evaluating the products of innovative gas adsorption research requires increased computational simulation capability to more effectively transition from fundamental research to operational design. Early modeling efforts produced the Off-Gas SeParation and REcoverY (OSPREY) model that, while efficient in terms of computation time, was of limited value for complex systems. However, the computational and programming lessons learned in development of the initial model were used to develop Discontinuous Galerkin OSPREY (DGOSPREY), a more effective model. Initial comparisons between OSPREY and DGOSPREY show that, while OSPREY does reasonably well to capture the initial breakthrough time, it displays far too much numerical dispersion to accurately capture the real shape of the breakthrough curves. DGOSPREY is a much better tool as it utilizes a more stable set of numerical methods. In addition, DGOSPREY has shown the capability to capture complex, multispecies adsorption behavior, while OSPREY currently only works for a single adsorbing species. This capability makes DGOSPREY ultimately a more practical tool for real world simulations involving many different gas species. While DGOSPREY has initially performed very well, there is still need for improvement. The current state of DGOSPREY does not include any micro-scale adsorption kinetics and therefore assumes instantaneous adsorption. This is a major source of error in predicting water vapor breakthrough because the kinetics of that adsorption mechanism is particularly slow. However, this deficiency can be remedied by building kinetic kernels into DGOSPREY. Another source of error in DGOSPREY stems from data gaps in single species, such as Kr and Xe, isotherms. Since isotherm data for each gas is currently available at a single temperature, the model is unable to predict adsorption at temperatures outside of the set of data currently

Paediatric end-of-life care needs in Switzerland: current practices, and perspectives from parents and professionals. A study protocol.

Science.gov (United States)

Bergstraesser, Eva; Zimmermann, Karin; Eskola, Katri; Luck, Patricia; Ramelet, Anne-Sylvie; Cignacco, Eva

2015-08-01

To present a protocol for a multi-phase study about the current practice of end-of-life care in paediatric settings in Switzerland. In Switzerland, paediatric palliative care is usually provided by teams, who may not necessarily have specific training. There is a lack of systematic data about specific aspects of care at the end of a child's life, such as symptom management, involvement of parents in decision-making and family-centred care and experiences and needs of parents, and perspectives of healthcare professionals. This retrospective nationwide multicentre study, Paediatric End-of-LIfe CAre Needs in Switzerland (PELICAN), combines quantitative and qualitative methods of enquiry. The PELICAN study consists of three observational parts, PELICAN I describes practices of end-of-life care (defined as the last 4 weeks of life) in the hospital and home care setting of children (0-18 years) who died in the years 2011-2012 due to a cardiac, neurological or oncological disease, or who died in the neonatal period. PELICAN II assesses the experiences and needs of parents during the end-of-life phase of their child. PELICAN III focuses on healthcare professionals and explores their perspectives concerning the provision of end-of-life care. This first study across Switzerland will provide comprehensive insight into the current end-of-life care in children with distinct diagnoses and the perspectives of affected parents and health professionals. The results may facilitate the development and implementation of programmes for end-of-life care in children across Switzerland, building on real experiences and needs. ClinicalTrials.gov Identifier: NCT01983852. © 2015 John Wiley & Sons Ltd.

The health care system for female workers and its current status in Japan.

Science.gov (United States)

Nohara, M; Kagawa, J

2000-11-01

In this paper we describe female workers' health care, the women's and maternal protection system within the Japanese legal system, the current status of female workers in Japan, and problems regarding methods of advancing health care and the women's or maternal protection system. Motherhood is respected in the workplace in Japan, and in order to provide an environment in which women can work and still bear and rear children with a sense of security, laws concerning maternal protection of female workers, and revisions in terms of the system have been made, and a new system has been in effect since the fiscal year of 1998. Nevertheless, gender discrimination against women and the disparagement of women, rooted in gender role stereotypes concerning the division of labor, remain firmly planted in the social environment and in long-established custom.

Current Trends in Discharge Disposition and Post-discharge Care After Total Joint Arthroplasty.

Science.gov (United States)

Tarity, T David; Swall, Marion M

2017-09-01

The purpose of this manuscript is to review published literature over the last 5 years to assess recent trends and influencing factors regarding discharge disposition and post-discharge care following total joint arthroplasty. We evaluated instruments proposed to predict a patient's discharge disposition and summarize reports investigating the safety in sending more patients home by reviewing complications and readmission rates. Current literature supports decreased length of hospital stay and increased discharge to home with cost savings and stable readmission rates. Surgeons with defined clinical pathways and those who shape patient expectations may more effectively control costs than those without defined pathways. Further research is needed analyzing best practices in care coordination, managing patient expectations, and cost-effective analysis of home discharge while at the same time ensuring patient outcomes are optimized following total joint arthroplasty.

Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-first-responder training program.

Science.gov (United States)

Jayaraman, Sudha; Mabweijano, Jacqueline R; Lipnick, Michael S; Caldwell, Nolan; Miyamoto, Justin; Wangoda, Robert; Mijumbi, Cephas; Hsia, Renee; Dicker, Rochelle; Ozgediz, Doruk

2009-12-01

Uganda currently has no organized prehospital emergency system. We sought to measure the current burden of injury seen by lay people in Kampala, Uganda and to determine the feasibility of a lay first-responder training program. We conducted a cross-sectional survey of current prehospital care providers in Kampala: police officers, minibus taxi drivers, and Local Council officials, and collected data on types and frequencies of emergencies witnessed, barriers to aid provision, history of training, and current availability of first-aid supplies. A context-appropriate course on basic first-aid for trauma was designed and implemented. We measured changes in trainees' fund of knowledge before and after training. A total of 309 lay people participated in the study, and during the previous 6 months saw 18 traumatic emergencies each; 39% saw an injury-related death. The most common injury mechanisms were road crashes, assault, and burns. In these cases, 90% of trainees provided some aid, most commonly lifting (82%) or transport (76%). Fifty-two percent of trainees had previous first-aid training, 44% had some access to equipment, and 32% had ever purchased a first-aid kit. Before training, participants answered 45% of test questions correctly (mean %) and this increased to 86% after training (p emergencies and deaths in Kampala, Uganda and provide much needed care but are ill-prepared to do so. A context-appropriate prehospital trauma care course can be developed and improve lay people's knowledge of basic trauma care. The effectiveness of such a training program needs to be evaluated prospectively.

Rapid prototyping for biomedical engineering: current capabilities and challenges.

Science.gov (United States)

Lantada, Andrés Díaz; Morgado, Pilar Lafont

2012-01-01

A new set of manufacturing technologies has emerged in the past decades to address market requirements in a customized way and to provide support for research tasks that require prototypes. These new techniques and technologies are usually referred to as rapid prototyping and manufacturing technologies, and they allow prototypes to be produced in a wide range of materials with remarkable precision in a couple of hours. Although they have been rapidly incorporated into product development methodologies, they are still under development, and their applications in bioengineering are continuously evolving. Rapid prototyping and manufacturing technologies can be of assistance in every stage of the development process of novel biodevices, to address various problems that can arise in the devices' interactions with biological systems and the fact that the design decisions must be tested carefully. This review focuses on the main fields of application for rapid prototyping in biomedical engineering and health sciences, as well as on the most remarkable challenges and research trends.

[The Development of Long-Term Care Policies and the Impact on Nursing].

Science.gov (United States)

Wu, Shiao-Chi; Tsai, Yin-Yin; Yeh, Shin-Ting

2015-10-01

The government must reform and enhance current medical and long-term care services in order to respond effectively to societal ageing and labor shortage trends and to ensure sustainable operations. The post-acute care system should be reoriented on the home and community instead of the hospital. The Long Term Care Service Act integrates long-term care services that were previously dispersed amongst different departments, sets up a long-term care development fund, and improves the quality and allocation of long-term care services. Moreover, the Long Term Care Insurance Act will implement a bundle payment system to assist disabled families. The integration of automation and information technology will make long-term care more efficient. Although nurses are more skilled at elderly care and counseling than other community care professionals, nurses generally lack training in business management. Home and community-based services thus require better-trained manpower, opportunities to set care agents, and opportunities to offer flexible caring jobs. Therefore, nurses should strengthen their capabilities in post-acute care, business management, cooperation, and coordination.

Sexuality Education and Implications for Quality of Care for Individuals with Adult Onset Disability: A Review of Current Literature

Science.gov (United States)

Eglseder, Kate; Webb, Sheridan

2017-01-01

Purpose: To investigate the need for sexuality education for individuals with adult onset physical disabilities as it relates to quality of life and to identify current trends in the provision of sexuality education by health care providers relating to quality of care. Data Sources: Literature review from January 1986 to December 2016. Study…

Impact of Personnel Capabilities on Organizational Innovation Capability

DEFF Research Database (Denmark)

Nielsen, Susanne Balslev; Momeni, Mostafa

2016-01-01

in this rapidly changing world. This research focuses on definition of the personnel aspect of innovation capability, and proposes a conceptual model based on the scientific articles of academic literature on organisations innovation capability. This paper includes an expert based validation in three rounds...... of the Delphi method. And for the purpose of a better appreciation of the relationship dominating the factors of the model, it has distributed the questionnaire to Iranian companies in the Food industry. This research proposed a direct relationship between Innovation Capability and the Personnel Capability...

Current status of quality evaluation of nursing care through director review and reflection from the Nursing Quality Control Centers

OpenAIRE

Duan, Xia; Shi, Yan

2014-01-01

Background: The quality evaluation of nursing care is a key link in medical quality management. It is important and worth studying for the nursing supervisors to know the disadvantages during the process of quality evaluation of nursing care and then to improve the whole nursing quality. This study was to provide director insight on the current status of quality evaluation of nursing care from Nursing Quality Control Centers (NQCCs). Material and Methods: This qualitative study used a sample ...

Challenges for Infants’ Home Care: a Qualitative Study

Directory of Open Access Journals (Sweden)

Zeinab Hemati

2016-06-01

Full Text Available Background Home care is an acceptable strategy for the relationship between family and healthcare team and implementation of healthcare interventions, and infants’ nurses could play an important role in enhancing the capability of families and promoting child health in this area. This study examined challenges facing infants’ home care from nurses’ viewpoints in Iranian culture.Materials and MethodsA qualitative design was used to explain challenges facing infants’ home care from nurses’ viewpoints. Participants included 20 nurses’ working in the neonatal units of University hospitals in Isfahan, Iran in 2015. Data collection was done by interviewing nurses working in neonatal units of Shahid Beheshti and Alzahra hospitals. All the data were analyzed by qualitative content analysis.ResultsFour main categories of “The need to warn the community ", “culture",” need for security " and ” legal support" were extracted from the participants' explanations, indicating the dimensions of Challenges for Infants’ Home Care.Conclusion Nursing policy makers and managers are able to help to facilitate home care and improve the infants’ health through correcting the infrastructure and eliminating current obstacles.

Palliative care in India: Current progress and future needs

Directory of Open Access Journals (Sweden)

Divya Khosla

2012-01-01

Full Text Available Despite its limited coverage, palliative care has been present in India for about 20 years. Obstacles in the growth of palliative care in India are too many and not only include factors like population density, poverty, geographical diversity, restrictive policies regarding opioid prescription, workforce development at base level, but also limited national palliative care policy and lack of institutional interest in palliative care. Nonetheless we have reasons to be proud in that we have overcome several hurdles and last two decades have seen palpable changes in the mindset of health care providers and policy makers with respect to need of palliative care in India. Systematic and continuous education for medical staff is mandatory, and a major break-through for achieving this purpose would be to increase the number of courses and faculties in palliative medicine at most universities.

Group Capability Model

Science.gov (United States)

Olejarski, Michael; Appleton, Amy; Deltorchio, Stephen

2009-01-01

The Group Capability Model (GCM) is a software tool that allows an organization, from first line management to senior executive, to monitor and track the health (capability) of various groups in performing their contractual obligations. GCM calculates a Group Capability Index (GCI) by comparing actual head counts, certifications, and/or skills within a group. The model can also be used to simulate the effects of employee usage, training, and attrition on the GCI. A universal tool and common method was required due to the high risk of losing skills necessary to complete the Space Shuttle Program and meet the needs of the Constellation Program. During this transition from one space vehicle to another, the uncertainty among the critical skilled workforce is high and attrition has the potential to be unmanageable. GCM allows managers to establish requirements for their group in the form of head counts, certification requirements, or skills requirements. GCM then calculates a Group Capability Index (GCI), where a score of 1 indicates that the group is at the appropriate level; anything less than 1 indicates a potential for improvement. This shows the health of a group, both currently and over time. GCM accepts as input head count, certification needs, critical needs, competency needs, and competency critical needs. In addition, team members are categorized by years of experience, percentage of contribution, ex-members and their skills, availability, function, and in-work requirements. Outputs are several reports, including actual vs. required head count, actual vs. required certificates, CGI change over time (by month), and more. The program stores historical data for summary and historical reporting, which is done via an Excel spreadsheet that is color-coded to show health statistics at a glance. GCM has provided the Shuttle Ground Processing team with a quantifiable, repeatable approach to assessing and managing the skills in their organization. They now have a common

Meeting the milestones. Strategies for including high-value care education in pulmonary and critical care fellowship training.

Science.gov (United States)

Courtright, Katherine R; Weinberger, Steven E; Wagner, Jason

2015-04-01

Physician decision making is partially responsible for the roughly 30% of U.S. healthcare expenditures that are wasted annually on low-value care. In response to both the widespread public demand for higher-quality care and the cost crisis, payers are transitioning toward value-based payment models whereby physicians are rewarded for high-value, cost-conscious care. Furthermore, to target physicians in training to practice with cost awareness, the Accreditation Council for Graduate Medical Education has created both individual objective milestones and institutional requirements to incorporate quality improvement and cost awareness into fellowship training. Subsequently, some professional medical societies have initiated high-value care educational campaigns, but the overwhelming majority target either medical students or residents in training. Currently, there are few resources available to help guide subspecialty fellowship programs to successfully design durable high-value care curricula. The resource-intensive nature of pulmonary and critical care medicine offers unique opportunities for the specialty to lead in modeling and teaching high-value care. To ensure that fellows graduate with the capability to practice high-value care, we recommend that fellowship programs focus on four major educational domains. These include fostering a value-based culture, providing a robust didactic experience, engaging trainees in process improvement projects, and encouraging scholarship. In doing so, pulmonary and critical care educators can strive to train future physicians who are prepared to provide care that is both high quality and informed by cost awareness.

Capability Paternalism

NARCIS (Netherlands)

Claassen, R.J.G.|info:eu-repo/dai/nl/269266224

A capability approach prescribes paternalist government actions to the extent that it requires the promotion of specific functionings, instead of the corresponding capabilities. Capability theorists have argued that their theories do not have much of these paternalist implications, since promoting

Current Care and Investigational Therapies in Achondroplasia.

Science.gov (United States)

Unger, Sheila; Bonafé, Luisa; Gouze, Elvire

2017-04-01

The goal of this review is to evaluate the management options for achondroplasia, the most common non-lethal skeletal dysplasia. This disease is characterized by short stature and a variety of complications, some of which can be quite severe. Despite several attempts to standardize care, there is still no widely accepted consensus. This is in part due to absence of concrete data on the incidence of sudden unexplained death in infants with achondroplasia and the best investigation for ascertaining which individuals could benefit from foramen magnum decompression surgery. In this review, we identify the different options of care and management for the various orthopedic, neurologic, and respiratory complications. In parallel, several innovative or drug repositioning therapies are being investigated that would restore bone growth but may also prevent complications. Achondroplasia is the most common non-lethal skeletal dysplasia. It is characterized by short stature and a variety of complications, some of which can be quite severe. Despite several attempts to standardize care, there is still no widely accepted consensus. This is in part due to absence of concrete data on the incidence of sudden unexplained death in infants with achondroplasia and the best investigation for ascertaining which individuals could benefit from foramen magnum decompression surgery. In this review, we identify the different options of care and management for the various orthopedic, neurologic, and respiratory complications. In parallel, several innovative or drug repositioning therapies are being investigated that would restore bone growth but may also prevent complications.

Music therapy in cardiac health care: current issues in research.

Science.gov (United States)

Hanser, Suzanne B

2014-01-01

Music therapy is a service that has become more prevalent as an adjunct to medical practice-as its evidence base expands and music therapists begin to join the cardiology team in every phase of care, from the most serious cases to those maintaining good heart health. Although applications of music medicine, primarily listening to short segments of music, are capable of stabilizing vital signs and managing symptoms in the short-term, music therapy interventions by a qualified practitioner are showing promise in establishing deeper and more lasting impact. On the basis of mind-body approaches, stress/coping models, the neuromatrix theory of pain, and entrainment, music therapy capitalizes on the ability of music to affect the autonomic nervous system. Although only a limited number of randomized controlled trials pinpoint the efficacy of specific music therapy interventions, qualitative research reveals some profound outcomes in certain individuals. A depth of understanding related to the experience of living with a cardiovascular disease can be gained through music therapy approaches such as nonverbal music psychotherapy and guided imagery and music. The multifaceted nature of musical responsiveness contributes to strong individual variability and must be taken into account in the development of research protocols for future music therapy and music medicine interventions. The extant research provides a foundation for exploring the many potential psychosocial, physiological, and spiritual outcomes of a music therapy service for cardiology patients.

Primary care practice-based care management for chronically ill patients (PraCMan: study protocol for a cluster randomized controlled trial [ISRCTN56104508

Directory of Open Access Journals (Sweden)

Baldauf Annika

2011-06-01

status and severity (PHQ-9, self-management capabilities and clinical parameters. Data collection will be performed at baseline, 12 and 24 months (12 months post-intervention. Discussion Practice-based care management for high risk individuals involving trained HCAs appears to be a promising approach to face the needs of an aging population with increasing care demands. Trial registration Current Controlled Trials ISRCTN56104508

Advance Care Planning Documentation in Electronic Health Records: Current Challenges and Recommendations for Change.

Science.gov (United States)

Lamas, Daniela; Panariello, Natalie; Henrich, Natalie; Hammes, Bernard; Hanson, Laura C; Meier, Diane E; Guinn, Nancy; Corrigan, Janet; Hubber, Sean; Luetke-Stahlman, Hannah; Block, Susan

2018-04-01

To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation. However, there are no standards to guide ACP documentation in the electronic health record (EHR). We interviewed 21 key informants to understand the strengths and weaknesses of EHR documentation systems for ACP and identify best practices. We analyzed these interviews using a qualitative content analysis approach and subsequently developed a preliminary set of recommendations. These recommendations were vetted and refined in a second round of input from a national panel of content experts. Informants identified six themes regarding current inadequacies in documentation and accessibility of ACP information and opportunities for improvement. We offer a set of concise, clinically relevant recommendations, informed by expert opinion, to improve the state of ACP documentation in the EHR.

Current use and possibilities of robots in care

NARCIS (Netherlands)

Bouwhuis, D. G.

2016-01-01

Background Robots are seen as one of the possibilities to provide care to older people, especially when care by humans becomes scarce and too expensive. In the past sixty years, however, robots have diversified into many different types with a very broad range of functionalities. Despite this large

Current Capabilities and Development Potential in Surgical Robotics

Directory of Open Access Journals (Sweden)

Mathias Hoeckelmann

2015-05-01

Full Text Available Commercial surgical robots have been in clinical use since the mid-1990s, supporting surgeons in various tasks. In the past decades, many systems emerged as research platforms, and a few entered the global market. This paper summarizes the currently available surgical systems and research directions in the broader field of surgical robotics. The widely deployed teleoperated manipulators aim to enhance human cognitive and physical skills and provide smart tools for surgeons, while image-guided robotics focus on surpassing human limitations by introducing automated targeting and treatment delivery methods. Both concepts are discussed based on prototypes and commercial systems. Through concrete examples the possible future development paths of surgical robots are illustrated. While research efforts are taking different approaches to improve the capacity of such systems, the aim of this survey is to assess their maturity from the commercialization point of view.

New facility boost CSIRO's micromanfacturing capability

International Nuclear Information System (INIS)

Grad, Paul.

1997-01-01

CSIRO is developing a leading edge microengineering capability, an electron beam lithography and device fabrication facility. Structures of submicron size can be manufactured and incorporated in microelectronic or micromechanical devices. Current and potential uses are outlined in this paper and include: chemical sensors, electronic surveillance and radar systems, microsensors, micromotors and microgages to be used in telecommunication, environment monitoring or medicine

OVERVIEW OF DEVELOPMENT OF P-CARES: PROBABILISTIC COMPUTER ANALYSIS FOR RAPID EVALUATION OF STRUCTURES

International Nuclear Information System (INIS)

NIE, J.; XU, J.; COSTANTINO, C.; THOMAS, V.

2007-01-01

Brookhaven National Laboratory (BNL) undertook an effort to revise the CARES (Computer Analysis for Rapid Evaluation of Structures) program under the auspices of the US Nuclear Regulatory Commission (NRC). The CARES program provided the NRC staff a capability to quickly check the validity and/or accuracy of the soil-structure interaction (SSI) models and associated data received from various applicants. The aim of the current revision was to implement various probabilistic simulation algorithms in CARES (referred hereinafter as P-CARES [1]) for performing the probabilistic site response and soil-structure interaction (SSI) analyses. This paper provides an overview of the development process of P-CARES, including the various probabilistic simulation techniques used to incorporate the effect of site soil uncertainties into the seismic site response and SSI analyses and an improved graphical user interface (GUI)

Blind spots of dynamic capabilities: A systems theoretic perspective

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Robert Burisch

2016-05-01

Full Text Available Dynamic capabilities remain one of the most popular, but also one of the most controversial topics in current knowledge and innovation research. This study exposes strengths and weaknesses of existing conceptualizations of dynamic capabilities by using a systems theoretic lens. Systems theory suggests that organizations operate in environments they cannot fully understand. Thus, organizational action patterns inevitably involve simplification, selectivity and uncertainty leading to inherent blind spots in every kind of strategic action. As the resulting insight, fully flexible organizational capabilities might not be achievable and continuous adaptation to every kind of environmental change cannot be possible from a systems theoretic perspective. Accordingly, this work discusses empirical difficulties that derive from the preceding argumentation and outlines a corresponding re-conceptualization of the dynamic capabilities concept.

Current Projects Strengthening Capabilities in Disused Sealed Radioactive Source (DSRS) Management

International Nuclear Information System (INIS)

Roughan, Cathleen Maura

2017-01-01

IAEA NEFW-WTS Operations - Overview: •Condition and store or remove DSRS Categories 1-5 •Provide tools and technology for management of DSRS •Assist in design of facilities for safe and secure handling and storage •Work with suppliers, recycles and service company providers to find suitable handling and transport options – limited options available •Coordinated missions with Safety, Security to address DSRS needs in the Member State – holistic approach •Build capacity and sustainability in Member States. Qualified Technical Centre: •Increase the worldwide capability to manage DSRS: –Encouraging countries with well-equipped centres or facilities and trained personnel to provide a range of technical services for the management of DSRS; –Within their countries and regionally; –Assist in implementing IAEA activities; •Build capacity and sustainability in MSs

The current and ideal state of mental health training: pediatric resident perspectives.

Science.gov (United States)

Hampton, Elisa; Richardson, Joshua E; Bostwick, Susan; Ward, Mary J; Green, Cori

2015-01-01

PHENOMENON: Mental health (MH) problems are prevalent in the pediatric population, and in a setting of limited resources, pediatricians need to provide MH care in the primary medical home yet are uncomfortable doing so citing a lack of training during residency as one barrier. The purpose of this study is to describe pediatric residents' experiences and perspectives on the current and ideal states of MH training and ideas for curriculum development to bridge this gap. A qualitative study using focus groups of pediatric residents from an urban academic medical center was performed. Audio recordings were transcribed and analyzed using a grounded theory approach. Twenty-six residents participated in three focus groups, which is when thematic saturation was achieved. The team generated five major themes: capabilities, comfort, organizational capacity, coping, and education. Residents expressed uncertainty at every step of an MH visit. Internal barriers identified included low levels of comfort and negative emotional responses. External barriers included a lack of MH resources and mentorship in MH care, or an inadequate organizational capacity. These internal and external barriers resulted in a lack of perceived capability in handling MH issues. In response, residents reported inadequate coping strategies, such as ignoring MH concerns. To build knowledge and skills, residents prefer educational modalities including didactics, experiential learning through collaborations with MH specialists, and tools built into patient care flow. Insights: Pediatric residency programs need to evolve in order to improve resident training in MH care. The skills and knowledge requested by residents parallel the American Academy of Pediatrics statement on MH competencies. Models of collaborative care provide similar modalities of learning requested by residents. These national efforts have not been operationalized in training programs yet may be useful for curriculum development and

Educating Medical Laboratory Technologists: Revisiting Our Assumptions in the Current Economic and Health-Care Environment

Directory of Open Access Journals (Sweden)

Regina Linder

2012-08-01

Full Text Available Health care occupies a distinct niche in an economy struggling to recover from recession. Professions related to the care of patients are thought to be relatively resistant to downturns, and thus become attractive to students typically drawn to more lucrative pursuits. Currently, a higher profile for clinical laboratory technology among college students and those considering career change results in larger and better prepared applicant pools. However, after decades of contraction marked by closing of programs, prospective students encounter an educational system without the capacity or vigor to meet their needs. Here discussed are some principles and proposals to allow universities, partnering with health-care providers, government agencies, and other stakeholders to develop new programs, or reenergize existing ones to serve our students and patients. Principles include academic rigor in biomedical and clinical science, multiple points of entry for students, flexibility in format, cost effectiveness, career ladders and robust partnerships.

Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

Directory of Open Access Journals (Sweden)

Christos Lionis

2009-07-01

Full Text Available Background: Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. Purpose: This paper explores the extent to which integrated primary health care (PHC is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. Methods: A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Results: Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Conclusion: Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development.

Dynamic capabilities, Marketing Capability and Organizational Performance

Directory of Open Access Journals (Sweden)

Adriana Roseli Wünsch Takahashi

2017-01-01

Full Text Available The goal of the study is to investigate the influence of dynamic capabilities on organizational performance and the role of marketing capabilities as a mediator in this relationship in the context of private HEIs in Brazil. As a research method we carried out a survey with 316 IES and data analysis was operationalized with the technique of structural equation modeling. The results indicate that the dynamic capabilities have influence on organizational performance only when mediated by marketing ability. The marketing capability has an important role in the survival, growth and renewal on educational services offerings for HEIs in private sector, and consequently in organizational performance. It is also demonstrated that mediated relationship is more intense for HEI with up to 3,000 students and other organizational profile variables such as amount of courses, the constitution, the type of institution and type of education do not significantly alter the results.

Design Mechanism as Territorial Strategic Capability

Directory of Open Access Journals (Sweden)

Gianita BLEOJU

2009-01-01

Full Text Available The current exigencies that a territory must faced in order to its’ optimalpositioning in future regional competition requires the ability to design theappropriate mechanism which better valorize the territory capability. Such aconstruct is vital for territorial sustainable development and supposes thecreation of a specific body of knowledge from distinctive local resourceexploitation and unique value creation and allocation. Territorial mechanismdesign is a typical management decision about identification, ownership andcontrol of specific strategic capabilities and their combination in a distinctiveterritorial portfolio. The most difficult responsibility is to allocate the territorialvalue added which is a source of conflict among territorial components. Ourcurrent paper research covers the basics of two complementary territorialpillars-rural and tourism potential and proves the lack of specific designmechanisms which explain the current diminishing value of Galati Brailaregion. The proposed management system, relying upon territorial controlmechanism, will ensure knowledge sharing process via collaborative learning,with the final role of appropriate territorial attractivity signals, reinforcingidentity as key factor of territorial attractability. Our paper is fully documentedon there years of data analyzing from territorial area of interest. This offers usthe necessary empiric contrasting for our proposed solution.

Current Standards of Care and Long Term Outcomes for Thalassemia and Sickle Cell Disease.

Science.gov (United States)

Chonat, Satheesh; Quinn, Charles T

2017-01-01

Thalassemia and sickle cell disease (SCD) are disorders of hemoglobin that affect millions of people worldwide. The carrier states for these diseases arose as common, balanced polymorphisms during human history because they afforded protection against severe forms of malaria. These complex, multisystem diseases are reviewed here with a focus on current standards of clinical management and recent research findings. The importance of a comprehensive, multidisciplinary and lifelong system of care is also emphasized.

Aircraft Capability Management

Science.gov (United States)

Mumaw, Randy; Feary, Mike

2018-01-01

This presentation presents an overview of work performed at NASA Ames Research Center in 2017. The work concerns the analysis of current aircraft system management displays, and the initial development of an interface for providing information about aircraft system status. The new interface proposes a shift away from current aircraft system alerting interfaces that report the status of physical components, and towards displaying the implications of degradations on mission capability. The proposed interface describes these component failures in terms of operational consequences of aircraft system degradations. The research activity was an effort to examine the utility of different representations of complex systems and operating environments to support real-time decision making of off-nominal situations. A specific focus was to develop representations that provide better integrated information to allow pilots to more easily reason about the operational consequences of the off-nominal situations. The work is also seen as a pathway to autonomy, as information is integrated and understood in a form that automated responses could be developed for the off-nominal situations in the future.

Current state of knowledge about nutritional care of pregnant women

Directory of Open Access Journals (Sweden)

Luciana Barretto

2014-12-01

Full Text Available Pregnancy involves a significant anabolic activity that leads to increased nutritional needs relative to the preconception period. This paper aims to review the current understanding of the energy needs of macro and micronutrients during pregnancy as well as guidelines to address common gastrointestinal disorders during pregnancy, the issue of pica and anthropometric assessment to ensure an optimum weight gain. With the exception of iron, most of the nutrients needed by the pregnancy can be provided by a complete and balanced diet. Currently the scientific evidence shows that routine supplementation with iron and folic acid during pregnancy is a practice that prevents iron deficiency anemia, neural tube disorders and preterm births. Intermittent iron supplementation can also be an appropriated intervention. If the diet does not guarantee and adequate support, iodine, vitamin B12 and vitamin D supplements should also be necessaries. The anthropometric assessment by the pattern of weight gain should be present at each prenatal care visit to prevent maternal and fetal complications. In situations where the mother’s weight cannot be assessed, arm muscle circumference is possible to make an overall assessment as it correlates with maternal weight gain alternative. Measurements of biceps, triceps and subscapular skinfolds are another alternative that is useful to evaluate the fatty deposits and their location, in a complementary way to gain weight.

Sandia Laboratories technical capabilities. Auxiliary capabilities: environmental health information science

International Nuclear Information System (INIS)

1975-09-01

Sandia Laboratories is an engineering laboratory in which research, development, testing, and evaluation capabilities are integrated by program management for the generation of advanced designs. In fulfilling its primary responsibility to ERDA, Sandia Laboratories has acquired extensive research and development capabilities. The purpose of this series of documents is to catalog the many technical capabilities of the Laboratories. After the listing of capabilities, supporting information is provided in the form of highlights, which show applications. This document deals with auxiliary capabilities, in particular, environmental health and information science. (11 figures, 1 table) (RWR)

Leveraging Innovation Capabilities of Asian Micro, Small and ...

International Development Research Centre (IDRC) Digital Library (Canada)

Leveraging Innovation Capabilities of Asian Micro, Small and Medium Enterprises through Intermediary Organizations. Micro, small and medium enterprises (MSMEs) are a source of livelihood for billions of poor people worldwide. The current global economic downturn has hit these enterprises particularly hard, putting ...

Diagnosing the uncertainty and detectability of emission reductions for REDD + under current capabilities: an example for Panama

International Nuclear Information System (INIS)

Pelletier, Johanne; Potvin, Catherine; Ramankutty, Navin

2011-01-01

In preparation for the deployment of a new mechanism that could address as much as one fifth of global greenhouse gas emissions by reducing emissions from deforestation and forest degradation (REDD +), important work on methodological issues is still needed to secure the capacity to produce measurable, reportable, and verifiable emissions reductions from REDD + in developing countries. To contribute to this effort, we have diagnosed the main sources of uncertainty in the quantification of emission from deforestation for Panama, one of the first countries to be supported by the Forest Carbon Partnership Facility of the World Bank and by UN-REDD. Performing sensitivity analyses using a land-cover change emissions model, we identified forest carbon stocks and the quality of land-cover maps as the key parameters influencing model uncertainty. The time interval between two land-cover assessments, carbon density in fallow and secondary forest, and the accuracy of land-cover classifications also affect our ability to produce accurate estimates. Further, we used the model to compare emission reductions from five different deforestation reduction scenarios drawn from governmental input. Only the scenario simulating a reduction in deforestation by half succeeds in crossing outside the confidence bounds surrounding the baseline emission obtained from the uncertainty analysis. These results suggest that with current data, real emission reductions in developing countries could be obscured by their associated uncertainties. Ways of addressing the key sources of error are proposed, for developing countries involved in REDD + , for improving the accuracy of their estimates in the future. These new considerations confirm the importance of current efforts to establish forest monitoring systems and enhance capabilities for REDD + in developing countries.

A qualitative study of the current situation of elderly care in Iran: what can we do for the future?

Science.gov (United States)

Goharinezhad, Salime; Maleki, Mohammadreza; Baradaran, Hamid Reza; Ravaghi, Hamid

2016-01-01

With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran. This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare. This study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis. The elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services. According to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities' job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue.

A qualitative study of the current situation of elderly care in Iran: what can we do for the future?

Directory of Open Access Journals (Sweden)

Salime Goharinezhad

2016-11-01

Full Text Available Background: With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran. Objectives: This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare. Design: This study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis. Results: The elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services. Discussion: According to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities’ job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue.

On the capabilities and limitations of high altitude pseudo-satellites

Science.gov (United States)

Gonzalo, Jesús; López, Deibi; Domínguez, Diego; García, Adrián; Escapa, Alberto

2018-04-01

The idea of self-sustaining air vehicles that excited engineers in the seventies has nowadays become a reality as proved by several initiatives worldwide. High altitude platforms, or Pseudo-satellites (HAPS), are unmanned vehicles that take advantage of weak stratospheric winds and solar energy to operate without interfering with current commercial aviation and with enough endurance to provide long-term services as satellites do. Target applications are communications, Earth observation, positioning and science among others. This paper reviews the major characteristics of stratospheric flight, where airplanes and airships will compete for best performance. The careful analysis of involved technologies and their trends allow budget models to shed light on the capabilities and limitations of each solution. Aerodynamics and aerostatics, structures and materials, propulsion, energy management, thermal control, flight management and ground infrastructures are the critical elements revisited to assess current status and expected short-term evolutions. Stratospheric airplanes require very light wing loading, which has been demonstrated to be feasible but currently limits their payload mass to few tenths of kilograms. On the other hand, airships need to be large and operationally complex but their potential to hover carrying hundreds of kilograms with reasonable power supply make them true pseudo-satellites with enormous commercial interest. This paper provides useful information on the relative importance of the technology evolutions, as well as on the selection of the proper platform for each application or set of payload requirements. The authors envisage prompt availability of both types of HAPS, aerodynamic and aerostatic, providing unprecedented services.

LAMPF II capabilities from an experimenter's viewpoint

International Nuclear Information System (INIS)

Macek, R.J.

1985-01-01

LAMPF II has been proposed to extend the intensity frontier of nuclear and particle physics from about 1 GeV to 45 GeV. It is reviewed here with emphasis on capabilities of the experimental facilities. Major accelerator features, costs, and the choice of energy and current are also discussed. 5 refs., 16 figs

Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

OpenAIRE

Eibner, Christine; Krull, Heather; Brown, Kristine M.; Cefalu, Matthew; Mulcahy, Andrew W.; Pollard, Michael; Shetty, Kanaka; Adamson, David M.; Amaral, Ernesto F. L.; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii

2016-01-01

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next...

Current Capabilities at SNL for the Integration of Small Modular Reactors onto Smart Microgrids Using Sandia's Smart Microgrid Technology High Performance Computing and Advanced Manufacturing.

Energy Technology Data Exchange (ETDEWEB)

Rodriguez, Salvador B. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2017-05-01

Smart grids are a crucial component for enabling the nation’s future energy needs, as part of a modernization effort led by the Department of Energy. Smart grids and smart microgrids are being considered in niche applications, and as part of a comprehensive energy strategy to help manage the nation’s growing energy demands, for critical infrastructures, military installations, small rural communities, and large populations with limited water supplies. As part of a far-reaching strategic initiative, Sandia National Laboratories (SNL) presents herein a unique, three-pronged approach to integrate small modular reactors (SMRs) into microgrids, with the goal of providing economically-competitive, reliable, and secure energy to meet the nation’s needs. SNL’s triad methodology involves an innovative blend of smart microgrid technology, high performance computing (HPC), and advanced manufacturing (AM). In this report, Sandia’s current capabilities in those areas are summarized, as well as paths forward that will enable DOE to achieve its energy goals. In the area of smart grid/microgrid technology, Sandia’s current computational capabilities can model the entire grid, including temporal aspects and cyber security issues. Our tools include system development, integration, testing and evaluation, monitoring, and sustainment.

Induced electric currents in the Alaska oil pipeline measured by gradient, fluxgate, and SQUID magnetometers

Science.gov (United States)

Campbell, W. H.; Zimmerman, J. E.

1979-01-01

The field gradient method for observing the electric currents in the Alaska pipeline provided consistent values for both the fluxgate and SQUID method of observation. These currents were linearly related to the regularly measured electric and magnetic field changes. Determinations of pipeline current were consistent with values obtained by a direct connection, current shunt technique at a pipeline site about 9.6 km away. The gradient method has the distinct advantage of portability and buried- pipe capability. Field gradients due to the pipe magnetization, geological features, or ionospheric source currents do not seem to contribute a measurable error to such pipe current determination. The SQUID gradiometer is inherently sensitive enough to detect very small currents in a linear conductor at 10 meters, or conversely, to detect small currents of one amphere or more at relatively great distances. It is fairly straightforward to achieve imbalance less than one part in ten thousand, and with extreme care, one part in one million or better.

Integration of Community Pharmacists in Transition of Care (TOC) Services: Current Trends and Pharmacist Perceptions.

Science.gov (United States)

Zeleznikar, Elizabeth A; Kroehl, Miranda E; Perica, Katharine M; Thompson, Angela M; Trinkley, Katy E

2017-01-01

Barriers exist for patients transitioning from one health-care setting to another, or to home, and health-care systems are falling short of meeting patient needs during this time. Community pharmacist incorporation poses a solution to the current communication breakdown and high rates of medication errors during transitions of care (TOC). The purpose of this study was to determine community pharmacists' involvement in and perceptions of TOC services. Cross-sectional study using electronic surveys nationwide to pharmacists employed by a community pharmacy chain. Of 7236 pharmacists surveyed, 546 (7.5%) responded. Only 33 (6%) pharmacists reported their pharmacy participates in TOC services. Most pharmacists (81.5%) reported receiving discharge medication lists. The most common reported barrier to TOC participation is lack of electronic integration with surrounding hospitals (51.1%). Most pharmacists agreed that (1) it is valuable to receive discharge medication lists (83.3%), (2) receiving discharge medication lists is beneficial for patients' health (89.1%), (3) discharge medication list receipt improves medication safety (88.8%). Most pharmacists reported receiving discharge medication lists and reported discharge medication lists are beneficial, but less than half purposefully used medication lists. To close TOC gaps, health-care providers must collaborate to overcome barriers for successful TOC services.

Current State and Model for Development of Technology-Based Care for Attention Deficit Hyperactivity Disorder

Science.gov (United States)

Riley, Steven J.; Calub, Catrina A.; Schweitzer, Julie B.

2016-01-01

Abstract Introduction: Care (i.e., evaluation and intervention) delivered through technology is used in many areas of mental health services, including for persons with attention deficit hyperactivity disorder (ADHD). Technology can facilitate care for individuals with ADHD, their parents, and their care providers. The adoption of technological tools for ADHD care requires evidence-based studies to support the transition from development to integration into use in the home, school, or work for persons with the disorder. The initial phase, which is development of technological tools, has begun in earnest; however, the evidence base for many of these tools is lacking. In some instances, the uptake of a piece of technology into home use or clinical practice may be further along than the research to support its use. Methods: In this study, we review the current evidence regarding technology for ADHD and also propose a model to evaluate the support for other tools that have yet to be tested. Results: We propose using the Research Domain Criteria as a framework for evaluating the tools' relationships to dimensions related to ADHD. Conclusion: This article concludes with recommendations for testing new tools that may have promise in improving the evaluation or treatment of persons with ADHD. PMID:26985703

Automated ultrasonic testing--capabilities, limitations and methods

International Nuclear Information System (INIS)

Beller, L.S.; Mikesell, C.R.

1977-01-01

The requirements for precision and reproducibility of ultrasonic testing during inservice inspection of nuclear reactors are both quantitatively and qualitatively more severe than most current practice in the field can provide. An automated ultrasonic testing (AUT) system, which provides a significant advancement in field examination capabilities, is described. Properties of the system, its application, and typical results are discussed

Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities.

Science.gov (United States)

Beer, Christopher; Horner, Barbara; Almeida, Osvaldo P; Scherer, Samuel; Lautenschlager, Nicola T; Bretland, Nick; Flett, Penelope; Schaper, Frank; Flicker, Leon

2009-08-12

Residential care is important for older adults, particularly for those with advanced dementia and their families. Education interventions that achieve sustainable improvement in the care of older adults are critical to quality care. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF) staff and General Practitioners (GPs) relating to dementia, or the sustainability of educational interventions. We sought to determine participation in dementia education, perceived levels of current knowledge regarding dementia, perceived unmet educational needs, current barriers, facilitators and preferences for dementia education. A mixed methods study design was utilised. A survey was distributed to a convenience sample of general practitioners, and staff in 223 consecutive residential care facilities in Perth, Western Australia. Responses were received from 102 RCF staff working in 10 facilities (out of 33 facilities who agreed to distribute the survey) and 202 GPs (19% of metropolitan GPs). Quantitative survey data were summarised descriptively and chi squared statistics were used to analyse the distribution of categorical variables. Qualitative data were collected from general practitioners, staff in residential care facilities and family carers of people with dementia utilizing individual interviews, surveys and focus groups. Qualitative data were analysed thematically. Among RCF staff and GPs attending RCF, participation in dementia education was high, and knowledge levels generally perceived as good. The individual experiences and needs of people with dementia and their families were emphasised. Participants identified the need for a person centred philosophy to underpin educational interventions. Limited time was a frequently mentioned barrier, especially in relation to attending dementia care education. Perceived educational needs relating to behaviours of concern, communication, knowledge regarding dementia, aspects of

Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities

Directory of Open Access Journals (Sweden)

Scherer Samuel

2009-08-01

Full Text Available Abstract Background Residential care is important for older adults, particularly for those with advanced dementia and their families. Education interventions that achieve sustainable improvement in the care of older adults are critical to quality care. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF staff and General Practitioners (GPs relating to dementia, or the sustainability of educational interventions. We sought to determine participation in dementia education, perceived levels of current knowledge regarding dementia, perceived unmet educational needs, current barriers, facilitators and preferences for dementia education. Methods A mixed methods study design was utilised. A survey was distributed to a convenience sample of general practitioners, and staff in 223 consecutive residential care facilities in Perth, Western Australia. Responses were received from 102 RCF staff working in 10 facilities (out of 33 facilities who agreed to distribute the survey and 202 GPs (19% of metropolitan GPs. Quantitative survey data were summarised descriptively and chi squared statistics were used to analyse the distribution of categorical variables. Qualitative data were collected from general practitioners, staff in residential care facilities and family carers of people with dementia utilizing individual interviews, surveys and focus groups. Qualitative data were analysed thematically. Results Among RCF staff and GPs attending RCF, participation in dementia education was high, and knowledge levels generally perceived as good. The individual experiences and needs of people with dementia and their families were emphasised. Participants identified the need for a person centred philosophy to underpin educational interventions. Limited time was a frequently mentioned barrier, especially in relation to attending dementia care education. Perceived educational needs relating to behaviours of concern

Nuclear Research and Development Capabilities Needed to Support Future Growth

Energy Technology Data Exchange (ETDEWEB)

Wham, Robert M. [ORNL, P.O. Box 2008, Oak Ridge, TN 37831-6154 (United States); Kearns, Paul [Battelle Memorial Institute (United States); Marston, Ted [Marston Consulting (United States)

2009-06-15

The energy crisis looming before the United States can be resolved only by an approach that integrates a 'portfolio' of options. Nuclear energy, already an important element in the portfolio, should play an even more significant role in the future as the U.S. strives to attain energy independence and reduce carbon emissions. The DOE Office of Nuclear Energy asked Battelle Memorial Institute to obtain input from the commercial power generation industry on industry's vision for nuclear energy over the next 30-50 years. With this input, Battelle was asked to generate a set of research and development capabilities necessary for DOE to support the anticipated growth in nuclear power generation. This presentation, based on the report generated for the Office of Nuclear Energy, identifies the current and future nuclear research and development capabilities required to make this happen. The capabilities support: (1) continued, safe operation of the current fleet of nuclear plants; (2) the availability of a well qualified and trained workforce; (3) demonstration of the next generation nuclear plants; (4) development of a sustainable fuel cycle; (5) advanced technologies for maximizing resource utilization and minimization of waste and (6) advanced modeling and simulation for rapid and reliable development and deployment of new nuclear technologies. In order to assure these capabilities are made available, a Strategic Nuclear Energy Capability Initiative is proposed to provide the required resources during this critical period of time. (authors)

The new frontier of strategic alliances in health care: New partnerships under accountable care organizations.

Science.gov (United States)

Lewis, Valerie A; Tierney, Katherine I; Colla, Carrie H; Shortell, Stephen M

2017-10-01

Accountable care organizations (ACOs) and similar reforms aim to improve coordination between health care providers; however, due to the fragmented nature of the US health care system, successful coordination will hinge in large part on the ability of health care organizations to successfully partner across organizational boundaries. Little is known about new partnerships formed under the ACO model. We use mixed methods data from the National Survey of ACOs, Medicare ACO performance data and interviews with executive leaders across 31 ACOs to examine the prevalence, characteristics, and capabilities of partnership ACOs and why and how ACO partnerships form. We find that a striking percentage of ACOs - 81% - involve new partnerships between independent health care organizations. These "partnership ACOs" generally report lower capabilities on care management, care coordination, and health information technology. Additionally, under Medicare ACO programs partnership ACO achieved somewhat lower quality performance. Qualitative interviews revealed that providers are motivated to partner for resource complementarity, risk reduction, and legislative requirements, and are using a variety of formal and informal accountability mechanisms. Most partnership ACOs were formed out of existing, positive relationships, but a minority of ACOs formed out of previously competitive or conflictual relationships. Our findings suggests that the success of the ACO model will hinge in large part upon the success of new partnerships, with important implications for understanding ACO readiness and capabilities, the relatively small savings achieved to date by ACO programs, and the path to providers bearing more risk for population health management. In addition, ACO partnerships may provide an important window to monitor a potential wave of health care consolidation or, in contrast, a new model of independent providers successfully coordinating patient care. Copyright © 2017 Elsevier Ltd

Managing Capabilities for Supply Chain Resilience Through it Integration

Directory of Open Access Journals (Sweden)

Gružauskas Valentas

2017-08-01

Full Text Available The trend for e-commerce, estimated population size to 11 billion by 2050, and an increase in urbanization level to 70 % is requiring to re-think the current supply chain. These trends changed the distribution process: delivery distances are decreasing, the product variety is increasing, and more products are being sold in smaller quantities. Therefore, the concept of supply chain resilience has gained more recognition in recent years. The scientific literature analysis conducted by the authors indicate several capabilities that influence supply chain resilience. Collaboration, flexibility, redundancy and integration are the most influential capabilities to supply chain resilience. However, the authors identify that the combination of these capabilities to supply chain resilience is under researched. The authors indicate that by combining these capabilities with the upcoming technologies of industry 4.0, supply chain resilience can be achieved. In the future, the authors are planning to conduct further research to identify the influence of these capabilities to supply chain resilience, to quantify supply chain resilience, and to provide further practices of industry 4.0 concept usage for supply chain resilience.

Current Capabilities, Requirements and a Proposed Strategy for Interdependency Analysis in the UK

Science.gov (United States)

Bloomfield, Robin; Chozos, Nick; Salako, Kizito

The UK government recently commissioned a research study to identify the state-of-the-art in Critical Infrastructure modelling and analysis, and the government/industry requirements for such tools and services. This study (Cetifs) concluded with a strategy aiming to bridge the gaps between the capabilities and requirements, which would establish interdependency analysis as a commercially viable service in the near future. This paper presents the findings of this study that was carried out by CSR, City University London, Adelard LLP, a safety/security consultancy and Cranfield University, defense academy of the UK.

Co-occurring Mental Disorders in Substance Abuse Treatment: the Current Health Care Situation in Germany.

Science.gov (United States)

Dauber, Hanna; Braun, Barbara; Pfeiffer-Gerschel, Tim; Kraus, Ludwig; Pogarell, Oliver

2018-01-01

Aim of this study was to investigate the current health care situation for patients with co-occurring mental disorders in addiction treatment. Therefore, data from the German Substance Abuse Treatment System ( N  = 194,406) was analysed with regard to the prevalence of comorbid mental disorders, treatment characteristics and outcomes of patients with comorbid psychiatric diagnosis. In outpatient setting, the prevalence of comorbid diagnoses was considerably lower (4.6%) than in inpatient setting (50.7%), but mood and anxiety disorders were the most prevalent additional diagnoses in both settings. In the treatment of patients with these comorbid disorders, we found higher rates of complementary internal and external (psychiatric) treatment, more co-operations and referrals after treatment, and positive treatment process outcomes. Findings indicate that the knowledge of an additional diagnosis influences the health care provision of affected patients and can therefore be seen as the essential precondition for providing adequate and comprehensive treatment. This highlights the importance of a sufficient consideration and diagnostic assessment of mental disorders in addiction treatment to further improve the health care situation of comorbid patients.

Bubble Radiation Detection: Current and Future Capability

International Nuclear Information System (INIS)

Peurrung, A.J.; Craig, R.A.

1999-01-01

Despite a number of noteworthy achievements in other fields, superheated droplet detectors (SDDs) and bubble chambers (BCs) have not been used for nuclear nonproliferation and arms control. This report examines these two radiation-detection technologies in detail and answers the question of how they can be or should be ''adapted'' for use in national security applications. These technologies involve closely related approaches to radiation detection in which an energetic charged particle deposits sufficient energy to initiate the process of bubble nucleation in a superheated fluid. These detectors offer complete gamma-ray insensitivity when used to detect neutrons. They also provide controllable neutron-energy thresholds and excellent position resolution. SDDs are extraordinarily simple and inexpensive. BCs offer the promise of very high efficiency (∼75%). A notable drawback for both technologies is temperature sensitivity. As a result of this problem, the temperature must be controlled whenever high accuracy is required, or harsh environmental conditions are encountered. The primary findings of this work are listed and briefly summarized below: (1) SDDs are ready to function as electronics-free neutron detectors on demand for arms-control applications. The elimination of electronics at the weapon's location greatly eases the negotiability of radiation-detection technologies in general. (2) As a result of their high efficiency and sharp energy threshold, current BCs are almost ready for use in the development of a next-generation active assay system. Development of an instrument based on appropriately safe materials is warranted. (3) Both kinds of bubble detectors are ready for use whenever very high gamma-ray fields must be confronted. Spent fuel MPC and A is a good example where this need presents itself. (4) Both kinds of bubble detectors have the potential to function as low-cost replacements for conventional neutron detectors such as 3 He tubes. For SDDs

Dynamic capabilities and innovation capabilities: The case of the ‘Innovation Clinic’

Directory of Open Access Journals (Sweden)

Fred Strønen

2017-01-01

Full Text Available In this explorative study, we investigate the relationship between dynamic capabilities and innovation capabilities. Dynamic capabilities are at the core of strategic management in terms of how firms can ensure adaptation to changing environments over time. Our paper follows two paths of argumentation. First, we review and discuss some major contributions to the theories on ordinary capabilities, dynamic capabilities, and innovation capabilities. We seek to identify different understandings of the concepts in question, in order to clarify the distinctions and relationships between dynamic capabilities and innovation capabilities. Second, we present a case study of the ’Innovation Clinic’ at a major university hospital, including four innovation projects. We use this case study to explore and discuss how dynamic capabilities can be extended, as well as to what extent innovation capabilities can be said to be dynamic. In our conclusion, we discuss the conditions for nurturing ‘dynamic innovation capabilities’ in organizations.

Transportation capabilities study of DOE-owned spent nuclear fuel

Energy Technology Data Exchange (ETDEWEB)

Clark, G.L.; Johnson, R.A.; Smith, R.W. [Packaging Technology, Inc., Tacoma, WA (United States); Abbott, D.G.; Tyacke, M.J. [Lockheed Idaho Technologies Co., Idaho Falls, ID (United States)

1994-10-01

This study evaluates current capabilities for transporting spent nuclear fuel owned by the US Department of Energy. Currently licensed irradiated fuel shipping packages that have the potential for shipping the spent nuclear fuel are identified and then matched against the various spent nuclear fuel types. Also included are the results of a limited investigation into other certified packages and new packages currently under development. This study is intended to support top-level planning for the disposition of the Department of Energy`s spent nuclear fuel inventory.

Capability ethics

OpenAIRE

Robeyns, Ingrid

2012-01-01

textabstractThe capability approach is one of the most recent additions to the landscape of normative theories in ethics and political philosophy. Yet in its present stage of development, the capability approach is not a full-blown normative theory, in contrast to utilitarianism, deontological theories, virtue ethics, or pragmatism. As I will argue in this chapter, at present the core of the capability approach is an account of value, which together with some other (more minor) normative comm...

Reframing Inclusive Education: Educational Equality as Capability Equality

Science.gov (United States)

Terzi, Lorella

2014-01-01

In this paper, I argue that rethinking questions of inclusive education in the light of the value of educational equality--specifically conceived as capability equality, or genuine opportunities to achieve educational functionings--adds some important insights to the current debate on inclusive education. First, it provides a cohesive value…

Gossiping Capabilities

DEFF Research Database (Denmark)

Mogensen, Martin; Frey, Davide; Guerraoui, Rachid

Gossip-based protocols are now acknowledged as a sound basis to implement collaborative high-bandwidth content dissemination: content location is disseminated through gossip, the actual contents being subsequently pulled. In this paper, we present HEAP, HEterogeneity Aware gossip Protocol, where...... nodes dynamically adjust their contribution to gossip dissemination according to their capabilities. Using a continuous, itself gossip-based, approximation of relative capabilities, HEAP dynamically leverages the most capable nodes by (a) increasing their fanouts (while decreasing by the same proportion...... declare a high capability in order to augment their perceived quality without contributing accordingly. We evaluate HEAP in the context of a video streaming application on a 236 PlanetLab nodes testbed. Our results shows that HEAP improves the quality of the streaming by 25% over a standard gossip...

Team working in intensive care: current evidence and future endeavors.

Science.gov (United States)

Richardson, Joanne; West, Michael A; Cuthbertson, Brian H

2010-12-01

It has recently been argued that the future of intensive care medicine will rely on high quality management and teamwork. Therefore, this review takes an organizational psychology perspective to examine the most recent research on the relationship between teamwork, care processes, and patient outcomes in intensive care. Interdisciplinary communication within a team is crucial for the development of negotiated shared treatment goals and short-team patient outcomes. Interventions for maximizing team communication have received substantial interest in recent literature. Intensive care coordination is not a linear process, and intensive care teams often fail to discuss how to implement goals, trigger and align activities, or reflect on their performance. Despite a move toward interdisciplinary team working, clinical decision-making is still problematic and continues to be perceived as a top-down and authoritative process. The topic of team leadership in intensive care is underexplored and requires further research. Based on findings from the most recent research evidence in medicine and management, four principles are identified for improving the effectiveness of team working in intensive care: engender professional efficacy, create stable teams and leaders, develop trust and participative safety, and enable frequent team reflexivity.

Capabilities and diagnostics of the Sandia Pelletron-raster system

International Nuclear Information System (INIS)

Buckalew, W.H.; Lockwood, G.J.; Luker, S.M.; Ruggles, L.E.; Wyant, F.J.

1984-07-01

The radiation capabilities of the PELLETRON Electron Beam Accelerator have been expanded to include a controllable, variable dimension, beam diffusion option. This rastered beam option has been studied in detail. Beam characteristics have been determined as a function of incident electron beam energy, current, and deflection system parameters. The beam diagnostics required to define any given diffuse beam pattern are accurate and predictable. Recently, utility of this added PELLETRON capability was demonstrated by simulating the effects of complex nuclear reactor accident electron environments on electrical insulation materials similar to those used in nuclear power plants

Materials Capability Review Los Alamos National Laboratory April 29-May 2, 2012

Energy Technology Data Exchange (ETDEWEB)

Taylor, Antoinette J [Los Alamos National Laboratory

2012-04-20

Los Alamos National Laboratory (LANL) uses Capability Reviews to assess the quality and institutional integration of science, technology and engineering (STE) and to advise Laboratory Management on the current and future health of LANL STE. The capabilities are deliberately chosen to be crosscutting over the Laboratory and therefore will include experimental, theoretical and simulation disciplines from multiple line organizations. Capability Reviews are designed to provide a more holistic view of the STE quality, integration to achieve mission requirements, and mission relevance. The scope of these capabilities necessitate that there will be significant overlap in technical areas covered by capability reviews (e.g., materials research and weapons science and engineering). In addition, LANL staff may be reviewed in different capability reviews because of their varied assignments and expertise. The principal product of the Capability Review is the report that includes the review committee's assessments, recommendations, and recommendations for STE.

Fusion Materials Irradiation Test Facility: experimental capabilities and test matrix

International Nuclear Information System (INIS)

Opperman, E.K.

1982-01-01

This report describes the experimental capabilities of the Fusion Materials Irradiation Test Facility (FMIT) and reference material specimen test matrices. The description of the experimental capabilities and the test matrices has been updated to match the current single test cell facility ad assessed experimenter needs. Sufficient detail has been provided so that the user can plan irradiation experiments and conceptual hardware. The types of experiments, irradiation environment and support services that will be available in FMIT are discussed

Defining a caring hospital by using currently implemented survey tools.

Science.gov (United States)

Jennings, Nancy

2010-09-01

Health care organizations are constantly striving to provide a more cost-effective and higher quality treatment within a caring environment. However, balancing the demands of regulatory agencies with the holistic needs of the patient is challenging. Further challenging is how to define those hospitals that provide an exceptional caring environment for their patients. By using survey tools that are already being administered in hospital settings, the opportunity exists to analyze the results obtained from these tools to define a hospital as a caring organization without the added burden of separate data collection.

Enhanced Monte-Carlo-Linked Depletion Capabilities in MCNPX

International Nuclear Information System (INIS)

Fensin, Michael L.; Hendricks, John S.; Anghaie, Samim

2006-01-01

As advanced reactor concepts challenge the accuracy of current modeling technologies, a higher-fidelity depletion calculation is necessary to model time-dependent core reactivity properly for accurate cycle length and safety margin determinations. The recent integration of CINDER90 into the MCNPX Monte Carlo radiation transport code provides a completely self-contained Monte-Carlo-linked depletion capability. Two advances have been made in the latest MCNPX capability based on problems observed in pre-released versions: continuous energy collision density tracking and proper fission yield selection. Pre-released versions of the MCNPX depletion code calculated the reaction rates for (n,2n), (n,3n), (n,p), (n,a), and (n,?) by matching the MCNPX steady-state 63-group flux with 63-group cross sections inherent in the CINDER90 library and then collapsing to one-group collision densities for the depletion calculation. This procedure led to inaccuracies due to the miscalculation of the reaction rates resulting from the collapsed multi-group approach. The current version of MCNPX eliminates this problem by using collapsed one-group collision densities generated from continuous energy reaction rates determined during the MCNPX steady-state calculation. MCNPX also now explicitly determines the proper fission yield to be used by the CINDER90 code for the depletion calculation. The CINDER90 code offers a thermal, fast, and high-energy fission yield for each fissile isotope contained in the CINDER90 data file. MCNPX determines which fission yield to use for a specified problem by calculating the integral fission rate for the defined energy boundaries (thermal, fast, and high energy), determining which energy range contains the majority of fissions, and then selecting the appropriate fission yield for the energy range containing the majority of fissions. The MCNPX depletion capability enables complete, relatively easy-to-use depletion calculations in a single Monte Carlo code

Rights, goals, and capabilities

NARCIS (Netherlands)

van Hees, M.V.B.P.M

This article analyses the relationship between rights and capabilities in order to get a better grasp of the kind of consequentialism that the capability theory represents. Capability rights have been defined as rights that have a capability as their object (rights to capabilities). Such a

Neurocognitive capabilities modulate the integration of evidence in schizophrenia

NARCIS (Netherlands)

Eifler, Sarah; Rausch, Franziska; Schirmbeck, Frederike; Veckenstedt, Ruth; Englisch, Susanne; Meyer-Lindenberg, Andreas; Kirsch, Peter; Zink, Mathias

2014-01-01

Previous studies have demonstrated a cognitive bias in the integration of disconfirmatory evidence (BADE) in patients with schizophrenia. This bias has been associated with delusions. So far, it is unclear how the integration of evidence is associated with neurocognitive capabilities. In the current

Deliberative democracy in health care: current challenges and future prospects.

Science.gov (United States)

Safaei, Jalil

2015-01-01

There is a vast body of literature on deliberative, participative, or engaged democracy. In the area of health care there is a rapidly expanding literature on deliberative democracy as embodied in various notions of public engagement, shared decision-making (SDM), patient-centered care, and patient/care provider autonomy over the past few decades. It is useful to review such literature to get a sense of the challenges and prospects of introducing deliberative democracy in health care. This paper reviews the key literature on deliberative democracy and SDM in health care settings with a focus on identifying the main challenges of promoting this approach in health care, and recognizing its progress so far for mapping out its future prospects in the context of advanced countries. Several databases were searched to identify the literature pertinent to the subject of this study. A total of 56 key studies in English were identified and reviewed carefully for indications and evidence of challenges and/or promising avenues of promoting deliberative democracy in health care. Time pressure, lack of financial motivation, entrenched professional interests, informational imbalance, practical feasibility, cost, diversity of decisions, and contextual factors are noted as the main challenges. As for the prospects, greater clarity on conception of public engagement and policy objectives, real commitment of the authorities to public input, documenting evidence of the effectiveness of public involvement, development of patient decision supports, training of health professionals in SDM, and use of multiple and flexible methods of engagement leadership suited to specific contexts are the main findings in the reviewed literature. Seeking deliberative democracy in health care is both challenging and rewarding. The challenges have been more or less identified. However, its prospects are potentially significant. Such prospects are more likely to materialize if deliberative democracy is

Current status of quality evaluation of nursing care through director review and reflection from the Nursing Quality Control Centers

Science.gov (United States)

Duan, Xia; Shi, Yan

2014-01-01

Background: The quality evaluation of nursing care is a key link in medical quality management. It is important and worth studying for the nursing supervisors to know the disadvantages during the process of quality evaluation of nursing care and then to improve the whole nursing quality. This study was to provide director insight on the current status of quality evaluation of nursing care from Nursing Quality Control Centers (NQCCs). Material and Methods: This qualitative study used a sample of 12 directors from NQCCs who were recruited from 12 provinces in China to evaluate the current status of quality evaluation of nursing care. Data were collected by in-depth interviews. Content analysis method was used to analyze the data. Results: Four themes emerged from the data: 1) lag of evaluation index; 2) limitations of evaluation content; 3) simplicity of evaluation method; 4) excessive emphasis on terminal quality. Conclusion: It is of great realistic significance to ameliorate nursing quality evaluation criteria, modify the evaluation content based on patient needs-oriented idea, adopt scientific evaluation method to evaluate nursing quality, and scientifically and reasonably draw horizontal comparisons of nursing quality between hospitals, as well as longitudinal comparisons of a hospital’s nursing quality. These methods mentioned above can all enhance a hospital’s core competitiveness and benefit more patients. PMID:25419427

Assessment of Mobile Accident Response Capability

International Nuclear Information System (INIS)

1983-03-01

This report presents the results of a DOE-sponsored assessment of nuclear accident response resources. It identifies the mobile resources that could be required to respond to different types of nuclear accidents including major ones like TMI-2, identifies the resources currently available and makes recommendations for the design and construction of additional mobile accident response resources to supplement those already in existence. This project is referred to as the Mobile Accident Response Capability (MARC) program

How can eHealth enhance adherence to cancer therapy and supportive care?

Directory of Open Access Journals (Sweden)

Bateman Emma H.

2016-01-01

Full Text Available eHealth is currently a hot topic, but is certainly not a new one. The use of communications technology to relay health-related information or provide medical services has been around since the advent of this technology. It has been primarily over the last decade that eHealth has seen a global expansion, due to the far-reaching capabilities of the Internet and the widespread use of wireless technology. This paper will outline what eHealth is, what adherence is, and how eHealth can help with adherence, in cancer and supportive care particularly. It will discuss the current state of the art, and project into the future.

A Device for Automatically Measuring and Supervising the Critical Care Patient’S Urine Output

Directory of Open Access Journals (Sweden)

Roemi Fernández

2010-01-01

Full Text Available Critical care units are equipped with commercial monitoring devices capable of sensing patients’ physiological parameters and supervising the achievement of the established therapeutic goals. This avoids human errors in this task and considerably decreases the workload of the healthcare staff. However, at present there still is a very relevant physiological parameter that is measured and supervised manually by the critical care units’ healthcare staff: urine output. This paper presents a patent-pending device capable of automatically recording and supervising the urine output of a critical care patient. A high precision scale is used to measure the weight of a commercial urine meter. On the scale’s pan there is a support frame made up of Bosch profiles that isolates the scale from force transmission from the patient’s bed, and guarantees that the urine flows properly through the urine meter input tube. The scale’s readings are sent to a PC via Bluetooth where an application supervises the achievement of the therapeutic goals. The device is currently undergoing tests at a research unit associated with the University Hospital of Getafe in Spain.

Building Visual Artists’ Resilience Capabilities: Current Educator Strategies and Methods

Directory of Open Access Journals (Sweden)

Eileen Maree Siddins

2016-07-01

Full Text Available Enrolments in higher education programs in the creative and performing arts are increasing in many countries. Yet graduates of these degrees, who enter the broad sector known as the creative industries, face particular challenges in terms of securing long-term and sustainable employment. In addition, creative and performing artists face a range of mental challenges, caused by such factors as: the solitary nature of much creative practice, critical feedback by audiences and gatekeepers, or the general pressures associated with maintaining artistic relevance or integrity. The concepts of resilience and professional wellbeing are therefore highly relevant to those who pursue a career in creative industries, and while there has been an emerging body of work in this area, to date it has focussed on the performing arts area (e.g. music, theatre. Hence, in order to expand knowledge relevant to resilience and artists, this paper sets out to explore the extent to which current educators in the Australian context specifically address these issues within higher visual arts curricula; specifically the areas of illustration, design, film and photography. This was achieved via interviews with seventeen current academics working in these areas. The findings propose that higher education providers of programs in the visual arts consider placing a stronger emphasis on the embedded development of resilience and professional wellbeing capacities.

What is the role of community capabilities for maternal health? An exploration of community capabilities as determinants to institutional deliveries in Bangladesh, India, and Uganda

Directory of Open Access Journals (Sweden)

Ligia Paina

2016-11-01

Full Text Available Abstract Background While community capabilities are recognized as important factors in developing resilient health systems and communities, appropriate metrics for these have not yet been developed. Furthermore, the role of community capabilities on access to maternal health services has been underexplored. In this paper, we summarize the development of a community capability score based on the Future Health System (FHS project’s experience in Bangladesh, India, and Uganda, and, examine the role of community capabilities as determinants of institutional delivery in these three contexts. Methods We developed a community capability score using a pooled dataset containing cross-sectional household survey data from Bangladesh, India, and Uganda. Our main outcome of interest was whether the woman delivered in an institution. Our predictor variables included the community capability score, as well as a series of previously identified determinants of maternal health. We calculate both population-averaged effects (using GEE logistic regression, as well as sub-national level effects (using a mixed effects model. Results Our final sample for analysis included 2775 women, of which 1238 were from Bangladesh, 1199 from India, and 338 from Uganda. We found that individual-level determinants of institutional deliveries, such as maternal education, parity, and ante-natal care access were significant in our analysis and had a strong impact on a woman’s odds of delivering in an institution. We also found that, in addition to individual-level determinants, greater community capability was significantly associated with higher odds of institutional delivery. For every additional capability, the odds of institutional delivery would increase by up to almost 6 %. Conclusion Individual-level characteristics are strong determinants of whether a woman delivered in an institution. However, we found that community capability also plays an important role, and should be

Paediatric cardiac intensive care unit: current setting and organization in 2010.

Science.gov (United States)

Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan

2010-10-01

Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Capability ethics

NARCIS (Netherlands)

I.A.M. Robeyns (Ingrid)

2012-01-01

textabstractThe capability approach is one of the most recent additions to the landscape of normative theories in ethics and political philosophy. Yet in its present stage of development, the capability approach is not a full-blown normative theory, in contrast to utilitarianism, deontological

Care Coordination with Schools: The Role of Family-Centered Care for Children with Special Health Care Needs.

Science.gov (United States)

Barnard-Brak, Lucy; Stevens, Tara; Carpenter, Julianna

2017-05-01

Objectives Family-centered care has been associated with positive outcomes for children with special health care needs. The purpose of the current study was to examine the relationship of family-centered care as associated with care coordination with schools and school absences (e.g., missed days) as reported by parents of children with special health care needs. Methods The current study utilized data from the National Survey of Children with Special Health Care Needs 2009-201 (N = 40,242) to achieve this purpose. The National Survey of Children with Special Health Care Needs may be considered a nationally-representative and community-based sample of parent responses for children with special health care needs across the United States. Results Results from the current study indicate that family-centered care is associated with fewer absences and improved care coordination with schools when applicable. The variables of functional difficulties, poverty level, and the number of conditions were statistically controlled. Conclusions We suggest that the positive influence of family-centered care when practiced extends beyond the family and interacts with educational outcomes. We also suggest that the role of schools appears to be under-studied given the role that schools can play in family-centered care.

32 CFR 732.17 - Nonemergency care requirements.

Science.gov (United States)

2010-07-01

... her leave address or travel to the most accessible USMTF or USTF with capability for maternity care... approval of nonemergency care (medical, dental, or maternity) from non-Federal sources to the adjudication... information addressee on each letter of authorization. (c) Maternity care. (1) Pregnant active duty members...

The SCEC Community Modeling Environment (SCEC/CME) - An Overview of its Architecture and Current Capabilities

Science.gov (United States)

Maechling, P. J.; Jordan, T. H.; Minster, B.; Moore, R.; Kesselman, C.; SCEC ITR Collaboration

2004-12-01

these models. In some cases, the CME system also provides alternatives to the SCEC community models. The CME system hosts a collection of community geophysical software codes. These codes include seismic hazard analysis (SHA) programs developed by the SCEC/USGS OpenSHA group. Also, the CME system hosts anelastic wave propagation codes including Kim Olsen's Finite Difference code and Carnegie Mellon's Hercules Finite Element tool chain. The CME system can execute a workflow, that is, a series of geophysical computations using the output of one processing step as the input to a subsequent step. Our workflow capability utilizes grid-based computing software that can submit calculations to a pool of computing resources as well as data management tools that help us maintain an association between data files and metadata descriptions of those files. The CME system maintains, and provides access to, a collection of valuable geophysical data sets. The current CME Digital Library holdings include a collection of 60 ground motion simulation results calculated by a SCEC/PEER working group and a collection of Greens Functions calculated for 33 TriNet broadband receiver sites in the Los Angeles area.

Electro-Thermal-Mechanical Simulation Capability Final Report

International Nuclear Information System (INIS)

White, D

2008-01-01

This is the Final Report for LDRD 04-ERD-086, 'Electro-Thermal-Mechanical Simulation Capability'. The accomplishments are well documented in five peer-reviewed publications and six conference presentations and hence will not be detailed here. The purpose of this LDRD was to research and develop numerical algorithms for three-dimensional (3D) Electro-Thermal-Mechanical simulations. LLNL has long been a world leader in the area of computational mechanics, and recently several mechanics codes have become 'multiphysics' codes with the addition of fluid dynamics, heat transfer, and chemistry. However, these multiphysics codes do not incorporate the electromagnetics that is required for a coupled Electro-Thermal-Mechanical (ETM) simulation. There are numerous applications for an ETM simulation capability, such as explosively-driven magnetic flux compressors, electromagnetic launchers, inductive heating and mixing of metals, and MEMS. A robust ETM simulation capability will enable LLNL physicists and engineers to better support current DOE programs, and will prepare LLNL for some very exciting long-term DoD opportunities. We define a coupled Electro-Thermal-Mechanical (ETM) simulation as a simulation that solves, in a self-consistent manner, the equations of electromagnetics (primarily statics and diffusion), heat transfer (primarily conduction), and non-linear mechanics (elastic-plastic deformation, and contact with friction). There is no existing parallel 3D code for simulating ETM systems at LLNL or elsewhere. While there are numerous magnetohydrodynamic codes, these codes are designed for astrophysics, magnetic fusion energy, laser-plasma interaction, etc. and do not attempt to accurately model electromagnetically driven solid mechanics. This project responds to the Engineering R and D Focus Areas of Simulation and Energy Manipulation, and addresses the specific problem of Electro-Thermal-Mechanical simulation for design and analysis of energy manipulation systems

Dynamic Capabilities

DEFF Research Database (Denmark)

Grünbaum, Niels Nolsøe; Stenger, Marianne

2013-01-01

The findings reveal a positive relationship between dynamic capabilities and innovation performance in the case enterprises, as we would expect. It was, however, not possible to establish a positive relationship between innovation performance and profitability. Nor was there any positive...... relationship between dynamic capabilities and profitability....

Reactivity Insertion Accident (RIA) Capability Status in the BISON Fuel Performance Code

Energy Technology Data Exchange (ETDEWEB)

Williamson, Richard L. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Folsom, Charles Pearson [Idaho National Lab. (INL), Idaho Falls, ID (United States); Pastore, Giovanni [Idaho National Lab. (INL), Idaho Falls, ID (United States); Veeraraghavan, Swetha [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2016-05-01

One of the Challenge Problems being considered within CASL relates to modelling and simulation of Light Water Reactor LWR) fuel under Reactivity Insertion Accident (RIA) conditions. BISON is the fuel performance code used within CASL for LWR fuel under both normal operating and accident conditions, and thus must be capable of addressing the RIA challenge problem. This report outlines required BISON capabilities for RIAs and describes the current status of the code. Information on recent accident capability enhancements, application of BISON to a RIA benchmark exercise, and plans for validation to RIA behavior are included.

Deliberative democracy in health care: current challenges and future prospects

Directory of Open Access Journals (Sweden)

Safaei J

2015-12-01

Full Text Available Jalil Safaei Department of Economics, University of Northern British Columbia, Prince George, BC, CanadaBackground: There is a vast body of literature on deliberative, participative, or engaged democracy. In the area of health care there is a rapidly expanding literature on deliberative democracy as embodied in various notions of public engagement, shared decision-making (SDM, patient-centered care, and patient/care provider autonomy over the past few decades. It is useful to review such literature to get a sense of the challenges and prospects of introducing deliberative democracy in health care.Objective: This paper reviews the key literature on deliberative democracy and SDM in health care settings with a focus on identifying the main challenges of promoting this approach in health care, and recognizing its progress so far for mapping out its future prospects in the context of advanced countries.Method: Several databases were searched to identify the literature pertinent to the subject of this study. A total of 56 key studies in English were identified and reviewed carefully for indications and evidence of challenges and/or promising avenues of promoting deliberative democracy in health care.Results: Time pressure, lack of financial motivation, entrenched professional interests, informational imbalance, practical feasibility, cost, diversity of decisions, and contextual factors are noted as the main challenges. As for the prospects, greater clarity on conception of public engagement and policy objectives, real commitment of the authorities to public input, documenting evidence of the effectiveness of public involvement, development of patient decision supports, training of health professionals in SDM, and use of multiple and flexible methods of engagement leadership suited to specific contexts are the main findings in the reviewed literature.Conclusion: Seeking deliberative democracy in health care is both challenging and rewarding. The

IT capabilities for the realization of the laboratory without walls.

OpenAIRE

Covvey, H. D.

1996-01-01

This article presents the factors that are driving the restructuring of laboratory services and the information technology capabilities that are necessary to support the regionalized laboratory services organization. The overall need is for a trans-entity laboratory information system with point of care ordering and results reporting and enterprise-wide specimen transportation and tracking, that is interfaced with other information resources required for clinical decision-making, and patient ...

PHISICS multi-group transport neutronic capabilities for RELAP5

Energy Technology Data Exchange (ETDEWEB)

Epiney, A.; Rabiti, C.; Alfonsi, A.; Wang, Y.; Cogliati, J.; Strydom, G. [Idaho National Laboratory (INL), 2525 N. Fremont Ave., Idaho Falls, ID 83402 (United States)

2012-07-01

PHISICS is a neutronic code system currently under development at INL. Its goal is to provide state of the art simulation capability to reactor designers. This paper reports on the effort of coupling this package to the thermal hydraulic system code RELAP5. This will enable full prismatic core and system modeling and the possibility to model coupled (thermal-hydraulics and neutronics) problems with more options for 3D neutron kinetics, compared to the existing diffusion theory neutron kinetics module in RELAP5 (NESTLE). The paper describes the capabilities of the coupling and illustrates them with a set of sample problems. (authors)

Capabilities and Incapabilities of the Capabilities Approach to Health Justice.

Science.gov (United States)

Selgelid, Michael J

2016-01-01

This first part of this article critiques Sridhar Venkatapuram's conception of health as a capability. It argues that Venkatapuram relies on the problematic concept of dignity, implies that those who are unhealthy lack lives worthy of dignity (which seems politically incorrect), sets a low bar for health, appeals to metaphysically problematic thresholds, fails to draw clear connections between appealed-to capabilities and health, and downplays the importance/relevance of health functioning. It concludes by questioning whether justice entitlements should pertain to the capability for health versus health achievements, challenging Venkatapuram's claims about the strength of health entitlements, and demonstrating that the capabilities approach is unnecessary to address social determinants of health. © 2016 John Wiley & Sons Ltd.

The evolution of parental care in insects: A test of current hypotheses

Science.gov (United States)

Gilbert, James D J; Manica, Andrea

2015-01-01

Which sex should care for offspring is a fundamental question in evolution. Invertebrates, and insects in particular, show some of the most diverse kinds of parental care of all animals, but to date there has been no broad comparative study of the evolution of parental care in this group. Here, we test existing hypotheses of insect parental care evolution using a literature-compiled phylogeny of over 2000 species. To address substantial uncertainty in the insect phylogeny, we use a brute force approach based on multiple random resolutions of uncertain nodes. The main transitions were between no care (the probable ancestral state) and female care. Male care evolved exclusively from no care, supporting models where mating opportunity costs for caring males are reduced—for example, by caring for multiple broods—but rejecting the “enhanced fecundity” hypothesis that male care is favored because it allows females to avoid care costs. Biparental care largely arose by males joining caring females, and was more labile in Holometabola than in Hemimetabola. Insect care evolution most closely resembled amphibian care in general trajectory. Integrating these findings with the wealth of life history and ecological data in insects will allow testing of a rich vein of existing hypotheses. PMID:25825047

A proposed clinical decision support architecture capable of supporting whole genome sequence information.

Science.gov (United States)

Welch, Brandon M; Loya, Salvador Rodriguez; Eilbeck, Karen; Kawamoto, Kensaku

2014-04-04

Whole genome sequence (WGS) information may soon be widely available to help clinicians personalize the care and treatment of patients. However, considerable barriers exist, which may hinder the effective utilization of WGS information in a routine clinical care setting. Clinical decision support (CDS) offers a potential solution to overcome such barriers and to facilitate the effective use of WGS information in the clinic. However, genomic information is complex and will require significant considerations when developing CDS capabilities. As such, this manuscript lays out a conceptual framework for a CDS architecture designed to deliver WGS-guided CDS within the clinical workflow. To handle the complexity and breadth of WGS information, the proposed CDS framework leverages service-oriented capabilities and orchestrates the interaction of several independently-managed components. These independently-managed components include the genome variant knowledge base, the genome database, the CDS knowledge base, a CDS controller and the electronic health record (EHR). A key design feature is that genome data can be stored separately from the EHR. This paper describes in detail: (1) each component of the architecture; (2) the interaction of the components; and (3) how the architecture attempts to overcome the challenges associated with WGS information. We believe that service-oriented CDS capabilities will be essential to using WGS information for personalized medicine.

Identifying management competencies for health care executives: review of a series of Delphi studies.

Science.gov (United States)

Hudak, R P; Brooke, P P; Finstuen, K

2000-01-01

This analysis reviews a selected body of research that identifies the essential areas of management expertise required of future health care executives. To ensure consistency, six studies are analyzed, utilizing the Delphi technique, to query a broad spectrum of experts in different fields and sites of health care management. The analysis identifies a number of management competencies, i.e., managerial capabilities, which current and aspiring health care executives, in various settings and with differing educational backgrounds, should possess to enhance the probability of their success in current and future positions of responsibility. In addition, this review identifies the skills (technical expertise), knowledge (facts and principles) and abilities (physical, mental or legal power) required to support achievement of these competencies. Leadership and resource management, including cost and finance dimensions, are the highest-rated requisite management competencies. The dominant skills, knowledge and abilities (SKAs) are related to interpersonal skills. The lowest-rated SKAs are related to job-specific, technical skills. Recommendations include the review of this research by formal and continuing education programs to determine the content of their courses and areas for future research. Similarly, current health care executives should assess this research to assist in identifying competency gaps. Lastly, this analysis recommends that the Delphi technique, as a valid and replicable methodology, be applied toward the study of non-executive health care managers, e.g., students, clinicians, mid-level managers and integrated systems administrators, to determine their requisite management competencies and SKAs.

Performance of current intensive care unit ventilators during pressure and volume ventilation.

Science.gov (United States)

Marchese, Andrew D; Sulemanji, Demet; Chipman, Daniel; Villar, Jesús; Kacmarek, Robert M

2011-07-01

Intensive-care mechanical ventilators regularly enter the market, but the gas-delivery capabilities of many have never been assessed. We evaluated 6 intensive-care ventilators in the pressure support (PS), pressure assist/control (PA/C), and volume assist/control (VA/C) modes, with lung-model mechanics combinations of compliance and resistance of 60 mL/cm H(2)O and 10 cm H(2)O/L/s, 60 mL/cm H(2)O and 5 cm H(2)O/L/s, and 30 mL/cm H(2)O and 10 cm H(2)O/L/s, and inspiratory muscle effort of 5 and 10 cm H(2)O. PS and PA/C were set to 15 cm H(2)O, and PEEP to 5 and 15 cm H(2)O in all modes. During VA/C, tidal volume was set at 500 mL and inspiratory time was set at 0.8 second. Rise time and termination criteria were set at the manufacturers' defaults, and to an optimal level during PS and PA/C. There were marked differences in ventilator performance in all 3 modes. VA/C had the greatest difficulty meeting lung model demand and the greatest variability across all tested scenarios and ventilators. From high to low inspiratory muscle effort, pressure-to-trigger, time for pressure to return to baseline, and triggering pressure-time product decreased in all modes. With increasing resistance and decreasing compliance, tidal volume, pressure-to-trigger, time-to-trigger, time for pressure to return to baseline, time to 90% of peak pressure, and pressure-time product decreased. There were large differences between the default and optimal settings for all the variables in PS and PA/C. Performance was not affected by PEEP. Most of the tested ventilators performed at an acceptable level during the majority of evaluations, but some ventilators performed inadequately during specific settings. Bedside clinical evaluation is needed.

The evolution of the pathway and its role in improving patient care.

Science.gov (United States)

Mould, G; Bowers, J; Ghattas, M

2010-10-01

Redesign in healthcare has increased the focus on the needs of the patient. The redesign process typically involves a review of current practice using the patient pathway before considering possible improvements. The patient pathway can serve various roles, and it may be mapped in different ways using a variety of media. This paper reviews the evolution of the patient pathway comparing the merits of different media. Simple approaches to mapping pathways can be most useful. However, experience in the redesign of Unscheduled Care in NHS Fife suggests that computer-based, hierarchical pathway models using stylised icons offer many advantages. Such approaches can increase the effectiveness of pathways in the redesign process, providing both the detail and the system view in an accessible graphical form. This enhanced capability helps staff analyse current practice and visualise and assess redesign options. In addition, the pathway can fulfil new roles as a training tool and an effective basis for organising knowledge about patient care.

My Daddy Takes Care of Me! Fathers as Care Providers. Current Population Reports. Household Economic Studies.

Science.gov (United States)

Casper, Lynne M.

1997-01-01

This report examines statistical data on fathers caring for their children during mothers' working hours and which types of fathers are the most likely to take care of their children. Data are taken from the Survey of Income and Program Participation, a longitudinal survey conducted at four-month intervals by the Census Bureau. Care by fathers is…

Capabilities for Strategic Adaptation

DEFF Research Database (Denmark)

Distel, Andreas Philipp

This dissertation explores capabilities that enable firms to strategically adapt to environmental changes and preserve competitiveness over time – often referred to as dynamic capabilities. While dynamic capabilities being a popular research domain, too little is known about what these capabiliti...

The evolution of parental care in insects: A test of current hypotheses.

Science.gov (United States)

Gilbert, James D J; Manica, Andrea

2015-05-01

Which sex should care for offspring is a fundamental question in evolution. Invertebrates, and insects in particular, show some of the most diverse kinds of parental care of all animals, but to date there has been no broad comparative study of the evolution of parental care in this group. Here, we test existing hypotheses of insect parental care evolution using a literature-compiled phylogeny of over 2000 species. To address substantial uncertainty in the insect phylogeny, we use a brute force approach based on multiple random resolutions of uncertain nodes. The main transitions were between no care (the probable ancestral state) and female care. Male care evolved exclusively from no care, supporting models where mating opportunity costs for caring males are reduced-for example, by caring for multiple broods-but rejecting the "enhanced fecundity" hypothesis that male care is favored because it allows females to avoid care costs. Biparental care largely arose by males joining caring females, and was more labile in Holometabola than in Hemimetabola. Insect care evolution most closely resembled amphibian care in general trajectory. Integrating these findings with the wealth of life history and ecological data in insects will allow testing of a rich vein of existing hypotheses. © 2015 The Author(s). Evolution published by Wiley Periodicals, Inc. on behalf of The Society for the Study of Evolution.

Dementia Care: Intersecting Informal Family Care and Formal Care Systems

Directory of Open Access Journals (Sweden)

Prabhjot Singh

2014-01-01

Full Text Available Dementia is one of the major causes of disability and dependence amongst older people and previous research has highlighted how the well-being of people with dementia is inherently connected to the quality of their relationships with their informal carers. In turn, these carers can experience significant levels of emotional stress and physical burden from the demands of caring for a family member with dementia, yet their uptake of formal services tends to be lower than in other conditions related to ageing. This paper is based on a qualitative study undertaken in the Australian state of Queensland and explores issues of access to and use of formal services in dementia care from the perspective of the informal family carers. It identifies three critical points at which changes in policy and practice in the formal care system could improve the capability of informal carers to continue to care for their family member with dementia: when symptoms first become apparent and a diagnosis is sought; when the condition of the person with dementia changes resulting in a change to their support needs; and when the burden of informal care being experienced by the carer is so great that some form of transition appears to be immanent in the care arrangement.

Size and transportation capabilities of the existing US cask fleet

International Nuclear Information System (INIS)

Danese, F.L.; Johnson, P.E.; Joy, D.S.

1990-01-01

This study investigates the current spent nuclear fuel cask fleet capability in the United States. In addition, it assesses the degree to which the current fleet would be available, as a contingency, until proposed Office of Civilian Radioactive Waste Management casks become operational. A limited fleet of ten spent fuel transportation casks is found to be readily available for use in Federal waste management efforts over the next decade

NASA Stennis Space Center Integrated System Health Management Test Bed and Development Capabilities

Science.gov (United States)

Figueroa, Fernando; Holland, Randy; Coote, David

2006-01-01

Integrated System Health Management (ISHM) is a capability that focuses on determining the condition (health) of every element in a complex System (detect anomalies, diagnose causes, prognosis of future anomalies), and provide data, information, and knowledge (DIaK)-not just data-to control systems for safe and effective operation. This capability is currently done by large teams of people, primarily from ground, but needs to be embedded on-board systems to a higher degree to enable NASA's new Exploration Mission (long term travel and stay in space), while increasing safety and decreasing life cycle costs of spacecraft (vehicles; platforms; bases or outposts; and ground test, launch, and processing operations). The topics related to this capability include: 1) ISHM Related News Articles; 2) ISHM Vision For Exploration; 3) Layers Representing How ISHM is Currently Performed; 4) ISHM Testbeds & Prototypes at NASA SSC; 5) ISHM Functional Capability Level (FCL); 6) ISHM Functional Capability Level (FCL) and Technology Readiness Level (TRL); 7) Core Elements: Capabilities Needed; 8) Core Elements; 9) Open Systems Architecture for Condition-Based Maintenance (OSA-CBM); 10) Core Elements: Architecture, taxonomy, and ontology (ATO) for DIaK management; 11) Core Elements: ATO for DIaK Management; 12) ISHM Architecture Physical Implementation; 13) Core Elements: Standards; 14) Systematic Implementation; 15) Sketch of Work Phasing; 16) Interrelationship Between Traditional Avionics Systems, Time Critical ISHM and Advanced ISHM; 17) Testbeds and On-Board ISHM; 18) Testbed Requirements: RETS AND ISS; 19) Sustainable Development and Validation Process; 20) Development of on-board ISHM; 21) Taxonomy/Ontology of Object Oriented Implementation; 22) ISHM Capability on the E1 Test Stand Hydraulic System; 23) Define Relationships to Embed Intelligence; 24) Intelligent Elements Physical and Virtual; 25) ISHM Testbeds and Prototypes at SSC Current Implementations; 26) Trailer

The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities.

Science.gov (United States)

Ascoli, Micol; Palinski, Andrea; Owiti, John Arianda; De Jongh, Bertine; Bhui, Kamaldeep S

2012-09-28

Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering "culture" in the presentation and expression of mental distress. The narratives reveal an overall "culture of understanding cultural issues" and specific "cultures of care". These emerged as necessary foci of intervention to improve service user outcomes. Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery.

[Symposium The future of informal care].

Science.gov (United States)

Broese van Groenou, Marjolein; de Boer, Alice; Putters, Kim; Henkens, Kène; Nies, Henk; Dykstra, Pearl A; van Solinge, Hanna; van Campen, Cretien; Kooiker, Sjoerd

2017-04-01

Due to the reform of long term care in 2015, there is growing concern about whether groups at risk receive the care they need. People in need of care have to rely more on help from their social network. The increased need for informal care requires resilience and organizational skills of families, but also of volunteers, professionals and employers. What does this mean for the provision of informal care in the next decennia? The symposium 'The future of informal care', organized on January 26 2017 by the National Institute for Social Research and the Institute for Societal Resilience of the Vrije Universiteit, addressed possible answers to this question. In her inaugural speech Alice de Boer discussed social inequality as possible determinant and outcome of informal care. Some conclusions:Until 2050 the absolute number of 75-plus doubled to about 3 million persons, but the number of informal caregivers will decrease. In addition to the importance of social and economic resources (the 'have & have-nots'), the ability to arrange care (the 'can & can-nots') gains importance.Almost half of the older employers provides informal care just before retirement. Flexibility in working hours and work location facilitates combining work and care, but about half of the employers indicates that partial retirement and working at home are no options.Informal caregivers and professionals often provide care from comparable perspectives and identities. Addressing similarities rather than differences improves their chances for collaboration.The number of adult children providing household care to older parents increased between 2002 and 2014. This suggests an increase in family solidarity, but current reform policies may increase the gender inequality in caregiving families.Spouses and children remain primary caregivers in the future, preferably supported by many different types of caregivers. Not everybody has the capabilities to organize and direct such a large care network

Current advance care planning practice in the Australian community: an online survey of home care package case managers and service managers.

Science.gov (United States)

Sellars, Marcus; Detering, Karen M; Silvester, William

2015-04-23

Advance care planning (ACP) is the process of planning for future healthcare that is facilitated by a trained healthcare professional, whereby a person's values, beliefs and treatment preferences are made known to guide clinical decision-making at a future time when they cannot communicate their decisions. Despite the potential benefits of ACP for community aged care clients the availability of ACP is unknown, but likely to be low. In Australia many of these clients receive services through Home Care Package (HCP) programs. This study aimed to explore current attitudes, knowledge and practice of advance care planning among HCP service managers and case managers. An invitation to take part in a cross-sectional online survey was distributed by email to all HCP services across Australia in November 2012. Descriptive analyses were used to examine overall patterns of responses to each survey item in the full sample. 120 (response rate 25%) service managers and 178 (response rate 18%) case managers completed the survey. Only 34% of services had written ACP policies and procedures in place and 48% of case managers had previously completed any ACP training. In addition, although most case managers (70%) had initiated an ACP discussion in the past 12 months and viewed ACP as part of their role, the majority of the conversations (80%) did not result in documentation of the client's wishes and most (85%) of the case managers who responded did not believe ACP was done well within their service. This survey shows low organisational ACP systems and support for case managers and a lack of a normative approach to ACP across Australian HCP services. As HCPs become more prevalent it is essential that a model of ACP is developed and evaluated in this setting, so that clients have the opportunity to discuss and document their future healthcare wishes if they choose to.

A Comparison of Two Commercial Volumetry Software Programs in the Analysis of Pulmonary Ground-Glass Nodules: Segmentation Capability and Measurement Accuracy

Science.gov (United States)

Kim, Hyungjin; Lee, Sang Min; Lee, Hyun-Ju; Goo, Jin Mo

2013-01-01

Objective To compare the segmentation capability of the 2 currently available commercial volumetry software programs with specific segmentation algorithms for pulmonary ground-glass nodules (GGNs) and to assess their measurement accuracy. Materials and Methods In this study, 55 patients with 66 GGNs underwent unenhanced low-dose CT. GGN segmentation was performed by using 2 volumetry software programs (LungCARE, Siemens Healthcare; LungVCAR, GE Healthcare). Successful nodule segmentation was assessed visually and morphologic features of GGNs were evaluated to determine factors affecting segmentation by both types of software. In addition, the measurement accuracy of the software programs was investigated by using an anthropomorphic chest phantom containing simulated GGNs. Results The successful nodule segmentation rate was significantly higher in LungCARE (90.9%) than in LungVCAR (72.7%) (p = 0.012). Vascular attachment was a negatively influencing morphologic feature of nodule segmentation for both software programs. As for measurement accuracy, mean relative volume measurement errors in nodules ≥ 10 mm were 14.89% with LungCARE and 19.96% with LungVCAR. The mean relative attenuation measurement errors in nodules ≥ 10 mm were 3.03% with LungCARE and 5.12% with LungVCAR. Conclusion LungCARE shows significantly higher segmentation success rates than LungVCAR. Measurement accuracy of volume and attenuation of GGNs is acceptable in GGNs ≥ 10 mm by both software programs. PMID:23901328

A comparison of two commercial volumetry software programs in the analysis of pulmonary ground-glass nodules: Segmentation capability and measurement accuracy

International Nuclear Information System (INIS)

Kim, Hyung Jin; Park, Chang Min; Lee, Sang Min; Lee, Hyun Joo; Goo, Jin Mo

2013-01-01

To compare the segmentation capability of the 2 currently available commercial volumetry software programs with specific segmentation algorithms for pulmonary ground-glass nodules (GGNs) and to assess their measurement accuracy. In this study, 55 patients with 66 GGNs underwent unenhanced low-dose CT. GGN segmentation was performed by using 2 volumetry software programs (LungCARE, Siemens Healthcare; LungVCAR, GE Healthcare). Successful nodule segmentation was assessed visually and morphologic features of GGNs were evaluated to determine factors affecting segmentation by both types of software. In addition, the measurement accuracy of the software programs was investigated by using an anthropomorphic chest phantom containing simulated GGNs. The successful nodule segmentation rate was significantly higher in LungCARE (90.9%) than in LungVCAR (72.7%) (p = 0.012). Vascular attachment was a negatively influencing morphologic feature of nodule segmentation for both software programs. As for measurement accuracy, mean relative volume measurement errors in nodules ≥ 10 mm were 14.89% with LungCARE and 19.96% with LungVCAR. The mean relative attenuation measurement errors in nodules ≥ 10 mm were 3.03% with LungCARE and 5.12% with LungVCAR. LungCARE shows significantly higher segmentation success rates than LungVCAR. Measurement accuracy of volume and attenuation of GGNs is acceptable in GGNs ≥ 10 mm by both software programs.

A comparison of two commercial volumetry software programs in the analysis of pulmonary ground-glass nodules: Segmentation capability and measurement accuracy

Energy Technology Data Exchange (ETDEWEB)

Kim, Hyung Jin; Park, Chang Min; Lee, Sang Min; Lee, Hyun Joo; Goo, Jin Mo [Dept. of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul (Korea, Republic of)

2013-08-15

To compare the segmentation capability of the 2 currently available commercial volumetry software programs with specific segmentation algorithms for pulmonary ground-glass nodules (GGNs) and to assess their measurement accuracy. In this study, 55 patients with 66 GGNs underwent unenhanced low-dose CT. GGN segmentation was performed by using 2 volumetry software programs (LungCARE, Siemens Healthcare; LungVCAR, GE Healthcare). Successful nodule segmentation was assessed visually and morphologic features of GGNs were evaluated to determine factors affecting segmentation by both types of software. In addition, the measurement accuracy of the software programs was investigated by using an anthropomorphic chest phantom containing simulated GGNs. The successful nodule segmentation rate was significantly higher in LungCARE (90.9%) than in LungVCAR (72.7%) (p = 0.012). Vascular attachment was a negatively influencing morphologic feature of nodule segmentation for both software programs. As for measurement accuracy, mean relative volume measurement errors in nodules ≥ 10 mm were 14.89% with LungCARE and 19.96% with LungVCAR. The mean relative attenuation measurement errors in nodules ≥ 10 mm were 3.03% with LungCARE and 5.12% with LungVCAR. LungCARE shows significantly higher segmentation success rates than LungVCAR. Measurement accuracy of volume and attenuation of GGNs is acceptable in GGNs ≥ 10 mm by both software programs.

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

Science.gov (United States)

Tintoré, Mar; Alexander, Maggie; Costello, Kathleen; Duddy, Martin; Jones, David E; Law, Nancy; O’Neill, Gilmore; Uccelli, Antonio; Weissert, Robert; Wray, Sibyl

2017-01-01

Background Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. Methods A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. Results A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Conclusion Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment. PMID:28053511

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction.

Science.gov (United States)

Tintoré, Mar; Alexander, Maggie; Costello, Kathleen; Duddy, Martin; Jones, David E; Law, Nancy; O'Neill, Gilmore; Uccelli, Antonio; Weissert, Robert; Wray, Sibyl

2017-01-01

Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment.

Emergency department characteristics and capabilities in Beijing, China.

Science.gov (United States)

Wen, Leana S; Xu, Jun; Steptoe, Anne P; Sullivan, Ashley F; Walline, Joseph H; Yu, Xuezhong; Camargo, Carlos A

2013-06-01

Emergency Departments (EDs) are a critical, yet heterogeneous, part of international emergency care. We sought to describe the characteristics, resources, capabilities, and capacity of EDs in Beijing, China. Beijing EDs accessible to the general public 24 h per day/7 days per week were surveyed using the National ED Inventories survey instrument (www.emnet-nedi.org). ED staff were asked about ED characteristics during the calendar year 2008. Thirty-six EDs participated (88% response rate). All were located in hospitals and were independent hospital departments. Participating EDs saw a median of 80,000 patients (interquartile range 40,000-118,508). The vast majority (91%; 95% confidence interval [CI] 78-98%) had a contiguous layout, with medical and surgical care provided in one area. Most EDs (55%) saw only adults; 39% saw both adults and children, and 6% saw only children. Availability of technological and consultant resource in EDs was high. The typical ED length of stay was between 1 and 6 h in 49% of EDs (95% CI 32-67%), whereas in the other half, patients reportedly remained for over 6 h; 36% (95% CI 21-54%) of respondents considered their ED over capacity. Beijing EDs have high volume, long length of stay, and frequent reports of EDs being over capacity. To meet its rapidly growing health needs in urban areas, China should consider improving urban ED capacity and training more Emergency Medicine specialists capable of efficiently staffing its crowded EDs. Copyright © 2013 Elsevier Inc. All rights reserved.

Critical operations capabilities in a high cost environment: a multiple case study

Science.gov (United States)

Sansone, C.; Hilletofth, P.; Eriksson, D.

2018-04-01

Operations capabilities have been a popular research area for many years and several frameworks have been proposed in the literature. The current frameworks do not take specific contexts into consideration, for instance a high cost environment. This research gap is of particular interest since a manufacturing relocation process has been ongoing the last decades, leading to a huge amount of manufacturing being moved from high to low cost environments. The purpose of this study is to identify critical operations capabilities in a high cost environment. The two research questions were: What are the critical operations capabilities dimensions in a high cost environment? What are the critical operations capabilities in a high cost environment? A multiple case study was conducted and three Swedish manufacturing firms were selected. The study was based on the investigation of an existing framework of operations capabilities. The main dimensions of operations capabilities included in the framework were: cost, quality, delivery, flexibility, service, innovation and environment. Each of the dimensions included two or more operations capabilities. The findings confirmed the validity of the framework and its usefulness in a high cost environment and a new operations capability was revealed (employee flexibility).

Heavy Lift Launch Capability with a New Hydrocarbon Engine

Science.gov (United States)

Threet, Grady E., Jr.; Holt, James B.; Philips, Alan D.; Garcia, Jessica A.

2011-01-01

The Advanced Concepts Office at NASA's George C. Marshall Space Flight Center was tasked to define the thrust requirement of a new liquid oxygen rich staged combustion cycle hydrocarbon engine that could be utilized in a launch vehicle to meet NASA s future heavy lift needs. Launch vehicle concepts were sized using this engine for different heavy lift payload classes. Engine out capabilities for one of the heavy lift configurations were also analyzed for increased reliability that may be desired for high value payloads or crewed missions. The applicability for this engine in vehicle concepts to meet military and commercial class payloads comparable to current ELV capability was also evaluated.

The Relationship Between the Educational Background and Managerial Experience of Senior Navy Medical Service Corps Executives (Health Care Administrators) and their Perceived Current and Required Management Capabilities.

Science.gov (United States)

1994-03-01

practitioner-based assessment of baccalaureate-level skills and knowledge needs ranked interpersonal skills, knowledge of the health care sector , and...OdM ctr and predicted onviroamsma nasional and world imawrelated military, economico political. scientific, and social factors. Designed for 0.5S016

Status of simulation in health care education: an international survey

Science.gov (United States)

Qayumi, Karim; Pachev, George; Zheng, Bin; Ziv, Amitai; Koval, Valentyna; Badiei, Sadia; Cheng, Adam

2014-01-01

Simulation is rapidly penetrating the terrain of health care education and has gained growing acceptance as an educational method and patient safety tool. Despite this, the state of simulation in health care education has not yet been evaluated on a global scale. In this project, we studied the global status of simulation in health care education by determining the degree of financial support, infrastructure, manpower, information technology capabilities, engagement of groups of learners, and research and scholarly activities, as well as the barriers, strengths, opportunities for growth, and other aspects of simulation in health care education. We utilized a two-stage process, including an online survey and a site visit that included interviews and debriefings. Forty-two simulation centers worldwide participated in this study, the results of which show that despite enormous interest and enthusiasm in the health care community, use of simulation in health care education is limited to specific areas and is not a budgeted item in many institutions. Absence of a sustainable business model, as well as sufficient financial support in terms of budget, infrastructure, manpower, research, and scholarly activities, slows down the movement of simulation. Specific recommendations are made based on current findings to support simulation in the next developmental stages. PMID:25489254

Process for Upgrading Cognitive Assessment Capabilities Onboard the International Space Station

Science.gov (United States)

Picano, J. J.; Seaton, K. A.; Holland, A. W.

2016-01-01

MOTIVATION: Spaceflight poses varied and unique risks to the brain and cognitive functioning including radiation exposure, sleep disturbance, fatigue, fluid shifts (increased intracranial pressure), toxin exposure, elevated carbon dioxide, and traumatic brain injury, among others. These potential threats to cognitive functioning are capable of degrading performance and compromising mission success. Furthermore, the threats may increase in severity, and new types of threats may emerge for longer duration exploration missions. This presentation will describe the process used to identify gaps in our current approach, evaluate best practices in cognitive assessment, and transition new cognitive assessment tools to operational use. OVERVIEW: Risks to brain health and performance posed by spaceflight missions require sensitive tools to assess cognitive functioning of astronauts in flight. The Spaceflight Cognitive Assessment Tool for Windows (WinSCAT) is the automated cognitive assessment tool currently deployed onboard the International Space Station (ISS). WinSCAT provides astronauts and flight surgeons with objective data to monitor neurocognitive functioning. WinSCAT assesses 5 discrete cognitive domains, is sensitive to changes in cognitive functioning, and was designed to be completed in less than 15 minutes. However, WinSCAT does not probe other areas of cognitive functioning that might be important to mission success. Researchers recently have developed batteries that may expand current capabilities, such as increased sensitivity to subtle fluctuations in cognitive functioning. Therefore, we engaged in a systematic process review in order to improve upon our current capabilities and incorporate new advances in cognitive assessment. This process included a literature review on newer measures of neurocognitive assessment, surveys of operational flight surgeons at NASA regarding needs and gaps in our capabilities, and expert panel review of candidate cognitive

The impact of free healthcare on women's capability: A qualitative study in rural Burkina Faso.

Science.gov (United States)

Samb, Oumar Mallé; Ridde, Valery

2018-01-01

In March 2006, the government of Burkina Faso implemented an 80% subsidy for emergency obstetric and neonatal care (EmONC). To complement this subsidy, an NGO decided to cover the remaining 20% in two districts of the country, making EmONC completely free for women there. In addition, the NGO instituted fee exemptions for children under five years of age in those two districts. We conducted a qualitative study in 2011 to examine the impact of these free healthcare interventions on women's capability. We conducted semi-structured interviews with 40 women, 16 members of health centre management committees, and eight healthcare workers in three health districts, as well as a documentary analysis. Results showed free healthcare helped reinforce women's capability to make health decisions by eliminating the need for them to negotiate access to household resources, which in turn helped shorten delays in health services use. Other effects were also observed, such as increased self-esteem among the women and greater respect within their marital relationship. However, cultural barriers remained, limiting women's capability to achieve certain things they valued, such as contraception. In conclusion, this study's results illustrate the transformative effect that eliminating fees for obstetric care can have on women's capability to make health decisions and their social position. Furthermore, if women's capability is to be strengthened, the results impel us to go beyond health and to organize social and economic policies to reinforce their positions in other spheres of social life. Copyright © 2017 Elsevier Ltd. All rights reserved.

Buck-Boost Current-Source Inverters With Diode-Inductor Network

DEFF Research Database (Denmark)

Gao, Feng; Liang, Chao; Loh, Poh Chiang

2009-01-01

This paper presents a number of novel currentsource inverters (CSIs) with enhanced current buck-boost capability. By adding a unique diode-inductor network between the inverter circuitry and current-boost elements, the proposed buck-boost CSIs demonstrate a doubling of current-boost capability......, as compared with other recently reported buck-boost CSIs. For controlling the proposed CSIs, two modulation schemes are designed for achieving either optimized harmonic performance or minimized commutation count without influencing the inverter current buck-boost gain. These theoretical findings were...

Capability-based computer systems

CERN Document Server

Levy, Henry M

2014-01-01

Capability-Based Computer Systems focuses on computer programs and their capabilities. The text first elaborates capability- and object-based system concepts, including capability-based systems, object-based approach, and summary. The book then describes early descriptor architectures and explains the Burroughs B5000, Rice University Computer, and Basic Language Machine. The text also focuses on early capability architectures. Dennis and Van Horn's Supervisor; CAL-TSS System; MIT PDP-1 Timesharing System; and Chicago Magic Number Machine are discussed. The book then describes Plessey System 25

ROV: improving remotely operated vehicle (ROV) intervention capabilities for blowout preventer override systems

Energy Technology Data Exchange (ETDEWEB)

Lazar, Stephen [Christopher S. Mancini, Tomball, TX (United States)

2012-07-01

Events during 2010 have focused attention on increased ROV/BOP Intervention capabilities and standardization of BOP/ROV interfaces in the oil and gas offshore industry. Currently no enforced set standards for ROV intervention panels or manifold types for use on BOP Override systems are specified. The industry offers multiple configurations at present. This abstract will discuss the advantages and disadvantages of the various configurations in existence, trending toward suggested industry standards taking shape as requirements in the near term. Standards for the offshore industry or a set specification must be made to increase safety and functionality of BOP control systems. To date, ROV override capabilities have been added to existing engineered BOP systems. BOP designed closing times were not a critical consideration, only that the access was there to allow for ROV override. Increased ROV flow and pressure capabilities: no current minimum flow requirements for Emergency BOP Override pumps are established. Based on stack valving and configuration, a minimum, 7 gpm may be required to shift valving fully to allow BOP operator function. IADC/API minimum requirements may be proposed at 10 gpm at 3000psi. Based on shear pressures exceeding 3000psi, pressures of 5000psi should be considered. Current intervention skids/pump capabilities will be required if ROVs must achieve API 16D BOP minimum closing times. Remote or isolated accumulation for increased intervention capabilities offers possibilities when ANY ROV of opportunity can trigger a function (such as small inspection type ROVs). Increased volumes will be required. This is critical in functioning stack rams with an ROV of opportunity to achieve API 16D closing times. We now understand that higher flows and pressures are required along with standardization of stab types. Current recommendations: API 17H Hi-Flow manifolds should be added to essential ROV overrides. ROV skids will have a minimum requirement of 10gpm

Individualised care for women with assisted conception pregnancies and midwifery practice implications: An analysis of the existing research and current practice.

Science.gov (United States)

Younger, Mimi; Hollins-Martin, Caroline; Choucri, Lesley

2015-02-01

the aim is to explore the psychosocial needs of women who are pregnant after assisted conception, specifically in vitro Fertilisation and whether their needs are being addressed within the current maternity care service. critical review of the literature using a narrative approach. 15 papers were identified. These included both qualitative and quantitative studies, literature reviews and surveys. The findings of this limited narrative review imply that women who undergo assistive reproductive techniques to achieve pregnancy have higher levels of anxiety in pregnancy and may have some difficulties in the transition to parenthood leading to perinatal morbidity. It appears that for this group of women it is important that their history in achieving pregnancy is known to the care providers, to enable the alleviation of some of the anxieties they face. Various aspects of antenatal care have been identified as possible areas which if addressed may reduce these levels of anxiety leading to a reduction in perinatal morbidity. currently, there is insufficient evidence to suggest that providing specialist midwifery care reduces morbidity in these women. However, maternity service providers should consider offering additional antenatal and postnatal services to meet the needs of this group in advance of further research in this area. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mobile Test Capabilities

Data.gov (United States)

Federal Laboratory Consortium — The Electrical Power Mobile Test capabilities are utilized to conduct electrical power quality testing on aircraft and helicopters. This capability allows that the...

Reforming health care in Canada: current issues La reforma del sistema de atención a la salud en Canadá: situación actual

OpenAIRE

Enis Baris

1998-01-01

This paper examines the current health care reform issues in Canada. The provincial health insurance plans of the 1960s and 1970s had the untoward effects of limiting the federal government’s clout for cost control and of promoting a system centered on inpatient and medical care. Recently, several provincial commissions reported that the current governance structures and management processes are outmoded in light of new knowledge, new fiscal realities and the evolution of power among sta...

Study of magnetorheology and sensing capabilities of MR elastomers

International Nuclear Information System (INIS)

Tian, T F; Li, W H; Alici, G

2013-01-01

This study focuses on the magnetorheology and sensing capability of graphite based Magnetorheological Elastomers (Gr MREs). By introducing graphite (Gr) to conventional MREs, the Gr MREs are derived. The anisotropic sample with 20% graphite weight fraction was selected to be compared with anisotropic conventional MREs. The microstructures of anisotropic Gr MREs and conventional MREs were observed. Both steady state tests and dynamic tests were conducted to study rheological properties of the samples. For dynamic tests, the effects of strain amplitude, and frequency on both storage modulus and loss modulus were measured. For sensing capability, the resistance of selected Gr MREs under different magnetic fields and external loadings is measured with a multi-meter. Either higher magnetic field or more external loading results in the resistance increment. Based on an ideal assumption of perfect chain structure, a mathematical model was proposed to investigate the relationship between the MRE resistance with the external loadings. In this model, the current flowing through the chain structure consists of both tunnel current and conductivity current, both of which depends on external loadings. The modelling parameters were identified and reconstructed from comparison with experimental results. The comparison indicates that both experimental results and modelling prediction agree favourably well.

Diode-Assisted Buck-Boost Current Source Inverters

DEFF Research Database (Denmark)

Gao, F.; Cai, Liang; Loh, P.C.

2007-01-01

This paper presents a couple of novel current source inverters (CSIs) with the enhanced current buckboost capability. With the unique diode-inductor network added between current source inverter circuitry and current boost elements, the proposed buck-boost current source inverters demonstrate...... uninfluenced. Lastly, all theoretical findings were verified experimentally using constructed laboratory prototypes....

PRESCRIBING OF ANTIHYPERTENSIVE AGENTS IN PUBLIC PRIMARY CARE CLINICS – IS IT IN ACCORDANCE WITH CURRENT EVIDENCE?

Directory of Open Access Journals (Sweden)

SAJARI J

2010-01-01

Full Text Available Background: Large population surveys in Malaysia have consistently shown minimal improvement of blood pressure control rates over the last 10 years. Poor adherence to antihypertensive medication has been recognized as a major reason for poor control of hypertension. This study aimed to describe the prescribing pattern of antihypertensive agents in 2 public primary care clinics and assess its appropriateness in relation to current evidence and guidelines. Methods: A cross-sectional survey to describe the prescribing pattern of antihypertensive agents was carried out in 2 publicprimary care clinics in Selangor from May to June 2009. Hypertensive patients on pharmacological treatment for ≥1 year who attended the clinics within the study period of 7 weeks were selected. Appropriate use of antihypertensive agents was defined based on current evidence and the recommendations by the Malaysian Clinical Practice Guidelines (CPG on the Management of Hypertension, 2008. Data were obtained from patients’ medical records and were analysed using the SPSS software version 16.0. Results: A total of 400 hypertensive patients on treatment were included. Mean age was 59.5 years (SD ±10.9, range 28 to91 years, of which 52.8% were females and 47.2% were males. With regards to pharmacotherapy, 45.7% were on monotherapy,43.3% were on 2 agents and 11.0% were on ≥3 agents. Target blood pressure of <140/90mmHg was achieved in 51.4% of patients on monotherapy, and 33.2% of patients on combination of ≥2 agents. The commonest monotherapy agents being prescribed were β-blockers (atenolol or propranolol, followed by the short-acting calcium channel blocker (nifedipine. The commonest combination of 2-drug therapy prescribed was β-blockers and short-acting calcium channel blocker. Conclusion: This study shows that the prescribing pattern of antihypertensive agents in the 2 primary care clinics was not in accordance with current evidence and guidelines. �

Maintaining operational excellence: building capability beyond knowledge transfer

International Nuclear Information System (INIS)

Ramjist, S.

2013-01-01

This paper describes the issues relating to human resources and maintaining capabilities in an organization. The sustaining elements are: vision and plan for excellence; invest in the plant; invest in human capital; find and fix problems. There is much discussion about knowledge transfer and retention that is mainly focused on technical attributes and proficiency. We are losing more people with the requisite managerial and leadership capability than we can develop and backfill at a Time when our industry is facing increased competition and decreased margins. We are vulnerable because this Increases our dependence on augmented staff for certain key leadership roles. Previous methods for developing people will take too long and does not appeal to current generation. A solution, not the only solution, but the one we have chosen is initial hiring of operators, maintainers and engineers, internal promotion for key roles (FLM, FSOS, Shift Supervisor, Section Manager, ANO) and focus on all three aspects of capability and looking for leadership traits. Look for ambition, drive, initiative and motivation. Identify, separate and stream. Take specific measures to accelerate growth.

Maintaining operational excellence: building capability beyond knowledge transfer

Energy Technology Data Exchange (ETDEWEB)

Ramjist, S. [Ontario Power Generation, Darlington Nuclear Generating Station, Bowmanville, Ontario (Canada)

2013-07-01

This paper describes the issues relating to human resources and maintaining capabilities in an organization. The sustaining elements are: vision and plan for excellence; invest in the plant; invest in human capital; find and fix problems. There is much discussion about knowledge transfer and retention that is mainly focused on technical attributes and proficiency. We are losing more people with the requisite managerial and leadership capability than we can develop and backfill at a Time when our industry is facing increased competition and decreased margins. We are vulnerable because this Increases our dependence on augmented staff for certain key leadership roles. Previous methods for developing people will take too long and does not appeal to current generation. A solution, not the only solution, but the one we have chosen is initial hiring of operators, maintainers and engineers, internal promotion for key roles (FLM, FSOS, Shift Supervisor, Section Manager, ANO) and focus on all three aspects of capability and looking for leadership traits. Look for ambition, drive, initiative and motivation. Identify, separate and stream. Take specific measures to accelerate growth.

A Web Service Protocol Realizing Interoperable Internet of Things Tasking Capability

Science.gov (United States)

Huang, Chih-Yuan; Wu, Cheng-Hung

2016-01-01

The Internet of Things (IoT) is an infrastructure that interconnects uniquely-identifiable devices using the Internet. By interconnecting everyday appliances, various monitoring, and physical mashup applications can be constructed to improve human’s daily life. In general, IoT devices provide two main capabilities: sensing and tasking capabilities. While the sensing capability is similar to the World-Wide Sensor Web, this research focuses on the tasking capability. However, currently, IoT devices created by different manufacturers follow different proprietary protocols and are locked in many closed ecosystems. This heterogeneity issue impedes the interconnection between IoT devices and damages the potential of the IoT. To address this issue, this research aims at proposing an interoperable solution called tasking capability description that allows users to control different IoT devices using a uniform web service interface. This paper demonstrates the contribution of the proposed solution by interconnecting different IoT devices for different applications. In addition, the proposed solution is integrated with the OGC SensorThings API standard, which is a Web service standard defined for the IoT sensing capability. Consequently, the Extended SensorThings API can realize both IoT sensing and tasking capabilities in an integrated and interoperable manner. PMID:27589759

A Web Service Protocol Realizing Interoperable Internet of Things Tasking Capability.

Science.gov (United States)

Huang, Chih-Yuan; Wu, Cheng-Hung

2016-08-31

The Internet of Things (IoT) is an infrastructure that interconnects uniquely-identifiable devices using the Internet. By interconnecting everyday appliances, various monitoring, and physical mashup applications can be constructed to improve human's daily life. In general, IoT devices provide two main capabilities: sensing and tasking capabilities. While the sensing capability is similar to the World-Wide Sensor Web, this research focuses on the tasking capability. However, currently, IoT devices created by different manufacturers follow different proprietary protocols and are locked in many closed ecosystems. This heterogeneity issue impedes the interconnection between IoT devices and damages the potential of the IoT. To address this issue, this research aims at proposing an interoperable solution called tasking capability description that allows users to control different IoT devices using a uniform web service interface. This paper demonstrates the contribution of the proposed solution by interconnecting different IoT devices for different applications. In addition, the proposed solution is integrated with the OGC SensorThings API standard, which is a Web service standard defined for the IoT sensing capability. Consequently, the Extended SensorThings API can realize both IoT sensing and tasking capabilities in an integrated and interoperable manner.

Building Service Provider Capabilities

DEFF Research Database (Denmark)

Brandl, Kristin; Jaura, Manya; Ørberg Jensen, Peter D.

2015-01-01

In this paper we study whether and how the interaction between clients and the service providers contributes to the development of capabilities in service provider firms. In situations where such a contribution occurs, we analyze how different types of activities in the production process...... process. We find that clients influence the development of human capital capabilities and management capabilities in reciprocally produced services. While in sequential produced services clients influence the development of organizational capital capabilities and management capital capabilities....... of the services, such as sequential or reciprocal task activities, influence the development of different types of capabilities. We study five cases of offshore-outsourced knowledge-intensive business services that are distinguished according to their reciprocal or sequential task activities in their production...

The Professional Development Plan of a Health Care Workforce as a Qualitative Indicator of the Health Care System's Well-Being

Science.gov (United States)

Saiti, Anna; Mylona, Vasiliki

2015-01-01

The quality of a health care system is heavily dependent on a capable and skillful health care workforce so as to guarantee the delivery of quality health care services to its user groups. Hence, only through continuous training and development can the health care workforce follow rapid scientific progress while equitably balancing investment…

Dynamic capabilities for cooperation in Brazilian multinational and factors determining its management

Directory of Open Access Journals (Sweden)

Priscila Rezende da Costa

2015-05-01

Full Text Available In the context of emerging companies’ growth, current challenges depend on the local generation of product and process innovations, as well as dynamic capability to generate innovative solutions cooperatively and new globe business models. The objective of this study is to analyse the determining managerial factors for the dynamic capability of cooperation in Brazilian multinationals (BMNs. A survey was conducted with a sample of 60 BMNs, and a structured questionnaire and statistical tests with factorial analysis and Cronbach's alpha were used. The aggregate analysis of the results indicates that BMNs are going through a transitional process between the operational capability of cooperation and the capability for dynamic cooperation, which are relevant to the continuous adaptation of already-established cooperative management routines and the evaluation and incorporation of the relational capability of management practices that consider systemic flows, open innovation and integrate strategic intentionality into cooperative processes.

A Proposed Clinical Decision Support Architecture Capable of Supporting Whole Genome Sequence Information

Directory of Open Access Journals (Sweden)

Brandon M. Welch

2014-04-01

Full Text Available Whole genome sequence (WGS information may soon be widely available to help clinicians personalize the care and treatment of patients. However, considerable barriers exist, which may hinder the effective utilization of WGS information in a routine clinical care setting. Clinical decision support (CDS offers a potential solution to overcome such barriers and to facilitate the effective use of WGS information in the clinic. However, genomic information is complex and will require significant considerations when developing CDS capabilities. As such, this manuscript lays out a conceptual framework for a CDS architecture designed to deliver WGS-guided CDS within the clinical workflow. To handle the complexity and breadth of WGS information, the proposed CDS framework leverages service-oriented capabilities and orchestrates the interaction of several independently-managed components. These independently-managed components include the genome variant knowledge base, the genome database, the CDS knowledge base, a CDS controller and the electronic health record (EHR. A key design feature is that genome data can be stored separately from the EHR. This paper describes in detail: (1 each component of the architecture; (2 the interaction of the components; and (3 how the architecture attempts to overcome the challenges associated with WGS information. We believe that service-oriented CDS capabilities will be essential to using WGS information for personalized medicine.

Size and transportation capabilities of the existing U.S. cask fleet

International Nuclear Information System (INIS)

Danese, F.L.; Johnson, P.E.; Joy, D.S.

1990-01-01

This paper investigates the current spent nuclear fuel cask fleet capability in the United States. It assesses the degree to which the current fleet would be available, as a contingency, until proposed Office of Civilian Radioactive Waste Management casks become operational. A limited fleet of ten spent fuel transportation casks is found to be readily available for use in Federal waste management efforts over the next decade

Sensing capabilities of graphite based MR elastomers

International Nuclear Information System (INIS)

Tian, T F; Li, W H; Deng, Y M

2011-01-01

This paper presents both experimental and theoretical investigations of the sensing capabilities of graphite based magnetorheological elastomers (MREs). In this study, eight MRE samples with varying graphite weight fractions were fabricated and their resistance under different magnetic fields and external loadings were measured with a multi-meter. With an increment of graphite weight fraction, the resistance of MRE sample decreases steadily. Higher magnetic fields result in a resistance increase. Based on an ideal assumption of a perfect chain structure, a mathematical model was developed to investigate the relationship between the MRE resistance with external loading. In this model, the current flowing through the chain structure consists of both a tunnel current and a conductivity current, both of which depend on external loadings. The modelling parameters have been identified and reconstructed from comparison with experimental results. The comparison indicates that both experimental results and modelling predictions agree favourably well

Capabilities of current wildfire models when simulating topographical flow

Science.gov (United States)

Kochanski, A.; Jenkins, M.; Krueger, S. K.; McDermott, R.; Mell, W.

2009-12-01

Accurate predictions of the growth, spread and suppression of wild fires rely heavily on the correct prediction of the local wind conditions and the interactions between the fire and the local ambient airflow. Resolving local flows, often strongly affected by topographical features like hills, canyons and ridges, is a prerequisite for accurate simulation and prediction of fire behaviors. In this study, we present the results of high-resolution numerical simulations of the flow over a smooth hill, performed using (1) the NIST WFDS (WUI or Wildland-Urban-Interface version of the FDS or Fire Dynamic Simulator), and (2) the LES version of the NCAR Weather Research and Forecasting (WRF-LES) model. The WFDS model is in the initial stages of development for application to wind flow and fire spread over complex terrain. The focus of the talk is to assess how well simple topographical flow is represented by WRF-LES and the current version of WFDS. If sufficient progress has been made prior to the meeting then the importance of the discrepancies between the predicted and measured winds, in terms of simulated fire behavior, will be examined.

The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities

Directory of Open Access Journals (Sweden)

Ascoli Micol

2012-09-01

Full Text Available Abstract Introduction Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. Results These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering “culture” in the presentation and expression of mental distress. The narratives reveal an overall “culture of understanding cultural issues” and specific “cultures of care”. These emerged as necessary foci of intervention to improve service user outcomes. Conclusion Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery.

The intervention of robot caregivers and the cultivation of children's capability to play.

Science.gov (United States)

Pearson, Yvette; Borenstein, Jason

2013-03-01

In this article, the authors examine whether and how robot caregivers can contribute to the welfare of children with various cognitive and physical impairments by expanding recreational opportunities for these children. The capabilities approach is used as a basis for informing the relevant discussion. Though important in its own right, having the opportunity to play is essential to the development of other capabilities central to human flourishing. Drawing from empirical studies, the authors show that the use of various types of robots has already helped some children with impairments. Recognizing the potential ethical pitfalls of robot caregiver intervention, however, the authors examine these concerns and conclude that an appropriately designed robot caregiver has the potential to contribute positively to the development of the capability to play while also enhancing the ability of human caregivers to understand and interact with care recipients.

Building human resources capability in health care: a global analysis of best practice--Part III.

Science.gov (United States)

Zairi, M

1998-01-01

This is the last part of a series of three papers which discussed very comprehensively best practice applications in human resource management by drawing special inferences to the healthcare context. It emerged from parts I and II that high performing organisations plan and intend to build sustainable capability through a systematic consideration of the human element as the key asset and through a continuous process of training, developing, empowering and engaging people in all aspects of organisational excellence. Part III brings this debate to a close by demonstrating what brings about organisational excellence and proposes a road map for effective human resource development and management, based on world class standards. Healthcare human resource professionals can now rise to the challenge and plan ahead for building organisational capability and sustainable performance.

FMEF/experimental capabilities

International Nuclear Information System (INIS)

Burgess, C.A.; Dronen, V.R.

1981-01-01

The Fuels and Materials Examination Facility (FMEF), under construction at the Hanford site north of Richland, Washington, will be one of the most modern facilities offering irradiated fuels and materials examination capabilities and fuel fabrication development technologies. Scheduled for completion in 1984, the FMEF will provide examination capability for fuel assemblies, fuel pins and test pins irradiated in the FFTF. Various functions of the FMEF are described, with emphasis on experimental data-gathering capabilities in the facility's Nondestructive and Destructive examination cell complex

Rapid Business Transformations in Health Care: A Systems Approach

Science.gov (United States)

Shulaiba, Refaat A.

2011-01-01

The top two priorities of health care business leaders are to constantly improve the quality of health care while striving to contain and reduce the high cost of health care. The Health Care industry, similar to all businesses, is motivated to deliver innovative solutions that accelerate business transformation and increase business capabilities. …

Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management

OpenAIRE

Enrique Jiménez-Rodríguez; José Manuel Feria-Domínguez; Alonso Sebastián-Lacave

2018-01-01

Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identificati...

Quality care as ethical care: a poststructural analysis of palliative and supportive district nursing care.

Science.gov (United States)

Nagington, Maurice; Walshe, Catherine; Luker, Karen A

2016-03-01

Quality of care is a prominent discourse in modern health-care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse-patient-carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi-structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health-care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved. © 2015 The Authors Nursing Inquiry Published by John Wiley & Sons Ltd.

Marshall Space Flight Center's Impact Testing Facility Capabilities

Science.gov (United States)

Finchum, Andy; Hubbs, Whitney; Evans, Steve

2008-01-01

Marshall Space Flight Center s (MSFC) Impact Testing Facility (ITF) serves as an important installation for space and missile related materials science research. The ITF was established and began its research in spacecraft debris shielding in the early 1960s, then played a major role in the International Space Station debris shield development. As NASA became more interested in launch debris and in-flight impact concerns, the ITF grew to include research in a variety of impact genres. Collaborative partnerships with the DoD led to a wider range of impact capabilities being relocated to MSFC as a result of the closure of Particle Impact Facilities in Santa Barbara, California. The Particle Impact Facility had a 30 year history in providing evaluations of aerospace materials and components during flights through rain, ice, and solid particle environments at subsonic through hypersonic velocities. The facility s unique capabilities were deemed a "National Asset" by the DoD. The ITF now has capabilities including environmental, ballistic, and hypervelocity impact testing utilizing an array of air, powder, and two-stage light gas guns to accommodate a variety of projectile and target types and sizes. Numerous upgrades including new instrumentation, triggering circuitry, high speed photography, and optimized sabot designs have been implemented. Other recent research has included rain drop demise characterization tests to obtain data for inclusion in on-going model development. The current and proposed ITF capabilities range from rain to micrometeoroids allowing the widest test parameter range possible for materials investigations in support of space, atmospheric, and ground environments. These test capabilities including hydrometeor, single/multi-particle, ballistic gas guns, exploding wire gun, and light gas guns combined with Smooth Particle Hydrodynamics Code (SPHC) simulations represent the widest range of impact test capabilities in the country.

[Current status of costs and utilizations of hospital based home health nursing care in Korea].

Science.gov (United States)

Ryu, Hosihn

2006-12-01

The purpose of this study was to describe the current status of utilization and costs of home health nursing care by the levels of medical institutes in Korea. A secondary analysis of existing data was used from the national electronic data information(EDI) of 148 home health agencies for 6 months from May to Oct 2005 in total. The 148 agencies had multiple services in cerebral infaction, essential hypertension, sequela of cerebrovascular disease, type 2 diabetes mellitus, etc.. The highest 10 rankings of 76 categories of home health nursing services were composed of 96.4% of the total services, such as simple treatment, inflammatory treatment, urethra & bladder irrigation, inserting indwelling catheter etc., in that order. The highest 20 rankings of 226 categories of home examination services were composed of 77.0% of the total home examination services. In addition, the average cost of home health care per visit was 46,088 Won ( approximately 48 $, 1 $=960 Won). The costs ranged from 74,523 Won ( approximately 78 $, loss of chronic kidney function, N18) to 32,270 Won ( approximately 34 $, other cerebrovascular diseases, I67). Results suggest that client characteristics of hospital based HHNC are not different from community based HHNC or visiting nursing services for elderly. The national results will contribute to baseline data used to establish a policy for the home health nursing care system and education.

Satellite-based Tropical Cyclone Monitoring Capabilities

Science.gov (United States)

Hawkins, J.; Richardson, K.; Surratt, M.; Yang, S.; Lee, T. F.; Sampson, C. R.; Solbrig, J.; Kuciauskas, A. P.; Miller, S. D.; Kent, J.

2012-12-01

Satellite remote sensing capabilities to monitor tropical cyclone (TC) location, structure, and intensity have evolved by utilizing a combination of operational and research and development (R&D) sensors. The microwave imagers from the operational Defense Meteorological Satellite Program [Special Sensor Microwave/Imager (SSM/I) and the Special Sensor Microwave Imager Sounder (SSMIS)] form the "base" for structure observations due to their ability to view through upper-level clouds, modest size swaths and ability to capture most storm structure features. The NASA TRMM microwave imager and precipitation radar continue their 15+ yearlong missions in serving the TC warning and research communities. The cessation of NASA's QuikSCAT satellite after more than a decade of service is sorely missed, but India's OceanSat-2 scatterometer is now providing crucial ocean surface wind vectors in addition to the Navy's WindSat ocean surface wind vector retrievals. Another Advanced Scatterometer (ASCAT) onboard EUMETSAT's MetOp-2 satellite is slated for launch soon. Passive microwave imagery has received a much needed boost with the launch of the French/Indian Megha Tropiques imager in September 2011, basically greatly supplementing the very successful NASA TRMM pathfinder with a larger swath and more frequent temporal sampling. While initial data issues have delayed data utilization, current news indicates this data will be available in 2013. Future NASA Global Precipitation Mission (GPM) sensors starting in 2014 will provide enhanced capabilities. Also, the inclusion of the new microwave sounder data from the NPP ATMS (Oct 2011) will assist in mapping TC convective structures. The National Polar orbiting Partnership (NPP) program's VIIRS sensor includes a day night band (DNB) with the capability to view TC cloud structure at night when sufficient lunar illumination exits. Examples highlighting this new capability will be discussed in concert with additional data fusion efforts.

Building EOS capability for Malaysia - the options

Science.gov (United States)

Subari, M. D.; Hassan, A.

2014-06-01

Earth observation satellite (EOS) is currently a major tool to monitor earth dynamics and increase human understanding of earth surface process. Since the early 80s, Malaysia has been using EOS images for various applications, such as weather forecasting, land use mapping, agriculture, environment monitoring and others. Until now, all EOS images were obtained from foreign satellite systems. Realising on the strategic need of having its own capability, Malaysia embarked into EOS development programs in the early 90s. Starting with TiungSAT-1, a micro-satellite carrying small camera, then followed by RazakSAT, a small satellite carrying 2.5 m panchromatic (PAN) medium-aperture-camera, the current satellite program development, the RazakSAT-2, designed to carry a 1.0 m high resolution PAN and 4.0m multi-spectral camera, would become a strategic initiative of the government in developing and accelerating the nation's capability in the area of satellite technology and its application. Would this effort continue until all needs of the remote sensing community being fulfilled by its own EOS? This paper will analyze the intention of the Malaysian government through its National Space Policy and other related policy documents, and proposes some policy options on this. Key factors to be considered are specific data need of the EOS community, data availability and the more subjective political motivations such as national pride.

Evaluation of Current Planetary Boundary Layer Retrieval Capabilities from Space

Science.gov (United States)

Santanello, Joseph A., Jr.; Schaefer, Alexander J.; Blaisdell, John; Yorks, John

2016-01-01

The PBL over land remains a significant gap in our water and energy cycle understanding from space. This work combines unique NASA satellite and model products to demonstrate the ability of current sensors (advanced IR sounding and lidar) to retrieve PBL properties and in turn their potential to be used globally to evaluate and improve weather and climate prediction models. While incremental progress has been made in recent AIRS retrieval versions, insufficient vertical resolution remains in terms of detecting PBL properties. Lidar shows promise in terms of detecting vertical gradients (and PBLh) in the lower troposphere, but daytime conditions over land remain a challenge due to noise, and their coverage is limited to approximately 2 weeks or longer return times.

Measuring Group Care Worker Interventions in Residential Youth Care

NARCIS (Netherlands)

Bastiaanssen, I.L.W.; Kroes, G.; Nijhof, K.S.; Delsing, M.J.M.H.; Engels, R.C.M.E.; Veerman, J.W.

2012-01-01

Background By interacting with children, group care workers shape daily living environments to influence treatment. Current literature provides little knowledge about the content of youth residential care. Objective In this study, a questionnaire called the Group care worker Intervention

Mechanical ventilators in US acute care hospitals.

Science.gov (United States)

Rubinson, Lewis; Vaughn, Frances; Nelson, Steve; Giordano, Sam; Kallstrom, Tom; Buckley, Tim; Burney, Tabinda; Hupert, Nathaniel; Mutter, Ryan; Handrigan, Michael; Yeskey, Kevin; Lurie, Nicole; Branson, Richard

2010-10-01

The supply and distribution of mechanical ventilation capacity is of profound importance for planning for severe public health emergencies. However, the capability of US health systems to provide mechanical ventilation for children and adults remains poorly quantified. The objective of this study was to determine the quantity of adult and pediatric mechanical ventilators at US acute care hospitals. A total of 5,752 US acute care hospitals included in the 2007 American Hospital Association database were surveyed. We measured the quantities of mechanical ventilators and their features. Responding to the survey were 4305 (74.8%) hospitals, which accounted for 83.8% of US intensive care unit beds. Of the 52,118 full-feature mechanical ventilators owned by respondent hospitals, 24,204 (46.4%) are pediatric/neonatal capable. Accounting for nonrespondents, we estimate that there are 62,188 full-feature mechanical ventilators owned by US acute care hospitals. The median number of full-feature mechanical ventilators per 100,000 population for individual states is 19.7 (interquartile ratio 17.2-23.1), ranging from 11.9 to 77.6. The median number of pediatric-capable device full-feature mechanical ventilators per 100,000 population younger than 14 years old is 52.3 (interquartile ratio 43.1-63.9) and the range across states is 22.1 to 206.2. In addition, respondent hospitals reported owning 82,755 ventilators other than full-feature mechanical ventilators; we estimate that there are 98,738 devices other than full-feature ventilators at all of the US acute care hospitals. The number of mechanical ventilators per US population exceeds those reported by other developed countries, but there is wide variation across states in the population-adjusted supply. There are considerably more pediatric-capable ventilators than there are for adults only on a population-adjusted basis.

Alzheimer's: From Caring to Commitment

Science.gov (United States)

... Current Issue Past Issues Home Current issue contents Alzheimer's: From Caring to Commitment From Caring to Commitment ... Caring to Commitment During her sister’s battle with Alzheimer’s, Anne Murphy stayed by her side and continues ...

Communitarian claims and community capabilities: furthering priority setting?

Science.gov (United States)

Mooney, Gavin

2005-01-01

Priority setting in health care is generally not done well. This paper draws on ideas from Amartya Sen and Martha Nussbaum and adds some communitarian underpinnings to provide a way of improving on current uses of program budgeting and marginal analysis (PBMA) in priority setting. The paper suggests that shifting to a communitarian base for priority setting alters the distribution of property rights over health service decision making and increases the probability that recommendations from PBMA exercises will be implemented. The approach is built on a paradigm which departs from three tenets of welfarism as it is normally conceived: (i) individuals qua individuals seek to maximise their individual utility/well-being; (ii) individuals want to do this; and (iii) it is the values of individuals qua individuals that count. Some of the problems of PBMA, as it has been applied to date, are highlighted. It is argued that these are due largely to a lack of 'credible commitment'. Bringing in the community and communitarian values to PBMA priority setting exercises can help to overcome some of the barriers to getting PBMA recommendations implemented. The approach has the merit of reflecting Sen's concept of capabilities (but extending that to a community level). It avoids the often consequentialist base of a conventional welfarist framework, and it allows community values as opposed to individual values to come to the fore. How to elicit communitarian values is explored.

Medical capability team: the clinical microsystem for combat healthcare delivery in counterinsurgency operations.

Science.gov (United States)

Clark, Susz; Van Steenvort, Jon K

2008-01-01

Today's operational environment in the support of counterinsurgency operations requires greater tactical and operational flexibility and diverse medical capabilities. The skills and organizations required for full spectrum medical operations are different from those of the past. Combat healthcare demands agility and the capacity for rapid change in clinical systems and processes to better support the counterinsurgency environment. This article proposes the Army Medical Department (AMEDD) develop and implement the medical capability team (MCT) for combat healthcare delivery. It discusses using the concept of the brigade combat team to develop medical capability teams as the unit of effectiveness to transform frontline care; provides a theoretical overview of the MCT as a "clinical microsystem"; discusses MCT leadership, training, and organizational support, and the deployment and employment of the MCT in a counterinsurgency environment. Additionally, this article proposes that the AMEDD initiate the development of an AMEDD Combat Training Center of Excellence to train and validate the MCTs. The complexity of combat healthcare demands an agile and campaign quality AMEDD with joint expeditionary capability in order to promote the best patient outcomes in a counterinsurgency environment.

Current surgical practices in cleft care: cleft palate repair techniques and postoperative care.

Science.gov (United States)

Katzel, Evan B; Basile, Patrick; Koltz, Peter F; Marcus, Jeffrey R; Girotto, John A

2009-09-01

The purpose of this study was to objectively report practices commonly used in cleft palate repair in the United States. This study investigates current surgical techniques, postoperative care, and complication rates for cleft palate repair surgery. All 803 surgeon members of the American Cleft Palate-Craniofacial Association were sent online and/or paper surveys inquiring about their management of cleft palate patients. Three-hundred six surveys were received, a 38 percent response rate. This represented responses of surgeons from 100 percent of American Cleft Palate-Craniofacial Association registered cleft teams. Ninety-six percent of respondents perform a one-stage repair. Eighty-five percent of surgeons perform palate surgery when the patient is between 6 and 12 months of age. The most common one-stage repair techniques are the Bardach style (two flaps) with intravelar veloplasty and the Furlow palatoplasty. After surgery, 39 percent of surgeons discharge patients within 24 hours. Another 43 percent discharge patients within 48 hours. During postoperative management, 92 percent of respondents implement feeding restrictions. Eighty-five percent of physicians use arm restraints. Surgeons' self-reported complications rates are minimal: 54 percent report a fistula in less than 5 percent of cases. The reported need for secondary speech surgery varies widely. The majority of respondents repair clefts in one stage. The most frequently used repair techniques are the Furlow palatoplasty and the Bardach style with intravelar veloplasty. After surgery, the majority of surgeons discharge patients in 1 or 2 days, and nearly all surgeons implement feeding restrictions and the use of arm restraints. The varying feeding protocols are reviewed in this article.

Does Care Matter?

DEFF Research Database (Denmark)

Loft, Lisbeth Trille Gylling; Hogan, Dennis P.

2014-01-01

The aim of this study is to introduce the concept of care capital and provide an example of its application in the context of child care and maternal employment using the currently most suitable American data. We define care capital as the nexus of available, accessible, and experienced resources...... for care. The American setting is an ideal context to investigate the linkages between child care capital and maternal employment as the patterns of child care use tend to be more diverse compared to other national context. In the presented application of care capital, we examine mothers’ entry to paid......-parental child care prior to employment is independently and positively associated with the timing of maternal employment entry. This finding applies both to first-time mothers (n = 3,800) and to mothers of multiple children (n = 6,600). Although data currently available for investigating child care capital...

Clinical decision support systems in hospital care using ubiquitous devices: Current issues and challenges.

Science.gov (United States)

Baig, Mirza Mansoor; GholamHosseini, Hamid; Moqeem, Aasia A; Mirza, Farhaan; Lindén, Maria

2017-11-01

Supporting clinicians in decision making using advanced technologies has been an active research area in biomedical engineering during the past years. Among a wide range of ubiquitous systems, smartphone applications have been increasingly developed in healthcare settings to help clinicians as well as patients. Today, many smartphone applications, from basic data analysis to advanced patient monitoring, are available to clinicians and patients. Such applications are now increasingly integrating into healthcare for clinical decision support, and therefore, concerns around accuracy, stability, and dependency of these applications are rising. In addition, lack of attention to the clinicians' acceptability, as well as the low impact on the medical professionals' decision making, are posing more serious issues on the acceptability of smartphone applications. This article reviews smartphone-based decision support applications, focusing on hospital care settings and their overall impact of these applications on the wider clinical workflow. Additionally, key challenges and barriers of the current ubiquitous device-based healthcare applications are identified. Finally, this article addresses current challenges, future directions, and the adoption of mobile healthcare applications.

Measurement capabilities of the Bendix Metrology Organization

International Nuclear Information System (INIS)

Barnes, L.M.

1984-01-01

The purpose of this manual is to communicate the measurement and calibration capabilities of the Metrology Organization of the Bendix Kansas City Division. Included is a listing of the measurement types and ranges available, and the accuracies normally attainable under conditions at the Kansas City Division. Also described are currently used standards and measurement devices. The manual is divided into four major sections, each describing a broad general area of measurement: mechanical; environmental, gas, liquid; electrical; and optical and radiation

Expanding rural access to mental health care through online postgraduate nurse practitioner education.

Science.gov (United States)

Kverno, Karan; Kozeniewski, Kate

2016-12-01

Workforce shortages in mental health care are especially relevant to rural communities. People often turn to their primary care providers for mental healthcare services, yet primary care providers indicate that more education is needed to fill this role. Rural primary care nurse practitioners (NPs) are ideal candidates for educational enhancement. Online programs allow NPs to continue living and working in their communities while developing the competencies to provide comprehensive and integrated mental healthcare services. This article presents a review of current online postgraduate psychiatric mental health NP (PMHNP) options. Website descriptions of online PMHNP programs were located using keywords: PMHNP or psychiatric nurse practitioner, postgraduate or post-master's, and distance or online. Across the United States, 15 online postgraduate certificate programs were located that are designed for primary care NPs seeking additional PMHNP specialization. For rural primary care NPs who are ready, willing, and able, a postgraduate PMHNP specialty certificate can be obtained online in as few as three to four semesters. The expected outcome is a cadre of dually credentialed NPs capable of functioning in an integrated role and of increasing rural access to comprehensive mental healthcare services. ©2016 American Association of Nurse Practitioners.

Cancer Supportive and Survivorship Care in Singapore: Current Challenges and Future Outlook

Directory of Open Access Journals (Sweden)

Kiley Wei-Jen Loh

2018-02-01

Full Text Available Despite being a relatively young nation, Singapore has established itself as a leading multifaceted medical hub, both regionally and globally. Although Singapore continues to pursue excellence in oncology care, cancer supportive care and survivorship care remain in the infancy stage. In an effort to advance this important aspect of oncology care in Singapore, the first cancer supportive and survivorship care forum was held in December 2016, involving 74 oncology practitioners. The primary goals of this forum were to raise awareness of the importance of cancer supportive and survivorship care and to provide a platform for oncology practitioners of diverse backgrounds to converge and address the challenges associated with the delivery of cancer supportive and survivorship care in Singapore. Key challenges identified during this forum included, but were not limited to, care fragmentation in an oncologist-centric model of care, poor integration of allied health and rehabilitation services, passive engagement of community partners, lack of specialized skill sets and knowledge in supportive and survivorship care, and patient-related barriers such as poor health literacy. The survivorship care model commonly used in Singapore places an imbalanced emphasis on surveillance for cancer recurrence and second primary cancers, with little attention given to the supportive and survivorship needs of the survivors. In summary, these challenges set the stage for the development and use of a more survivor-centric model, one that focuses not only on cancer surveillance, but also on the broad and unique physical and psychosocial needs of survivors of cancer in Singapore.

PROGRAMS WITH DATA MINING CAPABILITIES

Directory of Open Access Journals (Sweden)

Ciobanu Dumitru

2012-03-01

Full Text Available The fact that the Internet has become a commodity in the world has created a framework for anew economy. Traditional businesses migrate to this new environment that offers many features and options atrelatively low prices. However competitiveness is fierce and successful Internet business is tied to rigorous use of allavailable information. The information is often hidden in data and for their retrieval is necessary to use softwarecapable of applying data mining algorithms and techniques. In this paper we want to review some of the programswith data mining capabilities currently available in this area.We also propose some classifications of this softwareto assist those who wish to use such software.

Developing Alliance Capabilities

DEFF Research Database (Denmark)

Heimeriks, Koen H.; Duysters, Geert; Vanhaverbeke, Wim

This paper assesses the differential performance effects of learning mechanisms on the development of alliance capabilities. Prior research has suggested that different capability levels could be identified in which specific intra-firm learning mechanisms are used to enhance a firm's alliance...

Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs.

Science.gov (United States)

Eibner, Christine; Krull, Heather; Brown, Kristine M; Cefalu, Matthew; Mulcahy, Andrew W; Pollard, Michael; Shetty, Kanaka; Adamson, David M; Amaral, Ernesto F L; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii; Mendelsohn, Joshua; Ross, Rachel; Rutter, Carolyn M; Weinick, Robin M; Woods, Dulani; Hosek, Susan D; Farmer, Carrie M

2016-05-09

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next decade, and the demographic mix and geographic locations of these veterans will change. While the number of veterans using VA health care has increased over time, demand will level off in the coming years. Veterans have more favorable economic circumstances than non-veterans, but they are also older and more likely to be diagnosed with many health conditions. Not all veterans are eligible for or use VA health care. Whether and to what extent an eligible veteran uses VA health care depends on a number of factors, including access to other sources of health care. Veterans who rely on VA health care are older and less healthy than veterans who do not, and the prevalence of costly conditions in this population is projected to increase. Potential changes to VA policy and the context for VA health care, including effects of the Affordable Care Act, could affect demand. Analysis of a range of data sources provided insight into how the veteran population is likely to change in the next decade.

Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

Science.gov (United States)

Eibner, Christine; Krull, Heather; Brown, Kristine M.; Cefalu, Matthew; Mulcahy, Andrew W.; Pollard, Michael; Shetty, Kanaka; Adamson, David M.; Amaral, Ernesto F. L.; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii; Mendelsohn, Joshua; Ross, Rachel; Rutter, Carolyn M.; Weinick, Robin M.; Woods, Dulani; Hosek, Susan D.; Farmer, Carrie M.

2016-01-01

Abstract The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next decade, and the demographic mix and geographic locations of these veterans will change. While the number of veterans using VA health care has increased over time, demand will level off in the coming years. Veterans have more favorable economic circumstances than non-veterans, but they are also older and more likely to be diagnosed with many health conditions. Not all veterans are eligible for or use VA health care. Whether and to what extent an eligible veteran uses VA health care depends on a number of factors, including access to other sources of health care. Veterans who rely on VA health care are older and less healthy than veterans who do not, and the prevalence of costly conditions in this population is projected to increase. Potential changes to VA policy and the context for VA health care, including effects of the Affordable Care Act, could affect demand. Analysis of a range of data sources provided insight into how the veteran population is likely to change in the next decade. PMID:28083423

Synthetic aperture radar capabilities in development

Energy Technology Data Exchange (ETDEWEB)

Miller, M. [Lawrence Livermore National Lab., CA (United States)

1994-11-15

The Imaging and Detection Program (IDP) within the Laser Program is currently developing an X-band Synthetic Aperture Radar (SAR) to support the Joint US/UK Radar Ocean Imaging Program. The radar system will be mounted in the program`s Airborne Experimental Test-Bed (AETB), where the initial mission is to image ocean surfaces and better understand the physics of low grazing angle backscatter. The Synthetic Aperture Radar presentation will discuss its overall functionality and a brief discussion on the AETB`s capabilities. Vital subsystems including radar, computer, navigation, antenna stabilization, and SAR focusing algorithms will be examined in more detail.

Leadership capabilities of physiotherapy leaders in Ireland: Part 1 physiotherapy managers.

Science.gov (United States)

McGowan, Emer; Elliott, Naomi; Stokes, Emma

2018-05-07

Investigation of the leadership capabilities of physiotherapists is needed to allow understanding of current leadership practice and to enable appropriate training programs to be developed. To explore physiotherapy managers´ perceptions of their leadership capabilities. Semi-structured interviews were conducted with a purposive sample of 18 physiotherapy managers from a range of public services and private practices in Ireland. The interviews were analyzed using template analysis and the coding template was based on the Bolman and Deal Leadership framework which details four leadership frames: structural, human resource, political, and symbolic. The physiotherapy managers described demonstrating leadership capabilities associated with each of the four leadership frames. However, the language used by the physiotherapy managers suggested that they work predominantly through the structural and human resource frames. The employment of capabilities associated with the political frame varied between participants; some participants described working through this frame while others reported difficulties. The symbolic frame was underused; there were fewer examples given of capabilities such as communicating their vision, demonstrating passion and facilitating a positive workplace culture. Physiotherapy managers work predominantly through the structural and human resource frames. To successfully meet the leadership requirements of their roles physiotherapy managers may benefit from specific leadership development training to develop leadership capabilities in the political and symbolic frames.

Current leads for superconducting magnets

International Nuclear Information System (INIS)

Ishibashi, Kenji

1989-01-01

Current leads for superconducting magnets have been studied since 1960's. The technology of current leads may seem to have been established both in theory and experiment before the middle of 1970's. Nevertheless, a wide variety of superconducting magnets have been introduced in the last 15 years, and the demands for special current leads have increased in accordance to the variety. A steady advance has been made in the design theory and fabrication of current leads. This paper describes the recent current lead technology regarding the design theory, safety in accidents, and high current capability. (author)

Current and emerging treatment options for nasopharyngeal carcinoma

Directory of Open Access Journals (Sweden)

Spratt DE

2012-10-01

Full Text Available Daniel E Spratt, Nancy LeeDepartment of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USAAbstract: In this article, we focus on the current and emerging treatments in nasopharyngeal cancer (NPC. A detailed evolution of the current standard of care, and new techniques and treatment options will be reviewed. Intergroup 0099 established the role for chemoradiotherapy (chemo-RT in the treatment of nasopharyngeal carcinoma. Multiple randomized Phase III trials have shown the benefit of chemo-RT; however, none of these studies utilized modern radiotherapy (RT techniques of intensity-modulated radiation therapy (IMRT. IMRT has the ability to deliver high doses of radiation to the target structures while sparing adjacent bystander healthy tissues, and has now become the preferred RT treatment modality. Chemotherapy also has had a shifting paradigm of induction and/or adjuvant chemotherapy combined with RT alone, to the investigation with concurrent chemo-RT. New treatment options including targeted monoclonal antibodies and small molecule tyrosine kinase inhibitors are being studied in NPC. These new biologic therapies have promising in vitro activity for NPC, and emerging clinical studies are beginning to define their role. RT continues to expand its capabilities, and since IMRT and particle therapy, specifically intensity-modulated proton therapy (IMPT, has reports of impressive dosimetric efficacy in-silica. Adaptive RT is attempting to reduce toxicity while maintaining treatment efficacy, and the clinical results are still in their youth. Lastly, Epstein–Barr virus (EBV DNA has recently been studied for prediction of tumor response and its use as a biomarker is increasingly promising to aid in early detection as well as supplementing the current staging system. RT with or without chemotherapy remains the standard of care for nasopharyngeal carcinoma. Advances in RT technique, timing of chemotherapy, biologically

Capabilities, innovation, and overall performance in Brazilian export firms.

Directory of Open Access Journals (Sweden)

José Ednilson de Oliveira Cabral

2015-06-01

Full Text Available This article extends the current research on innovation by investigating the relationship between innovative capabilities and export firms’ overall performance. From the perspectives of the resource-based view (RBV and dynamic capability, we examine the differential and interactive effects of exploration and exploitation capabilities in product innovation for external markets and overall performance (direct and mediated by a new product. In addition, we test the moderating effect of market dynamism and the controlling effect of firm size on these relationships. Hence, the main contribution of this article is developing and empirically testing an original model, by combining these constructs that address new relationships, in an emerging country. This model was tested with data from 498 Brazilian export firms, distributed throughout all Brazilian manufacturing sectors, by firm size, and in states. The analysis was made with application of the structural equation modeling (SEM. As a result, we found support for the assumptions that exploitation capabilities influence product innovation and overall performance, whereas exploration capabilities and their interaction to exploitation capabilities influence overall performance, but not product innovation. Additionally, the relationship between exploitation capabilities and overall performance is mediated by product innovation. Unlike hypothesized, market dynamism does not moderate the relationship between product innovation and overall performance. Furthermore, firm size works as a controlling variable in the relationships analyzed. Regarding the implications for theory, this study contributes to grasp that exploitation capabilities influences a firm’s overall performance, both directly and indirectly (via product innovation, and highlights the various direct and mediatory effects of innovation on overall performance. These insights show the importance of considering the role of mediating and

Palliative Care.

Science.gov (United States)

Swetz, Keith M; Kamal, Arif H

2018-03-06

Palliative care prioritizes symptom management and quality of life throughout the course of serious illness. Regardless of whether care is inpatient or outpatient, primary or subspecialty, a solid understanding of the basics of effective communication, symptom management, and end-of-life care is crucial. This article reviews these essentials and provides an overview of current evidence to support patient-centered palliative care.

Scientific user facilities at Oak Ridge National Laboratory: New research capabilities and opportunities

Science.gov (United States)

Roberto, James

2011-10-01

Over the past decade, Oak Ridge National Laboratory (ORNL) has transformed its research infrastructure, particularly in the areas of neutron scattering, nanoscale science and technology, and high-performance computing. New facilities, including the Spallation Neutron Source, Center for Nanophase Materials Sciences, and Leadership Computing Facility, have been constructed that provide world-leading capabilities in neutron science, condensed matter and materials physics, and computational physics. In addition, many existing physics-related facilities have been upgraded with new capabilities, including new instruments and a high- intensity cold neutron source at the High Flux Isotope Reactor. These facilities are operated for the scientific community and are available to qualified users based on competitive peer-reviewed proposals. User facilities at ORNL currently welcome more than 2,500 researchers each year, mostly from universities. These facilities, many of which are unique in the world, will be reviewed including current and planned research capabilities, availability and operational performance, access procedures, and recent research results. Particular attention will be given to new neutron scattering capabilities, nanoscale science, and petascale simulation and modeling. In addition, user facilities provide a portal into ORNL that can enhance the development of research collaborations. The spectrum of partnership opportunities with ORNL will be described including collaborations, joint faculty, and graduate research and education.

Preferences of Current and Potential Patients and Family Members Regarding Implementation of Electronic Communication Portals in Intensive Care Units.

Science.gov (United States)

Brown, Samuel M; Bell, Sigall K; Roche, Stephanie D; Dente, Erica; Mueller, Ariel; Kim, Tae-Eun; O'Reilly, Kristin; Lee, Barbara Sarnoff; Sands, Ken; Talmor, Daniel

2016-03-01

The quality of communication with patients and family members in intensive care units (ICUs) is a focus of current interest for clinical care improvement. Electronic communication portals are commonly used in other healthcare settings to improve communication. We do not know whether patients and family members desire such portals in ICUs, and if so, what functionality they should provide. To define interest in and desired elements of an electronic communication portal among current and potential ICU patients and their family members. We surveyed, via an Internet panel, 1,050 English-speaking adults residing in the United States with a personal or family history of an ICU admission within 10 years (cohort A) and 1,050 individuals without a history of such admission (cohort B). We also administered a survey instrument in person to 105 family members of patients currently admitted to ICUs at an academic medical center in Boston (cohort C). Respondents, especially current ICU family members, supported an electronic communication portal, including access via an electronic tablet. They wanted at least daily updates, one-paragraph summaries of family meetings including a list of key decisions made, and knowledge of the role and experience of treating clinicians. Overall, they preferred detailed rather than "big picture" information. Respondents were generally comfortable sharing information with their family members. Preferences regarding a communication portal varied significantly by age, sex, ethnicity, and prior experience with ICU hospitalization. Electronic communication portals appear welcome in contemporary ICUs. Frequent updates, knowledge about the professional qualifications of clinicians, detailed medical information, and documentation of family meetings are particularly desired.

Emergency department characteristics and capabilities in Bogotá, Colombia.

Science.gov (United States)

Bustos, Yury; Castro, Jenny; Wen, Leana S; Sullivan, Ashley F; Chen, Dinah K; Camargo, Carlos A

2015-12-01

Emergency departments (EDs) are a critical, yet heterogeneous, part of international emergency care. The National ED Inventories (NEDI) survey has been used in multiple countries as a standardized method to benchmark ED characteristics. We sought to describe the characteristics, resources, capabilities, and capacity of EDs in the densely populated capital city of Bogotá, Colombia. Bogotá EDs accessible to the general public 24/7 were surveyed using the 23-item NEDI survey used in several other countries ( www.emnet-nedi.org ). ED staff were asked about ED characteristics with reference to calendar year 2011. Seventy EDs participated (82 % response). Most EDs (87 %) were located in hospitals, and 83 % were independent hospital departments. The median annual ED visit volume was approximately 50,000 visits. Approximately 90 % (95 % confidence interval (CI) 80-96 %) had a contiguous layout, with medical and surgical care provided in one area. Almost all EDs saw both adults and children (91 %), while 6 % saw only adults and 3 % saw only children. Availability of technological and consultant resources in EDs was variable. Nearly every ED had cardiac monitoring (99 %, 95 % CI 92-100 %), but less than half had a dedicated CT scanner (39 %, 95 % CI 28-52 %). While most EDs were able to treat trauma 24/7 (81 %, 95 % CI 69-89 %), few could manage oncological (22 %, 95 % CI 13-34 %) or dental (3 %, 95 % CI 0-11 %) emergencies 24/7. The typical ED length-of-stay was between 1 and 6 h in 59 % of EDs (95 % CI, 46-70 %), while most others reported that patients remained for >6 h (39 %). Almost half of respondents (46 %, 95 % CI 34-59 %) reported their ED was over capacity. Bogotá EDs have high annual visit volumes and long length-of-stay, and half are over capacity. To meet the emergency care needs of people in Bogotá and other large cities, Colombia should consider improving urban ED capacity and training more emergency medicine specialists capable of efficiently staffing its

An agent-based simulation model of patient choice of health care providers in accountable care organizations.

Science.gov (United States)

Alibrahim, Abdullah; Wu, Shinyi

2018-03-01

Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.

Key Future Engineering Capabilities for Human Capital Retention

Science.gov (United States)

Sivich, Lorrie

Projected record retirements of Baby Boomer generation engineers have been predicted to result in significant losses of mission-critical knowledge in space, national security, and future scientific ventures vital to high-technology corporations. No comprehensive review or analysis of engineering capabilities has been performed to identify threats related to the specific loss of mission-critical knowledge posed by the increasing retirement of tenured engineers. Archival data from a single diversified Fortune 500 aerospace manufacturing engineering company's engineering career database were analyzed to ascertain whether relationships linking future engineering capabilities, engineering disciplines, and years of engineering experience could be identified to define critical knowledge transfer models. Chi square, logistic, and linear regression analyses were used to map patterns of discipline-specific, mission-critical knowledge using archival data of engineers' perceptions of engineering capabilities, key developmental experiences, and knowledge learned from their engineering careers. The results from the study were used to document key engineering future capabilities. The results were then used to develop a proposed human capital retention plan to address specific key knowledge gaps of younger engineers as veteran engineers retire. The potential for social change from this study involves informing leaders of aerospace engineering corporations on how to build better quality mentoring or succession plans to fill the void of lost knowledge from retiring engineers. This plan can secure mission-critical knowledge for younger engineers for current and future product development and increased global competitiveness in the technology market.

Determination of death after circulatory arrest by intensive care physicians: A survey of current practice in the Netherlands.

Science.gov (United States)

Wind, Jentina; van Mook, Walther N K A; Dhanani, Sonny; van Heurn, Ernest W L

2016-02-01

Determination of death is an essential part of donation after circulatory death (DCD). We studied the current practices of determination of death after circulatory arrest by intensive care physicians in the Netherlands, the availability of guidelines, and the occurrence of the phenomenon of autoresuscitation. The Determination of Cardiac Death Practices in Intensive Care Survey was sent to all intensive care physicians. Fifty-five percent of 568 Dutch intensive care physicians responded. Most respondents learned death determination from clinical practice. The most commonly used tests for death determination were flat arterial line tracing, flat electrocardiogram (standard 3-lead electrocardiogram), and fixed and dilated pupils. Rarely used tests were absence pulse by echo Doppler, absent blood pressure by noninvasive monitoring, and unresponsiveness to painful stimulus. No diagnostic test or procedure was uniformly performed, but 80% of respondents perceived a need for standardization of death determination. Autoresuscitation was witnessed by 37%, after withdrawal of treatment or after unsuccessful resuscitation. Extensive variability in the practice of determining death after circulatory arrest exists, and a need for guidelines and standardization, especially if organ donation follows death, is reported. Autoresuscitation is reported; this observation requires attention in further prospective observational studies. Copyright © 2015 Elsevier Inc. All rights reserved.

Transforming organizational capabilities in strategizing

DEFF Research Database (Denmark)

Jørgensen, Claus; Friis, Ole Uhrskov; Koch, Christian

2014-01-01

Offshored and networked enterprises are becoming an important if not leading organizational form and this development seriously challenges their organizational capabilities. More specifically, over the last years, SMEs have commenced entering these kinds of arrangements. As the organizational...... capabilities of SMEs are limited at the outset, even more emphasis is needed regarding the issues of developing relevant organizational capabilities. This paper aims at investigating how capabilities evolve during an offshoring process of more than 5 years in two Danish SMEs, i.e. not only short- but long......-term evolvements within the companies. We develop our framework of understanding organizational capabilities drawing on dynamic capability, relational capability and strategy as practice concepts, appreciating the performative aspects of developing new routines. Our two cases are taken from one author’s Ph...

Statistical methods for quality assurance basics, measurement, control, capability, and improvement

CERN Document Server

Vardeman, Stephen B

2016-01-01

This undergraduate statistical quality assurance textbook clearly shows with real projects, cases and data sets how statistical quality control tools are used in practice. Among the topics covered is a practical evaluation of measurement effectiveness for both continuous and discrete data. Gauge Reproducibility and Repeatability methodology (including confidence intervals for Repeatability, Reproducibility and the Gauge Capability Ratio) is thoroughly developed. Process capability indices and corresponding confidence intervals are also explained. In addition to process monitoring techniques, experimental design and analysis for process improvement are carefully presented. Factorial and Fractional Factorial arrangements of treatments and Response Surface methods are covered. Integrated throughout the book are rich sets of examples and problems that help readers gain a better understanding of where and how to apply statistical quality control tools. These large and realistic problem sets in combination with the...

Development of a Proactive Care Program (U-CARE) to Preserve Physical Functioning of Frail Older People in Primary Care

NARCIS (Netherlands)

Bleijenberg, N.; Ten Dam, V.H.; Drubbel, I.; Numans, M.E.; De Wit, N.J.; Schuurmans, M.J.

2013-01-01

Purpose: Care for older patients in primary care is currently reactive, fragmented, and time consuming. An innovative structured and proactive primary care program (U-CARE) has been developed to preserve physical functioning and enhance quality of life of frail older people. This study describes in

First Materials Science Research Facility Rack Capabilities and Design Features

Science.gov (United States)

Cobb, S.; Higgins, D.; Kitchens, L.; Curreri, Peter (Technical Monitor)

2002-01-01

The first Materials Science Research Rack (MSRR-1) is the primary facility for U.S. sponsored materials science research on the International Space Station. MSRR-1 is contained in an International Standard Payload Rack (ISPR) equipped with the Active Rack Isolation System (ARIS) for the best possible microgravity environment. MSRR-1 will accommodate dual Experiment Modules and provide simultaneous on-orbit processing operations capability. The first Experiment Module for the MSRR-1, the Materials Science Laboratory (MSL), is an international cooperative activity between NASA's Marshall Space Flight Center (MSFC) and the European Space Agency's (ESA) European Space Research and Technology Center (ESTEC). The MSL Experiment Module will accommodate several on-orbit exchangeable experiment-specific Module Inserts which provide distinct thermal processing capabilities. Module Inserts currently planned for the MSL are a Quench Module Insert, Low Gradient Furnace, and a Solidification with Quench Furnace. The second Experiment Module for the MSRR-1 configuration is a commercial device supplied by MSFC's Space Products Development (SPD) Group. Transparent furnace assemblies include capabilities for vapor transport processes and annealing of glass fiber preforms. This Experiment Module is replaceable on-orbit. This paper will describe facility capabilities, schedule to flight and research opportunities.

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

Directory of Open Access Journals (Sweden)

Ashley Sanello

2018-03-01

Full Text Available Introduction: In the United States emergency medical services (EMS protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management. Results: Protocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64% suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39% give specific parameters. Half the agencies (52% recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24% recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42% advise supplemental oxygen as needed; only seven (21% give specific parameters. In terms of considering various etiologies of AMS, 25 (76% give instructions to consider trauma, 20 (61% to consider stroke, and 18 (55% to consider seizure. Twenty-three (70% of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol. Conclusion: Protocols

[A theory on care].

Science.gov (United States)

Svandra, Philippe

2008-12-01

Trying to define the nature of care when you are a health care professional, means, inevitably, going back to the very source of your professional commitment. Caring, an essential form of responsibility for the other, is thus revealed as a way of behaving towards other people, as an active and concrete commitment testifying as much to the humanity of the one who gives it as to that of the one who receives it. Starting with the notion of the phenomenology of human capacity, Paul Ricoeur thinks of independence in terms of capacity. He calls upon work of the Indian economist Amartya Sen published in the 1980s on the notion of capabilities. This leads to conceiving disease or disability as a lack of elementary or basic capacity. According to Ricoeur, this notion of capacity can only be understood by looking at its contrary: vulnerability. In this way, only a weakened frail person can be called upon to become independent. Thus the human being, and particularly the ill human being, must be looked upon as both vulnerable, and thus suffering, and capable, and thus active.

The home care teaching and learning process in undergraduate health care degree courses.

Science.gov (United States)

Hermann, Ana Paula; Lacerda, Maria Ribeiro; Maftum, Mariluci Alves; Bernardino, Elizabeth; Mello, Ana Lúcia Schaefer Ferreira de

2017-07-01

Home care, one of the services provided by the health system, requires health practitioners who are capable of understanding its specificities. This study aimed to build a substantive theory that describes experiences of home care teaching and learning during undergraduate degree courses in nursing, pharmacy, medicine, nutrition, dentistry and occupational therapy. A qualitative analysis was performed using the grounded theory approach based on the results of 63 semistructured interviews conducted with final year students, professors who taught subjects related to home care, and recent graduates working with home care, all participants in the above courses. The data was analyzed in three stages - open coding, axial coding and selective coding - resulting in the phenomenon Experiences of home care teaching and learning during the undergraduate health care degree courses. Its causes were described in the category Articulating knowledge of home care, strategies in the category Experiencing the unique nature of home care, intervening conditions in the category Understanding the multidimensional characteristics of home care, consequences in the category Changing thinking about home care training, and context in the category Understanding home care in the health system. Home care contributes towards the decentralization of hospital care.

Short term braking capability during power interruptions for integrated matrix converter

DEFF Research Database (Denmark)

Klumpner, Christian; Blaabjerg, Frede

2004-01-01

attractive. Sinusoidal input currents and bi-directional power flow are other advantages of the matrix converter, but it is less immune to power grid disturbances compared to a standard ASD. In hoisting applications, short-term braking capability during a power outage is needed until the mechanical brake...... engages or to perform more effective a combined braking. This paper proposes a new method to provide short-term braking capability during a power outage for matrix converters. A braking chopper is needed in the clamp circuit, which allows for a drastically reduction of the capacitor size. The power flow...

Assessing the Capacity of the US Health Care System to Use Additional Mechanical Ventilators During a Large-Scale Public Health Emergency.

Science.gov (United States)

Ajao, Adebola; Nystrom, Scott V; Koonin, Lisa M; Patel, Anita; Howell, David R; Baccam, Prasith; Lant, Tim; Malatino, Eileen; Chamberlin, Margaret; Meltzer, Martin I

2015-12-01

A large-scale public health emergency, such as a severe influenza pandemic, can generate large numbers of critically ill patients in a short time. We modeled the number of mechanical ventilators that could be used in addition to the number of hospital-based ventilators currently in use. We identified key components of the health care system needed to deliver ventilation therapy, quantified the maximum number of additional ventilators that each key component could support at various capacity levels (ie, conventional, contingency, and crisis), and determined the constraining key component at each capacity level. Our study results showed that US hospitals could absorb between 26,200 and 56,300 additional ventilators at the peak of a national influenza pandemic outbreak with robust pre-pandemic planning. The current US health care system may have limited capacity to use additional mechanical ventilators during a large-scale public health emergency. Emergency planners need to understand their health care systems' capability to absorb additional resources and expand care. This methodology could be adapted by emergency planners to determine stockpiling goals for critical resources or to identify alternatives to manage overwhelming critical care need.

Conceptualising energy use and energy poverty using a capabilities framework

International Nuclear Information System (INIS)

Day, Rosie; Walker, Gordon; Simcock, Neil

2016-01-01

In this article we conceptualise energy use from a capabilities perspective, informed by the work of Amartya Sen, Martha Nussbaum and others following them. Building on this, we suggest a corresponding definition of energy poverty, as understood in the capabilities space. We argue that such an understanding provides a theoretically coherent means of comprehending the relationship between energy and wellbeing, and thus conceptualising energy deprivation, that makes sense across settings including both the global North and South: a coherence which has previously been lacking. At the same time, it has the flexibility to be deployed in a way that is sensitive to local contexts. Understanding energy use in the capabilities space also provides a means for identifying multiple sites of intervention, including some areas that are currently largely overlooked. We argue that this is advantageous for attempts to address energy poverty in the context of climate change and imperatives for the containment of aggregate energy consumption. - Highlights: •We apply the capabilities approach of Amartya Sen and Martha Nussbaum to conceptualising why energy is used and needed. •We propose a definition of energy poverty based on the capabilities approach. •We argue that this understanding integrates approaches to energy poverty from global North and South contexts. •The proposed definition of energy poverty is multi-dimensional. •This understanding opens new conceptual space for interventions to alleviate energy poverty.

Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff.

Science.gov (United States)

Villarosa, Amy R; Clark, Sally; Villarosa, Ariana C; Patterson Norrie, Tiffany; Macdonald, Susan; Anlezark, Jennifer; Srinivas, Ravi; George, Ajesh

2018-04-23

This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

COMPUTER SUPPORT SYSTEMS FOR ESTIMATING CHEMICAL TOXICITY: PRESENT CAPABILITIES AND FUTURE TRENDS

Science.gov (United States)

Computer Support Systems for Estimating Chemical Toxicity: Present Capabilities and Future Trends A wide variety of computer-based artificial intelligence (AI) and decision support systems exist currently to aid in the assessment of toxicity for environmental chemicals. T...

How Stakeholder Sensing and Anticipations Shape the Firm’s Strategic Response Capability

DEFF Research Database (Denmark)

Hallin, Carina Antonia; Andersen, Torben Juul; Ooi, Can-Seng

We outline a strategic response capability framework drawing on cognitive neuroscience to explain stakeholder sensing and anticipations as essential input to environmental analysis. Stakeholders receive stimuli from ongoing interactions with the firm and thereby sense current environmental changes...

A business analytics capability framework

Directory of Open Access Journals (Sweden)

Ranko Cosic

2015-09-01

Full Text Available Business analytics (BA capabilities can potentially provide value and lead to better organisational performance. This paper develops a holistic, theoretically-grounded and practically relevant business analytics capability framework (BACF that specifies, defines and ranks the capabilities that constitute an organisational BA initiative. The BACF was developed in two phases. First, an a priori conceptual framework was developed based on the Resource-Based View theory of the firm and a thematic content analysis of the BA literature. Second, the conceptual framework was further developed and refined using a three round Delphi study involving 16 BA experts. Changes from the Delphi study resulted in a refined and confirmed framework including detailed capability definitions, together with a ranking of the capabilities based on importance. The BACF will help academic researchers and industry practitioners to better understand the capabilities that constitute an organisational BA initiative and their relative importance. In future work, the capabilities in the BACF will be operationalised to measure their as-is status, thus enabling organisations to identify key areas of strength and weakness and prioritise future capability improvement efforts.

Sensor Alerting Capability

Science.gov (United States)

Henriksson, Jakob; Bermudez, Luis; Satapathy, Goutam

2013-04-01

There is a large amount of sensor data generated today by various sensors, from in-situ buoys to mobile underwater gliders. Providing sensor data to the users through standardized services, language and data model is the promise of OGC's Sensor Web Enablement (SWE) initiative. As the amount of data grows it is becoming difficult for data providers, planners and managers to ensure reliability of data and services and to monitor critical data changes. Intelligent Automation Inc. (IAI) is developing a net-centric alerting capability to address these issues. The capability is built on Sensor Observation Services (SOSs), which is used to collect and monitor sensor data. The alerts can be configured at the service level and at the sensor data level. For example it can alert for irregular data delivery events or a geo-temporal statistic of sensor data crossing a preset threshold. The capability provides multiple delivery mechanisms and protocols, including traditional techniques such as email and RSS. With this capability decision makers can monitor their assets and data streams, correct failures or be alerted about a coming phenomena.

Assessment of nuclear medicine capabilities in responding to a radiological terrorism event. Technical memorandum

Energy Technology Data Exchange (ETDEWEB)

Stodilka, R.Z. [Univ. of Western Ontario, Schulich School of Medicine, London, Ontario (Canada); Wilkinson, D

2006-09-15

Substantial effort has been placed into enhancing federal capabilities for responding to a Chemical, Biological, Radiological, or Nuclear (CBRN) terrorist attack. However, little emphasis has been placed on including the local-level medical responders in these efforts. In effecting response to a radiological incident, potentially useful resources to access are health care professionals with training in matters of ionizing radiation, namely: nuclear medicine physicians, radiologists, radiation oncologists, medical physicists, and technologists. In this report, we focus on Nuclear Medicine expertise in Canada, and place this expertise into the context of assisting with a radiological terrorist incident. Nuclear Medicine expertise, along with its supporting infrastructure has already been deployed in proportion to the distribution of the civilian population. Given the expectations that the civilian population places in these health care professionals, their immediate access to specialized equipment, and the delay between a radiological terrorist incident and the arrival of federal expert capabilities, it is likely that these health care professionals will play important roles in emergency response. These roles will likely be: identifying the nature of the incident, triage, decontamination, coordinating with First Responders, and communicating with the media. Acknowledging the potential value of these professionals in responding to a radiological terrorist incident, steps should be taken to enlist their support and integrate them into a coherent national strategy. (author)

Assessment of nuclear medicine capabilities in responding to a radiological terrorism event. Technical memorandum

International Nuclear Information System (INIS)

Stodilka, R.Z.; Wilkinson, D.

2006-09-01

Substantial effort has been placed into enhancing federal capabilities for responding to a Chemical, Biological, Radiological, or Nuclear (CBRN) terrorist attack. However, little emphasis has been placed on including the local-level medical responders in these efforts. In effecting response to a radiological incident, potentially useful resources to access are health care professionals with training in matters of ionizing radiation, namely: nuclear medicine physicians, radiologists, radiation oncologists, medical physicists, and technologists. In this report, we focus on Nuclear Medicine expertise in Canada, and place this expertise into the context of assisting with a radiological terrorist incident. Nuclear Medicine expertise, along with its supporting infrastructure has already been deployed in proportion to the distribution of the civilian population. Given the expectations that the civilian population places in these health care professionals, their immediate access to specialized equipment, and the delay between a radiological terrorist incident and the arrival of federal expert capabilities, it is likely that these health care professionals will play important roles in emergency response. These roles will likely be: identifying the nature of the incident, triage, decontamination, coordinating with First Responders, and communicating with the media. Acknowledging the potential value of these professionals in responding to a radiological terrorist incident, steps should be taken to enlist their support and integrate them into a coherent national strategy. (author)

Social Capital, IT Capability, and the Success of Knowledge Management Systems

Directory of Open Access Journals (Sweden)

Irene Y.L. Chen

2009-03-01

Full Text Available Many organizations have implemented knowledge management systems to support knowledge management. However, many of such systems have failed due to the lack of relationship networks and IT capability within organizations. Motivated by such concerns, this paper examines the factors that may facilitate the success of knowledge management systems. The ten constructs derived from social capital theory, resource-based view and IS success model are integrated into the current research model. Twenty-one hypotheses derived from the research model are empirically validated using a field survey of KMS users. The results suggest that social capital and organizational IT capability are important preconditions of the success of knowledge management systems. Among the posited relationships, trust, social interaction ties, IT capability do not significantly impact service quality, system quality and IT capability, respectively. Against prior expectation, service quality and knowledge quality do not significantly influence perceived KMS benefits and user satisfaction, respectively. Discussion of the results and conclusion are provided. This study then provides insights for future research avenue.

Current and emerging practice of end-of-life care in British prisons: findings from an online survey of prison nurses.

Science.gov (United States)

Papadopoulos, Irena; Lay, Margaret

2016-03-01

There are concerns about prisoners and detainees not having equal access to end-of-life care while in prison. There is a lack of existing literature about the standards of end-of-life care in UK prisons. The aim of this study was to investigate the views of current and former prison nurses with regard to the end-of-life care being provided in UK prisons. Prison nurses were invited to participate in an online survey and asked about their role in the prison, prisoners' access to healthcare facilities, and any barriers and good practices to end-of-life care. The survey included open-ended and closed questions. The closed questions were analysed using descriptive statistics. The open-ended responses were coded and grouped into themes. 31 (N=31) prison nurses responded to the survey. The reported barriers to end-of-life care included some prison regimes, lack of appropriate care and visiting facilities, lack of privacy and inadequate visiting hours. Respondents also reported examples of good practice, including having access to specialist palliative care and specialist equipment, and being able to receive visits from family and friends. The findings suggest that there is considerable variability in the end-of-life care provided to prisoners in the UK. Further research is needed in order to reduce the health inequalities and improve the quality of end-of-life care experienced by prisoners in the UK. 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/

Materials Capability Review Los Alamos National Laboratory May 4-7, 2009

Energy Technology Data Exchange (ETDEWEB)

Taylor, Antoniette J [Los Alamos National Laboratory

2009-01-01

Los Alamos National Laboratory (LANL) uses external peer review to measure and continuously improve the quality of its science, technology and engineering (STE). LANL uses capability reviews to assess the STE quality and institutional integration and to advise Laboratory Management on the current and future health of the STE. Capability reviews address the STE integration that LANL uses to meet mission requirements. STE capabilities are define to cut across directorates providing a more holistic view of the STE quality, integration to achieve mission requirements, and mission relevance. The scope of these capabilities necessitate that there will be significant overlap in technical areas covered by capability reviews (e.g ., materials research and weapons science and engineering). In addition, LANL staff may be reviewed in different capability reviews because of their varied assignments and expertise. LANL plans to perform a complete review of the Laboratory's STE capabilities (hence staff) in a three-year cycle. The principal product of an external review is a report that includes the review committee's assessments, commendations, and recommendations for STE. The Capability Review Committees serve a dual role of providing assessment of the Laboratory's technical contributions and integration towards its missions and providing advice to Laboratory Management. The assessments and advice are documented in reports prepared by the Capability Review Committees that are delivered to the Director and to the Principal Associate Director for Science, Technology and Engineering (PADSTE). This report will be used by Laboratory Management for STE assessment and planning. The report is also provided to the Department of Energy (DOE) as part of LANL's Annual Performance Plan and to the Los Alamos National Security (LANS) LLC's Science and Technology Committee (STC) as part of its responsibilities to the LANS Board of Governors. LANL has defined fourteen

Supply capability creation process: Key milestone criteria and activities

Energy Technology Data Exchange (ETDEWEB)

Verrollot, J.; Tolonen, A.; Harkonen, J.; Haapasalo, H.

2017-07-01

The article focuses on supply capability creation (SCC) within the new product development (NPD). The purpose is to establish an SCC process describing the main SCC activities and milestone criteria in preparing the supply process for new products Design/methodology/approach: The article analyses the earlier research, carries out current state analysis of six case companies regarding the SCC areas, and proposes a SCC process. Findings: The developed SCC process aims at preparing the operational supply capability for a developed new product based on the preferred, qualified and contracted suppliers and materials along the NPD process, and ultimately at the product ramp-up. Originality/value: This paper introduces a SCC process that has not been presented earlier in the literature, highlighting the important role of the SCC for successful product ramp-ups.

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

Directory of Open Access Journals (Sweden)

Tintoré M

2016-12-01

Full Text Available Mar Tintoré,1 Maggie Alexander,2 Kathleen Costello,3 Martin Duddy,4 David E Jones,5 Nancy Law,6 Gilmore O’Neill,7 Antonio Uccelli,8 Robert Weissert,9 Sibyl Wray10 1Multiple Sclerosis Centre of Catalonia, Hospital Vall d’Hebron, Barcelona, Spain; 2European Multiple Sclerosis Platform, Brussels, Belgium; 3National Multiple Sclerosis Society, Denver, CO, USA; 4Royal Victoria Infirmary, Newcastle-upon-Tyne, UK; 5Department of Neurology, University of Virginia, Charlottesville, VA, USA; 6Nancy Law Consulting LLC, Parker, CO, USA; 7Biogen, Cambridge, MA, USA; 8Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; 9Department of Neurology, University of Regensburg, Regensburg, Germany; 10Hope Neurology Multiple Sclerosis Center, Knoxville, TN, USA Background: Managing multiple sclerosis (MS treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. Methods: A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. Results: A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT; satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment

Core Capabilities and Technical Enhancement -- FY-98 Annual Report

Energy Technology Data Exchange (ETDEWEB)

Miller, David Lynn

1999-04-01

The Core Capability and Technical Enhancement (CC&TE) Program, a part of the Verification, Validation, and Engineering Assessment Program, was implemented to enhance and augment the technical capabilities of the Idaho National Engineering and Environmental Laboratory (INEEL). The purpose for strengthening the technical capabilities of the INEEL is to provide the technical base to serve effectively as the Environmental Management Laboratory for the Office of Environmental Management (EM). An analysis of EM's science and technology needs as well as the technology investments currently being made by EM across the complex was used to formulate a portfolio of research activities designed to address EM's needs without overlapping work being done elsewhere. An additional purpose is to enhance and maintain the technical capabilities and research infrastructure at the INEEL. This is a progress report for fiscal year 1998 for the five CC&TE research investment areas: (a) transport aspects of selective mass transport agents, (b) chemistry of environmental surfaces, (c) materials dynamics, (d) characterization science, and (e) computational simulation of mechanical and chemical systems. In addition to the five purely technical research areas, this report deals with the science and technology foundations element of the CC&TE from the standpoint of program management and complex-wide issues. This report also provides details of ongoing and future work in all six areas.

Core capabilities and technical enhancement, FY-98 annual report

Energy Technology Data Exchange (ETDEWEB)

Miller, D.L.

1999-04-01

The Core Capability and Technical Enhancement (CCTE) Program, a part of the Verification, Validation, and Engineering Assessment Program, was implemented to enhance and augment the technical capabilities of the Idaho National Engineering and Environmental Laboratory (INEEL). The purpose for strengthening the technical capabilities of the INEEL is to provide the technical base to serve effectively as the Environmental Management Laboratory for the Department of Energy's Office of Environmental Management (EM). An analysis of EM's science and technology needs as well as the technology investments currently being made by EM across the complex was used to formulate a portfolio of research activities designed to address EM's needs without overlapping work being done elsewhere. An additional purpose is to enhance and maintain the technical capabilities and research infrastructure at the INEEL. This is a progress report for fiscal year 1998 for the five CCTE research investment areas: (a) transport aspects of selective mass transport agents, (b) chemistry of environmental surfaces, (c) materials dynamics, (d) characterization science, and (e) computational simulation of mechanical and chemical systems. In addition to the five purely technical research areas, this report deals with the science and technology foundations element of the CCTE from the standpoint of program management and complex-wide issues. This report also provides details of ongoing and future work in all six areas.

Diagnosed, identified, current and complete depression among patients attending primary care in southern Catalonia: different aspects of the same concept.

Science.gov (United States)

Montesó-Curto, Pilar; Ferré-Grau, Carme; Lleixà-Fortuño, Mar; Albacar-Riobóo, Nuria; Lejeune, Marylene

2014-02-01

The aims of this study were to explore the prevalence and the conceptualizations of depression detected by the healthcare system, identified by the patient or classified/identified in the validated Goldberg's questionnaire in a community. We conducted a cross-sectional evaluation of 317 patients. The different types of depression diagnosed, identified, current or total were stratified by age and gender groups. The difference in the conceptualization of depression from the medical or ordinary people point of view indicate that depression care requires the understanding of the lifestyle, beliefs, attitudes, family and social networks of the people the physicians and nurses care for. © 2014.

Long-term care of the elderly: Current status, policies and dilemmas

Directory of Open Access Journals (Sweden)

Matković Gordana

2012-01-01

Full Text Available In Serbia, the long-term care as a system does not actually exist. One part of the system is regulated through cash benefits, one part through institutional social care and community-based social services, and one part is just being established under the health care system. The linkages among these segments are not strong and there is insufficient awareness of the need to regard the different parts of the system as being interdependent and interconnected. According to the different surveys, home care is needed for the daily functioning of more than 80,000 elderly people, especially for around 27,000 of those who are completely immobile. More than 300 thousand elderly persons have indicated that they are in need of some type of self-care support. By tradition, elderly people in Serbia rely primarily on family support. Some are getting the state support as well. Research shows that 62 thousand elderly persons (5 percent receive attendance allowance; 9,000 elderly are accommodated in institutions (0.7 percent, while 11.7 thousand (1 percent persons received some type of support through home care community based services. In addition, in Belgrade there are also 2,000 elderly who are beneficiaries of medical and palliative care at home. The government expenditures for these purposes can be very roughly estimated at 0.55 percent of GDP, largely for cash benefits (0.37 percent. Considered over a medium and longer term, the government expenditures on longterm care in Serbia will inevitably increase significantly, primarily due to an increase in the number and share of elderly people and the increase in additional life years spent in ill health or in need of assistance. An increase in the expenditures will also be influenced by a change in the family models and the increasing number of elderly that will be living alone, as well as the diminishing possibilities for reliance on the closest family members, especially due to emigration flows both at local

Building EOS capability for Malaysia – the options

International Nuclear Information System (INIS)

Subari, M D; Hassan, A

2014-01-01

Earth observation satellite (EOS) is currently a major tool to monitor earth dynamics and increase human understanding of earth surface process. Since the early 80s, Malaysia has been using EOS images for various applications, such as weather forecasting, land use mapping, agriculture, environment monitoring and others. Until now, all EOS images were obtained from foreign satellite systems. Realising on the strategic need of having its own capability, Malaysia embarked into EOS development programs in the early 90s. Starting with TiungSAT-1, a micro-satellite carrying small camera, then followed by RazakSAT, a small satellite carrying 2.5 m panchromatic (PAN) medium-aperture-camera, the current satellite program development, the RazakSAT-2, designed to carry a 1.0 m high resolution PAN and 4.0m multi-spectral camera, would become a strategic initiative of the government in developing and accelerating the nation's capability in the area of satellite technology and its application. Would this effort continue until all needs of the remote sensing community being fulfilled by its own EOS? This paper will analyze the intention of the Malaysian government through its National Space Policy and other related policy documents, and proposes some policy options on this. Key factors to be considered are specific data need of the EOS community, data availability and the more subjective political motivations such as national pride

Identifying and acting on potentially inappropriate care? Inadequacy of current hospital coding for this task.

Science.gov (United States)

Cooper, P David; Smart, David R

2017-06-01

Recent Australian attempts to facilitate disinvestment in healthcare, by identifying instances of 'inappropriate' care from large Government datasets, are subject to significant methodological flaws. Amongst other criticisms has been the fact that the Government datasets utilized for this purpose correlate poorly with datasets collected by relevant professional bodies. Government data derive from official hospital coding, collected retrospectively by clerical personnel, whilst professional body data derive from unit-specific databases, collected contemporaneously with care by clinical personnel. Assessment of accuracy of official hospital coding data for hyperbaric services in a tertiary referral hospital. All official hyperbaric-relevant coding data submitted to the relevant Australian Government agencies by the Royal Hobart Hospital, Tasmania, Australia for financial year 2010-2011 were reviewed and compared against actual hyperbaric unit activity as determined by reference to original source documents. Hospital coding data contained one or more errors in diagnoses and/or procedures in 70% of patients treated with hyperbaric oxygen that year. Multiple discrete error types were identified, including (but not limited to): missing patients; missing treatments; 'additional' treatments; 'additional' patients; incorrect procedure codes and incorrect diagnostic codes. Incidental observations of errors in surgical, anaesthetic and intensive care coding within this cohort suggest that the problems are not restricted to the specialty of hyperbaric medicine alone. Publications from other centres indicate that these problems are not unique to this institution or State. Current Government datasets are irretrievably compromised and not fit for purpose. Attempting to inform the healthcare policy debate by reference to these datasets is inappropriate. Urgent clinical engagement with hospital coding departments is warranted.

Campus Capability Plan

Energy Technology Data Exchange (ETDEWEB)

Adams, C. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Arsenlis, T. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Bailey, A. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Bergman, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Brase, J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Brenner, J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Camara, L. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Carlton, H. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Cheng, J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Chrzanowski, P. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Colson, J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); East, D. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Farrell, J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Ferranti, L. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Gursahani, A. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hansen, R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Helms, L. L. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hernandez, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Jeffries, J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Larson, D. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Lu, K. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); McNabb, D. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Mercer, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Skeate, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Sueksdorf, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Zucca, B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Le, D. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Ancria, R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Scott, J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Leininger, L. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Gagliardi, F. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Gash, A. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Bronson, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Chung, B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hobson, B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Meeker, J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Sanchez, J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Zagar, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Quivey, B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Sommer, S. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Atherton, J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

2017-06-06

Lawrence Livermore National Laboratory Campus Capability Plan for 2018-2028. Lawrence Livermore National Laboratory (LLNL) is one of three national laboratories that are part of the National Nuclear Security Administration. LLNL provides critical expertise to strengthen U.S. security through development and application of world-class science and technology that: Ensures the safety, reliability, and performance of the U.S. nuclear weapons stockpile; Promotes international nuclear safety and nonproliferation; Reduces global danger from weapons of mass destruction; Supports U.S. leadership in science and technology. Essential to the execution and continued advancement of these mission areas are responsive infrastructure capabilities. This report showcases each LLNL capability area and describes the mission, science, and technology efforts enabled by LLNL infrastructure, as well as future infrastructure plans.

The perceived impact of public involvement in palliative care in a provincial palliative care network in the Netherlands : a qualitative study

NARCIS (Netherlands)

Henk van Rijswijk; Esther Stoffers; Anna Beurskens; M. Beckers; F.A. Haarsma; Albine Moser

2015-01-01

Background and objective Public involvement in palliative care is challenging and difficult, because people in need of palliative care are often not capable of speaking up for themselves. Patient representatives advocate for their common interests. The aim of our study was to examine in depth the

Indonesian heath care and the economic crisis: is managed care the needed reform?

Science.gov (United States)

Hotchkiss, D R; Jacobalis, S

1999-03-01

The ramifications of the current economic crisis are being felt throughout Asia, but problems are particularly acute in Indonesia; in the midst of high inflation and unemployment the government is considering expanding managed care reform. In this paper, we discuss the impact of the recent economic crisis on the health sector in Indonesia, and analyze the potential for implementing effective reform following the managed care model. The health sector is discussed, highlighting pre-existing problems in the health care supply environment. The determinants of the economic crisis are summarized, and the broad impacts of the crisis to date on the health sector are assessed. Next the prospects for success of current managed-care reform proposals are examined in some detail: viability of expanded managed care reform measures are assessed in light of the continuing crisis and its likely impacts on the consumers and suppliers of health care. Analysis of the potential impact of the continuing crisis focuses on key participants in health care reform: households, the government, and private health care providers. In conclusion the potential viability of managed care appears poor, given the current economic, political, and institutional conditions and likely future impacts, and suggest some alternative reform measures.

Self-reported interoceptive awareness in primary care patients with past or current low back pain

Directory of Open Access Journals (Sweden)

Mehling WE

2013-05-01

Full Text Available Wolf E Mehling,1,2 Jennifer Daubenmier,1,3 Cynthia J Price,5 Mike Acree,1 Elizabeth Bartmess,1 Anita L Stewart41Osher Center for Integrative Medicine, 2Department of Family and Community Medicine, 3Department of Medicine, 4School of Nursing, Institute for Health and Aging, University of California, San Francisco, CA, 5School of Nursing, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USABackground: Mind–body interactions play a major role in the prognosis of chronic pain, and mind–body therapies such as meditation, yoga, Tai Chi, and Feldenkrais presumably provide benefits for pain patients. The Multidimensional Assessment of Interoceptive Awareness (MAIA scales, designed to measure key aspects of mind–body interaction, were developed and validated with individuals practicing mind–body therapies, but have never been used in pain patients.Methods: We administered the MAIA to primary care patients with past or current low back pain and explored differences in the performance of the MAIA scales between this and the original validation sample. We compared scale means, exploratory item cluster and confirmatory factor analyses, scale–scale correlations, and internal-consistency reliability between the two samples and explored correlations with validity measures.Results: Responses were analyzed from 435 patients, of whom 40% reported current pain. Cross-sectional comparison between the two groups showed marked differences in eight aspects of interoceptive awareness. Factor and cluster analyses generally confirmed the conceptual model with its eight dimensions in a pain population. Correlations with validity measures were in the expected direction. Internal-consistency reliability was good for six of eight MAIA scales. We provided specific suggestions for their further development.Conclusion: Self-reported aspects of interoceptive awareness differ between primary care patients with past or current

Systems Engineering for Space Exploration Medical Capabilities

Science.gov (United States)

Mindock, Jennifer; Reilly, Jeffrey; Rubin, David; Urbina, Michelle; Hailey, Melinda; Hanson, Andrea; Burba, Tyler; McGuire, Kerry; Cerro, Jeffrey; Middour, Chris;

Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data.

Science.gov (United States)

Loresto, Figaro L; Jupiter, Daniel; Kuo, Yong-Fang

2017-06-01

Few studies have examined differences in functional, cognitive, and psychological factors between patients utilizing only nurse practitioners (NPs) and those utilizing only primary care medical doctors (PCMDs) for primary care. Patients utilizing NP-only or PCMD-only models for primary care will be characterized and compared in terms of functional, cognitive, and psychological factors. Cohorts were obtained from the Medicare Current Beneficiary Survey linked to Medicare claims data. Weighted analysis was conducted to compare the patients within the two care models in terms of functional, cognitive, and psychological factors. From 2007 to 2013, there was a 170% increase in patients utilizing only NPs for primary care. In terms of health status, patients utilizing only NPs in their primary care were not statistically different from patients utilizing only PCMDs. There is a perception that NPs, as compared with PCMDs, tend to provide care to healthier patients. Our results are contrary to this perception. In terms of health status, NP-only patients are similar to PCMD-only patients. Results of this study may inform research comparing NP-only care and PCMD-only care using Medicare and the utilization of NPs in primary care. ©2017 American Association of Nurse Practitioners.

Development of students learning capabilities and professional capabilities

DEFF Research Database (Denmark)

Ringtved, Ulla Lunde; Wahl, Christian; Belle, Gianna

This paper describes the work-in-progress on a project that aims todevelop a tool that via learning analytic methods enable studentsto enhance, document and assess the development of their learningcapabilities and professional capabilities in consequence of theirself-initiated study activities...... during their bachelor educations. Thetool aims at enhancing the development of students’ capabilities toself-initiate, self-regulate and self-assess their study activities.The tool uses the concept of collective intelligence as source formotivation and inspiration in self-initiating study activities...... as wellas self-assessing them. The tool is based on a heutagogical approachto support reflection on learning potential in these activities. Thisenhances the educational use of students self-initiated learningactivities by bringing visibility and evidence to them, and therebybringing value to the assessment...

Decreased suicide rate after induced abortion, after the Current Care Guidelines in Finland 1987-2012.

Science.gov (United States)

Gissler, Mika; Karalis, Elina; Ulander, Veli-Matti

2015-02-01

Women with a recent induced abortion have a 3-fold risk for suicide, compared to non-pregnant women. The increased risk was recognised in unofficial guidelines (1996) and Current Care Guidelines (2001) on abortion treatment, highlighting the importance of a check-up 2 - 3 weeks after the termination, to monitor for mental health disorders. We studied the suicide trends after induced abortion in 1987 - 2012 in Finland. We linked the Register on Induced Abortions (N = 284,751) and Cause-of-Death Register (N = 3798 suicides) to identify women who had committed suicide within 1 year after an induced abortion (N = 79). The abortion rates per 100,000 person-years were calculated for 1987 - 1996 (period with no guidelines), 1997 - 2001 (with unofficial guidelines) and 2002 - 2012 (with Current Care Guidelines). The suicide rate after induced abortion declined by 24%, from 32.4/100,000 in 1987 - 1996 to 24.3/100,000 in 1997 - 2001 and then 24.8/100,000 in 2002 - 2012. The age-adjusted suicide rate among women aged 15 - 49 decreased by 13%; from 11.4/100,000 to 10.4/100,000 and 9.9/100,000, respectively. After induced abortions, the suicide rate increased by 30% among teenagers (to 25/100,000), stagnated for women aged 20 - 24 (at 32/100,000), but decreased by 43% (to 21/100,000) for women aged 25 - 49. The excess risk for suicide after induced abortion decreased, but the change was not statistically significant. Women with a recent induced abortion still have a 2-fold suicide risk. A mandatory check-up may decrease this risk. The causes for the increased suicide risk, including mental health prior to pregnancy and the social circumstances, should be investigated further. © 2014 the Nordic Societies of Public Health.

Identifying the barriers and enablers to palliative care nurses' recognition and assessment of delirium symptoms: a qualitative study.

Science.gov (United States)

Hosie, Annmarie; Lobb, Elizabeth; Agar, Meera; Davidson, Patricia M; Phillips, Jane

2014-11-01

Delirium is underrecognized by nurses, including those working in palliative care settings where the syndrome occurs frequently. Identifying contextual factors that support and/or hinder palliative care nurses' delirium recognition and assessment capabilities is crucial, to inform development of clinical practice and systems aimed at improving patients' delirium outcomes. The aim of the study was to identify nurses' perceptions of the barriers and enablers to recognizing and assessing delirium symptoms in palliative care inpatient settings. A series of semistructured interviews, guided by critical incident technique, were conducted with nurses working in Australian palliative care inpatient settings. A hypoactive delirium vignette prompted participants' recall of delirium and identification of the perceived factors (barriers and enablers) that impacted on their delirium recognition and assessment capabilities. Thematic content analysis was used to analyze the qualitative data. Thirty participants from nine palliative care services provided insights into the barriers and enablers of delirium recognition and assessment in the inpatient setting that were categorized as patient and family, health professional, and system level factors. Analysis revealed five themes, each reflecting both identified barriers and current and/or potential enablers: 1) value in listening to patients and engaging families, 2) assessment is integrated with care delivery, 3) respecting and integrating nurses' observations, 4) addressing nurses' delirium knowledge needs, and 5) integrating delirium recognition and assessment processes. Supporting the development of palliative care nursing delirium recognition and assessment practice requires attending to a range of barriers and enablers at the patient and family, health professional, and system levels. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Capitalizing on capabilities.

Science.gov (United States)

Ulrich, Dave; Smallwood, Norm

2004-06-01

By making the most of organizational capabilities--employees' collective skills and fields of expertise--you can dramatically improve your company's market value. Although there is no magic list of proficiencies that every organization needs in order to succeed, the authors identify 11 intangible assets that well-managed companies tend to have: talent, speed, shared mind-set and coherent brand identity, accountability, collaboration, learning, leadership, customer connectivity, strategic unity, innovation, and efficiency. Such companies typically excel in only three of these capabilities while maintaining industry parity in the other areas. Organizations that fall below the norm in any of the 11 are likely candidates for dysfunction and competitive disadvantage. So you can determine how your company fares in these categories (or others, if the generic list doesn't suit your needs), the authors explain how to conduct a "capabilities audit," describing in particular the experiences and findings of two companies that recently performed such audits. In addition to highlighting which intangible assets are most important given the organization's history and strategy, this exercise will gauge how well your company delivers on its capabilities and will guide you in developing an action plan for improvement. A capabilities audit can work for an entire organization, a business unit, or a region--indeed, for any part of a company that has a strategy to generate financial or customer-related results. It enables executives to assess overall company strengths and weaknesses, senior leaders to define strategy, midlevel managers to execute strategy, and frontline leaders to achieve tactical results. In short, it helps turn intangible assets into concrete strengths.

Maximum field capability of energy saver superconducting magnets

International Nuclear Information System (INIS)

Turkot, F.; Cooper, W.E.; Hanft, R.; McInturff, A.

1983-01-01

At an energy of 1 TeV the superconducting cable in the Energy Saver dipole magnets will be operating at ca. 96% of its nominal short sample limit; the corresponding number in the quadrupole magnets will be 81%. All magnets for the Saver are individually tested for maximum current capability under two modes of operation; some 900 dipoles and 275 quadrupoles have now been measured. The dipole winding is composed of four individually wound coils which in general come from four different reels of cable. As part of the magnet fabrication quality control a short piece of cable from both ends of each reel has its critical current measured at 5T and 4.3K. In this paper the authors describe and present the statistical results of the maximum field tests (including quench and cycle) on Saver dipole and quadrupole magnets and explore the correlation of these tests with cable critical current

Network Communication as a Service-Oriented Capability

Energy Technology Data Exchange (ETDEWEB)

Johnston, William; Johnston, William; Metzger, Joe; Collins, Michael; Burrescia, Joseph; Dart, Eli; Gagliardi, Jim; Guok, Chin; Oberman, Kevin; O' Conner, Mike

2008-01-08

In widely distributed systems generally, and in science-oriented Grids in particular, software, CPU time, storage, etc., are treated as"services" -- they can be allocated and used with service guarantees that allows them to be integrated into systems that perform complex tasks. Network communication is currently not a service -- it is provided, in general, as a"best effort" capability with no guarantees and only statistical predictability. In order for Grids (and most types of systems with widely distributed components) to be successful in performing the sustained, complex tasks of large-scale science -- e.g., the multi-disciplinary simulation of next generation climate modeling and management and analysis of the petabytes of data that will come from the next generation of scientific instrument (which is very soon for the LHC at CERN) -- networks must provide communication capability that is service-oriented: That is it must be configurable, schedulable, predictable, and reliable. In order to accomplish this, the research and education network community is undertaking a strategy that involves changes in network architecture to support multiple classes of service; development and deployment of service-oriented communication services, and; monitoring and reporting in a form that is directly useful to the application-oriented system so that it may adapt to communications failures. In this paper we describe ESnet's approach to each of these -- an approach that is part of an international community effort to have intra-distributed system communication be based on a service-oriented capability.

Radiation in pediatric health care: current situation and challenges in the Philippines

International Nuclear Information System (INIS)

Cabrera, Maria Gladys R.

2009-01-01

Radiation exposure to human health has been the topic of much research to date, focusing particularly on children as they are especially vulnerable and have longer life span to develop log term health effects. Taking into account the higher vulnerability of children, prevention of unnecessary radiation exposure is critical in pediatric patients. Issues such as pediatric patient receive a higher dose than necessary has been identified because adult computed tomography (CT) settings are used for children. Assessment of population exposures resulting from medical use of radiation is mainly available in industrialized countries, while in developing countries such as the Philippines, data are scarce. This information is very much scarce in the field of pediatric medical exposures and appropriate national surveys including frequency of pediatric procedures and children doses are still lacking. A broader and more effective participation of the regulatory authorities in such surveys could contribute to children risk assessment. The presentation explains the current situation, approach and challenges in the Philippines in dealing with radiation in pediatric health care. (author)

Advanced DNA-Based Point-of-Care Diagnostic Methods for Plant Diseases Detection

OpenAIRE

Lau, Han Yih; Botella, Jose R.

2017-01-01

Diagnostic technologies for the detection of plant pathogens with point-of-care capability and high multiplexing ability are an essential tool in the fight to reduce the large agricultural production losses caused by plant diseases. The main desirable characteristics for such diagnostic assays are high specificity, sensitivity, reproducibility, quickness, cost efficiency and high-throughput multiplex detection capability. This article describes and discusses various DNA-based point-of care di...

Current perceptions of the term Clinical Pharmacy and its relationship to Pharmaceutical Care: a survey of members of the European Society of Clinical Pharmacy.

Science.gov (United States)

Dreischulte, Tobias; Fernandez-Llimos, Fernando

2016-12-01

Background The definitions that are being used for the terms 'clinical pharmacy' and 'pharmaceutical care' seem to have a certain overlap. Responsibility for therapy outcomes seems to be especially linked to the latter term. Both terms need clarification before a proper definition of clinical pharmacy can be drafted. Objective To identify current disagreements regarding the term 'Clinical Pharmacy' and its relationship to 'Pharmaceutical Care' and to assess to which extent pharmacists with an interest in Clinical Pharmacy are willing to accept responsibility for drug therapy outcomes. Setting The membership of the European Society of Clinical Pharmacy. Methods A total of 1,285 individuals affiliated with the European Society of Clinical Pharmacy were invited by email to participate in an online survey asking participants to state whether certain professional activities, providers, settings, aims and general descriptors constituted (a) 'Clinical Pharmacy only', (b) 'Pharmaceutical Care only', (c) 'both' or (d) 'neither'. Further questions examined pharmacists' willingness to accept ethical or legal responsibility for drug therapy outcomes, under current and ideal working conditions. Main outcome measures Level of agreement with a number of statements. Results There was disagreement (responsibility under current/ideal working conditions were: safety (32.7%/64.3%), effectiveness (17.9%/49.2%), patient-centeredness (17.1%/46.2%), cost-effectiveness (20.3%/44.0%). Conclusions The survey identified key disagreements around the term 'Clinical Pharmacy' and its relationship to 'Pharmaceutical Care', which future discussions around a harmonised definition of 'Clinical Pharmacy' should aim to resolve. Further research is required to understand barriers and facilitators to pharmacists accepting responsibility for drug therapy outcomes.

The evolution of alliance capabilities

NARCIS (Netherlands)

Heimeriks, K.H.; Duysters, G.M.; Vanhaverbeke, W.P.M.

2004-01-01

This paper assesses the effectiveness and differential performance effects of learning mechanisms on the evolution of alliance capabilities. Relying on the concept of capability lifecycles, prior research has suggested that different capability levels could be identified in which different

Partnership for the Revitalization of National Wind Tunnel Force Measurement Capability

Science.gov (United States)

Rhew, Ray D.; Skelley, Marcus L.; Woike, Mark R.; Bader, Jon B.; Marshall, Timothy J.

2009-01-01

Lack of funding and lack of focus on research over the past several years, coupled with force measurement capabilities being decentralized and distributed across the National Aeronautics and Space Administration (NASA) research centers, has resulted in a significant erosion of (1) capability and infrastructure to produce and calibrate force measurement systems; (2) NASA s working knowledge of those systems; and (3) the quantity of high-quality, full-capability force measurement systems available for use in aeronautics testing. Simultaneously, and at proportional rates, the capability of industry to design, manufacture, and calibrate these test instruments has been eroding primarily because of a lack of investment by the aeronautics community. Technical expertise in this technology area is a core competency in aeronautics testing; it is highly specialized and experience-based, and it represents a niche market for only a few small precision instrument shops in the United States. With this backdrop, NASA s Aeronautics Test Program (ATP) chartered a team to examine the issues and risks associated with the problem, focusing specifically on strain- gage balances. The team partnered with the U.S. Air Force s Arnold Engineering Development Center (AEDC) to exploit their combined capabilities and take a national level government view of the problem. This paper describes the team s approach, its findings, and its recommendations, and the current status for revitalizing the government s balance capability with respect to designing, fabricating, calibrating, and using the instruments.

Optical Design Capabilities at Lawrence Livermore National Laboratory

International Nuclear Information System (INIS)

Lawson, J.K.

2002-01-01

Optical design capabilities continue to play the same strong role at Lawrence Livermore National Laboratory (LLNL) that they have played in the past. From defense applications to the solid-state laser programs to the Atomic Vapor Laser Isotope Separation (AVLIS), members of the optical design group played critical roles in producing effective system designs and are actively continuing this tradition. This talk will explain the role optical design plays at LLNL, outline current capabilities and summarize a few activities in which the optical design team has been recently participating. Among the many optical engineers working at LLNL, a distinct group exists which specializes in optical design issues. The optical design group collectively has a wide range of fields of expertise as well as a diversity of background histories including LLNL, university, industry and aerospace experience. This unique resource has resulted many effective and productive designs for customers at LLNL and outside the lab.

Capturing Firms’ Heterogeneity through Marketing and IT Capabilities in SMEs

Directory of Open Access Journals (Sweden)

María A. Ramón-Jerónimo

2017-11-01

Full Text Available To achieve sustainability, firms capable of surviving economic recessions is of key relevance; the capabilities that firms need to face dynamic environments remain an open question. In this work, a new procedure is proposed to capture firms’ heterogeneity with regard to the capabilities they possess in operating efficiently in dynamic environments. This approach enables the identification of the classes of firms that develop efficiency with a specific integration of resources. While the literature has most often measured firm capabilities using subjective measures, this study suggests the use of Data Envelopment Analysis to capture the ability to transform resources into outcomes and of Latent Class Regression to capture differences across firms that explain firms’ heterogeneity in the way they perform. By combining these two techniques, this work presents a way to identify those firms that need to invest in and develop certain capabilities. This work analyses a large dataset of manufacturing Small Medium Enterprises (SMEs extracted from the Business and Strategy survey provided by Fundación de la Sociedad Estatal de Participaciones Industriales( SEPI in Spain. The dataset used enfolds 10,960 observations from 2048 firms during the period 1994–2011. The complete dataset has been employed to calculate manufacturing firms’ efficiency. In a second step, data were cleaned to eliminate outliers, and to identify SMEs and observations with records of IT capabilities. As a result, 329 manufacturing SMEs were analysed to capture their heterogeneity. The results contribute to the current literature by explaining how manufacturing SMEs show a different need in their development of capabilities to be efficient and adapt to environmental changes. While approximately 20% of firms analysed really take advantage of recessions through their investment in R&D, the remaining 80% need to adjust their size or invest in IT capabilities to become competitive

Security, Violent Events, and Anticipated Surge Capabilities of Emergency Departments in Washington State

Science.gov (United States)

Weyand, Jonathan S.; Junck, Emily; Kang, Christopher S.; Heiner, Jason D.

2017-01-01

Introduction Over the past 15 years, violent threats and acts against hospital patients, staff, and providers have increased and escalated. The leading area for violence is the emergency department (ED) given its 24/7 operations, role in patient care, admissions gateway, and center for influxes during acute surge events. This investigation had three objectives: to assess the current security of Washington State EDs; to estimate the prevalence of and response to threats and violence in Washington State EDs; and to appraise the Washington State ED security capability to respond to acute influxes of patients, bystanders, and media during acute surge events. Methods A voluntary, blinded, 28-question Web-based survey developed by emergency physicians was electronically delivered to all 87 Washington State ED directors in January 2013. We evaluated responses by descriptive statistical analyses. Results Analyses occurred after 90% (78/87) of ED directors responded. Annual censuses of the EDs ranged from violent threats or acts occurring in their ED. Of these, 93% were directed towards nursing staff, 90% towards physicians, 74% towards security personnel, and 51% towards administrative personnel. Nearly half (48%) noted incidents directed towards another patient, and 50% towards a patient’s family or friend. These events were variably reported to the hospital administration. After an acute surge event, 35% believed the initial additional security response would not be adequate, with 26% reporting no additional security would be available within 15 minutes. Conclusion Our study reveals the variability of ED security staffing and a heterogeneity of capabilities throughout Washington State. These deficiencies and vulnerabilities highlight the need for other EDs and regional emergency preparedness planners to conduct their own readiness assessments. PMID:28435498

Aquantis Ocean Current Turbine Development Project Report

Energy Technology Data Exchange (ETDEWEB)

Fleming, Alex J.

2014-08-23

The Aquantis® Current Plane (“C-Plane”) technology developed by Dehlsen Associates, LLC (DA) and Aquantis, Inc. is an ocean current turbine designed to extract kinetic energy from ocean currents. The technology is capable of achieving competitively priced base-load, continuous, and reliable power generation from a source of renewable energy not before possible in this scale or form.

Parent Experiences with State Child Care Subsidy Systems and Their Perceptions of Choice and Quality in Care Selected

Science.gov (United States)

Raikes, Helen; Torquati, Julia; Wang, Cixin; Shjegstad, Brinn

2012-01-01

Research Findings: This study investigated parents' experiences using Child Care and Development Fund and other state-dispersed child care subsidies, reasons for choosing their current child care program, and perceptions of the quality of child care received from their current program. A telephone survey of 659 parents receiving child care…

Current trends in Canadian health care: myths and misconceptions in health economics.

Science.gov (United States)

Coyte, P C

1990-01-01

This paper is concerned with the economic aspects of the trends in Canadian health care. Various myths and misconceptions abound regarding the applicability of economics to behaviour in the health care industry as well as to the interpretation of recent trends. Both issues are examined in this paper. While most discussions regarding health care trends begin with the share of health expenditures in Gross National Product, I propose an alternative share that adjusts for cyclical variations in both unemployment and labour force participation. Using this measure, I show that the "real" growth of resources devoted to the health care industry is much larger than that obtained with conventional measures, and that the difference in growth rates between Canada and the U.S. is narrowed considerably. The paper outlines and disputes the validity of three public health policy propositions. First, it is not empirically valid to say that the introduction of universal medical insurance in Canada successfully contained the growth in the share of society's resources devoted to the health care industry. Second, it is not correct to argue that the change in the federal funding for hospital and medical care in 1977 was a "fiscal non-event". And finally, the proposed "equity" funding formula for Ontario hospitals is unlikely to contain costs and will potentially skew hospitals towards the provision of complex forms of care instead of cost-effective community-based alternatives.

Brandishing Cyberattack Capabilities

Science.gov (United States)

2013-01-01

Advertising cyberwar capabilities may be helpful. It may back up a deterrence strategy. It might dissuade other states from conventional mischief or...to enable the attack.5 Many of the instruments of the attack remain with the target system, nestled in its log files, or even in the malware itself...debat- able. Even if demonstrated, what worked yesterday may not work today. But difficult does not mean impossible. Advertising cyberwar capabilities

MODERN CAPABILITIES OF BREAST PATHOLOGY DIAGNOSTICS

Directory of Open Access Journals (Sweden)

I. V. Vysotskaya

2015-01-01

Full Text Available Every year more than 1 million new cases of breast cancer are being recorded worldwide. Choice of appropriate tactics of treatment depends on the timely diagnosis and correct assessment of the prevalence of cancer.The algorithm of patient»s examination includes clinical examination, X-ray mammography and ultrasonic diagnosis of breast. However, this is not sufficient for a complete interpretation of the patient»s condition in case of non-palpable breast formations, ambiguous interpretation of imaging under structural changes, increased density of breast tissue, etc.In this regard, the introduction of new technologies and their evaluation in terms of practicality is a logical and developing method of early diagnosis of breast pathology.One of the methods that enables enhancing the information capability of ultrasonic diagnosis of breast is elastography. It allows for the differential diagnosis of benign and malignant changes not only in the breast tissue, but also in the areas of regional lymph drainage.Promising method of modern diagnostic breast care is digital mammography tomosynthesis. However, in spite of the first and very optimisticdata, this technique is still far from standard.Complex diagnostics of breast pathology, in addition to clinical data and imaging results, are based on information obtained from biopsies. At the present stage core-biopsy is considered as the best way of verification, where the resulting material is subjected to immunohistochemical studies.Thus, the spectrum of diagnostic capabilities is constantly expanding. Highly informative techniques included in the daily practice today enable clinicians to achieve optimal results in curing even greater number of patients.

Supply capability creation process: Key milestone criteria and activities

Directory of Open Access Journals (Sweden)

Jordan Verrollot

2017-09-01

Full Text Available Purpose: The article focuses on supply capability creation (SCC within the new product development (NPD. The purpose is to establish an SCC process describing the main SCC activities and milestone criteria in preparing the supply process for new products Design/methodology/approach: The article analyses the earlier research, carries out current state analysis of six case companies regarding the SCC areas, and proposes a SCC process. Findings: The developed SCC process aims at preparing the operational supply capability for a developed new product based on the preferred, qualified and contracted suppliers and materials along the NPD process, and ultimately at the product ramp-up. Originality/value: This paper introduces a SCC process that has not been presented earlier in the literature, highlighting the important role of the SCC for successful product ramp-ups.

Pain management in primary care – current perspectives | Meyer ...

African Journals Online (AJOL)

According to a 1998 World Health Organization Survey of 26 000 primary care ... in pain medicine and continue to follow the biomedical approach, which ... The modern paradigm of pain management has moved from this biomedical to the ...

Substrate decoration for improvement of current-carrying capabilities of YBa2Cu3Ox thin films

International Nuclear Information System (INIS)

Khoryushin, Alexey V.; Mozhaev, Peter B.; Mozhaeva, Julia E.; Bdikin, Igor K.; Zhao, Yue; Andersen, Niels H.; Jacobsen, Claus S.; Hansen, Jørn Bindslev

2013-01-01

Highlights: ► Effects of substrate decoration on properties of YBCO thin films were studied. ► Y 2 O 3 nanoparticles, ultra-thin Y 2 O 3 and Y:ZrO 2 layers were used as decoration layer. ► Decoration improves j C (5 T and 50 K) up to 0.97 MA/cm 2 vs. 0.76 MA/cm 2 for a reference film. ► Ultra-thin layer of yttria and yttria nanoparticles have a similar effect on YBCO. ► Y 2 O 3 decoration results in power law coefficient α = 0.3 vs. α = 0.4 for a reference film. -- Abstract: The effects of substrate decoration with yttria and Y:ZrO 2 on the structural and electrical properties of the YBa 2 Cu 3 O x (YBCO) thin films are studied. The films were deposited on (LaAlO 3 ) 3 –(Sr 2 AlTaO 8 ) 7 substrates by pulsed laser deposition. Two different structures of decoration layer were applied, a template layer of nanoparticles and an uniform ultra-thin layer. Significant improvement of current-carrying capabilities was observed, especially at high external magnetic fields. Structural studies of these films reveal the presence of extended linear defects in the YBCO matrix. The formation of these structures is attributed to seeding of randomly oriented YBCO grains due to suppression of epitaxy in the very beginning of the deposition. The films of both kinds of decoration layers show nearly the same improvement of j C over the reference film at 77 and 50 K: j C (5T and 50 K) reaches 0.92 and 0.97 MA/cm 2 for uniform and template decoration layers. At 5 and 20 K the effect of template decoration layers is more beneficial: j C (5T and 20 K) values are 3.5 and 4.1 MA/cm 2 , j C (5T and 5 K) values are 6.4 and 7.9 MA/cm 2 , for uniform and template decoration layers, respectively

The universe of ANA testing: a case for point-of-care ANA testing.

Science.gov (United States)

Konstantinov, Konstantin N; Rubin, Robert L

2017-12-01

Testing for total antinuclear antibodies (ANA) is a critical tool for diagnosis and management of autoimmune diseases at both the primary care and subspecialty settings. Repurposing of ANA from a test for lupus to a test for any autoimmune condition has driven the increase in ANA requests. Changes in ANA referral patterns include early or subclinical autoimmune disease detection in patients with low pre-test probability and use of negative ANA results to rule out underlying autoimmune disease. A positive result can lead to further diagnostic considerations. Currently, ANA tests are performed in centralized laboratories; an alternative would be ANA testing at the clinical point-of-care (POC). By virtue of its near real-time data collection capability, low cost, and ease of use, we believe the POC ANA has the potential to enable a new paradigm shift in autoimmune serology testing.

KSC Technical Capabilities Website

Science.gov (United States)

Nufer, Brian; Bursian, Henry; Brown, Laurette L.

2010-01-01

This document is the website pages that review the technical capabilities that the Kennedy Space Center (KSC) has for partnership opportunities. The purpose of this information is to make prospective customers aware of the capabilities and provide an opportunity to form relationships with the experts at KSC. The technical capabilities fall into these areas: (1) Ground Operations and Processing Services, (2) Design and Analysis Solutions, (3) Command and Control Systems / Services, (4) Materials and Processes, (5) Research and Technology Development and (6) Laboratories, Shops and Test Facilities.

Implementing NASA's Capability-Driven Approach: Insight into NASA's Processes for Maturing Exploration Systems

Science.gov (United States)

Williams-Byrd, Julie; Arney, Dale; Rodgers, Erica; Antol, Jeff; Simon, Matthew; Hay, Jason; Larman, Kevin

2015-01-01

NASA is engaged in transforming human spaceflight. The Agency is shifting from an exploration-based program with human activities focused on low Earth orbit (LEO) and targeted robotic missions in deep space to a more sustainable and integrated pioneering approach. Through pioneering, NASA seeks to address national goals to develop the capacity for people to work, learn, operate, live, and thrive safely beyond the Earth for extended periods of time. However, pioneering space involves more than the daunting technical challenges of transportation, maintaining health, and enabling crew productivity for long durations in remote, hostile, and alien environments. This shift also requires a change in operating processes for NASA. The Agency can no longer afford to engineer systems for specific missions and destinations and instead must focus on common capabilities that enable a range of destinations and missions. NASA has codified a capability driven approach, which provides flexible guidance for the development and maturation of common capabilities necessary for human pioneers beyond LEO. This approach has been included in NASA policy and is captured in the Agency's strategic goals. It is currently being implemented across NASA's centers and programs. Throughout 2014, NASA engaged in an Agency-wide process to define and refine exploration-related capabilities and associated gaps, focusing only on those that are critical for human exploration beyond LEO. NASA identified 12 common capabilities ranging from Environmental Control and Life Support Systems to Robotics, and established Agency-wide teams or working groups comprised of subject matter experts that are responsible for the maturation of these exploration capabilities. These teams, called the System Maturation Teams (SMTs) help formulate, guide and resolve performance gaps associated with the identified exploration capabilities. The SMTs are defining performance parameters and goals for each of the 12 capabilities

Ideas of home in palliative care research: A concept analysis.

Science.gov (United States)

Tryselius, Kristina; Benzein, Eva; Persson, Carina

2018-04-23

To explore the concept of home and its' expressed spatialities in current palliative care research. Home is a central environment for living, caring, and dying. However, pure investigations of the sets of ideas linked to the concept seemed missing. Although identified as an important location, spatial perspectives expressed through the concept of home appeared unexplored. Rodgers' evolutionary concept analysis. Scientific articles published between January 2009 and September 2015. Rodgers' evolutionary concept analysis. Resulting attributes were explored from two geographically informed spatial perspectives. As main results, six attributes were identified and explored: Home as actor-capable of acting; emotional environment-something people have feelings for; place-a part of personal identity and a location; space-complex and relational spatial connections and a site for care; setting-passive background and absolute space; becoming-a fluid spatiality constantly folded. Examples of attributes and suggestions for further concept development were identified. The concept reflects various sets of ideas as well as expressing both relational and absolute perspectives of space. The most challenging for nursing research and practice seems to be investigation, operationalization, and testing the implementation of sets of ideas reflecting a relational thinking of space. © 2018 Wiley Periodicals, Inc.

Organizational Economics of Capability and Heterogeneity

DEFF Research Database (Denmark)

Argyres, Nicholas S.; Felin, Teppo; Foss, Nicolai Juul

2012-01-01

For decades, the literatures on firm capabilities and organizational economics have been at odds with each other, specifically relative to explaining organizational boundaries and heterogeneity. We briefly trace the history of the relationship between the capabilities literature and organizational...... economics, and we point to the dominance of a “capabilities first” logic in this relationship. We argue that capabilities considerations are inherently intertwined with questions about organizational boundaries and internal organization, and we use this point to respond to the prevalent capabilities first...... logic. We offer an integrative research agenda that focuses first on the governance of capabilities and then on the capability of governance....

A Fast Response Capability within NOAA/NOS/CO-OPS

Science.gov (United States)

2007-01-01

A Fast Response Capability within NOAA/NOS/CO-OPS P. B. Burke NOAA/National Ocean Service/CO-OPS 1305 East-West Hwy. Silver Spring, MD 20910...USA pat.burke@noaa.gov T. Graff NOAA/National Ocean Service/CO-OPS 1305 East-West Hwy. Silver Spring, MD 20910 USA tammy.graff@noaa.gov... flotation hull, an instrumentation tower mounted atop the hull and a current meter mount with a mooring attachment. The triangular tower housed two

Metrology Measurement Capabilities

Energy Technology Data Exchange (ETDEWEB)

Dr. Glen E. Gronniger

2007-10-02

This document contains descriptions of Federal Manufacturing & Technologies (FM&T) Metrology capabilities, traceability flow charts, and the measurement uncertainty of each measurement capability. Metrology provides NIST traceable precision measurements or equipment calibration for a wide variety of parameters, ranges, and state-of-the-art uncertainties. Metrology laboratories conform to the requirements of the Department of Energy Development and Production Manual Chapter 13.2, ANSI/ISO/IEC ANSI/ISO/IEC 17025:2005, and ANSI/NCSL Z540-1. FM&T Metrology laboratories are accredited by NVLAP for the parameters, ranges, and uncertainties listed in the specific scope of accreditation under NVLAP Lab code 200108-0. See the Internet at http://ts.nist.gov/Standards/scopes/2001080.pdf. These parameters are summarized. The Honeywell Federal Manufacturing & Technologies (FM&T) Metrology Department has developed measurement technology and calibration capability in four major fields of measurement: (1) Mechanical; (2) Environmental, Gas, Liquid; (3) Electrical (DC, AC, RF/Microwave); and (4) Optical and Radiation. Metrology Engineering provides the expertise to develop measurement capabilities for virtually any type of measurement in the fields listed above. A strong audit function has been developed to provide a means to evaluate the calibration programs of our suppliers and internal calibration organizations. Evaluation includes measurement audits and technical surveys.

Capable design or designing capabilities? An exploration of service design as an emerging organizational capability in Telenor – Martinkenaite

Directory of Open Access Journals (Sweden)

Ieva Martinkenaite

2017-01-01

Full Text Available This empirical paper examines a process, starting with the managerial decision to make service design an organizational capability, and follows it as it unfolds over time within one organization. Service design has become an established business practice of how firms create new products and services to promote differentiation in an increasingly uncertain business landscape. Implicit in the literature on service design are assumptions about strategic implications of adopting the prescribed innovation methods and tools. However, little is known about how service design evolves into an organizational capability enabling firms to transform their existing businesses and sustain competitiveness. Through a longitudinal, exploratory case study of service design practices in one of the world’s largest telecommunications companies, we explicate mechanisms through which service design evolves into an organizational capability by exploring the research question: what are the mechanisms through which service design develops into an organizational capability? Our study reveals the effect of an initial introduction of service design tools, identification of boundaryspanning actors and co-alignment of dedicated resources between internal functions, as well as through co-creation with customers. Over time, these activities lead to the adoption of service design practices, and subsequently these practices spark incremental learning throughout the organization, alter managerial decisions and influence multiple paths for the development of new capabilities. Reporting on this process, we are able to describe how service design practices were disseminated and institutionalized within the organization we observed. This study thus contributes by informing how service design can evolve into an organizational capability, as well as by bridging the emerging literature on service design and design thinking with established strategy theory. Further research will have to

Drift chamber electronics with multi-hit capability for time and current division measurements

Energy Technology Data Exchange (ETDEWEB)

Manarin, A; Pregernig, L; Rabany, M; Saban, R; Vismara, G

1983-11-15

Drift chambers have been installed for luminosity measurements in intersection 5 of the SPS accelerator working in panti p colliding mode. The required electronics is described. The system is able to process up to 16 hits per wire with a double pulse resolution of 40 ns; drift time and current division, with 1.25 ns and 1.6% resolution respectively, are recorded. Transconductance preamplifiers and discriminators are directly mounted on the chamber; 160 m of twisted-apir cable bring the signals to the digitizer unit. Coarse time is measured using RAM techniques, while fine time is obtained by means of a microstrip delay associated with a 100 K ECL priority encoder. Current division used a single 50 MHz Flash ADC which alows 26 dB dynamic range with 6 bit resolution. First operational results are reported.

The Capability to Hold Property

NARCIS (Netherlands)

Claassen, Rutger

2015-01-01

This paper discusses the question of whether a capability theory of justice (such as that of Martha Nussbaum) should accept a basic “capability to hold property.” Answering this question is vital for bridging the gap between abstract capability theories of justice and their institutional

IMPROVEMENTS IN THE CAPABILITY PROFILE OF 3-D PRINTING: AN UPDATE

Directory of Open Access Journals (Sweden)

Dimitrov, Dimitar Marinov

2014-08-01

Full Text Available Knowledge about the capabilities of a production system is an important issue. The three- dimensional (3-D printing (drop-on-bed process has become a well-established Additive Manufacturing (AM technology. Initially intended for use mainly as a concept modeller, its scope of application has expanded to include, among others, fit and functional models, pattern-making for casting and moulding processes, rapid tooling, and medical and architectural models. This growth in applications has stimulated a reciprocal improvement in available materials and the technological capabilities of 3-D printing, such as accuracy, strength and elongation, surface finish, build time, and cost. These factors are of significance to users who want to control their processes better and to designers who want to define their expectations and determine their requirements. Thus this paper aims to provide a technical update, highlighting the influence level of different factors on a system’s capabilities. This paper uses the example of the ZPrinter 310 system from the Z Corporation, applies appropriate statistical techniques, and takes into consideration the latest material and machine developments, in order to report on the current improvements of the capability profile of this important process.

Baseline Assessment and Prioritization Framework for IVHM Integrity Assurance Enabling Capabilities

Science.gov (United States)

Cooper, Eric G.; DiVito, Benedetto L.; Jacklin, Stephen A.; Miner, Paul S.

2009-01-01

Fundamental to vehicle health management is the deployment of systems incorporating advanced technologies for predicting and detecting anomalous conditions in highly complex and integrated environments. Integrated structural integrity health monitoring, statistical algorithms for detection, estimation, prediction, and fusion, and diagnosis supporting adaptive control are examples of advanced technologies that present considerable verification and validation challenges. These systems necessitate interactions between physical and software-based systems that are highly networked with sensing and actuation subsystems, and incorporate technologies that are, in many respects, different from those employed in civil aviation today. A formidable barrier to deploying these advanced technologies in civil aviation is the lack of enabling verification and validation tools, methods, and technologies. The development of new verification and validation capabilities will not only enable the fielding of advanced vehicle health management systems, but will also provide new assurance capabilities for verification and validation of current generation aviation software which has been implicated in anomalous in-flight behavior. This paper describes the research focused on enabling capabilities for verification and validation underway within NASA s Integrated Vehicle Health Management project, discusses the state of the art of these capabilities, and includes a framework for prioritizing activities.

NGNP Data Management and Analysis System Analysis and Web Delivery Capabilities

Energy Technology Data Exchange (ETDEWEB)

Cynthia D. Gentillon

2011-09-01

Projects for the Very High Temperature Reactor (VHTR) Technology Development Office provide data in support of Nuclear Regulatory Commission licensing of the very high temperature reactor. Fuel and materials to be used in the reactor are tested and characterized to quantify performance in high-temperature and high-fluence environments. The NGNP Data Management and Analysis System (NDMAS) at the Idaho National Laboratory has been established to ensure that VHTR data are (1) qualified for use, (2) stored in a readily accessible electronic form, and (3) analyzed to extract useful results. This document focuses on the third NDMAS objective. It describes capabilities for displaying the data in meaningful ways and for data analysis to identify useful relationships among the measured quantities. The capabilities are described from the perspective of NDMAS users, starting with those who just view experimental data and analytical results on the INL NDMAS web portal. Web display and delivery capabilities are described in detail. Also the current web pages that show Advanced Gas Reactor, Advanced Graphite Capsule, and High Temperature Materials test results are itemized. Capabilities available to NDMAS developers are more extensive, and are described using a second series of examples. Much of the data analysis efforts focus on understanding how thermocouple measurements relate to simulated temperatures and other experimental parameters. Statistical control charts and correlation monitoring provide an ongoing assessment of instrument accuracy. Data analysis capabilities are virtually unlimited for those who use the NDMAS web data download capabilities and the analysis software of their choice. Overall, the NDMAS provides convenient data analysis and web delivery capabilities for studying a very large and rapidly increasing database of well-documented, pedigreed data.

Developing Collaborative Product Development Capabilities

DEFF Research Database (Denmark)

Mahnke, Volker; Tran, Yen

2012-01-01

innovation strategies’. Our analyses suggest that developing such collaboration capabilities benefits from the search for complementary practices, the combination of learning styles, and the development of weak and strong ties. Results also underscore the crucial importance of co-evolution of multi......Collaborative product development capabilities support a company’s product innovation activities. In the context of the fast fashion sector, this paper examines the development of the product development capabilities (PDC) that align product development capabilities in a dual innovation context......, one, slow paced, where the firm is well established and the other, fast paced, which represents a new competitive arena in which the company competes. To understand the process associated with collaborative capability development, we studied three Scandinavian fashion companies pursuing ‘dual...

Global surgery: current evidence for improving surgical care.

Science.gov (United States)

Fuller, Jennifer C; Shaye, David A

2017-08-01

The field of global surgery is undergoing rapid transformation, owing to several recent prominent reports positioning it as a cost-effective means of relieving global disease burden. The purpose of this article is to review the recent advances in the field of global surgery. Efforts to grow the global surgical workforce and procedural capacity have focused on innovative methods to increase surgeon training, enhance international collaboration, leverage technology, optimize existing health systems, and safely implement task-sharing. Computer modeling offers a novel means of informing policy to optimize timely access to care, equitably promote health and financial protection, and efficiently grow infrastructure. Tools and checklists have recently been developed to enhance data collection and ensure methodologically rigorous publications to inform planning, benchmark surgical systems, promote accurate modeling, track key health indicators, and promote safety. Creation of institutional partnerships and trainee exchanges can enrich training, stimulate commitment to humanitarian work, and promote the equal exchange of ideas and expertise. The recent body of work creates a strong foundation upon which work toward the goal of universal access to safe, affordable surgical care can be built; however, further collection and analysis of country-specific data is necessary for accurate modeling and outcomes research into the efficacy of policies such as task-sharing is greatly needed.

A Dangerous Idea? Freedom, Children and the Capability Approach to Education

Science.gov (United States)

Bessant, Judith

2014-01-01

This article begins by observing how education is currently appreciated primarily for its utility value, a view informed by utilitarianism and neoclassical economic theory. A critique of that framing is offered and an alternative way of valuing education informed by a Capabilities Approach is presented. In doing so, I also observe that while key…

Aeromedical Evacuation Enroute Critical Care Validation Study

Science.gov (United States)

2015-02-27

percentile TP, suggesting that TPs assumed complex postures to accomplish patient care tasks. The findings suggest that ergonomic specifications...bending has been associated with back pain (Guo, 2002). Enhanced medical treatment capabilities (e.g., enroute critical care nurses [ECCN...heights, including ergonomic factors such as medic stance and stability and the medic’s ability to maneuver into challenging work angles. The light

Trauma care in Oman: A call for action.

Science.gov (United States)

Mehmood, Amber; Allen, Katharine A; Al-Maniri, Abdullah; Al-Kashmiri, Ammar; Al-Yazidi, Mohamed; Hyder, Adnan A

2017-12-01

Many Arab countries have undergone the epidemiologic transition of diseases with increasing economic development and a proportionately decreasing prevalence of communicable diseases. With this transition, injuries have emerged as a major cause of mortality and morbidity in the Gulf Cooperation Council countries in addition to diseases of affluence. Injuries are the number one cause of years of life lost and disability-adjusted life-years in the Sultanate of Oman. The burden of injuries, which affects mostly young Omani males, has a unique geographic distribution that is in contrast to the trauma care capabilities of the country. The concentration of health care resources in the northern part of the country makes it difficult for the majority of Omanis who live elsewhere to access high-quality and time-sensitive care. A broader multisectorial national injury prevention strategy should be evidence based and must strengthen human resources, service delivery, and information systems to improve care of the injured and loss of life. This paper provides a unique overview of the Omani health system with the goal of examining its trauma care capabilities and injury control policies. Copyright © 2017 Elsevier Inc. All rights reserved.