Shaping the learning curve: epigenetic dynamics in neural plasticity

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Zohar Ziv Bronfman

2014-07-01

Full Text Available A key characteristic of learning and neural plasticity is state-dependent acquisition dynamics reflected by the non-linear learning curve that links increase in learning with practice. Here we propose that the manner by which epigenetic states of individual cells change during learning contributes to the shape of the neural and behavioral learning curve. We base our suggestion on recent studies showing that epigenetic mechanisms such as DNA methylation, histone acetylation and RNA-mediated gene regulation are intimately involved in the establishment and maintenance of long-term neural plasticity, reflecting specific learning-histories and influencing future learning. Our model, which is the first to suggest a dynamic molecular account of the shape of the learning curve, leads to several testable predictions regarding the link between epigenetic dynamics at the promoter, gene-network and neural-network levels. This perspective opens up new avenues for therapeutic interventions in neurological pathologies.

Implementation Learning and Forgetting Curve to Scheduling in Garment Industry

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Muhamad Badri, Huda; Deros, Baba Md; Syahri, M.; Saleh, Chairul; Fitria, Aninda

2016-02-01

The learning curve shows the relationship between time and the cumulative number of units produced which using the mathematical description on the performance of workers in performing repetitive works. The problems of this study is level differences in the labors performance before and after the break which affects the company's production scheduling. The study was conducted in the garment industry, which the aims is to predict the company production scheduling using the learning curve and forgetting curve. By implementing the learning curve and forgetting curve, this paper contributes in improving the labors performance that is in line with the increase in maximum output 3 hours productive before the break are 15 unit product with learning curve percentage in the company is 93.24%. Meanwhile, the forgetting curve improving maximum output 3 hours productive after the break are 11 unit product with the percentage of forgetting curve in the company is 92.96%. Then, the obtained 26 units product on the productive hours one working day is used as the basic for production scheduling.

Developments in Interpreting Learning Curves and Applications to Energy Technology Policy

International Nuclear Information System (INIS)

Van der Zwaan, B.C.C.; Wene, C.O.

2011-01-01

The book 'Learning Curves: Theory, Models, and Applications' first draws a learning map that shows where learning is involved within organizations, then examines how it can be sustained, perfected, and accelerated. The book reviews empirical findings in the literature in terms of different sources for learning and partial assessments of the steps that make up the actual learning process inside the learning curve. Chapter 23 on 'Developments in Interpreting Learning Curves and Applications to Energy Technology Policy' is written by Bob van der Zwaan and Clas-Otto Wene. In this chapter they provide some interpretations of experience and learning curves starting from three different theoretical platforms. These interpretations are aimed at explaining learning rates for different energy technologies. The ultimate purpose is to find the role that experience and learning curves can legitimately play in designing efficient government deployment programs and in analyzing the implications of different energy scenarios. The 'Component Learning' section summarizes recent work by the authors that focuses on the disaggregation of technologies in their respective components and argues that traditional learning for overall technology should perhaps be replaced by a phenomenology that recognizes learning for individual components. The 'Learning and Time' section presents an approach that departs more strongly from the conventional learning curve methodology, by suggesting that exponential growth and progress may be the deeper underlying processes behind observed learning-by-doing. Contrary to this view, the cybernetic approach presented in the 'Cybernetic Approach' section sees learning curves as expressing a fundamental property of organizations in competitive markets and applies the findings from second order cybernetics to calculate the learning rates for operationally closed systems. All three interpretations find empirical support. The 'Conclusions' section summarizes the

Developments in Interpreting Learning Curves and Applications to Energy Technology Policy

Energy Technology Data Exchange (ETDEWEB)

Van der Zwaan, B.C.C. [Energy research Centre of the Netherlands, ECN Policy Studies, Petten (Netherlands); Wene, C.O. [Wenergy, Lund (Sweden)

2011-06-15

The book 'Learning Curves: Theory, Models, and Applications' first draws a learning map that shows where learning is involved within organizations, then examines how it can be sustained, perfected, and accelerated. The book reviews empirical findings in the literature in terms of different sources for learning and partial assessments of the steps that make up the actual learning process inside the learning curve. Chapter 23 on 'Developments in Interpreting Learning Curves and Applications to Energy Technology Policy' is written by Bob van der Zwaan and Clas-Otto Wene. In this chapter they provide some interpretations of experience and learning curves starting from three different theoretical platforms. These interpretations are aimed at explaining learning rates for different energy technologies. The ultimate purpose is to find the role that experience and learning curves can legitimately play in designing efficient government deployment programs and in analyzing the implications of different energy scenarios. The 'Component Learning' section summarizes recent work by the authors that focuses on the disaggregation of technologies in their respective components and argues that traditional learning for overall technology should perhaps be replaced by a phenomenology that recognizes learning for individual components. The 'Learning and Time' section presents an approach that departs more strongly from the conventional learning curve methodology, by suggesting that exponential growth and progress may be the deeper underlying processes behind observed learning-by-doing. Contrary to this view, the cybernetic approach presented in the 'Cybernetic Approach' section sees learning curves as expressing a fundamental property of organizations in competitive markets and applies the findings from second order cybernetics to calculate the learning rates for operationally closed systems. All three interpretations find empirical

Clinical experience with the first 40 cases with femtosecond laser cataract surgery technology: safety of the learning curve

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Joao Crispim

2015-10-01

Full Text Available ABSTRACT Objective: To evaluate the introduction of the femtosecond laser (FSL to perform the key steps of the traditional cataract surgery process and the operational difficulties and safety of this new technology during routine use in an operating room in Brazil. Methods A retrospective study was conducted using the first cases operated on at a single center using the laser platform LenSx/Alcon with a soft contact lens patient interface.All patients underwent a detailed preoperative assessment.The anterior capsulotomy, nuclear fragmentation, and corneal incisions were created with the FSL; then, the surgery was completed following the standard phacoemulsification procedure. The main outcome measurements were difficulties and complications related to the learning curve and an analysis of postoperative uncorrected distance visual acuity (UDVA. Results: Of 31 patients (40 eyes, 9 patients had FSL cataract surgery in both eyes.The mean age was 64 ± 12 years (ranging from 42 to 82, the mean cataract nuclear sclerosis was grading 2 ± 0.6 (ranging from 1 to 4, and the preoperative mean UDVA in logMAR was 0.4 ± 0.2 (ranging from 0.1 to 1.3. Anterior capsulotomy was complete in all patients, and scissors were not needed to cut off any intact portion. The postoperative corneal incisions were not completely linear and showed some irregularities. Laser phaco-fragmentation was effective, with the division of the nucleus into smaller segments easily performed before phacoemulsification.After 1 month, the postoperative mean UDVA in logMAR was 0.1 ± 0.1 (ranging from 0.0 to 0.4 (P < 0.0001. Conclusion: With increasing surgical cases and experience, the phacoemulsification steps are performed precisely and effectively with FSL pretreatment, resulting in a safe learning curve.

An appraisal of the learning curve in robotic general surgery.

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Pernar, Luise I M; Robertson, Faith C; Tavakkoli, Ali; Sheu, Eric G; Brooks, David C; Smink, Douglas S

2017-11-01

Robotic-assisted surgery is used with increasing frequency in general surgery for a variety of applications. In spite of this increase in usage, the learning curve is not yet defined. This study reviews the literature on the learning curve in robotic general surgery to inform adopters of the technology. PubMed and EMBASE searches yielded 3690 abstracts published between July 1986 and March 2016. The abstracts were evaluated based on the following inclusion criteria: written in English, reporting original work, focus on general surgery operations, and with explicit statistical methods. Twenty-six full-length articles were included in final analysis. The articles described the learning curves in colorectal (9 articles, 35%), foregut/bariatric (8, 31%), biliary (5, 19%), and solid organ (4, 15%) surgery. Eighteen of 26 (69%) articles report single-surgeon experiences. Time was used as a measure of the learning curve in all studies (100%); outcomes were examined in 10 (38%). In 12 studies (46%), the authors identified three phases of the learning curve. Numbers of cases needed to achieve plateau performance were wide-ranging but overlapping for different kinds of operations: 19-128 cases for colorectal, 8-95 for foregut/bariatric, 20-48 for biliary, and 10-80 for solid organ surgery. Although robotic surgery is increasingly utilized in general surgery, the literature provides few guidelines on the learning curve for adoption. In this heterogeneous sample of reviewed articles, the number of cases needed to achieve plateau performance varies by case type and the learning curve may have multiple phases as surgeons add more complex cases to their case mix with growing experience. Time is the most common determinant for the learning curve. The literature lacks a uniform assessment of outcomes and complications, which would arguably reflect expertise in a more meaningful way than time to perform the operation alone.

Microvascular Anastomosis: Proposition of a Learning Curve.

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Mokhtari, Pooneh; Tayebi Meybodi, Ali; Benet, Arnau; Lawton, Michael T

2018-04-14

Learning to perform a microvascular anastomosis is one of the most difficult tasks in cerebrovascular surgery. Previous studies offer little regarding the optimal protocols to maximize learning efficiency. This failure stems mainly from lack of knowledge about the learning curve of this task. To delineate this learning curve and provide information about its various features including acquisition, improvement, consistency, stability, and recall. Five neurosurgeons with an average surgical experience history of 5 yr and without any experience in bypass surgery performed microscopic anastomosis on progressively smaller-caliber silastic tubes (Biomet, Palm Beach Gardens, Florida) during 24 consecutive sessions. After a 1-, 2-, and 8-wk retention interval, they performed recall test on 0.7-mm silastic tubes. The anastomoses were rated based on anastomosis patency and presence of any leaks. Improvement rate was faster during initial sessions compared to the final practice sessions. Performance decline was observed in the first session of working on a smaller-caliber tube. However, this rapidly improved during the following sessions of practice. Temporary plateaus were seen in certain segments of the curve. The retention interval between the acquisition and recall phase did not cause a regression to the prepractice performance level. Learning the fine motor task of microvascular anastomosis adapts to the basic rules of learning such as the "power law of practice." Our results also support the improvement of performance during consecutive sessions of practice. The objective evidence provided may help in developing optimized learning protocols for microvascular anastomosis.

Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia.

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Yano, Fumiaki; Omura, Nobuo; Tsuboi, Kazuto; Hoshino, Masato; Yamamoto, Seryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2017-01-01

Although laparoscopic Heller myotomy and Dor fundoplication (LHD) is widely performed to address achalasia, little is known about the learning curve for this technique. We assessed the learning curve for performing LHD. Of the 514 cases with LHD performed between August 1994 and March 2016, the surgical outcomes of 463 cases were evaluated after excluding 50 cases with reduced port surgery and one case with the simultaneous performance of laparoscopic distal partial gastrectomy. A receiver operating characteristic (ROC) curve analysis was used to identify the cut-off value for the number of surgical experiences necessary to become proficient with LHD, which was defined as the completion of the learning curve. We defined the completion of the learning curve when the following 3 conditions were satisfied. 1) The operation time was less than 165 minutes. 2) There was no blood loss. 3) There was no intraoperative complication. In order to establish the appropriate number of surgical experiences required to complete the learning curve, the cut-off value was evaluated by using a ROC curve (AUC 0.717, p < 0.001). Finally, we identified the cut-off value as 16 surgical cases (sensitivity 0.706, specificity 0.646). Learning curve seems to complete after performing 16 cases.

Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia.

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Fumiaki Yano

Full Text Available Although laparoscopic Heller myotomy and Dor fundoplication (LHD is widely performed to address achalasia, little is known about the learning curve for this technique. We assessed the learning curve for performing LHD.Of the 514 cases with LHD performed between August 1994 and March 2016, the surgical outcomes of 463 cases were evaluated after excluding 50 cases with reduced port surgery and one case with the simultaneous performance of laparoscopic distal partial gastrectomy. A receiver operating characteristic (ROC curve analysis was used to identify the cut-off value for the number of surgical experiences necessary to become proficient with LHD, which was defined as the completion of the learning curve.We defined the completion of the learning curve when the following 3 conditions were satisfied. 1 The operation time was less than 165 minutes. 2 There was no blood loss. 3 There was no intraoperative complication. In order to establish the appropriate number of surgical experiences required to complete the learning curve, the cut-off value was evaluated by using a ROC curve (AUC 0.717, p < 0.001. Finally, we identified the cut-off value as 16 surgical cases (sensitivity 0.706, specificity 0.646.Learning curve seems to complete after performing 16 cases.

The learning curve of laparoendoscopic single-site (LESS) cholecystectomy: definable, short, and safe.

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Hernandez, Jonathan; Ross, Sharona; Morton, Connor; McFarlin, Kellie; Dahal, Sujat; Golkar, Farhaad; Albrink, Michael; Rosemurgy, Alexander

2010-11-01

The applications of laparoendoscopic single-site (LESS) surgery, including cholecystectomy, are occurring quickly, although little is generally known about issues associated with the learning curve of this new technique including operative time, conversion rates, and safety. We prospectively followed all patients undergoing LESS cholecystectomy, and compared operations undertaken at our institutions in cohorts of 25 patients with respect to operative times, conversion rates, and complications. One-hundred fifty patients of mean age 46 years underwent LESS cholecystectomy. No significant differences in operative times were demonstrable between any of the 25-patient cohorts operated on at our institution. A significant reduction in operative times (p < 0.001) after completion of 75 LESS procedures was, however, identified with the experience of a single surgeon. No significant reduction in the number of procedures requiring an additional trocar(s) or conversion to open operations was observed after completion of 25 LESS cholecystectomies. Complication rates were low, and not significantly different between any 25-patient cohorts. For surgeons proficient with multi-incision laparoscopic cholecystectomy, the learning curve for LESS cholecystectomy begins near proficiency. Operative complications and conversions were infrequent and unchanged across successive 25-patient cohorts, and were similar to those reported for multi-incision laparoscopic cholecystectomy after the learning curve. Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The learning curve for hip arthroscopy: a systematic review.

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Hoppe, Daniel J; de Sa, Darren; Simunovic, Nicole; Bhandari, Mohit; Safran, Marc R; Larson, Christopher M; Ayeni, Olufemi R

2014-03-01

The learning curve for hip arthroscopy is consistently characterized as "steep." The purpose of this systematic review was to (1) identify the various learning curves reported in the literature, (2) examine the evidence supporting these curves, and (3) determine whether this evidence supports an accepted number of cases needed to achieve proficiency. The electronic databases Embase and Medline were screened for any clinical studies reporting learning curves in hip arthroscopy. Two reviewers conducted a full-text review of eligible studies and a hand search of conference proceedings and reference sections of the included articles. Inclusion/exclusion criteria were applied, and a quality assessment was completed for each included article. Descriptive statistics were compiled. We identified 6 studies with a total of 1,063 patients. Studies grouped surgical cases into "early" versus "late" in a surgeon's experience, with 30 cases being the most common cutoff used. Most of these studies used descriptive statistics and operative time and complication rates as measures of competence. Five of 6 studies showed improvement in these measures between early and late experience, but only one study proposed a bona fide curve. This review shows that when 30 cases was used as the cutoff point to differentiate between early and late cases in a surgeon's experience, there were significant reductions in operative time and complication rates. However, there was insufficient evidence to quantify the learning curve and validate 30, or any number of cases, as the point at which the learning curve plateaus. As a result, this number should be interpreted with caution. Level IV, systematic review of Level IV studies. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

A learning curve for solar thermal power

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Platzer, Werner J.; Dinter, Frank

2016-05-01

Photovoltaics started its success story by predicting the cost degression depending on cumulated installed capacity. This so-called learning curve was published and used for predictions for PV modules first, then predictions of system cost decrease also were developed. This approach is less sensitive to political decisions and changing market situations than predictions on the time axis. Cost degression due to innovation, use of scaling effects, improved project management, standardised procedures including the search for better sites and optimization of project size are learning effects which can only be utilised when projects are developed. Therefore a presentation of CAPEX versus cumulated installed capacity is proposed in order to show the possible future advancement of the technology to politics and market. However from a wide range of publications on cost for CSP it is difficult to derive a learning curve. A logical cost structure for direct and indirect capital expenditure is needed as the basis for further analysis. Using derived reference cost for typical power plant configurations predictions of future cost have been derived. Only on the basis of that cost structure and the learning curve levelised cost of electricity for solar thermal power plants should be calculated for individual projects with different capacity factors in various locations.

A Literature-Based Analysis of the Learning Curves of Laparoscopic Radical Prostatectomy

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Daniel W. Good

2014-05-01

Full Text Available There is a trend for the increased adoption of minimally invasive techniques of radical prostatectomy (RP – laparoscopic (LRP and robotic assisted (RARP – from the traditional open radical retropubic prostatectomy (ORP, popularised by Partin et al. Recently there has been a dramatic expansion in the rates of RARP being performed, and there have been many early reports postulating that the learning curve for RARP is shorter than for LRP. The aim of this study was to review the literature and analyse the length of the LRP learning curves for the various outcome measures: perioperative, oncologic, and functional outcomes. A broad search of the literature was performed in November 2013 using the PubMed database. Only studies of real patients and those from 2004 until 2013 were included; those on simulators were excluded. In total, 239 studies were identified after which 13 were included. The learning curve is a heterogeneous entity, depending entirely on the criteria used to define it. There is evidence of multiple learning curves; however the length of these is dependent on the definitions used by the authors. Few studies use the more rigorous definition of plateauing of the curve. Perioperative learning curve takes approximately 150-200 cases to plateau, oncologic curve approximately 200 cases, and the functional learning curve up to 700 cases to plateau (700 for potency, 200 cases for continence. In this review, we have analysed the literature with respect to the learning curve for LRP. It is clear that the learning curve is long. This necessitates centralising LRP to high volume centres such that surgeons, trainees, and patients are able to utilise the benefits of LRP.

The learning curve: implications of a quantitative analysis.

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Gallistel, Charles R; Fairhurst, Stephen; Balsam, Peter

2004-09-07

The negatively accelerated, gradually increasing learning curve is an artifact of group averaging in several commonly used basic learning paradigms (pigeon autoshaping, delay- and trace-eye-blink conditioning in the rabbit and rat, autoshaped hopper entry in the rat, plus maze performance in the rat, and water maze performance in the mouse). The learning curves for individual subjects show an abrupt, often step-like increase from the untrained level of responding to the level seen in the well trained subject. The rise is at least as abrupt as that commonly seen in psychometric functions in stimulus detection experiments. It may indicate that the appearance of conditioned behavior is mediated by an evidence-based decision process, as in stimulus detection experiments. If the appearance of conditioned behavior is taken instead to reflect the increase in an underlying associative strength, then a negligible portion of the function relating associative strength to amount of experience is behaviorally visible. Consequently, rate of learning cannot be estimated from the group-average curve; the best measure is latency to the onset of responding, determined for each subject individually.

The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor?

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Ferrarese, Alessia; Gentile, Valentina; Bindi, Marco; Rivelli, Matteo; Cumbo, Jacopo; Solej, Mario; Enrico, Stefano; Martino, Valter

2016-01-01

A well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient. Electronic databases were interrogated to better define the terms "surgeon", "specialized surgeon", and "specialist surgeon"; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy. Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee's progress. The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy skills proportional to the instructor

The Predictive Value of Ultrasound Learning Curves Across Simulated and Clinical Settings

DEFF Research Database (Denmark)

Madsen, Mette E; Nørgaard, Lone N; Tabor, Ann

2017-01-01

OBJECTIVES: The aim of the study was to explore whether learning curves on a virtual-reality (VR) sonographic simulator can be used to predict subsequent learning curves on a physical mannequin and learning curves during clinical training. METHODS: Twenty midwives completed a simulation-based tra......OBJECTIVES: The aim of the study was to explore whether learning curves on a virtual-reality (VR) sonographic simulator can be used to predict subsequent learning curves on a physical mannequin and learning curves during clinical training. METHODS: Twenty midwives completed a simulation......-based training program in transvaginal sonography. The training was conducted on a VR simulator as well as on a physical mannequin. A subgroup of 6 participants underwent subsequent clinical training. During each of the 3 steps, the participants' performance was assessed using instruments with established...... settings. RESULTS: A good correlation was found between time needed to achieve predefined performance levels on the VR simulator and the physical mannequin (Pearson correlation coefficient .78; P VR simulator correlated well to the clinical performance scores (Pearson...

Learning curve for intracranial angioplasty and stenting in single center.

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Cai, Qiankun; Li, Yongkun; Xu, Gelin; Sun, Wen; Xiong, Yunyun; Sun, Wenshan; Bao, Yuanfei; Huang, Xianjun; Zhang, Yao; Zhou, Lulu; Zhu, Wusheng; Liu, Xinfeng

2014-01-01

To identify the specific caseload to overcome learning curve effect based on data from consecutive patients treated with Intracranial Angioplasty and Stenting (IAS) in our center. The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis trial was prematurely terminated owing to the high rate of periprocedural complications in the endovascular arm. To date, there are no data available for determining the essential caseload sufficient to overcome the learning effect and perform IAS with an acceptable level of complications. Between March 2004 and May 2012, 188 consecutive patients with 194 lesions who underwent IAS were analyzed retrospectively. The outcome variables used to assess the learning curve were periprocedural complications (included transient ischemic attack, ischemic stroke, vessel rupture, cerebral hyperperfusion syndrome, and vessel perforation). Multivariable logistic regression analysis was employed to illustrate the existence of learning curve effect on IAS. A risk-adjusted cumulative sum chart was performed to identify the specific caseload to overcome learning curve effect. The overall rate of 30-days periprocedural complications was 12.4% (24/194). After adjusting for case-mix, multivariate logistic regression analysis showed that operator experience was an independent predictor for periprocedural complications. The learning curve of IAS to overcome complications in a risk-adjusted manner was 21 cases. Operator's level of experience significantly affected the outcome of IAS. Moreover, we observed that the amount of experience sufficient for performing IAS in our center was 21 cases. Copyright © 2013 Wiley Periodicals, Inc.

Learning curve for radical retropubic prostatectomy

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Fernando J. A. Saito

2011-02-01

Full Text Available PURPOSE: The learning curve is a period in which the surgical procedure is performed with difficulty and slowness, leading to a higher risk of complications and reduced effectiveness due the surgeon's inexperience. We sought to analyze the residents' learning curve for open radical prostatectomy (RP in a training program. MATERIALS AND METHODS: We conducted a prospective study from June 2006 to January 2008 in the academic environment of the University of São Paulo. Five residents operated on 184 patients during a four-month rotation in the urologic oncology division, mentored by the same physician assistants. We performed sequential analyses according to the number of surgeries, as follows: = 10, 11 to 19, 20 to 28, and = 29. RESULTS: The residents performed an average of 37 RP each. The average psa was 9.3 ng/mL and clinical stage T1c in 71% of the patients. The pathological stage was pT2 (73%, pT3 (23%, pT4 (4%, and 46% of the patients had a Gleason score 7 or higher. In all surgeries, the average operative time and estimated blood loss was 140 minutes and 488 mL. Overall, 7.2% of patients required blood transfusion, and 23% had positive surgical margins. CONCLUSION: During the initial RP learning curve, we found a significant reduction in the operative time; blood transfusion during the procedures and positive surgical margin rate were stable in our series.

Endoscopic sleeve gastroplasty: the learning curve.

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Hill, Christine; El Zein, Mohamad; Agnihotri, Abhishek; Dunlap, Margo; Chang, Angela; Agrawal, Alison; Barola, Sindhu; Ngamruengphong, Saowanee; Chen, Yen-I; Kalloo, Anthony N; Khashab, Mouen A; Kumbhari, Vivek

2017-09-01

 Endoscopic sleeve gastroplasty (ESG) is gaining traction as a minimally invasive bariatric treatment. Concern that the learning curve may be slow, even among those proficient in endoscopic suturing, is a barrier to widespread implementation of the procedure. Therefore, we aimed to define the learning curve for ESG in a single endoscopist experienced in endoscopic suturing who participated in a 1-day ESG training program.  Consecutive patients who underwent ESG between February 2016 and November 2016 were included. The performing endoscopist, who is proficient in endoscopic suturing for non-ESG procedures, participated in a 1-day ESG training session before offering ESG to patients. The outcome measurements were length of procedure (LOP) and number of plications per procedure. Nonlinear regression was used to determine the learning plateau and calculate the learning rate.  Twenty-one consecutive patients (8 males), with mean age 47.7 ± 11.2 years and mean body mass index 41.8 ± 8.5 kg/m 2 underwent ESG. LOP decreased significantly across consecutive procedures, with a learning plateau at 101.5 minutes and a learning rate of 7 cases ( P  = 0.04). The number of plications per procedure also decreased significantly across consecutive procedures, with a plateau at 8 sutures and a learning rate of 9 cases ( P  < 0.001). Further, the average time per plication decreased significantly with consecutive procedures, reaching a plateau at 9 procedures ( P  < 0.001).  Endoscopists experienced in endoscopic suturing are expected to achieve a reduction in LOP and number of plications per procedure in successive cases, with progress plateauing at 7 and 9 cases, respectively.

Learning curves for mutual information maximization

International Nuclear Information System (INIS)

Urbanczik, R.

2003-01-01

An unsupervised learning procedure based on maximizing the mutual information between the outputs of two networks receiving different but statistically dependent inputs is analyzed [S. Becker and G. Hinton, Nature (London) 355, 161 (1992)]. For a generic data model, I show that in the large sample limit the structure in the data is recognized by mutual information maximization. For a more restricted model, where the networks are similar to perceptrons, I calculate the learning curves for zero-temperature Gibbs learning. These show that convergence can be rather slow, and a way of regularizing the procedure is considered

Influence of pavement condition on horizontal curve safety.

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Buddhavarapu, Prasad; Banerjee, Ambarish; Prozzi, Jorge A

2013-03-01

Crash statistics suggest that horizontal curves are the most vulnerable sites for crash occurrence. These crashes are often severe and many involve at least some level of injury due to the nature of the collisions. Ensuring the desired pavement surface condition is one potentially effective strategy to reduce the occurrence of severe accidents on horizontal curves. This study sought to develop crash injury severity models by integrating crash and pavement surface condition databases. It focuses on developing a causal relationship between pavement condition indices and severity level of crashes occurring on two-lane horizontal curves in Texas. In addition, it examines the suitability of the existing Skid Index for safety maintenance of two-lane curves. Significant correlation is evident between pavement condition and crash injury severity on two-lane undivided horizontal curves in Texas. Probability of a crash becoming fatal is appreciably sensitive to certain pavement indices. Data suggested that road facilities providing a smoother and more comfortable ride are vulnerable to severe crashes on horizontal curves. In addition, the study found that longitudinal skid measurement barely correlates with injury severity of crashes occurring on curved portions. The study recommends exploring the option of incorporating lateral friction measurement into Pavement Management System (PMS) databases specifically at curved road segments. Copyright © 2012 Elsevier Ltd. All rights reserved.

From Curve Fitting to Machine Learning

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Zielesny, Achim

2011-01-01

The analysis of experimental data is at heart of science from its beginnings. But it was the advent of digital computers that allowed the execution of highly non-linear and increasingly complex data analysis procedures - methods that were completely unfeasible before. Non-linear curve fitting, clustering and machine learning belong to these modern techniques which are a further step towards computational intelligence. The goal of this book is to provide an interactive and illustrative guide to these topics. It concentrates on the road from two dimensional curve fitting to multidimensional clus

Statistical assessment of the learning curves of health technologies.

Science.gov (United States)

Ramsay, C R; Grant, A M; Wallace, S A; Garthwaite, P H; Monk, A F; Russell, I T

2001-01-01

(1) To describe systematically studies that directly assessed the learning curve effect of health technologies. (2) Systematically to identify 'novel' statistical techniques applied to learning curve data in other fields, such as psychology and manufacturing. (3) To test these statistical techniques in data sets from studies of varying designs to assess health technologies in which learning curve effects are known to exist. METHODS - STUDY SELECTION (HEALTH TECHNOLOGY ASSESSMENT LITERATURE REVIEW): For a study to be included, it had to include a formal analysis of the learning curve of a health technology using a graphical, tabular or statistical technique. METHODS - STUDY SELECTION (NON-HEALTH TECHNOLOGY ASSESSMENT LITERATURE SEARCH): For a study to be included, it had to include a formal assessment of a learning curve using a statistical technique that had not been identified in the previous search. METHODS - DATA SOURCES: Six clinical and 16 non-clinical biomedical databases were searched. A limited amount of handsearching and scanning of reference lists was also undertaken. METHODS - DATA EXTRACTION (HEALTH TECHNOLOGY ASSESSMENT LITERATURE REVIEW): A number of study characteristics were abstracted from the papers such as study design, study size, number of operators and the statistical method used. METHODS - DATA EXTRACTION (NON-HEALTH TECHNOLOGY ASSESSMENT LITERATURE SEARCH): The new statistical techniques identified were categorised into four subgroups of increasing complexity: exploratory data analysis; simple series data analysis; complex data structure analysis, generic techniques. METHODS - TESTING OF STATISTICAL METHODS: Some of the statistical methods identified in the systematic searches for single (simple) operator series data and for multiple (complex) operator series data were illustrated and explored using three data sets. The first was a case series of 190 consecutive laparoscopic fundoplication procedures performed by a single surgeon; the second

LearnSafe. Learning organisations for nuclear safety

International Nuclear Information System (INIS)

Wahlstroem, B.; Kettunen, J.; Reiman, T.

2005-03-01

The nuclear power industry is currently undergoing a period of major change, which has brought with it a number of challenges. These changes have forced the nuclear power plants to initiate their own processes of change in order to adapt to the new situation. This adaptation must not compromise safety at any time, but during a rapid process of change there is a danger that minor problems may trigger a chain of events leading to a degraded safety. Organisational learning has been identified as an important component in ensuring the continued safety and efficiency of nuclear organisations. In response to these challenges a project LearnSafe 'Learning organisations for nuclear safety' was set up and funded by the European Community under the 5th Euratom Framework Programme. The present report gives an account of the LearnSafe project and its major results. (orig.)

Hysteroscopic sterilization using a virtual reality simulator: assessment of learning curve.

Science.gov (United States)

Janse, Juliënne A; Goedegebuure, Ruben S A; Veersema, Sebastiaan; Broekmans, Frank J M; Schreuder, Henk W R

2013-01-01

To assess the learning curve using a virtual reality simulator for hysteroscopic sterilization with the Essure method. Prospective multicenter study (Canadian Task Force classification II-2). University and teaching hospital in the Netherlands. Thirty novices (medical students) and five experts (gynecologists who had performed >150 Essure sterilization procedures). All participants performed nine repetitions of bilateral Essure placement on the simulator. Novices returned after 2 weeks and performed a second series of five repetitions to assess retention of skills. Structured observations on performance using the Global Rating Scale and parameters derived from the simulator provided measurements for analysis. The learning curve is represented by improvement per procedure. Two-way repeated-measures analysis of variance was used to analyze learning curves. Effect size (ES) was calculated to express the practical significance of the results (ES ≥ 0.50 indicates a large learning effect). For all parameters, significant improvements were found in novice performance within nine repetitions. Large learning effects were established for six of eight parameters (p learning curve established in this study endorses future implementation of the simulator in curricula on hysteroscopic skill acquisition for clinicians who are interested in learning this sterilization technique. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

Learning curves for solid oxide fuel cells

International Nuclear Information System (INIS)

Rivera-Tinoco, Rodrigo; Schoots, Koen; Zwaan, Bob van der

2012-01-01

Highlights: ► We present learning curves for fuel cells based on empirical data. ► We disentangle different cost reduction mechanisms for SOFCs. ► We distinguish between learning-by-doing, R and D, economies-of-scale and automation. - Abstract: In this article we present learning curves for solid oxide fuel cells (SOFCs). With data from fuel cell manufacturers we derive a detailed breakdown of their production costs. We develop a bottom-up model that allows for determining overall SOFC manufacturing costs with their respective cost components, among which material, energy, labor and capital charges. The results obtained from our model prove to deviate by at most 13% from total cost figures quoted in the literature. For the R and D stage of development and diffusion, we find local learning rates between 13% and 17% and we demonstrate that the corresponding cost reductions result essentially from learning-by-searching effects. When considering periods in time that focus on the pilot and early commercial production stages, we find regional learning rates of 27% and 1%, respectively, which we assume derive mainly from genuine learning phenomena. These figures turnout significantly higher, approximately 44% and 12% respectively, if also effects of economies-of-scale and automation are included. When combining all production stages we obtain lr = 35%, which represents a mix of cost reduction phenomena. This high learning rate value and the potential to scale up production suggest that continued efforts in the development of SOFC manufacturing processes, as well as deployment and use of SOFCs, may lead to substantial further cost reductions.

Prospects for PV: a learning curve analysis

International Nuclear Information System (INIS)

Zwaan, Bob van der; Rabi, A.

2003-01-01

This article gives an overview of the current state-of-the-art of photovoltaic electricity technology, and addresses its potential for cost reductions over the first few decades of the 21st century. Current PV production cost ranges are presented, both in terms of capacity installation and electricity generation, of single crystalline silicon, multi-crystalline silicon, amorphous silicon and other thin film technologies. Possible decreases of these costs are assessed, as expected according to the learning-curve methodology. We also estimate how much PV could gain if external costs (due to environmental and health damage) of energy were internalised, for example by an energy tax. Our conclusions are that, (1) mainly due its high costs, PV electricity is unlikely to play a major role in global energy supply and carbon emissions abatement before 2020, (2) extrapolating learning curves observed in the past, one can expect its costs to decrease significantly over the coming years, so that a considerable PV electricity share world-wide could materialise after 2020, (3) niche-market applications, e.g. using stand-alone systems in remote areas, are crucial for continuing 'the ride along the learning curve', (4) damage costs of conventional (fossil) power sources are considerable, and their internalisation would improve the competitiveness of PV, although probably not enough to close the current cost gap. (author)

Learning Curves of Virtual Mastoidectomy in Distributed and Massed Practice

DEFF Research Database (Denmark)

Andersen, Steven Arild Wuyts; Konge, Lars; Cayé-Thomasen, Per

2015-01-01

IMPORTANCE: Repeated and deliberate practice is crucial in surgical skills training, and virtual reality (VR) simulation can provide self-directed training of basic surgical skills to meet the individual needs of the trainee. Assessment of the learning curves of surgical procedures is pivotal...... in understanding skills acquisition and best-practice implementation and organization of training. OBJECTIVE: To explore the learning curves of VR simulation training of mastoidectomy and the effects of different practice sequences with the aim of proposing the optimal organization of training. DESIGN, SETTING...... plateaued on a score of 16.0 (15.3-16.7) at approximately the ninth repetition, but the individual learning curves were highly variable. CONCLUSIONS AND RELEVANCE: Novices can acquire basic mastoidectomy competencies with self-directed VR simulation training. Training should be organized with distributed...

Application of Learning Curves for Didactic Model Evaluation: Case Studies

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Felix Mödritscher

2013-01-01

Full Text Available The success of (online courses depends, among other factors, on the underlying didactical models which have always been evaluated with qualitative and quantitative research methods. Several new evaluation techniques have been developed and established in the last years. One of them is ‘learning curves’, which aim at measuring error rates of users when they interact with adaptive educational systems, thereby enabling the underlying models to be evaluated and improved. In this paper, we report how we have applied this new method to two case studies to show that learning curves are useful to evaluate didactical models and their implementation in educational platforms. Results show that the error rates follow a power law distribution with each additional attempt if the didactical model of an instructional unit is valid. Furthermore, the initial error rate, the slope of the curve and the goodness of fit of the curve are valid indicators for the difficulty level of a course and the quality of its didactical model. As a conclusion, the idea of applying learning curves for evaluating didactical model on the basis of usage data is considered to be valuable for supporting teachers and learning content providers in improving their online courses.

Teaching Learning Curves in an Undergraduate Economics or Operations Management Course

Science.gov (United States)

Naidu, Jaideep T.; Sanford, John F.

2012-01-01

Learning Curves has its roots in economics and behavioral psychology. Learning Curves theory has several business applications and is widely used in the industry. As faculty of Operations Management courses, we cover this topic in some depth in the classroom. In this paper, we present some of our teaching methods and material that have helped us…

Patient Safety and Organizational Learning

DEFF Research Database (Denmark)

Zinck Pedersen, Kirstine

pragmatism, situated learning theory and science and technology studies, the paper contrasts the notion of ‘systemic’ learning expressed by the safety policy program with notions of learning as a socio-materially situated practice. Based on fieldwork conducted in 2010 in a Danish university hospital, I...... propose that learning, and more specifically learning from critical incidents, should be understood as a practical and experience-based activity as well as an equally individual and social achievement, which is always formed in relation to the specificities of the concrete situation. Parting from......The key trope of patient safety policy is learning. With the motto of going from ‘a culture of blame to a learning culture’, the safety program introduces a ‘systemic perspective’ to facilitate openness and willingness to talk about failures, hereby making failures into a system property. Within...

Training in robotics: The learning curve and contemporary concepts in training.

Science.gov (United States)

Bach, Christian; Miernik, Arkadiusz; Schönthaler, Martin

2014-03-01

To define the learning curve of robot-assisted laparoscopic surgery for prostatectomy (RALP) and upper tract procedures, and show the differences between the classical approach to training and the new concept of parallel learning. This mini-review is based on the results of a Medline search using the keywords 'da Vinci', 'robot-assisted laparoscopic surgery', 'training', 'teaching' and 'learning curve'. For RALP and robot-assisted upper tract surgery, a learning curve of 8-150 procedures is quoted, with most articles proposing that 30-40 cases are needed to carry out the procedure safely. There is no consensus about which endpoints should be measured. In the traditional proctored training model, the surgeon learns the procedure linearly, following the sequential order of the surgical steps. A more recent approach is to specify the relative difficulty of each step and to train the surgeon simultaneously in several steps of equal difficulty. The entire procedure is only performed after all the steps are mastered in a timely manner. Recently, a 'warm-up' before robotic surgery has been shown to be beneficial for successful surgery in the operating room. There is no clear definition of the duration of the effective learning curve for RALP and robotic upper tract surgery. The concept of stepwise, parallel learning has the potential to accelerate the learning process and to make sure that initial cases are not too long. It can also be assumed that a preoperative 'warm up' could help significantly to improve the progress of the trainee.

Learning curves for ultrasound guided lung biopsy in the hands of respiratory physicians

DEFF Research Database (Denmark)

Laursen, Christian; Naur, Therese Maria Henriette; Bodtger, Uffe

2016-01-01

are depicted in figure 1. Six of the physicians had learning curves with a relatively downward or stable projection as a sign of developing competence. Three physicians, however, had learning curves with an upward projection indicating unacceptable competence in performing the procedure......Background: The aim of this study was to determine learning curves for ultrasound guided transthoracic needle biopsies (US-TTNB) performed by respiratory physicians after implementation at three different centers.Methods: During January 2012 to August 2014 patients were included if they had...... a registered US-TTNB procedure at any of the three centers. The US-TTNB was defined as being successful if the result was diagnostic and otherwise as being unsuccessful. Histology or cytology results and clinical follow-up were used as a reference tests. The learning curves for physicians having performed...

Machine Learning Techniques for Stellar Light Curve Classification

Science.gov (United States)

Hinners, Trisha A.; Tat, Kevin; Thorp, Rachel

2018-07-01

We apply machine learning techniques in an attempt to predict and classify stellar properties from noisy and sparse time-series data. We preprocessed over 94 GB of Kepler light curves from the Mikulski Archive for Space Telescopes (MAST) to classify according to 10 distinct physical properties using both representation learning and feature engineering approaches. Studies using machine learning in the field have been primarily done on simulated data, making our study one of the first to use real light-curve data for machine learning approaches. We tuned our data using previous work with simulated data as a template and achieved mixed results between the two approaches. Representation learning using a long short-term memory recurrent neural network produced no successful predictions, but our work with feature engineering was successful for both classification and regression. In particular, we were able to achieve values for stellar density, stellar radius, and effective temperature with low error (∼2%–4%) and good accuracy (∼75%) for classifying the number of transits for a given star. The results show promise for improvement for both approaches upon using larger data sets with a larger minority class. This work has the potential to provide a foundation for future tools and techniques to aid in the analysis of astrophysical data.

Colorectal Stenting in Malignant Large Bowel Obstruction: The Learning Curve

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D. Williams

2011-01-01

Full Text Available Aim. Self-expanding metal stents (SEMSs are increasingly used for the palliation of metastatic colorectal cancer and as a bridge to surgery for obstructing tumours. This case series analyses the learning curve and changes in practice of colorectal stenting over a three year period. Methods. A study of 40 patients who underwent placement of SEMS for the management of colorectal cancer. Patients spanned the learning curve of a single surgeon endoscopist. Results. Technical success rates increased from 82% initially, using an average of 1.7 stents per procedure, to a 94% success rate where all patients were stented using a single stent. There has been a change in practice from elective palliative stenting toward emergency preoperative stenting. Conclusion. There is a steep learning curve for the use of SEMS in the management of malignant colorectal bowel obstruction. We suggest that at least 20 cases are required for an operator to be considered experienced.

The Quantitative Evaluation of Functional Neuroimaging Experiments: Mutual Information Learning Curves

DEFF Research Database (Denmark)

Kjems, Ulrik; Hansen, Lars Kai; Anderson, Jon

2002-01-01

Learning curves are presented as an unbiased means for evaluating the performance of models for neuroimaging data analysis. The learning curve measures the predictive performance in terms of the generalization or prediction error as a function of the number of independent examples (e.g., subjects......) used to determine the parameters in the model. Cross-validation resampling is used to obtain unbiased estimates of a generic multivariate Gaussian classifier, for training set sizes from 2 to 16 subjects. We apply the framework to four different activation experiments, in this case \\$\\backslash......\\$[/sup 15/ O]water data sets, although the framework is equally valid for multisubject fMRI studies. We demonstrate how the prediction error can be expressed as the mutual information between the scan and the scan label, measured in units of bits. The mutual information learning curve can be used...

SILC for SILC: Single Institution Learning Curve for Single-Incision Laparoscopic Cholecystectomy

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Chee Wei Tay

2013-01-01

Full Text Available Objectives. We report the single-incision laparoscopic cholecystectomy (SILC learning experience of 2 hepatobiliary surgeons and the factors that could influence the learning curve of SILC. Methods. Patients who underwent SILC by Surgeons A and B were studied retrospectively. Operating time, conversion rate, reason for conversion, identity of first assistants, and their experience with previous laparoscopic cholecystectomy (LC were analysed. CUSUM analysis is used to identify learning curve. Results. Hundred and nineteen SILC cases were performed by Surgeons A and B, respectively. Eight cases required additional port. In CUSUM analysis, most conversion occurred during the first 19 cases. Operating time was significantly lower (62.5 versus 90.6 min, P = 0.04 after the learning curve has been overcome. Operating time decreases as the experience increases, especially Surgeon B. Most conversions are due to adhesion at Calot’s triangle. Acute cholecystitis, patients’ BMI, and previous surgery do not seem to influence conversion rate. Mean operating times of cases assisted by first assistant with and without LC experience were 48 and 74 minutes, respectively (P = 0.004. Conclusion. Nineteen cases are needed to overcome the learning curve of SILC. Team work, assistant with CLC experience, and appropriate equipment and technique are the important factors in performing SILC.

Learning curves for solid oxide fuel cells

Energy Technology Data Exchange (ETDEWEB)

Rivera-Tinoco, R.; Schoots, K. [Energy research Centre of the Netherlands (Netherlands). Policy Studies; Zwaan, B.C.C. van der [Energy research Centre of the Netherlands (Netherlands). Policy Studies; Columbia Univ., New York City, NY (United States). Lenfest Center for Sustainable Energy

2010-07-01

We present learning curves for solid oxide fuel cells (SOFCs) and combined heat and power (CHP) SOFC systems with an electric capacity between 1 and 250 kW. On the basis of the cost breakdown of production cost data from fuel cell manufacturers, we developed a bottom-up model that allows for determining overall manufacturing costs from their respective cost components, among which material, energy, labor, and capital charges. The results obtained from our model prove to deviate by at most 13% from total cost figures quoted in the literature. For the early pilot stage of development, we find for SOFC manufacturing a learning rate between 14% and 17%, and for total SOFC system fabrication between 16% and 19%. We argue that the corresponding cost reductions result largely from learning-by-searching effects (R and D) rather than learning-by-doing. When considering a longer time frame that includes the early commercial production stage, we find learning rates between 14% and 39%, which represent a mix of phenomena such as learning-by-doing, learning-by-searching, economies-of-scale and automation. (orig.)

Climbing the health learning curve together | IDRC - International ...

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

2011-01-25

Jan 25, 2011 ... Climbing the health learning curve together ... Many of the projects are creating master's programs at their host universities ... Formerly based in the high Arctic, Atlantis is described by Dr Martin Forde of St George's University ...

Learning Curves of Virtual Mastoidectomy in Distributed and Massed Practice.

Science.gov (United States)

Andersen, Steven Arild Wuyts; Konge, Lars; Cayé-Thomasen, Per; Sørensen, Mads Sølvsten

2015-10-01

Repeated and deliberate practice is crucial in surgical skills training, and virtual reality (VR) simulation can provide self-directed training of basic surgical skills to meet the individual needs of the trainee. Assessment of the learning curves of surgical procedures is pivotal in understanding skills acquisition and best-practice implementation and organization of training. To explore the learning curves of VR simulation training of mastoidectomy and the effects of different practice sequences with the aim of proposing the optimal organization of training. A prospective trial with a 2 × 2 design was conducted at an academic teaching hospital. Participants included 43 novice medical students. Of these, 21 students completed time-distributed practice from October 14 to November 29, 2013, and a separate group of 19 students completed massed practice on May 16, 17, or 18, 2014. Data analysis was performed from June 6, 2014, to March 3, 2015. Participants performed 12 repeated virtual mastoidectomies using a temporal bone surgical simulator in either a distributed (practice blocks spaced in time) or massed (all practice in 1 day) training program with randomization for simulator-integrated tutoring during the first 5 sessions. Performance was assessed using a modified Welling Scale for final product analysis by 2 blinded senior otologists. Compared with the 19 students in the massed practice group, the 21 students in the distributed practice group were older (mean age, 25.1 years), more often male (15 [62%]), and had slightly higher mean gaming frequency (2.3 on a 1-5 Likert scale). Learning curves were established and distributed practice was found to be superior to massed practice, reported as mean end score (95% CI) of 15.7 (14.4-17.0) in distributed practice vs. 13.0 (11.9-14.1) with massed practice (P = .002). Simulator-integrated tutoring accelerated the initial performance, with mean score for tutored sessions of 14.6 (13.9-15.2) vs. 13.4 (12.8-14.0) for

Unraveling the photovoltaic technology learning curve by incorporation of input price changes and scale effects

International Nuclear Information System (INIS)

Yu, C.F.; van Sark, W.G.J.H.M.; Alsema, E.A.

2011-01-01

In a large number of energy models, the use of learning curves for estimating technological improvements has become popular. This is based on the assumption that technological development can be monitored by following cost development as a function of market size. However, recent data show that in some stages of photovoltaic technology (PV) production, the market price of PV modules stabilizes even though the cumulative capacity increases. This implies that no technological improvement takes place in these periods: the cost predicted by the learning curve in the PV study is lower than the market one. We propose that this bias results from ignoring the effects of input prices and scale effects, and that incorporating the input prices and scale effects into the learning curve theory is an important issue in making cost predictions more reliable. In this paper, a methodology is described to incorporate the scale and input-prices effect as the additional variables into the one factor learning curve, which leads to the definition of the multi-factor learning curve. This multi-factor learning curve is not only derived from economic theories, but also supported by an empirical study. The results clearly show that input prices and scale effects are to be included, and that, although market prices are stabilizing, learning is still taking place. (author)

LEARNING CURVE IN ENDOSCOPIC TRANSNASAL SELLAR REGION SURGERY

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Ananth G

2016-07-01

Full Text Available BACKGROUND The endoscopic endonasal approach for the sellar region lesions is a novel technique and an effective surgical option. The evidence thus far has been conflicting with reports in favour and against a learning curve. We attempt to determine the learning curve associated with this approach. METHODS Retrospective and prospective data of the patients who were surgically treated for sellar region lesions between the year 2013 and 2016 was collected, 32 patients were operated by the endoscopic endonasal approach at Vydehi Institute of Medical Sciences and Research Centre, Bangalore. Age, sex, presenting symptoms, length of hospital stay, surgical approach, type of dissection, duration of surgery, sellar floor repair, intraoperative and postoperative complications were noted. All the procedures were performed by a single neurosurgeon. RESULTS A total of 32 patients were operated amongst which 21 patients were non-functioning pituitary adenomas, 2 were growth hormone secreting functional adenomas, 1 was an invasive pituitary adenoma, 4 were craniopharyngiomas, 2 were meningiomas, 1 was Rathke’s cleft cyst and 1 was a clival chordoma. Headache was the mode of presentation in 12 patients, 12 patients had visual deficits, 6 patients presented with hormonal disturbances amongst which 4 patients presented with features of panhypopituitarism and 2 with acromegaly. Amongst the 4 patients with panhypopituitarism, 2 also had DI, two patients presented with CSF rhinorrhoea. There was a 100% improvement in the patients who presented with visual symptoms. Gross total resection was achieved in all 4 cases of craniopharyngiomas and 13 cases of pituitary adenomas. Postoperative CSF leak was seen in 4 patients who underwent re-exploration and sellar floor repair, 9 patients had postoperative Diabetes Insipidus (DI which was transient, the incidence of DI reduced towards the end of the study. There was a 25% decrease in the operating time towards the end of

The relationship between organizational leadership for safety and learning from patient safety events.

Science.gov (United States)

Ginsburg, Liane R; Chuang, You-Ta; Berta, Whitney Blair; Norton, Peter G; Ng, Peggy; Tregunno, Deborah; Richardson, Julia

2010-06-01

To examine the relationship between organizational leadership for patient safety and five types of learning from patient safety events (PSEs). Forty-nine general acute care hospitals in Ontario, Canada. A nonexperimental design using cross-sectional surveys of hospital patient safety officers (PSOs) and patient care managers (PCMs). PSOs provided data on organization-level learning from (a) minor events, (b) moderate events, (c) major near misses, (d) major event analysis, and (e) major event dissemination/communication. PCMs provided data on organizational leadership (formal and informal) for patient safety. Hospitals were the unit of analysis. Seemingly unrelated regression was used to examine the influence of formal and informal leadership for safety on the five types of learning from PSEs. The interaction between leadership and hospital size was also examined. Formal organizational leadership for patient safety is an important predictor of learning from minor, moderate, and major near-miss events, and major event dissemination. This relationship is significantly stronger for small hospitals (learning from safety events. Formal leadership support for safety is of particular importance in small organizations where the economic burden of safety programs is disproportionately large and formal leadership is closer to the front lines.

Using a high-fidelity patient simulator with first-year medical students to facilitate learning of cardiovascular function curves.

Science.gov (United States)

Harris, David M; Ryan, Kathleen; Rabuck, Cynthia

2012-09-01

Students are relying on technology for learning more than ever, and educators need to adapt to facilitate student learning. High-fidelity patient simulators (HFPS) are usually reserved for the clinical years of medical education and are geared to improve clinical decision skills, teamwork, and patient safety. Finding ways to incorporate HFPS into preclinical medical education represents more of a challenge, and there is limited literature regarding its implementation. The main objective of this study was to implement a HFPS activity into a problem-based curriculum to enhance the learning of basic sciences. More specifically, the focus was to aid in student learning of cardiovascular function curves and help students develop heart failure treatment strategies based on basic cardiovascular physiology concepts. Pretests and posttests, along with student surveys, were used to determine student knowledge and perception of learning in two first-year medical school classes. There was an increase of 21% and 22% in the percentage of students achieving correct answers on a posttest compared with their pretest score. The median number of correct questions increased from pretest scores of 2 and 2.5 to posttest scores of 4 and 5 of a possible total of 6 in each respective year. Student survey data showed agreement that the activity aided in learning. This study suggests that a HFPS activity can be implemented during the preclinical years of medical education to address basic science concepts. Additionally, it suggests that student learning of cardiovascular function curves and heart failure strategies are facilitated.

Balloon dilation of the eustachian tube in a cadaver model: technical considerations, learning curve, and potential barriers.

Science.gov (United States)

McCoul, Edward D; Singh, Ameet; Anand, Vijay K; Tabaee, Abtin

2012-04-01

The surgical management options for eustachian tube dysfunction have historically been limited. The goal of the current study was to evaluate the technical considerations, learning curve, and potential barriers for balloon dilation of the eustachian tube (BDET) as an alternative treatment modality. Prospective preclinical trial of BDET in a cadaver model. A novel balloon catheter device was used for eustachian tube dilation. Twenty-four BDET procedures were performed by three independent rhinologists with no prior experience with the procedure (eight procedures per surgeon). The duration and number of attempts of the individual steps and overall procedure were recorded. Endoscopic examination of the eustachian tube was performed after each procedure, and the surgeon was asked to rate the subjective difficulty on a five-point scale. Successful completion of the procedure occurred in each case. The overall mean duration of the procedure was 284 seconds, and a mean number of 1.15 attempts were necessary to perform the individual steps. The mean subjective procedure difficulty was noted as somewhat easy. Statistically shorter duration and subjectively easier procedure were noted in the second compared to the first half of the series, indicating a favorable learning curve. Linear fissuring within the eustachian tube lumen without submucosal disruption (nine procedures, 37%) and with submucosal disruption (five procedures, 21%) were noted. The significance of these physical findings is unclear. Preclinical testing of BDET is associated with favorable duration, learning curve, and overall ease of completion. Clinical trials are necessary to evaluate safety and efficacy. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Industrial Learning Curves Series Production of the LHC Main Superconduting Dipoles

CERN Document Server

Fessia, Paolo; Rossi, Lucio

2007-01-01

By mid August 2006, 1160 of the 1232 of LHC main dipoles have been delivered to CERN by the three suppliers in charge of the production. The training of the staff, mostly hired just for this manufacture, and the improvement of the procedures with the acquired experience, naturally decrease the time necessary for the assembly of a unit. The aim of this paper is to apply methodologies like the cost-based learning curves and the time-based learning curves to the LHC Main Dipole production comparing the estimated learning percentage to the ones experienced in other industries. This type of analysis, already presented on 500 units is here extended to more than 1000 completed units. The work also tries to identify which type of industry presents the learning percentages that are the most similar to our case and to investigate the impact of the production strategy on the process efficiency.

Learner Characteristic Based Learning Effort Curve Mode: The Core Mechanism on Developing Personalized Adaptive E-Learning Platform

Science.gov (United States)

Hsu, Pi-Shan

2012-01-01

This study aims to develop the core mechanism for realizing the development of personalized adaptive e-learning platform, which is based on the previous learning effort curve research and takes into account the learner characteristics of learning style and self-efficacy. 125 university students from Taiwan are classified into 16 groups according…

Learning-curve estimation techniques for nuclear industry

Energy Technology Data Exchange (ETDEWEB)

Vaurio, J.K.

1983-01-01

Statistical techniques are developed to estimate the progress made by the nuclear industry in learning to prevent accidents. Learning curves are derived for accident occurrence rates based on acturial data, predictions are made for the future, and compact analytical equations are obtained for the statistical accuracies of the estimates. Both maximum likelihood estimation and the method of moments are applied to obtain parameters for the learning models, and results are compared to each other and to earlier graphical and analytical results. An effective statistical test is also derived to assess the significance of trends. The models used associate learning directly to accidents, to the number of plants and to the cumulative number of operating years. Using as a data base nine core damage accidents in electricity-producing plants, it is estimated that the probability of a plant to have a serious flaw has decreased from 0.1 to 0.01 during the developmental phase of the nuclear industry. At the same time the frequency of accidents has decreased from 0.04 per reactor year to 0.0004 per reactor year.

Learning-curve estimation techniques for nuclear industry

International Nuclear Information System (INIS)

Vaurio, J.K.

1983-01-01

Statistical techniques are developed to estimate the progress made by the nuclear industry in learning to prevent accidents. Learning curves are derived for accident occurrence rates based on acturial data, predictions are made for the future, and compact analytical equations are obtained for the statistical accuracies of the estimates. Both maximum likelihood estimation and the method of moments are applied to obtain parameters for the learning models, and results are compared to each other and to earlier graphical and analytical results. An effective statistical test is also derived to assess the significance of trends. The models used associate learning directly to accidents, to the number of plants and to the cumulative number of operating years. Using as a data base nine core damage accidents in electricity-producing plants, it is estimated that the probability of a plant to have a serious flaw has decreased from 0.1 to 0.01 during the developmental phase of the nuclear industry. At the same time the frequency of accidents has decreased from 0.04 per reactor year to 0.0004 per reactor year

Learning curve estimation techniques for nuclear industry

International Nuclear Information System (INIS)

Vaurio, Jussi K.

1983-01-01

Statistical techniques are developed to estimate the progress made by the nuclear industry in learning to prevent accidents. Learning curves are derived for accident occurrence rates based on actuarial data, predictions are made for the future, and compact analytical equations are obtained for the statistical accuracies of the estimates. Both maximum likelihood estimation and the method of moments are applied to obtain parameters for the learning models, and results are compared to each other and to earlier graphical and analytical results. An effective statistical test is also derived to assess the significance of trends. The models used associate learning directly to accidents, to the number of plants and to the cumulative number of operating years. Using as a data base nine core damage accidents in electricity-producing plants, it is estimated that the probability of a plant to have a serious flaw has decreased from 0.1 to 0.01 during the developmental phase of the nuclear industry. At the same time the frequency of accidents has decreased from 0.04 per reactor year to 0.0004 per reactor year

Beyond the learning curve: factors influencing cost reductions in photovoltaics

International Nuclear Information System (INIS)

Nemet, Gregory F.

2006-01-01

The extent and timing of cost-reducing improvements in low-carbon energy systems are important sources of uncertainty in future levels of greenhouse-gas emissions. Models that assess the costs of climate change mitigation policy, and energy policy in general, rely heavily on learning curves to include technology dynamics. Historically, no energy technology has changed more dramatically than photovoltaics (PV), the cost of which has declined by a factor of nearly 100 since the 1950s. Which changes were most important in accounting for the cost reductions that have occurred over the past three decades? Are these results consistent with the notion that learning from experience drove technical change? In this paper, empirical data are assembled to populate a simple model identifying the most important factors affecting the cost of PV. The results indicate that learning from experience, the theoretical mechanism used to explain learning curves, only weakly explains change in the most important factors-plant size, module efficiency, and the cost of silicon. Ways in which the consideration of a broader set of influences, such as technical barriers, industry structure, and characteristics of demand, might be used to inform energy technology policy are discussed

Improving Accuracy and Temporal Resolution of Learning Curve Estimation for within- and across-Session Analysis

Science.gov (United States)

Tabelow, Karsten; König, Reinhard; Polzehl, Jörg

2016-01-01

Estimation of learning curves is ubiquitously based on proportions of correct responses within moving trial windows. Thereby, it is tacitly assumed that learning performance is constant within the moving windows, which, however, is often not the case. In the present study we demonstrate that violations of this assumption lead to systematic errors in the analysis of learning curves, and we explored the dependency of these errors on window size, different statistical models, and learning phase. To reduce these errors in the analysis of single-subject data as well as on the population level, we propose adequate statistical methods for the estimation of learning curves and the construction of confidence intervals, trial by trial. Applied to data from an avoidance learning experiment with rodents, these methods revealed performance changes occurring at multiple time scales within and across training sessions which were otherwise obscured in the conventional analysis. Our work shows that the proper assessment of the behavioral dynamics of learning at high temporal resolution can shed new light on specific learning processes, and, thus, allows to refine existing learning concepts. It further disambiguates the interpretation of neurophysiological signal changes recorded during training in relation to learning. PMID:27303809

Improving Accuracy and Temporal Resolution of Learning Curve Estimation for within- and across-Session Analysis.

Directory of Open Access Journals (Sweden)

Matthias Deliano

Full Text Available Estimation of learning curves is ubiquitously based on proportions of correct responses within moving trial windows. Thereby, it is tacitly assumed that learning performance is constant within the moving windows, which, however, is often not the case. In the present study we demonstrate that violations of this assumption lead to systematic errors in the analysis of learning curves, and we explored the dependency of these errors on window size, different statistical models, and learning phase. To reduce these errors in the analysis of single-subject data as well as on the population level, we propose adequate statistical methods for the estimation of learning curves and the construction of confidence intervals, trial by trial. Applied to data from an avoidance learning experiment with rodents, these methods revealed performance changes occurring at multiple time scales within and across training sessions which were otherwise obscured in the conventional analysis. Our work shows that the proper assessment of the behavioral dynamics of learning at high temporal resolution can shed new light on specific learning processes, and, thus, allows to refine existing learning concepts. It further disambiguates the interpretation of neurophysiological signal changes recorded during training in relation to learning.

New method of safety assessment for pressure vessel of nuclear power plant--brief introduction of master curve approach

International Nuclear Information System (INIS)

Yang Wendou

2011-01-01

The new Master Curve Method is called as a revolutionary advance to the assessment of- reactor pressure vessel integrity in USA. This paper explains the origin, basis and standard of the Master Curve from the reactor pressure-temperature limit curve which assures the safety of nuclear power plant. According to the characteristics of brittle fracture which is greatly susceptible to the microstructure, the theory and the test method of the Master Curve as well as its statistical law which can be modeled using Weibull distribution are described in this paper. The meaning, advantage, application and importance of the Master Curve as well as the relation between the Master Curve and nuclear power safety are understood from the fitting formula for the fracture toughness database by Weibull distribution model. (author)

Impact of the learning curve on outcome after transcatheter mitral valve repair

DEFF Research Database (Denmark)

Ledwoch, Jakob; Franke, Jennifer; Baldus, Stephan

2014-01-01

AIMS: This analysis from the German Mitral Valve Registry investigates the impact of the learning curve with the MitraClip(®) technique on procedural success and complications. METHODS AND RESULTS: Consecutive patients treated since 2009 in centers that performed more than 50 transcatheter mitral...... not decrease over time. CONCLUSION: A learning curve using the MitraClip(®) device does not appear to significantly affect acute MR reduction, hospital and 30-day mortality. Most likely, the proctor system leads to already high initial procedure success and relatively short procedure time....

Use of the t-distribution to construct seismic hazard curves for seismic probabilistic safety assessments

Energy Technology Data Exchange (ETDEWEB)

Yee, Eric [KEPCO International Nuclear Graduate School, Dept. of Nuclear Power Plant Engineering, Ulsan (Korea, Republic of)

2017-03-15

Seismic probabilistic safety assessments are used to help understand the impact potential seismic events can have on the operation of a nuclear power plant. An important component to seismic probabilistic safety assessment is the seismic hazard curve which shows the frequency of seismic events. However, these hazard curves are estimated assuming a normal distribution of the seismic events. This may not be a strong assumption given the number of recorded events at each source-to-site distance. The use of a normal distribution makes the calculations significantly easier but may underestimate or overestimate the more rare events, which is of concern to nuclear power plants. This paper shows a preliminary exploration into the effect of using a distribution that perhaps more represents the distribution of events, such as the t-distribution to describe data. The integration of a probability distribution with potentially larger tails basically pushes the hazard curves outward, suggesting a different range of frequencies for use in seismic probabilistic safety assessments. Therefore the use of a more realistic distribution results in an increase in the frequency calculations suggesting rare events are less rare than thought in terms of seismic probabilistic safety assessment. However, the opposite was observed with the ground motion prediction equation considered.

Use of the t-distribution to construct seismic hazard curves for seismic probabilistic safety assessments

International Nuclear Information System (INIS)

Yee, Eric

2017-01-01

Seismic probabilistic safety assessments are used to help understand the impact potential seismic events can have on the operation of a nuclear power plant. An important component to seismic probabilistic safety assessment is the seismic hazard curve which shows the frequency of seismic events. However, these hazard curves are estimated assuming a normal distribution of the seismic events. This may not be a strong assumption given the number of recorded events at each source-to-site distance. The use of a normal distribution makes the calculations significantly easier but may underestimate or overestimate the more rare events, which is of concern to nuclear power plants. This paper shows a preliminary exploration into the effect of using a distribution that perhaps more represents the distribution of events, such as the t-distribution to describe data. The integration of a probability distribution with potentially larger tails basically pushes the hazard curves outward, suggesting a different range of frequencies for use in seismic probabilistic safety assessments. Therefore the use of a more realistic distribution results in an increase in the frequency calculations suggesting rare events are less rare than thought in terms of seismic probabilistic safety assessment. However, the opposite was observed with the ground motion prediction equation considered

Resting heart rate variability predicts safety learning and fear extinction in an interoceptive fear conditioning paradigm.

Directory of Open Access Journals (Sweden)

Meike Pappens

Full Text Available This study aimed to investigate whether interindividual differences in autonomic inhibitory control predict safety learning and fear extinction in an interoceptive fear conditioning paradigm. Data from a previously reported study (N = 40 were extended (N = 17 and re-analyzed to test whether healthy participants' resting heart rate variability (HRV - a proxy of cardiac vagal tone - predicts learning performance. The conditioned stimulus (CS was a slight sensation of breathlessness induced by a flow resistor, the unconditioned stimulus (US was an aversive short-lasting suffocation experience induced by a complete occlusion of the breathing circuitry. During acquisition, the paired group received 6 paired CS-US presentations; the control group received 6 explicitly unpaired CS-US presentations. In the extinction phase, both groups were exposed to 6 CS-only presentations. Measures included startle blink EMG, skin conductance responses (SCR and US-expectancy ratings. Resting HRV significantly predicted the startle blink EMG learning curves both during acquisition and extinction. In the unpaired group, higher levels of HRV at rest predicted safety learning to the CS during acquisition. In the paired group, higher levels of HRV were associated with better extinction. Our findings suggest that the strength or integrity of prefrontal inhibitory mechanisms involved in safety- and extinction learning can be indexed by HRV at rest.

An exploratory analysis of personality, attitudes, and study skills on the learning curve within a team-based learning environment.

Science.gov (United States)

Persky, Adam M; Henry, Teague; Campbell, Ashley

2015-03-25

To examine factors that determine the interindividual variability of learning within a team-based learning environment. Students in a pharmacokinetics course were given 4 interim, low-stakes cumulative assessments throughout the semester and a cumulative final examination. Students' Myers-Briggs personality type was assessed, as well as their study skills, motivations, and attitudes towards team-learning. A latent curve model (LCM) was applied and various covariates were assessed to improve the regression model. A quadratic LCM was applied for the first 4 assessments to predict final examination performance. None of the covariates examined significantly impacted the regression model fit except metacognitive self-regulation, which explained some of the variability in the rate of learning. There were some correlations between personality type and attitudes towards team learning, with introverts having a lower opinion of team-learning than extroverts. The LCM could readily describe the learning curve. Extroverted and introverted personality types had the same learning performance even though preference for team-learning was lower in introverts. Other personality traits, study skills, or practice did not significantly contribute to the learning variability in this course.

Hydrogen technologies and the technology learning curve

International Nuclear Information System (INIS)

Rogner, H.-H.

1998-01-01

On their bumpy road to commercialization, hydrogen production, delivery and conversion technologies not only require dedicated research, development and demonstration efforts, but also protected niche markets and early adopters. While niche markets utilize the unique technological properties of hydrogen, adopters exhibit a willingness to pay a premium for hydrogen fueled energy services. The concept of the technology learning curve is applied to estimate the capital requirements associated with the commercialization process of several hydrogen technologies. (author)

Development of E-Learning Materials for Machining Safety Education

Science.gov (United States)

Nakazawa, Tsuyoshi; Mita, Sumiyoshi; Matsubara, Masaaki; Takashima, Takeo; Tanaka, Koichi; Izawa, Satoru; Kawamura, Takashi

We developed two e-learning materials for Manufacturing Practice safety education: movie learning materials and hazard-detection learning materials. Using these video and sound media, students can learn how to operate machines safely with movie learning materials, which raise the effectiveness of preparation and review for manufacturing practice. Using these materials, students can realize safety operation well. Students can apply knowledge learned in lectures to the detection of hazards and use study methods for hazard detection during machine operation using the hazard-detection learning materials. Particularly, the hazard-detection learning materials raise students‧ safety consciousness and increase students‧ comprehension of knowledge from lectures and comprehension of operations during Manufacturing Practice.

Teamwork, organizational learning, patient safety and job outcomes.

Science.gov (United States)

Goh, Swee C; Chan, Christopher; Kuziemsky, Craig

2013-01-01

This article aims to encourage healthcare administrators to consider the learning organization concept and foster collaborative learning among teams in their attempt to improve patient safety. Relevant healthcare, organizational behavior and human resource management literature was reviewed. A patient safety culture, fostered by healthcare leaders, should include an organizational culture that encourages collaborative learning, replaces the blame culture, prioritizes patient safety and rewards individuals who identify serious mistakes. As healthcare institution staffs are being asked to deliver more complex medical services with fewer resources, there is a need to understand how hospital staff can learn from other organizational settings, especially the non-healthcare sectors. The paper provides suggestions for improving patient safety which are drawn from the health and business management literature.

The learning curve associated with the introduction of the subcutaneous implantable defibrillator

NARCIS (Netherlands)

Knops, Reinoud E.; Brouwer, Tom F.; Barr, Craig S.; Theuns, Dominic A.; Boersma, Lucas; Weiss, Raul; Neuzil, Petr; Scholten, Marcoen; Lambiase, Pier D.; Leon, Angel R.; Hood, Margaret; Jones, Paul W.; Wold, Nicholas; Grace, Andrew A.; Olde Nordkamp, Louise R. A.; Burke, Martin C.

2016-01-01

Aims The subcutaneous implantable cardioverter defibrillator (S-ICD) was introduced to overcome complications related to transvenous leads. Adoption of the S-ICD requires implanters to learn a new implantation technique. The aim of this study was to assess the learning curve for S-ICD implanters

The learning curve associated with the introduction of the subcutaneous implantable defibrillator

NARCIS (Netherlands)

R.E. Knops (Reinoud); T.F. Brouwer (Tom F.); C.S. Barr (Craig); D.A.M.J. Theuns (Dominic); L. Boersma (Lucas); R. Weiss (Ram); P. Neuzil (Petr); M.F. Scholten (Marcoen); P.D. Lambiase (Pier); A. Leon (Angel); A.M. Hood (Margaret); P. Jones; Wold, N. (Nicholas); Grace, A.A. (Andrew A.); L.R.A. Olde Nordkamp (Louise R.A.); M.C. Burke (Martin)

2016-01-01

textabstractAims: The subcutaneous implantable cardioverter defibrillator (S-ICD) was introduced to overcome complications related to transvenous leads. Adoption of the S-ICD requires implanters to learn a new implantation technique. The aim of this study was to assess the learning curve for S-ICD

Carbon Intensities of Economies from the Perspective of Learning Curves

Directory of Open Access Journals (Sweden)

Henrique Pacini

2014-03-01

Full Text Available While some countries have achieved considerable development, many others still lack accessto the goods and services considered standard in the modern society. As CO2 emissions and development are often correlated, this paper employs the theoretical background of the Environmental Kuznets Curve (EKC and the learning curves toolkit to analyze how carbon intensities have changed as countries move towards higher development (and cumulative wealth levels. The EKC concept is then tested with the methodology of learning curves for the period between 1971 and 2010, so as to capture a dynamic picture of emissions trends and development. Results of both analyses reveal that empirical data fails to provide direct evidence of an EKC for emissions and development. The data does show, however, an interesting pattern in the dispersion of emissions levels for countries within the same HDI categories. While data does not show that countries grow more polluting during intermediary development stages, it does provide evidence that countries become more heterogeneous in their emission intensities as they develop, later re-converging to lower emission intensities at higher HDI levels. Learning rates also indicate heterogeneity among developing countries and relative convergence among developed countries. Given the heterogeneity of development paths among countries, the experiences of those which are managing to develop at low carbon intensities can prove valuable examples for ongoing efforts in climate change mitigation, especially in the developing world.

An Organizational Learning Framework for Patient Safety.

Science.gov (United States)

Edwards, Marc T

Despite concerted effort to improve quality and safety, high reliability remains a distant goal. Although this likely reflects the challenge of organizational change, persistent controversy over basic issues suggests that weaknesses in conceptual models may contribute. The essence of operational improvement is organizational learning. This article presents a framework for identifying leverage points for improvement based on organizational learning theory and applies it to an analysis of current practice and controversy. Organizations learn from others, from defects, from measurement, and from mindfulness. These learning modes correspond with contemporary themes of collaboration, no blame for human error, accountability for performance, and managing the unexpected. The collaborative model has dominated improvement efforts. Greater attention to the underdeveloped modes of organizational learning may foster more rapid progress in patient safety by increasing organizational capabilities, strengthening a culture of safety, and fixing more of the process problems that contribute to patient harm.

Learning from error: leading a culture of safety.

Science.gov (United States)

Gibson, Russell; Armstrong, Alexander; Till, Alex; McKimm, Judy

2017-07-02

A recent shift towards more collective leadership in the NHS can help to achieve a culture of safety, particularly through encouraging frontline staff to participate and take responsibility for improving safety through learning from error and near misses. Leaders must ensure that they provide psychological safety, organizational fairness and learning systems for staff to feel confident in raising concerns, that they have the autonomy and skills to lead continual improvement, and that they have responsibility for spreading this learning within and across organizations.

A Primer on the Statistical Modelling of Learning Curves in Health Professions Education

Science.gov (United States)

Pusic, Martin V.; Boutis, Kathy; Pecaric, Martin R.; Savenkov, Oleksander; Beckstead, Jason W.; Jaber, Mohamad Y.

2017-01-01

Learning curves are a useful way of representing the rate of learning over time. Features include an index of baseline performance (y-intercept), the efficiency of learning over time (slope parameter) and the maximal theoretical performance achievable (upper asymptote). Each of these parameters can be statistically modelled on an individual and…

Safety through organizational learning

International Nuclear Information System (INIS)

Fahlbruch, B.; Miller, R.; Wilpert, B.

1998-01-01

Systems safety is a characteristic of a system enabling it to function under the required operating conditions with a minimum of losses and unforeseen damage to the system and its environment and without any systems breakdowns. The system is influenced by human factors as those factors which, in a general way, influence people in working with a technical system, i.e., people, technology, and organization. Different approaches to learning from events, and processes of event analysis in nuclear technology are presented. The theoretical basis of the 'Safety through Organizational Learning' event analysis technique is the sociotechnical event creation model, which postulates that events can be described as a chain of individual events arising from the joint action of factors contributing directly and indirectly. (orig.) [de

Evaluation of the learning curve for external cephalic version using cumulative sum analysis.

Science.gov (United States)

Kim, So Yun; Han, Jung Yeol; Chang, Eun Hye; Kwak, Dong Wook; Ahn, Hyun Kyung; Ryu, Hyun Mi; Kim, Moon Young

2017-07-01

We evaluated the learning curve for external cephalic version (ECV) using learning curve-cumulative sum (LC-CUSUM) analysis. This was a retrospective study involving 290 consecutive cases between October 2013 and March 2017. We evaluated the learning curve for ECV on nulli and over para 1 group using LC-CUSUM analysis on the assumption that 50% and 70% of ECV procedures succeeded by description a trend-line of quadratic function with reliable R 2 values. The overall success rate for ECV was 64.8% (188/290), while the success rate for nullipara and over para 1 groups was 56.2% (100/178) and 78.6% (88/112), respectively. 'H' value, that the actual failure rate does not differ from the acceptable failure rate, was -3.27 and -1.635 when considering ECV success rates of 50% and 70%, respectively. Consequently, in order to obtain a consistent 50% success rate, we would require 57 nullipara cases, and in order to obtain a consistent 70% success rate, we would require 130 nullipara cases. In contrast, 8 to 10 over para 1 cases would be required for an expected success rate of 50% and 70% on over para 1 group. Even a relatively inexperienced physician can experience success with multipara and after accumulating experience, they will manage nullipara cases. Further research is required for LC-CUSUM involving several practitioners instead of a single practitioner. This will lead to the gradual implementation of standard learning curve guidelines for ECV.

Learning Road Safety Skills in the Classroom

Science.gov (United States)

Brown, Freddy Jackson; Gillard, Duncan

2009-01-01

This case study demonstrates the effectiveness of a classroom based learning programme in the acquisition of road safety skills. The participant, a child with severe learning disabilities, was taught road safety behaviours in the classroom with the aid of photograph cards. When he had mastered these skills in the classroom, he returned to the…

Detection of player learning curve in a car driving game

NARCIS (Netherlands)

Bontchev, Boyan; Vassileva, Dessislava

2018-01-01

Detection of learning curves of player metrics is very important for the serious (or so called applied) games, because it provides an indicator representing how players master the game tasks by acquiring cognitive abilities, knowledge, and necessary skills for solving the game challenges. Real

Learning curve estimation techniques for the nuclear industry

International Nuclear Information System (INIS)

Vaurio, J.K.

1983-01-01

Statistical techniques are developed to estimate the progress made by the nuclear industry in learning to prevent accidents. Learning curves are derived for accident occurrence rates based on actuarial data, predictions are made for the future, and compact analytical equations are obtained for the statistical accuracies of the estimates. Both maximum likelihood estimation and the method of moments are applied to obtain parameters for the learning models, and results are compared to each other and to earlier graphical and analytical results. An effective statistical test is also derived to assess the significance of trends. The models used associate learning directly to accidents, to the number of plants and to the cumulative number of operating years. Using as a data base nine core damage accidents in electricity-producing plants, it is estimated that the probability of a plant to have a serious flaw has decreased from 0.1 to 0.01 during the developmental phase of the nuclear industry. At the same time the frequency of accidents has decreased from 0.04 per reactor year to 0.0004 per reactor year

Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method.

Science.gov (United States)

Yamaguchi, Tomohiro; Kinugasa, Yusuke; Shiomi, Akio; Sato, Sumito; Yamakawa, Yushi; Kagawa, Hiroyasu; Tomioka, Hiroyuki; Mori, Keita

2015-07-01

Few data are available to assess the learning curve for robotic-assisted surgery for rectal cancer. The aim of the present study was to evaluate the learning curve for robotic-assisted surgery for rectal cancer by a surgeon at a single institute. From December 2011 to August 2013, a total of 80 consecutive patients who underwent robotic-assisted surgery for rectal cancer performed by the same surgeon were included in this study. The learning curve was analyzed using the cumulative sum method. This method was used for all 80 cases, taking into account operative time. Operative procedures included anterior resections in 6 patients, low anterior resections in 46 patients, intersphincteric resections in 22 patients, and abdominoperineal resections in 6 patients. Lateral lymph node dissection was performed in 28 patients. Median operative time was 280 min (range 135-683 min), and median blood loss was 17 mL (range 0-690 mL). No postoperative complications of Clavien-Dindo classification Grade III or IV were encountered. We arranged operative times and calculated cumulative sum values, allowing differentiation of three phases: phase I, Cases 1-25; phase II, Cases 26-50; and phase III, Cases 51-80. Our data suggested three phases of the learning curve in robotic-assisted surgery for rectal cancer. The first 25 cases formed the learning phase.

Assessing propensity to learn from safety-related events

NARCIS (Netherlands)

Drupsteen, L.; Wybo, J.L.

2015-01-01

Most organisations aim to use experience from the past to improve safety, for instance through learning from safety-related incidents and accidents. Whether an organisation is able to learn successfully can however only be determined afterwards. So far, there are no proactive measures to assess

Medical learning curves and the Kantian ideal.

Science.gov (United States)

Le Morvan, P; Stock, B

2005-09-01

A hitherto unexamined problem for the "Kantian ideal" that one should always treat patients as ends in themselves, and never only as a means to other ends, is explored in this paper. The problem consists of a prima facie conflict between this Kantian ideal and the reality of medical practice. This conflict arises because, at least presently, medical practitioners can only acquire certain skills and abilities by practising on live, human patients, and given the inevitability and ubiquity of learning curves, this learning requires some patients to be treated only as a means to this end. A number of ways of attempting to establish the compatibility of the Kantian Ideal with the reality of medical practice are considered. Each attempt is found to be unsuccessful. Accordingly, until a way is found to reconcile them, we conclude that the Kantian ideal is inconsistent with the reality of medical practice.

Robotic partial nephrectomy - Evaluation of the impact of case mix on the procedural learning curve.

Science.gov (United States)

Roman, A; Ahmed, K; Challacombe, B

2016-05-01

Although Robotic partial nephrectomy (RPN) is an emerging technique for the management of small renal masses, this approach is technically demanding. To date, there is limited data on the nature and progression of the learning curve in RPN. To analyse the impact of case mix on the RPN LC and to model the learning curve. The records of the first 100 RPN performed, were analysed at our institution that were carried out by a single surgeon (B.C) (June 2010-December 2013). Cases were split based on their Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score into the following groups: 6-7, 8-9 and >10. Using a split group (20 patients in each group) and incremental analysis, the mean, the curve of best fit and R(2) values were calculated for each group. Of 100 patients (F:28, M:72), the mean age was 56.4 ± 11.9 years. The number of patients in each PADUA score groups: 6-7, 8-9 and >10 were 61, 32 and 7 respectively. An increase in incidence of more complex cases throughout the cohort was evident within the 8-9 group (2010: 1 case, 2013: 16 cases). The learning process did not significantly affect the proxies used to assess surgical proficiency in this study (operative time and warm ischaemia time). Case difficulty is an important parameter that should be considered when evaluating procedural learning curves. There is not one well fitting model that can be used to model the learning curve. With increasing experience, clinicians tend to operate on more difficult cases. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

The learning curve of laparoscopic treatment of rectal cancer does not increase morbidity.

Science.gov (United States)

Luján, Juan; Gonzalez, Antonio; Abrisqueta, Jesús; Hernandez, Quiteria; Valero, Graciela; Abellán, Israel; Frutos, María Dolores; Parrilla, Pascual

2014-01-01

The treatment of rectal cancer via laparoscopy is controversial due to its technical complexity. Several randomized prospective studies have demonstrated clear advantages for the patient with similar oncological results to those of open surgery, although during the learning of this surgical technique there may be an increase in complications and a worse prognosis. Our aim is to analyze how the learning curve for rectal cancer via laparoscopy influences intra- and postoperative results and oncological markers. A retrospective review was conducted of the first 120 patients undergoing laparoscopic surgery for rectal neoplasia. The operations were performed by the same surgical team with a wide experience in the treatment of open colorectal cancer and qualified to perform advanced laparoscopic surgery. We analyzed sex, ASA, tumour location, neoadjuvant treatment, surgical technique, operating time, conversion, postoperative complications, length of hospital stay, number of lymph nodes, stage and involvement of margins. Significant differences were observed with regard to surgical time (224 min in the first group, 204 min in the second group), with a higher rate of conversion in the first group (22.5%) than in the second (11.3%). No significant differences were noted for rate of conservative sphincter surgery, length of hospital stay, post-surgical complications, number of affected/isolated lymph nodes or affected circumferential and distal margins. It is possible to learn this complex surgical technique without compromising the patient's safety and oncological outcome. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

Learning curve for laparoendoscopic single-site surgery for an experienced laparoscopic surgeon

Directory of Open Access Journals (Sweden)

Pao-Ling Torng

2013-11-01

Conclusion: LESS is a safe and feasible alternative to conventional laparoscopic surgery for adnexal and uterine diseases. A learning curve is not required for LESS surgery for experienced laparoscopic surgeons.

Learning curve of thyroid fine-needle aspiration biopsy.

Science.gov (United States)

Penín, Manuel; Martín, M Ángeles; San Millán, Beatriz; García, Juana

2017-12-01

Fine-needle aspiration biopsy (FNAB) is the reference procedure for thyroid nodule evaluation. Its main limitation are inadequate samples, which should be less than 20%. To analyze the learning curve of the procedure by comparing the results of a non-experienced endocrinologist (endocrinologist 2) to those of an experienced one (endocrinologist 1). Sixty FNABs were analyzed from February to June 2016. Each endocrinologist made 2punctures of every nodule in a random order. This order and the professional making every puncture were unknown to the pathologist who examined the samples. Endocrinologist 1 had a higher percentage of diagnoses than endocrinologist 2 (82% vs. 72%, P=.015). In the first 20 FNABs, the difference between both physicians was remarkable and statistically significant (80% vs. 50%, P=.047). In the following 20 FNABs, the difference narrowed and was not statistically significant (90% vs. 65%, P=.058). In the final 20 FNABs, the difference was minimal and not statistically significant (75% vs. 70%, P=.723). The learning curve of ultrasound-guided FNAB may be completed in a suitable environment by performing it at least 60 times. Although the guidelines recommend at least 3punctures per nodule, 2are enough to achieve an accurate percentage of diagnoses. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Learning curve analysis of mitral valve repair using telemanipulative technology.

Science.gov (United States)

Charland, Patrick J; Robbins, Tom; Rodriguez, Evilio; Nifong, Wiley L; Chitwood, Randolph W

2011-08-01

To determine if the time required to perform mitral valve repairs using telemanipulation technology decreases with experience and how that decrease is influenced by patient and procedure variables. A single-center retrospective review was conducted using perioperative and outcomes data collected contemporaneously on 458 mitral valve repair surgeries using telemanipulative technology. A regression model was constructed to assess learning with this technology and predict total robot time using multiple predictive variables. Statistical analysis was used to determine if models were significantly useful, to rule out correlation between predictor variables, and to identify terms that did not contribute to the prediction of total robot time. We found a statistically significant learning curve (P learning percentage∗ derived from total robot times† for the first 458 recorded cases of mitral valve repair using telemanipulative technology is 95% (R(2) = .40). More than one third of the variability in total robot time can be explained through our model using the following variables: type of repair (chordal procedures, ablations, and leaflet resections), band size, use of clips alone in band implantation, and the presence of a fellow at bedside (P Learning in mitral valve repair surgery using telemanipulative technology occurs at the East Carolina Heart Institute according to a logarithmic curve, with a learning percentage of 95%. From our regression output, we can make an approximate prediction of total robot time using an additive model. These metrics can be used by programs for benchmarking to manage the implementation of this new technology, as well as for capacity planning, scheduling, and capital budget analysis. Copyright © 2011 The American Association for Thoracic Surgery. All rights reserved.

Laparoscopy Instructional Videos : The Effect of Preoperative Compared With Intraoperative Use on Learning Curves

NARCIS (Netherlands)

Broekema, Theo H.; Talsma, Aaldert K.; Wevers, Kevin P.; Pierie, Jean-Pierre E. N.

OBJECTIVE: Previous studies have shown that the use of intraoperative instructional videos has a positive effect on learning laparoscopic procedures. This study investigated the effect of the timing of the instructional videos on learning curves in laparoscopic skills training. DESIGN: After

Improving health care quality and safety: the role of collective learning.

Science.gov (United States)

Singer, Sara J; Benzer, Justin K; Hamdan, Sami U

2015-01-01

Despite decades of effort to improve quality and safety in health care, this goal feels increasingly elusive. Successful examples of improvement are infrequently replicated. This scoping review synthesizes 76 empirical or conceptual studies (out of 1208 originally screened) addressing learning in quality or safety improvement, that were published in selected health care and management journals between January 2000 and December 2014 to deepen understanding of the role that collective learning plays in quality and safety improvement. We categorize learning activities using a theoretical model that shows how leadership and environmental factors support collective learning processes and practices, and in turn team and organizational improvement outcomes. By focusing on quality and safety improvement, our review elaborates the premise of learning theory that leadership, environment, and processes combine to create conditions that promote learning. Specifically, we found that learning for quality and safety improvement includes experimentation (including deliberate experimentation, improvisation, learning from failures, exploration, and exploitation), internal and external knowledge acquisition, performance monitoring and comparison, and training. Supportive learning environments are characterized by team characteristics like psychological safety, appreciation of differences, openness to new ideas social motivation, and team autonomy; team contextual factors including learning resources like time for reflection, access to knowledge, organizational capabilities; incentives; and organizational culture, strategy, and structure; and external environmental factors including institutional pressures, environmental dynamism and competitiveness and learning collaboratives. Lastly learning in the context of quality and safety improvement requires leadership that reinforces learning through actions and behaviors that affect people, such as coaching and trust building, and through

Non-Constant Learning Rates in Retrospective Experience Curve Analyses and their Correlation to Deployment Programs

Energy Technology Data Exchange (ETDEWEB)

Wei, Max [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Smith, Sarah J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sohn, Michael D. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2015-07-16

A key challenge for policy-makers and technology market forecasters is to estimate future technology costs and in particular the rate of cost reduction versus production volume. A related, critical question is what role should state and federal governments have in advancing energy efficient and renewable energy technologies? This work provides retrospective experience curves and learning rates for several energy-related technologies, each of which have a known history of federal and state deployment programs. We derive learning rates for eight technologies including energy efficient lighting technologies, stationary fuel cell systems, and residential solar photovoltaics, and provide an overview and timeline of historical deployment programs such as state and federal standards and state and national incentive programs for each technology. Piecewise linear regimes are observed in a range of technology experience curves, and public investments or deployment programs are found to be strongly correlated to an increase in learning rate across multiple technologies. A downward bend in the experience curve is found in 5 out of the 8 energy-related technologies presented here (electronic ballasts, magnetic ballasts, compact fluorescent lighting, general service fluorescent lighting, and the installed cost of solar PV). In each of the five downward-bending experience curves, we believe that an increase in the learning rate can be linked to deployment programs to some degree. This work sheds light on the endogenous versus exogenous contributions to technological innovation and highlights the impact of exogenous government sponsored deployment programs. This work can inform future policy investment direction and can shed light on market transformation and technology learning behavior.

Learning Curve for Seawater Reverse Osmosis Desalination Plants: Capital Cost Trend of the Past, Present, and Future

Science.gov (United States)

Caldera, Upeksha; Breyer, Christian

2017-12-01

Seawater reverse osmosis (SWRO) desalination is expected to play a pivotal role in helping to secure future global water supply. While the global reliance on SWRO plants for water security increases, there is no consensus on how the capital costs of SWRO plants will vary in the future. The aim of this paper is to analyze the past trends of the SWRO capital expenditures (capex) as the historic global cumulative online SWRO capacity increases, based on the learning curve concept. The SWRO capex learning curve is found based on 4,237 plants that came online from 1977 to 2015. A learning rate of 15% is determined, implying that the SWRO capex reduced by 15% when the cumulative capacity was doubled. Based on SWRO capacity annual growth rates of 10% and 20%, by 2030, the global average capex of SWRO plants is found to fall to 1,580 USD/(m3/d) and 1,340 USD/(m3/d), respectively. A learning curve for SWRO capital costs has not been presented previously. This research highlights the potential for decrease in SWRO capex with the increase in installation of SWRO plants and the value of the learning curve approach to estimate future SWRO capex.

Nicotine disrupts safety learning by enhancing fear associated with a safety cue via the dorsal hippocampus.

Science.gov (United States)

Connor, David A; Kutlu, Munir G; Gould, Thomas J

2017-07-01

Learned safety, a learning process in which a cue becomes associated with the absence of threat, is disrupted in individuals with post-traumatic stress disorder (PTSD). A bi-directional relationship exists between smoking and PTSD and one potential explanation is that nicotine-associated changes in cognition facilitate PTSD emotional dysregulation by disrupting safety associations. Therefore, we investigated whether nicotine would disrupt learned safety by enhancing fear associated with a safety cue. In the present study, C57BL/6 mice were administered acute or chronic nicotine and trained over three days in a differential backward trace conditioning paradigm consisting of five trials of a forward conditioned stimulus (CS)+ (Light) co-terminating with a footshock unconditioned stimulus followed by a backward CS- (Tone) presented 20 s after cessation of the unconditioned stimulus. Summation testing found that acute nicotine disrupted learned safety, but chronic nicotine had no effect. Another group of animals administered acute nicotine showed fear when presented with the backward CS (Light) alone, indicating the formation of a maladaptive fear association with the backward CS. Finally, we investigated the brain regions involved by administering nicotine directly into the dorsal hippocampus, ventral hippocampus, and prelimbic cortex. Infusion of nicotine into the dorsal hippocampus disrupted safety learning.

Huang's three-step maneuver shortens the learning curve of laparoscopic spleen-preserving splenic hilar lymphadenectomy.

Science.gov (United States)

Huang, Chang-Ming; Huang, Ze-Ning; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Jun, Lu; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi; Tu, Ru-Hong

2017-12-01

The goal of this study was to investigate the difference between the learning curves of different maneuvers in laparoscopic spleen-preserving splenic hilar lymphadenectomy for advanced upper gastric cancer. From January 2010 to April 2014, 53 consecutive patients who underwent laparoscopic spleen-preserving splenic hilar lymphadenectomy via the traditional-step maneuver (group A) and 53 consecutive patients via Huang's three-step maneuver (group B) were retrospectively analyzed. No significant difference in patient characteristics were found between the two groups. The learning curves of groups A and B were divided into phase 1 (1-43 cases and 1-30 cases, respectively) and phase 2 (44-53 cases and 31-53 cases, respectively). Compared with group A, the dissection time, bleeding loss and vascular injury were significantly decreased in group B. No significant differences in short-term outcomes were found between the two maneuvers. The multivariate analysis indicated that the body mass index, short gastric vessels, splenic artery type and maneuver were significantly associated with the dissection time in group B. No significant difference in the survival curve was found between the maneuvers. The learning curve of Huang's three-step maneuver was shorter than that of the traditional-step maneuver, and the former represents an ideal maneuver for laparoscopic spleen-preserving splenic hilar lymphadenectomy.To shorten the learning curve at the beginning of laparoscopic spleen-preserving splenic hilar lymphadenectomy, beginners should beneficially use Huang's three-step maneuver and select patients with advanced upper gastric cancer with a body mass index of less than 25 kg/m 2 and the concentrated type of splenic artery. Copyright © 2017. Published by Elsevier Ltd.

Adult Learning in Health and Safety: Some Issues and Approaches.

Science.gov (United States)

O Fathaigh, Mairtin

This document, which was developed for presentation at a seminar on adult learning and safety, examines approaches to occupational safety and health (OSH) learning/training in the workplace. Section 1 examines selected factors affecting adults' learning in workplace OSH programs. The principal dimensions along which individual adult learners will…

A New Proposal for Learning Curve of TEP Inguinal Hernia Repair: Ability to Complete Operation Endoscopically as a First Phase of Learning Curve

Directory of Open Access Journals (Sweden)

Mustafa Hasbahceci

2014-01-01

Full Text Available Background. The exact nature of learning curve of totally extraperitoneal inguinal hernia and the number required to master this technique remain controversial. Patients and Methods. We present a retrospective review of a single surgeon experience on patients who underwent totally extraperitoneal inguinal hernia repair. Results. There were 42 hernias (22 left- and 20 right-sided in 39 patients with a mean age of 48.8±15.1 years. Indirect, direct, and combined hernias were present in 18, 12, and 12 cases, respectively. The mean operative time was 55.1±22.8 minutes. Peritoneal injury occurred in 9 cases (21.4%. Conversion to open surgery was necessitated in 7 cases (16.7%. After grouping of all patients into two groups as cases between 1–21 and 22–42, it was seen that the majority of peritoneal injuries (7 out of 9, 77.8%, P=0.130 and all conversions (P=0.001 occurred in the first 21 cases. Conclusions. Learning curve of totally extraperitoneal inguinal hernia repair can be divided into two consequent steps: immediate and late. At least 20 operations are required for gaining anatomical knowledge and surgical pitfalls based on the ability to perform this operation without conversion during immediate phase.

Scenario analysis for estimating the learning rate of photovoltaic power generation based on learning curve theory in South Korea

International Nuclear Information System (INIS)

Hong, Sungjun; Chung, Yanghon; Woo, Chungwon

2015-01-01

South Korea, as the 9th largest energy consuming in 2013 and the 7th largest greenhouse gas emitting country in 2011, established ‘Low Carbon Green Growth’ as the national vision in 2008, and is announcing various active energy policies that are set to gain the attention of the world. In this paper, we estimated the decrease of photovoltaic power generation cost in Korea based on the learning curve theory. Photovoltaic energy is one of the leading renewable energy sources, and countries all over the world are currently expanding R and D, demonstration and deployment of photovoltaic technology. In order to estimate the learning rate of photovoltaic energy in Korea, both conventional 1FLC (one-factor learning curve), which considers only the cumulative power generation, and 2FLC, which also considers R and D investment were applied. The 1FLC analysis showed that the cost of power generation decreased by 3.1% as the cumulative power generation doubled. The 2FCL analysis presented that the cost decreases by 2.33% every time the cumulative photovoltaic power generation is doubled and by 5.13% every time R and D investment is doubled. Moreover, the effect of R and D investment on photovoltaic technology took after around 3 years, and the depreciation rate of R and D investment was around 20%. - Highlights: • We analyze the learning effects of photovoltaic energy technology in Korea. • In order to calculate the learning rate, we use 1FLC (one-factor learning curve) and 2FLC methods, respectively. • 1FLC method considers only the cumulative power generation. • 2FLC method considers both cumulative power generation and knowledge stock. • We analyze a variety of scenarios by time lag and depreciation rate of R and D investment

Learning Curve Analysis and Surgical Outcomes of Single-port Laparoscopic Myomectomy.

Science.gov (United States)

Lee, Hee Jun; Kim, Ju Yeong; Kim, Seul Ki; Lee, Jung Ryeol; Suh, Chang Suk; Kim, Seok Hyun

2015-01-01

To identify learning curves for single-port laparoscopic myomectomy (SPLM) and evaluate surgical outcomes according to the sequence of operation. A retrospective study. A university-based hospital (Canadian Task Force classification II-2). The medical records from 205 patients who had undergone SPLM from October 2009 to May 2013 were reviewed. Because the myomectomy time was significantly affected by the size and number of myomas removed by SPLM, cases in which 2 or more of the myomas removed were >7 cm in diameter were excluded. Furthermore, cases involving additional operations performed simultaneously (e.g., ovarian or hysteroscopic surgery) were also excluded. A total of 161 cases of SPLM were included. None. We assessed the SPLM learning curve via a graph based on operation time versus sequence of cases. Patients were chronologically arranged according to their surgery dates and were then placed into 1 of 4 groups according to their operation sequence. SPLM was completed successfully in 160 of 161 cases (99.4%). One case was converted to multiport surgery. Basal characteristics of the patients between the 4 groups did not differ. The median operation times for the 4 groups were 112.0, 92.8, 83.7, and 90.0 minutes, respectively. Operation time decreased significantly in the second, third, and fourth groups compared with that in the first group (p learning curve became less steep, was evident after about 45 operations. Results from the current study suggested that proficiency for SPLM was achieved after about 45 operations. Additionally, operation time decreased with experience without an increase in complication rate. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Displays mounted on cutting blocks reduce the learning curve in navigated total knee arthroplasty.

Science.gov (United States)

Schnurr, Christoph; Eysel, Peer; König, Dietmar Pierre

2011-01-01

The use of computer navigation in total knee arthroplasty (TKA) improves the implant alignment but increases the operation time. Studies have shown that the operation time is further prolonged due to the surgeon's learning curve, and longer operation times have been associated with higher morbidity risks. It has been our hypothesis that an improvement in the human-machine interface might reduce the time required during the learning curve. Accordingly, we asked whether the use of navigation devices with a display fixed on the surgical instruments would reduce the operation time in navigated TKAs performed by navigation beginners. Thirty medical students were randomized and used two navigation devices in rotation: these were the Kolibri® device with an external display and the Dash® device with a display that was fixed on the cutting blocks. The time for adjustment of the tibial and femoral cutting blocks on knee models while using these devices was measured. A significant time reduction was demonstration when the Dash® device was used: The time reduction was 21% for the tibial block (p = 0.007), 40% for the femoral block (p learning curve may be diminished.

Learning from Fukushima: Institutional Isomorphism as Constraining and Contributing Nuclear Safety

International Nuclear Information System (INIS)

Ylönen, M.

2016-01-01

This paper is an analysis of the international institutional isomorphic pressures and lessons learned from the Fukushima accident. The recent upgrading of nuclear safety requirements at the international and national level, as well as harmonisation attempts of nuclear reactor safety by the Western European Nuclear Regulators’ Association (WENRA), show serious efforts to improve nuclear safety and implement lessons learned from the Fukushima accident. After Fukushima new requirements for the new nuclear power plants were set, such as preparedness for natural hazards, multiple failure and core melt situations. In addition, improvement of safety culture was emphasised, as well as strengthening of independence of the regulatory body from external pressures, and increasing of independence between different levels of defence in depth safety. However, learning from accidents is often affected by institutional factors, which may both contribute and hamper safety and learning.

Feedback of safety - related operational experience: Lessons learned

Energy Technology Data Exchange (ETDEWEB)

Elias, D [Commonwealth Edison Co. (United States)

1997-09-01

The presentation considers the following aspects of feedback of safety-related operational experience: lessons learned program, objectives, personnel characteristics; three types of documents for transmitting lessons learned issues.

Feedback of safety - related operational experience: Lessons learned

International Nuclear Information System (INIS)

Elias, D.

1997-01-01

The presentation considers the following aspects of feedback of safety-related operational experience: lessons learned program, objectives, personnel characteristics; three types of documents for transmitting lessons learned issues

Space reactor safety, 1985--1995 lessons learned

International Nuclear Information System (INIS)

Marshall, A.C.

1995-01-01

Space reactor safety activities and decisions have evolved over the last decade. Important safety decisions have been made in the SP-100, Space Exploration Initiative, NEPSTP, SNTP, and Bimodal Space Reactor programs. In addition, international guidance on space reactor safety has been instituted. Space reactor safety decisions and practices have developed in the areas of inadvertent criticality, reentry, radiological release, orbital operation, programmatic, and policy. In general, the lessons learned point out the importance of carefully reviewing previous safety practices for appropriateness to space nuclear programs in general and to the specific mission under consideration

Space reactor safety, 1985--1995 lessons learned

Energy Technology Data Exchange (ETDEWEB)

Marshall, A.C.

1995-12-31

Space reactor safety activities and decisions have evolved over the last decade. Important safety decisions have been made in the SP-100, Space Exploration Initiative, NEPSTP, SNTP, and Bimodal Space Reactor programs. In addition, international guidance on space reactor safety has been instituted. Space reactor safety decisions and practices have developed in the areas of inadvertent criticality, reentry, radiological release, orbital operation, programmatic, and policy. In general, the lessons learned point out the importance of carefully reviewing previous safety practices for appropriateness to space nuclear programs in general and to the specific mission under consideration.

Improving health care quality and safety: the role of collective learning

Directory of Open Access Journals (Sweden)

Singer SJ

2015-11-01

Full Text Available Sara J Singer,1–4 Justin K Benzer,4–6 Sami U Hamdan4,6 1Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; 2Department of Medicine, Harvard Medical School, Boston, MA, USA; 3Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA; 4Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA; 5VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; 6Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA Abstract: Despite decades of effort to improve quality and safety in health care, this goal feels increasingly elusive. Successful examples of improvement are infrequently replicated. This scoping review synthesizes 76 empirical or conceptual studies (out of 1208 originally screened addressing learning in quality or safety improvement, that were published in selected health care and management journals between January 2000 and December 2014 to deepen understanding of the role that collective learning plays in quality and safety improvement. We categorize learning activities using a theoretical model that shows how leadership and environmental factors support collective learning processes and practices, and in turn team and organizational improvement outcomes. By focusing on quality and safety improvement, our review elaborates the premise of learning theory that leadership, environment, and processes combine to create conditions that promote learning. Specifically, we found that learning for quality and safety improvement includes experimentation (including deliberate experimentation, improvisation, learning from failures, exploration, and exploitation, internal and external knowledge acquisition, performance monitoring and comparison, and training. Supportive learning environments are characterized by team characteristics like psychological

Application of the Learning Curve Analysis to the LHC Main Dipole Production First Assessment

CERN Document Server

Fessia, P; Rossi, L

2006-01-01

About two third of the LHC main dipoles have been delivered by the three suppliers charged of the production. The training of the staff, mostly hired just for this manufacture, and the natural improvement of the procedures with the acquired experience, decrease naturally the time necessary for the assembly of a unit. The aim of this paper is to apply methodologies like the cost-based learning curves and the time-based learning curves to the LHC Main Dipole comparing the estimated learning percentage to the ones experienced in other industries. This type of analysis, still in a preliminary phase and here applied to about 40% of the total production of the LHC magnets that will end by 2006, shows that our production has a relatively high learning percentage and it is similar to aerospace and complex machine tools for new models. Therefore with the LHC project, accelerator magnets seem to have reached industrial maturity and this production can be used as bench mark for other large scientific projects implying s...

Patient Safety Learning Systems: A Systematic Review and Qualitative Synthesis.

Science.gov (United States)

2017-01-01

A patient safety learning system (sometimes called a critical incident reporting system) refers to structured reporting, collation, and analysis of critical incidents. To inform a provincial working group's recommendations for an Ontario Patient Safety Event Learning System, a systematic review was undertaken to determine design features that would optimize its adoption into the health care system and would inform implementation strategies. The objective of this review was to address two research questions: (a) what are the barriers to and facilitators of successful adoption of a patient safety learning system reported by health professionals and (b) what design components maximize successful adoption and implementation? To answer the first question, we used a published systematic review. To answer the second question, we used scoping study methodology. Common barriers reported in the literature by health care professionals included fear of blame, legal penalties, the perception that incident reporting does not improve patient safety, lack of organizational support, inadequate feedback, lack of knowledge about incident reporting systems, and lack of understanding about what constitutes an error. Common facilitators included a non-accusatory environment, the perception that incident reporting improves safety, clarification of the route of reporting and of how the system uses reports, enhanced feedback, role models (such as managers) using and promoting reporting, legislated protection of those who report, ability to report anonymously, education and training opportunities, and clear guidelines on what to report. Components of a patient safety learning system that increased successful adoption and implementation were emphasis on a blame-free culture that encourages reporting and learning, clear guidelines on how and what to report, making sure the system is user-friendly, organizational development support for data analysis to generate meaningful learning outcomes

Learning Curves and Bootstrap Estimates for Inference with Gaussian Processes: A Statistical Mechanics Study

DEFF Research Database (Denmark)

Malzahn, Dorthe; Opper, Manfred

2003-01-01

We employ the replica method of statistical physics to study the average case performance of learning systems. The new feature of our theory is that general distributions of data can be treated, which enables applications to real data. For a class of Bayesian prediction models which are based...... on Gaussian processes, we discuss Bootstrap estimates for learning curves....

Lessons learned on digital systems safety

International Nuclear Information System (INIS)

Sivertsen, Terje

2005-06-01

A decade ago, in 1994, lessons learned from Halden research activities on digital systems safety were summarized in the reports HWR-374 and HWR-375, under the title 'A Lessons Learned Report on Software Dependability'. The reports reviewed all activities made at the Halden Project in this field since 1977. As such, the reports provide a wealth of information on Halden research. At the same time, the lessons learned from the different activities are made more accessible to the reader by being summarized in terms of results, conclusions and recommendations. The present report provides a new lessons learned report, covering the Halden Project research activities in this area from 1994 to medio 2005. As before, the emphasis is on the results, conclusions and recommendations made from these activities, in particular how they can be utilized by different types of organisations, such as licensing authorities, safety assessors, power companies, and software developers. The contents of the report have been edited on the basis of input from a large number of Halden work reports, involving many different authors. Brief summaries of these reports are included in the last part of the report. (Author)

Environmental management by the learning curve

International Nuclear Information System (INIS)

Fehr, M.

2003-01-01

This is a futuristic appreciation of waste management challenges and their solution by means of good management models. A literature review, administrative initiatives, research results, and experiences from practice are combined in this study to render an evolutionary picture of the change in paradigm relative to municipal solid waste possible to occur between 2000 and 2025. The principal stages of progress in the 25 years studied were: the correct characterization of municipal solid waste as a function of geographical location and recycling potential, the divided collection model and its corresponding learning curve, correct opportunity cost accounting tools, and the generally admitted and accepted changeover of municipal solid waste treatment from a technical to a management problem. It is reported that as a result of this progress, the municipal landfill is a species in extinction. Regional landfills with long life spans are the rule in 2025

Defining the learning curve of laparoendoscopic single-site Heller myotomy.

Science.gov (United States)

Ross, Sharona B; Luberice, Kenneth; Kurian, Tony J; Paul, Harold; Rosemurgy, Alexander S

2013-08-01

Initial outcomes suggest laparoendoscopic single-site (LESS) Heller myotomy with anterior fundoplication provides safe, efficacious, and cosmetically superior outcomes relative to conventional laparoscopy. This study was undertaken to define the learning curve of LESS Heller myotomy with anterior fundoplication. One hundred patients underwent LESS Heller myotomy with anterior fundoplication. Symptom frequency and severity were scored using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). Symptom resolution, additional trocars, and complications were compared among patient quartiles. Median data are presented. Preoperative frequency/severity scores were: dysphagia = 10/8 and regurgitation = 8/7. Additional trocars were placed in 12 patients (10%), of whom all were in the first two quartiles. Esophagotomy/gastrotomy occurred in three patients. Postoperative complications occurred in 9 per cent. No conversions to "open" operations occurred. Length of stay was 1 day. Postoperative frequency/severity scores were: dysphagia = 2/0 and regurgitation = 0/0; scores were less than before myotomy (P Heller myotomy with anterior fundoplication well palliates symptoms of achalasia with no apparent scar. Placement of additional trocars only occurred early in the experience. For surgeons proficient with the conventional laparoscopic approach, the learning curve of LESS Heller myotomy with anterior fundoplication is short and safe, because proficiency is quickly attained.

Laparoscopic colorectal surgery in learning curve: Role of implementation of a standardized technique and recovery protocol. A cohort study

Directory of Open Access Journals (Sweden)

Gaetano Luglio

2015-06-01

Conclusion: Proper laparoscopic colorectal surgery is safe and leads to excellent results in terms of recovery and short term outcomes, even in a learning curve setting. Key factors for better outcomes and shortening the learning curve seem to be the adoption of a standardized technique and training model along with the strict supervision of an expert colorectal surgeon.

Irreversible electroporation ablation (IRE of unresectable soft tissue tumors: learning curve evaluation in the first 150 patients treated.

Directory of Open Access Journals (Sweden)

Prejesh Philips

Full Text Available BACKGROUND: Irreversible electroporation (IRE is a novel technology that uses peri-target discrete probes to deliver high-voltage localized electric current to induce cell death without thermal-induced coagulative necrosis. "Learnability" and consistently effective results by novice practitioners is essential for determining acceptance of novel techniques. This multi-center prospectively-collected database study evaluates the learning curve of IRE. METHODS: Analysis of 150 consecutive patients over 7 institutions from 9/2010-7/2012 was performed with patients treated divided into 3 groups A (1(st 50 patients treated, B (2(nd 50 and C (3(rd 50 patients treated chronologically and analyzed for outcomes. RESULTS: A total of 167 IRE procedures were performed, with a majority being liver(39.5% and pancreatic(35.5% lesions. The three groups were similar with respect to co-morbidities and demographics. Group C had larger lesions (3.9 vs 3 cm,p=0.001, more numerous lesions (3.2 vs 2.2,p=0.07, more vascular invasion(p=0.001, underwent more associated procedures(p=0.001 and had longer operative times(p<0.001. Despite this, they had similar complication and high-grade complication rates(p=0.24. Attributable morbidity rate was 13.3%(total 29.3% and high-grade complications were seen in 4.19%(total 12.6%. Pancreatic lesions(p=0.001 and laparotomy(p=0.001 were associated with complications. CONCLUSION: The review represents that single largest review of IRE soft tissue ablation demonstrating initial patient selection and safety. Over time, complex treatments of larger lesions and lesions with greater vascular involvement were performed without a significant increase in adverse effects or impact on local relapse free survival. This evolution demonstrates the safety profile of IRE and speed of graduation to more complex lesions, which was greater than 5 cases by institution. IRE is a safe and effective alternative to conventional ablation with a demonstrable

Systematic review of learning curves for minimally invasive abdominal surgery: a review of the methodology of data collection, depiction of outcomes, and statistical analysis.

Science.gov (United States)

Harrysson, Iliana J; Cook, Jonathan; Sirimanna, Pramudith; Feldman, Liane S; Darzi, Ara; Aggarwal, Rajesh

2014-07-01

To determine how minimally invasive surgical learning curves are assessed and define an ideal framework for this assessment. Learning curves have implications for training and adoption of new procedures and devices. In 2000, a review of the learning curve literature was done by Ramsay et al and it called for improved reporting and statistical evaluation of learning curves. Since then, a body of literature is emerging on learning curves but the presentation and analysis vary. A systematic search was performed of MEDLINE, EMBASE, ISI Web of Science, ERIC, and the Cochrane Library from 1985 to August 2012. The inclusion criteria are minimally invasive abdominal surgery formally analyzing the learning curve and English language. 592 (11.1%) of the identified studies met the selection criteria. Time is the most commonly used proxy for the learning curve (508, 86%). Intraoperative outcomes were used in 316 (53%) of the articles, postoperative outcomes in 306 (52%), technical skills in 102 (17%), and patient-oriented outcomes in 38 (6%) articles. Over time, there was evidence of an increase in the relative amount of laparoscopic and robotic studies (P statistical evidence of a change in the complexity of analysis (P = 0.121). Assessment of learning curves is needed to inform surgical training and evaluate new clinical procedures. An ideal analysis would account for the degree of complexity of individual cases and the inherent differences between surgeons. There is no single proxy that best represents the success of surgery, and hence multiple outcomes should be collected.

Patient safety: lessons learned

International Nuclear Information System (INIS)

Bagian, James P.

2006-01-01

The traditional approach to patient safety in health care has ranged from reticence to outward denial of serious flaws. This undermines the otherwise remarkable advances in technology and information that have characterized the specialty of medical practice. In addition, lessons learned in industries outside health care, such as in aviation, provide opportunities for improvements that successfully reduce mishaps and errors while maintaining a standard of excellence. This is precisely the call in medicine prompted by the 1999 Institute of Medicine report ''To Err Is Human: Building a Safer Health System.'' However, to effect these changes, key components of a successful safety system must include: (1) communication, (2) a shift from a posture of reliance on human infallibility (hence ''shame and blame'') to checklists that recognize the contribution of the system and account for human limitations, and (3) a cultivation of non-punitive open and/or de-identified/anonymous reporting of safety concerns, including close calls, in addition to adverse events. (orig.)

Basic safety principles: Lessons learned

International Nuclear Information System (INIS)

Erp, J.B. van

1997-01-01

The presentation reviews the following issues: basic safety principles and lessons learned; some conclusions from the Kemeny report on the accident at TMI; some recommendations from the Kemeny report on the accident at TMI; conclusions and recommendations from the Rogovin report on the accident on TMI; instrumentation deficiencies (from Rogovin report)

Basic safety principles: Lessons learned

Energy Technology Data Exchange (ETDEWEB)

Erp, J.B. van [Argonne National Lab., IL (United States)

1997-09-01

The presentation reviews the following issues: basic safety principles and lessons learned; some conclusions from the Kemeny report on the accident at TMI; some recommendations from the Kemeny report on the accident at TMI; conclusions and recommendations from the Rogovin report on the accident on TMI; instrumentation deficiencies (from Rogovin report).

The learning curve of robot-assisted laparoscopic aortofemoral bypass grafting for aortoiliac occlusive disease.

Science.gov (United States)

Novotný, Tomáš; Dvorák, Martin; Staffa, Robert

2011-02-01

Since the end of the 20th century, robot-assisted surgery has been finding its role among other minimally invasive methods. Vascular surgery seems to be another specialty in which the benefits of this technology can be expected. Our objective was to assess the learning curve of robot-assisted laparoscopic aortofemoral bypass grafting for aortoiliac occlusive disease in a group of 40 patients. Between May 2006 and January 2010, 40 patients (32 men, 8 women), who were a median age of 58 years (range, 48-75 years), underwent 40 robot-assisted laparoscopic aortofemoral reconstructions. Learning curve estimations were used for anastomosis, clamping, and operative time assessment. For conversion rate evaluation, the cumulative summation (CUSUM) technique was used. Statistical analysis comparing the first and second half of our group, and unilateral-to-bilateral reconstructions were performed. We created 21 aortofemoral and 19 aortobifemoral bypasses. The median proximal anastomosis time was 23 minutes (range, 18-50 minutes), median clamping time was 60 minutes (range, 40-95 minutes), and median operative time was 295 minutes (range, 180-475 minutes). The 30-day mortality rate was 0%, and no graft or wound infection or cardiopulmonary or hepatorenal complications were observed. During the median 18-month follow-up (range, 2-48 months), three early graft occlusions occurred (7%). After reoperations, the secondary patency of reconstructions was 100%. Data showed a typical short learning curve for robotic proximal anastomosis creation with anastomosis and clamping time reduction. The operative time learning curve was flat, confirming the procedure's complexity. There were two conversions to open surgery. CUSUM analysis confirmed that an acceptable conversion rate set at 5% was achieved. Comparing the first and second half of our group, all recorded times showed statistically significant improvements. Differences between unilateral and bilateral reconstructions were not

Overall Memory Impairment Identification with Mathematical Modeling of the CVLT-II Learning Curve in Multiple Sclerosis

Directory of Open Access Journals (Sweden)

Igor I. Stepanov

2012-01-01

Full Text Available The CVLT-II provides standardized scores for each of the List A five learning trials, so that the clinician can compare the patient's raw trials 1–5 scores with standardized ones. However, frequently, a patient's raw scores fluctuate making a proper interpretation difficult. The CVLT-II does not offer any other methods for classifying a patient's learning and memory status on the background of the learning curve. The main objective of this research is to illustrate that discriminant analysis provides an accurate assessment of the learning curve, if suitable predictor variables are selected. Normal controls were ninety-eight healthy volunteers (78 females and 20 males. A group of MS patients included 365 patients (266 females and 99 males with clinically defined multiple sclerosis. We show that the best predictor variables are coefficients 3 and 4 of our mathematical model 3∗exp(−2∗(−1+4∗(1−exp(−2∗(−1 because discriminant functions, calculated separately for 3 and 4, allow nearly 100% correct classification. These predictors allow identification of separate impairment of readiness to learn or ability to learn, or both.

Predicting and preventing organizational failure: learning, stability and safety culture

International Nuclear Information System (INIS)

Duffey, R.B.

2009-01-01

The physical definition of 'safety culture' is the creation of an organizational and operational structure that places unending emphasis on safety at every level. We propose and prefer the use of the term and the objective of sustaining a 'Learning Environment', where mistakes, outcomes and errors are used as learning vehicles to improve, and we can now define why that is true. Therefore we can manage and quantify safety effectively tracking and analyzing outcomes, using the trends to guide our needed organizational behaviors. (author)

Measurable improvement in patient safety culture: A departmental experience with incident learning.

Science.gov (United States)

Kusano, Aaron S; Nyflot, Matthew J; Zeng, Jing; Sponseller, Patricia A; Ermoian, Ralph; Jordan, Loucille; Carlson, Joshua; Novak, Avrey; Kane, Gabrielle; Ford, Eric C

2015-01-01

Rigorous use of departmental incident learning is integral to improving patient safety and quality of care. The goal of this study was to quantify the impact of a high-volume, departmental incident learning system on patient safety culture. A prospective, voluntary, electronic incident learning system was implemented in February 2012 with the intent of tracking near-miss/no-harm incidents. All incident reports were reviewed weekly by a multiprofessional team with regular department-wide feedback. Patient safety culture was measured at baseline with validated patient safety culture survey questions. A repeat survey was conducted after 1 and 2 years of departmental incident learning. Proportional changes were compared by χ(2) or Fisher exact test, where appropriate. Between 2012 and 2014, a total of 1897 error/near-miss incidents were reported, representing an average of 1 near-miss report per patient treated. Reports were filed by a cross section of staff, with the majority of incidents reported by therapists, dosimetrists, and physicists. Survey response rates at baseline and 1 and 2 years were 78%, 80%, and 80%, respectively. Statistically significant and sustained improvements were noted in several safety metrics, including belief that the department was openly discussing ways to improve safety, the sense that reports were being used for safety improvement, and the sense that changes were being evaluated for effectiveness. None of the surveyed dimensions of patient safety culture worsened. Fewer punitive concerns were noted, with statistically significant decreases in the worry of embarrassment in front of colleagues and fear of getting colleagues in trouble. A comprehensive incident learning system can identify many areas for improvement and is associated with significant and sustained improvements in patient safety culture. These data provide valuable guidance as incident learning systems become more widely used in radiation oncology. Copyright © 2015

Does my high blood pressure improve your survival? Overall and subgroup learning curves in health.

Science.gov (United States)

Van Gestel, Raf; Müller, Tobias; Bosmans, Johan

2017-09-01

Learning curves in health are of interest for a wide range of medical disciplines, healthcare providers, and policy makers. In this paper, we distinguish between three types of learning when identifying overall learning curves: economies of scale, learning from cumulative experience, and human capital depreciation. In addition, we approach the question of how treating more patients with specific characteristics predicts provider performance. To soften collinearity problems, we explore the use of least absolute shrinkage and selection operator regression as a variable selection method and Theil-Goldberger mixed estimation to augment the available information. We use data from the Belgian Transcatheter Aorta Valve Implantation (TAVI) registry, containing information on the first 860 TAVI procedures in Belgium. We find that treating an additional TAVI patient is associated with an increase in the probability of 2-year survival by about 0.16%-points. For adverse events like renal failure and stroke, we find that an extra day between procedures is associated with an increase in the probability for these events by 0.12%-points and 0.07%-points, respectively. Furthermore, we find evidence for positive learning effects from physicians' experience with defibrillation, treating patients with hypertension, and the use of certain types of replacement valves during the TAVI procedure. Copyright © 2017 John Wiley & Sons, Ltd.

Why the Kantian ideal survives medical learning curves, and why it matters.

Science.gov (United States)

Brecher, B

2006-09-01

The "Kantian ideal" is often misunderstood as invoking individual autonomy rather than rational self legislation. Le Morvan and Stock's otherwise insightful discussion of "Medical learning curves and the Kantian ideal"--for example--draws the mistaken inference that that ideal is inconsistent with the realities of medical practice. But it is not. Rationally to be a patient entails accepting its necessary conditions.

Preliminary Results and Learning Curve of the Minimally Invasive Chevron Akin Operation for Hallux Valgus.

Science.gov (United States)

Jowett, Charlie R J; Bedi, Harvinder S

Minimally invasive surgery is increasing in popularity. It is relevant in hallux valgus surgery owing to the potential for reduced disruption of the soft tissues and improved wound healing. We present our results and assess the learning curve of the minimally invasive Chevron Akin operation for hallux valgus. A total of 120 consecutive feet underwent minimally invasive Chevron Akin for symptomatic hallux valgus, of which 14 were excluded. They were followed up for a mean of 25 (range 18 to 38) months. The patients were clinically assessed using the American Orthopaedic Foot and Ankle Society score. Complications and patient satisfaction were recorded. The radiographs were analyzed and measurements recorded for hallux valgus and intermetatarsal angle correction. The mean age of the patients undergoing surgery was 55 (range 25 to 81) years. Of the 78 patients, 76 (97.4%) were female and 2 (2.6%) were male; 28 (35.9%) cases were bilateral. The mean American Orthopaedic Foot and Ankle Society score improved from 56 (range 23 to 76) preoperatively to 87 (range 50 to 100) postoperatively (p technique. They display a steep associated learning curve. However, the results are promising, and the learning curve is comparable to that for open hallux valgus surgery. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Overall Memory Impairment Identification with Mathematical Modeling of the CVLT-II Learning Curve in Multiple Sclerosis

Science.gov (United States)

Stepanov, Igor I.; Abramson, Charles I.; Hoogs, Marietta; Benedict, Ralph H. B.

2012-01-01

The CVLT-II provides standardized scores for each of the List A five learning trials, so that the clinician can compare the patient's raw trials 1–5 scores with standardized ones. However, frequently, a patient's raw scores fluctuate making a proper interpretation difficult. The CVLT-II does not offer any other methods for classifying a patient's learning and memory status on the background of the learning curve. The main objective of this research is to illustrate that discriminant analysis provides an accurate assessment of the learning curve, if suitable predictor variables are selected. Normal controls were ninety-eight healthy volunteers (78 females and 20 males). A group of MS patients included 365 patients (266 females and 99 males) with clinically defined multiple sclerosis. We show that the best predictor variables are coefficients B3 and B4 of our mathematical model B3 ∗ exp(−B2  ∗  (X − 1)) + B4  ∗  (1 − exp(−B2  ∗  (X − 1))) because discriminant functions, calculated separately for B3 and B4, allow nearly 100% correct classification. These predictors allow identification of separate impairment of readiness to learn or ability to learn, or both. PMID:22745911

Analysis of the learning curve for peroral endoscopic myotomy for esophageal achalasia: Single-center, two-operator experience.

Science.gov (United States)

Lv, Houning; Zhao, Ningning; Zheng, Zhongqing; Wang, Tao; Yang, Fang; Jiang, Xihui; Lin, Lin; Sun, Chao; Wang, Bangmao

2017-05-01

Peroral endoscopic myotomy (POEM) has emerged as an advanced technique for the treatment of achalasia, and defining the learning curve is mandatory. From August 2011 to June 2014, two operators in our institution (A&B) carried out POEM on 35 and 33 consecutive patients, respectively. Moving average and cumulative sum (CUSUM) methods were used to analyze the POEM learning curve for corrected operative time (cOT), referring to duration of per centimeter myotomy. Additionally, perioperative outcomes were compared among distinct learning curve phases. Using the moving average method, cOT reached a plateau at the 29th case and at the 24th case for operators A and B, respectively. CUSUM analysis identified three phases: initial learning period (Phase 1), efficiency period (Phase 2) and mastery period (Phase 3). The relatively smooth state in the CUSUM graph occurred at the 26th case and at the 24th case for operators A and B, respectively. Mean cOT of distinct phases for operator A were 8.32, 5.20 and 3.97 min, whereas they were 5.99, 3.06 and 3.75 min for operator B, respectively. Eckardt score and lower esophageal sphincter pressure significantly decreased during the 1-year follow-up period. Data were comparable regarding patient characteristics and perioperative outcomes. This single-center study demonstrated that expert endoscopists with experience in esophageal endoscopic submucosal dissection reached a plateau in learning of POEM after approximately 25 cases. © 2016 Japan Gastroenterological Endoscopy Society.

Work Placements as Learning Environments for Patient Safety: Finnish and British Preregistration Nursing Students' Important Learning Events

Science.gov (United States)

Tella, Susanna; Smith, Nancy-Jane; Partanen, Pirjo; Turunen, Hannele

2016-01-01

Learning to ensure patient safety in complex health care environments is an internationally recognised concern. This article explores and compares Finnish (n = 22) and British (n = 32) pre-registration nursing students' important learning events about patient safety from their work placements in health care organisations. Written descriptions were…

Yield curve and Recession Forecasting in a Machine Learning Framework

OpenAIRE

Theophilos Papadimitriou; Periklis Gogas; Maria Matthaiou; Efthymia Chrysanthidou

2014-01-01

In this paper, we investigate the forecasting ability of the yield curve in terms of the U.S. real GDP cycle. More specifically, within a Machine Learning (ML) framework, we use data from a variety of short (treasury bills) and long term interest rates (bonds) for the period from 1976:Q3 to 2011:Q4 in conjunction with the real GDP for the same period, to create a model that can successfully forecast output fluctuations (inflation and output gaps) around its long-run trend. We focus our attent...

Does Prior Laparoscopic and Open Surgery Experience Have Any Impact on Learning Curve in Transition to Robotic Surgery?

Directory of Open Access Journals (Sweden)

Cüneyt Adayener

2016-12-01

Full Text Available It has been 15 years since the Food And Drug Administration approved the Da Vinci® robotic surgery system. Robotic applications are being used extensively in urology, particularly in radical prostatectomy. Like all high-tech products, this system also has a high cost and a steep learning curve, therefore, preventing it from becoming widespread. There are various studies on the effect of open surgery or laparoscopy experience on the learning curve of robotic surgery. Analyzing these interactions well will provide valuable information on making the training period of robotic system more efficient.

Using Active Learning to Identify Health Information Technology Related Patient Safety Events.

Science.gov (United States)

Fong, Allan; Howe, Jessica L; Adams, Katharine T; Ratwani, Raj M

2017-01-18

The widespread adoption of health information technology (HIT) has led to new patient safety hazards that are often difficult to identify. Patient safety event reports, which are self-reported descriptions of safety hazards, provide one view of potential HIT-related safety events. However, identifying HIT-related reports can be challenging as they are often categorized under other more predominate clinical categories. This challenge of identifying HIT-related reports is exacerbated by the increasing number and complexity of reports which pose challenges to human annotators that must manually review reports. In this paper, we apply active learning techniques to support classification of patient safety event reports as HIT-related. We evaluated different strategies and demonstrated a 30% increase in average precision of a confirmatory sampling strategy over a baseline no active learning approach after 10 learning iterations.

On the Safety of Machine Learning: Cyber-Physical Systems, Decision Sciences, and Data Products.

Science.gov (United States)

Varshney, Kush R; Alemzadeh, Homa

2017-09-01

Machine learning algorithms increasingly influence our decisions and interact with us in all parts of our daily lives. Therefore, just as we consider the safety of power plants, highways, and a variety of other engineered socio-technical systems, we must also take into account the safety of systems involving machine learning. Heretofore, the definition of safety has not been formalized in a machine learning context. In this article, we do so by defining machine learning safety in terms of risk, epistemic uncertainty, and the harm incurred by unwanted outcomes. We then use this definition to examine safety in all sorts of applications in cyber-physical systems, decision sciences, and data products. We find that the foundational principle of modern statistical machine learning, empirical risk minimization, is not always a sufficient objective. We discuss how four different categories of strategies for achieving safety in engineering, including inherently safe design, safety reserves, safe fail, and procedural safeguards can be mapped to a machine learning context. We then discuss example techniques that can be adopted in each category, such as considering interpretability and causality of predictive models, objective functions beyond expected prediction accuracy, human involvement for labeling difficult or rare examples, and user experience design of software and open data.

Learning curve of hysteroscopic placement of tubal sterilization microinserts in 15 gynecologists in the Netherlands.

Science.gov (United States)

Janse, Juliënne A; Pattij, Thyrza O S; Eijkemans, Marinus J C; Broekmans, Frank J; Veersema, Sebastiaan; Schreuder, Henk W R

2013-09-01

To evaluate the learning curve of hysteroscopic placement of tubal sterilization microinserts by gynecologists in the Netherlands. Prospective multicenter study (Canadian Task Force II-2). Ten community (teaching) hospitals in the Netherlands. A total of 631 women who underwent permanent sterilization by tubal microinserts. Hysteroscopic placement of tubal sterilization microinserts performed by 15 gynecologists experienced in performing operative hysteroscopy, starting from their very first placement. Effect of increasing experience in time on procedure time, pain score, successful bilateral placement, and complications. Bilateral successful placement with confirmation of adequate positioning at follow-up evaluation was achieved in 480 (76.1%) patients at first attempt and in 44 (7.0%) at second attempt. Median procedure time was 8.0 minutes (range: 3-40), and 31 (4.9%) patients were lost to follow-up evaluation. Gravidity showed to be a confounding factor and was consequently adjusted for. A learning curve was seen in a statistically significant decrease of procedure time with increasing experience. The decrease in procedure time extended to 11 to 15 cases and was followed by a plateau phase of the subsequent 60 cases. In contrast, pain scores, successful placement, and complication rate appeared not to improve with increasing experience. A learning curve for hysteroscopic tubal sterilization was seen for procedure time, but successful placement, pain score, and complication rate were not clearly influenced by increasing experience. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Extinction of avoidance behavior by safety learning depends on endocannabinoid signaling in the hippocampus.

Science.gov (United States)

Micale, Vincenzo; Stepan, Jens; Jurik, Angela; Pamplona, Fabricio A; Marsch, Rudolph; Drago, Filippo; Eder, Matthias; Wotjak, Carsten T

2017-07-01

The development of exaggerated avoidance behavior is largely responsible for the decreased quality of life in patients suffering from anxiety disorders. Studies using animal models have contributed to the understanding of the neural mechanisms underlying the acquisition of avoidance responses. However, much less is known about its extinction. Here we provide evidence in mice that learning about the safety of an environment (i.e., safety learning) rather than repeated execution of the avoided response in absence of negative consequences (i.e., response extinction) allowed the animals to overcome their avoidance behavior in a step-down avoidance task. This process was context-dependent and could be blocked by pharmacological (3 mg/kg, s.c.; SR141716) or genetic (lack of cannabinoid CB1 receptors in neurons expressing dopamine D1 receptors) inactivation of CB1 receptors. In turn, the endocannabinoid reuptake inhibitor AM404 (3 mg/kg, i.p.) facilitated safety learning in a CB1-dependent manner and attenuated the relapse of avoidance behavior 28 days after conditioning. Safety learning crucially depended on endocannabinoid signaling at level of the hippocampus, since intrahippocampal SR141716 treatment impaired, whereas AM404 facilitated safety learning. Other than AM404, treatment with diazepam (1 mg/kg, i.p.) impaired safety learning. Drug effects on behavior were directly mirrored by drug effects on evoked activity propagation through the hippocampal trisynaptic circuit in brain slices: As revealed by voltage-sensitive dye imaging, diazepam impaired whereas AM404 facilitated activity propagation to CA1 in a CB1-dependent manner. In line with this, systemic AM404 enhanced safety learning-induced expression of Egr1 at level of CA1. Together, our data render it likely that AM404 promotes safety learning by enhancing information flow through the trisynaptic circuit to CA1. Copyright © 2017 Elsevier Ltd. All rights reserved.

Social learning of fear and safety is determined by the demonstrator's racial group.

Science.gov (United States)

Golkar, Armita; Castro, Vasco; Olsson, Andreas

2015-01-01

Social learning offers an efficient route through which humans and other animals learn about potential dangers in the environment. Such learning inherently relies on the transmission of social information and should imply selectivity in what to learn from whom. Here, we conducted two observational learning experiments to assess how humans learn about danger and safety from members ('demonstrators') of an other social group than their own. We show that both fear and safety learning from a racial in-group demonstrator was more potent than learning from a racial out-group demonstrator. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Automated Blazar Light Curves Using Machine Learning

Energy Technology Data Exchange (ETDEWEB)

Johnson, Spencer James [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2017-07-27

This presentation describes a problem and methodology pertaining to automated blazar light curves. Namely, optical variability patterns for blazars require the construction of light curves and in order to generate the light curves, data must be filtered before processing to ensure quality.

[Evaluation of the learning curve of residents in localizing a phantom target with ultrasonography].

Science.gov (United States)

Dessieux, T; Estebe, J-P; Bloc, S; Mercadal, L; Ecoffey, C

2008-10-01

Few information are available regarding the learning curve in ultrasonography and even less for ultrasound-guided regional anesthesia. This study aimed to evaluate in a training program the learning curve on a phantom of 12 residents novice in ultrasonography. Twelve trainees inexperienced in ultrasonography were given introductory training consisting of didactic formation on the various components of the portable ultrasound machine (i.e. on/off button, gain, depth, resolution, and image storage). Then, students performed three trials, in two sets of increased difficulty, at executing these predefined tasks: adjustments of the machine, then localization of a small plastic piece introduced into roasting pork (3 cm below the surface). At the end of the evaluation, the residents were asked to insert a 22 G needle into an exact predetermined target (i.e. point of fascia intersection). The progression of the needle was continuously controlled by ultrasound visualization using injection of a small volume of water (needle perpendicular to the longitudinal plane of the ultrasound beam). Two groups of two different examiners evaluated for each three trials the skill of the residents (quality, time to perform the machine adjustments, to localize the plastic target, and to hydrolocalize, and volume used for hydrolocalization). After each trial, residents evaluated their performance using a difficulty scale (0: easy to 10: difficult). All residents performed the adjustments from the last trial of each set, with a learning curve observed in terms of duration. Localization of the plastic piece was achieved by all residents at the 6th trial, with a shorter duration of localization. Hydrolocalization was achieved after the 4th trial by all subjects. Difficulty scale was correlated to the number of trials. All these results were independent of the experience of residents in regional anesthesia. Four trials were necessary to adjust correctly the machine, to localize a target, and to

Utility of Interobserver Agreement Statistics in Establishing Radiology Resident Learning Curves During Self-directed Radiologic Anatomy Training.

Science.gov (United States)

Tureli, Derya; Altas, Hilal; Cengic, Ismet; Ekinci, Gazanfer; Baltacioglu, Feyyaz

2015-10-01

The aim of the study was to ascertain the learning curves for the radiology residents when first introduced to an anatomic structure in magnetic resonance images (MRI) to which they have not been previously exposed to. The iliolumbar ligament is a good marker for testing learning curves of radiology residents because the ligament is not part of a routine lumbar MRI reporting and has high variability in detection. Four radiologists, three residents without previous training and one mentor, studied standard axial T1- and T2-weighted images of routine lumbar MRI examinations. Radiologists had to define iliolumbar ligament while blinded to each other's findings. Interobserver agreement analyses, namely Cohen and Fleiss κ statistics, were performed for groups of 20 cases to evaluate the self-learning curve of radiology residents. Mean κ values of resident-mentor pairs were 0.431, 0.608, 0.604, 0.826, and 0.963 in the analysis of successive groups (P 0.8). Therefore, a junior radiology resident can obtain enough experience in identifying a rather ambiguous anatomic structure in routine MRI after a brief instruction of a few minutes by a mentor and studying approximately 80 cases by oneself. Implementing this methodology will help radiology educators obtain more concrete ideas on the optimal time and effort required for supported self-directed visual learning processes in resident education. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

Optimizing area under the ROC curve using semi-supervised learning.

Science.gov (United States)

Wang, Shijun; Li, Diana; Petrick, Nicholas; Sahiner, Berkman; Linguraru, Marius George; Summers, Ronald M

2015-01-01

Receiver operating characteristic (ROC) analysis is a standard methodology to evaluate the performance of a binary classification system. The area under the ROC curve (AUC) is a performance metric that summarizes how well a classifier separates two classes. Traditional AUC optimization techniques are supervised learning methods that utilize only labeled data (i.e., the true class is known for all data) to train the classifiers. In this work, inspired by semi-supervised and transductive learning, we propose two new AUC optimization algorithms hereby referred to as semi-supervised learning receiver operating characteristic (SSLROC) algorithms, which utilize unlabeled test samples in classifier training to maximize AUC. Unlabeled samples are incorporated into the AUC optimization process, and their ranking relationships to labeled positive and negative training samples are considered as optimization constraints. The introduced test samples will cause the learned decision boundary in a multidimensional feature space to adapt not only to the distribution of labeled training data, but also to the distribution of unlabeled test data. We formulate the semi-supervised AUC optimization problem as a semi-definite programming problem based on the margin maximization theory. The proposed methods SSLROC1 (1-norm) and SSLROC2 (2-norm) were evaluated using 34 (determined by power analysis) randomly selected datasets from the University of California, Irvine machine learning repository. Wilcoxon signed rank tests showed that the proposed methods achieved significant improvement compared with state-of-the-art methods. The proposed methods were also applied to a CT colonography dataset for colonic polyp classification and showed promising results.

Learning from uncertain curves

DEFF Research Database (Denmark)

Mallasto, Anton; Feragen, Aasa

2017-01-01

We introduce a novel framework for statistical analysis of populations of nondegenerate Gaussian processes (GPs), which are natural representations of uncertain curves. This allows inherent variation or uncertainty in function-valued data to be properly incorporated in the population analysis. Us...

Learning Curve Characteristics for Caesarean Section Among Associate Clinicians : A Prospective Study from Sierra Leone

NARCIS (Netherlands)

Waalewijn, B.P.; van Duinen, A.; Koroma, A. P.; Rijken, M. J.; Elhassein, M.; Bolkan, H. A.

2017-01-01

Background: In response to the high maternal mortality ratio, Sierra Leone has adopted an associate clinician postgraduate surgical task-sharing training programme. Little is known about learning curve characteristics for caesarean sections among associate clinicians. The aim of this study is to

Virtual reality cataract surgery training: learning curves and concurrent validity.

Science.gov (United States)

Selvander, Madeleine; Åsman, Peter

2012-08-01

To investigate initial learning curves on a virtual reality (VR) eye surgery simulator and whether achieved skills are transferable between tasks. Thirty-five medical students were randomized to complete ten iterations on either the VR Caspulorhexis module (group A) or the Cataract navigation training module (group B) and then two iterations on the other module. Learning curves were compared between groups. The second Capsulorhexis video was saved and evaluated with the performance rating tool Objective Structured Assessment of Cataract Surgical Skill (OSACSS). The students' stereoacuity was examined. Both groups demonstrated significant improvements in performance over the 10 iterations: group A for all parameters analysed including score (p < 0.0001), time (p < 0.0001) and corneal damage (p = 0.0003), group B for time (p < 0.0001), corneal damage (p < 0.0001) but not for score (p = 0.752). Training on one module did not improve performance on the other. Capsulorhexis score correlated significantly with evaluation of the videos using the OSACSS performance rating tool. For stereoacuity < and ≥120 seconds of arc, sum of both modules' second iteration score was 73.5 and 41.0, respectively (p = 0.062). An initial rapid improvement in performance on a simulator with repeated practice was shown. For capsulorhexis, 10 iterations with only simulator feedback are not enough to reach a plateau for overall score. Skills transfer between modules was not found suggesting benefits from training on both modules. Stereoacuity may be of importance in the recruitment and training of new cataract surgeons. Additional studies are needed to investigate this further. Concurrent validity was found for Capsulorhexis module. © 2010 The Authors. Acta Ophthalmologica © 2010 Acta Ophthalmologica Scandinavica Foundation.

How Organisations Learn from Safety Incidents: A Multifaceted Problem

Science.gov (United States)

Lukic, Dane; Margaryan, Anoush; Littlejohn, Allison

2010-01-01

Purpose: This paper seeks to review current approaches to learning from health and safety incidents in the workplace. The aim of the paper is to identify the diversity of approaches and analyse them in terms of learning aspects. Design/methodology/approach: A literature review was conducted searching for terms incident/accident/near…

Learning curves of theta/beta neurofeedback in children with ADHD.

Science.gov (United States)

Janssen, Tieme W P; Bink, Marleen; Weeda, Wouter D; Geladé, Katleen; van Mourik, Rosa; Maras, Athanasios; Oosterlaan, Jaap

2017-05-01

Neurofeedback is widely applied as non-pharmacological intervention aimed at reducing symptoms of ADHD, even though efficacy has not been unequivocally established. Neuronal changes during the neurofeedback intervention that resemble learning can provide crucial evidence for the feasibility and specificity of this intervention. A total of 38 children (aged between 7 and 13 years) with a DSM-IV-TR diagnosis of ADHD, completed on average 29 sessions of theta (4-8 Hz)/beta (13-20 Hz) neurofeedback training. Dependent variables included training-related measures as well as theta and beta power during baseline and training runs for each session. Learning effects were analyzed both within and between sessions. To further specify findings, individual learning curves were explored and correlated with behavioral changes in ADHD symptoms. Over the course of the training, there was a linear increase in participants' mean training level, highest obtained training level and the number of earned credits (range b = 0.059, -0.750, p neurofeedback, although a lack of behavioral correlates may indicate insufficient transfer to daily functioning, or to confounding reinforcement of electromyographic activity. This trial is registered at the US National Institutes of Health (ClinicalTrials.gov, ref. no: NCT01363544); https://clinicaltrials.gov/show/NCT01363544 .

Descemet Membrane Endothelial Keratoplasty Learning Curve for Graft Preparation in an Eye Bank Using 645 Donor Corneas.

Science.gov (United States)

Parekh, Mohit; Ruzza, Alessandro; Romano, Vito; Favaro, Elisa; Baruzzo, Mattia; Salvalaio, Gianni; Grassetto, Andrea; Ferrari, Stefano; Ponzin, Diego

2018-03-01

To investigate the learning curve of Descemet membrane endothelial keratoplasty (DMEK) graft preparation in an eye bank. Four operators prepared 645 DMEK grafts using the stripping technique between 2014 and 2017 at the Veneto Eye Bank Foundation, Italy. Endothelial cell loss (ECL) and tissue wastage were recorded retrospectively after DMEK preparation and correlated with the number of tissues prepared each year by each operator. On average, our operators performed 1 donor preparation a week over the course of this study. Only donors older than 60 years were used in this study, and approximately 10% of donors had diabetes. The Wilcoxon test for paired data and 1-way ANOVA were used for checking statistical significance with the Tukey test as post hoc analysis. P 0.05). There is a learning curve for DMEK graft preparation. ECL and tissue wastage can be reduced with practice and skills. However, each operator may be limited to his or her own learning capability.

EHS Open House: Learning Lab and Life Safety | Poster

Science.gov (United States)

Attendees of the Environment, Health, and Safety Program’s (EHS’) Open House had a chance to learn self-defense techniques, as well as visit with vendors demonstrating the latest trends in laboratory safety. “Working with sharps in labs is inherently dangerous, so EHS proactively focused on featuring equipment that would promote safer techniques,” said Siobhan Tierney, program

Crashes and near-crashes on horizontal curves along rural two-lane highways: Analysis of naturalistic driving data.

Science.gov (United States)

Wang, Bo; Hallmark, Shauna; Savolainen, Peter; Dong, Jing

2017-12-01

Prior research has shown the probability of a crash occurring on horizontal curves to be significantly higher than on similar tangent segments, and a disproportionally higher number of curve-related crashes occurred in rural areas. Challenges arise when analyzing the safety of horizontal curves due to imprecision in integrating information as to the temporal and spatial characteristics of each crash with specific curves. The second Strategic Highway Research Program(SHRP 2) conducted a large-scale naturalistic driving study (NDS),which provides a unique opportunity to better understand the contributing factors leading to crash or near-crash events. This study utilizes high-resolution behavioral data from the NDS to identify factors associated with 108 safety critical events (i.e., crashes or near-crashes) on rural two-lane curves. A case-control approach is utilized wherein these events are compared to 216 normal, baseline-driving events. The variables examined in this study include driver demographic characteristics, details of the traffic environment and roadway geometry, as well as driver behaviors such as in-vehicle distractions. Logistic regression models are estimated to discern those factors affecting the likelihood of a driver being crash-involved. These factors include high-risk behaviors, such as speeding and visual distractions, as well as curve design elements and other roadway characteristics such as pavement surface conditions. This paper successfully integrated driver behavior, vehicle characteristics, and roadway environments into the same model. Logistic regression model was found to be an effective way to investigate crash risks using naturalistic driving data. This paper revealed a number of contributing factors to crashes on rural two-lane curves, which has important implications in traffic safety policy and curve geometry design. This paper also discussed limitations and lessons learned from working with the SHRP 2 NDS data. It will benefit

Innovation and learning curves. Report on knowledge questions of the Working Group Energy and Climate

International Nuclear Information System (INIS)

Schoots, K.

2010-05-01

This report has been written on account of knowledge questions formulated by the Working Group Energy and Climate. This Working Group has been established in the framework of the Broad Reconsideration of Dutch government policy caused by the economic crisis of 2008-2009. Its task is to investigate the possibilities for a structural reduction of government spending by 20% on sustainable energy, energy saving and fiscal advantages carrying non-sustainable incentives. Apart from that, spending on policies aimed at mitigating climate change are scrutinized. In connection with this task, the working group has formulated knowledge questions which refer to cost effectiveness and possibilities for target achievement, possibilities within the European Renewables Directive and learning curves and innovation. This report addresses the latter two themes: learning curves and innovation. The selection of technologies assessed is not all-embracing, but based on the technologies within the SDE regulation (Dutch regulation on support for sustainable energy) supplemented by some promising innovations. [nl

Transforaminal Lumbar Interbody Fusion with Rigid Interspinous Process Fixation: A Learning Curve Analysis of a Surgeon Team's First 74 Cases.

Science.gov (United States)

Doherty, Patrick; Welch, Arthur; Tharpe, Jason; Moore, Camille; Ferry, Chris

2017-05-30

Studies have shown that a significant learning curve may be associated with adopting minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) with bilateral pedicle screw fixation (BPSF). Accordingly, several hybrid TLIF techniques have been proposed as surrogates to the accepted BPSF technique, asserting that less/fewer fixation(s) or less disruptive fixation may decrease the learning curve while still maintaining the minimally disruptive benefits. TLIF with interspinous process fixation (ISPF) is one such surrogate procedure. However, despite perceived ease of adaptability given the favorable proximity of the spinous processes, no evidence exists demonstrating whether or not the technique may possess its own inherent learning curve. The purpose of this study was to determine whether an intraoperative learning curve for one- and two-level TLIF + ISPF may exist for a single lead surgeon. Seventy-four consecutive patients who received one- or two-Level TLIF with rigid ISPF by a single lead surgeon were retrospectively reviewed. It was the first TLIF + ISPF case series for the lead surgeon. Intraoperative blood loss (EBL), hospitalization length-of-stay (LOS), fluoroscopy time, and postoperative complications were collected. EBL, LOS, and fluoroscopy time were modeled as a function of case number using multiple linear regression methods. A change point was included in each model to allow the trajectory of the outcomes to change during the duration of the case series. These change points were determined using profile likelihood methods. Models were fit using the maximum likelihood estimates for the change points. Age, sex, body mass index (BMI), and the number of treated levels were included as covariates. EBL, LOS, and fluoroscopy time did not significantly differ by age, sex, or BMI (p ≥ 0.12). Only EBL differed significantly by the number of levels (p = 0.026). The case number was not a significant predictor of EBL, LOS, or fluoroscopy time (p ≥ 0

The Dread Factor: How Hazards and Safety Training Influence Learning and Performance

Science.gov (United States)

Burke, Michael J.; Salvador, Rommel O.; Smith-Crowe, Kristin; Chan-Serafin, Suzanne; Smith, Alexis; Sonesh, Shirley

2011-01-01

On the basis of hypotheses derived from social and experiential learning theories, we meta-analytically investigated how safety training and workplace hazards impact the development of safety knowledge and safety performance. The results were consistent with an expected interaction between the level of engagement of safety training and hazardous…

Learning curves and long-term outcome of simulation-based thoracentesis training for medical students

Science.gov (United States)

2011-01-01

Background Simulation-based medical education has been widely used in medical skills training; however, the effectiveness and long-term outcome of simulation-based training in thoracentesis requires further investigation. The purpose of this study was to assess the learning curve of simulation-based thoracentesis training, study skills retention and transfer of knowledge to a clinical setting following simulation-based education intervention in thoracentesis procedures. Methods Fifty-two medical students were enrolled in this study. Each participant performed five supervised trials on the simulator. Participant's performance was assessed by performance score (PS), procedure time (PT), and participant's confidence (PC). Learning curves for each variable were generated. Long-term outcome of the training was measured by the retesting and clinical performance evaluation 6 months and 1 year, respectively, after initial training on the simulator. Results Significant improvements in PS, PT, and PC were noted among the first 3 to 4 test trials (p 0.05). Clinical competency in thoracentesis was improved in participants who received simulation training relative to that of first year medical residents without such experience (p simulation-based thoracentesis training can significantly improve an individual's performance. The saturation of learning from the simulator can be achieved after four practice sessions. Simulation-based training can assist in long-term retention of skills and can be partially transferred to clinical practice. PMID:21696584

Mild decentration measured by a Scheimpflug camera and its impact on visual quality following SMILE in the early learning curve.

Science.gov (United States)

Li, Meiyan; Zhao, Jing; Miao, Huamao; Shen, Yang; Sun, Ling; Tian, Mi; Wadium, Elizabeth; Zhou, Xingtao

2014-05-20

To measure decentration following femtosecond laser small incision lenticule extraction (SMILE) for the correction of myopia and myopic astigmatism in the early learning curve, and to investigate its impact on visual quality. A total of 55 consecutive patients (100 eyes) who underwent the SMILE procedure were included. Decentration was measured using a Scheimpflug camera 6 months after surgery. Uncorrected and corrected distance visual acuity (UDVA, CDVA), manifest refraction, and wavefront errors were also measured. Associations between decentration and the preoperative spherical equivalent were analyzed, as well as the associations between decentration and wavefront aberrations. Regarding efficacy and safety, 40 eyes (40%) had an unchanged CDVA; 32 eyes (32%) gained one line; and 11 eyes (11%) gained two lines. Fifteen eyes (15%) lost one line of CDVA, and two eyes (2%) lost two lines. Ninety-nine of the treated eyes (99%) had a postoperative UDVA better than 1.0, and 100 eyes (100%) had a UDVA better than 0.8. The mean decentered displacement was 0.17 ± 0.09 mm. The decentered displacement of all treated eyes (100%) was within 0.50 mm; 70 eyes (70%) were within 0.20 mm; and 90 eyes (90%) were within 0.30 mm. The vertical coma showed the greatest increase in magnitude. The magnitude of horizontal decentration was found to be associated with an induced horizontal coma. This study suggests that, although mild decentration occurred in the early learning curve, good visual outcomes were achieved after the SMILE surgery. Special efforts to minimize induced vertical coma are necessary. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

Retrospective analysis of the learning curve associated with laparoscopic ovariectomy in dogs and associated perioperative complication rates.

Science.gov (United States)

Pope, Juliet Frances Anne; Knowles, Toby Grahame

2014-08-01

To assess the learning curve associated with laparoscopic ovariectomy (LOE) in 618 dogs and to report perioperative complication rates. Case series. Dogs (n = 618). Data retrieved from the medical records of bitches admitted for LOE over 42 months included date of surgery, breed, weight (kg), age (months), surgeon, suture material used, intraoperative complications and postoperative complications. Each LOE was defined as "successful" or "unsuccessful" by the absence or presence of an intraoperative complication and "failure" rate described using a CUSUM technique. Follow-up time ranged from 152 to 1,435 days (median, 737 days). Intraoperative complications occurred in 10 dogs (1.6%) and included: splenic laceration (6 dogs; 1%), urinary bladder perforation (3 dogs; 0.5%), and subcutaneous emphysema (1 dog; 0.2%). Postoperative complications occurred in 99 dogs (16%) and included: incisional inflammation treated with antibiotics (87 dogs [14%]; 96/1,854 incisions; 5.1%), incisional seroma (5 dogs [0.8%]; 5/1,854 incisions, 0.3%), incisional hernia (4 dogs [0.6%]; 4/1,854 incisions, 0.2%), and ovarian remnant syndrome (3 dogs; 0.5%). CUSUM charts indicated an initial "learning curve" of ∼80 LOE. LOE is a technique with an initial learning curve but once surgical proficiency is reached after ∼80 procedures then intraoperative complication rates associated with the procedure can be low. © Copyright 2014 by The American College of Veterinary Surgeons.

Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

Directory of Open Access Journals (Sweden)

Chang Wook Jeong

2012-06-01

Full Text Available PURPOSE: To appraise the evaluation methods for learning curve and to analyze the non-mentor-aided learning curve and early complications following the holmium laser enucleation of the prostate. MATERIALS AND METHODS:One-hundred and forty (n=140 consecutive patients who underwent HoLEP from July 2008 to July 2010 by a single surgeon (SJO were enrolled. Perioperative clinical variables, including enucleation time, morcellation time, enucleation ratio (enucleation weight/transitional zone volume, enucleation efficacy (enucleated weight/enucleation time, enucleation ratio efficacy (enucleation ratio/enucleation time, and early complication rate were analyzed. RESULTS: Mean prostate volume was 62.7 mL (range 21-162 and preoperative International Prostate Symptom Score (IPSS was 19.0 (4-35. Mean enucleation time and morcellation time were 49.9±23.8 (S.D. min and 11.0±9.7 min, respectively. Median duration of postoperative indwelling catheter was 1 (1-7 day and median hospital stay was 1 (1-6 day. There were a total of 31 surgery-related complications in 27 patients (19.3%, and all were manageable. There was an increasing trend of enucleation efficacy in the first 50 cases. However, enucleation efficacy was linearly correlated with the prostate size (correlation coefficients, R=0.701, p<0.001. But, enucleation ratio efficacy could eliminate the confounding effect of the prostate size (R=-0.101, p=0.233. The plateau of enucleation ratio efficacy was reached around the twenty-fifth case. CONCLUSIONS: Our results demonstrated that the operative learning curve plateau is reached after about 25 cases. We propose that a more appropriate parameter for estimating the operative learning curve is enucleation ratio efficacy, rather than enucleation efficacy.

[Individual learning curve for radical robot-assisted prostatectomy based on the example of three professionals working in one clinic].

Science.gov (United States)

Rasner, P I; Pushkar', D Iu; Kolontarev, K B; Kotenkov, D V

2014-01-01

The appearance of new surgical technique always requires evaluation of its effectiveness and ease of acquisition. A comparative study of the results of the first three series of successive robot-assisted radical prostatectomy (RARP) performed on at time by three surgeons, was conducted. The series consisted of 40 procedures, and were divided into 4 groups of 10 operations for the analysis. When comparing data, statistically significant improvement of intra- and postoperative performance in each series was revealed, with increase in the number of operations performed, and in each subsequent series compared with the preceding one. We recommend to perform the planned conversion at the first operation. In our study, previous laparoscopic experience did not provide any significant advantages in the acquisition of robot-assisted technology. To characterize the individual learning curve, we recommend the use of the number of operations that the surgeon looked in the life-surgery regimen and/or in which he participated as an assistant before his own surgical activity, as well as the indicator "technical defect". In addition to the term "individual learning curve", we propose to introduce the terms "surgeon's individual training phase", and "clinic's learning curve".

Factors Influencing Learning Satisfaction of Migrant Workers in Korea with E-learning-Based Occupational Safety and Health Education

Directory of Open Access Journals (Sweden)

Young Joo Lee

2015-09-01

Conclusion: E-learning-based OSH education for migrant workers may be an effective way to increase their safety knowledge and behavior if the accuracy, credibility, and novelty of learning content; strategies to promote learners' motivation to learn; and interactions with learners and instructors are systematically applied during the development and implementation of e-learning programs.

Effects of technological learning and uranium price on nuclear cost: Preliminary insights from a multiple factors learning curve and uranium market modeling

International Nuclear Information System (INIS)

Kahouli, Sondes

2011-01-01

This paper studies the effects of returns to scale, technological learning, i.e. learning-by-doing and learning-by-searching, and uranium price on the prospects of nuclear cost decrease. We use an extended learning curve specification, named multiple factors learning curve (MFLC). In a first stage, we estimate a single MFLC. In a second stage, we estimate the MFLC under the framework of simultaneous system of equations which takes into account the uranium supply and demand. This permits not only to enhance the reliability of the estimation by incorporating the uranium price formation mechanisms in the MFLC via the price variable, but also to give preliminary insights about uranium supply and demand behaviors and the associated effects on the nuclear expansion. Results point out that the nuclear cost has important prospects for decrease via capacity expansion, i.e. learning-by-doing effects. In contrast, they show that the learning-by-searching as well as the scale effects have a limited effect on the cost decrease prospects. Conversely, results also show that uranium price exerts a positive and significant effect on nuclear cost, implying that when the uranium price increases, the nuclear power generation cost decreases. Since uranium is characterized by important physical availability, and since it represents only a minor part in the total nuclear cost, we consider that in a context of increasing demand for nuclear energy the latter result can be explained by the fact that the positive learning effects on the cost of nuclear act in a way to dissipate the negative ones that an increase in uranium price may exert. Further, results give evidence of important inertia in the supply and demand sides as well as evidence of slow correlation between the uranium market and oil market which may limit the inter-fuels substituability effects, that is, nuclear capacity expansion and associated learning-by-doing benefits. - Highlights: → We study the prospects of nuclear cost

Provincial carbon intensity abatement potential estimation in China: A PSO–GA-optimized multi-factor environmental learning curve method

International Nuclear Information System (INIS)

Yu, Shiwei; Zhang, Junjie; Zheng, Shuhong; Sun, Han

2015-01-01

This study aims to estimate carbon intensity abatement potential in China at the regional level by proposing a particle swarm optimization–genetic algorithm (PSO–GA) multivariate environmental learning curve estimation method. The model uses two independent variables, namely, per capita gross domestic product (GDP) and the proportion of the tertiary industry in GDP, to construct carbon intensity learning curves (CILCs), i.e., CO 2 emissions per unit of GDP, of 30 provinces in China. Instead of the traditional ordinary least squares (OLS) method, a PSO–GA intelligent optimization algorithm is used to optimize the coefficients of a learning curve. The carbon intensity abatement potentials of the 30 Chinese provinces are estimated via PSO–GA under the business-as-usual scenario. The estimation reveals the following results. (1) For most provinces, the abatement potentials from improving a unit of the proportion of the tertiary industry in GDP are higher than the potentials from raising a unit of per capita GDP. (2) The average potential of the 30 provinces in 2020 will be 37.6% based on the emission's level of 2005. The potentials of Jiangsu, Tianjin, Shandong, Beijing, and Heilongjiang are over 60%. Ningxia is the only province without intensity abatement potential. (3) The total carbon intensity in China weighted by the GDP shares of the 30 provinces will decline by 39.4% in 2020 compared with that in 2005. This intensity cannot achieve the 40%–45% carbon intensity reduction target set by the Chinese government. Additional mitigation policies should be developed to uncover the potentials of Ningxia and Inner Mongolia. In addition, the simulation accuracy of the CILCs optimized by PSO–GA is higher than that of the CILCs optimized by the traditional OLS method. - Highlights: • A PSO–GA-optimized multi-factor environmental learning curve method is proposed. • The carbon intensity abatement potentials of the 30 Chinese provinces are estimated by

Evaluating the Clinical Learning Environment: Resident and Fellow Perceptions of Patient Safety Culture.

Science.gov (United States)

Bump, Gregory M; Calabria, Jaclyn; Gosman, Gabriella; Eckart, Catherine; Metro, David G; Jasti, Harish; McCausland, Julie B; Itri, Jason N; Patel, Rita M; Buchert, Andrew

2015-03-01

The Accreditation Council for Graduate Medical Education has begun to evaluate teaching institutions' learning environments with Clinical Learning Environment Review visits, including trainee involvement in institutions' patient safety and quality improvement efforts. We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment. Using the Hospital Survey on Patient Safety Culture (HSOPSC), we measured resident and fellow perceptions of patient safety culture in 50 graduate medical education programs at 10 hospitals within an integrated health system. As institution-specific physician scores were not available, resident and fellow scores on the HSOPSC were compared with national data from 29 162 practicing providers at 543 hospitals. Of the 1337 residents and fellows surveyed, 955 (71.4%) responded. Compared with national practicing providers, trainees had lower perceptions of patient safety culture in 6 of 12 domains, including teamwork within units, organizational learning, management support for patient safety, overall perceptions of patient safety, feedback and communication about error, and communication openness. Higher perceptions were observed for manager/supervisor actions promoting patient safety and for staffing. Perceptions equaled national norms in 4 domains. Perceptions of patient safety culture did not improve with advancing postgraduate year. Trainees in a large integrated health system have variable perceptions of patient safety culture, as compared with national norms for some practicing providers. Administration of the HSOPSC was feasible and acceptable to trainees, and may be used to track perceptions over time.

Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves.

Science.gov (United States)

Melich, George; Hong, Young Ki; Kim, Jieun; Hur, Hyuk; Baik, Seung Hyuk; Kim, Nam Kyu; Sender Liberman, A; Min, Byung Soh

2015-03-01

Laparoscopy offers some evidence of benefit compared to open rectal surgery. Robotic rectal surgery is evolving into an accepted approach. The objective was to analyze and compare laparoscopic and robotic rectal surgery learning curves with respect to operative times and perioperative outcomes for a novice minimally invasive colorectal surgeon. One hundred and six laparoscopic and 92 robotic LAR rectal surgery cases were analyzed. All surgeries were performed by a surgeon who was primarily trained in open rectal surgery. Patient characteristics and perioperative outcomes were analyzed. Operative time and CUSUM plots were used for evaluating the learning curve for laparoscopic versus robotic LAR. Laparoscopic versus robotic LAR outcomes feature initial group operative times of 308 (291-325) min versus 397 (373-420) min and last group times of 220 (212-229) min versus 204 (196-211) min-reversed in favor of robotics; major complications of 4.7 versus 6.5 % (NS), resection margin involvement of 2.8 versus 4.4 % (NS), conversion rate of 3.8 versus 1.1 (NS), lymph node harvest of 16.3 versus 17.2 (NS), and estimated blood loss of 231 versus 201 cc (NS). Due to faster learning curves for extracorporeal phase and total mesorectal excision phase, the robotic surgery was observed to be faster than laparoscopic surgery after the initial 41 cases. CUSUM plots demonstrate acceptable perioperative surgical outcomes from the beginning of the study. Initial robotic operative times improved with practice rapidly and eventually became faster than those for laparoscopy. Developing both laparoscopic and robotic skills simultaneously can provide acceptable perioperative outcomes in rectal surgery. It might be suggested that in the current milieu of clashing interests between evolving technology and economic constrains, there might be advantages in embracing both approaches.

Assessing the impact of windfarms - the learning curve in Cornwall

International Nuclear Information System (INIS)

Hull, A.

1998-01-01

This paper uses windfarm application decisions in Cornwall between 1989 and 1995 to illustrate the learning curve of planners in assessing appropriate windfarm locations, and in particular how the process of knowledge construction is constantly reviewed and modified in the light of experience and circumstance. One of the accepted purposes of Environmental Impact Assessment is to predict the possible effects, both beneficial and adverse, of the development on the environment. In practice what is beneficial and what is adverse can be a matter of dispute. The paper draws out the role of the planning system in assessing what is problematic or benign, and the practical strategies and procedures used to assess and control the environmental impacts of wind energy schemes. (Author)

Speed choice and steering behavior in curve driving

NARCIS (Netherlands)

Winsum, W. van; Godthelp, J.

1996-01-01

The relation between speed choice and steering performance during curve negotiation was studied in a driving simulator. The hypothesis was that curve radius and steering competence both affect steering error during curve driving, resulting in compensatory speed choice. In this, the control of safety

Safety learning among young newly employed in three trades – the role of the profession?

DEFF Research Database (Denmark)

Grytnes, Regine; Dyreborg, Johnny; Jørgensen, Astrid

2017-01-01

Background Young workers aged 18-24 years have an increased risk of injuries at work compared to older workers. This is a problem not only for young workers themselves but also for the society and it lends relevance to the question of how young people learn safe working practices. Safety learning...... to be 'something everyone can do'. Learning safe working practices are shown to be part of canonical and non- canonical professional norms and safety learning is thus an integral part of local and professional induction practices....... is not achieved through information and campaigns alone; it also involves practical training and mentorship at the specific work place. In this paper an analysis of how induction practices relates to safety learning in three different trades is pursued focusing especially on the role of the professions...

Criticality Safety Lessons Learned in a Deactivation and Decommissioning Environment [A Guide for Facility and Project Managers

Energy Technology Data Exchange (ETDEWEB)

Nirider, L. Tom

2003-08-06

This document was designed as a reference and a primer for facility and project managers responsible for Deactivation and Decommissioning (D&D) processes in facilities containing significant inventories of fissionable materials. The document contains lessons learned and guidance for the development and management of criticality safety programs. It also contains information gleaned from occurrence reports, assessment reports, facility operations and management, NDA program reviews, criticality safety experts, and criticality safety evaluations. This information is designed to assist in the planning process and operational activities. Sufficient details are provided to allow the reader to understand the events, the lessons learned, and how to apply the information to present or planned D&D processes. Information is also provided on general lessons learned including criticality safety evaluations and criticality safety program requirements during D&D activities. The document also explores recent and past criticality accidents in operating facilities, and it extracts lessons learned pertinent to D&D activities. A reference section is included to provide additional information. This document does not address D&D lessons learned that are not pertinent to criticality safety.

Education Isn’t Education: The Creativity Response or How to Improve the Learning Curve in Our Society

Directory of Open Access Journals (Sweden)

Stefan Brunnhuber

2017-06-01

Full Text Available Despite rising expenditure and general enrolment rates on a global level, educational output is stagnating, if not declining. There is increasing empirical evidence that we need a completely different approach to enhancing the learning curve; this holds true for early childhood, primary education, secondary education and higher education. Most existing educational programs do not tap into the full creative potential of our minds and our brains and often lead to suboptimal outcomes both for the individual and for society as a whole. Findings in clinical psychology, neurobiology and social psychology are not sufficiently considered when setting up appropriate educational programs. It is not the cognitive part of the curriculum that makes a difference, but rather the non-cognitive features (including stress management, impulse control, self-regulation, emotional attachment etc. that improve creativity. A ‘six-pack’ of features, including exercise, nutrition, social contact, mindfulness-based practices, sleeping well, and multi-sensory learning, is introduced as part of a ‘creativity response’. They are simple, affordable, evidence-based and efficient strategies that can be implemented promptly without additional costs, increasing our learning curve.

Analysis of the learning curve for pre-cut corneal specimens in preparation for lamellar transplantation: a prospective, single-centre, consecutive case series prepared at the Lions New South Wales Eye Bank.

Science.gov (United States)

Martin, Aifric Isabel; Devasahayam, Rajnesh; Hodge, Christopher; Cooper, Simon; Sutton, Gerard L

2017-09-01

This study is the first paper to establish a learning curve by a single technician. Preparation of pre-cut corneal endothelial grafts commenced at Lions New South Wales Eye Bank in December 2014. The primary objective of this study was to review the safety and reliability of the preparation method during the first year of production. This is a hospital-based, prospective case series. There were 234 consecutive donor corneal lenticules. Donor lenticules were prepared by a single operator using a linear cutting microkeratome. Immediately prior to cutting, central corneal thickness values were recorded. Measurements of the corneal bed were taken immediately following lenticule preparation. Outcomes were separated by blade sizes, and intended thickness was compared to actual thickness for each setting. Early specimens were compared to later ones to assess for a learning curve within the technique. The main parameter measured is the mean difference from intended lamellar cut thickness. The mean final cut thickness was 122.36 ± 20.35 μm, and the mean difference from intended cut was 30.17 ± 37.45 μm. No significant difference was found between results achieved with early specimens versus those achieved with later specimens (P = 0.425). Thin, reproducible endothelial grafts can routinely be produced by trained technicians at their respective eye banks without significant concerns for an extended learning curve. This service can reduce perioperative surgical complexity, required surgical paraphernalia and theatre times. The consistent preparation of single-pass, ultrathin pre-cut corneas may have additional advantages for surgeons seeking to introduce lamellar techniques. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

LHC Run 2 – reaching the top of the learning curve

CERN Multimedia

2015-01-01

As the LHC Physics conference gets underway in St Petersburg, it’s a good time to take stock of where things stand with Run 2.    For all those involved with operating the LHC and its experiments in this new energy and intensity regime, 2015 was always going to be a learning curve. And learning we most certainly are. The main objective for this year has always been to set up the machine and experiments for production running at high energy and high intensity in 2016, 17 and 18.  That said, the experiments have all been able to collect quality data at 13 TeV, with the first Run 2 papers and conference presentations being written and delivered this summer. It would be unfair of me, however, to give the impression that it’s all been plain sailing. As well as the highs: smooth recommissioning of the machine, physics getting underway, and a successful transition to 25-nanosecond bunch spacing, we’ve also had our fair share of lows. There have been no sho...

The neurobiology of safety and threat learning in infancy.

Science.gov (United States)

Debiec, Jacek; Sullivan, Regina M

2017-09-01

What an animal needs to learn to survive is altered dramatically as they change from dependence on the parent for protection to independence and reliance on self-defense. This transition occurs in most altricial animals, but our understanding of the behavioral neurobiology has mostly relied on the infant rat. The transformation from dependence to independence occurs over three weeks in pups and is accompanied by complex changes in responses to both natural and learned threats and the supporting neural circuitry. Overall, in early life, the threat system is quiescent and learning is biased towards acquiring attachment related behaviors to support attachment to the caregiver and proximity seeking. Caregiver-associated cues learned in infancy have the ability to provide a sense of safety throughout lifetime. This attachment/safety system is activated by learning involving presumably pleasurable stimuli (food, warmth) but also painful stimuli (tailpinch, moderate shock). At about the midway point to independence, pups begin to have access to the adult-like amygdala-dependent threat system and amygdala-dependent responses to natural dangers such as predator odors. However, pups have the ability to switch between the infant and adult-like system, which is controlled by maternal presence and modification of stress hormones. Specifically, if the pup is alone, it will learn fear but if with the mother it will learn attachment (10-15days of age). As pups begin to approach weaning, pups lose access to the attachment system and rely only on the amygdala-dependent threat system. However, pups learning system is complex and exhibits flexibility that enables the mother to override the control of the attachment circuit, since newborn pups may acquire threat responses from the mother expressing fear in their presence. Together, these data suggest that the development of pups' threat learning system is not only dependent upon maturation of the amygdala, but it is also exquisitely

Factors Influencing Learning Satisfaction of Migrant Workers in Korea with E-learning-Based Occupational Safety and Health Education

Science.gov (United States)

Lee, Young Joo; Lee, Dongjoo

2015-01-01

Background E-learning-based programs have recently been introduced to the occupational safety and health (OSH) education for migrant workers in Korea. The purpose of this study was to investigate how the factors related to migrant workers' backgrounds and the instructional design affect the migrant workers' satisfaction with e-learning-based OSH education. Methods The data were collected from the surveys of 300 migrant workers who had participated in an OSH education program. Independent sample t test and one-way analysis of variance were conducted to examine differences in the degree of learning satisfaction using background variables. In addition, correlation analysis and multiple regression analysis were conducted to examine relationships between the instructional design variables and the degree of learning satisfaction. Results There was no significant difference in the degree of learning satisfaction by gender, age, level of education, number of employees, or type of occupation, except for nationality. Among the instructional design variables, “learning content” (β = 0.344, p e-learning” (β = 0.095, p E-learning-based OSH education for migrant workers may be an effective way to increase their safety knowledge and behavior if the accuracy, credibility, and novelty of learning content; strategies to promote learners' motivation to learn; and interactions with learners and instructors are systematically applied during the development and implementation of e-learning programs. PMID:26929830

Single-centre experience of retroperitoneoscopic approach in urology with tips to overcome the steep learning curve

Directory of Open Access Journals (Sweden)

Aneesh Srivastava

2016-01-01

Full Text Available Context: The retroperitoneoscopic or retroperitoneal (RP surgical approach has not become as popular as the transperitoneal (TP one due to the steeper learning curve. Aims: Our single-institution experience focuses on the feasibility, advantages and complications of retroperitoneoscopic surgeries (RS performed over the past 10 years. Tips and tricks have been discussed to overcome the steep learning curve and these are emphasised. Settings and Design: This study made a retrospective analysis of computerised hospital data of patients who underwent RP urological procedures from 2003 to 2013 at a tertiary care centre. Patients and Methods: Between 2003 and 2013, 314 cases of RS were performed for various urological procedures. We analysed the operative time, peri-operative complications, time to return of bowel sound, length of hospital stay, and advantages and difficulties involved. Post-operative complications were stratified into five grades using modified Clavien classification (MCC. Results: RS were successfully completed in 95.5% of patients, with 4% of the procedures electively performed by the combined approach (both RP and TP; 3.2% required open conversion and 1.3% were converted to the TP approach. The most common cause for conversion was bleeding. Mean hospital stay was 3.2 ± 1.2 days and the mean time for returning of bowel sounds was 16.5 ± 5.4 h. Of the patients, 1.4% required peri-operative blood transfusion. A total of 16 patients (5% had post-operative complications and the majority were grades I and II as per MCC. The rates of intra-operative and post-operative complications depended on the difficulty of the procedure, but the complications diminished over the years with the increasing experience of surgeons. Conclusion: Retroperitoneoscopy has proven an excellent approach, with certain advantages. The tips and tricks that have been provided and emphasised should definitely help to minimise the steep learning curve.

Criticality Safety Lessons Learned in a Deactivation and Decommissioning Environment [A Guide for Facility and Project Managers

International Nuclear Information System (INIS)

NIRIDER, L.T.

2003-01-01

This document was designed as a reference and a primer for facility and project managers responsible for Deactivation and Decommissioning (D and D) processes in facilities containing significant inventories of fissionable materials. The document contains lessons learned and guidance for the development and management of criticality safety programs. It also contains information gleaned from occurrence reports, assessment reports, facility operations and management, NDA program reviews, criticality safety experts, and criticality safety evaluations. This information is designed to assist in the planning process and operational activities. Sufficient details are provided to allow the reader to understand the events, the lessons learned, and how to apply the information to present or planned D and D processes. Information is also provided on general lessons learned including criticality safety evaluations and criticality safety program requirements during D and D activities. The document also explores recent and past criticality accidents in operating facilities, and it extracts lessons learned pertinent to D and D activities. A reference section is included to provide additional information. This document does not address D and D lessons learned that are not pertinent to criticality safety

The learning curve for narrow-band imaging in the diagnosis of precancerous gastric lesions by using Web-based video.

Science.gov (United States)

Dias-Silva, Diogo; Pimentel-Nunes, Pedro; Magalhães, Joana; Magalhães, Ricardo; Veloso, Nuno; Ferreira, Carlos; Figueiredo, Pedro; Moutinho, Pedro; Dinis-Ribeiro, Mário

2014-06-01

A simplified narrow-band imaging (NBI) endoscopy classification of gastric precancerous and cancerous lesions was derived and validated in a multicenter study. This classification comes with the need for dissemination through adequate training. To address the learning curve of this classification by endoscopists with differing expertise and to assess the feasibility of a YouTube-based learning program to disseminate it. Prospective study. Five centers. Six gastroenterologists (3 trainees, 3 fully trained endoscopists [FTs]). Twenty tests provided through a Web-based program containing 10 randomly ordered NBI videos of gastric mucosa were taken. Feedback was sent 7 days after every test submission. Measures of accuracy of the NBI classification throughout the time. From the first to the last 50 videos, a learning curve was observed with a 10% increase in global accuracy, for both trainees (from 64% to 74%) and FTs (from 56% to 65%). After 200 videos, sensitivity and specificity of 80% and higher for intestinal metaplasia were observed in half the participants, and a specificity for dysplasia greater than 95%, along with a relevant likelihood ratio for a positive result of 7 to 28 and likelihood ratio for a negative result of 0.21 to 0.82, were achieved by all of the participants. No constant learning curve was observed for the identification of Helicobacter pylori gastritis and sensitivity to dysplasia. The trainees had better results in all of the parameters, except specificity for dysplasia, compared with the FTs. Globally, participants agreed that the program's structure was adequate, except on the feedback, which should have consisted of a more detailed explanation of each answer. No formal sample size estimate. A Web-based learning program could be used to teach and disseminate classifications in the endoscopy field. In this study, an NBI classification for gastric mucosal features seems to be easily learned for the identification of gastric preneoplastic

Safety culture in nuclear installations: Bangladesh perspectives and key lessons learned from major events

International Nuclear Information System (INIS)

Jalil, A.; Rabbani, G.

2002-01-01

Steps necessary to be taken to ensure safety in nuclear installations are suggested. One of the steps suggested is enhancing the safety culture. It is necessary to gain a common understanding of the concept itself, the development stages of safety culture by way of good management practices and leadership for safety culture improvement in the long-term. International topical meetings on safety culture may serve as an important forum for exchange of experiences. From such conventions new initiatives and programmes may crop up which when implemented around the world is very likely to improve safety management and thus boost up the safety culture in nuclear installations. International co-operation and learning are to be prompted to facilitate the sharing of the achievements to face the challenges involved in the management of safety and fixing priorities for future work and identify areas of co-operations. Key lessons learned from some major events have been reported. Present status and future trend of nuclear safety culture in Bangladesh have been dealt with. (author)

Using learning curves on energy-efficient technologies to estimate future energy savings and emission reduction potentials in the U.S. iron and steel industry

Energy Technology Data Exchange (ETDEWEB)

Karali, Nihan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Park, Won Young [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); McNeil, Michael A. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2015-06-18

Increasing concerns on non-sustainable energy use and climate change spur a growing research interest in energy efficiency potentials in various critical areas such as industrial production. This paper focuses on learning curve aspects of energy efficiency measures in the U.S iron and steel sector. A number of early-stage efficient technologies (i.e., emerging or demonstration technologies) are technically feasible and have the potential to make a significant contribution to energy saving and CO₂ emissions reduction, but fall short economically to be included. However, they may also have the cost effective potential for significant cost reduction and/or performance improvement in the future under learning effects such as ‘learning-by-doing’. The investigation is carried out using ISEEM, a technology oriented, linear optimization model. We investigated how steel demand is balanced with/without the availability learning curve, compared to a Reference scenario. The retrofit (or investment in some cases) costs of energy efficient technologies decline in the scenario where learning curve is applied. The analysis also addresses market penetration of energy efficient technologies, energy saving, and CO₂ emissions in the U.S. iron and steel sector with/without learning impact. Accordingly, the study helps those who use energy models better manage the price barriers preventing unrealistic diffusion of energy-efficiency technologies, better understand the market and learning system involved, predict future achievable learning rates more accurately, and project future savings via energy-efficiency technologies with presence of learning. We conclude from our analysis that, most of the existing energy efficiency technologies that are currently used in the U.S. iron and steel sector are cost effective. Penetration levels increases through the years, even though there is no price reduction. However, demonstration technologies are not economically

Training anesthesiology residents in providing anesthesia for awake craniotomy: learning curves and estimate of needed case load.

Science.gov (United States)

Bilotta, Federico; Titi, Luca; Lanni, Fabiana; Stazi, Elisabetta; Rosa, Giovanni

2013-08-01

To measure the learning curves of residents in anesthesiology in providing anesthesia for awake craniotomy, and to estimate the case load needed to achieve a "good-excellent" level of competence. Prospective study. Operating room of a university hospital. 7 volunteer residents in anesthesiology. Residents underwent a dedicated training program of clinical characteristics of anesthesia for awake craniotomy. The program was divided into three tasks: local anesthesia, sedation-analgesia, and intraoperative hemodynamic management. The learning curve for each resident for each task was recorded over 10 procedures. Quantitative assessment of the individual's ability was based on the resident's self-assessment score and the attending anesthesiologist's judgment, and rated by modified 12 mm Likert scale, reported ability score visual analog scale (VAS). This ability VAS score ranged from 1 to 12 (ie, very poor, mild, moderate, sufficient, good, excellent). The number of requests for advice also was recorded (ie, resident requests for practical help and theoretical notions to accomplish the procedures). Each task had a specific learning rate; the number of procedures necessary to achieve "good-excellent" ability with confidence, as determined by the recorded results, were 10 procedures for local anesthesia, 15 to 25 procedures for sedation-analgesia, and 20 to 30 procedures for intraoperative hemodynamic management. Awake craniotomy is an approach used increasingly in neuroanesthesia. A dedicated training program based on learning specific tasks and building confidence with essential features provides "good-excellent" ability. © 2013 Elsevier Inc. All rights reserved.

Aviation Safety Risk Modeling: Lessons Learned From Multiple Knowledge Elicitation Sessions

Science.gov (United States)

Luxhoj, J. T.; Ancel, E.; Green, L. L.; Shih, A. T.; Jones, S. M.; Reveley, M. S.

2014-01-01

Aviation safety risk modeling has elements of both art and science. In a complex domain, such as the National Airspace System (NAS), it is essential that knowledge elicitation (KE) sessions with domain experts be performed to facilitate the making of plausible inferences about the possible impacts of future technologies and procedures. This study discusses lessons learned throughout the multiple KE sessions held with domain experts to construct probabilistic safety risk models for a Loss of Control Accident Framework (LOCAF), FLightdeck Automation Problems (FLAP), and Runway Incursion (RI) mishap scenarios. The intent of these safety risk models is to support a portfolio analysis of NASA's Aviation Safety Program (AvSP). These models use the flexible, probabilistic approach of Bayesian Belief Networks (BBNs) and influence diagrams to model the complex interactions of aviation system risk factors. Each KE session had a different set of experts with diverse expertise, such as pilot, air traffic controller, certification, and/or human factors knowledge that was elicited to construct a composite, systems-level risk model. There were numerous "lessons learned" from these KE sessions that deal with behavioral aggregation, conditional probability modeling, object-oriented construction, interpretation of the safety risk results, and model verification/validation that are presented in this paper.

Colorectal endoscopic submucosal dissection (ESD) in the West - when can satisfactory results be obtained? A single-operator learning curve analysis.

Science.gov (United States)

Spychalski, Michał; Skulimowski, Aleksander; Dziki, Adam; Saito, Yutaka

2017-12-01

Up to date we lack a detailed description of the colorectal endoscopic submucosal dissection (ESD) learning curve, that would represent the experience of the Western center. The aim of this study was to define the critical points of the learning curve and to draw up lesions qualification guidelines tailored to the endoscopists experience. We have carried out a single center prospective study. Between June 2013 and December 2016, 228 primary colorectal lesions were managed by ESD procedure. In order to create a learning curve model and to carry out the analysis the cases were divided into six periods, each consisting of 38 cases. The overall en bloc resection rate was 79.39%. The lowest en bloc resection rate (52.36%) was observed in the first period. After completing 76 procedures, the resection rate surged to 86% and it was accompanied by the significant increase in the mean procedure speed of ≥9 cm 2 /h. Lesions localization and diameter had a signification impact on the outcomes. After 76 procedures, en bloc resection rate of 90.9 and 90.67% were achieved for the left side of colon and rectum, respectively. In the right side of colon statistically significant lower resection rate of 67.57% was observed. We have proved that in the setting of the Western center, colorectal ESD can yield excellent results. It seems that the key to the success during the learning period is 'tailoring' lesions qualification guidelines to the experience of the endoscopist, as lesions diameter and localization highly influence the outcomes.

How can leaders foster team learning? Effects of leader-assigned mastery and performance goals and psychological safety.

Science.gov (United States)

Ashauer, Shirley A; Macan, Therese

2013-01-01

Learning and adapting to change are imperative as teams today face unprecedented change. Yet, an important part of learning involves challenging assumptions and addressing differences of opinion openly within a group--the kind of behaviors that pose the potential for embarrassment or threat. How can leaders foster an environment in which team members feel it is safe to take interpersonal risks in order to learn? In a study of 71 teams, we found that psychological safety and learning behavior were higher for teams with mastery than performance goal instructions or no goal instructions. Team psychological safety mediated the relationship between mastery and performance goal instructions and learning behavior. Findings contribute to our understanding of how leader-assigned goals are related to psychological safety and learning behavior in a team context, and suggest approaches to foster such processes.

Applying interprofessional Team-Based Learning in patient safety: a pilot evaluation study.

Science.gov (United States)

Lochner, Lukas; Girardi, Sandra; Pavcovich, Alessandra; Meier, Horand; Mantovan, Franco; Ausserhofer, Dietmar

2018-03-27

Interprofessional education (IPE) interventions are not always successful in achieving learning outcomes. Team-Based Learning (TBL) would appear to be a suitable pedagogical method for IPE, as it focuses on team performance; however, little is known about interprofessional TBL as an instructional framework for patient safety. In this pilot-study, we aimed to (1) describe participants' reactions to TBL, (2) observe their achievement with respect to interprofessional education learning objectives, and (3) document their attitudinal shifts with regard to patient safety behaviours. We developed and implemented a three-day course for pre-qualifying, non-medical healthcare students to give instruction on non-technical skills related to 'learning from errors'. The course consisted of three sequential modules: 'Recognizing Errors', 'Analysing Errors', and 'Reporting Errors'. The evaluation took place within a quasi-experimental pre-test-post-test study design. Participants completed self-assessments through valid and reliable instruments such as the Mennenga's TBL Student Assessment Instrument and the University of the West of England's Interprofessional Questionnaire. The mean scores of the individual readiness assurance tests were compared with the scores of the group readiness assurance test in order to explore if students learned from each other during group discussions. Data was analysed using descriptive (i.e. mean, standard deviation), parametric (i.e. paired t-test), and non-parametric (i.e. Wilcoxon signed-rank test) methods. Thirty-nine students from five different bachelor's programs attended the course. The participants positively rated TBL as an instructional approach. All teams outperformed the mean score of their individual members during the readiness assurance process. We observed significant improvements in 'communication and teamwork' and 'interprofessional learning' but not in 'interprofessional interaction' and 'interprofessional relationships

Effective Learning on the Web Using the Internet for Safety Training

International Nuclear Information System (INIS)

Bar-Noy, T.; Sugarman, H.

2004-01-01

A previous article, Nuclear Physics Education on the web, concentrated on identifying some of the many resources for information on nuclear physics education. This article will concentrate on utilizing these resources in order to create effective learning environments. As more and more learning and training moves from the traditional face to face classroom to the internet, it is becoming increasingly important to improve the quality of online courses. In the examples given here, we concentrate on the area of radiation safety. The reason for this is that government regulations mandate that every worker who comes in contact with radioactive (and other hazardous) materials must undergo safety training before he begins work and at regular intervals thereafter. Unfortunately this training often consists of boring lectures and reading materials, with no interactivity and little or no evaluation following the training. Because of the importance of safety training, it is imperative to improve the quality of this training by creating effective learning environments. One way to do this is to create online courses via the internet. Aside from the fact that use of the internet vastly expands the resources available to the student and instructor, giving a course via the web is much more efficient in terms of time and expense

Laparoscopy Instructional Videos: The Effect of Preoperative Compared With Intraoperative Use on Learning Curves.

Science.gov (United States)

Broekema, Theo H; Talsma, Aaldert K; Wevers, Kevin P; Pierie, Jean-Pierre E N

Previous studies have shown that the use of intraoperative instructional videos has a positive effect on learning laparoscopic procedures. This study investigated the effect of the timing of the instructional videos on learning curves in laparoscopic skills training. After completing a basic skills course on a virtual reality simulator, medical students and residents with less than 1 hour experience using laparoscopic instruments were randomized into 2 groups. Using an instructional video either preoperatively or intraoperatively, both groups then performed 4 repetitions of a standardized task on the TrEndo augmented reality. With the TrEndo, 9 motion analysis parameters (MAPs) were recorded for each session (4 MAPs for each hand and time). These were the primary outcome measurements for performance. The time spent watching the instructional video was also recorded. Improvement in performance was studied within and between groups. Medical Center Leeuwarden, a secondary care hospital located in Leeuwarden, The Netherlands. Right-hand dominant medical student and residents with more than 1 hour experience operating any kind of laparoscopic instruments were participated. A total of 23 persons entered the study, of which 21 completed the study course. In both groups, at least 5 of 9 MAPs showed significant improvements between repetition 1 and 4. When both groups were compared after completion of repetition 4, no significant differences in improvement were detected. The intraoperative group showed significant improvement in 3 MAPs of the left-nondominant-hand, compared with one MAP for the preoperative group. No significant differences in learning curves could be detected between the subjects who used intraoperative instructional videos and those who used preoperative instructional videos. Intraoperative video instruction may result in improved dexterity of the nondominant hand. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc

Adolescent Idiopathic Scoliosis Surgery by a Neurosurgeon: Learning Curve for Neurosurgeons.

Science.gov (United States)

Hyun, Seung-Jae; Han, Sanghyun; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Yongjung J; Rhim, Seung-Chul; Kim, Hyun-Jib

2018-02-01

To determine a neurosurgeon's learning curve of surgical treatment for adolescent idiopathic scoliosis (AIS) patients. This study is a retrospective analysis. Forty-six patients were treated by a single neurosurgeon between 2011 and 2017 using posterior segmental instrumentation and fusion. According to the time period, the former and latter 23 patients were divided into group 1 and group 2, respectively. Patients' demographic data, curve magnitude, number of levels treated, amount of correction achieved, radiographic/clinical outcomes, and complications were compared between the groups. The majority were females (34 vs. 12) with average ages of 15.0 versus 15.6, respectively. The mean follow-up period was 24.6 months. The average number of fusion levels was similar with 10.3 and 11.5 vertebral bodies in groups 1 and 2, respectively. The average Cobb angle of major curvature was 59.8° and 58.5° in groups 1 and 2, respectively. There observed significant reductions of operative time (324.4 vs. 224.7 minutes, P = 0.007) and estimated blood loss (648.3 vs. 438.0 mL, P = 0.027) in group 2. The correction rate of the major structural curve was greater in group 2 (70.7% vs. 81.0%, P = 0.001). There was no case of neurologic deficit, infection, and revision for screw malposition. One patient of group 1 underwent fusion extension surgery for shoulder asymmetry. Radiographic and clinical outcomes of AIS patients treated by a neurosurgeon were acceptable. AIS surgery may be performed with an acceptable rate of complications after about 20 surgeries. With acquisition of surgical experiences, neurosurgeons could perform deformity surgery for AIS effectively and safely. Copyright © 2017 Elsevier Inc. All rights reserved.

Deep-learnt classification of light curves

DEFF Research Database (Denmark)

Mahabal, Ashish; Gieseke, Fabian; Pai, Akshay Sadananda Uppinakudru

2017-01-01

is to derive statistical features from the time series and to use machine learning methods, generally supervised, to separate objects into a few of the standard classes. In this work, we transform the time series to two-dimensional light curve representations in order to classify them using modern deep......Astronomy light curves are sparse, gappy, and heteroscedastic. As a result standard time series methods regularly used for financial and similar datasets are of little help and astronomers are usually left to their own instruments and techniques to classify light curves. A common approach...... learning techniques. In particular, we show that convolutional neural networks based classifiers work well for broad characterization and classification. We use labeled datasets of periodic variables from CRTS survey and show how this opens doors for a quick classification of diverse classes with several...

Reminder: Bike safety – e-learning module still available!

CERN Multimedia

HSE Unit

2014-01-01

The “Safe bike riding” e-learning module offered by the Safety Training Section of the HSE Unit is designed for anyone who uses a bike on the CERN site.   The course, which takes around 10 minutes to complete, can be accessed via the SIR application. It presents safety information, such as the road traffic rules, and practical advice, such as the appropriate safety equipment to wear and to have fitted to your bike. Regarding the rules, we would like to remind you that CERN's Safety Code A7 applies to cyclists as well as motorists.  The training module was created by the accident prevention service of the HSE Unit after it was noticed that the number of occupational accidents involving cyclists had been constantly increasing since 2008, with a rise from about 20 in 2009 to about 50 in 2013. Since its launch in September 2013, the course has been taken by more than 670 people. It can be completed at any time, in either English or French. The Safety T...

Organizational learning in commercial nuclear power plant safety: An empirical analysis

International Nuclear Information System (INIS)

Marcus, A.A.; Bromiley, P.; Nichols, M.L.

1989-01-01

The need for knowledge in organizations that manage and run high risk technologies is very high. The acquisition of useful knowledge is referred to as organizational learning. The theoretical roots of this concept are well established in the academic literature and in practice, especially in manufacturing industries. This paper focuses on organizational problem solving and learning as it relates to the safe and efficient management of commercial nuclear power plants. The authors are co-investigators on a larger team working under contract with the Nuclear Regulatory Commission to develop a logical framework that enables systematic examination of potential linkages between management and organizational factors and safety in nuclear power plant performance. Management and organizational factors that facilitate or impede organizational learning are only a part of the larger study, but are the major focus of this paper. In this paper, the theoretical roots of the concept of organizational learning are discussed, relationships to measures of safety and efficiency of commercial nuclear power plants are hypothesized, and empirical findings which provide partial tests of the hypotheses are discussed. This line of research appears promising; implications for further research, regulatory application, and nuclear power plant management are described

Implementing Safety Cultures in Medicine: What We Learn by Watching Physicians

National Research Council Canada - National Science Library

Hoff, Timothy J; Pohl, Henry; Bartfield, Joel

2005-01-01

.... Key findings that suggest greater contextual barriers to the advancement of learning cultures in residency settings with respect to patient safety include the small number of mistakes and near misses...

PV experience curves for the Netherlands

International Nuclear Information System (INIS)

Gerwig, R.

2005-01-01

Experience curves are one of several tools used by policy makers to take a look at market development. Numerous curves have been constructed for PV but none specific to the Netherlands. The objective of this report is to take a look at the price development of grid-connected PV systems in the Netherlands using the experience curve theory. After a literature and internet search and attempts to acquire information from PV companies information on 51% of the totally installed capacity was found. Curves for the period 1991-2001 were constructed based on system price, BOS (balance-of-system) price and inverter price. The progress ratio of the locally learning BOS was similar to the globally learning module market. This indicates that the pace of development of the Dutch PV market is similar to the globally followed pace. Improvement of the detail of the data might help to get a better idea of which BOS components have declined most. The similar progress ratio also shows the importance of investing both in module and system research as is the case in the Netherlands

Learning and nuclear safety: New reactors and US regulation

International Nuclear Information System (INIS)

Nichols, E.; Wildavsky, A.

1992-01-01

Gathering and analyzing data from operating reactors has become part of government and industry programs to improve performance in plants already on line and to inform development of future reactors. In the United States, however, early development and certain other factors combined to encourage a bias in learning. Regulation and learning from operational data intersect in ways that limit participation, data collection, and positive response to findings. Past learning has shown the advantage of simpler more standard designs with passive or inherent safety features. However, even designs incorporating these past lessons are apt to face tough regulatory tests and much criticism as operating experience is gathered. Only the operational success of new standardized reactors is apt to help rationalize regulation. (orig.)

Safety Requirements / Design Criteria for SFR. Lessons Learned from the Fukushima Dai-ichi Accident

International Nuclear Information System (INIS)

Yllera, Javier

2013-01-01

After the Fukushima event (March 2011) the IAEA has started an action to review and revise, if necessary, all Safety Standards to take into consideration the lessons learned from the accident. The Safety Standards that need to be revised have been identified. A Prioritization Approach has been established: The first priority is to review safety guides applicable for NPPs and spent fuel storage with focus on the measures for the prevention and mitigation of severe accident due to external hazards - ● Regulatory framework, Safety assessment, Management system, Radiation protection and Emergency Preparedness and response; ● Sitting, Design, Operation of NPPs ● Decommissioning and Waste Management. Original sources for lessons learned: IAE fact Finding Mission, Japan´s report to the Ministerial Conference, INSAG Report, etc. Later, other lesson sources considered

Learning Patient Safety in Academic Settings: A Comparative Study of Finnish and British Nursing Students' Perceptions.

Science.gov (United States)

Tella, Susanna; Smith, Nancy-Jane; Partanen, Pirjo; Turunen, Hannele

2015-06-01

Globalization of health care demands nursing education programs that equip students with evidence-based patient safety competences in the global context. Nursing students' entrance into clinical placements requires professional readiness. Thus, evidence-based learning activities about patient safety must be provided in academic settings prior to students' clinical placements. To explore and compare Finnish and British nursing students' perceptions of learning about patient safety in academic settings to inform nursing educators about designing future education curriculum. A purpose-designed instrument, Patient Safety in Nursing Education Questionnaire (PaSNEQ) was used to examine the perceptions of Finnish (n = 195) and British (n = 158) nursing students prior to their final year of registration. Data were collected in two Finnish and two English nursing schools in 2012. Logistic regressions were used to analyze the differences. British students reported more inclusion (p motivation" related to patient safety in their programs. Both student groups considered patient safety education to be more valuable for their own learning than what their programs had provided. Training patient safety skills in the academic settings were the strongest predictors for differences (odds ratio [OR] = 34.69, 95% confidence interval [CI] 7.39-162.83), along with work experience in the healthcare sector (OR = 3.02, 95% CI 1.39-6.58). To prepare nursing students for practical work, training related to clear communication, reporting errors, systems-based approaches, interprofessional teamwork, and use of simulation in academic settings requires comprehensive attention, especially in Finland. Overall, designing patient safety-affirming nursing curricula in collaboration with students may enhance their positive experiences on teaching and learning about patient safety. An international collaboration between educators could help to develop and harmonize patient safety education and to better

Learning health 'safety' within non-technical skills interprofessional simulation education: a qualitative study.

Science.gov (United States)

Gordon, Morris; Fell, Christopher W R; Box, Helen; Farrell, Michael; Stewart, Alison

2017-01-01

Healthcare increasingly recognises and focusses on the phenomena of 'safe practice' and 'patient safety.' Success with non-technical skills (NTS) training in other industries has led to widespread transposition to healthcare education, with communication and teamwork skills central to NTS frameworks. This study set out to identify how the context of interprofessional simulation learning influences NTS acquisition and development of 'safety' amongst learners. Participants receiving a non-technical skills (NTS) safety focussed training package were invited to take part in a focus group interview which set out to explore communication, teamwork, and the phenomenon of safety in the context of the learning experiences they had within the training programme. The analysis was aligned with a constructivist paradigm and took an interactive methodological approach. The analysis proceeded through three stages, consisting of open, axial, and selective coding, with constant comparisons taking place throughout each phase. Each stage provided categories that could be used to explore the themes of the data. Additionally, to ensure thematic saturation, transcripts of observed simulated learning encounters were then analysed. Six themes were established at the axial coding level, i.e., analytical skills, personal behaviours, communication, teamwork, context, and pedagogy. Underlying these themes, two principal concepts emerged, namely: intergroup contact anxiety - as both a result of and determinant of communication - and teamwork, both of which must be considered in relation to context. These concepts have subsequently been used to propose a framework for NTS learning. This study highlights the role of intergroup contact anxiety and teamwork as factors in NTS behaviour and its dissipation through interprofessional simulation learning. Therefore, this should be a key consideration in NTS education. Future research is needed to consider the role of the affective non

Contrast agents provide a faster learning curve in dipyridamole stress echocardiography.

Science.gov (United States)

Zamorano, Jose; Sánchez, Violeta; Moreno, Raúl; Almería, Carlos; Rodrigo, Jose; Serra, Viviana; Azcona, Luis; Aubele, Adalia; Mataix, Luis; Sánchez-Harguindey, Luis

2002-12-01

Interobserver variability is an important limitation of the stress echocardiography and depends on the echocardiographer training. Our aim was to evaluate if the use of contrast agents during dipyridamole stress echocardiography would improve the agreement between an experienced and a non-experienced observer in stress echo and therefore if contrast would affect the learning period of dypyridamole stress echo. Two independent observers without knowledge of any patient data interpreted all stress studies. One observer was an experienced one and the other had experience in echocardiography but not in stress echo. Two observers analysed 87 non-selected and consecutive studies. Out of the 87 studies, 46 were performed without contrast administration, whereas i.v. contrast (2.5 g Levovist by two bolus at rest and at peak stress) was administered in 41. In all cases, second harmonic imaging and stress digitalisation pack was used. The agreement between observers showed a kappa index of 0.58 and 0.83 without and with contrast administration, respectively. The use of contrast agents provides a better agreement in the evaluation of stress echo between an experienced and a non-experienced observer in stress echo. Adding routinely contrast agents could probably reduce the number of exams required for the necessary learning curve in stress echocardiography.

The learning curve of the three-port two-instrument complete thoracoscopic lobectomy for lung cancer—A feasible technique worthy of popularization

Directory of Open Access Journals (Sweden)

Yu-Jen Cheng

2015-07-01

Conclusion: Three-port complete thoracoscopic lobectomy with the two-instrument technique is feasible for lung cancer treatment. The length of the learning curve consisted of 28 cases. This TPTI technique should be popularized.

Development Process and Technical Aspects of Laparoscopic Hepatectomy: Learning Curve Based on 15 Years of Experience.

Science.gov (United States)

Komatsu, Shohei; Scatton, Olivier; Goumard, Claire; Sepulveda, Ailton; Brustia, Raffaele; Perdigao, Fabiano; Soubrane, Olivier

2017-05-01

Laparoscopic hepatectomy continues to be a challenging operation associated with a steep learning curve. This study aimed to evaluate the learning process during 15 years of experience with laparoscopic hepatectomy and to identify approaches to standardization of this procedure. Prospectively collected data of 317 consecutive laparoscopic hepatectomies performed from January 2000 to December 2014 were reviewed retrospectively. The operative procedures were classified into 4 categories (minor hepatectomy, left lateral sectionectomy [LLS], left hepatectomy, and right hepatectomy), and indications were classified into 5 categories (benign-borderline tumor, living donor, metastatic liver tumor, biliary malignancy, and hepatocellular carcinoma). During the first 10 years, the procedures were limited mainly to minor hepatectomy and LLS, and the indications were limited to benign-borderline tumor and living donor. Implementation of major hepatectomy rapidly increased the proportion of malignant tumors, especially hepatocellular carcinoma, starting from 2011. Conversion rates decreased with experience for LLS (13.3% vs 3.4%; p = 0.054) and left hepatectomy (50.0% vs 15.0%; p = 0.012), but not for right hepatectomy (41.4% vs 35.7%; p = 0.661). Our 15-year experience clearly demonstrates the stepwise procedural evolution from LLS through left hepatectomy to right hepatectomy, as well as the trend in indications from benign-borderline tumor/living donor to malignant tumors. In contrast to LLS and left hepatectomy, a learning curve was not observed for right hepatectomy. The ongoing development process can contribute to faster standardization necessary for future advances in laparoscopic hepatectomy. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Experience Curves: A Tool for Energy Policy Assessment

Energy Technology Data Exchange (ETDEWEB)

Neij, Lena; Helby, Peter [Lund Univ. (Sweden). Environmental and Energy Systems Studies; Dannemand Andersen, Per; Morthorst, Poul Erik [Riso National Laboratory, Roskilde (Denmark); Durstewitz, Michael; Hoppe-Kilpper, Martin [Inst. fuer Solare Energieversorgungstechnik e.V., Kassel (DE); and others

2003-07-01

The objective of the project, Experience curves: a tool for energy policy assessment (EXTOOL), was to analyse the experience curve as a tool for the assessment of energy policy measures. This is of special interest, since the use of experience curves for the assessment of energy policy measures requires the development of the established experience curve methodology. This development raises several questions which have been addressed and analysed in this project. The analysis is based on case studies of wind power, an area with considerable experience in technology development, deployment and policy measures. Therefore, a case study based on wind power provides a good opportunity to study the usefulness of experience curves as a tool for the assessment of energy policy measures. However, the results are discussed in terms of using experience curves for the assessment of any energy technology. The project shows that experience curves can be used to assess the effect of combined policy measures in terms of cost reductions. Moreover, the result of the project show that experience curves could be used to analyse international 'learning systems', i.e. cost reductions brought about by the development of wind power and policy measures used in other countries. Nevertheless, the use of experience curves for the assessment of policy programmes has several limitations. First, the analysis and assessment of policy programmes cannot be achieved unless relevant experience curves based on good data can be developed. The authors are of the opinion that only studies that provide evidence of the validity, reliability and relevance of experience curves should be taken into account in policy making. Second, experience curves provide an aggregated picture of the situation and more detailed analysis of various sources of cost reduction, and cost reductions resulting from individual policy measures, requires additional data and analysis tools. Third, we do not recommend the use of

Launch of new e-learning course “Safety during LS1”

CERN Multimedia

HSE Unit

2013-01-01

After 3 years of activity, the LHC and the rest of the accelerator chain have been shut down for about 2 years (from February 2013 to December 2014) due to maintenance and upgrade work, on the surface as well as underground.   CERN has developed a new e-learning course related to this Long Shutdown period (LS1) so as to provide all the collaborators working in the LS1 area with accurate security-oriented information. The objectives of this new course are to: Present LS1 and its context, Identify CERN facilities’ major risks, Identify the main risks associated with our co-activities, Explain how safety issues are being handled at CERN, Present all the basic safety measures to be respected, Present all emergency and rescue instructions. The course is available via the e-learning SIR application. It is compulsory for all newcomers at CERN, along with the “CERN Safety Introduction” training. It is also highly recommended that people who were already w...

Horizontal Curve Virtual Peer Exchange : an RSPCB Peer Exchange

Science.gov (United States)

2014-06-01

This report summarizes the Horizontal Curve Virtual Peer Exchange sponsored by the Federal Highway Administration (FHWA) Office of Safetys Roadway Safety Professional Capacity Building Program on June 17, 2014. This virtual peer exchange was the f...

Consideration of uncertainties in CCDF risk curves in safety oriented decision making processes

International Nuclear Information System (INIS)

Stern, E.; Tadmor, J.

1988-01-01

In recent years, some of the results of Probabilistic Risk Assessment (i.e. the magnitudes of the various adverse health effects and other effects of potential accidents in nuclear power plants) have usually been presented in Complementary Cumulative Distribution Function curves, widely known as CCDF risk curves. CCDF curves are characteristic of probabilistic accident analyses and consequence calculations, although, in many cases, the codes producing the CCDF curves consist of a mixture of both probabilistic and deterministic calculations. One of the main difficulties in the process of PRA is the problem of uncertainties associated with the risk assessments. The uncertainties, as expressed in CCDF risk curves can be classified into two main categories: (a) uncertainties expressed by the CCDF risk curve itself due to its probabilistic nature and - (b) the uncertainty band of CCDF risk curves. The band consists of a ''family of CCDF curves'' which represents the risks (e.g. early/late fatalities) evaluated at various levels of confidence for a specific Plant-Site Combination (PSC) i.e. a certain nuclear power plant located at a certain site. The reasons why a family of curves rather than a single curve represents the risk of a certain PSC have been discussed. Generally, the uncertainty band of CCDF curves is limited by the 95% (''conservative'') and the 5% curves. In most cases the 50% (median, ''best estimate'') curve is also shown because scientists tend to believe that it represents the ''realistic'' (or real) risk of the plant

Problem Based Learning as a Cultural Tool for Health and Safety Learning in a Multi-national Company

DEFF Research Database (Denmark)

Adam, Henrik; Petersson, Eva

2013-01-01

The general background of this study is an interest in how cultural tools contribute to structuring learning activities. The specific interest is to explore how such tools co-determine employees’ problem solving actions in health, safety and environment (HSE) training activities in a multi...... learn to organise HSE actions in the context of using Problem Based Learning (PBL) applied as a cultural tool. More specifically, our interest is in how PBL promotes adult learning by drawing on learners’ experience and involving them in reflective and social processes in the given context......-national company context. Theoretically, the research takes its point of departure in a socio-cultural perspective on the role of cultural tools in learning, and in a complementary interest in the role of communicative framing of learning activities. In the research reported here, the focus is on how employees...

A retrospective analysis of compact fluorescent lamp experience curves and their correlations to deployment programs

International Nuclear Information System (INIS)

Smith, Sarah Josephine; Wei, Max; Sohn, Michael D.

2016-01-01

Experience curves are useful for understanding technology development and can aid in the design and analysis of market transformation programs. Here, we employ a novel approach to create experience curves, to examine both global and North American compact fluorescent lamp (CFL) data for the years 1990–2007. We move away from the prevailing method of fitting a single, constant, exponential curve to data and instead search for break points where changes in the learning rate may have occurred. Our analysis suggests a learning rate of approximately 21% for the period of 1990–1997, and 51% and 79% in global and North American datasets, respectively, after 1998. We use price data for this analysis; therefore our learning rates encompass developments beyond typical “learning by doing”, including supply chain impacts such as market competition. We examine correlations between North American learning rates and the initiation of new programs, abrupt technological advances, and economic and political events, and find an increased learning rate associated with design advancements and federal standards programs. Our findings support the use of segmented experience curves for retrospective and prospective technology analysis, and may imply that investments in technology programs have contributed to an increase of the CFL learning rate. - Highlights: • We develop a segmented regression technique to estimate historical CFL learning curves. • CFL experience curves do not have a constant learning rate. • CFLs exhibited a learning rate of approximately 21% from 1990 to 1997. • The CFL learning rate significantly increased after 1998. • Increased CFL learning rate is correlated to technology deployment programs.

Organizational safety factors research lessons learned

International Nuclear Information System (INIS)

Ryan, T.G.

1995-01-01

This Paper reports lessons learned and state of knowledge gained from an organizational factors research activity involving commercial nuclear power plants in the United States, through the end of 1991, as seen by the scientists immediately involved in the research. Lessons learned information was gathered from the research teams and individuals using a question and answer format. The following five questions were submitted to each team and individual: (1) What organizational factors appear to influence safety performance in some systematic way, (2) Should organizational factors research focus at the plant level, or should it extend beyond the plant level to the parent company, rate setting commissions, regulatory agencies, (3) How important is having direct access to plants for doing organizational factors research, (4) What lessons have been learned to date as the result of doing organizational factors research in a nuclear regulatory setting, and (5) What organizational research topics and issues should be pursued in the future? Conclusions based on the responses provided for this report are that organizational factors research can be conducted in a regulatory setting and produce useful results. Technologies pioneered in other academic, commercial, and military settings can be adopted for use in a nuclear regulatory setting. The future success of such research depends upon the cooperation of regulators, contractors, and the nuclear industry

A Comparison of a Machine Learning Model with EuroSCORE II in Predicting Mortality after Elective Cardiac Surgery: A Decision Curve Analysis.

Science.gov (United States)

Allyn, Jérôme; Allou, Nicolas; Augustin, Pascal; Philip, Ivan; Martinet, Olivier; Belghiti, Myriem; Provenchere, Sophie; Montravers, Philippe; Ferdynus, Cyril

2017-01-01

The benefits of cardiac surgery are sometimes difficult to predict and the decision to operate on a given individual is complex. Machine Learning and Decision Curve Analysis (DCA) are recent methods developed to create and evaluate prediction models. We conducted a retrospective cohort study using a prospective collected database from December 2005 to December 2012, from a cardiac surgical center at University Hospital. The different models of prediction of mortality in-hospital after elective cardiac surgery, including EuroSCORE II, a logistic regression model and a machine learning model, were compared by ROC and DCA. Of the 6,520 patients having elective cardiac surgery with cardiopulmonary bypass, 6.3% died. Mean age was 63.4 years old (standard deviation 14.4), and mean EuroSCORE II was 3.7 (4.8) %. The area under ROC curve (IC95%) for the machine learning model (0.795 (0.755-0.834)) was significantly higher than EuroSCORE II or the logistic regression model (respectively, 0.737 (0.691-0.783) and 0.742 (0.698-0.785), p machine learning model, in this monocentric study, has a greater benefit whatever the probability threshold. According to ROC and DCA, machine learning model is more accurate in predicting mortality after elective cardiac surgery than EuroSCORE II. These results confirm the use of machine learning methods in the field of medical prediction.

Impact of cap-assisted colonoscopy on the learning curve and quality in colonoscopy: a randomized controlled trial.

Science.gov (United States)

Tang, Zhouwen; Zhang, Daniel S; Thrift, Aaron P; Patel, Kalpesh K

2018-03-01

Colonoscopy competency assessment in trainees traditionally has been informal. Comprehensive metrics such as the Assessment of Competency in Endoscopy (ACE) tool suggest that competency thresholds are higher than assumed. Cap-assisted colonoscopy (CAC) may improve competency, but data regarding novice trainees are lacking. We compared CAC versus standard colonoscopy (SC) performed by novice trainees in a randomized controlled trial. All colonoscopies performed by 3 gastroenterology fellows without prior experience were eligible for the study. Exclusion criteria included patient age 90 years, pregnancy, prior colon resection, diverticulitis, colon obstruction, severe hematochezia, referral for EMR, or a procedure done without patient sedation. Patients were randomized to either CAC or SC in a 1:1 fashion. The primary outcome was the independent cecal intubation rate (ICIR). Secondary outcomes were cecal intubation time, polyp detection rate, polyp miss rate, adenoma detection rate, ACE tool scores, and cumulative summation learning curves. A total of 203 colonoscopies were analyzed, 101 in CAC and 102 in SC. CAC resulted in a significantly higher cecal intubation rate, at 79.2% in CAC compared with 66.7% in SC (P = .04). Overall cecal intubation time was significantly shorter at 13.7 minutes for CAC versus 16.5 minutes for SC (P =.02). Cecal intubation time in the case of successful independent fellow intubation was not significantly different between CAC and SC (11.6 minutes vs 12.7 minutes; P = .29). Overall ACE tool motor and cognitive scores were higher with CAC. Learning curves for ICIR approached the competency threshold earlier with cap use but reached competency for only 1 fellow. The polyp detection rate, polyp miss rate, and adenoma detection rate were not significantly different between groups. CAC resulted in significant improvement in ICIR, overall ACE tool scores, and trend toward competency on learning curves when compared with SC in colonoscopy

Team Psychological Safety and Team Learning: A Cultural Perspective

Science.gov (United States)

Cauwelier, Peter; Ribière, Vincent M.; Bennet, Alex

2016-01-01

Purpose: The purpose of this paper was to evaluate if the concept of team psychological safety, a key driver of team learning and originally studied in the West, can be applied in teams from different national cultures. The model originally validated for teams in the West is applied to teams in Thailand to evaluate its validity, and the views team…

Development of the Mathematics of Learning Curve Models for Evaluating Small Modular Reactor Economics

Energy Technology Data Exchange (ETDEWEB)

Harrison, T. J. [ORNL

2014-02-01

The cost of nuclear power is a straightforward yet complicated topic. It is straightforward in that the cost of nuclear power is a function of the cost to build the nuclear power plant, the cost to operate and maintain it, and the cost to provide fuel for it. It is complicated in that some of those costs are not necessarily known, introducing uncertainty into the analysis. For large light water reactor (LWR)-based nuclear power plants, the uncertainty is mainly contained within the cost of construction. The typical costs of operations and maintenance (O&M), as well as fuel, are well known based on the current fleet of LWRs. However, the last currently operating reactor to come online was Watts Bar 1 in May 1996; thus, the expected construction costs for gigawatt (GW)-class reactors in the United States are based on information nearly two decades old. Extrapolating construction, O&M, and fuel costs from GW-class LWRs to LWR-based small modular reactors (SMRs) introduces even more complication. The per-installed-kilowatt construction costs for SMRs are likely to be higher than those for the GW-class reactors based on the property of the economy of scale. Generally speaking, the economy of scale is the tendency for overall costs to increase slower than the overall production capacity. For power plants, this means that doubling the power production capacity would be expected to cost less than twice as much. Applying this property in the opposite direction, halving the power production capacity would be expected to cost more than half as much. This can potentially make the SMRs less competitive in the electricity market against the GW-class reactors, as well as against other power sources such as natural gas and subsidized renewables. One factor that can potentially aid the SMRs in achieving economic competitiveness is an economy of numbers, as opposed to the economy of scale, associated with learning curves. The basic concept of the learning curve is that the more a

Safety Culture: Lessons Learned from the US Chemical Safety and Hazard Investigations Board

International Nuclear Information System (INIS)

Griffon, M.

2016-01-01

investigate the Macondo incident, it became clear that there were similarities with the BP Texas City situation. In 2014 the CSB released two other investigation reports, Tesoro, Anacortes,WA and Chevron, Richmond, CA, which noted deficient safety cultures as contributing to the incidents. The on-going trend of a great deal of focus on personal safety and a lack of adequate focus on process safety was recently discussed in a DNV-GL report. DNV-GL, an international oil and gas technical consulting group, concluded that personal injury rates in offshore oil and gas operations have shown a ten-fold magnitude of improvement. The report concluded that the available data for looking at process safety in the last five years shows no unified global trend toward improved performance. This presentation will examine the lessons learned from the CSBs investigations regarding safety management systems and safety culture as contributing factors to some major incidents in the oil and gas and chemical industrial sectors. (author)

Lessons learned from process incident databases and the process safety incident database (PSID) approach sponsored by the Center for Chemical Process Safety

International Nuclear Information System (INIS)

Sepeda, Adrian L.

2006-01-01

Learning from the experiences of others has long been recognized as a valued and relatively painless process. In the world of process safety, this learning method is an essential tool since industry has neither the time and resources nor the willingness to experience an incident before taking corrective or preventative steps. This paper examines the need for and value of process safety incident databases that collect incidents of high learning value and structure them so that needed information can be easily and quickly extracted. It also explores how they might be used to prevent incidents by increasing awareness and by being a tool for conducting PHAs and incident investigations. The paper then discusses how the CCPS PSID meets those requirements, how PSID is structured and managed, and its attributes and features

Exploring Machine Learning Techniques Using Patient Interactions in Online Health Forums to Classify Drug Safety

Science.gov (United States)

Chee, Brant Wah Kwong

2011-01-01

This dissertation explores the use of personal health messages collected from online message forums to predict drug safety using natural language processing and machine learning techniques. Drug safety is defined as any drug with an active safety alert from the US Food and Drug Administration (FDA). It is believed that this is the first…

The Impact of Learning Curve Model Selection and Criteria for Cost Estimation Accuracy in the DoD

Science.gov (United States)

2016-04-30

different in the future due to machines” • Heightened scrutiny of cost estimates • Budget Control Act of 2011 seeks to reduce federal deficit ...qÜáêíÉÉåíÜ=^ååì~ä= ^Åèìáëáíáçå=oÉëÉ~êÅÜ= póãéçëáìã= qÜìêëÇ~ó=pÉëëáçåë= sçäìãÉ=ff= = The Impact of Learning Curve Model Selection and Criteria for Cost...Assistant Division Director, Institute for Defense Analyses Bruce Harmon, Research Staff Member, Institute for Defense Analyses The Impact of Learning

Taking the brakes off the learning curve.

Science.gov (United States)

Gheysen, Freja; Lasne, Gabriel; Pélégrini-Issac, Mélanie; Albouy, Genevieve; Meunier, Sabine; Benali, Habib; Doyon, Julien; Popa, Traian

2017-03-01

Motor learning is characterized by patterns of cerebello-striato-cortical activations shifting in time, yet the early dynamic and function of these activations remains unclear. Five groups of subjects underwent either continuous or intermittent theta-burst stimulation of one cerebellar hemisphere, or no stimulation just before learning a new motor sequence during fMRI scanning. We identified three phases during initial learning: one rapid, one slow, and one quasi-asymptotic performance phase. These phases were not changed by left cerebellar stimulation. Right cerebellar inhibition, however, accelerated learning and enhanced brain activation in critical motor learning-related areas during the first phase, continuing with reduced brain activation but high-performance in late phase. Right cerebellar excitation did not affect the early learning process, but slowed learning significantly in late phase, along with increased brain activation. We conclude that the right cerebellum is a key factor coordinating other neuronal loops in the early acquisition of an explicit motor sequential skill. Hum Brain Mapp 38:1676-1691, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

An efficient RFID authentication protocol to enhance patient medication safety using elliptic curve cryptography.

Science.gov (United States)

Zhang, Zezhong; Qi, Qingqing

2014-05-01

Medication errors are very dangerous even fatal since it could cause serious even fatal harm to patients. In order to reduce medication errors, automated patient medication systems using the Radio Frequency Identification (RFID) technology have been used in many hospitals. The data transmitted in those medication systems is very important and sensitive. In the past decade, many security protocols have been proposed to ensure its secure transition attracted wide attention. Due to providing mutual authentication between the medication server and the tag, the RFID authentication protocol is considered as the most important security protocols in those systems. In this paper, we propose a RFID authentication protocol to enhance patient medication safety using elliptic curve cryptography (ECC). The analysis shows the proposed protocol could overcome security weaknesses in previous protocols and has better performance. Therefore, the proposed protocol is very suitable for automated patient medication systems.

The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database.

Science.gov (United States)

Ward, S T; Hancox, A; Mohammed, M A; Ismail, T; Griffiths, E A; Valori, R; Dunckley, P

2017-06-01

The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time. OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy (JAG) in the UK. All trainees were included unless they were known to have a baseline experience of >20 procedures or had submitted data for 90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion. There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate. 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/.

Evaluation of learning curves for ovariohysterectomy of dogs and cats and castration of dogs.

Science.gov (United States)

Freeman, Lynetta J; Ferguson, Nancy; Fellenstein, Carol; Johnson, Ron; Constable, Peter D

2017-08-01

OBJECTIVE To define learning curves for fourth-year veterinary students performing ovariohysterectomy procedures in dogs and cats and castration in dogs. DESIGN Retrospective study. SAMPLE 3,196 ovariohysterectomies or castrations performed in dogs and cats by 88 veterinary students during a spay-neuter surgery and animal shelter rotation (n = 3,056) or by 1 experienced general practitioner (n = 140). PROCEDURES Data collected from medical records included patient signalment, type and duration of procedure, and sequence (by date and time) of the procedure within a list of procedures of the same type generated for each student. For each procedure type, geometric mean surgery time and 95% confidence intervals were determined for each number of surgeries completed by ≥ 10 students. Median surgery times for the same procedure types were determined for the experienced practitioner. The learning curve for each procedure was modeled with nonlinear (3-factor exponential equation with a nonzero asymptote) and linear regression. For each procedure, the asymptote (optimal surgery time) for students was compared with the experienced practitioner's median surgery time. RESULTS 2,945 surgeries (mean, 33/student) performed by ≥ 10 students were analyzed. Surgery time decreased in a nonlinear manner as student experience increased for castration of adult or pediatric dogs and ovariohysterectomy of pediatric dogs and adult or pediatric cats. Surgery time decreased in a linear manner as experience increased for ovariohysterectomy of adult dogs. CONCLUSIONS AND CLINICAL RELEVANCE To the authors' knowledge, this was the first study to map surgery times for common surgical procedures consecutively performed by veterinary students. Results clearly indicated the value of repetition to improve surgical skills (as measured by surgery time) during a 3-week period.

Laparoscopic colorectal surgery in learning curve: Role of implementation of a standardized technique and recovery protocol. A cohort study

Science.gov (United States)

Luglio, Gaetano; De Palma, Giovanni Domenico; Tarquini, Rachele; Giglio, Mariano Cesare; Sollazzo, Viviana; Esposito, Emanuela; Spadarella, Emanuela; Peltrini, Roberto; Liccardo, Filomena; Bucci, Luigi

2015-01-01

Background Despite the proven benefits, laparoscopic colorectal surgery is still under utilized among surgeons. A steep learning is one of the causes of its limited adoption. Aim of the study is to determine the feasibility and morbidity rate after laparoscopic colorectal surgery in a single institution, “learning curve” experience, implementing a well standardized operative technique and recovery protocol. Methods The first 50 patients treated laparoscopically were included. All the procedures were performed by a trainee surgeon, supervised by a consultant surgeon, according to the principle of complete mesocolic excision with central vascular ligation or TME. Patients underwent a fast track recovery programme. Recovery parameters, short-term outcomes, morbidity and mortality have been assessed. Results Type of resections: 20 left side resections, 8 right side resections, 14 low anterior resection/TME, 5 total colectomy and IRA, 3 total panproctocolectomy and pouch. Mean operative time: 227 min; mean number of lymph-nodes: 18.7. Conversion rate: 8%. Mean time to flatus: 1.3 days; Mean time to solid stool: 2.3 days. Mean length of hospital stay: 7.2 days. Overall morbidity: 24%; major morbidity (Dindo–Clavien III): 4%. No anastomotic leak, no mortality, no 30-days readmission. Conclusion Proper laparoscopic colorectal surgery is safe and leads to excellent results in terms of recovery and short term outcomes, even in a learning curve setting. Key factors for better outcomes and shortening the learning curve seem to be the adoption of a standardized technique and training model along with the strict supervision of an expert colorectal surgeon. PMID:25859386

Effects of Pathologic Stage on the Learning Curve for Radical Prostatectomy: Evidence That Recurrence in Organ-Confined Cancer Is Largely Related to Inadequate Surgical Technique

Science.gov (United States)

Vickers, Andrew J.; Bianco, Fernando J.; Gonen, Mithat; Cronin, Angel M.; Eastham, James A.; Schrag, Deborah; Klein, Eric A.; Reuther, Alwyn M.; Kattan, Michael W.; Pontes, J. Edson; Scardino, Peter T.

2008-01-01

Objectives We previously demonstrated that there is a learning curve for open radical prostatectomy. We sought to determine whether the effects of the learning curve are modified by pathologic stage. Methods The study included 7765 eligible prostate cancer patients treated with open radical prostatectomy by one of 72 surgeons. Surgeon experience was coded as the total number of radical prostatectomies conducted by the surgeon prior to a patient’s surgery. Multivariable regression models of survival time were used to evaluate the association between surgeon experience and biochemical recurrence, with adjustment for PSA, stage, and grade. Analyses were conducted separately for patients with organ-confined and locally advanced disease. Results Five-year recurrence-free probability for patients with organ-confined disease approached 100% for the most experienced surgeons. Conversely, the learning curve for patients with locally advanced disease reached a plateau at approximately 70%, suggesting that about a third of these patients cannot be cured by surgery alone. Conclusions Excellent rates of cancer control for patients with organ-confined disease treated by the most experienced surgeons suggest that the primary reason such patients recur is inadequate surgical technique. PMID:18207316

Barriers to Implementing a Reporting and Learning Patient Safety System: Pediatric Chiropractic Perspective.

Science.gov (United States)

Pohlman, Katherine A; Carroll, Linda; Hartling, Lisa; Tsuyuki, Ross T; Vohra, Sunita

2016-04-01

A reporting and learning system is a method of monitoring the occurrence of incidents that affect patient safety. This cross-sectional survey asked pediatric chiropractors about factors that may limit their participation in such a system. The list of potential barriers for participation was developed using a systematic approach. All members of the 2 pediatric councils associated with US national chiropractic organizations were invited to complete the survey (N = 400). The cross-sectional survey was created using an online survey tool (REDCap) and sent directly to member emails addressed by the respective executive committees. Of the 400 potential respondents, 81 responded (20.3%). The most common limitations to participating were identified as time pressure (96%) and patient concerns (81%). Reporting and learning systems have been utilized to increase safety awareness in many high-risk industries. To be successful, future patient safety studies with pediatric chiropractors need to ensure these barriers are understood and addressed. © The Author(s) 2015.

Application of the statistical process control method for prospective patient safety monitoring during the learning phase: robotic kidney transplantation with regional hypothermia (IDEAL phase 2a-b).

Science.gov (United States)

Sood, Akshay; Ghani, Khurshid R; Ahlawat, Rajesh; Modi, Pranjal; Abaza, Ronney; Jeong, Wooju; Sammon, Jesse D; Diaz, Mireya; Kher, Vijay; Menon, Mani; Bhandari, Mahendra

2014-08-01

Traditional evaluation of the learning curve (LC) of an operation has been retrospective. Furthermore, LC analysis does not permit patient safety monitoring. To prospectively monitor patient safety during the learning phase of robotic kidney transplantation (RKT) and determine when it could be considered learned using the techniques of statistical process control (SPC). From January through May 2013, 41 patients with end-stage renal disease underwent RKT with regional hypothermia at one of two tertiary referral centers adopting RKT. Transplant recipients were classified into three groups based on the robotic training and kidney transplant experience of the surgeons: group 1, robot trained with limited kidney transplant experience (n=7); group 2, robot trained and kidney transplant experienced (n=20); and group 3, kidney transplant experienced with limited robot training (n=14). We employed prospective monitoring using SPC techniques, including cumulative summation (CUSUM) and Shewhart control charts, to perform LC analysis and patient safety monitoring, respectively. Outcomes assessed included post-transplant graft function and measures of surgical process (anastomotic and ischemic times). CUSUM and Shewhart control charts are time trend analytic techniques that allow comparative assessment of outcomes following a new intervention (RKT) relative to those achieved with established techniques (open kidney transplant; target value) in a prospective fashion. CUSUM analysis revealed an initial learning phase for group 3, whereas groups 1 and 2 had no to minimal learning time. The learning phase for group 3 varied depending on the parameter assessed. Shewhart control charts demonstrated no compromise in functional outcomes for groups 1 and 2. Graft function was compromised in one patient in group 3 (pcontrol chart analytic techniques. These methods allow determination of the duration of mentorship and identification of adverse events in a timely manner. A new operation

The future role of photovoltaics: A learning curve versus portfolio perspective

International Nuclear Information System (INIS)

Albrecht, Johan

2007-01-01

The current cost disadvantage of photovoltaics (PV) risks to reduce its relevance in climate policy strategies. Depending on the used assumptions, electricity from PV can become competitive between 2015 and 2040. Cost competitiveness is, however, a conditional criterion and as an alternative to the learning curve perspective, the future role of PV in electricity production is assessed from a portfolio theory or Capital Asset Pricing Model perspective. In this analysis, the focus is on the input price risks. Fossil fuel price volatility can strongly reduce the financial return of conventional generating technologies. From a welfare perspective, energy planners should try to minimise this risk by adding risk-neutral or no-risk technologies to their portfolio. With an analysis for the year 2025, we illustrate how the addition of renewable capacity to an existing portfolio can lower total portfolio risk without a significant reduction of profitability. PV then emerges as an attractive technology, especially once the best locations for wind energy are already developed

The future role of photovoltaics: a learning curve versus portfolio perspective

International Nuclear Information System (INIS)

Albrecht, J.

2007-01-01

The current cost disadvantage of photovoltaics (PV) risks to reduce its relevance in climate policy strategies. Depending on the used assumptions, electricity from PV can become competitive between 2015 and 2040. Cost competitiveness is, however, a conditional criterion and as an alternative to the learning curve perspective, the future role of PV in electricity production is assessed from a portfolio theory or Capital Asset Pricing Model perspective. In this analysis, the focus is on the input price risks. Fossil fuel price volatility can strongly reduce the financial return of conventional generating technologies. From a welfare perspective, energy planners should try to minimise this risk by adding risk-neutral or no-risk technologies to their portfolio. With an analysis for the year 2025, we illustrate how the addition of renewable capacity to an existing portfolio can lower total portfolio risk without a significant reduction of profitability. PV then emerges as an attractive technology, especially once the best locations for wind energy are already developed. (author)

Learning from the Sun. Analysis of the use of experience curves for energy policy purposes. The case of photovoltaic power. Final report of the Photex project

International Nuclear Information System (INIS)

Schaeffer, G.J.; Seebregts, A.J.; Beurskens, L.W.M.; De Moor, H.H.C.; Alsema, E.; Sark, W.; Durstewicz, M.; Perrin, M.; Boulanger, P.; Laukamp, H.; Zuccaro, C.

2004-08-01

Since the 1990s energy policy scientists have started to explore the possibilities of using the experience curve approach for energy policy making. The concept of the experience curve is simple, at least in principle. It states that, for every doubling of cumulative produced capacity of a product or technology, the cost for making it declines with a fixed percentage (learning rate). Historical statistical analysis can be used to define this percentage. Extrapolating the trend thus found, into the future will then give relevant information about future cost developments and will also give information how much 'learning money' will be needed to get to the break-even point. The Photex project used the development of solar PV as a case to further explore this approach, and also to deduce lessons for PV policy. Other aims were to look at learning rates of the different components of PV-systems and to combine the experience curve analyses with bottom-up engineering studies. The main conclusion with regard to the use of experience curves for energy policy making is that this is an interesting approach, but that such an analysis should be done with much care. For the historical analysis the availability of reliable and firm data is essential. As cost data often are not available, price data could be used as a proxy, as long as sufficient long time ranges are used. Also, the analyst should take care he considers the right learning system boundaries. Furthermore the number of years to be included in the statistical analysis should at least be 10 years and this period sample should not over-represent stable price periods or periods of steep price decline. If possible, data uncertainties should be taken into account as well. An interesting finding was that, at least in the case of PV, the learning rate is not a constant, but can vary over time. In the case of PV it improved from 20% to 23%. Extrapolations into the future should take uncertainties into account and always be

New laws of practice for learning and error correction

International Nuclear Information System (INIS)

Duffey, R.B.

2008-01-01

Relevant to design, operation and safety is the determination of risk and error rates. We provide the detailed comparison of our new learning and statistical theories for system outcome data with the traditional analysis of the learning curves obtained from tests with individual human subjects. The results provide a consistent predictive basis for the learning trends emerging all the way from timescales of many years in large technological system outcomes to actions that occur in about a tenth of a second for individual human decisions. Hence, we demonstrate both the common influence of the human element and the importance of statistical reasoning and analysis. (author)

Case study: the Argentina Road Safety Project: lessons learned for the decade of action for road safety, 2011-2020.

Science.gov (United States)

Raffo, Veronica; Bliss, Tony; Shotten, Marc; Sleet, David; Blanchard, Claire

2013-12-01

This case study of the Argentina Road Safety Project demonstrates how the application of World Bank road safety project guidelines focused on institution building can accelerate knowledge transfer, scale up investment and improve the focus on results. The case study highlights road safety as a development priority and outlines World Bank initiatives addressing the implementation of the World Report on Road Traffic Injury's recommendations and the subsequent launch of the Decade of Action for Road Safety, from 2011-2020. The case study emphasizes the vital role played by the lead agency in ensuring sustainable road safety improvements and promoting the shift to a 'Safe System' approach, which necessitated the strengthening of all elements of the road safety management system. It summarizes road safety performance and institutional initiatives in Argentina leading up to the preparation and implementation of the project. We describe the project's development objectives, financing arrangements, specific components and investment staging. Finally, we discuss its innovative features and lessons learned, and present a set of supplementary guidelines, both to assist multilateral development banks and their clients with future road safety initiatives, and to encourage better linkages between the health and transportation sectors supporting them.

Clinical Relation Extraction Toward Drug Safety Surveillance Using Electronic Health Record Narratives: Classical Learning Versus Deep Learning.

Science.gov (United States)

Munkhdalai, Tsendsuren; Liu, Feifan; Yu, Hong

2018-04-25

Medication and adverse drug event (ADE) information extracted from electronic health record (EHR) notes can be a rich resource for drug safety surveillance. Existing observational studies have mainly relied on structured EHR data to obtain ADE information; however, ADEs are often buried in the EHR narratives and not recorded in structured data. To unlock ADE-related information from EHR narratives, there is a need to extract relevant entities and identify relations among them. In this study, we focus on relation identification. This study aimed to evaluate natural language processing and machine learning approaches using the expert-annotated medical entities and relations in the context of drug safety surveillance, and investigate how different learning approaches perform under different configurations. We have manually annotated 791 EHR notes with 9 named entities (eg, medication, indication, severity, and ADEs) and 7 different types of relations (eg, medication-dosage, medication-ADE, and severity-ADE). Then, we explored 3 supervised machine learning systems for relation identification: (1) a support vector machines (SVM) system, (2) an end-to-end deep neural network system, and (3) a supervised descriptive rule induction baseline system. For the neural network system, we exploited the state-of-the-art recurrent neural network (RNN) and attention models. We report the performance by macro-averaged precision, recall, and F1-score across the relation types. Our results show that the SVM model achieved the best average F1-score of 89.1% on test data, outperforming the long short-term memory (LSTM) model with attention (F1-score of 65.72%) as well as the rule induction baseline system (F1-score of 7.47%) by a large margin. The bidirectional LSTM model with attention achieved the best performance among different RNN models. With the inclusion of additional features in the LSTM model, its performance can be boosted to an average F1-score of 77.35%. It shows that

Statistical re-evaluation of the ASME KIC and KIR fracture toughness reference curves

International Nuclear Information System (INIS)

Wallin, K.

1999-01-01

Historically the ASME reference curves have been treated as representing absolute deterministic lower bound curves of fracture toughness. In reality, this is not the case. They represent only deterministic lower bound curves to a specific set of data, which represent a certain probability range. A recently developed statistical lower bound estimation method called the 'master curve', has been proposed as a candidate for a new lower bound reference curve concept. From a regulatory point of view, the master curve is somewhat problematic in that it does not claim to be an absolute deterministic lower bound, but corresponds to a specific theoretical failure probability that can be chosen freely based on application. In order to be able to substitute the old ASME reference curves with lower bound curves based on the master curve concept, the inherent statistical nature (and confidence level) of the ASME reference curves must be revealed. In order to estimate the true inherent level of safety, represented by the reference curves, the original database was re-evaluated with statistical methods and compared to an analysis based on the master curve concept. The analysis reveals that the 5% lower bound master curve has the same inherent degree of safety as originally intended for the K IC -reference curve. Similarly, the 1% lower bound master curve corresponds to the K IR -reference curve. (orig.)

Statistical re-evaluation of the ASME KIC and KIR fracture toughness reference curves

International Nuclear Information System (INIS)

Wallin, K.; Rintamaa, R.

1998-01-01

Historically the ASME reference curves have been treated as representing absolute deterministic lower bound curves of fracture toughness. In reality, this is not the case. They represent only deterministic lower bound curves to a specific set of data, which represent a certain probability range. A recently developed statistical lower bound estimation method called the 'Master curve', has been proposed as a candidate for a new lower bound reference curve concept. From a regulatory point of view, the Master curve is somewhat problematic in that it does not claim to be an absolute deterministic lower bound, but corresponds to a specific theoretical failure probability that can be chosen freely based on application. In order to be able to substitute the old ASME reference curves with lower bound curves based on the master curve concept, the inherent statistical nature (and confidence level) of the ASME reference curves must be revealed. In order to estimate the true inherent level of safety, represented by the reference curves, the original data base was re-evaluated with statistical methods and compared to an analysis based on the master curve concept. The analysis reveals that the 5% lower bound Master curve has the same inherent degree of safety as originally intended for the K IC -reference curve. Similarly, the 1% lower bound Master curve corresponds to the K IR -reference curve. (orig.)

A randomized control trial to evaluate the importance of pre-training basic laparoscopic psychomotor skills upon the learning curve of laparoscopic intra-corporeal knot tying.

Science.gov (United States)

Molinas, Carlos Roger; Binda, Maria Mercedes; Sisa, Cesar Manuel; Campo, Rudi

2017-01-01

Training of basic laparoscopic psychomotor skills improves the acquisition of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial was designed to evaluate whether pre-training of basic skills, as laparoscopic camera navigation (LCN), hand-eye coordination (HEC), and bimanual coordination (BMC), and the combination of the three of them, has any beneficial effect upon the learning curve of LICK. The study was carried out in a private center in Asunción, Paraguay, by 80 medical students without any experience in surgery. Four laparoscopic tasks were performed in the ENCILAP model (LCN, HEC, BMC, and LICK). Participants were allocated to 5 groups (G1-G5). The study was structured in 5 phases. In phase 1, they underwent a base-line test ( T 1 ) for all tasks (1 repetition of each task in consecutive order). In phase 2, participants underwent different training programs (30 consecutive repetitions) for basic tasks according to the group they belong to (G1: none; G2: LCN; G3: HEC; G4: BMC; and G5: LCN, HEC, and BMC). In phase 3, they were tested again ( T 2 ) in the same manner than at T 1 . In phase 4, they underwent a standardized training program for LICK (30 consecutive repetitions). In phase 5, they were tested again ( T 3 ) in the same manner than at T 1 and T 2 . At each repetition, scoring was based on the time taken for task completion system. The scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). The LICK group learning curves fitted better to the two-phase exponential decay model. From these curves, the starting points ( Y 0), the point after HEC training/before LICK training ( Y 1), the Plateau, and the rate constants ( K ) were calculated. All groups, except for G4, started from a similar point ( Y 0). At Y 1, G5 scored already

From curve fitting to machine learning an illustrative guide to scientific data analysis and computational intelligence

CERN Document Server

Zielesny, Achim

2016-01-01

This successful book provides in its second edition an interactive and illustrative guide from two-dimensional curve fitting to multidimensional clustering and machine learning with neural networks or support vector machines. Along the way topics like mathematical optimization or evolutionary algorithms are touched. All concepts and ideas are outlined in a clear cut manner with graphically depicted plausibility arguments and a little elementary mathematics. The major topics are extensively outlined with exploratory examples and applications. The primary goal is to be as illustrative as possible without hiding problems and pitfalls but to address them. The character of an illustrative cookbook is complemented with specific sections that address more fundamental questions like the relation between machine learning and human intelligence. All topics are completely demonstrated with the computing platform Mathematica and the Computational Intelligence Packages (CIP), a high-level function library developed with M...

Playing off the curve - testing quantitative predictions of skill acquisition theories in development of chess performance.

Science.gov (United States)

Gaschler, Robert; Progscha, Johanna; Smallbone, Kieran; Ram, Nilam; Bilalić, Merim

2014-01-01

Learning curves have been proposed as an adequate description of learning processes, no matter whether the processes manifest within minutes or across years. Different mechanisms underlying skill acquisition can lead to differences in the shape of learning curves. In the current study, we analyze the tournament performance data of 1383 chess players who begin competing at young age and play tournaments for at least 10 years. We analyze the performance development with the goal to test the adequacy of learning curves, and the skill acquisition theories they are based on, for describing and predicting expertise acquisition. On the one hand, we show that the skill acquisition theories implying a negative exponential learning curve do a better job in both describing early performance gains and predicting later trajectories of chess performance than those theories implying a power function learning curve. On the other hand, the learning curves of a large proportion of players show systematic qualitative deviations from the predictions of either type of skill acquisition theory. While skill acquisition theories predict larger performance gains in early years and smaller gains in later years, a substantial number of players begin to show substantial improvements with a delay of several years (and no improvement in the first years), deviations not fully accounted for by quantity of practice. The current work adds to the debate on how learning processes on a small time scale combine to large-scale changes.

Learning Safety Assessment from Accidents in a University Environment

OpenAIRE

Jensen, Niels; Jørgensen, Sten Bay

2013-01-01

This contribution describes how a chemical engineering department started learning from accidents during experimental work and ended up implementing an industrially inspired system for risk assessment of new and existing experimental setups as well as a system for assessing potential risk from the chemicals used in the experimental work. These experiences have led to recent developments which focus increasingly on the a theoretical basis for modeling and reasoning on safety as well as operati...

Establishing the minimal number of virtual reality simulator training sessions necessary to develop basic laparoscopic skills competence: evaluation of the learning curve

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Ricardo Jordao Duarte

2013-09-01

Full Text Available Introduction Medical literature is scarce on information to define a basic skills training program for laparoscopic surgery (peg and transferring, cutting, clipping. The aim of this study was to determine the minimal number of simulator sessions of basic laparoscopic tasks necessary to elaborate an optimal virtual reality training curriculum. Materials and Methods Eleven medical students with no previous laparoscopic experience were spontaneously enrolled. They were submitted to simulator training sessions starting at level 1 (Immersion Lap VR, San Jose, CA, including sequentially camera handling, peg and transfer, clipping and cutting. Each student trained twice a week until 10 sessions were completed. The score indexes were registered and analyzed. The total of errors of the evaluation sequences (camera, peg and transfer, clipping and cutting were computed and thereafter, they were correlated to the total of items evaluated in each step, resulting in a success percent ratio for each student for each set of each completed session. Thereafter, we computed the cumulative success rate in 10 sessions, obtaining an analysis of the learning process. By non-linear regression the learning curve was analyzed. Results By the non-linear regression method the learning curve was analyzed and a r2 = 0.73 (p < 0.001 was obtained, being necessary 4.26 (∼five sessions to reach the plateau of 80% of the estimated acquired knowledge, being that 100% of the students have reached this level of skills. From the fifth session till the 10th, the gain of knowledge was not significant, although some students reached 96% of the expected improvement. Conclusions This study revealed that after five simulator training sequential sessions the students' learning curve reaches a plateau. The forward sessions in the same difficult level do not promote any improvement in laparoscopic basic surgical skills, and the students should be introduced to a more difficult training

Establishing the minimal number of virtual reality simulator training sessions necessary to develop basic laparoscopic skills competence: evaluation of the learning curve.

Science.gov (United States)

Duarte, Ricardo Jordão; Cury, José; Oliveira, Luis Carlos Neves; Srougi, Miguel

2013-01-01

Medical literature is scarce on information to define a basic skills training program for laparoscopic surgery (peg and transferring, cutting, clipping). The aim of this study was to determine the minimal number of simulator sessions of basic laparoscopic tasks necessary to elaborate an optimal virtual reality training curriculum. Eleven medical students with no previous laparoscopic experience were spontaneously enrolled. They were submitted to simulator training sessions starting at level 1 (Immersion Lap VR, San Jose, CA), including sequentially camera handling, peg and transfer, clipping and cutting. Each student trained twice a week until 10 sessions were completed. The score indexes were registered and analyzed. The total of errors of the evaluation sequences (camera, peg and transfer, clipping and cutting) were computed and thereafter, they were correlated to the total of items evaluated in each step, resulting in a success percent ratio for each student for each set of each completed session. Thereafter, we computed the cumulative success rate in 10 sessions, obtaining an analysis of the learning process. By non-linear regression the learning curve was analyzed. By the non-linear regression method the learning curve was analyzed and a r2 = 0.73 (p sessions) to reach the plateau of 80% of the estimated acquired knowledge, being that 100% of the students have reached this level of skills. From the fifth session till the 10th, the gain of knowledge was not significant, although some students reached 96% of the expected improvement. This study revealed that after five simulator training sequential sessions the students' learning curve reaches a plateau. The forward sessions in the same difficult level do not promote any improvement in laparoscopic basic surgical skills, and the students should be introduced to a more difficult training tasks level.

Comparison of plant-specific probabilistic safety assessments and lessons learned

International Nuclear Information System (INIS)

Balfanz, H.P.; Berg, H.P.; Steininger, U.

2001-01-01

Probabilistic safety assessments (PSA) have been performed for all German nuclear power plants in operation. These assessments are mainly based on the recent German PSA guide and an earlier draft, respectively. However, comparison of these PSA show differences in the results which are discussed in this paper. Lessons learned from this comparison and further development of the PSA methodology are described. (orig.) [de

Retrospective North American CFL Experience Curve Analysis and Correlation to Deployment Programs

Energy Technology Data Exchange (ETDEWEB)

Smith, Sarah J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Wei, Max [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sohn, Michael D. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2015-07-01

Retrospective experience curves are a useful tool for understanding historic technology development, and can contribute to investment program analysis and future cost estimation efforts. This work documents our development of an analysis approach for deriving retrospective experience curves with a variable learning rate, and its application to develop an experience curve for compact fluorescent lamps for the global and North American markets over the years 1990-2007. Uncertainties and assumptions involved in interpreting data for our experience curve development are discussed, including the processing and transformation of empirical data, the selection of system boundaries, and the identification of historical changes in the learning rate over the course of 15 years. In the results that follow, we find that that the learning rate has changed at least once from 1990-2007. We also explore if, and to what degree, public deployment programs may have contributed to an increased technology learning rate in North America. We observe correlations between the changes in the learning rate and the initiation of new policies, abrupt technological advances, including improvements to ballast technology, and economic and political events such as trade tariffs and electricity prices. Finally, we discuss how the findings of this work (1) support the use of segmented experience curves for retrospective and prospective analysis and (2) may imply that investments in technological research and development have contributed to a change in market adoption and penetration.

Lessons Learned for Space Safety from the Fukushima Nuclear Power Plant Accident

Science.gov (United States)

Nogami, Manami; Miki, Masami; Mitsui, Masami; Kawada, Ysuhiro; Takeuchi, Nobuo

2013-09-01

On March 11 2011, Tohoku Region Pacific Coast Earthquake hit Japan and caused the devastating damage. The Fukushima Nuclear Power Station (NPS) was also severely damaged.The Japanese NPSs are designed based on the detailed safety requirements and have multiple-folds of hazard controls to the catastrophic hazards as in space system. However, according to the initial information from the Tokyo Electric Power Company (TEPCO) and the Japanese government, the larger-than-expected tsunami and subsequent events lost the all hazard controls to the release of radioactive materials.At the 5th IAASS, Lessons Learned from this disaster was reported [1] mainly based on the "Report of the Japanese Government to the IAEA Ministerial Conference on Nuclear Safety" [2] published by Nuclear Emergency Response Headquarters in June 2011, three months after the earthquake.Up to 2012 summer, the major investigation boards, including the Japanese Diet, the Japanese Cabinet and TEPCO, published their final reports, in which detailed causes of this accident and several recommendations are assessed from each perspective.In this paper, the authors examine to introduce the lessons learned to be applied to the space safety as findings from these reports.

Undergraduate baccalaureate nursing students' self-reported confidence in learning about patient safety in the classroom and clinical settings: an annual cross-sectional study (2010-2013).

Science.gov (United States)

Lukewich, Julia; Edge, Dana S; Tranmer, Joan; Raymond, June; Miron, Jennifer; Ginsburg, Liane; VanDenKerkhof, Elizabeth

2015-05-01

Given the increasing incidence of adverse events and medication errors in healthcare settings, a greater emphasis is being placed on the integration of patient safety competencies into health professional education. Nurses play an important role in preventing and minimizing harm in the healthcare setting. Although patient safety concepts are generally incorporated within many undergraduate nursing programs, the level of students' confidence in learning about patient safety remains unclear. Self-reported patient safety competence has been operationalized as confidence in learning about various dimensions of patient safety. The present study explores nursing students' self-reported confidence in learning about patient safety during their undergraduate baccalaureate nursing program. Cross-sectional study with a nested cohort component conducted annually from 2010 to 2013. Participants were recruited from one Canadian university with a four-year baccalaureate of nursing science program. All students enrolled in the program were eligible to participate. The Health Professional Education in Patient Safety Survey was administered annually. The Health Professional Education in Patient Safety Survey captures how the six dimensions of the Canadian Patient Safety Institute Safety Competencies Framework and broader patient safety issues are addressed in health professional education, as well as respondents' self-reported comfort in speaking up about patient safety issues. In general, nursing students were relatively confident in what they were learning about the clinical dimensions of patient safety, but they were less confident about the sociocultural aspects of patient safety. Confidence in what they were learning in the clinical setting about working in teams, managing adverse events and responding to adverse events declined in upper years. The majority of students did not feel comfortable speaking up about patient safety issues. The nested cohort analysis confirmed these

Outline of the Fukushima Daiichi Accident. Lessons Learned and Safety Enhancements

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Hirano Masashi

2017-01-01

This paper briefly presents the outline of the Fukushima Daiichi accident and summarizes the major lessons learned having been drawn and safety enhancements having been done in Japan for the purpose of giving inputs to the discussions to be taken place in the Special Invited Session “Fukushima, 5 years after”.

Method of construction spatial transition curve

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S.V. Didanov

2013-04-01

Full Text Available Purpose. The movement of rail transport (speed rolling stock, traffic safety, etc. is largely dependent on the quality of the track. In this case, a special role is the transition curve, which ensures smooth insertion of the transition from linear to circular section of road. The article deals with modeling of spatial transition curve based on the parabolic distribution of the curvature and torsion. This is a continuation of research conducted by the authors regarding the spatial modeling of curved contours. Methodology. Construction of the spatial transition curve is numerical methods for solving nonlinear integral equations, where the initial data are taken coordinate the starting and ending points of the curve of the future, and the inclination of the tangent and the deviation of the curve from the tangent plane at these points. System solutions for the numerical method are the partial derivatives of the equations of the unknown parameters of the law of change of torsion and length of the transition curve. Findings. The parametric equations of the spatial transition curve are calculated by finding the unknown coefficients of the parabolic distribution of the curvature and torsion, as well as the spatial length of the transition curve. Originality. A method for constructing the spatial transition curve is devised, and based on this software geometric modeling spatial transition curves of railway track with specified deviations of the curve from the tangent plane. Practical value. The resulting curve can be applied in any sector of the economy, where it is necessary to ensure a smooth transition from linear to circular section of the curved space bypass. An example is the transition curve in the construction of the railway line, road, pipe, profile, flat section of the working blades of the turbine and compressor, the ship, plane, car, etc.

Integrating safety and health during deactiviation: With lessons learned from PUREX

International Nuclear Information System (INIS)

1995-01-01

This report summarizes an integrated safety and health approach used during facility deactivation activities at the Department of Energy (DOE) Plutonium-Uranium Extraction (PUREX) Facility in Hanford, Washington. Resulting safety and health improvements and the potential, complex-wide application of this approach are discussed in this report through a description of its components and the impacts, or lessons-learned, of its use during the PUREX deactivation project. As a means of developing and implementing the integrated safety and health approach, the PUREX technical partnership was established in 1993 among the Office of Environment, Safety and Health's Office of Worker Health and Safety (EH-5); the Office of Environmental Management's Offices of Nuclear Material and Facility Stabilization (EM-60) and Compliance and Program Coordination (EM-20); the DOE Richland Operations Office; and the Westinghouse Hanford Company. It is believed that this report will provide guidance for instituting an integrated safety and health approach not only for deactivation activities, but for decommissioning and other clean-up activities as well. This confidence is based largely upon the rationality of the approach, often termed as common sense, and the measurable safety and health and project performance results that application of the approach produced during actual deactivation work at the PUREX Facility

Fluoroscopy Learning Curve in Hip Arthroscopy-A Single Surgeon's Experience.

Science.gov (United States)

Smith, Kevin M; Duplantier, Neil L; Crump, Kimbelyn H; Delgado, Domenica A; Sullivan, Stephanie L; McCulloch, Patrick C; Harris, Joshua D

2017-10-01

To determine if (1) absorbed radiation dose and (2) fluoroscopy time decreased with experience over the first 100 cases of a single surgeon's hip arthroscopy practice. Subjects who underwent hip arthroscopy for symptomatic femoroacetabular impingement and labral injury were eligible for analysis. Inclusion criteria included the first 100 subjects who underwent hip arthroscopy by a single surgeon (December 2013 to December 2014). Subject demographics, procedure details, fluoroscopy absorbed dose (milligray [mGy]), and time were recorded. Subjects were categorized by date of surgery to one of 4 possible groups (25 per group). One-way analysis of variance was used to determine if a significant difference in dose (mGy) or time was present between groups. Simple linear regression analysis was performed to determine the relation between case number and both radiation dose and fluoroscopy time. Subjects underwent labral repair (n = 93), cam osteoplasty (n = 90), and pincer acetabuloplasty (n = 65). There was a significant (P arthroscopy practice learning curve. Level IV, therapeutic, retrospective, noncomparative case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Impaired Curve Negotiation in Drivers with Parkinson’s Disease

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Ergun Y Uç

2009-03-01

Full Text Available OBJECTIVE: To assess the ability to negotiate curves in drivers with Parkinson’s disease (PD. METHODS: Licensed active drivers with mild-moderate PD (n= 76; 65 male, 11 female and elderly controls (n= 51; 26 male, 25 female drove on a simulated 2-lane rural highway in a high-fidelity simulator scenario in which the drivers had to negotiate 6 curves during a 37-mile drive. The participants underwent motor, cognitive, and visual testing before the simulator drive. RESULTS: Compared to controls, the drivers with PD had less vehicle control and driving safety, both on curves and straight baseline segments, as measured by significantly higher standard deviation of lateral position (SDLP and lane violation counts. The PD group also scored lower on tests of motor, cognitive, and visual abilities. In the PD group, lower scores on tests of motion perception, visuospatial ability, executive function, postural instability, and general cognition, as well as a lower level of independence in daily activities predicted low vehicle control on curves. CONCLUSION: Drivers with PD had less vehicle control and driving safety on curves compared to controls, which was associated primarily with impairments in visual perception and cognition, rather than motor function

The Learning Curve in neurofeedback of Peter Van Deusen: A review article

Directory of Open Access Journals (Sweden)

Valdenilson Ribeiro Ribas

Full Text Available ABSTRACT The Learning Curve (TLC in neurofeedback concept emerged after Peter Van Deusen compiled the results of articles on the expected electrical activity of the brain. This concept was subsequently tested on patients at four clinics in Atlanta between 1994 and 2001. The aim of this paper was to report the historical aspects of TLC. Articles published on the electronic databases MEDLINE/PubMed and Web of Science were reviewed. During patient evaluation, TLC investigates categories called disconnected, hot temporal lobes, reversal of alpha and beta waves, blocking, locking, and filtering or processing. This enables neuroscientists to use their training designs and, by means of behavioral psychology, to work on neuroregulation, as self-regulation for patients. TLC shows the relationships between electrical, mental and behavioral activity in patients. It also identifies details of patterns that can assist physicians in their choice of treatment.

The New Keynesian Phillips Curve

DEFF Research Database (Denmark)

Ólafsson, Tjörvi

This paper provides a survey on the recent literature on the new Keynesian Phillips curve: the controversies surrounding its microfoundation and estimation, the approaches that have been tried to improve its empirical fit and the challenges it faces adapting to the open-economy framework. The new......, learning or state-dependant pricing. The introduction of openeconomy factors into the new Keynesian Phillips curve complicate matters further as it must capture the nexus between price setting, inflation and the exchange rate. This is nevertheless a crucial feature for any model to be used for inflation...... forecasting in a small open economy like Iceland....

Learning from Aviation to Improve Safety in the Operating Room - a Systematic Literature Review

Directory of Open Access Journals (Sweden)

Linda S. G. L. Wauben

2012-01-01

Full Text Available Lessons learned from other high-risk industries could improve patient safety in the operating room (OR. This review describes similarities and differences between high-risk industries and describes current methods and solutions within a system approach to reduce errors in the OR. PubMed and Scopus databases were systematically searched for relevant articles written in the English language published between 2000 and 2011. In total, 25 articles were included, all within the medical domain focusing on the comparison between surgery and aviation. In order to improve safety in the OR, multiple interventions have to be implemented. Additionally, the healthcare organization has to become a ‘learning organization’ and the OR team has to become a team with shared responsibilities and flat hierarchies. Interpersonal and technical skills can be trained by means of simulation and can be supported by implementing team briefings, debriefings and cross-checks. However, further development and research is needed to prove if these solutions are useful, practical, and actually increase safety.

Organisational learning and continuous improvement of health and safety in certified manufacturers

DEFF Research Database (Denmark)

Granerud, Lise; Rocha, Robson Sø

2011-01-01

and raise goals within health and safety on a continuous basis. The article examines how certified occupational and health management systems influence this process to evaluate how far they hinder or support learning. It presents a model with which it is possible to identify and analyse improvement......Certified management systems have increasingly been applied by firms in recent decades and now cover the management of health and safety, principally through the OHSAS 18001 standard. In order to become certified, firms must not only observe the relevant legislation, but also improve performance...... processes. The model is applied to five cases from a qualitative study of Danish manufacturers with certified health and safety management systems. The cases illustrate the wide variation in health and safety management among certified firms. Certification is found to support lower levels of continuous...

Support for learning in the perspective of patient safety in primary health care

Directory of Open Access Journals (Sweden)

Thatianny Tanferri de Brito Paranaguá

Full Text Available ABSTRACT Objective: to analyze the support for learning, in the perspective of patient safety, offered in the work environment, according to health professionals working in primary care. Method: a transversal study, held with 86 health professionals working in primary care. A validated instrument was used, applied via the Internet. Descriptive statistical analysis was undertaken with a presentation of median, mean, standard deviation and coefficient of variation. Results: points which are favorable to supporting learning were evidenced, such as mutual respect, autonomy for organizing the work and valorization of new ideas, which obtained means above 7.0. The variables which hinder the process of learning in the work environment, perceived by the professionals, were: resistance to changes, and excess of work impeding reflection on how to improve the work, with means above 6.0. Conclusion: the study found evidence of indicators related to the process of staff development in the area of health and indicates the influence of support for learning for the improvement of the work processes and of patient safety. It is necessary that a culture involving the systematic assessment of educational interventions in health should be established, the aim being to diagnose actions which are more incisive for changing health professionals' attitude and, therefore, clinical practice.

Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator.

Science.gov (United States)

Sánchez-Peralta, L F; Sánchez-Margallo, F M; Moyano-Cuevas, J L; Pagador, J B; Enciso, S; Gómez-Aguilera, E J; Usón-Gargallo, J

2012-11-01

Surgical simulators are currently essential within any laparoscopic training program because they provide a low-stakes, reproducible and reliable environment to acquire basic skills. The purpose of this study is to determine the training learning curve based on different metrics corresponding to five tasks included in SINERGIA laparoscopic virtual reality simulator. Thirty medical students without surgical experience participated in the study. Five tasks of SINERGIA were included: Coordination, Navigation, Navigation and touch, Accurate grasping and Coordinated pulling. Each participant was trained in SINERGIA. This training consisted of eight sessions (R1-R8) of the five mentioned tasks and was carried out in two consecutive days with four sessions per day. A statistical analysis was made, and the results of R1, R4 and R8 were pair-wise compared with Wilcoxon signed-rank test. Significance is considered at P value psychomotor skills that can be trained in SINERGIA. Therefore, and based on these results together with previous works, SINERGIA could be used as training tool with a properly designed training program.

Using Machine Learning for Risky Module Estimation of Safety-Critical Software

International Nuclear Information System (INIS)

Kim, Young Mi; Jeong, Choong Heui

2009-01-01

With the rapid development of digital computer and information processing technologies, nuclear I and C (Instrument and Control) system which needs safety critical function has adopted digital technologies. Software used in safety-critical system must have high dependability. Highly dependable software needs strict software testing and V and V activities. These days, regulatory demands for nuclear power plants are more and more increasing. But, human resources and time for regulation are limited. So, early software risky module prediction is very useful for software testing and regulation activities. Early estimation can be built from a collection of internal metrics during early development phase. Internal metrics are measures of a product derived from assessment of the product itself, and external metrics are measures of a product derived from assessment of the behavior of the systems. Internal metrics can be collected more easily and early than external metrics. In addition, internal metrics can be useful for estimating fault-prone software modules using machine learning. In this paper, we introduce current research status and techniques related to estimating risky software module using machine learning techniques. Section 2 describes the overview of the estimation model using machine learning and section 3 describes processes of the estimation model. Section 4 describes several estimation models using machine leanings. Section 5 concludes the paper

A novel tool for organisational learning and its impact on safety culture in a hospital dispensary

International Nuclear Information System (INIS)

Sujan, Mark A.

2012-01-01

Incident reporting as a key mechanism for organisational learning and the establishment of a stronger safety culture are pillars of the current patient safety movement. Studies have suggested that incident reporting in healthcare does not achieve its full potential due to serious barriers to reporting and that sometimes staff may feel alienated by the process. The aim of the work reported in this paper was to prototype a novel approach to organisational learning that allows an organisation to assess and to monitor the status of processes that often give rise to latent failure conditions in the work environment, and to assess whether and through which mechanisms participation in this approach affects local safety culture. The approach was prototyped in a hospital dispensary using Plan-Do-Study-Act (PDSA) cycles, and the effect on safety culture was described qualitatively through semi-structured interviews. The results suggest that the approach has had a positive effect on the safety culture within the dispensary, and that staff perceive the approach to be useful and usable.

Digital tomosynthesis for evaluating metastatic lung nodules: Nodule visibility, learning curves, and reading times

International Nuclear Information System (INIS)

Lee, Kyung Hee; Goo, Jin Mo; Lee, Sang Min; Park, Chang Min; Bahn, Young Eun; Kim, Hyung Jin; Song, Yong Sub; Hwang, Eui Jin

2015-01-01

To evaluate nodule visibility, learning curves, and reading times for digital tomosynthesis (DT). We included 80 patients who underwent computed tomography (CT) and DT before pulmonary metastasectomy. One experienced chest radiologist annotated all visible nodules on thin-section CT scans using computer-aided detection software. Two radiologists used CT as the reference standard and retrospectively graded the visibility of nodules on DT. Nodule detection performance was evaluated in four sessions of 20 cases each by six readers. After each session, readers were unblinded to the DT images by revealing the true-positive markings and were instructed to self-analyze their own misreads. Receiver-operating-characteristic curves were determined. Among 414 nodules on CT, 53.3% (221/414) were visible on DT. The main reason for not seeing a nodule on DT was small size (93.3%, < or = 5 mm). DT revealed a substantial number of malignant nodules (84.1%, 143/170). The proportion of malignant nodules among visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p < 0.001). Area under the curve (AUC) values at the initial session were > 0.8, and the average detection rate for malignant nodules was 85% (210/246). The inter-session analysis of the AUC showed no significant differences among the readers, and the detection rate for malignant nodules did not differ across sessions. A slight improvement in reading times was observed. Most malignant nodules > 5 mm were visible on DT. As nodule detection performance was high from the initial session, DT may be readily applicable for radiology residents and board-certified radiologists.

Digital tomosynthesis for evaluating metastatic lung nodules: Nodule visibility, learning curves, and reading times

Energy Technology Data Exchange (ETDEWEB)

Lee, Kyung Hee; Goo, Jin Mo; Lee, Sang Min; Park, Chang Min; Bahn, Young Eun; Kim, Hyung Jin; Song, Yong Sub; Hwang, Eui Jin [Dept. of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul (Korea, Republic of)

2015-04-15

To evaluate nodule visibility, learning curves, and reading times for digital tomosynthesis (DT). We included 80 patients who underwent computed tomography (CT) and DT before pulmonary metastasectomy. One experienced chest radiologist annotated all visible nodules on thin-section CT scans using computer-aided detection software. Two radiologists used CT as the reference standard and retrospectively graded the visibility of nodules on DT. Nodule detection performance was evaluated in four sessions of 20 cases each by six readers. After each session, readers were unblinded to the DT images by revealing the true-positive markings and were instructed to self-analyze their own misreads. Receiver-operating-characteristic curves were determined. Among 414 nodules on CT, 53.3% (221/414) were visible on DT. The main reason for not seeing a nodule on DT was small size (93.3%, < or = 5 mm). DT revealed a substantial number of malignant nodules (84.1%, 143/170). The proportion of malignant nodules among visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p < 0.001). Area under the curve (AUC) values at the initial session were > 0.8, and the average detection rate for malignant nodules was 85% (210/246). The inter-session analysis of the AUC showed no significant differences among the readers, and the detection rate for malignant nodules did not differ across sessions. A slight improvement in reading times was observed. Most malignant nodules > 5 mm were visible on DT. As nodule detection performance was high from the initial session, DT may be readily applicable for radiology residents and board-certified radiologists.

Operation of TRR-1/M1 for 25 years and lessons learned in management of safety and safety culture

International Nuclear Information System (INIS)

Keinmeesuke, Sirichai

2002-01-01

The first Thai Research Reactor, TRR-1, was installed and put into operation in 1962. In 1975 the reactor was converted to a 2 MW TRIGA Mark III by replacing of the reactor core and the control system. The renamed TRR-1/M1 research reactor went critical again in November 1977. TRR-1/M1 has been operated safely for 25 years with its main utilization in research, isotope production and training. Safety management and safety culture have been implemented for 25 years both in the legislation level and the operation level. There was no nuclear incident and there were a few radiological incidents during the 25 years of operation of TRR-1/M1. The lessons learned from the incident events such as the release of N-16 and Ar-41, the release of radioactive Bromine gave valued opportunities to improve our operation procedure, safety procedure and safety culture. All type of activities with respect to safety culture such as individual awareness, commitment, motivation, supervision and responsibility have been seriously reviewed and being set as normal practices. (author)

Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer

Institute of Scientific and Technical Information of China (English)

Min-Chan Kim; Ghap-Joong Jung; Hyung-Ho Kim

2005-01-01

AIM: To evaluate the nature of the "learning curve" for laparoscopy-assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer. METHODS: The data of 90 consecutive patients with early gastric cancer who underwent LADG with systemic lymphadenectomy between April 2003 and November 2004 were reviewed. The 90 patients were divided into 9 sequential groups of 10 cases in each group and the average operative time of these 9 groups were determined. Other learning indicators, such as transfusion requirements, conversion rates to open surgery, postoperative complication, time to first flatus, and postoperative hospital stay, were evaluated. RESULTS: After the first 10 LADGs, the operative time reached its first plateau (230-240 min/operation) and then reached a second plateau (＜200 min/operation) for the final 30 cases. Although a significant improvement in the operative time was noted after the first 50 cases, there were no significant differences in transfusion requirements, conversion rates to open surgery, postoperative complications, time to first flatus, or postoperative hospital stay between the groups. CONCLUSION: Based on operative time analysis, this study show that experience of 50 cases of LADG with systemic lymphadenectomy for early gastric cancer is required to achieve optimum proficiency.

Rapid learning curve assessment in an ex vivo training system for microincisional glaucoma surgery.

Science.gov (United States)

Dang, Yalong; Waxman, Susannah; Wang, Chao; Parikh, Hardik A; Bussel, Igor I; Loewen, Ralitsa T; Xia, Xiaobo; Lathrop, Kira L; Bilonick, Richard A; Loewen, Nils A

2017-05-09

Increasing prevalence and cost of glaucoma have increased the demand for surgeons well trained in newer, microincisional surgery. These procedures occur in a highly confined space, making them difficult to learn by observation or assistance alone as is currently done. We hypothesized that our ex vivo outflow model is sensitive enough to allow computing individual learning curves to quantify progress and refine techniques. Seven trainees performed nine trabectome-mediated ab interno trabeculectomies in pig eyes (n = 63). An expert surgeon rated the procedure using an Operating Room Score (ORS). The extent of outflow beds accessed was measured with canalograms. Data was fitted using mixed effect models. ORS reached a half-maximum on an asymptote after only 2.5 eyes. Surgical time decreased by 1.4 minutes per eye in a linear fashion. The ablation arc followed an asymptotic function with a half-maximum inflection point after 5.3 eyes. Canalograms revealed that this progress did not correlate well with improvement in outflow, suggesting instead that about 30 eyes are needed for true mastery. This inexpensive pig eye model provides a safe and effective microsurgical training model and allows objective quantification of outcomes for the first time.

Learning curve for the management of tyrosine kinase inhibitors as the first line of treatment for patients with metastatic renal cancer.

Science.gov (United States)

Lendínez-Cano, G; Osman García, I; Congregado Ruiz, C B; Conde Sánchez, J M; Medina López, R A

2018-03-07

To analyse the learning curve for the management of tyrosine kinase inhibitors as the first line of treatment for patients with metastatic renal cancer. We evaluated 32 consecutive patients treated in our department for metastatic renal cancer with tyrosine kinase inhibitors (pazopanib or sunitinib) as first-line treatment between September 2012 and November 2015. We retrospectively analysed this sample. We measured the time to the withdrawal of the first-line treatment, the time to progression and overall survival using Kaplan-Meier curves. The learning curve was analysed with the cumulative sum (CUSUM) methodology. In our series, the median time to the withdrawal of the first-line treatment was 11 months (95% CI 4.9-17.1). The mean time to progression was 30.4 months (95% CI 22.7-38.1), and the mean overall survival was 34.9 months (95% CI 27.8-42). By applying the CUSUM methodology, we obtained a graph for the CUSUM value of the time to withdrawal of the first-line treatment (CUSUM TW), observing 3 well-differentiated phases: phase 1 or initial learning phase (1-15), phase 2 (16-26) in which the management of the drug progressively improved and phase 3 (27-32) of maximum experience or mastery of the management of these drugs. The number of treated patients needed to achieve the proper management of these patients was estimated at 15. Despite the limitations of the sample size and follow-up time, we estimated (in 15 patients) the number needed to reach the necessary experience in the management of these patients with tyrosine kinase inhibitors. We observed no relationship between the time to the withdrawal of the first-line treatment for any cause and progression. Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Preoperative risk factors for conversion and learning curve of minimally invasive distal pancreatectomy.

Science.gov (United States)

Hua, Yongfei; Javed, Ammar A; Burkhart, Richard A; Makary, Martin A; Weiss, Matthew J; Wolfgang, Christopher L; He, Jin

2017-11-01

Although laparoscopic distal pancreatectomy is considered a standard approach, 10% to 40% of these are converted. The preoperative risk factors for conversion are not well described. The aim of this study was to identify risk factors associated with conversion. Clinicopathological variables of 211 consecutive patients who underwent laparoscopic distal pancreatectomy between January 2007 and December 2015 at Johns Hopkins were analyzed to identify factors associated with conversion. Furthermore, the learning curve for laparoscopic distal pancreatectomy was studied. On univariate analysis of diabetes mellitus, preoperative diagnosis of malignant disease, multiorgan resection, surgeons' years and case experience were significantly associated with conversion (all P pancreatectomy with a preoperative diagnosis of malignant disease or possible multiorgan resection are at a higher risk of conversion. Surgeon experience of performing >15 procedures significantly reduces the risk of conversion. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of Three-Dimensional Laparoscopy in a Bariatric Surgery Program: Influence in the Learning Curve.

Science.gov (United States)

Padin, Esther Mariño; Santos, Raquel Sánchez; Fernández, Sonia González; Jimenez, Antonia Brox; Fernández, Sergio Estevez; Dacosta, Ester Carrera; Duran, Agata Rial; Artime Rial, Maria; Dominguez Sanchez, Ivan

2017-10-01

3D laparoscopy allows the surgeon to regain the sense of depth and improve accuracy. The aim of the study was to assess the impact of 3D in bariatric surgery. A retrospective cohort study was conducted. All our patients who underwent bariatric surgery (sleeve gastrectomy (SG) or gastric bypass (GB)) between 2013 and 2016 were included. We compared 3D laparoscopy cohort and 2D laparoscopy cohort. Variables are as follows: age, sex, DM, hypertension, surgeon experience, and type of intervention. Comparisons of operative time, hospital stay, conversion, complications, reoperation, and exitus are completed. Three hundred twelve consecutive patients were included. 56.9% of patients underwent GB and 43.1% SG. Global complications were 3.2% (fistula 2.5%, hemoperitoneum 0.3%, others 0.4%). One hundred four procedures were performed in the 3D cohort and 208 in the 2D cohort. The 2D cohort and 3D cohort were similar regarding the following: percentage of GB vs SG, age, gender, learning curve, diabetes mellitus 2, hypertension, and sleep apnea. The operating time and hospital stay were significantly reduced in the 3D cohort (144.07 ± 58.07 vs 172.11 ± 76.11 min and 5.12 ± 9.6 vs 7.7 ± 13.2 days. It was the same when we stratified the sample by type of surgery or experience of the surgeon. Complications were reduced in the 3D cohort in the surgeries performed by novice surgeons (10.2 vs 1.8%, p = 0.034). The use of 3D laparoscopy in bariatric surgery in our center has helped reducing the operating time and hospital stay, and improving the safety of the surgery, either in GB or SG, being equally favorable in novice or more experienced surgeons.

[On line learning in urologic surgery. The value of the 2.0 Web tools.

Science.gov (United States)

Castillón Vela, Ignacio T

2018-01-01

The field of Surgery is under the pressure of accelerated change where technological cycles get shorter and shorter, sometimes transformational. Learning and training have gotten a key role because learning curves for new techniques directly affect patient's safety and learning cycles are slower. The traditional learning model within the urology department is overwhelmed. We need new training and learning methods. The aim of this article is to perform a critical analysis of the current status of learning in urological surgery and the challenges we face, evaluating how new information and communication technologies can help us to facilitate the learning process. We also present our initial experience with on line education on upper urinary tract laparoscopic and robotic surgery using the 2.0 Web tools.

Lessons Learned in Preparation and Review of Safety Analysis Report of PUSPATI TRIGA Reactor in Malaysia

Energy Technology Data Exchange (ETDEWEB)

Maskin, Mazleha [Korea Advanced Institute for Science and Technology, Daejeon (Korea, Republic of); Choi, Kwang Sik [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

2010-05-15

PUSPATI TRIGA Reactor (RTP) is the one and only research reactor in Malaysia. Since the day it was supplied by General Atomic (GA) in 1983, periodic safety reviews were carried out but not published in the form of a complete SAR. In fact, the original SAR (SAR 1983) document was provided by GA as soon as GA was selected as the supplier of RTP. The focus of this report is on the lessons learned from the preparation of SAR. The lessons learned were to address the preparation and regulatory review of the second SAR (SAR 2006). Realizing that safety is important as RTP is aging, the experiences and lessons learned from SAR development and updating processes are of great value for all parties involved. The purpose of this report is to consolidate and organize the lessons learned and suggest the best practice for the next SAR development both in preparation and regulatory review

Lessons Learned in Preparation and Review of Safety Analysis Report of PUSPATI TRIGA Reactor in Malaysia

International Nuclear Information System (INIS)

Maskin, Mazleha; Choi, Kwang Sik

2010-01-01

PUSPATI TRIGA Reactor (RTP) is the one and only research reactor in Malaysia. Since the day it was supplied by General Atomic (GA) in 1983, periodic safety reviews were carried out but not published in the form of a complete SAR. In fact, the original SAR (SAR 1983) document was provided by GA as soon as GA was selected as the supplier of RTP. The focus of this report is on the lessons learned from the preparation of SAR. The lessons learned were to address the preparation and regulatory review of the second SAR (SAR 2006). Realizing that safety is important as RTP is aging, the experiences and lessons learned from SAR development and updating processes are of great value for all parties involved. The purpose of this report is to consolidate and organize the lessons learned and suggest the best practice for the next SAR development both in preparation and regulatory review

Transformational leadership as a moderator of the relationship between psychological safety and learning behaviour in work teams in Ghana

Directory of Open Access Journals (Sweden)

Stephen K. Kumako

2013-07-01

Research purpose: The study was aimed at investigating the relationship between psychological safety and learning behaviour in teams, as well as the moderating role of transformational team leadership in this relationship. Motivation for the study: For a team to be effective, adaptive and innovative and engage in learning behaviours, the transformational team leader must set the right climate in the team, where he or she welcomes the team members’ opinions, questions and feedback at no risk to their image. An understanding of this will be important in team leader selection and training. Research design, approach and method: Using a cross-sectional survey design, 57 work teams comprising 456 respondents in teams of 7–9 members were purposively sampled from five financial institutions in Accra, Ghana. Hierarchical regression and moderation analyses were run on the data at the team level. Main findings: Results indicated a positive relationship between team psychological safety and team learning behaviour, with transformational team leadership moderating this relationship. Practical/managerial implication: Transformational team leadership is important in creating a climate of psychological safety that will enable team members to engage in learning behaviours. Contribution/value-add: The study provided theoretical and empirical evidence that, in organisational contexts, transformational team leadership is an important variable that can facilitate psychological safety and learning behaviour in teams.

Femtosecond laser-assisted cataract surgery with bimanual technique: learning curve for an experienced cataract surgeon.

Science.gov (United States)

Cavallini, Gian Maria; Verdina, Tommaso; De Maria, Michele; Fornasari, Elisa; Volpini, Elisa; Campi, Luca

2017-11-29

To describe the intraoperative complications and the learning curve of microincision cataract surgery assisted by femtosecond laser (FLACS) with bimanual technique performed by an experienced surgeon. It is a prospective, observational, comparative case series. A total of 120 eyes which underwent bimanual FLACS by the same experienced surgeon during his first experience were included in the study; we considered the first 60 cases as Group A and the second 60 cases as Group B. In both groups, only nuclear sclerosis of grade 2 or 3 was included; an intraocular lens was implanted through a 1.4-mm incision. Best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), central corneal thickness and endothelial cell loss (ECL) were evaluated before and at 1 and 3 months after surgery. Intraoperative parameters, and intra- and post-operative complications were recorded. In Group A, we had femtosecond laser-related minor complications in 11 cases (18.3%) and post-operative complications in 2 cases (3.3%); in Group B, we recorded 2 cases (3.3%) of femtosecond laser-related minor complications with no post-operative complications. Mean effective phaco time (EPT) was 5.32 ± 3.68 s in Group A and 4.34 ± 2.39 s in Group B with a significant difference (p = 0.046). We recorded a significant mean BCVA improvement at 3 months in both groups (p  0.05). Finally, we found significant ECL in both groups with a significant difference between the two groups (p = 0.042). FLACS with bimanual technique and low-energy LDV Z8 is associated with a necessary initial learning curve. After the first adjustments in the surgical technique, this technology seems to be safe and effective with rapid visual recovery and it helps surgeons to standardize the crucial steps of cataract surgery.

Safety culture and learning from incidents: the role of incident reporting and causal analyses

International Nuclear Information System (INIS)

Wilpert, B.

1994-01-01

Nuclear industry more than any other industrial branch has developed and used predictive risk analysis as a method of feedforward control of safety and reliability. Systematic evaluation of operating experience, statistical documentation of component failures, systematic documentation and analysis of incidents are important complementary elements of feedback control: we are dealing here with adjustment and learning from experience, in particular from past incidents. Using preliminary findings from ongoing research at the Research Center Systems Safety at the Berlin University of Technology the contribution discusses preconditions for an effective use of lessons to be learnt from closely matched incident reporting and in depth analyses of causal chains leading to incidents. Such conditions are especially standardized documentation, reporting and analyzing methods of incidents; structured information flows and feedback loops; abstaining from culpability search; mutual trust of employees and management; willingness of all concerned to continually evaluate and optimize the established learning system. Thus, incident related reporting and causal analyses contribute to safety culture, which is seen to emerge from tightly coupled organizational measures and respective change in attitudes and behaviour. (author) 2 figs., 7 refs

Lab Safety and Bioterrorism Readiness Curricula Using Active Learning and Hands-on Strategies as Continuing Education for Medical Technologists

Directory of Open Access Journals (Sweden)

Steven Fiester

2010-04-01

Full Text Available Frequent reports of laboratory- (and hospital- acquired infection suggest a deficiency in safety training or lack of compliance. To assess the need for continuing education (CE addressing this problem, an original education needs assessment survey was designed and administered to medical technologists (med-techs in Northeast Ohio. Survey results were used to design a learner-centered training curriculum (for example, Lab Safety and Bioterrorism Readiness trainings that engaged med-techs in active learning, integrative peer-to-peer teaching, and hands-on exercises in order to improve microbiology safety knowledge and associated laboratory techniques. The Lab Safety training was delivered six times and the Bioterrorism Readiness training was delivered five times. Pre/posttesting revealed significant gains in knowledge and techniques specific to laboratory safety, security, risk assessment, and bioterrorism readiness amongst the majority of med-techs completing the CE trainings. The majority of participants felt that the hands-on exercises met their needs and that their personal laboratory practices would change as a result of the training course, as measured by attitudinal surveys. We conclude that active learning techniques and peer education significantly enhance microbiology learning amongst participating med-techs.

Bypassing the learning curve in permanent seed implants using state-of-the-art technology

International Nuclear Information System (INIS)

Beaulieu, Luc; Evans, Dee-Ann Radford; Aubin, Sylviane; Angyalfi, Steven; Husain, Siraj; Kay, Ian; Martin, Andre-Guy; Varfalvy, Nicolas; Vigneault, Eric; Dunscombe, Peter

2007-01-01

Purpose: The aim of this study was to demonstrate, based on clinical postplan dose distributions, that technology can be used efficiently to eliminate the learning curve associated with permanent seed implant planning and delivery. Methods and Materials: Dose distributions evaluated 30 days after the implant of the initial 22 consecutive patients treated with permanent seed implants at two institutions were studied. Institution 1 (I1) consisted of a new team, whereas institution 2 (I2) had performed more than 740 preplanned implantations over a 9-year period before the study. Both teams had adopted similar integrated systems based on three-dimensional (3D) transrectal ultrasonography, intraoperative dosimetry, and an automated seed delivery and needle retraction system (FIRST, Nucletron). Procedure time and dose volume histogram parameters such as D90, V100, V150, V200, and others were collected in the operating room and at 30 days postplan. Results: The average target coverage from the intraoperative plan (V100) was 99.4% for I1 and 99.9% for I2. D90, V150, and V200 were 191.4 Gy (196.3 Gy), 75.3% (73.0%), and 37.5% (34.1%) for I1 (I2) respectively. None of these parameters shows a significant difference between institutions. The postplan D90 was 151.2 Gy for I1 and 167.3 Gy for I2, well above the 140 Gy from the Stock et al. analysis, taking into account differences at planning, results in a p value of 0.0676. The procedure time required on average 174.4 min for I1 and 89 min for I2. The time was found to decrease with the increasing number of patients. Conclusion: State-of-the-art technology enables a new brachytherapy team to obtain excellent postplan dose distributions, similar to those achieved by an experienced team with proven long-term clinical results. The cost for bypassing the usual dosimetry learning curve is time, with increasing team experience resulting in shorter treatment times

Advanced Test Reactor Safety Basis Upgrade Lessons Learned Relative to Design Basis Verification and Safety Basis Management

International Nuclear Information System (INIS)

G. L. Sharp; R. T. McCracken

2004-01-01

The Advanced Test Reactor (ATR) is a pressurized light-water reactor with a design thermal power of 250 MW. The principal function of the ATR is to provide a high neutron flux for testing reactor fuels and other materials. The reactor also provides other irradiation services such as radioisotope production. The ATR and its support facilities are located at the Test Reactor Area of the Idaho National Engineering and Environmental Laboratory (INEEL). An audit conducted by the Department of Energy's Office of Independent Oversight and Performance Assurance (DOE OA) raised concerns that design conditions at the ATR were not adequately analyzed in the safety analysis and that legacy design basis management practices had the potential to further impact safe operation of the facility.1 The concerns identified by the audit team, and issues raised during additional reviews performed by ATR safety analysts, were evaluated through the unreviewed safety question process resulting in shutdown of the ATR for more than three months while these concerns were resolved. Past management of the ATR safety basis, relative to facility design basis management and change control, led to concerns that discrepancies in the safety basis may have developed. Although not required by DOE orders or regulations, not performing design basis verification in conjunction with development of the 10 CFR 830 Subpart B upgraded safety basis allowed these potential weaknesses to be carried forward. Configuration management and a clear definition of the existing facility design basis have a direct relation to developing and maintaining a high quality safety basis which properly identifies and mitigates all hazards and postulated accident conditions. These relations and the impact of past safety basis management practices have been reviewed in order to identify lessons learned from the safety basis upgrade process and appropriate actions to resolve possible concerns with respect to the current ATR safety

Learning Safety Assessment from Accidents in a University Environment

DEFF Research Database (Denmark)

Jensen, Niels; Jørgensen, Sten Bay

2013-01-01

This contribution describes how a chemical engineering department started learning from accidents during experimental work and ended up implementing an industrially inspired system for risk assessment of new and existing experimental setups as well as a system for assessing potential risk from...... the chemicals used in the experimental work. These experiences have led to recent developments which focus increasingly on the a theoretical basis for modeling and reasoning on safety as well as operational aspects within a common framework. Presently this framework is being extended with barrier concepts both...

Kant, curves and medical learning practice: a reply to Le Morvan and Stock.

Science.gov (United States)

Ives, J

2007-02-01

In a recent paper published in the Journal of Medical Ethics, Le Morvan and Stock claim that the kantian ideal of treating people always as ends in themselves and never merely as a means is in direct and insurmountable conflict with the current medical practice of allowing practitioners at the bottom of their "learning curve" to "practise their skills" on patients. In this response, I take up the challenge they issue [corrected] and try to reconcile this conflict. The kantian ideal offered in the paper is an incomplete characterisation of Kant's moral philosophy, and the formula of humanity is considered in isolation without taking into account other salient kantian principles. I also suggest that their argument based on "necessary for the patient" assumes too narrow a reading of "necessary". This reply is intended as an extension to, rather than a criticism of, their work.

A variation reduction allocation model for quality improvement to minimize investment and quality costs by considering suppliers’ learning curve

Science.gov (United States)

Rosyidi, C. N.; Jauhari, WA; Suhardi, B.; Hamada, K.

2016-02-01

Quality improvement must be performed in a company to maintain its product competitiveness in the market. The goal of such improvement is to increase the customer satisfaction and the profitability of the company. In current practice, a company needs several suppliers to provide the components in assembly process of a final product. Hence quality improvement of the final product must involve the suppliers. In this paper, an optimization model to allocate the variance reduction is developed. Variation reduction is an important term in quality improvement for both manufacturer and suppliers. To improve suppliers’ components quality, the manufacturer must invest an amount of their financial resources in learning process of the suppliers. The objective function of the model is to minimize the total cost consists of investment cost, and quality costs for both internal and external quality costs. The Learning curve will determine how the employee of the suppliers will respond to the learning processes in reducing the variance of the component.

An Interoperability Consideration in Selecting Domain Parameters for Elliptic Curve Cryptography

Science.gov (United States)

Ivancic, Will (Technical Monitor); Eddy, Wesley M.

2005-01-01

Elliptic curve cryptography (ECC) will be an important technology for electronic privacy and authentication in the near future. There are many published specifications for elliptic curve cryptosystems, most of which contain detailed descriptions of the process for the selection of domain parameters. Selecting strong domain parameters ensures that the cryptosystem is robust to attacks. Due to a limitation in several published algorithms for doubling points on elliptic curves, some ECC implementations may produce incorrect, inconsistent, and incompatible results if domain parameters are not carefully chosen under a criterion that we describe. Few documents specify the addition or doubling of points in such a manner as to avoid this problematic situation. The safety criterion we present is not listed in any ECC specification we are aware of, although several other guidelines for domain selection are discussed in the literature. We provide a simple example of how a set of domain parameters not meeting this criterion can produce catastrophic results, and outline a simple means of testing curve parameters for interoperable safety over doubling.

Optimization of ACC system spacing policy on curved highway

Science.gov (United States)

Ma, Jun; Qian, Kun; Gong, Zaiyan

2017-05-01

The paper optimizes the original spacing policy when adopting VTH (Variable Time Headway), proposes to introduce the road curve curvature K to the spacing policy to cope with following the wrong vehicle or failing to follow the vehicle owing to the radar limitation of curve in ACC system. By utilizing MATLAB/Simulink, automobile longitudinal dynamics model is established. At last, the paper sets up such three common cases as the vehicle ahead runs at a uniform velocity, an accelerated velocity and hits the brake suddenly, simulates these cases on the curve with different curvature, analyzes the curve spacing policy in the perspective of safety and vehicle following efficiency and draws the conclusion whether the optimization scheme is effective or not.

An application of the learning curve-cumulative summation test to evaluate training for endotracheal intubation in emergency medicine.

Science.gov (United States)

Je, Sangmo; Cho, Youngsuk; Choi, Hyuk Joong; Kang, Boseung; Lim, Taeho; Kang, Hyunggoo

2015-04-01

The learning curve-cumulative summation (LC-CUSUM) test allows for quantitative and individual assessments of the learning process. In this study, we evaluated the process of skill acquisition for performing endotracheal intubation (ETI) in three emergency medicine (EM) residents over a 2 year period in their first 2 years of their EM residency. We evaluated 342 ETI cases performed by three EM residents using the LC-CUSUM test according to their rate of success or failure of ETI. A 90% success rate (SR) was chosen to define adequate performance and an SR of 80% was considered inadequate. After the learning phase, the standard CUSUM test was applied to ensure that performance was maintained. The mean number of ETI cases required to reach the predefined level of performance was 74.7 (95% CI 62.0 to 87.3). CUSUM tests confirmed that performance was maintained after the learning phase. By using the LC-CUSUM test, we were able to quantitatively monitor the acquisition of the skill of ETI by EM residents. The LC-CUSUM could be useful for monitoring the learning process for the training of airway management in the practice of EM. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Rational points on elliptic curves

CERN Document Server

Silverman, Joseph H

2015-01-01

The theory of elliptic curves involves a pleasing blend of algebra, geometry, analysis, and number theory. This book stresses this interplay as it develops the basic theory, thereby providing an opportunity for advanced undergraduates to appreciate the unity of modern mathematics. At the same time, every effort has been made to use only methods and results commonly included in the undergraduate curriculum. This accessibility, the informal writing style, and a wealth of exercises make Rational Points on Elliptic Curves an ideal introduction for students at all levels who are interested in learning about Diophantine equations and arithmetic geometry. Most concretely, an elliptic curve is the set of zeroes of a cubic polynomial in two variables. If the polynomial has rational coefficients, then one can ask for a description of those zeroes whose coordinates are either integers or rational numbers. It is this number theoretic question that is the main subject of this book. Topics covered include the geometry and ...

Is there a learning curve for the TVT-O procedure? A prospective single-surgeon study of 372 consecutive cases.

Science.gov (United States)

Serati, Maurizio; Bogani, Giorgio; Braga, Andrea; Sorice, Paola; Salvatore, Stefano; Uccella, Stefano; Ghezzi, Fabio

2015-03-01

To evaluate for the first time in the literature the learning curve of Inside-out transobturator tape (TVT-O™). A prospective observational study was conducted in a tertiary reference center. Consecutive women treated by TVT-O™ performed by one surgeon were included. Data regarding subjective, objective cure rates, and adverse events were collected. Trends, over the number of procedures, were estimated using assay analyses. Number of procedures and variables were interpolating in standard curves using linear lines. Three hundred and seventy two procedures were included. Postoperative pain levels decreased with the increase in the level of expertise (pain levels: 1-day: from 6.6 (±3.3) to 4.3 (±3.1); 95%CI: -0.01603 to 0.001235, p=0.04; 2-day: from 5.6 (±4.1) to 3.6 (±3.7); 95%CI: -0.02092 to -0.002497, p=0.01; 12-month: from 0.1 (±0.7) to 0 (±0); 95%CI: -0.001814 to 0.05019, p=0.07). Overall, objective cure rate was achieved in 93.5% of patients. Additionally, 88.2% and 88.7% patients reported "much better" feeling at PGI-I scale and 80% reduction in UDI score, respectively. We observed, that delta ICIQ-sf (from 12 (±8.7) to 14 (±6.0); p=0.04) and delta-UDI (from 91% to 97%; p=0.04) improved over the time. TVT-O procedure offers excellent outcomes with high objective and subjective cure rates and low complications rate, even at the beginning of the surgeon's learning curve. However, a high experience of the surgeon could significantly improve the subjective cure rate and could reduce postoperative the groin pain. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Análise de conglomerados em curvas de aprendizado para formação de agrupamentos homogêneos de trabalhadores Cluster analysis of learning curves for grouping workers with homogeneous learning profiles

Directory of Open Access Journals (Sweden)

Renato Eduardo Stroieke

2012-01-01

Full Text Available Em diversos setores da indústria é desejado que trabalhadores reunidos em uma estação de trabalho apresentem perfil de aprendizado similar. O presente artigo apresenta um método de agrupamento de trabalhadores utilizando modelagem por curva de aprendizado e técnicas de clusterização. O método modela dados de desempenho de trabalhadores por intermédio de diversos modelos de curvas de aprendizado; os parâmetros de aprendizado dos modelos testados permitem predizer o desempenho dos trabalhadores em intervalos de tempo pré-determinados. Os valores preditos são agrupados através de ferramentas de clusterização. O maior índice de ajuste (IA, gerado a partir do Silhouette Index e do coeficiente de determinação, indica o modelo de curva mais consistente em termos de aderência aos dados e qualidade de agrupamento de perfis de aprendizado. Ao ser aplicado em dados de uma indústria de calçados, o método gerou agrupamentos consistentes de trabalhadores com base nos distintos perfis de aprendizado.In many industrial segments, it is desirable to allocate workers with similar learning profiles in the same workstation. This paper presents a method that groups workers based on learning curve modeling and clustering techniques. Workers' performance data are modeled through several learning curve models; learning parameters allow for workers' performance prediction at intervals of predetermined time. The predicted values are then grouped by clustering techniques. The largest Adjustment Index (AI, derived from the Silhouette Index and Coefficient of Determination, indicates the model yielding superior adherence to data and better clustering of learning profiles. When applied to a shoe manufacturing process, the method generated consistent groups of workers based on their learning profiles.

Lessons Learned from Process Safety Management: A Practical Guide to Defence in Depth

Energy Technology Data Exchange (ETDEWEB)

Langerman, N., E-mail: neal@chemical-safety.com [Advanced Chemical Safety, Inc., San Diego (United States)

2014-10-15

Full text: Beginning with the experiences of Alfred Nobel, the chemical enterprise has learned from failures and implemented layers of protection to prevent unwanted incidents. Nobel developed dynamite as a more stable alternative to nitroglycerin, a process we would today call “inherently safer technology”. In recent years, the USA has issued regulations requiring formal “risk management plans” to identify and mitigate production risks. The USA set up the “Chemical Safety and Hazard Investigation Board” as an independent investigator of serious chemical enterprise incidents with a mission to issue recommendations aimed at preventing repeated incidents based on lessons learned. Following a particularly violent explosion in Texas in 1989, the US Occupational Safety and Health Administration issued the “Process Safety Management” (PSM) rule. PSM is a singular guide to defence in depth for preventing large-scale production incidents. The formalism is equally applicable to the chemical enterprise and the nuclear installation enterprise. This presentation will discuss the key elements of PSM and offer suggestions on using PSM as a guide to developing multiple layers of protection. The methods of PSM are applicable to Nuclear Generating Stations, research reactors, fuel reprocessing plants and fissile material storage and handling. Examples from both the chemical and nuclear enterprises will be used to illustrate key points. (author)

Lessons Learned and Regulatory Countermeasures of Nuclear Safety Issues Last Year

Energy Technology Data Exchange (ETDEWEB)

Lee, Y. E. [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

2013-05-15

Competitiveness of nuclear as the electric resource in terms of the least cost and the carbon abatement has been debated. Some institutions insist that the radioactive wastes management cost, nuclear accident cost and cheap shale gas would make the nuclear energy less competitive, while others still address the ability of nuclear energy as economical and low-carbon electric resource. This situation reminds that ensuring nuclear safety is the most important prerequisite to use of nuclear energy. Therefore, this paper will compare the different views on future nuclear competitiveness discussed right after the Fukushima accident and summarize the lessons learned and regulatory countermeasures from nuclear safety issues last year. Korea has improved the effectiveness of safety regulation up to now and still has been making efforts on further enhancing nuclear safety. The outcomes of these efforts have resulted in a high level of safety in Korean NPPs and contributing largely to the global nuclear safety through sharing and exchanging the information and knowledge of our nuclear experiences. However, now we are faced with the new challenges such as decreasing the public. Additionally, public criticism of the regulatory activities demands more clear regulatory guides and transparent process. Recently, new president announced the 'Priority to Safety and Public Trust' as the precondition to utilize the nuclear energy. We will continue to make much more efforts for the improvement of the quality of regulatory activities and effectiveness of regulatory decision making process than we have done so far. Competence through effective capacity building would be a helpful pathway to build up the public trust and ensure the acceptable level of nuclear safety. We are set to prepare the action items to be taken in the near future for improving the technical competency and transparency as the essential components of the national safety and will make efforts to implement them

Considering lessons learned about safety culture and their reflection to activity. After Fukushima Daiichi Nuclear Power Plant accident experience

International Nuclear Information System (INIS)

Obu, Etsuji; Hamada, Jun; Fukano, Takuya

2011-01-01

Fukushima Daiichi Nuclear Power Plant accident forced neighboring residents to evacuate for a long time and gave Public anxieties greatly and significant effects to social activities in Japan. Public trust of nuclear power was lost by not preventing the accident and future of nuclear power became reconsidered, which nuclear industry people regretted deeply. Japan Nuclear Technology Institute (JANTI) had conducted activities enhancing safety culture in nuclear industry. It would be necessary to consider improvements of accident prevention and mitigation measures after evaluating the accident in a viewpoint of 'safety culture'. Based on published information and knowledge accumulated by activities of JANTI, the accident was examined taking account of greatness of nuclear accident and its effects from the side of safety culture. Lessons learned about safety culture were pointed out as; (1) reconfirmation of specialty of nuclear technology. (2) reinforcement of questioning and learning attitudes and (3) improvement of evaluation capability of nuclear safety and safety assurance against external event. These were reflected in activities such as; (1) reconsideration of safety culture assessment, (2) strengthening further support to improve safety culture consciousness and (3) improvement of peer review activity. (T. Tanaka)

[An approach to care indicators benchmarking. Learning to improve patient safety].

Science.gov (United States)

de Andrés Gimeno, B; Salazar de la Guerra, R M; Ferrer Arnedo, C; Revuelta Zamorano, M; Ayuso Murillo, D; González Soria, J

2014-01-01

Improvements in clinical safety can be achieved by promoting a safety culture, professional training, and learning through benchmarking. The aim of this study was to identify areas for improvement after analysing the safety indicators in two public Hospitals in North-West Madrid Region. Descriptive study performed during 2011 in Hospital Universitario Puerta de Hierro Majadahonda (HUPHM) and Hospital de Guadarrama (HG). The variables under study were 40 indicators on nursing care related to patient safety. Nineteen of them were defined in the SENECA project as care quality standards in order to improve patient safety in the hospitals. The data collected were clinical history, Madrid Health Service assessment reports, care procedures, and direct observation Within the 40 indicators: 22 of them were structured (procedures), HUPHM had 86%, and HG 95% 14 process indicators (training and protocols compliance) with similar results in both hospitals, apart from the care continuity reports and training in hand hygiene. The 4 results indicators (pressure ulcer, falls and pain) showed different results. The analysis of the indicators allowed the following actions to be taken: to identify improvements to be made in each hospital, to develop joint safety recommendations in nursing care protocols in prevention and treatment of chronic wound, to establish systematic pain assessments, and to prepare continuity care reports on all patients transferred from HUPHM to HG. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Considerations for reference pump curves

International Nuclear Information System (INIS)

Stockton, N.B.

1992-01-01

This paper examines problems associated with inservice testing (IST) of pumps to assess their hydraulic performance using reference pump curves to establish acceptance criteria. Safety-related pumps at nuclear power plants are tested under the American Society of Mechanical Engineers (ASME) Boiler and Pressure Vessel Code (the Code), Section 11. The Code requires testing pumps at specific reference points of differential pressure or flow rate that can be readily duplicated during subsequent tests. There are many cases where test conditions cannot be duplicated. For some pumps, such as service water or component cooling pumps, the flow rate at any time depends on plant conditions and the arrangement of multiple independent and constantly changing loads. System conditions cannot be controlled to duplicate a specific reference value. In these cases, utilities frequently request to use pump curves for comparison of test data for acceptance. There is no prescribed method for developing a pump reference curve. The methods vary and may yield substantially different results. Some results are conservative when compared to the Code requirements; some are not. The errors associated with different curve testing techniques should be understood and controlled within reasonable bounds. Manufacturer's pump curves, in general, are not sufficiently accurate to use as reference pump curves for IST. Testing using reference curves generated with polynomial least squares fits over limited ranges of pump operation, cubic spline interpolation, or cubic spline least squares fits can provide a measure of pump hydraulic performance that is at least as accurate as the Code required method. Regardless of the test method, error can be reduced by using more accurate instruments, by correcting for systematic errors, by increasing the number of data points, and by taking repetitive measurements at each data point

Promoting the health, safety and welfare of adults with learning disabilities in acute care settings: a structured literature review.

Science.gov (United States)

Bradbury-Jones, Caroline; Rattray, Janice; Jones, Martyn; Macgillivray, Stephen

2013-06-01

To present the findings of a structured literature review that aimed to identify the influences on the health, safety and welfare of adults with learning disabilities in acute hospitals. There is increasing evidence regarding the inadequacy of care for people with learning disabilities in acute care settings. However, few studies have specifically addressed their health, safety and welfare in such contexts. Four key electronic databases (Medline; PsycINFO; British Nursing Index and archive; Cumulative Index to Nursing and Allied Health Literature) were searched for relevant literature published between 2000 and 2011. Publications assessed as meeting the inclusion criteria were retrieved in full. Data were extracted regarding methods used; primary aims of the study being reported; and key findings. Of the 3505 papers identified in the initial search, eight met the inclusion criteria. Analysis revealed six areas of influence on the health, safety and welfare of adults with learning disabilities in acute hospitals: care provision (meeting health and personal needs); communication; staff attitudes; staff knowledge; supporters; and carers (valuing their role); physical environment. We represent these six areas diagrammatically, as concentric rings. These influence on health, safety and welfare form an inner (direct) layer and an outer (indirect) layer consisting of liaison services and education/training. This new conceptualisation of influences as being multi-layered assists in the identification of similarly multi-layered improvement strategies. Adults with learning disabilities can exert their own influence on health, safety and welfare and should be supported to make decisions about their own care. More broadly they should be involved with policy development, nurse education and research. This can be achieved through inclusive approaches, for example, inviting people with learning disabilities to input into nursing curricula or to engage in research as

Lessons Learned During the Manufacture of the NCSX Modular Coils

International Nuclear Information System (INIS)

Chrzanowski, James H.; Meighan, Thomas G.; Raftopoulos, Steven; Dudek, Lawrence; Fogarty, Paul J.

2009-01-01

The National Compact Stellarator Experiment's (NCSX) modular coils presented a number of engineering and manufacturing challenges due to their complex shapes, requirements for high dimensional accuracy and high current density requirements due to space constraints. Being the first of their kind, these coils required the implementation of many new manufacturing and measuring techniques and procedures. This was the first time that these manufacturing techniques and methods were applied in the production of coils at the laboratory. This resulted in a steep learning curve for the first several coils. Through the effective use of procedures, tooling modifications, involvement and ownership by the manufacturing workforce, and an emphasis on safety, the assembly team was able to reduce the manufacturing times and improve upon the manufacturing methods. This paper will discuss the learning curve and steps that were taken to improve the manufacturing efficiency and reduce the manufacturing times for the modular coils without forfeiting quality

Initial laparoscopic basic skills training shortens the learning curve of laparoscopic suturing and is cost-effective.

Science.gov (United States)

Stefanidis, Dimitrios; Hope, William W; Korndorffer, James R; Markley, Sarah; Scott, Daniel J

2010-04-01

Laparoscopic suturing is an advanced skill that is difficult to acquire. Simulator-based skills curricula have been developed that have been shown to transfer to the operating room. Currently available skills curricula need to be optimized. We hypothesized that mastering basic laparoscopic skills first would shorten the learning curve of a more complex laparoscopic task and reduce resource requirements for the Fundamentals of Laparoscopic Surgery suturing curriculum. Medical students (n = 20) with no previous simulator experience were enrolled in an IRB-approved protocol, pretested on the Fundamentals of Laparoscopic Surgery suturing model, and randomized into 2 groups. Group I (n = 10) trained (unsupervised) until proficiency levels were achieved on 5 basic tasks; Group II (n = 10) received no basic training. Both groups then trained (supervised) on the Fundamentals of Laparoscopic Surgery suturing model until previously reported proficiency levels were achieved. Two weeks later, they were retested to evaluate their retention scores, training parameters, instruction requirements, and cost between groups using t-test. Baseline characteristics and performance were similar for both groups, and 9 of 10 subjects in each group achieved the proficiency levels. The initial performance on the simulator was better for Group I after basic skills training, and their suturing learning curve was shorter compared with Group II. In addition, Group I required less active instruction. Overall time required to finish the curriculum was similar for both groups; but the Group I training strategy cost less, with a savings of $148 per trainee. Teaching novices basic laparoscopic skills before a more complex laparoscopic task produces substantial cost savings. Additional studies are needed to assess the impact of such integrated curricula on ultimate educational benefit. Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Transcatheter closure of patent ductus arteriosus: Evaluating the effect of the learning curve on the outcome

Directory of Open Access Journals (Sweden)

Azhar Ahmad

2009-01-01

Full Text Available Background and Objectives : Initial experience with transcatheter closure of patent ductus arteriosus (PDA using detachable coils and Amplatzer duct occluder devices is reported. We evaluated the outcome, complications, and influence of the learning curve, and also assessed the need of surgical backup for such interventional procedures. Methods: From January 2000 to December 2004, 121 patients underwent transcatheter closure of PDA. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for appropriately choosing the occluder device type and size. A second aortic angiogram was performed 10 minutes after device deployment. Echocardiography was repeated at intervals of 24 hours, then at 1, 3, and 6 months after the procedure to assess complications. Stepwise multiple regression analysis was used to assess the role of experience in improving the outcome of the procedure. Results: Of 121 cases, four patients had pulmonary artery embolization of the occluder device which was successfully retrieved in the catheterization laboratory, while two others had embolization that required surgical intervention. Four patients had temporary residual leak, nine had protrusion of the device into the aorta without significant Doppler pressure gradient or hemolysis on follow-up, and five had partial hemodynamically insignificant obstruction to the left pulmonary artery. Statistical analysis showed that the effect of the learning curve and experience was responsible for 93% improvement in the procedural outcome over the five-year study period. Conclusion: Transcatheter occlusion of PDA is safe and effective alternative to surgery. Complications occurred in those with unfavorable duct anatomy and with the use of multiple coils. Surgical backup was important for such interventional procedures. Experience played a major role in the proper choice of device type and size which greatly influenced the outcome of the procedure.

Water safety and drowning

Science.gov (United States)

... among people of all ages. Learning and practicing water safety is important to prevent drowning accidents. ... Water safety tips for all ages include: Learn CPR . Never swim alone. Never dive into water unless ...

Statistical re-evaluation of the ASME K{sub IC} and K{sub IR} fracture toughness reference curves

Energy Technology Data Exchange (ETDEWEB)

Wallin, K.; Rintamaa, R. [Valtion Teknillinen Tutkimuskeskus, Espoo (Finland)

1998-11-01

Historically the ASME reference curves have been treated as representing absolute deterministic lower bound curves of fracture toughness. In reality, this is not the case. They represent only deterministic lower bound curves to a specific set of data, which represent a certain probability range. A recently developed statistical lower bound estimation method called the `Master curve`, has been proposed as a candidate for a new lower bound reference curve concept. From a regulatory point of view, the Master curve is somewhat problematic in that it does not claim to be an absolute deterministic lower bound, but corresponds to a specific theoretical failure probability that can be chosen freely based on application. In order to be able to substitute the old ASME reference curves with lower bound curves based on the master curve concept, the inherent statistical nature (and confidence level) of the ASME reference curves must be revealed. In order to estimate the true inherent level of safety, represented by the reference curves, the original data base was re-evaluated with statistical methods and compared to an analysis based on the master curve concept. The analysis reveals that the 5% lower bound Master curve has the same inherent degree of safety as originally intended for the K{sub IC}-reference curve. Similarly, the 1% lower bound Master curve corresponds to the K{sub IR}-reference curve. (orig.)

Calibration of the inertial consistency index to assess road safety on horizontal curves of two-lane rural roads.

Science.gov (United States)

Llopis-Castelló, David; Camacho-Torregrosa, Francisco Javier; García, Alfredo

2018-05-26

One of every four road fatalities occurs on horizontal curves of two-lane rural roads. To this regard, many studies have been undertaken to analyze the crash risk on this road element. Most of them were based on the concept of geometric design consistency, which can be defined as how drivers' expectancies and road behavior relate. However, none of these studies included a variable which represents and estimates drivers' expectancies. This research presents a new local consistency model based on the Inertial Consistency Index (ICI). This consistency parameter is defined as the difference between the inertial operating speed, which represents drivers' expectations, and the operating speed, which represents road behavior. The inertial operating speed was defined as the weighted average operating speed of the preceding road section. In this way, different lengths, periods of time, and weighting distributions were studied to identify how the inertial operating speed should be calculated. As a result, drivers' expectancies should be estimated considering 15 s along the segment and a linear weighting distribution. This was consistent with drivers' expectancies acquirement process, which is closely related to Short-Term Memory. A Safety Performance Function was proposed to predict the number of crashes on a horizontal curve and consistency thresholds were defined based on the ICI. To this regard, the crash rate increased as the ICI increased. Finally, the proposed consistency model was compared with previous models. As a conclusion, the new Inertial Consistency Index allowed a more accurate estimation of the number of crashes and a better assessment of the consistency level on horizontal curves. Therefore, highway engineers have a new tool to identify where road crashes are more likely to occur during the design stage of both new two-lane rural roads and improvements of existing highways. Copyright © 2018 Elsevier Ltd. All rights reserved.

Management of safety and safety culture at the NPPs of Ukraine

International Nuclear Information System (INIS)

Koltakov, Vladimir

2002-01-01

The report contains general aspects of safety and safety culture. The brief description of operational characteristics and basic indexes of atomic power plants at the Ukraine are represented. The information referring to structure of NPPs of Operation organization license-holder, safety responsibility of both Regulatory and Utility Bodies also is given. The main part of the report include seven sections: 1. Practical application of safety management models; 2. erspective on the relationship between safety management and safety culture; 3. The role of leadership in achieving high standards of safety; 4. Current and future challengers that impact on safety culture and safety management (e.g. the impact of competition, changing, economic and political circumstances, workforce demographics, etc.); 5. Key lessons learned from major events; 6. Practical applications of safety culture concepts (e.g. learning organizations, training staff communications, etc.); 7. dvance in human performance. Some of the main pending safety and safety culture problems that are necessary to achieve in the near future are mentioned

Learning from aviation to improve safety in the operating room - a systematic literature review

NARCIS (Netherlands)

L.S.G.L. Wauben; J.F. Lange (Johan); R.H.M. Goossens (Richard)

2012-01-01

textabstractLessons learned from other high-risk industries could improve patient safety in the operating room (OR). This review describes similarities and differences between high-risk industries and describes current methods and solutions within a system approach to reduce errors in the OR. PubMed

Development of a harmonized approach to safety assessment of decommissioning: Lessons learned from international experience (DeSa project)

International Nuclear Information System (INIS)

Percival, K.; Nokhamzon, J.-G.; Ferch, R.; Batandjieva, B.

2006-01-01

The number of nuclear facilities being or planned to be shutdown as they reach the end of their design life, due to accidents or other political and social factors has been increasing worldwide. This has led to an increase in the awareness of regulators and operators of the importance of development and implementation of adequate safety requirements and criteria for decommissioning of these facilities. A general requirement at international and national levels, even for new facilities to be commissioned, is the development of a decommissioning plan, which includes evaluation of potential radiological consequences to public and workers during planned and accidental decommissioning activities. Experience has been gained in the safety assessment of decommissioning at various sites with different complexities and hazard potentials. This experience shows that various approaches have been used in conducting safety assessments and that there is a need for harmonisation of these approaches and for transferring the good practice and lessons learned to other countries, in particular developing countries with limited financial and human resources. The IAEA launched an international project on Evaluation and Demonstration of Safety during Decommissioning (DeSa) in 2004 to provide a forum for exchange of lessons learned between site operators, regulators, safety assessors and other specialists in safety assessment of decommissioning of nuclear power plants, research reactors, laboratories, nuclear fuel cycle facilities, etc. This paper presents the lessons learned through the project up to date, i.e.; (i) a common approach to safety assessment is being applied worldwide with the following steps - establishment of assessment framework; description of the facility; definition of decommissioning activities; hazard identification and analysis; calculation of consequences; and analysis of results; (ii) a deterministic approach to safety assessment is most commonly applied; (iii) a

Technology learning in a global - local perspective: - the interplay between technology diffusion, niche markets and experience curves

International Nuclear Information System (INIS)

Martinsen, Thomas

2010-01-01

Preventing dangerous global climate change requires timely deployment of nascent energy technologies with zero or low Co2 emissions. Managing the shift to a common sustainable technology path calls for insight about the influence of global technological change on the national energy system. Moreover, national policies are required to promote the shift to the new technology path. This calls for methods to analyse the national energy system within a global perspective. The objective of the work presented in this thesis was to investigate interplay between technology diffusion, niche markets and technology learning from the perspective of a small open economy like Norway. More specifically, develop methods to include the influence of technology learning manifested in experience and learning curves into national energy-economy-environment models. Moreover, apply the methods to investigate the potential influence and sensitivity to technology learning in a small open economy. In this thesis three such methods have been developed, applied and its importance assessed using Norway as an example. In this work three models have been linked. They are the global Energy Technology Perspectives model operated by the International Energy Agency, the Norwegian Markal model at the Institute for Energy Technology and the macro economic model MSG6 at Statistics Norway. Method one and two has been developed to manage the interplay between the models. In a local perspective technology learning in the global market is perceived as spillover. Based upon a review of the characteristics of technological change and learning curves and its application to energy system modelling some criteria important for the parameterization and modelling of spillover in a small open economy are suggested. The first method incorporates spillover into the national Markal model. The second method establishes a soft-link between the national models. The soft-link served two purposes; to provide input on demand

Power learning or path dependency? Investigating the roots of the European Food Safety Authority.

Science.gov (United States)

Roederer-Rynning, Christilla; Daugbjerg, Carsten

2010-01-01

A key motive for establishing the European Food Safety Authority (EFSA) was restoring public confidence in the wake of multiplying food scares and the BSE crisis. Scholars, however, have paid little attention to the actual political and institutional logics that shaped this new organization. This article explores the dynamics underpinning the making of EFSA. We examine the way in which learning and power shaped its organizational architecture. It is demonstrated that the lessons drawn from the past and other models converged on the need to delegate authority to an external agency, but diverged on its mandate, concretely whether or not EFSA should assume risk management responsibilities. In this situation of competitive learning, power and procedural politics conditioned the mandate granted to EFSA. The European Commission, the European Parliament and the European Council shared a common interest in preventing the delegation of regulatory powers to an independent EU agency in food safety policy.

Safety Learning, Organizational Contradictions and the Dynamics of Safety Practice

Science.gov (United States)

Ripamonti, Silvio Carlo; Scaratti, Giuseppe

2015-01-01

Purpose: The purpose of this paper is to explore the enactment of safety routines in a transshipment port. Research on work safety and reliability has largely neglected the role of the workers' knowledge in practice in the enactment of organisational safety. The workers' lack of compliance with safety regulations represents an enduring problem…

Apprentice or Student? The Structures of Construction Industry Vocational Education and Training in Denmark and Sweden and their Possible Consequences for Safety Learning

DEFF Research Database (Denmark)

Grytnes, Regine; Grill, Martin; Pousette, Anders

2018-01-01

There is a notable difference in occupational injury rates in the two Scandinavian countries, Sweden and Denmark, with the latter having a 40% higher rate of fatal occupational injuries in the construction industry. This study explored differences in the vocational education and training (VET......) systems between Sweden and Denmark that may be important for students’ safety learning and practice during VET. In both countries, students participate in full-time education, and the curriculum includes school-based as well as company- based training. However, during company- based training Swedish...... for their safety practices and also for the teachers’ position to influence safety learning and practices during company-based training. An analysis of interview and survey data focusing on how VET students enact safety ‘knowings’ across learning sites, suggest how different forms of connectivity models in VET...

Fast algorithm selection using learning curves

NARCIS (Netherlands)

Rijn, van J.N.; Abdulrahman, S.M.; Brazdil, P.; Vanschoren, J.; Fromont, E.; De Bie, T.; Leeuwen, van M.

2015-01-01

One of the challenges in Machine Learning to find a classifier and parameter settings that work well on a given dataset. Evaluating all possible combinations typically takes too much time, hence many solutions have been proposed that attempt to predict which classifiers are most promising to try. As

Safety design criteria for the next generation Sodium-cooled fast reactors based on lessons learned from the Fukushima NPS accident

International Nuclear Information System (INIS)

Sakai, Takaaki

2012-01-01

In this presentation, architecture of the safety design criteria as requirements for SFR system and the activities on safety research works to establish safety evaluation methods for the next generation SFRs are summarized with the basis on lessons learned from the Fukushima NPS accident. Nuclear safety is a grovel issue which should be achieved by the international cooperation. In respect of the development for the next generation reactor, it is necessary to build the harmonized safety criteria and evaluation methods to establish the next level of safety

Assessment of performance measures and learning curves for use of a virtual-reality ultrasound simulator in transvaginal ultrasound examination

DEFF Research Database (Denmark)

Madsen, M E; Konge, L; Nørgaard, L N

2014-01-01

OBJECTIVE: To assess the validity and reliability of performance measures, develop credible performance standards and explore learning curves for a virtual-reality simulator designed for transvaginal gynecological ultrasound examination. METHODS: A group of 16 ultrasound novices, along with a group......-6), corresponding to an average of 219 min (range, 150-251 min) of training. The test/retest reliability was high, with an intraclass correlation coefficient of 0.93. CONCLUSIONS: Competence in the performance of gynecological ultrasound examination can be assessed in a valid and reliable way using virtual-reality...

Equilibrium spherically curved two-dimensional Lennard-Jones systems

NARCIS (Netherlands)

Voogd, J.M.; Sloot, P.M.A.; van Dantzig, R.

2005-01-01

To learn about basic aspects of nano-scale spherical molecular shells during their formation, spherically curved two-dimensional N-particle Lennard-Jones systems are simulated, studying curvature evolution paths at zero-temperature. For many N-values (N < 800) equilibrium configu- rations are traced

Facilitating students' application of the integral and the area under the curve concepts in physics problems

Science.gov (United States)

Nguyen, Dong-Hai

This research project investigates the difficulties students encounter when solving physics problems involving the integral and the area under the curve concepts and the strategies to facilitate students learning to solve those types of problems. The research contexts of this project are calculus-based physics courses covering mechanics and electromagnetism. In phase I of the project, individual teaching/learning interviews were conducted with 20 students in mechanics and 15 students from the same cohort in electromagnetism. The students were asked to solve problems on several topics of mechanics and electromagnetism. These problems involved calculating physical quantities (e.g. velocity, acceleration, work, electric field, electric resistance, electric current) by integrating or finding the area under the curve of functions of related quantities (e.g. position, velocity, force, charge density, resistivity, current density). Verbal hints were provided when students made an error or were unable to proceed. A total number of 140 one-hour interviews were conducted in this phase, which provided insights into students' difficulties when solving the problems involving the integral and the area under the curve concepts and the hints to help students overcome those difficulties. In phase II of the project, tutorials were created to facilitate students' learning to solve physics problems involving the integral and the area under the curve concepts. Each tutorial consisted of a set of exercises and a protocol that incorporated the helpful hints to target the difficulties that students expressed in phase I of the project. Focus group learning interviews were conducted to test the effectiveness of the tutorials in comparison with standard learning materials (i.e. textbook problems and solutions). Overall results indicated that students learning with our tutorials outperformed students learning with standard materials in applying the integral and the area under the curve

Digital tomosynthesis for evaluating metastatic lung nodules: nodule visibility, learning curves, and reading times.

Science.gov (United States)

Lee, Kyung Hee; Goo, Jin Mo; Lee, Sang Min; Park, Chang Min; Bahn, Young Eun; Kim, Hyungjin; Song, Yong Sub; Hwang, Eui Jin

2015-01-01

To evaluate nodule visibility, learning curves, and reading times for digital tomosynthesis (DT). We included 80 patients who underwent computed tomography (CT) and DT before pulmonary metastasectomy. One experienced chest radiologist annotated all visible nodules on thin-section CT scans using computer-aided detection software. Two radiologists used CT as the reference standard and retrospectively graded the visibility of nodules on DT. Nodule detection performance was evaluated in four sessions of 20 cases each by six readers. After each session, readers were unblinded to the DT images by revealing the true-positive markings and were instructed to self-analyze their own misreads. Receiver-operating-characteristic curves were determined. Among 414 nodules on CT, 53.3% (221/414) were visible on DT. The main reason for not seeing a nodule on DT was small size (93.3%, ≤ 5 mm). DT revealed a substantial number of malignant nodules (84.1%, 143/170). The proportion of malignant nodules among visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p 0.8, and the average detection rate for malignant nodules was 85% (210/246). The inter-session analysis of the AUC showed no significant differences among the readers, and the detection rate for malignant nodules did not differ across sessions. A slight improvement in reading times was observed. Most malignant nodules > 5 mm were visible on DT. As nodule detection performance was high from the initial session, DT may be readily applicable for radiology residents and board-certified radiologists.

FN-curves: preliminary estimation of severe accident risks after Fukushima

International Nuclear Information System (INIS)

Vasconcelos, Vanderley de; Soares, Wellington Antonio; Costa, Antonio Carlos Lopes da

2015-01-01

Doubts of whether the risks related to severe accidents in nuclear reactors are indeed very low were raised after the nuclear accident at Fukushima Daiichi in 2011. Risk estimations of severe accidents in nuclear power plants involve both probability and consequence assessment of such events. Among the ways to display risks, risk curves are tools that express the frequency of exceeding a certain magnitude of consequence. Societal risk is often represented graphically in a FN-curve, a type of risk curve, which displays the probability of having N or more fatalities per year, as a function of N, on a double logarithmic scale. The FN-curve, originally introduced for the assessment of the risks in the nuclear industry through the U.S.NRC Reactor Safety Study WASH-1400 (1975), is used in various countries to express and limit risks of hazardous activities. This first study estimated an expected rate of core damage equal to 5x10 -5 by reactor-year and suggested an upper bound of 3x10 -4 by reactor-year. A more recent report issued by Electric Power Research Institute - EPRI (2008) estimates a figure of the order of 2x10 -5 by reactor-year. The Fukushima nuclear accident apparently implies that the observed core damage frequency is higher than that predicted by these probabilistic safety assessments. Therefore, this paper presents a preliminary analyses of the FN-curves related to severe nuclear reactor accidents, taking into account a combination of available data of past accidents, probability modelling to estimate frequencies, and expert judgments. (author)

FN-curves: preliminary estimation of severe accident risks after Fukushima

Energy Technology Data Exchange (ETDEWEB)

Vasconcelos, Vanderley de; Soares, Wellington Antonio; Costa, Antonio Carlos Lopes da, E-mail: vasconv@cdtn.br, E-mail: soaresw@cdtn.br, E-mail: aclc@cdtn.br [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil)

2015-07-01

Doubts of whether the risks related to severe accidents in nuclear reactors are indeed very low were raised after the nuclear accident at Fukushima Daiichi in 2011. Risk estimations of severe accidents in nuclear power plants involve both probability and consequence assessment of such events. Among the ways to display risks, risk curves are tools that express the frequency of exceeding a certain magnitude of consequence. Societal risk is often represented graphically in a FN-curve, a type of risk curve, which displays the probability of having N or more fatalities per year, as a function of N, on a double logarithmic scale. The FN-curve, originally introduced for the assessment of the risks in the nuclear industry through the U.S.NRC Reactor Safety Study WASH-1400 (1975), is used in various countries to express and limit risks of hazardous activities. This first study estimated an expected rate of core damage equal to 5x10{sup -5} by reactor-year and suggested an upper bound of 3x10{sup -4} by reactor-year. A more recent report issued by Electric Power Research Institute - EPRI (2008) estimates a figure of the order of 2x10{sup -5} by reactor-year. The Fukushima nuclear accident apparently implies that the observed core damage frequency is higher than that predicted by these probabilistic safety assessments. Therefore, this paper presents a preliminary analyses of the FN-curves related to severe nuclear reactor accidents, taking into account a combination of available data of past accidents, probability modelling to estimate frequencies, and expert judgments. (author)

Safety culture

International Nuclear Information System (INIS)

Keen, L.J.

2003-01-01

Safety culture has become a topic of increasing interest for industry and regulators as issues are raised on safety problems around the world. The keys to safety culture are organizational effectiveness, effective communications, organizational learning, and a culture that encourages the identification and resolution of safety issues. The necessity of a strong safety culture places an onus on all of us to continually question whether the safety measures already in place are sufficient, and are being applied. (author)

LCC: Light Curves Classifier

Science.gov (United States)

Vo, Martin

2017-08-01

Light Curves Classifier uses data mining and machine learning to obtain and classify desired objects. This task can be accomplished by attributes of light curves or any time series, including shapes, histograms, or variograms, or by other available information about the inspected objects, such as color indices, temperatures, and abundances. After specifying features which describe the objects to be searched, the software trains on a given training sample, and can then be used for unsupervised clustering for visualizing the natural separation of the sample. The package can be also used for automatic tuning parameters of used methods (for example, number of hidden neurons or binning ratio). Trained classifiers can be used for filtering outputs from astronomical databases or data stored locally. The Light Curve Classifier can also be used for simple downloading of light curves and all available information of queried stars. It natively can connect to OgleII, OgleIII, ASAS, CoRoT, Kepler, Catalina and MACHO, and new connectors or descriptors can be implemented. In addition to direct usage of the package and command line UI, the program can be used through a web interface. Users can create jobs for ”training” methods on given objects, querying databases and filtering outputs by trained filters. Preimplemented descriptors, classifier and connectors can be picked by simple clicks and their parameters can be tuned by giving ranges of these values. All combinations are then calculated and the best one is used for creating the filter. Natural separation of the data can be visualized by unsupervised clustering.

Designing learning curves for carbon capture based on chemical absorption according to the minimum work of separation

International Nuclear Information System (INIS)

Rochedo, Pedro R.R.; Szklo, Alexandre

2013-01-01

Highlights: • This work defines the minimum work of separation (MWS) for a capture process. • Findings of the analysis indicated a MWS of 0.158 GJ/t for post-combustion. • A review of commercially available processes based on chemical absorption was made. • A review of learning models was conducted, with the addition on a novel model. • A learning curve for post-combustion carbon capture was successfully designed. - Abstract: Carbon capture is one of the most important alternatives for mitigating greenhouse gas emissions in energy facilities. The post-combustion route based on chemical absorption with amine solvents is the most feasible alternative for the short term. However, this route implies in huge energy penalties, mainly related to the solvent regeneration. By defining the minimum work of separation (MWS), this study estimated the minimum energy required to capture the CO 2 emitted by coal-fired thermal power plants. Then, by evaluating solvents and processes and comparing it to the MWS, it proposes the learning model with the best fit for the post-combustion chemical absorption of CO 2 . Learning models are based on earnings from experience, which can include the intensity of research and development. In this study, three models are tested: Wright, DeJong and D and L. Findings of the thermochemical analysis indicated a MWS of 0.158 GJ/t for post-combustion. Conventional solvents currently present an energy penalty eight times the MWS. By using the MWS as a constraint, this study found that the D and L provided the best fit to the available data of chemical solvents and absorption plants. The learning rate determined through this model is very similar to the ones found in the literature

Key regulatory and safety issues emerging NEA activities. Lessons Learned from Fukushima Dai-ichi NPS Accident - Key Regulatory and Safety Issues

International Nuclear Information System (INIS)

Nakoski, John

2013-01-01

A presentation was provided on the key safety and regulatory issues and an update of activities undertaken by the NEA and its members in response to the accident at the Fukushima Daiichi nuclear power stations (NPS) on 11 March 2011. An overview of the accident sequence and the consequences was provided that identified the safety functions that were lost (electrical power, core cooling, and primary containment) that lead to units 1, 2, and 3 being in severe accident conditions with large off-site releases. Key areas identified for which activities of the NEA and member countries are in progress include accident management; defence-in-depth; crisis communication; initiating events; operating experience; deterministic and probabilistic assessments; regulatory infrastructure; radiological protection and public health; and decontamination and recovery. For each of these areas, a brief description of the on-going and planned NEA activities was provided within the three standing technical committees of the NEA with safety and regulatory mandates (the Committee on Nuclear Regulatory Activities - CNRA, the Committee on the Safety of Nuclear Installations - CSNI, and the Committee on Radiation Protection and Public Health - CRPPH). On-going activities of CNRA include a review of enhancement being made to the regulatory aspects for the oversight of on-site accident management strategies and processes in light of the lessons learned from the accident; providing guidance to regulators on crisis communication; and supporting the peer review of the safety assessments of risk-significant research reactor facilities in light of the accident. Within the scope of the CSNI mandate, activities are being undertaken to better understand accident progression; characteristics of new fuel designs; and a benchmarking study of fast-running software for estimating source term under severe accident conditions to support protective measure recommendations. CSNI also has ongoing work in human

Lessons learned from recent safety related incidents at A Canadian uranium conversion facility

International Nuclear Information System (INIS)

Jaferi, Jafir

2013-01-01

This paper presents the Canadian Nuclear Safety Commission's (CNSC) regulatory requirements for nuclear fuel facility licensees to report any situation or incident that results or is likely to result in a hazard to the health or safety of any person or the environment and to submit its incident investigation report with cause(s) of the incident and corrective actions taken or planned. In addition, the paper presents two recent safety-related incidents that occurred at a uranium conversion facility in Canada along with their consequences, causes, corrective actions and any lessons learned. The first incident resulted in a release of uranium hexafluoride (UF6) inside the UF6 cylinder filling station and the second one resulted in a spill of uranium tetrafluoride (UF 4 ) slurry inside the UF6 plant. Both incidents had no impact on the workers or the environment. (authors)

What have we learned from quantum field theory in curved space-time

International Nuclear Information System (INIS)

Fulling, S.A.

1984-01-01

The paper reviews the quantum field theory in curved space-time. Field quantization in gravitational backgrounds; particle creation by black holes; Hawking radiation; quantum field theory in curved space-time; covariant renormalization of the stress-energy-momentum tensor; quantum field theory and quantum gravity; are all discussed. (U.K.)

Automated pavement horizontal curve measurement methods based on inertial measurement unit and 3D profiling data

Directory of Open Access Journals (Sweden)

Wenting Luo

2016-04-01

Full Text Available Pavement horizontal curve is designed to serve as a transition between straight segments, and its presence may cause a series of driving-related safety issues to motorists and drivers. As is recognized that traditional methods for curve geometry investigation are time consuming, labor intensive, and inaccurate, this study attempts to develop a method that can automatically conduct horizontal curve identification and measurement at network level. The digital highway data vehicle (DHDV was utilized for data collection, in which three Euler angles, driving speed, and acceleration of survey vehicle were measured with an inertial measurement unit (IMU. The 3D profiling data used for cross slope calibration was obtained with PaveVision3D Ultra technology at 1 mm resolution. In this study, the curve identification was based on the variation of heading angle, and the curve radius was calculated with kinematic method, geometry method, and lateral acceleration method. In order to verify the accuracy of the three methods, the analysis of variance (ANOVA test was applied by using the control variable of curve radius measured by field test. Based on the measured curve radius, a curve safety analysis model was used to predict the crash rates and safe driving speeds at horizontal curves. Finally, a case study on 4.35 km road segment demonstrated that the proposed method could efficiently conduct network level analysis.

Outline of the Fukushima Daiichi Accident. Lessons Learned and Safety Enhancements

Science.gov (United States)

Hirano, Masashi

2017-09-01

Abstract. On March 11, 2011, an earthquake and subsequent tsunamis off the Pacific coastline of Japan's Tohoku region caused widespread devastation in Japan. As of June 10, 2016, it is reported that a total of 15,894 people lost their lives and 2,558 people are still unaccounted for. In Fukushima Prefecture, approximately 100,000 people are still obliged to live away from their homes due to the earthquake and tsunami as well as the Fukushima Daiichi accident. On the day, the earthquake and tsunami caused severe damages to the Tokyo Electric Power Company (TEPCO)'s Fukushima Daiichi Nuclear Power Station (NPS). All the units in operation, namely Units 1 to 3, were automatically shut down on seismic reactor protection system trips but the earthquake led to the loss of all off-site electrical power supplies to that site. The subsequent tsunami inundated the site up to 4 to 5 m above its ground level and caused, in the end, the loss of core cooling function in Units 1 to 3, resulting in severe core damages and containment vessel failures in these three units. Hydrogen was released from the containment vessels, leading to explosions in the reactor buildings of Units 1, 3 and 4. Radioactive materials were released to the atmosphere and were deposited on the land and in the ocean. One of the most important lessons learned is an importance to prevent such large scale common cause failures due to extreme natural events. This leads to a conclusion that application of the defense-in-depth philosophy be enhanced because the defense-in-depth philosophy has been and continues to be an effective way to account for uncertainties associated with risks. From the human and organizational viewpoints, the final report from the Investigation Committee of the Government pointed out so-called "safety myth" that existed among nuclear operators including TEPCO as well as the government, that serious severe accidents could never occur in nuclear power plants in Japan. After the accident, the

Happy 50th Birthday Smokey Bear! A Learning Kit about Forests and Fire Safety for Grades K-3.

Science.gov (United States)

Hall, Meryl

For over 50 years, the primary goal of Smokey Bear has been to introduce the forest fire prevention message to young children. This learning kit provides the K-3 teacher with activities and resources to help students learn about Smokey Bear and fire safety, about forests as habitats, and about what they can do to protect forests. Students are…

The learning curve, interobserver, and intraobserver agreement of endoscopic confocal laser endomicroscopy in the assessment of mucosal barrier defects.

Science.gov (United States)

Chang, Jeff; Ip, Matthew; Yang, Michael; Wong, Brendon; Power, Theresa; Lin, Lisa; Xuan, Wei; Phan, Tri Giang; Leong, Rupert W

2016-04-01

Confocal laser endomicroscopy can dynamically assess intestinal mucosal barrier defects and increased intestinal permeability (IP). These are functional features that do not have corresponding appearance on histopathology. As such, previous pathology training may not be beneficial in learning these dynamic features. This study aims to evaluate the diagnostic accuracy, learning curve, inter- and intraobserver agreement for identifying features of increased IP in experienced and inexperienced analysts and pathologists. A total of 180 endoscopic confocal laser endomicroscopy (Pentax EC-3870FK; Pentax, Tokyo, Japan) images of the terminal ileum, subdivided into 6 sets of 30 were evaluated by 6 experienced analysts, 13 inexperienced analysts, and 2 pathologists, after a 30-minute teaching session. Cell-junction enhancement, fluorescein leak, and cell dropout were used to represent increased IP and were either present or absent in each image. For each image, the diagnostic accuracy, confidence, and quality were assessed. Diagnostic accuracy was significantly higher for experienced analysts compared with inexperienced analysts from the first set (96.7% vs 83.1%, P 0.86 for experienced observers. Features representative of increased IP can be rapidly learned with high inter- and intraobserver agreement. Confidence and image quality were significant predictors of accurate interpretation. Previous pathology training did not have an effect on learning. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Self-organizing adaptive map: autonomous learning of curves and surfaces from point samples.

Science.gov (United States)

Piastra, Marco

2013-05-01

Competitive Hebbian Learning (CHL) (Martinetz, 1993) is a simple and elegant method for estimating the topology of a manifold from point samples. The method has been adopted in a number of self-organizing networks described in the literature and has given rise to related studies in the fields of geometry and computational topology. Recent results from these fields have shown that a faithful reconstruction can be obtained using the CHL method only for curves and surfaces. Within these limitations, these findings constitute a basis for defining a CHL-based, growing self-organizing network that produces a faithful reconstruction of an input manifold. The SOAM (Self-Organizing Adaptive Map) algorithm adapts its local structure autonomously in such a way that it can match the features of the manifold being learned. The adaptation process is driven by the defects arising when the network structure is inadequate, which cause a growth in the density of units. Regions of the network undergo a phase transition and change their behavior whenever a simple, local condition of topological regularity is met. The phase transition is eventually completed across the entire structure and the adaptation process terminates. In specific conditions, the structure thus obtained is homeomorphic to the input manifold. During the adaptation process, the network also has the capability to focus on the acquisition of input point samples in critical regions, with a substantial increase in efficiency. The behavior of the network has been assessed experimentally with typical data sets for surface reconstruction, including suboptimal conditions, e.g. with undersampling and noise. Copyright © 2012 Elsevier Ltd. All rights reserved.

Lagrangian Curves on Spectral Curves of Monopoles

International Nuclear Information System (INIS)

Guilfoyle, Brendan; Khalid, Madeeha; Ramon Mari, Jose J.

2010-01-01

We study Lagrangian points on smooth holomorphic curves in TP 1 equipped with a natural neutral Kaehler structure, and prove that they must form real curves. By virtue of the identification of TP 1 with the space LE 3 of oriented affine lines in Euclidean 3-space, these Lagrangian curves give rise to ruled surfaces in E 3 , which we prove have zero Gauss curvature. Each ruled surface is shown to be the tangent lines to a curve in E 3 , called the edge of regression of the ruled surface. We give an alternative characterization of these curves as the points in E 3 where the number of oriented lines in the complex curve Σ that pass through the point is less than the degree of Σ. We then apply these results to the spectral curves of certain monopoles and construct the ruled surfaces and edges of regression generated by the Lagrangian curves.

Safety based on organisational learning (SOL) - Conceptual approach and verification of a method for event analysis

International Nuclear Information System (INIS)

Miller, R.; Wilpert, B.; Fahlbruch, B.

1999-01-01

This paper discusses a method for analysing safety-relevant events in NPP which is known as 'SOL', safety based on organisational learning. After discussion of the specific organisational and psychological problems examined in the event analysis, the analytic process using the SOL approach is explained as well as the required general setting. The SOL approach has been tested both with scientific experiments and from the practical perspective, by operators of NPPs and experts from other branches of industry. (orig./CB) [de

Effect of Practice Ownership on Work Environment, Learning Culture, Psychological Safety, and Burnout.

Science.gov (United States)

Cuellar, Alison; Krist, Alex H; Nichols, Len M; Kuzel, Anton J

2018-04-01

Physicians have joined larger groups and hospital systems in the face of multiple environmental challenges. We examine whether there are differences across practice ownership in self-reported work environment, a practice culture of learning, psychological safety, and burnout. Using cross-sectional data from staff surveys of small and medium-size practices that participated in EvidenceNOW in Virginia, we tested for differences in work environment, culture of learning, psychological safety, and burnout by practice type. We conducted weighted multivariate linear regression of outcomes on ownership, controlling for practice size, specialty mix, payer mix, and whether the practice was located in a medically underserved area. We further analyzed clinician and staff responses separately. Participating were 104 hospital-owned and 61 independent practices and 24 federally qualified health centers (FQHCs). We analyzed 2,005 responses from practice clinicians and staff, a response rate of 49%. Working in a hospital-owned practice was associated with favorable ratings of work environment, psychological safety, and burnout compared with independent practices. When we examined separately the responses of clinicians vs staff, however, the association appears to be largely driven by staff. Hospital ownership was associated with positive perceptions of practice work environment and lower burnout for staff relative to independent ownership, whereas clinicians in FQHCs perceive a more negative, less joyful work environment and burnout. Our findings are suggestive that clinician and nonclinician staff perceive practice adaptive reserve differently, which may have implications for creating the energy for ongoing quality improvement work. © 2018 Annals of Family Medicine, Inc.

Safety Teams: An Approach to Engage Students in Laboratory Safety

Science.gov (United States)

Alaimo, Peter J.; Langenhan, Joseph M.; Tanner, Martha J.; Ferrenberg, Scott M.

2010-01-01

We developed and implemented a yearlong safety program into our organic chemistry lab courses that aims to enhance student attitudes toward safety and to ensure students learn to recognize, demonstrate, and assess safe laboratory practices. This active, collaborative program involves the use of student "safety teams" and includes…

Insight and Lessons Learned on Organizational Factors and Safety Culture from the Review of Human Error-related Events of NPPs in Korea

International Nuclear Information System (INIS)

Kim, Ji Tae; Lee, Dhong Hoon; Choi, Young Sung

2014-01-01

Event investigation is one of the key means of enhancing nuclear safety deriving effective measures and preventing recurrences. However, it is difficult to analyze organizational factors and safety culture. This paper tries to review human error-related events from perspectives of organizational factors and safety culture, and to derive insights and lessons learned in developing the regulatory infrastructure of plant oversight on safety culture

Insight and Lessons Learned on Organizational Factors and Safety Culture from the Review of Human Error-related Events of NPPs in Korea

Energy Technology Data Exchange (ETDEWEB)

Kim, Ji Tae; Lee, Dhong Hoon; Choi, Young Sung [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

2014-08-15

Event investigation is one of the key means of enhancing nuclear safety deriving effective measures and preventing recurrences. However, it is difficult to analyze organizational factors and safety culture. This paper tries to review human error-related events from perspectives of organizational factors and safety culture, and to derive insights and lessons learned in developing the regulatory infrastructure of plant oversight on safety culture.

Modeling Patterns of Activities using Activity Curves.

Science.gov (United States)

Dawadi, Prafulla N; Cook, Diane J; Schmitter-Edgecombe, Maureen

2016-06-01

Pervasive computing offers an unprecedented opportunity to unobtrusively monitor behavior and use the large amount of collected data to perform analysis of activity-based behavioral patterns. In this paper, we introduce the notion of an activity curve , which represents an abstraction of an individual's normal daily routine based on automatically-recognized activities. We propose methods to detect changes in behavioral routines by comparing activity curves and use these changes to analyze the possibility of changes in cognitive or physical health. We demonstrate our model and evaluate our change detection approach using a longitudinal smart home sensor dataset collected from 18 smart homes with older adult residents. Finally, we demonstrate how big data-based pervasive analytics such as activity curve-based change detection can be used to perform functional health assessment. Our evaluation indicates that correlations do exist between behavior and health changes and that these changes can be automatically detected using smart homes, machine learning, and big data-based pervasive analytics.

The International Technical Safety Forum

CERN Multimedia

CERN Bulletin

2010-01-01

The International Technical Safety Forum is a meeting of safety experts from several physics labs in Europe and the US. Since 1998 participants have been meeting every couple of years to discuss common challenges in safety matters. The Forum helps them define best practices and learn from the important lessons learned by others.   The Forum's participants in front of building 40. This year, the meeting took place at CERN from 12 to 16 April. “This year's meeting covered subjects ranging from communication and training in matters of safety, to cryogenic safety, emergency preparedness and risk analysis”, explains Ralf Trant, head of the CERN Safety Commission and organiser of this year’s Forum. Radiation protection issues are not discussed at the meeting since they involve different expertise. The goal of the Forum is to allow participants to share experience, learn lessons and acquire specific knowledge in a very open way. Round-table discussions, dedicated time for ...

EC6 safety enhancement - including impact of Fukushima lessons learned

Energy Technology Data Exchange (ETDEWEB)

Yu, S.; Zemdegs, R.; Boyle, S.; Soulard, M., E-mail: stephen.yu@candu.com [Candu Energy Inc., Mississauga, Ontario (Canada)

2012-09-15

The Enhanced CANDU 6 (EC6) is the new Generation III CANDU reactor design that meets the most up to date regulatory requirements and customer expectations. EC6 builds on the proven high performance design inch as the Qinshan CANDU 6 units and has made improvements to safety and operational performance, and has incorporated extensive operational feedback including Fukushima. The Fukushima Dai-ichi March 11, 2011 event has demonstrated the importance of defence-in-depth considerations for beyond-design basis events, including severe accidents. The EC6 design is based on the defence-in-depth principles and provides further design features that address the lessons learned from Fukushima. (author)

The integration of computerised accounting in the accounting curriculum as an educational learning curve for students entering the business world

Directory of Open Access Journals (Sweden)

Elmarie Papageorgiou

2014-06-01

Full Text Available At universities, educating students on real-life practices is one of the key drivers in a changing academic environment. Academic institutions encourage the study of the learning environment and ensure that appropriate strategies are in place for educating students. A first-year Accounting I student stated the importance of computerised accounting: ‘Computerised accounting is used in the workplace and therefore using it in varsity, grants students a view on how things will be after completion of their respective degrees.’ Accordingly, the purpose of this study was to empirically investigate the perceived acquisition of information technology (IT knowledge and determine the skills required for students to convert the knowledge gained into actions as a learning curve for accounting students entering the business world. The results indicated that students’ knowledge of Accounting I increased with the integration of computerised Accounting in the Accounting I Curriculum.

Evaluating the Learning Curve for Percutaneous Nephrolithotomy under Total Ultrasound Guidance.

Directory of Open Access Journals (Sweden)

Yan Song

Full Text Available To investigate the learning curve of percutaneous nephrolithotomy under total ultrasound guidance.One hundred and twenty consecutive PCNL operations under total ultrasound guidance performed by a novice surgeon in a tertiary referral center were studied. Operations were analyzed in cohorts of 15 to determine when a plateau was reached for the variables such as operation duration, ultrasound screening time, tract dilation time, stone-free rate and complication rate. Comparison was made with the results of a surgeon who had performed more than 1000 PCNLs. Fluoroscopy was not used at all during procedure.The mean operation time dropped from 82.5 min for the first 15 patients to a mean of 64.7 min for cases 46 through 60(P = 0.047. The ultrasound screening time was a peak of 6.4 min in the first 15 cases, whereas it dropped to a mean of 3.9 min for cases 46 through 60(P = 0.01. The tract dilation time dropped from 4.9 min for the first 15 patients to a mean of 3.8 min for cases 46 through 60(P = 0.036. The senior surgeon had a mean operating time, screening time and tract dilation time equivalent to those of the novice surgeon after 60 cases. There was no significant difference in stone free rate and complication rate.The competence of ultrasound guided PCNL is reached after 60 cases with good stone free rate and without major complications.

The TRIPOD e-learning Platform for the Training of Earthquake Safety Assessment

International Nuclear Information System (INIS)

Coppari, S.; Di Pasquale, G.; Goretti, A.; Papa, F.; Papa, S.; Paoli, G.; Pizza, A. G.; Severino, M.

2008-01-01

The paper summarizes the results of the in progress EU Project titled TRIPOD (Training Civil Engineers on Post-Earthquake Safety Assessment of Damaged Buildings), funded under the Leonardo Da Vinci program. The main theme of the project is the development of a methodology and a learning platform for the training of technicians involved in post-earthquake building safety inspections. In the event of a catastrophic earthquake, emergency building inspections constitute a major undertaking with severe social impact. Given the inevitable chaotic conditions and the urgent need of a great number of specialized individuals to carry out inspections, past experience indicates that inspection teams are often formed in an adhoc manner, under stressful conditions, at a varying levels of technical expertise and experience, sometime impairing the reliability and consistency of the inspection results. Furthermore each Country has its own building damage and safety assessment methodology, developed according to its experience, laws, building technology and seismicity. This holds also for the partners participating to the project (Greece, Italy, Turkey, Cyprus), that all come from seismically sensitive Mediterranean countries. The project aims at alleviating the above shortcomings by designing and developing a training methodology and e-platform, forming a complete training program targeted at inspection engineers, specialized personnel and civil protection agencies. The e-learning platform will provide flexible and friendly authoring mechanisms, self-teaching and assessment capabilities, course and trainee management, etc. Courses will be also made available as stand-alone multimedia applications on CD and in the form of a complete pocket handbook. Moreover the project will offer the possibility of upgrading different experiences and practices: a first step towards the harmonization of methodologies and tools of different Countries sharing similar problems. Finally, through wide

Educating future leaders in patient safety

Science.gov (United States)

Leotsakos, Agnès; Ardolino, Antonella; Cheung, Ronny; Zheng, Hao; Barraclough, Bruce; Walton, Merrilyn

2014-01-01

Education of health care professionals has given little attention to patient safety, resulting in limited understanding of the nature of risk in health care and the importance of strengthening systems. The World Health Organization developed the Patient Safety Curriculum Guide: Multiprofessional Edition to accelerate the incorporation of patient safety teaching into higher educational curricula. The World Health Organization Curriculum Guide uses a health system-focused, team-dependent approach, which impacts all health care professionals and students learning in an integrated way about how to operate within a culture of safety. The guide is pertinent in the context of global educational reforms and growing recognition of the need to introduce patient safety into health care professionals’ curricula. The guide helps to advance patient safety education worldwide in five ways. First, it addresses the variety of opportunities and contexts in which health care educators teach, and provides practical recommendations to learning. Second, it recommends shared learning by students of different professions, thus enhancing student capacity to work together effectively in multidisciplinary teams. Third, it provides guidance on a range of teaching methods and pedagogical activities to ensure that students understand that patient safety is a practical science teaching them to act in evidence-based ways to reduce patient risk. Fourth, it encourages supportive teaching and learning, emphasizing the need to establishing teaching environments in which students feel comfortable to learn and practice patient safety. Finally, it helps educators incorporate patient safety topics across all areas of clinical practice. PMID:25285012

Evaluation of the learning curve of non-penetrating glaucoma surgery.

Science.gov (United States)

Aslan, Fatih; Yuce, Berna; Oztas, Zafer; Ates, Halil

2017-08-11

To evaluate the learning curve of non-penetrating glaucoma surgery (NPGS). The study included 32 eyes of 27 patients' (20 male and 7 female) with medically uncontrolled glaucoma. Non-penetrating glaucoma surgeries performed by trainees under control of an experienced surgeon between 2005 and 2007 at our tertiary referral hospital were evaluated. Residents were separated into two groups. Humanistic training model applied to the one in the first group, he studied with experimental models before performing NPGS. Two residents in the second group performed NPGS after a conventional training model. Surgeries of the residents were recorded on video and intraoperative parameters were scored by the experienced surgeon at the end of the study. Postoperative intraocular pressure, absolute and total success rates were analyzed. In the first group 19 eyes of 16 patients and in the second group 13 eyes of 11 patients had been operated by residents. Intraoperative parameters and complication rates were not statistically significant between groups (p > 0.05, Chi-square). The duration of surgery was 32.7 ± 5.6 min in the first group and 45 ± 3.8 min in the second group. The difference was statistically significant (p < 0.001, Student's t test). Absolute and total success was 68.8 and 93.8% in the first group and 62.5 and 87.5% in the second group, respectively. The difference was not statistically significant. Humanistic and conventional training models under control of an experienced surgeon are safe and effective for senior residents who manage phacoemulsification surgery in routine cataract cases. Senior residents can practice these surgical techniques with reasonable complication rates.

U. S. Department of energy actions to ensure nuclear safety at its nuclear facilities in response to lessons being learned from the Fukushima dacha accident

Energy Technology Data Exchange (ETDEWEB)

Chung, Dae; O' Brien, James [U. S. Department of Energy, Washington (United States)

2012-03-15

The U. S. Department of Energy (DOE) has established a rigorous nuclear safety regulatory infrastructure for the protection of workers, the public, and the environment. An essential part of this infrastructure is a safety culture that promotes organizational learning and includes a commitment to safety by senior leaders that is demonstrated through their actions and behaviors. The tragic Fukushima Dacha accident presented an important challenge for DOE leaders to demonstrate a robust safety culture by critically examining the Department' s regulatory infrastructure and its implementation to ensure that appropriate safety provisions were in place. This paper discusses the actions DOE has taken to date in this regard and further planned action to ensure safety at DOE facilities in light of lessons being learned from the Fukushima Dacha accident.

U. S. Department of energy actions to ensure nuclear safety at its nuclear facilities in response to lessons being learned from the Fukushima dacha accident

International Nuclear Information System (INIS)

Chung, Dae; O'Brien, James

2012-01-01

The U. S. Department of Energy (DOE) has established a rigorous nuclear safety regulatory infrastructure for the protection of workers, the public, and the environment. An essential part of this infrastructure is a safety culture that promotes organizational learning and includes a commitment to safety by senior leaders that is demonstrated through their actions and behaviors. The tragic Fukushima Dacha accident presented an important challenge for DOE leaders to demonstrate a robust safety culture by critically examining the Department' s regulatory infrastructure and its implementation to ensure that appropriate safety provisions were in place. This paper discusses the actions DOE has taken to date in this regard and further planned action to ensure safety at DOE facilities in light of lessons being learned from the Fukushima Dacha accident

Lessons Learned from Implementing National Nuclear Safety Knowledge Platforms

International Nuclear Information System (INIS)

Simo, A.

2016-01-01

The Integrated Nuclear Security Advisory Services (INSServ) took place in Cameroon from 21st to 25th April 2014 and the Integrated Regulatory Review Service (IRRS) from 12th to 21st October 2014. This was after the government requested the Director General of International Atomic Energy Agency (IAEA) through an official correspondence on 11th June 2013, for these missions. The main objective was to further improve the effectiveness of the Cameroon governmental, legal and regulatory framework for safety and security. Revision of the legal and regulatory framework so that all international safety and security standards are addressed in laws and statutes have been done with documents downloaded from Nuclear portal sites found in GNSSN. Establishment and implementation of integrated management systems by NRPA is being done with documentation under the National Nuclear Portal with lessons learned from the IAEA review missions. The regulatory documents have been uploaded on the platform and can be accessed through FNRBA and NRPA website (www.anrp.cm). UN organizations implementing projects in Cameroon are also linked to the platform. The action plans and progress reports for IAEA/AFRA projects are also available. Moreover, NRPA regulatory activities and licensing sources are available on this platform.

Learning curve of robot-assisted laparoscopic radical prostatectomy for a single experienced surgeon: comparison with simultaneous laparoscopic radical prostatectomy.

Science.gov (United States)

Ku, Ja Yoon; Ha, Hong Koo

2015-04-01

Despite the large number of analytical reports regarding the learning curve in the transition from open to robot-assisted radical prostatectomy (RARP), few comparative results with laparoscopic radical prostatectomy (LRP) have been reported. Thus, we evaluated operative and postoperative outcomes in RARP versus 100 simultaneously performed LRPs. A single surgeon had performed more than 1,000 laparoscopic operations, including 415 cases of radical nephrectomy, 85 radical cystectomies, 369 radical prostatectomies, and treatment of 212 other urological tumors, since 2009. We evaluated operative (operation time, intraoperative transfusion, complications, hospital stay, margin status, pathological stage, Gleason score) and postoperative (continence and erectile function) parameters in initial cases of RARP without tutoring compared with 100 recently performed LRPs. Mean operation time and length of hospital stay for RARP and LRP were 145.5±43.6 minutes and 118.1±39.1 minutes, and 6.4±0.9 days and 6.6±1.1 days, respectively (p=0.003 and p=0.721). After 17 cases, the mean operation time for RARP was similar to LRP (less than 2 hours). Positive surgical margins in localized cancer were seen in 11.1% and 8.9% of cases in RARP and LRP, respectively (p=0.733). At postoperative 3 months, sexual intercourse was reported in 14.0% and 12.0%, and pad-free continence in 96.0% and 81.0% in patients with RARP and LRP, respectively (p=0.796 and p=0.012). Previous large-volume experience of LRPs may shorten the learning curve for RARP in terms of oncological outcome. Additionally, previous experience with laparoscopy may improve the functional outcomes of RARP.

Reliability assessment of a manual-based procedure towards learning curve modeling and fmea analysis

Directory of Open Access Journals (Sweden)

Gustavo Rech

2013-03-01

Full Text Available Separation procedures in drug Distribution Centers (DC are manual-based activities prone to failures such as shipping exchanged, expired or broken drugs to the customer. Two interventions seem as promising in improving the reliability in the separation procedure: (i selection and allocation of appropriate operators to the procedure, and (ii analysis of potential failure modes incurred by selected operators. This article integrates Learning Curves (LC and FMEA (Failure Mode and Effect Analysis aimed at reducing the occurrence of failures in the manual separation of a drug DC. LCs parameters enable generating an index to identify the recommended operators to perform the procedures. The FMEA is then applied to the separation procedure carried out by the selected operators in order to identify failure modes. It also deployed the traditional FMEA severity index into two sub-indexes related to financial issues and damage to company´s image in order to characterize failures severity. When applied to a drug DC, the proposed method significantly reduced the frequency and severity of failures in the separation procedure.

Developing a strong safety culture - a safety management challenge

International Nuclear Information System (INIS)

Low, M.; Gipson, G. P.; Williams, M.

1995-01-01

The approach is presented adapted by Nuclear Electric to build a strong safety culture through the development of its safety management system. Two features regarded as critical to a strong safety culture are: provision of effective communications to promote an awareness and ownership of safety among craft, and commitment to continuous improvement with a genuine willingness to learn from own experiences and those from others. (N.T.) 5 refs., 4 figs., 1 tab

Multimedia for occupational safety and health training: a pilot study examining a multimedia learning theory.

Science.gov (United States)

Wallen, Erik S; Mulloy, Karen B

2006-10-01

Occupational diseases are a significant problem affecting public health. Safety training is an important method of preventing occupational illness. Training is increasingly being delivered by computer although theories of learning from computer-based multimedia have been tested almost entirely on college students. This study was designed to determine whether these theories might also be applied to safety training applications for working adults. Participants viewed either computer-based multimedia respirator use training with concurrent narration, narration prior to the animation, or unrelated safety training. Participants then took a five-item transfer test which measured their ability to use their knowledge in new and creative ways. Participants who viewed the computer-based multimedia trainings both did significantly better than the control group on the transfer test. The results of this pilot study suggest that design guidelines developed for younger learners may be effective for training workers in occupational safety and health although more investigation is needed.

Implementing and measuring safety goals and safety culture. 2. Extensive Efforts to Learn Lessons from Overseas Nuclear Power Plants

International Nuclear Information System (INIS)

Maki, Nobuo

2001-01-01

The transfer of nuclear power plant (NPP) operating experiences is one of the important measures for the safe operation of NPPs. The Institute of Nuclear Power Operations (INPO),World Association of Nuclear Operators (WANO), and Nuclear Information Center of Central Research Institute of Electric Power Industry are the organizations providing Japanese utilities with useful information on incidents and accidents that have occurred at foreign NPPs. The Kansai Electric Power Company (KEPCO) has established two organizations to make extensive efforts to learn lessons from overseas NPPs: One is the Nuclear Power Plant Maintenance Training Center (MTC), and the other is the Institute of Nuclear Safety System (INSS). This paper describes the function of these organizations in transferring knowledge and expertise to ensure the safe operation of Japanese NPPs as well as recent outcomes. MTC was set up in October 1983. Before its establishment, expertise on NPP maintenance was mainly transferred on an on-the-job basis through daily maintenance work. However, after various NPP incidents and accidents, the importance of off-site training for maintenance personnel was emphasized. MTC possesses full-sized or nearly full sized mockups of Mihama NPP Unit 3 and Takahama NPP Unit 3. Furthermore, many kinds of mechanical, electrical, and instrumental equipment are furnished for training. In 1999, more than 2400 (man/day) maintenance personnel in total had training at MTC. In the tube rupture accident of a steam generator of KEPCO's Mihama Unit 2 on February 9, 1991, the emergency core cooling system actuated for the first time in the history of NPP operation in Japan. The cause of the accident was a fault in the manufacturing process of the steam generator, which was not detected until the accident. After an in-depth evaluation of the accident, many corrective actions were taken to prevent the recurrence of a similar accident. As a part of the actions, KEPCO established INSS in March

Validation of the NASA-TLX Score in Ongoing Assessment of Mental Workload During a Laparoscopic Learning Curve in Bariatric Surgery.

Science.gov (United States)

Ruiz-Rabelo, Juan Francisco; Navarro-Rodriguez, Elena; Di-Stasi, Leandro Luigi; Diaz-Jimenez, Nelida; Cabrera-Bermon, Juan; Diaz-Iglesias, Carlos; Gomez-Alvarez, Manuel; Briceño-Delgado, Javier

2015-12-01

Fatigue and mental workload are directly associated with high-complexity tasks. In general, difficult tasks produce a higher mental workload, leaving little opportunity to deal with new/unexpected events and increasing the likelihood of performance errors. The laparoscopic Roux-en-Y gastric bypass (LRYGB) learning curve is considered to be one of the most difficult to complete in laparoscopic surgery. We wished to validate the National Aeronautics and Space Administration Task Load Index (NASA-TLX) in LRYGB and identify factors that could provoke a higher mental workload for surgeons during the learning curve. A single surgeon was enrolled to undertake 70 consecutive LRYGB procedures with two internal surgeons mentoring the first 35 cases. Patients were consecutive and ranked from case 35 to case 105 according to the date of the surgical procedure ("case rank"). Self-ratings of satisfaction, performance, and fatigue were measured at the end of surgery using a validated NASA-TLX questionnaire. The procedure was recorded for later viewing by two external evaluators. General data for patients and surgical variables were collected prospectively. A moderate correlation between the NASA-TLX score, BMI, operative time, and volumes of blood drainage was observed. There was no correlation between the NASA-TLX score and duration of hospital stay or time of drain removal. BMI ≥50 kg/m(2), male sex, inexperienced first assistant, and type 2 diabetes mellitus were identified as independent predictive factors of a higher NASA-TLX score. The NASA-TLX is a valid tool to gauge mental workload in LRYGB.

Reliability Based Geometric Design of Horizontal Circular Curves

Science.gov (United States)

Rajbongshi, Pabitra; Kalita, Kuldeep

2018-06-01

Geometric design of horizontal circular curve primarily involves with radius of the curve and stopping sight distance at the curve section. Minimum radius is decided based on lateral thrust exerted on the vehicles and the minimum stopping sight distance is provided to maintain the safety in longitudinal direction of vehicles. Available sight distance at site can be regulated by changing the radius and middle ordinate at the curve section. Both radius and sight distance depend on design speed. Speed of vehicles at any road section is a variable parameter and therefore, normally the 98th percentile speed is taken as the design speed. This work presents a probabilistic approach for evaluating stopping sight distance, considering the variability of all input parameters of sight distance. It is observed that the 98th percentile sight distance value is much lower than the sight distance corresponding to 98th percentile speed. The distribution of sight distance parameter is also studied and found to follow a lognormal distribution. Finally, the reliability based design charts are presented for both plain and hill regions, and considering the effect of lateral thrust.

Reliability Based Geometric Design of Horizontal Circular Curves

Science.gov (United States)

Rajbongshi, Pabitra; Kalita, Kuldeep

2018-03-01

Geometric design of horizontal circular curve primarily involves with radius of the curve and stopping sight distance at the curve section. Minimum radius is decided based on lateral thrust exerted on the vehicles and the minimum stopping sight distance is provided to maintain the safety in longitudinal direction of vehicles. Available sight distance at site can be regulated by changing the radius and middle ordinate at the curve section. Both radius and sight distance depend on design speed. Speed of vehicles at any road section is a variable parameter and therefore, normally the 98th percentile speed is taken as the design speed. This work presents a probabilistic approach for evaluating stopping sight distance, considering the variability of all input parameters of sight distance. It is observed that the 98th percentile sight distance value is much lower than the sight distance corresponding to 98th percentile speed. The distribution of sight distance parameter is also studied and found to follow a lognormal distribution. Finally, the reliability based design charts are presented for both plain and hill regions, and considering the effect of lateral thrust.

Sign up to Safety: developing a safety improvement plan.

Science.gov (United States)

Dight, Carol; Peters, Hayley

2015-04-01

The Sign up to Safety (SutS) programme was launched in June 2014 by health secretary Jeremy Hunt. It focuses on listening to patients, carers and staff, learning from what they say when things go wrong, and then taking action to improve patient safety. The programme aims to make the NHS the safest healthcare system in the world by creating a culture devoted to continuous learning and improvement (NHS England 2014). Musgrove Park Hospital, part of Taunton and Somerset NHS Foundation Trust, was one of 12 NHS organisations that signed up to the SutS programme, making public its commitment to the national pledges to be 'open and transparent' and to develop a safety improvement plan. This paper describes the development of the strategy.

Levels of Reflective Thinking and Patient Safety: An Investigation of the Mechanisms that Impact on Student Learning in a Single Cohort over a 5 Year Curriculum

Science.gov (United States)

Ambrose, Lucy J.; Ker, Jean S.

2014-01-01

Existing research into learning about patient safety focuses on identifying how educational interventions improve educational outcomes but few studies offer evidence that inform educators about the mechanisms involved in learning about patient safety. The current evidence based in undergraduates is also limited to outcomes that relate to knowledge…

Multiobjective optimisation of bogie suspension to boost speed on curves

Science.gov (United States)

Milad Mousavi-Bideleh, Seyed; Berbyuk, Viktor

2016-01-01

To improve safety and maximum admissible speed on different operational scenarios, multiobjective optimisation of bogie suspension components of a one-car railway vehicle model is considered. The vehicle model has 50 degrees of freedom and is developed in multibody dynamics software SIMPACK. Track shift force, running stability, and risk of derailment are selected as safety objective functions. The improved maximum admissible speeds of the vehicle on curves are determined based on the track plane accelerations up to 1.5 m/s2. To attenuate the number of design parameters for optimisation and improve the computational efficiency, a global sensitivity analysis is accomplished using the multiplicative dimensional reduction method (M-DRM). A multistep optimisation routine based on genetic algorithm (GA) and MATLAB/SIMPACK co-simulation is executed at three levels. The bogie conventional secondary and primary suspension components are chosen as the design parameters in the first two steps, respectively. In the last step semi-active suspension is in focus. The input electrical current to magnetorheological yaw dampers is optimised to guarantee an appropriate safety level. Semi-active controllers are also applied and the respective effects on bogie dynamics are explored. The safety Pareto optimised results are compared with those associated with in-service values. The global sensitivity analysis and multistep approach significantly reduced the number of design parameters and improved the computational efficiency of the optimisation. Furthermore, using the optimised values of design parameters give the possibility to run the vehicle up to 13% faster on curves while a satisfactory safety level is guaranteed. The results obtained can be used in Pareto optimisation and active bogie suspension design problems.

French PWR Safety Philosophy

International Nuclear Information System (INIS)

Conte, M. M.

1986-01-01

The first 900 MWe units, built under the American Westinghouse licence and with reference to the U. S. regulation, were followed by 28 standardized units, C P1 and C P2 series. Increasing knowledge and lessons learned from starting and operating experience of French nuclear power plants, completed by the experience learned from the operation of foreign reactors, has contributed to the improvement of French PWR design and safety philosophy. As early as 1976, this experience was taken into account by French Safety organisms to discuss, with Electricite de France, the safety options for the planned 1300 MWe units, P4 and P4 series. In 1983, the new reactor scheduled, Ni4 series 1400 MWe, is a totally French design which satisfies the French regulations and other French standards and codes. Based on a deterministic approach, the French safety analysis was progressively completed by a probabilistic approach each of them having possibilities and limits. Increasing knowledge and lessons learned from operating experience have contributed to the French safety philosophy improvement. The methodology now applied to safety evaluation develops a new facet of the in depth defense concept by taking highly unlikely events into consideration, by developing the search of safety consistency of the design, and by completing the deterministic approach by the probabilistic one

Safety learning from drugs of the same class

DEFF Research Database (Denmark)

Stefansdottir, G; Knol, M J; Arnardottir, A H

2012-01-01

This study was aimed at assessing the extent of safety learning from data pertaining to other drugs of the same class. We studied drug classes for which the first and second drugs were centrally registered in the European Union from 1995 to 2008. We assessed whether adverse drug reactions (ADRs......) associated with one of the drugs also appeared in the Summary of Product Characteristics (SPC) of the other drug, either initially or during the postmarketing phase. We identified 977 ADRs from 19 drug pairs, of which 393 ADRs (40.2%) were listed in the SPCs of both drugs of a pair. Of these 393 that were...... present in both SPCs of a drug pair, 241 (61.3%) were present when the drug entered the market and 152 (30.7%) appeared in the postmarketing phase. The mention of ADRs in the SPCs of both same-class drugs in the postmarketing phase was associated with type A ADRs, marketing in the same regulator country...

Developing tools for the safety specification in risk management plans: lessons learned from a pilot project.

Science.gov (United States)

Cooper, Andrew J P; Lettis, Sally; Chapman, Charlotte L; Evans, Stephen J W; Waller, Patrick C; Shakir, Saad; Payvandi, Nassrin; Murray, Alison B

2008-05-01

Following the adoption of the ICH E2E guideline, risk management plans (RMP) defining the cumulative safety experience and identifying limitations in safety information are now required for marketing authorisation applications (MAA). A collaborative research project was conducted to gain experience with tools for presenting and evaluating data in the safety specification. This paper presents those tools found to be useful and the lessons learned from their use. Archive data from a successful MAA were utilised. Methods were assessed for demonstrating the extent of clinical safety experience, evaluating the sensitivity of the clinical trial data to detect treatment differences and identifying safety signals from adverse event and laboratory data to define the extent of safety knowledge with the drug. The extent of clinical safety experience was demonstrated by plots of patient exposure over time. Adverse event data were presented using dot plots, which display the percentages of patients with the events of interest, the odds ratio, and 95% confidence interval. Power and confidence interval plots were utilised for evaluating the sensitivity of the clinical database to detect treatment differences. Box and whisker plots were used to display laboratory data. This project enabled us to identify new evidence-based methods for presenting and evaluating clinical safety data. These methods represent an advance in the way safety data from clinical trials can be analysed and presented. This project emphasises the importance of early and comprehensive planning of the safety package, including evaluation of the use of epidemiology data.

Resolving conflicting safety cultures

International Nuclear Information System (INIS)

Slider, J.E.; Patterson, M.

1993-01-01

Several nuclear power plant sites have been wounded in the crossfire between two distinct corporate cultures. The traditional utility culture lies on one side and that of the nuclear navy on the other. The two corporate cultures lead to different perceptions of open-quotes safety culture.close quotes This clash of safety cultures obscures a very important point about nuclear plant operations: Safety depends on organizational learning. Organizational learning provides the foundation for a perception of safety culture that transcends the conflict between utility and nuclear navy cultures. Corporate culture may be defined as the knowledge, attitudes, and beliefs shared by employees of a given company. Safety culture is the part of corporate culture concerning shared attitudes and beliefs affecting individual or public safety. If the safety culture promotes behaviors that lead to greater safety, employees will tend to open-quotes do the right thingclose quotes even when circumstances and formal guidance alone do not ensure that actions will be correct. Safety culture has become particularly important to nuclear plant owners and regulators as they have sought to establish and maintain a high level of safety in today's plants

Technology learning for fuel cells. An assessment of past and potential cost reductions

International Nuclear Information System (INIS)

Schoots, K.; Van der Zwaan, B.C.C.; Kramer, G.J.

2010-01-01

Fuel cells have gained considerable interest as a means to efficiently convert the energy stored in gases like hydrogen and methane into electricity. Further developing fuel cells in order to reach cost, safety and reliability levels at which their widespread use becomes feasible is an essential prerequisite for the potential establishment of a 'hydrogen economy'. A major factor currently obviating the extensive use of fuel cells is their relatively high costs. At present we estimate these at about 1100 EUR(2005)W for an 80 kW fuel cell system but notice that specific costs vary markedly with fuel cell system power capacity. We analyze past fuel cell cost reductions for both individual manufacturers and the global market. We determine learning curves, with fairly high uncertainty ranges, for three different types of fuel cell technology - AFC, PAFC and PEMFC - each manufactured by a different producer. For PEMFC technology we also calculate a global learning curve, characterised by a learning rate of 21% with an error margin of 4%. Given their respective uncertainties, this global learning rate value is in agreement with those we find for different manufacturers. In contrast to some other new energy technologies, R and D still plays a major role in today's fuel cell improvement process and hence probably explains a substantial part of our observed cost reductions. The remaining share of these cost reductions derives from learning-by-doing proper. Since learning-by-doing usually involves a learning rate of typically 20%, the residual value for pure learning we find for fuel cells is relatively low. In an ideal scenario for fuel cell technology we estimate a bottom-line for specific (80 kW system) manufacturing costs of 95 EUR(2005)W. Although learning curves observed in the past constitute no guarantee for sustained cost reductions in the future, when we assume global total learning at the pace calculated here as the only cost reduction mechanism, this ultimate cost

Seismic Fragility Curves of Industrial Buildings by Using Nonlinear Analysis

Directory of Open Access Journals (Sweden)

Mohamed Nazri Fadzli

2017-01-01

Full Text Available This study presents the steel fragility curves and performance curves of industrial buildings of different geometries. The fragility curves were obtained for different building geometries, and the performance curves were developed based on lateral load, which is affected by the geometry of the building. Three records of far-field ground motion were used for incremental dynamic analysis (IDA, and the design lateral loads for pushover analysis (POA. All designs were based on British Standard (BS 5950; however, Eurocode 8 was preferred for seismic consideration in the analysis because BS 5950 does not specify any seismic provision. The five levels of performance stated by FEMA-273, namely, operational phase, immediate occupancy, damage control, life safety, and collapse prevention (CP were used as main guidelines for evaluating structural performance. For POA, Model 2 had highest base shear, followed by Model 1 and Model 3, even though Model 2 has a smaller structure compared with Model 3. Meanwhile, the fragility curves showed that the probability of reaching or exceeding the CP level of Model 2 is the highest, followed by that of Models 1 and 3.

International R&M/Safety Cooperation Lessons Learned Between NASA and JAXA

Science.gov (United States)

Fernandez, Rene; Havenhill, Maria T.; Zampino, Edward J.; Kiefer, Dwayne E.

2013-01-01

Presented are a number of important experiences gained and lessons learned from the collaboration of the National Aeronautics and Space Administration (NASA) and the Japanese Aerospace Exploration Agency (JAXA) on the CoNNeCT (Communications, Navigation, and Networking re-Configurable Testbed) project. Both space agencies worked on the CoNNeCT Project to design, assemble, test, integrate, and launch a communications testbed facility mounted onto the International Space Station (ISS) truss. At the 2012 RAMS, two papers about CoNNeCT were presented: one on Ground Support Equipment Reliability & System Safety, and the other one on combined application of System Safety & Reliability for the flight system. In addition to the logistics challenges present when two organizations are on the opposite side of the world, there is also a language barrier. The language barrier encompasses not only the different alphabet, it encompasses the social interactions; these were addressed by techniques presented in the paper. The differences in interpretation and application of Spaceflight Requirements will be discussed in this paper. Although many, but definitely not all, of JAXA's Spaceflight Requirements were inspired by NASA, there were significant and critically important differences in how they were interpreted and applied. This paper intends to summarize which practices worked and which did not for an international collaborative effort so that future missions may benefit from our experiences. The CoNNeCT flight system has been successfully assembled, integrated, tested, shipped, launched and installed on the ISS without incident. This demonstrates that the steps taken to facilitate international understanding, communication, and coordination were successful and warrant discussion as lessons learned.

Team safety and innovation by learning from errors in long-term care settings.

Science.gov (United States)

Buljac-Samardžić, Martina; van Woerkom, Marianne; Paauwe, Jaap

2012-01-01

Team safety and team innovation are underexplored in the context of long-term care. Understanding the issues requires attention to how teams cope with error. Team managers could have an important role in developing a team's error orientation and managing team membership instabilities. The aim of this study was to examine the impact of team member stability, team coaching, and a team's error orientation on team safety and innovation. A cross-sectional survey method was employed within 2 long-term care organizations. Team members and team managers received a survey that measured safety and innovation. Team members assessed member stability, team coaching, and team error orientation (i.e., problem-solving and blaming approach). The final sample included 933 respondents from 152 teams. Stable teams and teams with managers who take on the role of coach are more likely to adopt a problem-solving approach and less likely to adopt a blaming approach toward errors. Both error orientations are related to team member ratings of safety and innovation, but only the blaming approach is (negatively) related to manager ratings of innovation. Differences between members' and managers' ratings of safety are greater in teams with relatively high scores for the blaming approach and relatively low scores for the problem-solving approach. Team coaching was found to be positively related to innovation, especially in unstable teams. Long-term care organizations that wish to enhance team safety and innovation should encourage a problem-solving approach and discourage a blaming approach. Team managers can play a crucial role in this by coaching team members to see errors as sources of learning and improvement and ensuring that individuals will not be blamed for errors.

Effects of a case-based interactive e-learning course on knowledge and attitudes about patient safety: a quasi-experimental study with third-year medical students.

Science.gov (United States)

Gaupp, Rainer; Körner, Mirjam; Fabry, Götz

2016-07-11

Patient safety (PS) is influenced by a set of factors on various levels of the healthcare system. Therefore, a systems-level approach and systems thinking is required to understand and improve PS. The use of e-learning may help to develop a systems thinking approach in medical students, as case studies featuring audiovisual media can be used to visualize systemic relationships in organizations. The goal of this quasi-experimental study was to determine if an e-learning can be utilized to improve systems thinking, knowledge, and attitudes towards PS. A quasi-experimental, longitudinal within- subjects design was employed. Participants were 321 third-year medical students who received online surveys before and after they participated in an e-learning course on PS. Primary outcome measures where levels of systems thinking and attitudes towards PS. Secondary outcome measures were the improvement of PS specific knowledge through the e-learning course. Levels of systems thinking showed significant improvement (58.72 vs. 61.27; p e-learning. Student's attitudes towards patient safety improved in several dimensions: After the course, students rated the influence of fatigue on safety higher (6.23 vs. 6.42, p e-learning (p e-learning can be used to teach PS. Attitudes towards PS improved on several dimensions. Furthermore, we were able to demonstrate that a specifically designed e-learning program can foster the development of conceptual frameworks such as systems thinking, which facilitates the understanding of complex socio-technical systems within healthcare organisations.

Introducing Laboratory Safety.

Science.gov (United States)

DeLorenzo, Ronald

1985-01-01

Presents a simple, 10-item quiz designed to make students aware that they must learn laboratory safety. The items include questions on acid/base accidents, several types of fire extinguishers, and safety glassses. Answers and some explanations are included. (DH)

Changing the Learning Curve in Novice Laparoscopists: Incorporating Direct Visualization into the Simulation Training Program.

Science.gov (United States)

Dawidek, Mark T; Roach, Victoria A; Ott, Michael C; Wilson, Timothy D

A major challenge in laparoscopic surgery is the lack of depth perception. With the development and continued improvement of 3D video technology, the potential benefit of restoring 3D vision to laparoscopy has received substantial attention from the surgical community. Despite this, procedures conducted under 2D vision remain the standard of care, and trainees must become proficient in 2D laparoscopy. This study aims to determine whether incorporating 3D vision into a 2D laparoscopic simulation curriculum accelerates skill acquisition in novices. Postgraduate year-1 surgical specialty residents (n = 15) at the Schulich School of Medicine and Dentistry, at Western University were randomized into 1 of 2 groups. The control group practiced the Fundamentals of Laparoscopic Surgery peg-transfer task to proficiency exclusively under standard 2D laparoscopy conditions. The experimental group first practiced peg transfer under 3D direct visualization, with direct visualization of the working field. Upon reaching proficiency, this group underwent a perceptual switch, changing to standard 2D laparoscopy conditions, and once again trained to proficiency. Incorporating 3D direct visualization before training under standard 2D conditions significantly (p learning curves for each respective training protocol. An adaptive learning approach, which incorporates 3D direct visualization into a 2D laparoscopic simulation curriculum, accelerates skill acquisition. This is in contrast to previous work, possibly owing to the proficiency-based methodology employed, and has implications for resource savings in surgical training. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Comparison of plant-specific probabilistic safety assessments and lessons learned

Energy Technology Data Exchange (ETDEWEB)

Balfanz, H.P. [TUeV Nord, Hamburg (Germany); Berg, H.P. [Bundesamt fuer Strahlenschutz, Salzgitter (Germany); Steininger, U. [TUeV Energie- und Systemtechnik GmbH, Unternehmensgruppe TUeV Sueddeutschland, Muenchen (Germany)

2001-11-01

Probabilistic safety assessments (PSA) have been performed for all German nuclear power plants in operation. These assessments are mainly based on the recent German PSA guide and an earlier draft, respectively. However, comparison of these PSA show differences in the results which are discussed in this paper. Lessons learned from this comparison and further development of the PSA methodology are described. (orig.) [German] Probabilistische Sicherheitsanalysen (PSA) sind fuer alle in Betrieb befindlichen deutschen Kernkraftwerke durchgefuehrt worden. Diese Analysen basierten in der Regel auf dem aktuellen deutschen PSA-Leitfaden bzw. einem frueheren Entwurf. Ein Vergleich dieser PSA zeigt Unterschiede in den Ergebnissen, die in diesem Beitrag diskutiert werden. Erfahrungen und Erkenntnisse, die aus diesem Vergleich abgeleitet werden koennen, und weitere Entwicklungen der PSA-Methoden werden beschrieben. (orig.)

Safety in the c-suite: How chief executive officers influence organizational safety climate and employee injuries.

Science.gov (United States)

Tucker, Sean; Ogunfowora, Babatunde; Ehr, Dayle

2016-09-01

According to social learning theory, powerful and high status individuals can significantly influence the behaviors of others. In this paper, we propose that chief executive officers (CEOs) indirectly impact frontline injuries through the collective social learning experiences and effort of different groups of organizational actors-including members of the top management team (TMT), organizational supervisors, and frontline employees. We found support for our collective social learning model using data from 2,714 frontline employees, 1,398 supervisors, and 229 members of TMTs in 54 organizations. TMT members' experiences within a CEO-driven TMT safety climate was positively related to organizational supervisors' reports of the broader organizational safety climate and their subsequent collective support for safety (reported by frontline employees). In turn, supervisory support for safety was associated with fewer employee injuries at the individual level. We discuss the theoretical and practical implications of these findings for workplace safety research and practice. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Defining safety goals. 2. Basic Consideration on Defining Safety Goals

International Nuclear Information System (INIS)

Hakata, T.

2001-01-01

cancer and severe hereditary effects are 10 x 10 -2 /Sv and 1.3 x10 -2 /Sv, respectively. The basic safety goals can be expressed by the complementary accumulative distribution function (CCDF) of dose versus frequencies of events: Pc(C > Cp) 5 (Cp/Co) -α . The aversion factor a is here expressed by the following arbitrary equation, which gives a polynomial curve of the order of m on a logarithmic plane: α = a+b(log(Cp/Co)) m , where: Pc = CCDF frequency for Cp (/yr), Cp = dose (mSv), Co = Cp for Pc =1, a, b, m = constants. Figure 1 shows a typical tolerable risk profile (risk limit curve), which is drawn so that all the points obtained in the previous discussions are above the curve (Co=1, a=1, b=0.0772, and m = 2). Safety criteria by ANS (Ref. 2) and SHE (Ref. 3) are shown in Fig. 1 for comparison. An aversion of a factor of 2 is resulted between 1 mSv and 1 Sv. No ALARA is included, which must be considered in defining specific safety goals. The frequency of a single class of events must be lower than the CCDF profile, and a curve lower by a factor of 10 is drawn in Fig. 1. The doses referenced in the current Japanese safety guidelines and site criteria are shown in Fig. 1. The referenced doses seem reasonable, considering the conservatism in the analysis of design-basis accidents. Specific safety goals for each sort of facility can be defined based on the basic safety goals, reflecting the characteristics of the facilities and considering ALARA. The indexes of engineering terms, such as CMF and LERF, are preferable for nuclear power plants, although interpretation from dose to the engineering terms is needed. Other indexes may be used (such as frequency of criticality accidents, etc.) for facilities except for power plants. The applicability of safety goals will thus be improved. Figure 2 shows the relative risk factors (1, 1%, and 0.1%) versus the severity of radiation effects. This might indicate the adequacy of the risk factors. The absolute risk limits, which

How safe is the safety paradigm?

NARCIS (Netherlands)

O.A. Arah (Onyebuchi); N.S. Klazinga (Niek)

2004-01-01

textabstractThis paper reviews safety initiatives in the health systems of the UK, Canada, Australia, and the US. Initiatives to tackle safety shortcomings involve public-private collaborations. Patient safety agencies (to institute learning, action and safety culture), adverse

Operator learning effects in teleoperated rendezvous & docking

Science.gov (United States)

Wilde, M.; Harder, J.; Purschke, R.

Teleoperation of spacecraft proximity operations and docking requires delicate timing and coordination of spacecraft maneuvers. Experience has shown that human operators show large performance fluctuations in these areas, which are a major factor to be addressed in operator training. In order to allow the quantification of the impact of these human fluctuations on control system performance and the human perception of this performance, a learning curve study was conducted with teleoperated final approach and docking scenarios. Over a period of ten experiment days, three test participants were tasked with repeatedly completing a set of three training scenarios. The scenarios were designed to contain different combinations of the major elements of any final approach and docking situation, and to feature an increasing difficulty level. The individual difficulty levels for the three operators furthermore differed in the level of operator support functions available in their human-machine interfaces. Operator performance in the test scenarios were evaluated in the fields approach success and precision, docking safety, and approach efficiency by a combination of recorded maneuver data and questionnaires. The results show that operator experience and the associated learning curves increase operator performance substantially, regardless of the support system used. The paper also shows that the fluctuations in operator performance and self-perception are substantial between as well as within experiment days, and must be reckoned with in teleoperation system design and mission planning.

Working material. IAEA seismic safety of nuclear power plants. International workshop on lessons learned from strong earthquake

International Nuclear Information System (INIS)

2008-08-01

The International Workshop on Lessons Learned from Strong Earthquake was held at Kashiwazaki civic plaza, Kashiwazaki, Niigata-prefecture, Japan, for three days in June 2008. Kashiwazaki-Kariwa NPP (KK-NPP) is located in the city of Kashiwazaki and the village of Kariwa, and owned and operated by Tokyo Electric Power Company Ltd. (TEPCO). After it experienced the Niigata-ken Chuetsu-oki earthquake in July 2007, IAEA dispatched experts' missions twice and held technical discussions with TEPCO. Through such activities, the IAEA secretariat and experts obtained up-dated information of plant integrity, geological and seismological evaluation and developments of the consultation in the regulatory framework of Japan. Some of the information has been shared with the member states through the reports on findings and lessons learned from the missions to Japan. The international workshop was held to discuss and share the information of lessons learned from strong earthquakes in member states' nuclear installations. It provided the opportunity for participants from abroad to share the information of the recent earthquake and experience in Japan and to visit KK-NPP. And for experts in Japan, the workshop provided the opportunity to share the international approach on seismic-safety-related measures and experiences. The workshop was organised by the IAEA as a part of an extra budgetary project, in cooperation with OECD/NEA, hosted by Japanese organisations including Nuclear and Industrial Safety Agency (NISA), Nuclear Safety Commission (NSC), and Japan Nuclear Energy Safety Organization (JNES). The number of the workshop participants was 70 experts from outside Japan, 27 countries and 2 international organisations, 154 Japanese experts and 81 audience and media personnel, totalling to 305 participants. The three-day workshop was open to the media including the site visit, and covered by NHK (the nation's public broadcasting corporation) and nation-wide and local television

French PWR safety philosophy

International Nuclear Information System (INIS)

Conte, M.

1986-05-01

Increasing knowledge and lessons learned from starting and operating experience of French nuclear power plants, completed by the experience learned from the operation of foreign reactors, has contributed to the improvement of French PWR design and safety philosophy. Based on a deterministic approach, the French safety analysis was progressively completed by a probabilistic approach, each of them having possibilities and limits. As a consequence of the global risk objective set in 1977 for nuclear reactors, safety analysis was extended to the evaluation of events more complex than the conventional ones, and later to the evaluation of the feasibility of the offsite emergency plans in case of severe accidents

A Collaborative Learning Network Approach to Improvement: The CUSP Learning Network.

Science.gov (United States)

Weaver, Sallie J; Lofthus, Jennifer; Sawyer, Melinda; Greer, Lee; Opett, Kristin; Reynolds, Catherine; Wyskiel, Rhonda; Peditto, Stephanie; Pronovost, Peter J

2015-04-01

Collaborative improvement networks draw on the science of collaborative organizational learning and communities of practice to facilitate peer-to-peer learning, coaching, and local adaption. Although significant improvements in patient safety and quality have been achieved through collaborative methods, insight regarding how collaborative networks are used by members is needed. Improvement Strategy: The Comprehensive Unit-based Safety Program (CUSP) Learning Network is a multi-institutional collaborative network that is designed to facilitate peer-to-peer learning and coaching specifically related to CUSP. Member organizations implement all or part of the CUSP methodology to improve organizational safety culture, patient safety, and care quality. Qualitative case studies developed by participating members examine the impact of network participation across three levels of analysis (unit, hospital, health system). In addition, results of a satisfaction survey designed to evaluate member experiences were collected to inform network development. Common themes across case studies suggest that members found value in collaborative learning and sharing strategies across organizational boundaries related to a specific improvement strategy. The CUSP Learning Network is an example of network-based collaborative learning in action. Although this learning network focuses on a particular improvement methodology-CUSP-there is clear potential for member-driven learning networks to grow around other methods or topic areas. Such collaborative learning networks may offer a way to develop an infrastructure for longer-term support of improvement efforts and to more quickly diffuse creative sustainment strategies.

Experience curve for natural gas production by hydraulic fracturing

International Nuclear Information System (INIS)

Fukui, Rokuhei; Greenfield, Carl; Pogue, Katie; Zwaan, Bob van der

2017-01-01

From 2007 to 2012 shale gas production in the US expanded at an astounding average growth rate of over 50%/yr, and thereby increased nearly tenfold over this short time period alone. Hydraulic fracturing technology, or “fracking”, as well as new directional drilling techniques, played key roles in this shale gas revolution, by allowing for extraction of natural gas from previously unviable shale resources. Although hydraulic fracturing technology had been around for decades, it only recently became commercially attractive for large-scale implementation. As the production of shale gas rapidly increased in the US over the past decade, the wellhead price of natural gas dropped substantially. In this paper we express the relationship between wellhead price and cumulative natural gas output in terms of an experience curve, and obtain a learning rate of 13% for the industry using hydraulic fracturing technology. This learning rate represents a measure for the know-how and skills accumulated thus far by the US shale gas industry. The use of experience curves for renewable energy options such as solar and wind power has allowed analysts, practitioners, and policy makers to assess potential price reductions, and underlying cost decreases, for these technologies in the future. The reasons for price reductions of hydraulic fracturing are fundamentally different from those behind renewable energy technologies – hence they cannot be directly compared – and hydraulic fracturing may soon reach, or maybe has already attained, a lower bound for further price reductions, for instance as a result of its water requirements or environmental footprint. Yet, understanding learning-by-doing phenomena as expressed by an industry-wide experience curve for shale gas production can be useful for strategic planning in the gas sector, as well as assist environmental policy design, and serve more broadly as input for projections of energy system developments. - Highlights: • Hydraulic

The association between event learning and continuous quality improvement programs and culture of patient safety.

Science.gov (United States)

Mazur, Lukasz; Chera, Bhishamjit; Mosaly, Prithima; Taylor, Kinley; Tracton, Gregg; Johnson, Kendra; Comitz, Elizabeth; Adams, Robert; Pooya, Pegah; Ivy, Julie; Rockwell, John; Marks, Lawrence B

2015-01-01

To present our approach and results from our quality and safety program and to report their possible impact on our culture of patient safety. We created an event learning system (termed a "good catch" program) and encouraged staff to report any quality or safety concerns in real time. Events were analyzed to assess the utility of safety barriers. A formal continuous quality improvement program was created to address these reported events and make improvements. Data on perceptions of the culture of patient safety were collected using the Agency for Health Care Research and Quality survey administered before, during, and after the initiatives. Of 560 good catches reported, 367 could be ascribed to a specific step on our process map. The calculated utility of safety barriers was highest for those embedded into the pretreatment quality assurance checks performed by physicists and dosimetrists (utility score 0.53; 93 of 174) and routine checks done by therapists on the initial day of therapy. Therapists and physicists reported the highest number of good catches (24% each). Sixty-four percent of events were caused by performance issues (eg, not following standardized processes, including suboptimal communications). Of 31 initiated formal improvement events, 26 were successfully implemented and sustained, 4 were discontinued, and 1 was not implemented. Most of the continuous quality improvement program was conducted by nurses (14) and therapists (7). Percentages of positive responses in the patient safety culture survey appear to have increased on all dimensions (p continuous quality improvement programs can be successfully implemented and that there are contemporaneous improvements in the culture of safety. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

How safe is the safety paradigm?

NARCIS (Netherlands)

Arah, O. A.; Klazinga, N. S.

2004-01-01

This paper reviews safety initiatives in the health systems of the UK, Canada, Australia, and the US. Initiatives to tackle safety shortcomings involve public-private collaborations. Patient safety agencies (to institute learning, action and safety culture), adverse event reporting and, to a lesser

Lessons Learned in the Update of a Safety Limit for the High Flux Isotope Reactor

International Nuclear Information System (INIS)

Cook, David Howard

2009-01-01

A recent unreviewed safety question (USQ) regarding a portion of the High Flux Isotope Reactor (HFIR) transient decay heat removal analysis focused on applicability of a heat transfer correlation at the low flow end of reactor operations. During resolution of this issue, review of the correlations used to establish the safety limit (SL) on reactor flux-to-flow ratio revealed the need to change the magnitude of the SL at the low flow end of reactor operations and the need to update the hot spot fuel damage criteria to incorporate current knowledge involving parallel channel flow stability. Because of the original safety design strategy for the reactor, resolution of the issues for the flux-to-flow ratio involved reevaluation of all key process variable SLs and limiting control settings (LCSs) using the current version of the heat transfer analysis code for the reactor. Goals of the work involved updating and upgrading the SL analysis where necessary, while preserving the safety design strategy for the reactor. Changes made include revisions to the safety design criteria at low flows to address the USQ, update of the process- and analysis input-variable uncertainty considerations, and upgrade of the safety design criteria at high flow. The challenges faced during update/upgrade of this SL and LCS are typical of the problems found in the integration of safety into the design process for a complex facility. In particular, the problems addressed in the area of instrument uncertainties provide valuable lessons learned for establishment and configuration control of SLs for large facilities

Learning from safety in other industries

NARCIS (Netherlands)

Terwel, K.C.; Zwaard, W

2012-01-01

The Dutch building industry has been shocked by some major structural accidents during the last 10 years with buildings during construction as well as with delivered buildings. Several initiatives were started to improve the safety. In other industries the safety awareness seemed to be more

Cost-effective facility disposition planning with safety and health lessons learned and good practices from the Oak Ridge Decontamination and Decommissioning Program

International Nuclear Information System (INIS)

1998-05-01

An emphasis on transition and safe disposition of DOE excess facilities has brought about significant challenges to managing worker, public, and environmental risks. The transition and disposition activities involve a diverse range of hazardous facilities that are old, poorly maintained, and contain radioactive and hazardous substances, the extent of which may be unknown. In addition, many excess facilities do not have historical facility documents such as operating records, plant and instrumentation diagrams, and incident records. The purpose of this report is to present an overview of the Oak Ridge Decontamination and Decommissioning (D and D) Program, its safety performance, and associated safety and health lessons learned and good practices. Illustrative examples of these lessons learned and good practices are also provided. The primary focus of this report is on the safety and health activities and implications associated with the planning phase of Oak Ridge facility disposition projects. Section 1.0 of this report provides the background and purpose of the report. Section 2.0 presents an overview of the facility disposition activities from which the lessons learned and good practices discussed in Section 3.0 were derived

A preliminary study on the application of system dynamics methodology to organizational safety in nuclear power plants: Learning from past models

Energy Technology Data Exchange (ETDEWEB)

Do, Giang [Sol Bridge International School of Business, Daejeon (Korea, Republic of); Kim, Sakil; Lee, Yong Hee; Lee, Yong Hee [KAERI, Daejeon (Korea, Republic of)

2012-10-15

Besides technical design, organizational and human factor are of increasing interest in literature on nuclear safety. Among the methodologies employed to study these factors, System Dynamics (SD) is considered to be suitable for addressing the complexity and dynamicity of the organizational system in nuclear power plants (NPPs). In the following sections, the method will be described and its several prior applications to studying organizational safety will be introduced. An SD model with emphasis on the role of organizational learning in organizational safety will be presented.

The Radiation Safety Culture: Image Gently

International Nuclear Information System (INIS)

Applegate, E.K.

2015-01-01

Barriers to Implementing Safety include Silos of Knowledge, Time, training and Resources. Creating a Safety Culture in Healthcare include Decreased authority gradients, Checklists and audits (QA), Use of structured language (SBAR), Situation, Background, Assessment, Recommendation Team briefings and debriefings (immediate learning, team building tools), Lifelong learning (PQI). Use of Collective Learning Opportunities - QA and PQI that include Web sites: IG, WFPI, IAEA, ISR and Data Registries: ACR . The Key Principles of Radiation Protection: When do we learn them? For Occupational Workers:Time, Distance and Shielding while those of For Patients: Justification, Optimization and Dose Limits (dose reference levels)

System Design and the Safety Basis

International Nuclear Information System (INIS)

Ellingson, Darrel

2008-01-01

The objective of this paper is to present the Bechtel Jacobs Company, LLC (BJC) Lessons Learned for system design as it relates to safety basis documentation. BJC has had to reconcile incomplete or outdated system description information with current facility safety basis for a number of situations in recent months. This paper has relevance in multiple topical areas including documented safety analysis, decontamination and decommissioning (D and D), safety basis (SB) implementation, safety and design integration, potential inadequacy of the safety analysis (PISA), technical safety requirements (TSR), and unreviewed safety questions. BJC learned that nuclear safety compliance relies on adequate and well documented system design information. A number of PIS As and TSR violations occurred due to inadequate or erroneous system design information. As a corrective action, BJC assessed the occurrences caused by systems design-safety basis interface problems. Safety systems reviewed included the Molten Salt Reactor Experiment (MSRE) Fluorination System, K-1065 fire alarm system, and the K-25 Radiation Criticality Accident Alarm System. The conclusion was that an inadequate knowledge of system design could result in continuous non-compliance issues relating to nuclear safety. This was especially true with older facilities that lacked current as-built drawings coupled with the loss of 'historical knowledge' as personnel retired or moved on in their careers. Walkdown of systems and the updating of drawings are imperative for nuclear safety compliance. System design integration with safety basis has relevance in the Department of Energy (DOE) complex. This paper presents the BJC Lessons Learned in this area. It will be of benefit to DOE contractors that manage and operate an aging population of nuclear facilities

Can CCM law properly represent all extinction curves?

International Nuclear Information System (INIS)

Geminale, Anna; Popowski, Piotr

2005-01-01

We present the analysis of a large sample of lines of sight with extinction curves covering wavelength range from near-infrared (NIR) to ultraviolet (UV). We derive total to selective extinction ratios based on the Cardelli, Clayton and Mathis (1989, CCM) law, which is typically used to fit the extinction data both for diffuse and dense interstellar medium. We conclude that the CCM law is able to fit most of the extinction curves in our sample. We divide the remaining lines of sight with peculiar extinction into two groups according to two main behaviors: a) the optical/IR or/and UV wavelength region cannot be reproduced by the CCM formula; b) the optical/NIR and UV extinction data are best fit by the CCM law with different values of R v . We present examples of such curves. The study of both types of peculiar cases can help us to learn about the physical processes that affect dust in the interstellar medium, e.g., formation of mantles on the surface of grains, evaporation, growing or shattering

Customs and regulations in the learning process of operational safety. Lernprozesse zur Arbeitssicherheit

Energy Technology Data Exchange (ETDEWEB)

Burkhardt, F [Frankfurt Univ. (Germany, F.R.)

1991-06-01

In recent years, the human factor in accidents has come into prominence in consideration. Today, effective psychological concepts are replacing traditional ones. The learning psychology stems from the fact that only a procedure which has been successful is repeated and eventually becomes a normal standard, whilst procedures which bring with them disadvantages are eliminated. From the point of view of operational safety, strategies are being derived for the development of procedures and are being introduced as methods for application. Controls on actions are described by means of field studies. (orig.).

Occupational Therapy Home Safety Intervention via Telehealth

Directory of Open Access Journals (Sweden)

Lori E. Breeden

2016-07-01

Full Text Available Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist.  In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety.  After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions each.  Sessions were recorded and transcribed.  Data were examined using content analysis.  A content analysis identified the following themes as well as an understanding of the learning process.  Analyses yielded themes of: the value of photos to support learning, the value of narrative learning related to home safety education, abstract versus concrete learners.  Procedural findings are included to support future endeavors.  Findings indicate that within a wellness context, home safety education for older adults can be delivered effectively via telehealth when using photography as a part of an occupational therapy intervention.

Evaluation of Effects of Warning Sign Position on Driving Behavior in Horizontal Sharp Curves

Directory of Open Access Journals (Sweden)

Xiao-hua Zhao

2015-02-01

Full Text Available In present time, the guidelines on warning sign position in the China National Standard lack detailed and standard regulations of placing warning signs on sharp curves, which may cause road safety problems. Therefore, this paper briefly discussed how to optimize the position of a warning sign on a sharp curve through a driving simulator experiment. This study concluded that a warning sign placed at different positions prior to a sharp curve will have different influence ranges for drivers approaching and negotiating the curve. Meanwhile, different positions of a warning sign imposed different effect obviously on the adjustment of vehicle's lane position on sharp curves with the same radius, especially at the midpoint of a sharp curve. The evaluation results of five positions (0 m, 50 m, 100 m, 200 m, and 400 m in advance showed that only when the warning signs were placed 100 m or 200 m prior to sharp curves, can they achieve positive influence on driving behavior. On this basis, the authors look forward to providing rationalization proposals in selecting the best position of a warning sign on a sharp curve for the engineering implementation and national standard.

"Alarm-corrected" ergonomic armrest use could improve learning curves of novices on robotic simulator.

Science.gov (United States)

Yang, Kun; Perez, Manuela; Hossu, Gabriela; Hubert, Nicolas; Perrenot, Cyril; Hubert, Jacques

2017-01-01

In robotic surgery, the professional ergonomic habit of using an armrest reduces operator fatigue and increases the precision of motion. We designed and validated a pressure surveillance system (PSS) based on force sensors to investigate armrest use. The objective was to evaluate whether adding an alarm to the PSS system could shorten ergonomic training and improve performance. Twenty robot and simulator-naïve participants were recruited and randomized in two groups (A and B). The PSS was installed on a robotic simulator, the dV-Trainer, to detect contact with the armrest. The Group A members completed three tasks on the dV-Trainer without the alarm, making 15 attempts at each task. The Group B members practiced the first two tasks with the alarm and then completed the final tasks without the alarm. The simulator provided an overall score reflecting the trainees' performance. We used the new concept of an "armrest load" score to describe the ergonomic habit of using the armrest. Group B had a significantly higher performance score (p ergonomic errors and accelerated professional ergonomic habit acquisition. The combination of the PSS and alarm is effective in significantly shortening the learning curve in the robotic training process.

Safety Culture: A Requirement for New Business Models — Lessons Learned from Other High Risk Industries

International Nuclear Information System (INIS)

Kecklund, L.

2016-01-01

-cost subcontractors can turn out to be much more expensive due to interface proliferation. Other negative effects are social dumping by external contractors and loss of competence if procurement requirements are not taking quality and safety issues into account. Based on MTO Safety’s extensive experience in the nuclear domain and work on safety management and safety culture in the aviation, railway and maritime domain, the paper will present lessons learned which are applicable to the nuclear industry for facing the major challenges ahead. Assuring safety is a fundamental requirement for obtaining a licence to operate a business in nuclear power, aviation and railways, thus safety culture is an essential requirement for a successful business. Therefore safety culture must be part of any new business model in high risk industries. In the future safety culture and leadership commitment and skills in creating safety culture will be even more important. The paper will discuss how companies and public utilities are to achieve this and how the regulators are to assess this where learning across industries is a key success factor. (author)

Simulation of a G-tolerance curve using the pulsatile cardiovascular model

Science.gov (United States)

Solomon, M.; Srinivasan, R.

1985-01-01

A computer simulation study, performed to assess the ability of the cardiovascular model to reproduce the G tolerance curve (G level versus tolerance time) is reported. A composite strength duration curve derived from experimental data obtained in human centrifugation studies was used for comparison. The effects of abolishing automomic control and of blood volume loss on G tolerance were also simulated. The results provide additional validation of the model. The need for the presence of autonomic reflexes even at low levels of G is pointed out. The low margin of safety with a loss of blood volume indicated by the simulation results underscores the necessity for protective measures during Shuttle reentry.

On-line learning through simple perceptron learning with a margin.

Science.gov (United States)

Hara, Kazuyuki; Okada, Masato

2004-03-01

We analyze a learning method that uses a margin kappa a la Gardner for simple perceptron learning. This method corresponds to the perceptron learning when kappa = 0 and to the Hebbian learning when kappa = infinity. Nevertheless, we found that the generalization ability of the method was superior to that of the perceptron and the Hebbian methods at an early stage of learning. We analyzed the asymptotic property of the learning curve of this method through computer simulation and found that it was the same as for perceptron learning. We also investigated an adaptive margin control method.

A multiplicative reinforcement learning model capturing learning dynamics and interindividual variability in mice

OpenAIRE

Bathellier, Brice; Tee, Sui Poh; Hrovat, Christina; Rumpel, Simon

2013-01-01

Learning speed can strongly differ across individuals. This is seen in humans and animals. Here, we measured learning speed in mice performing a discrimination task and developed a theoretical model based on the reinforcement learning framework to account for differences between individual mice. We found that, when using a multiplicative learning rule, the starting connectivity values of the model strongly determine the shape of learning curves. This is in contrast to current learning models ...

Implementation of the safety culture for HANARO Safety Management

International Nuclear Information System (INIS)

Wu, Jongsup; Han, Geeyang; Kim, Iksoo

2008-01-01

Safety is the fundamental principal upon which the management system is based. The IAEA INSAG(International Nuclear Safety Group) states the general aims of the safety management system. One of which is to foster and support a strong safety culture through the development and reinforcement of good safety attitudes and behavior in individuals and teams so as to allow them to carry out their tasks safety. The safety culture activities have been implemented and the importance of safety management in nuclear activities for a reactor application and utilization has also been emphasized more than 10 years in HANARO which is a 30 MW multi-purpose research reactor and achieved its first criticality in February 1995. The safety culture activities and implementations have been conducted continuously to enhance its safe operation like the seminars and lectures related to safety matters, participation in international workshops, the development of safety culture indicators, the survey on the attitude of safety culture, the development of operational safety performance indicators (SPIs), the preparation of a safety text book and the development of an e-Learning program for safety education. (author)

WE-G-BRA-03: Developing a Culture of Patient Safety Utilizing the National Radiation Oncology Incident Learning System (ROILS)

Energy Technology Data Exchange (ETDEWEB)

Hasson, B; Workie, D; Geraghty, C [Anne Arundel Medical Center, Annapolis, MD (United States)

2015-06-15

Purpose: To transition from an in-house incident reporting system to a ROILS standards system with the intent to develop a safety focused culture in the Department and enroll in ROILS. Methods: Since the AAPM Safety Summit (2010) several safety and reporting systems have been implemented within the Department. Specific checklists and SBAR reporting systems were introduced. However, the active learning component was lost due to reporting being viewed with distrust and possible retribution.To Facilitate introducing ROILS each leader in the Department received a copy of the ROILS participation guide. Four specific tasks were assigned to each leader: develop a reporting tree, begin the ROILS based system, facilitate adopting ROILS Terminology, and educate the staff on expectations of safety culture. Next, the ROILS questions were broken down into area specific questions (10–15) per departmental area. Excel spreadsheets were developed for each area and setup for error reporting entries. The Role of the Process Improvement Committee (PI) has been modified to review and make recommendations based on the ROILS entries. Results: The ROILS based Reporting has been in place for 4 months. To date 64 reports have been entered. Since the adoption of ROILS the reporting of incidents has increased from 2/month to 18/month on average. Three reports had a dosimetric effect on the patient (<5%) dose variance. The large majority of entries have been Characterized as Processes not followed or not sure how to Characterize, and Human Behavior. Conclusion: The majority of errors are typo’s that create confusion. The introduction of the ROILS standards has provided a platform for making changes to policies that increase patient safety. The goal is to develop a culture that sees reporting at a national level as a safe and effective way to improve our safety, and to dynamically learn from other institutions reporting.

WE-G-BRA-03: Developing a Culture of Patient Safety Utilizing the National Radiation Oncology Incident Learning System (ROILS)

International Nuclear Information System (INIS)

Hasson, B; Workie, D; Geraghty, C

2015-01-01

Purpose: To transition from an in-house incident reporting system to a ROILS standards system with the intent to develop a safety focused culture in the Department and enroll in ROILS. Methods: Since the AAPM Safety Summit (2010) several safety and reporting systems have been implemented within the Department. Specific checklists and SBAR reporting systems were introduced. However, the active learning component was lost due to reporting being viewed with distrust and possible retribution.To Facilitate introducing ROILS each leader in the Department received a copy of the ROILS participation guide. Four specific tasks were assigned to each leader: develop a reporting tree, begin the ROILS based system, facilitate adopting ROILS Terminology, and educate the staff on expectations of safety culture. Next, the ROILS questions were broken down into area specific questions (10–15) per departmental area. Excel spreadsheets were developed for each area and setup for error reporting entries. The Role of the Process Improvement Committee (PI) has been modified to review and make recommendations based on the ROILS entries. Results: The ROILS based Reporting has been in place for 4 months. To date 64 reports have been entered. Since the adoption of ROILS the reporting of incidents has increased from 2/month to 18/month on average. Three reports had a dosimetric effect on the patient (<5%) dose variance. The large majority of entries have been Characterized as Processes not followed or not sure how to Characterize, and Human Behavior. Conclusion: The majority of errors are typo’s that create confusion. The introduction of the ROILS standards has provided a platform for making changes to policies that increase patient safety. The goal is to develop a culture that sees reporting at a national level as a safe and effective way to improve our safety, and to dynamically learn from other institutions reporting

Placement of central venous port catheters and peripherally inserted central catheters in the routine clinical setting of a radiology department: analysis of costs and intervention duration learning curve.

Science.gov (United States)

Rotzinger, Roman; Gebauer, Bernhard; Schnapauff, Dirk; Streitparth, Florian; Wieners, Gero; Grieser, Christian; Freyhardt, Patrick; Hamm, Bernd; Maurer, Martin H

2017-12-01

Background Placement of central venous port catheters (CVPS) and peripherally inserted central catheters (PICC) is an integral component of state-of-the-art patient care. In the era of increasing cost awareness, it is desirable to have more information to comprehensively assess both procedures. Purpose To perform a retrospective analysis of interventional radiologic implantation of CVPS and PICC lines in a large patient population including a cost analysis of both methods as well as an investigation the learning curve in terms of the interventions' durations. Material and Methods All CVPS and PICC line related interventions performed in an interventional radiology department during a three-year period from January 2011 to December 2013 were examined. Documented patient data included sex, venous access site, and indication for CVPS or PICC placement. A cost analysis including intervention times was performed based on the prorated costs of equipment use, staff costs, and expenditures for disposables. The decrease in intervention duration in the course of time conformed to the learning curve. Results In total, 2987 interventions were performed by 16 radiologists: 1777 CVPS and 791 PICC lines. An average implantation took 22.5 ± 0.6 min (CVPS) and 10.1 ± 0.9 min (PICC lines). For CVPS, this average time was achieved by seven radiologists newly learning the procedures after performing 20 CVPS implantations. Total costs per implantation were €242 (CVPS) and €201 (PICC lines). Conclusion Interventional radiologic implantations of CVPS and PICC lines are well-established procedures, easy to learn by residents, and can be implanted at low costs.

An exploratory study of knowledge brokering in hospital settings: facilitating knowledge sharing and learning for patient safety?

Science.gov (United States)

Waring, Justin; Currie, Graeme; Crompton, Amanda; Bishop, Simon

2013-12-01

This paper reports on an exploratory study of intra-organisational knowledge brokers working within three large acute hospitals in the English National Health Services. Knowledge brokering is promoted as a strategy for supporting knowledge sharing and learning in healthcare, especially in the diffusion of research evidence into practice. Less attention has been given to brokers who support knowledge sharing and learning within healthcare organisations. With specific reference to the need for learning around patient safety, this paper focuses on the structural position and role of four types of intra-organisational brokers. Through ethnographic research it examines how variations in formal role, location and relationships shape how they share and support the use of knowledge across organisational and occupational boundaries. It suggests those occupying hybrid organisational roles, such as clinical-managers, are often best positioned to support knowledge sharing and learning because of their 'ambassadorial' type position and legitimacy to participate in multiple communities through dual-directed relationships. Copyright © 2013 Elsevier Ltd. All rights reserved.

Spaghetti Sine Curves: Virtual Environments for Reasoning and Sense Making

Science.gov (United States)

Özgün-Koca, S. Asli; Edwards, Michael Todd; Meagher, Michael

2013-01-01

In a recent collaboration with an area high school teacher, the authors were asked to develop an introductory sinusoidal curves lesson for a group of second-year algebra students. Because the topic was abstract and unfamiliar to these tenth graders, they looked for hands-on lessons to support their learning. One lesson that they found, which they…

Implementation of the safety culture for HANARO safety management

Energy Technology Data Exchange (ETDEWEB)

Wu, Jongsup; Han, Geeyang; Kim, Iksoo [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2008-11-15

Safety is the fundamental principal upon which a management system is based. The IAEA INSAG (International Nuclear Safety Group) states the general aims of a safety management system. One of which is to foster and support a strong safety culture through the development and reinforcement of good safety attitudes and behavior in individuals and teams, so as to allow them to carry out their tasks safely. The safety culture activities have been implemented and the importance of a safety management in nuclear activities for a reactor application and utilization has also been emphasized for more than 10 years in HANARO which is a 30MW multi-purpose research reactor that achieved its first criticality in February 1995. The safety culture activities and implementations have been conducted continuously to enhance its safe operation such as the seminars and lectures related to safety matters, participation in international workshops and the development of safety culture indicators, a survey on the attitude of HANARO staff toward the safety culture, the development of operational safety performance indicators (SPIs), the preparation of a safety text book and the development of a e-learning program for a safety education purpose.

Implementation of the safety culture for HANARO safety management

International Nuclear Information System (INIS)

Wu, Jongsup; Han, Geeyang; Kim, Iksoo

2008-01-01

Safety is the fundamental principal upon which a management system is based. The IAEA INSAG (International Nuclear Safety Group) states the general aims of a safety management system. One of which is to foster and support a strong safety culture through the development and reinforcement of good safety attitudes and behavior in individuals and teams, so as to allow them to carry out their tasks safely. The safety culture activities have been implemented and the importance of a safety management in nuclear activities for a reactor application and utilization has also been emphasized for more than 10 years in HANARO which is a 30MW multi-purpose research reactor that achieved its first criticality in February 1995. The safety culture activities and implementations have been conducted continuously to enhance its safe operation such as the seminars and lectures related to safety matters, participation in international workshops and the development of safety culture indicators, a survey on the attitude of HANARO staff toward the safety culture, the development of operational safety performance indicators (SPIs), the preparation of a safety text book and the development of a e-learning program for a safety education purpose

Use of the cumulative sum method (CUSUM) to assess the learning curves of ultrasound-guided continuous femoral nerve block.

Science.gov (United States)

Kollmann-Camaiora, A; Brogly, N; Alsina, E; Gilsanz, F

2017-10-01

Although ultrasound is a basic competence for anaesthesia residents (AR) there is few data available on the learning process. This prospective observational study aims to assess the learning process of ultrasound-guided continuous femoral nerve block and to determine the number of procedures that a resident would need to perform in order to reach proficiency using the cumulative sum (CUSUM) method. We recruited 19 AR without previous experience. Learning curves were constructed using the CUSUM method for ultrasound-guided continuous femoral nerve block considering 2 success criteria: a decrease of pain score>2 in a [0-10] scale after 15minutes, and time required to perform it. We analyse data from 17 AR for a total of 237 ultrasound-guided continuous femoral nerve blocks. 8/17 AR became proficient for pain relief, however all the AR who did more than 12 blocks (8/8) became proficient. As for time of performance 5/17 of AR achieved the objective of 12minutes, however all the AR who did more than 20 blocks (4/4) achieved it. The number of procedures needed to achieve proficiency seems to be 12, however it takes more procedures to reduce performance time. The CUSUM methodology could be useful in training programs to allow early interventions in case of repeated failures, and develop competence-based curriculum. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

KHNP Safety Culture Framework based on Global Standard, and Lessons learned from Safety Culture Evaluation

International Nuclear Information System (INIS)

Kim, Younggab; Hur, Nam Young; Jeong, Hyeon Jong

2015-01-01

In order to eliminate the vague fears of the people about the nuclear power and operate continuously NPPs, a strong safety culture of NPPs should be demonstrated. Strong safety culture awareness of workers can overcome social distrust about NPPs. KHNP has been a variety efforts to improve and establish safety culture of NPPs. Safety culture framework applying global standards was set up and safety culture assessment has been carried out periodically to enhance safety culture of workers. In addition, KHNP developed various safety culture contents and they are being used in NPPs by workers. As a result of these efforts, safety culture awareness of workers is changed positively and the safety environment of NPPs is expected to be improved. KHNP makes an effort to solve areas for improvement derived from safety culture assessment. However, there are some areas to take a long time in completing the work. Therefore, these actions are necessary to be carried out consistently and continuously. KHNP also developed recently safety culture enhancement system based on web. All information related to safety culture in KHNP will be shared through this web system and this system will be used to safety culture assessment. In addition to, KHNP plans to develop safety culture indicators for monitoring the symptoms of safety culture weakening

KHNP Safety Culture Framework based on Global Standard, and Lessons learned from Safety Culture Evaluation

Energy Technology Data Exchange (ETDEWEB)

Kim, Younggab; Hur, Nam Young; Jeong, Hyeon Jong [KHNP Central Research Institute, Daejeon (Korea, Republic of)

2015-05-15

In order to eliminate the vague fears of the people about the nuclear power and operate continuously NPPs, a strong safety culture of NPPs should be demonstrated. Strong safety culture awareness of workers can overcome social distrust about NPPs. KHNP has been a variety efforts to improve and establish safety culture of NPPs. Safety culture framework applying global standards was set up and safety culture assessment has been carried out periodically to enhance safety culture of workers. In addition, KHNP developed various safety culture contents and they are being used in NPPs by workers. As a result of these efforts, safety culture awareness of workers is changed positively and the safety environment of NPPs is expected to be improved. KHNP makes an effort to solve areas for improvement derived from safety culture assessment. However, there are some areas to take a long time in completing the work. Therefore, these actions are necessary to be carried out consistently and continuously. KHNP also developed recently safety culture enhancement system based on web. All information related to safety culture in KHNP will be shared through this web system and this system will be used to safety culture assessment. In addition to, KHNP plans to develop safety culture indicators for monitoring the symptoms of safety culture weakening.

Safety aspects and shield design of a Poton irradiator

International Nuclear Information System (INIS)

Mehta, S.K.; Nayak, A.R.; Bongirwar, D.R.; Modi, R.K.; Ramkumar, M.S.

1998-01-01

An irradiation plant, POTON, for irradiation of potatoes and onions is being set up at Nashik. Shield design and safety features of this plant incorporate some novel and innovative features like a compact cell, curved cell boundaries for smooth conveyor movement though the cell labyrinth and conform to ICRP and AERB design safety requirements. The safety features include multiple safety interlocks, audio-visual alarms, scram switches and trip wire for avoiding accidental exposures. (author)

Occupational Therapy Home Safety Intervention via Telehealth