WorldWideScience

Sample records for care improve efficiency

  1. Improving care efficiency in a radiotherapy center using Lean philosophy

    OpenAIRE

    Trilling, Lorraine; Pellet, Bertrand; Delacroix, Sabine; Colella Fleury, Hélène; Marcon, Eric

    2010-01-01

    In the field of health care, as in production or services, there is a need for tailor made methodology to help managers improving quality of care as well as efficiency of the organization. Quality Improvement (QI) has become a major preoccupation in the current context where hospitals and health care services need to provide a high level of care and a welcoming environment for patients while reducing costs and maintaining a pleasant work atmosphere for staff. In this paper we present how, wit...

  2. Teleglaucoma: improving access and efficiency for glaucoma care.

    Science.gov (United States)

    Kassam, Faazil; Yogesan, Kanagasingam; Sogbesan, Enitan; Pasquale, Louis R; Damji, Karim F

    2013-01-01

    Teleglaucoma is the application of telemedicine for glaucoma. We review and present the current literature on teleglaucoma; present our experience with teleglaucoma programs in Alberta, Canada and Western Australia; and discuss the challenges and opportunities in this emerging field. Teleglaucoma is a novel area that was first explored a little over a decade ago and early studies highlighted the technical challenges of delivering glaucoma care remotely. Advanced technologies have since emerged that show great promise in providing access to underserviced populations. Additionally, these technologies can improve the efficiency of healthcare systems burdened with an increasing number of patients with glaucoma, and a limited supply of ophthalmologists. Additional benefits of teleglaucoma systems include e-learning and e-research. Further work is needed to fully validate and study the cost and comparative effectiveness of this approach relative to traditional models of healthcare. PMID:23741133

  3. Integrating hospital administrative data to improve health care efficiency and outcomes: "the socrates story".

    Science.gov (United States)

    Lawrence, Justin; Delaney, Conor P

    2013-03-01

    Evaluation of health care outcomes has become increasingly important as we strive to improve quality and efficiency while controlling cost. Many groups feel that analysis of large datasets will be useful in optimizing resource utilization; however, the ideal blend of clinical and administrative data points has not been developed. Hospitals and health care systems have several tools to measure cost and resource utilization, but the data are often housed in disparate systems that are not integrated and do not permit multisystem analysis. Systems Outcomes and Clinical Resources AdministraTive Efficiency Software (SOCRATES) is a novel data merging, warehousing, analysis, and reporting technology, which brings together disparate hospital administrative systems generating automated or customizable risk-adjusted reports. Used in combination with standardized enhanced care pathways, SOCRATES offers a mechanism to improve the quality and efficiency of care, with the ability to measure real-time changes in outcomes.

  4. The Systemic Changes to Improve Efficiency in Polish Primary Health Care.

    Science.gov (United States)

    Holecki, Tomasz; Romaniuk, Piotr; Woźniak-Holecka, Joanna

    2016-01-01

    Primary health care is an important part of any health care system. In highly developed countries it secures the population's most elementary health needs, with particular emphasis on preventive care and early intervention. Polish PHC model is currently undergoing a thorough transformation, associated with the need to adapt to standards designated based on the WHO's criteria, and with reference to the experience of other European countries. The paper describes the process of changes being carried out, in the context of previous experiences of reform relating to the sphere of organization, processes and efficiency. A review and systematization has been made, with regard to the undertaken activities in the field of deregulation and change of legal provisions, which are aimed at achieving the improvement of the efficiency of treatment and resource allocation. A set of recommendations based on expert's discourse have also been provided, with respect to future directions of Polish PHC transformation. PMID:27468269

  5. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care

    Directory of Open Access Journals (Sweden)

    Darko Gvozdanovi_

    2007-09-01

    Full Text Available In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1 to provide efficient healthcare-related data management in support of decision-making processes; (2 to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

  6. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care.

    Science.gov (United States)

    Gvozdanović, Darko; Koncar, Miroslav; Kojundzić, Vinko; Jezidzić, Hrvoje

    2007-01-01

    In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1) to provide efficient healthcare-related data management in support of decision-making processes; (2) to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS) on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories) into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution. PMID:18005567

  7. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care

    OpenAIRE

    Darko Gvozdanovi_; Miroslav Kon_ar; Vinko Kojund_i_; Hrvoje Jezid_i_

    2007-01-01

    In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on...

  8. Computer network for improving quality and efficiency of children's primary health care

    Science.gov (United States)

    Deutsch, Larry

    1995-10-01

    Health care is at its best when both the practitioner and patient are well-informed. In many central urban and remote rural areas, however, health care is characterized by a lack of continuity and coordination among providers. In these areas, a local information infrastructure and a patient-centered system of primary care are missing. Decision-making and ability to follow through is hampered, with limited involvement of patients in planning care and insufficient aggregate data for cost analysis, outcome research, community health planning, and other purposes. A Children's Health Network has been designed to extend current information technology to these underserved areas. Our approach to improving quality of individual care and controlling costs emphasizes use of computerized clinical information networks for better decision making and continuity, and secondarily through data aggregation for financial, research, and public health functions. This is in distinction to information systems centered on billing and administrative needs and to cost-control efforts which rely on fiscal and managerial ('gatekeeper') mechanisms. A uniform data base among sites serving the same population will answer several clinical and public health needs.

  9. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction

    Directory of Open Access Journals (Sweden)

    Gausvik C

    2015-01-01

    Full Text Available Christian Gausvik,1 Ashley Lautar,2 Lisa Miller,2 Harini Pallerla,3 Jeffrey Schlaudecker4,5 1University of Cincinnati College of Medicine, 2The Christ Hospital, Cincinnati, OH, USA; 3Department of Family and Community Medicine, 4Division of Geriatric Medicine, University of Cincinnati, Cincinnati, OH, USA; 5Geriatric Medicine Fellowship Program, University of Cincinnati/The Christ Hospital, Cincinnati, OH, USA Abstract: Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR on an acute care for the elderly (ACE unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer

  10. Improving palliative care.

    LENUS (Irish Health Repository)

    Moran, Sue

    2009-05-01

    Any service improvement project requires planning, action and evaluation. Using a recognised quality improvement framework can offer a structured approach to implementing and assessing changes to patient care. This article describes how use of the Deming Cycle has helped to identify nurses\\' learning needs.

  11. Improving assisted living care.

    Science.gov (United States)

    Gregory, Nancy; Gesell, Sabina B; Widmer, Tom

    2007-01-01

    In the absence of a national measurement system, private vendors of satisfaction measurement and improvement services have played a crucial role in the quality movement in the assisted living industry. Survey responses from 175 resident-family dyads at 20 facilities were analyzed to identify priorities for service improvement from the customers' perspective. They include improving care provided by aides and management, meal service, and activities. Practical solutions for addressing these issues are presented.

  12. Improving combustion efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Bulsari, A.; Wemberg, A.; Multas, A. [Nonlinear Solutions Oy (Finland)

    2009-06-15

    The paper describes how nonlinear models are used to improve the efficiency of coal combustion while keeping NOx and other emissions under desired limits in the Naantali 2 boiler of Fortum Power and Heat Oy. 16 refs., 6 figs.

  13. Retaining caregivers, improving care.

    Science.gov (United States)

    Bodwell, Wendy; Dent, Sara; Grant, Tracie; Hammerly, Milt; Mamula, Jeanie

    2006-01-01

    Text Summary In 2004, Centura Health's long-term care centers took part in a pilot project, sponsored by the Centers for Medicare & Medicaid Services, called "Improving Nursing Home Culture through Workforce Retention." A 30-member team comprising Centura leaders and long-term facility staff looked at Centura's eight participating facilities through residents' and employees' eyes. The goal of the team's reflection and subsequent changes was to create a culture in which decisions are focused on resident care and organizational policies are based on respect for employees. At the end of the first year, residents seemed happier and employee satisfaction and involvement increased at all eight Centura facilities. PMID:16519278

  14. Efficient use of health care resources: the interaction between improved health and reduced health related income loss.

    Science.gov (United States)

    Hoel, Michael

    2002-11-01

    Cost effectiveness is a criterion that is often recommended for prioritizing between different types of health care. A modified use of this criterion can be justified as the outcome of a choice that is made "behind a veil of ignorance." Reduced health will in many cases also gives an income loss that is shared between the patient and society ar large. In the special case where the marginal utilities of health status (measured by QALYs) and income are independent of the health state, an efficient allocation of health resources is characterized by net marginal costs per QALY being equalized across different types of health care. Net marginal costs are equal to gross marginal costs minus the reduction in health related income losses due to treatment. In the general case where marginal utilities depend on the health state this rule must be modified.

  15. Improving efficiency in stereology

    DEFF Research Database (Denmark)

    Keller, Kresten Krarup; Andersen, Ina Trolle; Andersen, Johnnie Bremholm;

    2013-01-01

    of the study was to investigate the time efficiency of the proportionator and the autodisector on virtual slides compared with traditional methods in a practical application, namely the estimation of osteoclast numbers in paws from mice with experimental arthritis and control mice. Tissue slides were scanned......, a proportionator sampling and a systematic, uniform random sampling were simulated. We found that the proportionator was 50% to 90% more time efficient than systematic, uniform random sampling. The time efficiency of the autodisector on virtual slides was 60% to 100% better than the disector on tissue slides. We...... conclude that both the proportionator and the autodisector on virtual slides may improve efficiency of cell counting in stereology....

  16. Wind energy efficiency improvements

    Energy Technology Data Exchange (ETDEWEB)

    Hauge Madsen, P.; Badger, J.; Rasmussen, Flemming; Soerensen, Poul

    2012-11-15

    As we have shown above, wind energy can help to secure energy efficiency in power generation, and research results and tools are being developed that will increase the role of wind energy in the global energy supply. An important instrument is the development of wind turbine technology to reduce capital and operational costs. This has not been the emphasis in this chapter, though; instead we have focused on equally important instruments, namely making best use of the wind resource and available sites, adapting wind farm layout and technology to the increased exploitation of wind, and improving the interaction between wind farms and the power system. With these developments we expect that wind energy can become the backbone of the power system globally and play a major role in creating an efficient and sustainable power system. (Author)

  17. Orthogeriatric care: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Tarazona-Santabalbina FJ

    2016-06-01

    Full Text Available Francisco José Tarazona-Santabalbina,1,2 Ángel Belenguer-Varea,1,2 Eduardo Rovira,1,2 David Cuesta-Peredó1,21Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera, 2Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, SpainAbstract: Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. Keywords: hip fractures, geriatric assessment, orthogeriatric care, recovery of function, mortality

  18. Nuclear energy efficiency improvements

    Energy Technology Data Exchange (ETDEWEB)

    Lauritzen, B.; Nonboel, E. [Technical Univ. of Denmark. DTU Nutech, Roskilde (Denmark); Kyrki-Rajamaeki, R. [Lappeenranta Univ. of Technology (Finland)

    2012-11-15

    Nuclear energy already today plays an important role in decarbonisation of the electricity sector while providing energy security and being economically competitive. Nuclear energy is characterized by its very high energy density and is well suited for large-scale, baseload electricity supply. Similar to renewable energy sources such as wind, solar or biomass, nuclear power is characterized by an abundant supply of its primary energy source, uranium, but is not limited to the same extent as these renewable energy sources from being an intermittent energy supply or imposing severe restrictions on land-use. Improving energy efficiency of nuclear power plants has contributed to a better utilization of the uranium resources and has helped improving the economic performance of nuclear power plants. This is to a large degree accomplished through optimisation of nuclear fuel assemblies as well as renewing turbines and generators. More importantly however, the overall economy of nuclear power has improved though better plant management leading to higher capacity factors and by extending the lifetimes of existing nuclear power plants. Provided that improved safety, economics and successful waste management can be demonstrated nuclear power is likely to grow in the future. Non-electricity applications may further boost the growth of nuclear energy, especially with the development of new reactor systems allowing for cogeneration of electricity and hydrogen or biofuels for transport. (Author)

  19. Efficiency improvements in transport

    Energy Technology Data Exchange (ETDEWEB)

    Schramm, J. [Technical Univ. of Denmark. DTU Mechanical Engineering, Kgs. Lyngby (Denmark); Christensen, Linda; Jensen, Thomas C. [Technical Univ. of Denmark. DTU Transport, Kgs. Lyngby (Denmark)

    2012-11-15

    Transport of people, personal belongings and goods in private cars is fundamental to our modern welfare society and economic growth, and has grown steadily over many decades. Motor fuels have been based almost entirely on crude oil for the last century. During the last couple of decades engines built for traditional fuels have become more advanced and efficient; this has reduced fuel consumption by around 40% and emissions by more than 90%. Only in the same time span have we begun to look at alternatives to fossil fuels. Biofuels such as biodiesel, bioethanol, biomethanol and biogas can replace petrol and diesel, and in recent years algae have shown a new potential for diesel fuel. Natural gas is also becoming an interesting fuel due to its large resources worldwide. GTL, CTL and BTL are liquid fuels produced from solid or gaseous sources. GTL and CTL are expensive to produce and not very CO{sub 2}-friendly, but they are easily introduced and need little investment in infrastructure and vehicles. DME is an excellent fuel for diesel engines. Methanol and DME produced from biomass are among the most CO{sub 2}-reducing fuels and at the same time the most energy-efficient renewable fuels. Fuel cell vehicles (FCVs) are currently fuelled by hydrogen, but other fuels are also possible. There are, however, several barriers to the implementation of fuel cell vehicles. In particular, a hydrogen infrastructure needs to be developed. Electric vehicles (EVs) have the advantage that energy conversion is centralised at the power plant where it can be done at optimum efficiency and emissions. EVs have to be charged at home, and also away from home when travelling longer distances. With an acceptable fast charging infrastructure at least 85% of the one-car families in Denmark could be potential EV customers. Range improvements resulting from better batteries are expected to create a large increase in the number of EVs in Denmark between 2020 and 2030. The hybrid electric vehicle

  20. Improving Palliative Care Team Meetings: Structure, Inclusion, and "Team Care".

    Science.gov (United States)

    Brennan, Caitlin W; Kelly, Brittany; Skarf, Lara Michal; Tellem, Rotem; Dunn, Kathleen M; Poswolsky, Sheila

    2016-07-01

    Increasing demands on palliative care teams point to the need for continuous improvement to ensure teams are working collaboratively and efficiently. This quality improvement initiative focused on improving interprofessional team meeting efficiency and subsequently patient care. Meeting start and end times improved from a mean of approximately 9 and 6 minutes late in the baseline period, respectively, to a mean of 4.4 minutes late (start time) and ending early in our sustainability phase. Mean team satisfaction improved from 2.4 to 4.5 on a 5-point Likert-type scale. The improvement initiative clarified communication about patients' plans of care, thus positively impacting team members' ability to articulate goals to other professionals, patients, and families. We propose several recommendations in the form of a team meeting "toolkit." PMID:25794871

  1. Improved wound care product

    DEFF Research Database (Denmark)

    2012-01-01

    The present invention pertains to use of sodium diacetate (NaHAc 2) as an antimicrobial agent against bacteria growing in biofilms. The aspects of the invention include a wound care product comprising sodium diacetate, a kit comprising a wound care product,and a methodof treating an infected wound....

  2. Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature – 2001–2007

    Directory of Open Access Journals (Sweden)

    Soumerai Stephen B

    2008-04-01

    Full Text Available Abstract Background Managed care organizations use a variety of strategies to reduce the cost and improve the quality of medication use. The effectiveness of such policies is not well understood. The objective of this research was to update a previous systematic review of interventions, published between 1966 and 2001, to improve the quality and efficiency of medication use in the US managed care setting. Methods We searched MEDLINE and EMBASE for publications from July 2001 to January 2007 describing interventions targeting drug use conducted in the US managed care setting. We categorized studies by intervention type and adequacy of research design using commonly accepted criteria. We summarized the outcomes of well-controlled strategies and documented the significance and magnitude of effects for key study outcomes. Results We identified 164 papers published during the six-year period. Predominant strategies were: educational interventions (n = 20, including dissemination of educational materials, and group or one-to-one educational outreach; monitoring and feedback (n = 22, including audit/feedback and computerized monitoring; formulary interventions (n = 66, including tiered formulary and patient copayment; collaborative care involving pharmacists (n = 15; and disease management with pharmacotherapy as a primary focus (n = 41, including care for depression, asthma, and peptic ulcer disease. Overall, 51 studies met minimum criteria for methodological adequacy. Effective interventions included one-to-one academic detailing, computerized alerts and reminders, pharmacist-led collaborative care, and multifaceted disease management. Further, changes in formulary tier-design and related increases in copayments were associated with reductions in medication use and increased out-of-pocket spending by patients. The dissemination of educational materials alone had little or no impact, while the impact of group education was inconclusive. Conclusion

  3. Improving OR Efficiency.

    Science.gov (United States)

    Vassell, Patricia

    2016-08-01

    The high-cost/high-revenue environment of the OR requires special attention from managers to scrutinize and reduce costs. In the OR, nonlabor cost savings (ie, no staff member will be laid off or reclassified to realize cost savings) can typically be identified most readily. Operational costs in the OR are affected by start times, turnover times, cancellation rates, and adequate supplies, equipment, and staffing. Inefficiency in the OR can increase costs and lead to dissatisfied patients, physicians, and staff members. This article describes concepts that contribute to efficiency in the OR and illustrates the importance of staff member engagement in achieving desired outcomes.

  4. Improving efficiency, securing savings.

    Science.gov (United States)

    Baillie, Jonathan

    2016-03-01

    The NHS in England could save £1 bn annually if all NHS acute Trustsachieved the median level of estates and facilities running costs, the second (and 'final') report by Lord Carter and his team into the 'productivity and efficiency' of acute NHS Trusts across England, published on 5 February,suggests. As HEJ, editor, Jonathan Baillie reports, Lord Carter's team'songoing recent discussions with senior personnel working in a range of disciplines at 32 NHS Trusts--which followed dialogue with an initial 22 Trusts--identified 'unwarranted variation' in the use of resources ranging from staff to land and buildings on such a scale that effectively addressing this 'variation' could, the DH-commissioned team says, potentially reduce by £5 bn annually the NHS in England's costs. PMID:27132300

  5. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction

    OpenAIRE

    Gausvik C; Lautar A; Miller L; Pallerla H; Schlaudecker J

    2015-01-01

    Christian Gausvik,1 Ashley Lautar,2 Lisa Miller,2 Harini Pallerla,3 Jeffrey Schlaudecker4,5 1University of Cincinnati College of Medicine, 2The Christ Hospital, Cincinnati, OH, USA; 3Department of Family and Community Medicine, 4Division of Geriatric Medicine, University of Cincinnati, Cincinnati, OH, USA; 5Geriatric Medicine Fellowship Program, University of Cincinnati/The Christ Hospital, Cincinnati, OH, USA Abstract: Efficient, accurate, and timely communication is required for quality he...

  6. Improving aircraft energy efficiency

    Science.gov (United States)

    Povinelli, F. P.; Klineberg, J. M.; Kramer, J. J.

    1976-01-01

    Investigations conducted by a NASA task force concerning the development of aeronautical fuel-conservation technology are considered. The task force estimated the fuel savings potential, prospects for implementation in the civil air-transport fleet, and the impact of the technology on air-transport fuel use. Propulsion advances are related to existing engines in the fleet, to new production of current engine types, and to new engine designs. Studies aimed at the evolutionary improvement of aerodynamic design and a laminar flow control program are discussed and possibilities concerning the use of composite structural materials are examined.

  7. Improving Gas Flooding Efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Reid Grigg; Robert Svec; Zheng Zeng; Alexander Mikhalin; Yi Lin; Guoqiang Yin; Solomon Ampir; Rashid Kassim

    2008-03-31

    This study focuses on laboratory studies with related analytical and numerical models, as well as work with operators for field tests to enhance our understanding of and capabilities for more efficient enhanced oil recovery (EOR). Much of the work has been performed at reservoir conditions. This includes a bubble chamber and several core flood apparatus developed or modified to measure interfacial tension (IFT), critical micelle concentration (CMC), foam durability, surfactant sorption at reservoir conditions, and pressure and temperature effects on foam systems.Carbon dioxide and N{sub 2} systems have been considered, under both miscible and immiscible conditions. The injection of CO2 into brine-saturated sandstone and carbonate core results in brine saturation reduction in the range of 62 to 82% brine in the tests presented in this paper. In each test, over 90% of the reduction occurred with less than 0.5 PV of CO{sub 2} injected, with very little additional brine production after 0.5 PV of CO{sub 2} injected. Adsorption of all considered surfactant is a significant problem. Most of the effect is reversible, but the amount required for foaming is large in terms of volume and cost for all considered surfactants. Some foams increase resistance to the value beyond what is practical in the reservoir. Sandstone, limestone, and dolomite core samples were tested. Dissolution of reservoir rock and/or cement, especially carbonates, under acid conditions of CO2 injection is a potential problem in CO2 injection into geological formations. Another potential change in reservoir injectivity and productivity will be the precipitation of dissolved carbonates as the brine flows and pressure decreases. The results of this report provide methods for determining surfactant sorption and can be used to aid in the determination of surfactant requirements for reservoir use in a CO{sub 2}-foam flood for mobility control. It also provides data to be used to determine rock permeability

  8. Atrial fibrillation care improvement collaborative

    OpenAIRE

    Robelia, Paul; Kopecky, Stephen; Thacher, Tom

    2015-01-01

    Atrial fibrillation (AF) is an increasingly common cardiac arrhythmia. Many patients with new onset or recurrent AF present to the emergency department and are subsequently admitted to the hospital and seen by cardiology specialists for follow up. In an attempt to address this high utilization of acute health care resources, reduce costs, and improve patient care, our institution instituted a collaborative project between the departments of emergency medicine, cardiology, family medicine, and...

  9. Improving efficiency in meat production.

    Science.gov (United States)

    Brameld, John M; Parr, Tim

    2016-08-01

    Selective breeding and improved nutritional management over the past 20-30 years has resulted in dramatic improvements in growth efficiency for pigs and poultry, particularly lean tissue growth. However, this has been achieved using high-quality feed ingredients, such as wheat and soya that are also used for human consumption and more recently biofuels production. Ruminants on the other hand are less efficient, but are normally fed poorer quality ingredients that cannot be digested by human subjects, such as grass or silage. The challenges therefore are to: (i) maintain the current efficiency of growth of pigs and poultry, but using more ingredients not needed to feed the increasing human population or for the production of biofuels; (ii) improve the efficiency of growth in ruminants; (iii) at the same time produce animal products (meat, milk and eggs) of equal or improved quality. This review will describe the use of: (a) enzyme additives for animal feeds, to improve feed digestibility; (b) known growth promoting agents, such as growth hormone, β-agonists and anabolic steroids, currently banned in the European Union but used in other parts of the world; (c) recent transcriptomic studies into molecular mechanisms for improved growth efficiency via low residual feed intake. In doing so, the use of genetic manipulation in animals will also be discussed. PMID:27087253

  10. Improving efficiency in meat production.

    Science.gov (United States)

    Brameld, John M; Parr, Tim

    2016-08-01

    Selective breeding and improved nutritional management over the past 20-30 years has resulted in dramatic improvements in growth efficiency for pigs and poultry, particularly lean tissue growth. However, this has been achieved using high-quality feed ingredients, such as wheat and soya that are also used for human consumption and more recently biofuels production. Ruminants on the other hand are less efficient, but are normally fed poorer quality ingredients that cannot be digested by human subjects, such as grass or silage. The challenges therefore are to: (i) maintain the current efficiency of growth of pigs and poultry, but using more ingredients not needed to feed the increasing human population or for the production of biofuels; (ii) improve the efficiency of growth in ruminants; (iii) at the same time produce animal products (meat, milk and eggs) of equal or improved quality. This review will describe the use of: (a) enzyme additives for animal feeds, to improve feed digestibility; (b) known growth promoting agents, such as growth hormone, β-agonists and anabolic steroids, currently banned in the European Union but used in other parts of the world; (c) recent transcriptomic studies into molecular mechanisms for improved growth efficiency via low residual feed intake. In doing so, the use of genetic manipulation in animals will also be discussed.

  11. Managed care and the scale efficiency of US hospitals.

    Science.gov (United States)

    Brown, H Shelton; Pagán, José A

    2006-12-01

    Managed care penetration has been partly responsible for slowing down increases in health care costs in recent years. This study uses a 1992-1996 Health Care Utilization Project sample of hospitals to analyze the relationship between managed care penetration in local insurance markets and hospital scale efficiency. After controlling for hospital and market area variables, we find that managed care insurance, particularly the preferred provider type, is associated with increases in hospital scale efficiency in tertiary cases. The results presented here are consistent with the view that managed care can lead to reductions in health cost inflation by controlling the diffusion of technology via improvements in the scale efficiency of hospitals. PMID:17111213

  12. Efficiency of a Care Coordination Model: A Randomized Study with Stroke Patients

    Science.gov (United States)

    Claiborne, Nancy

    2006-01-01

    Objectives: This study investigated the efficiency of a social work care coordination model for stroke patients. Care coordination addresses patient care and treatment resources across the health care system to reduce risk, improve clinical outcomes, and maximize efficiency. Method: A randomly assigned, pre-post experimental design measured…

  13. Fuel Efficiencies Through Airframe Improvements

    Science.gov (United States)

    Bezos-O'Connor, Gaudy M.; Mangelsdorf, Mark F.; Maliska, Heather A.; Washburn, Anthony E.; Wahls, Richard A.

    2011-01-01

    The factors of continuing strong growth in air traffic volume, the vital role of the air transport system on the economy, and concerns about the environmental impact of aviation have added focus to the National Aeronautics Research Policy. To address these concerns in the context of the National Policy, NASA has set aggressive goals in noise reduction, emissions, and energy consumption. With respect to the goal of reducing energy consumption in the fleet, the development of promising airframe technologies is required to realize the significant improvements that are desired. Furthermore, the combination of advances in materials and structures with aerodynamic technologies may lead to a paradigm shift in terms of potential configurations for the future. Some of these promising airframe technologies targeted at improved efficiency are highlighted.

  14. Accelerating patient-care improvement in the ED.

    Science.gov (United States)

    Forrester, Nancy E

    2003-08-01

    Quality improvement is always in the best interest of healthcare providers. One hospital examined the patient-care delivery process used in its emergency department to determine ways to improve patient satisfaction while increasing the effectiveness and efficiency of healthcare delivery. The hospital used activity-based costing (ABC) plus additional data related to rework, information opportunity costs, and other effectiveness measures to create a process map that helped it accelerate diagnosis and improve redesign of the care process. PMID:12938618

  15. Improving Customer Service in Elderly Care

    OpenAIRE

    Nielsen, Chris

    2015-01-01

    The elderly care sector is increasingly facing more competition and demanding customers. This leads to a growing pressure on elderly care home providers to find new and improved solutions that will enhance their level of customer service. The will ensure that the elderly service provider is remaining competitive in the elderly care service marketplace. The purpose of this thesis is to identify areas for improvements and propose implementable solutions for enhancing the elderly care custom...

  16. An electronic dashboard to improve nursing care.

    Science.gov (United States)

    Tan, Yung-Ming; Hii, Joshua; Chan, Katherine; Sardual, Robert; Mah, Benjamin

    2013-01-01

    With the introduction of CPOE systems, nurses in a Singapore hospital were facing difficulties monitoring key patient information such as critical tasks and alerts. Issues include unfriendly user interfaces of clinical systems, information overload, and the loss of visual cues for action due to paperless workflows. The hospital decided to implement an interactive electronic dashboard on top of their CPOE system to improve visibility of vital patient data. A post-implementation survey was performed to gather end-user feedback and evaluate factors that influence user satisfaction of the dashboard. Questionnaires were sent to all nurses of five pilot wards. 106 valid responses were received. User adoption was good with 86% of nurses using the dashboard every shift. Mean satisfaction score was 3.6 out of 5. User satisfaction was strongly and positively correlated to the system's perceived impact on work efficiency and care quality. From qualitative feedback, nurses generally agreed that the dashboard had improved their awareness of critical patient issues without the hassle of navigating a CPOE system. This study shows that an interactive clinical dashboard when properly integrated with a CPOE system could be a useful tool to improve daily patient care. PMID:23920542

  17. Home Care Nursing Improves Cancer Symptom Management

    Science.gov (United States)

    Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.

  18. Corporate Accounting Policy Efficiency Improvement

    OpenAIRE

    Elena K. Vorobei; Svetlana G. Sidashova

    2013-01-01

    The article is focused on the issues of efficient use of different methods of tax accounting for the optimization of income tax expenses and their consolidation in corporate accounting policy. The article makes reasoned conclusions, concerning optimal selection of depreciation methods for tax and bookkeeping accounting and their consolidation in corporate accounting policy and consolidation of optimal methods of cost recovery in production, considering business environment. The impact of the ...

  19. Nationwide quality improvement in lung cancer care

    DEFF Research Database (Denmark)

    Jakobsen, Erik Winther; Green, Anders; Oesterlind, Kell;

    2013-01-01

    To improve prognosis and quality of lung cancer care the Danish Lung Cancer Group has developed a strategy consisting of national clinical guidelines and a clinical quality and research database. The first edition of our guidelines was published in 1998 and our national lung cancer registry...... was opened for registrations in 2000. This article describes methods and results obtained by multidisciplinary collaboration and illustrates how quality of lung cancer care can be improved by establishing and monitoring result and process indicators....

  20. Corporate Accounting Policy Efficiency Improvement

    Directory of Open Access Journals (Sweden)

    Elena K. Vorobei

    2013-01-01

    Full Text Available The article is focused on the issues of efficient use of different methods of tax accounting for the optimization of income tax expenses and their consolidation in corporate accounting policy. The article makes reasoned conclusions, concerning optimal selection of depreciation methods for tax and bookkeeping accounting and their consolidation in corporate accounting policy and consolidation of optimal methods of cost recovery in production, considering business environment. The impact of the selected methods on corporate income tax rates and corporate property tax rates was traced and tax recovery was estimated.

  1. Monitoring and improving care in thoracic surgery

    OpenAIRE

    Numan, R.C.

    2016-01-01

    Quality of Care (QoC) plays a central role in the way healthcare is delivered. In the world of thoracic surgery for lung cancer, surgeons are faced with complex and sometimes high-risk surgical resections on an aging patient population with an increasing incidence of frail physical health. This increasing complexity demands a multidisciplinary approach rearranging pre-, peri- and postoperative care in a way safety, efficiency and high quality are guaranteed. The safety and quality of healthca...

  2. Orthogeriatric care: improving patient outcomes

    OpenAIRE

    Tarazona-Santabalbina, Francisco J.

    2016-01-01

    Francisco José Tarazona-Santabalbina,1,2 Ángel Belenguer-Varea,1,2 Eduardo Rovira,1,2 David Cuesta-Peredó1,21Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera, 2Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, SpainAbstract: Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements i...

  3. Measuring Residential Energy Efficiency Improvements with DEA

    OpenAIRE

    Grösche, Peter

    2008-01-01

    This paper measures energy efficiency improvements of US single-family homes between 1997 and 2001 using a two-stage procedure. In the first stage, an indicator of energy efficiency is derived by means of Data Envelopment Analysis (DEA), and the analogy between the DEA estimator and traditional measures of energy efficiency is demonstrated. The second stage employs a bootstrapped truncated regression technique to decompose the variation in the obtained efficiency estimates into a climatic com...

  4. Does Audit Improve the Quality of Care?

    OpenAIRE

    Areti Tsaloglidou

    2009-01-01

    BACKGROUND: The quality of health care and quality assurance are concepts which have been established for many years. Audit nowadays is adopted as a means of developing high quality care.AIM: This study aims to identify the perspectives of audit in practice and its relationship to quality assessment and assurance, quality improvement, and clinical effectiveness.METHODS: There were used the databases Medline and Cinahl to identify studies related to clinical audit. These databases were searche...

  5. Molecular markers: tools to improve genebank efficiency

    NARCIS (Netherlands)

    Hintum, van T.J.L.; Treuren, van R.

    2002-01-01

    Possibilities for using molecular markers to improve genebank efficiency are increasingly present thanks to developments in genebanks and developments in molecular genetics. These possibilities relate to all aspects of genebank management: acquisition, maintenance, characterisation and utilisation.

  6. Improving Efficiency of Prevention in Telemedicine

    OpenAIRE

    Nálevka, Petr

    2010-01-01

    This thesis employs data-mining techniques and modern information and communication technology to develop methods which may improve efficiency of prevention oriented telemedical programs. In particular this thesis uses the ITAREPS program as a case study and demonstrates that an extension of the program based on the proposed methods may significantly improve the program's efficiency. ITAREPS itself is a state of the art telemedical program operating since 2006. It has been deployed in 8 diffe...

  7. The Gains from Improved Market Efficiency

    DEFF Research Database (Denmark)

    Persson, Karl Gunnar; Ejrnæs, Mette

    faster, violations of the law of one price become smaller and hence less persistent. There were also significant gains from improved market efficiency but that improvement took place after the information ‘regime’ shifted from pre-telegraphic communication to a regime with swift transmission...... of information in an era which developed a sophisticated commercial press and telegraphic communication. Improved market efficiency probably stimulated trade more than falling transport costs......This paper looks at the gains from improved market efficiency in long-distance grain trade in the second half of the 19th century when violations of the law of one price were reduced due to improved information transmission. Two markets, a major export centre, Chicago, and a major importer...

  8. An empirical investigation of the efficiency effects of integrated care models in Switzerland

    Directory of Open Access Journals (Sweden)

    Oliver Reich

    2012-01-01

    Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency. Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model. Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection. Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

  9. An empirical investigation of the efficiency effects of integrated care models in Switzerland

    Directory of Open Access Journals (Sweden)

    Oliver Reich

    2012-01-01

    Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency.Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model.Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection.Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

  10. Improving plasmonic waveguides coupling efficiency using nanoantennas

    DEFF Research Database (Denmark)

    Andryieuski, Andrei; Malureanu, Radu; Bouillard, Jean-Sebastien;

    2012-01-01

    Plasmonic waveguides bear a lot of potential for photonic applications. However, one of the challenges for implementing them in devices is the low coupling efficiency to and from optical fibers. We report on our approach to facilitate the coupling efficiency with the use of metallic nanoantennas....... The classical dipole antenna scheme can be improved by changing the nanoantenna geometry, adding constructive elements such as reflecting bars and mirrors and using arrays of antennas. The modelling designates that the coupling efficiency from a vertical fiber to a plasmonic waveguide can be improved more than...

  11. Common challenge in resource efficiency improvement

    International Nuclear Information System (INIS)

    Energy efficiency and technology improvements on their own will not achieve the Low Carbon Societies (LCS) goals. Thus, resource efficiency and a circular economy are keys to a low carbon society. Resource efficiency improvement potential has been analysed from the industrial and territorial management perspectives. Exploring synergies between LCS and the larger area of sustainable development and green economy, highlighting co-benefits and trade-offs, is of utmost importance to pave the way to a more equitable and largely participated low carbon transition.

  12. Improving care at cystic fibrosis centers through quality improvement.

    Science.gov (United States)

    Kraynack, Nathan C; McBride, John T

    2009-10-01

    Quality improvement (QI) using a clinical microsystems approach provides cystic fibrosis (CF) centers the opportunity to make a significant positive impact on the health of their patients. The availability of center-specific outcomes data and the support of the Cystic Fibrosis Foundation are important advantages for these quality improvement efforts. This article illustrates how the clinical microsystems methodology can improve care delivery and outcomes by describing the gradual application of quality improvement principles over the past 5 years by the CF team at the Lewis Walker Cystic Fibrosis Center at Akron Children's Hospital in Akron, Ohio. Using the example of a project to improve the pulmonary function of the pediatric patients at our center as a framework, we describe the QI process from the initial team-building phase, through the assessment of care processes, standardization of care, and developing a culture of continuous improvement. We outline how enthusiastic commitment from physician leadership, clinical managers and central administration, the availability of coaches, and an appreciation of the importance of measurement, patient involvement, communication, and standardization are critical components for successful process improvement. PMID:19760542

  13. Dynamic culture improves cell reprogramming efficiency.

    Science.gov (United States)

    Sia, Junren; Sun, Raymond; Chu, Julia; Li, Song

    2016-06-01

    Cell reprogramming to pluripotency is an inefficient process and various approaches have been devised to improve the yield of induced pluripotent stem cells. However, the effect of biophysical factors on cell reprogramming is not well understood. Here we showed that, for the first time, dynamic culture with orbital shaking significantly improved the reprogramming efficiency in adherent cells. Manipulating the viscosity of the culture medium suggested that the improved efficiency is mainly attributed to convective mixing rather than hydrodynamic shear stress. Temporal studies demonstrated that the enhancement of reprogramming efficiency required the dynamic culture in the middle but not early phase. In the early phase, fibroblasts had a high proliferation rate, but as the culture became over-confluent in the middle phase, expression of p57 was upregulated to inhibit cell proliferation and consequently, cell reprogramming. Subjecting the over confluent culture to orbital shaking prevented the upregulation of p57, thus improving reprogramming efficiency. Seeding cells at low densities to avoid over-confluency resulted in a lower efficiency, and optimal reprogramming efficiency was attained at a high seeding density with dynamic culture. Our findings provide insight into the underlying mechanisms of how dynamic culture condition regulate cell reprogramming, and will have broad impact on cell engineering for regenerative medicine and disease modeling.

  14. The Taiwanese health care system under efficiency scrutiny

    OpenAIRE

    Schreyögg, Jonas

    2004-01-01

    This thesis describes the status quo of the Taiwanese health care system in the year 2000, 5 years after the reforms, analyses the economic efficiency of single components of the new health care system and searches for possible solutions to solve uncovered problems. For a better understanding of the Taiwanese health care system, the economic, political and demographic environment is described first of all. Although the Taiwanese economy developed rapidly, the health care system was still look...

  15. Does Audit Improve the Quality of Care?

    Directory of Open Access Journals (Sweden)

    Areti Tsaloglidou

    2009-01-01

    Full Text Available BACKGROUND: The quality of health care and quality assurance are concepts which have been established for many years. Audit nowadays is adopted as a means of developing high quality care.AIM: This study aims to identify the perspectives of audit in practice and its relationship to quality assessment and assurance, quality improvement, and clinical effectiveness.METHODS: There were used the databases Medline and Cinahl to identify studies related to clinical audit. These databases were searched up to May 2009.DISCUSSION: Audit is used as a tool to assure and assess the quality of patient health care. It is also an educational tool as it creates a lot of opportunities for professionals to think about practice and to learn from the experience of others.CONCLUSIONS: Although that audit is a powerfull and useful tool to improve and evaluate the quality of health care, on the other hand there are many barriers that make its use difficult in everyday practice.

  16. Effectiveness and efficiency of policy instruments for energy efficiency improvement

    International Nuclear Information System (INIS)

    The title project aims at increasing the knowledge about the possible application of these policy instruments. This knowledge should be suitable for the design of future policy instruments within the framework of climate policy. One of the results of the project should be a further improvement of models for evaluating of policy instruments. We hereby focus on the newer types of policy instruments. The key research issues considered in this project are: optimum design of policy instruments; effectiveness (how much energy is saved); efficiency (cost-benefit ratio; for the government; for the regulated parties; for society). In the analysis the following three stages of application of policy instruments are distinguished: policy formulation (e.g. by national governments); policy implementation (e.g. by regulatory agencies); policy impact (actual effect in firms). In this paper an overview is given of the results of the project 'Policy instruments for energy efficiency improvement' up to now. 13 refs

  17. Improving Quality of Emergency Care Through Integration of Mental Health.

    Science.gov (United States)

    Okafor, Martha; Wrenn, Glenda; Ede, Victor; Wilson, Nana; Custer, William; Risby, Emile; Claeys, Michael; Shelp, Frank E; Atallah, Hany; Mattox, Gail; Satcher, David

    2016-04-01

    The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput.

  18. Quantum entanglement helps in improving economic efficiency

    International Nuclear Information System (INIS)

    We propose an economic regulation approach based on quantum game theory for the government to reduce the abuses of oligopolistic competition. Theoretical analysis shows that this approach can help government improve the economic efficiency of the oligopolistic market, and help prevent monopoly due to incorrect information. These advantages are completely attributed to the quantum entanglement, a unique quantum mechanical character

  19. Combining business process and data discovery techniques for analyzing and improving integrated care pathways

    NARCIS (Netherlands)

    J. Poelmans; G. Dedene; G. Verheyden; H. van der Mussele; S. Viaene; E. Peters

    2010-01-01

    Hospitals increasingly use process models for structuring their care processes. Activities performed to patients are logged to a database but these data are rarely used for managing and improving the efficiency of care processes and quality of care. In this paper, we propose a synergy of process min

  20. Improving client-centred care and services : the role of front/back-office configurations

    NARCIS (Netherlands)

    Broekhuis, Manda; de Blok, C.; Meijboom, B.

    2009-01-01

    Improving client-centred care and services: the role of front/back-officeconfigurations. This paper is a report of a study conducted to explore the application of designing front- and back-office work resulting in efficient client-centred care in healthcare organizations that supply home care, welfa

  1. Improving quality of care through improved audit and feedback

    Directory of Open Access Journals (Sweden)

    Hysong Sylvia J

    2012-05-01

    Full Text Available Abstract Background The Department of Veterans Affairs (VA has led the industry in measuring facility performance as a critical element in improving quality of care, investing substantial resources to develop and maintain valid and cost-effective measures. The External Peer Review Program (EPRP of the VA is the official data source for monitoring facility performance, used to prioritize the quality areas needing most attention. Facility performance measurement has significantly improved preventive and chronic care, as well as overall quality; however, much variability still exists in levels of performance across measures and facilities. Audit and feedback (A&F, an important component of effective performance measurement, can help reduce this variability and improve overall performance. Previous research suggests that VA Medical Centers (VAMCs with high EPRP performance scores tend to use EPRP data as a feedback source. However, the manner in which EPRP data are used as a feedback source by individual providers as well as service line, facility, and network leadership is not well understood. An in-depth understanding of mental models, strategies, and specific feedback process characteristics adopted by high-performing facilities is thus urgently needed. This research compares how leaders of high, low, and moderately performing VAMCs use clinical performance data from the EPRP as a feedback tool to maintain and improve quality of care. Methods We will conduct a qualitative, grounded theory analysis of up to 64 interviews using a novel method of sampling primary care, facility, and Veterans Integrated Service Network (VISN leadership at high-, moderate-, and low-performing facilities. We will analyze interviews for evidence of cross-facility differences in perceptions of performance data usefulness and strategies for disseminating performance data evaluating performance, with particular attention to timeliness, individualization, and punitiveness

  2. Health care quality improvement publication trends.

    Science.gov (United States)

    Sun, Gordon H; MacEachern, Mark P; Perla, Rocco J; Gaines, Jean M; Davis, Matthew M; Shrank, William H

    2014-01-01

    To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991.

  3. The gain from improved market efficiency

    DEFF Research Database (Denmark)

    Ejrnæs, Mette; Persson, Karl Gunnar

    2010-01-01

    demand as well as excess supply, which triggered off the tâtonnement process. Over time, adjustments to equilibrium, as measured by the half-life of a shock, became faster and violations of the law of one price become smaller. There were significant gains from improved market efficiency, which took place......This article looks at the gains from improved market efficiency in long-distance grain trade in the second half of the nineteenth century, when violations of the law of one price were reduced due to improved information transmission. Two markets, a major export centre, Chicago, and a major importer......, Liverpool, are analysed. We show that the law of one price equilibrium was an ‘attractor equilibrium'. The implication is that prices converged to that equilibrium in a tâtonnement process. Because of asymmetrically timed information between markets separated by long distances there were periods of excess...

  4. Efficiency evaluation for pooling resources in health care

    NARCIS (Netherlands)

    Vanberkel, Peter T.; Boucherie, Richard J.; Hans, Erwin W.; Hurink, Johann L.; Litvak, Nelly

    2012-01-01

    Hospitals traditionally segregate resources into centralized functional departments such as diagnostic departments, ambulatory care centers, and nursing wards. In recent years this organizational model has been challenged by the idea that higher quality of care and efficiency in service delivery can

  5. Idaho Chemical Processing Plant Process Efficiency improvements

    Energy Technology Data Exchange (ETDEWEB)

    Griebenow, B.

    1996-03-01

    In response to decreasing funding levels available to support activities at the Idaho Chemical Processing Plant (ICPP) and a desire to be cost competitive, the Department of Energy Idaho Operations Office (DOE-ID) and Lockheed Idaho Technologies Company have increased their emphasis on cost-saving measures. The ICPP Effectiveness Improvement Initiative involves many activities to improve cost effectiveness and competitiveness. This report documents the methodology and results of one of those cost cutting measures, the Process Efficiency Improvement Activity. The Process Efficiency Improvement Activity performed a systematic review of major work processes at the ICPP to increase productivity and to identify nonvalue-added requirements. A two-phase approach was selected for the activity to allow for near-term implementation of relatively easy process modifications in the first phase while obtaining long-term continuous improvement in the second phase and beyond. Phase I of the initiative included a concentrated review of processes that had a high potential for cost savings with the intent of realizing savings in Fiscal Year 1996 (FY-96.) Phase II consists of implementing long-term strategies too complex for Phase I implementation and evaluation of processes not targeted for Phase I review. The Phase II effort is targeted for realizing cost savings in FY-97 and beyond.

  6. Idaho Chemical Processing Plant Process Efficiency improvements

    International Nuclear Information System (INIS)

    In response to decreasing funding levels available to support activities at the Idaho Chemical Processing Plant (ICPP) and a desire to be cost competitive, the Department of Energy Idaho Operations Office (DOE-ID) and Lockheed Idaho Technologies Company have increased their emphasis on cost-saving measures. The ICPP Effectiveness Improvement Initiative involves many activities to improve cost effectiveness and competitiveness. This report documents the methodology and results of one of those cost cutting measures, the Process Efficiency Improvement Activity. The Process Efficiency Improvement Activity performed a systematic review of major work processes at the ICPP to increase productivity and to identify nonvalue-added requirements. A two-phase approach was selected for the activity to allow for near-term implementation of relatively easy process modifications in the first phase while obtaining long-term continuous improvement in the second phase and beyond. Phase I of the initiative included a concentrated review of processes that had a high potential for cost savings with the intent of realizing savings in Fiscal Year 1996 (FY-96.) Phase II consists of implementing long-term strategies too complex for Phase I implementation and evaluation of processes not targeted for Phase I review. The Phase II effort is targeted for realizing cost savings in FY-97 and beyond

  7. Improving Engine Efficiency Through Core Developments

    Science.gov (United States)

    Heidmann, James D.

    2011-01-01

    The NASA Environmentally Responsible Aviation (ERA) Project and Fundamental Aeronautics Projects are supporting compressor and turbine research with the goal of reducing aircraft engine fuel burn and greenhouse gas emissions. The primary goals of this work are to increase aircraft propulsion system fuel efficiency for a given mission by increasing the overall pressure ratio (OPR) of the engine while maintaining or improving aerodynamic efficiency of these components. An additional area of work involves reducing the amount of cooling air required to cool the turbine blades while increasing the turbine inlet temperature. This is complicated by the fact that the cooling air is becoming hotter due to the increases in OPR. Various methods are being investigated to achieve these goals, ranging from improved compressor three-dimensional blade designs to improved turbine cooling hole shapes and methods. Finally, a complementary effort in improving the accuracy, range, and speed of computational fluid mechanics (CFD) methods is proceeding to better capture the physical mechanisms underlying all these problems, for the purpose of improving understanding and future designs.

  8. Improving Electrical Efficiency of Edm Power Supply

    Science.gov (United States)

    Toma, Emanoil; Simion, Carmen Mihaela

    2014-11-01

    This paper briefly presents the principal types of Pulse Generators for Electrical Discharge Machining and ways to improve electrical efficiency. A resonant converter with series-parallel LCC circuit, for EDM applications, was analyzed by PSpice simulation. The performances of EDM Power Supply were improved by adding an energy recovering - voltage limiter circuit. The shape of current pulse was changed by adding a supplementary MOSFET Switch in parallel with the gap. Two or more converters can be parallelized, in this way output current can be changed. A bloc-schema was conceived for EDM experimental set up

  9. Practical Strategies to Improve Test Efficiency

    Institute of Scientific and Technical Information of China (English)

    DING Zhigang; WANG Hongcheng; LING Lianghe

    2007-01-01

    This paper introduces strategies to detect software bugs in earlier life cycle stage in order to improve test efficiency. Static analysis tool is one of the effective methods to reveal software bugs during software development. Three popular static analysis tools are introduced, two of which, PolySpace and Splint, are compared with each other by analyzing a set of test cases generatedd by the authors. PolySpace can reveal 60% bugs with 100% R/W ratio (ratio of real bugs and total warnings), while Splint reveal 73.3% bugs with 44% R/W ratio. And they are good at finding different categories of bugs. Two strategies are concluded to improve test efficiency, under the guideline that static analysis tools should be used in finding different categories of bugs according to their features. The first one aims at finding bugs as many as possible, while the second concentrates to reduce the average time on bug revelation. Experimental data shows the first strategy can find 100% bugs with 60% RAN ratio, the second one find 80% bugs with 66.7% R/W ratio. Experiment results prove that these two strategies can improve the test efficiency in both fault coverage and testing time.

  10. Efficiency of primary care in rural Burkina Faso. A two-stage DEA analysis

    Science.gov (United States)

    2011-01-01

    Background Providing health care services in Africa is hampered by severe scarcity of personnel, medical supplies and financial funds. Consequently, managers of health care institutions are called to measure and improve the efficiency of their facilities in order to provide the best possible services with their resources. However, very little is known about the efficiency of health care facilities in Africa and instruments of performance measurement are hardly applied in this context. Objective This study determines the relative efficiency of primary care facilities in Nouna, a rural health district in Burkina Faso. Furthermore, it analyses the factors influencing the efficiency of these institutions. Methodology We apply a two-stage Data Envelopment Analysis (DEA) based on data from a comprehensive provider and household information system. In the first stage, the relative efficiency of each institution is calculated by a traditional DEA model. In the second stage, we identify the reasons for being inefficient by regression technique. Results The DEA projections suggest that inefficiency is mainly a result of poor utilization of health care facilities as they were either too big or the demand was too low. Regression results showed that distance is an important factor influencing the efficiency of a health care institution Conclusions Compared to the findings of existing one-stage DEA analyses of health facilities in Africa, the share of relatively efficient units is slightly higher. The difference might be explained by a rather homogenous structure of the primary care facilities in the Burkina Faso sample. The study also indicates that improving the accessibility of primary care facilities will have a major impact on the efficiency of these institutions. Thus, health decision-makers are called to overcome the demand-side barriers in accessing health care. PMID:22828358

  11. CPI (clinical practice improvement): improving quality and decreasing cost in managed care.

    Science.gov (United States)

    Horn, S D

    1995-07-01

    The focus on quality has never been greater. As a result, a new concept, clinical practice improvement (CPI), is emerging. Clinical practice improvement is the application of the scientific method to the day-to-day practice of medicine and can be employed in all health care settings: inpatient or ambulatory, large or small. According to the author, CPI has proved to be effective in reducing costs and improving outcomes because it requires the committed support of clinicians who are involved directly in the process of designing studies, analyzing data, and developing more efficient forms of treatment in their own organizations. PMID:10143825

  12. Incentivizing behaviour change to improve diabetes care.

    Science.gov (United States)

    Petry, N M; Cengiz, E; Wagner, J A; Hood, K K; Carria, L; Tamborlane, W V

    2013-12-01

    Behavioural economics refers to the study of psychological and cognitive factors that relate to decision-making processes. This field is being applied increasingly to health care settings, in which patients receive tangible reinforcers or incentives for meeting objective behavioural criteria consistent with healthy lifestyles. This article reviews the background and efficacy of reinforcement interventions in general, and then as applied to behaviours related to diabetes prevention and management. Specifically, reinforcement interventions have been applied with some notable success towards promoting greater attendance at medical appointments, enhancing weight loss efforts, augmenting exercising regimes, improving medication adherence and increasing blood glucose monitoring. Suggestions for promising areas of future research are provided, keeping in mind the controversial nature of these interventions.

  13. Tape write-efficiency improvements in CASTOR

    CERN Document Server

    Murray, S; Cancio, G; Cano, E; Kotlyar, V; Lo Presti, G; Lo Re, G; Ponce, S

    2012-01-01

    The CERN Advanced STORage manager (CASTOR) is used to archive to tape the physics data of past and present physics experiments. For reasons of physical storage space, all of the tape resident data in CASTOR are repacked onto higher density tapes approximately every two years. Improving the performance of writing files smaller than 2GB to tape is essential in order to keep the time needed to repack all of the tape resident data within a period of no more than 1 year. This paper reports on the solution to writing efficiently to tape that is currently in its early deployment phases at CERN.

  14. Diagnosing and improving functioning in interdisciplinary health care teams.

    Science.gov (United States)

    Blackmore, Gail; Persaud, D David

    2012-01-01

    Interdisciplinary teams play a key role in the delivery of health care. Team functioning can positively or negatively impact the effective and efficient delivery of health care services as well as the personal well-being of group members. Additionally, teams must be able and willing to work together to achieve team goals within a climate that reflects commitment to team goals, accountability, respect, and trust. Not surprisingly, dysfunctional team functioning can limit the success of interdisciplinary health care teams. The first step in improving dysfunctional team function is to conduct an analysis based on criteria necessary for team success, and this article provides meaningful criteria for doing such an analysis. These are the following: a common team goal, the ability and willingness to work together to achieve team goals, decision making, communication, and team member relationships. High-functioning interdisciplinary teams must exhibit features of good team function in all key domains. If a team functions well in some domains and needs to improve in others, targeted strategies are described that can be used to improve team functioning.

  15. Efficiency improvements in pipeline transportation systems

    Energy Technology Data Exchange (ETDEWEB)

    Banks, W. F.; Horton, J. F.

    1977-09-09

    This report identifies potential energy-conservative pipeline innovations that are most energy- and cost-effective and formulates recommendations for the R, D, and D programs needed to exploit those opportunities. From a candidate field of over twenty classes of efficiency improvements, eight systems are recommended for pursuit. Most of these possess two highly important attributes: large potential energy savings and broad applicability outside the pipeline industry. The R, D, and D program for each improvement and the recommended immediate next step are described. The eight technologies recommended for R, D, and D are gas-fired combined cycle compressor station; internally cooled internal combustion engine; methanol-coal slurry pipeline; methanol-coal slurry-fired and coal-fired engines; indirect-fired coal-burning combined-cycle pump station; fuel-cell pump station; drag-reducing additives in liquid pipelines; and internal coatings in pipelines.

  16. MPACT Subgroup Self-Shielding Efficiency Improvements

    Energy Technology Data Exchange (ETDEWEB)

    Stimpson, Shane [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Liu, Yuxuan [Univ. of Michigan, Ann Arbor, MI (United States); Collins, Benjamin S. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Clarno, Kevin T. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2016-08-31

    Recent developments to improve the efficiency of the MOC solvers in MPACT have yielded effective kernels that loop over several energy groups at once, rather that looping over one group at a time. These kernels have produced roughly a 2x speedup on the MOC sweeping time during eigenvalue calculation. However, the self-shielding subgroup calculation had not been reevaluated to take advantage of these new kernels, which typically requires substantial solve time. The improvements covered in this report start by integrating the multigroup kernel concepts into the subgroup calculation, which are then used as the basis for further extensions. The next improvement that is covered is what is currently being termed as “Lumped Parameter MOC”. Because the subgroup calculation is a purely fixed source problem and multiple sweeps are performed only to update the boundary angular fluxes, the sweep procedure can be condensed to allow for the instantaneous propagation of the flux across a spatial domain, without the need to sweep along all segments in a ray. Once the boundary angular fluxes are considered to be converged, an additional sweep that will tally the scalar flux is completed. The last improvement that is investigated is the possible reduction of the number of azimuthal angles per octant in the shielding sweep. Typically 16 azimuthal angles per octant are used for self-shielding and eigenvalue calculations, but it is possible that the self-shielding sweeps are less sensitive to the number of angles than the full eigenvalue calculation.

  17. Structuring diabetes care in general practices: many improvements, remaining challenges.

    LENUS (Irish Health Repository)

    Jennings, S

    2009-08-07

    BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

  18. Improving Energy Efficiency in Industrial Solutions – Walk the Talk

    DEFF Research Database (Denmark)

    Wegener, Dieter; Finkbeiner, Matthias; Holst, Jens-Christian;

    2011-01-01

    This paper describes the outline of the energy efficiency and environmental care policy and management at Siemens Industry Solutions Division. This environmental policy coherently embraces strategic planning, eco-design of energy-efficient industrial processes and solutions, design evaluation...

  19. Measuring technical efficiency of output quality in intensive care units.

    Science.gov (United States)

    Junoy, J P

    1997-01-01

    Presents some examples of the implications derived from imposing the objective of maximizing social welfare, subject to limited resources, on ethical care patients management in respect of quality performance of health services. Conventional knowledge of health economics points out that critically ill patients are responsible for increased use of technological resources and that they receive a high proportion of health care resources. Attempts to answer, from the point of view of microeconomics, the question: how do we measure comparative efficiency in the management of intensive care units? Analyses this question through data from an international empirical study using micro-economic measures of productive efficiency in public services (data envelopment analysis). Results show a 28.8 per cent level of technical inefficiency processing data from 25 intensive care units in the USA. PMID:10169231

  20. Industrial energy-efficiency-improvement program

    Energy Technology Data Exchange (ETDEWEB)

    1980-12-01

    Progress made by industry toward attaining the voluntary 1980 energy efficiency improvement targets is reported. The mandatory reporting population has been expanded from ten original industries to include ten additional non-targeted industries and all corporations using over one trillion Btu's annually in any manufacturing industry. The ten most energy intensive industries have been involved in the reporting program since the signing of the Energy Policy and Conservation Act and as industrial energy efficiency improvement overview, based primarily on information from these industries (chemicals and allied products; primary metal industry; petroleum and coal products; stone, clay, and glass products; paper and allied products; food and kindred products; fabricated metal products; transportation equipment; machinery, except electrical; and textile mill products), is presented. Reports from industries, now required to report, are included for rubber and miscellaneous plastics; electrical and electronic equipment; lumber and wood; and tobacco products. Additional data from voluntary submissions are included for American Gas Association; American Hotel and Motel Association; General Telephone and Electronics Corporation; and American Telephone and Telegraph Company. (MCW)

  1. Improving energy efficiency in the transportation sector

    Energy Technology Data Exchange (ETDEWEB)

    Plotkin, S.E.

    1994-12-31

    A primary characteristic of transportation in the United States is its high per capita energy consumption. The average US citizen consumes nearly five times as much energy for transportation as the average Japanese and nearly three times as much as the average citizen of France, Britain, or West Germany. The energy efficiency of US transportation has improved substantially over the past two decades (both absolutely and in comparison to Europe), and US travel volume has grown more slowly than in most of the developed world. However, the United States still consumes more than one-third of the world`s transport energy. Also, 96 percent of US transport energy is in the form of oil products. This is more oil than the United States produces, despite its position as one of the world`s largest oil producers. With current problems and expectation of continued growth in travel and energy use, Congress has increasingly turned to transportation energy conservation - in the form of improvements in the technical efficiency of travel, increases in load factors, reductions in travel demand, shifting to alternative fuels, and shifts to more efficient travel modes - as an important policy goal. For example, the Clean Air Amendments of 1990 incorporate transportation demand management as a critical tool in reducing urban air pollution. Legislation proposed in the 102d Congress sought rigorous new automobile and light truck fuel economy standards. With continued increases in U.S. oil imports, urban traffic congestion, and greenhouse gas emissions, and the failure of many urban areas to meet air quality standards, strong congressional interest in new energy conservation initiates is likely to continue.

  2. Social networks in improvement of health care.

    Science.gov (United States)

    Masic, Izet; Sivic, Suad; Toromanovic, Selim; Borojevic, Tea; Pandza, Haris

    2012-01-01

    , etc., which gives a special emphasis on public health aspects of information, especially in the field of medicine and health care. The authors of this paper discuss the role and practical importance of social networks in improving the health and solving of health problems without the physical entrance into the health care system. Social networks have their advantages and disadvantages, benefits and costs, especially when it comes to information which within the network set unprofessional people from unreliable sources, without an adequate selection. The ethical aspect of the norms in this segment is still not adequately regulated, so any sanctions for the unauthorized and malicious use of social networks in private and other purposes in order to obtain personal gain at the expense of individuals or groups (sick or healthy, owners of certain businesses and companies, health organizations and pharmaceutical manufacturers, etc.), for which there is still no global or European codes and standards of conduct. Cyber crime is now one of the mostly present types of crime in modern times, as evidenced by numerous scandals that are happening both globally and locally. PMID:23922516

  3. Improvement of Sweep Efficiency in Gasflooding

    Energy Technology Data Exchange (ETDEWEB)

    Kishore Mohanty

    2008-12-31

    Miscible and near-miscible gasflooding has proven to be one of the few cost effective enhance oil recovery techniques in the past twenty years. As the scope of gas flooding is being expanded to medium viscosity oils in shallow sands in Alaska and shallower reservoirs in the lower 48, there are questions about sweep efficiency in near-miscible regions. The goal of this research is to evaluate sweep efficiency of various gas flooding processes in a laboratory model and develop numerical tools to estimate their effectiveness in the field-scale. Quarter 5-spot experiments were conducted at reservoir pressure to evaluate the sweep efficiency of gas, WAG and foam floods. The quarter 5-spot model was used to model vapor extraction (VAPEX) experiments at the lab scale. A streamline-based compositional simulator and a commercial simulator (GEM) were used to model laboratory scale miscible floods and field-scale pattern floods. An equimolar mixture of NGL and lean gas is multicontact miscible with oil A at 1500 psi; ethane is a multicontact miscible solvent for oil B at pressures higher than 607 psi. WAG improves the microscopic displacement efficiency over continuous gas injection followed by waterflood in corefloods. WAG improves the oil recovery in the quarter 5-spot over the continuous gas injection followed by waterflood. As the WAG ratio increases from 1:2 to 2:1, the sweep efficiency in the 5-spot increases, from 39.6% to 65.9%. A decrease in the solvent amount lowers the oil recovery in WAG floods, but significantly higher amount of oil can be recovered with just 0.1 PV solvent injection over just waterflood. Use of a horizontal production well lowers the oil recovery over the vertical production well during WAG injection phase in this homogeneous 5-spot model. Estimated sweep efficiency decreases from 61.5% to 50.5%. In foam floods, as surfactant to gas slug size ratio increases from 1:10 to 1:1, oil recovery increases. In continuous gasflood VAPEX processes, as the

  4. Hospital medicine (Part 2): what would improve acute hospital care?

    LENUS (Irish Health Repository)

    Kellett, John

    2009-09-01

    There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.

  5. Improving stroke care for patients at Cavan hospital [poster

    LENUS (Irish Health Repository)

    Murugasu, G Dr.

    2013-07-01

    Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.

  6. Condition based payment: improving care of chronic illness

    OpenAIRE

    DiPiero, Albert; Sanders, David G

    2005-01-01

    Fee-for-service is more than a payment method; it defines the method of care. Fee-for-condition—a payment method that rewards superior results and encourages innovation—could greatly improve care for chronic conditions

  7. Efficiency and functionality of an internal purchaser-provider model in public specialized health care services

    OpenAIRE

    Iso-Mustajärvi, Anni

    2016-01-01

    There is an increasing demand to find solutions for improving cost-efficiency in health care. The demand for services continues to increase and there is a need to control the increasing resource requirements. Market-oriented organization models and management methods have been seen as one way to address the challenge and as an alternative to traditional hierarchical organization models in health care. Researchers highlight the importance of investigating how different kinds of changes actuall...

  8. Possible improvement of solar cell efficiency

    International Nuclear Information System (INIS)

    We present the development of a new solar cell prototype in order to improve photovoltaic efficiency. In this model we show that the material can have three successive incident ray absorptions instead of two currently, by varying the incidence angle, the aperture between the summits of two neighbouring pyramids and their height. This study concerns in particular the photovoltaic parameters such as the spectral response. This model was checked for angles varying between 54 and 60 deg and for pyramid heights between 5 and 10 μm. For these values of incidence angle, the apertures between the summits of two neighbouring pyramids varied respectively from 14.54 to 11.54 μm for a pyramid angle height of 10 μm

  9. Integrated Circuit Chip Improves Network Efficiency

    Science.gov (United States)

    2008-01-01

    Prior to 1999 and the development of SpaceWire, a standard for high-speed links for computer networks managed by the European Space Agency (ESA), there was no high-speed communications protocol for flight electronics. Onboard computers, processing units, and other electronics had to be designed for individual projects and then redesigned for subsequent projects, which increased development periods, costs, and risks. After adopting the SpaceWire protocol in 2000, NASA implemented the standard on the Swift mission, a gamma ray burst-alert telescope launched in November 2004. Scientists and developers on the James Webb Space Telescope further developed the network version of SpaceWire. In essence, SpaceWire enables more science missions at a lower cost, because it provides a standard interface between flight electronics components; new systems need not be custom built to accommodate individual missions, so electronics can be reused. New protocols are helping to standardize higher layers of computer communication. Goddard Space Flight Center improved on the ESA-developed SpaceWire by enabling standard protocols, which included defining quality of service and supporting plug-and-play capabilities. Goddard upgraded SpaceWire to make the routers more efficient and reliable, with features including redundant cables, simultaneous discrete broadcast pulses, prevention of network blockage, and improved verification. Redundant cables simplify management because the user does not need to worry about which connection is available, and simultaneous broadcast signals allow multiple users to broadcast low-latency side-band signal pulses across the network using the same resources for data communication. Additional features have been added to the SpaceWire switch to prevent network blockage so that more robust networks can be designed. Goddard s verification environment for the link-and-switch implementation continuously randomizes and tests different parts, constantly anticipating

  10. Improving depression care: barriers, solutions, and research needs.

    Science.gov (United States)

    Von Korff, M; Katon, W; Unützer, J; Wells, K; Wagner, E H

    2001-06-01

    Potential solutions for barriers to improved organization of care of depressive illness were identified. These included (1) aligning efforts to improve depression care with broader strategies for improving care of other chronic conditions; (2) increasing the availability of depression case management services in primary care; (3) developing registries and reminder systems to ensure active follow-up of depressed patients; (4) achieving agreement on how depression outcomes should be measured to provide outcomes-based performance standards; (5) providing greater support from mental health specialists for management of depressed patients by primary care providers; (6) campaigns to reduce the stigma associated with treatment of depressive illness; (7) increased dissemination of interventions that activate and empower patients managing a depressive illness; (8) redefining the lack of time of primary care providers for high-quality depression care as issues in organization of care and provider training; and (9) development of incentives (organizational or financial) for high-quality depression care. Research needs were identified according to what has been learned to date. Identified research needs included: studies of approaches to organization of case management, research in new populations (e.g., new diagnostic groups, rural populations, the disadvantaged, the elderly, and those with chronic medical illnesses), research on stepped care and relapse prevention strategies, evaluation of the societal benefits of improved depression care, and multisite trials and meta-analytic approaches that can provide adequate statistical power to assess societal benefits of improved care.

  11. Improving Decision Making in Intensive Care

    NARCIS (Netherlands)

    I.A. Meynaar (Iwan)

    2012-01-01

    textabstractMany decisions are made during a day’s work in critical care. Should this octogenarian with pneumonia and cancer be admitted to the ICU or left on the ward with palliative care? And if admitted to the ICU, will she benefit from being ventilated or should she only be treated with antibiot

  12. Improving primary health care through technological innovation.

    NARCIS (Netherlands)

    Groenewegen, P.P.; Hutten, J.B.F.

    1989-01-01

    As a result of policy changes and developments on the demand side, the importance of technology in primary health care will grow fast. An approach to the implementation of new technologies in primary health care is presented in this article. First we describe the main problems in Dutch primary healt

  13. Improving Energy Efficiency in CNC Machining

    Science.gov (United States)

    Pavanaskar, Sushrut S.

    We present our work on analyzing and improving the energy efficiency of multi-axis CNC milling process. Due to the differences in energy consumption behavior, we treat 3- and 5-axis CNC machines separately in our work. For 3-axis CNC machines, we first propose an energy model that estimates the energy requirement for machining a component on a specified 3-axis CNC milling machine. Our model makes machine-specific predictions of energy requirements while also considering the geometric aspects of the machining toolpath. Our model - and the associated software tool - facilitate direct comparison of various alternative toolpath strategies based on their energy-consumption performance. Further, we identify key factors in toolpath planning that affect energy consumption in CNC machining. We then use this knowledge to propose and demonstrate a novel toolpath planning strategy that may be used to generate new toolpaths that are inherently energy-efficient, inspired by research on digital micrography -- a form of computational art. For 5-axis CNC machines, the process planning problem consists of several sub-problems that researchers have traditionally solved separately to obtain an approximate solution. After illustrating the need to solve all sub-problems simultaneously for a truly optimal solution, we propose a unified formulation based on configuration space theory. We apply our formulation to solve a problem variant that retains key characteristics of the full problem but has lower dimensionality, allowing visualization in 2D. Given the complexity of the full 5-axis toolpath planning problem, our unified formulation represents an important step towards obtaining a truly optimal solution. With this work on the two types of CNC machines, we demonstrate that without changing the current infrastructure or business practices, machine-specific, geometry-based, customized toolpath planning can save energy in CNC machining.

  14. Improving pumping system efficiency at coal plants

    Energy Technology Data Exchange (ETDEWEB)

    Livoti, W.C.; McCandless, S.; Poltorak, R. [Baldor Electric Co. (United States)

    2009-03-15

    The industry must employ ultramodern technologies when building or upgrading power plant pumping systems thereby using fuels more efficiently. The article discusses the uses and efficiencies of positive displacement pumps, centrifugal pumps and multiple screw pumps. 1 ref., 4 figs.

  15. From Practice Culture to Patient Outcomes: Improving Primary Care Through Interdisciplinary Health Care Teams

    OpenAIRE

    Grace, Sherry M.

    2013-01-01

    Background: In 2011, a large integrated healthcare organization implemented a primary care team redesign in five pilot practices to improve the delivery of patient-centered chronic illness care and augment the physician-medical assistant dyads by adding two new primary care team roles for each practice - a nurse care manager (NCM) and a patient health coach (PHC). This work examines three aspects of implementing the care team redesign: 1) The facilitators and barriers of implementation, 2) Th...

  16. Efficiency improvement of thermal coal power plants

    Energy Technology Data Exchange (ETDEWEB)

    Hourfar, D. [VEBA Kraftwerke Ruhr Ag, Gelsenkirchen (Germany)

    1996-12-31

    The discussion concerning an increase of the natural greenhouse effect by anthropogenic changes in the composition of the atmosphere has increased over the past years. The greenhouse effect has become an issue of worldwide debate. Carbon dioxide is the most serious emission of the greenhouse gases. Fossil-fired power plants have in the recent past been responsible for almost 30 % of the total CO{sub 2} emissions in Germany. Against this background the paper will describe the present development of CO{sub 2} emissions from power stations and present actual and future opportunities for CO{sub 2} reduction. The significance attached to hard coal as one of today`s prime sources of energy with the largest reserves worldwide, and, consequently, its importance for use in power generation, is certain to increase in the years to come. The further development of conventional power plant technology, therefore, is vital, and must be carried out on the basis of proven operational experience. The main incentive behind the development work completed so far has been, and continues to be, the achievement of cost reductions and environmental benefits in the generation of electricity by increasing plant efficiency, and this means that, in both the short and the long term, power plants with improved conventional technology will be used for environmentally acceptable coal-fired power generation.

  17. Continuous improvement and TQM in health care: an emerging operational paradigm becomes a strategic imperative.

    Science.gov (United States)

    Swinehart, K; Green, R F

    1995-01-01

    Argues that US health care is in a state of crisis. Escalating costs account for 13 per cent of GNP, making health care the third largest industry in the USA, and spending is expected to increase. Claims health-care providers need to control rising costs, improve productivity and flexibility, adopt appropriate technologies, and maintain competitive levels of quality and value. States that TQM may provide an environment that will focus on quality of patient care and continuous quality improvement at all levels of the organization including the governing body, the administrative, managerial, and clinical areas. Any new national or state health-care plan will force providers to be more efficient while maintaining quality standards. Concludes that it will be strategically imperative that health-care providers ranging from family physicians to major medical centres and suppliers ranging from laboratories to pharmaceutical firms establish methods for making rapid continuous improvement and total quality management the cornerstone of the strategic planning process.

  18. Family physicians improve patient health care quality and outcomes.

    Science.gov (United States)

    Bowman, Marjorie A; Neale, Anne Victoria

    2013-01-01

    This issue exemplifies family physicians' ability to provide great care and to continuously improve. For example, beyond other specialty care, the care provided by family physicians is associated with improved melanoma diagnosis and outcomes and improved preventive services for those with a history of breast cancer. Electronic health records are providing new avenues to both assess outcomes and influence care. However, to truly reward quality care, simplistic and readily measurable items such as laboratory results or assessment of the provision of preventive services must be adjusted for risk. Health insurance influences classic preventive care services more than personal health behaviors. The care provided at federally qualified health centers throughout the nation is highly appreciated by the people they serve and is not plagued by the types of disparities in other settings.

  19. Bundled Payments for Care Improvement Chart Book

    Data.gov (United States)

    U.S. Department of Health & Human Services — The HHS Assistant Secretary for Policy and Evaluation (ASPE) has conducted several research projects in the area of Medicare acute and post acute care episodes. The...

  20. Early Palliative Care Improves Patients' Quality of Life

    Science.gov (United States)

    ... fullstory_160885.html Early Palliative Care Improves Patients' Quality of Life Also increases chances of having end-of-life ... incurable cancer helps patients cope and improves their quality of life, a new study shows. It also leads to ...

  1. Monitoring and improving care in thoracic surgery

    NARCIS (Netherlands)

    R.C. Numan

    2016-01-01

    Quality of Care (QoC) plays a central role in the way healthcare is delivered. In the world of thoracic surgery for lung cancer, surgeons are faced with complex and sometimes high-risk surgical resections on an aging patient population with an increasing incidence of frail physical health. This incr

  2. Improved energy efficiency in sawmill drying system

    International Nuclear Information System (INIS)

    Highlights: • A heating system at a sawmill was investigated and improved. • Different impacts of external technologies at the energy usage were explored. • The heat and electricity consumption was analysed separate between technologies type. • The result point out a significant decrease of the biomass consumptions. - Abstract: The worldwide use of biomass has increased drastically during the last decade. At Swedish sawmills about half of the entering timber becomes lumber, with the remainder considered as by-product (biomass). A significant part of this biomass is used for internal heat production, mainly for forced drying of lumber in drying kilns. Large heat losses in kilns arise due to difficulties in recovering evaporative heat in moist air at low temperatures. This paper addresses the impact of available state-of-the-art technologies of heat recycling on the most common drying schemes used in Swedish sawmills. Simulations of different technologies were performed on an hourly basis to compare the heat and electricity demand with the different technologies. This was executed for a total sawmill and finally to the national level to assess the potential effects upon energy efficiency and biomass consumption. Since some techniques produce a surplus of heat the comparison has to include the whole sawmill. The impact on a national level shows the potential of the different investigated techniques. The results show that if air heat exchangers were introduced across all sawmills in Sweden, the heat demand would decrease by 0.3 TWh/year. The mechanical heat pump technology would decrease the heat demand by 5.6 TWh/year and would also produce a surplus for external heat sinks, though electricity demand would increase by 1 TWh/year. The open absorption system decreases the heat demand by 3.4 TWh/year on a national level, though at the same time there is a moderate increase in electricity demand of 0.05 TWh/year. Introducing actual energy prices in Sweden gives an

  3. Improving the efficiency of manuscript selection

    Directory of Open Access Journals (Sweden)

    A. Martínez–Abrain

    2009-01-01

    previous submittal were taken into account. Option b is suggested as an alternative to obliging authors to declare whether or not their submission was previously rejected by another journal, because they think this could prejudice the evaluation of the new submission. However, I believe that the system I propose here would prevent prejudiced evaluations because authors would have the opportunity to upload the response to reviewer’s comments so that second-round reviewers would have the chance to see both the problems previously de¬tected in the manuscript and the defence offered by authors. Although not a perfect system its benefits would probably outweigh the caveats. Such a system would improve the quality of the final paper and facilitate the work load for second–round reviewers and editors. Indeed, some journals already seem to be implementing a solution which is fairly similar to our proposal, asking authors of rejected papers for permission to forward reviewer reports to the new journal chosen by the authors to submit the revised work (see Hochberg et al., 2009. Proposals to reward or punish reviewers depending on their rapidity to elaborate their reports (Hauser & Fehr, 2007 does not foster accumulated quality improvement. Science quality would undoubtedly gain from making previous information concerning a manuscript’s review available to new reviewers, as in a Bayesian framework of inference (Martin et al., 2005 because starting a new each time, as if previous information did not exist, is simply not an efficient way to proceed in science.

  4. Do primary care providers who speak Chinese improve access to mental health care of Chinese immigrants?

    OpenAIRE

    Chen, Alice W.; Kazanjian, Arminée

    2009-01-01

    Background The utilization of health care providers who share the language and culture of their patients has been advocated as a strategy to improve access to the mental health care of immigrants. This study examines the relationship between patients receiving primary care from health care providers who speak Chinese and the rate of mental health diagnosis and consultation among Chinese immigrants in British Columbia (BC), Canada. Methods The study analyzed 3 linked administrative databases: ...

  5. Kaizen: a process improvement model for the business of health care and perioperative nursing professionals.

    Science.gov (United States)

    Tetteh, Hassan A

    2012-01-01

    Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement. PMID:22201574

  6. Kaizen: a process improvement model for the business of health care and perioperative nursing professionals.

    Science.gov (United States)

    Tetteh, Hassan A

    2012-01-01

    Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement.

  7. Mobile phones improve antenatal care attendance in Zanzibar

    DEFF Research Database (Denmark)

    Lund, Stine; Nielsen, Birgitte B; Hemed, Maryam;

    2014-01-01

    BACKGROUND: Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems. Antenatal care has the potential to reduce maternal morbidity and improve newborns' survival but this benefit may not be realized in sub-Saharan Africa where the attendance and quality...... measure was four or more antenatal care visits during pregnancy. Secondary outcome measures were tetanus vaccination, preventive treatment for malaria, gestational age at last antenatal care visit, and antepartum referral. RESULTS: The mobile phone intervention was associated with an increase in antenatal...... care attendance. In the intervention group 44% of the women received four or more antenatal care visits versus 31% in the control group (OR, 2.39; 95% CI, 1.03-5.55). There was a trend towards improved timing and quality of antenatal care services across all secondary outcome measures although...

  8. Improving the quality of cardiovascular preventive care in general practice

    OpenAIRE

    Lobo, Claudia

    2002-01-01

    textabstractIn this thesis we target cardiovascular preventive care from a continuous quality improvement point of view in a project called CARPE (CArdiovascular Risk reduction in Primary carE). We created a multifaceted intervention based on a ·quality cycle· and used outreach visitors for its implementation, since this approach has proven successful in modifying professional behavior. 13 In addressing prevention we considered Donebedian's model 14 to assess quality of care: i.e. we distingu...

  9. Improving organizational climate for excellence in patient care.

    Science.gov (United States)

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance. PMID:23903945

  10. Improving organizational climate for excellence in patient care.

    Science.gov (United States)

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance.

  11. Improving Prescribing Practices in Primary Care

    OpenAIRE

    Atle Fretheim; Oxman, Andrew D.; Kari Håvelsrud; Shaun Treweek; Kristoffersen, Doris T; Arild Bjørndal

    2006-01-01

    Editors' Summary Background. An important issue in health care is “getting research into practice,” in other words, making sure that, when evidence from research has established the best way to treat a disease, doctors actually use that approach with their patients. In reality, there is often a gap between evidence and practice.   An example concerns the treatment of people who have high blood pressure (hypertension) and/or high cholesterol. These are common conditions, and both increase the ...

  12. Approaches of Improving University Assets Management Efficiency

    Science.gov (United States)

    Wang, Jingliang

    2015-01-01

    University assets management, as an important content of modern university management, is generally confronted with the issue of low efficiency. Currently, to address the problems exposed in university assets management and take appropriate modification measures is an urgent issue in front of Chinese university assets management sectors. In this…

  13. Improving the Efficiency of Dialogue in Tutoring

    Science.gov (United States)

    Kopp, Kristopher J.; Britt, M. Anne; Millis, Keith; Graesser, Arthur C.

    2012-01-01

    The current studies investigated the efficient use of dialogue in intelligent tutoring systems that use natural language interaction. Such dialogues can be relatively time-consuming. This work addresses the question of how much dialogue is needed to produce significant learning gains. In Experiment 1, a full dialogue condition and a read-only…

  14. Improving quantum sensing efficiency with virtual modes

    Science.gov (United States)

    Lanzagorta, Marco; Uhlmann, Jeffrey; Le, Truc; Jitrik, Oliverio; Venegas-Andraca, Salvador E.

    2016-05-01

    Recent research suggests that quantum radar offers several potential advantages over classical sensing technologies. At present, the primary practical challenge is the fast and efficient generation of entangled microwave photons. To mitigate this limitation we propose and briefly examine a distributed architecture to synthetically increase the number of effectively-distinguishable modes.

  15. Big data analytics to improve cardiovascular care: promise and challenges.

    Science.gov (United States)

    Rumsfeld, John S; Joynt, Karen E; Maddox, Thomas M

    2016-06-01

    The potential for big data analytics to improve cardiovascular quality of care and patient outcomes is tremendous. However, the application of big data in health care is at a nascent stage, and the evidence to date demonstrating that big data analytics will improve care and outcomes is scant. This Review provides an overview of the data sources and methods that comprise big data analytics, and describes eight areas of application of big data analytics to improve cardiovascular care, including predictive modelling for risk and resource use, population management, drug and medical device safety surveillance, disease and treatment heterogeneity, precision medicine and clinical decision support, quality of care and performance measurement, and public health and research applications. We also delineate the important challenges for big data applications in cardiovascular care, including the need for evidence of effectiveness and safety, the methodological issues such as data quality and validation, and the critical importance of clinical integration and proof of clinical utility. If big data analytics are shown to improve quality of care and patient outcomes, and can be successfully implemented in cardiovascular practice, big data will fulfil its potential as an important component of a learning health-care system. PMID:27009423

  16. Big data analytics to improve cardiovascular care: promise and challenges.

    Science.gov (United States)

    Rumsfeld, John S; Joynt, Karen E; Maddox, Thomas M

    2016-06-01

    The potential for big data analytics to improve cardiovascular quality of care and patient outcomes is tremendous. However, the application of big data in health care is at a nascent stage, and the evidence to date demonstrating that big data analytics will improve care and outcomes is scant. This Review provides an overview of the data sources and methods that comprise big data analytics, and describes eight areas of application of big data analytics to improve cardiovascular care, including predictive modelling for risk and resource use, population management, drug and medical device safety surveillance, disease and treatment heterogeneity, precision medicine and clinical decision support, quality of care and performance measurement, and public health and research applications. We also delineate the important challenges for big data applications in cardiovascular care, including the need for evidence of effectiveness and safety, the methodological issues such as data quality and validation, and the critical importance of clinical integration and proof of clinical utility. If big data analytics are shown to improve quality of care and patient outcomes, and can be successfully implemented in cardiovascular practice, big data will fulfil its potential as an important component of a learning health-care system.

  17. The Coach Is in: Improving Nutritional Care in Nursing Homes

    Science.gov (United States)

    Rahman, Anna N.; Simmons, Sandra F.; Applebaum, Robert; Lindabury, Kate; Schnelle, John F.

    2012-01-01

    Purpose: This article describes and evaluates a long distance coaching course aimed at improving nutritional care in nursing homes (NHs). The course was structured to provide more support than traditional training programs offer. Methods: In a series of 6 monthly teleconferences led by an expert in NH nutritional care, participating NH staff…

  18. Training primary care physicians improves the management of depression

    NARCIS (Netherlands)

    van Os, TWDP; Ormel, J; van den Brink, RHS; Jenner, JA; Van der Meer, K; Tiemens, BG; van der Doorn, W; Smit, A; van den Brink, W

    1999-01-01

    The purpose of this pretest-posttest study was to evaluate effects of a training program designed to improve primary care physicians' (PCPs) ability to recognize mental health problems (MHP) and Co diagnose and manage depression according to clinical guidelines. The primary care settings were in the

  19. Geospatial Technologies to Improve Urban Energy Efficiency

    OpenAIRE

    Bharanidharan Hemachandran; Arvai, Joseph L.; Fung, Tak S.; Gang Chen; Christopher Kyle; Geoffrey J. Hay; Mir Mustafizur Rahman

    2011-01-01

    The HEAT (Home Energy Assessment Technologies) pilot project is a FREE Geoweb mapping service, designed to empower the urban energy efficiency movement by allowing residents to visualize the amount and location of waste heat leaving their homes and communities as easily as clicking on their house in Google Maps. HEAT incorporates Geospatial solutions for residential waste heat monitoring using Geographic Object-Based Image Analysis (GEOBIA) and Canadian built Thermal Airborne Broadband Imager...

  20. Improving Aquifer Thermal Energy Storage Efficiency

    OpenAIRE

    S. Kranz; G. Blöcher; Ali Saadat

    2015-01-01

    Aquifer thermal energy storage systems play an important role for the future energy supply systems. Such systems can decouple energy availability (e.g. fluctuating renewable energy, waste heat) and energy supply in times of demand. In order to fully contribute to the sustainability of energy supply, the essential requirements of energy storages are high energy efficiency, high reliability, cost effectiveness, as well as operational flexibility. Aquifer Thermal Energy Storage Systems (ATES) me...

  1. Improving Nitrogen Efficiency: Lessons from Malawi and Michigan

    Directory of Open Access Journals (Sweden)

    Sieglinde Snapp

    2001-01-01

    Full Text Available Two case studies are presented here of nitrogen (N dynamics in potato/maize systems. Contrasting systems were investigated from (1 the highland tropics of Dedza, Malawi in southern Africa and (2 the northern temperate Great Lakes region of Michigan. Formal surveys were conducted to document grower perceptions and N management strategies. Survey data were linked with N budgets conducted by reviewing on-farm data from representative farms in the targeted agroecosystems and simulation modeling to estimate N losses. Potential N-loss junctures were identified. Interventions that farmers might accept are discussed. The Malawi system uses targeted application of very small amounts of fertilizer (average 18 kg N ha-1 to growing plants. This low rate is on the steep part of plant response to N curve and should serve to enhance efficiency; plant growth, however, is generally stunted in Malawi due to degraded soils and weed competition. Very limited crop yields reduce N efficiency from a simulated 60 kg grain per kg N to an actual of ~20 kg grain per kg N (at 40 kg N ha-1 applied. Legume-intensified systems could improve growth potential and restore N use efficiency through amelioration of soil quality and transfer functions and from biological fixation N inputs. In the Michigan system, N efficiency is enhanced currently through multiple, split applications of N fertilizer tailored to plant growth rate and demand. Fertilizer N rates used by growers, however, averaged 32% higher than recommended rates and 40% higher than N removed in crop product. Application of 50 kg N ha-1 to cover crops in the fall may contribute to the apparent high potential for N leaching losses. Careful consideration of N credits from legumes and residual soil N would improve N efficiency. Overall, N budgets indicated 0 to 20 kg N ha-1 loss potential from the Malawi systems and tenfold higher loss potential from current practice in Michigan maize/potato rotations. Best management

  2. Delivering On Accountable Care: Lessons From A Behavioral Health Program To Improve Access And Outcomes.

    OpenAIRE

    Clarke, RM; Jeffrey, J; Grossman, M.; Strouse, T; Gitlin, M.; Skootsky, SA

    2016-01-01

    Patients with behavioral health disorders often have worse health outcomes and have higher health care utilization than patients with medical diseases alone. As such, people with behavioral health conditions are important populations for accountable care organizations (ACOs) seeking to improve the efficiency of their delivery systems. However, ACOs have historically faced numerous barriers in implementing behavioral health population-based programs, including acquiring reimbursement, recruiti...

  3. A FRAMEWORK FOR MEASURING AND IMPROVING EFFICIENCY IN DISTRIBUTION CHANNELS

    Directory of Open Access Journals (Sweden)

    Milan Andrejić

    2016-06-01

    Full Text Available Distribution of products is largely conditioned by the efficiency of logistics processes. The efficient logistics processes provide loyal and satisfied customers, dominant position on the market and revenue. In this paper new approach for measuring and improving efficiency of logistics processes in distribution channel is proposed. Model based on the Principal Component Analysis – Data Envelopment Analysis approach evaluates efficiency of ordering, warehousing, packaging, inventory management and transport processes as well as distribution channel efficiency. Proposed approach also gives information about corrective actions for efficiency improvement. According results efficiency should be improved in several ways: information system improvement, failures decreasing, utilization increasing and output increasing. The results of proposed approach testing show great applicability of developed approach.

  4. Process improvement in healthcare: Overall resource efficiency

    NARCIS (Netherlands)

    J. de Mast; B. Kemper; R.J.M.M. Does; M. Mandjes; Y. van der Bijl

    2011-01-01

    This paper aims to develop a unifying and quantitative conceptual framework for healthcare processes from the viewpoint of process improvement. The work adapts standard models from operation management to the specifics of healthcare processes. We propose concepts for organizational modeling of healt

  5. The business case for health-care quality improvement.

    Science.gov (United States)

    Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M

    2013-03-01

    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance.

  6. The business case for health-care quality improvement.

    Science.gov (United States)

    Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M

    2013-03-01

    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance. PMID:23429226

  7. Improved input-legitimacy and efficient policies?

    DEFF Research Database (Denmark)

    Agger, Annika

    a proliferation of attempts to create both more efficient as well as flexible public services. Theories of innovation haw inspired efforts to close the gap between high public expecta-tions and limited public resources. The fact that the innovation agenda is to a large extent inspired by theories and models from......-ours. Empirically, the paper draws on a case study of collaborative policy innovation in a Danish municipality. We have studied a local task force set up to develop a municipal policy for “Citizen – and stakeholder participation”. The members of the taskforce were the local mayor, the city manager, 6 citizens, 6...

  8. Using routine data to improve palliative and end of life care.

    Science.gov (United States)

    Davies, Joanna M; Gao, Wei; Sleeman, Katherine E; Lindsey, Katie; Murtagh, Fliss E; Teno, Joan M; Deliens, Luc; Wee, Bee; Higginson, Irene J; Verne, Julia

    2016-09-01

    Palliative and end of life care is essential to healthcare systems worldwide, yet a minute proportion of research funding is spent on palliative and end of life care research. Routinely collected health and social care data provide an efficient and useful opportunity for evaluating and improving care for patients and families. There are excellent examples of routine data research in palliative and end of life care, but routine data resources are widely underutilised. We held four workshops on using routinely collected health and social care data in palliative and end of life care. Researchers presented studies from the UK, USA and Europe. The aim was to highlight valuable examples of work with routine data including work with death registries, hospital activity records, primary care data and specialist palliative care registers. This article disseminates that work, describes the benefits of routine data research and identifies major challenges for the future use of routine data, including; access to data, improving data linkage, and the need for more palliative and end of life care specific data.

  9. Improved particle swarm optimization algorithm for android medical care IOT using modified parameters.

    Science.gov (United States)

    Sung, Wen-Tsai; Chiang, Yen-Chun

    2012-12-01

    This study examines wireless sensor network with real-time remote identification using the Android study of things (HCIOT) platform in community healthcare. An improved particle swarm optimization (PSO) method is proposed to efficiently enhance physiological multi-sensors data fusion measurement precision in the Internet of Things (IOT) system. Improved PSO (IPSO) includes: inertia weight factor design, shrinkage factor adjustment to allow improved PSO algorithm data fusion performance. The Android platform is employed to build multi-physiological signal processing and timely medical care of things analysis. Wireless sensor network signal transmission and Internet links allow community or family members to have timely medical care network services. PMID:22492176

  10. Improved particle swarm optimization algorithm for android medical care IOT using modified parameters.

    Science.gov (United States)

    Sung, Wen-Tsai; Chiang, Yen-Chun

    2012-12-01

    This study examines wireless sensor network with real-time remote identification using the Android study of things (HCIOT) platform in community healthcare. An improved particle swarm optimization (PSO) method is proposed to efficiently enhance physiological multi-sensors data fusion measurement precision in the Internet of Things (IOT) system. Improved PSO (IPSO) includes: inertia weight factor design, shrinkage factor adjustment to allow improved PSO algorithm data fusion performance. The Android platform is employed to build multi-physiological signal processing and timely medical care of things analysis. Wireless sensor network signal transmission and Internet links allow community or family members to have timely medical care network services.

  11. [Strategies for improving care of oncologic patients: SHARE Project results].

    Science.gov (United States)

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients.

  12. Improved nurse-parent communication in neonatal intensive care unit

    DEFF Research Database (Denmark)

    Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid

    2014-01-01

    and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification. RESULTS: Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context...... family-centred care was developed to facilitate person-centred communication by bridging the gap between theory and practice in family-centred care. Main mechanisms of guided family-centred care are structured dialogue, reflection and person-centred communication. DESIGN: Qualitative and quantitative...... data were used to monitor participatory implementation of a systematic approach to training and certification of nurses delivering guided family-centred care. METHODS: Systematic implementation of guided family-centred care included workshops, supervised delivery and certification. Evaluation...

  13. Process improvement in healthcare: Overall resource efficiency

    OpenAIRE

    Mast, de, J.; Kemper, B; Does, R.J.M.M.; Mandjes, M.; Bijl, van der, Hans

    2011-01-01

    This paper aims to develop a unifying and quantitative conceptual framework for healthcare processes from the viewpoint of process improvement. The work adapts standard models from operation management to the specifics of healthcare processes. We propose concepts for organizational modeling of healthcare processes, breaking down work into micro processes, tasks, and resources. In addition, we propose an axiological model which breaks down general performance goals into process metrics. The co...

  14. Ecological Factors Improving Efficiency of Business Activities

    OpenAIRE

    Kononova G. A.; Tsiganov V. V.

    2015-01-01

    The economic importance of optimizing the environmental situation from the perspective of an entrepreneur are assessed in the article. The classification of administrative decisions taken in the course of the business activities is proposed. The authors identified a group of solutions directly providing optimization of environment external to the enterprise, solutions that have an indirect positive impact on the environment and solutions that improve ecology of industrial premises. The nature...

  15. Strategies for Improving Enzymes for Efficient Biocatalysis

    OpenAIRE

    Adamczak, Marek; Krishna, Sajja Hari

    2004-01-01

    Biocatalytic processes are finding increasingly widespread application not only in academia, but also in industry. This is particularly true in the pharmaceutical and agrochemical industries where the need for optically pure molecules is critical. Biocatalysis is also receiving a major thrust from the generation of new and novel biocatalysts via microbial screening, developments in the biocatalytic processes themselves (e.g. use of nonaqueous solvents for synthetic purposes) and improvements ...

  16. Improving care quality and preventing maltreatment in institutional care – a feasibility study with caregivers

    OpenAIRE

    Hermenau, Katharin; Kaltenbach, Elisa; Mkinga, Getrude; Hecker, Tobias

    2015-01-01

    Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy...

  17. Surface Operations Systems Improve Airport Efficiency

    Science.gov (United States)

    2009-01-01

    With Small Business Innovation Research (SBIR) contracts from Ames Research Center, Mosaic ATM of Leesburg, Virginia created software to analyze surface operations at airports. Surface surveillance systems, which report locations every second for thousands of air and ground vehicles, generate massive amounts of data, making gathering and analyzing this information difficult. Mosaic?s Surface Operations Data Analysis and Adaptation (SODAA) tool is an off-line support tool that can analyze how well the airport surface operation is working and can help redesign procedures to improve operations. SODAA helps researchers pinpoint trends and correlations in vast amounts of recorded airport operations data.

  18. Using COPE To Improve Quality of Care: The Experience of the Family Planning Association of Kenya.

    Science.gov (United States)

    Bradley, Janet

    1998-01-01

    COPE (Client-Oriented, Provider-Efficient) methodology, a self-assessment tool that has been used in 35 countries around the world, was used to improve the quality of care in family planning clinics in Kenya. COPE involves a process that legitimately invests power with providers and clinic-level staff. It gives providers more control over their…

  19. Improving the efficiency of genomic selection.

    Science.gov (United States)

    Scutari, Marco; Mackay, Ian; Balding, David

    2013-08-01

    We investigate two approaches to increase the efficiency of phenotypic prediction from genome-wide markers, which is a key step for genomic selection (GS) in plant and animal breeding. The first approach is feature selection based on Markov blankets, which provide a theoretically-sound framework for identifying non-informative markers. Fitting GS models using only the informative markers results in simpler models, which may allow cost savings from reduced genotyping. We show that this is accompanied by no loss, and possibly a small gain, in predictive power for four GS models: partial least squares (PLS), ridge regression, LASSO and elastic net. The second approach is the choice of kinship coefficients for genomic best linear unbiased prediction (GBLUP). We compare kinships based on different combinations of centring and scaling of marker genotypes, and a newly proposed kinship measure that adjusts for linkage disequilibrium (LD). We illustrate the use of both approaches and examine their performances using three real-world data sets with continuous phenotypic traits from plant and animal genetics. We find that elastic net with feature selection and GBLUP using LD-adjusted kinships performed similarly well, and were the best-performing methods in our study. PMID:23934612

  20. Energy efficiency improvement by gear shifting optimization

    Directory of Open Access Journals (Sweden)

    Blagojevic Ivan A.

    2013-01-01

    Full Text Available Many studies have proved that elements of driver’s behavior related to gear selection have considerable influence on the fuel consumption. Optimal gear shifting is a complex task, especially for inexperienced drivers. This paper presents an implemented idea for gear shifting optimization with the aim of fuel consumption minimization with more efficient engine working regimes. Optimized gear shifting enables the best possible relation between vehicle motion regimes and engine working regimes. New theoretical-experimental approach has been developed using On-Board Diagnostic technology which so far has not been used for this purpose. The matrix of driving modes according to which tests were performed is obtained and special data acquisition system and analysis process have been developed. Functional relations between experimental test modes and adequate engine working parameters have been obtained and all necessary operations have been conducted to enable their use as inputs for the designed algorithm. The created Model has been tested in real exploitation conditions on passenger car with Otto fuel injection engine and On-Board Diagnostic connection without any changes on it. The conducted tests have shown that the presented Model has significantly positive effects on fuel consumption which is an important ecological aspect. Further development and testing of the Model allows implementation in wide range of motor vehicles with various types of internal combustion engines.

  1. Care coordination between specialty care and primary care: a focus group study of provider perspectives on strong practices and improvement opportunities

    Directory of Open Access Journals (Sweden)

    Kim B

    2015-01-01

    Full Text Available Bo Kim,1,2 Michelle A Lucatorto,3 Kara Hawthorne,4 Janis Hersh,5 Raquel Myers,6 A Rani Elwy,1,7 Glenn D Graham81Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, 2Department of Psychiatry, Harvard Medical School, Boston, MA, 3Office of Nursing Services, Department of Veterans Affairs, 4Chief Business Office, Purchased Care, Washington, DC, 5New England Veterans Engineering Resource Center, Boston, MA, 6SJ Quinney College of Law, University of Utah, Salt Lake City, UT, 7Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, 8Specialty Care Services (10P4E, Department of Veterans Affairs, Washington, DC, USAAbstract: Care coordination between the specialty care provider (SCP and the primary care provider (PCP is a critical component of safe, efficient, and patient-centered care. Veterans Health Administration conducted a series of focus groups of providers, from specialty care and primary care clinics at VA Medical Centers nationally, to assess 1 what SCPs and PCPs perceive to be current practices that enable or hinder effective care coordination with one another and 2 how these perceptions differ between the two groups of providers. A qualitative thematic analysis of the gathered data validates previous studies that identify communication as being an important enabler of coordination, and uncovers relationship building between specialty care and primary care (particularly through both formal and informal relationship-building opportunities such as collaborative seminars and shared lunch space, respectively to be the most notable facilitator of effective communication between the two sides. Results from this study suggest concrete next steps that medical facilities can take to improve care coordination, using as their basis the mutual understanding and respect developed between SCPs and PCPs through relationship-building efforts

  2. Improving timeliness and efficiency in the referral process for safety net providers: application of the Lean Six Sigma methodology.

    Science.gov (United States)

    Deckard, Gloria J; Borkowski, Nancy; Diaz, Deisell; Sanchez, Carlos; Boisette, Serge A

    2010-01-01

    Designated primary care clinics largely serve low-income and uninsured patients who present a disproportionate number of chronic illnesses and face great difficulty in obtaining the medical care they need, particularly the access to specialty physicians. With limited capacity for providing specialty care, these primary care clinics generally refer patients to safety net hospitals' specialty ambulatory care clinics. A large public safety net health system successfully improved the effectiveness and efficiency of the specialty clinic referral process through application of Lean Six Sigma, an advanced process-improvement methodology and set of tools driven by statistics and engineering concepts.

  3. Evidence of improved quality of life with pediatric palliative care.

    Science.gov (United States)

    O'Quinn, Lucy P; Giambra, Barbara K

    2014-01-01

    Pediatric nurses provide holistic family-centered care for children with life-limiting illnesses while being sensitive to children's growth and developmental needs. To learn how pediatric palliative care programs benefit children and their families, the following clinical question was asked: Among children with a life-limiting illness, does the use of a palliative care program compared with not using a palliative care program improve quality of life for patients and their families? Evidence from two studies found that palliative care services improve quality of life for children with life-limiting illness and their families in the areas of the child's emotional well-being and parental perception of preparation for the child's end of life, resulting in a low grade for the body of evidence. Future research should include high quality studies with larger sample sizes and control groups, and include children's perspectives--from both patients and siblings--to give a more complete picture of how best to improve their quality of life. A reliable tool is needed that includes a spiritual component and sensitive indicators specific to children with a life-limiting illness. Future research using this tool will more fully answer how palliative care services improve children's quality of life. PMID:25929123

  4. Geospatial Technologies to Improve Urban Energy Efficiency

    Directory of Open Access Journals (Sweden)

    Bharanidharan Hemachandran

    2011-07-01

    Full Text Available The HEAT (Home Energy Assessment Technologies pilot project is a FREE Geoweb mapping service, designed to empower the urban energy efficiency movement by allowing residents to visualize the amount and location of waste heat leaving their homes and communities as easily as clicking on their house in Google Maps. HEAT incorporates Geospatial solutions for residential waste heat monitoring using Geographic Object-Based Image Analysis (GEOBIA and Canadian built Thermal Airborne Broadband Imager technology (TABI-320 to provide users with timely, in-depth, easy to use, location-specific waste-heat information; as well as opportunities to save their money and reduce their green-house-gas emissions. We first report on the HEAT Phase I pilot project which evaluates 368 residences in the Brentwood community of Calgary, Alberta, Canada, and describe the development and implementation of interactive waste heat maps, energy use models, a Hot Spot tool able to view the 6+ hottest locations on each home and a new HEAT Score for inter-city waste heat comparisons. We then describe current challenges, lessons learned and new solutions as we begin Phase II and scale from 368 to 300,000+ homes with the newly developed TABI-1800. Specifically, we introduce a new object-based mosaicing strategy, an adaptation of Emissivity Modulation to correct for emissivity differences, a new Thermal Urban Road Normalization (TURN technique to correct for scene-wide microclimatic variation. We also describe a new Carbon Score and opportunities to update city cadastral errors with automatically defined thermal house objects.

  5. Improving Depression Care Through an Online Learning Collaborative.

    Science.gov (United States)

    Starkey, Melissa; Wiest, Dawn; Qaseem, Amir

    2016-01-01

    Depression is a leading cause of disability worldwide, and many internists diagnose and treat depression. This study aimed to examine the impact of a practice improvement intervention on screening and managing patients with depression in primary care. This pre-post study design included a physician practice survey designed to capture what the physicians believed they were doing in practice, a chart audit tool to capture what physicians were actually doing in practice, and an intervention that included an evidence-based educational program, online toolkit, and practice improvement coaching conference calls that promoted group learning. Following completion of the intervention, participants increasingly used the Patient Health Questionnaire-9 to detect, diagnose, and gauge treatment success for depression and reported increased use of guidelines and team-based care. Although barriers to improving depression care exist, this study suggests that evidence-based quality improvement programs can positively affect practice. PMID:25351473

  6. High-quality chronic care delivery improves experiences of chronically ill patients receiving care

    NARCIS (Netherlands)

    J.M. Cramm (Jane); A.P. Nieboer (Anna)

    2013-01-01

    markdownabstract__Abstract__ Objective. Investigate whether high-quality chronic care delivery improved the experiences of patients. Design. This study had a longitudinal design. Setting and Participants. We surveyed professionals and patients in 17 disease management programs targeting patients wi

  7. Reforming primary care in England--again. Plans for improving the quality of care.

    Science.gov (United States)

    Baker, R

    2000-06-01

    An extensive programme of health service reform has begun in England. Improvement in the quality of care is a key objective of the reforms, and several initiatives are being introduced in response. These include systems to provide national guidance about appropriate treatment and services, a local system to support quality improvement and arrangements to monitor performance, including a new performance framework, an inspection agency and an annual survey of patients. The local quality improvement system has features of particular interest. These include arrangements for setting objectives for quality improvement, the use of various quality improvement methods tailored to local needs and a new system to provide accountability to both the health service and the public. The introduction of clinical governance and all the other reforms presents primary care practitioners with a major challenge. However, if sufficient time is allowed and adequate resources are made available, the reforms do have the potential to improve health care in England. PMID:10944059

  8. Ecological Factors Improving Efficiency of Business Activities

    Directory of Open Access Journals (Sweden)

    Kononova G. A.

    2015-01-01

    Full Text Available The economic importance of optimizing the environmental situation from the perspective of an entrepreneur are assessed in the article. The classification of administrative decisions taken in the course of the business activities is proposed. The authors identified a group of solutions directly providing optimization of environment external to the enterprise, solutions that have an indirect positive impact on the environment and solutions that improve ecology of industrial premises. The nature of economic effect of resulting solutions of various types is taken into account. Vectors of influence of working conditions on the economic results of business activities are described. The nature and strength of the impact of model management decisions results of business activities are defined. Key performance indicators of entrepreneurial activity are identified: employee productivity, the amount of revenue and profitability, solvency, staff stability, the competitiveness of enterprises. Grouping the costs of ecological parameters optimization of the production environment is proposed. Relationship between level of working conditions and socio-psychological climate in the collective enterprise is disclosed. The methods of motivation of entrepreneurs in solving of environmental, production problems are considered. The role of training entrepreneurs engaged of medium and small businesses are underlined especially. Thus, in the article the relationship between environmental and economic problems of entrepreneurial activity is investigated. Role and opportunities of entrepreneurs in solving these problems are defined and structured.

  9. Government Responsibility in New Rural Cooperative Medical Care System from the Perspective of Equity and Efficiency

    Institute of Scientific and Technical Information of China (English)

    Liuni; GUAN

    2015-01-01

    Equity and efficiency,as two essential parts of social security,always influence construction of China’s new rural cooperative medical care system.The new rural cooperative medical care system is a rural social security system particularly intended to make it more affordable for the rural poor.It is a multi-channel fundraising system with fund of comprehensive arrangement for serious disease composed by the government,collectives and individuals.Since its implementation,it has made considerable achievements,but there are still many apparent and hidden problems.Through analyzing existing problems in the implementation of new rural cooperative medical care system,from the perspective of equity and efficiency,it reached the conclusion that government should take corresponding responsibilities.At the same time of constantly increasing efficiency,it is recommended to attach importance to the equity,so as to realize the objective of improving the security level of new rural cooperative medical care system.

  10. Health System Quality Improvement: Impact of Prompt Nutrition Care on Patient Outcomes and Health Care Costs.

    Science.gov (United States)

    Meehan, Anita; Loose, Claire; Bell, Jvawnna; Partridge, Jamie; Nelson, Jeffrey; Goates, Scott

    2016-01-01

    Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. We implemented a quality improvement program that positioned early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications, guided and monitored by medication administration records. Post-quality improvement program, pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced. PMID:26910129

  11. Family welfare through improved health care.

    Science.gov (United States)

    Solon, F

    1986-11-01

    Education is an integral part of any development effort, particularly in the developing countries. Many educational measures do not accomplish their objectives because many strategies used were neither appropriate nor adaptable to the actual needs of the target audience. Current education projects are more effective than traditional approaches for several reasons including: target audiences are reached through a combination of face-to-face communication and mass media information; development testing, evaluative research and message design based on audience response are inherent in the program; and nutrition education is used to support material inputs. The behavioral method of cummunication has gained recognition as a health education model. The Philippines has long been engaged in the practive of health education. Health education should work at integrating different health problems. A mobile and comprehensive system called the Nutri-bus was organized in 1978 to provide logistical, supervisory and communications support to the village nutrition worker. The Nutri-bus package of services includes: health and nutrition education through video showings and the distribution of print materials. In 1980, a series of educational materials was produced and distributed to over 30,000 schools nationwide for school teachers. The teacher's role in the health and nutrition effort was highlighted. The Teacher-Child-Parent (TCP) Approach was developed to improve the strategies used by school teachers. Developmental description pads containing illustrated food instructions recommending the amounts and kinds of food for the preschool child were designed. Mass media are used extensively. It is necessary to make health education specific so that activities can be evaluated. PMID:12314462

  12. Closing The Gap: Improving Trauma Care On The Ukrainian Battlefield.

    Science.gov (United States)

    Stacey, Stephen K; Jones, Peter H

    2016-01-01

    Since early 2014, Ukraine has been involved in a violent social and political revolution that has taken more than 7,000 lives. Many of these deaths were due to limited field medical care and prolonged evacuation times because the Ukrainian military has been slow to adopt standard combat medical processes. We deployed with the US Army's 173rd Airborne Brigade to train soldiers in the National Guard of Ukraine (NGU) on combat first aid. We discovered that a major deficiency limiting the quality of trauma care and evacuation is an endemic lack of prior coordination and planning. The responsibility for this coordination falls on military leaders; therefore, we delivered medical operations training to officers of the NGU unit and observed great improvement in medical care sustainment. We recommend systematic leader education in best medical practices be institutionalized at all levels of the Ukrainian Army to foster sustained improvement and refinement of trauma care. PMID:27045509

  13. Depression Care Management: Can Employers Purchase Improved Outcomes?

    Directory of Open Access Journals (Sweden)

    Kathryn Rost

    2011-01-01

    Full Text Available Fourteen vendors are currently selling depression care management products to US employers after randomized trials demonstrate improved work outcomes. The research team interviewed 10 (71.4% of these vendors to compare their products to four key components of interventions demonstrated to improve work outcomes. Five of 10 depression products incorporate all four key components, three of which are sold by health maintenance organizations (HMOs; however, HMOs did not deliver these components at the recommended intensity and/or duration. Only one product delivered by a disease management company delivered all four components of care at the recommended intensity and duration. This “voltage drop,” which we anticipate will increase with product implementation, suggests that every delivery system should carefully evaluate the design of its depression product before implementation for its capacity to deliver evidence-based care, repeating these evaluations as new evidence emerges.

  14. Improving Obesity Prevention and Management in Primary Care in Canada.

    Science.gov (United States)

    Campbell-Scherer, Denise; Sharma, Arya Mitra

    2016-09-01

    Obesity is a major risk factor for chronic diseases with significant morbidity, mortality and health care cost. There is concern due to the dramatic increase in overweight and obesity in Canada in the last 20 years. The causes of obesity are multifactorial, with underestimation by patients and healthcare providers of the long-term nature of the condition, and its complexity. Solutions related to prevention and management will require multifaceted strategies involving education, health policy, public health and health systems across the care continuum. We believe that to support such strategies we need to have a strong primary care workforce equipped with appropriate knowledge, skills and attitudes to support persons at risk for, or with, obesity. To achieve this end, significant skills building is required to improve primary care obesity prevention and management efforts. This review will first examine the current state, and then will outline how we can improve. PMID:27342445

  15. Emergency care center turnaround time--an improvement story.

    Science.gov (United States)

    Gelrud, Joan; Burroughs, Helen; Koterwas, Joanne

    2008-01-01

    Emergency department overcrowding is a nationally recognized barrier to patient safety. Other obstacles to efficiency and adequate care in emergency rooms include lengthy patient waits and side-tracked ambulances. This article explores one community hospital's approach to significantly decreasing emergency visit turnaround times while increasing patient satisfaction.

  16. The Coach Is In: Improving Nutritional Care in Nursing Homes

    OpenAIRE

    Rahman, Anna N.; Simmons, Sandra F.; Applebaum, Robert; Lindabury, Kate; Schnelle, John F.

    2011-01-01

    Purpose: This article describes and evaluates a long distance coaching course aimed at improving nutritional care in nursing homes (NHs). The course was structured to provide more support than traditional training programs offer. Methods: In a series of 6 monthly teleconferences led by an expert in NH nutritional care, participating NH staff received step-by-step instructions for implementing an evidence-based nutritional management program. After each session, participants were asked to impl...

  17. Pain management improves care and revenue: an interview with ProCare Systems.

    Science.gov (United States)

    Davis, F N; Walsh, C

    2000-01-01

    As provider and managed care organizations continue to look for better ways to control costs and improve patient outcomes, disease management programs are getting an increasing share of their attention. One often-over-looked area with significant potential to improve outcomes, reduce costs, and enhance revenues is pain management. It has been estimated that at least 40 percent of senior citizens suffer from chronic pain, and as the population ages, the number of chronic pain sufferers will only increase. Pain management companies have been forming to meet the current and future demand for comprehensive pain management programs. One such company is ProCare Systems, a single-specialty physician practice management company based in Grand Rapids, Michigan. HFM spoke with Fred N. Davis, MD, president and cofounder of ProCare Systems, and Cyndy Walsh, ProCare System's CEO, about pain management programs and the patient care and financial impact they can effect.

  18. Superefficient Refrigerators: Opportunities and Challenges for Efficiency Improvement Globally

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Nihar; Park, Won Young; Bojda, Nicholas; McNeil, Michael A.

    2014-08-01

    As an energy-intensive mainstream product, residential refrigerators present a significant opportunity to reduce electricity consumption through energy efficiency improvements. Refrigerators expend a considerable amount of electricity during normal use, typically consuming between 100 to 1,000 kWh of electricity per annum. This paper presents the results of a technical analysis done for refrigerators in support of the Super-efficient Equipment and Appliance Deployment (SEAD) initiative. Beginning from a base case representative of the average unit sold in India, we analyze efficiency improvement options and their corresponding costs to build a cost-versus-efficiency relationship. We then consider design improvement options that are known to be the most cost effective and that can improve efficiency given current design configurations. We also analyze and present additional super-efficient options, such as vacuum-insulated panels. We estimate the cost of conserved electricity for the various options, allowing flexible program design for market transformation programs toward higher efficiency. We estimate ~;;160TWh/year of energy savings are cost effective in 2030, indicating significant potential for efficiency improvement in refrigerators in SEAD economies and China.

  19. The Multiple Benefits of Measures to Improve Energy Efficiency

    DEFF Research Database (Denmark)

    Puig, Daniel; Farrell, Tim C.

    Understanding the barriers to, and enablers for, energy efficiency requires targeted information and analysis. This report is a summary of four detailed studies providing new insights on how to promote efficiency in selected priority areas. It complements initiatives such as the so-called energy...... efficiency accelerators, which seek to increase the uptake of selected technologies, as well as the work of many other institutions committed to improving energy efficiency. The modelling estimates and the case studies presented in this report illustrate that, while significant progress has already been...... achieved, the case for accelerating energy efficiency action is strong. Key highlights include: • At the global level, energy efficiency improvements would account for between 2.6 and 3.3 Gt CO2e of the reductions in 2030, equivalent to between 23 and 26 percent of the overall reductions achieved...

  20. Melatonin improves spermatogonial stem cells transplantation efficiency in azoospermic mice

    Directory of Open Access Journals (Sweden)

    Mohammadreza Gholami

    2014-02-01

    Conclusion: Administration of melatonin (20 mg/kg simultaneously with transplantation of spermatogonial stem cells in azoospermia mouse testis increases the efficiency of transplantation and improves structural properties of the testes tissue.

  1. Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care.

    Directory of Open Access Journals (Sweden)

    Henry T Stelfox

    Full Text Available Large amounts of scientific evidence are generated, but not implemented into patient care (the 'knowledge-to-care' gap. We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare.We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14 and pediatric (n = 2 medical-surgical intensive care units (ICUs in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38 and frontline providers (n = 1,790. Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback.Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate evaluated the priorities, and rated 9 as 'necessary' (median score 7-9. Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs.A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.

  2. Using implementation science to improve urologic oncology care.

    Science.gov (United States)

    Skolarus, Ted A; Sales, Anne E

    2016-09-01

    There are many gaps between recommended urologic cancer care and real-world practice. Although we increasingly define these quality gaps because of our growing health services research capacity in urologic oncology, we often fall short in translating these findings into effective interventions and strategies to reduce gaps in care. In this article, we highlight implementation research as a logical next step for translating our health services research findings into effective individual and organizational behavior change strategies to improve quality of care. We explain how implementation research focuses on different, upstream outcomes from our clinical outcomes to get the right care to the right patient at the right time. Lastly, we share information about resources and training for those interested in learning more about this emerging, transdisciplinary field. PMID:27401405

  3. Refractories for Industrial Processing. Opportunities for Improved Energy Efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James G. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Hayden, H. Wayne [Metals Manufacture Process and Controls Technology, Inc., Oak Ridge, TN (United States); Angelini, Peter [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Moore, Robert E. [R.E. Moore Associates, Maricopa, AZ (United States); Headrick, William L. [R.E. Moore Associates, Maricopa, AZ (United States)

    2005-01-01

    Refractories are a class of materials of critical importance to manufacturing industries with high-temperature unit processes. This study describes industrial refractory applications and identifies refractory performance barriers to energy efficiency for processing. The report provides recommendations for R&D pathways leading to improved refractories for energy-efficient manufacturing and processing.

  4. A treatment of thermal efficiency improvement in the Brayton cycle

    International Nuclear Information System (INIS)

    So far, as the working fluid for power-generating plants, mainly water and air (combustion gas) have been used. In this study, in regeneration and isothermal compression processes being considered as the means for the efficiency improvement in Brayton cycle, the investigation of equivalent graphical presentation method with T-S diagrams, the introduction of the new characteristic number expressing the possibility of thermal efficiency improvement by regeneration, and the investigation of the effect of the difference of working fluid on thermal efficiency were carried out. Next, as the cycle approximately realizing isothermal compression process with condensation process, the super-critical pressure cycle with liquid phase compression was rated, and four working fluids, NH3, SO2, CO2 and H2O were examined as perfect gas and real gas. The advantage of CO2 regeneration for the thermal efficiency improvement was clarified by using the dimensionless characteristic number. The graphical presentation of effective work, the thermal efficiency improvement by regeneration, the thermal efficiency improvement by making compression process isothermal, the effect on thermal efficiency due to various factors and working fluids, the characteristic number by regeneration, and the application to real working fluids are reported. (Kako, I.)

  5. Health Care Improvement and Continuing Interprofessional Education: Continuing Interprofessional Development to Improve Patient Outcomes

    Science.gov (United States)

    Wilcock, Peter M.; Janes, Gillian; Chambers, Alison

    2009-01-01

    Health care improvement and continuing professional education must be better understood if we are to promote continuous service improvement through interprofessional learning in the workplace. We propose that situating interprofessional working, interprofessional learning, work-based learning, and service improvement within a framework of social…

  6. Demonstrating a Conceptual Framework to Provide Efficient Wound Management Service for a Wound Care Center in a Tertiary Hospital.

    Science.gov (United States)

    Chen, Yu-Tsung; Chang, Chang-Cheng; Shen, Jen-Hsiang; Lin, Wei-Nung; Chen, Mei-Yen

    2015-11-01

    Although the benefits of wound care services and multidisciplinary team care have been well elaborated on in the literature, there is a gap in the actual practice of wound care and the establishment of an efficient referral system. The conceptual framework for establishing efficient wound management services requires elucidation.A wound care center was established in a tertiary hospital in 2010, staffed by an integrated multidisciplinary team including plastic surgeons, a full-time coordinator, a physical therapist, occupational therapists, and other physician specialists. Referral patients were efficiently managed following a conceptual framework for wound care. This efficient wound management service consists of 3 steps: patient entry and onsite immediate wound debridement, wound re-evaluation, and individual wound bed preparation plan. Wound conditions were documented annually over 4 consecutive years.From January 2011 to December 2014, 1103 patients were recruited from outpatient clinics or inpatient consultations for the 3-step wound management service. Of these, 62% of patients achieved healing or improvement in wounds, 13% of patients experienced no change, and 25% of patients failed to follow-up. The outcome of wound treatment varied by wound type. Sixty-nine percent of diabetic foot ulcer patients were significantly healed or improved. In contrast, pressure ulcers were the most poorly healed wound type, with only 55% of patients achieving significantly healed or improved wounds.The 3-step wound management service in the wound care center efficiently provided onsite screening, timely debridement, and multidisciplinary team care. Patients could schedule appointments instead of waiting indefinitely for care. Further wound condition follow-up, education, and prevention were also continually provided.

  7. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach

    Science.gov (United States)

    Borden, Timothy C; Bellaire, Laura L; Fletcher, Nicholas D

    2016-01-01

    The complex nature of the surgical treatment of adolescent idiopathic scoliosis (AIS) requires a wide variety of health care providers. A well-coordinated, multidisciplinary team approach to the care of these patients is essential for providing high-quality care. This review offers an up-to-date overview of the numerous interventions and safety measures for improving outcomes after AIS surgery throughout the perioperative phases of care. Reducing the risk of potentially devastating and costly complications after AIS surgery is the responsibility of every single member of the health care team. Specifically, this review will focus on the perioperative measures for preventing surgical site infections, reducing the risk of neurologic injury, minimizing surgical blood loss, and preventing postoperative complications. Also, the review will highlight the postoperative protocols that emphasize early mobilization and accelerated discharge. PMID:27695340

  8. Issues of therapeutic communication relevant for improving quality of care

    OpenAIRE

    Popa-Velea, O; Purcărea, VL

    2014-01-01

    Communication issues are extensively considered a topic of high interest for improving the efficacy of the therapeutic act. This article aimed to overview several issues of therapeutic communication relevant for improving quality of care. A number of 15 bibliographic resources on these topics published in peer-reviewed journals between 1975 and 2010, and indexed in PubMed, ProQuest and EBSCO databases were examined, to seek for evidence regarding these data. Results highlight a number of comm...

  9. Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping

    Directory of Open Access Journals (Sweden)

    Tara Sampalli

    2015-07-01

    Full Text Available Background Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely – an adaptation of Value Stream Mapping (VSM to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Methods Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. Results The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Conclusion Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.

  10. Training in data definitions improves quality of intensive care data

    NARCIS (Netherlands)

    Arts, DGT; Bosman, RJ; de Jonge, E; Joore, JCA; de Keizer, NF

    2003-01-01

    Background Our aim was to assess the contribution of training in data definitions and data extraction guidelines to improving quality of data for use in intensive care scoring systems such as the Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS)

  11. Incentives to improve energy efficiency in EU Grids

    Energy Technology Data Exchange (ETDEWEB)

    Papaefthymiou, G.; Beestermoeller, C.; Gardiner, A.

    2013-04-15

    The Energy Efficiency Directive (2012/27/EU) includes provisions related to network tariffs and regulation. It is timely therefore to revisit the potential options for energy efficiency in grids, the treatment of energy efficiency in network tariffs and alternative policies for improving energy efficiency. This project builds on work done previously for the European Copper Institute in this area. In this paper, we concentrate on energy efficiency in electricity network design and operation. Other articles in the Directive relate to the role of the network tariffs and regulations in enabling or incentivising the provision of energy efficiency to end users. In section 2, we describe technical efficiency measures to reduce losses (improve energy efficiency) in the grid. Section 3 reviews grid tariffs in three countries to identify whether they provide incentives or disincentives for energy efficiency in the grid. Section 4 discusses and evaluates alternative regulations for energy efficiency in grids. Section 5 concludes and discusses the main components of the optimal policy framework.

  12. Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples

    Directory of Open Access Journals (Sweden)

    McDermott Robyn

    2010-05-01

    health care and fostering effective and efficient exchange and use of data and information among service providers and policy makers to achieve evidence-based resource allocation, service planning, system development, and improvements of service delivery and Indigenous health outcomes.

  13. Costs and benefits of energy efficiency improvements in ceiling fans

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Nihar; Sathaye, Nakul; Phadke, Amol; Letschert, Virginie [Lawrence Berkeley National Lab., CA (United States). Environmental Energy Technology Division

    2013-10-15

    Ceiling fans contribute significantly to residential electricity consumption, especially in developing countries with warm climates. The paper provides analysis of costs and benefits of several options to improve the efficiency of ceiling fans to assess the global potential for electricity savings and green house gas (GHG) emission reductions. Ceiling fan efficiency can be cost-effectively improved by at least 50% using commercially available technology. If these efficiency improvements are implemented in all ceiling fans sold by 2020, 70 terawatt hours per year could be saved and 25 million metric tons of carbon dioxide equivalent (CO2-e) emissions per year could be avoided, globally. We assess how policies and programs such as standards, labels, and financial incentives can be used to accelerate the adoption of efficient ceiling fans in order to realize potential savings.

  14. DTU International Energy Report 2012: Energy efficiency improvements

    DEFF Research Database (Denmark)

    Increased energy efficiency can reduce global CO2 emissions over the period to 2050 with up to 25%. On the top of that large profits can be gained for very little investment. Energy efficiency improvements can save investment in new energy infrastructure, cut fuel costs, increase competitiveness...... and increase consumer welfare. Thus, it is natural for DTU International Energy Report 2012 to take up this issue and analyze the global, regional and national challenges in exploiting energy efficiency and promote research and development in energy efficiency....

  15. Method for calculating annual energy efficiency improvement of TV sets

    Energy Technology Data Exchange (ETDEWEB)

    Varman, M. [Department of Mechanical Engineering, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur (Malaysia); Mahlia, T.M.I. [Department of Mechanical Engineering, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur (Malaysia)]. E-mail: indra@um.edu.my; Masjuki, H.H. [Department of Mechanical Engineering, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur (Malaysia)

    2006-10-15

    The popularization of 24 h pay-TV, interactive video games, web-TV, VCD and DVD are poised to have a large impact on overall TV electricity consumption in the Malaysia. Following this increased consumption, energy efficiency standard present a highly effective measure for decreasing electricity consumption in the residential sector. The main problem in setting energy efficiency standard is identifying annual efficiency improvement, due to the lack of time series statistical data available in developing countries. This study attempts to present a method of calculating annual energy efficiency improvement for TV set, which can be used for implementing energy efficiency standard for TV sets in Malaysia and other developing countries. Although the presented result is only an approximation, definitely it is one of the ways of accomplishing energy standard. Furthermore, the method can be used for other appliances without any major modification.

  16. Improving haemophilia patient care through sharing best practice.

    Science.gov (United States)

    de Moerloose, Philippe; Arnberg, Daniel; O'Mahony, Brian; Colvin, Brian

    2015-10-01

    At the 2014 Annual Congress of the European Haemophilia Consortium (EHC) held in Belfast, Northern Ireland, Pfizer initiated and funded a satellite symposium entitled: 'Improving Patient Care Through Sharing Best Practice'. Co-chaired by Brian Colvin (Pfizer Global Innovative Pharma Business, Rome, Italy) and Brian O'Mahony [President of the EHC, Brussels, Belgium], the symposium provided an opportunity to consider patient care across borders, to review how patient advocacy groups can successfully engage with policymakers in healthcare decision-making and to discuss the importance of patient involvement in data collection to help shape the future environment for people with haemophilia. Professor Philippe de Moerloose (University Hospitals and Faculty of Medicine of Geneva, Switzerland) opened the session by discussing the gap between the haemophilia management guidelines and the reality of care for many patients living in Europe, highlighting the importance of sharing of best practice and building a network of treaters and patient organisations to support the improvement of care across Europe. Daniel Arnberg (SCISS AB, Hägersten, Sweden) reviewed the health technology assessment process conducted in Sweden, the first for haemophilia products, as a case study, focusing on the role of the patient organisation. Finally, Brian O'Mahony reflected on the central role of patients as individuals and also within patient organisations in shaping the future of haemophilia care. PMID:26338268

  17. Improving the quality of health care: what's taking so long?

    Science.gov (United States)

    Chassin, Mark R

    2013-10-01

    Nearly fourteen years ago the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, triggered a national movement to improve patient safety. Despite the substantial and concentrated efforts that followed, quality and safety problems in health care continue to routinely result in harm to patients. Desired progress will not be achieved unless substantial changes are made to the way in which quality improvement is conducted. Alongside important efforts to eliminate preventable complications of care, there must also be an effort to seriously address the widespread overuse of health services. That overuse, which places patients at risk of harm and wastes resources at the same time, has been almost entirely left out of recent quality improvement endeavors. Newer and much more effective strategies and tools are needed to address the complex quality challenges confronting health care. Tools such as Lean, Six Sigma, and change management are proving highly effective in tackling problems as difficult as hand-off communication failures and patient falls. Finally, the organizational culture of most American hospitals and other health care organizations must change. To create a culture of safety, leaders must eliminate intimidating behaviors that suppress the reporting of errors and unsafe conditions. Leaders must also hold everyone accountable for adherence to safe practices. PMID:24101066

  18. Improving maternal confidence in neonatal care through a checklist intervention.

    Science.gov (United States)

    Radenkovic, Dina; Kotecha, Shrinal; Patel, Shreena; Lakhani, Anjali; Reimann-Dubbers, Katharina; Shah, Shreya; Jafree, Daniyal; Mitrasinovic, Stefan; Whitten, Melissa

    2016-01-01

    Previous qualitative studies suggest a lack of maternal confidence in care of their newborn child upon discharge into the community. This observation was supported by discussion with healthcare professionals and mothers at University College London Hospital (UCLH), highlighting specific areas of concern, in particular identifying and managing common neonatal presentations. The aim of this study was to design and introduce a checklist, addressing concerns, to increase maternal confidence in care of their newborn child. Based on market research, an 8-question checklist was designed, assessing maternal confidence in: feeding, jaundice, nappy care, rashes and dry skin, umbilical cord care, choking, bowel movements, and vomiting. Mothers were assessed as per the checklist, and received a score representative of their confidence in neonatal care. Mothers were followed up with a telephone call, and were assessed after a 7-day-period. Checklist scores before as compared to after the follow-up period were analysed. This process was repeated for three study cycles, with the placement of information posters on the ward prior to the second study cycle, and the stapling of the checklist to the mother's personal child health record (PCHR) prior to the third study cycle. A total of 99 mothers on the Maternity Care Unit at UCLH were enrolled in the study, and 92 were contactable after a 7-day period. During all study cycles, a significant increase in median checklist score was observed after, as compared to before, the 7-day follow up period (p < 0.001). The median difference in checklist score from baseline was greatest for the third cycle. These results suggest that introduction of a simple checklist can be successfully utilised to improve confidence of mothers in being able to care for their newborn child. Further investigation is indicated, but this intervention has the potential for routine application in postnatal care. PMID:27335642

  19. A systems approach to improving rural care in Ethiopia.

    Directory of Open Access Journals (Sweden)

    Elizabeth H Bradley

    Full Text Available BACKGROUND: Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI, we identified PHCUs with consistently higher performance (n = 2, most improved performance (n = 3, or consistently lower performance (n = 2 in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51, we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1 managerial problem solving capacity, 2 relationship with the woreda (district health office, and 3 community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, and PHCU communities' leadership, particularly religious leadership, were strongly engaged with the health improvement effort. Distance from the nearest city, quality of roads and transportation, and cultural norms did not differ substantially among PHCUs. CONCLUSIONS/SIGNIFICANCE: Effective health strengthening efforts may require intensive

  20. Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

    OpenAIRE

    Kimberly Ramsbottom; Mary Lou Kelley

    2014-01-01

    Long term care (LTC) homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP) important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descript...

  1. Cost-Effectiveness of Improving Health Care to People with HIV in Nicaragua

    Directory of Open Access Journals (Sweden)

    Edward Broughton

    2014-01-01

    Full Text Available Background. A 2010 evaluation found generally poor outcomes among HIV patients on antiretroviral therapy in Nicaragua. We evaluated an intervention to improve HIV nursing services in hospital outpatient departments to improve patient treatment and retention in care. The intervention included improving patient tracking, extending clinic hours, caring for children of HIV+ mothers, ensuring medication availability, promoting self-help groups and family involvement, and coordinating multidisciplinary care. Methods. This pre/postintervention study examined opportunistic infections and clinical status of HIV patients before and after implementation of changes to the system of nursing care. Hospital expenditure data were collected by auditors and hospital teams tracked intervention expenses. Decision tree analysis determined incremental cost-effectiveness from the implementers’ perspective. Results. Opportunistic infections decreased by 24% (95% CI: 14%–34% and 11.3% of patients improved in CDC clinical stage. Average per-patient costs decreased by $133/patient/year (95% CI: $29–$249. The intervention, compared to business-as-usual strategy, saved money while improving outcomes. Conclusions. Improved efficiency of services can allow more ART-eligible patients to receive therapy. We recommended the intervention be implemented in all HIV service facilities in Nicaragua.

  2. Potentials and policy implications of energy and material efficiency improvement

    Energy Technology Data Exchange (ETDEWEB)

    Worrell, Ernst; Levine, Mark; Price, Lynn; Martin, Nathan; van den Broek, Richard; Block, Kornelis

    1997-01-01

    There is a growing awareness of the serious problems associated with the provision of sufficient energy to meet human needs and to fuel economic growth world-wide. This has pointed to the need for energy and material efficiency, which would reduce air, water and thermal pollution, as well as waste production. Increasing energy and material efficiency also have the benefits of increased employment, improved balance of imports and exports, increased security of energy supply, and adopting environmentally advantageous energy supply. A large potential exists for energy savings through energy and material efficiency improvements. Technologies are not now, nor will they be, in the foreseeable future, the limiting factors with regard to continuing energy efficiency improvements. There are serious barriers to energy efficiency improvement, including unwillingness to invest, lack of available and accessible information, economic disincentives and organizational barriers. A wide range of policy instruments, as well as innovative approaches have been tried in some countries in order to achieve the desired energy efficiency approaches. These include: regulation and guidelines; economic instruments and incentives; voluntary agreements and actions, information, education and training; and research, development and demonstration. An area that requires particular attention is that of improved international co-operation to develop policy instruments and technologies to meet the needs of developing countries. Material efficiency has not received the attention that it deserves. Consequently, there is a dearth of data on the qualities and quantities for final consumption, thus, making it difficult to formulate policies. Available data, however, suggest that there is a large potential for improved use of many materials in industrialized countries.

  3. Recovery Act--Class 8 Truck Freight Efficiency Improvement Project

    Energy Technology Data Exchange (ETDEWEB)

    Trucks, Daimler [Daimler Trucks North America Llc, Portland, OR (United States)

    2015-07-26

    Daimler Trucks North America completed a five year, $79.6M project to develop and demonstrate a concept vehicle with at least 50% freight efficiency improvement over a weighted average of several drive cycles relative to a 2009 best-in-class baseline vehicle. DTNA chose a very fuel efficient baseline vehicle, the 2009 Freightliner Cascadia with a DD15 engine, yet successfully demonstrated a 115% freight efficiency improvement. DTNA learned a great deal about the various technologies that were incorporated into Super Truck and those that, through down-selection, were discarded. Some of the technologies competed with each other for efficiency, and notably some of the technologies complemented each other. For example, we found that Super Truck’s improved aerodynamic drag resulted in improved fuel savings from eCoast, relative to a similar vehicle with worse aerodynamic drag. However, some technologies were in direct competition with each other, namely the predictive technologies which use GPS and 3D digital maps to efficiently manage the vehicles kinetic energy through controls and software, versus hybrid which is a much costlier technology that essentially targets the same inefficiency. Furthermore, the benefits of a comprehensive, integrated powertrain/vehicle approach was proven, in which vast improvements in vehicle efficiency (e.g. lower aero drag and driveline losses) enabled engine strategies such as downrating and downspeeding. The joint engine and vehicle developments proved to be a multiplier-effect which resulted in large freight efficiency improvements. Although a large number of technologies made the selection process and were used on the Super Truck demonstrator vehicle, some of the technologies proved not feasible for series production.

  4. Point-of-care technology: integration for improved delivery of care.

    Science.gov (United States)

    Gregory, Debbie; Buckner, Martha

    2014-01-01

    The growing complexity of technology, equipment, and devices involved in patient care delivery can be staggering and overwhelming. Technology is intended to be a tool to help clinicians, but it can also be a frustrating hindrance if not thoughtfully planned and strategically aligned. Critical care nurses are key partners in the collaborations needed to improve safety and quality through health information technology (IT). Nurses must advocate for systems that are interoperable and adapted to the context of care experiences. The involvement and collaboration between clinicians, information technology specialists, biomedical engineers, and vendors has never been more relevant and applicable. Working together strategically with a shared vision can effectively provide a seamless clinical workflow, maximize technology investments, and ultimately improve patient care delivery and outcomes. Developing a strategic integrated clinical and IT roadmap is a critical component of today's health care environment. How can technology strategy be aligned from the executive suite to the bedside caregiver? What is the model for using clinical workflows to drive technology adoption? How can the voice of the critical care nurse strengthen this process? How can success be assured from the initial assessment and selection of technology to a sustainable support model? What is the vendor's role as a strategic partner and "co-caregiver"?

  5. Point-of-care technology: integration for improved delivery of care.

    Science.gov (United States)

    Gregory, Debbie; Buckner, Martha

    2014-01-01

    The growing complexity of technology, equipment, and devices involved in patient care delivery can be staggering and overwhelming. Technology is intended to be a tool to help clinicians, but it can also be a frustrating hindrance if not thoughtfully planned and strategically aligned. Critical care nurses are key partners in the collaborations needed to improve safety and quality through health information technology (IT). Nurses must advocate for systems that are interoperable and adapted to the context of care experiences. The involvement and collaboration between clinicians, information technology specialists, biomedical engineers, and vendors has never been more relevant and applicable. Working together strategically with a shared vision can effectively provide a seamless clinical workflow, maximize technology investments, and ultimately improve patient care delivery and outcomes. Developing a strategic integrated clinical and IT roadmap is a critical component of today's health care environment. How can technology strategy be aligned from the executive suite to the bedside caregiver? What is the model for using clinical workflows to drive technology adoption? How can the voice of the critical care nurse strengthen this process? How can success be assured from the initial assessment and selection of technology to a sustainable support model? What is the vendor's role as a strategic partner and "co-caregiver"? PMID:24896558

  6. The Hospital Medicine Reengineering Network (HOMERuN): a learning organization focused on improving hospital care.

    Science.gov (United States)

    Auerbach, Andrew D; Patel, Mitesh S; Metlay, Joshua P; Schnipper, Jeffrey L; Williams, Mark V; Robinson, Edmondo J; Kripalani, Sunil; Lindenauer, Peter K

    2014-03-01

    Converting the health care delivery system into a learning organization is a key strategy for improving health outcomes. Although the collaborative learning organization approach has been successful in neonatal intensive care units and disease-specific collaboratives, there are few examples in general medicine and none in adult medicine that have leveraged the role of hospitalists nationally across multiple institutions to implement improvements. The authors describe the rationale for and early work of the Hospital Medicine Reengineering Network (HOMERuN), a collaborative of hospitals, hospitalists, and multidisciplinary care teams founded in 2011 that seeks to measure, benchmark, and improve the efficiency, quality, and outcomes of care in the hospital and afterwards. Robust and timely evaluation, with learning and refinement of approaches across institutions, should accelerate improvement efforts. The authors review HOMERuN's collaborative model, which focuses on a community-based participatory approach modified to include hospital-based staff as well as the larger community. HOMERuN's initial project is described, focusing on care transition measurement using perspectives from the patient, caregiver, and providers. Next steps and sustainability of the organization are discussed, including benchmarking, collaboration, and effective dissemination of best practices to stakeholders. PMID:24448050

  7. Applied Strategies for Improving Patient Safety: A Comprehensive Process To Improve Care in Rural and Frontier Communities

    Science.gov (United States)

    Westfall, John M.; Fernald, Douglas H.; Staton, Elizabeth W.; VanVorst, Rebecca; West, David; Pace, Wilson D.

    2004-01-01

    Medical errors and patient safety have gained increasing attention throughout all areas of medical care. Understanding patient safety in rural settings is crucial for improving care in rural communities. To describe a system to decrease medical errors and improve care in rural and frontier primary care offices. Applied Strategies for Improving…

  8. Healthcare Commercialization Programs: Improving the Efficiency of Translating Healthcare Innovations From Academia Into Practice

    Science.gov (United States)

    Reizes, Ofer; Dempsey, Michael K.

    2016-01-01

    Academic investigators are generating a plethora of insights and technologies that have the potential to significantly improve patient care. However, to address the imperative to improve the quality, cost and access to care with ever more constrained funding, the efficiency and the consistency with which they are translated into cost effective products and/or services need to improve. Healthcare commercialization programs (HCPs) are described and proposed as an option that institutions can add to their portfolio to improve translational research. In helping teams translate specific healthcare innovations into practice, HCPs expand the skillset of investigators and enhance an institution’s innovation capacity. Lessons learned are shared from configuring and delivering HCPs, which build on the fundamentals of the National Science Foundation’s Innovation Corps program, to address the unique challenges in supporting healthcare innovations and innovators. PMID:27766188

  9. Spreading The Net: The Multiple Benefits Of Energy Efficiency Improvements

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-07-01

    Improving energy efficiency can deliver a range of benefits to the economy and society. However energy efficiency programmes are often evaluated only on the basis of the energy savings they deliver. As a result, the full value of energy efficiency improvements in both national and global economies may be significantly underestimated. This also means that energy efficiency policy may not be optimised to target the potential of the full range of outcomes possible. Moreover, when the merit of energy efficiency programmes is judged solely on reductions in energy demand, programmes are susceptible to criticisms related to the rebound effect when the energy savings are less than expected due to other welfare gains. There are several reasons why the full range of outcomes from energy efficiency policy is not generally evaluated. First, it is due to the non-market, somewhat intangible, nature of the socioeconomic benefits, which makes them difficult to quantify. Second, the effects due to energy efficiency alone can be complex to isolate and to determine causality. Third, evaluators and policy makers working in the energy efficiency sphere are usually energy professionals, working for an energy agency or ministry, with little experience of how energy efficiency might impact other non-energy sectors. The result is an under-appreciation – and related underinvestment – in energy efficiency, and as a consequence, missed opportunities and benefits. These foregone benefits represent the ‘opportunity cost’ of failing to adequately evaluate and prioritize energy efficiency investments. The objective of this report is to fully outline the array of different benefits from improved energy efficiency and investigate their implications for policy design. By better understanding the different benefits arising from energy efficiency it should be easier for policy makers to prioritise the most significant outcomes, in addition to energy savings, in optimising energy efficiency

  10. Improvement of Dye Solar Cell Efficiency by Photoanode Posttreatment

    Directory of Open Access Journals (Sweden)

    Tanja Ivanovska

    2014-01-01

    Full Text Available The basic concept for efficiency improvement in dye-sensitized solar cells (DSSC is limiting the electron-hole recombination. One way to approach the problem is to improve the photogenerated charge carriers lifetime and consequently reduce their recombination probability. We are reporting on a facile posttreatment of the mesoporous photoanode by using a colloidal solution of TiO2 nanoparticles. We have investigated the outcome of the different sintering temperature of the posttreated photoanodes on their morphology as well as on the conversion efficiency of the DSSC. The DSSCs composed of posttreated photoanodes at 450°C showed an increase in JSC and consequently an increase in efficiency of 10%. Investigations were made to determine the electron recombination via the electrolyte by the OCVD technique. We found that the posttreatment has the effect of reducing the surface trap states and thus increases the electron lifetime, which is responsible for the increase of the overall cell efficiency.

  11. Linking quality improvement and energy efficiency/waste reduction

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, R.E.; Moore, N.L.

    1995-04-01

    For some time industry has recognized the importance of both energy efficiency/waste reduction (ee/wr) and quality/manufacturing improvement. However, industry has not particularly recognized that manufacturing efficiency is, in part, the result of a more efficient use of energy. For that reason, the energy efficiency efforts of most companies have involved admonishing employees to save energy. Few organizations have invested resources in training programs aimed at increasing energy efficiency and reducing waste. This describes a program to demonstrate how existing utility and government training and incentive programs can be leveraged to increase ee/wr and benefit both industry and consumers. Fortunately, there are a variety of training tools and resources that can be applied to educating workers on the benefits of energy efficiency and waste reduction. What is lacking is a method of integrating ee/wr training with other important organizational needs. The key, therefore, is to leverage ee/wr investments with other organizational improvement programs. There are significant strides to be made by training industry to recognize fully the contribution that energy efficiency gains make to the bottom line. The federal government stands in the unique position of being able to leverage the investments already made by states, utilities, and manufacturing associations by coordinating training programs and defining the contribution of energy-efficiency practices. These aims can be accomplished by: developing better measures of energy efficiency and waste reduction; promoting methods of leveraging manufacturing efficiency programs with energy efficiency concepts; helping industry understand how ee/wr investments can increase profits; promoting research on the needs of, and most effective ways to, reach the small and medium-sized businesses that so often lack the time, information, and finances to effectively use the hardware and training technologies available.

  12. European Energy Market Integration: Efficiency Improvements in Electricity Producing Firms

    OpenAIRE

    Armada Ramírez, Ferran

    2015-01-01

    In this paper, we review and use different methods to measure and compare efficiency scores in energy producing plants. In particular, we use non-parametric and parametric techniques. We focus our attention in electricity producing power plants on eighteen European countries, as well as in thirty energy systems as a whole. This paper also state some results such as that efficiency has widely improved in the period studied, but these positive results are not homogeneous among energy systems or...

  13. Improving Midwifery Care in Ugandan Public Hospitals: The Midwives’ Perspective

    Science.gov (United States)

    Nabirye, Rose C.; Beinempaka, Florence; Okene, Cindrella; Groves, Sara

    2016-01-01

    Background A serious shortage of nurses and midwives in public hospitals has been reported in Uganda. In addition, over 80% of the nurses and midwives working in public hospitals have been found to have job stress and only 17% to be satisfied on the job. Stress and lack of job satisfaction affect quality of nursing and midwifery care and puts patients’ lives at risk. This is coupled with rampant public outcry about the deteriorating nursing and midwifery care in Ugandan public hospitals. Objective To explore factors that result in poor quality of midwifery care and strategies to improve this care from the perspective of the midwives. Method It was a qualitative exploratory design. Participants were midwives and their supervisors working in four Regional Referral hospitals in Uganda. Data was collected by FGDs and KIIs. Content analysis was used to analyze the transcribed data from the voice recordings. Results Four major themes emerged from the study. They were organizational (poor work environment and lack of materials/equipment), professional (midwives’ attitudes, lack of supervision), public/consumer issues (interference) and policy issues (remuneration, promotion and retirement). Conclusions and implications for Practice Midwives love their work but they need support to provide quality care. Continuous neglect of midwives’ serious concerns will lead to more shortages as more dissatisfied midwives leave service.

  14. Antenatal care strengthening for improved quality of care in Jimma, Ethiopia

    DEFF Research Database (Denmark)

    Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe;

    2015-01-01

    and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. METHODS: The intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included...... of intervention on various outcomes was significantly modified by maternal education. CONCLUSION: The quality of care can be improved in some important aspects with limited resources. Moreover, the study provides strategic perspectives on how to facilitate improved quality of ANC....

  15. Recommendations for evaluation of health care improvement initiatives.

    Science.gov (United States)

    Parry, Gareth J; Carson-Stevens, Andrew; Luff, Donna F; McPherson, Marianne E; Goldmann, Donald A

    2013-01-01

    Intensive efforts are underway across the world to improve the quality of health care. It is important to use evaluation methods to identify improvement efforts that work well before they are replicated across a broad range of contexts. Evaluation methods need to provide an understanding of why an improvement initiative has or has not worked and how it can be improved in the future. However, improvement initiatives are complex, and evaluation is not always well aligned with the intent and maturity of the intervention, thus limiting the applicability of the results. We describe how initiatives can be grouped into 1 of 3 improvement phases-innovation, testing, and scale-up and spread-depending on the degree of belief in the associated interventions. We describe how many evaluation approaches often lead to a finding of no effect, consistent with what has been termed Rossi's Iron Law of Evaluation. Alternatively, we recommend that the guiding question of evaluation in health care improvement be, "How and in what contexts does a new model work or can be amended to work?" To answer this, we argue for the adoption of formative, theory-driven evaluation. Specifically, evaluations start by identifying a program theory that comprises execution and content theories. These theories should be revised as the initiative develops by applying a rapid-cycle evaluation approach, in which evaluation findings are fed back to the initiative leaders on a regular basis. We describe such evaluation strategies, accounting for the phase of improvement as well as the context and setting in which the improvement concept is being deployed. Finally, we challenge the improvement and evaluation communities to come together to refine the specific methods required so as to avoid the trap of Rossi's Iron Law. PMID:24268081

  16. COPD exacerbation care bundle improves standard of care, length of stay, and readmission rates

    Directory of Open Access Journals (Sweden)

    Parikh R

    2016-03-01

    Full Text Available Raj Parikh,1 Trushil G Shah,2 Rajive Tandon2 1Department of Internal Medicine, 2Department of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA Introduction: COPD is the third leading cause of death in the world. Utilizing care bundles during acute COPD exacerbations results in fewer complications and lower costs. Our aim was to construct a COPD exacerbation care bundle and evaluate the effects on patient care. Methods: We conducted a prospective analysis of 44 patients admitted with a COPD exacerbation to a single tertiary care facility. Primary outcomes included length of stay, readmission rates, and hospital costs. Secondary outcomes included patient education, pulmonologist follow-up, and timeliness of medication administration. Two cohorts were analyzed: those treated with an electronic COPD care bundle (cases; N=22 versus those treated without the care bundle (controls; N=22. Results: Mean length of stay (51.2 vs 101.1 hours in controls; P-value =0.001, 30-day readmission rates (9.1% vs 54.4% in controls; P-value =0.001, and 60-day readmission rates (22.7% vs 77% in controls; P-value =0.0003 decreased in the care bundle group. Ninety-day hospital costs had a significant difference in the care bundle group (US$7,652 vs US$19,954 in controls; P-value =0.044. Secondary outcomes included a 100% rate of COPD inhaler teaching (vs 27.3% in controls; P-value <0.001, 59.1% rate of pulmonologist follow-up after discharge (vs 18.2% in controls; P-value =0.005, and a mean reduction in time to steroid administration (7.0 hours; P-value =0.015 seen in the care bundle cases. Conclusion: Our significant findings coupled with the recent success of standardized algorithms in managing COPD exacerbations stress the importance of enforcing clinical guidelines that can enhance patient care. We demonstrated improved care for COPD exacerbation patients during hospitalizations, thereby decreasing morbidity and the financial

  17. Electric motor systems in developing countries: Opportunities for efficiency improvement

    Energy Technology Data Exchange (ETDEWEB)

    Meyers, S.; Monahan, P.; Lewis, P.; Greenberg, S. [Lawrence Berkeley Lab., CA (United States); Nadel, S. [American Council for an Energy-Efficient Economy, Washington, DC (United States)

    1993-08-01

    This report presents an overview of the current status and efficiency improvement potential of industrial motor systems in developing countries. Better management of electric motor systems is of particular relevance in developing countries, where improved efficiency can lead to increased productivity and slower growth in electricity demand. Motor systems currently consume some 65--80% of the industrial electricity in developing countries. Drawing on studies from Thailand, India, Brazil, China, Pakistan, and Costa Rica, we describe potential efficiency gains in various parts of the motor system, from the electricity delivery system through the motor to the point where useful work is performed. We report evidence of a significant electricity conservation potential. Most of the efficiency improvement methods we examine are very cost-effective from a societal viewpoint, but are generally not implemented due to various barriers that deter their adoption. Drawing on experiences in North America, we discuss a range of policies to overcome these barriers, including education, training, minimum efficiency standards, motor efficiency testing protocols, technical assistance programs, and financial incentives.

  18. Opportunities for improving phosphorus-use efficiency in crop plants.

    Science.gov (United States)

    Veneklaas, Erik J; Lambers, Hans; Bragg, Jason; Finnegan, Patrick M; Lovelock, Catherine E; Plaxton, William C; Price, Charles A; Scheible, Wolf-Rüdiger; Shane, Michael W; White, Philip J; Raven, John A

    2012-07-01

    Limitation of grain crop productivity by phosphorus (P) is widespread and will probably increase in the future. Enhanced P efficiency can be achieved by improved uptake of phosphate from soil (P-acquisition efficiency) and by improved productivity per unit P taken up (P-use efficiency). This review focuses on improved P-use efficiency, which can be achieved by plants that have overall lower P concentrations, and by optimal distribution and redistribution of P in the plant allowing maximum growth and biomass allocation to harvestable plant parts. Significant decreases in plant P pools may be possible, for example, through reductions of superfluous ribosomal RNA and replacement of phospholipids by sulfolipids and galactolipids. Improvements in P distribution within the plant may be possible by increased remobilization from tissues that no longer need it (e.g. senescing leaves) and reduced partitioning of P to developing grains. Such changes would prolong and enhance the productive use of P in photosynthesis and have nutritional and environmental benefits. Research considering physiological, metabolic, molecular biological, genetic and phylogenetic aspects of P-use efficiency is urgently needed to allow significant progress to be made in our understanding of this complex trait.

  19. Efficient Generation and Selection of Combined Features for Improved Classification

    KAUST Repository

    Shono, Ahmad N.

    2014-05-01

    This study contributes a methodology and associated toolkit developed to allow users to experiment with the use of combined features in classification problems. Methods are provided for efficiently generating combined features from an original feature set, for efficiently selecting the most discriminating of these generated combined features, and for efficiently performing a preliminary comparison of the classification results when using the original features exclusively against the results when using the selected combined features. The potential benefit of considering combined features in classification problems is demonstrated by applying the developed methodology and toolkit to three sample data sets where the discovery of combined features containing new discriminating information led to improved classification results.

  20. SAGD CO2 mitigation through energy efficiency improvements

    International Nuclear Information System (INIS)

    An evaluation of the carbon dioxide (CO2) emissions reductions achieved using energy efficiency measures in steam assisted gravity drainage (SAGD) operations was presented. The efficiency of a typical SAGD operation was analyzed using an indexing tool based on the Carnot cycle efficiency to develop an ideal SAGD heat cycle. The benefits of using an organic Rankine cycle (ORC) technology to convert waste heat to electrical power were also investigated. A CO2 abatement curve was used to identify the economic benefits and costs of various greenhouse gas (GHG) reductions. The level of recovered energy was determined in relation to energy prices, capital costs, and carbon penalties in order to determine the most efficient means of decreasing energy usage. The study demonstrated that energy efficiency can be improved by up to 20 percent, and water loss reductions of up to 50 percent can be achieved using cost-effective energy efficiency measures. Results of the study can be used to guide government policy and provide industry with practical tools to benchmark performance and improve efficiencies. 4 refs., 1 tab., 10 figs.

  1. Improvement of teamwork in health care through interprofessional education

    OpenAIRE

    Simin Dragana; Milutinović Dragana; Brestovački Branislava; Andrijević Ilija; Cigić Tomislav

    2010-01-01

    Introduction. Collaboration, within and between healthcare teams, facilitates effective healthcare. Internationally, the development of interprofessional education, as a means to facilitate more effective teamwork in health care, has been recognized for over forty years. Objective. The aim of this paper is to evaluate students' attitudes toward the influence of interprofessional education on improvement of collaboration and teamwork. Methods. The research was conducted by interviewing student...

  2. A Systems Approach to Improving Rural Care in Ethiopia

    OpenAIRE

    Bradley, Elizabeth H.; Byam, Patrick; Alpern, Rachelle; Thompson, Jennifer W.; Zerihun, Abraham; Abeb, Yigeremu; Leslie A Curry

    2012-01-01

    Background Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation i...

  3. Quality improvement in radiography in a neonatal intensive care unit

    Energy Technology Data Exchange (ETDEWEB)

    Loovere, L.; Boyle, E.M. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada); Blatz, S. [Dept. of Pediactrics, McMaster Children' s Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Bowslaugh, M.; Kereliuk, M. [Dept. of Radiology, Diagnostic Imaging, Hamilton Health Sciences, Hamilton, Ontario (Canada); Paes, B. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada)], E-mail: paes@mcmaster.ca

    2008-10-15

    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  4. Quality improvement in radiography in a neonatal intensive care unit

    International Nuclear Information System (INIS)

    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  5. TV Energy Consumption Trends and Energy-Efficiency Improvement Options

    Energy Technology Data Exchange (ETDEWEB)

    Park, Won Young; Phadke, Amol; Shah, Nihar; Letschert, Virginie

    2011-07-01

    The SEAD initiative aims to transform the global market by increasing the penetration of highly efficient equipment and appliances. SEAD is a government initiative whose activities and projects engage the private sector to realize the large global energy savings potential from improved appliance and equipment efficiency. SEAD seeks to enable high-level global action by informing the Clean Energy Ministerial dialogue as one of the initiatives in the Global Energy Efficiency Challenge. In keeping with its goal of achieving global energy savings through efficiency, SEAD was approved as a task within the International Partnership for Energy Efficiency Cooperation (IPEEC) in January 2010. SEAD partners work together in voluntary activities to: (1) ?raise the efficiency ceiling? by pulling super-efficient appliances and equipment into the market through cooperation on measures like incentives, procurement, awards, and research and development (R&D) investments; (2) ?raise the efficiency floor? by working together to bolster national or regional policies like minimum efficiency standards; and (3) ?strengthen the efficiency foundations? of programs by coordinating technical work to support these activities. Although not all SEAD partners may decide to participate in every SEAD activity, SEAD partners have agreed to engage actively in their particular areas of interest through commitment of financing, staff, consultant experts, and other resources. In addition, all SEAD partners are committed to share information, e.g., on implementation schedules for and the technical detail of minimum efficiency standards and other efficiency programs. Information collected and created through SEAD activities will be shared among all SEAD partners and, to the extent appropriate, with the global public.As of April 2011, the governments participating in SEAD are: Australia, Brazil, Canada, the European Commission, France, Germany, India, Japan, Korea, Mexico, Russia, South Africa, Sweden

  6. New directions for hospital strategic management: the market for efficient care.

    Science.gov (United States)

    Chilingerian, J A

    1992-01-01

    An analysis of current trends in the health care industry points to buyers seeking high quality, yet efficient, care as an emerging market segment. To target this market segment, hospitals must be prepared to market the efficient physicians. In the coming years, hospitals that can identify and market their best practicing providers will achieve a competitive advantage.

  7. New directions for hospital strategic management: the market for efficient care.

    Science.gov (United States)

    Chilingerian, J A

    1992-01-01

    An analysis of current trends in the health care industry points to buyers seeking high quality, yet efficient, care as an emerging market segment. To target this market segment, hospitals must be prepared to market the efficient physicians. In the coming years, hospitals that can identify and market their best practicing providers will achieve a competitive advantage. PMID:1428863

  8. Integration of quality improvement and cost-efficiency through industrial improvement techniques

    OpenAIRE

    Vink, Jasper

    2016-01-01

    Jasper P Vink,1 Maxime T Rigaudy,1,2 Karl O Elmqvist11Imperial College Business School, Imperial College London, London, 2Hull York Medical School, York, UKIn this journal, Crema and Verbano1 discussed the importance of defining quality of health care and how quality can be improved through various industrial instruments and techniques. Quality of health care is a heavily debated topic that requires a wide scope of considerations across the many stakeholders of the health system. We acknowled...

  9. Improving radiation use efficiency in greenhouse production systems

    OpenAIRE

    Li, Tao

    2015-01-01

    SUMMARY A large increase in agricultural production is needed to feed the increasing world population with their increasing demand per capita. However, growing competition for arable land, water, energy, and the degradation of the environment impose challenges to improve crop production. Hence agricultural production efficiency needs to increase. Greenhouses provide the possibility to create optimal growth conditions for crops, thereby improving production and product quality. Light is the dr...

  10. IMPROVING TACONITE PROCESSING PLANT EFFICIENCY BY COMPUTER SIMULATION, Final Report

    Energy Technology Data Exchange (ETDEWEB)

    William M. Bond; Salih Ersayin

    2007-03-30

    This project involved industrial scale testing of a mineral processing simulator to improve the efficiency of a taconite processing plant, namely the Minorca mine. The Concentrator Modeling Center at the Coleraine Minerals Research Laboratory, University of Minnesota Duluth, enhanced the capabilities of available software, Usim Pac, by developing mathematical models needed for accurate simulation of taconite plants. This project provided funding for this technology to prove itself in the industrial environment. As the first step, data representing existing plant conditions were collected by sampling and sample analysis. Data were then balanced and provided a basis for assessing the efficiency of individual devices and the plant, and also for performing simulations aimed at improving plant efficiency. Performance evaluation served as a guide in developing alternative process strategies for more efficient production. A large number of computer simulations were then performed to quantify the benefits and effects of implementing these alternative schemes. Modification of makeup ball size was selected as the most feasible option for the target performance improvement. This was combined with replacement of existing hydrocyclones with more efficient ones. After plant implementation of these modifications, plant sampling surveys were carried out to validate findings of the simulation-based study. Plant data showed very good agreement with the simulated data, confirming results of simulation. After the implementation of modifications in the plant, several upstream bottlenecks became visible. Despite these bottlenecks limiting full capacity, concentrator energy improvement of 7% was obtained. Further improvements in energy efficiency are expected in the near future. The success of this project demonstrated the feasibility of a simulation-based approach. Currently, the Center provides simulation-based service to all the iron ore mining companies operating in northern

  11. Improving the financial viability of primary care health centers.

    Science.gov (United States)

    Finkler, S A; Knickman, J R; Hanson, K L

    1994-01-01

    This article presents findings from a national demonstration program to improve the long-term financial viability of small not-for-profit primary care health centers. The program initiatives and their implementation are described in some detail. A standard pre/post study design was used to measure the impact of the initiatives on general outcome measures, financial ratios, and the utilization of management techniques. Overall, demonstration centers showed improvement over the study period. Notable short-term improvements included significant growth in the volume of patient visits and increased profit. Observed changes also revealed an increased use of sophisticated management techniques, expected to positively affect longer-term financial health. The findings suggest that improving the financial viability of health centers need not be expensive.

  12. Wastewater treatment facilities: Energy efficient improvements and cogeneration

    International Nuclear Information System (INIS)

    The Washington State Energy Office (WSEO) has worked with both the Bonneville Power Administration (BPA) and the US Department of Energy to provide technical and financial assistance to local governments. Based on a recent study conducted by Ecotope for WSEO, local governments spend an estimated $45 million on utility bills statewide. Water and wastewater facilities account for almost a third of this cost. As a result, WSEO decided to focus its efforts on the energy intensive water and wastewater sector. The ultimate goal of this project was to develop mechanisms to incorporate energy efficiency improvements into wastewater treatment facilities in retrofits and during upgrades, remodels, and new construction. Project activities included the following: The review of the existing regulatory environment for treatment system construction, A summary of financing options for efficiency improvements in treatment facilities, A literature review of energy efficiency opportunities in treatment plants, Survey and site visits to characterize existing facilities in Washington State, Estimates of the energy efficiency and cogeneration potential in the sector, and A case study to illustrate the implementation of an efficiency improvement in a treatment facility

  13. Improving diabetic foot screening at a primary care clinic: A quality improvement project

    Science.gov (United States)

    Allen, Michelle L.; Gunst, Colette

    2016-01-01

    Background Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected. Aim This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices. Setting A primary health care clinic in the Western Cape province of South Africa Methods A quality improvement project was conducted. HCWs’ needs were assessed using a questionnaire. This was followed by focus group discussions with the HCWs, which were recorded, transcribed and assessed using a general inductive approach. An intervention was designed based on common themes. Staff members were trained on foot screening and patient information pamphlets and screening tools were made available to all clinic staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 with that in 2014 after initiation of the quality improvement cycle. Results HCWs’ confidence in conducting foot screening using the diabetic foot assessment questionnaire improved markedly after training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first quality improvement cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles. Conclusion The findings showed a significant improvement in the number of diabetic patients screened. Using strategic planning with appreciative intent based on SOAR, proved to be motivational and can be used in the planning of the next cycle. PMID:27608673

  14. Improving the quality of care for patients with hypertension in Moshupa District, Botswana: Quality improvement cycle

    Directory of Open Access Journals (Sweden)

    Cathy Kande

    2014-01-01

    Full Text Available Background: Although there are no prevalence studies on hypertension in Botswana, this condition is thought to be common and the quality of care to be poor.Aim: The aim of this project was to assess and improve the quality of primary care forhypertension.Setting: Moshupa clinic and catchment area, Botswana.Methods: Quality improvement cycle.Results: Two hundred participants were included in the audit. Sixty-eight per cent were women with a mean age of 55 years. In the baseline audit none of the target standards were met. During the re-audit six months later, six out of nine structural target standards, five out of 11 process target standards and one out of two outcome target standards were achieved. Statistically-significant improvement in performance (p < 0.05 was shown in 10 criteria although the target standard was not always met. In the re-audit, the target of achieving blood pressure control (< 140/90 in 70% of patients was achieved.Conclusion: The quality of care for hypertension was suboptimal in our setting. Simple interventions were designed and implemented to improve the quality of care. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen.

  15. Russia : Towards Improving the Efficiency of Public Investment Expenditures

    OpenAIRE

    World Bank

    2001-01-01

    This report documents the current levels and patterns of public investment in Russia, analyzes the institutional arrangements in place for investment budgeting, and develops short- and medium-term recommendations where policy or institutional strengthening is required for improving the efficiency of investment expenditures. The analysis of public investment is based primarily on the federa...

  16. Implementation of Consolidated HIS: Improving Quality and Efficiency of Healthcare

    OpenAIRE

    Choi, Jinwook; Kim, Jin Wook; Seo, Jeong-Wook; Chung, Chun Kee; Kim, Kyung-Hwan; Kim, Ju Han; Kim, Jong Hyo; Chie, Eui Kyu; Cho, Hyun-Jai; Goo, Jin Mo; Lee, Hyuk-Joon; Wee, Won Ryang; Nam, Sang Mo; Lim, Mi-sun; Kim, Young-Ah

    2010-01-01

    Objectives Adoption of hospital information systems offers distinctive advantages in healthcare delivery. First, implementation of consolidated hospital information system in Seoul National University Hospital led to significant improvements in quality of healthcare and efficiency of hospital management. Methods The hospital information system in Seoul National University Hospital consists of component applications: clinical information systems, clinical research support systems, administrati...

  17. Does Competition Improve Public School Efficiency? A Spatial Analysis

    Science.gov (United States)

    Misra, Kaustav; Grimes, Paul W.; Rogers, Kevin E.

    2012-01-01

    Advocates for educational reform frequently call for policies to increase competition between schools because it is argued that market forces naturally lead to greater efficiencies, including improved student learning, when schools face competition. Researchers examining this issue are confronted with difficulties in defining reasonable measures…

  18. Numerical Processing Efficiency Improved in Experienced Mental Abacus Children

    Science.gov (United States)

    Wang, Yunqi; Geng, Fengji; Hu, Yuzheng; Du, Fenglei; Chen, Feiyan

    2013-01-01

    Experienced mental abacus (MA) users are able to perform mental arithmetic calculations with unusual speed and accuracy. However, it remains unclear whether their extraordinary gains in mental arithmetic ability are accompanied by an improvement in numerical processing efficiency. To address this question, the present study, using a numerical…

  19. An improved and efficient synthesis of Irbesartan, an antihypertensive drug

    Directory of Open Access Journals (Sweden)

    Somisetti Narender Rao

    2011-01-01

    Full Text Available Development of a new improved and efficient process suitable for the large-scale production of Irbesartan has been described. The key steps are tetrazole formation from secondary amide for the preparation of the key intermediate 1-Benzyl-5-(4'-bromomethyl-biphenyl-2-yl-1H-tetrazole (9, N-alkylation and debenzylation.

  20. Solution for Improve the Efficiency of Solar Photovoltaic Installation

    OpenAIRE

    Petru Chioncel; Cristian Paul Chioncel; Nicoleta Gillich

    2013-01-01

    This paper present a solution for improving efficiency of solar photovoltaic installation, realized with fixed solar photovoltaic modules, placed in solar parks or individual installations. The proposed solution to increase the radiation on the solar photovoltaic panels is to use some thin plates covered with a reflective blanket, mounted in front of the solar photovoltaic modules, with the possibility of their adjustment.

  1. Best Practices Implementation for Hydropower Efficiency and Utilization Improvement

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Brennan T [ORNL; Zhang, Qin Fen [ORNL; March, Patrick [Hydro Performance Processes, Inc.; Cones, Marvin [Mesa Associates, Inc.; Dham, Rajesh [U.S. Department of Energy; Spray, Michael [New West Technologies, LLC.

    2012-01-01

    By using best practices to manage unit and plant efficiency, hydro owner/operators can achieve significant improvements in overall plant performance, resulting in increased generation and profitability and, frequently, reduced maintenance costs. The Hydropower Advancement Project (HAP) was initiated by the Wind and Hydropower Technologies Program within the U.S. Department of Energy (DOE) Office of Energy Efficiency and Renewable Energy to develop and implement a systematic process with standard methodology, based on the best practices of operations, maintenance and upgrades; to identify the improvement opportunities at existing hydropower facilities; and to predict and trend the overall condition and improvement opportunity within the U.S. hydropower fleet. The HAP facility assessment includes both quantitative condition ratings and data-based performance analyses. However, this paper, as an overview document for the HAP, addresses the general concepts, project scope and objectives, best practices for unit and plant efficiency, and process and methodology for best practices implementation for hydropower efficiency and utilization improvement.

  2. Improving personal health records for patient-centered care

    Science.gov (United States)

    Feldman, Henry J; Ross, Stephen E; Safran, Charles

    2010-01-01

    Objective To assess the patient-centeredness of personal health records (PHR) and offer recommendations for best practice guidelines. Design Semi-structured interviews were conducted in seven large early PHR adopter organizations in 2007. Organizations were purposively selected to represent a variety of US settings, including medium and large hospitals, ambulatory care facilities, insurers and health plans, government departments, and commercial sectors. Measurements Patient-centeredness was assessed against a framework of care that includes: (1) respect for patient values, preferences, and expressed needs; (2) information and education; (3) access to care; (4) emotional support to relieve fear and anxiety; (5) involvement of family and friends; (6) continuity and secure transition between healthcare providers; (7) physical comfort; (8) coordination of care. Within this framework we used evidence for patient preferences (where it exists) to compare existing PHR policies, and propose a best practice model. Results Most organizations enable many patient-centered functions such as data access for proxies and minors. No organization allows patient views of clinical progress notes, and turnaround times for PHR reporting of normal laboratory results can be up to 7 days. Conclusion Findings suggest patient-centeredness for personal health records can be improved, and recommendations are made for best practice guidelines. PMID:20190063

  3. Progressive Dwindling in Multiple Sclerosis: An Opportunity to Improve Care

    Science.gov (United States)

    Martin, Jessica E.; Raffel, Joel; Nicholas, Richard

    2016-01-01

    Introduction In the general ageing population, 40% of deaths occur following a prolonged trajectory of “progressive dwindling,” characterised by chronic accumulation of disability and frailty, and associated with increased dependency and reduced reserves. Those who progressively dwindle are poorly catered for by current healthcare systems and would benefit from a coordinated approach to their medical and social care, known as formative care. People with multiple sclerosis (pwMS) may be more likely to progressively dwindle, and may be appropriate targets for formative care pathways. Objectives To determine the proportion of pwMS who follow a progressive dwindling trajectory prior to death. To relate trajectory to place of death, and examine what factors predict the progressively dwindling trajectory. Methods A retrospective observational study of 582 deceased pwMS enrolled in the UK MS Tissue Bank, including death certificates and extensive clinical summaries. Results 73.7% of pwMS had a “progressively dwindling” trajectory of dying. This was predicted by those who reach MS disease milestones earlier. 72.5% of pwMS died an MS-related death, which was predicted by an aggressive disease course from onset. Those who progressively dwindled were equally likely to die in hospital as those with other trajectories to death. Conclusions The progressively dwindling trajectory of dying is very common in pwMS, and can be predicted by earlier disease milestones. Pathways could target pwMS in these years prior to death, to improve care. PMID:27441557

  4. Efficient recovery of uranium using genetically improved microalgae

    International Nuclear Information System (INIS)

    We propose an alternative process for the efficient recovery of dissolved uranium based on genetically improved microalgae. We isolate Chlamydomonas cf. fonticola from a pond extremely contaminated by uranium (∼ 25 ppm) from ENUSA U-mine, Saelices (Salamanca, Spain). After a process of genetic improvement we obtained a strain capable to recover 115 mg of U per g of dry weight, by mean of bio-adsorption on the cell wall (mostly) and intra-cytoplasm bioaccumulation. Such a genetically improved microalgae resist extremes of acidity and pollution, but even its dead biomass is still able to recover a large amount of uranium. (Author)

  5. Low Impedance Voice Coils for Improved Loudspeaker Efficiency

    DEFF Research Database (Denmark)

    Iversen, Niels Elkjær; Knott, Arnold; Andersen, Michael A. E.

    2015-01-01

    In modern audio systems utilizing switch-mode amplifiers the total efficiency is dominated by the rather poor efficiency of the loudspeaker. For decades voice coils have been designed so that nominal resistances of 4 to 8 Ohms is obtained, despite modern audio amplifiers, using switch......-mode technology, can be designed to much lower loads. A thorough analysis of the loudspeaker efficiency is presented and its relation to the voice coil fill factor is described. A new parameter, the drivers mass ratio, is introduced and it indicates how much a fill factor optimization will improve a driver......’s efficiency. Different voice coil winding layouts are described and their fill factors analyzed. It is found that by lowering the nominal resistance of a voice coil, using rectangular wire, one can increase the fill factor. Three voice coils are designed for a standard 10” woofer and corresponding frequency...

  6. Efficient Adoption and Assessment of Multiple Process Improvement Reference Models

    Directory of Open Access Journals (Sweden)

    Simona Jeners

    2013-06-01

    Full Text Available A variety of reference models such as CMMI, COBIT or ITIL support IT organizations to improve their processes. These process improvement reference models (IRMs cover different domains such as IT development, IT Services or IT Governance but also share some similarities. As there are organizations that address multiple domains and need to coordinate their processes in their improvement we present MoSaIC, an approach to support organizations to efficiently adopt and conform to multiple IRMs. Our solution realizes a semantic integration of IRMs based on common meta-models. The resulting IRM integration model enables organizations to efficiently implement and asses multiple IRMs and to benefit from synergy effects.

  7. Efficiency improvements by geothermal heat integration in a lignocellulosic biorefinery.

    Science.gov (United States)

    Sohel, M Imroz; Jack, Michael

    2010-12-01

    In an integrated geothermal biorefinery, low-grade geothermal heat is used as process heat to allow the co-products of biofuel production to become available for higher-value uses. In this paper we consider integrating geothermal heat into a biochemical lignocellulosic biorefinery so that the lignin-enriched residue can be used either as a feedstock for chemicals and materials or for on-site electricity generation. Depending on the relative economic value of these two uses, we can maximize revenue of a biorefinery by judicious distribution of the lignin-enriched residue between these two options. We quantify the performance improvement from integrating geothermal energy for an optimized system. We then use a thermodynamic argument to show that integrating geothermal heat into a biorefinery represents an improvement in overall resource utilization efficiency in all cases considered. Finally, possible future technologies for electricity generation are considered which could improve this efficiency further.

  8. From coordinated care trials to medicare locals: what difference does changing the policy driver from efficiency to quality make for coordinating care?

    Science.gov (United States)

    Gardner, Karen; Yen, Laurann; Banfield, Michelle; Gillespie, James; McRae, Ian; Wells, Robert

    2013-02-01

    The terms coordination and integration refer to a wide range of interventions, from strategies aimed at coordinating clinical care for individuals to organizational and system interventions such as managed care, which contract medical and support services. Ongoing debate about whether financial and organizational integration are needed to achieve clinical integration is evident in policy debates over several decades, from a focus through the 1990s on improving coordination through structural reform and the use of market mechanisms to achieve allocative efficiencies (better overall service mix) to more recent attention on system performance to improve coordination and quality. We examine this shift in Australia and ask how has changing the policy driver affected efforts to achieve coordination? Care planning, fund pooling and purchasing are still important planks in coordination. Evidence suggests that financial strategies can be used to drive improvements for particular patient groups, but these are unlikely to improve outcomes without being linked to clinical strategies that support coordination through multidisciplinary teamwork, IT, disease management guidelines and audit and feedback. Meso level organizational strategies might align the various elements to improve coordination. Changing the policy driver has refocused research and policy over the last two decades from a focus on achieving allocative efficiencies to achieving quality and value for money. Research is yet to develop theoretical approaches that can deal with the implications for assessing effectiveness. Efforts need to identify intervention mechanisms, plausible relationships between these and their measurable outcomes and the components of contexts that support the emergence of intervention attributes.

  9. From coordinated care trials to medicare locals: what difference does changing the policy driver from efficiency to quality make for coordinating care?

    Science.gov (United States)

    Gardner, Karen; Yen, Laurann; Banfield, Michelle; Gillespie, James; McRae, Ian; Wells, Robert

    2013-02-01

    The terms coordination and integration refer to a wide range of interventions, from strategies aimed at coordinating clinical care for individuals to organizational and system interventions such as managed care, which contract medical and support services. Ongoing debate about whether financial and organizational integration are needed to achieve clinical integration is evident in policy debates over several decades, from a focus through the 1990s on improving coordination through structural reform and the use of market mechanisms to achieve allocative efficiencies (better overall service mix) to more recent attention on system performance to improve coordination and quality. We examine this shift in Australia and ask how has changing the policy driver affected efforts to achieve coordination? Care planning, fund pooling and purchasing are still important planks in coordination. Evidence suggests that financial strategies can be used to drive improvements for particular patient groups, but these are unlikely to improve outcomes without being linked to clinical strategies that support coordination through multidisciplinary teamwork, IT, disease management guidelines and audit and feedback. Meso level organizational strategies might align the various elements to improve coordination. Changing the policy driver has refocused research and policy over the last two decades from a focus on achieving allocative efficiencies to achieving quality and value for money. Research is yet to develop theoretical approaches that can deal with the implications for assessing effectiveness. Efforts need to identify intervention mechanisms, plausible relationships between these and their measurable outcomes and the components of contexts that support the emergence of intervention attributes. PMID:23175532

  10. Using a big conversation to improve care quality.

    Science.gov (United States)

    Boyd, Maggie

    The Collaboration for Leadership in Applied Health Research and Care (CLAHRC) compiled a report on the day, in which it noted: "The overriding result was one of inspiration through being heard, having honest, genuine and open dialogue and positively engaging with like-minded people. The event gave many the confidence to try to take things forward and influence others, and there was a sense of the event being an opportunity that gave hope for the future." The next step is to set up a "nursing cabinet"--a stakeholder board that will oversee work to improve "care through the patients' eyes". This will involve health professionals, academics, voluntary organisations and patient groups. Box 1 outlines key actions taken as a result of the event. The report on the day's findings is available on the trust website. PMID:22667075

  11. Activity-based costing for clinical paths. An example to improve clinical cost & efficiency.

    Science.gov (United States)

    Asadi, M J; Baltz, W A

    1996-01-01

    How much does this medical service or surgical procedure cost the hospital to provide? What is the most efficient clinical pathway that maximizes the quality of patient care while minimizing costs? More and more hospitals are discovering that they don't have solid answers to these critically important questions. In an age of managed care and capitation, however, it is imperative for management to know if the patient care services they provide are making or losing money-and by how much. This article discusses how a powerful new tool called activity-based costing (ABC) can be used to help hospitals accurately determine patient care costs. We show how to build a model that combines both clinical and financial data to measure how efficiently the operation allocates human, material and capital resources to provide its services. The modeling approach described in this article can be used to better analyze a wide range of important operational and financial issues, including: How to efficiently allocate resources, and what resources will be needed as patient demand changes-ideal for operational management and planning; How efficiently activities and processes are performed to meet patient needs-effective for measuring performance and improving quality; Determining clinical pathway profitability-essential for understanding where you're making or losing money; Cycle time, throughput and the impact of resource capacity constraints-critical for meeting patient demand; Costs of idle capacity-important for using resources more efficiently. We will illustrate with an example how this modeling technique can be used to develop and implement efficient clinical pathways. PMID:8982988

  12. Activity-based costing for clinical paths. An example to improve clinical cost & efficiency.

    Science.gov (United States)

    Asadi, M J; Baltz, W A

    1996-01-01

    How much does this medical service or surgical procedure cost the hospital to provide? What is the most efficient clinical pathway that maximizes the quality of patient care while minimizing costs? More and more hospitals are discovering that they don't have solid answers to these critically important questions. In an age of managed care and capitation, however, it is imperative for management to know if the patient care services they provide are making or losing money-and by how much. This article discusses how a powerful new tool called activity-based costing (ABC) can be used to help hospitals accurately determine patient care costs. We show how to build a model that combines both clinical and financial data to measure how efficiently the operation allocates human, material and capital resources to provide its services. The modeling approach described in this article can be used to better analyze a wide range of important operational and financial issues, including: How to efficiently allocate resources, and what resources will be needed as patient demand changes-ideal for operational management and planning; How efficiently activities and processes are performed to meet patient needs-effective for measuring performance and improving quality; Determining clinical pathway profitability-essential for understanding where you're making or losing money; Cycle time, throughput and the impact of resource capacity constraints-critical for meeting patient demand; Costs of idle capacity-important for using resources more efficiently. We will illustrate with an example how this modeling technique can be used to develop and implement efficient clinical pathways.

  13. Improving Integrated Care: Modelling the performance of an online community of practice

    Directory of Open Access Journals (Sweden)

    Ángel Díaz-Chao

    2014-03-01

    Full Text Available Introduction: This article aims to confirm the following core hypothesis: a Community of Practice’s use of a Web 2.0 platform for communication between primary and hospital care leads to improved primary care and fewer hospital referrals. This core hypothesis will be corroborated by testing a further five partial hypotheses that complete the main hypothesis being estimated.Methods: An ad-hoc questionnaire was designed and sent to a sample group of 357 professionals from the Badalona-Sant Adrià de Besòs Primary Care Service in Catalonia, Spain, which includes nine primary care centres and three specialist care centres. The study sample was formed by 159 respondents. The partial least squares methodology was used to estimate the model of the causal relationship and the proposed hypotheses.Results: It was found that when healthcare staff used social networks and information and communication technologies professionally, and the more contact hours they have with patients, the more a Web 2.0 platform was likely to be used for communication between primary and hospital care professionals. Such use led to improved primary care and fewer hospital referrals according to the opinions of health professionals on its use.Conclusions: The research suggests that the efficiency of medical practice is explained by the intensity of Web 2.0 platform use for communication between primary and specialist care professionals. Public policies promoting the use of information and communication technologies in communities of practice should go beyond the technological dimension and consider other professional, organisational and social determinants.

  14. Efficient Work Team Scheduling: Using Psychological Models of Knowledge Retention to Improve Code Writing Efficiency

    Directory of Open Access Journals (Sweden)

    Michael J. Pelosi

    2014-12-01

    Full Text Available Development teams and programmers must retain critical information about their work during work intervals and gaps in order to improve future performance when work resumes. Despite time lapses, project managers want to maximize coding efficiency and effectiveness. By developing a mathematically justified, practically useful, and computationally tractable quantitative and cognitive model of learning and memory retention, this study establishes calculations designed to maximize scheduling payoff and optimize developer efficiency and effectiveness.

  15. Improving interunit transitions of care between emergency physicians and hospital medicine physicians: a conceptual approach.

    Science.gov (United States)

    Beach, Christopher; Cheung, Dickson S; Apker, Julie; Horwitz, Leora I; Howell, Eric E; O'Leary, Kevin J; Patterson, Emily S; Schuur, Jeremiah D; Wears, Robert; Williams, Mark

    2012-10-01

    Patient care transitions across specialties involve more complexity than those within the same specialty, yet the unique social and technical features remain underexplored. Further, little consensus exists among researchers and practitioners about strategies to improve interspecialty communication. This concept article addresses these gaps by focusing on the hand-off process between emergency and hospital medicine physicians. Sensitivity to cultural and operational differences and a common set of expectations pertaining to hand-off content will more effectively prepare the next provider to act safely and efficiently when caring for the patient. Through a consensus decision-making process of experienced and published authorities in health care transitions, including physicians in both specialties as well as in communication studies, the authors propose content and style principles clinicians may use to improve transition communication. With representation from both community and academic settings, similarities and differences between emergency medicine and internal medicine are highlighted to heighten appreciation of the values, attitudes, and goals of each specialty, particularly pertaining to communication. The authors also examine different communication media, social and cultural behaviors, and tools that practitioners use to share patient care information. Quality measures are proposed within the structure, process, and outcome framework for institutions seeking to evaluate and monitor improvement strategies in hand-off performance. Validation studies to determine if these suggested improvements in transition communication will result in improved patient outcomes will be necessary. By exploring the dynamics of transition communication between specialties and suggesting best practices, the authors hope to strengthen hand-off skills and contribute to improved continuity of care. PMID:23035952

  16. Efficient Terahertz Photoconductive Emitters with Improved Electrode Structures

    Institute of Scientific and Technical Information of China (English)

    Ying-Xin Wang; Yi-Jie Niu; Wei Cheng; Zhi-Qiang Li; Zi-Ran Zhao

    2014-01-01

    We present the design, fabrication, and characterization of two new types of terahertz photoconductive emitters. One has an asymmetric four-contact electrode structure and the other has an arc-shaped electrode structure, which are all modified from a traditional strip line antenna. Numerical simulations and real experiments confirm the good performance of the proposed antennas. An amplitude increase of about 40% is experimentally observed for the terahertz signals generated from the new structures. The special electrode structure and its induced local bias field enhancement are responsible for this radiation efficiency improvement. Our work demonstrates the feasibility of developing highly efficient terahertz photoconductive emitters by optimizing the electrode structure.

  17. Choosing quality of care measures based on the expected impact of improved care on health.

    OpenAIRE

    Siu, A L; McGlynn, E A; Morgenstern, H; Beers, M H; Carlisle, D M; Keeler, E B; Beloff, J.; Curtin, K; Leaning, J; Perry, B C

    1992-01-01

    Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy o...

  18. Community Partners in Care: Leveraging Community Diversity to Improve Depression Care for Underserved Populations

    OpenAIRE

    Khodyakov, Dmitry; Mendel, Peter; Dixon, Elizabeth; Jones, Andrea; Masongsong, Zoe; Wells, Kenneth

    2009-01-01

    Research suggests that the quality and outcomes of depression treatment for adults can be substantially improved through “collaborative care” programs. However, there is a lack of resources required to implement such programs in vulnerable communities. Our paper examines the planning phase of the Community Partners in Care (CPIC) initiative, which addresses this problem through a unique approach in which academic institutions partner directly with a wide range of community-based and service o...

  19. Nurses Improving the Care of Healthsystem Elders: creating a sustainable business model to improve care of hospitalized older adults.

    Science.gov (United States)

    Capezuti, Elizabeth A; Bricoli, Barbara; Briccoli, Barbara; Boltz, Marie P

    2013-08-01

    The Nurses Improving the Care of Healthsystem Elders (NICHE) program helps its more than 450 member sites to build the leadership capabilities to enact system-level change that targets the unique needs of older adults and embeds evidence-based geriatrics knowledge into practice. NICHE received expansion funding to establish a sustainable business model for operations while positioning the program to continue as a leader in innovative senior care programs. The expansion program focused on developing an internal business infrastructure, expanding NICHE-specific resources, creating a Web platform, increasing the number of participating NICHE hospitals, enhancing and expanding the NICHE benchmarking service, supporting research that generates evidence-based practices, fostering interorganizational collaboration, developing sufficient diversified revenue sources, and increasing the penetration and level of activity of current NICHE sites. These activities (improved services, Web-based tools, better benchmarking) added value and made it feasible to charge hospitals an annual fee for access and participation. NICHE does not stipulate how institutions should modify geriatric care; rather, NICHE principles and tools are meant to be adapted to each site's unique institutional culture. This article describes the historical context, the rationale, and the business plan that has resulted in successful organizational outcomes, including financial sustainability of the business operations of NICHE.

  20. Improving Quality of Care in Peptic Ulcer Bleeding

    DEFF Research Database (Denmark)

    Rosenstock, Steffen J; Møller, Morten H; Larsson, Heidi Jeanet;

    2013-01-01

    OBJECTIVES:The treatment of peptic ulcer bleeding (PUB) is complex, and mortality remains high. We present results from a nationwide initiative to monitor and improve the quality of care (QOC) in PUB.METHODS:All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered...... demographic, clinical, and prognostic data. QOC was evaluated using eight process and outcome indicators, including time to initial endoscopy, hemostasis obtainment, proportion undergoing surgery, rebleeding risks, and 30-day mortality.RESULTS:A total of 13,498 PUB patients (median age 74 years) were included...

  1. The national improvement partnership network: state-based partnerships that improve primary care quality.

    Science.gov (United States)

    Shaw, Judith S; Norlin, Chuck; Gillespie, R J; Weissman, Mark; McGrath, Jane

    2013-01-01

    Improvement partnerships (IPs) are a model for collaboration among public and private organizations that share interests in improving child health and the quality of health care delivered to children. Their partners typically include state public health and Medicaid agencies, the local chapter of the American Academy of Pediatrics, and an academic health care organization or children's hospital. Most IPs also engage other partners, including a variety of public, private, and professional organizations and individuals. IPs lead and support measurement-based, systems-focused quality improvement (QI) efforts that primarily target primary care practices that care for children. Their projects are most often conducted as learning collaboratives that involve a team from each of 8 to 15 participating practices over 9 to 12 months. The improvement teams typically include a clinician, office manager, clinical staff (nurses or medical assistants), and, for some projects, a parent; the IPs provide the staff and local infrastructure. The projects target clinical topics, chosen because of their importance to public health, local clinicians, and funding agencies, including asthma, attention-deficit/hyperactivity disorder, autism, developmental screening, obesity, mental health, medical home implementation, and several others. Over the past 13 years, 19 states have developed (and 5 are exploring developing) IPs. These organizations share similar aims and methods but differ substantially in leadership, structure, funding, and longevity. Their projects generally engage pediatric and family medicine practices ranging from solo private practices to community health centers to large corporate practices. The practices learn about the project topic and about QI, develop specific improvement strategies and aims that align with the project aims, perform iterative measures to evaluate and guide their improvements, and implement systems and processes to support and sustain those improvements

  2. Analyzing demand-side efficiency in global health: an application to maternal care in Vietnam.

    Science.gov (United States)

    Radin, Elizabeth; Ariana, Proochista; Broekel, Tom; Tran, Toan Khanh

    2016-11-01

    This article investigates demand-side efficiency in global health-or the efficiency with which health system users convert public health resources into health outcomes. We introduce and explain the concept of demand-side efficiency as well as quantitative methods to empirically estimate it. Using a robust nonparametric form of technical efficiency analysis, we estimate demand side efficiency and its social determinants. We pilot these methods looking at how efficiently pregnant women in Northern Vietnam convert public health resources into appropriate maternal care as defined by national policy. We find that women who live in non-mountainous geographies, who are formally employed, who are pregnant with a boy and who are ethnic minorities are all more likely to be efficient at achieving appropriate care. We find no significant association between wealth or education and efficiency. Our results suggest that, in the Vietnamese context, women who are the most likely to achieve appropriate maternal care, are not necessarily the most likely to do so efficiently. Women who live in non-mountainous geographies and who are formally employed are both more likely to achieve appropriate care and to do so efficiently. Yet ethnic minority women, who do not systematically achieve better care, are more likely to be efficient or to achieve better care when compared with those with the same endowment of public health resources. On the methodological level, the pilot highlights that this approach can provide useful information for policy by identifying which groups of people are more and less likely to be efficient. By understanding which groups are more likely to be efficient-and in turn how and why-it may be possible to devise policies to promote the drivers of, or conversely address the constraints to, optimizing demand-side efficiency.

  3. Measuring efficiency in health care: an application to out of hours primary care services in the island of Ireland

    OpenAIRE

    Grace Lordan

    2007-01-01

    This paper is a cross border study that explores isolating the efficiency component and measuring its overall contribution to productivity in the case of out of hours (OOH) primary care services operating on the Island of Ireland. Out of hours GP care is supplied throughout the Island of Ireland by OOH co-operatives. Although Northern Ireland (NI) and the Republic of Ireland (ROI) have their own individual health systems the OOH organisations themselves are relatively homogenous in structure....

  4. Immediate Care of Open Extremity Fractures: Where Can We Improve?

    Directory of Open Access Journals (Sweden)

    R. Walton

    2014-01-01

    Full Text Available Clear guidelines are set by the British Orthopaedic Association (BOA and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS on the preoperative management of open fractures. This as well as the clinical consequences of poor management of open fractures means the patient workup for surgery is important as well as the timing of surgery. Experience suggests few patients are managed 100% as per the guidelines and we look to test this hypothesis. A retrospective analysis was undertaken of all open long bone fractures (total 133, excluding hand injuries, which presented to a district general hospital over a 5-year period. The implementation of 7 defined key tasks for initial management was recorded. 101 cases were eligible, with the majority of cases (71.4% having initial orthopaedic assessment outside normal working hours. The mean number of tasks completed was 3.23/7. Assessment out of hours was associated with less tasks being implemented but doctor seniority and the presence of polytrauma made no difference to the quality of acute care. Staff involved in the acute care of open fractures require targeted education to improve the delivery of initial preoperative care. We recommend that other centres assess their performance against this data.

  5. Efficiency Improvement of Vehicular Antenna Systems for Ubiquitous Intelligent Systems

    Directory of Open Access Journals (Sweden)

    Kyubong Yeon

    2014-11-01

    Full Text Available This paper describes the design of a high-efficiency vehicular roof-mounted antenna for wireless access for vehicular environment (WAVE communication systems used for ubiquitous intelligent systems. The main objective of the ubiquitous intelligent system’s automotive IT technology is to enhance the connectivity among vehicles to ensure seamless communication and to reduce the initial access time using high-performance antenna systems. The efficiency of WAVE communication systems used for ubiquitous intelligent systems depends on the antenna efficiency. The proposed vehicular antenna for WAVE communication systems shows an improvement of approximately 4.77 dB in the return loss, as compared with a conventional antenna system.

  6. Improved efficient routing strategy on two-layer complex networks

    Science.gov (United States)

    Ma, Jinlong; Han, Weizhan; Guo, Qing; Zhang, Shuai; Wang, Junfang; Wang, Zhihao

    2016-10-01

    The traffic dynamics of multi-layer networks has become a hot research topic since many networks are comprised of two or more layers of subnetworks. Due to its low traffic capacity, the traditional shortest path routing (SPR) protocol is susceptible to congestion on two-layer complex networks. In this paper, we propose an efficient routing strategy named improved global awareness routing (IGAR) strategy which is based on the betweenness centrality of nodes in the two layers. With the proposed strategy, the routing paths can bypass hub nodes of both layers to enhance the transport efficiency. Simulation results show that the IGAR strategy can bring much better traffic capacity than the SPR and the global awareness routing (GAR) strategies. Because of the significantly improved traffic performance, this study is helpful to alleviate congestion of the two-layer complex networks.

  7. Efficiency improvements in GaAs-on-Si solar cells

    Science.gov (United States)

    Vernon, S. M.; Tobin, S. P.; Haven, V. E.; Bajgar, C.; Dixon, T. M.

    The thermal cycle growth (TCG) method is shown to be effective in improving GaAs/Si photovoltaic performance. Transmission electron microscope studies revealed that dislocation densities were reduced by approximately an order of magnitude and minority-carrier lifetimes increased by more than a factor of two. The efficiency of GaAs-on-Si cells were increased from 11.2 percent to 17.6 percent (one-sun) and from 13.9 percent to 18.5 percent (concentrated light) by use of the TCG technique. Improvements in basic GaAs cell growth and processing technology were also responsible for a portion of these increases, as GaAs/GaAs control cell efficiencies climbed from 21.3 to 24.3 percent over the span of these experiments.

  8. 75 FR 30387 - Improving Market and Planning Efficiency Through Improved Software; Notice of Agenda and...

    Science.gov (United States)

    2010-06-01

    ..., Secretary. Agenda for AD10-12 Staff Technical Conference on Planning Models and Software Federal Energy... Federal Energy Regulatory Commission Improving Market and Planning Efficiency Through Improved Software; Notice of Agenda and Procedures for Staff Technical Conference May 24, 2010. This notice establishes...

  9. 75 FR 34734 - Improving Market and Planning Efficiency Through Improved Software; Notice of Agenda and...

    Science.gov (United States)

    2010-06-18

    ... Federal Energy Regulatory Commission Improving Market and Planning Efficiency Through Improved Software... discuss issues related to enhanced optimal power flow models and software. The technical conference will... at http://www.ferc.gov . A free webcast of this event is available through...

  10. Energy-Efficiency Improvement Opportunities for the Textile Industry

    Energy Technology Data Exchange (ETDEWEB)

    China Energy Group; Hasanbeigi, Ali

    2010-09-29

    The textile industry is one of the most complicated manufacturing industries because it is a fragmented and heterogeneous sector dominated by small and medium enterprises (SMEs). Energy is one of the main cost factors in the textile industry. Especially in times of high energy price volatility, improving energy efficiency should be a primary concern for textile plants. There are various energy-efficiency opportunities that exist in every textile plant, many of which are cost-effective. However, even cost-effective options often are not implemented in textile plants mostly because of limited information on how to implement energy-efficiency measures, especially given the fact that a majority of textile plants are categorized as SMEs and hence they have limited resources to acquire this information. Know-how on energy-efficiency technologies and practices should, therefore, be prepared and disseminated to textile plants. This guidebook provides information on energy-efficiency technologies and measures applicable to the textile industry. The guidebook includes case studies from textile plants around the world and includes energy savings and cost information when available. First, the guidebook gives a brief overview of the textile industry around the world, with an explanation of major textile processes. An analysis of the type and the share of energy used in different textile processes is also included in the guidebook. Subsequently, energy-efficiency improvement opportunities available within some of the major textile sub-sectors are given with a brief explanation of each measure. The conclusion includes a short section dedicated to highlighting a few emerging technologies in the textile industry as well as the potential for the use of renewable energy in the textile industry.

  11. Solution for Improve the Efficiency of Solar Photovoltaic Installation

    Directory of Open Access Journals (Sweden)

    Petru Chioncel

    2013-01-01

    Full Text Available This paper present a solution for improving efficiency of solar photovoltaic installation, realized with fixed solar photovoltaic modules, placed in solar parks or individual installations. The proposed solution to increase the radiation on the solar photovoltaic panels is to use some thin plates covered with a reflective blanket, mounted in front of the solar photovoltaic modules, with the possibility of their adjustment.

  12. Do Security-differentiated Water Rights Improve Efficiency?

    OpenAIRE

    Lefebvre, Marianne; Gangadharan, Lata; Thoyer, Sophie

    2011-01-01

    Most existing water markets combine water rights trading and water allocation trading. Offering different levels of security for rights can make the market more sophisticated and allow water users to manage the risks of supply uncertainty better. We compare results from a laboratory experiment with two water right designs, one with a unique security level and another with two security levels. We found that a two security levels system improves both allocative efficiency and risk management, b...

  13. Expected improvement in efficient global optimization through bootstrapped kriging

    OpenAIRE

    Van Nieuwenhuyse, Inneke; Kleijnen, Jack; van Beers, Wim

    2012-01-01

    This paper uses a sequentialized experimental design to select simulation input combinations for global optimization, based on Kriging (also called Gaussian process or spatial correlation modeling); this Kriging is used to analyze the input/output data of the simulation model (computer code). This paper adapts the classic "expected improvement" (EI) in "efficient global optimization" (EGO) through the introduction of an unbiased estimator of the Kriging predictor variance; this estimator uses...

  14. An Initial Study of Improving English Reading Efficiency

    Institute of Scientific and Technical Information of China (English)

    刘琼

    2013-01-01

    Reading,as an important medium for human beings to gain knowledge,also plays a major part in the teaching and learning of English.Nevertheless,in practical teaching,we find that the students are quite at a loss at what to do.This article will probe into how to improve the reading efficiency from two aspects:linguistic factors and non-linguistic factors.

  15. Improving the Energy Efficiency of Pumped-Storage Power Plants

    Energy Technology Data Exchange (ETDEWEB)

    Artyukh, S. F., E-mail: artjuch@mail.ru [Kharkov Polytechnic Institute (Ukraine); Galat, V. V. [JSC “UkrHydroEnergo” (Ukraine); Kuz’min, V. V. [JSC “Interregional Electricity Association ELTA” (Ukraine); Chervonenko, I. I. [Kharkov Polytechnic Institute (Ukraine); Shakaryan, Yu. G.; Sokur, P. V. [JSC “R& D Center at Federal Grid Company of Unified Energy System” (Russian Federation)

    2015-01-15

    Possible ways to improve the energy efficiency of hydroelectric generating sets of pumped-storage power plants (PSPPs) are studied. The Kiev PSPP is used as an example to show how its generating sets can be upgraded. It is concluded based on studies conducted that synchronous motor-generators should be replaced with asynchronized motor-generators. The feasibility of changing over the turbine to variable-speed operation is shown.

  16. High Performance Healthcare Buildings: A Roadmap to Improved Energy Efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Singer, Brett C.; Tschudi, William F.

    2009-09-08

    This document presents a road map for improving the energy efficiency of hospitals and other healthcare facilities. The report compiles input from a broad array of experts in healthcare facility design and operations. The initial section lists challenges and barriers to efficiency improvements in healthcare. Opportunities are organized around the following ten themes: understanding and benchmarking energy use; best practices and training; codes and standards; improved utilization of existing HVAC designs and technology; innovation in HVAC design and technology; electrical system design; lighting; medical equipment and process loads; economic and organizational issues; and the design of next generation sustainable hospitals. Achieving energy efficiency will require a broad set of activities including research, development, deployment, demonstration, training, etc., organized around 48 specific objectives. Specific activities are prioritized in consideration of potential impact, likelihood of near- or mid-term feasibility and anticipated cost-effectiveness. This document is intended to be broad in consideration though not exhaustive. Opportunities and needs are identified and described with the goal of focusing efforts and resources.

  17. Improving crop nutrient efficiency through root architecture modifications

    Institute of Scientific and Technical Information of China (English)

    Xinxin Li; Rensen Zeng; Hong Liao

    2016-01-01

    Improving crop nutrient efficiency becomes an essential consideration for environmentally friendly and sustainable agriculture. Plant growth and development is dependent on 17 essential nutrient elements, among them, nitrogen (N) and phosphorus (P) are the two most important mineral nutrients. Hence it is not surprising that low N and/or low P availability in soils severely constrains crop growth and productivity, and thereby have become high priority targets for improving nutrient efficiency in crops. Root exploration largely determines the ability of plants to acquire mineral nutrients from soils. Therefore, root architecture, the 3-dimensional configuration of the plant’s root system in the soil, is of great importance for improving crop nutrient efficiency. Furthermore, the symbiotic associations between host plants and arbuscular mycorrhiza fungi/rhizobial bacteria, are additional important strategies to enhance nutrient acquisition. In this review, we summarize the recent advances in the current understanding of crop species control of root architecture alterations in response to nutrient availability and root/microbe symbioses, through gene or QTL regulation, which results in enhanced nutrient acquisition.

  18. Improving crop nutrient efficiency through root architecture modifications.

    Science.gov (United States)

    Li, Xinxin; Zeng, Rensen; Liao, Hong

    2016-03-01

    Improving crop nutrient efficiency becomes an essential consideration for environmentally friendly and sustainable agriculture. Plant growth and development is dependent on 17 essential nutrient elements, among them, nitrogen (N) and phosphorus (P) are the two most important mineral nutrients. Hence it is not surprising that low N and/or low P availability in soils severely constrains crop growth and productivity, and thereby have become high priority targets for improving nutrient efficiency in crops. Root exploration largely determines the ability of plants to acquire mineral nutrients from soils. Therefore, root architecture, the 3-dimensional configuration of the plant's root system in the soil, is of great importance for improving crop nutrient efficiency. Furthermore, the symbiotic associations between host plants and arbuscular mycorrhiza fungi/rhizobial bacteria, are additional important strategies to enhance nutrient acquisition. In this review, we summarize the recent advances in the current understanding of crop species control of root architecture alterations in response to nutrient availability and root/microbe symbioses, through gene or QTL regulation, which results in enhanced nutrient acquisition.

  19. Improving crop nutrient efficiency through root architecture modifications.

    Science.gov (United States)

    Li, Xinxin; Zeng, Rensen; Liao, Hong

    2016-03-01

    Improving crop nutrient efficiency becomes an essential consideration for environmentally friendly and sustainable agriculture. Plant growth and development is dependent on 17 essential nutrient elements, among them, nitrogen (N) and phosphorus (P) are the two most important mineral nutrients. Hence it is not surprising that low N and/or low P availability in soils severely constrains crop growth and productivity, and thereby have become high priority targets for improving nutrient efficiency in crops. Root exploration largely determines the ability of plants to acquire mineral nutrients from soils. Therefore, root architecture, the 3-dimensional configuration of the plant's root system in the soil, is of great importance for improving crop nutrient efficiency. Furthermore, the symbiotic associations between host plants and arbuscular mycorrhiza fungi/rhizobial bacteria, are additional important strategies to enhance nutrient acquisition. In this review, we summarize the recent advances in the current understanding of crop species control of root architecture alterations in response to nutrient availability and root/microbe symbioses, through gene or QTL regulation, which results in enhanced nutrient acquisition. PMID:26460087

  20. Improving quality of care in substance abuse treatment using five key process improvement principles.

    Science.gov (United States)

    Hoffman, Kim A; Green, Carla A; Ford, James H; Wisdom, Jennifer P; Gustafson, David H; McCarty, Dennis

    2012-07-01

    Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: (1) understand and involve the customer, (2) fix key problems, (3) pick a powerful change leader, (4) get ideas from outside the organization, and (5) use rapid cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate successful applications of each principle. Results suggest that organizations can successfully integrate and apply the five principles as they develop and test change strategies, improving access and retention in treatment, and agencies' financial status. Upcoming changes requiring increased provision of behavioral health care will result in greater demand for services. Treatment organizations, already struggling to meet demand and client needs, will need strategies that improve the quality of care they provide without significantly increasing costs. The five NIATx principles have potential for helping agencies achieve these goals.

  1. Women's health groups to improve perinatal care in rural Nepal

    Directory of Open Access Journals (Sweden)

    Manandhar Dharma

    2005-03-01

    Full Text Available Abstract Background Neonatal mortality rates are high in rural Nepal where more than 90% of deliveries are in the home. Evidence suggests that death rates can be reduced by interventions at community level. We describe an intervention which aimed to harness the power of community planning and decision making to improve maternal and newborn care in rural Nepal. Methods The development of 111 women's groups in a population of 86 704 in Makwanpur district, Nepal is described. The groups, facilitated by local women, were the intervention component of a randomized controlled trial to reduce perinatal and neonatal mortality rates. Through participant observation and analysis of reports, we describe the implementation of this intervention: the community entry process, the facilitation of monthly meetings through a participatory action cycle of problem identification, community planning, and implementation and evaluation of strategies to tackle the identified problems. Results In response to the needs of the group, participatory health education was added to the intervention and the women's groups developed varied strategies to tackle problems of maternal and newborn care: establishing mother and child health funds, producing clean home delivery kits and operating stretcher schemes. Close linkages with community leaders and community health workers improved strategy implementation. There were also indications of positive effects on group members and health services, and most groups remained active after 30 months. Conclusion A large scale and potentially sustainable participatory intervention with women's groups, which focused on pregnancy, childbirth and the newborn period, resulted in innovative strategies identified by local communities to tackle perinatal care problems.

  2. Rare disease policies to improve care for patients in Europe.

    Science.gov (United States)

    Rodwell, Charlotte; Aymé, Ségolène

    2015-10-01

    Rare diseases are those with a particularly low prevalence; in Europe, diseases are considered to be rare when they affect not more than 5 in 10000 persons in the European Union. The specificities of rare diseases make the area a veritable public health challenge: the limited number of patients and scarcity of knowledge and expertise single rare diseases out as a distinctive domain of high European added-value. The Orphan Medicinal Product Regulation of 1999 was the first European legislative text concerning rare diseases, followed by many initiatives, including recommendations by the Council of Ministers of the European Union in 2009. These initiatives contributed to the development of rare diseases policies at European and national level aimed at improving care for patients with rare diseases. A review of the political framework at European level and in European countries is provided to demonstrate how legislation has created a dynamic that is progressively improving care for patients with rare diseases. This article is part of a Special Issue entitled: "Current Research on the Neuronal Ceroid Lipofuscinoses (Batten Disease)".

  3. Lessons learnt from a primary care asthma improvement project.

    Science.gov (United States)

    Lenney, Warren; Clayton, Sadie; Gilchrist, Francis J; Price, David; Small, Iain; Smith, Judy; Sutton, Emma J

    2016-01-07

    Asthma is a very common disease that can occur at any age. In the UK and in many other countries it is mainly managed in primary care. The published evidence suggests that the key to improving diagnosis and management lies in better training and education rather than in the discovery of new medications. An asthma improvement project managed through the British Lung Foundation is attempting to do this. The project has three pilot sites: two in England supported by the Department of Health and one in Scotland supported by the Scottish Government. If the project is successful it will be rolled out to other health areas within the UK. The results of this project are not yet available. This article highlights the challenges encountered in setting up the project and may well be applicable to other areas in the UK and to other countries where similar healthcare systems exist. The encountered challenges reflect the complex nature of healthcare systems and electronic data capture in primary care. We discuss the differences between general practices in their ability and willingness to support the project, the training and education of their staff on asthma management, governance issues in relation to information technology systems, and the quality of data capture. Virtually all the challenges have now been overcome, but discussing them should ensure that others become aware of them at an early stage should they wish to undertake similar projects in the future.

  4. Lessons learnt from a primary care asthma improvement project.

    Science.gov (United States)

    Lenney, Warren; Clayton, Sadie; Gilchrist, Francis J; Price, David; Small, Iain; Smith, Judy; Sutton, Emma J

    2016-01-01

    Asthma is a very common disease that can occur at any age. In the UK and in many other countries it is mainly managed in primary care. The published evidence suggests that the key to improving diagnosis and management lies in better training and education rather than in the discovery of new medications. An asthma improvement project managed through the British Lung Foundation is attempting to do this. The project has three pilot sites: two in England supported by the Department of Health and one in Scotland supported by the Scottish Government. If the project is successful it will be rolled out to other health areas within the UK. The results of this project are not yet available. This article highlights the challenges encountered in setting up the project and may well be applicable to other areas in the UK and to other countries where similar healthcare systems exist. The encountered challenges reflect the complex nature of healthcare systems and electronic data capture in primary care. We discuss the differences between general practices in their ability and willingness to support the project, the training and education of their staff on asthma management, governance issues in relation to information technology systems, and the quality of data capture. Virtually all the challenges have now been overcome, but discussing them should ensure that others become aware of them at an early stage should they wish to undertake similar projects in the future. PMID:26741114

  5. Improving patient care through student leadership in team quality improvement projects.

    Science.gov (United States)

    Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen

    2015-01-01

    In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes.

  6. Improving care quality and preventing maltreatment in institutional care – a feasibility study with caregivers

    Directory of Open Access Journals (Sweden)

    Katharin eHermenau

    2015-07-01

    Full Text Available Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy of the training immediately before, directly after, and three months following the training workshop. The results showed high demand, good feasibility, high motivation and acceptance of caregivers. They reported improvements in caregiver-child relationships, as well as in the children’s behavior. Study 2 assessed exposure to maltreatment and the mental health of 28 orphans living in one institution in which all caregivers had been trained. The children were interviewed 20 months before, one month before, and three months after the training. Children reported a decrease in physical maltreatment and assessments showed a decrease in mental health problems. Our approach seems feasible under challenging circumstances and provides first hints for its efficacy. These promising findings call for further studies testing the efficacy and sustainability of this maltreatment prevention approach.

  7. Taxing energy to improve the environment. Efficiency and distributional effects

    International Nuclear Information System (INIS)

    The effects of environmental tax policy in a dynamic overlapping-generations model of a small open economy with environmental quality incorporated as a durable consumption good have been studied. Raising the energy tax may deliver an efficiency gain if agents care enough about the environment. The benefits are unevenly distributed across generations since capital ownership, and the capital loss induced by a tax increase, rises with age. A suitable egalitarian bond policy can be employed in order to ensure everybody gains to the same extent. With this additional instrument the optimal energy tax can be computed. The authors further considered a tax reform that simultaneously lowers labour taxation and raises the energy tax. This policy delivers qualitatively similar consequences as the first scenario, though all changes are less pronounced. A double dividend may appear soon after the reform but vanishes in the course of the transition. 22 refs

  8. The Child Care Industry: Cost Functions, Efficiency, and Quality

    OpenAIRE

    H. Naci Mocan

    1995-01-01

    Using a newly compiled data set, this paper provides insights into the characteristics of the child care industry. First, there is no difference in average quality of the services produced between nonprofit and for-profit centers. This indicates that nonprofit status cannot be taken as a signal of higher quality. Second, the hypothesis of relative inefficiency of nonprofit centers with respect to for-profits is unfounded. On the other hand, centers that receive public money, either from the s...

  9. How Health Care Organizations Are Using Data on Patients' Race and Ethnicity to Improve Quality of Care

    OpenAIRE

    Thorlby, Ruth; Jorgensen, Selena; Siegel, Bruce; Ayanian, John Z.

    2011-01-01

    Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system. Reducing these disparities requires action by health care organizations. Collecting accurate data from patients about their race and ethnicity is an essential first step for health care organizations to take such action, but these data are not systematically collected and used for quality improvement purposes in the United States. This study explores the challenges encounte...

  10. Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project.

    Science.gov (United States)

    Buck, Harleah G; Kolanowski, Ann; Fick, Donna; Baronner, Lawrence

    2016-07-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project," found on pages 306-313, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until June 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Describe the unique nursing challenges that occur in caring for older adults in rural areas. Discuss the

  11. Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project.

    Science.gov (United States)

    Buck, Harleah G; Kolanowski, Ann; Fick, Donna; Baronner, Lawrence

    2016-07-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project," found on pages 306-313, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until June 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Describe the unique nursing challenges that occur in caring for older adults in rural areas. Discuss the

  12. Using Evidence-Based Design to Improve Pharmacy Department Efficiency.

    Science.gov (United States)

    Greenroyd, Fraser L; Hayward, Rebecca; Price, Andrew; Demian, Peter; Sharma, Shrikant

    2016-10-01

    Using a case study of a pharmacy department rebuild in the South West of England, this article examines the use of evidence-based design to improve the efficiency and staff well-being with a new design. This article compares three designs, the current design, an anecdotal design, and an evidence-based design, to identify how evidence-based design can improve efficiency and staff well-being by reducing walking time and distance. Data were collected from the existing building and used to measure the efficiency of the department in its current state. These data were then mapped onto an anecdotal design, produced by architects from interviews and workshops with the end users, and an evidence-based design, produced by highlighting functions with high adjacencies. This changed the view on the working processes within the department, shifting away from a focus on the existing robotic dispensing system. Using evidence-based design was found to decrease the walking time and distance for staff by 24%, as opposed to the anecdotal design, which increased these parameters by 9%, and is predicted to save the department 248 min across 2 days in staff time spent walking.

  13. Efficient Use of Geothermal Energy in Spas - Call for Improvements

    Science.gov (United States)

    Straka, W.; Ponweiser, K.; Gollob, K.; Götzl, G.; Schneider, J. F.

    2009-04-01

    European partners contributed to the attempt to develop the energy flow calculation model designed for said spa into a numerical planning tool with broad applicability to other technical boundary conditions. This aim could not yet be fully achieved with the given means, by virtue of the fact that huge differences exist among spas, regarding technical design (sometimes accumulations of ad-hoc solutions to past technical problems) as well as characteristic energy demand of the various functional units of the investigated facilities. What could be achieved, though, was a better understanding how the communication between clients and consultants shall be conducted and what steps have to be taken in order to reach the original goal in a subsequent project. Furthermore, it was the ideational aim of our work to set up a network of established players, capable of influencing national developments, and make it a proponent of the envisaged improvements in their home countries and beyond. Among the recommended measures to improve on the energy management of existing thermal spas, on the one hand, there are those that only specialized knowledge can reveal or the proper application of which only painstaking monitoring and calculation can ascertain and which, therefore, will not easily be at the hand of many planners. These include, for example, combining geothermal heat with advanced heating technology (gas condensing boiler, cogeneration plant) for peak load conditions, deciding on the kind of advanced technology to be used (condensing boiler or cogeneration plus heat pump), making consistent said technology with the temperature control system (e.g. substitution of bypass design of heat exchanger control by volume flow control); introducing solar energy, in particular, has to be carefully designed. On the other hand, there are some improvements to be called for, which are meaningful and applicable even as belated additions, and in cases would, on top of this, be obvious to most non

  14. Efficient national surveillance for health-care-associated infections

    NARCIS (Netherlands)

    van Bunnik, B. A. D.; Ciccolini, M.; Gibbons, C. L.; Edwards, G.; Fitzgerald, R.; McAdam, P. R.; Ward, M. J.; Laurenson, I. F.; Woolhouse, M. E. J.

    2015-01-01

    Background: Detecting novel healthcare-associated infections (HCAI) as early as possible is an important public health priority. However, there is currently no evidence base to guide the design of efficient and reliable surveillance systems. Here we address this issue in the context of a novel patho

  15. Improving energy efficiency in industrial solutions - Walk the talk

    Energy Technology Data Exchange (ETDEWEB)

    Wegener, D. (Siemens AG. Industry Solutions Div., Erlangen (Germany)); Finkbeiner, M. (Technische Univ. Berlin (TUB). Sustainable Engineering, Berlin (Germany)); Holst, J.-C.; Walachowicz, F. (Siemens AG. Corporate Technology, Berlin (Germany)); Irving Olsen, S. (Technical Univ. of Denmark (DTU). Management Engineering, Kgs. Lyngby (Denmark))

    2011-05-15

    This paper describes the outline of the energy efficiency and environmental care policy and management at Siemens Industry Solutions Division. This environmental policy coherently embraces strategic planning, eco-design of energy-efficient industrial processes and solutions, design evaluation and finally communication of both environmental and economic performance of solutions to customers. One of the main tools supporting eco-design and evaluation and controlling of derived design solutions is the so called 'Eco-Care-Matrix' (ECM). The ECM simply visualizes the eco-efficiency of solutions compared to a given baseline. In order to prevent from 'green washing' criticism and to ensure 'walk the talk' attitude the ECM should be scientifically well-founded using appropriate and consistent methodology. The vertical axis of an ECM illustrates the environmental performance and the horizontal axis describes the economical customer benefit of one or more green solutions compared to a defined reference solution. Different scientific approaches for quantifying the environmental performance based on life cycle assessment methodology are discussed especially considering the ISO standards 14040/14044:2006. Appropriate ECM application is illustrated using the example of the Siemens MEROS technology (Maximized Emission Reduction of Sintering) for the steel industry. MEROS is currently the most modern and powerful system for cleaning off-gas in sinter plants. As an environmental technology MEROS is binding and removing sulfur dioxide and other acidic gas components present in the off-gas stream by using dry absorbents and additional electrical power. Advantage in the impact category of acidification potential (by desulfurization) is a trade-off to disadvantages in global warming and resource depletion potential caused by use of electricity. Representing different impacts, indicator results for impact categories with different tendencies have to be

  16. Energy Efficiency Improvement in the Petroleum RefiningIndustry

    Energy Technology Data Exchange (ETDEWEB)

    Worrell, Ernst; Galitsky, Christina

    2005-05-01

    Information has proven to be an important barrier inindustrial energy efficiency improvement. Voluntary government programsaim to assist industry to improve energy efficiency by supplyinginformation on opportunities. ENERGY STAR(R) supports the development ofstrong strategic corporate energy management programs, by providingenergy management information tools and strategies. This paper summarizesENERGY STAR research conducted to develop an Energy Guide for thePetroleum Refining industry. Petroleum refining in the United States isthe largest in the world, providing inputs to virtually every economicsector, including the transport sector and the chemical industry.Refineries spend typically 50 percent of the cash operating costs (e.g.,excluding capital costs and depreciation) on energy, making energy amajor cost factor and also an important opportunity for cost reduction.The petroleum refining industry consumes about 3.1 Quads of primaryenergy, making it the single largest industrial energy user in the UnitedStates. Typically, refineries can economically improve energy efficiencyby 20 percent. The findings suggest that given available resources andtechnology, there are substantial opportunities to reduce energyconsumption cost-effectively in the petroleum refining industry whilemaintaining the quality of the products manufactured.

  17. High resolution PET breast imager with improved detection efficiency

    Science.gov (United States)

    Majewski, Stanislaw

    2010-06-08

    A highly efficient PET breast imager for detecting lesions in the entire breast including those located close to the patient's chest wall. The breast imager includes a ring of imaging modules surrounding the imaged breast. Each imaging module includes a slant imaging light guide inserted between a gamma radiation sensor and a photodetector. The slant light guide permits the gamma radiation sensors to be placed in close proximity to the skin of the chest wall thereby extending the sensitive region of the imager to the base of the breast. Several types of photodetectors are proposed for use in the detector modules, with compact silicon photomultipliers as the preferred choice, due to its high compactness. The geometry of the detector heads and the arrangement of the detector ring significantly reduce dead regions thereby improving detection efficiency for lesions located close to the chest wall.

  18. Indoor climate quality after renovation for improved energy efficiency

    DEFF Research Database (Denmark)

    Gunnarsen, Lars Bo; Løck, Sebastian; Kolarik, Barbara;

    2016-01-01

    The building sector is responsible for approximately 40 % of the Danish energy consumption. As every year less than 1 % of the building stock is rebuild after demolition of old buildings, improved energy efficiency of existing buildings are in focus. In the late seventies to mid-eighties unwise...... energy efficiency retrofitting caused several cases of indoor climate degradation. This project describes possibilities, barriers and methods of combining energy performance and indoor climate enhancements in today’s retrofitting of rental dwellings. The project followed three energy retrofitting...... before and after the retrofitting. The results showed significant energy savings in all projects. There was a marked difference between expected and measured energy consumption in one building and good agreement in the two others indicating a strong impact of good maintenance and operations on energy...

  19. Improvement of teamwork in health care through interprofessional education

    Directory of Open Access Journals (Sweden)

    Simin Dragana

    2010-01-01

    Full Text Available Introduction. Collaboration, within and between healthcare teams, facilitates effective healthcare. Internationally, the development of interprofessional education, as a means to facilitate more effective teamwork in health care, has been recognized for over forty years. Objective. The aim of this paper is to evaluate students' attitudes toward the influence of interprofessional education on improvement of collaboration and teamwork. Methods. The research was conducted by interviewing students at the Medical Faculty in Novi Sad in the form of cross-sectional study. The study sample included students from two undergraduate programmes: School of Nursing (n=52 and Integrated Studies of Medicine (n=53. Students admitted to the research had to be exposed to clinical experience. The instrument used in this study was the Readiness for Interprofessional Learning Scale (RIPLS. Results. As many as 93.3% of students indicated that basics of teamwork skills should be obtained prior to graduation, whereas 96.2% considered that interprofessional education would enable them to improve mutual trust and respect. The majority of interviewees indicated that patients would ultimately benefit if healthcare students worked together to solve patient problems. Multivariate procedures MANOVA p<0.05 and discriminative analysis p<0.05 of students' attitudes toward teamwork and collaboration showed significant differences between the students of medicine and nursing. Conclusion. The students of the Integrated Studies of Medicine and School of Nursing had a positive attitude toward the influence of interprofessional education on the improvement of collaboration and teamwork.

  20. Involving older people in improving general hospital care.

    Science.gov (United States)

    Hayes, Nicky; Dearnley, Barbara

    2007-05-01

    User involvement is high on the NHS agenda. At King's College Hospital, London, older people helped to develop the Improving Hospital Care for Older People project by producing teaching and learning materials for staff using e-learning. The project was set up by holding focus groups with older people. Staff surveys were also conducted to explore views and identify issues to be addressed. Older people's representatives were selected and directly involved in developing learning materials. This article describes the process of working together and includes the personal reflections of some of the key players. It discusses barriers to effective user involvement work between staff and older people, and identifies some benefits and opportunities presented by this approach. PMID:17518196

  1. Demystifying and improving organizational culture in health-care.

    Science.gov (United States)

    Pellegrin, Karen L; Currey, Hal S

    2011-01-01

    Organizational culture is defined as the shared values and beliefs that guide behavior within each organization, and it matters because it is related to performance. While culture is generally considered important, it is mysterious and intangible to most leaders. The first step toward understanding organizational culture is to measure it properly. This chapter describes methods for measuring culture in health-care organizations and how these methods were implemented in a large academic medical center. Because of the consistent empirical link between the dimension of communication, other culture dimensions, and employee satisfaction, special attention is focused in this area. Specifically, a case study of successful communication behaviors during a major "change management" initiative at a large academic medical center is described. In summary, the purpose of this chapter is to demystify the concept of culture and demonstrate how to improve it.

  2. Collaborating With Music Therapists to Improve Patient Care.

    Science.gov (United States)

    Palmer, Jaclyn Bradley; Lane, Deforia; Mayo, Diane

    2016-09-01

    Collaboration between perioperative nurses and music therapists can be beneficial in providing a safe, cost-effective means of managing patients' anxiety and pain and reducing the need for pharmacologic intervention in the perioperative setting. The use of a board-certified music therapist may help to improve patient outcomes, ease nurse workload, and serve as an adjunct therapeutic modality that is enjoyable for both patients and staff members. We conducted a two-year, randomized controlled trial to determine how to best implement a music therapy program, navigate its challenges, and collaborate with nurse colleagues to bring its benefits to surgical patients. This article offers suggestions for alliances between perioperative nursing and music therapy staff members and describes the potential of music therapists to help provide optimal patient care.

  3. Collaborating With Music Therapists to Improve Patient Care.

    Science.gov (United States)

    Palmer, Jaclyn Bradley; Lane, Deforia; Mayo, Diane

    2016-09-01

    Collaboration between perioperative nurses and music therapists can be beneficial in providing a safe, cost-effective means of managing patients' anxiety and pain and reducing the need for pharmacologic intervention in the perioperative setting. The use of a board-certified music therapist may help to improve patient outcomes, ease nurse workload, and serve as an adjunct therapeutic modality that is enjoyable for both patients and staff members. We conducted a two-year, randomized controlled trial to determine how to best implement a music therapy program, navigate its challenges, and collaborate with nurse colleagues to bring its benefits to surgical patients. This article offers suggestions for alliances between perioperative nursing and music therapy staff members and describes the potential of music therapists to help provide optimal patient care. PMID:27568531

  4. Improving Transitions of Care With an Advanced Practice Nurse: A Pilot Study.

    Science.gov (United States)

    Hsueh, Martha; Dorcy, Kathleen

    2016-06-01

    Gaps in complex oncology care coordination between inpatient and outpatient settings can result in treatment and monitoring delays and omissions, which can negatively affect patient outcomes. Gaps also exist for patients facing complex treatment modalities and collaborations between multiple care teams working at geographically distant sites. A pilot advanced practice nurse care coordinator 
(APNCC) role to coordinate these complex care transitions and implement processes for safer and more efficient care has shown promise.
. PMID:27206289

  5. Reductions in inpatient mortality following interventions to improve emergency hospital care in Freetown, Sierra Leone.

    OpenAIRE

    Clark, M.; Spry, E.; Daoh, K.; Baion, D.; Skordis-Worrall, J

    2012-01-01

    Background The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children's hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. Methods and Findings A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children's H...

  6. Energy efficiency improvement and cost saving opportunities forpetroleum refineries

    Energy Technology Data Exchange (ETDEWEB)

    Worrell, Ernst; Galitsky, Christina

    2005-02-15

    The petroleum refining industry in the United States is the largest in the world, providing inputs to virtually any economic sector,including the transport sector and the chemical industry. The industry operates 146 refineries (as of January 2004) around the country,employing over 65,000 employees. The refining industry produces a mix of products with a total value exceeding $151 billion. Refineries spend typically 50 percent of cash operating costs (i.e., excluding capital costs and depreciation) on energy, making energy a major cost factor and also an important opportunity for cost reduction. Energy use is also a major source of emissions in the refinery industry making energy efficiency improvement an attractive opportunity to reduce emissions and operating costs. Voluntary government programs aim to assist industry to improve competitiveness through increased energy efficiency and reduced environmental impact. ENERGY STAR (R), a voluntary program managed by the U.S. Environmental Protection Agency, stresses the need for strong and strategic corporate energy management programs. ENERGY STAR provides energy management tools and strategies for successful corporate energy management programs. This Energy Guide describes research conducted to support ENERGY STAR and its work with the petroleum refining industry.This research provides information on potential energy efficiency opportunities for petroleum refineries. This Energy Guide introduces energy efficiency opportunities available for petroleum refineries. It begins with descriptions of the trends, structure, and production of the refining industry and the energy used in the refining and conversion processes. Specific energy savings for each energy efficiency measure based on case studies of plants and references to technical literature are provided. If available, typical payback periods are also listed. The Energy Guide draws upon the experiences with energy efficiency measures of petroleum refineries worldwide

  7. Fast reactor core concepts to improve transmutation efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Fujimura, Koji; Kawashima, Katsuyuki [Hitachi Research Laboratory, Hitachi, Ltd., 7-1-1, Omika-cho, Hitachi-shi, Ibaraki, 319-1221 Japan (Japan); Itooka, Satoshi [Hitachi-GE Nuclear Energy, Ltd., 3-1-1, Saiwai-cho, Hitachi-shi, Ibaraki, 317-0073 Japan (Japan)

    2015-12-31

    Fast Reactor (FR) core concepts to improve transmutation efficiency were conducted. A heterogeneous MA loaded core was designed based on the 1000MWe-ABR breakeven core. The heterogeneous MA loaded core with Zr-H loaded moderated targets had a better transmutation performance than the MA homogeneous loaded core. The annular pellet rod design was proposed as one of the possible design options for the MA target. It was shown that using annular pellet MA rods mitigates the self-shielding effect in the moderated target so as to enhance the transmutation rate.

  8. Improved energy efficiency and optimization of microclimate in buildings

    Directory of Open Access Journals (Sweden)

    Trifunovič Dragišić Vesna

    2016-01-01

    Full Text Available Nowadays it is possible to reduce energy consumption without losing comfort as a result of using efficient energy saving technologies and advanced environment control methods for buildings. One of the measures to improve energy performance of buildings can be installation of decentralized air intake and exhaust mechanical ventilation systems with plate heat exchangers in apartments making it possible to «return» up to 85% of thermal energy. The article deals with the decentralized system controlled ventilation with heat recovery and alternative solutions heating supply air in residential buildings.

  9. Energy efficiency improvement of medical electric tools and devices

    Directory of Open Access Journals (Sweden)

    Meshkov Aleksandr S.

    2014-01-01

    Full Text Available With the ever-increasing volume of applications of various kinds of electric drives in all spheres of human activity, the issues in improving the efficiency of the electromechanical converters of electric energy, one of the most important components of the electric drive (ED, are becoming increasingly important. Such issues include reducing their weight and size, improving the functional characteristics of these devices to increase their operational life and reducing the cost of manufacture. Taking full advantage of these opportunities relates to the AC and DC single-phase commutator motor (SCM, which is widely used in regulated and high-speed motor drives in medical electric hand tools. The SCM is used in machinery where the load torque has a hyperbolic dependence on the rotational speed and the need to work with a large motor overload due to the “soft” mechanical characteristics of such motors.

  10. Efficiency improvements in pipeline transportation systems. Technical report, Task 3

    Energy Technology Data Exchange (ETDEWEB)

    Banks, W. F.; Horton, J. H.

    1977-01-01

    This report identifies those potential energy-conservative pipeline innovations that are most energy- and cost-effective, and formulates recommendations for the R, D, and D programs needed to exploit those opportunities. From a candidate field of over twenty classes of efficiency improvements, eight systems are recommended for pursuit. Most of these possess two highly important attributes: large potential energy savings and broad applicability outside the pipeline industry. The R, D, and D program for each improvement and the recommended immediate next step are described. The eight programs recommended for pursuit are: gas-fired combined-cycle compressor station; internally cooled internal combustion engine; methanol-coal slurry pipeline; methanol-coal slurry-fired and coal-fired engines; indirect-fired coal-burning combined-cycle pump station; fuel-cycle pump station; internal coatings in pipelines; and drag-reducing additives in liquid pipelines.

  11. Comprehensive care of pain: Developing systems and tools to improve patient care and resident education.

    Science.gov (United States)

    Rickert, Julie; Devlin, Kwanza; Krohn, Kimberly

    2016-05-01

    Chronic non-cancer pain is a common condition associated with tremendous risk for morbidity and mortality. In many settings, the management of chronic non-cancer pain by primary care providers, although customary, can be difficult due to inadequate training and conflicts between patient expectations and best practices. Resident physicians, faculty, and staff of this family medicine residency program developed a comprehensive chronic pain management program to address these issues while improving patient outcomes. The program was aligned with evidence-based chronic non-cancer pain management strategies yet tailored to the needs of the providers and patients and the strengths of the clinic. In the end, the societal demand for improved chronic non-cancer pain management resulted in a massive curricular and clinical practice overhaul for this residency program. PMID:27497454

  12. Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

    Science.gov (United States)

    Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

    2016-01-01

    Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

  13. IMPROVING CO2 EFFICIENCY FOR RECOVERING OIL IN HETEROGENEOUS RESERVOIRS

    International Nuclear Information System (INIS)

    A three-year contract for the project, DOE Contract No. DE-FG26-01BC15364, ''Improving CO2 Efficiency for Recovering Oil in Heterogeneous Reservoirs'', was started on September 28, 2001. This project examines three major areas in which CO2 flooding can be improved: fluid and matrix interactions, conformance control/sweep efficiency, and reservoir simulation for improved oil recovery. The project has received a one-year, no-cost extension to September 27, 2005. During this extra time additional deliverables will be (1) the version of MASTER that has been debugged and a foam option added for CO2 mobility control and (2) adsorption/desorption data on pure component minerals common in reservoir rock that will be used to improve predictions of chemical loss to adsorption in reservoirs. This report discusses the activity during the six-month period covering October 1, 2003 through March 31, 2004 that comprises the first and second fiscal quarters of the project's third year. During this period of the project several areas have advanced: reservoir fluid/rock interactions and their relationships to changing injectivity, and surfactant adsorption on quarried core and pure component granules, foam stability, and high flow rate effects. Presentations and papers included: a papers covered in a previous report was presented at the fall SPE ATCE in Denver in October 2003, a presentation at the Southwest ACS meeting in Oklahoma City, presentation on CO2 flood basic behavior at the Midland Annual CO2 Conference December 2003; two papers prepared for the biannual SPE/DOE Symposium on IOR, Tulsa, April 2004; one paper accepted for the fall 2004 SPE ATCE in Houston; and a paper submitted to an international journal Journal of Colloid and Interface Science which is being revised after peer review

  14. Assessment of the Efficiency of Tobacco Cessation Counseling in Primary Care.

    Science.gov (United States)

    El-Shahawy, Omar; Shires, Deirdre A; Elston Lafata, Jennifer

    2016-09-01

    Clinical Practice Guidelines for Treating Tobacco Use and Dependence advocate for using counseling targeted at tobacco users' motivation to quit during each office visit. We evaluate tobacco use screening and counseling interventions delivered during routine periodic health examinations by 44 adult primary care physicians practicing in 22 clinics of a large health system in southeast Michigan. 484 office visits were audio-recorded and transcribed. For this study, current tobacco users (N = 91) were identified using pre-visit surveys and audio-recordings. Transcripts were coded for the delivery of tobacco-related counseling interventions. The extent to which counseling interventions were used and/or targeted to the patients' readiness to quit was the main outcome measure. The majority of tobacco users (n = 77) had their tobacco use status assessed, and most received some sort of tobacco-related counseling (n = 74). However, only 15% received the recommended counseling targeted to their readiness to quit. On the other hand, 19% received less counseling than recommended given their readiness to quit, 7% received only nonindicated counseling, and 59% received nonindicated counseling in addition to indicated counseling. Results illustrate physicians' commitment to cessation counseling and also identify potential opportunities to improve the efficiency of tobacco-related counseling in primary care. PMID:26290271

  15. Efficiency Improvements of Antenna Optimization Using Orthogonal Fractional Experiments

    Directory of Open Access Journals (Sweden)

    Yen-Sheng Chen

    2015-01-01

    Full Text Available This paper presents an extremely efficient method for antenna design and optimization. Traditionally, antenna optimization relies on nature-inspired heuristic algorithms, which are time-consuming due to their blind-search nature. In contrast, design of experiments (DOE uses a completely different framework from heuristic algorithms, reducing the design cycle by formulating the surrogates of a design problem. However, the number of required simulations grows exponentially if a full factorial design is used. In this paper, a much more efficient technique is presented to achieve substantial time savings. By using orthogonal fractional experiments, only a small subset of the full factorial design is required, yet the resultant response surface models are still effective. The capability of orthogonal fractional experiments is demonstrated through three examples, including two tag antennas for radio-frequency identification (RFID applications and one internal antenna for long-term-evolution (LTE handheld devices. In these examples, orthogonal fractional experiments greatly improve the efficiency of DOE, thereby facilitating the antenna design with less simulation runs.

  16. Restructuring and energy efficiency improvement of the Bulgarian energy economy

    International Nuclear Information System (INIS)

    The structure of the national energy economy of Bulgaria implies characteristic features that specify low efficiency as regards power production, ecology and economics. Even the qualitative assessments show that these indices stand far away from the standards established in developed countries like Denmark, Finland, Sweden, etc. The best starting position for harmful energy efficiency improvement as well as emission reduction must be based on the restructuring of energy economy. The strategy of restructuring and development of energy economy covers the whole integrated national energy flow system 'resources - end user'. The preliminary study shows that energy efficiency can be increased by 25-30% within a period of 6-10 years using the least-cost investment strategy (including the research and development activities expenses). The study covers the existing structure of energy sector. Scenarios are being elaborated for its development and restructuring in respect to: heat production and transfer; electricity generation and transmission; energy consumption and conservation in residential buildings, public buildings and commercial sector; energy consumption in transport sector and agriculture. The approach for identification of the real potential opportunities in relation to the above stated areas is based on mathematical statistics and stochastic differential equations, multicriterial assessments, approach of self organisation systems and demand-side management. (author)

  17. The new health-care quality: value, outcomes, and continuous improvement.

    Science.gov (United States)

    O'Connor, S J; Lanning, J A

    1991-01-01

    No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa. PMID:10118887

  18. The new health-care quality: value, outcomes, and continuous improvement.

    Science.gov (United States)

    O'Connor, S J; Lanning, J A

    1991-01-01

    No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa.

  19. Improving thermoelectric energy harvesting efficiency by using graphene

    Directory of Open Access Journals (Sweden)

    Muhammad Usman

    2016-05-01

    Full Text Available This study is aimed at enhancing the efficiency of a thermoelectric (TE energy harvesting system by using a thick graphene layer. This method is a simple yet effective way to increase the temperature gradient across a conventional TE module by accelerating heat dissipation on the cold side of the system. Aqueous dispersions of graphene were used to prepare a 112-μm thick graphene layer on the cold side of the TE system with aluminum as the substrate material. The maximum efficiency of the proposed system was improved by 25.45 %, as compared to the conventional TE system, which does not have a graphene layer. Additionally, the proposed system shows very little performance deterioration (2.87 % in the absence of enough air flow on the cold side of the system, compared to the case of the conventional system (10.59 %. Hence, the proposed system, when coupled with the latest research on high performance TE materials, presents a groundbreaking improvement in the practical application of the TE energy harvesting systems.

  20. Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

    Directory of Open Access Journals (Sweden)

    Kimberly Ramsbottom

    2014-01-01

    Full Text Available Long term care (LTC homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descriptive study conducted 34 individual semistructured interviews in two LTC homes, located in Canada. The participants were 31 family members and three staff, consisting of a front line care worker, a registered nurse, and a nurse practitioner. All participants perceived ACP conversations as valuable to provide “resident-centred care”; however, none of the participants had a good understanding of ACP, limiting its effectiveness. Strategies generated through the research to improve ACP were as follows: educating families and staff on ACP and end-of-life care options; better preparing staff for ACP conversations; providing staff skills training and guidelines; and LTC staff initiating systematic, proactive conversations using careful timing. These strategies can guide quality improvement of palliative care and development of ACP tools and resources specific to the LTC home sector.

  1. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia

    OpenAIRE

    Norbert eMayer-Amberg; Rainer eWoltmann; Stefanie eWalther

    2016-01-01

    The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various healthcare service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The current work is a quality monitoring report of a novel care setting, called Integrated Care Initiative Schizophrenia. It has implemented a networked care con...

  2. Improving palliative care outcomes for Aboriginal Australians: service providers’ perspectives

    OpenAIRE

    Shahid, Shaouli; Bessarab, Dawn; van Schaik, Katherine D; Aoun, Samar M.; Thompson, Sandra C

    2013-01-01

    Background: Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers’ experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. Methods: In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient a...

  3. Decomposing Cost Efficiency in Regional Long-term Care Provision in Japan.

    Science.gov (United States)

    Yamauchi, Yasuhiro

    2016-03-01

    Many developed countries face a growing need for long-term care provision because of population ageing. Japan is one such example, given its population's longevity and low birth rate. In this study, we examine the efficiency of Japan's regional long-term care system in FY2010 by performing a data envelopment analysis, a non-parametric frontier approach, on prefectural data and separating cost efficiency into technical, allocative, and price efficiencies under different average unit costs across regions. In doing so, we elucidate the structure of cost inefficiency by incorporating a method for restricting weight flexibility to avoid unrealistic concerns arising from zero optimal weight. The results indicate that technical inefficiency accounts for the highest share of losses, followed by price inefficiency and allocation inefficiency. Moreover, the majority of technical inefficiency losses stem from labor costs, particularly those for professional caregivers providing institutional services. We show that the largest share of allocative inefficiency losses can also be traced to labor costs for professional caregivers providing institutional services, while the labor provision of in-home care services shows an efficiency gain. However, although none of the prefectures gains efficiency by increasing the number of professional caregivers for institutional services, quite a few prefectures would gain allocative efficiency by increasing capital inputs for institutional services. These results indicate that preferred policies for promoting efficiency might vary from region to region, and thus, policy implications should be drawn with care. PMID:26493427

  4. Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care

    DEFF Research Database (Denmark)

    Nørgaard, Birgitte; Kofoed, Poul-Erik; Ohm Kyvik, Kirsten;

    2012-01-01

    Scand J Caring Sci; 2012; Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care Rationale:  Despite the fact that communication has become a core topic in health care, patients still experience the information provided...... as insufficient or incorrect and a lack of involvement. Objective:  To investigate whether adult orthopaedic patients' evaluation of the quality of care had improved after a communication skills training course for healthcare professionals. Design and methods:  The study was designed as an intervention study...... limitation. Response rates were comparable to those of other studies. Conclusion:  Patients show increased satisfaction with the quality of health care after professionals have attended a communication skills training course, even when implemented in an entire department. Practice implications:  We recommend...

  5. The Impact Of Medicare ACOs On Improving Integration And Coordination Of Physical And Behavioral Health Care.

    Science.gov (United States)

    Fullerton, Catherine A; Henke, Rachel M; Crable, Erica; Hohlbauch, Andriana; Cummings, Nicholas

    2016-07-01

    The accountable care organization (ACO) model holds the promise of reducing costs and improving the quality of care by realigning payment incentives to focus on health outcomes instead of service volume. One key to managing the total cost of care is improving care coordination for and treatment of people with behavioral health disorders. We examined qualitative data from ninety organizations participating in Medicare ACO demonstration programs from 2012 through 2015 to determine whether and how they focused on behavioral health care. These ACOs had mixed degrees of engagement in improving behavioral health care for their populations. The biggest challenges included a lack of behavioral health care providers, data availability, and sustainable financing models. Nonetheless, we found substantial interest in integrating behavioral health care into primary care across a majority of the ACOs. PMID:27385242

  6. Improving outcomes in lung cancer: the value of the multidisciplinary health care team.

    Science.gov (United States)

    Denton, Eve; Conron, Matthew

    2016-01-01

    Lung cancer is a major worldwide health burden, with high disease-related morbidity and mortality. Unlike other major cancers, there has been little improvement in lung cancer outcomes over the past few decades, and survival remains disturbingly low. Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, despite a relative lack of evidence that this model of care improves outcomes. In this article, the available literature concerning the impact of multidisciplinary care on key measures of lung cancer outcomes is reviewed. This includes the limited observational data supporting improved survival with multidisciplinary care. The impact of multidisciplinary care on other benchmark measures of quality lung cancer treatment is also examined, including staging accuracy, access to diagnostic investigations, improvements in clinical decision making, better utilization of radiotherapy and palliative care services, and improved quality of life for patients. Health service research suggests that multidisciplinary care improves care coordination, leading to a better patient experience, and reduces variation in care, a problem in lung cancer management that has been identified worldwide. Furthermore, evidence suggests that the multidisciplinary model of care overcomes barriers to treatment, promotes standardized treatment through adherence to guidelines, and allows audit of clinical services and for these reasons is more likely to provide quality care for lung cancer patients. While there is strengthening evidence suggesting that the multidisciplinary model of care contributes to improvements in lung cancer outcomes, more quality studies are needed. PMID:27099511

  7. Depression among Alumni of Foster Care: Decreasing Rates through Improvement of Experiences in Care

    Science.gov (United States)

    White, Catherine Roller; O'Brien, Kirk; Pecora, Peter J.; English, Diana; Williams, Jason R.; Phillips, Chereese M.

    2009-01-01

    The Northwest Foster Care Alumni Study examined the relation between experiences in foster care and depression among young adults who spent at least a year in foster care as adolescents. Results indicate that preparation for leaving foster care, nurturing supports from the foster family, school stability, access to tutoring, access to therapeutic…

  8. Modeling solar cells: A method for improving their efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Morales-Acevedo, Arturo, E-mail: amorales@solar.cinvestav.mx [Centro de Investigacion y de Estudios Avanzados del IPN, Electrical Engineering Department, Avenida IPN No. 2508, 07360 Mexico, D.F. (Mexico); Hernandez-Como, Norberto; Casados-Cruz, Gaspar [Centro de Investigacion y de Estudios Avanzados del IPN, Electrical Engineering Department, Avenida IPN No. 2508, 07360 Mexico, D.F. (Mexico)

    2012-09-20

    After a brief discussion on the theoretical basis for simulating solar cells and the available programs for doing this we proceed to discuss two examples that show the importance of doing numerical simulation of solar cells. We shall concentrate in silicon Heterojunction Intrinsic Thin film aSi/cSi (HIT) and CdS/CuInGaSe{sub 2} (CIGS) solar cells. In the first case, we will show that numerical simulation indicates that there is an optimum transparent conducting oxide (TCO) to be used in contact with the p-type aSi:H emitter layer although many experimental researchers might think that the results can be similar without regard of the TCO film used. In this case, it is shown that high work function TCO materials such as ZnO:Al are much better than smaller work function films such as ITO. HIT solar cells made with small work function TCO layers (<4.8 eV) will never be able to reach the high efficiencies already reported experimentally. It will also be discussed that simulations of CIGS solar cells by different groups predict efficiencies around 18-19% or even less, i.e. below the record efficiency reported experimentally (20.3%). In addition, the experimental band-gap which is optimum in this case is around 1.2 eV while several theoretical results predict a higher optimum band-gap (1.4-1.5 eV). This means that there are other effects not included in most of the simulation models developed until today. One of them is the possible presence of an interfacial (inversion) layer between CdS and CIGS. It is shown that this inversion layer might explain the smaller observed optimum band-gap, but some efficiency is lost. It is discussed that another possible explanation for the higher experimental efficiency is the possible variation of Ga concentration in the CIGS film causing a gradual variation of the band-gap. This band-gap grading might help improve the open-circuit voltage and, if it is appropriately done, it can also cause the enhancement of the photo-current density.

  9. Physician attitude toward depression care interventions: Implications for implementation of quality improvement initiatives

    OpenAIRE

    Chanin Johann C; Chou Ann F; Henke Rachel; Zides Amanda B; Scholle Sarah

    2008-01-01

    Abstract Background Few individuals with depression treated in the primary care setting receive care consistent with clinical treatment guidelines. Interventions based on the chronic care model (CCM) have been promoted to address barriers and improve the quality of care. A current understanding of barriers to depression care and an awareness of whether physicians believe interventions effectively address those barriers is needed to enhance the success of future implementation. Methods We cond...

  10. Quality Improvement in Critical Care: Selection and Development of Quality Indicators

    Directory of Open Access Journals (Sweden)

    Carla A. Chrusch

    2016-01-01

    Full Text Available Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts.

  11. Quality Improvement in Critical Care: Selection and Development of Quality Indicators.

    Science.gov (United States)

    Chrusch, Carla A; Martin, Claudio M; Project, The Quality Improvement In Critical Care

    2016-01-01

    Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts.

  12. A framework for improving access and customer service times in health care: application and analysis at the UCLA Medical Center.

    Science.gov (United States)

    Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas

    2013-01-01

    There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics. PMID:23903937

  13. A framework for improving access and customer service times in health care: application and analysis at the UCLA Medical Center.

    Science.gov (United States)

    Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas

    2013-01-01

    There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics.

  14. Community health workers in primary care practice: redesigning health care delivery systems to extend and improve diabetes care in underserved populations.

    Science.gov (United States)

    Collinsworth, Ashley; Vulimiri, Madhulika; Snead, Christine; Walton, James

    2014-11-01

    New, comprehensive, approaches for chronic disease management are needed to ensure that patients, particularly those more likely to experience health disparities, have access to the clinical care, self-management resources, and support necessary for the prevention and control of diabetes. Community health workers (CHWs) have worked in community settings to reduce health care disparities and are currently being deployed in some clinical settings as a means of improving access to and quality of care. Guided by the chronic care model, Baylor Health Care System embedded CHWs within clinical teams in community clinics with the goal of reducing observed disparities in diabetes care and outcomes. This study examines findings from interviews with patients, CHWs, and primary care providers (PCPs) to understand how health care delivery systems can be redesigned to effectively incorporate CHWs and how embedding CHWs in primary care teams can produce informed, activated patients and prepared, proactive practice teams who can work together to achieve improved patient outcomes. Respondents indicated that the PCPs continued to provide clinical exams and manage patient care, but the roles of diabetes education, nutritional counseling, and patient activation were shifted to the CHWs. CHWs also provided patients with social support and connection to community resources. Integration of CHWs into clinical care teams improved patient knowledge and activation levels, the ability of PCPs to identify and proactively address specific patient needs, and patient outcomes.

  15. [Internationalized medical care services increase need of health care providers to improve English communication skills].

    Science.gov (United States)

    Yang, Chia-Ling

    2011-02-01

    English is the most important language used in international communication. Nurses today have significantly more opportunities to come into contact with clients of different nationalities. Therefore, English communication abilities are a critical to the effective care of foreign clients. Miscommunication due to language barriers can endanger the health and safety of foreign clients and hinder their access to healthcare resources. Basic English communicate skills allow nurses to better understand the feelings of foreign clients and to affect their satisfaction with healthcare services provided. The majority of clinical nurses in Taiwan are inadequately prepared to communicate with foreign clients or use English when delivering nursing care services. Although English is not an official language in Taiwan, strengthening English communication skills is necessary for Taiwan's healthcare service system. Faced with increasing numbers of foreign clients in their daily work, first-line nursing staffs need more training to improve English proficiency. In order to do so, support from the hospital director is the first priority. The second priority is to motivate nursing staffs to learn English; the third is to incorporate different English classes into the medical system and schedule class times to meet nurse scheduling needs; and the fourth is to establish international medical wards, with appropriate incentives in pay designed to attract and retain nursing staff proficient in English communication. PMID:21328212

  16. Improving transitions of care at hospital discharge--implications for pediatric hospitalists and primary care providers.

    Science.gov (United States)

    Harlan, Gregory A; Nkoy, Flory L; Srivastava, Rajendu; Lattin, Gena; Wolfe, Doug; Mundorff, Michael B; Colling, Dayvalena; Valdez, Angelika; Lange, Shay; Atkinson, Sterling D; Cook, Lawrence J; Maloney, Christopher G

    2010-01-01

    Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. Opportunities for improvement (leverage points) to achieve optimal transfer of discharge information were identified using tally sheets and Pareto charts. Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high.

  17. Improving transitions of care at hospital discharge--implications for pediatric hospitalists and primary care providers.

    Science.gov (United States)

    Harlan, Gregory A; Nkoy, Flory L; Srivastava, Rajendu; Lattin, Gena; Wolfe, Doug; Mundorff, Michael B; Colling, Dayvalena; Valdez, Angelika; Lange, Shay; Atkinson, Sterling D; Cook, Lawrence J; Maloney, Christopher G

    2010-01-01

    Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. Opportunities for improvement (leverage points) to achieve optimal transfer of discharge information were identified using tally sheets and Pareto charts. Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high. PMID:20854359

  18. Energy efficiency in the iron and steel industry : Factors influencing improvement of energy efficiency in Jiangsu, China

    OpenAIRE

    2013-01-01

    Improvement of energy efficiency is widely accepted as an efficient measure to relieve the crisis of energy resources and environment pollution; however, the energy utilization efficiency in China is still at a low level: the unit GDP energy consumption in China is 4 times to the world average level. Moreover, to fulfill the commitments of reducing 40% carbon emissions in 2020, China needs to improve the energy efficiency immediately. As a major resource of energy consumption as well as carbo...

  19. Rapeseed is an efficient energy crop which can still improve

    Directory of Open Access Journals (Sweden)

    Flenet Francis

    2007-11-01

    Full Text Available The ability of biofuels to contribute efficiently to the replacement of fossil energy and to the reduction of greenhouse gas emissions has been a matter of debate. Hence, there is a need to assess accurately the energy balance of biofuels and their ability to reduce greenhouse gas emissions, in order to evaluate and to improve the benefit for society. In rapeseed, the energy ratio (energy produced per unit of non-renewable energy input is well above 2 whatever the method of calculation. In order to investigate the variability of energy ratios and to identify ways of improvement, a study was conducted in France in 2005 and 2006. The method of mass allocation of input energy was used for calculations, instead of the substitution method, because with this method the results do not depend on the utilization of co-products. Hence, this method is better adapted to follow improvements. A great variability in the energy ratio was observed in 2005 and 2006. Seed yields and energy cost of fertilizer N explained most of this variability. Hence, improvements should focus on increasing yield with little increase in energy cost, and on decreasing wasting of N fertilizer. However the farmer incomes, and the net production of energy per hectare, must also be a matter of concern. The inventories of greenhouse gas emissions of biofuels are still uncertain because of the great variability of soil emissions, due to environmental and management factors. Hence, in order to assess the effect of rapeseed on greenhouse gas emissions, methods based on process-oriented models accounting for these factors must be used. Such models give promising results, but further testing is still needed.

  20. Improvement in Delay of Information flow in Energy Efficiency Organization

    Directory of Open Access Journals (Sweden)

    Elham Hasanzadeh

    2010-09-01

    Full Text Available One of the most important issues in task organization is service speed and reduction of delays. High speedin tasks and reduction of delay cause high performance in task organization. So many studies have done inthis field. Some of these studies during the past ten years are redesigning tasks in information process,using the simulation product development, designing and manufacturing managing supply chain, and FINCmethodology which has been used in military of American and Australia.In this article FINC methodology is modified for a business organization. The proposed method applied oninformation flows of current situation of Iran energy efficiency organization. Mind manager software isused for viewing it by social network analysis and then FINC methodology for calculation of delay rate onit. Sum of delay rate with delays in decision nodes was added and then improved.

  1. Leanergy(TM): how lean manufacturing can improve energy efficiency.

    Science.gov (United States)

    Riche, Jean-Pierre

    2013-01-01

    Energy efficiency has become a competitive issue for industrial companies. The evolution of energy prices and regulation will make this issue even more important in the future. For several years, the energy-intensive chemical industry has been implementing corrective actions. Helped by the absorption of base load energy consumption by larger production volumes, specific energy consumption (KWh per production unit) has been significantly reduced in recent years. However, most plants have reached the end of their first action plan based on improving the utilities performance. The Leanergy(TM) method developed by the consultancy company Okavango-energy, is a structured approach based on lean manufacturing which widens the scope of saving sources to process and operations. Starting from the analysis of actual production requirements, Okavango is able to adjust consumption to minimum requirements and so remove any energy consumption that does not contribute to the added value creation. PMID:24388133

  2. Improvement of the efficiency of OPC data handling

    Science.gov (United States)

    Toyama, Nobuhito; Ikemoto, Takayuki; Ishida, Kouji; Miyashita, Hiroyuki

    2001-01-01

    OPC has been acknowledged essential technique to achieve low k1 lithography applying any optical process or even if phase-shift controlling. Since several years ago some aspect of OPC technique has been realized with OPC oriented tools, applied to actual design, and many success stories are reported. However according to semiconductor design scale itself is growing as millions of transistors a year as the rule decreasing, so called aggressive OPC is forcing not only data handling distress but also reticle fabrication difficulty even though the hardware's progressing. In this paper, we introduce the evaluation of the performance and the effect from weak to aggressive OPC that has been proposed. Then we will discuss the improved OPC applying modeling and criteria based on the trade off between OPC data handling efficiency and the effect.

  3. Leanergy(TM): how lean manufacturing can improve energy efficiency.

    Science.gov (United States)

    Riche, Jean-Pierre

    2013-01-01

    Energy efficiency has become a competitive issue for industrial companies. The evolution of energy prices and regulation will make this issue even more important in the future. For several years, the energy-intensive chemical industry has been implementing corrective actions. Helped by the absorption of base load energy consumption by larger production volumes, specific energy consumption (KWh per production unit) has been significantly reduced in recent years. However, most plants have reached the end of their first action plan based on improving the utilities performance. The Leanergy(TM) method developed by the consultancy company Okavango-energy, is a structured approach based on lean manufacturing which widens the scope of saving sources to process and operations. Starting from the analysis of actual production requirements, Okavango is able to adjust consumption to minimum requirements and so remove any energy consumption that does not contribute to the added value creation.

  4. A new job migration algorithm to improve data center efficiency

    CERN Document Server

    Calzolari, Federico

    2012-01-01

    The under exploitation of the available resources risks to be one of the main problems for a computing center. The growing demand of computational power necessarily entails more complex approaches in the management of the computing resources, with particular attention to the batch queue system scheduler. In a heterogeneous batch queue system, available for both serial single core processes and parallel multi core jobs, it may happen that one or more computational nodes composing the cluster are not fully occupied, running a number of jobs lower than their actual capability. A typical case is represented by more single core jobs running each one over a different multi core server, while more parallel jobs - requiring all the available cores of a host - are queued. A job rearrangement executed at runtime is able to free extra resources, in order to host new processes. We present an efficient method to improve the computing resources exploitation.

  5. An Efficient and Configurable Preprocessing Algorithm to Improve Stability Analysis.

    Science.gov (United States)

    Sesia, Ilaria; Cantoni, Elena; Cernigliaro, Alice; Signorile, Giovanna; Fantino, Gianluca; Tavella, Patrizia

    2016-04-01

    The Allan variance (AVAR) is widely used to measure the stability of experimental time series. Specifically, AVAR is commonly used in space applications such as monitoring the clocks of the global navigation satellite systems (GNSSs). In these applications, the experimental data present some peculiar aspects which are not generally encountered when the measurements are carried out in a laboratory. Space clocks' data can in fact present outliers, jumps, and missing values, which corrupt the clock characterization. Therefore, an efficient preprocessing is fundamental to ensure a proper data analysis and improve the stability estimation performed with the AVAR or other similar variances. In this work, we propose a preprocessing algorithm and its implementation in a robust software code (in MATLAB language) able to deal with time series of experimental data affected by nonstationarities and missing data; our method is properly detecting and removing anomalous behaviors, hence making the subsequent stability analysis more reliable.

  6. Root restriction: A tool for improving volume utilization efficiency in bioregenerative life-support systems

    Science.gov (United States)

    Graham, Thomas; Wheeler, Raymond

    2016-06-01

    The objective of this study was to evaluate root restriction as a tool to increase volume utilization efficiency in spaceflight crop production systems. Bell pepper plants (Capsicum annuum cv. California Wonder) were grown under restricted rooting volume conditions in controlled environment chambers. The rooting volume was restricted to 500 ml and 60 ml in a preliminary trial, and 1500 ml (large), 500 ml (medium), and 250 ml (small) for a full fruiting trial. To reduce the possible confounding effects of water and nutrient restrictions, care was taken to ensure an even and consistent soil moisture throughout the study, with plants being watered/fertilized several times daily with a low concentration soluble fertilizer solution. Root restriction resulted in a general reduction in biomass production, height, leaf area, and transpiration rate; however, the fruit production was not significantly reduced in the root restricted plants under the employed environmental and horticultural conditions. There was a 21% reduction in total height and a 23% reduction in overall crown diameter between the large and small pot size in the fruiting study. Data from the fruiting trial were used to estimate potential volume utilization efficiency improvements for edible biomass in a fixed production volume. For fixed lighting and rooting hardware situations, the majority of improvement from root restriction was in the reduction of canopy area per plant, while height reductions could also improve volume utilization efficiency in high stacked or vertical agricultural systems.

  7. Improving the Efficiency of Medical Services Systems: A New Integrated Mathematical Modeling Approach

    Directory of Open Access Journals (Sweden)

    Davood Shishebori

    2013-01-01

    Full Text Available Nowadays, the efficient design of medical service systems plays a critical role in improving the performance and efficiency of medical services provided by governments. Accordingly, health care planners in countries especially with a system based on a National Health Service (NHS try to make decisions on where to locate and how to organize medical services regarding several conditions in different residence areas, so as to improve the geographic equity of comfortable access in the delivery of medical services while accounting for efficiency and cost issues especially in crucial situations. Therefore, optimally locating of such services and also suitable allocating demands them, can help to enhance the performance and responsiveness of medical services system. In this paper, a multiobjective mixed integer nonlinear programming model is proposed to decide locations of new medical system centers, link roads that should be constructed or improved, and also urban residence centers covered by these medical service centers and link roads under investment budget constraint in order to both minimize the total transportation cost of the overall system and minimize the total failure cost (i.e., maximize the system reliability of medical service centers under unforeseen situations. Then, the proposed model is linearized by suitable techniques. Moreover, a practical case study is presented in detail to illustrate the application of the proposed mathematical model. Finally, a sensitivity analysis is done to provide an insight into the behavior of the proposed model in response to changes of key parameters of the problem.

  8. Danish energy efficiency policy: revisited and future improvements

    Energy Technology Data Exchange (ETDEWEB)

    Togeby, Mikael; Dyhr-Mikkelsen, Kirsten (Ea Energy Analyses (Denmark)); Larsen, Anders; Juel Hansen, Morten (Roskilde Univ., Dept. of Society and Globalisation, Roskilde (Denmark)); Bach, Peter (Danish Energy Authority, Copenhagen (Denmark))

    2009-07-01

    Ten groups of policy instruments for promoting energy efficiency are actively used in Denmark. Among these are the EU instruments such as the CO{sub 2} emissions trading scheme and labelling of appliances, labelling of all buildings, combined with national instruments such as high taxes especially on households and the public sector, obligations for energy companies (electricity, natural gas, district heating, and oil) to deliver documented savings, strict building codes, special instructions for the public sector, and an Electricity Saving Trust. A political agreement from 2005 states that an evaluation of the entire Danish energy efficiency policy portfolio must be carried out before end 2008 and put forward for discussion among governing parties no later than February 2009. A consortium comprising Ea Energy Analyses, Niras, the Dept. of Society and Globalisation (Roskilde Univ.) and 4-Fact was assigned with this task. The evaluation aimed to answer the crucial questions: - Is the overall design of the portfolio of instruments appropriate? - Does the impact of the instruments justify the costs, so that we reach the national goals in a cost efficient way? - Will the current instrument portfolio be able to meet the required reduction in final energy consumption (goal for 2013) and in primary energy consumption (with goals in 2011 and 2020) as planned by parliament? Recommendations were made on how to improve and develop the portfolio using cost effectiveness as well as organisational clarity as criteria in developing the recommendations. The evaluation was completed in December 2008, and this paper presents the main findings and proceeds to discuss the issues from an EU perspective.

  9. Improving Efficiency of Aluminium Sacrificial Anode Using Cold Work Process

    Science.gov (United States)

    Asmara, Y. P.; Siregar, J. P.; Tezara, C.; Ann, Chang Tai

    2016-02-01

    Aluminium is one of the preferred materials to be used as sacrificial anode for carbon steel protection. The efficiency of these can be low due to the formation of oxide layer which passivate the anodes. Currently, to improve its efficiency, there are efforts using a new technique called surface modifications. The objective of this research is to study corrosion mechanism of aluminium sacrificial anode which has been processed by cold work. The cold works are applied by reducing the thickness of aluminium sacrificial anodes at 20% and 40% of thickness reduction. The cathodic protection experiments were performed by immersion of aluminium connected to carbon steel cylinder in 3% NaCl solutions. Visual inspections using SEM had been conducted during the experiments and corrosion rate data were taken in every week for 8 weeks of immersion time. Corrosion rate data were measured using weight loss and linear polarization technique (LPR). From the results, it is observed that cold worked aluminium sacrificial anode have a better corrosion performance. It shows higher corrosion rate and lower corrosion potential. The anodes also provided a long functional for sacrificial anode before it stop working. From SEM investigation, it is shown that cold works have changed the microstructure of anodes which is suspected in increasing corrosion rate and cause de-passivate of the surface anodes.

  10. Improving robustness and computational efficiency using modern C++

    International Nuclear Information System (INIS)

    For nearly two decades, the C++ programming language has been the dominant programming language for experimental HEP. The publication of ISO/IEC 14882:2011, the current version of the international standard for the C++ programming language, makes available a variety of language and library facilities for improving the robustness, expressiveness, and computational efficiency of C++ code. However, much of the C++ written by the experimental HEP community does not take advantage of the features of the language to obtain these benefits, either due to lack of familiarity with these features or concern that these features must somehow be computationally inefficient. In this paper, we address some of the features of modern C+-+, and show how they can be used to make programs that are both robust and computationally efficient. We compare and contrast simple yet realistic examples of some common implementation patterns in C, currently-typical C++, and modern C++, and show (when necessary, down to the level of generated assembly language code) the quality of the executable code produced by recent C++ compilers, with the aim of allowing the HEP community to make informed decisions on the costs and benefits of the use of modern C++.

  11. Improving Remote Species Identification through Efficient Training Data Collection

    Directory of Open Access Journals (Sweden)

    Claire A. Baldeck

    2014-03-01

    Full Text Available Plant species identification and mapping based on remotely-sensed spectral signatures is a challenging task with the potential to contribute enormously to ecological studies. Success in this task rests upon the appropriate collection and use of costly field-based training data, and researchers are in need of ways to improve collection efficiency based on quantitative evidence. Using imaging spectrometer data collected by the Carnegie Airborne Observatory for hundreds of field-identified tree crowns in Kruger National Park, South Africa, we developed woody plant species classification models and evaluated how classification accuracy increases with increasing numbers of training crowns. First, we show that classification accuracy must be estimated while respecting the crown as the basic unit of data; otherwise, accuracy will be overestimated and the amount of training data needed to perform successful classification will be underestimated. We found that classification accuracy and the number of training crowns needed to perform successful classification varied depending on the number and spectral separability of species in the model. We also used a modified Michaelis-Menten function to describe the empirical relationship between training crowns and model accuracy, and show how this function may be useful for predicting accuracy. This framework can assist researchers in designing field campaigns to maximize the efficiency of field data collection, and thus the amount of biodiversity information gained from remote species identification models.

  12. Improving robustness and computational efficiency using modern C++

    Science.gov (United States)

    Paterno, M.; Kowalkowski, J.; Green, C.

    2014-06-01

    For nearly two decades, the C++ programming language has been the dominant programming language for experimental HEP. The publication of ISO/IEC 14882:2011, the current version of the international standard for the C++ programming language, makes available a variety of language and library facilities for improving the robustness, expressiveness, and computational efficiency of C++ code. However, much of the C++ written by the experimental HEP community does not take advantage of the features of the language to obtain these benefits, either due to lack of familiarity with these features or concern that these features must somehow be computationally inefficient. In this paper, we address some of the features of modern C+-+, and show how they can be used to make programs that are both robust and computationally efficient. We compare and contrast simple yet realistic examples of some common implementation patterns in C, currently-typical C++, and modern C++, and show (when necessary, down to the level of generated assembly language code) the quality of the executable code produced by recent C++ compilers, with the aim of allowing the HEP community to make informed decisions on the costs and benefits of the use of modern C++.

  13. Improving the operational efficiency of Phase 2 and 3 trials.

    Science.gov (United States)

    Ganju, Jitendra

    2016-01-01

    The period toward the end of patients' participation in late stage blinded clinical trials is highly resource intensive for the sponsor. Consider first a Phase 3 trial. If the trial is a success, the sponsor has to implement the next steps, which might be filing for approval of the drug with the US Food and Drug Administration (FDA). To shorten the time interval between trial completion and submission of the package to the FDA, sponsors front-load as much work as is possible at risk. The approach is efficient if the trial succeeds but is inefficient if it fails. For a failed trial, the sponsor is unlikely to proceed with the plan that assumed success. Phase 2 trials are also at risk of being inefficient. Many activities, such as planning for drug interaction studies, thorough QT studies, or site selection for Phase 3 trials, are set in motion prior to completion of the Phase 2 trial. The work going on in parallel is wasted if the trial fails. The proposal to improve the efficiency is to let an independent entity provide the sponsor critical information at an earlier time necessary to reevaluate activities ongoing in parallel and external to the trial. PMID:27439520

  14. Improving robustness and computational efficiency using modern C++

    Energy Technology Data Exchange (ETDEWEB)

    Paterno, M. [Fermilab; Kowalkowski, J. [Fermilab; Green, C. [Fermilab

    2014-01-01

    For nearly two decades, the C++ programming language has been the dominant programming language for experimental HEP. The publication of ISO/IEC 14882:2011, the current version of the international standard for the C++ programming language, makes available a variety of language and library facilities for improving the robustness, expressiveness, and computational efficiency of C++ code. However, much of the C++ written by the experimental HEP community does not take advantage of the features of the language to obtain these benefits, either due to lack of familiarity with these features or concern that these features must somehow be computationally inefficient. In this paper, we address some of the features of modern C+-+, and show how they can be used to make programs that are both robust and computationally efficient. We compare and contrast simple yet realistic examples of some common implementation patterns in C, currently-typical C++, and modern C++, and show (when necessary, down to the level of generated assembly language code) the quality of the executable code produced by recent C++ compilers, with the aim of allowing the HEP community to make informed decisions on the costs and benefits of the use of modern C++.

  15. In- Depth Colloidal Dispersion Gels Improve Oil Recovery Efficiency

    Institute of Scientific and Technical Information of China (English)

    Luo Jiangtao; Yang Haibo; Wu Tianhu; Xiao Long

    2000-01-01

    Daqing Oilfield has carried out the production of polymer flooding was promoted since in 1996.Presently, polymer flooding is very successful in several production plants of Daqing Oilfield, and getting into industrialisation production. It has played a very important role in maintaining the oilfield stable production of over 50 million tons of oil.But the high permeability variation is serious, resulting in polymer production in some production wells recylingly and production concentration increasing slowly, which adversely affects polymer flooding efficiency.Colloid dispersion gels (CDG) is a unique in- depth permeability modification process. It can reduce in- depth reservoir permeability variation by moving into highly permeable, water saturated zones and providing high resistance to subsequent water injection in those zones, so that oil can be produced from tighter rock. So CDG can enlarge volumetric sweep, and improve oil recovery efficiency.We had a CDG pilot programme in Daqing Oil Field in 1999, now this pilot has been entering into effective period with produing more oil and less water.Introduction

  16. Topping gas turbines improve steam power plant efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Lezuo, A. (Siemens AG, Erlangen (Germany, F.R.). KWU Group)

    An interesting option for improving the efficiency and output of an existing conventional steam power plant is to convert it into a combined steam-and-gas cycle power plant by adding a topping gas turbine. The investment involved is relatively low, the payback period is short, and the low specific fuel consumption makes it possible to save on overall running costs. At the same time, the amount of residue for disposal and also pollutant emissions are drastically reduced. This article describes the configuration of a fully-fired combined-cycle power plant and discusses thermodynamic design and efficiency, operational aspects, emissions and residues and investment and economic viability. Both coal-fired and gas or oil-fired steam power plants can be converted by adding a topping cycle and the investment cost is about 20% of the cost of a new plant with the same output rating as the plant to be converted. Conversion reduces pollutant emission and residues produced (SO{sub 2}, NO{sub x}, CO{sub 2}, dust, ash, gypsum, waste heat). 4 figs.

  17. Biohydrogen Production: Strategies to Improve Process Efficiency through Microbial Routes

    Directory of Open Access Journals (Sweden)

    Kuppam Chandrasekhar

    2015-04-01

    Full Text Available The current fossil fuel-based generation of energy has led to large-scale industrial development. However, the reliance on fossil fuels leads to the significant depletion of natural resources of buried combustible geologic deposits and to negative effects on the global climate with emissions of greenhouse gases. Accordingly, enormous efforts are directed to transition from fossil fuels to nonpolluting and renewable energy sources. One potential alternative is biohydrogen (H2, a clean energy carrier with high-energy yields; upon the combustion of H2, H2O is the only major by-product. In recent decades, the attractive and renewable characteristics of H2 led us to develop a variety of biological routes for the production of H2. Based on the mode of H2 generation, the biological routes for H2 production are categorized into four groups: photobiological fermentation, anaerobic fermentation, enzymatic and microbial electrolysis, and a combination of these processes. Thus, this review primarily focuses on the evaluation of the biological routes for the production of H2. In particular, we assess the efficiency and feasibility of these bioprocesses with respect to the factors that affect operations, and we delineate the limitations. Additionally, alternative options such as bioaugmentation, multiple process integration, and microbial electrolysis to improve process efficiency are discussed to address industrial-level applications.

  18. Improvement in hearing after chiropractic care: a case series

    Directory of Open Access Journals (Sweden)

    Di Duro Joseph O

    2006-01-01

    Full Text Available Abstract Background The first chiropractic adjustment given in 1895 was reported to have cured deafness. This study examined the effects of a single, initial chiropractic visit on the central nervous system by documenting clinical changes of audiometry in patients after chiropractic care. Case presentation Fifteen patients are presented (9 male, 6 female with a mean age of 54.3 (range 34–71. A Welch Allyn AudioScope 3 was used to screen frequencies of 1000, 2000, 4000 and 500 Hz respectively at three standard decibel levels 20 decibels (dB, 25 dB and 40 dB, respectively, before and immediately after the first chiropractic intervention. Several criteria were used to determine hearing impairment. Ventry & Weinstein criteria of missing one or more tones in either ear at 40 dB and Speech-frequency criteria of missing one or more tones in either ear at 25 dB. All patients were classified as hearing impaired though greater on the right. At 40 dB using the Ventry & Weinstein criteria, 6 had hearing restored, 7 improved and 2 had no change. At 25 dB using the Speech-frequency criteria, none were restored, 11 improved, 4 had no change and 3 missed a tone. Conclusion A percentage of patients presenting to the chiropractor have a mild to moderate hearing loss, most notably in the right ear. The clinical progress documented in this report suggests that manipulation delivered to the neuromusculoskeletal system may create central plastic changes in the auditory system.

  19. Improving care coordination using organisational routines: care pathways as a coordination mechanism

    DEFF Research Database (Denmark)

    Prætorius, Thim

    2016-01-01

    Purpose: This conceptual article systematically applies theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can......: care pathways and (a) coordination, (b) change, (c) replication, (d) the organisation and (e) health care professionals. Research limitations/implications: The article is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point...... for empirical research. Practical implications: The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals...

  20. Addressing Literacy and Numeracy to Improve Diabetes Care

    OpenAIRE

    Cavanaugh, Kerri; Wallston, Kenneth A.; Gebretsadik, Tebeb; Shintani, Ayumi; Huizinga, Mary Margaret; Davis, Dianne; Gregory, Rebecca Pratt; Malone, Robb; Pignone, Michael; DeWalt, Darren; Elasy, Tom A.; Rothman, Russell L.

    2009-01-01

    OBJECTIVE Diabetic patients with lower literacy or numeracy skills are at greater risk for poor diabetes outcomes. This study evaluated the impact of providing literacy- and numeracy-sensitive diabetes care within an enhanced diabetes care program on A1C and other diabetes outcomes. RESEARCH DESIGN AND METHODS In two randomized controlled trials, we enrolled 198 adult diabetic patients with most recent A1C ≥7.0%, referred for participation in an enhanced diabetes care program. For 3 months, c...

  1. The efficiency of chronic disease care in sub-Saharan Africa.

    Science.gov (United States)

    Geldsetzer, Pascal; Ortblad, Katrina; Bärnighausen, Till

    2016-01-01

    The number of people needing chronic disease care is projected to increase in sub-Saharan Africa as a result of expanding human immunodeficiency virus (HIV) treatment coverage, rising life expectancies, and lifestyle changes. Using nationally representative data of healthcare facilities, Di Giorgio et al. found that many HIV clinics in Kenya, Uganda, and Zambia appear to have considerable untapped capacity to provide care for additional patients. These findings highlight the potential for increasing the efficiency of clinical processes for chronic disease care at the facility level. Important questions for future research are how estimates of comparative technical efficiency across facilities change, when they are adjusted for quality of care and the composition of patients by care complexity. Looking ahead, substantial research investment will be needed to ensure that we do not forgo the opportunity to learn how efficiency changes, as chronic care is becoming increasingly differentiated by patient type and integrated across diseases and health systems functions.Please see related article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0653-z. PMID:27566531

  2. Lean Six Sigma in Health Care: Improving Utilization and Reducing Waste.

    Science.gov (United States)

    Almorsy, Lamia; Khalifa, Mohamed

    2016-01-01

    Healthcare costs have been increasing worldwide mainly due to over utilization of resources. The savings potentially achievable from systematic, comprehensive, and cooperative reduction in waste are far higher than from more direct and blunter cuts in care and coverage. At King Faisal Specialist Hospital and Research Center inappropriate and over utilization of the glucose test strips used for whole blood glucose determination using glucometers was observed. The hospital implemented a project to improve its utilization. Using the Six Sigma DMAIC approach (Define, Measure, Analyze, Improve and Control), an efficient practice was put in place including updating the related internal policies and procedures and the proper implementation of an effective users' training and competency check off program. That resulted in decreasing the unnecessary Quality Control (QC) runs from 13% to 4%, decreasing the failed QC runs from 14% to 7%, lowering the QC to patient testing ratio from 24/76 to 19/81.

  3. Lean Six Sigma in Health Care: Improving Utilization and Reducing Waste.

    Science.gov (United States)

    Almorsy, Lamia; Khalifa, Mohamed

    2016-01-01

    Healthcare costs have been increasing worldwide mainly due to over utilization of resources. The savings potentially achievable from systematic, comprehensive, and cooperative reduction in waste are far higher than from more direct and blunter cuts in care and coverage. At King Faisal Specialist Hospital and Research Center inappropriate and over utilization of the glucose test strips used for whole blood glucose determination using glucometers was observed. The hospital implemented a project to improve its utilization. Using the Six Sigma DMAIC approach (Define, Measure, Analyze, Improve and Control), an efficient practice was put in place including updating the related internal policies and procedures and the proper implementation of an effective users' training and competency check off program. That resulted in decreasing the unnecessary Quality Control (QC) runs from 13% to 4%, decreasing the failed QC runs from 14% to 7%, lowering the QC to patient testing ratio from 24/76 to 19/81. PMID:27350502

  4. Aortic Center: specialized care improves outcomes and decreases mortality

    Directory of Open Access Journals (Sweden)

    Marcela da Cunha Sales

    2014-12-01

    Full Text Available Objective: To compare in-hospital outcomes in aortic surgery in our cardiac surgery unit, before and after foundation of our Center for Aortic Surgery (CTA. Methods: Prospective cohort with non-concurrent control. Foundation of CTA required specialized training of surgical, anesthetic and intensive care unit teams, routine neurological monitoring, endovascular and hybrid facilities, training of the support personnel, improvement of the registry and adoption of specific protocols. We included 332 patients operated on between: January/2003 to December/2007 (before-CTA, n=157, 47.3%; and January/2008 to December/2010 (CTA, n=175, 52.7%. Baseline clinical and demographic data, operative variables, complications and in-hospital mortality were compared between both groups. Results: Mean age was 58±14 years, with 65% male. Group CTA was older, had higher rate of diabetes, lower rates of COPD and HF, more non-urgent surgeries, endovascular procedures, and aneurysms. In the univariate analysis, CTA had lower mortality (9.7 vs. 23.0%, P=0.008, which occurred consistently across different diseases and procedures. Other outcomes which were reduced in CTA included lower rates of reinterventions (5.7 vs 11%, P=0.046, major complications (20.6 vs. 33.1%, P=0.007, stroke (4.6 vs. 10.9%, P=0.045 and sepsis (1.7 vs. 9.6%, P=0.001, as compared to before-CTA. Multivariable analysis adjusted for potential counfounders revealed that CTA was independently associated with mortality reduction (OR=0.23, IC 95% 0.08 – 0.67, P=0.007. CTA independent mortality reduction was consistent in the multivariable analysis stratified by disease (aneurysm, OR=0.18, CI 95% 0.03 – 0.98, P=0.048; dissection, OR=0.31, CI 95% 0.09 – 0.99, P=0.049 and by procedure (hybrid, OR=0.07, CI 95% 0.007 – 0.72, P=0.026; Bentall, OR=0.18, CI 95% 0.038 – 0.904, P=0.037. Additional multivariable predictors of in-hospital mortality included creatinine (OR=1.7 [1.1-2.6], P=0.008, urgent

  5. COOLING FAN AND SYSTEM PERFORMANCE AND EFFICIENCY IMPROVEMENTS

    Energy Technology Data Exchange (ETDEWEB)

    Ronald Dupree

    2005-07-31

    Upcoming emissions regulations (Tiers 3, 4a and 4b) are imposing significantly higher heat loads on the cooling system than lesser regulated machines. This work was a suite of tasks aimed at reducing the parasitic losses of the cooling system, or improving the design process through six distinct tasks: 1. Develop an axial fan that will provide more airflow, with less input power and less noise. The initial plan was to use Genetic Algorithms to do an automated fan design, incorporating forward sweep for low noise. First and second generation concepts could not meet either performance or sound goals. An experienced turbomachinery designer, using a specialized CFD analysis program has taken over the design and has been able to demonstrate a 5% flow improvement (vs 10% goal) and 10% efficiency improvement (vs 10% goal) using blade twist only. 2. Fan shroud developments, using an 'aeroshroud' concept developed at Michigan State University. Performance testing at Michigan State University showed the design is capable of meeting the goal of a 10% increase in flow, but over a very narrow operating range of fan performance. The goal of 10% increase in fan efficiency was not met. Fan noise was reduced from 0 to 2dB, vs. a goal of 5dB at constant airflow. The narrow range of fan operating conditions affected by the aeroshroud makes this concept unattractive for further development at this time 3. Improved axial fan system modeling is needed to accommodate the numbers of cooling systems to be redesigned to meet lower emissions requirements. A CFD fan system modeling guide has been completed and transferred to design engineers. Current, uncontrolled modeling practices produce flow estimates in some cases within 5% of measured values, and in some cases within 25% of measured values. The techniques in the modeling guide reduced variability to the goal of + 5% for the case under study. 4. Demonstrate the performance and design versatility of a high performance fan. A

  6. Improving end of life care: an information systems approach to reducing medical errors.

    Science.gov (United States)

    Tamang, S; Kopec, D; Shagas, G; Levy, K

    2005-01-01

    Chronic and terminally ill patients are disproportionately affected by medical errors. In addition, the elderly suffer more preventable adverse events than younger patients. Targeting system wide "error-reducing" reforms to vulnerable populations can significantly reduce the incidence and prevalence of human error in medical practice. Recent developments in health informatics, particularly the application of artificial intelligence (AI) techniques such as data mining, neural networks, and case-based reasoning (CBR), presents tremendous opportunities for mitigating error in disease diagnosis and patient management. Additionally, the ubiquity of the Internet creates the possibility of an almost ideal network for the dissemination of medical information. We explore the capacity and limitations of web-based palliative information systems (IS) to transform the delivery of care, streamline processes and improve the efficiency and appropriateness of medical treatment. As a result, medical error(s) that occur with patients dealing with severe, chronic illness and the frail elderly can be reduced.The palliative model grew out of the need for pain relief and comfort measures for patients diagnosed with cancer. Applied definitions of palliative care extend this convention, but there is no widely accepted definition. This research will discuss the development life cycle of two palliative information systems: the CONFER QOLP management information system (MIS), currently used by a community-based palliative care program in Brooklyn, New York, and the CAREN case-based reasoning prototype. CONFER is a web platform based on the idea of "eCare". CONFER uses XML (extensible mark-up language), a W3C-endorced standard mark up to define systems data. The second system, CAREN, is a CBR prototype designed for palliative care patients in the cancer trajectory. CBR is a technique, which tries to exploit the similarities of two situations and match decision-making to the best

  7. Energy Efficiency Improvement Potential in Historical Brick Building

    OpenAIRE

    Žogla, Gatis; Blumberga, Andra; Zvaigznītis, Kristaps; Dzikēvičs, Miķelis; Blumberga, Dagnija; Burinskiene, Marija

    2013-01-01

    Energy efficiency in historical heritage buildings is viewed as a taboo because these buildings usually are law-protected and no energy efficiency measures that would change the appearance of building are allowed. In this paper we look at a potential of increasing energy efficiency level in historical buildings. Measurements to determine energy efficiency of a historical brick building have been done, which also give the possibility to determine the potential of energy efficiency measures in ...

  8. IMPROVING CO2 EFFICIENCY FOR RECOVERING OIL IN HETEROGENEOUS RESERVOIRS

    Energy Technology Data Exchange (ETDEWEB)

    Reid B. Grigg; Robert K. Svec

    2002-12-20

    This document is the First Annual Report for the U.S. Department of Energy under contract No., a three-year contract entitled: ''Improving CO{sub 2} Efficiency for Recovering Oil in Heterogeneous Reservoirs.'' The research improved our knowledge and understanding of CO{sub 2} flooding and includes work in the areas of injectivity and mobility control. The bulk of this work has been performed by the New Mexico Petroleum Recovery Research Center, a research division of New Mexico Institute of Mining and Technology. This report covers the reporting period of September 28, 2001 and September 27, 2002. Injectivity continues to be a concern to the industry. During this period we have contacted most of the CO{sub 2} operators in the Permian Basin and talked again about their problems in this area. This report has a summary of what we found. It is a given that carbonate mineral dissolution and deposition occur in a formation in geologic time and are expected to some degree in carbon dioxide (CO{sub 2}) floods. Water-alternating-gas (WAG) core flood experiments conducted on limestone and dolomite core plugs confirm that these processes can occur over relatively short time periods (hours to days) and in close proximity to each other. Results from laboratory CO{sub 2}-brine flow experiments performed in rock core were used to calibrate a reactive transport simulator. The calibrated model is being used to estimate in situ effects of a range of possible sequestration options in depleted oil/gas reservoirs. The code applied in this study is a combination of the well known TOUGH2 simulator, for coupled groundwater/brine and heat flow, with the chemistry code TRANS for chemically reactive transport. Variability in response among rock types suggests that CO{sub 2} injection will induce ranges of transient and spatially dependent changes in intrinsic rock permeability and porosity. Determining the effect of matrix changes on CO{sub 2} mobility is crucial in

  9. The Relevance of the Affordable Care Act for Improving Mental Health Care.

    Science.gov (United States)

    Mechanic, David; Olfson, Mark

    2016-03-28

    Provisions of the Affordable Care Act provide unprecedented opportunities for expanded access to behavioral health care and for redesigning the provision of services. Key to these reforms is establishing mental and substance abuse care as essential coverage, extending Medicaid eligibility and insurance parity, and protecting insurance coverage for persons with preexisting conditions and disabilities. Many provisions, including Accountable Care Organizations, health homes, and other structures, provide incentives for integrating primary care and behavioral health services and coordinating the range of services often required by persons with severe and persistent mental health conditions. Careful research and experience are required to establish the services most appropriate for primary care and effective linkage to specialty mental health services. Research providing guidance on present evidence and uncertainties is reviewed. Success in redesign will follow progress building on collaborative care and other evidence-based practices, reshaping professional incentives and practices, and reinvigorating the behavioral health workforce. PMID:26666969

  10. [The UHSA, an improvement in the care provision].

    Science.gov (United States)

    Chanty, Jérôme

    2016-01-01

    Established by the law on the orientation and programming of justice of September 2002, the specially equipped hospital unit (UHSA) provides psychiatric treatment with full medical care to prisoners, in direct cooperation with the prison. In this specific social context, can the organisation of the care and the structure itself represent a lasting solution?

  11. Use of Care Paths to Improve Patient Management

    Science.gov (United States)

    Campbell, Suzann K.

    2013-01-01

    The purpose of this special issue of Physical & Occupational Therapy in Pediatrics is to present an evidence-based system to guide the physical therapy management of patients in the Neonatal Intensive Care Unit (NICU). Two systematic guides to patient management will be presented. The first is a care path intended primarily for use by physical…

  12. Measuring and improving the societal impact of health care research

    NARCIS (Netherlands)

    Hansen, J.; Muscat, N.A.; Keskimäki, I.; Lindahl, A.K.; Pfaff, H.; Wismar, M.; Groenewegen, P.P.; et al, [No Value

    2013-01-01

    Health care research is increasingly being evaluated in terms of its contribution to new market products and services, among other factors, in the European Union’s new Framework Programme for Research and Innovation, Horizon 2020. However, discoveries in health care research often are not marketable

  13. A model to improve efficiency and effectiveness of safeguards measures

    International Nuclear Information System (INIS)

    Full text: The main purpose of our current studies is to analyse the measures to be adopted tending to integrate the traditional safeguard measures to the ones stated in the Additional Protocol (AP). A simplified nuclear fuel cycle model is considered to draw some conclusions on the application of integrated safeguard measures. This paper includes a briefing, describing the historical review that gave birth to the A.P. and proposes a model to help the control bodies in the making decision process. In May 1997, the Board of Governors approved the Model Additional Protocol (MAP) which aimed at strengthening the effectiveness and improving the efficiency of safeguard measures. For States under a comprehensive safeguard agreement the measures adopted provide credible assurance on the absence of undeclared nuclear material and activities. In September 1999, the governments of Argentina and Brazil formally announced in the Board of Governors that both countries would start preliminary consultations on one adapted MAP applied to the Agreement between the Republic of Argentina, the Federative Republic of Brazil, the Brazilian-Argentine Agency for Accounting and Control of Nuclear Materials and the International Atomic Energy Agency for the Application of Safeguards (Quatripartite Agreement/INFCIRC 435). In December 1999, a first draft of the above mentioned document was provided as a starting point of discussion. During the year 2000 some modifications to the original draft took place. These were the initial steps in the process aiming at reaching the adequate conditions to adhere to the A.P. in each country in a future Having in mind the future AP implementation, the safeguards officers of the Regulatory Body of Argentina (ARN) began to think about the future simultaneous application of the two types of safeguards measures, the traditional and the non traditional ones, what should converge in an integrated system. By traditional safeguards it is understood quantitative

  14. Improving long-term care provision: towards demand-based care by means of modularity

    NARCIS (Netherlands)

    C. de Blok; K. Luijkx; B. Meijboom; J. Schols

    2010-01-01

    Background: As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of d

  15. [The transformation of the healthcare model in Catalonia to improve the quality of care].

    Science.gov (United States)

    Padrosa, Josep Maria; Guarga, Àlex; Brosa, Francesc; Jiménez, Josep; Robert, Roger

    2015-11-01

    The changes taking place in western countries require health systems to adapt to the public's evolving needs and expectations. The healthcare model in Catalonia is undergoing significant transformation in order to provide an adequate response to this new situation while ensuring the system's sustainability in the current climate of economic crisis. This transformation is based on converting the current disease-centred model which is fragmented into different levels, to a more patient-centred integrated and territorial care model that promotes the use of a shared network of the different specialities, the professionals, resources and levels of care, entering into territorial agreements and pacts which stipulate joint goals or objectives. The changes the Catalan Health Service (CatSalut) has undergone are principally focused on increasing resolution capacity of the primary level of care, eliminating differences in clinical practice, evolving towards more surgery-centred hospitals, promoting alternatives to conventional hospitalization, developing remote care models, concentrating and organizing highly complex care into different sectors at a territorial level and designing specific health codes in response to health emergencies. The purpose of these initiatives is to improve the effectiveness, quality, safety and efficiency of the system, ensuring equal access for the public to these services and ensuring a territorial balance. These changes should be facilitated and promoted using several different approaches, including implementing shared access to clinical history case files, the new model of results-based contracting and payment, territorial agreements, alliances between centres, harnessing the potential of information and communications technology and evaluation of results. PMID:26711056

  16. [The transformation of the healthcare model in Catalonia to improve the quality of care].

    Science.gov (United States)

    Padrosa, Josep Maria; Guarga, Àlex; Brosa, Francesc; Jiménez, Josep; Robert, Roger

    2015-11-01

    The changes taking place in western countries require health systems to adapt to the public's evolving needs and expectations. The healthcare model in Catalonia is undergoing significant transformation in order to provide an adequate response to this new situation while ensuring the system's sustainability in the current climate of economic crisis. This transformation is based on converting the current disease-centred model which is fragmented into different levels, to a more patient-centred integrated and territorial care model that promotes the use of a shared network of the different specialities, the professionals, resources and levels of care, entering into territorial agreements and pacts which stipulate joint goals or objectives. The changes the Catalan Health Service (CatSalut) has undergone are principally focused on increasing resolution capacity of the primary level of care, eliminating differences in clinical practice, evolving towards more surgery-centred hospitals, promoting alternatives to conventional hospitalization, developing remote care models, concentrating and organizing highly complex care into different sectors at a territorial level and designing specific health codes in response to health emergencies. The purpose of these initiatives is to improve the effectiveness, quality, safety and efficiency of the system, ensuring equal access for the public to these services and ensuring a territorial balance. These changes should be facilitated and promoted using several different approaches, including implementing shared access to clinical history case files, the new model of results-based contracting and payment, territorial agreements, alliances between centres, harnessing the potential of information and communications technology and evaluation of results.

  17. Improving the quality of care in Chinese family planning programme.

    Science.gov (United States)

    Jiang, Y; Geng, Q; Haffey, J; Douglas, E

    1994-10-01

    The Chinese State Family Planning Commission (SFPC) is the government department responsible for coordinating and implementing the national population and family planning programs. The commission includes about 300,000 family planning workers and 50 million volunteers. Community workers provide IEC and technical services to couples of reproductive age. In July 1991, SFPC began a five year project to train rural family planning workers in contraceptive technology and interpersonal communication and counseling. These workers were important because of their service to a population of 800 million or 75% of total population. The training program was part of an effort to standardize training and institutionalize it throughout the country. The project involved 20 pilot training stations in 19 provinces. The primary task was to train family planning workers at the grassroots level. 80,000 persons were expected to be trained during the five years. Activities included a training needs assessment, development of training curricula and programs, training of workers, and monitoring and evaluation. Training techniques and topics will include participatory training methods, interpersonal communication and counseling, development of audience based training methods, issues of contraceptive choice and quality of care, and counseling issues such as sexually transmitted disease and HIV infection prevention. About 40,000 family planning workers and volunteers were trained by 1992 in counties, townships, and villages. Trainees learned about "informed choice" and the importance of counseling. Feedback from training activities focused on the appreciation for the participatory training methods such as brainstorming, case study, and role play. Workers appreciated the process involved in training as well as the information received. Evaluation showed that clients improved their knowledge and had positive interactions with workers.

  18. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial

    Directory of Open Access Journals (Sweden)

    van de Ven Geertje

    2012-01-01

    Full Text Available Abstract Background The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursing-home dementia care. Methods/Design The study is a cluster-randomised controlled trial, with nursing homes grouped in clusters. Studywise minimisation is the allocation method. Nursing homes in the intervention group will receive a dementia-care-mapping intervention, while the control group will receive usual care. The primary outcome measure is resident agitation, to be assessed with the Cohen-Mansfield Agitation Inventory. The secondary outcomes are resident neuropsychiatric symptoms, assessed with the Neuropsychiatric Inventory - Nursing Homes and quality of life, assessed with Qualidem and the EQ-5D. The staff outcomes are stress reactions, job satisfaction and job-stress-related absenteeism, and staff turnover rate, assessed with the Questionnaire about Experience and Assessment of Work, the General Health Questionnaire-12, and the Maastricht Job Satisfaction Scale for Health Care, respectively. We will collect the data from the questionnaires and electronic registration systems. We will employ linear mixed-effect models and cost-effectiveness analyses to evaluate the outcomes. We will use structural equation modelling in the secondary analysis to evaluate the plausibility of a theoretical model regarding the effectiveness of the dementia-care mapping intervention. We will set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementia-care mapping broadly. Discussion A novelty of dementia-care mapping is that it offers an

  19. Developing evidence-based maternity care in Iran: a quality improvement study

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem

    2008-06-01

    Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

  20. 45 CFR 98.51 - Activities to improve the quality of child care.

    Science.gov (United States)

    2010-10-01

    ... health and safety, nutrition, first aid, the recognition of communicable diseases, child abuse detection... 45 Public Welfare 1 2010-10-01 2010-10-01 false Activities to improve the quality of child care... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to...

  1. Bronchodilation improves endurance but not muscular efficiency in chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    van der Vaart, Hester; Postma, Dirkje S.; Grevink, Rene; Roemer, Willem; ten Hacken, Nick

    2011-01-01

    We hypothesized that bronchodilator treatment not only improves hyperinflation and endurance capacity but also muscular efficiency in stable chronic obstructive pulmonary disease (COPD). We aimed to demonstrate that tiotropium and salmeterol improve muscular efficiency compared with placebo. Twenty-

  2. Implementing collaborative care for depression treatment in primary care: A cluster randomized evaluation of a quality improvement practice redesign

    Directory of Open Access Journals (Sweden)

    Lee Martin

    2011-10-01

    Full Text Available Abstract Background Meta-analyses show collaborative care models (CCMs with nurse care management are effective for improving primary care for depression. This study aimed to develop CCM approaches that could be sustained and spread within Veterans Affairs (VA. Evidence-based quality improvement (EBQI uses QI approaches within a research/clinical partnership to redesign care. The study used EBQI methods for CCM redesign, tested the effectiveness of the locally adapted model as implemented, and assessed the contextual factors shaping intervention effectiveness. Methods The study intervention is EBQI as applied to CCM implementation. The study uses a cluster randomized design as a formative evaluation tool to test and improve the effectiveness of the redesign process, with seven intervention and three non-intervention VA primary care practices in five different states. The primary study outcome is patient antidepressant use. The context evaluation is descriptive and uses subgroup analysis. The primary context evaluation measure is naturalistic primary care clinician (PCC predilection to adopt CCM. For the randomized evaluation, trained telephone research interviewers enrolled consecutive primary care patients with major depression in the evaluation, referred enrolled patients in intervention practices to the implemented CCM, and re-surveyed at seven months. Results Interviewers enrolled 288 CCM site and 258 non-CCM site patients. Enrolled intervention site patients were more likely to receive appropriate antidepressant care (66% versus 43%, p = 0.01, but showed no significant difference in symptom improvement compared to usual care. In terms of context, only 40% of enrolled patients received complete care management per protocol. PCC predilection to adopt CCM had substantial effects on patient participation, with patients belonging to early adopter clinicians completing adequate care manager follow-up significantly more often than patients of

  3. Electronic Equipment Proposal to Improve the Photovoltaic Systems Efficiency

    Science.gov (United States)

    Flores-Mena, J. E.; Juárez Morán, L. A.; Díaz Reyes, J.

    2011-05-01

    This paper reports a new technique proposal to improve the photovoltaic systems. It was made to design and implement an electronic system that will detect, capture, and transfer the maximum power of the photovoltaic (PV) panel to optimize the supplied power of a solar panel. The electronic system works on base technical proposal of electrical sweeping of electric characteristics using capacitive impedance. The maximum power is transformed and the solar panel energy is sent to an automotive battery. This electronic system reduces the energy lost originated when the solar radiation level decreases or the PV panel temperature is increased. This electronic system tracks, captures, and stores the PV module's maximum power into a capacitor. After, a higher voltage level step-up circuit was designed to increase the voltage of the PV module's maximum power and then its current can be sent to a battery. The experimental results show that the developed electronic system has 95% efficiency. The measurement was made to 50 W, the electronic system works rightly with solar radiation rate from 100 to 1,000 W m - 2 and the PV panel temperature rate changed from 1 to 75°C. The main advantage of this electronic system compared with conventional methods is the elimination of microprocessors, computers, and sophisticated numerical approximations, and it does not need any small electrical signals to track the maximum power. The proposed method is simple, fast, and it is also cheaper.

  4. Improve the efficiency of PEMFC using neutron imaging

    International Nuclear Information System (INIS)

    The water management is one of the most critical issues for PEMFC commercialization. In order to make a proper scheme for water management, the information of water distribution and behavior is very important. But the visualization is difficult due to metallic coverage. Recently, neutron imaging has joined the canon of diagnostic methods for fuel cell research and is applied worldwide with qualitative and quantitative results. In this investigation, we prepared 3-parallel serpentine single PEMFC. The active area is 250 mm2 and channel size is 1 Χ 1 mm, respectively. Distribution and transport of water in an operating PEMFC were observed as functions of flow directions and differential pressures between anode and cathodes. This investigation was performed at BST-2, Nest. The collimation ratio is 600 and neutron fluence of BST-2 is 7.2 Χ 106 n/s, respectively. Neutron image was captured by A-Si detector with 1 sec expsosure time. The PEMFC has different performances for each differential pressure and flow directions. When the neutron images are compared with operating conditions, the distribution and behavior of water are different. Total water fraction is increased and then decreases as the current density increases. This situation is similar trend for the flow directions. It is shown that neutron imaging technique is powerful tool to visualize the PEMFC and the water distribution and behavior of an operating PEMFC helps improve the efficiency of PEMFC

  5. Improving Intra Prediction in High-Efficiency Video Coding.

    Science.gov (United States)

    Chen, Haoming; Zhang, Tao; Sun, Ming-Ting; Saxena, Ankur; Budagavi, Madhukar

    2016-08-01

    Intra prediction is an important tool in intra-frame video coding to reduce the spatial redundancy. In current coding standard H.265/high-efficiency video coding (HEVC), a copying-based method based on the boundary (or interpolated boundary) reference pixels is used to predict each pixel in the coding block to remove the spatial redundancy. We find that the conventional copying-based method can be further improved in two cases: 1) the boundary has an inhomogeneous region and 2) the predicted pixel is far away from the boundary that the correlation between the predicted pixel and the reference pixels is relatively weak. This paper performs a theoretical analysis of the optimal weights based on a first-order Gaussian Markov model and the effects when the pixel values deviate from the model and the predicted pixel is far away from the reference pixels. It also proposes a novel intra prediction scheme based on the analysis that smoothing the copying-based prediction can derive a better prediction block. Both the theoretical analysis and the experimental results show the effectiveness of the proposed intra prediction method. An average gain of 2.3% on all intra coding can be achieved with the HEVC reference software. PMID:27249831

  6. A Retrofit Tool for Improving Energy Efficiency of Commercial Buildings

    Energy Technology Data Exchange (ETDEWEB)

    Levine, Mark; Feng, Wei; Ke, Jing; Hong, Tianzhen; Zhou, Nan

    2013-06-06

    Existing buildings will dominate energy use in commercial buildings in the United States for three decades or longer and even in China for the about two decades. Retrofitting these buildings to improve energy efficiency and reduce energy use is thus critical to achieving the target of reducing energy use in the buildings sector. However there are few evaluation tools that can quickly identify and evaluate energy savings and cost effectiveness of energy conservation measures (ECMs) for retrofits, especially for buildings in China. This paper discusses methods used to develop such a tool and demonstrates an application of the tool for a retrofit analysis. The tool builds on a building performance database with pre-calculated energy consumption of ECMs for selected commercial prototype buildings using the EnergyPlus program. The tool allows users to evaluate individual ECMs or a package of ECMs. It covers building envelope, lighting and daylighting, HVAC, plug loads, service hot water, and renewable energy. The prototype building can be customized to represent an actual building with some limitations. Energy consumption from utility bills can be entered into the tool to compare and calibrate the energy use of the prototype building. The tool currently can evaluate energy savings and payback of ECMs for shopping malls in China. We have used the tool to assess energy and cost savings for retrofit of the prototype shopping mall in Shanghai. Future work on the tool will simplify its use and expand it to cover other commercial building types and other countries.

  7. Process Cycle Efficiency Improvement Through Lean: A Case Study

    Directory of Open Access Journals (Sweden)

    P.V. Mohanram

    2011-06-01

    Full Text Available Lean manufacturing is an applied methodology of scientific, objective techniques that cause work tasks in a process to be performed with a minimum of non-value adding activities resulting in greatly reduced wait time, queue time, move time, administrative time, and other delays. This work addresses the implementation of lean principles in a construction equipment company. The prime objective is to evolve and test several strategies to eliminate waste on the shop floor. This paper describes an application of value stream mapping (VSM. Consequently, the present and future states of value stream maps are constructed to improve the production process by identifying waste and its sources. A noticeable reduction in cycle time and increase in cycle efficiency is confirmed. The production flow was optimized thus minimizing several non-value added activities/times such as bottlenecking time, waiting time, material handling time, etc. This case study can be useful in developing a more generic approach to design lean environment.

  8. IMPROVING CO2 EFFICIENCY FOR RECOVERING OIL IN HETEROGENEOUS RESERVOIRS

    Energy Technology Data Exchange (ETDEWEB)

    Reid B. Grigg

    2003-10-31

    The second annual report of ''Improving CO{sub 2} Efficiency for Recovery Oil in Heterogeneous Reservoirs'' presents results of laboratory studies with related analytical models for improved oil recovery. All studies have been undertaken with the intention to optimize utilization and extend the practice of CO{sub 2} flooding to a wider range of reservoirs. Many items presented in this report are applicable to other interest areas: e.g. gas injection and production, greenhouse gas sequestration, chemical flooding, reservoir damage, etc. Major areas of studies include reduction of CO{sub 2} mobility to improve conformance, determining and understanding injectivity changes in particular injectivity loses, and modeling process mechanisms determined in the first two areas. Interfacial tension (IFT) between a high-pressure, high-temperature CO{sub 2} and brine/surfactant and foam stability are used to assess and screen surfactant systems. In this work the effects of salinity, pressure, temperature, surfactant concentration, and the presence of oil on IFT and CO{sub 2} foam stability were determined on the surfactant (CD1045{trademark}). Temperature, pressure, and surfactant concentration effected both IFT and foam stability while oil destabilized the foam, but did not destroy it. Calcium lignosulfonate (CLS) can be used as a sacrificial and an enhancing agent. This work indicates that on Berea sandstone CLS concentration, brine salinity, and temperature are dominant affects on both adsorption and desorption and that adsorption is not totally reversible. Additionally, CLS adsorption was tested on five minerals common to oil reservoirs; it was found that CLS concentration, salinity, temperature, and mineral type had significant effects on adsorption. The adsorption density from most to least was: bentonite > kaolinite > dolomite > calcite > silica. This work demonstrates the extent of dissolution and precipitation from co-injection of CO{sub 2} and

  9. Observing nurses has improved my alcohol dependency care.

    Science.gov (United States)

    Jaques, Ellise

    2016-09-21

    My first placement in my first year of nursing training was on a gastrointestinal/hepatology ward. Alongside my mentor, I was caring for a patient who had been withdrawing from alcohol since admission to hospital the previous evening.

  10. Characterizing emergency departments to improve understanding of emergency care systems

    OpenAIRE

    Steptoe, Anne P; Corel, Blanka; Sullivan, Ashley F; Camargo, Carlos A.

    2011-01-01

    International emergency medicine aims to understand different systems of emergency care across the globe. To date, however, international emergency medicine lacks common descriptors that can encompass the wide variety of emergency care systems in different countries. The frequent use of general, system-wide indicators (e.g. the status of emergency medicine as a medical specialty or the presence of emergency medicine training programs) does not account for the diverse methods that contribute t...

  11. Evidence Summary and Recommendations for Improved Communication during Care Transitions

    Science.gov (United States)

    Jackson, Patricia D.; Biggins, Mary Sue; Cowan, Linda; French, Brenda; Hopkins, Sherry L.; Uphold, Constance R.

    2016-01-01

    Background Communication between levels of care can be complex for any patient. For the Servicemember or Veteran with complex medical issues, who needs transitioning between multiple levels of care, this communication involves detailed, individualized information pivotal to quality clinical outcomes and patient/family satisfaction. These complex cases also typically include communication between multiple family members. Purpose The purpose was to summarize the evidence and present recommendations for facilitating effective transitions of patient care within the complex Veterans Affairs (VA) Polytrauma System of Care. Design Evidence Based Review. Methods Selected members of the VA Office of Nursing Service Polytrauma Field Advisory Committee conducted an evidence-based review, and queried a clinical panel of polytrauma nursing experts and direct care rehabilitation nurses. Findings Search results, key practice recommendations, a plan of care template, and future plans for dissemination and implementation are presented. Conclusions Communication is a key to success when managing many details and requires both focus and knowledge of larger systems. Clinical Relevance Direct communication, using a standardized approach, is recommended for successful patient transitions. PMID:26391532

  12. Improving Quality of Care among COPD outpatients in Denmark 2008-2011

    DEFF Research Database (Denmark)

    Tøttenborg, Sandra Søgaard; Thomsen, Reimar W.; Nielsen, Henrik;

    2013-01-01

    using data from the Danish Clinical Register of COPD (DrCOPD). Since 2008 the register has systematically monitored and audited the use of recommended processes of COPD care. RESULTS: Substantial improvements were observed for all processes of care and registration fulfillment increased to well above 85...... of care fulfillment between regions and hospital clinics still existed in 2011. The proportion of patients with mild- to moderate COPD increased during the study period (pimportant processes of care, the present study indicates...

  13. Health care quality improvement in the emergency department: a reengineering approach.

    Science.gov (United States)

    Schaming, J S; Gulati, A

    1998-05-01

    Most health care organization processes can be compared with those in typical engineering, manufacturing, and service businesses, and improvement can be achieved in health care by means of many of the tools that are commonly found in non-health care industries. In fact, it may prove beneficial for health care organizations to consider obtaining help from professionals outside health care because such individuals probably will not have preconceived ideas about process improvement in such organizations. The article provides a success story in a health care process improvement effort that was undertaken by engineers in a large Los Angeles regional hospital in 1993. It discusses specific steps that were taken to obtain and synthesize data, achieve employee and management buy-in, analyze processes for strengths and improvement opportunities, assess customer satisfaction, implement changes, and measure results. PMID:10179278

  14. Using Digital Crumbs from an Electronic Health Record to Identify, Study and Improve Health Care Teams

    Science.gov (United States)

    Gray, James E; Feldman, Henry; Reti, Shane; Markson, Larry; Lu, Xiaoning; Davis, Roger B.; Safran, Charles A

    2011-01-01

    We have developed a novel approach, the Digital Crumb Investigator, for using data collected as a byproduct of Electonic Health Record (EHR) use to help define care teams and care processes. We are developing tools and methods to utilize these routinely collected data to visualize and quantify care networks across acute care and ambulatory settings We have chosen a clinical care domain where clinicians use EHRs in their offices, on the maternity wards and in the neonatal intensive care units as a test paradigm for this technology. The tools and methods we deliver should readily translate to other health care settings that collect behind-the-scenes electronic metadata such as audit trails. We believe that by applying the methods of social networking to define clinical relationships around a patient’s care we will enable new areas of research into the usage of EHRs to promote patient safety and other improvements in care. PMID:22195103

  15. Improving the delivery of care for patients with diabetes through understanding optimised team work and organisation in primary care

    Directory of Open Access Journals (Sweden)

    Hrisos Susan

    2009-04-01

    Full Text Available Abstract Background Type 2 diabetes is an increasingly prevalent chronic illness and is an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of the primary care team. Studies of the quality of care for patients with diabetes suggest less than optimum care in a number of areas. Aim The aim of this study is to improve the quality of care for patients with diabetes cared for in primary care in the UK by identifying individual, team, and organisational factors that predict the implementation of best practice. Design Participants will be clinical and non-clinical staff within 100 general practices sampled from practices who are members of the MRC General Practice Research Framework. Self-completion questionnaires will be developed to measure the attributes of individual health care professionals, primary care teams (including both clinical and non-clinical staff, and their organisation in primary care. Questionnaires will be administered using postal survey methods. A range of validated theories will be used as a framework for the questionnaire instruments. Data relating to a range of dimensions of the organisational structure of primary care will be collected via a telephone interview at each practice using a structured interview schedule. We will also collect data relating to the processes of care, markers of biochemical control, and relevant indicator scores from the quality and outcomes framework (QOF. Process data (as a proxy indicator of clinical behaviours will be collected from practice databases and via a postal questionnaire survey of a random selection of patients from each practice. Levels of biochemical control will be extracted from practice databases. A series of analyses will be conducted to relate the individual, team, and organisational data to the process, control, and QOF data to identify configurations associated with high quality care. Study

  16. Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples

    OpenAIRE

    McDermott Robyn; Thompson Sandra; Weeramanthri Tarun; Connors Christine; Anderson Ian; Nagel Tricia; Scrimgeour David J; Rowley Kevin; Semmens James; Shannon Cindy; Si Damin; Bailie Ross; Burke Hugh; Moore Elizabeth; Leon Dallas

    2010-01-01

    Abstract Background Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermedia...

  17. A Proposed mHealth Model for Improving the Quality Care in Hospitals

    Directory of Open Access Journals (Sweden)

    Hussain Abu-Dalbouh

    2014-02-01

    Full Text Available As the hospitals face increasing demands to participate in a wide range of quality improvement activities, the role and influence of physicians and nurses in these efforts is also increasing. The growing population has led to increase the number of patients in hospital. Therefore, healthcare workers have to see more patients and do more with each patient than ever before. Thus, Hospitals confront challenges with regard tracking patient condition, share information about the patient and difficulty follow up all patients with the lack of the number of specialist physician at all levels. This marks mobile devices an important opportunity for the next generation healthcare delivery. This study proposed a mobile health model that could support hospitals in tracking patient’s progress and improve the quality care in hospitals. It allows physicians and nurses to track the patients’ conditions more efficiently and easily. It also able to assist in crucial clinical decisions 24/7 and available on call wherever physicians to manage their care process from start to finish and from inside and outside the hospital.

  18. Optimizing information technology to improve sexual health-care delivery: public and patient preferences.

    Science.gov (United States)

    Ross, J D C; Copas, A; Stephenson, J; Fellows, L; Gilleran, G

    2007-07-01

    Information and communication technology (ICT) has the potential to improve the quality of care and efficiency in sexual health clinics, but its introduction requires input not only from health-care professionals and ICT specialists but also from service users and potential future users. In this study, views on ICT in relation to the delivery of sexual health services were assessed using a structured interview in two groups - a community sample of young people and a clinic sample of existing patients. In all, 542 community interviewees and 202 clinic patients participated. About 75% of respondents had access to the Internet and overall 60% reported that the self-collection of a sexual history on an electronic form was acceptable. Black Caribbean individuals had significantly less access to the Internet and a lower acceptance of electronic data collection. For booking an appointment, the majority of patients reported the telephone (community sample 93%, clinic sample 96%) or attending in person (community sample 77%, clinic sample 54%) to be acceptable, with a smaller proportion choosing email (community sample 10%, clinic sample 27%) or the Internet (community sample 7%, clinic sample 11%). Electronic booking was significantly less acceptable to Black Caribbean respondents. Although new technologies offer the opportunity to improve the quality of sexual health services, patient preferences and differences between groups in access to technology also need to be considered when services are reconfigured. PMID:17623499

  19. Health care professional development: Working as a team to improve patient care.

    Science.gov (United States)

    Babiker, Amir; El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad

    2014-01-01

    In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care.

  20. Delivering Cost-Efficient Public Services in Health Care, Education and Housing in Chile. OECD Economics Department Working Papers, No. 606

    Science.gov (United States)

    Moccero, D.

    2008-01-01

    The Chilean authorities plan to raise budgetary allocations over the medium term for a variety of social programmes, including education, health care and housing. This incremental spending will need to be carried out in a cost-efficient manner to make sure that it yields commensurate improvements in social outcomes. Chile's health indicators show…

  1. SOEC efficiency and cost improvement Part 1 and 2

    International Nuclear Information System (INIS)

    Part I: Electrochemical and X-ray Characterization of Solid-Oxide Electrolysis Cell Oxygen Electrodes on Electrolyte Substrates--The governing reaction mechanisms, and the electrode and electrolyte material compositions and structures, that controls the efficiency and durability of the solid oxide electrolysis cells (SOEC) need to be identified and well-understood for a significant improvement in nuclear hydrogen production using high temperature steam electrolysis. ANL conducted experimental analysis of SOEC electrolyte and electrodes to progress in this objective. Our study on the oxygen electrode focused on specifically the effect of electrode crystal structure on its electrochemical performance, and the evolution of the electronic and structural properties of the electrodes while under electrochemical conditions and high temperature. We found through electrochemical impedance spectroscopy experiments that, while different crystal orientations in La0.8Sr0.2MnO3+d (LSM) show different initial performance and different electrochemical activation under SOEC conditions, a good mixed ionic electronic conductor La0.8Sr0.2CoO3+d (LSC) does not seem to exhibit similar variations. Our in-situ x-ray and electrochemical measurements at the Advanced Photon Source of ANL have identified the chemical states of the A-site elements of the doped lanthanum manganite electrodes. We found that the changes in the concentration and in the electronic state of the La and Sr (the A-site elements of the perovskite) occurring only at the top airelectrode film interface can be responsible from the electrochemical improvement of the SOEC anode under DC current. Our observation related to the La chemical state change is unexpected and probably unique to the electrochemical current-conditioning. Part II: Progress Towards the Atomic Layer Deposition of Lanthanum Strontium Manganate--Lanthanum strontium manganate (LSM) is the most commonly used cathode material for solid oxide fuel cells (SOFC

  2. Measuring health care efficiency with a tripartite configuration under the "National" Health Insurance system

    Institute of Scientific and Technical Information of China (English)

    Victor B.Kreng; Yang Shao-wei; Lin Chien-Hsu

    2014-01-01

    Background The "National" Health Insurance (NHI) in Taiwan,China is a single-payer system that was introduced in 1995 to provide universal health care.It is worth noting that three stakeholders are involved in Taiwan's NHI,which can be seen as a triangular governance regime between the Bureau of "National" Health Insurance (BNHI),the insured and providers.Accordingly,this study intended to assess the efficiency of various different production processes that occur among these stakeholders in Taiwan's NHI system.Methods A two-stage relational Data Envelopment Analysis (DEA) model is adopted to investigate the sub-process efficiencies of the health care resources held by 23 cities and counties through stages Ⅰ or Ⅱ,where the outputs of the first stage serve the inputs of the second.The dataset was collected from the annual reports published by the Department of Health,Taiwan,China.Results Under the proposed framework,the efficiency of the whole process can be obtained from the product of productivity and allocative efficiency.Ten DMUs are efficient either in stages Ⅰ or Ⅱ,with only two DMUs being efficient with regard to both sub-processes.Conclusion The relational DEA model not only demonstrates the physical relationship between the whole process and the sub-process components,but also produces reliable outcomes in efficiency measurement among different stakeholders in Taiwan's NHI system.

  3. Pricing in Noncooperative Interference Channels for Improved Energy Efficiency

    Directory of Open Access Journals (Sweden)

    Chong Zhijiat

    2010-01-01

    Full Text Available We consider noncooperative energy-efficient resource allocation in the interference channel. Energy efficiency is achieved when each system pays a price proportional to its allocated transmit power. In noncooperative game-theoretic notation, the power allocation chosen by the systems corresponds to the Nash equilibrium. We study the existence and characterize the uniqueness of this equilibrium. Afterwards, pricing to achieve energy-efficiency is examined. We introduce an arbitrator who determines the prices that satisfy minimum QoS requirements and minimize total power consumption. This energy-efficient assignment problem is formulated and solved. We compare our setting to that without pricing with regard to energy-efficiency by simulation. It is observed that pricing in this distributed setting achieves higher energy-efficiency in different interference regimes.

  4. A new method for improving efficiency of protocol testing

    Institute of Scientific and Technical Information of China (English)

    ZHAO Baohua; JIANG Zhenhai

    2007-01-01

    Traditional solutions have encountered some bottleneck in ireproving the efficiency of protocol testing.A novel method that records the test sequence dynamically is proposed.Three dynamically reordering algorithms are brought forward in line with difrerent fault conditions.The impact of the new method of testing efficiency is also presented.Simulation results demonstrate that the proposed solution is better than the traditional ones in terms of testing efficiency.

  5. A concept for improving efficiency of multistage centrifugal pumps

    Science.gov (United States)

    Gardy, H. F.

    1970-01-01

    Multichannel impeller consists of successive stage impellers arranged concentrically without clearances between them. Reduction in friction is predicted to increase pump efficiency by 5 to 10 percent.

  6. Operationalizing reflexivity to improve the rigor of palliative care research.

    Science.gov (United States)

    Johnston, Bridget; Pringle, Jan; Buchanan, Deans

    2016-08-01

    Reflective practice involves deliberate consideration of actions, attitudes and behaviors. Reflexivity in research is considered important for ensuring that research is ethically and rigorously conducted. This paper details the challenges of conducting research involving patients with palliative care needs within the acute hospital environment. It discusses the contribution of reflexivity to a pilot study using the Patient Dignity Question (PDQ) "What do I need to know about you as a person to take the best care of you that I can?" as a brief intervention to foster a more person-centered climate. Challenges that emerged are discussed from the perspectives of the researchers, the participants, and the setting; they relate to: timing and recruitment, the nature of palliative care illness, attitudes to research, and the research environment. Awareness of such issues can prompt researchers to devise appropriate strategies and approaches that may inform and assist the rigor and conduct of future research. PMID:26620579

  7. Child care at CERN: Recommendations for Improvements of the Child Care Situation at CERN

    CERN Document Server

    Alviggi, M G; Avramidou, R; Barillari, T; Bates, R; Benelli, G; Beolè, S; Berger, N; Boeriu, O; Bölla, G; Bornheim, A; Brigido, F; Calheiros, F; Garrido, M C; Llatas, M C; Chesneanu, D; Conde-Muíño, P; D'Auria, S; De Santo, A; David Tinoco Mendes, A; De La Cruz Burelo, E; Della Volpe, M; Delmastro, M; Demers, S M; Dimovasili, E; Dindar, K; Elder, S; Eno, S; Eschrich, K G; Fonseca Martin, T M; Gagnon, P; Gateau, M; Gemme, C; Gentile, S; Geurts, F; Goldfarb, S; Grabowska-Bold, I; Grothe, M; Hadjidakis, C; Hoffmann, D; Issever, C; Josa-Mutuberria, I; Kandasamy, S; Koblitz, S; Koval'S'Kyi, D; Krivda, M; Lançon, E; Leahu, A E; Leahu, L; Lester, C G; Lipniacka-Wesolowska, A L; List, J; López-Noriega, M; Manca, G; Mariotti, C; Maselli, S; Merkel, P; Nachtman, J; Natale, S; Oldeman, R; Organtini, G; Patterson, R; Pesci, A; Primavera, M; Quadt, A; Rosati, M; Sbarra, C; Teuscher, R; Tique Aires Viegas, F; Trigger, I M; Tuominen, E; Van Lingen, F; Vandoni, G; Vanini, S; Veverkovai, K; Vickey, T; Wang, D; Wells, P; Wengler, T; Wittmer, B; Yumiceva Del Pozo, F X; CERN. Geneva. HR Department

    2008-01-01

    This is a document summarizing a survey of child care needs of CERN staff and users which was performed in February 2008 by the CERN Child Care Initiative. The document presents the analysis of this data. Conclusions on the minimal facilities size are derived and possible funding source at the European Union are discussed.

  8. Improving Chronic Care: Developing and testing disease-management interventions applied in COPD care

    NARCIS (Netherlands)

    K.M.M. Lemmens (Karin)

    2009-01-01

    textabstractDisease management has emerged as a new strategy to enhance quality of care for patients suffering from chronic conditions, and to control health care costs. So far, however, the effects of this strategy remain unclear. The purpose of this thesis was to determine the core elements of dis

  9. Improving timely medical reviews for patients discharged from intensive care

    OpenAIRE

    Kumar, Prashant

    2015-01-01

    Transferring patients from the intensive care unit (ICU) to a general ward is commonly associated with error and adverse events, and is one of the most challenging and high-risk transitions of care. Patients discharged from ICUs often require sustained intensive multi-disciplinary team input, part of which can be provided by nurse or clinician-led outreach teams. Unfortunately, due to a lack of resources many institutions do not have such programmes. We work in one such hospital with no ICU o...

  10. Improving breast care: providing, guiding, expertise, and leadership.

    Science.gov (United States)

    Granai, Cornelius O; Orr, James W

    2011-03-01

    Optimal healthcare blends timeless doctor-patient values with state-of-the-art medical knowledge. The physician's role varies from delivering therapies to guiding patients through the healthcare maze to their best decisions. Breast care should not be parceling out of anatomic parts, as if biological relationships do not exist. Instead, it should stem from an understanding of the "total woman"--biological and otherwise--and how important that unity is for quality of life, even when confronting breast cancer. Breast fellowships for gynecologic and general surgeons create superior clinicians and better patient advocates -essential in advancing women-centric care and healthcare leadership. PMID:21278506

  11. Improving breast care: providing, guiding, expertise, and leadership.

    Science.gov (United States)

    Granai, Cornelius O; Orr, James W

    2011-03-01

    Optimal healthcare blends timeless doctor-patient values with state-of-the-art medical knowledge. The physician's role varies from delivering therapies to guiding patients through the healthcare maze to their best decisions. Breast care should not be parceling out of anatomic parts, as if biological relationships do not exist. Instead, it should stem from an understanding of the "total woman"--biological and otherwise--and how important that unity is for quality of life, even when confronting breast cancer. Breast fellowships for gynecologic and general surgeons create superior clinicians and better patient advocates -essential in advancing women-centric care and healthcare leadership.

  12. An intelligent partner system for improving chronic illness care

    Directory of Open Access Journals (Sweden)

    Tibor Deutsch

    2003-02-01

    Full Text Available Chronic care consists of a sequence of actions to treat a specific clinical disorder over time as a function of the ways in which illness progresses and patients respond to management actions. Outcomes depend on physicians' skills to select the actions best suited for their patients and competent self-management. This paper presents the architecture of an intelligent partner system (IPS, which helps to provide doctors with relevant data and skills and empowers chronically ill patients with the information and confidence to manage their health wisely. The services of this intelligent system are presented as 'therapies' for the information-processing 'pathologies' associated with traditional chronic illness care.

  13. Why we need interprofessional education to improve the delivery of safe and effective care

    Directory of Open Access Journals (Sweden)

    Scott Reeves

    2016-03-01

    Full Text Available Interprofessional education (IPE is an activity that involves two or more professions who learn interactively together to improve collaboration and the quality of care. Research has continually revealed that health and social care professionals encounter a range of problems with interprofessional coordination and collaboration which impact on the quality and safety of care. This empirical work resulted in policymakers across health care education and practice to invest in IPE to help resolve this collaborative failures. It is anticipated that IPE will provide health and social care professionals with the abilities required to work together effectively in providing safe high quality care to patients. Through a discussion of a range of key professional, educational and organization issues related to IPE, this paper argues that this form of education is an important strategy to improve the delivery of safe and effective care

  14. Improvement treatments and criteria assessing banks the energy efficiency projects

    Directory of Open Access Journals (Sweden)

    Ryzhkova Anna Vladimirovna

    2013-05-01

    Full Text Available Stimulate bank lending to businesses for energy efficiency projects is possible by increasing the accuracy of the valuation the project and the effect of its implementation. The paper presents a sequence of procedures and appropriate assessment criteria for energy efficiency projects, which will increase the chances of success of the investment project and to ensure the financial stability of the bank.

  15. Developing concepts for improved efficiency of robot work preparation

    NARCIS (Netherlands)

    Essers, M.S.; Vaneker, T.H.J.

    2013-01-01

    SInBot[1] is a large research project that focuses on maximizing the efficient use of mobile industrial robots during medium sized production runs. The system that will be described in this paper will focusses on the development and validation of concepts for efficient work preparation for cells of

  16. Minimizing ED Waiting Times and Improving Patient Flow and Experience of Care

    Directory of Open Access Journals (Sweden)

    Assaad Sayah

    2014-01-01

    Full Text Available We conducted a pre- and postintervention analysis to assess the impact of a process improvement project at the Cambridge Hospital ED. Through a comprehensive and collaborative process, we reengineered the emergency patient experience from arrival to departure. The ED operational changes have had a significant positive impact on all measured metrics. Ambulance diversion decreased from a mean of 148 hours per quarter before changes in July 2006 to 0 hours since April 2007. ED total length of stay decreased from a mean of 204 minutes before the changes to 132 minutes. Press Ganey patient satisfaction scores rose from the 12th percentile to the 59th percentile. ED patient volume grew by 11%, from a mean of 7,221 patients per quarter to 8,044 patients per quarter. Compliance with ED specific quality core measures improved from a mean of 71% to 97%. The mean rate of ED patients that left without being seen (LWBS dropped from 4.1% to 0.9%. Improving ED operational efficiency allowed us to accommodate increasing volume while improving the quality of care and satisfaction of the ED patients with minimal additional resources, space, or staffing.

  17. Shared Decision Making: Improving Care for Children with Autism

    Science.gov (United States)

    Golnik, Allison; Maccabee-Ryaboy, Nadia; Scal, Peter; Wey, Andrew; Gaillard, Philippe

    2012-01-01

    We assessed the extent to which parents of children with autism spectrum disorder report that they are engaged in shared decision making. We measured the association between shared decision making and (a) satisfaction with care, (b) perceived guidance regarding controversial issues in autism spectrum disorder, and (c) perceived assistance…

  18. Improving Educational Outcomes for Children in Foster Care

    Science.gov (United States)

    Watson, Christina; Kabler, Brenda

    2012-01-01

    Recent statistics estimate that there are 783,000 children living in foster care in the United States. This vulnerable population is at risk for academic failure as well as internalizing and externalizing behavioral problems. Compared to their peers, foster youth face significant educational difficulties, including lower levels of academic…

  19. Commentary to Adam Oliver's 'Incentivising improvements in health care delivery'

    DEFF Research Database (Denmark)

    Vrangbaek, Karsten

    2015-01-01

    The commentary discusses key issues for assessment of performance management within health care. It supports the ambition to develop more realistic understandings of performance management based on insights from behavioral economics as suggested by Adam Oliver. However, it also points to several...

  20. Energy Efficiency Improvement and Cost Saving Oportunities for the Concrete Industry

    Energy Technology Data Exchange (ETDEWEB)

    Kermeli, Katerina; Worrell, Ernst; Masanet, Eric

    2011-12-01

    The U.S. concrete industry is the main consumer of U.S.-produced cement. The manufacturing of ready mixed concrete accounts for more than 75% of the U.S. concrete production following the manufacturing of precast concrete and masonry units. The most significant expenditure is the cost of materials accounting for more than 50% of total concrete production costs - cement only accounts for nearly 24%. In 2009, energy costs of the U.S. concrete industry were over $610 million. Hence, energy efficiency improvements along with efficient use of materials without negatively affecting product quality and yield, especially in times of increased fuel and material costs, can significantly reduce production costs and increase competitiveness. The Energy Guide starts with an overview of the U.S. concrete industry’s structure and energy use, a description of the various manufacturing processes, and identification of the major energy consuming areas in the different industry segments. This is followed by a description of general and process related energy- and cost-efficiency measures applicable to the concrete industry. Specific energy and cost savings and a typical payback period are included based on literature and case studies, when available. The Energy Guide intends to provide information on cost reduction opportunities to energy and plant managers in the U.S. concrete industry. Every cost saving opportunity should be assessed carefully prior to implementation in individual plants, as the economics and the potential energy and material savings may differ.

  1. Improving end-of-life care for ESRD patients: an initiative for professionals.

    Science.gov (United States)

    Moss, Alvin H; Armistead, Nancy C

    2013-09-01

    The Coalition for Supportive Care of Kidney Patients convened subject matter experts (SMEs) to assess the current state of palliative care for pre-dialysis (chronic kidney disease) and end-stage renal disease patients (stages 3-5). The SMEs noted that in the final month of life, dialysis patients have the higher percentage of hospitalizations, longer length of stay, greater intensive care admissions, and higher number of deaths in hospitals than cancer or heart failure patients, but use hospice only half as much as these two groups. The group identified a strategic approach and framework for achieving specific aims to improve palliative care education of health care providers, raise awareness of supportive care resources, define palliative care skills for nephrologists, and continue the implementation of shared decision-making for individualized patient-centered care. PMID:24266270

  2. IMPROVING CO2 EFFICIENCY FOR RECOVERING OIL IN HETEROGENEOUS RESERVOIRS

    Energy Technology Data Exchange (ETDEWEB)

    Reid B. Grigg; Robert K. Svec; Zhengwen Zeng; Baojun Bai; Yi Liu

    2004-09-27

    The third annual report of ''Improving CO{sub 2} Efficiency for Recovery Oil in Heterogeneous Reservoirs'' presents results of laboratory studies with related analytical models for improved oil recovery. All studies were designed to optimize utilization and extend the practice of CO{sub 2} flooding to a wider range of reservoirs. Chapter 1 describes the behavior at low concentrations of the surfactant Chaser International CD1045{trademark} (CD) versus different salinity, pressure and temperature. Results of studies on the effects of pH and polymer (hydrolyzed polyacrylamide?HPAM) and CO{sub 2} foam stability after adsorption in the core are also reported. Calcium lignosulfonate (CLS) transport mechanisms through sandstone, description of the adsorption of CD and CD/CLS onto three porous media (sandstone, limestone and dolomite) and five minerals, and the effect of adsorption on foam stability are also reported. In Chapter 2, the adsorption kinetics of CLS in porous Berea sandstone and non-porous minerals are compared by monitoring adsorption density change with time. Results show that adsorption requires a much longer time for the porous versus non-porous medium. CLS adsorption onto sandstone can be divided into three regions: adsorption controlled by dispersion, adsorption controlled by diffusion and adsorption equilibrium. NaI tracer used to characterize the sandstone had similar trends to earlier results for the CLS desorption process, suggesting a dual porosity model to simulate flow through Berea sandstone. The kinetics and equilibrium test for CD adsorption onto five non-porous minerals and three porous media are reported in Chapter 3. CD adsorption and desorption onto non-porous minerals can be established in less than one hour with adsorption densities ranging from 0.4 to 1.2 mg of CD per g of mineral in decreasing order of montmorillonite, dolomite, kaolinite, silica and calcite. The surfactant adsorption onto three porous media takes

  3. Prerequisites for sustainable care improvement using the reflective team as a work model.

    Science.gov (United States)

    Jonasson, Lise-Lotte; Carlsson, Gunilla; Nyström, Maria

    2014-01-01

    Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work.

  4. Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations

    Science.gov (United States)

    Andrulis, Dennis P.; Brach, Cindy

    2016-01-01

    Objective To understand the interrelationship of literacy, culture, and language and the importance of addressing their intersection. Methods Health literacy, cultural competence, and linguistic competence strategies to quality improvement were analyzed. Results Strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally diverse and individuals with limited English proficiency (LEP). The lack of integration results in health care that is unresponsive to some vulnerable groups’ needs. A vision for integrated care is presented. Conclusion Clinicians, the health care team, and health care organizations have important roles to play in addressing challenges related to literacy, culture, and language. PMID:17931131

  5. Organizational interventions to implement improvements in patient care: a structured review of reviews

    OpenAIRE

    Grol Richard; Wollersheim Hub; Wensing Michel

    2006-01-01

    Abstract Background Changing the organization of patient care should contribute to improved patient outcomes as functioning of clinical teams and organizational structures are important enablers for improvement. Objective To provide an overview of the research evidence on effects of organizational strategies to implement improvements in patient care. Design Structured review of published reviews of rigorous evaluations. Data sources Published reviews of studies on organizational interventions...

  6. Improving Chronic Care: Developing and testing disease-management interventions applied in COPD care

    OpenAIRE

    Lemmens, Karin

    2009-01-01

    textabstractDisease management has emerged as a new strategy to enhance quality of care for patients suffering from chronic conditions, and to control health care costs. So far, however, the effects of this strategy remain unclear. The purpose of this thesis was to determine the core elements of disease management and to understand how they operate and interact in order to effectively evaluate disease-management programmes, particularly for patients with chronic obstructive pulmonary disease....

  7. Improving operating room efficiency by applying bin-packing and portfolio techniques to surgical case scheduling

    NARCIS (Netherlands)

    Houdenhoven, van M.; Oostrum, van J.M.; Hans, E.W.; Wullink, G.; Kazemier, G.

    2013-01-01

    BACKGROUND: An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques.

  8. Improving maternal confidence in neonatal care through a checklist intervention

    OpenAIRE

    Radenkovic, D.; KOTECHA, S.; Patel, S; Lakhani, A; Reimann-Dubbers, K.; Shah, S; Jafree, D.; Mitrasinovic, S.; Whitten, S. M.

    2016-01-01

    Previous qualitative studies suggest a lack of maternal confidence in care of their newborn child upon discharge into the community. This observation was supported by discussion with healthcare professionals and mothers at University College London Hospital (UCLH), highlighting specific areas of concern, in particular identifying and managing common neonatal presentations. The aim of this study was to design and introduce a checklist, addressing concerns, to increase maternal confidence in ca...

  9. Improving health care communication for persons with mental retardation.

    OpenAIRE

    Harper, D C; Wadsworth, J S

    1992-01-01

    There has been little effort directed at training health care professionals in behaviors and attitudes that are effective in communicating with persons with mental retardation. Such training would be beneficial not only to assist those with congenital cognitive deficits but for those with acquired central nervous system conditions as well, for example, dementia. Persons with mental retardation are living in community settings in greater numbers and increasingly participating in vocational, re...

  10. Reducing risk by improving standards of intrapartum fetal care

    OpenAIRE

    Young, Peter; Hamilton, Rosie; Hodgett, Sheena; Moss, Mary; Rigby, Claire; Jones, Peter; Johanson, Richard

    2001-01-01

    Confidential Enquiries into Stillbirths and Deaths in Infancy (CESDI) have pointed to a high frequency of suboptimal intrapartum fetal care of a kind that, in the event of an adverse outcome, is hard to defend in court. In an effort to minimize liability, various strategies were applied in a district hospital labour ward—guidelines, cyclical audit, monthly feedback meetings and training sessions in cardiotocography (CTG). The effects of these interventions on quality o...

  11. Improved communication in post-ICU care by improving writing of ICU discharge letters: a longitudinal before-after study

    NARCIS (Netherlands)

    S. Medlock; S. Eslami; M. Askari; E.J. van Lieshout; D.A. Dongelmans; A. Abu-Hanna

    2011-01-01

    Background: The discharge letter is the primary means of communication at patient discharge, yet discharge letters are often not completed on time. A multifaceted intervention was performed to improve communication in patient hand-off from the intensive care unit (ICU) to the wards by improving the

  12. [Community resources prescription for self-care improvement in chronic illnesses. Clinical case management in Primary Health Care].

    Science.gov (United States)

    Pérez-Vico-Díaz de Rada, Lucía; González-Suárez, Miriam; Duarte-Clíments, Gonzalo; Brito-Brito, Pedro Ruymán

    2014-01-01

    A case is presented of a 52 year-old male seen in a Primary Care nursing clinic for a type 2 diabetes mellitus metabolic control. The frequency of the visits increased due to perceived difficulties caused by changing the medical treatment. A focused interview was conducted under functional health patterns framework. The patient was unable to write or read, had not worked for the last 25 years, and expressed a lack of control over his self-care. An action plan was prepared, prioritizing Ineffective Health Maintenance, Powerlessness, and Impaired Social Interaction NANDA-I nursing diagnoses. The goals were set at improving knowledge and control over his disease and participating in leisure activities. To achieve these, the social health resources in the area were contacted, and agreed that the patient could attend activities that could improve his self-care and his quality of life. An improvement in his diabetes control was observed in the following evaluations, with an increase in his level of knowledge and self-care. The Primary Health care nurse should consider available community resources by using a comprehensive approach to chronic diseases for their therapeutic benefit and management, especially in those patients with adverse sociocultural conditions.

  13. Telestroke a viable option to improve stroke care in India.

    Science.gov (United States)

    Srivastava, Padma V; Sudhan, Paulin; Khurana, Dheeraj; Bhatia, Rohit; Kaul, Subash; Sylaja, P N; Moonis, Majaz; Pandian, Jeyaraj Durai

    2014-10-01

    In India, stroke care services are not well developed. There is a need to explore alternative options to tackle the rising burden of stroke. Telemedicine has been used by the Indian Space Research Organization (ISRO) to meet the needs of remote hospitals in India. The telemedicine network implemented by ISRO in 2001 presently stretches to around 100 hospitals all over the country, with 78 remote/rural/district health centers connected to 22 specialty hospitals in major cities, thus providing treatment to more than 25 000 patients, which includes stroke patients. Telemedicine is currently used in India for diagnosing stroke patients, subtyping stroke as ischemic or hemorrhagic, and treating accordingly. However, a dedicated telestroke system for providing acute stroke care is needed. Keeping in mind India's flourishing technology sector and leading communication networks, the hub-and-spoke model could work out really well in the upcoming years. Until then, simpler alternatives like smartphones, online data transfer, and new mobile applications like WhatsApp could be used. Telestroke facilities could increase the pool of patients eligible for thrombolysis. But this primary aim of telestroke can be achieved in India only if thrombolysis and imaging techniques are made available at all levels of health care.

  14. Aligning health information technologies with effective service delivery models to improve chronic disease care

    Science.gov (United States)

    Bauer, Amy M.; Thielke, Stephen M.; Katon, Wayne; Unützer, Jürgen; Areán, Patricia

    2014-01-01

    Objective Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. Method A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Results Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. Conclusion HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. PMID:24963895

  15. Medical savings accounts: assessing their impact on efficiency, equity and financial protection in health care.

    Science.gov (United States)

    Wouters, Olivier J; Cylus, Jonathan; Yang, Wei; Thomson, Sarah; McKee, Martin

    2016-07-01

    Medical savings accounts (MSAs) allow enrolees to withdraw money from earmarked funds to pay for health care. The accounts are usually accompanied by out-of-pocket payments and a high-deductible insurance plan. This article reviews the association of MSAs with efficiency, equity, and financial protection. We draw on evidence from four countries where MSAs play a significant role in the financing of health care: China, Singapore, South Africa, and the United States of America. The available evidence suggests that MSA schemes have generally been inefficient and inequitable and have not provided adequate financial protection. The impact of these schemes on long-term health-care costs is unclear. Policymakers and others proposing the expansion of MSAs should make explicit what they seek to achieve given the shortcomings of the accounts. PMID:26883211

  16. Efficiency and quality of care in nursing homes: an Italian case study.

    Science.gov (United States)

    Garavaglia, Giulia; Lettieri, Emanuele; Agasisti, Tommaso; Lopez, Silvano

    2011-03-01

    This study investigates efficiency and quality of care in nursing homes. By means of Data Envelopment Analysis (DEA), the efficiency of 40 nursing homes that deliver their services in the north-western area of the Lombardy Region was assessed over a 3-year period (2005-2007). Lombardy is a very peculiar setting, since it is the only Region in Italy where the healthcare industry is organised as a quasi-market, in which the public authority buys health and nursing services from independent providers-establishing a reimbursement system for this purpose. The analysis is conducted by generating bootstrapped DEA efficiency scores for each nursing home (stage one), then regressing those scores on explanatory variables (stage two). Our DEA model employed two input (i.e. costs for health and nursing services and costs for residential services) and three output variables (case mix, extra nursing hours and residential charges). In the second-stage analysis, Tobit regressions and the Kruskall-Wallis tests of hypothesis to the efficiency scores were applied to define what are the factors that affect efficiency: (a) the ownership (private nursing houses outperform their public counterparts); and (b) the capability to implement strategies for labour cost and nursing costs containment, since the efficiency heavily depends upon the alignment of the costs to the public reimbursement system. Lastly, even though the public institutions are less efficient than the private ones, the results suggest that public nursing homes are moving towards their private counterparts, and thus competition is benefiting efficiency. PMID:20922483

  17. The Effects of Simulation-based Transvaginal Ultrasound Training on Quality and Efficiency of Care

    DEFF Research Database (Denmark)

    Tolsgaard, Martin G; Ringsted, Charlotte; Rosthøj, Susanne;

    2016-01-01

    , but no studies have examined its effects on quality and efficiency of care. METHODS: Trainees from 4 University Hospitals in East Denmark were included (N = 54). Participants were randomized to either simulation-based ultrasound training and clinical training (intervention group, n = 28), or to clinical training......OBJECTIVE: To explore the effect of adding simulation-based transvaginal ultrasound training to trainees' clinical training compared with only clinical training on quality of and efficiency of care. BACKGROUND: Simulation-based ultrasound training may be an effective adjunct to clinical training....... The intervention group participants received 11.1% (95% CI, 2.5-18.9) higher scores on patients' confidence compared with control group participants (P = 0.01). When the number of days of clinical training was doubled, the odds for trainee supervision or repeated patient examination was reduced by 45.3% (95% CI...

  18. Multiplexed lateral flow biosensors: Technological advances for radically improving point-of-care diagnoses.

    Science.gov (United States)

    Li, Jia; Macdonald, Joanne

    2016-09-15

    Lateral flow biosensors are a leading technology in point-of-care diagnostics due to their simplicity, rapidness and low cost. Their primacy in this arena continues through technological breakthroughs such as multiplexing: the detection of more than one biomarker in a single assay. Multiplexing capacity is critical for improving diagnostic efficiency, enhancing the diagnostic precision for specific diseases and reducing diagnostic cost. Here we review, for the first time, the various types and strategies employed for creating multiplexed lateral flow biosensors. These are classified into four main categories in terms of specific application or multiplexing level, namely linear, parameter, spatial and conceptual. We describe the practical applications and implications for each approach and compare their advantages and disadvantages. Importantly, multiplexing is still subject to limitations of the traditional lateral flow biosensor, such as sensitivity and specificity. However, by pushing the limitations of the traditional medium into the multiplex arena, several technological breakthroughs are emerging with novel solutions that further expand the utility of lateral flow biosensing for point-of-care applications.

  19. Multiplexed lateral flow biosensors: Technological advances for radically improving point-of-care diagnoses.

    Science.gov (United States)

    Li, Jia; Macdonald, Joanne

    2016-09-15

    Lateral flow biosensors are a leading technology in point-of-care diagnostics due to their simplicity, rapidness and low cost. Their primacy in this arena continues through technological breakthroughs such as multiplexing: the detection of more than one biomarker in a single assay. Multiplexing capacity is critical for improving diagnostic efficiency, enhancing the diagnostic precision for specific diseases and reducing diagnostic cost. Here we review, for the first time, the various types and strategies employed for creating multiplexed lateral flow biosensors. These are classified into four main categories in terms of specific application or multiplexing level, namely linear, parameter, spatial and conceptual. We describe the practical applications and implications for each approach and compare their advantages and disadvantages. Importantly, multiplexing is still subject to limitations of the traditional lateral flow biosensor, such as sensitivity and specificity. However, by pushing the limitations of the traditional medium into the multiplex arena, several technological breakthroughs are emerging with novel solutions that further expand the utility of lateral flow biosensing for point-of-care applications. PMID:27125840

  20. Through Their Eyes: Lessons Learned Using Participatory Methods in Health Care Quality Improvement Projects.

    Science.gov (United States)

    Balbale, Salva N; Locatelli, Sara M; LaVela, Sherri L

    2016-08-01

    In this methodological article, we examine participatory methods in depth to demonstrate how these methods can be adopted for quality improvement (QI) projects in health care. We draw on existing literature and our QI initiatives in the Department of Veterans Affairs to discuss the application of photovoice and guided tours in QI efforts. We highlight lessons learned and several benefits of using participatory methods in this area. Using participatory methods, evaluators can engage patients, providers, and other stakeholders as partners to enhance care. Participant involvement helps yield actionable data that can be translated into improved care practices. Use of these methods also helps generate key insights to inform improvements that truly resonate with stakeholders. Using participatory methods is a valuable strategy to harness participant engagement and drive improvements that address individual needs. In applying these innovative methodologies, evaluators can transcend traditional approaches to uniquely support evaluations and improvements in health care. PMID:26667882

  1. Model for the cost-efficient delivery of continuous quality cancer care: a hospital and private-practice collaboration

    OpenAIRE

    Coyle, Yvonne M.; Miller, Alan M.; Paulson, R. Steven

    2013-01-01

    Cancer care is expensive due to the high costs of treatment and preventable utilization of resources. Government, employer groups, and insurers are seeking cancer care delivery models that promote both cost-efficiency and quality care. Baylor University Medical Center at Dallas (BUMC), a large tertiary care hospital, in collaboration with Texas Oncology, a large private oncology practice, established two independent centers that function cooperatively within the Baylor Charles A. Sammons Canc...

  2. Academic Detailing in Diabetes: Using Outreach Education to Improve the Quality of Care.

    Science.gov (United States)

    Fischer, Michael A

    2016-10-01

    Most diabetes care is provided in primary care settings, but typical primary care clinicians struggle to keep up with the latest evidence on diabetes screening, pharmacotherapy, and monitoring. Accordingly, many patients with diabetes are not receiving optimal guideline-based therapy. Relying on front-line clinicians on their own to assess the huge volume of new literature and incorporate it into their practice is unrealistic, and conventional continuing medical education has not proven adequate to address gaps in care. Academic detailing, direct educational outreach to clinicians that uses social marketing techniques to provide specific evidence-based recommendations, has been proven in clinical trials to improve the quality of care for a range of conditions. By directly engaging with clinicians to assess their needs, identify areas for change in practice, and provide them with specific tools to implement these changes, academic detailing can serve as a tool to improve care processes and outcomes for patients with diabetes. PMID:27586191

  3. Strategies for improving the efficiency of quantum Monte Carlo calculations

    CERN Document Server

    Lee, R M; Nemec, N; Rios, P Lopez; Drummond, N D

    2010-01-01

    We describe a number of strategies for optimizing the efficiency of quantum Monte Carlo (QMC) calculations. We investigate the dependence of the efficiency of the variational Monte Carlo method on the sampling algorithm. Within a unified framework, we compare several commonly used variants of diffusion Monte Carlo (DMC). We then investigate the behavior of DMC calculations on parallel computers and the details of parallel implementations, before proposing a technique to optimize the efficiency of the extrapolation of DMC results to zero time step, finding that a relative time step ratio of 1:4 is optimal. Finally, we discuss the removal of serial correlation from data sets by reblocking, setting out criteria for the choice of block length and quantifying the effects of the uncertainty in the estimated correlation length and the presence of divergences in the local energy on estimated error bars on QMC energies.

  4. Application of pulse index continuous cardiac output monitoring to improve efficiency of acute heart failure care%应用脉搏指数连续心输出量监测提升急性心力衰竭护理效果

    Institute of Scientific and Technical Information of China (English)

    孙秀月; 张领; 赵书琴

    2015-01-01

    Objective To ihvestigate the effect of pulse index continuous cardiac output (PiCCO) monitoring to nursing care of acute heart failure care.Methods The clinical data of 43 acute heart failure patients were retrospectively analyzed,patients were given pulse index continuous cardiac output monitoring and care,the patient' s nursing outcomes were observed,and the intrathoracic blood volume,cardiac output and oxygen consumption before and after the intervention were compared.Results After the implementation of PiCCO and nursing intervention,43 patients had no serious complications,improved 42 cases discharged,the other 1 patient in critical condition due to old age and heart function improvement sustained no automatic discharge.Oxygen consumption,cardiac output and intrathoracic blood volume were improved after the intervention,there was a significant difference (P < 0.05) compared to the previous indicators and intervention after intervention.Conclusions Application of pulse index continuous cardiac output can effectively improve patient's clinical parameters such as cardiac output,through the implementation of appropriate care can improve symptoms and reduce complications.%目的 探讨急性心力衰竭患者护理中应用脉搏指数连续心输出量监测(PiCCO)的效果.方法 选取平顶山市第二人民医院收治的43例急性心力衰竭患者作为研究对象,收集患者的临床资料并对其做回顾性分析,对患者实施脉搏指数连续心输出量监测和护理,对患者的护理效果进行观察,并对其干预前后的胸腔内血容量、心排血量与氧耗量进行对比观察.结果 实施PiCCO和护理干预,本研究43例患者均无严重并发症产生,42例好转出院,1例由于病情危重、高龄及心功能持续无改善自动出院.患者干预后的氧耗量、心排血量与胸腔内血容量均有所改善,干预后各项指标与干预前比较差异有统计学意义(P<0.05).结论 应用脉搏指数连续心

  5. Quantum effects improve the energy efficiency of feedback control.

    Science.gov (United States)

    Horowitz, Jordan M; Jacobs, Kurt

    2014-04-01

    The laws of thermodynamics apply equally well to quantum systems as to classical systems, and because of this, quantum effects do not change the fundamental thermodynamic efficiency of isothermal refrigerators or engines. We show that, despite this fact, quantum mechanics permits measurement-based feedback control protocols that are more thermodynamically efficient than their classical counterparts. As part of our analysis, we perform a detailed accounting of the thermodynamics of unitary feedback control and elucidate the sources of inefficiency in measurement-based and coherent feedback. PMID:24827219

  6. A technique to improve crystal channeling efficiency of charged particles

    CERN Document Server

    Tikhomirov, V V

    2007-01-01

    It is shown that a narrow plane cut near the crystal surface considerably increases the probability of capture into the stable channeling motion of positively charged particles entering a crystal at angles smaller than a quarter of the critical channeling angle with respect to the crystal planes. At smallest incidence angles the capture probability reaches 99 percent. A pair of crystals bent in orthogonal planes and provided with the cuts allows to reach a 99.9 percent efficiency of single-pass deflection of a proton beam with an ultra small divergence. Conditions necessary for efficient single-pass deflection of protons from the LHC beam halo are also discussed.

  7. Care Coordination Associated with Improved Timing of Newborn Primary Care Visits.

    Science.gov (United States)

    Goyal, Neera K; Hall, Eric S; Kahn, Robert S; Wexelblatt, Scott L; Greenberg, James M; Samaan, Zeina M; Brown, Courtney M

    2016-09-01

    Objective Despite practice recommendations that all newborns be examined within 3-5 days after discharge, many are not seen within this timeframe. Our objective was to determine the association between care coordination and timing of newborn follow-up. Methods This retrospective study evaluated 6251 newborns from eight maternity hospitals who scheduled a primary care appointment at one of two academic pediatric practices over 3.5 years. Two programs were sequentially implemented: (1) newborn discharge coordination, and (2) primary care intake coordination. Primary outcome was days between discharge and follow-up, dichotomized as ≤ or >5 days. Number of rescheduled appointments and loss to follow-up were also assessed. Adjusted relative risks (RR) and odds ratios (OR) were determined by piecewise generalized linear and logistic regression. Results Among 5943 newborns with a completed visit, 52.9 % were seen within 5 days of discharge (mean 6.7 days). After multivariable adjustment, the pre-exposure period (8 months) demonstrated a downward monthly trend in completing early follow-up (RR 0.93, p coordinator implementation and roughly 33 % after primary care coordinator implementation. The latter was also associated with a 13 % monthly decrease in odds of loss to follow-up (OR 0.87, p Care coordination increases adherence among low income families to recommended newborn follow-up after birth hospitalization.

  8. Implementing "lean" principles to improve the efficiency of the endoscopy department of a community hospital: a case study.

    Science.gov (United States)

    Laing, Karen; Baumgartner, Katherine

    2005-01-01

    Many endoscopy units are looking for ways to improve their efficiency without increasing the number of staff, purchasing additional equipment, or making the patients feel as if they have been rushed through the care process. To accomplish this, a few hospitals have looked to other industries for help. Recently, "lean" methods and tools from the manufacturing industry, have been applied successfully in health care systems, and have proven to be an effective way to eliminate waste and redundancy in workplace processes. The "lean" method and tools in service organizations focuses on providing the most efficient and effective flow of service and products. This article will describe the journey of one endoscopy department within a community hospital to illustrate application of "lean" methods and tools and results.

  9. Geisinger's ProvenCare methodology: driving performance improvement within a shared governance structure.

    Science.gov (United States)

    Nolan, Ruth; Wary, Andrea; King, Megan; Laam, Leslie A; Hallick, Susan

    2011-05-01

    Many performance improvement projects fail because they occur in parallel to the organization's shared governance structure. Leveraging the full potential of its nursing shared governance structure, Geisinger Health System's ProvenCare methodology harnessed the full potential of its staff nurses to create truly reliable workflows that benefit patients and that the team finds professionally satisfying. Using ProvenCare Perinatal and its smoking cessation education intervention and outcomes as an example, the authors describe the ProvenCare methodology.

  10. Medicaid and the Cost of Improving Access to Nursing Home Care

    OpenAIRE

    Gertler, Paul J.

    1989-01-01

    In this paper I show that the Medicaid program can improve the access of financially indigent patients to nursing home care by raising the rate of return paid on Medicaid patients' care, but only at the cost of lower quality of care. To quantify the policy tradeoff, I derive expressions for the elasticity of access with respect to total Medicaid expenditures and the elasticity of access with respect to quality. These elasticities expressions are complicated by the fact that Medicaid payment f...

  11. Improving palliative care in selected settings in England using quality indicators: a realist evaluation

    OpenAIRE

    Iliffe, Steve; Davies, Nathan; Manthorpe, Jill; Crome, Peter; Ahmedzai, Sam H; Vernooij-Dassen, Myrra; Engels, Yvonne

    2016-01-01

    Background: There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England.Methods: 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service ch...

  12. Iraqi primary care system in Kurdistan region: providers’ perspectives on problems and opportunities for improvement

    Directory of Open Access Journals (Sweden)

    Shabila Nazar P

    2012-09-01

    Full Text Available Abstract Background As part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary care providers’ perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system. Methods A qualitative study based on four focus groups involving 40 primary care providers from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis. Results Problems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene, health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system, shortage in resources (shortage and low quality of medical supplies and shortage in financing, poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary care providers and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring. Conclusions This study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq’s Kurdistan region from the perspective of primary care providers. From their experience

  13. Improving palliative care in selected settings in England using quality indicators: a realist evaluation

    OpenAIRE

    Iliffe, S.; Davies, N; Manthorpe, J; Crome, P; Ahmedzai, S.; Vernooij-Dassen, M; Engels, Y.

    2016-01-01

    Background: There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England. / Methods: 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service...

  14. From theory to practice: identifying authentic opinion leaders to improve care.

    Science.gov (United States)

    Collins, B A; Hawks, J W; Davis, R

    2000-07-01

    Diffusion of Innovations and Opinion Leader theories can be translated into practical applications to improve health care delivery and financial performance by applying them to influence referral patterns and decrease variations in care. Health care organizations can rapidly spread "better practices" to their practicing physicians by understanding the social and communication networks that are naturally developed by those practitioners. Physicians view this diffusion process as promoting autonomy, and as a legitimate approach to adoption of information needed in daily practice. PMID:18540342

  15. Comparing the implementation of team approaches for improving diabetes care in community health centers

    OpenAIRE

    Wees, P.J. van der; Friedberg, M.W.; Guzman, E; Ayanian, J.Z.; Rodriguez, H.P.

    2014-01-01

    Background: Patient panel management and community-based care management may be viable strategies for community health centers to improve the quality of diabetes care for vulnerable patient populations. The objective of our study was to clarify implementation processes and experiences of integrating office-based medical assistant (MA) panel management and community health worker (CHW) community-based management into routine care for diabetic patients. Methods: Mixed methods study with intervi...

  16. Proving or Improving: On Health Care Research as a Form of Self-Reflection

    OpenAIRE

    Mol, Annemarie

    2006-01-01

    As it is, clinical trials are the gold standard of health care research, employed to prove that the care practices they study are good. Here, the author suggests that we would do better to develop research methods that work toward another goal: to improve care practices. This requires that we no longer foreground the effectiveness but, instead, investigate the various effects of interventions. If undesirable, they might then be tinkered with. As a part of this, the effects on bodily parameter...

  17. 205_WS: Improving the Delivery of Primary Care Through Risk Stratification

    DEFF Research Database (Denmark)

    Kinder, Karen; Kristensen, Troels; Abrams, Chad

    . Content The workshop will open with an introductory presentation on the numerous applications of risk stratification within the integrated and primary care sectors. The workshop will then focus on individual sessions based on three applications: – Case Management. – Improving Coordination......Objectives The aim of this workshop is to provide an insight into how information gained through applications of risk stratification in the primary health care sector, from integrated care networks to primary care clinics and finally at the individual clinician level can improve the delivery...... of primary care. Background As has been demonstrated in both public and private healthcare systems around the globe, risk stratification contributes to improved clinical management of populations. This includes the ability to: – Predict high-risk individuals for inclusion in population health management...

  18. Improving health care costing with resource consumption accounting.

    Science.gov (United States)

    Ozyapici, Hasan; Tanis, Veyis Naci

    2016-07-11

    Purpose - The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital. Design/methodology/approach - A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS). Findings - The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service's selling price and variable costs incurred in providing that service. Research limitations/implications - The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital. Practical implications - This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest

  19. Improving health care costing with resource consumption accounting.

    Science.gov (United States)

    Ozyapici, Hasan; Tanis, Veyis Naci

    2016-07-11

    Purpose - The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital. Design/methodology/approach - A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS). Findings - The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service's selling price and variable costs incurred in providing that service. Research limitations/implications - The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital. Practical implications - This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest

  20. ALTERNATIVES TO IMPROVE HYBRIDIZATION EFFICIENCY IN Eucalyptus BREEDING PROGRAMS

    Directory of Open Access Journals (Sweden)

    Roselaine Cristina Pereira

    2002-01-01

    Full Text Available Simple and quick hybridization procedures and ways to keep pollen grains viable for long periods are sought in plant breeding programs to provide greater work flexibility. The presentstudy was carried out to assess the efficiency of pollinations made shortly after flower emasculationand the viability of stored pollen from Eucalyptus camaldulensis and Eucalyptus urophylla clones cultivated in Northwestern Minas Gerais State. Controlled pollinations were carried out at zero, one,three, five and seven days after emasculation. Hybridization efficiency was assessed by thepercentage of viable fruits, number of seeds produced per fruit, percentage of viable seeds and also bycytological observation of the pollen development along the style. Flower buds from clones of the twospecies were collected close to anthesis to assess the viability of pollen grain storage. Pollen was thencollected and stored in a freezer (-18oC for 1, 2 and 3 months. Pollen assessed was carried out by invitro and in vivo germination tests. The efficiency of the pollinations varied with their delay and alsobetween species. The greatest pollination efficiency was obtained when they were carried out on thethird and fifth day after emasculation, but those performed simultaneously with emasculationproduced enough seeds to allow this practice in breeding programs. The decrease in pollen viabilitywith storage was not sufficiently significant to preclude the use of this procedure in artificialhybridization.

  1. Improving dryer energy efficiency and controllability simultaneously by process modification

    NARCIS (Netherlands)

    Atuonwu, J.C.; Straten, van G.; Deventer, van H.C.; Boxtel, van A.J.B.

    2013-01-01

    This work establishes a relationship between dryer energy performance and controllability using energy balances and process resiliency analysis. It is shown that using the process gain matrix, the dryer energy efficiency can be reliably calculated with conditions for simultaneous controllability imp

  2. Policies for improving energy efficiency in the European housing stock

    NARCIS (Netherlands)

    Sunikka, M.M.

    2006-01-01

    According to EC forecasts, if energy efficiency could be increased 1% annually until 2010, two-thirds of the potential energy saving in the EU could be achieved. This would comply with 40% of the EU's Kyoto obligation to reduce greenhouse gas emissions by 8% on the 1990 level by 2010-12, by cutting

  3. Cambridge journals blog: Improving feed efficiency in dairy production

    Science.gov (United States)

    Because the cost of feeding animals is one of the greatest expenses in dairy production (40-60% of production costs), research focused on ways to identify and select for animals that are the most efficient at converting feed into milk has greatly expanded during the last decade. The animal Article o...

  4. What do primary care physicians and researchers consider the most important patient safety improvement strategies?

    NARCIS (Netherlands)

    Gaal, S.; Verstappen, W.H.J.M.; Wensing, M.J.P.

    2011-01-01

    BACKGROUND: Although it has been increasingly recognised that patient safety in primary care is important, little is known about the feasibility and effectiveness of different strategies to improve patient safety in primary care. In this study, we aimed to identify the most important strategies by c

  5. Improving Population Health by Incorporating Chronic Disease and Injury Prevention Into Value-Based Care Models.

    Science.gov (United States)

    Petersen, Ruth; Rushing, Jill; Nelson, Sharon; Rhyne, Sharon

    2016-01-01

    Today's health system transformation provides a prime opportunity to leverage the capacity of public health to reduce the burden of chronic disease and injury, improve population health, and contain health care costs. Health care settings and organizations should support public health capacity as a key investment in population health. PMID:27422946

  6. Comparing the implementation of team approaches for improving diabetes care in community health centers

    NARCIS (Netherlands)

    Wees, P.J. van der; Friedberg, M.W.; Guzman, E.; Ayanian, J.Z.; Rodriguez, H.P.

    2014-01-01

    BackgroundPatient panel management and community-based care management may be viable strategies for community health centers to improve the quality of diabetes care for vulnerable patient populations. The objective of our study was to clarify implementation processes and experiences of integrating o

  7. 76 FR 53137 - Bundled Payments for Care Improvement Initiative: Request for Applications

    Science.gov (United States)

    2011-08-25

    ... payment methods. The RFA requests applications to test models centered around acute care; these models... payment approaches that reward providers who take accountability for the three-part aim at the level of... Bundled Payment for Care Improvement initiative request for applications (RFA) will test...

  8. Improving CO2 Efficiency for Recovering Oil in Heterogeneous Reservoirs

    Energy Technology Data Exchange (ETDEWEB)

    Grigg, Reid B.; Svec, Robert K.

    2003-03-10

    The work strived to improve industry understanding of CO2 flooding mechanisms with the ultimate goal of economically recovering more of the U.S. oil reserves. The principle interests are in the related fields of mobility control and injectivity.

  9. Improving work efficiency in Traffic Planning : Finnair Plc

    OpenAIRE

    Tonteri, Antti

    2015-01-01

    The purpose of the present thesis was to find out the most important improvement areas in the work of Traffic Planning team, which is part of Resource Management department at Finnair Plc. Finnair is a Finnish commercial airline focusing on the traffic between Europe and Asia. The team members have reported dissatisfaction about the working environment especially during the last two years. The objective of this this study was to identify the main problem areas and find solution(s) to improve ...

  10. Posttraumatic Stress Disorder in Rural Primary Care: Improving Care for Mental Health Following Bioterrorism

    Science.gov (United States)

    Tsao, Jennie C. I.; Dobalian, Aram; Wiens, Brenda A.; Gylys, Julius A.; Evans, Garret D.

    2006-01-01

    Context: Recent bioterrorist attacks have highlighted the critical need for health care organizations to prepare for future threats. Yet, relatively little attention has been paid to the mental health needs of rural communities in the wake of such events. A critical aspect of bioterrorism is emphasis on generating fear and uncertainty, thereby…

  11. An improved collision efficiency model for particle aggregation

    Science.gov (United States)

    Olsen, Aaron; Franks, George; Biggs, Simon; Jameson, Graeme J.

    2006-11-01

    A generalized geometric model is presented which describes the collision efficiency factor of aggregation (the probability of a binary particle or aggregate collision resulting in adhesion) for systems comprised of two oppositely charged species. Application of the general model to specific systems requires calculation of the area of each species available for collision with a second species. This is in contrast to previous models developed for polymer-particle flocculation that are based on the fractional surface coverage of adsorbed polymer. The difference between these approaches is suggested as an explanation for previously observed discrepancies between theory and observation. In the current work the specific case of oppositely charged nondeformable spherical particles (heteroaggregation) is quantitatively addressed. The optimum concentration of oppositely charged particles for rapid aggregation (maximum collision efficiency) as a function of relative particle size is calculated and an excellent correlation is found with data taken from literature.

  12. DC/DC converter with improved rectification for higher efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Maisel, Peter; Saliternig, Martin [Continental AG, Nuernberg (Germany)

    2010-07-01

    High-power dc-dc converters are an important element of the electrical system of electric vehicles and hybrid electric vehicles. These complex modular components provide the link between the high-voltage level used for the powertrain and the low-voltage bus for the lighting system, engine management and auxiliary needs in the vehicle. The essential requirements for all converters are high efficiency, compact size, lightweight and reliability. A very popular method to increase the efficiency is the synchronous rectification. Parasitic inductances in the commutation circuit and reverse recovery effects can produce a ringing with voltage overshoots at the diodes and the transistors. These spikes can cause higher average power dissipation in the seminconductors and higher EMI (electromagnetic interference).

  13. CONVERSION EFFICIENCY IMPROVEMENT FOR ENERGY CONSERVATION USING MATRIX CONVERTER

    OpenAIRE

    G.N. SURYA; SUBROTO DUTT

    2012-01-01

    Efficient conversion of electrical energy from one form to another has always been a fascinating domain for researchers. Right from the era of mercury arc rectifiers to present AC-DC-AC two stage converters and cycloconverters, efforts are consistently being laid to minimize the losses involved in conversion process. In the present study the AC-AC conversion topology known as Matrix Converter (MC), is modeled using MATLAB. Venturini’s simplified algorithm is used to determine the switch modul...

  14. Energy Efficiency Improvements in Household Refrigeration Cooling Systems

    OpenAIRE

    Björk, Erik

    2012-01-01

    This thesis is based on eight articles all related to the characteristics of the cooling system and plate evaporator of a household refrigerator. Through these articles, knowledge is provided that can be used to increase the operational efficiency in household refrigeration. Papers A, B and C focus on heat transfer and pressure drop in a commonly used free convection evaporator – the plate evaporator. Applicable correlations are suggested on how to estimate the air side heat transfer, the ref...

  15. Achromatic Fresnel Lens with Improved Efficiency for PV Systems

    Directory of Open Access Journals (Sweden)

    Mario González Montes

    2014-01-01

    Full Text Available This work is aimed to design and evaluate different achromatic Fresnel lens solutions capable of operating as concentrators aimed at photovoltaic cells systems. Throughout this study, the theoretical parametric design of the achromatic lens will be shown together with a series of simulations to verify the performance of each lens topology. The results will be compared with a standard Fresnel lens to ascertain the validity and effectiveness of the obtained design. Finally, a novel kind of hybrid lens is proposed, which combines the advantages of each type of lens (standard and Fresnel according to the optimal operating region of each design. Efficiency and concentration ratios of each particular lens are shown, regarding lens dimension, light’s incidence angle, or wavelength. Through this innovative achromatic design concentration ratios above 1000 suns, which hardly reach standard Fresnel lenses. Furthermore chromatic dispersion is minimized and the efficiency rate is over 85% of efficiency for a wide spectral range (from 350 nm to 1100 nm.

  16. Improving Woody Biomass Estimation Efficiency Using Double Sampling

    Directory of Open Access Journals (Sweden)

    B. Scott Shouse

    2012-05-01

    Full Text Available Although double sampling has been shown to be an effective method to estimate timber volume in forest inventories, only a limited body of research has tested the effectiveness of double sampling on forest biomass estimation. From forest biomass inventories collected over 9,683 ha using systematic point sampling, we examined how a double sampling scheme would have affected precision and efficiency in these biomass inventories. Our results indicated that double sample methods would have yielded biomass estimations with similar precision as systematic point sampling when the small sample was ≥ 20% of the large sample. When the small to large sample time ratio was 3:1, relative efficiency (a combined measure of time and precision was highest when the small sample was a 30% subsample of the large sample. At a 30% double sample intensity, there was a < 3% deviation from the original percent margin of error and almost half the required time. Results suggest that double sampling can be an efficient tool for natural resource managers to estimate forest biomass.

  17. Interdisciplinary diabetes care teams operating on the interface between primary and specialty care are associated with improved outcomes of care: findings from the Leuven Diabetes Project

    Directory of Open Access Journals (Sweden)

    Mathieu Chantal

    2009-10-01

    Full Text Available Abstract Background Type 2 diabetes mellitus is a complex, progressive disease which requires a variety of quality improvement strategies. Limited information is available on the feasibility and effectiveness of interdisciplinary diabetes care teams (IDCT operating on the interface between primary and specialty care. A first study hypothesis was that the implementation of an IDCT is feasible in a health care setting with limited tradition in shared care. A second hypothesis was that patients who make use of an IDCT would have significantly better outcomes compared to non-users of the IDCT after an 18-month intervention period. A third hypothesis was that patients who used the IDCT in an Advanced quality Improvement Program (AQIP would have significantly better outcomes compared to users of a Usual Quality Improvement Program (UQIP. Methods This investigation comprised a two-arm cluster randomized trial conducted in a primary care setting in Belgium. Primary care physicians (PCPs, n = 120 and their patients with type 2 diabetes mellitus (n = 2495 were included and subjects were randomly assigned to the intervention arms. The IDCT acted as a cornerstone to both the intervention arms, but the number, type and intensity of IDCT related interventions varied depending upon the intervention arm. Results Final registration included 67 PCPs and 1577 patients in the AQIP and 53 PCPs and 918 patients in the UQIP. 84% of the PCPs made use of the IDCT. The expected participation rate in patients (30% was not attained, with 12,5% of the patients using the IDCT. When comparing users and non-users of the IDCT (irrespective of the intervention arm and after 18 months of intervention the use of the IDCT was significantly associated with improvements in HbA1c, LDL-cholesterol, an increase in statins and anti-platelet therapy as well as the number of targets that were reached. When comparing users of the IDCT in the two intervention arms no significant differences

  18. Efficient Satellite Scheduling Based on Improved Vector Evaluated Genetic Algorithm

    Directory of Open Access Journals (Sweden)

    Tengyue Mao

    2012-03-01

    Full Text Available Satellite scheduling is a typical multi-peak, many-valley, nonlinear multi-objective optimization problem. How to effectively implement the satellite scheduling is a crucial research in space areas.This paper mainly discusses the performance of VEGA (Vector Evaluated Genetic Algorithm based on the study of basic principles of VEGA algorithm, algorithm realization and test function, and then improves VEGA algorithm through introducing vector coding, new crossover and mutation operators, new methods to assign fitness and hold good individuals. As a result, the diversity and convergence of improved VEGA algorithm of improved VEGA algorithm have been significantly enhanced and will be applied to Earth-Mars orbit optimization. At the same time, this paper analyzes the results of the improved VEGA, whose results of performance analysis and evaluation show that although VEGA has a profound impact upon multi-objective evolutionary research,  multi-objective evolutionary algorithm on the basis of Pareto seems to be a more effective method to get the non-dominated solutions from the perspective of diversity and convergence of experimental result. Finally, based on Visual C + + integrated development environment, we have implemented improved vector evaluation algorithm in the satellite scheduling.

  19. Improving Confidence for Self Care in Patients with Depression and Chronic Illnesses

    OpenAIRE

    Ludman, Evette J; Peterson, Do; Katon, Wayne J; Lin, Elizabeth H. B.; Von Korff, Michael; Ciechanowski, Paul; Young, Bessie; Gensichen, Jochen

    2013-01-01

    The aim of this study was to examine whether patients who received a multi-condition collaborative care intervention for chronic illnesses and depression had greater improvement in self-care knowledge and efficacy, and whether greater knowledge and self-efficacy is positively associated with improved target outcomes. A randomized controlled trial with 214 patients with comorbid depression and poorly controlled diabetes and/or coronary heart disease tested a 12-month team-based intervention th...

  20. Improving the efficiency of deconvolution algorithms for sound source localization

    DEFF Research Database (Denmark)

    Lylloff, Oliver Ackermann; Fernandez Grande, Efren; Agerkvist, Finn T.;

    2015-01-01

    The localization of sound sources with delay-and-sum (DAS) beamforming is limited by a poor spatial resolution - particularly at low frequencies. Various methods based on deconvolution are examined to improve the resolution of the beamforming map, which can be modeled by a convolution of the unkn......The localization of sound sources with delay-and-sum (DAS) beamforming is limited by a poor spatial resolution - particularly at low frequencies. Various methods based on deconvolution are examined to improve the resolution of the beamforming map, which can be modeled by a convolution...

  1. The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: a qualitative study.

    Science.gov (United States)

    Rix, Elizabeth F; Barclay, Lesley; Stirling, Janelle; Tong, Allison; Wilson, Shawn

    2015-01-01

    Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the "costly" crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family-focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal-led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system.

  2. The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: a qualitative study.

    Science.gov (United States)

    Rix, Elizabeth F; Barclay, Lesley; Stirling, Janelle; Tong, Allison; Wilson, Shawn

    2015-01-01

    Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the "costly" crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family-focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal-led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system. PMID:25056441

  3. Prescription data improve the medication history in primary care

    DEFF Research Database (Denmark)

    Glintborg, Bente; Andersen, S K; Poulsen, H E

    2010-01-01

    Incomplete medication lists increase the risk of medication errors and adverse drug effects. In Denmark, dispensing data and pharmacy records are available directly online to treating physicians. We aimed (1) to describe if use of pharmacy records improved the medication history among patients...

  4. Development of a Medical Care Terminal for Efficient Monitoring of Bedridden Subjects

    Directory of Open Access Journals (Sweden)

    Filipe Pereira

    2016-01-01

    Full Text Available This work is developed in the context of Ambient Assisted Living (AAL and has as main objective the development of a mechatronic system that allows the care of bedridden patients with ongoing medical care handled by a single person. The developed Medical Care Terminal (MCT improves autonomy in home care, safety, comfort, and hygiene of bedridden patients. The MCT has six biomedical sensors and four environmental sensors. Data acquisition and processing is performed using Arduino and LabVIEW platforms, respectively. The proposed solution has, as main feature, its adaptability to the patient needs. One of the MCT functionalities is the remote access to the patient data through the web. The caregiver may request help from a specialist who sends back information in real time to perform first aid assistance. This device has a flexible configuration allowing a fast and cheap reconfiguration according the specific needs of the patient. The proposed mechatronic system intends to meet the needs of bedridden patients improving their quality of life, health, safety, and comfort, while enabling the remote monitoring of the patients.

  5. How to Further Decrease the Efficiency of Care at a Level I Trauma Center: Implement the Amended Resident Work Hours.

    Science.gov (United States)

    Schroeppel, Thomas J; Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Croce, Martin A; Fabian, Timothy C

    2015-07-01

    Work-hour restrictions were amended in 2011 to limit interns to 16 continuous duty hours, essentially requiring a night float system of 12-hour shifts. We hypothesize that there has been no improvement in outcomes after implementation of the amended work-hour restrictions. Outcomes from trauma admissions were queried from the trauma registry from 2009 to 2011 (PRE) and 2011 to 2013 (POST). The primary outcome was mortality with secondary outcomes intensive care unit length of stay (LOS)and LOS. Patients were stratified based on age, mechanism, gender, blood pressure, heart rate, and injury severity (Injury Severity Score, Glasgow Coma Scale, Base Deficit). Outcomes were then compared from admissions PRE to POST. A total of 9178 patients were included in the study population. The mean age was 42 with most being male (72%) and blunt mechanism (81%). Patient populations were well matched except patients in the POST period were slightly older (43 vs 42 years; P = 0.01). Intensive care unit LOS and LOS were higher in the POST period. After adjusted analysis, admission in the POST period was not a predictor of mortality (odds ratio 0.857; confidence interval 0.655-1.12). The POST period was an independent predictor for LOS (β = 0.74; P = 0.002). This study adds to the mounting evidence that the implementation of the amended limits on work hours leads to furthermore decreased efficiency of care.

  6. Improving efficiency of sugarcane genotype selection in Florida

    Science.gov (United States)

    The Canal Point (CP) sugarcane (Saccharum spp.) breeding program has consistently developed high yielding cultivars for the organic (muck) soils of South Florida, but cultivar development has not been as successful for sand soils in this region. The objective of this study was to improve this progra...

  7. Improving radiation use efficiency in greenhouse production systems

    NARCIS (Netherlands)

    Li, Tao

    2015-01-01

    SUMMARY A large increase in agricultural production is needed to feed the increasing world population with their increasing demand per capita. However, growing competition for arable land, water, energy, and the degradation of the environment impose challenges to improve crop produc

  8. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities.

    Science.gov (United States)

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high

  9. Pilot program to improve self-management of patients with heart failure by redesigning care coordination.

    Science.gov (United States)

    Shaw, Jessica D; O'Neal, Daniel J; Siddharthan, Kris; Neugaard, Britta I

    2014-01-01

    Objectives. We tested both an educational and a care coordination element of health care to examine if better disease-specific knowledge leads to successful self-management of heart failure (HF). Background. The high utilization of health care resources and poor patient outcomes associated with HF justify tests of change to improve self-management of HF. Methods. This prospective study tested two components of the Chronic Care Model (clinical information systems and self-management support) to improve outcomes in the self-management of HF among patients who received intensive education and care coordination during their acute care stay. A postdischarge follow-up phone call assessed their knowledge of HF self-management compared to usual care patients. Results. There were 20 patients each in the intervention and usual care groups. Intervention patients were more likely to have a scale at home, write down their weight, and practice new or different health behaviors. Conclusion. Patients receiving more intensive education knew more about their disease and were better able to self-manage their weight compared to patients receiving standard care.

  10. Pilot Program to Improve Self-Management of Patients with Heart Failure by Redesigning Care Coordination

    Directory of Open Access Journals (Sweden)

    Jessica D. Shaw

    2014-01-01

    Full Text Available Objectives. We tested both an educational and a care coordination element of health care to examine if better disease-specific knowledge leads to successful self-management of heart failure (HF. Background. The high utilization of health care resources and poor patient outcomes associated with HF justify tests of change to improve self-management of HF. Methods. This prospective study tested two components of the Chronic Care Model (clinical information systems and self-management support to improve outcomes in the self-management of HF among patients who received intensive education and care coordination during their acute care stay. A postdischarge follow-up phone call assessed their knowledge of HF self-management compared to usual care patients. Results. There were 20 patients each in the intervention and usual care groups. Intervention patients were more likely to have a scale at home, write down their weight, and practice new or different health behaviors. Conclusion. Patients receiving more intensive education knew more about their disease and were better able to self-manage their weight compared to patients receiving standard care.

  11. Patient safety culture in hospital settings : Measurements, health care staff perceptions and suggestions for improvement

    OpenAIRE

    Nordin, Anna

    2015-01-01

    The aim was to psychometrically test the S-HSOPSC and HSOPSC, investigate health care staff’s perceptions of patient safety culture and their suggestions for improvement. Methods: A three-time cross-sectional study with data from health care staff (N= 3721) in a Swedish county council was conducted in 2009 (N = 1,023), 2011 (N = 1,228) and 2013 (N =1,470) using the S-HSOPSC (I, II, III). Health care staff’s suggestions for improvement were analyzed in a qualitative content analysis study (IV)...

  12. Reductions in inpatient mortality following interventions to improve emergency hospital care in Freetown, Sierra Leone.

    Directory of Open Access Journals (Sweden)

    Matthew Clark

    Full Text Available BACKGROUND: The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children's hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. METHODS AND FINDINGS: A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children's Hospital, Freetown, Sierra Leone. Following focus group discussions, five priority areas were identified to improve emergency care; staff training, hospital layout, staff allocation, medical equipment, and medical record keeping. A team of international volunteers worked with local staff for six months to design and implement improvements in these five priority areas. The improvements were evaluated collectively rather than individually. Before the intervention, the inpatient mortality rate was 12.4%. After the intervention this improved to 5.9%. The relative risk of dying was 47% (95% CI 0.369-0.607 lower after the intervention. The estimated number of lives saved in the first two months after the intervention was 103. The total cost of the intervention was USD 29 714, the estimated cost per death averted was USD 148. There are two main limitation of the study. Firstly, the brevity of the study and secondly, the assumed homogeneity of the clinical cases that presented to the hospital before and after the intervention. CONCLUSIONS: This study demonstarted a signficant reductuion in inpatient mortality rate after an intervention to improve emergency hospital care If the findings of this paper could be reproduced in a larger more rigorous study, improving the quality of care in hospitals would be a very cost effective strategy to save children's lives in low resource settings.

  13. Improving COPD Care in a Medically Underserved Primary Care Clinic: A Qualitative Study of Patient Perspectives.

    Science.gov (United States)

    Glasser, Irene; Wang, Fei; Reardon, Jane; Vergara, Cunegundo D; Salvietti, Ralph; Acevedo, Myrtha; Santana, Blanca; Fortunato, Gil

    2016-10-01

    We conducted a focus group study in an urban hospital-based primary care teaching clinic serving an indigent and Hispanic (predominantly Puerto Rican) population in New England in order to learn how patients with Chronic Obstructive Lung Disease (COPD) perceive their disease, how they experience their medical care, and the barriers they face managing their disease and following medical recommendations. The research team included medical doctors, nurses, a medical anthropologist, a clinical pharmacist, a hospital interpreter, and a systems analyst. Four focus groups were conducted in Spanish and English in April and May 2014. The demographic characteristics of the 25 focus group participants closely reflected the demographics of the total COPD clinic patients. The participants were predominantly female (72%) and Hispanic (72%) and had a median age of 63. The major themes expressed in the focus groups included: problems living with COPD; coping with complexities of comorbid illnesses; challenges of quitting smoking and maintaining cessation; dealing with second-hand smoke; beliefs and myths about quitting smoking; difficulty paying for and obtaining medications; positive experiences obtaining and managing medications; difficulties in using sleep machines at home; expressions of disappointment with the departure of their doctors; and overall satisfaction with the clinic health care providers. The study led to the creation of an action plan that addresses the concerns expressed by the focus study participants. The action plan is spearheaded by a designated bilingual and bicultural nurse and is now in operation. PMID:26807853

  14. Improving COPD Care in a Medically Underserved Primary Care Clinic: A Qualitative Study of Patient Perspectives.

    Science.gov (United States)

    Glasser, Irene; Wang, Fei; Reardon, Jane; Vergara, Cunegundo D; Salvietti, Ralph; Acevedo, Myrtha; Santana, Blanca; Fortunato, Gil

    2016-10-01

    We conducted a focus group study in an urban hospital-based primary care teaching clinic serving an indigent and Hispanic (predominantly Puerto Rican) population in New England in order to learn how patients with Chronic Obstructive Lung Disease (COPD) perceive their disease, how they experience their medical care, and the barriers they face managing their disease and following medical recommendations. The research team included medical doctors, nurses, a medical anthropologist, a clinical pharmacist, a hospital interpreter, and a systems analyst. Four focus groups were conducted in Spanish and English in April and May 2014. The demographic characteristics of the 25 focus group participants closely reflected the demographics of the total COPD clinic patients. The participants were predominantly female (72%) and Hispanic (72%) and had a median age of 63. The major themes expressed in the focus groups included: problems living with COPD; coping with complexities of comorbid illnesses; challenges of quitting smoking and maintaining cessation; dealing with second-hand smoke; beliefs and myths about quitting smoking; difficulty paying for and obtaining medications; positive experiences obtaining and managing medications; difficulties in using sleep machines at home; expressions of disappointment with the departure of their doctors; and overall satisfaction with the clinic health care providers. The study led to the creation of an action plan that addresses the concerns expressed by the focus study participants. The action plan is spearheaded by a designated bilingual and bicultural nurse and is now in operation.

  15. Improving energy efficiency in robot limbs through hydraulic dangle

    Science.gov (United States)

    Whitman, Julian S.; Meller, Mike; Garcia, Ephrahim

    2015-03-01

    Animals often allow their limbs to swing passively under their own inertia. For example, about 40% of a human walking gait consists of the primarily passive swing phase. Current hydraulic robots employ traditional actuation methods in which fluid power is expended for all limb movements, even when passive dynamics could be utilized. "Dangle" is the ability to allow a hydraulic actuator to freely sway in response to external loads, in which both sides of the actuator are disconnected from pressure and connected to the tank. Dangle offers the opportunity for efficiency gains by enabling the use of momentum, gravity, and external loads to move a limb without expending fluid power. To demonstrate these efficiency gains, this paper presents an experiment that compares the fluid power consumed to actuate a two degree of freedom hydraulic leg following a human walking gait cycle trajectory in both a traditional manner and utilizing dangle. It was shown that the use of dangle can decrease fluid power consumption by 20% by utilizing pendular dynamics during the swing phase. At speeds higher than the free dangling rate, more power must be used to maintain the desired trajectory due to damping inherent in the configuration. The use of dangle as a power saving method when driving hydraulic limbs could increase operation time for untethered hydraulic walking robots.

  16. Efficiency improvement of silicon nanostructure-based solar cells

    International Nuclear Information System (INIS)

    Solar cells based on a high-efficiency silicon nanostructure (SNS) were developed using a two-step metal-assisted electroless etching (MAEE) technique, phosphorus silicate glass (PSG) doping and screen printing. This process was used to produce solar cells with a silver nitrate (AgNO3) etching solution in different concentrations. Compared to cells produced using the single MAEE technique, SNS-based solar cells produced with the two-step MAEE technique showed an increase in silicon surface coverage of ∼181.1% and a decrease in reflectivity of ∼144.3%. The performance of the SNS-based solar cells was found to be optimized (∼11.86%) in an SNS with a length of ∼300 nm, an aspect ratio of ∼5, surface coverage of ∼84.9% and a reflectivity of ∼6.1%. The ∼16.8% increase in power conversion efficiency (PCE) for the SNS-based solar cell indicates good potential for mass production. (paper)

  17. Improving Charge-Collection Efficiency of Kyoto's SOI Pixel Sensors

    CERN Document Server

    Matsumura, Hideaki; Tanaka, Takaaki; Takeda, Ayaki; Ito, Makoto; Ohmura, Syunichi; Arai, Yasuo; Mori, Koji; Nishioka, Yusuke; Takenaka, Ryota; Kohmura, Takayoshi

    2015-01-01

    We have been developing X-ray SOIPIXs for next-generation satellites for X-ray astronomy. Their high time resolution ($\\sim10~\\mu$s) and event-trigger-output function enable us to read out without pile-ups and to use anti-coincidence systems. Their performance in imaging spectroscopy is comparable to that in the CCDs. A problem in our previous model was degradation of charge-collection efficiency (CCE) at pixel borders. We measured the response in the sub-pixel scale, using finely collimated X-ray beams at $10~\\mu$m\\Phi$ at SPring-8, and investigated the non-uniformity of the CCE within a pixel. We found that the X-ray detection efficiency and CCE degrade in the sensor region under the pixel circuitry placed outside the buried p-wells (BPW). A 2D simulation of the electric fields shows that the isolated pixel-circuitry outside the BPW creates local minimums in the electric potentials at the interface between the sensor and buried oxide layers. Thus, a part of signal charge is trapped there and is not collecte...

  18. Study on Efficiency Improvement of Hermetic Rotary Compressors

    Science.gov (United States)

    Matsushima, Masatoshi; Nomura, Tomohiro; Nishimura, Nobuya; Iyota, Hiroyuki; Inaba, Koichi

    This research was conducted in order to better identify the torque loss of a hermetic rotary compressor for one revolution, and to directly obtain the actual shaft power of the compressor. A testing compressor and a gas cycle type simplified calorimeter were developed for direct measurement of the compressor torque. A strain gauge was stuck on the shaft between a compressor and a motor. Thus, the compressor torque could be measured directly by the strain gauge and data were transmitted to out of the compressor's vessel through a slip ring. Rotational speed of the compressor was measured by using a gap sensor also. From these measurement results, actual shaft power was calculated experimentally. On the other hand, effective compressive torque for compressing refrigerant gas was predicted theoretically. From both experimental and theoretical results, torque loss of the compressor was determined as the difference of the compressor torque from the effective compressive torque. Consequently, a loss of over-compression could be revealed from the torque loss experimentally. Furthermore, overall adiabatic efficiencies of compressors obtained by the actual shaft power were 1.1∼3.5% higher than former overall adiabatic efficiencies obtained by the motor output.

  19. A woman-led approach to improving postnatal care.

    Science.gov (United States)

    Fryer-Croxall, Claire; Bailey, Elizabeth

    2014-01-01

    As a large NHS teaching trust we see 6,000 women a year who birth with us. Newly appointed as a modern matron, I noted that poor experience on our postnatal ward has always been a key issue in the complaints we receive and from the feedback that our women give to us. The ImPosE (improving postnatal experience) project was launched in December 2013. This brought together members of the multidisciplinary team who were committed to developing our postnatal ward and improving it for our women and their families. We used a quality management approach, putting 'customer' experience at the core, and implemented a varied package of changes as directed by feedback from service users.

  20. Exercise And Heart Failure: Advancing Knowledge And Improving Care

    Science.gov (United States)

    Alvarez, Paulino; Hannawi, Bashar; Guha, Ashrith

    2016-01-01

    Exercise limitation is the hallmark of heart failure, and an increasing degree of intolerance is associated with poor prognosis. Objective evaluation of functional class (e.g., cardiopulmonary exercise testing) is essential for adequate prognostication in patients with advanced heart failure and for implementing an appropriate exercise training program. A graded exercise program has been shown to be beneficial in patients with heart failure and has become an essential component of comprehensive cardiac rehabilitation in these patients. An exercise program tailored to the patient's preferences, possibilities, and physiologic reserve has the greatest chance of being successful. Despite being safe, effective, and a guideline-recommended treatment to improve quality of life, exercise training remains grossly underutilized. Patient, physician, insurance and practice barriers need to be addressed to improve this quality gap. PMID:27486494

  1. Prescription data improve the medication history in primary care

    DEFF Research Database (Denmark)

    Glintborg, Bente; Andersen, S K; Poulsen, H E

    2010-01-01

    Incomplete medication lists increase the risk of medication errors and adverse drug effects. In Denmark, dispensing data and pharmacy records are available directly online to treating physicians. We aimed (1) to describe if use of pharmacy records improved the medication history among patients...... consulting their general practitioner and (2) to characterise inconsistencies between the medication history reported by the patient and the general practitioner's recordings....

  2. Innovative semielliptical seismic pattern improving line-change efficiency

    Science.gov (United States)

    Walus, Artur; Gucma, Lucjan; Bąk, Andrzej

    2016-08-01

    The paper presents a new method for conducting turns by vessels towing seismic cables. A comparison was made between the traditional way of turning to indicate the advantages of the proposed pattern. In order to improve the overview of the complete geometry of a towed streamer system, a model of marine seismic research quality coefficients was applied. The turning method was tested onboard a seismic vessel towing eight streamers of 6 km in length. A significant reduction of time required for line-change was achieved (up to 45 % depending on ocean current speed and direction, speed of the vessel, skills of navigating team). The introduced quality coefficient of geophysical research works is based on the mathematical model of positions deviation of streamers geophones with relation to their idealized position. The model was created to be used while the vessel is on a steady course to improve the quality of acquired data; however, it was found useful during line changes as well.

  3. Improving efficiencies in logistics operations by converging tangible & intangible aspects

    OpenAIRE

    Gurkirat Singh; Sanjay Sharma; Pankaj Maan

    2012-01-01

    The principal objective of this paper is to conceptualize the scope of improving the responsiveness of logistics by eradicating the restrictions posed by unnecessary delays and human factors, in conjunction with underscoring the positive externalities that will emerge as societal benefits. Various attributes like ‘idle time’, ‘geographical & regional aspects’, ‘truckers limitations’, and ‘uncertainties’ have been taken into consideration to expand the outlook of logistics operations. This pap...

  4. Profit of Chemical Fibre Industry Surges on Efficiency Improvement

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    According to data collected from 1935 statistics-worthy Chinese chemical fibre enterprises surveyed by National Bureau of Statistics of China, the total profits reached CNY8.066 billion in Jan. -May, 2010, up 200.08 per cent y/y, 234.78 percentage points higher than the Jan.-May 2009 period. Technology improvement and industrial structural adjustment played a very major role on profi t growth.

  5. Active filter to improve the energetic efficiency in electric installations.

    OpenAIRE

    Amarís Duarte, Hortensia; Robles Muñoz, Guillermo

    2009-01-01

    The Department of Electrical Engineering of the University Carlos III of Madrid has developed a prototype of active filter to compensate the disturbances that a nonlinear load produces. The active filters appears like the dynamic solution that best fits to the needs of compensation of electrical disturbances in industrial facilities. This active filter allows correcting the power factor of the installation. With this improvement, electrical consumes are reduced, which results in significa...

  6. Interdisciplinary diabetes care teams operating on the interface between primary and specialty care are associated with improved outcomes of care: findings from the Leuven Diabetes Project.

    NARCIS (Netherlands)

    Borgermans, L.D.A.; Goderis, G.; Broeke, C. Van Den; Verbeke, G.; Carbonez, A.; Ivanova, A.; Mathieu, C.; Aertgeerts, B.; Heyrman, J.; Grol, R.P.T.M.

    2009-01-01

    BACKGROUND: Type 2 diabetes mellitus is a complex, progressive disease which requires a variety of quality improvement strategies. Limited information is available on the feasibility and effectiveness of interdisciplinary diabetes care teams (IDCT) operating on the interface between primary and spec

  7. Improving confidence for self care in patients with depression and chronic illnesses.

    Science.gov (United States)

    Ludman, Evette J; Peterson, Do; Katon, Wayne J; Lin, Elizabeth H B; Von Korff, Michael; Ciechanowski, Paul; Young, Bessie; Gensichen, Jochen

    2013-01-01

    The aim of this study was to examine whether patients who received a multicondition collaborative care intervention for chronic illnesses and depression had greater improvement in self-care knowledge and efficacy, and whether greater knowledge and self-efficacy was positively associated with improved target outcomes. A randomized controlled trial with 214 patients with comorbid depression and poorly controlled diabetes and/or coronary heart disease tested a 12-month team-based intervention that combined self-management support and collaborative care management. At 6 and 12 month outcomes the intervention group showed significant improvements over the usual care group in confidence in ability to follow through with medical regimens important to managing their conditions and to maintain lifestyle changes even during times of stress. Improvements in self care-efficacy were significantly related to improvements in depression, and early improvements in confidence to maintain lifestyle changes even during times of stress explained part of the observed subsequent improvements in depression. PMID:23398269

  8. Improving the Efficiency and Ease of Healthcare Analysis Through Use of Data Visualization Dashboards.

    Science.gov (United States)

    Stadler, Jennifer G; Donlon, Kipp; Siewert, Jordan D; Franken, Tessa; Lewis, Nathaniel E

    2016-06-01

    The digitization of a patient's health record has profoundly impacted medicine and healthcare. The compilation and accessibility of medical history has provided clinicians an unprecedented, holistic account of a patient's conditions, procedures, medications, family history, and social situation. In addition to the bedside benefits, this level of information has opened the door for population-level monitoring and research, the results of which can be used to guide initiatives that are aimed at improving quality of care. Cerner Corporation partners with health systems to help guide population management and quality improvement projects. With such an enormous and diverse client base-varying in geography, size, organizational structure, and analytic needs-discerning meaning in the data and how they fit with that particular hospital's goals is a slow, difficult task that requires clinical, statistical, and technical literacy. This article describes the development of dashboards for efficient data visualization at the healthcare facility level. Focusing on two areas with broad clinical importance, sepsis patient outcomes and 30-day hospital readmissions, dashboards were developed with the goal of aggregating data and providing meaningful summary statistics, highlighting critical performance metrics, and providing easily digestible visuals that can be understood by a wide range of personnel with varying levels of skill and areas of expertise. These internal-use dashboards have allowed associates in multiple roles to perform a quick and thorough assessment on a hospital of interest by providing the data to answer necessary questions and to identify important trends or opportunities. This automation of a previously manual process has greatly increased efficiency, saving hours of work time per hospital analyzed. Additionally, the dashboards have standardized the analysis process, ensuring use of the same metrics and processes so that overall themes can be compared across

  9. IMPROVING THE LABOUR COSTS EFFICIENCY AT UKRAINIAN ENTERPRISES

    Directory of Open Access Journals (Sweden)

    Olga Sukach

    2014-04-01

    Full Text Available Generally, labor costs are more complicated than other inputs. But wages and labor productivity in Ukraine are significantly lower than in the market economies. Also the share of the basic wages consisted by 61.1 per cent at Ukrainian enterprises. While, the developed countries keep a basic wage at the rate of about 80-85 per cent. Consequently, wage is transformed into one of the version of a social assistance, which in less degree dependents on the results. The main purpose of the article is a theoretical studied of a system of economic indicators of labor costs efficiency and a critical analysis of their calculations in Ukrainian enterprises and abroad. In support of correlation between the share of basic wages and labor productivity the multiplicative model of labor productivity is developed and was practically used by the author on one of Ukrainian enterprises.

  10. Calculation and Improvement on External Quantum Efficiency of OLEDs

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    The calculation of the external quantum efficiency(ηext) of organic light-emitting devices(OLEDs) is presented theoretically. The basic idea is to obtain ηext by calculating the fraction of the generated light that can escape through the top surface and the average transmittance over the escape cone. During the calculation, the effects of the interference, absorption and multiple reflections are neglected. Then a result of a typical 8-tris-hydroxyquinoline aluminum(Alq3)-based OLEDs on a planar glass substrate is obtained. And a twice increase in ηext can be achieved by using a high-index-glass substrate with an antireflection coating(SiO2) on substrate surface.

  11. FORSCOM installation characterization and ranking for water efficiency improvement

    Energy Technology Data Exchange (ETDEWEB)

    Fitzpatrick, Q.K.; McMordie, K.L.; Di Massa, F.V. [and others

    1995-05-01

    On March 11, 1994, President Clinton signed Executive Order 12902-Energy Efficiency and Water Conservation at Federal Facilities. Section 302 of the Executive Order calls for energy and water prioritization surveys of federal facilities to be conducted. The surveys will be used to establish priorities for conducting comprehensive facility audits. In response to the requirements of the Executive Order, the U.S. Army Forces Command (FORSCOM) has tasked Pacific Northwest Laboratory (PNL) to initiate a broad study of the water savings potential at each of its major installations. This report provides an assessment of the water, sewer, energy (for hot water production and pumping), and associated cost savings potential at ten of the major FORSCOM installations. This assessment is meant to be a {open_quotes}first pass{close_quotes} estimate of the water savings potential, to assist FORSCOM in prioritizing installations for detailed water audits and potential water efficient retrofits. In addition, the end uses (toilets, sinks, showerheads, irrigation, etc.) with the greatest water savings potential are identified at each installation. This report is organized in the following manner. Following this Introduction, Section 2 provides important background information pertaining to the water analysis. Section 3 describes the methodology employed in the analysis, and Section 4 summarizes the study results. Section 5 prioritizes the installations based on both water/sewer savings and cost associated with water, sewer, and energy savings. Section 6 provides recommendations on where to start detailed water audits, as well as other recommendations. References are listed in Section 7. The appendices provide specific information on the analysis results and methodology, along with a discussion of special issues.

  12. A revolutionary concept to improve the efficiency of IC antennas

    Energy Technology Data Exchange (ETDEWEB)

    Milanesio, D.; Maggiora, R. [Politecnico di Torino, Dipartimento di Elettronica e Telecomunicazioni (DET), Torino (Italy)

    2014-02-12

    The successful design of an Ion Cyclotron (IC) antenna mainly relies on the capability of coupling high power to the plasma (MW), feature that is currently reached by allowing rather high voltages (tens of kV) on the unavoidable unmatched part of the feeding lines. This requirement is often responsible of arcs along the transmission lines and other unwanted phenomena that considerably limit the usage of IC launchers. In this work, we suggest and describe a revolutionary approach based on high impedance surfaces, which allows to increase the antenna radiation efficiency and, hence, to highly reduce the imposed voltages to couple the same level of power to the plasma. High-impedance surfaces are periodic metallic structures (patches) displaced usually on top of a dielectric substrate and grounded by means of vertical posts usually embedded inside a dielectric, in a mushroom-like shape. In terms of working properties, high impedance surfaces are electrically thin in-phase reflectors, i.e. they present a high impedance, within a given frequency band, such that the image currents are in-phase with the currents of the antenna itself, thus determining a significant efficiency increase. While the usual design of a high impedance surface requires the presence of a dielectric layer, some alternative solutions can be realized in vacuum, taking advantage of double layers ofmetallic patches. After an introductory part on the properties of high impedance surfaces, this work documents both their design by means of numerical codes and their implementation on a scaled mock-up.

  13. Scotland's Knowledge Network: translating knowledge into action to improve quality of care.

    Science.gov (United States)

    Wales, A; Graham, S; Rooney, K; Crawford, A

    2012-11-01

    The Knowledge Network (www.knowledge.scot.nhs.uk) is Scotland's online knowledge service for health and social care. It is designed to support practitioners to apply knowledge in frontline delivery of care, helping to translate knowledge into better health-care outcomes through safe, effective, person-centred care. The Knowledge Network helps to combine the worlds of evidence-based practice and quality improvement by providing access to knowledge about the effectiveness of clinical interventions ('know-what') and knowledge about how to implement this knowledge to support individual patients in working health-care environments ('know-how'). An 'evidence and guidance' search enables clinicians to quickly access quality-assured evidence and best practice, while point of care and mobile solutions provide knowledge in actionable formats to embed in clinical workflow. This research-based knowledge is complemented by social networking services and improvement tools which support the capture and exchange of knowledge from experience, facilitating practice change and systems improvement. In these cases, the Knowledge Network supports key components of the knowledge-to-action cycle--acquiring, creating, sharing and disseminating knowledge to improve performance and innovate. It provides a vehicle for implementing the recommendations of the national Knowledge into Action review, which outlines a new national approach to embedding knowledge in frontline practice and systems improvement.

  14. THE ORGANIZATION WORKS TO IMPROVE THE CLINICAL AND ECONOMIC OUTCOMES OF CARE FOR PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    O. I. Apolikhin

    2015-01-01

    Programme on the territory of theVoronezh region they deployed 7 Interdistrict (ITC and 1 regional centre. The most difficult clinical cases were sent to the Federal urology center - research Institute of urology. They humiliated 140 experts from the region, with 80 of them they studied using remote sensing technology. For the realisation of the Program it was established an Advisory portal NetHealth.ru, which considered 498 clinical cases of prostate cancer, with 28 of specialists in various stages of the region took an active part in distance counseling.      From 2009 to 2013 an improvement of a number of indicators was marked: increase in the absolute number of patients with newly diagnosed prostate cancer from 451 to 603 cases, a localized increase in the share stages with 60.3% to 71.2 %, a decrease of deaths within one year from the date of diagnosis for prostate cancer from 14.6% to 6.5% and deaths among all registered patients with prostate cancer from 10.4% to 5.5%, reducing the proportion of clinically insignificant PCA from 36.4 to 14.1%.Conclusions. "PC module" of integrated phased standardized program "Urology" is a universal tool for solving the problems of improving the organization of medical care for prostate cancer, as well as the principles of operation can be used in other diseases of urology and other medical fields. Clinical and economic efficiency and the versatility of the basis for its recommendations as a priority in the organization of medical care at a cancer on the entire territory of the Russian Federation.

  15. Improving cancer care in India: prospects and challenges.

    Science.gov (United States)

    Pal, Sanjoy Kumar; Mittal, Balraj

    2004-01-01

    The World Cancer Report, a 351 - page global report issued by International Agency for Research on Cancer (IARC) tells us that cancer rates are set to increase at an alarming rate globally (Stewart and Kleiues 2003). Cancer rates could increase by 50 % to 15 million new cases in the year 2020. This will be mainly due to steadily aging populations in both developed and developing countries and also to current trends in smoking prevalence and the growing adoption of unhealthy lifestyles. The report also reveals that cancer has emerged as a major public health problem in developing countries, matching its effect in industrialized nations. Healthy lifestyles and public health action by governments and health practitioners could stem this trend, and prevent as many as one third of cancers worldwide. In a developing country such as India there has been a steady increase in the Crude Incidence Rate (CIR) of all cancers affecting both men and women over the last 15 years. The increase reported by the cancer registries is nearly 12 per cent from 1985 to 2001, representing a 57 per cent rise in India's cancer burden. The total number of new cases, which stood at 5.3 lakhs Care lakh is 100,000 in 1985 has risen to over 8.3 lakhs today. The pattern of cancers has changed over the years, with a disturbing increase in cases that are linked to the use of tobacco. In 2003, there were 3.85 lakhs of cases coming under this category in comparison with 1.94 lakhs cases two decades ago. Lung cancer is now the second most common cancer among men. Earlier, it was in fifth place. Among women in urban areas, cancer of the uterine cervix had the highest incidence 15 years ago, but it has now been overtaken by breast cancer. In rural areas, cervical cancer remains the most common form of the disease (The Hindu 2004). PMID:15244530

  16. Follow-up care for breast cancer survivors: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Chopra I

    2014-08-01

    Full Text Available Ishveen Chopra,1 Avijeet Chopra2 1Department of Pharmacy Administration, Duquesne University, Pittsburgh, PA, USA; 2Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT, USA Background: Appropriate follow-up care is important for improving health outcomes in breast cancer survivors (BCSs and requires determination of the optimum intensity of clinical examination and surveillance, assessment of models of follow-up care such as primary care-based follow-up, an understanding of the goals of follow-up care, and unique psychosocial aspects of care for these patients. The objective of this systematic review was to identify studies focusing on follow-up care in BCSs from the patient's and physician's perspective or from patterns of care and to integrate primary empirical evidence on the different aspects of follow-up care from these studies. Methods: A comprehensive literature review and evaluation was conducted for all relevant publications in English from January 1, 1990 to December 31, 2013 using electronic databases. Studies were included in the final review if they focused on BCS’s preferences and perceptions, physician's perceptions, patterns of care, and effectiveness of follow-up care. Results: A total of 47 studies assessing the different aspects of follow-up care were included in the review, with a majority of studies (n=13 evaluating the pattern of follow-up care in BCSs, followed by studies focusing on BCS's perceptions (n=9 and preferences (n=9. Most of the studies reported variations in recommended frequency, duration, and intensity of follow-up care as well as frequency of mammogram screening. In addition, variations were noted in patient preferences for type of health care provider (specialist versus non-specialist. Further, BCSs perceived a lack of psychosocial support and information for management of side effects. Conclusion: The studies reviewed, conducted in a range of settings, reflect variations in

  17. Pathways for improving the nitrogen efficiency of grazing bovines

    OpenAIRE

    Hoekstra, N.J.

    2007-01-01

    Livestock production has been identified as a major source of nitrogen (N) losses in agro-ecosystems. N excreted in dung and urine contributes to environmental N pollution either as ammonia and N oxides in air, or as nitrate in soil and ground water. Therefore, it is important to reduce N output through animal excretions by improving N utilisation by the animal. Bovine N utilisation can be increased substantially through changing the composition of the diet. In many parts of Europe, a large p...

  18. 75 FR 27341 - Increasing Market and Planning Efficiency Through Improved Software; Notice of Technical...

    Science.gov (United States)

    2010-05-14

    ... together diverse experts from ISOs/RTOs, the software industry, government, research centers and academia... adopted into market operation software. Smarter software is a valuable tool for improving the efficiency... Energy Regulatory Commission Increasing Market and Planning Efficiency Through Improved Software;...

  19. EQUIP: Implementing chronic care principles and applying formative evaluation methods to improve care for schizophrenia: QUERI Series

    Directory of Open Access Journals (Sweden)

    Chinman Matthew J

    2008-02-01

    Full Text Available Abstract Background This paper presents a case study that demonstrates the evolution of a project entitled "Enhancing QUality-of-care In Psychosis" (EQUIP that began approximately when the U.S. Department of Veterans Affairs' Quality Enhancement Research Initiative (QUERI, and implementation science were emerging. EQUIP developed methods and tools to implement chronic illness care principles in the treatment of schizophrenia, and evaluated this implementation using a small-scale controlled trial. The next iteration of the project, EQUIP-2, was further informed by implementation science and the use of QUERI tools. Methods This paper reports the background, development, results and implications of EQUIP, and also describes ongoing work in the second phase of the project (EQUIP-2. The EQUIP intervention uses implementation strategies and tools to increase the adoption and implementation of chronic illness care principles. In EQUIP-2, these strategies and tools are conceptually grounded in a stages-of-change model, and include clinical and delivery system interventions and adoption/implementation tools. Formative evaluation occurs in conjunction with the intervention, and includes developmental, progress-focused, implementation-focused, and interpretive evaluation. Results Evaluation of EQUIP provided an understanding of quality gaps and how to address related problems in schizophrenia. EQUIP showed that solutions to quality problems in schizophrenia differ by treatment domain and are exacerbated by a lack of awareness of evidence-based practices. EQUIP also showed that improving care requires creating resources for physicians to help them easily implement practice changes, plus intensive education as well as product champions who help physicians use these resources. Organizational changes, such as the addition of care managers and informatics systems, were shown to help physicians with identifying problems, making referrals, and monitoring follow

  20. Thermal efficiency improvement for a hydrogen-air fired regenerative micro gas turbine cycle

    Energy Technology Data Exchange (ETDEWEB)

    Nasr, A.A.; Jedi, A.S. [Higher Inst. of Engineering-Hoon, Hoon (Libya). Mechanical Engineering Dept.; Gringo, A.O. [Higher Inst. of Engineering-Hoon, Hoon (Libya). Physics Dept.; Bennaser, A.Y. [Higher Inst. of Engineering-Hoon, Hoon (Libya). Energy Studies

    2008-07-01

    Potential application of high temperature of air-combustors has been described in a number of publications. This is because of its environmental advantages as well as its expected performance This paper is a continuation to our previous work [1] aiming at improving the performance of a micro-gas turbine unit. The work was originally carried out by a group of researchers of Tohoku University in Japan [2]. Indeed we found out some improvement in the cycle thermal efficiency of the cycle under the same operation conditions. The cycle thermal efficiency was further improved by increasing turbine pressure ratio by introducing a steam condenser into the cycle. Proper selection of combustor and regenerator materials-ceramic in particular-to withstand higher temperature values and attain better regenerator effectiveness as well, improves the cycle efficiency On the other hand, better selection of turbine materials, should improve the cycle efficiency due to internal efficiency increase. (orig.)