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. Teleglaucoma: Improving access and efficiency for glaucoma care

    Directory of Open Access Journals (Sweden)

    Faazil Kassam

    2013-01-01

    Full Text Available 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.

  4. Teleglaucoma: Improving access and efficiency for glaucoma care

    OpenAIRE

    Faazil Kassam; Kanagasingam Yogesan; Enitan Sogbesan; 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 emerge...

  5. Integrating Hospital Administrative Data to Improve Health Care Efficiency and Outcomes: “The Socrates Story”

    OpenAIRE

    Lawrence, Justin; Delaney, Conor P

    2013-01-01

    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 integr...

  6. 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

  7. 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

  8. 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.

  9. 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...

  10. 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

  11. Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

    Directory of Open Access Journals (Sweden)

    Glazier Richard H

    2011-05-01

    Full Text Available Abstract Background Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. Methods Articles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, Embase, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand-search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attending physicians were included (n = 65. After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance. Results The majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69% and total hospital costs (70%; however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30, patients lost to follow-up (n = 42 and estimates of effect or random variability (n = 35; inappropriate use of statistical tests (n = 55; and failure to adjust for established confounders (n = 37. Conclusions Future research should include

  12. 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.

  13. Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

    OpenAIRE

    Glazier Richard H; White Heather L

    2011-01-01

    Abstract Background Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. M...

  14. 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

  15. Improving efficiency in stereology

    DEFF Research Database (Denmark)

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

    2013-01-01

    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...... 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. Transformational leadership and economic efficiency : Can a charismatic leader in an administration for care motivate the subordinates to improve the economic performance?

    OpenAIRE

    Pehrson, Tony

    2006-01-01

    Title: Transformational leadership and economic efficiency – Can a charismatic leader in an administration for care motivate the subordinates to improve the economic performance? Author: Tony Pehrson Supervisor: Thomas Danborg and Anders Hederstierna Department: School of Management, Blekinge Institute of Technology Course: Masters’s thesis in business administration, 10 credits. Background and Problem Discussion: Skövde Kommun is a public organization and one of many tasks is to provide help...

  17. 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

  18. Improving Palliative Cancer Care

    OpenAIRE

    Del Ferraro, Catherine; Ferrell, Betty; Van Zyl, Carin; Freeman, Bonnie; Klein, Linda

    2014-01-01

    Over a decade ago, the Institute of Medicine (IOM) presented Ensuring Quality Cancer Care in the United States, with recommendations for change (IOM, 1999). However, barriers to integrating palliative care (PC) to achieve high-quality care in cancer still remain. As novel therapeutic agents evolve, patients are living longer, and advanced cancer is now considered a chronic illness. In addition to complex symptom concerns, patients and family caregivers are burdened with psychological, social,...

  19. Improving Palliative Cancer Care.

    Science.gov (United States)

    Del Ferraro, Catherine; Ferrell, Betty; Van Zyl, Carin; Freeman, Bonnie; Klein, Linda

    2014-01-01

    Over a decade ago, the Institute of Medicine (IOM) presented Ensuring Quality Cancer Care in the United States, with recommendations for change (IOM, 1999). However, barriers to integrating palliative care (PC) to achieve high-quality care in cancer still remain. As novel therapeutic agents evolve, patients are living longer, and advanced cancer is now considered a chronic illness. In addition to complex symptom concerns, patients and family caregivers are burdened with psychological, social, and spiritual distress. Furthermore, data show that PC continues to be underutilized and inaccessible, and current innovative models of integrating PC into standard cancer care lack uniformity. The aim of this article is to address the existing barriers in implementing PC into our cancer care delivery system and discuss how the oncology advanced practice nurse plays an essential role in providing high-quality cancer care. We also review the IOM recommendations; highlight the work done by the National Consensus Project in promoting quality PC; and discuss a National Cancer Institute-funded program project currently conducted at a National Comprehensive Cancer Center, "Palliative Care for Quality of Life and Symptoms Concerns in Lung Cancer," which serves as a model to promote high-quality care for patients and their families. PMID:26114013

  20. 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....

  1. 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

  2. The art of communication: strategies to improve efficiency, quality of care and patient safety in the emergency department

    International Nuclear Information System (INIS)

    The practice of pediatric emergency medicine (PEM) has been supported by wonderful advancements in diagnostic testing, particularly in medical imaging. One of the most remarkable has been CT, which has arguably become our most valuable diagnostic tool in the emergency department (ED). PEM specialists have grown increasingly aware of quality and safety concerns in the care of children in emergency medical settings, spurred in part by a rapid growth in ED utilization and significant overcrowding. In the midst of this comes the revelation that one of our most valued diagnostic tools might place our youngest patients at a significant risk for the development of fatal cancer. This article reinforces the fundamental importance of communication and teamwork as a means to promote patient care quality and safety in the ED, and it offers partnership strategies for PEM and pediatric radiology specialists to consider as they address these important concerns. (orig.)

  3. 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...

  4. 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...

  5. Bioenergy efficiency improvements

    Energy Technology Data Exchange (ETDEWEB)

    Oestergaerd, H.; Hauggaard-Nielsen, H.; Pilegaard, K.

    2012-11-15

    A prerequisite for biomass-based energy carriers should be that they support sustainable development. The EU has set up requirements for sustainable biofuels (1G) in Directive 2009/28/EU. These include requirements on reductions in GHG emissions compared to fossil fuels, and on the land used to produce biomass. They do not directly include requirements on energy invested, as measured by EROI, nor on recycling of nutrients. As commercial fertiliser is very energy-intensive and recycling would reduce the need for other fertilisers, more emphasis on recycling would contribute to the energy efficiency of bioenergy. In this chapter we have considered various technologies with emphasis on how each can help to support the cycling of nutrients while also producing energy at the highest possible efficiency. In most cases the EROI is much lower than what we are used to from fossil energy production. However, if we combine different conversion processes and integrate the resulting energy production and nutrient flows into the agricultural management system we can expect better returns. (Author)

  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. 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

  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. Frontier technologies to improve efficiency

    International Nuclear Information System (INIS)

    The author discusses conservation technology to improve the efficiency of energy production. Although coal is seen as the largest source of fuel for producing electricity until the year 2040, the heating value of coal is expected to be increased by using Integrated Gasification Combined Cycle (IGCC) technology. Use of fuel cells to produce electricity will be a viable option only if costs can be reduced to make the technology competitive. By coupling IGCC with fuel cells it may be possible to increase total conversion efficiency of coal to electricity at 50%. Photovoltaics technology is more likely to be used in developing countries. Electric utilities target power electronics, lighting fixtures, heat pumps, plasma processing, freeze concentration and application of superconductivity as electricity end use technologies that have the most potential for efficiency improvement. The impact of these technologies in coping with the greenhouse effect was not addressed

  11. Managed care opportunities for improving asthma care.

    Science.gov (United States)

    Campbell, Jonathan D

    2011-04-01

    Uncontrolled asthma is an enormous burden in terms of the propensity to reach asthma control in the future, direct and indirect costs, and health-related quality of life. The complex pathophysiology, treatment, and triggers of asthma warrant a unified, yet targeted, approach to care. No single factor is fully responsible for poor control. Complicating the problem of asthma control is adherence to long-term controller medications. The National Asthma Education and Prevention Program (NAEPP) established several key points for asthma control, and developed classifications for asthma control and recommended actions for treatment. All parties involved in the management of asthma, including physicians, pharmacists, nurses, patients, family members, and insurance companies, need to be aware of the NAEPP guidelines. To determine if the goals of asthma therapy are being met, assessment of asthma outcomes is necessary. Unfortunately, some measures may get overlooked, and patient-reported outcomes (as assessed by the validated control instruments) are not often collected during routine examinations. The Healthcare Effectiveness Data and Information Set measure for asthma may be used to quantify asthma care, but there is evidence that it does not fully capture the goals of asthma management. Most well-designed, education-based interventions are considered good value for money, but it can be difficult to put into practice such policy interventions. An optimal managed care plan will adhere to known evidence-based guidelines, can measure outcomes, is targeted to the patient's risk and impairment, and can adapt to changes in our understanding of asthma and its treatment. PMID:21761959

  12. 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...

  13. 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

  14. Bedside Reporting: Protocols for Improving Patient Care.

    Science.gov (United States)

    Ferguson, Teresa D; Howell, Teresa L

    2015-12-01

    Bedside reporting continues to gain much attention and is being investigated to support the premise that "hand-off" communications enhance efficacy in delivery of patient care. Patient inclusion in shift reports enhances good patient outcomes, increased satisfaction with care delivery, enhanced accountability for nursing professionals, and improved communications between patients and their direct care providers. This article discusses the multiple benefits of dynamic dialogue between patients and the health care team, challenges often associated with bedside reporting, and protocols for managing bedside reporting with the major aim of improving patient care. Nursing research supporting the concept of bedside reporting is examined. PMID:26596661

  15. 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.

  16. 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....

  17. 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...

  18. Changing education to improve patient care

    OpenAIRE

    Leach, D.

    2001-01-01

    Health professionals need competencies in improvement skills if they are to contribute usefully to improving patient care. Medical education programmes in the USA have not systematically taught improvement skills to residents (registrars in the UK). The Accreditation Council for Graduate Medical Education (ACGME) has recently developed and begun to deploy a competency based model for accreditation that may encourage the development of improvement skills by the 100 000 residents in accredited ...

  19. 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...

  20. 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 ...

  1. 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...

  2. Improving care for children with cerebral palsy.

    Science.gov (United States)

    Newey, Colin

    2008-09-01

    A report about the health care of people with learning disability published by a UK charity concluded that this group was discriminated against and that healthcare professionals had a poor understanding of their needs. A case report of a young person with cerebral palsy is used here to demonstrate good practice in the care of children with learning disabilities. The careful development over time of individualised solutions makes a difference to the quality of life for children and families. Improved understanding through education as well as collaborative working and family participation will help ensure that children and young people receive the range of services they require. PMID:18808052

  3. Improving Energy Efficiency of Auxiliaries

    International Nuclear Information System (INIS)

    The summaries of this report are: Economics Ultimately Dictates Direction; Electric Auxiliaries Provide Solid Benefits. The Impact on Vehicle Architecture Will be Important; Integrated Generators With Combined With Turbo Generators Can Meet the Electrical Demands of Electric Auxiliaries; Implementation Will Follow Automotive 42V Transition; Availability of Low Cost Hardware Will Slow Implementation; Industry Leadership and Cooperation Needed; Standards and Safety Protocols Will be Important. Government Can Play an Important Role in Expediting: Funding Technical Development; Incentives for Improving Fuel Economy; Developing Standards, Allowing Economy of Scale; and Providing Safety Guidelines

  4. 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...

  5. 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

  6. Systems modelling for improving health care

    OpenAIRE

    Pitt, Martin; Monks, Thomas; Allen, Michael

    2016-01-01

    The growing complexity of health care coupled with the ever-increasing pressures to ensure efficient and effective use of limited resources have encouraged policy makers to turn to system modelling solutions. Such techniques have been available for decades, but despite ample research which demonstrates potential, their application in health services to date is limited. This presentation surveys the breadth of approaches available to support delivery and design across many areas and levels of ...

  7. 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.

  8. 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...

  9. Improving plasmonic waveguides coupling efficiency using nanoantennas

    DEFF Research Database (Denmark)

    Andryieuski, Andrei; Malureanu, Radu; Bouillard, Jean-Sebastien; Zayats, Anatoly V.; Lavrinenko, Andrei

    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...

  10. 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.

  11. 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.

  12. Scalable and Efficient Improved Apriori Algorithm

    OpenAIRE

    NUTAN DHANGE; PROF. SHEETAL DHANDE

    2013-01-01

    Apriori algorithm is a classical algorithm of association rule mining and widely used for mining association rule which uses frequent item. Based on the Apriori algorithm analysis and research, this paper points out the main problems on the application, and puts forward the improved This paper presents an improved Apriori algorithm to increase the efficiency of generating association rules.

  13. 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...

  14. 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

  15. 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

  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. 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

  18. 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

  19. 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...

  20. How Can Health System Efficiency Be Improved in Canada?

    Science.gov (United States)

    Allin, Sara; Veillard, Jeremy; Wang, Li; Grignon, Michel

    2015-08-01

    Improving value for money in the health system is an often-stated policy goal. This study is the first to systematically measure the efficiency of health regions in Canada in producing health gains with their available resources, and to identify the factors that are associated with increased efficiency. Based on the objective elicited from decision-makers that the health system should ensure access to care for Canadians when they need it, we measured the efficiency with which regions reduce causes of death that are amenable to healthcare interventions using a linear programming approach (data envelopment analysis). Variations in efficiency were explained in part by public health factors, such as the prevalence of obesity and smoking in the population; in part by characteristics of the population, such as their average income; and in part by managerial factors, such as hospital readmissions. PMID:26571467

  1. 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

  2. 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.

  3. 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

  4. 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.

  5. Energy efficiency improvement of the dyeing process

    International Nuclear Information System (INIS)

    On the basis of concrete technological data of the dyeing process the current state of heat energy usage is analysed. It is found that at present time a certain amount of reusable waste heat is continually being lost. Thus the paper presents a possibility of heat energy recovery in the analysed technological process. The proposed heat recovery results with improved energy efficiency, the process working time is reduced, all with considerable environmental benefits. (author)

  6. 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.

  7. Barriers to improvements in energy efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Reddy, A.K.N.

    1991-10-01

    To promote energy-efficiency improvements, actions may be required at one or more levels -- from the lowest level of the consumer (residential, commercial, industrial, etc.) through the highest level of the global agencies. But barriers to the implementation of energy-efficiency improvements exist or can arise at all these levels. Taking up each one of these barriers in turn, the paper discusses specific measures that can contribute to overcoming the barriers. However, a one-barrier-one-measure approach must be avoided. Single barriers may in fact involve several sub-barriers. Also, combinations of measures are much more effective in overcoming barriers. In particular, combinations of measures that simultaneously overcome several barriers are most successful. The paper discusses the typology of barriers, explores their origin and suggests measures that by themselves or in combination with other measures, will overcome these barriers. Since most of the barriers dealt with can be found in the ``barriers`` literature, any originality in the paper lies in its systematic organization, synoptic view and holistic treatment of this issue. This paper is intended to initiate a comprehensive treatment of barriers, their origins and the measures that contribute to overcoming them. Hopefully, such a treatment will facilitate the implementation of energy-efficiency improvements involving a wide diversity of ever-changing energy end uses and consumer preferences.

  8. Barriers to improvements in energy efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Reddy, A.K.N.

    1991-10-01

    To promote energy-efficiency improvements, actions may be required at one or more levels -- from the lowest level of the consumer (residential, commercial, industrial, etc.) through the highest level of the global agencies. But barriers to the implementation of energy-efficiency improvements exist or can arise at all these levels. Taking up each one of these barriers in turn, the paper discusses specific measures that can contribute to overcoming the barriers. However, a one-barrier-one-measure approach must be avoided. Single barriers may in fact involve several sub-barriers. Also, combinations of measures are much more effective in overcoming barriers. In particular, combinations of measures that simultaneously overcome several barriers are most successful. The paper discusses the typology of barriers, explores their origin and suggests measures that by themselves or in combination with other measures, will overcome these barriers. Since most of the barriers dealt with can be found in the barriers'' literature, any originality in the paper lies in its systematic organization, synoptic view and holistic treatment of this issue. This paper is intended to initiate a comprehensive treatment of barriers, their origins and the measures that contribute to overcoming them. Hopefully, such a treatment will facilitate the implementation of energy-efficiency improvements involving a wide diversity of ever-changing energy end uses and consumer preferences.

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. 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

  14. 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.

  15. System Change: Quality Assessment and Improvement for Medicaid Managed Care

    OpenAIRE

    Smith, Wally R.; Cotter, J. James; Louis F Rossiter

    1996-01-01

    Rising Medicaid health expenditures have hastened the development of State managed care programs. Methods to monitor and improve health care under Medicaid are changing. Under fee-for-service (FFS), the primary concern was to avoid overutilization. Under managed care, it is to avoid underutilization. Quality enhancement thus moves from addressing inefficiency to addressing insufficiency of care. This article presents a case study of Virginia's redesign of Quality Assessment and Improvement (Q...

  16. Tape write-efficiency improvements in CASTOR

    International Nuclear Information System (INIS)

    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.

  17. 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.

  18. 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...

  19. 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)

  20. 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.

  1. 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

  2. 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...

  3. 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

  4. Leadership: improving the quality of patient care.

    Science.gov (United States)

    Clegg, A

    The satisfaction staff achieve from their work is in part determined by the style of management they work under. This article analyses the impact of a proactive leadership style on team performance and the quality of patient care. PMID:11973895

  5. 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...

  6. 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

  7. Eat walk engage: an interdisciplinary collaborative model to improve care of hospitalized elders.

    Science.gov (United States)

    Mudge, Alison M; McRae, Prudence; Cruickshank, Mark

    2015-01-01

    High-quality, efficient health care for older patients is a priority for health care systems. Acute Care for Elders units improve outcomes but there is a need for generalizable models of care that adopt the principles pioneered in these units. This report describes Eat Walk Engage, a collaborative care model on a general medical ward in Brisbane, Australia. The model focused on early mobilization, feeding assistance, and cognitive stimulation. Using the Promoting Action on Research Implementation in Health Services implementation framework, the facilitation team enabled the clinical team to recognize barriers and develop solutions. Challenges included unclear responsibility, workload concerns, and risk aversion. Implementation strategies included engaging champions, education, audit and feedback, task delineation and delegation, improving physical resources, and workforce redesign. During the first 18 months, audits showed improved nursing documentation in targeted domains and improved performance of mobilizing and cognitive strategies; length of stay for older inpatients fell by 3 days on the intervention ward. PMID:24270172

  8. 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.

  9. Health care in China: improvement, challenges, and reform.

    Science.gov (United States)

    Wang, Chen; Rao, Keqin; Wu, Sinan; Liu, Qian

    2013-02-01

    Over the past 2 decades, significant progress has been made in improving the health-care system and people's health conditions in China. Following rapid economic growth and social development, China's health-care system is facing new challenges, such as increased health-care demands and expenditure, inefficient use of health-care resources, unsatisfying implementation of disease management guidelines, and inadequate health-care insurance. Facing these challenges, the Chinese government carried out a national health-care reform in 2009. A series of policies were developed and implemented to improve the health-care insurance system, the medical care system, the public health service system, the pharmaceutical supply system, and the health-care institution management system in China. Although these measures have shown promising results, further efforts are needed to achieve the ultimate goal of providing affordable and high-quality care for both urban and rural residents in China. This article not only covers the improvement, challenges, and reform of health care in general in China, but also highlights the status of respiratory medicine-related issues. PMID:23381317

  10. 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.

  11. 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

  12. Individual decisions and efficiency in health care demand

    OpenAIRE

    Lukas, Daniel

    2013-01-01

    Individual decision-making and the generation of medical demand are crucial subjects in healthcare economics. The following scientific discussion can be classified into these threads. The demand for health care services is typically connected to characteristic imperfections reflecting a bias between an objective and a subjective assessment of a specific demand situation or externally caused frictions. For that reason, the realized demand is not necessarily connected to an efficient allocation...

  13. 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: ...

  14. 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

  15. Measuring quality of care for colorectal cancer care: comprehensive feedback driving quality improvement

    OpenAIRE

    Kolfschoten, Nicoline Elisabeth

    2015-01-01

    Data from clinical audits such as the Dutch Surgical Colorectal Audit, can be used for valid and meaningful feedback information, which may support improvement of quality of care. First, we showed that the continuous feedback cycle of clinical auditing has an autonomous, positive effect on the quality of surgical care. Second, we describe how data from clinical audits can be used to monitor and improve national practice and performance in colorectal cancer care, especially for high-risk patie...

  16. 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...

  17. Crossing boundaries : improving communication in cerebral palsy care

    OpenAIRE

    Gulmans, J.

    2012-01-01

    In the Netherlands, children with cerebral palsy are the largest diagnostic group treated in paediatric rehabilitation, requiring specialized health-, education- and social services of multiple professionals from diverse organizations. To provide ‘integrated care’ in these settings, effective care coordination is essential, though in practice this is challenged by inadequate communication across the child’s care network. In order to improve communication across the integrated care setting of ...

  18. 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

  19. Improving Access to Hospice Care: Informing the Debate

    OpenAIRE

    Carlson, Melissa D.A.; Morrison, R. Sean; Bradley, Elizabeth H.

    2008-01-01

    The most frequently cited policy solution for improving access to hospice care for patients and families is to expand hospice eligibility criteria under the Medicare Hospice Benefit. However, the substantial implications of such a policy change have not been fully articulated or evaluated. This paper seeks to identify and describe the implications of expanding Medicare Hospice Benefit eligibility on the nature of hospice care, the cost of hospice care to the Medicare program, and the very str...

  20. Improving care requires leadership in nursing.

    Science.gov (United States)

    Cook, M J

    1999-05-01

    The purpose of this paper is to provide a model of leadership in nursing. The model outlines factors that influence leadership styles, discusses approaches to leadership and the impact of the leadership style on nursing care. The model is based on a critical examination of the current leadership themes from nursing literature in the UK, USA and Australia, between 1992 and 1997, and the findings from semi-structured interviews with five leaders in nursing. These findings help support the proposed leadership model as a basis for further exploration and as a framework for thinking about leadership and leadership preparation. PMID:10595066

  1. 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 ...

  2. 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

  3. 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…

  4. Improving the Quality of Behavioral Health Care for Medicaid Beneficiaries

    OpenAIRE

    Allison Siegwarth

    2015-01-01

    This brief highlights Mathematica’s work to find opportunities for quality improvement in Medicaid’s behavioral health services, develop measures that can help monitor the quality of care, and to identify innovative strategies to better coordinate behavioral and physical health care.

  5. 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

  6. Effects of Quality Improvement System for Child Care Centers

    Science.gov (United States)

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace

    2011-01-01

    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

  7. Quality improvement in depression care in the Netherlands: the Depression Breakthrough Collaborative. A quality improvement report.

    OpenAIRE

    2009-01-01

    Background: Improving the healthcare for patients with depression is a priority health policy across the world. Roughly, two major problems can be identified in daily practice: (1) the content of care is often not completely consistent with recommendations in guidelines and (2) the organization of care is not always integrated and delivered by multidisciplinary teams. Aim: To describe the content and preliminary results of a quality improvement project in primary care, aiming at improving th...

  8. 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

  9. 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.

  10. Does good practice organization improve the outcome of care for diabetic patients?

    OpenAIRE

    Dunn, N; R. Pickering

    1998-01-01

    BACKGROUND: Audit of diabetic care is becoming common in general practice. Most of this audit is concerned with structure and process; outcome audit is much more difficult to achieve. AIM: To determine whether the structure of general practice diabetic care influenced the process or outcome and whether efficiency of process predicted improved outcome. METHOD: Cross-sectional survey, by questionnaire and review of notes, among general practices in the East Dorset district, involving diabetic p...

  11. 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...

  12. 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

  13. How to improve patient care by learning from mistakes.

    Science.gov (United States)

    Brady, Mike

    2013-02-01

    Mistakes made in healthcare settings and the challenges to staff that arise from them can harm service users, consume time and money, and often receive bad publicity. However, by learning from these mistakes and meeting these challenges, practitioners can improve the quality of the care they provide. This article explores what is meant by mistakes and challenges in the context of health care. It suggests that front line managers are best placed to prevent and learn from mistakes, and thereby improve care for patients. PMID:23516729

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

    DEFF Research Database (Denmark)

    Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid

    2014-01-01

    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 of...... a busy neonatal care unit. Promoting practice uptake was initially underestimated, but nurse guided family-centred care training was improved by increasing the visibility of the study in the unit, demonstrating intervention progress to the nurses and assuring a sense of ownership among nurse leaders...... and nonguided-family-centred-care-trained nurses. CONCLUSIONS: An adjusted framework for guided family-centred care implementation was successful in overcoming barriers and promoting facilitators. RELEVANCE TO CLINICAL PRACTICE: Insights gained from our pioneering work might help nurses in a similar...

  15. 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

  16. QUALITY MANAGEMENT IN HEALTH CARE - CONTRIBUTING TO PATIENT SAFETY AND EFFICIENCY OF BUSINESS OPERATION

    OpenAIRE

    Nevenka Kovac

    2014-01-01

    In order to ensure efficient and effective health care, of equal high quality and accessibility, at all the levels of healthcare and across the entire Croatian territory, all operators in health services are required to establish, develop and maintain a system for assuring and improving the quality in healthcare. Legal requirement to introduce quality management systems into healthcare institutions notwithstanding, a quality management system is equally important in regard to the provision of...

  17. 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...

  18. 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.

  19. Improving Energy Efficiency in Constanta, Romania

    OpenAIRE

    Mot, Manuela; Bose, Ranjan; Burduja, Sebastian; Ionescu-Heroiu, Marcel

    2013-01-01

    The Tool for Rapid Assessment of City Energy (TRACE) is used for conducting rapid assessments of energy use in cities. It helps prioritize sectors with significant energy savings potential, and identifies appropriate energy efficiency interventions across six sectors-transport, municipal buildings, water and waste water, public lighting, solid waste, and power and heat. It is a simple, low...

  20. Improving Energy Efficiency in Iasi, Romania

    OpenAIRE

    Mot, Manuela; Bose, Ranjan; Burduja, Sebastian; Ionescu-Heroiu, Marcel

    2013-01-01

    The Tool for Rapid Assessment of City Energy (TRACE) is used for conducting rapid assessments of energy use in cities. It helps prioritize sectors with significant energy savings potential, and identifies appropriate energy efficiency interventions across six sectors-transport, municipal buildings, water and waste water, public lighting, solid waste, and power and heat. It is a simple, low...

  1. 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…

  2. 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

  3. Improving the energy efficiency of accelerator facilities

    OpenAIRE

    Seidel, M.; E., Jensen; R., Gehring; J., Stadlmann; P., Spiller; Parker, Thomas

    2015-01-01

    New particle accelerator based research facilities tend to be much more productive, but often in coincidence with higher energy consumption. The total energy consumption of mankind is steeply rising and this is mainly caused by quickly developing countries. Some European countries decided to terminate nuclear power generation and to switch to sustainable energy production. Also the CO2 problem gives rise to new approaches for energy production and in all strategies the efficiency of utilizati...

  4. 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...

  5. 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...

  6. Technical efficiency improvement of rice farming in southern Thailand

    OpenAIRE

    Kiatpathomchai, Sirirat; Schmitz, P. Michael; Thongrak, Sutonya

    2009-01-01

    The objective of this study is to assess the technical efficient frontier of rice farms using input-oriented data envelopment analysis. The frontier represents the minimum applicable level of efficiency of inputs given the current level of yields, technologies, and managerial ability among the farmers which can be used as a benchmark for efficiency improvement of rice farms. Two-stage DEA methodology of efficiency analysis was applied. The empirical results revealed that the technical efficie...

  7. Improving Diabetes Care for Hospice Patients.

    Science.gov (United States)

    Lee, Sei J; Jacobson, Margaret A; Johnston, C Bree

    2016-07-01

    Although type 2 diabetes guidelines recommend less aggressive glycemic control for patients with limited life expectancy, many hospice patients continue their glucose-lowering medications, resulting in an increased risk of hypoglycemia. Three common reasons for overly tight glycemic control in hospice patients include (1) discussions about reducing or stopping chronic medications are uncomfortable; (2) many patients and families believe that mild hyperglycemia can cause symptoms; and (3) until 2014, Healthcare Information and Data Information Set (HEDIS) quality indicators for glycemic control included hospice patients. To address these issues, we recommend (1) providers discuss with patients and families upon hospice enrollment that diabetes medications can be reduced or discontinued as their life-limiting disease progresses; (2) keeping blood glucose levels between 200 and 300 mg/dL; and (3) educate providers that HEDIS measures now exclude hospice patients. Implementing these recommendations should decrease the risk of hypoglycemia in hospice patients and improve their quality of life. PMID:25852204

  8. 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

  9. 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

  10. 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

  11. 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.

  12. 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

  13. 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

  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. 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

  16. 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...

  17. 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...

  18. 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 ...

  19. Improved input-legitimacy and efficient policies?

    DEFF Research Database (Denmark)

    Agger, Annika

    The call for more innovative public policies is increasing as many governments are faced with complex problems and increased demands. Public resources are considered to be scarce and the expectations among citizens and their demands to public services are often huge. As a result, there has been 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...... empirical part of the project is gathered in collaboration with professor Eva Sørensen and consist of data gathered in a period from September 2010 and will continue to the end of 2011. We have observed meetings, conducted qualitative interviews in the beginning and 8 months later with all the members of...

  20. 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.

  1. Aberration analysis and efficiency improvement of a bidirectional optical subassembly

    Science.gov (United States)

    Wu, Hao; Huang, Zhangdi; Yu, Ziyan; Qian, Xiaoshi; Xu, Fei; Chen, Beckham; Lu, Yanqing

    2009-10-01

    An approach to improve the coupling efficiency of bidirectional optical subassembly (BOSA) modules is proposed and experimentally demonstrated. We analyzed the wavefront aberration coefficients of a typical BOSA. It was found that the 45-deg wavelength filter induces coma and astigmatism, and then it further deteriorates the laser diode to fiber coupling. We measured the BOSA efficiencies based on a series of different filters. For a typical 0.5-mm filter, 25% coupling efficiency improvement was achieved by optimizing the filter parameters.

  2. 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

  3. Burning clean fuel gas improves energetic efficiency

    International Nuclear Information System (INIS)

    One the most critical problems faced by refineries nowadays is the continuous increasing of legislation urging emissions reductions specifically SO2, NOx, and particles. Therefore there is a substantial need for refineries to burn fuel gas instead of fuel oil and avoiding, if possible, the use of imported natural gas. The refinery case study presents a substantial excess of fuel gas resulting from the production of hydrogen to obtain clean flues with low sulphurs. The aim of this paper is to optimize the use of the hydrogen excess with the implementation of a gas turbine with heat recovery with a feed near 28-31% of hydrogen. The cogeneration system was modelled by GateCycle 5.34.0.r. and the results obtained for the simulation were considered optimistic. Considering a production of 13 MW of electrical power the overall efficiency reached a value of 76% and 22 t/h of vapour (17 MW) from a feed of 3 t/h of fuel gas (39 MW). These results allow a higher electrical power production and a consequent reduction in the emissions of SO2 and CO2.

  4. Burning clean fuel gas improves energetic efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Fonseca, Andre; Gomes, Luisa A.C.N. [Chemical Engineering Department, Instituto Superior de Engenharia do Porto, Rua Dr. Antonio Bernardino de Almeida 431, P4200-072 Porto (Portugal); Tavares, Manuel L.C. [Galp Energia, Area de Tecnologia, Apartado 3015, 4451-852 Leca da Palmeira (Portugal)

    2010-03-15

    One the most critical problems faced by refineries nowadays is the continuous increasing of legislation urging emissions reductions specifically SO{sub 2}, NO{sub x}, and particles. Therefore there is a substantial need for refineries to burn fuel gas instead of fuel oil and avoiding, if possible, the use of imported natural gas. The refinery case study presents a substantial excess of fuel gas resulting from the production of hydrogen to obtain clean flues with low sulphurs. The aim of this paper is to optimize the use of the hydrogen excess with the implementation of a gas turbine with heat recovery with a feed near 28-31% of hydrogen. The cogeneration system was modelled by GateCycle 5.34.0.r. and the results obtained for the simulation were considered optimistic. Considering a production of 13 MW of electrical power the overall efficiency reached a value of 76% and 22 t/h of vapour (17 MW) from a feed of 3 t/h of fuel gas (39 MW). These results allow a higher electrical power production and a consequent reduction in the emissions of SO{sub 2} and CO{sub 2}. (author)

  5. 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.

  6. A person-centred segmentation study in elderly care: towards efficient demand-driven care.

    Science.gov (United States)

    Eissens van der Laan, M R; van Offenbeek, M A G; Broekhuis, H; Slaets, J P J

    2014-07-01

    Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on diseases. A person-centred segmentation, i.e., based on persons' own experienced difficulties in fulfilling needs, is an elementary but often overlooked first step in developing efficient demand-driven care. This paper describes a person-centred segmentation study of elderly, a large and increasing target group confronted with heterogeneous and often interrelated difficulties in their functioning. In twenty-five diverse healthcare and welfare organizations as well as elderly associations in the Netherlands, data were collected on the difficulties in biopsychosocial functioning experienced by 2019 older adults. Data were collected between March 2010 and January 2011 and sampling took place based on their (temporarily) living conditions. Factor Mixture Model was conducted to categorize the respondents into segments with relatively similar experienced difficulties concerning their functioning. First, the analyses show that older adults can be empirically categorized into five meaningful segments: feeling vital; difficulties with psychosocial coping; physical and mobility complaints; difficulties experienced in multiple domains; and feeling extremely frail. The categorization seems robust as it was replicated in two population-based samples in the Netherlands. The segmentation's usefulness is discussed and illustrated through an evaluation of the alignment between a segment's unfulfilled biopsychosocial needs and current healthcare utilization. The set of person-centred segmentation variables provides healthcare providers the option to perform a more comprehensive first triage step than only a disease-based one. The outcomes of this first step could guide a focused and

  7. 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.

  8. Improving recovery time following heart transplantation: the role of the multidisciplinary health care team

    Directory of Open Access Journals (Sweden)

    Roussel MG

    2013-08-01

    Full Text Available Maureen G Roussel,1 Noreen Gorham,2 Lynn Wilson,2 Abeel A Mangi2 1Heart and Vascular Center, Yale-New Haven Hospital, New Haven, CT, USA; 2Center for Advanced Heart Failure, Mechanical Circulatory Support and Cardiac Transplantation, Yale New Haven Heart and Vascular Institute, Yale-New Haven Hospital, New Haven, CT, USA Background: The care of cardiac transplant patients is complex requiring a finely orchestrated endeavor to save a patient’s life. Given the chronic and complex nature of these patients, multiple disciplines are involved in their care. Recognizing difficulties with communication among team members and striving for improved efficiencies in our pretransplant listing process and in our inpatient care, our team was prompted to change the existing approach to patient care related to heart transplantation. Methods: Daily multidisciplinary rounds were instituted and the format of the weekly Multidisciplinary Review Committee (MDRC meetings was modified with the list of attendees broadened to include a larger interdisciplinary team. Additionally, the approach to patient care was analyzed for process improvement. Results: The quality improvements are improved communication and throughput, quantified in an 85% decrease in time to complete transplant evaluation, a 37% decrease in median length of stay posttransplantation, and a 33% reduction in the 30 day readmission rate. In addition, pre- and posttransplant caregivers now participate in MDRC in person or via an electronic meeting platform to support the continuum of care. Quality metrics were chosen and tracked via a transparent electronic platform allowing all involved to assess progress toward agreed upon goals. These were achieved in an 18 month time period following the recruitment of new leadership and invested team members working together as a multidisciplinary team to improve the quality of cardiac transplant care. Discussion: Implementation of daily multidisciplinary rounds and

  9. 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.

  10. 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.

  11. 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

  12. 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…

  13. 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.

  14. 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...

  15. 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)

  16. Efficiency improvement for wind energy pumped storage systems

    DEFF Research Database (Denmark)

    Forcos, A.; Marinescu, C.; Teodorescu, Remus;

    2011-01-01

    Integrating wind energy into the grid may raise stability problems. Solutions for avoiding these situations are studied and energy storage methods are suitable for balancing the energy between the wind turbine and grid. In this paper, an autonomous wind turbine pumped storage system is presented....... The focus of this paper is to improve the efficiency of this system, which is small at low power levels. The driving motorpump group of the storage system is the key point presented in this paper for efficiency improving. Two control methods, experimentally implemented for induction machine are...... presented, and the comparison of the system efficiencies highlights the improvement of the proposed control method....

  17. 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 and...... finally communication of both environmental and economic performance of solutions to customers. One of the main tools supporting eco-design and evaluation & controlling of derived design solutions is the so called “Eco-Care-Matrix” (ECM). The ECM simply visualizes the eco-efficiency of solutions compared...... 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...

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. 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...

  3. 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

  4. 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

  5. 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.)

  6. Designing Effective National Programs to Improve Industrial Energy Efficiency

    OpenAIRE

    Feng LIU; Tromop, Robert

    2016-01-01

    This guidance note, about Industrial energy efficiency is closely linked to the economic competitiveness of countries with significant manufacturing bases and to the energy security of countries that rely heavily on imported energy. For individual enterprises, improving energy efficiency strengthens the bottom line, often reducing direct energy costs by 10 to 30 percent Industry accounts f...

  7. 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.

  8. 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

  9. 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.

  10. 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

  11. 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

    in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems......BACKGROUND: Interventions for curing most diseases and save lives of pregnant and delivering women exist, yet the power of health systems to deliver them to those in most need is not sufficient. The aims of this study were to design a participatory antenatal care (ANC) strengthening intervention....... The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. RESULTS: The continued attention to the ANC provision during implementation stimulated...

  12. 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…

  13. 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.

  14. Quality improvement and accountability in the Danish health care system.

    Science.gov (United States)

    Mainz, Jan; Kristensen, Solvejg; Bartels, Paul

    2015-12-01

    Denmark has unique opportunities for quality measurement and benchmarking since Denmark has well-developed health registries and unique patient identifier that allow all registries to include patient-level data and combine data into sophisticated quality performance monitoring. Over decades, Denmark has developed and implemented national quality and patient safety initiatives in the healthcare system in terms of national clinical guidelines, performance and outcome measurement integrated in clinical databases for important diseases and clinical conditions, measurement of patient experiences, reporting of adverse events, national handling of patient complaints, national accreditation and public disclosure of all data on the quality of care. Over the years, Denmark has worked up a progressive and transparent just culture in quality management; the different actors at the different levels of the healthcare system are mutually attentive and responsive in a coordinated effort for quality of the healthcare services. At national, regional, local and hospital level, it is mandatory to participate in the quality initiatives and to use data and results for quality management, quality improvement, transparency in health care and accountability. To further develop the Danish governance model, it is important to expand the model to the primary care sector. Furthermore, a national quality health programme 2015-18 recently launched by the government supports a new development in health care focusing upon delivering high-quality health care-high quality is defined by results of value to the patients. PMID:26443814

  15. 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.

  16. 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

  17. 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.

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

    International Nuclear Information System (INIS)

    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

  19. 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....

  20. 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...

  1. 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...

  2. Improving outpatient access and patient experiences in academic ambulatory care.

    Science.gov (United States)

    O'Neill, Sarah; Calderon, Sherry; Casella, Joanne; Wood, Elizabeth; Carvelli-Sheehan, Jayne; Zeidel, Mark L

    2012-02-01

    Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume. PMID:22193182

  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. [Continuous nursing education to improve the quality of health care].

    Science.gov (United States)

    Fumić, Nera; Marinović, Marin; Brajan, Dolores

    2014-10-01

    Health care and today's medical and technical achievements and approved standards of treatment provide comprehensive quality, safety and traceability of medical procedures respecting the principles of health protection. Continuous education improves the quality of nursing health care and increases the effectiveness of patient care, consequently maintaining and enhancing patient safety. Patient health problems impose the need of appropriate, planned and timely nursing care and treatment. In providing quality nursing care, attention is focused on the patient and his/her needs in order to maintain and increase their safety, satisfaction, independence and recovery or peaceful death, so the health and nursing practices must be systematized, planned and based on knowledge and experience. Health and nursing care of patients at risk of developing acute and chronic wounds or already suffering from some form of this imply preventive measures that are provided through patient education, motivation, monitoring, early recognition of risk factors and causes, and reducing or removing them through the prescribed necessary medical treatment which is safe depending on the patient health status. Except for preventive measures, nursing care of patients who already suffer from some form of acute or chronic wounds is focused on the care and treatment of damaged tissue by providing appropriate and timely diagnosis, timely and proper evaluation of the wound and patient general status, knowledge and understanding of the wide range of local, oral and parenteral therapy and treatment, aiming to increase patient safety by preventing progression of the patient general condition and local wound status and reducing the possibility of developing infection or other complications of the underlying disease. In the overall patient management, through nursing process, medical interventions are implemented and aimed to maintain and optimize health status, prevent complications of existing diseases and

  6. Efficiency improvement opportunities in TVs: Implications for market transformation programs

    International Nuclear Information System (INIS)

    Televisions (TVs) account for a significant portion of residential electricity consumption and global TV shipments are expected to continue to increase. We assess the market trends in the energy efficiency of TVs that are likely to occur without any additional policy intervention and estimate that TV efficiency will likely improve by over 60% by 2015 with savings potential of 45 terawatt-hours [TW h] per year in 2015, compared to today’s technology. We discuss various energy-efficiency improvement options and evaluate the cost effectiveness of three of them. At least one of these options improves efficiency by at least 20% cost effectively beyond ongoing market trends. We provide insights for policies and programs that can be used to accelerate the adoption of efficient technologies to further capture global energy savings potential from TVs which we estimate to be up to 23 TW h per year in 2015. - Highlights: • We analyze the impact of the recent TV market transition on TV energy consumption. • We review TV technology options that could be realized in the near future. • We assess the cost-effectiveness of selected energy-efficiency improvement options. • We estimate global electricity savings potential in selected scenarios. • We discuss possible directions of market transformation programs

  7. Intensive-care unit lungs - possibilities to improve the quality

    International Nuclear Information System (INIS)

    X-ray lung diagnosis in an intensive-care unit makes special demands on technique, imaging and on the physician's experience. The quality of image interpretation and evaluation is considerably improved by superimposing the technical data on the X-ray image and by using an antiscatter grid cassette. Proper evaluation of the parameters important for diagnosis is improved by registration of the data on the X-ray film; taking a maximum possible score of 100 as reference value, quality of evaluation is improved from 66.5 points to 71.8 points by data registration on the film itself, whereas the simultaneous use of an antiscatter grid cassette improves the score still further, namely, to 84.3 points. The importance of the clinical condition of the patient, and of the type of breathing chosen, for assessing the chest X-ray, is emphasized. (orig.)

  8. 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.

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. 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.

  14. 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

  15. Improving circuit miniaturization and its efficiency using Rough Set Theory

    OpenAIRE

    Rawat, Sarvesh SS; Mor, Dheeraj Dilip; Kumar, Anugrah; Roy, Sanjiban Shekar; Kumar, Rohit

    2013-01-01

    High-speed, accuracy, meticulousness and quick response are notion of the vital necessities for modern digital world. An efficient electronic circuit unswervingly affects the maneuver of the whole system. Different tools are required to unravel different types of engineering tribulations. Improving the efficiency, accuracy and low power consumption in an electronic circuit is always been a bottle neck problem. So the need of circuit miniaturization is always there. It saves a lot of time and ...

  16. 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.

  17. 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.

  18. 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...

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. 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

  4. 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...

  5. An Efficient Sequential SAT Solver With Improved Search Strategies

    OpenAIRE

    Lu, F.; Iyer, M. K.; Parthasarathy, G.; Wang, L.-C.; Cheng, K.-T.; Chen, K C

    2005-01-01

    A sequential SAT solver Satori was recently proposed as an alternative to combinational SAT in verification applications. This paper describes the design of Seq-SAT - an efficient sequential SAT solver with improved search strategies over Satori. The major improvements include (1) a new and better heuristic for minimizing the set of assignments to state variables, (2) a new priority-based search strategy and a flexible sequential search framework which integrates different search strategies, ...

  6. 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

  7. 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...

  8. 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...

  9. 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

  10. Improving Quality of Care in Peptic Ulcer Bleeding

    DEFF Research Database (Denmark)

    Rosenstock, Steffen J; Møller, Morten H; Larsson, Heidi; Johnsen, Søren P; Madsen, Anders H; Bendix, Jørgen; Adamsen, Sven; Jensen, Anders G; Zimmermann-Nielsen, Erik; Nielsen, Ann-Sophie; Kallehave, Finn; Oxholm, Dorthe; Skarbye, Mona; Jølving, Line R; Jørgensen, Henrik S; de Muckadell, Ove B Schaffalitzky; Thomsen, Reimar W

    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...

  11. 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...

  12. 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.

  13. 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.

  14. 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…

  15. Energy efficiency improvements in ammonia production--perspectives and uncertainties

    International Nuclear Information System (INIS)

    The paper discusses the energy consumption and energy saving potential for a major energy-intensive product in the chemical industry-ammonia, based on technologies currently in use and possible process improvements. The paper consists of four parts. In the first part, mainly references to various ammonia production technologies are given. Energy consumption, emissions and saving potentials are discussed in the second part. Thereby, the situation in Europe, the US and India is highlighted and various data sources are compared. In the third part of the paper, a novel approach for modeling energy efficiency improvements is described that accounts for uncertainties and unobserved heterogeneity in the production processes. Besides new investments, revamping investments are also included in the modeling and the development of the production stock is accounted for. Finally, in the fourth part, this approach is applied to the modeling of energy efficiency improvements and CO2 emission reductions in ammonia production. Thereby, considerable improvements in specific energy use and CO2 emissions are found in the reference scenario, yet under the assumption of high oil and gas prices, a partial switch to coal based technologies is expected which lowers notably the CO2 efficiency. Introduction of a CO2 penalty under a certificate trading or other regime is on contrary found to foster energy efficiency and the use of low carbon technologies

  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. 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)

  18. 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

  19. 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.

  20. 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....

  1. 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.

  2. Improving search filter development: a study of palliative care literature

    Directory of Open Access Journals (Sweden)

    Tieman Jennifer

    2007-06-01

    Full Text Available Abstract Background It is difficult to systematically search for literature relevant to palliative care in general medical journals. A previously developed search filter for use on OVID Medline validated using a gold standard set of references identified through hand searching, achieved an unacceptably low sensitivity (45.4%. Retrieving relevant literature is integral to support evidence based practice, and understanding the nature of the incorrectly excluded citations (false negatives using the filter may lead to improvement in the filter's performance. Methods The objectives were to describe the nature of subjects reflected in the false negative citations and to empirically improve the sensitivity of the search filter. A thematic analysis of MeSH terms by three independent reviewers was used to describe the subject coverage of the missed records. Using a frequency analysis of MeSH terms, those headings which could individually contribute at least 2.5% to sensitivity (occurring 19 or more times were added to the search filter. All previously run searches were rerun at the same time as the revised filter, and results compared. Results Thematic analysis of MeSH terms identified thirteen themes reflected in the missing records, none of them intrinsically palliative. The addition of six MeSH terms to the existing search filter (physician-patient relations, prognosis, quality of life, survival rate, treatment outcome and attitude to health led to an increase in sensitivity from 46.3% to 64.7%, offset by a decrease in precision from 72.6% to 21.9%. Conclusion The filter's sensitivity was successfully increased using frequency analysis of MeSH terms, offset by a decrease in precision. A thematic analysis of MeSH terms for the false negative citations confirmed the absence of any intrinsically palliative theme or term, suggesting that future improvements to search filters for palliative care literature will first depend on better identifying how

  3. 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.

  4. Improving care quality and preventing maltreatment in institutional care - a feasibility study with caregivers.

    Science.gov (United States)

    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 of the training immediately before, directly after, and 3 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, 1 month before, and 3 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. PMID:26236248

  5. 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.

  6. 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

  7. 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.

  8. 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...

  9. 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.

  10. Using theory to improve low back pain care in Australian Aboriginal primary care: a mixed method single cohort pilot study

    OpenAIRE

    Lin, Ivan B; Coffin, Juli; O’Sullivan, Peter B.

    2016-01-01

    Background Low back pain (LBP) care is frequently discordant with research evidence. This pilot study evaluated changes in LBP care following a systematic, theory informed intervention in a rural Australian Aboriginal Health Service. We aimed to improve three aspects of care; reduce inappropriate LBP radiological imaging referrals, increase psychosocial oriented patient assessment and, increase the provision of LBP self-management information to patients. Methods Three interventions to improv...

  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. Prevention and control of health care-associated infections through improved hand hygiene

    OpenAIRE

    Mathai E; Allegranzi B; Kilpatrick C; Pittet D

    2010-01-01

    Determined actions are required to address the burden due to health care-associated infections worldwide and improve patient safety. Improving hand hygiene among health care workers is an essential intervention to achieve these goals. The World Health Organization (WHO) First Global Patient Safety Challenge, Clean Care is Safer Care, pledged to tackle the problem of health care-associated infection at its launch in 2005 and has elaborated a comprehensive set of guidelines for use in both deve...

  13. 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...

  14. 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...: Tom Dautel (Technical Information), Office of Energy Policy and Innovation, (202) 502-6196,...

  15. 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...

  16. IMPROVING CO2 EFFICIENCY FOR RECOVERING OIL IN HETEROGENEOUS RESERVOIRS

    International Nuclear Information System (INIS)

    A three-year contract, 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. This report discusses the activity during the six-month period covering January 1, 2002 through June 30, 2002 that covers the second and third fiscal quarters of the project's first year. Paper SPE 75178, ''Cost Reduction and Injectivity Improvements for CO2 Foams for Mobility Control,'' has been presented and included in the proceedings of the SPE/DOE Thirteenth Symposium on Improved Oil Recovery, Tulsa, OK, April 13-17, 2002. During these two quarters of the project we have been working in several areas: reservoir fluid/rock interactions and their relationships to changing injectivity, producer survey on injectivity, and surfactant adsorption on quarried and reservoir core

  17. 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.

  18. Domestic refrigeration appliances in Poland: Potential for improving energy efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Meyers, S.; Schipper, L. [Lawrence Berkeley Lab., CA (United States); Lebot, B. [Agence de l`Environnement and de la Maitrise de l`Energie, 6 - Sophia Antipolis (France)

    1993-08-01

    This report is based on information collected from the main Polish manufacturer of refrigeration appliances. We describe their production facilities, and show that the energy consumption of their models for domestic sale is substantially higher than the average for similar models made in W. Europe. Lack of data and uncertainty about future production costs in Poland limits our evaluation of the cost-effective potential to increase energy efficiency, but it appears likely that considerable improvement would be economic from a societal perspective. Many design options are likely to have a simple payback of less than five years. We found that the production facilities are in need of substantial modernization in order to produce higher quality and more efficient appliances. We discuss policy options that could help to build a market for more efficient appliances in Poland and thereby encourage investment to produce such equipment.

  19. Volumetric Efficiency Improvement by Overflow in Rolling Piston Compressor

    OpenAIRE

    Wang, Wen; Huang, Gensheng; Zhang, Yilin

    2014-01-01

    The rotary compressor with rolling piston is a widely used compressor with less clearance volume, while it is minimized from normal scale to meso or micro scale, the input and exit ports dimension is limited by port requirement and lead to a certain clearance volume, therefore, keeping or improving its volume efficiency is an important issue. Although rolling piston compressor is a kind of compact structure compressor, the existence of the clearance volume is inevitable in a compressor, the m...

  20. 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.

  1. 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...

  2. 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...

  3. Improvements of budget management efficiency based on strategy management system

    OpenAIRE

    Aleksandr Kuklin; Natalya Shpak

    2006-01-01

    The economic and finance efficiency of enterprise activity is one of the competitive-ness factors in the conditions of modern market. Two indicatives are the basis of economic and finance evaluation: liquidity ratio and profit ratio. Budget management is the unique technology, which can run liquidity and profitability by the system of budgets together. In this article the author describe the way of improvements in budgeting management by the sys-tem of BSC (Balanced Score Card). This tool giv...

  4. Efficiency improvements of a double acting reciprocating magnetic refrigerator

    International Nuclear Information System (INIS)

    Continuing the work with gadolinium gallium garnet (GGG) after the previously obtained results of 1.2 W at 1.8 K and 45% of the Carnot cycle, new steps using half of the volume of GGG have achieved a more suitable field profile, improved heat transfer and 0.9 W at 2.1 K has been obtained with efficiency of 64%. The competitive threshold values for a magnetic stage refrigerator have been computed. (author)

  5. Ties matter: improving efficiency in course allocation by introducing ties

    OpenAIRE

    Chen, Ning; Li, Mengling

    2013-01-01

    We study the course allocation system at Nanyang Technological University, where students submit strict preferences for courses and courses have implicit preferences for students. This formulates a many-to-many matching problem. We show the inefficiencies of the current mechanism and propose new competing mechanisms called Pareto-improving draft and dictatorship mechanisms, which introduce ties into students' preferences. Our mechanisms generate (group) stable and Pareto-efficient allocations...

  6. Second generation rigs: Improved exploration efficiency and economics

    International Nuclear Information System (INIS)

    The article deals with improved exploration efficiency and economics by the utilization of second generation rigs. The Norwegian Saga Petroleum has come up with a novel idea for moving these rigs out of lay-up and getting them back to service. According to the article, this new deep water concept makes it possible to drill two wells for the price of one. 2 fig

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. Improving newborn care practices through home visits: lessons from Malawi, Nepal, Bangladesh, and Uganda

    Directory of Open Access Journals (Sweden)

    Deborah Sitrin

    2015-03-01

    Full Text Available Background: Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda. Objective: This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices. Design: Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable – home visit from a community health worker (CHW during pregnancy (0, 1–2, 3+ – and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education. Results: There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices. Conclusion: Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of

  12. 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...

  13. 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.

  14. 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

  15. 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

  16. 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

  17. KEY FACTORS FOR IMPROVING TECHNICAL EFFICIENCY OF UPLAND RICE PRODUCTION

    Directory of Open Access Journals (Sweden)

    Thanaporn Athipanyakul

    2014-01-01

    Full Text Available Food security problems are major issues in developing countries, especially under the conditions of restricted farm resources and environmental degradation. The re-allocation of existing farm resources in the upland in order to reach a production of maximum output under given technologies and the estimated value of the technical efficiency have been important information for this purpose. The objective of this study, therefore, was to measure the technical efficiency of upland rice production in Thailand. The identification of key factors to improve the technical efficiency was additionally carried out. A stochastic frontier approach with the Cobb-Douglas production function was applied. Data used in this study has been drawn from 181 farmers. The findings showed that on average the technical efficiency was 0.70 and the rank of its value varied from 0.22 to 0.94. A significant factor affecting the technical efficiency has been support in terms of transforming knowledge through a training program on upland rice production. Farmers, who grew upland rice for both household consumption and for commercial purposes, had a better performance than those who grew upland rice only for home consumption.

  18. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Heijdra, B.J.; Van der Horst, A. [Faculty of Economics and Econometrics, University of Amsterdam, Amsterdam (Netherlands)

    1998-02-01

    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.

  20. 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

  1. 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

  2. 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.

  3. 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

  4. [The impact of education on chronic wound care improvement].

    Science.gov (United States)

    Novinscak, Tomislav; Filipović, Marinko; Kristofić, Jelena; Toplek, Goran

    2014-10-01

    Although not fully understood, close relationship between health and education ensures unambiguous health and quality of life advantages to educated individuals. Education ensures different thinking and decision making processes and man is enabled to receive information from the external world. Even though the process of education and learning still relies on banking principles and coping of common knowledge, modern and technological society drives the system as well as education opportunities towards the new learning sources. In the developed world, the impact of chronic wounds on health systems is fairly perceived, as well as chronic wound treatment and education. Our health system still neglects the significant impact of chronic wounds on social and economic, individual and community well-being. Recognizing the importance of chronic wounds and implementation of a developed educational system gives us the potential for improving care for chronic wounds, and thus to substantially improve the quality of life of patients. Furthermore, consequent reduction of unnecessary health costs could reallocate substantial resources to other points of interest. PMID:25326984

  5. 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

  6. Improving the efficiency of solar photovoltaic power system

    Science.gov (United States)

    Aribisala, Henry A.

    As the local and national clamor for foreign energy independent United States continues to grow unabated; renewable energy has been receiving increased focus and it's widely believed that it's not only the answer to ever increasing demand for energy in this country, but also the environmentally friendly means of meeting such demand. During the spring of 2010, I was involved with a 5KW solar power system design project; the project involved designing and building solar panels and associated accessories like the solar array mounts and Solar Inverter system. One of the key issues we ran into during the initial stage of the project was how to select efficient solar cells for panel building at a reasonable cost. While we were able to purchase good solar cells within our allocated budget, the issue of design for efficiency was not fully understood , not just in the contest of solar cells performance , but also in the overall system efficiency of the whole solar power system, hence the door was opened for this thesis. My thesis explored and expanded beyond the scope of the aforementioned project to research different avenues for improving the efficiency of solar photo-voltaic power system from the solar cell level to the solar array mounting, array tracking and DC-AC inversion system techniques.

  7. The myADHDportal.com Improvement Program: An innovative quality improvement intervention for improving the quality of ADHD care among community-based pediatricians

    OpenAIRE

    Epstein, Jeffery N.; Langberg, Joshua M.; Lichtenstein, Philip K.; Kolb, Rebecca; Simon, John O

    2013-01-01

    Though the American Academy of Pediatrics has developed and disseminated clear evidence-based guidelines for ADHD care, community-based pediatricians often have difficulty implementing these guidelines. New strategies are needed to improve the quality of care received by children with ADHD and to improve utilization of the AAP consensus guidelines by pediatricians. An evidence-based quality improvement intervention has been developed that effectively improves the quality of ADHD care delivere...

  8. 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.

  9. 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...

  10. 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.

  11. 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...

  12. 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

  13. Utilization of Portable Radios to Improve Ophthalmology Clinic Efficiency in an Academic Setting.

    Science.gov (United States)

    Davis, Alexander S; Elkeeb, Ahmed M; Vizzeri, Gianmarco; Godley, Bernard F

    2016-03-01

    Improvement in clinic efficiency in the ambulatory setting is often looked at as an area for development of lean management strategies to deliver a higher quality of healthcare while reducing errors, costs, and delays. To examine the benefits of improving team communication and its impact on clinic flow and efficiency, we describe a time-motion study performed in an academic outpatient Ophthalmology clinic and its objective and subjective results. Compared to clinic encounters without the use of the portable radios, objective data demonstrated an overall significant decreases in mean workup time (15.18 vs. 13.10), room wait (13.10 vs. 10.47), and decreased the total time needed with an MD per encounter (9.45 vs. 6.63). Subjectively, significant improvements were seen in careprovider scores for patient flow (60.78 vs. 84.29), getting assistance (61.89 vs. 88.57), moving patient charts (54.44 vs. 85.71), teamwork (69.56 vs. 91.0), communications (62.33 vs. 90.43), providing quality patient care (76.22 vs. 89.57), and receiving input on the ability to see walk-in patients (80.11 vs. 90.43). For academic purposes, an improvement in engagement in patient care and learning opportunities was noted by the clinic resident-in-training during the pilot study. Portable radios in our pilot study were preferred over the previous method of communication and demonstrates significant improvements in certain areas of clinical efficiency, subjective perception of teamwork and communications, and academic learning. PMID:26692044

  14. Fast reactor core concepts to improve transmutation efficiency

    International Nuclear Information System (INIS)

    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

  15. 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

  16. 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…

  17. Improving crop water use efficiency using carbon isotope discrimination

    International Nuclear Information System (INIS)

    Water scarcity, drought and salinity are among the most important environmental constraints challenging crop productivity in the arid and semi-arid regions of the world, especially the rain-fed production systems. The current challenge is to enhance food security in water-limited and/or salt-affected areas for the benefit of resource-poor farmers in developing countries. There is also an increasing need that water use in agriculture should focus on improvement in the management of existing water resources and enhancing crop water productivity. The method based on carbon-13 discrimination in plant tissues has a potentially important role in the selection and breeding of some crop species for increased water use efficiency in some specific environments. Under various water-limited environments, low delta in the plants, indicating low carbon isotope discrimination has been generally associated with high transpiration efficiency (TE). In contrast, for well-watered environments many positive genotypic correlations have been reported between delta and grain yield indicating potential value in selecting for greater delta in these environments. Few studies have been reported on the impact of selection for delta on adaptation and grain yield in saline environments. Studies of the impact of genetic selection for greater and lower delta are currently coordinated by the Soil and water Management and Crop Nutrition Section (SWMCN) of the Joint FAO/IAEA Division. A Coordinated Research Project (CRP) is currently on-going on the Selection for Greater Agronomic Water-Use Efficiency in Wheat and Rice using Carbon Isotope Discrimination (D1-20 08). The overall objective of this project is to contribute to increasing the agronomic water-use efficiency of wheat and rice production, where agronomic water-use efficiency is defined as grain yield/total water use including both transpiration and evaporation. The CRP is also aiming at increasing wheat productivity under drought and rice

  18. 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...

  19. Health-care Worker Engagement in HIV-related Quality Improvement in Dar es Salaam, Tanzania.

    OpenAIRE

    Garcia, Maria E; Li, Michelle S.; Siril, Hellen; Hawkins, Claudia; Kaaya, Sylvia; Ismail, Shabbir; Chalamilla, Guerino; Mdingi, Sarah Geoffrey; Hirschhorn, Lisa R.

    2011-01-01

    To assess health-care worker (HCW) awareness, interest and engagement in quality improvement (QI) in HIV care sites in Tanzania. Cross-sectional survey distributed in May 2009. Sixteen urban HIV care sites in Dar es Salaam, Tanzania, 1 year after the introduction of a quality management program. Two hundred seventy-nine HCWs (direct care, clinical support staff and management). HCW perceptions of care delivered, rates of engagement, knowledge and interest in QI. HCW-identified barriers to and...

  20. 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.

  1. Improving Efficiency of META Algorithm Using Record Reduction

    Directory of Open Access Journals (Sweden)

    Shweta Bidhan

    2013-06-01

    Full Text Available Erasable Itemset Mining is the key approach of data mining in production planning. The erasable itemset mining is the process of finding erasable itemsets that satisfy the constraint i.e. user defined threshold. Efficient algorithm to mine erasable itemsets is extremely important in data mining. Since the META Algorithm was proposed to generate the erasable itemsets. In last few years there have been several methods to improve its performance. But they do not consider the time constraint. If database is large META takes too much time to scan the database. In this paper, Author purposed an Improved META (I-META algorithm which reduces the scanning time by reduction of production records. It also reduces the redundant generation of sub-items during trimming the candidate itemsets, which can find directly the set of erasable itemsets and removing candidate having a subset that is not erasable.

  2. Prerequisites for sustainable care improvement using the reflective team as a work model

    OpenAIRE

    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 proce...

  3. Improvement Critical Care Patient Safety: Using Nursing Staff Development Strategies, At Saudi Arabia

    OpenAIRE

    2015-01-01

    Intensive care units (ICUs) provide lifesaving care for the critically ill patients and are associated with significant risks. Moreover complexity of care within ICUs requires that the health care professionals exhibit a trans-disciplinary level of competency to improve patient safety. This study aimed at using staff development strategies through implementing patient safety educational program that may minimize the medical errors and improve patient outcome in hospital. The study was carried...

  4. Measuring improvement in populations: implementing and evaluating successful change in lung cancer care

    OpenAIRE

    Yu, Xinhua; Klesges, Lisa M; Smeltzer, Mathew P.; Osarogiagbon, Raymond U.

    2015-01-01

    Improving quality of care in lung cancer, the leading cause of cancer death worldwide and in the United States, is a major public health challenge. Such improvement requires accurate and meaningful measurement of quality of care. Preliminary indicators have been derived from clinical practice guidelines and expert opinions, but there are few standard sets of quality of care measures for lung cancer in the United States or elsewhere. Research to develop validated evidence-based quality of care...

  5. 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

  6. [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

  7. 78 FR 43055 - Accelerating Improvements in HIV Prevention and Care in the United States Through the HIV Care...

    Science.gov (United States)

    2013-07-18

    ....) THE WHITE HOUSE, July 15, 2013. [FR Doc. 2013-17478 Filed 7-17-13; 11:15 am] Billing code 3295-F3 ... July 18, 2013 Part III The President Executive Order 13649--Accelerating Improvements in HIV Prevention and Care in the United States Through the HIV Care Continuum Initiative #0; #0; #0;...

  8. Pediatric recertification and quality of care: the role of the American Board of Pediatrics in improving children's health care.

    Science.gov (United States)

    Miles, Paul V

    2007-11-01

    American health care is in the middle of a second revolution in quality as profound as the Flexner revolution occurring almost 100 years ago. Although systems issues are the basis for most of the concern, physician quality and professional development are also pertinent. Specialty board certification and maintenance of certification are key drivers of professional development and improvement of care. PMID:17950317

  9. Improving Vehicle Efficiency, Reducing Dependence on Foreign Oil (Fact Sheet)

    Energy Technology Data Exchange (ETDEWEB)

    2012-03-01

    This fact sheet provides an overview of the U.S. Department of Energy's Vehicle Technologies Program. Today, the United States spends about $400 billion each year on imported oil. To realize a secure energy future, America must break its dependence on imported oil and its volatile costs. The transportation sector accounts for about 70% of U.S. oil demand and holds tremendous opportunity to increase America's energy security by reducing oil consumption. That's why the U.S. Department of Energy (DOE) conducts research and development (R and D) on vehicle technologies which can stem America's dependence on oil, strengthen the economy, and protect the environment. Hybrid-electric and plug-in hybrid-electric vehicles can significantly improve fuel economy, displacing petroleum. Researchers are making batteries more affordable and recyclable, while enhancing battery range, performance, and life. This research supports President Obama's goal of putting 1 million electric vehicles on the road by 2015. The program is also working with businesses to develop domestic battery and electric-drive component plants to improve America's economic competitiveness globally. The program facilitates deployment of alternative fuels (ethanol, biodiesel, hydrogen, electricity, propane, and natural gas) and fuel infrastructures by partnering with state and local governments, universities, and industry. Reducing vehicle weight directly improves vehicle efficiency and fuel economy, and can potentially reduce vehicle operating costs. Cost-effective, lightweight, high-strength materials can significantly reduce vehicle weight without compromising safety. Improved combustion technologies and optimized fuel systems can improve near-and mid-term fuel economy by 25% for passenger vehicles and 20% for commercial vehicles by 2015, compared to 2009 vehicles. Reducing the use of oil-based fuels and lubricants in vehicles has more potential to improve the nation

  10. 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

  11. 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

  12. Improving Glycemic Control and Insulin Ordering Efficiency for Hospitalized Patients With Diabetes Through Carbohydrate Counting.

    Science.gov (United States)

    Pearson, Kristina K; Reiland, Sarah A; Meara, John G O; Brown, Julie K; Fedraw, Leslie A; Mapes, David L

    2016-01-01

    Glycemic control in hospitalized patients is challenging but important for optimal outcomes. Insulin dosing through carbohydrate counting may address patient, provider, and institutional factors that complicate hospital glycemic management. On two surgical units at a tertiary care teaching hospital, we pilot tested postmeal insulin dosing based on carbohydrate counting (plus basal insulin) rather than the current process of ordering scheduled premeal insulin without knowledge of the patient's consumption. Analysis assessed hyperglycemia, hypoglycemia, insulin orders, and nurse and provider satisfaction and confidence. On general surgery, mean glucose level improved from 188 to 137 mg/dl (p nurses (preintervention, 72%; postintervention, 100%), and cardiovascular surgery nurses (preintervention, 69%; postintervention, 84%). Confidence in insulin dose accuracy improved for providers (preintervention, 50%; postintervention, 100%), general surgery nurses (preintervention, 59%; postintervention, 100%), and cardiovascular surgery nurses (preintervention, 48%; postintervention, 84%). Carbohydrate counting is effective and efficient and improved staff satisfaction and confidence in hospital mealtime insulin dosing. PMID:26164007

  13. 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.

  14. 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)

  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. Improving computational efficiency of Monte Carlo simulations with variance reduction

    International Nuclear Information System (INIS)

    CCFE perform Monte-Carlo transport simulations on large and complex tokamak models such as ITER. Such simulations are challenging since streaming and deep penetration effects are equally important. In order to make such simulations tractable, both variance reduction (VR) techniques and parallel computing are used. It has been found that the application of VR techniques in such models significantly reduces the efficiency of parallel computation due to 'long histories'. VR in MCNP can be accomplished using energy-dependent weight windows. The weight window represents an 'average behaviour' of particles, and large deviations in the arriving weight of a particle give rise to extreme amounts of splitting being performed and a long history. When running on parallel clusters, a long history can have a detrimental effect on the parallel efficiency - if one process is computing the long history, the other CPUs complete their batch of histories and wait idle. Furthermore some long histories have been found to be effectively intractable. To combat this effect, CCFE has developed an adaptation of MCNP which dynamically adjusts the WW where a large weight deviation is encountered. The method effectively 'de-optimises' the WW, reducing the VR performance but this is offset by a significant increase in parallel efficiency. Testing with a simple geometry has shown the method does not bias the result. This 'long history method' has enabled CCFE to significantly improve the performance of MCNP calculations for ITER on parallel clusters, and will be beneficial for any geometry combining streaming and deep penetration effects. (authors)

  17. 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.

  18. Improving Gas Turbine efficiency by chilled water system

    Directory of Open Access Journals (Sweden)

    Masoud Asadi

    2013-04-01

    Full Text Available The process in a gas turbine plant involves certain losses which can be divided into internal and external losses. In term of internal losses, the main factor is changing the state of working fluid. Since the temperature of atmospheric air may vary within a wide range, its variations can influence strongly the efficiency of gas turbine plants. With growing ambient air temperature, the specific volume of air increases, which can result in a larger work spent for air compression in the compressor. One of the most effective method for increasing the efficiency of gas turbine plants is to raise the gas temperature before the turbine. Since this temperature is the highest temperature in the cycle, this method is applicable for gas turbine plants of any scheme and type. However, there are some limitations on increasing gas temperature. The allowable temperature for reliable operation is between 1000 and 1400 k. However, decreasing ambient air temperature to increase the efficiency of gas turbine plants is easier and at low costs compared to rising gas temperature. As a decrease of 1°C temperature of inlet air increases the power output by 1%. In this paper our objective is improving the efficiency of gas turbine plants by decreasing ambient air temperature. To reach this we use a heat exchanger with different strip fins. The temperature of chilled water is constant on 7C°, but the ambient air temperature is variable between 20 and 36 C°. After designing process some graphs are presented, which give required mass flow rate to reach slightly ambient air temperature.

  19. Improved energy efficiency in juice production through waste heat recycling

    International Nuclear Information System (INIS)

    Highlights: • A heating system at a juice production was investigated and improved. • Different impacts of drying cycle improvements at the energy usage were explored. • The total heat use for drying could thereby be decreased with 52%. • The results point out a significant decrease of heat consumption with low investment costs. - Abstract: Berry juice concentrate is produced by pressing berries and heating up the juice. The by-products are berry skins and seeds in a press cake. Traditionally, these by-products have been composted, but due to their valuable nutrients, it could be profitable to sell them instead. The skins and seeds need to be separated and dried to a moisture content of less than 10 %wt (on dry basis) in order to avoid fermentation. A berry juice plant in the north of Sweden has been studied in order to increase the energy and resource efficiency, with special focus on the drying system. This was done by means of process integration with mass and energy balance, theory from thermodynamics and psychrometry along with measurements of the juice plant. Our study indicates that the drying system could be operated at full capacity without any external heat supply using waste heat supplied from the juice plant. This would be achieved by increasing the efficiency of the dryer by recirculation of the drying air and by heat supply from the flue gases of the industrial boiler. The recirculation would decrease the need of heat in the dryer with about 52%. The total heat use for the plant could thereby be decreased from 1262 kW to 1145 kW. The improvements could be done without compromising the production quality

  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. 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

  2. Exemplary Care and Learning Sites: A Model for Achieving Continual Improvement in Care and Learning in the Clinical Setting

    Science.gov (United States)

    Ogrinc, Greg; Hoffman, Kimberly G.; Stevenson, Katherine M.; Shalaby, Marc; Beard, Albertine S.; Thörne, Karin E.; Coleman, Mary T.; Baum, Karyn D.

    2016-01-01

    Problem Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting. Approach From 2008–2012, an iterative, interactive process was used to develop the ECLS model and its core elements—patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012–2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site’s ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden). Outcomes Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites. Next Steps The next test of the model should be prospective, linked to clinical and educa tional outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development. PMID:26760058

  3. 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

  4. 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

  5. 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

  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. Improving Adherence to Hand Hygiene among Health Care Workers

    Science.gov (United States)

    Maskerine, Courtney; Loeb, Mark

    2006-01-01

    Increased adherence to hand hygiene is widely acknowledged to be the most important way of reducing infections in health care facilities. Despite evidence of benefit, adherence to hand hygiene among health care professionals remains low. Several behavioral and organizational theories have been proposed to explain this. As a whole, the success of…

  9. 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...

  10. [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

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. AN ADAPTIVE REMOTE DISPLAY FRAMEWORK TO IMPROVE POWER EFFICIENCY

    Directory of Open Access Journals (Sweden)

    Dong Hyun, Jo

    2015-12-01

    Full Text Available As computing performance and network technology have evolved, mobile device users can enjoy high quality multimedia more easily. Remote Display - the technology which mirrors the screen of one device to another device - allows handheld mobile devices to share their screen contents with larger-sized display devices such as TVs. However, there is general concern about high power consumption caused by complex computation for encoding and continuous data transmission in the mobile devices. In this paper, we present an adaptive remote display framework considering and utilizing the processing capability of display device. By supporting the Content Mirroring Mode, we can skip unnecessary steps and perform core activities to improve power efficiency and extend overall processing capability

  16. Renewable energy: An efficient mechanism to improve GDP

    International Nuclear Information System (INIS)

    This article analyzes the effects of renewable energy on GDP for 116 economies in 2003 through Structural Equation Modeling (SEM) approach. In order to decipher the mechanism of how the use of renewables improves macroeconomic efficiency, we decompose GDP by the ''expenditure approach''. Although previous theory predicts positive effects of renewables on capital formation and trade balance, the SEM results show that renewables have a significant positive influence on capital formation only. The result that renewables do not have a significant impact on trade balance implies that renewables do not have an import substitution effect. Thus, we confirm the positive relationship between renewable energy and GDP through the path of increasing capital formation, but not for the path of increasing trade balance. (author)

  17. Renewable energy: An efficient mechanism to improve GDP

    International Nuclear Information System (INIS)

    This article analyzes the effects of renewable energy on GDP for 116 economies in 2003 through Structural Equation Modeling (SEM) approach. In order to decipher the mechanism of how the use of renewables improves macroeconomic efficiency, we decompose GDP by the 'expenditure approach'. Although previous theory predicts positive effects of renewables on capital formation and trade balance, the SEM results show that renewables have a significant positive influence on capital formation only. The result that renewables do not have a significant impact on trade balance implies that renewables do not have an import substitution effect. Thus, we confirm the positive relationship between renewable energy and GDP through the path of increasing capital formation, but not for the path of increasing trade balance

  18. 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.

  19. 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. PMID:26540679

  20. 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

  1. 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.

  2. 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...

  3. CSA: An efficient algorithm to improve circular DNA multiple alignment

    Directory of Open Access Journals (Sweden)

    Pereira Luísa

    2009-07-01

    Full Text Available Abstract Background The comparison of homologous sequences from different species is an essential approach to reconstruct the evolutionary history of species and of the genes they harbour in their genomes. Several complete mitochondrial and nuclear genomes are now available, increasing the importance of using multiple sequence alignment algorithms in comparative genomics. MtDNA has long been used in phylogenetic analysis and errors in the alignments can lead to errors in the interpretation of evolutionary information. Although a large number of multiple sequence alignment algorithms have been proposed to date, they all deal with linear DNA and cannot handle directly circular DNA. Researchers interested in aligning circular DNA sequences must first rotate them to the "right" place using an essentially manual process, before they can use multiple sequence alignment tools. Results In this paper we propose an efficient algorithm that identifies the most interesting region to cut circular genomes in order to improve phylogenetic analysis when using standard multiple sequence alignment algorithms. This algorithm identifies the largest chain of non-repeated longest subsequences common to a set of circular mitochondrial DNA sequences. All the sequences are then rotated and made linear for multiple alignment purposes. To evaluate the effectiveness of this new tool, three different sets of mitochondrial DNA sequences were considered. Other tests considering randomly rotated sequences were also performed. The software package Arlequin was used to evaluate the standard genetic measures of the alignments obtained with and without the use of the CSA algorithm with two well known multiple alignment algorithms, the CLUSTALW and the MAVID tools, and also the visualization tool SinicView. Conclusion The results show that a circularization and rotation pre-processing step significantly improves the efficiency of public available multiple sequence alignment

  4. 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.

  5. Biohydrogen production: strategies to improve process efficiency through microbial routes.

    Science.gov (United States)

    Chandrasekhar, Kuppam; Lee, Yong-Jik; Lee, Dong-Woo

    2015-01-01

    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. PMID:25874756

  6. Improvement of powertrain efficiency through energy breakdown analysis

    International Nuclear Information System (INIS)

    Highlights: • Energy breakdown analysis for the vehicular powertrain. • Model for road vehicles simulation in different missions. • Implemented powertrain management strategies: intelligent gearbox, Stop and Start, free wheel. • Innovative hybrid powertrain turned to engine thermodynamic cycles minimization. • Evaluation of fuel savings associated to each management strategy. - Abstract: A vehicular powertrain can be thought as an energy conversion chain, each component being characterized by its efficiency. Significant global efficiency improvements can be achieved once is identified the system energy breakdown, individuating the losses connected to each powertrain component; it is then possible to carry out the most appropriate interventions. This paper presents a simulation study of a diesel-fuelled commercial vehicle powertrain based on the above summarized point of view. The work aims at individuating the energy flows involved in the system during different missions, proposing an intelligent combination of technical solutions which minimize fuel consumption. Through a validated Matlab–Simulink model, able to indicate the powertrain energy breakdown, simulations are carried out to evaluate the fuel saving associated to a series of powertrain management logics which lead to the minimization of engine losses, the recovery of reverse power in deceleration and braking, the elimination of useless engine cycles. Tests were performed for different real missions (urban, extra-urban and highway). The results obtained point out a –23% fuel consumption (average value for urban, extra-urban and highway missions) compared to the traditional powertrain. Clearly, such result affects positively the CO2 emission

  7. 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.

  8. 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++.

  9. 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.

  10. 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

  11. 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++.

  12. 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.

  13. 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++.

  14. 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.

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

    DEFF Research Database (Denmark)

    Prætorius, Thim

    replicated, the way they are influenced by the organisation and the way they influence health care professionals. Design/methodology/approach: Theory of routines is systematically applied to the concept of care pathways in order to develop theoretically derived propositions. Findings: Care pathways mirror...... routines by being recurrent, collective and embedded and specific to an organisation. In particular, care pathways resemble standard operating procedures that can give rise to recurrent collective action patterns. Eleven propositions related to five categories are proposed by building on these insights......: 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...

  16. 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

  17. Improving efficiency of a regional stand alone bone bank.

    Science.gov (United States)

    Warnock, Jonathan M; Rowan, Clare H; Davidson, Helen; Millar, Ciara; McAlinden, M Gavan

    2016-03-01

    The introduction of a stand-alone Bone Bank in our Regional Orthopaedic Hospital has improved the availability of femoral head allograft. Benninger et al. (Bone Joint J 96-B:1307-1311, 2014), demonstrated their institutions bank to be cost effective despite a 30 % discard rate for harvested allograft. We sought to audit our own discard rates and subsequent cost-effectiveness of our bone bank. Donor recruitment. Before approaching a potential donor, our establishment's nurse specialists review their clinical notes and biochemical laboratory results, available on a regional Electronic Care Records. They view femoral head architecture on radiographs against set criteria, Patient Archive and Communication system (SECTRA, Sweden). In total 1383 femoral heads were harvested, 247 were discarded giving an overall rate of 17.9 %. The most common reasons for discard of harvested graft was a positive microbiology/bacteriology result, n = 96 (38.9 %). After a rise in discard rates in 2007, we have steadily reduced our discard rates since 2006/2007 (28.2 %), 2008/2009 (17 %), 2010/2011 (14.8 %), and finally to 10.3 % in 2012/2013. In the current financial year, our cost to harvest, test, store and release a femoral head is £610. With a structured donor recruitment process and unique pre-operative radiographic analysis we have successfully reduced our discard rates bi-annually making our bone bank increasingly cost-effective. PMID:26138308

  18. Improving the provision of pregnancy care for Aboriginal and Torres Strait Islander women: a continuous quality improvement initiative

    OpenAIRE

    Gibson-Helm, Melanie E.; Rumbold, Alice R; Teede, Helena J; Ranasinha, Sanjeeva; Bailie, Ross S; Jacqueline A. Boyle

    2016-01-01

    Background Australian Aboriginal and Torres Strait Islander (Indigenous) women are at greater risk of adverse pregnancy outcomes than non-Indigenous women. Pregnancy care has a key role in identifying and addressing modifiable risk factors that contribute to adverse outcomes. We investigated whether participation in a continuous quality improvement (CQI) initiative was associated with increases in provision of recommended pregnancy care by primary health care centers (PHCs) in predominantly I...

  19. Mobile phones improve antenatal care attendance in Zanzibar

    DEFF Research Database (Denmark)

    Lund, Stine; Nielsen, Birgitte B; Hemed, Maryam; Boas, Ida M; Said, Azzah; Said, Khadija; Makungu, Mkoko H; Rasch, Vibeke

    2014-01-01

    pregnancy. METHODS: This study was an open label pragmatic cluster-randomised controlled trial with primary healthcare facilities in Zanzibar as the unit of randomisation. 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary healthcare facilities were...... 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...

  20. Improving Water Use Efficiency in Agriculture: Field Campaign in Beijing

    International Nuclear Information System (INIS)

    Soil evaporation and plant transpiration measurements are important for estimating the amount of water required for plant growth. Stable isotope techniques can be a useful tool for measuring evaporation and transpiration. Evapotranspiration, an important part of the water cycle describes the sum of evaporation (E) and plant transpiration (T) from the land surface to the atmosphere where evaporation accounts for the movement of water to the air from sources such as the soil, canopy interception, and water bodies whereas transpiration accounts for the movement of water within a plant and the subsequent loss of water as vapor through stomata in its leaves. As the amounts of the stable isotope 18O in soil water and water vapor within the plant canopy can be different, the trapping and analyses of 18O in soil water and water vapour can help separate evaporation from evapotranspiration (ET). This information allows informed decisions to be made regarding improving irrigation scheduling. For example, recently, Picarro, Inc., a manufacturer of real-time water vapor isotope analysers was invited to participate in a FAO/IAEA field measurement campaign to assess ET from an arable land in Beijing. The data obtained demonstrates the efficacy of using stable isotopes as a means to differentiate evaporation and transpiration with an eye towards improving water use efficiency (WUE)

  1. Primary care satellite clinics and improved access to general and mental health services.

    OpenAIRE

    Rosenheck, R

    2000-01-01

    OBJECTIVES: To evaluate the relationship between the implementation of community-based primary care clinics and improved access to general health care and/or mental health care, in both the general population and among people with disabling mental illness. STUDY SETTING: The 69 new community-based primary care clinics in underserved areas, established by the Department of Veterans Affairs (VA) between the last quarter of FY 1995 and the second quarter of FY 1998, including the 21 new clinics ...

  2. Teamwork and solidarity: improving health care for all.

    Science.gov (United States)

    Blakey, Emma

    2015-12-10

    Emma Blakey considers one of most important lessons she learnt as a student nurse on placement, and explores how team work can influence patient care and how solidarity can change society. PMID:26653520

  3. Family Day Care Mothers Work Together to Improve Services

    Science.gov (United States)

    Sale, June Solnit

    1975-01-01

    Describes the history of Women Attentive to Children's Happiness (WATCH), a self-help organization of family day care mothers which has developed an effective method of producing developmental programs for children and families. (ED)

  4. 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...

  5. Benchmarking and audit of breast units improves quality of care

    OpenAIRE

    van Dam, P. A.; Verkinderen, L.; Hauspy, J.; Vermeulen, P.; Dirix, L.; Huizing, M.; Altintas, S.; K. Papadimitriou; Peeters, M.; Tjalma, W

    2013-01-01

    Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. Assessment quality of care can be performed on different levels: national, regional, on a hospital basis or on an individual basis. It can be a mandatory or voluntary system. In all cases development of an adequate database for data extraction, and feedback of the findings is of paramount importance. In the present paper we performed a Medline search on “QIs ...

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

    Directory of Open Access Journals (Sweden)

    Denton E

    2016-03-01

    Full Text Available Eve Denton,1 Matthew Conron2 1Allergy, Immunology and Respiratory Department, Alfred Hospital, 2Department of Respiratory and Sleep Medicine, St Vincent's Hospital, Melbourne, VIC, Australia Abstract: 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. Keywords: lung cancer, multidisciplinary care, mortality, tumor board

  7. 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

  8. 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

  9. 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

  10. Communication and Culture in the Surgical Intensive Care Unit: Boundary Production and the Improvement of Patient Care.

    Science.gov (United States)

    Conn, Lesley Gotlib; Haas, Barbara; Cuthbertson, Brian H; Amaral, Andre C; Coburn, Natalie; Nathens, Avery B

    2016-06-01

    This ethnography explores communication around critically ill surgical patients in three surgical intensive care units (ICUs) in Canada. A boundary framework is used to articulate how surgeons', intensivists', and nurses' communication practices shape and are shaped by their respective disciplinary perspectives and experiences. Through 50 hours of observations and 43 interviews, these health care providers are found to engage in seven communication behaviors that either mitigate or magnify three contested symbolic boundaries: expertise, patient ownership, and decisional authority. Where these boundaries are successfully mitigated, experiences of collaborative, high-quality patient care are produced; by contrast, boundary magnification produces conflict and perceptions of unsafe patient care. Findings reveal that high quality and safe patient care are produced through complex social and cultural interactions among surgeons, intensivists, and nurses that are also expressions of knowledge and power. This enhances our understanding of why current quality improvement efforts targeting communication may be ineffective. PMID:26481945

  11. Identifying resident care areas for a quality improvement intervention in long-term care: a collaborative approach

    Directory of Open Access Journals (Sweden)

    Cranley Lisa A

    2012-09-01

    Full Text Available Abstract Background In Canada, healthcare aides (also referred to as nurse aides, personal support workers, nursing assistants are unregulated personnel who provide 70-80% of direct care to residents living in nursing homes. Although they are an integral part of the care team their contributions to the resident care planning process are not always acknowledged in the organization. The purpose of the Safer Care for Older Persons [in residential] Environments (SCOPE project was to evaluate the feasibility of engaging front line staff (primarily healthcare aides to use quality improvement methods to integrate best practices into resident care. This paper describes the process used by teams participating in the SCOPE project to select clinical improvement areas. Methods The study employed a collaborative approach to identify clinical areas and through consensus, teams selected one of three areas. To select the clinical areas we recruited two nursing homes not involved in the SCOPE project and sampled healthcare providers and decision-makers within them. A vote counting method was used to determine the top five ranked clinical areas for improvement. Results Responses received from stakeholder groups included gerontology experts, decision-makers, registered nurses, managers, and healthcare aides. The top ranked areas from highest to lowest were pain/discomfort management, behaviour management, depression, skin integrity, and assistance with eating. Conclusions Involving staff in selecting areas that they perceive as needing improvement may facilitate staff engagement in the quality improvement process.

  12. 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...

  13. 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

  14. 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 ...

  15. 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

  16. 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

  17. Berkeley Lab Sheds Light on Improving Solar Cell Efficiency

    International Nuclear Information System (INIS)

    Typical manufacturing methods produce solar cells with an efficiency of 12-15%; and 14% efficiency is the bare minimum for achieving a profit. In work performed at the Ernest Orlando Lawrence Berkeley National Laboratory (Berkeley, CA, 5 10-486-577 1)--a US Department of Energy national laboratory that conducts unclassified scientific research and is managed by the University of California--scientist Scott McHugo has obtained keen insights into the impaired performance of solar cells manufactured from polycrystalline silicon. The solar cell market is potentially vast, according to Berkeley Lab. Lightweight solar panels are highly beneficial for providing electrical power to remote locations in developing nations, since there is no need to build transmission lines or truck-in generator fuel. Moreover, industrial nations confronted with diminishing resources have active programs aimed at producing improved, less expensive solar cells. 'In a solar cell, there is a junction between p-type silicon and an n-type layer, such as diffused-in phosphorous', explained McHugo, who is now with Berkeley Lab's Accelerator and Fusion Research Division. 'When sunlight is absorbed, it frees electrons, which start migrating in a random-walk fashion toward that junction. If the electrons make it to the junction; they contribute to the cell's output of electric current. Often, however, before they reach the junction, they recombine at specific sites in the crystal' (and, therefore, cannot contribute to current output). McHugo scrutinized a map of a silicon wafer in which sites of high recombination appeared as dark regions. Previously, researchers had shown that such phenomena occurred not primarily at grain boundaries in the polycrystalline material, as might be expected, but more often at dislocations in the crystal. However, the dislocations themselves were not the problem. Using a unique heat treatment technique, McHugo performed electrical measurements to investigate the material

  18. Efficient decellularization of whole porcine kidneys improves reseeded cell behavior.

    Science.gov (United States)

    Poornejad, Nafiseh; Momtahan, Nima; Salehi, Amin S M; Scott, Daniel R; Fronk, Cory A; Roeder, Beverly L; Reynolds, Paul R; Bundy, Bradley C; Cook, Alonzo D

    2016-01-01

    Combining patient-specific cells with the appropriate scaffold to create functional kidneys is a promising technology to provide immunocompatible kidneys for the 100 000+  patients on the organ waiting list. For proper recellularization to occur, the scaffold must possess the critical microstructure and an intact vascular network. Detergent perfusion through the vasculature of a kidney is the preferred method of decellularization; however, harsh detergents could be damaging to the microstructure of the renal tissue and may undesirably solubilize the endogenous growth and signaling factors. In this study, automated decellularization of whole porcine kidneys was performed using an improved method that combined physical and chemical steps to efficiently remove cellular materials while producing minimal damage to the collagenous extracellular matrix (ECM). Freezing/thawing, incremental increases in flow rate under constant pressure, applying osmotic shock to the cellular membranes, and low concentrations of the detergent sodium dodecyl sulfate (SDS) were factors used to decrease SDS exposure time during the decellularization process from 36 to 5 h, which preserved the microstructure while still removing 99% of the DNA. The well-preserved glycosaminoglycans (GAGs) and collagen fibers enhanced cell-ECM interactions. Human renal cortical tubular epithelium (RCTE) cells grew more rapidly when cultured on the ECM obtained from the improved decellularization process and also demonstrated more in vivo-like gene expression patterns. The optimized, automated process that resulted from this work is now used routinely in our laboratory to rapidly decellularize porcine kidneys and could be adapted to other large organs (e.g. heart, liver, and lung). PMID:26963774

  19. Modeling of Glass Making Processes for Improved Efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Thomas P. Seward III

    2003-03-31

    The overall goal of this project was to develop a high-temperature melt properties database with sufficient reliability to allow mathematical modeling of glass melting and forming processes for improved product quality, improved efficiency and lessened environmental impact. It was initiated by the United States glass industry through the NSF Industry/University Center for Glass Research (CGR) at Alfred University [1]. Because of their important commercial value, six different types/families of glass were studied: container, float, fiberglass (E- and wool-types), low-expansion borosilicate, and color TV panel glasses. CGR member companies supplied production-quality glass from all six families upon which we measured, as a function of temperature in the molten state, density, surface tension, viscosity, electrical resistivity, infrared transmittance (to determine high temperature radiative conductivity), non-Newtonian flow behavior, and oxygen partial pres sure. With CGR cost sharing, we also studied gas solubility and diffusivity in each of these glasses. Because knowledge of the compositional dependencies of melt viscosity and electrical resistivity are extremely important for glass melting furnace design and operation, these properties were studied more fully. Composition variations were statistically designed for all six types/families of glass. About 140 different glasses were then melted on a laboratory scale and their viscosity and electrical resistivity measured as a function of temperature. The measurements were completed in February 2003 and are reported on here. The next steps will be (1) to statistically analyze the compositional dependencies of viscosity and electrical resistivity and develop composition-property response surfaces, (2) submit all the data to CGR member companies to evaluate the usefulness in their models, and (3) publish the results in technical journals and most likely in book form.

  20. 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

  1. 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

  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. [Integration of nutritional care into cancer treatment: need for improvement].

    Science.gov (United States)

    Joly, Caroline; Jacqueline-Ravel, Nathalie; Pugliesi-Rinaldi, Angela; Bigler-Perrotin, Lucienne; Chikhi, Marinette; Dietrich, Pierre-Yves; Dulguerov, Pavel; Miralbell, Raymond; Picard-Kossovsky, Michel; Seium, Yodit; Thériault, Michel; Pichard, Claude

    2011-11-16

    Progresses in cancer treatment transformed cancer into a chronic disease associated with growing nutritional problems. Poor nutritional status of cancer patients worsens morbidity, mortality, overall cost of care and decreases patients' quality of life, oncologic treatments tolerance and efficacy. These adverse effects lead to treatment modifications or interruptions, reducing the chances to control or cure cancer. Implementation of an interdisciplinary and longitudinal integration of nutritional care and nutritional information into cancer treatment (The OncoNut Program) could prevent or treat poor nutritional status and its adversely side effects. PMID:22400355

  4. 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.

  5. 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.

  6. Integrated equipment improves efficiency of locating buried plant

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1999-09-01

    Tools that are sophisicated, new and outside the plant were developed to improve efficiency and reduce labor by combining several powerful functions in a single device. Some electric utilities are now employing integrated locating equipment that combines sheath fault location, cable tracing and marker location in one unit. The craftsperson is able to work more effectively with a smaller capital investment as multiple tasks are consolidated in fewer test devices. The important thing is to locate, repair and qualify outside plant troubles as quickly as possible to minimize client outages as well as field costs. In underground utilities it is a problem that the time required to locate, splice, or other underground parts can be greater than the time it takes to carry out the repair. The locators used to detect passive markers are portable, hand-held units that transmit a pulsed radio frequency signal into the ground. When in the vicinity of a marker, the signal is reflected back to the locator. The locator receives this secondary signal, and gives the operator an audible tone and visual display that indicates the proximity to the marker and leads the operator to a spot directly over the marker. With the passive marker system and integrated cable tracing and fault locating equipment, workers can easily pinpoint a spot accurately, easily distinguish electrical facilities from gas, telecommunications, CATV, water and waste water facilities, and cut locating time.

  7. 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

  8. 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.

  9. 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

  10. 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.

  11. 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

  12. 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

  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. 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…

  15. 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…

  16. 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. PMID:25361530

  17. Prerequisites for sustainable care improvement using the reflective team as a work model

    Directory of Open Access Journals (Sweden)

    Lise-Lotte Jonasson

    2014-10-01

    Full Text Available 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.

  18. 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, Josh; Schnipper, Jeffrey; Williams, Mark V.; Robinson, Edmondo; Kripalani, Sunil; Lindenauer, Peter K.

    2016-01-01

    Converting the health care delivery system into a learning organization is a key strategy for improving health outcomes. While the learning organization approach has been successful in neonatal intensive care units and disease specific collaboratives there are few examples in general medicine and fewer still have leveraged the role of hospitalists to implement improvements. This paper describes the rationale for and early work of the Hospital Medicine Reengineering Network (HOMERuN), a collaborative of hospitals, hospitalists, and care teams whose overarching purpose is to use data to guide collaborative efforts aimed at improving the care of hospitalized patients. We review HOMERuN’s collaborative model, which focuses on a community-based participatory approach modified to include hospital-based as well as the larger community, and HOMERuN’s initial project focusing on care transition improvement using perspectives from the patient and caregiver. PMID:24448050

  19. 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...

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

    OpenAIRE

    Edward Broughton; Danilo Nunez; Indira Moreno

    2014-01-01

    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 multidiscipli...

  1. 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....

  2. A proposed 'health literate care model' would constitute a systems approach to improving patients' engagement in care.

    Science.gov (United States)

    Koh, Howard K; Brach, Cindy; Harris, Linda M; Parchman, Michael L

    2013-02-01

    Improving health outcomes relies on patients' full engagement in prevention, decision-making, and self-management activities. Health literacy, or people's ability to obtain, process, communicate, and understand basic health information and services, is essential to those actions. Yet relatively few Americans are proficient in understanding and acting on available health information. We propose a Health Literate Care Model that would weave health literacy strategies into the widely adopted Care Model (formerly known as the Chronic Care Model). Our model calls for first approaching all patients with the assumption that they are at risk of not understanding their health conditions or how to deal with them, and then subsequently confirming and ensuring patients' understanding. For health care organizations adopting our model, health literacy would then become an organizational value infused into all aspects of planning and operations, including self-management support, delivery system design, shared decision-making support, clinical information systems to track and plan patient care, and helping patients access community resources. We also propose a measurement framework to track the impact of the new Health Literate Care Model on patient outcomes and quality of care. PMID:23381529

  3. 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

  4. SOEC efficiency and cost improvement Part 1 and 2.

    Energy Technology Data Exchange (ETDEWEB)

    Yildiz, B.; Chang, K.-C.; Meyers, D. J.; You, H.; Carter, J. D.; Elam, J. W.; Honegger, D. A.; Libera, J. A.; Pellin, M. J.

    2007-06-20

    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 La{sub 0.8}Sr{sub 0.2}MnO{sub 3+d} (LSM) show different initial performance and different electrochemical activation under SOEC conditions, a good mixed ionic electronic conductor La{sub 0.8}Sr{sub 0.2}CoO{sub 3+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

  5. Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review

    Science.gov (United States)

    2016-01-01

    Background People who are homeless encounter barriers to primary care despite having greater needs for health care, on average, than people who are not homeless. We evaluated the effectiveness of interventions to improve access to primary care for people who are homeless. Methods We performed a systematic review to identify studies in English published between January 1, 1995, and July 8, 2015, comparing interventions to improve access to a primary care provider with usual care among people who are homeless. The outcome of interest was access to a primary care provider. The risk of bias in the studies was evaluated, and the quality of the evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. Results From a total of 4,047 citations, we identified five eligible studies (one randomized controlled trial and four observational studies). With the exception of the randomized trial, the risk of bias was considered high in the remaining studies. In the randomized trial, people who were homeless, without serious mental illness, and who received either an outreach intervention plus clinic orientation or clinic orientation alone, had improved access to a primary care provider compared with those receiving usual care. An observational study that compared integration of primary care and other services for people who are homeless with usual care did not observe any difference in access to a primary care provider between the two groups. A small observational study showed improvement among participants with a primary care provider after receiving an intervention consisting of housing and supportive services compared with the period before the intervention. The quality of the evidence was considered moderate for both the outreach plus clinic orientation and clinic orientation alone, and low to very low for the other interventions. Despite limitations, the literature identified reports of

  6. Identify: Improving industrial energy efficiency and mitigating global climate change

    International Nuclear Information System (INIS)

    The use of energy in the industrial sectors of nations with both industrialized and developing economies will continue to be, a major source of greenhouse gas (GHG) emissions, particularly carbon dioxide. The patterns of industrial-sector energy use--energy provided primarily by the combustion of fossil fuels-have shifted both within the between countries in recent decades. Projections of future energy use and carbon-dioxide (CO2) emissions suggest continued shifts in these patterns, as industrial production in developed countries stabilizes and declines, while industrial output in the developing world continues to expand. This expansion of industrial-sector activity and CO2 emissions in developing countries presents both a challenge and an opportunity. To seize this opportunity and contribute to international efforts to mitigate global climate change, the United National Industrial Development Organization (UNIDO) recently initiated a two-phase effort to help improve the efficiency of energy-intensive industries (iron and steel, chemicals, refining, paper and pulp, and cement) in developing countries. As part of the Phase I, the authors reviewed industrial sector scenarios and to initiated development of a software-based toolkit for identifying and assessing GHG mitigating technologies. This toolkit, called IDENTIFY, is comprised of a technology inventory and a companion economic analysis tool. In addition, UNIDO commissioned institutions in India, South Africa, and Argentina to review energy use patterns and savings opportunities in selected industries across nine developing countries, and contribute to the development of the IDENTIFY toolkit. UNIDO is now preparing to launch Phase 2, which will focus on full development and dissemination of the IDENTIFY toolkit through seminars and case studies around the world. This paper describes Phase 1 of the UNIDO project

  7. Improving Efficiency of Apriori Algorithms for Sequential Pattern Mining

    Directory of Open Access Journals (Sweden)

    Alpa Reshamwala

    2014-03-01

    Full Text Available Computer Systems are exposed to an increasing number of different types of security threats due to the expanding of internet in recent years. How to detect network intrusions effectively becomes an important security technique. Many intrusions aren?t composed by single events, but by a series of attack steps taken in chronological order. Analyzing the order in which events occur can improve the attack detection accuracy and reduce false alarms. Intrusion is a multi step process in which a number of events must occur sequentially in order to launch a successful attack. Intrusion detection using sequential pattern mining is a research topic focusing on the field of information security. Sequential Pattern Mining is used to discover the frequent sequential pattern in the event dataset. Sequential Pattern mining algorithms can be broadly classified into Apriori based, Pattern growth based and a combination of both. The first algorithm is based on the characteristic of Apriori and the second uses a pattern growth approach. The major drawback of the Apriori based algorithm is the multiple scans of the database, generating maximal patterns. In this paper, a simulation study of both the algorithms, a modified AprioriALL Algorithm to optimize the processing by including set theory techniques and the original AprioriALL algorithm is done on a network intrusion dataset from KDD cup 1999. Experimental results show that the modified algorithm shrinks the dataset size. At the most, it also scans the database twice. Also, as the interestingness of the itemset is increased with the dataset shrinking it leads to efficient sequences with high associativity. As the database is reduced, the time taken to mine sequences also reduces and is faster than Apriori based algorithm.

  8. 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

  9. 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...

  10. 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...

  11. 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...

  12. DVB-S2 Spectrum Efficiency Improvement with Hierarchical Modulation

    OpenAIRE

    Meric, Hugo; Piquer, Jose Miguel

    2013-01-01

    We study the design of a DVB-S2 system in order to maximise spectrum efficiency. This task is usually challenging due to channel variability. Modern satellite communications systems such as DVB-SH and DVB-S2 rely mainly on a time sharing strategy to optimise the spectrum efficiency. Recently, we showed that combining time sharing with hierarchical modulation can provide significant gains (in terms of spectrum efficiency) compared to the best time sharing strategy. However, our previous design...

  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. PMID:25042038

  14. 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.

  15. Policy instruments to improve energy efficiency in buildings

    OpenAIRE

    Cialani, Catia; Perman, Karin

    2014-01-01

    The newly adopted energy efficiency directive (2012/27/EU) highlights the importance of energy efficiency in reaching the Union’s 2020 targets. The directive commits member states to defining national energy efficiency targets (art. 3), achieving yearly energy savings of 1.5% of the annual energy sales through the energy efficiency obligation scheme (art. 7), and providing a long-term strategy for the building sector that aims at a 3% refurbishment rate for public buildings (art. 4+5). Buildi...

  16. 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

  17. 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

  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. PMID:27125840

  19. Efficiency improvement of nuclear power plant operation: the significant role of advanced nuclear fuel technologies

    International Nuclear Information System (INIS)

    Due to the increased liberalisation of the power markets, nuclear power generation is being exposed to high cost reduction pressure. In this paper we highlight the role of advanced nuclear fuel technologies to reduce the fuel cycle costs and therefore increase the efficiency of nuclear power plant operation. The key factor is a more efficient utilisation of the fuel and present developments at Siemens are consequently directed at (i) further increase of batch average burnup, (ii) improvement of fuel reliability, (iii) enlargement of fuel operation margins and (iv) improvement of methods for fuel design and core analysis. As a result, the nuclear fuel cycle costs for a typical LWR have been reduced during the past decades by about US$ 35 million per year. The estimated impact of further burnup increases on the fuel cycle costs is expected to be an additional saving of US$10 - 15 million per year. Due to the fact that the fuel will operate closer to design limits, a careful approach is required when introducing advanced fuel features in reload quantities. Trust and co-operation between the fuel vendors and the utilities is a prerequisite for the common success. (authors)

  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. 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

  2. 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

  3. 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

  4. 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

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. Withholding or withdrawing therapy in intensive care units: improving interdisciplinary cooperation

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Ammentorp, Jette; Ørding, Helle

    INTRODUCTION. Decisions regarding withholding or withdrawing therapy are common in the intensive care units. The health care professionals involved in the decision-making process do not always assess the situation identically, leading to potential conflicts. Studies have suggested that improving...... (conducted at two hospitals) with participation of primary care physicians, anaesthesiologists (both with and without ICU as their main workplace) and intensive care nurses. A total of 29 participated in the audits. The participants received beforehand three complicated cases (borrowed from other hospitals...... intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med180:853-860. (2) Halvorsen K, Forde R, Nortvedt P (2009) Value choices and considerations when limiting intensive care treatment: a qualitative study. Acta Anaesthesiol Scand 53:10-17 GRANT ACKNOWLEDGMENT. The study was supported...

  11. 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

    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......, 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 only (control group, n = 26).The primary outcome was patient-reported discomfort during transvaginal ultrasound examinations performed by study participants. Secondary outcomes included patient-reported perceived safety and confidence in ultrasound provider. Finally, the need for trainee...

  12. 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

  13. Efficiency in Health Care Sector in Tamil Nadu (India): An Exploratory Analysis

    OpenAIRE

    Purohit BC

    2016-01-01

    Keeping in view the importance of efficiency in resource utilization in healthcare sector, we focus on efficiency of health care system at sub-state level (i.e., district level) in India using Tamil Nadu state and its district level data for 2012-13. It being an economically advanced state, in terms of Infant Mortality Rate (IMR) the state ranks second lowest among the Indian states. We explore the reasons for relative performance of different districts with Data Envelopment Analysis. We used...

  14. 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...

  15. 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

  16. 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

  17. 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

  18. Economics of Caring Labor: Improving Compensation in the Early Childhood Workforce. Summary. Working Paper Series.

    Science.gov (United States)

    Ripple, Carol

    Improving compensation in early care and education (ECE) has been and will continue to be an extremely difficult policy issue. The Mailman Family Foundation and the Foundation for Child Development convened a group of 18 representatives of diverse disciplines concerned about child- and elder-care compensation. This report details the issues…

  19. 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...

  20. 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

  1. 78 FR 29139 - Medicare Program; Bundled Payments for Care Improvement Model 1 Open Period

    Science.gov (United States)

    2013-05-17

    ... committed to achieving better health, better care, and lower costs through continuous improvement for... costs through continuous improvement. Create a cycle that leads to continually decreasing the cost of an... Improvement Model 1 Open Period AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION:...

  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. Fertigation for improved water use efficiency and crop yield

    International Nuclear Information System (INIS)

    A greenhouse experiment was carried out at the Al-Muzahmiya Research Station, King Abdulaziz City for Science and Technology, Riyadh, to evaluate the effect of fertigation on cucumber yield. Five labelled N (15N) treatments namely a control, soil application (120 mg N L-1), N-1 (60 mg N L-1 ), N-2 (120 mg N L-1 ) and N-3 (180 mg N L-1 ) were tried for their effect on greenhouse cucumber yield. A cucumber cultivar (Figaro F-1) was sown as test crop. The experiment was carried out during the period from April to July, 1997. The mean fresh fruit cucumber yield ranged between 7.73 to 33.74 t ha-1. Highest yield was obtained with the labelled N application of 180 mg L-1 . The mean ranges for the different elements in the plant leaves were 1.33- 2.70% (N), 0.364-0.515% (P) and 1.57-3.82% (K). Whereas, in the plant shoot these ranges were 1.26-2.42% (N), 0.28-0.49% (P) and 4.74-9.45% (K). The mean content of the different elements in the cucumber fruit was 2.15-3.70% (N), 0.47-0.73% (P) and 4.40-5.23% (K). The soil salinity varied between 2.23-4.66 dS m-1 in the top soil (0-20 cm depth) and 0.95-2.62 dS m-1 in the sub-surface (20-40 cm depth) soil. The application did not affect significantly the soil salinity and was found well below the hazardous limit for most crops. The evolution of the other elements was different.. For example, elements such as Ca, P and K showed an increase while Na showed a decrease, whereas the Mg content did not respond with increasing N application. The soil moisture ranged between 8.06-9.15% (0-20 cm depth) and 5.51-9.36% (20-40 cm depth) and did not show any effect of N application. The nitrogen use efficiency (NUE) varied between 72.70 to 129.53 kg kg-1 N in the different N treatments. The mean 15 N a.e. ranged from 0.010 to 0.844% (leaves), 0.058 to 0.855% (shoots), 0.044 to 0.747 (roots) and 0.07 to 0.823 % (fruits). In conclusion, the mean highest yield of cucumber as fresh fruit was 33.74 t ha-1 , obtained with 180 mg N L-1 relative to

  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. Improving documentation of clinical care within a clinical information network – an essential initial step in efforts to understand and improve care in kenyan hospitals

    OpenAIRE

    English, MC; Tuti, T; Paton, C.; Malla, L; Clinical Information Network

    2016-01-01

    In many low income countries health information systems are poorly equipped to provide detailed information on hospital care and outcomes. Information is thus rarely used to support practice improvement. We describe efforts to tackle this challenge and to foster learning concerning collection and use of information. This could improve hospital services in Kenya. We are developing a Clinical Information Network, a collaboration spanning 14 hospitals, policy makers and researchers with the g...

  6. Effective strategy for improving health care outcomes: Multidisciplinary care in cerebral infarction patients.

    Science.gov (United States)

    Han, Kyu-Tae; Park, Eun-Cheol; Kim, Sun Jung; Kim, Woorim; Hahm, Myung-Il; Jang, Sung-In; Lee, Sang Gyu

    2015-08-01

    Multidisciplinary teams provide effective patient treatment strategies. South Korea expanded its health program recently to include multidisciplinary treatment. This study characterized the relationship between multidisciplinary care and mortality within 30 days after hospitalization in cerebral infarction patients. We used the National Health Insurance claim data (n = 63,895) from 120 hospitals during 2010-2013 to analyze readmission within 30 days after hospitalization for cerebral infarction. We performed χ(2) tests, analysis of variance and multilevel modeling to investigate the associations between multidisciplinary care and death within 30 days after hospitalization for stroke. Deaths within 30 days of hospitalization due to cerebral infarction was 3.0% (n = 1898/63,895). Multidisciplinary care was associated with lower risk of death within 30 days in inpatients with cerebral infarction (odds ratio: 0.84, 95% confidence interval: 0.72-0.99). Patients treated by a greater number of specialists had lower risk of death within 30 days of hospitalization. Additional analyses showed that such associations varied by the combination of specialists (i.e., neurologist and neurosurgeon). In conclusion, death rates within 30 days of hospitalization for cerebral infarction were lower in hospitals with multidisciplinary care. Our findings certainly suggest that a high number of both neurosurgeon and neurologist is not always an effective alternative in managing stroke inpatients, and emphasize the importance of an optimal combination in the same number of hospital staffing. PMID:26169372

  7. KEY FACTORS FOR IMPROVING TECHNICAL EFFICIENCY OF UPLAND RICE PRODUCTION

    OpenAIRE

    Thanaporn Athipanyakul; Panusak Jitsaeng; Napa Pongkapan; Piansak Pakdee

    2014-01-01

    Food security problems are major issues in developing countries, especially under the conditions of restricted farm resources and environmental degradation. The re-allocation of existing farm resources in the upland in order to reach a production of maximum output under given technologies and the estimated value of the technical efficiency have been important information for this purpose. The objective of this study, therefore, was to measure the technical efficiency of upland rice production...

  8. POTENTIAL FOR TRANSPORT EFFICIENCY IMPROVEMENTS OF AVIATION TRANSPORTATION SYSTEMS

    OpenAIRE

    Gollnick, Volker

    2006-01-01

    The growing traffic volume and simultaneous decline of the energy resources raise the question about the most efficient system for a dedicated transportation task. In this study an approach is presented to analyze and assess the transportation efficiency using examples of motor vehicles, railway systems and aeroplanes. For this purpose the transportation systems in Germany are used as representative examples to describe the methodology. Moreover the transportation flows and railway network...

  9. 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...

  10. Ergonomic redesign using quality improvement for pre-hospital care of acute myocardial infarction

    OpenAIRE

    Essam, Nadya; Wood, Kate; Hall, Mark; Shaw, Deborah; Spaight, Anne; Baird, Andrew; Siriwardena, A Niroshan

    2012-01-01

    Context: Frontline emergency ambulance clinicians collaborated in a national quality improvement (QI) initiative to improve pre-hospital care for patients with acute myocardial infarction (AMI). Problem: The National Ambulance Clinical Performance Indicator (CPI) care bundle for AMI (consisting of aspirin, GTN, pain assessment and administration of analgesia) highlighted a consistent shortfall in patient pain assessment and inadequate provision of analgesia. Ineffective pain management in...

  11. Improvement in perinatal care for extremely premature infants in Denmark from 1994 to 2011

    DEFF Research Database (Denmark)

    Hasselager, Asbjørn Børch; Børch, Klaus; Pryds, Ole Axel

    2016-01-01

    gestational age and administration of surfactant. CONCLUSIONS: Centralisation of treatment of extremely premature infants has been implemented because more children are being born at highly specialised perinatal centres. Care improved as more infants received evidence-based treatment. IVH 3-4 rates declined......INTRODUCTION: Major advances in perinatal care over the latest decades have increased the survival rate of extremely premature infants. Centralisation of perinatal care was implemented in Denmark from 1995. This study evaluates the effect of organisational changes of perinatal care on survival and...

  12. 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

  13. 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

  14. 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.

  15. 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)...

  16. 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.

  17. 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...

  18. 205_WS: Improving the Delivery of Primary Care Through Risk Stratification

    DEFF Research Database (Denmark)

    Kinder, Karen; Kristensen, Troels; Abrams, Chad

    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......, pharmacy management, and disease management programs. – Identify individuals at risk of hospitalization and re-hospitalization. – Identify patients whose pharmacy expenditures are greater than what is predicted based upon their morbidity profile alone. – Identify those at risk of uncoordinated care...

  19. 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.

  20. 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

  1. 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

  2. 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.

  3. 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.

  4. 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

  5. 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

  6. Improving dryer energy efficiency and controllability simultaneously by process modification

    NARCIS (Netherlands)

    Atuonwu, J.C.; Straten, G. van; Deventer, H.C. van; Boxtel, A.J.B. van

    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

  7. 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.

  8. The Multiple Benefits of Measures to Improve Energy Efficiency

    DEFF Research Database (Denmark)

    Puig, Daniel; Farrell, Tim C.

    scenario where the price of carbon dioxide equivalents was USD 70 per tonne. • In absolute terms, the energy supply and industry sectors show the highest reductions in greenhouse gas emissions attributable to energy efficiency. In relative terms, it is the transport sector that shows the highest levels of...

  9. 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

  10. 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

    unknown acoustic source distribution and the beamformer's response to a point source, i.e., point-spread function. A significant limitation of deconvolution is, however, an additional computational effort compared to beamforming. In this paper, computationally efficient deconvolution algorithms are...

  11. 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....

  12. 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.

  13. 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 ...

  14. 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

  15. 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.

  16. 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

  17. Improving efficiencies of irrigation and nitrogen uptake in wheat

    International Nuclear Information System (INIS)

    Three years of field studies and lysimeter experiments on irrigated wheat had the objective of finding ways of managing irrigation and N fertilization to minimize losses and reduce contamination of groundwater. Applied N had significant positive effects on crop-water consumptive use. The highest N losses occurred during early growth. Irrigation had little effect on N loss when it was practiced efficiently. Under the prevailing conditions, it is recommended that no N be applied to wheat at planting, in order to limit N losses by leaching caused by the high precipitation that usually occurs during early development when crop-N requirements are small. No more than 120 kg N ha-1 should be applied in total to minimize groundwater pollution and maximize N-uptake efficiency and economic returns. Also, for economic and environmental reasons, irrigation should be limited to 80% of the total requirement and to depths of 40 to 60 mm. (author)

  18. Logistics Innovation in the Medico-Social Sector: An Optimized Workflow for an Efficient Patient Care

    Directory of Open Access Journals (Sweden)

    Hayfa Zgaya

    2013-11-01

    Full Text Available The issue of care for the elderly is a real challenge for our society. The French government offers solutions to users, particularly through institutions hosting for dependent elderly people (nursing homes. We position ourselves in this study in the field of health logistics. We are particularly interested in the implementation of an innovative tool to provide, in real-time, the best possible organization of resources for an efficient patient care. For that, we propose a software solution in the form of a dynamic dashboard, in order to represent and optimize the overall behaviour of a nursing home and especially in terms of resource allocation. This allocation should be in accordance with the workload, patient needs and time constraints. The results show the effectiveness of our solution compared to an intuitive organization based on the experience and the organizational strategies of staff.

  19. 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...

  20. 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...

  1. Sheep Wool as a Construction Material for Energy Efficiency Improvement

    OpenAIRE

    Azra Korjenic; Sanela Klarić; Almedina Hadžić; Sinan Korjenic

    2015-01-01

    The building sector is responsible for 40% of the current CO 2 emissions as well as energy consumption. Sustainability and energy efficiency of buildings are currently being evaluated, not only based on thermal insulation qualities and energy demands, but also based on primary energy demand, CO 2 reductions and the ecological properties of the materials used. Therefore, in order to make buildings as sustainable as possible, it is crucial to maximize the use of ecological materials. This study...

  2. Sheep Wool as a Construction Material for Energy Efficiency Improvement

    OpenAIRE

    Azra Korjenic; Sanela Klarić; Almedina Hadžić; Sinan Korjenic

    2015-01-01

    The building sector is responsible for 40% of the current CO2 emissions as well as energy consumption. Sustainability and energy efficiency of buildings are currently being evaluated, not only based on thermal insulation qualities and energy demands, but also based on primary energy demand, CO2 reductions and the ecological properties of the materials used. Therefore, in order to make buildings as sustainable as possible, it is crucial to maximize the use of ecological materials. This study ...

  3. Turbocharged HCCI Engine, Improving Efficiency and Operating Range

    OpenAIRE

    Johansson, Thomas

    2010-01-01

    Increasing fuel prices and environmental concern drives the research and development for the internal combustion engine. Homogeneous Charge Compression Ignition (HCCI) is a promising combustion concept with high fuel efficiency and low emissions. The auto-ignition in HCCI combustion has no flame propagation and therefore the combustible mixture is consumed rapidly, even at low temperature. This results in high peak pressure rate and therefore high combustion noise, that limits the possible op...

  4. Improving Woody Biomass Estimation Efficiency Using Double Sampling

    OpenAIRE

    B. Scott Shouse; Lhotka, John M.; Songlin Fei; Parrott, David L.

    2012-01-01

    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...

  5. 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.

  6. Improved photon counting efficiency calibration using superconducting single photon detectors

    Science.gov (United States)

    Gan, Haiyong; Xu, Nan; Li, Jianwei; Sun, Ruoduan; Feng, Guojin; Wang, Yanfei; Ma, Chong; Lin, Yandong; Zhang, Labao; Kang, Lin; Chen, Jian; Wu, Peiheng

    2015-10-01

    The quantum efficiency of photon counters can be measured with standard uncertainty below 1% level using correlated photon pairs generated through spontaneous parametric down-conversion process. Normally a laser in UV, blue or green wavelength range with sufficient photon energy is applied to produce energy and momentum conserved photon pairs in two channels with desired wavelengths for calibration. One channel is used as the heralding trigger, and the other is used for the calibration of the detector under test. A superconducting nanowire single photon detector with advantages such as high photon counting speed (responsivity (UV to near infrared) is used as the trigger detector, enabling correlated photons calibration capabilities into shortwave visible range. For a 355nm single longitudinal mode pump laser, when a superconducting nanowire single photon detector is used as the trigger detector at 1064nm and 1560nm in the near infrared range, the photon counting efficiency calibration capabilities can be realized at 532nm and 460nm. The quantum efficiency measurement on photon counters such as photomultiplier tubes and avalanche photodiodes can be then further extended in a wide wavelength range (e.g. 400-1000nm) using a flat spectral photon flux source to meet the calibration demands in cutting edge low light applications such as time resolved fluorescence and nonlinear optical spectroscopy, super resolution microscopy, deep space observation, and so on.

  7. 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.

  8. A Time and Place: The Role of Social Workers in Improving End-of-Life Care.

    Science.gov (United States)

    Peres, Judith

    2016-01-01

    Americans are living longer, but dying after a prolonged period of management of multiple chronic illnesses and functional disabilities. Despite waves of public and professional activity targeted toward improving care for the dying and supporting the families, gaps in care and challenges in end-of-life care persist. Contentious issues such as the so-called "death panels" or physician payment for discussion of advance directives and care wishes at the end of life; aid in dying; and regarding individuals who actively choose death (case of Brittney Maynard) are continually debated in the public media. Progress toward improvement in the experience of dying remains incremental and change has been slow. With the release of a second Institute of Medicine ( 2014 ) report devoted to what it means to die in America in the 21st century, momentum and opportunity for change may increase. If this is to happen, social workers will need to deliver the range of biopsychosocial care that patients and families so desperately need. However, holistic care of the individual will only improve, if the nation also addresses ongoing systemic problems in financing, policy, and service delivery in end-of-life care. PMID:27462948

  9. Can we improve the identification of cold homes for targeted home energy-efficiency improvements?

    International Nuclear Information System (INIS)

    Objective: To investigate the extent to which homes with low indoor-temperatures can be identified from dwelling and household characteristics. Design: Analysis of data from a national survey of dwellings, occupied by low-income households, scheduled for home energy-efficiency improvements. Setting: Five urban areas of England: Birmingham, Liverpool, Manchester, Newcastle and Southampton. Methods: Half-hourly living-room temperatures were recorded for two to four weeks in dwellings over the winter periods November to April 2001-2002 and 2002-2003. Regression of indoor on outdoor temperatures was used to identify cold-homes in which standardized daytime living-room and/or nighttime bedroom-temperatures were oC (when the outdoor temperature was 5 oC). Tabulation and logistic regression were used to examine the extent to which these cold-homes can be identified from dwelling and household characteristics. Results: Overall, 21.0% of dwellings had standardized daytime living-room temperatures oC, and 46.4% had standardized nighttime bedroom-temperatures below the same temperature. Standardized indoor-temperatures were influenced by a wide range of household and dwelling characteristics, but most strongly by the energy efficiency (SAP) rating and by standardized heating costs. However, even using these variables, along with other dwelling and household characteristics in a multi-variable prediction model, it would be necessary to target more than half of all dwellings in our sample to ensure at least 80% sensitivity for identifying dwellings with cold living-room temperatures. An even higher proportion would have to be targeted to ensure 80% sensitivity for identifying dwellings with cold-bedroom temperatures. Conclusion: Property and household characteristics provide only limited potential for identifying dwellings where winter indoor temperatures are likely to be low, presumably because of the multiple influences on home heating, including personal choice and behaviour

  10. What are the effective ways to translate clinical leadership into health care quality improvement?

    Directory of Open Access Journals (Sweden)

    McSherry R

    2016-02-01

    Full Text Available Robert McSherry,1 Paddy Pearce2 1School of Health and Social Care, University of Teesside, Middlesbrough, 2PKP Consulting, Yarm, United Kingdom Abstract: The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader's role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks. Keywords: governance

  11. SUM (Service Unit Management): An Organizational Approach To Improved Patient Care.

    Science.gov (United States)

    Jelinek, Richard C.; And Others

    To evaluate the effectiveness of Service Unit Management (SUM) in reducing costs, improving quality of care, saving professional nursing time, increasing personnel satisfaction, and setting a stage for further improvements, a national questionnaire survey identified the characteristics of SUM units, and compared the performance of a total of 55…

  12. Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Kwedza Ru K

    2011-03-01

    Full Text Available Abstract Background Australia's Aboriginal and Torres Strait Islander (Indigenous populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. Methods We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4 were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems. Results The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician. Conclusion Participating services had both strengths and weaknesses in the delivery of maternal

  13. The Scottish Emergency Care Summary – an evaluation of a national shared record system aiming to improve patient care: technology report

    Directory of Open Access Journals (Sweden)

    Libby MM Morris

    2013-12-01

    Full Text Available Background In Scotland, out-of-hours calls are all triaged by the National Health Service emergency service (NHS24 but the clinicians receiving calls have no direct access to patient records.Objective To improve the safety of patient care in unscheduled consultations when the usual primary care record is not available.Technology The Emergency Care Summary (ECS is a record system offering controlled access to medication and adverse reactions details for nearly every person registered with a general practice in Scotland. It holds a secure central copy of these parts of the GP practice record and is updated automatically twice daily. It is accessible under specified unplanned clinical circumstances by clinicians working in out-of-hours organisations, NHS24 and accident and emergency departments if they have consent from the patient and a current legitimate relationship for that patient’s care.Application We describe the design of the security model, management of data quality, deployment, costs and clinical benefits of the ECS over four years nationwide in Scotland, to inform the debate on the safe and effective sharing of health data in other nations.Evaluation Forms were emailed to 300 NHS24 clinicians and 81% of the 113 respondents said that the ECS was helpful or very helpful and felt that it changed their clinical management in 20% of cases.Conclusion The ECS is acceptable to patients and helpful for clinicians and is used routinely for unscheduled care when normal medical records are unavailable. Benefits include more efficient assessment and reduced drug interaction, adverse reaction and duplicate prescribing.

  14. A Practice Improvement Education Program Using a Mentored Approach to Improve Nursing Facility Depression Care-Preliminary Data.

    Science.gov (United States)

    Chodosh, Joshua; Price, Rachel M; Cadogan, Mary P; Damron-Rodriguez, JoAnn; Osterweil, Dan; Czerwinski, Alfredo; Tan, Zaldy S; Merkin, Sharon S; Gans, Daphna; Frank, Janet C

    2015-11-01

    Depression is common in nursing facility residents. Depression data obtained using the Minimum Data Set (MDS) 3.0 offer opportunities for improving diagnostic accuracy and care quality. How best to integrate MDS 3.0 and other data into quality improvement (QI) activity is untested. The objective was to increase nursing home (NH) capability in using QI processes and to improve depression assessment and management through focused mentorship and team building. This was a 6-month intervention with five components: facilitated collection of MDS 3.0 nine-item Patient Health Questionnaire (PHQ-9) and medication data for diagnostic interpretation; education and modeling on QI approaches, team building, and nonpharmacological depression care; mentored team meetings; educational webinars; and technical assistance. PHQ-9 and medication data were collected at baseline and 6 and 9 months. Progress was measured using team participation measures, attitude and care process self-appraisal, mentor assessments, and resident depression outcomes. Five NHs established interprofessional teams that included nursing (44.1%), social work (20.6%), physicians (8.8%), and other disciplines (26.5%). Members participated in 61% of eight offered educational meetings (three onsite mentored team meetings and five webinars). Competency self-ratings improved on four depression care measures (P = .05 to data, depression scores did not change while medication use declined, from 37.2% of residents at baseline to 31.0% at 9 months (P < .001). This structured mentoring program improved care processes, achieved medication reductions, and was well received. Application to other NH-prevalent syndromes is possible. PMID:26503548

  15. Expanding Continuous Quality Improvement Capacity in the Medical Intensive Care Unit: Prehealth Volunteers as a Solution.

    Science.gov (United States)

    Priest, Kelsey C; Lobingier, Hannah; McCully, Nancy; Lombard, Jackie; Hansen, Mark; Uchiyama, Makoto; Hagg, Daniel S

    2016-01-01

    Health care delivery systems are challenged to support the increasing demands for improving patient safety, satisfaction, and outcomes. Limited resources and staffing are common barriers for making significant and sustained improvements. At Oregon Health & Science University, the medical intensive care unit (MICU) leadership team faced internal capacity limitations for conducting continuous quality improvement, specifically for the implementation and evaluation of the mobility portion of an evidence-based care bundle. The MICU team successfully addressed this capacity challenge using the person power of prehealth volunteers. In the first year of the project, 52 trained volunteers executed an evidence-based mobility intervention for 305 critically ill patients, conducting more than 200 000 exercise repetitions. The volunteers contributed to real-time evaluation of the project, with the collection of approximately 26 950 process measure data points. Prehealth volunteers are an untapped resource for effectively expanding internal continuous quality improvement capacity in the MICU and beyond. PMID:27031356

  16. 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...

  17. 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

  18. The main issues and the ways of improvement of health care for patients with diseases of the circulatory system

    OpenAIRE

    Sazanova G.Yu.

    2014-01-01

    Regulations and publications on the provision of quality health care for patients with diseases of the circulatory system of the native scientists have been studied. The majority of the issues concerns the disorganization of health care standards: the uneven distribution of diagnostic resources mostly in the hospitals and preventive health care organizations. The proposed ways to improve the patient care have been analyzed.

  19. Efficiency improvement of silicon nanostructure-based solar cells

    Science.gov (United States)

    Huang, Bohr-Ran; Yang, Ying-Kan; Yang, Wen-Luh

    2014-01-01

    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.

  20. 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...

  1. 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.

  2. Nuclear turbine efficiency improvement by wet steam study

    International Nuclear Information System (INIS)

    Most of the turbine used at the nuclear power plant are operated at environment of wet steam, which composes of a big factor of its inner loss in comparison with those of the thermal power plant. If an analytical method predictable on behavior of the wet steam is established, it could be upgraded efficiency of the turbine and also reliability against corrosion formed by moisture. This study, therefore, aims at understanding of physical property of the wet steam flow scarcely known at present, development of an optimum turbine cascade design tool reflected by the property, development of a turbine cascade design reducible of steam loss due to wet steam by using the tool, and development on a method of removing moisture in the turbine to its outer portion. For the tool, a new three dimensional flow numerical analysis is necessary to be developed, to aim at accurately and numerically understanding of the behavior of wet steam. As this study is in advancing now, by using a turbine cascade optimized on the wet steam flow and a developed moisture removing apparatus, about 0.6 % of upgrading in turbine efficiency can be predicted in comparison with that of the advanced aero-cascade of the GE Corporation. (G.K.)

  3. 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)

  4. Initiatives to improve appropriate antibiotic prescribing in primary care.

    Science.gov (United States)

    Harris, Diane J

    2013-11-01

    Influencing clinicians' prescribing behaviour is important because inappropriate use and overuse of antibiotics are major drivers of antibiotic resistance. A systematic review of interventions for promoting prudent prescribing of antibiotics by general practitioners suggests that multifaceted interventions will maximize acceptability. This article reports how this type of approach has been used successfully in Derbyshire, UK over the last 4 years. The range of interventions that have been used includes educational meetings (both open group events and others targeted at higher prescribers in the surgery) using a supportive and guiding ethos; the provision of support materials aimed at empowering avoidance or delayed antibiotic prescribing, where appropriate, and improving patients' knowledge and confidence in self-management; and the production of different treatment guidelines incorporating key messages with evidence, indicating where antibiotics are unlikely to be of benefit. Education on antibiotics in schools was a novel approach, which was developed in North Derbyshire to increase public awareness of the appropriate treatment for common illnesses without using antibiotics. PMID:24030546

  5. Critical Care Delivery: The Importance of Process of Care and ICU Structure to Improved Outcomes: An Update From the American College of Critical Care Medicine Task Force on Models of Critical Care.

    Science.gov (United States)

    Weled, Barry J; Adzhigirey, Lana A; Hodgman, Tudy M; Brilli, Richard J; Spevetz, Antoinette; Kline, Andrea M; Montgomery, Vicki L; Puri, Nitin; Tisherman, Samuel A; Vespa, Paul M; Pronovost, Peter J; Rainey, Thomas G; Patterson, Andrew J; Wheeler, Derek S

    2015-07-01

    In 2001, the Society of Critical Care Medicine published practice model guidelines that focused on the delivery of critical care and the roles of different ICU team members. An exhaustive review of the additional literature published since the last guideline has demonstrated that both the structure and process of care in the ICU are important for achieving optimal patient outcomes. Since the publication of the original guideline, several authorities have recognized that improvements in the processes of care, ICU structure, and the use of quality improvement science methodologies can beneficially impact patient outcomes and reduce costs. Herein, we summarize findings of the American College of Critical Care Medicine Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery; 2) Process improvement is the backbone of achieving high-quality ICU outcomes; 3) Standardized protocols including care bundles and order sets to facilitate measurable processes and outcomes should be used and further developed in the ICU setting; and 4) Institutional support for comprehensive quality improvement programs as well as tele-ICU programs should be provided. PMID:25803647

  6. Sustainable practice improvements: impact of the Comprehensive Advanced Palliative Care Education (CAPCE) program.

    Science.gov (United States)

    Harris, Diane; Hillier, Loretta M; Keat, Nancy

    2007-01-01

    This paper describes an education program designed to improve palliative care practice through the development of workplace hospice palliative care resources (PCRs), and its impact on knowledge transfer and longer-term changes to clinical practice. Evaluation methods included pre- and post-program questionnaires, and a survey of learners' (n=301) perceptions of program learning strategies. Interviews (n=21) were conducted with a purposeful sample of PCRs and representatives from their work sites. Ratings of the sessions indicated that they were relevant to learners' clinical practice. At follow up, the majority of learners (83%) continued to serve as PCRs. Many positive effects were identified, including enhanced pain and symptom management, staff education, and development of care policies and guidelines. Management support, particularly the prioritization of palliative care and staff development, were factors facilitating sustained implementation. These findings highlight the importance of multimodal learning strategies and supportive work environments in the development of PCRs to enhance palliative care practice. PMID:18251444

  7. Using mHealth to Improve Usage of Antenatal Care, Postnatal Care, and Immunization: A Systematic Review of the Literature

    Directory of Open Access Journals (Sweden)

    Jessica L. Watterson

    2015-01-01

    Full Text Available Mobile health (mHealth technologies have been implemented in many low- and middle-income countries to address challenges in maternal and child health. Many of these technologies attempt to influence patients’, caretakers’, or health workers’ behavior. The purpose of this study was to conduct a systematic review of the literature to determine what evidence exists for the effectiveness of mHealth tools to increase the coverage and use of antenatal care (ANC, postnatal care (PNC, and childhood immunizations through behavior change in low- and middle-income countries. The full text of 53 articles was reviewed and 10 articles were identified that met all inclusion criteria. The majority of studies used text or voice message reminders to influence patient behavior change (80%, n=8 and most were conducted in African countries (80%, n=8. All studies showed at least some evidence of effectiveness at changing behavior to improve antenatal care attendance, postnatal care attendance, or childhood immunization rates. However, many of the studies were observational and further rigorous evaluation of mHealth programs is needed in a broader variety of settings.

  8. Using mHealth to Improve Usage of Antenatal Care, Postnatal Care, and Immunization: A Systematic Review of the Literature.

    Science.gov (United States)

    Watterson, Jessica L; Walsh, Julia; Madeka, Isheeta

    2015-01-01

    Mobile health (mHealth) technologies have been implemented in many low- and middle-income countries to address challenges in maternal and child health. Many of these technologies attempt to influence patients', caretakers', or health workers' behavior. The purpose of this study was to conduct a systematic review of the literature to determine what evidence exists for the effectiveness of mHealth tools to increase the coverage and use of antenatal care (ANC), postnatal care (PNC), and childhood immunizations through behavior change in low- and middle-income countries. The full text of 53 articles was reviewed and 10 articles were identified that met all inclusion criteria. The majority of studies used text or voice message reminders to influence patient behavior change (80%, n = 8) and most were conducted in African countries (80%, n = 8). All studies showed at least some evidence of effectiveness at changing behavior to improve antenatal care attendance, postnatal care attendance, or childhood immunization rates. However, many of the studies were observational and further rigorous evaluation of mHealth programs is needed in a broader variety of settings. PMID:26380263

  9. Improving the quality of palliative care for ambulatory patients with lung cancer

    DEFF Research Database (Denmark)

    von Plessen, Christian; Aslaksen, Aslak

    2005-01-01

    PROBLEM: Most patients with advanced lung cancer currently receive much of their health care, including chemotherapy, as outpatients. Patients have to deal with the complex and time consuming logistics of ambulatory cancer care. At the same time, members of staff often waste considerable time and...... energy in organisational aspects of care that could be better used in direct interaction with patients. DESIGN: Quality improvement study using direct observation and run and flow charts, and focus group meetings with patients and families regarding perceptions of the clinic and with staff regarding...... satisfaction with working conditions. SETTING: Thoracic oncology outpatient clinic at a Norwegian university hospital where patients receive chemotherapy and complementary palliative care. KEY MEASURES FOR IMPROVEMENT: Waiting time and time wasted during consultations; calmer working situation at the clinic...

  10. Evaluation of efficiency of primary health cares in Konya city centre

    Directory of Open Access Journals (Sweden)

    Mehmet Uyar

    2015-02-01

    RESULTS: Using the model developed in this study, 13 health centers (39% were assessed technically as being fully efficient. Five health centers had a technical efficiency score of between 0.900 and 0.999. The number of health centers with an input excess was found to be higher than the number of centers that had an output deficiency. CONCLUSION: The difference in productivity between health centers was found to be due to the difference in input rather than output. Health service managers can use this method to assess the performance of different health centers using their own fixed variables. Furthermore they can distinguish analytically the most productive and unproductive health centers and at the same time identify the causes of inefficiency. This method can used by health care professionals to better manage their facilities and organisations. [TAF Prev Med Bull 2015; 14(1.000: 1-6

  11. Improving Efficiency of Apriori Algorithms for Sequential Pattern Mining

    OpenAIRE

    Alpa Reshamwala; Dr. Sunita Mahajan

    2014-01-01

    Computer Systems are exposed to an increasing number of different types of security threats due to the expanding of internet in recent years. How to detect network intrusions effectively becomes an important security technique. Many intrusions aren?t composed by single events, but by a series of attack steps taken in chronological order. Analyzing the order in which events occur can improve the attack detection accuracy and reduce false alarms. Intrusion is a multi step process in which a num...

  12. A High Efficient Improved Soft Switched Interleaved Boost Converter

    OpenAIRE

    A High Efficient Improved Soft Switched Interleaved Boost Converter

    2013-01-01

    In this paper an improved ZVT interleaved boost PFC topology is introduced. The proposed ZVT interleaved boost converter is composed of two cell boost conversion units and an active auxiliary circuit. The proposed converter has two important advantages over the similar soft switching converters. The first one is that parallel to the main switches of the converter the auxiliary switch also operates under soft switching condition. Providing soft switching conditions for interleaved boost conver...

  13. 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...

  14. Interdisciplinary teamwork and the power of a quality improvement collaborative in tertiary neonatal intensive care units.

    Science.gov (United States)

    Grover, Theresa R; Pallotto, Eugenia K; Brozanski, Beverly; Piazza, Anthony J; Chuo, John; Moran, Susan; McClead, Richard; Mingrone, Teresa; Morelli, Lorna; Smith, Joan R

    2015-01-01

    Significant gaps in healthcare quality and outcomes can be reduced via quality improvement collaboratives (QICs), which improve care by leveraging data and experience from multiple organizations.The Children's Hospital Neonatal Consortium Collaborative Initiatives for Quality Improvement team developed an infrastructure for neonatal QICs. We describe the structure and components of an effective multi-institutional neonatal QIC that implemented the "SLUG Bug" project designed to reduce central line-associated bloodstream infections (CLABSIs).The operational infrastructure of SLUG Bug involved 17 tertiary care neonatal intensive care units with a goal to reduce CLABSI in high-risk neonates. Clinical Practice Recommendations were produced, and the Institute of Healthcare Improvement Breakthrough Series provided the framework for the collaborative. Process measures studied the effectiveness of the collaborative structure.CLABSI rates decreased by 20% during a 12-month study period. Compliance bundle reporting exceeded 80%. A QIC score of 2.5 or more ("improvement") was achieved by 94% of centers and a score 4 or more ("significant improvement") was achieved by 35%.Frequent interactive project meetings, well-defined project metrics, continual shared learning opportunities, and individual team coaching were key QIC success components. Through a coordinated approach and committed leadership, QICs can effectively implement change and improve the care of neonates with complex diagnoses and rare diseases. PMID:25919608

  15. Randomised controlled trial of tailored interventions to improve the management of anxiety and depressive disorders in primary care

    Directory of Open Access Journals (Sweden)

    Terluin Berend

    2011-07-01

    interventions selected for use will be described, as well as the factors that influence the provision of guideline-recommended care. Discussion It is hypothesised that the adherence to guideline recommendations will be improved by designing implementation interventions that are tailored to prospectively identified barriers in the local context of general practitioners. Currently, there is insufficient evidence on the most effective and efficient approaches to tailoring, including how barriers should be identified and how interventions should be selected to address the barriers. Trial registration NTR1912

  16. A secure and efficient uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care.

    Science.gov (United States)

    Das, Ashok Kumar; Goswami, Adrijit

    2013-06-01

    Connected health care has several applications including telecare medicine information system, personally controlled health records system, and patient monitoring. In such applications, user authentication can ensure the legality of patients. In user authentication for such applications, only the legal user/patient himself/herself is allowed to access the remote server, and no one can trace him/her according to transmitted data. Chang et al. proposed a uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care (Chang et al., J Med Syst 37:9902, 2013). Their scheme uses the user's personal biometrics along with his/her password with the help of the smart card. The user's biometrics is verified using BioHashing. Their scheme is efficient due to usage of one-way hash function and exclusive-or (XOR) operations. In this paper, we show that though their scheme is very efficient, their scheme has several security weaknesses such as (1) it has design flaws in login and authentication phases, (2) it has design flaws in password change phase, (3) it fails to protect privileged insider attack, (4) it fails to protect the man-in-the middle attack, and (5) it fails to provide proper authentication. In order to remedy these security weaknesses in Chang et al.'s scheme, we propose an improvement of their scheme while retaining the original merit of their scheme. We show that our scheme is efficient as compared to Chang et al.'s scheme. Through the security analysis, we show that our scheme is secure against possible attacks. Further, we simulate our scheme for the formal security verification using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications) tool to ensure that our scheme is secure against passive and active attacks. In addition, after successful authentication between the user and the server, they establish a secret session key shared between them for future secure communication. PMID

  17. Factors that may improve outcomes of early traumatic brain injury care: prospective multicenter study in Austria

    OpenAIRE

    Brazinova, Alexandra; Majdan, Marek; Leitgeb, Johannes; Trimmel, Helmut; Mauritz, Walter; ,

    2015-01-01

    Background Existing evidence concerning the management of traumatic brain injury (TBI) patients underlines the importance of appropriate treatment strategies in both prehospital and early in-hospital care. The objectives of this study were to analyze the current state of early TBI care in Austria with its physician-based emergency medical service. Subsequently, identified areas for improvement were transformed into treatment recommendations. The proposed changes were implemented in participat...

  18. Global initiatives for improving hospital care for children: state of the art and future prospects

    OpenAIRE

    Campbell, Harry; Duke, Trevor; Weber, Martin; English, Mike; Carai, Susanne; Tamburlini, Giorgio

    2008-01-01

    Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries, but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have a major role in child survival and that inequities in quality may be as important as inequities in access. Th...

  19. Global initiatives for improving hospital care for children: State of the art and future prospects

    OpenAIRE

    Campbell, Harry; Duke, Trevor; Weber, Martin; English, Mike; Carai, Susanne; Tamburlini, Giorgio; Pediat Hosp Improvement Grp

    2008-01-01

    Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have a major role in child survival, and that inequities in quality may be as important as inequities in access. Th...

  20. Implementing large-scale quality improvement – lessons from the productive ward: Releasing time to care

    OpenAIRE

    Morrow, Elizabeth; Robert, Glenn; Maben, Jill; Griffiths, Peter

    2011-01-01

    Purpose: This paper is concerned with facilitating large-scale quality improvement in health care, and specifically understanding more about the known challenges associated with implementation of Lean innovations: receptivity, the complexity of adoption processes, evidence of the innovation, and embedding change. Lessons are drawn from the implementation of The Productive Ward: Releasing Time to CareTM programme in English hospitals. Design/participants: The study which the paper draws up...