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Sample records for care improve efficiency

  1. Integrated hospital emergency care improves efficiency.

    Science.gov (United States)

    Boyle, A A; Robinson, S M; Whitwell, D; Myers, S; Bennett, T J H; Hall, N; Haydock, S; Fritz, Z; Atkinson, P

    2008-02-01

    There is uncertainty about the most efficient model of emergency care. An attempt has been made to improve the process of emergency care in one hospital by developing an integrated model. The medical admissions unit was relocated into the existing emergency department and came under the 4-hour target. Medical case records were redesigned to provide a common assessment document for all patients presenting as an emergency. Medical, surgical and paediatric short-stay wards were opened next to the emergency department. A clinical decision unit replaced the more traditional observation unit. The process of patient assessment was streamlined so that a patient requiring admission was fully clerked by the first attending doctor to a level suitable for registrar or consultant review. Patients were allocated directly to specialty on arrival. The effectiveness of this approach was measured with routine data over the same 3-month periods in 2005 and 2006. There was a 16.3% decrease in emergency medical admissions and a 3.9% decrease in emergency surgical admissions. The median length of stay for emergency medical patients was reduced from 7 to 5 days. The efficiency of the elective surgical services was also improved. Performance against the 4-hour target declined but was still acceptable. The number of bed days for admitted surgical and medical cases rose slightly. There was an increase in the number of medical outliers on surgical wards, a reduction in the number of incident forms and formal complaints and a reduction in income for the hospital. Integrated emergency care has the ability to use spare capacity within emergency care. It offers significant advantages beyond the emergency department. However, improved efficiency in processing emergency patients placed the hospital at a financial disadvantage.

  2. Improving primary health care to increase efficiency

    Directory of Open Access Journals (Sweden)

    V. M. Kornatsky

    2017-02-01

    Full Text Available Thus, the convergence of medicine, psychiatry and psychology is the reality of today to eliminate the imbalance, psychosomatic health. The role of medical practice in the correction of psychosomatic disorders is large, but insufficient. Complementary medical becomes a psychological resource in decision psychosomatic problems. A study of the leading role of psychogenic factors and mechanisms of somatic response to stressful situations, underlying the formation of the most common and socially significant diseases, is a current trend psychosomatic direction in the PC. The data obtained may become the basis for developing measures for the identification, treatment, and prevention of psychosomatic disorders in conditions of emotional stress and their prevention. Successful interdisciplinary interaction fosters the following principles: collegiality in matters of surveillance, social functioning capabilities; continuity in matters of treatment and preventive care; adherence to the principles of medical ethics and deontology; implementation of accounting volume of medical care. The formation of a new system will bring to the population high-tech methods of diagnostics and treatment, strengthen the development of the system of prevention of socially significant diseases and expand the possibilities of rehabilitation.

  3. A Primary Care System to Improve Health Care Efficiency: Lessons from Ecuador.

    Science.gov (United States)

    Aldulaimi, Sommer; Mora, Francisco E

    2017-01-01

    Ecuador is a country with few resources to spend on health care. Historically, Ecuador has struggled to find a model for health care that is efficient, effective, and available to all people in the country, even those in underserved and rural communities. In 2000, the Ecuador Ministry of Public Health implemented a new system of health care that used primary care as its platform. Since then, Ecuador has been able to increase its health care efficiency, increasing its ranking from 111 of 211 countries worldwide in 2000, to 20 of 211 countries in 2014. This article briefly reviews the new components of the system implemented in Ecuador and examines the tools used to accomplish this. The discussion also compares and contrasts the Ecuador and US systems, and identifies concepts and policies from Ecuador that could improve the US system. © Copyright 2017 by the American Board of Family Medicine.

  4. The Relationship between Quality Measurement and Efficiency Improvement in Health Care Systems

    OpenAIRE

    Gilbert Roland; Dr. Jane Marry Gill

    2017-01-01

    Quality measurement in health care organisation is most often considered as measures for cost-saving and error reduction in the clinical procedures. The concept of quality measurement in health care organisations is the analysis of effectiveness and accuracy in procedures for patients’ diagnosis and treatment. This study aimed to find the relationship between quality measurement and efficiency improvements in the healthcare sector of Mauritius. This was executed by using mixed methodological ...

  5. Improving primary health care facility performance in Ghana: efficiency analysis and fiscal space implications.

    Science.gov (United States)

    Novignon, Jacob; Nonvignon, Justice

    2017-06-12

    Health centers in Ghana play an important role in health care delivery especially in deprived communities. They usually serve as the first line of service and meet basic health care needs. Unfortunately, these facilities are faced with inadequate resources. While health policy makers seek to increase resources committed to primary healthcare, it is important to understand the nature of inefficiencies that exist in these facilities. Therefore, the objectives of this study are threefold; (i) estimate efficiency among primary health facilities (health centers), (ii) examine the potential fiscal space from improved efficiency and (iii) investigate the efficiency disparities in public and private facilities. Data was from the 2015 Access Bottlenecks, Cost and Equity (ABCE) project conducted by the Institute for Health Metrics and Evaluation. The Stochastic Frontier Analysis (SFA) was used to estimate efficiency of health facilities. Efficiency scores were then used to compute potential savings from improved efficiency. Outpatient visits was used as output while number of personnel, hospital beds, expenditure on other capital items and administration were used as inputs. Disparities in efficiency between public and private facilities was estimated using the Nopo matching decomposition procedure. Average efficiency score across all health centers included in the sample was estimated to be 0.51. Also, average efficiency was estimated to be about 0.65 and 0.50 for private and public facilities, respectively. Significant disparities in efficiency were identified across the various administrative regions. With regards to potential fiscal space, we found that, on average, facilities could save about GH₵11,450.70 (US$7633.80) if efficiency was improved. We also found that fiscal space from efficiency gains varies across rural/urban as well as private/public facilities, if best practices are followed. The matching decomposition showed an efficiency gap of 0.29 between private

  6. Process improvement methods increase the efficiency, accuracy, and utility of a neurocritical care research repository.

    Science.gov (United States)

    O'Connor, Sydney; Ayres, Alison; Cortellini, Lynelle; Rosand, Jonathan; Rosenthal, Eric; Kimberly, W Taylor

    2012-08-01

    Reliable and efficient data repositories are essential for the advancement of research in Neurocritical care. Various factors, such as the large volume of patients treated within the neuro ICU, their differing length and complexity of hospital stay, and the substantial amount of desired information can complicate the process of data collection. We adapted the tools of process improvement to the data collection and database design of a research repository for a Neuroscience intensive care unit. By the Shewhart-Deming method, we implemented an iterative approach to improve the process of data collection for each element. After an initial design phase, we re-evaluated all data fields that were challenging or time-consuming to collect. We then applied root-cause analysis to optimize the accuracy and ease of collection, and to determine the most efficient manner of collecting the maximal amount of data. During a 6-month period, we iteratively analyzed the process of data collection for various data elements. For example, the pre-admission medications were found to contain numerous inaccuracies after comparison with a gold standard (sensitivity 71% and specificity 94%). Also, our first method of tracking patient admissions and discharges contained higher than expected errors (sensitivity 94% and specificity 93%). In addition to increasing accuracy, we focused on improving efficiency. Through repeated incremental improvements, we reduced the number of subject records that required daily monitoring from 40 to 6 per day, and decreased daily effort from 4.5 to 1.5 h/day. By applying process improvement methods to the design of a Neuroscience ICU data repository, we achieved a threefold improvement in efficiency and increased accuracy. Although individual barriers to data collection will vary from institution to institution, a focus on process improvement is critical to overcoming these barriers.

  7. General surgery residents improve efficiency but not outcome of trauma care.

    Science.gov (United States)

    Offner, Patrick J; Hawkes, Allison; Madayag, Robert; Seale, Fred; Maines, Charles

    2003-07-01

    Current American College of Surgeons Level I trauma center verification requires the presence of a residency program in which trauma care is an integral part of the training. The rationale for this requirement remains unclear, with no scientific evidence that resident participation improves the quality of trauma care. The purpose of this study was to determine whether quality or efficiency of trauma care is influenced by general surgery residents. Our urban Level I trauma center has traditionally used 24-hour in-house postgraduate year-4 general surgery residents in conjunction with at-home trauma attending backup to provide trauma care. As of July 1, 2000, general surgery residents no longer participated in trauma patient care, leaving sole responsibility to an in-house trauma attending. Data regarding patient outcome and resource use with and without surgery resident participation were tabulated and analyzed. Continuous data were compared using Student's t test if normally distributed and the Mann-Whitney U test if nonparametric. Categorical data were compared using chi2 analysis or Fisher's exact test as appropriate. During the 5-month period with resident participation, 555 trauma patients were admitted. In the identical time period without residents, 516 trauma patients were admitted. During the period without housestaff, patients were older and more severely injured. Mechanism was not different during the two time periods. Mortality was not affected; however, time in the emergency department and hospital lengths of stay were significantly shorter with residents. Multiple regression confirmed these findings while controlling for age, mechanism, and Injury Severity Score. Although resident participation in trauma care at a Level I trauma center does not affect outcome, it does significantly improve the efficiency of trauma care delivery.

  8. QUEST®: A Data-Driven Collaboration to Improve Quality, Efficiency, Safety, and Transparency in Acute Care.

    Science.gov (United States)

    Crimmins, Mary M; Lowe, Timothy J; Barrington, Monica; Kaylor, Courtney; Phipps, Terri; Le-Roy, Charlene; Brooks, Tammy; Jones, Mashekia; Martin, John

    2016-06-01

    In 2008 Premier (Premier, Inc., Charlotte, North Carolina) began its Quality, Efficiency, and Safety with Transparency (QUEST®) collaborative, which is an acute health care organization program focused on improving quality and reducing patient harm. Retrospective performance data for QUEST hospitals were used to establish trends from the third quarter (Q3; July–September) of 2006 through Q3 2015. The study population included past and present members of the QUEST collaborative (N = 356), with each participating hospital considered a member. The QUEST program engages with member hospitals through a routine-coaching structure, sprints, minicollaboratives, and face-to-face meetings. Cost and efficiency data showed reductions in adjusted cost per discharge for hospitals between Q3 2013 (mean, $8,296; median, $8,459) and Q3 2015 (mean, $8,217; median, $7,895). Evidence-based care (EBC) measures showed improvement from baseline (Q3 2006; mean, 77%; median, 79%) to Q3 2015 (mean, 95%; median, 96%). Observed-to-expected (O/E) mortality improved from 1% to 22% better-than-expected outcomes on average. The QUEST safety harm composite score showed moderate reduction from Q1 2009 to Q3 2015, as did the O/E readmission rates--from Q1 2010 to Q3 2015--with improvement from a 5% to an 8% better-than-expected score. Quantitative and qualitative evaluation of QUEST collaborative hospitals indicated that for the 2006-2015 period, QUEST facilities reduced cost per discharge, improved adherence with evidence-based practice, reduced safety harm composite score, improved patient experience, and reduced unplanned readmissions.

  9. 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.

  10. Acute pain management efficiency improves with point-of-care handheld electronic billing system.

    Science.gov (United States)

    Fahy, Brenda G

    2009-02-01

    Technology advances continue to impact patient care and physician workflow. To enable more efficient performance of billing activities, a point-of-care (POC) handheld computer technology replaced a paper-based system on an acute pain management service. Using a handheld personal digital assistant (PDA) and software from MDeverywhere (MDe, MDeverywhere, Long Island, NY), we performed a 1-yr prospective observational study of an anesthesiology acute pain management service billings and collections. Seventeen anesthesiologists providing billable acute pain services were trained and entered their charges on a PDA. Twelve months of data, just before electronic implementation (pre-elec), were compared to a 12-m period after implementation (post-elec). The total charges were 4883 for 890 patients pre-elec and 5368 for 1128 patients post-elec. With adoption of handheld billing, the charge lag days decreased from 29.3 to 7.0 (P billing using PDAs to replace a paper-based billing system improved the collection rate and decreased the number of charge lag days with a positive return on investment. The handheld PDA billing system provided POC support for physicians during their daily clinical (e.g., patient locations, rounding lists) and billing activities, improving workflow.

  11. Reducing Bottlenecks to Improve the Efficiency of the Lung Cancer Care Delivery Process: A Process Engineering Modeling Approach to Patient-Centered Care.

    Science.gov (United States)

    Ju, Feng; Lee, Hyo Kyung; Yu, Xinhua; Faris, Nicholas R; Rugless, Fedoria; Jiang, Shan; Li, Jingshan; Osarogiagbon, Raymond U

    2017-12-01

    The process of lung cancer care from initial lesion detection to treatment is complex, involving multiple steps, each introducing the potential for substantial delays. Identifying the steps with the greatest delays enables a focused effort to improve the timeliness of care-delivery, without sacrificing quality. We retrospectively reviewed clinical events from initial detection, through histologic diagnosis, radiologic and invasive staging, and medical clearance, to surgery for all patients who had an attempted resection of a suspected lung cancer in a community healthcare system. We used a computer process modeling approach to evaluate delays in care delivery, in order to identify potential 'bottlenecks' in waiting time, the reduction of which could produce greater care efficiency. We also conducted 'what-if' analyses to predict the relative impact of simulated changes in the care delivery process to determine the most efficient pathways to surgery. The waiting time between radiologic lesion detection and diagnostic biopsy, and the waiting time from radiologic staging to surgery were the two most critical bottlenecks impeding efficient care delivery (more than 3 times larger compared to reducing other waiting times). Additionally, instituting surgical consultation prior to cardiac consultation for medical clearance and decreasing the waiting time between CT scans and diagnostic biopsies, were potentially the most impactful measures to reduce care delays before surgery. Rigorous computer simulation modeling, using clinical data, can provide useful information to identify areas for improving the efficiency of care delivery by process engineering, for patients who receive surgery for lung cancer.

  12. Strategies to improve the efficiency and utility of multidisciplinary team meetings in urology cancer care: a survey study.

    Science.gov (United States)

    Lamb, Benjamin W; Jalil, Rozh T; Sevdalis, Nick; Vincent, Charles; Green, James S A

    2014-09-08

    The prevalence of multidisciplinary teams (MDT) for the delivery of cancer care is increasing globally. Evidence exists of benefits to patients and healthcare professionals. However, MDT working is time and resource intensive. This study aims to explore members' views on existing practices of urology MDT working, and to identify potential interventions for improving the efficiency and productivity of the MDT meeting. Members of urology MDTs across the UK were purposively recruited to participate in an online survey. Survey items included questions about the utility and efficiency of MDT meetings, and strategies for improving the efficiency of MDT meetings: treating cases by protocol, prioritising cases, and splitting the MDT into subspeciality meetings. 173 MDT members participated (Oncologists n = 77, Cancer Nurses n = 54, Urologists n = 30, other specialities n = 12). 68% of respondents reported that attending the MDT meeting improves efficiency in care through improved clinical decisions, planning investigations, helping when discussing plans with patients, speciality referrals, documentation/patient records. Participants agreed that some cases including low risk, non-muscle invasive bladder cancer and localised, low-grade prostate cancer could be managed by pre-agreed pathways, without full MDT review. There was a consensus that cases at the MDT meeting could be prioritised by complexity, tumour type, or the availability of MDT members. Splitting the MDT meeting was unpopular: potential disadvantages included loss of efficiency, loss of team approach, unavailability of members and increased administrative work. Key urology MDT members find the MDT meeting useful. Improvements in efficiency and effectiveness may be possible by prioritising cases or managing some low-risk cases according to previously agreed protocols. Further research is needed to test the effectiveness of such strategies on MDT meetings, cancer care pathways and patient outcomes in clinical

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

    Science.gov (United States)

    Gausvik, Christian; Lautar, Ashley; Miller, Lisa; Pallerla, Harini; Schlaudecker, Jeffrey

    2015-01-01

    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 patient care. These results point to the interconnectedness and dual benefit to both job satisfaction and patient quality of care that can come from enhancements to team communication.

  14. 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

  15. Applying Lean Six Sigma methodologies to improve efficiency, timeliness of care, and quality of care in an internal medicine residency clinic.

    Science.gov (United States)

    Fischman, Daniel

    2010-01-01

    Patients' connectedness to their providers has been shown to influence the success of preventive health and disease management programs. Lean Six Sigma methodologies were employed to study workflow processes, patient-physician familiarity, and appointment compliance to improve continuity of care in an internal medicine residency clinic. We used a rapid-cycle test to evaluate proposed improvements to the baseline-identified factors impeding efficient clinic visits. Time-study, no-show, and patient-physician familiarity data were collected to evaluate the effect of interventions to improve clinic efficiency and continuity of medical care. Forty-seven patients were seen in each of the intervention and control groups. The wait duration between the end of triage and the resident-patient encounter was statistically shorter for the intervention group. Trends toward shorter wait times for medical assistant triage and total encounter were also seen in the intervention group. On all measures of connectedness, both the physicians and patients in the intervention group showed a statistically significant increased familiarity with each other. This study shows that incremental changes in workflow processes in a residency clinic can have a significant impact on practice efficiency and adherence to scheduled visits for preventive health care and chronic disease management. This project used a structured "Plan-Do-Study-Act" approach.

  16. Treatment for stable HIV patients in England: can we increase efficiency and improve patient care?

    Science.gov (United States)

    Adams, Elisabeth; Ogden, David; Ehrlich, Alice; Hay, Phillip

    2014-07-01

    To estimate the costs and potential efficiency gains of changing the frequency of clinic appointments and drug dispensing arrangements for stable HIV patients compared to the costs of hospital pharmacy dispensing and home delivery. We estimated the annual costs per patient (HIV clinic visits and either first-line treatment or a common second-line regimen, with some patients switching to a second-line regimen during the year). The cost of three-, four- and six-monthly clinic appointments and drug supply was estimated assuming hospital dispensing (incurring value-added tax) and home delivery. Three-monthly appointments and hospital drug dispensing (baseline) were compared to other strategies. The baseline was the most costly option (£10,587 if first-line treatment and no switch to second-line regimen). Moving to six-monthly appointments and home delivery yielded savings of £1883 per patient annually. Assuming patients start on different regimens and may switch to second-line therapies, six-monthly appointments and three-monthly home delivery of drugs is the least expensive option and could result in nearly £2000 savings per patient. This translates to annual cost reduction of about £8 million for the estimated 4000 eligible patients not currently on home delivery in London, England. Different appointment schedules and drug supply options should be considered for stable HIV patients based on efficiency gains. However, this should be assessed for individual patients to meet their needs, especially around adherence and patient support. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  17. Improving efficiency in stereology

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  18. Medical Care Provided Under California's Workers' Compensation Program: Effects of the Reforms and Additional Opportunities to Improve the Quality and Efficiency of Care.

    Science.gov (United States)

    Wynn, Barbara O; Timbie, Justin W; Sorbero, Melony E

    2011-01-01

    Since 2004, significant changes have been made to the California workers' compensation (WC) system. The Commission on Health and Safety and Workers' Compensation (CHSWC) asked the RAND Corporation to examine the impact that these changes have on the medical care provided to injured workers. This study synthesizes findings from interviews and available information regarding the implementation of the changes affecting WC medical care and identifies areas in which additional changes might increase the quality and efficiency of care delivered under the WC system. To improve incentives for efficiently providing medically appropriate care, California should revise its fee schedule allowances for services provided by hospitals to inpatients, freestanding ambulatory surgery centers, and physicians, create nonmonetary incentives for providing medically appropriate care in the medical provider network (MPN) context through more-selective contracting with providers and reducing medical review requirements for high-performing physicians; reduce incentives for inappropriate prescribing practices by curtailing in-office physician dispensing; and implement pharmacy benefit network regulations. To increase accountability for performance, California should revise the MPN certification process to place accountability for meeting MPN standards on the entity contracting with the physician network; strengthen Division of Workers' Compensation (DWC) authorities to provide intermediate sanctions for failure to comply with MPN requirements; and modify the Labor Code to remove payers and MPNs from the definition of individually identifiable data so that performance on key measures can be publicly available. To facilitate monitoring and oversight, California should provide DWC with more flexibility to add needed data elements to medical data reporting and provide penalties for a claim administrator failing to comply with the data-reporting requirements; require that medical cost

  19. The ED-inpatient dashboard: Uniting emergency and inpatient clinicians to improve the efficiency and quality of care for patients requiring emergency admission to hospital.

    Science.gov (United States)

    Staib, Andrew; Sullivan, Clair; Jones, Matt; Griffin, Bronwyn; Bell, Anthony; Scott, Ian

    2017-06-01

    Patients who require emergency admission to hospital require complex care that can be fragmented, occurring in the ED, across the ED-inpatient interface (EDii) and subsequently, in their destination inpatient ward. Our hospital had poor process efficiency with slow transit times for patients requiring emergency care. ED clinicians alone were able to improve the processes and length of stay for the patients discharged directly from the ED. However, improving the efficiency of care for patients requiring emergency admission to true inpatient wards required collaboration with reluctant inpatient clinicians. The inpatient teams were uninterested in improving time-based measures of care in isolation, but they were motivated by improving patient outcomes. We developed a dashboard showing process measures such as 4 h rule compliance rate coupled with clinically important outcome measures such as inpatient mortality. The EDii dashboard helped unite both ED and inpatient teams in clinical redesign to improve both efficiencies of care and patient outcomes. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  20. 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

  1. 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.

  2. 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

  3. Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management.

    Science.gov (United States)

    Kuupiel, Desmond; Bawontuo, Vitalis; Mashamba-Thompson, Tivani P

    2017-11-29

    Access to point-of-care (POC) diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs) and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings.

  4. Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management

    Directory of Open Access Journals (Sweden)

    Desmond Kuupiel

    2017-11-01

    Full Text Available Access to point-of-care (POC diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings.

  5. 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.

  6. Mobile technology: streamlining practice and improving care

    OpenAIRE

    Blake, Holly

    2013-01-01

    The use of mobile phones in care delivery has the potential to improve the way in which care is delivered. When implemented effectively, mobile technologies can empower patients and enhance communication between patients and their health-care providers. When barriers are recognised and addressed, mobile technologies can change working lives, facilitating rapid access to information and supporting efficiency in practice.

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

    International Nuclear Information System (INIS)

    Krug, Steven E.

    2008-01-01

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    Krug, Steven E. [Northwestern University, Children' s Memorial Hospital, Feinberg School of Medicine, Chicago, IL (United States)

    2008-11-15

    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.)

  9. Frontier technologies to improve efficiency

    International Nuclear Information System (INIS)

    Kalhammer, F.R.

    1992-01-01

    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

  10. GATE: Improving the computational efficiency

    International Nuclear Information System (INIS)

    Staelens, S.; De Beenhouwer, J.; Kruecker, D.; Maigne, L.; Rannou, F.; Ferrer, L.; D'Asseler, Y.; Buvat, I.; Lemahieu, I.

    2006-01-01

    GATE is a software dedicated to Monte Carlo simulations in Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET). An important disadvantage of those simulations is the fundamental burden of computation time. This manuscript describes three different techniques in order to improve the efficiency of those simulations. Firstly, the implementation of variance reduction techniques (VRTs), more specifically the incorporation of geometrical importance sampling, is discussed. After this, the newly designed cluster version of the GATE software is described. The experiments have shown that GATE simulations scale very well on a cluster of homogeneous computers. Finally, an elaboration on the deployment of GATE on the Enabling Grids for E-Science in Europe (EGEE) grid will conclude the description of efficiency enhancement efforts. The three aforementioned methods improve the efficiency of GATE to a large extent and make realistic patient-specific overnight Monte Carlo simulations achievable

  11. Improving Health Care Efficiency and Quality Using Tablet Personal Computers to Collect Research-Quality, Patient-Reported Data

    Science.gov (United States)

    Abernethy, Amy P; Herndon, James E; Wheeler, Jane L; Patwardhan, Meenal; Shaw, Heather; Lyerly, H Kim; Weinfurt, Kevin

    2008-01-01

    Objective To determine whether e/Tablets (wireless tablet computers used in community oncology clinics to collect review of systems information at point of care) are feasible, acceptable, and valid for collecting research-quality data in academic oncology. Data/Setting Primary/Duke Breast Cancer Clinic. Design Pilot study enrolling sample of 66 breast cancer patients. Methods Data were collected using paper- and e/Tablet-based surveys: Functional Assessment of Cancer Therapy General, Functional Assessment of Cancer Therapy-Breast, MD Anderson Symptom Inventory, Functional Assessment of Chronic Illness Therapy (FACIT), Self-Efficacy; and two questionnaires: feasibility, satisfaction. Principal Findings Patients supported e/Tablets as: easy to read (94 percent), easy to respond to (98 percent), comfortable weight (87 percent). Generally, electronic responses validly reflected responses provided by standard paper data collection on nearly all subscales tested. Conclusions e/Tablets offer a valid, feasible, acceptable method for collecting research-quality, patient-reported outcomes data in outpatient academic oncology. PMID:18761678

  12. Orthogeriatric care: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Tarazona-Santabalbina FJ

    2016-06-01

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

  13. 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....

  14. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.

    Science.gov (United States)

    Agwu, Allison L; Lee, Carlton K K; Jain, Sanjay K; Murray, Kara L; Topolski, Jason; Miller, Robert E; Townsend, Timothy; Lehmann, Christoph U

    2008-09-15

    Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program. A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated. After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy. The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World

  15. Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center.

    Science.gov (United States)

    Cima, Robert R; Brown, Michael J; Hebl, James R; Moore, Robin; Rogers, James C; Kollengode, Anantha; Amstutz, Gwendolyn J; Weisbrod, Cheryl A; Narr, Bradly J; Deschamps, Claude

    2011-07-01

    Operating rooms (ORs) are resource-intense and costly hospital units. Maximizing OR efficiency is essential to maintaining an economically viable institution. OR efficiency projects often focus on a limited number of ORs or cases. Efforts across an entire OR suite have not been reported. Lean and Six Sigma methodologies were developed in the manufacturing industry to increase efficiency by eliminating non-value-added steps. We applied Lean and Six Sigma methodologies across an entire surgical suite to improve efficiency. A multidisciplinary surgical process improvement team constructed a value stream map of the entire surgical process from the decision for surgery to discharge. Each process step was analyzed in 3 domains, ie, personnel, information processed, and time. Multidisciplinary teams addressed 5 work streams to increase value at each step: minimizing volume variation; streamlining the preoperative process; reducing nonoperative time; eliminating redundant information; and promoting employee engagement. Process improvements were implemented sequentially in surgical specialties. Key performance metrics were collected before and after implementation. Across 3 surgical specialties, process redesign resulted in substantial improvements in on-time starts and reduction in number of cases past 5 pm. Substantial gains were achieved in nonoperative time, staff overtime, and ORs saved. These changes resulted in substantial increases in margin/OR/day. Use of Lean and Six Sigma methodologies increased OR efficiency and financial performance across an entire operating suite. Process mapping, leadership support, staff engagement, and sharing performance metrics are keys to enhancing OR efficiency. The performance gains were substantial, sustainable, positive financially, and transferrable to other specialties. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Development of Electronic Medical Record-Based "Rounds Report" Results in Improved Resident Efficiency, More Time for Direct Patient Care and Education, and Less Resident Duty Hour Violations.

    Science.gov (United States)

    Ham, Phillip B; Anderton, Toby; Gallaher, Ryan; Hyrman, Mike; Simmerman, Erika; Ramanathan, Annamalai; Fallaw, David; Holsten, Steven; Howell, Charles Gordon

    2016-09-01

    Surgeons frequently report frustration and loss of efficiency with electronic medical record (EMR) systems. Together, surgery residents and a programmer at Augusta University created a rounds report (RR) summarizing 24 hours of vitals, intake/output, labs, and other values for each inpatient that were previously transcribed by hand. The objective of this study was to evaluate the RR's effect on surgery residents. Surgery residents were queried to assess the RR's impact. Outcome measures were time spent preparing for rounds, direct patient care time, educational activity time, rates of incorrect/incomplete data on rounds, and rate of duty hour violations. Hospital wide, 17,200 RRs were generated in the 1-month study. Twenty-three surgery residents participated. Time spent preparing for rounds decreased per floor patient (15.6 ± 3.0 vs 6.0 ± 1.2, P care unit patient (19.9 ± 2.9 vs 7.5 ± 1.2 P care increased from 45.1 ± 5.6 to 54.0 ± 5.7 per cent (P = 0.0044). Educational activity time increased from 35.2 ± 5.4 to 54.7 ± 7.1 minutes per resident per day (P = 0.0004). Reported duty hour violations decreased 58 per cent (P care at academic medical centers.

  17. Efficiency performance of China's health care delivery system.

    Science.gov (United States)

    Zhang, Luyu; Cheng, Gang; Song, Suhang; Yuan, Beibei; Zhu, Weiming; He, Li; Ma, Xiaochen; Meng, Qingyue

    2017-07-01

    Improving efficiency performance of the health care delivery system has been on the agenda for the health system reform that China initiated in 2009. This study examines the changes in efficiency performance and determinants of efficiency after the reform to provide evidence to assess the progress of the reform from the perspective of efficiency. Descriptive analysis, Data Envelopment Analysis, the Malmquist Index, and multilevel regressions are used with data from multiple sources, including the World Bank, the China Health Statistical Yearbook, and routine reports. The results indicate that over the last decade, health outcomes compared with health investment were relatively higher in China than in most other countries worldwide, and the trend was stable. The overall efficiency and total factor productivity increased after the reform, indicating that the reform was likely to have had a positive impact on the efficiency performance of the health care delivery system. However, the health care delivery structure showed low system efficiency, mainly attributed to the weakened primary health care system. Strengthening the primary health care system is central to enhancing the future performance of China's health care delivery system. Copyright © 2017 John Wiley & Sons, Ltd.

  18. Quality Improvement in Athletic Health Care.

    Science.gov (United States)

    Lopes Sauers, Andrea D; Sauers, Eric L; Valier, Alison R Snyder

    2017-11-01

      Quality improvement (QI) is a health care concept that ensures patients receive high-quality (safe, timely, effective, efficient, equitable, patient-centered) and affordable care. Despite its importance, the application of QI in athletic health care has been limited.   To describe the need for and define QI in health care, to describe how to measure quality in health care, and to present a QI case in athletic training.   As the athletic training profession continues to grow, a widespread engagement in QI efforts is necessary to establish the value of athletic training services for the patients that we serve. A review of the importance of QI in health care, historical perspectives of QI, tools to drive QI efforts, and examples of common QI initiatives is presented to assist clinicians in better understanding the value of QI for advancing athletic health care and the profession. Clinical and Research Advantages:  By engaging clinicians in strategies to measure outcomes and improve their patient care services, QI practice can help athletic trainers provide high-quality and affordable care to patients.

  19. Corporate Accounting Policy Efficiency Improvement

    Directory of Open Access Journals (Sweden)

    Elena K. Vorobei

    2013-01-01

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

  20. Improving Energy Efficiency of Auxiliaries

    International Nuclear Information System (INIS)

    Carl T. Vuk

    2001-01-01

    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

  1. ACO model should encourage efficient care delivery.

    Science.gov (United States)

    Toussaint, John; Krueger, David; Shortell, Stephen M; Milstein, Arnold; Cutler, David M

    2015-09-01

    The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model: finance spending and targets, attribution, and quality performance. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. The Gains from Improved Market Efficiency

    DEFF Research Database (Denmark)

    Persson, Karl Gunnar; Ejrnæs, Mette

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

  3. Common challenge in resource efficiency improvement

    International Nuclear Information System (INIS)

    La Motta, Sergio; Peronaci, Marcello

    2015-01-01

    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.

  4. Computer Simulation: A Methodology to Improve the Efficiency in the Brooke Army Medical Center Family Care Clinic (A Patient Wait Case Study)

    National Research Council Canada - National Science Library

    Merkie, John

    2000-01-01

    .... The purpose of this study was to describe the current system and to evaluate the potential impact of process/resource changes in patient wait times, access and resource utilization at the BAMC Family Care Clinic (FCC...

  5. Measures for energy efficiency improvement of buildings

    Directory of Open Access Journals (Sweden)

    Vukadinović Ana V.

    2015-01-01

    Full Text Available The increase in energy consumption in buildings causes the need to propose energy efficiency improvement measures. Urban planning in accordance with micro location conditions can lead to energy consumption reduction in buildings through the passive solar design. While satisfying the thermal comfort to the user space purpose, energy efficiency can be achieved by optimizing the architectural and construction parameters such as shape of the building, envelope structure and the percentage of glazing. The improvement of the proposed measures, including the use of renewable energy sources, can meet requirements of Directive 2010/31 / EU of 'nearly zero energy buildings'.

  6. Improving plasmonic waveguides coupling efficiency using nanoantennas

    DEFF Research Database (Denmark)

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

    2012-01-01

    . The classical dipole antenna scheme can be improved by changing the nanoantenna geometry, adding constructive elements such as reflecting bars and mirrors and using arrays of antennas. The modelling designates that the coupling efficiency from a vertical fiber to a plasmonic waveguide can be improved more than......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...... in 180 times in comparison with a direct fiber-waveguide coupling. Pros and cons of each configuration are discussed. Fabrication and characterisation results are reported....

  7. Quantum entanglement helps in improving economic efficiency

    International Nuclear Information System (INIS)

    Du Jiangfeng; Ju Chenyong; Li Hui

    2005-01-01

    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

  8. Improving biological efficiency of Oyster mushroom, Pleurotus ...

    African Journals Online (AJOL)

    International Journal of Biological and Chemical Sciences ... Yield improvement were observed in both pigeon pea and sunflower seed cake supplemented treatments with the highest mycelium vigor (91.65%) and biological ... Keywords: biological efficiency, compost, mycelium vigor, pigeon pea, sunflower seed cake

  9. Quantum entanglement helps in improving economic efficiency

    Science.gov (United States)

    Du, Jiangfeng; Ju, Chenyong; Li, Hui

    2005-02-01

    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.

  10. 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...

  11. Improving aspects of palliative care for children

    NARCIS (Netherlands)

    Jagt, C.T.

    2017-01-01

    This thesis is about improving aspects of palliative care for children, and covers three different areas of quality of care. First of all, palliative care should be anticipating. To be able to deliver this anticipating care, caregivers should know what to expect. The first two chapters of the thesis

  12. Improving the efficiency of aerodynamic shape optimization

    Science.gov (United States)

    Burgreen, Greg W.; Baysal, Oktay; Eleshaky, Mohamed E.

    1994-01-01

    The computational efficiency of an aerodynamic shape optimization procedure that is based on discrete sensitivity analysis is increased through the implementation of two improvements. The first improvement involves replacing a grid-point-based approach for surface representation with a Bezier-Bernstein polynomial parameterization of the surface. Explicit analytical expressions for the grid sensitivity terms are developed for both approaches. The second improvement proposes the use of Newton's method in lieu of an alternating direction implicit methodology to calculate the highly converged flow solutions that are required to compute the sensitivity coefficients. The modified design procedure is demonstrated by optimizing the shape of an internal-external nozzle configuration. Practically identical optimization results are obtained that are independent of the method used to represent the surface. A substantial factor of 8 decrease in computational time for the optimization process is achieved by implementing both of the design procedure improvements.

  13. Idaho Chemical Processing Plant Process Efficiency improvements

    International Nuclear Information System (INIS)

    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

  14. 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.

  15. 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.

  16. EFFICIENT USE OF BIOMASS IN IMPROVED COOKSTOVES

    Directory of Open Access Journals (Sweden)

    R. K. PAL

    2016-12-01

    Full Text Available Traditional biomass cookstoves have very low efficiency. The improved cookstoves have very high efficiency. These improved cookstoves with high efficiency saves biomass fuels. Biomass can be saved in case of rocket elbow cookstoves. The amount of biomass which can be saved in case of rocket elbow cookstoves is 65.88 MT. More biomass can be saved in case of gasifier fan cookstoves. The amount of biomass which can be saved is 155.71 MT. The pollutants like particulate matter, black carbon, carbon mono-oxide and carbon dioxide emission is lesser in case of rocket elbow cookstoves. The pollutants are least in case of gasifier fan cookstoves. The reduction in particulate matter, black carbon, carbon mono-oxide and carbon dioxide emission in gasifier fan cookstoves is 1.77 MT, 0.24 MT, 0.71 MT & 151.64 MT respectively in comparison to traditional cookstoves. Therefore indoor air pollution is greatly reduced in case of improved cookstoves especially in case of gasifier fan cookstoves as compared to traditional cookstoves.

  17. Study of the Relevance of the Quality of Care, Operating Efficiency and Inefficient Quality Competition of Senior Care Facilities.

    Science.gov (United States)

    Lin, Jwu-Rong; Chen, Ching-Yu; Peng, Tso-Kwei

    2017-09-11

    The purpose of this research is to examine the relation between operating efficiency and the quality of care of senior care facilities. We designed a data envelopment analysis, combining epsilon-based measure and metafrontier efficiency analyses to estimate the operating efficiency for senior care facilities, followed by an iterative seemingly unrelated regression to evaluate the relation between the quality of care and operating efficiency. In the empirical studies, Taiwan census data was utilized and findings include the following: Despite the greater operating scale of the general type of senior care facilities, their average metafrontier technical efficiency is inferior to that of nursing homes. We adopted senior care facility accreditation results from Taiwan as a variable to represent the quality of care and examined the relation of accreditation results and operating efficiency. We found that the quality of care of general senior care facilities is negatively related to operating efficiency; however, for nursing homes, the relationship is not significant. Our findings show that facilities invest more in input resources to obtain better ratings in the accreditation report. Operating efficiency, however, does not improve. Quality competition in the industry in Taiwan is inefficient, especially for general senior care facilities.

  18. 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.

  19. 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...

  20. New raw materials improve packing sealing efficiency

    International Nuclear Information System (INIS)

    Igel, B.; McKeague, L.

    2012-01-01

    End-users and OEM's using or manufacturing on/off and control valves expect a permanent and effective increase in service life together with an increased sealing capability while at the same time minimizing maintenance concerns. Developing materials which provide consistency and repeatability are essential characteristics to optimizing valve performance. “New Generation” materials and yarn allow us to meet this growing demand while complying with the requirements related to chemical purity and an increased level of safety to both plant workers and equipment in the nuclear environment. Through R&D initiatives and developments in new and improved raw materials; a new mechanical packing generation which optimizes friction coefficients and extended life cycle has been introduced to the industry. Lower friction values drastically optimize actuator effort and size improving efficiency for stem operation with significant improvements in flow control of fluids. Combined with new and improved procedures (installation, torque levels and consolidation recommendations), this new packing generation has provided significant improvement in the mechanical behavior of packing materials (independent tests carried out in collaboration with AECL and CETIM) this has provided the opportunity to develop successful Valve Enhancement Programs which offer improved efficiency, valve operation and repeatability. These NEW generation yarns are available with or without wire reinforcement depending on specific operating parameters and conditions. The purpose of this presentation is to demonstrate that new generation material(s). Which are available to the industry for AOV, MOV and Manual valves? - To highlight the steps taken in R&D and manufacturing contributing to the much improved yarns and finished packing products. - Comply and are designed to meet the stringent requirements in the nuclear industry - Simplify valve maintenance without risk to safety or performance - Increase service

  1. Nurses' Spirituality Improves Caring Behavior

    Science.gov (United States)

    Bakar, Abu; Nursalam; Adriani, Merryana; Kusnanto; Qomariah, Siti Nur; Hidayati, Laily; Pratiwi, Ika Nur; Ni'mah, Lailatun

    2017-01-01

    Caring is a behavior of giving holistic assistance to individuals. In fact, this important behavior still has not routinely performed in current nursing practice. Personality and sipirituality are important factors in forming one's caring behavior. Spirituality is a passion or impulse to perform noble action. The objective of this study was to…

  2. Tape write-efficiency improvements in CASTOR

    International Nuclear Information System (INIS)

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

    2012-01-01

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

  3. Health Care Efficiencies: Consolidation and Alternative Models vs. Health Care and Antitrust Regulation - Irreconcilable Differences?

    Science.gov (United States)

    King, Michael W

    2017-11-01

    Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation. Fundamentally, what is the best way to reduce U.S. health care spending, while improving the patient experience of care in terms of quality and satisfaction, and driving better patient health outcomes? Mergers, partnerships, and consolidation in the health care industry, new care delivery models like Accountable Care Organizations and integrated care systems, bundled payments, information technology, innovation through new drugs and new medical devices, or some combination of the foregoing? More importantly, recent ambitious reform efforts fall short of a cohesive approach, leaving fundamental internal inconsistencies across divergent arms of the federal government, raising the issue of whether the U.S. health care system can drive sufficient efficiencies within the current health care and antitrust regulatory environments. While debate rages on Capitol Hill over "repeal and replace," only limited attention has been directed toward reforming the current "fee-for-service" model pursuant to which providers are paid for volume of care rather than quality or outcomes. Indeed, both the Patient Protection and Affordable Care Act ("ACA") 3 and proposals for its replacement focus primarily on the reach and cost of providing coverage for

  4. 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.

  5. Energy efficiency improvement and environment in China

    International Nuclear Information System (INIS)

    Rouhier, Stephane

    2010-01-01

    Massive reliance on polluting sources of energy (coal, traditional biomass and oil) has damaged the environment in China over years. Now, China is the world's first carbon dioxide emitter and air pollution represents between 2 and 7 percent of loss of Gross Domestic Product per year, depending on the studies chosen. In order to reduce the level of pollution, one can either enhance the technology in use or reduce the share of polluting fuels in the energy mix. Indeed, current Chinese technologies are far less efficient than those of developed countries and the energy mix is massively composed of polluting sources of energy. So, they both represent huge potential savings. This article enquires the link between diversification, efficiency in the power sector and the per capita emissions and shows that emissions are negatively correlated to a diversification of the energy mix as well as an improvement of power generating technologies. Hence, it justifies the diversification of the energy mix and technology improvement as viable strategies to tackle pollution

  6. MPACT Subgroup Self-Shielding Efficiency Improvements

    International Nuclear Information System (INIS)

    Stimpson, Shane; Liu, Yuxuan; Collins, Benjamin S.; Clarno, Kevin T.

    2016-01-01

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

  7. 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.

  8. Efficiency improvements of offline metrology job creation

    Science.gov (United States)

    Zuniga, Victor J.; Carlson, Alan; Podlesny, John C.; Knutrud, Paul C.

    1999-06-01

    Progress of the first lot of a new design through the production line is watched very closely. All performance metrics, cycle-time, in-line measurement results and final electrical performance are critical. Rapid movement of this lot through the line has serious time-to-market implications. Having this material waiting at a metrology operation for an engineer to create a measurement job plan wastes valuable turnaround time. Further, efficient use of a metrology system is compromised by the time required to create and maintain these measurement job plans. Thus, having a method to develop metrology job plans prior to the actual running of the material through the manufacture area can significantly improve both cycle time and overall equipment efficiency. Motorola and Schlumberger have worked together to develop and test such a system. The Remote Job Generator (RJG) created job plans for new device sin a manufacturing process from an NT host or workstation, offline. This increases available system tim effort making production measurements, decreases turnaround time on job plan creation and editing, and improves consistency across job plans. Most importantly this allows job plans for new devices to be available before the first wafers of the device arrive at the tool for measurement. The software also includes a database manager which allows updates of existing job plans to incorporate measurement changes required by process changes or measurement optimization. This paper will review the result of productivity enhancements through the increased metrology utilization and decreased cycle time associated with the use of RJG. Finally, improvements in process control through better control of Job Plans across different devices and layers will be discussed.

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

    Directory of Open Access Journals (Sweden)

    Oliver Reich

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Oliver Reich

    2012-01-01

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

  11. Improving efficiency in the radiology department

    Energy Technology Data Exchange (ETDEWEB)

    Towbin, Alexander J.; Perry, Laurie A. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Larson, David B. [Stanford University School of Medicine, Department of Radiology, Stanford, CA (United States)

    2017-06-15

    The modern radiology department is built around the flow of information. Ordering providers request imaging studies to be performed, technologists complete the work required to perform the imaging studies, and radiologists interpret and report on the imaging findings. As each of these steps is performed, data flow between multiple information systems, most notably the radiology information system (RIS), the picture archiving and communication system (PACS) and the voice dictation system. Even though data flow relatively seamlessly, the majority of our systems and processes are inefficient. The purpose of this article is to describe the radiology value stream and describe how radiology informaticists in one department have worked to improve the efficiency of the value stream at each step. Through these examples, we identify and describe several themes that we believe have been crucial to our success. (orig.)

  12. Efficiency and hospital effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems ratings.

    Science.gov (United States)

    Al-Amin, Mona; Makarem, Suzanne C; Rosko, Michael

    2016-01-01

    Efficiency has emerged as a central goal to the operations of health care organizations. There are two competing perspectives on the relationship between efficiency and organizational performance. Some argue that organizational slack is a waste and that efficiency contributes to organizational performance, whereas others maintain that slack acts as a buffer, allowing organizations to adapt to environmental demands and contributing to organizational performance. As value-based purchasing becomes more prevalent, health care organizations are incented to become more efficient and, at the same time, improve their patients' experiences and outcomes. Unused slack resources might facilitate the timely implementation of these improvements. Building on previous research on organizational slack and inertia, we test whether efficiency and other organizational factors predict organizational effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. We rely on data from the American Hospital Association and HCAHPS. We estimate hospital cost-efficiency by Stochastic Frontier Analysis and use regression analysis to determine whether efficiency, competition, hospital size, and other organizational factors are significant predictors of hospital effectiveness. Our findings indicate that efficiency and hospital size have a significant negative association with organizational ability to improve HCAHPS ratings. Although achieving organizational efficiency is necessary for health care organizations, given the changes that are currently occurring in the U.S. health care system, it is important for health care managers to maintain a certain level of slack to respond to environmental demands and have the resources needed to improve their performance.

  13. 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

  14. Nurses improve migraine management in primary care

    NARCIS (Netherlands)

    Veenstra, Petra; Kollen, Boudewijn J.; de Jong, Gosse; Baarveld, Frans; van den Berg, J. S. Peter

    Introduction Migraine is a common disorder with a high burden. Adequate treatment results in improvement of quality of life. Migraine patients are mainly treated by general practitioners (GPs), but there is still room for improvement. This study investigated whether primary care nurses could improve

  15. An improvement project within urological care.

    Science.gov (United States)

    Khatami, Annelie; Rosengren, Kristina

    2015-01-01

    The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones. A qualitative descriptive study based on eight group interviews and 48 narratives, was performed. Data were analysed using qualitative content analysis. Trustworthiness was ensured by using a well-documented improvement process method during six months. The results formed three categories: an absent comprehensive view; complexity; and vulnerability within the organisation. A holistic perspective regarding urological care at the micro-, meso- and macro-levels is needed to improve planning and caring processes. This study includes one team (six members, different health professionals) within the same urology department. Results show that staff need information, such as guidelines and support throughout the improvement work to deliver high-quality care. Moreover, there is a need for evidence-based guidelines at national level to support improvement work. Healthcare staff need to pay attention to all team member needs to improve urological care. Organisational and managerial aspect are needed to support clear and common goals regarding healthcare improvement work. Urological improvement projects, generally, are lacking, which is why this study is important to improve nephrolithiasis patient care.

  16. 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.

  17. 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.

  18. Improving efficiency in bilateral emission trading

    International Nuclear Information System (INIS)

    Burtraw, D.; Harrison, K.W.; Turner, P.

    1998-01-01

    When environmental damages from emissions are spatially nonuniform, permit trading has been modeled most often as a 'pollution offset program' in which emission permits are traded between agents, subject to constraints on ambient air quality. To date the institution envisioned to implement such a program involves trading on a bilateral and sequential basis. However, simulation studies indicate that the sequence of trades may alter the outcome and undermine the cost savings from a pollution offset program. This paper identifies a design for the trading institution that tends to overcome this phenomenon and improve the efficiency of equilibria obtained in a simulation model. We model a bilateral trading process for the reduction of sulfur dioxide emissions with a stochastic description of the sequence of trades within groups of nations in Europe. When trading takes place between disaggregated, stylistic representations of economic enterprises, rather than between national governments, a significantly greater portion of potential savings is achieved. In fact, under most sets of assumptions, approximate first order stochastic dominance is achieved wherein the more decentralized the trading agents, the greater the expected savings from a trading program. 4 figs., 2 tabs., 31 refs

  19. Nationwide quality improvement in lung cancer care

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  20. Equity and efficiency in Italian health care.

    Science.gov (United States)

    Paci, P; Wagstaff, A

    1993-04-01

    Health care finance and provision in Italy is unusual by international standards: public financing relies heavily on both general taxation and social insurance, and although the vast majority of expenditure is publicly financed, the majority of care is provided by the private sector. The system suffers, however, from a chronic failure to control expenditures and its record on perinatal and infant mortality is poor. Hospitals in Italy have a low bed-occupancy rate by international standards and the per diem system of reimbursing private hospitals encourages unduly long stays. Costs per inpatient day are high by international standards, but costs per admission are close to the OECD average. Ambulatory care costs are extremely low, but this appears to be due to the fact that GPs see so many patients that their role is inevitably mainly administrative. Consumption of medicines is extremely high, but because the cost per item is low, expenditure per capita is not unduly high. Despite the emphasis on social insurance, the financing system appears to be progressive. There is evidence of inequalities in health in Italy, and some evidence that health care is not provided equally to those in the same degree of need.

  1. Improved energy efficiency in sawmill drying system

    International Nuclear Information System (INIS)

    Anderson, Jan-Olof; Westerlund, Lars

    2014-01-01

    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

  2. Physician education programme improves quality of diabetes care

    African Journals Online (AJOL)

    diabetes have been compiled and circulated to health care workers, but ... studied and attempted to improve the quality of diabetes care in primary care ..... project indicators in the Indian Health Service primary care setting. Diabetes Care ...

  3. Improving the efficiency of manuscript selection

    Directory of Open Access Journals (Sweden)

    A. Martínez–Abrain

    2009-01-01

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

  4. Restructuring primary care for performance improvement.

    Science.gov (United States)

    Fawcett, Kenneth J; Brummel, Stacy; Byrnes, John J

    2009-01-01

    Primary care practices can no longer consider ongoing quality assessment and management processes to be optional. There are ever-increasing demands from any number of interested parties for objectively measured proof of outcomes and quality of care. Primary Care Partners (PCP), a 16-site ambulatory affiliate of the Spectrum Health system in Grand Rapids, Michigan, began such a continuous quality improvement (CQI) effort in 2005. The intent was to develop an ongoing systematic process that would raise its performance potential and improve patient outcomes in the areas of chronic disease management and preventive services. This article describes the partnerships PCP established, specific benchmarks and measurements used, processes utilized, and results to date. This could be used as a roadmap for other primary care systems that are working to establish CQI in their daily operations.

  5. Improving the delivery of preventive care services.

    Science.gov (United States)

    Hung, Dorothy Y

    2007-05-01

    Performance of preventive services is an important indicator of high-quality health care, but many recommended services are not regularly offered in primary care practices. Health risk assessments, counseling, and referral to community-based programs help address risk behaviors, many of which are leading causes of preventable death and disability in the United States. This study examined various influences on the delivery of preventive services designed to address smoking, excessive consumption of alcohol, unhealthy diets, and sedentary lifestyles. More than 300 health care providers in 52 practices nationwide have contributed data to this study. Staff participation in quality improvement enhanced work relationships and also diminished the effect of practice size on the performance of preventive care. The use of nurse practitioners, allied health professionals, clinician reminders, and patient registries were positively associated with care delivery.

  6. Implementing electronic handover: interventions to improve efficiency, safety and sustainability.

    Science.gov (United States)

    Alhamid, Sharifah Munirah; Lee, Desmond Xue-Yuan; Wong, Hei Man; Chuah, Matthew Bingfeng; Wong, Yu Jun; Narasimhalu, Kaavya; Tan, Thuan Tong; Low, Su Ying

    2016-10-01

    Effective handovers are critical for patient care and safety. Electronic handover tools are increasingly used today to provide an effective and standardized platform for information exchange. The implementation of an electronic handover system in tertiary hospitals can be a major challenge. Previous efforts in implementing an electronic handover tool failed due to poor compliance and buy-in from end-users. A new electronic handover tool was developed and incorporated into the existing electronic medical records (EMRs) for medical patients in Singapore General Hospital (SGH). There was poor compliance by on-call doctors in acknowledging electronic handovers, and lack of adherence to safety rules, raising concerns about the safety and efficiency of the electronic handover tool. Urgent measures were needed to ensure its safe and sustained use. A quality improvement group comprising stakeholders, including end-users, developed multi-faceted interventions using rapid PDSA (P-Plan, D-Do, S-Study, A-Act ) cycles to address these issues. Innovative solutions using media and online software provided cost-efficient measures to improve compliance. The percentage of unacknowledged handovers per day was used as the main outcome measure throughout all PDSA cycles. Doctors were also assessed for improvement in their knowledge of safety rules and their perception of the electronic handover tool. An electronic handover tool complementing daily clinical practice can be successfully implemented using solutions devised through close collaboration with end-users supported by the senior leadership. A combined 'bottom-up' and 'top-down' approach with regular process evaluations is crucial for its long-term sustainability. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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

    Science.gov (United States)

    Marschall, Paul; Flessa, Steffen

    2011-07-20

    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. 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. 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. 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 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.

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

    Directory of Open Access Journals (Sweden)

    Vink JP

    2016-06-01

    Full Text Available 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 acknowledge Crema and Verbano’s arguments that patient safety is a basic pillar of quality, upon which we would like to expand by highlighting the clinical effectiveness and patient-reported outcomes, which are the two further crucial components of quality. The arguments made regarding quality improvement techniques and cost efficiency in health care provision are insightful, yet appear to make a distinction between efforts to improve quality, eliminate waste from processes, and cut costs in health care provision. We would argue that in fact these achievements are all closely related and can be achieved simultaneously, if the industrial techniques of quality management are applied adequately.View the original paper by Crema and Verbano.

  9. New advances in wet scrubbing improvement efficiencies

    Energy Technology Data Exchange (ETDEWEB)

    Keen, A.R. [Altech Group, Toronto, ON (Canada)

    2000-07-01

    Wet scrubbing systems are the most versatile and cost efficient of all air pollution abatement technologies. This paper presented System REITHER{sup TM} which is a new generation of venturi scrubber. The advantages of this design are that it is simple and compact, has high removal efficiencies for sub-micron dusts or aerosols and it is flexible to handle any mass flow rate. It also provides high and constant reliability, is easy to control and has the potential to absorb gaseous pollutants. Another advantage is that it can handle corrosive streams through corrosion resistant materials. Innovations in wet scrubbing have made it possible to provide reliable and efficient separation of fine particles, corrosive aerosols and gases. New technology provides industrial engineers with a cost effective option when control air emissions is required. 1 fig.

  10. 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. Copyright Thieme Medical Publishers.

  11. Hall devices improve electric motor efficiency

    Science.gov (United States)

    Haeussermann, W.

    1979-01-01

    Efficiency of electric motors and generators is reduced by radial magnetic forces created by symmetric fields within device. Forces are sensed and counteracted by Hall devices on excitation or control windings. Hall generators directly measure and provide compensating control of anu asymmetry, eliminating additional measurements needed for calibration feedback control loop.

  12. Approaches of Improving University Assets Management Efficiency

    Science.gov (United States)

    Wang, Jingliang

    2015-01-01

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

  13. Improved waterflooding efficiency by horizontal wells

    Energy Technology Data Exchange (ETDEWEB)

    Popa, C. G. [Petroleum and Gas Univ., Ploesti (Romania); Clipea, M. [SNP Petrom SA, ICPT Campina (Romania)

    1998-12-31

    The influence of well pattern involving the use of horizontal wells on the overall efficiency of the waterflooding process was analyzed. Three different scenarios were examined: (1) a pattern of using two parallel horizontal wells, one for injection, the other for production, (2) a pattern of one horizontal well for water injection and several vertical wells for production, and (3) a pattern of using vertical wells for injection and one horizontal well for production. In each case, the waterflooding process was simulated using a two phase two dimensional numerical model. Results showed that the pressure loss along the horizontal section had a large influence on the sweep efficiency whether the horizontal well was used for injection or production. Overall, the most successful combination appeared to be using vertical wells for injection and horizontal wells for production. 4 refs., 1 tab., 15 figs.

  14. Efficiency improvements of electromagnetic flow control

    International Nuclear Information System (INIS)

    Spong, E.; Reizes, J.A.; Leonardi, E.

    2005-01-01

    In turbulent flow, frictional resistance and heat transfer are controlled to a large degree by the intensity of the turbulence fluctuations in the near vicinity of a surface. In the case of a weak electrically conducting fluid, such as seawater, turbulence intensity can be controlled by subjecting the fluid to electromagnetic fields. This technique, known as Electro-magneto-hydro-dynamic (EMHD) flow control, has been shown to have promise as a means of reducing the turbulence intensity, and hence heat transfer or frictional drag of turbulent boundary layers. Unfortunately EMHD flow control currently suffers from poor efficiency due to the high energy requirements of the electromagnetic field. A numerical study has been conducted in which a new electromagnetic actuator design has been developed to provide a more efficient spatial distribution of the electromagnetic forces. The new actuator design has then been coupled to an ideal flow sensor. A flow control subroutine, embedded in the numerical model, uses the velocity information from the ideal sensor to determine the appropriate actuating force to apply to the flow at each time step. The new actuator design has been shown to be capable of successfully attenuating a sequence of artificial low speed streaks in a simplified model of a low Reynolds number turbulent boundary layer. Thus, a potential solution to the poor efficiency of EMHD flow control has been offered by providing the means whereby the expensive electromagnetic forces can be strategically and sparingly applied to the flow

  15. Improving Care for Children With Complex Needs

    Science.gov (United States)

    2017-10-10

    Medically Complex Children; Care Coordination; Case Manager; Care Manager; Collaborative Care; Disease Management; Patient Care Team or Organization; Managed Care; Children With Chronic Conditions; Children With Special Health Care Needs; Shared Care Plan; Patient Care Plan; Health Care and Resource Utilization; Adherence to Care; Functional Status and Productivity; Health Related Quality of Life; Satisfaction With Care; Care Coordinator; Family Experience of Care; Quality Health Care

  16. Improving care in care homes: a qualitative evaluation of the Croydon care home support team.

    Science.gov (United States)

    Lawrence, Vanessa; Banerjee, Sube

    2010-05-01

    The Croydon care home support team (CHST) was developed in response to reports of patient abuse within long-term care. It presents a novel strategy for improving standards of care within care homes. A qualitative methodology was used to assess the perceived impact of the CHST. In-depth interviews were conducted with 14 care home managers and 24 members of care home staff across 14 care homes. Grounded theory principles guided the collection and analysis of the data. Reports of improved communication between staff, improved staff development and confidence, and improved quality of care point towards the effectiveness of the CHST model. The collaborative approach of the CHST was considered pivotal to its success and presented as an effective method of engaging care home managers and staff. The CHST adopted a systemic approach that placed an equal emphasis on the social, mental health and nursing needs of residents and aimed to address the whole culture of care within the individual homes. The data demonstrate the potential for specialist multi-disciplinary teams to raise standards of care across long-term care settings. Increased awareness of safeguarding issues, improved staff morale and communication and ongoing opportunities for discussion and problem solving promised to sustain improvements. Such services could be instrumental in meeting the government priority of preventing abuse among vulnerable adults.

  17. Improved energy efficiency in the process industries

    Energy Technology Data Exchange (ETDEWEB)

    Pilavachi, P A [Commission of the European Communities, Brussels (Belgium)

    1992-12-31

    The European Commission, through the JOULE Programme, is promoting energy efficient technologies in the process industries; the topics of the various R and D activities are: heat exchangers (enhanced evaporation, shell and tube heat exchangers including distribution of fluids, and fouling), low energy separation processes (adsorption, melt-crystallization and supercritical extraction), chemical reactors (methanol synthesis and reactors with integral heat exchangers), other unit operations (evaporators, glass-melting furnaces, cement kilns and baking ovens, dryers and packed columns and replacements for R12 in refrigeration), energy and system process models (batch processes, simulation and control of transients and energy synthesis), development of advanced sensors.

  18. Practical strategies for increasing efficiency and effectiveness in critical care education.

    Science.gov (United States)

    Joyce, Maurice F; Berg, Sheri; Bittner, Edward A

    2017-02-04

    Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.

  19. Process improvement in healthcare: Overall resource efficiency

    NARCIS (Netherlands)

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

    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

  20. Strategies to improve quality of childbirth care

    Directory of Open Access Journals (Sweden)

    farahnaz Changaee

    2015-01-01

    Full Text Available Background: Access to affordable and quality health care is one of the most important ways for reducing maternal and child mortality. The purpose of this study was to provide strategies to promote the quality of care during childbirth in Lorestan province in 2011. Materials and Methods: This research was a mixed method (quantitative, qualitative, study in which quality of 200 care during childbirth in hospitals of Lorestan Province were evaluated. Data gathered through self-made tools (Checklists prepared according to the guidelines of the ministry of health. Descriptive statistics and SPSS software were used to data analysis.In the second part of the study which was qualitative, interview with service providers, hospital officials and high-ranking officials of Lorestan university of medical sciences (decision makers was used to discuss strategies to improve the quality of care. Results: The results showed that the care of the first stage delivery in %54.5, second stage %57 and third stage 66% were in accordance with the desired status and care in this three stages was of moderate quality. Based on the interviews, the officials who are in charge of Lorestan university of medical sciences, proposed strategies such as financial incentives and in-service training of midwives as suitable strategies to improve quality of services. Conclusion: According to the results, strategies such as financial incentives, increased use of private sector services to reduce the workload of the public sector and increase of quality and use of more in-service training, to improve the quality of services, are recommended.

  1. [Technical efficiency assessment of public primary care providers in the Basque Country (Spain), 2010-2013].

    Science.gov (United States)

    Cordero, José Manuel; Nuño-Solinís, Roberto; Orueta, Juan F; Polo, Cristina; Del Río-Cámara, Mario; Alonso-Morán, Edurne

    2016-01-01

    To evaluate the technical efficiency of primary care units operating in the Basque Health Service during the period 2010-2013, corresponding to the implementation of a care integration strategy by health authorities. This study included 11 of the 12 primary care units in the Basque Health Service during the period 2010-2013. Data envelopment analysis (DEA) was used to assess the technical efficiency of the units. In particular, we applied the extension DEA windows to analyse all units as if they were in a single period (33 observations) as well as a conditional model, which allowed incorporation of the effect of the characteristics of the population covered. The outputs considered were a quality index based on fulfilment of different requirements related to primary care delivery and the rate of avoidable hospitalizations (treated as an undesirable output). The inputs used were the number of physicians, the number of nurses and the costs of prescriptions. The morbidity index was included as an exogenous variable. The results showed that the efficiency of all the units improved during the study period. However, this improvement was not greater in the units incorporated in the integrated healthcare organisation. In a context of global transformation of care delivery in the Basque country in the study period, primary care units increased their efficiency. However, this effect was not larger in vertically integrated primary care providers. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

  2. Efficient Parallel Strategy Improvement for Parity Games

    OpenAIRE

    Fearnley, John

    2017-01-01

    We study strategy improvement algorithms for solving parity games. While these algorithms are known to solve parity games using a very small number of iterations, experimental studies have found that a high step complexity causes them to perform poorly in practice. In this paper we seek to address this situation. Every iteration of the algorithm must compute a best response, and while the standard way of doing this uses the Bellman-Ford algorithm, we give experimental results that show that o...

  3. Improvement of the Dehulling Efficiency of Sorghum and Millet using ...

    African Journals Online (AJOL)

    Conditioning of grain with heat and moisture is known to loosen the adhesion of the seed coat from the endosperm and therefore improve the dehulling efficiency of some grains such as beans, cowpea and canola. This study investigated the effect of hydrothermal treatment on the improvement of dehulling efficiency of ...

  4. Improving Reliability, Security, and Efficiency of Reconfigurable Hardware Systems (Habilitation)

    NARCIS (Netherlands)

    Ziener, Daniel

    2017-01-01

    In this treatise,  my research on methods to improve efficiency, reliability, and security of reconfigurable hardware systems, i.e., FPGAs, through partial dynamic reconfiguration is outlined. The efficiency of reconfigurable systems can be improved by loading optimized data paths on-the-fly on an

  5. 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.

  6. Networking to improve end of life care

    Science.gov (United States)

    2009-01-01

    Network organisations are increasingly common in healthcare. This paper describes an example of clinically led networking, which improved end of life care (EOLC) in care homes, differentiating between a ‘network’ as a formal entity and the more informal process of ‘networking’. The paper begins with a brief discussion of networks and their development in healthcare, then an overview of EOLC policy, the case setting and methods. The paper describes four key features of this networking; (1) how it enabled discussions and implemented processes to help people address difficult taboos about dying; (2) how personal communication and ‘distributed leadership’ facilitated learning; (3) how EOLC occasionally lapsed during the handover of patient care, where personal relationship and communication were weaker; and (4) how successful learning and sharing of best practice was fragile and could be potentially undermined by wider financial pressures in the NHS. PMID:25949588

  7. On improving the efficiency of tensor voting.

    Science.gov (United States)

    Moreno, Rodrigo; Garcia, Miguel Angel; Puig, Domenec; Pizarro, Luis; Burgeth, Bernhard; Weickert, Joachim

    2011-11-01

    This paper proposes two alternative formulations to reduce the high computational complexity of tensor voting, a robust perceptual grouping technique used to extract salient information from noisy data. The first scheme consists of numerical approximations of the votes, which have been derived from an in-depth analysis of the plate and ball voting processes. The second scheme simplifies the formulation while keeping the same perceptual meaning of the original tensor voting: The stick tensor voting and the stick component of the plate tensor voting must reinforce surfaceness, the plate components of both the plate and ball tensor voting must boost curveness, whereas junctionness must be strengthened by the ball component of the ball tensor voting. Two new parameters have been proposed for the second formulation in order to control the potentially conflictive influence of the stick component of the plate vote and the ball component of the ball vote. Results show that the proposed formulations can be used in applications where efficiency is an issue since they have a complexity of order O(1). Moreover, the second proposed formulation has been shown to be more appropriate than the original tensor voting for estimating saliencies by appropriately setting the two new parameters.

  8. 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.

  9. TIG welding power supply with improved efficiency

    Directory of Open Access Journals (Sweden)

    Сергій Володимирович Гулаков

    2015-03-01

    Full Text Available In the article, the influence of the DC component of the welding current during TIG (Tungsten Inert Gas welding is discussed. Known methods of DC current cancellation are reviewed, such as capacitor bank or diode/thyristor network insertion in the secondary circuit of the welding transformer. A new method of controlling the magnitude and shape of the TIG welding current is proposed. The idea is to insert a controlled voltage source in the secondary circuit of the welding transformer. This controlled voltage source is realized using a full-bridge voltage source inverter (VSI. VSI control system design issues are discussed. VSI is controlled by a three-level hysteretic current controller, while current reference is generated using lookup table driven by PLL (Phase Locked Loop locked to the mains frequency. Simulation results are shown. The proposed topology of TIG power supply allows to provide magnitude and shape control of the welding current, with the limitation that its DC component must be zero. Thus, some capabilities of professional AC-TIG welders are obtained using substantially lower cost components: VSI built using high-current low voltage MOSFETs with control system based on 32-bit ARM microcontroller. The use of proposed TIG welding power supply will eliminate the DC component of the welding current, improve welding transformer’s power factor and improve welding technology by increasing the welding arc stability

  10. Improving performance on core processes of care.

    Science.gov (United States)

    Austin, John Matthew; Pronovost, Peter J

    2016-06-01

    This article describes the recent literature on using extrinsic and intrinsic motivators to improve performance on core processes of care, highlighting literature that describes general frameworks for quality improvement work. The literature supporting the effectiveness of extrinsic motivators to improve quality is generally positive for public reporting of performance, with mixed results for pay-for-performance. A four-element quality improvement framework developed by The Armstrong Institute at Johns Hopkins Medicine was developed with intrinsic motivation in mind. The clear definition and communication of goals are important for quality improvement work. Training clinicians in improvement science, such as lean sigma, teamwork, or culture change provides clinicians with the skills they need to drive the improvement work. Peer learning communities offer the opportunity for clinicians to engage with each other and offer support in their work. The transparent reporting of performance helps ensure accountability of performance ranging from individual clinicians to governance. Quality improvement work that is led by and engages clinicians offers the opportunity for the work to be both meaningful and sustainable. The literature supports approaching quality improvement work in a systematic way, including the key elements of communication, infrastructure building, training, transparency, and accountability.

  11. 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.

  12. Care Plan Improvement in Nursing Homes: An Integrative Review.

    Science.gov (United States)

    Mariani, Elena; Chattat, Rabih; Vernooij-Dassen, Myrra; Koopmans, Raymond; Engels, Yvonne

    2017-01-01

    Care planning nowadays is a key activity in the provision of services to nursing home residents. A care plan describes the residents' needs and the actions to address them, providing both individualized and standardized interventions and should be updated as changes in the residents' conditions occur. The aim of this review was to identify the core elements of the implementation of changes in nursing homes' care plans, by providing an overview of the type of stakeholders involved, describing the implementation strategies used, and exploring how care plans changed. An integrative literature review was used to evaluate intervention studies taking place in nursing homes. Data were collected from PubMed, CINHAL-EBSCO, and PsycINFO. English language articles published between 1995 and April 2015 were included. Data analysis followed the strategy of Knafl and Whittemore. Twenty-six articles were included. The stakeholders involved were professionals, family caregivers, and patients. Only a few studies directly involved residents and family caregivers in the quality improvement process. The implementation strategies used were technology implementation, audit, training, feedback, and supervision. The majority of interventions changed the residents' care plans in terms of developing a more standardized care documentation that primarily focuses on its quality. Only some interventions developed more tailored care plans that focus on individualized needs. Care plans generally failed in providing both standardized and personalized interventions. Efforts should be made to directly involve residents in care planning and provide professionals with efficient tools to report care goals and actions in care plans.

  13. Creating a Professional Ladder for Interpreters for Improvement of Care.

    Science.gov (United States)

    Marshall, Lori; Fischer, Anna; Noyes Soeller, Allison; Cordova, Richard; Gutierrez, Yvonne R; Alford, Luis

    2016-01-01

    Children's Hospital Los Angeles (CHLA), a metropolitan academic medical center, recognized limitations in how the professional interpreters from the Diversity Services Department were used to support effective patient-provider communication across the organization. Given the importance of mitigating language and communication barriers, CHLA sought to minimize clinical and structural barriers to health care for limited English proficiency populations through a comprehensive restructuring of the Diversity Services Department. This approach entailed a new delivery model for hospital language assistance and cultural consultancy resources. The intervention focused on restructuring the Diversity Services Department, redefining priorities, reallocating resources, and redefining the roles of the language staff positions in the department. The language staff role was redesigned to fit a four-level professional career ladder modeled after the professional career ladders commonly used in hospitals for the RN role and other professional disciplines. The approach involved creating new levels of language specialist, each with progressive requirements for performance, leadership, and accountability for patient care outcomes. Language staff in the inpatient, clinic, and emergency department settings worked alongside nurses, physicians, and other disciplines to care for a specific set of patients. The result of this work was a positive culture change resulting in service efficiencies, care improvements, and improved access to language services. A professional career ladder for language staff contributed to improving the quality and access of language services and advancing the interpreting profession by incorporating care coordination support, vital document translation, and cultural consultancy.

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

    NARCIS (Netherlands)

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

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

  15. Measuring efficiency in health care: analytic techniques and health policy

    National Research Council Canada - National Science Library

    Smith, Peter C; Street, Andrew; Jacobs, Rowena

    2006-01-01

    ... the efficiency of systems and organisations, including data envelopment analysis and stochastic frontier analysis, and also presents some promising new methodological approaches. Such techniques offer the prospect of many new and fruitful insights into health care performance. Nevertheless, they also pose many practical and methodological c...

  16. [Initiatives to increase the efficiency of dermatological patient care

    NARCIS (Netherlands)

    Kerkhof, P.C.M. van de

    2006-01-01

    The number of tasks required of dermatologists has increased in the last decade. This article discusses potential ways to enhance the efficiency ofdermatological patient care and prevent problems of capacity. A study conducted in the UK found that, for the top 10 skin disorders, the accessibility of

  17. Improving energy efficiency in handheld biometric applications

    Science.gov (United States)

    Hoyle, David C.; Gale, John W.; Schultz, Robert C.; Rakvic, Ryan N.; Ives, Robert W.

    2012-06-01

    With improved smartphone and tablet technology, it is becoming increasingly feasible to implement powerful biometric recognition algorithms on portable devices. Typical iris recognition algorithms, such as Ridge Energy Direction (RED), utilize two-dimensional convolution in their implementation. This paper explores the energy consumption implications of 12 different methods of implementing two-dimensional convolution on a portable device. Typically, convolution is implemented using floating point operations. If a given algorithm implemented integer convolution vice floating point convolution, it could drastically reduce the energy consumed by the processor. The 12 methods compared include 4 major categories: Integer C, Integer Java, Floating Point C, and Floating Point Java. Each major category is further divided into 3 implementations: variable size looped convolution, static size looped convolution, and unrolled looped convolution. All testing was performed using the HTC Thunderbolt with energy measured directly using a Tektronix TDS5104B Digital Phosphor oscilloscope. Results indicate that energy savings as high as 75% are possible by using Integer C versus Floating Point C. Considering the relative proportion of processing time that convolution is responsible for in a typical algorithm, the savings in energy would likely result in significantly greater time between battery charges.

  18. Discontinuous interleaving of parallel inverters for efficiency improvement

    DEFF Research Database (Denmark)

    Rannestad, Bjørn; Munk-Nielsen, Stig; Gadgaard, Kristian

    2017-01-01

    Interleaved switching of parallel inverters has previously been proposed for efficiency/size improvements of grid connected three-phase inverters. This paper proposes a novel interleaving method which practically eliminates insulated gate bipolar transistor (IGBT) turn-on losses and drastically...... overall power module losses are reduced. The modulation strategy is suited for converters with doubly fed induction generators (DFIG) for wind turbines, but are not limited hereto. Improvement of switching performance are measured and operational efficiency improvements are calculated and verified...

  19. Improving performance management for delivering appropriate care for patients no longer needing acute hospital care.

    Science.gov (United States)

    Penney, Christine; Henry, Effie

    2008-01-01

    The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also

  20. Improved efficiency in OLEDs with a thin Alq3 interlayer

    International Nuclear Information System (INIS)

    Lian Jiarong; Yuan Yongbo; Cao Lingfang; Zhang Jie; Pang Hongqi; Zhou Yunfei; Zhou Xiang

    2007-01-01

    We demonstrate an improved efficiency in OLEDs with a thin Alq 3 interlayer, which is inserted into the hole-transport layer for adjusting the hole-injection and transport, and improving the hole-electron balance. The thin Alq 3 interlayer can effectively influence the electrical performance and electroluminescence (EL) efficiency of the devices. The devices with an optimum Alq 3 interlayer exhibit a maximum EL efficiency of around 3.3 cd/A, which is improved by a factor of two over the conventional devices (1.6 cd/A) without the interlayer

  1. 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.

  2. The Multiple Benefits of Measures to Improve Energy Efficiency

    DEFF Research Database (Denmark)

    Puig, Daniel; Farrell, Timothy Clifford

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

  3. Thermal efficiency improvements - an imperative for nuclear generating stations

    International Nuclear Information System (INIS)

    Hassanien, S.; Rouse, S.

    1997-01-01

    A one and a half percent thermal performance improvement of Ontario Hydro's operating nuclear units (Bruce B, Pickering B, and Darlington) means almost 980 GWh are available to the transmission system (assuming an 80% capacity factor). This is equivalent to the energy consumption of 34,000 electrically-heated homes in Ontario, and worth more than $39 million in revenue to Ontario Hydro Nuclear Generation. Improving nuclear plant thermal efficiency improves profitability (more GWh per unit of fuel) and competitiveness (cost of unit energy), and reduces environmental impact (less spent fuel and nuclear waste). Thermal performance will naturally decrease due to the age of the units unless corrective action is taken. Most Ontario Hydro nuclear units are ten to twenty years old. Some common causes for loss of thermal efficiency are: fouling and tube plugging of steam generators, condensers, and heat exchangers; steam leaks in the condenser due to valve wear, steam trap and drain leaks; deposition, pitting, cracking, corrosion, etc., of turbine blades; inadequate feedwater metering resulting from corrosion and deposition. This paper stresses the importance of improving the nuclear units' thermal efficiency. Ontario Hydro Nuclear has demonstrated energy savings results are achievable and affordable. Between 1994 and 1996, Nuclear reduced its energy use and improved thermal efficiency by over 430,000 MWh. Efficiency improvement is not automatic - strategies are needed to be effective. This paper suggests practical strategies to systematically improve thermal efficiency. (author)

  4. Does Automation Improve Stock Market Efficiency? Evidence from Ghana

    OpenAIRE

    Mensah, Justice T.; Pomaa-Berko, Maame; Adom, Philip Kofi

    2012-01-01

    As a burgeoning capital market in an emerging economy, automation of the stock market is regarded as a major step towards integrating the financial market as a conduit for economic growth. The automation of the Ghana Stock Exchange (GSE) in 2008 is expected among other things to improve the efficiency of the market. This paper therefore investigates the impact of the automation on the efficiency of the GSE within the framework of the weak-form Efficient Market Hypothesis (EMH) using daily mar...

  5. A history of industrial statistics and quality and efficiency improvement

    NARCIS (Netherlands)

    de Mast, J.; Coleman, S.; Greenfield, T.; Stewardson, D.; Montgomery, D.C.

    2008-01-01

    The twentieth century witnessed incredible increases in product quality, while in the same period product priced dropped dramatically. These important improvements in quality and efficiency in industry were the result of innovations in management and engineering. But these developments were

  6. 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.

  7. Spreading improvements for advanced COPD care through a Canadian Collaborative

    Directory of Open Access Journals (Sweden)

    Rocker GM

    2017-07-01

    Full Text Available Graeme M Rocker,1 Claudia Amar,2 Wendy L Laframboise,3 Jane Burns,4 Jennifer Y Verma2 1Division of Respirology, Nova Scotia Health Authority/Dalhousie University, Halifax, NS, 2Canadian Foundation for Healthcare Improvement, 3The Ottawa Hospital COPD Outreach Program, Ottawa, ON, 4Providence COPD Outreach Program, Vancouver, BC, Canada Background: A year-long pan-Canadian quality improvement collaborative (QIC led by the Canadian Foundation for Healthcare Improvement (CFHI supported the spread of the successful Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ to 19 teams in the 10 Canadian provinces. We describe QIC results, addressing two main questions: 1 Can the results of the Nova Scotia INSPIRED model be replicated elsewhere in Canada? 2 How did the teams implement and evaluate their versions of the INSPIRED program?Methods: Collaborative faculty selected measures that were evidence-based, relatively simple to collect, and relevant to local context. Chosen process and outcome measures are related to four quality domains: 1 patient- and family-centeredness, 2 coordination, 3 efficiency, and 4 appropriateness. Evaluation of a complex intervention followed a mixed-methods approach.Results: Most participants were nurse managers and/or COPD educators. Only 8% were physicians. Fifteen teams incorporated all core INSPIRED interventions. All teams carried out evaluation. Thirteen teams actively involved patients and families in customized, direct care planning, eg, asking them to complete evaluative surveys and/or conducting interviews. Patients consistently reported greater self-confidence in symptom management, a return to daily activities, and improvements to quality of life. Twelve teams collected data on care transitions using the validated three-item Care Transitions Measure (CTM-3. Twelve teams used the Lung Information Needs Questionnaire (LINQ. Admissions, emergency room visits, and patient-related costs fell substantially for

  8. Improvement in light-extraction efficiency of light emitting diode ...

    Indian Academy of Sciences (India)

    The effect of various microlens parameters such as diameter and area fraction on light-extraction efficiency was systematically studied. Improvement of 4% in extraction efficiency was obtained by employing it on white light emitting diode. The area fraction of microlenses was increased up to 0.34 by reducing the spin speed.

  9. Does automation improve stock market efficiency in Ghana ...

    African Journals Online (AJOL)

    The automation of the Ghana Stock Exchange (GSE) in 2008, among other reforms, was expected to improve the efficiency of the market. The extent of this truism has, however, not been empirically established for the GSE. In this study, we attempt to assess the impact of the automation on the efficiency of the GSE within the ...

  10. 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.

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

    International Nuclear Information System (INIS)

    Fujii, Terushige; Akagawa, Koji; Nakanishi, Shigeyasu; Inoue, Kiyoshi; Ishigai, Seikan.

    1982-01-01

    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, NH 3 , SO 2 , CO 2 and H 2 O were examined as perfect gas and real gas. The advantage of CO 2 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.)

  12. Judgment sampling: a health care improvement perspective.

    Science.gov (United States)

    Perla, Rocco J; Provost, Lloyd P

    2012-01-01

    Sampling plays a major role in quality improvement work. Random sampling (assumed by most traditional statistical methods) is the exception in improvement situations. In most cases, some type of "judgment sample" is used to collect data from a system. Unfortunately, judgment sampling is not well understood. Judgment sampling relies upon those with process and subject matter knowledge to select useful samples for learning about process performance and the impact of changes over time. It many cases, where the goal is to learn about or improve a specific process or system, judgment samples are not merely the most convenient and economical approach, they are technically and conceptually the most appropriate approach. This is because improvement work is done in the real world in complex situations involving specific areas of concern and focus; in these situations, the assumptions of classical measurement theory neither can be met nor should an attempt be made to meet them. The purpose of this article is to describe judgment sampling and its importance in quality improvement work and studies with a focus on health care settings.

  13. LEAN SIX SIGMA TECHNIQUES TO IMPROVE OPHTHALMOLOGY CLINIC EFFICIENCY.

    Science.gov (United States)

    Ciulla, Thomas A; Tatikonda, Mohan V; ElMaraghi, Yehya A; Hussain, Rehan M; Hill, Amanda L; Clary, Julie M; Hattab, Eyas

    2017-07-18

    Ophthalmologists serve an increasing volume of a growing elderly population undergoing increasingly complex outpatient medical care, including extensive diagnostic testing and treatment. The resulting prolonged patient visit times ("patient flow times") limit quality, patient and employee satisfaction, and represent waste. Lean Six Sigma process improvement was used in a vitreoretinal practice to decrease patient flow time, demonstrating that this approach can yield significant improvement in health care. Process flow maps were created to determine the most common care pathways within clinic. Three months' visits from the electronic medical record system, which tracks patient task times at each process step in the office were collected. Care tasks and care pathways consuming the greatest time and variation were identified and modified. Follow-up analysis from 6 weeks' visits was conducted to assess improvement. Nearly all patients took one of five paths through the office. Patient flow was redesigned to reduce waiting room time by having staff members immediately start patients into one of those five paths; staffing was adjusted to address high demand tasks, and scheduling was optimized around derived predictors of patient flow times. Follow-up analysis revealed a statistically significant decline in mean patient flow time by 18% and inpatient flow time SD by 4.6%. Patient and employee satisfaction scores improved. Manufacturing industry techniques, such as Lean and Six Sigma, can be used to improve patient care, minimize waste, and enhance patient and staff satisfaction in outpatient clinics.

  14. Taxing energy to improve the environment : Efficiency and distributional effects

    NARCIS (Netherlands)

    Heijdra, BJ; van der Horst, A

    We study 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. Raising the energy tax may yield an efficiency gain if agents care enough about the environment. The benefits are

  15. 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.

  16. Achieving palliative care research efficiency through defining and benchmarking performance metrics.

    Science.gov (United States)

    Lodato, Jordan E; Aziz, Noreen; Bennett, Rachael E; Abernethy, Amy P; Kutner, Jean S

    2012-12-01

    Research efficiency is gaining increasing attention in the research enterprise, including palliative care research. The importance of generating meaningful findings and translating these scientific advances to improved patient care creates urgency in the field to address well documented system inefficiencies. The Palliative Care Research Cooperative Group (PCRC) provides useful examples for ensuring research efficiency in palliative care. Literature on maximizing research efficiency focuses on the importance of clearly delineated process maps, working instructions, and standard operating procedures in creating synchronicity in expectations across research sites. Examples from the PCRC support these objectives and suggest that early creation and employment of performance metrics aligned with these processes are essential to generate clear expectations and identify benchmarks. These benchmarks are critical in effective monitoring and ultimately the generation of high-quality findings that are translatable to clinical populations. Prioritization of measurable goals and tasks to ensure that activities align with programmatic aims is critical. Examples from the PCRC affirm and expand the existing literature on research efficiency, providing a palliative care focus. Operating procedures, performance metrics, prioritization, and monitoring for success should all be informed by and inform the process map to achieve maximum research efficiency.

  17. Low Impedance Voice Coils for Improved Loudspeaker Efficiency

    DEFF Research Database (Denmark)

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

    2015-01-01

    In modern audio systems utilizing switch-mode amplifiers the total efficiency is dominated by the rather poor efficiency of the loudspeaker. For decades voice coils have been designed so that nominal resistances of 4 to 8 Ohms is obtained, despite modern audio amplifiers, using switch-mode techno...... responses are estimated. For this woofer it is shown that the sensitivity can be improved approximately 1 dB, corresponding to a 30% efficiency improvement, just by increasing the fill factor using a low impedance voice coil with rectangular wire....

  18. 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....

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

    International Nuclear Information System (INIS)

    Varman, M.; Mahlia, T.M.I.; Masjuki, H.H.

    2006-01-01

    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

  20. 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.

  1. 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.

  2. Improved Efficient Routing Strategy on Scale-Free Networks

    Science.gov (United States)

    Jiang, Zhong-Yuan; Liang, Man-Gui

    Since the betweenness of nodes in complex networks can theoretically represent the traffic load of nodes under the currently used routing strategy, we propose an improved efficient (IE) routing strategy to enhance to the network traffic capacity based on the betweenness centrality. Any node with the highest betweenness is susceptible to traffic congestion. An efficient way to improve the network traffic capacity is to redistribute the heavy traffic load from these central nodes to non-central nodes, so in this paper, we firstly give a path cost function by considering the sum of node betweenness with a tunable parameter β along the actual path. Then, by minimizing the path cost, our IE routing strategy achieved obvious improvement on the network transport efficiency. Simulations on scale-free Barabási-Albert (BA) networks confirmed the effectiveness of our strategy, when compared with the efficient routing (ER) and the shortest path (SP) routing.

  3. Improving eye care in the primary health care setting

    Directory of Open Access Journals (Sweden)

    M de Wet

    2000-09-01

    Full Text Available One of the challenges facing primary health care in South Africa is the delivery of quality eye care to all South Africans. In this regard the role of the primary health care worker, as the first point of contact, is crucial. This paper reports on the problems primary health care workers experience in providing quality eye care in Region B of the Free State. Problems identified by those involved in the study include the cumbersome referral system, the unavailability of appropriate medicine at clinics, the insufficient knowledge of primary health care workers regarding eye conditions and the lack of communication between the various eye care service providers. Suggestions to address the problems identified included more in-service training of primary health care workers regarding eye conditions, liaison with NGO’s providing eye care, decentralisation of services and the establishment of an eye care committee in the region.

  4. Quality and Efficiency Improvement Tools for Every Radiologist.

    Science.gov (United States)

    Kudla, Alexei U; Brook, Olga R

    2018-03-20

    In an era of value-based medicine, data-driven quality improvement is more important than ever to ensure safe and efficient imaging services. Familiarity with high-value tools enables all radiologists to successfully engage in quality and efficiency improvement. In this article, we review the model for improvement, strategies for measurement, and common practical tools with real-life examples that include Run chart, Control chart (Shewhart chart), Fishbone (Cause-and-Effect or Ishikawa) diagram, Pareto chart, 5 Whys, and Root Cause Analysis. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  5. Barriers to efficiency improvement and fuel switching in Karnataka, India

    International Nuclear Information System (INIS)

    Reddy, A.

    1991-01-01

    Implementing energy efficiency changes requires a wide range measures. Improvements, therefore, require actions at the lowest level of the consumer, through the highest level of the global agencies. Due to the multiplicity of participants, however, barriers to achieving these improvements can arise at every level. The major barriers to improving energy efficiency in developing countries are defined and paths to overcome these challenges are identified. Topics of discussion include: energy consumers; end-use equipment manufacturers; end-use equipment providers; energy carrier producers and distributors; actual/potential cogenerators; financial institutions; government; and international, multilateral and industrialized country funding/aid agencies

  6. [Improving the continuous care process in primary care during weekends and holidays: redesigning and FMEA].

    Science.gov (United States)

    Cañada Dorado, A; Cárdenas Valladolid, J; Espejo Matorrales, F; García Ferradal, I; Sastre Páez, S; Vicente Martín, I

    2010-01-01

    To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

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

    Science.gov (United States)

    Blackmore, Gail; Persaud, D David

    2012-01-01

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

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

    International Nuclear Information System (INIS)

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

    2013-01-01

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-07-01

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

  10. 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.

  11. 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.

  12. Efficiency improvement for vehicle powertrains using energy integration techniques

    OpenAIRE

    Dimitrova, Zlatina; Maréchal, François

    2016-01-01

    The main design criteria for the modern sustainable development of vehicle powertrains are the high energy efficiency of the conversion system, the competitive cost and the lowest possible environmental impacts. The need for efficiency improvement of the vehicle energy system induces the search for an innovative methodology during the design process. In this article the energy services for mobility and comfort are integrated. The energy integration of the mobility and the comfort service is a...

  13. Upgrading and efficiency improvement in coal-fired power plants

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-08-01

    Improving the efficiencies of the large number of older coal-fired power plants operating around the world would give major savings in CO2 emissions together with significant other benefits. This report begins with a summary of the ways efficiency can become degraded and of the means available to combat the decrease in performance. These include improvements to operating and maintenance practices and more major techniques that are available, including boiler and turbine retrofits. There is also an update on fuel drying developments as a route to higher efficiency in plants firing high moisture lignites. The largest chapter of the report contains a number of descriptions of case study improvement projects, to illustrate measures that have been applied, benefits that have been achieved and identify best practices, which are summarised. Major national and international upgrading programmes are described.

  14. 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.

  15. 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

  16. 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.

  17. SAGD CO2 mitigation through energy efficiency improvements

    International Nuclear Information System (INIS)

    Plessis du, D.

    2010-01-01

    An evaluation of the carbon dioxide (CO 2 ) 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 CO 2 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.

  18. Potential Global Benefits of Improved Ceiling Fan Energy Efficiency

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-10-31

    Ceiling fans contribute significantly to residential electricity consumption, both in an absolute sense and as a proportion of household consumption in many locations, especially in developing countries in warm climates. However, there has been little detailed assessment of the costs and benefits of efficiency improvement options for ceiling fans and the potential resulting electricity consumption and greenhouse gas (GHG) emissions reductions. We analyze the costs and benefits of several options to improve the efficiency of ceiling fans and assess the global potential for electricity savings and GHG emission reductions with more detailed assessments for India, China, and the U.S. We find that 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 terrawatt hours per year (TWh/year) could be saved and 25 million metric tons of carbon dioxide (CO2) 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 this savings potential.

  19. [Emergency care of vertigo patients: suggestions for efficient management].

    Science.gov (United States)

    Kogashiwa, Yasunao; Takei, Yasuhiko; Matsuda, Takeaki; Karaho, Takehiro; Morita, Masahiro; Kohno, Naoyuki

    2009-10-01

    Some diseases in which persons show vertigo or dizziness may be life-threatening, regardless of symptom severity, and require careful attention. These include diseases of the inner ear, central nervous system, and cardiovascular manifestation. In May 2006, a group in charge of primary emergency consultation began work enabling physicians to treat vertigo patients more efficiently and safely, as detailed in this report. Of the 173 persons with vertigo hospitalized from January 2004 to March 2008, six had cerebrovascular manifestations clarified only after hospitalization, underscoring the importance of careful examination, especially of those 75 years of age older, having continuous headache, having severe trunk ataxia despite apparently mild eye nystagmus, or reporting a history of high blood pressure, diabetes mellitus, hyperlipidemia, or ischemic heart disease.

  20. Improving care coordination using organisational routines

    DEFF Research Database (Denmark)

    Prætorius, Thim

    2016-01-01

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

  1. Improving care coordination using organisational routines.

    Science.gov (United States)

    Prætorius, Thim

    2016-01-01

    The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can be replicated, the way they are influenced by the organisation and the way they influence health care professionals. Theory of routines is systematically applied to care pathways in order to develop theoretically derived propositions. 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. In all, 11 propositions related to five categories are proposed by building on these insights: care pathways and coordination, change, replication, the organisation and health care professionals. Research limitations/implications - The paper is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point for empirical research. The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals. Originality/value - Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination.

  2. Improving Energy Efficiency In Thermal Oil Recovery Surface Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Murthy Nadella, Narayana

    2010-09-15

    Thermal oil recovery methods such as Cyclic Steam Stimulation (CSS), Steam Assisted Gravity Drainage (SAGD) and In-situ Combustion are being used for recovering heavy oil and bitumen. These processes expend energy to recover oil. The process design of the surface facilities requires optimization to improve the efficiency of oil recovery by minimizing the energy consumption per barrel of oil produced. Optimization involves minimizing external energy use by heat integration. This paper discusses the unit processes and design methodology considering thermodynamic energy requirements and heat integration methods to improve energy efficiency in the surface facilities. A design case study is presented.

  3. The Effects of Simulation-based Transvaginal Ultrasound Training on Quality and Efficiency of Care

    DEFF Research Database (Denmark)

    Tolsgaard, Martin Grønnebæk; Ringsted, Charlotte; Rosthøj, Susanne

    2017-01-01

    , but no studies have examined its effects on quality and efficiency of care. METHODS: Trainees from 4 University Hospitals in East Denmark were included (N = 54). Participants were randomized to either simulation-based ultrasound training and clinical training (intervention group, n = 28), or to clinical training......, 33.5-55.1) and 19.8% (95% CI, 4.1-32.9) in the intervention and control group, respectively (P = 0.005). CONCLUSIONS: Simulation-based ultrasound training improved quality of care and reduced the need for repeated patient examination and trainee supervision.......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...

  4. Improving quality of tuberculosis care in India.

    Science.gov (United States)

    Pai, Madhukar; Satyanarayana, Srinath; Hopewell, Phil

    2014-01-01

    In India, the quality of care that tuberculosis (TB) patients receive varies considerably and is often not in accordance with the national and international standards. In this article, we provide an overview of the third (latest) edition of the International Standards of Tuberculosis Care (ISTC). These standards are supported by the existing World Health Organization guidelines and policy statements pertaining to TB care and have been endorsed by a number of international organizations. We call upon all health care providers in the country to practice TB care that is consistent with these standards, as well as the upcoming Standards for TB Care in India (STCI).

  5. 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.

  6. 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.

  7. 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

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

    Science.gov (United States)

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

    2010-01-01

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

  9. Efficiency Improvement and Quality Initiatives Application in Financial Institutions

    Directory of Open Access Journals (Sweden)

    MSc. Ajtene Avdullahi

    2015-06-01

    Full Text Available Financial institutions in today’s economy have no longer the luxury to improve profit simply by increasing revenue. These firms, due to the significant measuring reductions in the financial services industry needed to improve operational efficiencies and merely support existing processes with fewer resources. This paper explains the benefits of Lean, Six Sigma, Total Quality Management and Lean Six Sigma that have improved organization's performance, by cutting costs and waste, improving their products or services, increasing profitability as well as enhancing customer satisfaction. The applicability of quality management practices in financial institutions in Kosovo is presented and also their efficiency and effectiveness. By analyzing data from Raiffeisen Bank Kosovo, this paper highlights the benefits of Individual and Micro companies customer segment as the result of organizational change and successful application of quality initiatives from financial institutions in Kosovo.

  10. Supply Chain Management for Improved Energy Efficiency: Review and Opportunities

    Directory of Open Access Journals (Sweden)

    Beatrice Marchi

    2017-10-01

    Full Text Available Energy efficiency represents a key resource for economic and social development, providing substantial benefits to different stakeholders, ranging from the entities which develop energy efficient measures to everyone in society. In addition to cost savings, multiple benefits can be achieved by supporting a better alignment between energy issues and strategic business priorities: e.g., improved competitiveness, profitability, quality, etc. Thus, energy efficiency can be a strategic advantage, not just a marginal issue, for companies. However, most firms, especially small and medium enterprises (SMEs, face many problems and, in some cases, hostility when trying to effectively implement energy efficiency actions. The most dominant barriers are the access to capital and the lack of awareness (especially in terms of life cycle cost effects. The supply chain viewpoint represents one of the main opportunities for overcoming those barriers and improving energy performance even for weaker companies. Since the current literature on energy efficiency and practical approaches to ensure energy efficiency mainly focus on energy performance on a single-firm basis, this paper aims to provide a systematic review of papers on the integration of energy efficiency in supply chain design and management published in academic journal, thereby defining potential research streams to close the gaps in the literature. A number of literature reviews have been published focusing on specific aspects of sustainable or on green supply chain management; however, to the best of our knowledge, no review has focused on the energy efficiency issue. Firstly, the present paper shows how considering energy consumption in supply chain management can contribute to more energy-efficient processes from a systemic point of view. Then, the review methodology used is defined and the sampled papers are analyzed and categorized based on the different approaches they propose. From these

  11. 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...

  12. Enhancing systems to improve the management of acute, unscheduled care.

    Science.gov (United States)

    Braithwaite, Sabina A; Pines, Jesse M; Asplin, Brent R; Epstein, Stephen K

    2011-06-01

    For acutely ill patients, health care services are available in many different settings, including hospital-based emergency departments (EDs), retail clinics, federally qualified health centers, and outpatient clinics. Certain conditions are the sole domain of particular settings: stabilization of critically ill patients can typically only be provided in EDs. By contrast, many conditions that do not require hospital resources, such as advanced radiography, admission, and same-day consultation can often be managed in clinic settings. Because clinics are generally not open nights, and often not on weekends or holidays, the ED remains the only option for face-to-face medical care during these times. For patients who can be managed in either setting, there are many open research questions about which is the best setting, because these venues differ in terms of access, costs of care, and potentially, quality. Consideration of these patients must be risk-adjusted, as patients may self-select a venue for care based upon perceived acuity. We present a research agenda for acute, unscheduled care in the United States developed in conjunction with an Agency for Healthcare Research and Quality-funded conference hosted by the American College of Emergency Physicians in October 2009, titled "Improving the Quality and Efficiency of Emergency Care Across the Continuum: A Systems Approach." Given the possible increase in ED utilization over the next several years as more people become insured, understanding differences in cost, quality, and access for conditions that may be treated in EDs or clinic settings will be vital in guiding national health policy. © 2011 by the Society for Academic Emergency Medicine.

  13. Case study: improving efficiency in a large hospital laboratory.

    Science.gov (United States)

    Bartel, Marilynn

    2004-01-01

    Saint Francis Health System (SFHS) consists of three hospitals and one clinic: Saint Francis Hospital (SFH); Broken Arrow Medical Center; Laureate Psychiatric Hospital; and Warren Clinic. SFHS has 670 physicians on staff and serves medical (oncology, orthopedic, neurology, and renal), surgical, cardiac, women and infant, pediatric, transplant, and trauma patients in Tulsa County, Oklahoma, which has a population of 660,000. SFH incorporates 706 staffed beds, including 126 pediatric beds and 119 critical care beds. Each year, the health system averages 38,000 admissions, 70,000 emergency department visits, 25,000 surgeries, and 3,500 births. Saint Francis Laboratory is located within the main hospital facility (SFH) and functions as a core lab for the health system. The lab also coordinates lab services with Saint Francis Heart Hospital, a physician-system joint venture. The Optimal Equipment Configuration (OEC) Project was designed by the Clinical Laboratory Services division of Premier, a group purchasing organization, with the goal of determining whether laboratories could improve efficiency and decrease unit cost by using a single-source vendor. Participants included seven business partners (Abbott, Bayer, Beckman/Coulter, Dade/Behring, J&J/ Ortho, Olympus, and Roche) and 21 laboratory sites (a small, mid-sized, and large site for each vendor). SFH laboratory staff embraced Premier's concept and viewed the OEC project as an opportunity to "energize" laboratory operations. SFH partnered with Abbott, their primary equipment vendor, for the project. Using resources and tools made available through the project, the laboratory was re-engineered to simplify workflow, increase productivity, and decrease costs by adding automation and changing to centralized specimen processing. Abbott and SFH shared a common vision for the project and enhanced their partnership through increased communication and problem solving. Abbott's area representatives provided for third

  14. Wastewater treatment facilities: Energy efficient improvements and cogeneration

    International Nuclear Information System (INIS)

    Kunkle, R.; Gray, R.; Delzel, D.

    1992-10-01

    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

  15. Scaling production and improving efficiency in DEA: an interactive approach

    Science.gov (United States)

    Rödder, Wilhelm; Kleine, Andreas; Dellnitz, Andreas

    2017-10-01

    DEA models help a DMU to detect its (in-)efficiency and to improve activities, if necessary. Efficiency is only one economic aim for a decision-maker; however, up- or downsizing might be a second one. Improving efficiency is the main topic in DEA; the long-term strategy towards the right production size should attract our attention as well. Not always the management of a DMU primarily focuses on technical efficiency but rather is interested in gaining scale effects. In this paper, a formula for returns to scale (RTS) is developed, and this formula is even applicable for interior points of technology. Particularly, technical and scale inefficient DMUs need sophisticated instruments to improve their situation. Considering RTS as well as efficiency, in this paper, we give an advice for each DMU to find an economically reliable path from its actual situation to better activities and finally to most productive scale size (mpss), perhaps. For realizing this path, we propose an interactive algorithm, thus harmonizing the scientific findings and the interests of the management. Small numerical examples illustrate such paths for selected DMUs; an empirical application in theatre management completes the contribution.

  16. Improving quality in Medicaid: the use of care management processes for chronic illness and preventive care.

    Science.gov (United States)

    Rittenhouse, Diane R; Robinson, James C

    2006-01-01

    Care management processes (CMPs), tools to improve the efficiency and quality of primary care delivery, are particularly important for low-income patients facing substantial barriers to care. To measure the adoption of CMPs by medical groups, Independent Practice Associations, community clinics, and hospital-based clinics in California's Medicaid program and the factors associated with CMP adoption. Telephone survey of every provider organization with at least 6 primary care physicians and at least 1 Medi-Cal HMO contract, Spring 2003. One hundred twenty-three organizations participated, accounting for 64% of provider organizations serving Medicaid managed care in California. We surveyed 30 measures of CMP use for asthma and diabetes, and for child and adolescent preventive services. The mean number of CMPs used by each organization was 4.5 for asthma and 4.9 for diabetes (of a possible 8). The mean number of CMPs for preventive services was 4.0 for children and 3.5 for adolescents (of a possible 7). Organizations with more extensive involvement in Medi-Cal managed care used more CMPs for chronic illness and preventive service. Community clinics and hospital-based clinics used more CMPs for asthma and diabetes than did Independent Practice Associations (IPAs), and profitable organizations used more CMPs for child and adolescent preventive services than did entities facing severe financial constraints. The use of CMPs by Medicaid HMOs and the presence of external (financial and nonfinancial) incentives for clinical performance were strongly associated with use of care management by provider organizations. Physician and provider organizations heavily involved in California's Medicaid program are extensively engaged in preventive and chronic care management programs.

  17. Improving care by understanding the way we work: human factors and behavioural science in the context of intensive care

    Science.gov (United States)

    Sevdalis, Nick; Brett, Stephen J

    2009-01-01

    Effectiveness and efficiency of care of the critically ill patient are subject to a number of systemic influences, including skills of individual physicians/nurses (technical and non-technical), team-working in the intensive care unit (ICU), and the ICU environment. We first discuss the paper of Fackler and colleagues as a contribution to the systems approach to clinical performance in the context of intensive care. We then highlight features of care delivery that are unique to intensive care and discuss the need for better understanding of human and non-human elements of the system of care of the critically ill patient as a driver for improvement of care delivery. PMID:19439048

  18. 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.

  19. Improving STEM Undergraduate Education with Efficient Learning Design

    DEFF Research Database (Denmark)

    Godsk, Mikkel

    2018-01-01

    The project investigates the potential of Learning Design for efficiently improving STEM undergraduate education with technology. In order to investigate this potential, the project consists of two main studies at Aarhus University: a study of the perspectives of the main stakeholders on Learning...... Design uptake. The project concludes that it is possible to improve STEM undergraduate education with Learning Design for technology-enhanced learning efficiently and that Efficient Learning Design provides a useful concept for qualifying educational decisions....... provided by technology-enhanced learning based on Learning Design, and in particular students’ learning was of a high common interest. However, only the educators were directly interested in Learning Design and its support for design, reuse in their practice and to inform pedagogy. A holistic concept...

  20. Improved production efficiency in cattle to reduce their carbon ...

    African Journals Online (AJOL)

    p2492989

    Keywords: Methane, global warming, greenhouse gas, crossbreeding, residual feed intake, feed efficiency. #Corresponding ... improved production per constant unit, crossbreeding and selection for residual feed intake. ... convert such a measure into kg calf produced per kg CO2 equivalent (CH4 can be converted to a CO2.

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

    International Nuclear Information System (INIS)

    Rafiqul, Islam; Weber, Christoph; Lehmann, Bianca; Voss, Alfred

    2005-01-01

    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 CO 2 emission reductions in ammonia production. Thereby, considerable improvements in specific energy use and CO 2 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 CO 2 efficiency. Introduction of a CO 2 penalty under a certificate trading or other regime is on contrary found to foster energy efficiency and the use of low carbon technologies

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

    Science.gov (United States)

    Misra, Kaustav

    2010-01-01

    Proponents of educational reform often call for policies to increase competition between schools. It is argued that market forces naturally lead to greater efficiencies, including improved student learning, when schools face competition. In many parts of the country, public schools experience significant competition from private schools; however,…

  3. 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.

  4. 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.

  5. Process Evaluation: Standard, Effectiveness, Efficiency and Sustainability of Maternity Nursing Care

    Directory of Open Access Journals (Sweden)

    Laili Rahayuwati

    2017-09-01

    Full Text Available Although globally there is a change in the trend of epidemiology from infectious diseases to chronic diseases, the prevalence and incidence of infectious diseases as well as MMR (Maternal Mortality Rate and IMR (infant mortality rate in Indonesia is still high. In year 2000, Faculty of Nursing of the Universitas Padjadjaran in collaboration with Hasan Sadikin Hospital built a model of treatment room, which was affiliated with obstetric gynecology room for improving integrated quality of health care services and education. The model built in this room aimed to : 1 Improve the quality of health care service; 2 to develop the student’s experiences with patients; 3 Provide quality nurse education to support students; 4 encourage students to improve the results of clinical prctice. The objective of process evaluation in this study was to give an insight to an appropriate model for maternity nursing service. This results showed on the one hand , there are some records not yet achieved an ideal standard , lack of effectiveness and efficiency of care delivery, namely: 1 the ratio of midwives and patients are not ideal ; 2 No one consultant obstetrician gynecologist and one doctor for every room . As well as challenges to sustainability care that meets the standards of maternity care. Conclusion: this study recommends to take a comprehensive strategic planning for improving nursing and midwifery services that involve all relevant stakeholders in the government, civil society, service delivery, education, and professional organizations.

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

    Directory of Open Access Journals (Sweden)

    Simona Jeners

    2013-06-01

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

  7. Improving cardiovascular care through outpatient cardiac rehabilitation: an analysis of payment models that would improve quality and promote use.

    Science.gov (United States)

    Mead, Holly; Grantham, Sarah; Siegel, Bruce

    2014-01-01

    Much attention has been paid to improving the care of patients with cardiovascular disease by focusing attention on delivery system redesign and payment reforms that encompass the healthcare spectrum, from an acute episode to maintenance of care. However, 1 area of cardiovascular disease care that has received little attention in the advancement of quality is cardiac rehabilitation (CR), a comprehensive secondary prevention program that is significantly underused despite evidence-based guidelines that recommending its use. The purpose of this article was to analyze the applicability of 2 payment and reimbursement models-pay-for-performance and bundled payments for episodes of care--that can promote the use of CR. We conclude that a payment model combining elements of both pay-for-performance and episodes of care would increase the use of CR, which would both improve quality and increase efficiency in cardiac care. Specific elements would need to be clearly defined, however, including: (a) how an episode is defined, (b) how to hold providers accountable for the care they provider, (c) how to encourage participation among CR providers, and (d) how to determine an equitable distribution of payment. Demonstrations testing new payment models must be implemented to generate empirical evidence that a melded pay-for-performance and episode-based care payment model will improve quality and efficiency.

  8. Options to improve energy efficiency for educational building

    Science.gov (United States)

    Jahan, Mafruha

    The cost of energy is a major factor that must be considered for educational facility budget planning purpose. The analysis of energy related issues and options can be complex and requires significant time and detailed effort. One way to facilitate the inclusion of energy option planning in facility planning efforts is to utilize a tool that allows for quick appraisal of the facility energy profile. Once such an appraisal is accomplished, it is then possible to rank energy improvement options consistently with other facility needs and requirements. After an energy efficiency option has been determined to have meaningful value in comparison with other facility planning options, it is then possible to utilize the initial appraisal as the basis for an expanded consideration of additional facility and energy use detail using the same analytic system used for the initial appraisal. This thesis has developed a methodology and an associated analytic model to assist in these tasks and thereby improve the energy efficiency of educational facilities. A detailed energy efficiency and analysis tool is described that utilizes specific university building characteristics such as size, architecture, envelop, lighting, occupancy, thermal design which allows reducing the annual energy consumption. Improving the energy efficiency of various aspects of an educational building's energy performance can be complex and can require significant time and experience to make decisions. The approach developed in this thesis initially assesses the energy design for a university building. This initial appraisal is intended to assist administrators in assessing the potential value of energy efficiency options for their particular facility. Subsequently this scoping design can then be extended as another stage of the model by local facility or planning personnel to add more details and engineering aspects to the initial screening model. This approach can assist university planning efforts to

  9. Process efficiency. Redesigning social networks to improve surgery patient flow.

    Science.gov (United States)

    Samarth, Chandrika N; Gloor, Peter A

    2009-01-01

    We propose a novel approach to improve throughput of the surgery patient flow process of a Boston area teaching hospital. A social network analysis was conducted in an effort to demonstrate that process efficiency gains could be achieved through redesign of social network patterns at the workplace; in conjunction with redesign of organization structure and the implementation of workflow over an integrated information technology system. Key knowledge experts and coordinators in times of crisis were identified and a new communication structure more conducive to trust and knowledge sharing was suggested. The new communication structure is scalable without compromising on coordination required among key roles in the network for achieving efficiency gains.

  10. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

    OpenAIRE

    Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

    2016-01-01

    Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

  11. Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services.

    Science.gov (United States)

    Stoneman, Alice; Atkinson, David; Davey, Maureen; Marley, Julia V

    2014-10-07

    Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia. Retrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI. A total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change. Well

  12. Improving Decision Making in Intensive Care

    NARCIS (Netherlands)

    I.A. Meynaar (Iwan)

    2012-01-01

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

  13. Betavoltaic Battery Conversion Efficiency Improvement Based on Interlayer Structures

    International Nuclear Information System (INIS)

    Li Da-Rang; Jiang Lan; Yin Jian-Hua; Lin Nai; Tan Yuan-Yuan

    2012-01-01

    Significant differences among the doping densities of PN junctions in semiconductors cause lattice mismatch and lattice defects that increase the recombination current of betavoltaic batteries. This extensively decreases the open circuit voltage and the short current, which results in low conversion efficiency. This study proposes P + PINN + -structure based betavoltaic batteries by adding an interlayer to typical PIN structures to improve conversion efficiency. Numerical simulations are conducted for the energy deposition of beta particles along the thickness direction in semiconductors. Based on this, 63 Ni-radiation GaAs batteries with PIN and P + PINN + structures are designed and fabricated to experimentally verify the proposed design. It turns out that the conversion efficiency of the betavoltaic battery with the proposed P + PINN + structure is about 1.45 times higher than that with the traditional PIN structure. (cross-disciplinary physics and related areas of science and technology)

  14. Improving the Efficiency of Solid State Light Sources

    International Nuclear Information System (INIS)

    Joanna McKittrick

    2003-01-01

    This proposal addresses the national need to develop a high efficiency light source for general illumination applications. The goal is to perform research that would lead to the fabrication of a unique solid state, white-emitting light source. This source is based on an InGaN/GaN UV-emitting chip that activates a luminescent material (phosphor) to produce white light. White-light LEDs are commercially available which use UV from a GaN chip to excite a phosphor suspended in epoxy around the chip. Currently, these devices are relatively inefficient. This research will target one technical barrier that presently limits the efficiency of GaN based devices. Improvements in efficiencies will be achieved by improving the internal conversion efficiency of the LED die, by improving the coupling between the die and phosphor(s) to reduce losses at the surfaces, and by selecting phosphors to maximize the emissions from the LEDs in conversion to white light. The UCSD research team proposes for this project to develop new phosphors that have high quantum efficiencies that can be activated by the UV-blue (360-410 nm) light emitted by the GaN device. The main goal for the UCSD team was to develop new phosphor materials with a very specific property: phosphors that could be excited at long UV-wavelengths (λ=350-410 nm). The photoluminescence of these new phosphors must be activated with photons emitted from GaN based dies. The GaN diodes can be designed to emit UV-light in the same range (λ=350-410 nm). A second objective, which is also very important, is to search for alternate methods to fabricate these phosphors with special emphasis in saving energy and time and reduce pollution

  15. Energy efficiency improvement potentials for the cement industry in Ethiopia

    International Nuclear Information System (INIS)

    Tesema, Gudise; Worrell, Ernst

    2015-01-01

    The cement sector is one of the fast growing economic sectors in Ethiopia. In 2010, it consumed 7 PJ of primary energy. We evaluate the potential for energy savings and CO_2 emission reductions. We start by benchmarking the energy performance of 8 operating plants in 2010, and 12 plants under construction. The benchmarking shows that the energy intensity of local cement facilities is high, when compared to the international best practice, indicating a significant potential for energy efficiency improvement. The average electricity intensity and fuel intensity of the operating plants is 34% and 36% higher. For plants under construction, electricity use is 36% and fuel use 27% higher. We identified 26 energy efficiency measures. By constructing energy conservation supply curves, the energy-efficiency improvement potential is assessed. For the 8 operating plants in 2010, the cost-effective energy savings equal 11 GWh electricity and 1.2 PJ fuel, resulting in 0.1 Mt CO_2 emissions reduction. For the 20 cement plants expected to be in operation by 2020, the cost-effective energy saving potentials is 159 GWh for electricity and 7.2 PJ for fuel, reducing CO_2 emissions by about 0.6 Mt. We discuss key barriers and recommendations to realize energy savings. - Highlights: • The cement sector in Ethiopia is growing rapidly, using mainly imported fuels. • Benchmarking demonstrates a significant potential for energy efficiency improvement. • A large part of the energy efficiency potential can be achieved cost-effectively. • Ethiopia should ban the construction of obsolete vertical shaft kilns.

  16. 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.

  17. Improved entropy encoding for high efficient video coding standard

    Directory of Open Access Journals (Sweden)

    B.S. Sunil Kumar

    2018-03-01

    Full Text Available The High Efficiency Video Coding (HEVC has better coding efficiency, but the encoding performance has to be improved to meet the growing multimedia applications. This paper improves the standard entropy encoding by introducing the optimized weighing parameters, so that higher rate of compression can be accomplished over the standard entropy encoding. The optimization is performed using the recently introduced firefly algorithm. The experimentation is carried out using eight benchmark video sequences and the PSNR for varying rate of data transmission is investigated. Comparative analysis based on the performance statistics is made with the standard entropy encoding. From the obtained results, it is clear that the originality of the decoded video sequence is preserved far better than the proposed method, though the compression rate is increased. Keywords: Entropy, Encoding, HEVC, PSNR, Compression

  18. Improved district heating substation efficiency with a new control strategy

    International Nuclear Information System (INIS)

    Gustafsson, Jonas; Delsing, Jerker; Deventer, Jan van

    2010-01-01

    In this paper, we describe a new alternative control approach for indirectly connected district heating substations. Simulations results showed that the new approach results in an increased ΔT across the substation. Results were obtained for both ideal and non-ideal operation of the system, meaning that less water must be pumped through the district heating network, and a higher overall fuel efficiency can be obtained in the district heating power plants. When a higher fuel efficiency is achieved, the usage of primary fuel sources can be reduced. Improved efficiency also increases the effective heat transfer capacity of a district heating network, allowing more customers to be connected to an existing network without increasing the heating plant or network capacity. Also, if combined heat and power plants are used to produce the heat, the increased ΔT will result in a further improved overall fuel efficiency, as more electricity can be produced with colder cooling water. The idea behind the new control method is to consider the temperature of the water supplying the district heating substation with heat, often referred to as the primary supply temperature. This represents a logical next step, as currently, the only parameter generally taken into account or measured when controlling the temperature level of the radiator circuit is the local outdoor temperature. In this paper we show how the primary supply temperature together with thermodynamic knowledge of the building can be used to maximize the ΔT across the district heating substation.

  19. Improving the efficiency of aerodynamic shape optimization procedures

    Science.gov (United States)

    Burgreen, Greg W.; Baysal, Oktay; Eleshaky, Mohamed E.

    1992-01-01

    The computational efficiency of an aerodynamic shape optimization procedure which is based on discrete sensitivity analysis is increased through the implementation of two improvements. The first improvement involves replacing a grid point-based approach for surface representation with a Bezier-Bernstein polynomial parameterization of the surface. Explicit analytical expressions for the grid sensitivity terms are developed for both approaches. The second improvement proposes the use of Newton's method in lieu of an alternating direction implicit (ADI) methodology to calculate the highly converged flow solutions which are required to compute the sensitivity coefficients. The modified design procedure is demonstrated by optimizing the shape of an internal-external nozzle configuration. A substantial factor of 8 decrease in computational time for the optimization process was achieved by implementing both of the design improvements.

  20. 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.

  1. IMPROVING CO2 EFFICIENCY FOR RECOVERING OIL IN HETEROGENEOUS RESERVOIRS

    International Nuclear Information System (INIS)

    Grigg, Reid B.

    2002-01-01

    A three-year contract, DOE Contract No. DE-FG26-01BC15364 ''Improving CO 2 Efficiency for Recovering Oil in Heterogeneous Reservoirs,'' was started on September 28, 2001. This project examines three major areas in which CO 2 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 CO 2 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

  2. New approaches for improving energy efficiency in the Brazilian industry

    Directory of Open Access Journals (Sweden)

    Paulo Henrique de Mello Santana

    2016-11-01

    Full Text Available The Brazilian government has been promoting energy efficiency measures for industry since the eighties but with very limited returns, as shown in this paper. The governments of some other countries dedicated much more effort and funds for this area and reached excellent results. The institutional arrangements and types of programmes adopted in these countries are briefly evaluated in the paper and provide valuable insights for several proposals put forward here to make more effective the Brazilian government actions directed to overcome market barriers and improve energy efficiency in the local industry. The proposed measures include the creation of Industrial Assessment Centres and an executive agency charged with the coordination of all energy efficiency programmes run by the Federal government. A large share of the Brazilian industry energy consumption comes from energy-intensive industrial branches. According to a recent survey, most of them have substantial energy conservation potentials. To materialize a fair amount of them, voluntary targets concerning energy efficiency gains should start to be negotiated between the Government and associations representing these industrial branches. Credit facilities and tax exemptions for energy-efficient equipment’s should be provided to stimulate the interest of the entrepreneurs and the setting-up of bolder targets.

  3. 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.

  4. 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. © 2015 Institute of Botany, Chinese Academy of Sciences.

  5. Improving perinatal outcome: towards individualized care

    NARCIS (Netherlands)

    Kazemier, B.M.

    2015-01-01

    Unfortunately not all pregnancies and deliveries take place without complications. Complications during pregnancy or delivery can lead to maternal morbidity and poor perinatal outcomes such as perinatal mortality or (severe) neonatal morbidity. First assessment in antenatal care is to distinguish

  6. 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...

  7. Improving perinatal outcome: towards individualized care

    OpenAIRE

    Kazemier, B.M.

    2015-01-01

    Unfortunately not all pregnancies and deliveries take place without complications. Complications during pregnancy or delivery can lead to maternal morbidity and poor perinatal outcomes such as perinatal mortality or (severe) neonatal morbidity. First assessment in antenatal care is to distinguish women who require standard care from those requiring special attention. At the moment, we can make some global risk assessments, but are not able to give a women a risk assessment that is adapted for...

  8. CFD Analysis of The Hydraulic Turbine Draft Tube to Improve System Efficiency

    Directory of Open Access Journals (Sweden)

    Chakrabarty Spandan

    2016-01-01

    Full Text Available Demand of the power is increasing day by day with the development of the science and technology. Development of the renewable energy sector has become essential issue at the present situation due to the limited source of the non-renewable energy. Hydro energy power generation sector is superior over the other renewable sector due to the high efficiency, ability to continuous generation and low generation cost. In India a great amount of the power generation is taken care by the hydro power system but still some more potential have unexplored. The efficiency improvement of the hydro turbine system can be done for the new installation or installed system by the improvement in component level. The system can be installed by the state of the art equipment, like modern inlet guide vane (IGV control system, improved design of the runner, IGV system, draft tube, penstock to reduce the loss, hence improve the efficiency. The energy recovery in the draft tube depends on the design of draft tube. In the present work the optimized design of the draft tube shape through computational fluid dynamics (CFD simulation has been carried out in ANSYS FLUENT platform. The design objective of the draft tube is to reduce the flow loss and improve the energy recovery, hence to improve the efficiency.

  9. Do competition and managed care improve quality?

    Science.gov (United States)

    Sari, Nazmi

    2002-10-01

    In recent years, the US health care industry has experienced a rapid growth of managed care, formation of networks, and an integration of hospitals. This paper provides new insights about the quality consequences of this dynamic in US hospital markets. I empirically investigate the impact of managed care and hospital competition on quality using in-hospital complications as quality measures. I use random and fixed effects, and instrumental variable fixed effect models using hospital panel data from up to 16 states in the 1992-1997 period. The paper has two important findings: First, higher managed care penetration increases the quality, when inappropriate utilization, wound infections and adverse/iatrogenic complications are used as quality indicators. For other complication categories, coefficient estimates are statistically insignificant. These findings do not support the straightforward view that increases in managed care penetration are associated with decreases in quality. Second, both higher hospital market share and market concentration are associated with lower quality of care. Hospital mergers have undesirable quality consequences. Appropriate antitrust policies towards mergers should consider not only price and cost but also quality impacts. Copyright 2002 John Wiley & Sons, Ltd.

  10. Crossing boundaries : improving communication in cerebral palsy care

    NARCIS (Netherlands)

    Gulmans-Weitenberg, Jitske

    2012-01-01

    The aim of the present thesis was to contribute to the improvement of patient care communication across the integrated care setting of children with cerebral palsy. Hereto, we followed two subsequent phases: 1) obtaining a better understanding of the experienced quality of patient care communication

  11. Improving the efficiency of a chemotherapy day unit: applying a business approach to oncology.

    Science.gov (United States)

    van Lent, Wineke A M; Goedbloed, N; van Harten, W H

    2009-03-01

    To improve the efficiency of a hospital-based chemotherapy day unit (CDU). The CDU was benchmarked with two other CDUs to identify their attainable performance levels for efficiency, and causes for differences. Furthermore, an in-depth analysis using a business approach, called lean thinking, was performed. An integrated set of interventions was implemented, among them a new planning system. The results were evaluated using pre- and post-measurements. We observed 24% growth of treatments and bed utilisation, a 12% increase of staff member productivity and an 81% reduction of overtime. The used method improved process design and led to increased efficiency and a more timely delivery of care. Thus, the business approaches, which were adapted for healthcare, were successfully applied. The method may serve as an example for other oncology settings with problems concerning waiting times, patient flow or lack of beds.

  12. Intensive care nurses' perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care-A quality improvement project.

    Science.gov (United States)

    Jennings, Fiona L; Mitchell, Marion

    2017-06-01

    Trauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses' knowledge. The purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement. The project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients' care. The rounds were evaluated to assess the nurse's perception of improvement. There were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues. Inter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Improving the efficiency of photovoltaic (PV) panels by oil coating

    International Nuclear Information System (INIS)

    Abd-Elhady, M.S.; Fouad, M.M.; Khalil, T.

    2016-01-01

    Highlights: • It is possible to improve the efficiency of PV panels by increasing the amount of light transmitted to the panel. • Coating PV panels by a fine layer of Labovac oil increases the amount of sun light transmitted to the panel. • Coating PV panels by a fine layer of Labovac oil increases the power output of the panel. • Coating PV panels with a layer of Labovac oil has to be applied in cold countries and not in hot regions. - Abstract: The objective of this research is to develop a new technique for improving the efficiency of Photovoltaic (PV) panels. This technique is done by coating the front surface of the PV panel by a fine layer of oil in order to increase the amount of light transmitted to the panel, and consequently its efficiency. Different types of oils are examined, including both mineral oils and natural oils. In case of mineral oils; vacuum pump oil (Labovac oil), engine oil (Mobil oil) and brake oil (Abro oil) are examined, while in case of natural oils; olive and sunflower oils are examined. An experimental setup has been developed to examine the performance of the PV panels as a function of oil coatings. The experimental setup consists of an artificial sun, the PV panel under investigation, a cooling system and a measuring system to measure the performance of the panel. It has been found that coating the PV panel with a fine layer of Labovac oil, ∼1 mm thick, improves the efficiency of the PV panel by more than 20%, and this is due to the high transmissivity of the Labovac oil compared to other oils. However, the Labovac oil has a drawback which is overheating of the panel due to its high transmissivity. Coating of PV panels with a fine layer of Labovac oil should be done only in cold regions, in order to avoid the heating effect that can decrease the power output of PV panels.

  14. Improving the energy efficiency of mine fan assemblages

    International Nuclear Information System (INIS)

    De Souza, Euler

    2015-01-01

    Energy associated with ventilating an underground operation comprises a significant portion of a mine operation's base energy demand and is consequently responsible for a large percentage of the total operating costs. Ventilation systems may account from 25 to 40% of the total energy costs and 40–50% of the energy consumption of a mine operation. Fans are the most important mechanical devices used to ventilate underground mines and the total fan power installed in a single mine operation can easily exceed 10,000 kW. Investigations of a number of mine main fan installations have determined their assemblage to be, in general, very energy inefficient. The author has found that 40–80% of the energy consumed by a main fan is used to overcome the resistance of fan assemblage components. This paper presents how engineering design principles can be applied to improve the performance and efficiency of fan installations, resulting in substantial reductions in power consumption, operating cost and greenhouse gas emissions. A detailed case study is presented to demonstrate that, by designing fan assemblages using proper engineering concepts of fluid physics and industrial ventilation design, main fan systems will operate at efficiencies well above 80–90% (compared to common operating efficiencies of between 20 and 65%), resulting in a drastic reduction in a mine's overall costs and base electrical and energy loads. - Highlights: • Increases in fan assemblage efficiencies with minimum capital investment. • Improved designs for substantial fan power and operating cost savings. • General solutions and tactics for improving existing main fan installations. • Case study presented to demonstrate proper design of fan assemblages.

  15. 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. Published by Elsevier Inc.

  16. Improvement of Engineering Work Efficiency through System Integration

    International Nuclear Information System (INIS)

    Lee, Sangdae; Jo, Sunghan; Hyun, Jinwoo

    2016-01-01

    This paper presents the concept of developing an integrated engineering system for ER to improve efficiency and utilization of engineering system. Each process including computer system and database was introduced separately by each department at that different time. Each engineering process has a close relation with other engineering processes. The introduction of processes in a different time has caused the several problems such as lack of interrelationship between engineering processes, lack of integration fleet-wide statistical data, lack of the function of data comparison among plants and increase of access time by different access location on internet. These problems have caused inefficiency of engineering system utilization to get proper information and degraded engineering system utilization. KHNP has introduced and conducted advanced engineering processes to maintain equipment effectively in a highly reliable condition since 2000s. But engineering systems for process implementation have been developed in each department at a different time. This has caused the problems of process inefficiency and data discordance. Integrated Engineering System(IES) to integrate dispersed engineering processes will improve work efficiency and utilization of engineering system because integration system would enable engineer to get total engineering information easily and do engineering work efficiently

  17. Improvement of Engineering Work Efficiency through System Integration

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sangdae; Jo, Sunghan; Hyun, Jinwoo [KHNP CRI, Daejeon (Korea, Republic of)

    2016-10-15

    This paper presents the concept of developing an integrated engineering system for ER to improve efficiency and utilization of engineering system. Each process including computer system and database was introduced separately by each department at that different time. Each engineering process has a close relation with other engineering processes. The introduction of processes in a different time has caused the several problems such as lack of interrelationship between engineering processes, lack of integration fleet-wide statistical data, lack of the function of data comparison among plants and increase of access time by different access location on internet. These problems have caused inefficiency of engineering system utilization to get proper information and degraded engineering system utilization. KHNP has introduced and conducted advanced engineering processes to maintain equipment effectively in a highly reliable condition since 2000s. But engineering systems for process implementation have been developed in each department at a different time. This has caused the problems of process inefficiency and data discordance. Integrated Engineering System(IES) to integrate dispersed engineering processes will improve work efficiency and utilization of engineering system because integration system would enable engineer to get total engineering information easily and do engineering work efficiently.

  18. Policy modeling for energy efficiency improvement in US industry

    International Nuclear Information System (INIS)

    Worrell, Ernst; Price, Lynn; Ruth, Michael

    2001-01-01

    We are at the beginning of a process of evaluating and modeling the contribution of policies to improve energy efficiency. Three recent policy studies trying to assess the impact of energy efficiency policies in the United States are reviewed. The studies represent an important step in the analysis of climate change mitigation strategies. All studies model the estimated policy impact, rather than the policy itself. Often the policy impacts are based on assumptions, as the effects of a policy are not certain. Most models only incorporate economic (or price) tools, which recent studies have proven to be insufficient to estimate the impacts, costs and benefits of mitigation strategies. The reviewed studies are a first effort to capture the effects of non-price policies. The studies contribute to a better understanding of the role of policies in improving energy efficiency and mitigating climate change. All policy scenarios results in substantial energy savings compared to the baseline scenario used, as well as substantial net benefits to the U.S. economy

  19. Modified paraffin wax for improvement of histological analysis efficiency.

    Science.gov (United States)

    Lim, Jin Ik; Lim, Kook-Jin; Choi, Jin-Young; Lee, Yong-Keun

    2010-08-01

    Paraffin wax is usually used as an embedding medium for histological analysis of natural tissue. However, it is not easy to obtain enough numbers of satisfactory sectioned slices because of the difference in mechanical properties between the paraffin and embedded tissue. We describe a modified paraffin wax that can improve the histological analysis efficiency of natural tissue, composed of paraffin and ethylene vinyl acetate (EVA) resin (0, 3, 5, and 10 wt %). Softening temperature of the paraffin/EVA media was similar to that of paraffin (50-60 degrees C). The paraffin/EVA media dissolved completely in xylene after 30 min at 50 degrees C. Physical properties such as the amount of load under the same compressive displacement, elastic recovery, and crystal intensity increased with increased EVA content. EVA medium (5 wt %) was regarded as an optimal composition, based on the sectioning efficiency measured by the numbers of unimpaired sectioned slices, amount of load under the same compressive displacement, and elastic recovery test. Based on the staining test of sectioned slices embedded in a 5 wt % EVA medium by hematoxylin and eosin (H&E), Masson trichrome (MT), and other staining tests, it was concluded that the modified paraffin wax can improve the histological analysis efficiency with various natural tissues. (c) 2010 Wiley-Liss, Inc.

  20. A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes.

    Science.gov (United States)

    Machta, Rachel M; Maurer, Kristin A; Jones, David J; Furukawa, Michael F; Rich, Eugene C

    2018-04-02

    Small independent practices are increasingly giving way to more complex affiliations between provider organizations and hospital systems. There are several ways in which vertically integrated health systems could improve quality and lower the costs of care. But there are also concerns that integrated systems may increase the price and costs of care without commensurate improvements in quality and outcomes. Despite a growing body of research on vertically integrated health systems, no systematic review that we know of compares vertically integrated health systems (defined as shared ownership or joint management of hospitals and physician practices) to nonintegrated hospitals or physician practices. We conducted a systematic search of the literature published from January 1996 to November 2016. We considered articles for review if they compared the performance of a vertically integrated health system and examined an outcome related to quality of care, efficiency, or patient-centered outcomes. Database searches generated 7,559 articles, with 29 articles included in this review. Vertical integration was associated with better quality, often measured as optimal care for specific conditions, but showed either no differences or lower efficiency as measured by utilization, spending, and prices. Few studies evaluated a patient-centered outcome; among those, most examined mortality and did not identify any effects. Across domains, most studies were observational and did not address the issue of selection bias. Recent evidence suggests the trend toward vertical integration will likely continue as providers respond to changing payment models and market factors. A growing body of research on comparative health system performance suggests that integration of physician practices with hospitals might not be enough to achieve higher-value care. More information is needed to identify the health system attributes that contribute to improved outcomes, as well as which policy levers

  1. Improving efficiency and effectiveness in natural gas regulation : discussion paper

    International Nuclear Information System (INIS)

    Rounding, M.C.

    2004-11-01

    Energy market liberalization is a world trend that has prompted the deregulation of natural gas and electricity over the past twenty years in North America. The Ontario Energy Board and the National Energy Board are conducting public hearings on natural gas regulation in response to the request by Canadian energy industries for better regulatory streamlining. The following 5 issues regarding natural gas regulation in Canada have been examined: (1) system gas in a regulated market, (2) natural gas infrastructure investments and capital renewal, (3) improving efficiency in gas regulation, (4) expectations of performance-based regulation (PBR) in the natural gas industry, and (5) the debate whether further deregulation of the natural gas industry is beneficial. This paper discusses the impact that natural gas regulation has had on the efficiency and competitiveness of the industry and its affect on customers and other stakeholders. It focuses on the efficiency of the regulatory process and examines regulatory objectives, best practices and performance indicators. The factors that determine the efficiency of natural gas regulation include alternative regulatory models, structure of the regulatory agency, regulatory framework approaches, and outcomes for the natural gas industry. The relationship between the government and the regulator was also examined in terms of their abilities to implement policy. A comparative evaluation between energy regulators in Canada, the United States, Australia and the United Kingdom was presented. The balancing of short-term and long-term objectives for gas supply and planning issues was also addressed. 17 refs

  2. 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.

  3. Evaluation and Improvement of Lighting Efficiency in Working Spaces

    Directory of Open Access Journals (Sweden)

    Ana Castillo-Martinez

    2018-04-01

    Full Text Available Lighting is an essential element for modern life, promoting a sense of wellbeing for users. However, bad illumination may produce health problems such as headaches and fatigue, among other vision problems. For that reason, this paper proposes the development of a smartphone-based application to help in lighting evaluation to guarantee the compliance of illumination regulations and to help increase illuminance efficiency, reducing its energy consumption. To perform this evaluation, the smartphone can be used as a lighting measurement tool, evaluating those measurements through an intelligent agent based in rules capable of guiding the decision-making process. As a result, this tool allows the evaluation of the real working environment to guarantee lighting requirements, helping in the prevention of health problems derived from bad illumination and improving the lighting efficiency at the same time.

  4. The ReACH Collaborative--improving quality home care.

    Science.gov (United States)

    Boyce, Patricia Simino; Pace, Karen B; Lauder, Bonnie; Solomon, Debra A

    2007-08-01

    Research on quality of care has shown that vigorous leadership, clear goals, and compatible incentive systems are critical factors in influencing successful change (Institute of Medicine, 2001). Quality improvement is a complex process, and clinical quality improvement applications are more likely to be effective in organizations that are ready for change and have strong leaders, who are committed to creating and reinforcing a work environment that supports quality goals (Shortell, 1998). Key leadership roles include providing clear and sustained direction, articulating a coherent set of values and incentives to guide group and individual activities, aligning and integrating improvement efforts into organizational priorities, obtaining or freeing up resources to implement improvement activities, and creating a culture of "continuous improvement" that encourages and rewards the pursuit and achievement of shared quality aims (Institute of Medicine, 2001, 70-71). In summary, home health care is a significant and growing sector of the health care system that provides care to millions of vulnerable patients. There seems little doubt that home health agencies want to focus on quality of care issues and provide optimal care to home-based patients. Furthermore, there is a growing awareness of the value for adapting innovative, effective models for improving the culture of home care practice. This awareness stems from the notion that some agencies see quality improvement activities as a way for them to distinguish themselves not only to regulators and customers, but also to meet the cultural and transformational needs to remain viable in a constantly evolving and competitive health care industry.

  5. Context in Quality of Care: Improving Teamwork and Resilience.

    Science.gov (United States)

    Tawfik, Daniel S; Sexton, John Bryan; Adair, Kathryn C; Kaplan, Heather C; Profit, Jochen

    2017-09-01

    Quality improvement in health care is an ongoing challenge. Consideration of the context of the health care system is of paramount importance. Staff resilience and teamwork climate are key aspects of context that drive quality. Teamwork climate is dynamic, with well-established tools available to improve teamwork for specific tasks or global applications. Similarly, burnout and resilience can be modified with interventions such as cultivating gratitude, positivity, and awe. A growing body of literature has shown that teamwork and burnout relate to quality of care, with improved teamwork and decreased burnout expected to produce improved patient quality and safety. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Impact of Medicare Advantage penetration and hospital competition on technical efficiency of nursing care in US intensive care units.

    Science.gov (United States)

    Min, Ari; Scott, Linda D; Park, Chang; Vincent, Catherine; Ryan, Catherine J; Lee, Taewha

    2018-04-10

    This study aimed to evaluate technical efficiency of US intensive care units and determine the effects of environmental factors on technical efficiency in providing quality of nursing care. Data were obtained from the 2014 National Database of Nursing Quality Indicators and the Centers for Medicare and Medicaid Services. Data envelopment analysis was used to estimate technical efficiency for each intensive care unit. Multilevel modeling was used to determine the effects of environmental factors on technical efficiency. Overall, Medicare Advantage penetration and hospital competition in a market did not create pressure for intensive care units to become more efficient by reducing their inputs. However, these 2 environmental factors showed positive influences on technical efficiency in intensive care units with certain levels of technical efficiency. The implications of the study results for management strategies and health policy may vary according to the levels of technical efficiency in intensive care units. Further studies are needed to examine why and how intensive care units with particular levels of technical efficiency are differently affected by certain environmental factors. Copyright © 2018 John Wiley & Sons, Ltd.

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

    International Nuclear Information System (INIS)

    Heijdra, B.J.; Van der Horst, A.

    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

  8. 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.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    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...... to a given baseline. In order to prevent from “green washing” criticism and to ensure “walk the talk” attitude the ECM should be scientifically well-founded using appropriate and consistent methodology. The vertical axis of an ECM illustrates the environmental performance and the horizontal axis describes...... ECM application is illustrated using the example of the Siemens MEROS® technology (Maximized Emission Reduction of Sintering) for the steel industry. MEROS® is currently the most modern and powerful system for cleaning off-gas in sinter plants. As an environmental technology MEROS® is binding...

  10. 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

  11. The SUSTAIN Project: A European Study on Improving Integrated Care for Older People Living at Home

    Science.gov (United States)

    Stoop, Annerieke; Billings, Jenny; Leichsenring, Kai; Ruppe, Georg; Tram, Nhu; Barbaglia, María Gabriela; Ambugo, Eliva A.; Zonneveld, Nick; Paat-Ahi, Gerli; Hoffmann, Henrik; Khan, Usman; Stein, Viktoria; Wistow, Gerald; Lette, Manon; Jansen, Aaltje P.D.; Nijpels, Giel; Baan, Caroline A.

    2018-01-01

    Introduction: Integrated care programmes are increasingly being put in place to provide care to older people who live at home. Knowledge of how to further develop integrated care and how to transfer successful initiatives to other contexts is still limited. Therefore, a cross-European research project, called Sustainable Tailored Integrated Care for Older People in Europe (SUSTAIN), has been initiated with a twofold objective: 1. to collaborate with local stakeholders to support and monitor improvements to established integrated care initiatives for older people with multiple health and social care needs. Improvements focus on person-centredness, prevention orientation, safety and efficiency; 2. to make these improvements applicable and adaptable to other health and social care systems, and regions in Europe. This paper presents the overall structure and approach of the SUSTAIN project. Methods: SUSTAIN uses a multiple embedded case study design. In three phases, SUSTAIN partners: (i) conduct interviews and workshops with stakeholders from fourteen established integrated care initiatives to understand where they would prefer improvements to existing ways of working; (ii) collaborate with local stakeholders to support the design and implementation of improvement plans, evaluate implementation progress and outcomes per initiative, and carry out overarching analyses to compare the different initiatives, and; (iii) translate knowledge and experience to an online roadmap. Discussion: SUSTAIN aims to generate evidence on how to improve integrated care, and apply and transfer the knowledge gained to other health and social care systems, and regions. Lessons learned will be brought together in practical tools to inform and support policy-makers and decision-makers, as well as other stakeholders involved in integrated care, to manage and improve care for older people living at home. PMID:29632456

  12. Improving crop water use efficiency using carbon isotope discrimination

    International Nuclear Information System (INIS)

    Serraj, R.

    2006-01-01

    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

  13. Improving the global efficiency in small hydropower practice

    Science.gov (United States)

    Razurel, P.; Gorla, L.; Crouzy, B.; Perona, P.

    2015-12-01

    The global increase in energy production from renewable sources has seen river exploitation for small hydropower plants to also grow considerably in the last decade. River intakes used to divert water from the main course to the power plant are at the base of such practice. A key issue concern with finding innovative concepts to both design and manage such structures in order to improve classic operational rules. Among these, the Minimal Flow Release (MFR) concept has long been used in spite of its environmental inconsistency.In this work, we show that the economical and ecological efficiency of diverting water for energy production in small hydropower plants can be improved towards sustainability by engineering a novel class of flow-redistribution policies. We use the mathematical form of the Fermi-Dirac statistical distribution to define non-proportional dynamic flow-redistribution rules, which broadens the spectrum of dynamic flow releases based on proportional redistribution. The theoretical background as well as the economic interpretation is presented and applied to three case studies in order to systematically test the global performance of such policies. Out of numerical simulations, a Pareto frontier emerges in the economic vs environmental efficiency plot, which show that non-proportional distribution policies improve both efficiencies with respect to those obtained from some traditional MFR and proportional policies. This picture is shown also for long term climatic scenarios affecting water availability and the natural flow regime.In a time of intense and increasing exploitation close to resource saturation, preserving natural river reaches requires to abandon inappropriate static release policies in favor of non-proportional ones towards a sustainable use of the water resource.

  14. Bringing quality improvement into the intensive care unit.

    Science.gov (United States)

    McMillan, Tracy R; Hyzy, Robert C

    2007-02-01

    During the last several years, many governmental and nongovernmental organizations have championed the application of the principles of quality improvement to the practice of medicine, particularly in the area of critical care. To review the breadth of approaches to quality improvement in the intensive care unit, including measures such as mortality and length of stay, and the use of protocols, bundles, and the role of large, multiple-hospital collaboratives. Several agencies have participated in the application of the quality movement to medicine, culminating in the development of standards such as the intensive care unit core measures of the Joint Commission on Accreditation of Healthcare Organizations. Although "zero defects" may not be possible in all measurable variables of quality in the intensive care unit, several measures, such as catheter-related bloodstream infections, can be significantly reduced through the implementation of improved processes of care, such as care bundles. Large, multiple-center, quality improvement collaboratives, such as the Michigan Keystone Intensive Care Unit Project, may be particularly effective in improving the quality of care by creating a "bandwagon effect" within a geographic region. The quality revolution is having a significant effect in the critical care unit and is likely to be facilitated by the transition to the electronic medical record.

  15. LSB steganography with improved embedding efficiency and undetectability

    OpenAIRE

    Khalind, Omed; Aziz, Benjamin Yowell Yousif

    2015-01-01

    In this paper, we propose a new method of non-adapt ive LSB steganography in still images to improve the embedding efficiency from 2 to 8/3 rand om bits per one embedding change even for the embedding rate of 1 bit per pixel. The method t akes 2-bits of the secret message at a time and compares them to the LSBs of the two chosen pix el values for embedding, it always assumes a single mismatch between the two and uses the seco nd LSB o...

  16. The technological raw material heating furnaces operation efficiency improving issue

    Science.gov (United States)

    Paramonov, A. M.

    2017-08-01

    The issue of fuel oil applying efficiency improving in the technological raw material heating furnaces by means of its combustion intensification is considered in the paper. The technical and economic optimization problem of the fuel oil heating before combustion is solved. The fuel oil heating optimal temperature defining method and algorithm analytically considering the correlation of thermal, operating parameters and discounted costs for the heating furnace were developed. The obtained optimization functionality provides the heating furnace appropriate thermal indices achievement at minimum discounted costs. The carried out research results prove the expediency of the proposed solutions using.

  17. Improving the Efficiency of Photon Collection by Compton Rescue

    Science.gov (United States)

    2011-03-01

    burnished by vibratory shot peening,” Acta Physica Polonica , vol. A 110, pp. 739–46, 2006. [4] M. Cunningham et al., “First-generation hybrid compact...Department of Defense, or the United States Government. This material is declared a work of the U.S. Government and is not subject to copyright...R. Kowash (Member) Date AFIT/GAP/ENP/11-M10 Abstract A method to improve the efficiency of photon collection in thin planar HPGe de- tectors was

  18. Improving the Efficient of Ernie Turner Center. Final Progress Report

    Energy Technology Data Exchange (ETDEWEB)

    Fredeen, Amy

    2011-03-21

    The objective of this project was to complete the specifications and drawings for a variable speed kitchen exhaust system and the boiler heating system which when implemented will improve the heating efficiency of the building. The design work was focused in two key areas: kitchen ventilation and heating for the Ernie Turner Center building (ETC). RSA completed design work and issued a set of 100% drawings. RSA also worked with a cost estimator to put together a detailed cost estimate for the project. The design components are summarized.

  19. Fast reactor core concepts to improve transmutation efficiency

    International Nuclear Information System (INIS)

    Fujimura, Koji; Kawashima, Katsuyuki; Itooka, Satoshi

    2015-01-01

    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

  20. 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.

  1. Impacts of market and organizational characteristics on hospital efficiency and uncompensated care.

    Science.gov (United States)

    Hsieh, Hui-Min; Clement, Dolores G; Bazzoli, Gloria J

    2010-01-01

    Hospitals have confronted a difficult financial environment given many factors, including expansion of managed care, changes in public policy, growing market competition for certain services, and growth in the number of uninsured. Policy makers have expressed concern that hospitals may forgo providing care to the indigent as a means to reduce costs and become more efficient when faced with financial pressures. This article examined the effects of environmental pressures on two dimensions of hospital performance: hospital efficiency and uncompensated care provision. Longitudinal data for the Commonwealth of Virginia from 1998 to 2004 were analyzed. Data Envelopment Analysis and bivariate probit were used to examine the factors associated with efficiency and uncompensated care. The results indicated that a positive relationship between hospital efficiency and uncompensated care provision exists. That is, hospitals that are categorized as efficient are likely to provide more uncompensated care. We also found that hospitals tended to provide more uncompensated care when increased demand for these services occurred in a market. Increases in Medicare or Medicaid patient share reduced the provision of uncompensated care. In relation to hospital efficiency, the results indicated that HMO penetration and Medicaid patient share reduced hospital efficiency. This study found that efficient hospitals tend to provide more uncompensated care over time. The findings also suggest that hospitals alter their efficiency and provision of uncompensated care in response to a number of environmental pressures, but it may depend on the type of pressures or uncertainties encountered.

  2. A quality improvement management model for renal care.

    Science.gov (United States)

    Vlchek, D L; Day, L M

    1991-04-01

    The purpose of this article is to explore the potential for applying the theory and tools of quality improvement (total quality management) in the renal care setting. We believe that the coupling of the statistical techniques used in the Deming method of quality improvement, with modern approaches to outcome and process analysis, will provide the renal care community with powerful tools, not only for improved quality (i.e., reduced morbidity and mortality), but also for technology evaluation and resource allocation.

  3. Complementary effect of patient volume and quality of care on hospital cost efficiency.

    Science.gov (United States)

    Choi, Jeong Hoon; Park, Imsu; Jung, Ilyoung; Dey, Asoke

    2017-06-01

    This study explores the direct effect of an increase in patient volume in a hospital and the complementary effect of quality of care on the cost efficiency of U.S. hospitals in terms of patient volume. The simultaneous equation model with three-stage least squares is used to measure the direct effect of patient volume and the complementary effect of quality of care and volume. Cost efficiency is measured with a data envelopment analysis method. Patient volume has a U-shaped relationship with hospital cost efficiency and an inverted U-shaped relationship with quality of care. Quality of care functions as a moderator for the relationship between patient volume and efficiency. This paper addresses the economically important question of the relationship of volume with quality of care and hospital cost efficiency. The three-stage least square simultaneous equation model captures the simultaneous effects of patient volume on hospital quality of care and cost efficiency.

  4. Efficiency improvement for a sustainable agriculture : the integration of agronomic and farm economics approaches

    NARCIS (Netherlands)

    Koeijer, de T.J.

    2002-01-01

    Keywords: Sustainable farming systems, Agronomic efficiency, Economic efficiency, Environmental efficiency, Sustainability index, Interdisciplinary analysis.

    The objective of the research described in this thesis was to determine what role improved agronomic efficiency can play in

  5. Indoor climate quality after renovation for improved energy efficiency

    DEFF Research Database (Denmark)

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

    2016-01-01

    The building sector is responsible for approximately 40 % of the Danish energy consumption. As every year less than 1 % of the building stock is rebuild after demolition of old buildings, improved energy efficiency of existing buildings are in focus. In the late seventies to mid-eighties unwise...... performance. The indoor quality classifications show minor improvements. By using design tools beyond the simple legal requirements, the rental dwelling marked is a far step ahead of most retrofitting of owner-occupied dwellings and houses. The fear of indoor climate degradation from retrofitted energy saving...... measures may be countered by the use of modern design tools and attention to inner moisture membranes and needs for renovation of ventilation systems....

  6. Energy efficiency improvement of medical electric tools and devices

    Directory of Open Access Journals (Sweden)

    Meshkov Aleksandr S.

    2014-01-01

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

  7. 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.

  8. Improving efficiency and value in health care. Intravenous iron management for anaemia associated with chronic kidney disease: linking treatment to an outpatient clinic, optimizing service provision and patient choice.

    Science.gov (United States)

    Bhandari, Sunil; Naudeer, Sarah

    2008-12-01

    The National Service Framework advocates correction of anaemia in patients with chronic kidney disease (CKD). Oral iron is insufficient, while intravenous (IV) supplementation replenishes and maintains iron stores. In Yorkshire numerous peripheral clinics exist to reduce travel for patients, but patients must travel to the main unit for IV iron therapy. Therefore an outpatient service in tandem with a routine clinic for administration of IV CosmoFer was created. To evaluate the feasibility and benefits of IV iron therapy in the outpatient clinic during active patient review for CKD patients. A cross-sectional study of patients attending for total dose IV iron (n = 57) at a peripheral clinic. Iron was administered and monitored according to protocol by one of the clinic nurses with medical staff available in the adjoining room. Haemoglobin, ferritin and renal function were recorded pre-infusion and after 4-6 months. Results are given as medians/means +/- standard error. A total of 76 IV infusions were carried out with no reported side effects or haemodynamic instability. Haemoglobin (median 10.9 vs. 11.3 g dL(-1), P = NS), creatinine and estimated glomerular filtration rate (eGFR) over the 6-month period remained stable. Serum ferritin rose significantly [80.9 +/- 6.2 vs. 186.4 +/- 18.2 g L(-1) (P Hospital time saved 380 day case bed hours, doctor hours saved 76 hours, and patient hours saved 3 hours/patient. Cost savings for TDI CosmoFer in peripheral clinic versus in centre therapy and versus sucrose, respectively, for 76 treatments was pound 5749.40 and pound 46,320.80 respectively. We have demonstrated, in a resource-limited service, the feasibility and cost-effectiveness of a management care pathway for patients with CKD, in a peripheral clinic, to receive total dose IV CosmoFer without disruption of a functioning renal clinic.

  9. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-05-15

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

  11. IMPROVING CO2 EFFICIENCY FOR RECOVERING OIL IN HETEROGENEOUS RESERVOIRS

    International Nuclear Information System (INIS)

    Reid B. Grigg; Robert K. Svec; Zheng-Wen Zeng; Liu Yi; Baojun Bai

    2004-01-01

    A three-year contract for the project, DOE Contract No. DE-FG26-01BC15364, ''Improving CO 2 Efficiency for Recovering Oil in Heterogeneous Reservoirs'', was started on September 28, 2001. This project examines three major areas in which CO 2 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 CO 2 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 CO 2 flood basic behavior at the Midland Annual CO 2 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

  12. Mobile phones improve antenatal care attendance in Zanzibar

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND: Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems. Antenatal care has the potential to reduce maternal morbidity and improve newborns' survival but this benefit may not be realized in sub-Saharan Africa where the attendance and quality...... of care is declining. We evaluated the association between a mobile phone intervention and antenatal care in a resource-limited setting. We aimed to assess antenatal care in a comprehensive way taking into consideration utilisation of antenatal care as well as content and timing of interventions during...... included at their first antenatal care visit and followed until 42 days after delivery. 24 primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text-message and voucher component. Primary outcome...

  13. Improving building energy efficiency in India: State-level analysis of building energy efficiency policies

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Sha; Tan, Qing; Evans, Meredydd; Kyle, Page; Vu, Linh; Patel, Pralit L.

    2017-11-01

    India is expected to add 40 billion m2 of new buildings till 2050. Buildings are responsible for one third of India’s total energy consumption today and building energy use is expected to continue growing driven by rapid income and population growth. The implementation of the Energy Conservation Building Code (ECBC) is one of the measures to improve building energy efficiency. Using the Global Change Assessment Model, this study assesses growth in the buildings sector and impacts of building energy policies in Gujarat, which would help the state adopt ECBC and expand building energy efficiency programs. Without building energy policies, building energy use in Gujarat would grow by 15 times in commercial buildings and 4 times in urban residential buildings between 2010 and 2050. ECBC improves energy efficiency in commercial buildings and could reduce building electricity use in Gujarat by 20% in 2050, compared to the no policy scenario. Having energy codes for both commercial and residential buildings could result in additional 10% savings in electricity use. To achieve these intended savings, it is critical to build capacity and institution for robust code implementation.

  14. 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.

  15. An efficiency improvement in warehouse operation using simulation analysis

    Science.gov (United States)

    Samattapapong, N.

    2017-11-01

    In general, industry requires an efficient system for warehouse operation. There are many important factors that must be considered when designing an efficient warehouse system. The most important is an effective warehouse operation system that can help transfer raw material, reduce costs and support transportation. By all these factors, researchers are interested in studying about work systems and warehouse distribution. We start by collecting the important data for storage, such as the information on products, information on size and location, information on data collection and information on production, and all this information to build simulation model in Flexsim® simulation software. The result for simulation analysis found that the conveyor belt was a bottleneck in the warehouse operation. Therefore, many scenarios to improve that problem were generated and testing through simulation analysis process. The result showed that an average queuing time was reduced from 89.8% to 48.7% and the ability in transporting the product increased from 10.2% to 50.9%. Thus, it can be stated that this is the best method for increasing efficiency in the warehouse operation.

  16. Improving computational efficiency of Monte Carlo simulations with variance reduction

    International Nuclear Information System (INIS)

    Turner, A.; Davis, A.

    2013-01-01

    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. Restructuring and energy efficiency improvement of the Bulgarian energy economy

    International Nuclear Information System (INIS)

    Moumdjian, G.

    1993-01-01

    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)

  18. Evaluating the Management System Approach for Industrial Energy Efficiency Improvements

    Directory of Open Access Journals (Sweden)

    Thomas Zobel

    2016-09-01

    Full Text Available Voluntary environmental management systems (EMS based on the international standard ISO 14001 have become widespread globally in recent years. The purpose of this study is to assess the impact of voluntary management systems on energy efficiency in the Swedish manufacturing industry by means of objective industrial energy data derived from mandatory annual environmental reports. The study focuses on changes in energy efficiency over a period of 12 years and includes both ISO 14001-certified companies and non-certified companies. Consideration is given to energy improvement efforts in the companies before the adoption of ISO 14001. The analysis has been carried out using statistical methods for two different industrial energy parameters: electricity and fossil fuel consumption. The results indicate that ISO 14001 adoption and certification has increased energy efficiency regarding the use of fossil fuel. In contrast, no effect of the management systems has been found concerning the use of electricity. The mixed results of this study are only partly in line with the results of previous studies based on perceptions of company representatives.

  19. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

    Science.gov (United States)

    Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

    2016-01-01

    Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

  20. Last Mile Towards Efficient Healthcare Delivery in Switzerland: eHealth Enabled Applications Could Speed Up the Care Process.

    Science.gov (United States)

    Deng, Yihan; Bürkle, Thomas; Holm, Jürgen; Zetz, Erwin; Denecke, Kerstin

    2018-01-01

    A precise and timely care delivery depends on an efficient triage performed by primary care providers and smooth collaboration with other medical specialities. In recent years telemedicine gained increasing importance for efficient care delivery. It's use, however, has been limited by legal issues, missing digital infrastructures, restricted support from health insurances and the digital divide in the population. A new era towards eHealth and telemedicine starts with the establishment of national eHealth regulations and laws. In Switzerland, a nation-wide digital infrastructure and electronic health record will be established. But appropriate healthcare apps to improve patient care based on this infrastructure remain rare. In this paper, we present two applications (self-anamnesis and eMedication assistant) for eHealth enabled care delivery which have the potential to speed up diagnosis and treatment.

  1. 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.

  2. Assembly Line Efficiency Improvement by Using WITNESS Simulation Software

    Science.gov (United States)

    Yasir, A. S. H. M.; Mohamed, N. M. Z. N.

    2018-03-01

    In the nowadays-competitive world, efficiencies and the productivity of the assembly line are essential in manufacturing company. This paper demonstrates the study of the existing production line performance. The actual cycle time observed and recorded during the working process. The current layout was designed and analysed using Witness simulation software. The productivity and effectiveness for every single operator are measured to determine the operator idle time and busy time. Two new alternatives layout were proposed and analysed by using Witness simulation software to improve the performance of production activities. This research provided valuable and better understanding of production effectiveness by adjusting the line balancing. After analysing the data, simulation result from the current layout and the proposed plan later been tabulated to compare the improved efficiency and productivity. The proposed design plan has shown an increase in yield and productivity compared to the current arrangement. This research has been carried out in company XYZ, which is one of the automotive premises in Pahang, Malaysia.

  3. Enhanced policies for the improvement of electricity efficiencies

    International Nuclear Information System (INIS)

    Blok, Kornelis

    2005-01-01

    Energy-efficiency improvement is considered as an important option to limit greenhouse gas emissions. In this paper, the possibilities to implement new policies to improve the efficiency of electricity end-use are explored. The following policy actions are considered: - introduction of a '1 W standard' for standby power consumption of appliances;- incremental standards for large electric appliances;- design guidelines for small electric appliances;- a technology-forcing standard for lighting;- a motor-drive program;- a program directed at the reduction of electricity use during empty-office hours;- actual energy performance requirements for service-sector buildings. The implementation of these programs will contribute substantially to reaching greenhouse gas emission targets in the European Union (total estimated effect to be 200-350 Mton CO 2 emission reduction in the year 2020). However, to reach these targets a very substantial effort is required, both in terms of policy ambition, force of the applied instruments, and implementation efforts. In the case of electric appliances, regulatory instruments may need wider application. And, in order to attain the substantial potential savings in motor-drive systems, an effort comparable to the effort to promote renewable electricity in the European Union may be both justified and necessary

  4. Training directionally selective motion pathways can significantly improve reading efficiency

    Science.gov (United States)

    Lawton, Teri

    2004-06-01

    This study examined whether perceptual learning at early levels of visual processing would facilitate learning at higher levels of processing. This was examined by determining whether training the motion pathways by practicing leftright movement discrimination, as found previously, would improve the reading skills of inefficient readers significantly more than another computer game, a word discrimination game, or the reading program offered by the school. This controlled validation study found that practicing left-right movement discrimination 5-10 minutes twice a week (rapidly) for 15 weeks doubled reading fluency, and significantly improved all reading skills by more than one grade level, whereas inefficient readers in the control groups barely improved on these reading skills. In contrast to previous studies of perceptual learning, these experiments show that perceptual learning of direction discrimination significantly improved reading skills determined at higher levels of cognitive processing, thereby being generalized to a new task. The deficits in reading performance and attentional focus experienced by the person who struggles when reading are suggested to result from an information overload, resulting from timing deficits in the direction-selectivity network proposed by Russell De Valois et al. (2000), that following practice on direction discrimination goes away. This study found that practicing direction discrimination rapidly transitions the inefficient 7-year-old reader to an efficient reader.

  5. Validation of Surgical Intensive Care-Infection Registry: a medical informatics system for intensive care unit research, quality of care improvement, and daily patient care.

    Science.gov (United States)

    Golob, Joseph F; Fadlalla, Adam M A; Kan, Justin A; Patel, Nilam P; Yowler, Charles J; Claridge, Jeffrey A

    2008-08-01

    We developed a prototype electronic clinical information system called the Surgical Intensive Care-Infection Registry (SIC-IR) to prospectively study infectious complications and monitor quality of care improvement programs in the surgical and trauma intensive care unit. The objective of this study was to validate SIC-IR as a successful health information technology with an accurate clinical data repository. Using the DeLone and McLean Model of Information Systems Success as a framework, we evaluated SIC-IR in a 3-month prospective crossover study of physician use in one of our two surgical and trauma intensive care units (SIC-IR unit versus non SIC-IR unit). Three simultaneous research methodologies were used: a user survey study, a pair of time-motion studies, and an accuracy study of SIC-IR's clinical data repository. The SIC-IR user survey results were positive for system reliability, graphic user interface, efficiency, and overall benefit to patient care. There was a significant decrease in prerounding time of nearly 4 minutes per patient on the SIC-IR unit compared with the non SIC-IR unit. The SIC-IR documentation and data archiving was accurate 74% to 100% of the time depending on the data entry method used. This accuracy was significantly improved compared with normal hand-written documentation on the non SIC-IR unit. SIC-IR proved to be a useful application both at individual user and organizational levels and will serve as an accurate tool to conduct prospective research and monitor quality of care improvement programs.

  6. Does competition improve health care quality?

    Science.gov (United States)

    Scanlon, Dennis P; Swaminathan, Shailender; Lee, Woolton; Chernew, Michael

    2008-12-01

    To identify the effect of competition on health maintenance organizations' (HMOs) quality measures. Longitudinal analysis of a 5-year panel of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Health Plans Survey(R) (CAHPS) data (calendar years 1998-2002). All plans submitting data to the National Committee for Quality Assurance (NCQA) were included regardless of their decision to allow NCQA to disclose their results publicly. NCQA, Interstudy, the Area Resource File, and the Bureau of Labor Statistics. Fixed-effects models were estimated that relate HMO competition to HMO quality controlling for an unmeasured, time-invariant plan, and market traits. Results are compared with estimates from models reliant on cross-sectional variation. Estimates suggest that plan quality does not improve with increased levels of HMO competition (as measured by either the Herfindahl index or the number of HMOs). Similarly, increased HMO penetration is generally not associated with improved quality. Cross-sectional models tend to suggest an inverse relationship between competition and quality. The strategies that promote competition among HMOs in the current market setting may not lead to improved HMO quality. It is possible that price competition dominates, with purchasers and consumers preferring lower premiums at the expense of improved quality, as measured by HEDIS and CAHPS. It is also possible that the fragmentation associated with competition hinders quality improvement.

  7. 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.

  8. Efficient perturbation theory to improve the density matrix renormalization group

    Science.gov (United States)

    Tirrito, Emanuele; Ran, Shi-Ju; Ferris, Andrew J.; McCulloch, Ian P.; Lewenstein, Maciej

    2017-02-01

    The density matrix renormalization group (DMRG) is one of the most powerful numerical methods available for many-body systems. It has been applied to solve many physical problems, including the calculation of ground states and dynamical properties. In this work, we develop a perturbation theory of the DMRG (PT-DMRG) to greatly increase its accuracy in an extremely simple and efficient way. Using the canonical matrix product state (MPS) representation for the ground state of the considered system, a set of orthogonal basis functions {| ψi> } is introduced to describe the perturbations to the ground state obtained by the conventional DMRG. The Schmidt numbers of the MPS that are beyond the bond dimension cutoff are used to define these perturbation terms. The perturbed Hamiltonian is then defined as H˜i j= ; its ground state permits us to calculate physical observables with a considerably improved accuracy compared to the original DMRG results. We benchmark the second-order perturbation theory with the help of a one-dimensional Ising chain in a transverse field and the Heisenberg chain, where the precision of the DMRG is shown to be improved O (10 ) times. Furthermore, for moderate L the errors of the DMRG and PT-DMRG both scale linearly with L-1 (with L being the length of the chain). The linear relation between the dimension cutoff of the DMRG and that of the PT-DMRG at the same precision shows a considerable improvement in efficiency, especially for large dimension cutoffs. In the thermodynamic limit we show that the errors of the PT-DMRG scale with √{L-1}. Our work suggests an effective way to define the tangent space of the ground-state MPS, which may shed light on the properties beyond the ground state. This second-order PT-DMRG can be readily generalized to higher orders, as well as applied to models in higher dimensions.

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

    International Nuclear Information System (INIS)

    Anderson, J.-O.; Elfgren, E.; Westerlund, L.

    2014-01-01

    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

  10. Improving organizational climate for excellence in patient care.

    Science.gov (United States)

    Arnold, Edwin

    2013-01-01

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

  11. Another link to improving the working environment in acute care hospitals: registered nurses' spirit at work.

    Science.gov (United States)

    Urban, Ann-Marie; Wagner, Joan I

    2013-12-01

    Hospitals are situated within historical and socio-political contexts; these influence the provision of patient care and the work of registered nurses (RNs). Since the early 1990s, restructuring and the increasing pressure to save money and improve efficiency have plagued acute care hospitals. These changes have affected both the work environment and the work of nurses. After recognizing this impact, healthcare leaders have dedicated many efforts to improving the work environment in hospitals. Admirable in their intent, these initiatives have made little change for RNs and their work environment, and thus, an opportunity exists for other efforts. Research indicates that spirit at work (SAW) not only improves the work environment but also strengthens the nurse's power to improve patient outcomes and contribute to a high-quality workplace. In this paper, we present findings from our research that suggest SAW be considered an important component in improving the work environment in acute care hospitals.

  12. Women's Suggestions for Improving Midwifery Care in The Netherlands.

    Science.gov (United States)

    Baas, Carien I; Erwich, Jan Jaap H M; Wiegers, Therese A; de Cock, T Paul; Hutton, Eileen K

    2015-12-01

    The experience of the care a woman receives during pregnancy and childbirth has an immediate and long-lasting effect on her well being. The involvement of patients and clients in health care has increased over the last decades. The Dutch maternity care system offers an excellent opportunity to explore and involve women's suggestions for the improvement of midwifery care in the current maternity care model. This qualitative study is part of the "DELIVER" study. Clients were recruited from 20 midwifery practices. Purposive sampling was used to select the practices. The clients received up to three questionnaires, in which they could respond to the question; "Do you have any suggestions on how your midwife could improve his/her provision of care?" The answers were analyzed with a qualitative thematic content analysis, using the software program MAXQDA. Altogether, 3,499 answers were provided. One overarching concept emerged: clients' desire for individualized care. Within this concept, suggestions could be clustered around 1) provider characteristics: interpersonal skills, communication, and competence, and 2) service characteristics: content and quantity of care, guidance and support, continuity of care provider, continuity of care, information, and coordination of care. Informed by the suggestions of women, care to women and their families could be improved by the following: 1) more continuity of the care provider during the prenatal, natal, and postnatal periods, 2) more information and information specifically tailored for the person, 3) client-centered communication, and 4) a personal approach with 5) enough time spent per client. © 2015 Wiley Periodicals, Inc.

  13. Improving The Efficiency Of Ammonia Electrolysis For Hydrogen Production

    Science.gov (United States)

    Palaniappan, Ramasamy

    Given the abundance of ammonia in domestic and industrial wastes, ammonia electrolysis is a promising technology for remediation and distributed power generation in a clean and safe manner. Efficiency has been identified as one of the key issues that require improvement in order for the technology to enter the market phase. Therefore, this research was performed with the aim of improving the efficiency of hydrogen production by finding alternative materials for the cathode and electrolyte. 1. In the presence of ammonia the activity for hydrogen evolution reaction (HER) followed the trend Rh>Pt>Ru>Ni. The addition of ammonia resulted in lower rates for HER for Pt, Ru, and Ni, which have been attributed to competition from the ammonia adsorption reaction. 2. The addition of ammonia offers insight into the role of metal-hydrogen underpotential deposition (M-Hupd) on HER kinetics. In addition to offering competition via ammonia adsorption it resulted in fewer and weaker M-Hupd bonds for all metals. This finding substantiates the theory that M-Hupd bonds favor HER on Pt electrocatalyst. However, for Rh results suggest that M-Hupd bond may hinder the HER. In addition, the presence of unpaired valence shell electrons is suggested to provide higher activity for HER in the presence of ammonia. 3. Bimetals PtxM1-x (M = Ir, Ru, Rh, and Ni) offered lower overpotentials for HER compared to the unalloyed metals in the presence of ammonia. The activity of HER in the presence of ammonia follows the trend Pt-Ir>Pt-Rh>Pt-Ru>Pt-Ni. The higher activity of HER is attributed to the synergistic effect of the alloy, where ammonia adsorbs onto the more electropositive alloying metal leaving Pt available for Hupd formation and HER to take place. Additionally, this supports the theory that the presence of a higher number of unpaired electrons favors the HER in the presence of ammonia. 4. Potassium polyacrylate (PAA-K) was successfully used as a substitute for aqueous KOH for ammonia

  14. Physician education programme improves quality of diabetes care ...

    African Journals Online (AJOL)

    Objectives. To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes patient care in a diabetes clinic. Setting. Two tertiary care diabetes clinics at Kalafong Hospital, Pretoria. Study design. Quasi-experimental controlled before-and-after study. Methods.

  15. Improving Patient Safety Culture in Primary Care: A Systematic Review

    NARCIS (Netherlands)

    Verbakel, Natasha J.; Langelaan, Maaike; Verheij, Theo J. M.; Wagner, Cordula; Zwart, Dorien L. M.

    Background: Patient safety culture, described as shared values, attitudes and behavior of staff in a health-care organization, gained attention as a subject of study as it is believed to be related to the impact of patient safety improvements. However, in primary care, it is yet unknown, which

  16. 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…

  17. 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.

  18. Improving patients' and staff's experiences of acute care.

    Science.gov (United States)

    Chaplin, Rob; Crawshaw, Jacob; Hood, Chloe

    2015-03-01

    The aim of this audit was to assess the effect of the Quality Mark programme on the quality of acute care received by older patients by comparing the experiences of staff and older adults before and after the programme. Data from 31 wards in 12 acute hospitals were collected over two stages. Patients and staff completed questionnaires on the perceived quality of care on the ward. Patients rated improved experiences of nutrition, staff availability and dignity. Staff received an increase in training and reported better access to support, increased time and skill to deliver care and improved morale, leadership and teamwork. Problems remained with ward comfort and mealtimes. Overall, results indicated an improvement in ratings of care quality in most domains during Quality Mark data collection. Further audits need to explore ways of improving ward comfort and mealtime experience.

  19. Efficiency improvement for a sustainable agriculture : the integration of agronomic and farm economics approaches

    OpenAIRE

    Koeijer, de, T.J.

    2002-01-01

    Keywords: Sustainable farming systems, Agronomic efficiency, Economic efficiency, Environmental efficiency, Sustainability index, Interdisciplinary analysis.

    The objective of the research described in this thesis was to determine what role improved agronomic efficiency can play in the transition towards more sustainable production systems. Agronomic efficiency measures the technical performance. If it could be improved, environmental damage could be reduced while, at the sam...

  20. Improving Health Care Accessibility: Strategies and Recommendations.

    Science.gov (United States)

    Almorsy, Lamia; Khalifa, Mohamed

    2016-01-01

    Access time refers to the interval between requesting and actual outpatient appointment. It reflects healthcare accessibility and has a great influence on patient treatment and satisfaction. King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia studied the accessibility to outpatient services in order to develop useful strategies and recommendations for improvement. Utilized, unutilized and no-show appointments were analyzed. It is crucial to manage no-shows and short notice appointment cancellations by preparing a waiting list for those patients who can be called in to an appointment on the same day using an open access policy. An overlapping appointment scheduling model can be useful to minimize patient waiting time and doctor idle time in addition to the sensible use of appointment overbooking that can significantly improve productivity.

  1. Evaluation of economic efficiency of process improvement in food packaging

    Directory of Open Access Journals (Sweden)

    Jana Hron

    2012-01-01

    Full Text Available In general, we make gains in process by the three fundamental ways. First, we define or redefine our process in a strategic sense. Second, once defined or redefined, we commence process operations and use process control methods to target and stabilize our process. Third, we use process improvement methods, as described in this paper, along with process control to fully exploit our process management and/or technology. Process improvement is focused primarily in our subprocesses and sub-subprocesses. Process leverage is the key to process improvement initiatives. This means that small improvements of the basic manufacturing operations can have (with the assumption of mass repetition of the operation a big impact on the functioning of the whole production unit. The complexity within even small organizations, in people, products, and processes, creates significant challenges in effectively and efficiently using these initiatives tools. In this paper we are going to place process purposes in the foreground and initiatives and tools in the background as facilitator to help accomplish process purpose. Initiatives and tools are not the ends we are seeking; result/outcomes in physical, economics, timeliness, and customer service performance matter. In the paper process boundaries (in a generic sense are set by our process purpose and our process definition. Process improvement is initiated within our existing process boundaries. For example, in a fast-food restaurant, if we define our cooking process around a frying technology, then we provide process improvements within our frying technology. On the other hand, if we are considering changing to a broiling technology, then we are likely faced with extensive change, impacting our external customers, and a process redefinition may be required. The result / aim of the paper are based on the example of the process improving of a food packaging quality. Specifically, the integration of two approaches

  2. 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.

  3. Renewable energy: An efficient mechanism to improve GDP

    International Nuclear Information System (INIS)

    Chien Taichen; Hu Jinli

    2008-01-01

    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

  4. Challenges in biobutanol production: How to improve the efficiency?

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, Veronica; Paekkilae, Johanna; Muurinen, Esa; Keiski, Riitta L. [Mass and Heat Transfer Process Laboratory, Department of Process and Environmental Engineering, POB 4300, FI-90014 University of Oulu, Oulu (Finland); Ojamo, Heikki [Bioprocess Engineering Laboratory, Department of Process and Environmental Engineering, POB 4300, FI-90014 University of Oulu, Oulu (Finland)

    2011-02-15

    There is an increasing interest in the production of chemicals and fuels from renewable resources due to the continuing price increase of fossil resources, the insecurity of the availability of fossil resources in the future, and additionally environmental concerns and legislations. Biobutanol may be produced by the acetone-butanol-ethanol (ABE) fermentation. This paper reviews the biobutanol production bringing up the problems and challenges to overcome. The aim of the paper is to help in finding opportunities to make the process feasible in the near future. The analysis stresses the idea of improving the efficiency of the fermentation stage by altering the up (pretreatment of the raw material) and downstream (product recovery and purification) processes. The paper also explores the biobutanol production from the biorefinery perspective. Finally the review brings up the important role of research in developing and implementing the production of biobutanol by the ABE fermentation. (author)

  5. Challenges in biobutanol production: How to improve the efficiency?

    International Nuclear Information System (INIS)

    Garcia, Veronica; Paekkilae, Johanna; Muurinen, Esa; Keiski, Riitta L.; Ojamo, Heikki

    2011-01-01

    There is an increasing interest in the production of chemicals and fuels from renewable resources due to the continuing price increase of fossil resources, the insecurity of the availability of fossil resources in the future, and additionally environmental concerns and legislations. Biobutanol may be produced by the acetone-butanol-ethanol (ABE) fermentation. This paper reviews the biobutanol production bringing up the problems and challenges to overcome. The aim of the paper is to help in finding opportunities to make the process feasible in the near future. The analysis stresses the idea of improving the efficiency of the fermentation stage by altering the up (pretreatment of the raw material) and downstream (product recovery and purification) processes. The paper also explores the biobutanol production from the biorefinery perspective. Finally the review brings up the important role of research in developing and implementing the production of biobutanol by the ABE fermentation. (author)

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

    International Nuclear Information System (INIS)

    Paterno, M; Kowalkowski, J; Green, C

    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++.

  7. Improvement of powertrain efficiency through energy breakdown analysis

    International Nuclear Information System (INIS)

    Damiani, Lorenzo; Repetto, Matteo; Prato, Alessandro Pini

    2014-01-01

    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 CO 2 emission

  8. 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.

  9. Improve photocurrent quantum efficiency of carbon nanotube by chemical treatment

    International Nuclear Information System (INIS)

    Wang Hongguang; Wei Jinquan; Jia Yi; Li Zhen; Zhu Hongwei; Wang Kunlin; Wu Dehai

    2012-01-01

    Highlights: ► The QE of photocurrent for the H 2 O 2 -treated CNTs reaches to 5.28% at U bias = 0.1 V. ► Moderate chemical treatment can enhance the QE of photocurrent of CNTs. ► Excessive chemical treatment decreases the photocurrent quantum efficiency of CNTs. - Abstract: High photocurrent quantum efficiency (QE) of carbon nanotubes (CNTs) is important to their photovoltaic applications. The ability of photocurrent generation of CNTs depends on their band structure and surface state. For given CNTs, it is possible to improve the QE of photocurrent by chemical modification. Here, we study the effects of simple chemical treatment on the QE of CNTs by measuring the photocurrent of macroscopic CNT bundles. The QE of the H 2 O 2 -treated CNT bundle reaches 5.28% at 0.1 V bias voltage at a laser (λ = 473 nm) illumination, which is 85% higher than that of the pristine sample. But the QE of the CNTs treated in concentrated HNO 3 is lower than that of the pristine sample. It shows that moderate chemical treatment can enhance the photocurrent QE and excessive chemical treatment will decrease the QE because of introducing lots of structural defects.

  10. Improving labeling efficiency in automatic quality control of MRSI data.

    Science.gov (United States)

    Pedrosa de Barros, Nuno; McKinley, Richard; Wiest, Roland; Slotboom, Johannes

    2017-12-01

    To improve the efficiency of the labeling task in automatic quality control of MR spectroscopy imaging data. 28'432 short and long echo time (TE) spectra (1.5 tesla; point resolved spectroscopy (PRESS); repetition time (TR)= 1,500 ms) from 18 different brain tumor patients were labeled by two experts as either accept or reject, depending on their quality. For each spectrum, 47 signal features were extracted. The data was then used to run several simulations and test an active learning approach using uncertainty sampling. The performance of the classifiers was evaluated as a function of the number of patients in the training set, number of spectra in the training set, and a parameter α used to control the level of classification uncertainty required for a new spectrum to be selected for labeling. The results showed that the proposed strategy allows reductions of up to 72.97% for short TE and 62.09% for long TE in the amount of data that needs to be labeled, without significant impact in classification accuracy. Further reductions are possible with significant but minimal impact in performance. Active learning using uncertainty sampling is an effective way to increase the labeling efficiency for training automatic quality control classifiers. Magn Reson Med 78:2399-2405, 2017. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

  11. Improving the energy efficiency of industrial refrigeration systems

    International Nuclear Information System (INIS)

    Oh, Jin-Sik; Binns, Michael; Park, Sangmin; Kim, Jin-Kuk

    2016-01-01

    Various retrofit design options are available for improving the energy efficiency and economics of industrial refrigeration systems. This study considers a novel retrofit option using a mixed refrigerant (MR) in refrigeration cycles designed for use with a pure refrigerant (PR). In this way energy savings can be realized by switching refrigerants without requiring extensive and expensive reconfiguration of equipment. Hence, the aim here is to test the common thinking that equipment should always be extensively reconfigured when switching from pure to mixed refrigerants. To determine the most energy-efficient operating conditions for each refrigeration design an optimization framework is utilized linking a process simulator with an external optimization method. A case study is presented to demonstrate how the proposed process modeling and optimization framework can be applied and to illustrate the economic benefits of using the retrofit design options considered here. For the case considered in this paper, savings of shaft power required for the refrigeration cycle can be achieved from 16.3% to 27.2% when the pure refrigerant is replaced with mixed refrigerants and operating conditions are re-optimized. - Highlights: • Design methods for the design of refrigeration cycles in retrofit cases. • Consideration of mixed refrigerants to the existing multi-level pure-refrigerant cycles. • Optimization of refrigeration cycles with integrated use of a process simulator with an optimizer.

  12. Improving Communication About Serious Illness in Primary Care: A Review.

    Science.gov (United States)

    Lakin, Joshua R; Block, Susan D; Billings, J Andrew; Koritsanszky, Luca A; Cunningham, Rebecca; Wichmann, Lisa; Harvey, Doreen; Lamey, Jan; Bernacki, Rachelle E

    2016-09-01

    The Institute of Medicine recently called for systematic improvements in clinician-led conversations about goals, values, and care preferences for patients with serious and life-threatening illnesses. Studies suggest that these conversations are associated with improved outcomes for patients and their families, enhanced clinician satisfaction, and lower health care costs; however, the role of primary care clinicians in driving conversations about goals and priorities in serious illness is not well defined. To present a review of a structured search of the evidence base about communication in serious illness in primary care. MEDLINE was searched, via PubMed, on January 19, 2016, finding 911 articles; 126 articles were reviewed and selected titles were added from bibliography searches. Review of the literature informed 2 major topic areas: the role of primary care in communication about serious illness and clinician barriers and system failures that interfere with effective communication. Literature regarding the role that primary care plays in communication focused primarily on the ambiguity about whether primary care clinicians or specialists are responsible for initiating conversations, the benefits of primary care clinicians and specialists conducting conversations, and the quantity and quality of discussions. Timely and effective communication about serious illness in primary care is hampered by key clinician barriers, which include deficits in knowledge, skills, and attitudes; discomfort with prognostication; and lack of clarity about the appropriate timing and initiation of conversations. Finally, system failures in coordination, documentation, feedback, and quality improvement contribute to lack of conversations. Clinician and system barriers will challenge primary care clinicians and institutions to meet the needs of patients with serious illness. Ensuring that conversations about goals and values occur at the appropriate time for seriously ill patients will

  13. 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

  14. Information management for aged care provision in Australia: development of an aged care minimum dataset and strategies to improve quality and continuity of care.

    Science.gov (United States)

    Davis, Jenny; Morgans, Amee; Burgess, Stephen

    2016-04-01

    Efficient information systems support the provision of multi-disciplinary aged care and a variety of organisational purposes, including quality, funding, communication and continuity of care. Agreed minimum data sets enable accurate communication across multiple care settings. However, in aged care multiple and poorly integrated data collection frameworks are commonly used for client assessment, government reporting and funding purposes. To determine key information needs in aged care settings to improve information quality, information transfer, safety, quality and continuity of care to meet the complex needs of aged care clients. Modified Delphi methods involving five stages were employed by one aged care provider in Victoria, Australia, to establish stakeholder consensus for a derived minimum data set and address barriers to data quality. Eleven different aged care programs were identified; with five related data dictionaries, three minimum data sets, five program standards or quality frameworks. The remaining data collection frameworks related to diseases classification, funding, service activity reporting, and statistical standards and classifications. A total of 170 different data items collected across seven internal information systems were consolidated to a derived set of 60 core data items and aligned with nationally consistent data collection frameworks. Barriers to data quality related to inconsistencies in data items, staff knowledge, workflow, system access and configuration. The development an internal aged care minimum data set highlighted the critical role of primary data quality in the upstream and downstream use of client information; and presents a platform to build national consistency across the sector.

  15. 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.

  16. Towards more efficient burn care: Identifying factors associated with good quality of life post-burn.

    Science.gov (United States)

    Finlay, V; Phillips, M; Allison, G T; Wood, F M; Ching, D; Wicaksono, D; Plowman, S; Hendrie, D; Edgar, D W

    2015-11-01

    As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n=106) was used to validate the predictive merit of the nomogram. Male gender (p=0.02), conservative management (p=0.03), upper limb burn (p=0.04) and high BSHS-B score within one month of burn (pburns were excluded due to loss to follow up. For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  17. Towards Improving the Transfer of Care of Kidney Transplant Recipients.

    Science.gov (United States)

    Gill, J S; Wright, A J; Delmonico, F L; Newell, K A

    2017-01-01

    Kidney transplant recipients require specialized medical care and may be at risk for adverse health outcomes when their care is transferred. This document provides opinion-based recommendations to facilitate safe and efficient transfers of care for kidney transplant recipients including minimizing the risk of rejection, avoidance of medication errors, ensuring patient access to immunosuppressant medications, avoidance of lapses in health insurance coverage, and communication of risks of donor disease transmission. The document summarizes information to be included in a medical transfer document and includes suggestions to help the patient establish an optimal therapeutic relationship with their new transplant care team. The document is intended as a starting point towards standardization of transfers of care involving kidney transplant recipients. © Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

  18. Involving patients in care decisions improves satisfaction: an outcomes-based quality improvement project.

    Science.gov (United States)

    Leff, Ellen W

    2004-05-01

    A home care agency used quality improvement processes to improve patient satisfaction survey ratings. The focus was on involving patients in decisions about their care. A multidisciplinary team developed creative strategies to increase staff awareness and enhance customer service skills, which had dramatic results.

  19. Improving quality of care among patients hospitalised with schizophrenia

    DEFF Research Database (Denmark)

    Jørgensen, Mette; Mainz, Jan; Svendsen, Marie Louise

    2015-01-01

    BACKGROUND: The effectiveness of systematic quality improvement initiatives in psychiatric care remains unclear. AIMS: To examine whether quality of care has changed following implementation of a systematic monitoring programme of hospital performance measures. METHOD: In a nationwide population.......27-1.62), psychoeducation (RR: 1.33, 95% CI: 1.19-1.48), psychiatric aftercare (RR: 1.06, 95% CI: 1.01-1.11) and suicide risk assessment (RR: 1.31, 95% CI: 1.21-1.42). CONCLUSIONS: Quality of care improved from 2004 to 2011 among patients hospitalised with schizophrenia in Denmark. DECLARATION OF INTEREST: None. COPYRIGHT...

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

    DEFF Research Database (Denmark)

    Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid

    2014-01-01

    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 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...

  1. 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.

  2. Improving patient satisfaction in glaucoma care

    Directory of Open Access Journals (Sweden)

    Islam S

    2017-12-01

    Full Text Available Samsul Islam, Ahmad Salha, Saeed Azizi Faculty of Medicine, St George’s Hospital Medical School, London, UKWe read the article by Foo et al1 with great interest. We were intrigued by the factors influencing satisfaction rates among glaucoma patients. It made us question what changes could be made in the future attempting to improve patient satisfaction.\tSimilar to Foo et al,1 we were also surprised to find a lower end-point intraocular pressure was linked with increased patient dissatisfaction. As stated by Foo et al,1 other studies exploring clinical outcomes and patient satisfaction found that a positive clinical state was linked to higher patient satisfaction. Prakash2 proposes a three-way association between patient satisfaction, increased compliance, and better clinical outcomes. Hence, in attempting to investigate patient satisfaction, it would be appropriate to assess patient compliance and clinical outcomes.View the original paper by Foo and colleagues.

  3. Ontario's primary care reforms have transformed the local care landscape, but a plan is needed for ongoing improvement.

    Science.gov (United States)

    Hutchison, Brian; Glazier, Richard

    2013-04-01

    Primary care in Ontario, Canada, has undergone a series of reforms designed to improve access to care, patient and provider satisfaction, care quality, and health system efficiency and sustainability. We highlight key features of the reforms, which included patient enrollment with a primary care provider; funding for interprofessional primary care organizations; and physician reimbursement based on varying blends of fee-for-service, capitation, and pay-for-performance. With nearly 75 percent of Ontario's population now enrolled in these new models, total payments to primary care physicians increased by 32 percent between 2006 and 2010, and the proportion of Ontario primary care physicians who reported overall satisfaction with the practice of medicine rose from 76 percent in 2009 to 84 percent in 2012. However, primary care in Ontario also faces challenges. There is no meaningful performance measurement system that tracks the impact of these innovations, for example. A better system of risk adjustment is also needed in capitated plans so that groups have the incentive to take on high-need patients. Ongoing investment in these models is required despite fiscal constraints. We recommend a clearly articulated policy road map to continue the transformation.

  4. Efficiency improvement of technological preparation of power equipment manufacturing

    Science.gov (United States)

    Milukov, I. A.; Rogalev, A. N.; Sokolov, V. P.; Shevchenko, I. V.

    2017-11-01

    Competitiveness of power equipment primarily depends on speeding-up the development and mastering of new equipment samples and technologies, enhancement of organisation and management of design, manufacturing and operation. Actual political, technological and economic conditions cause the acute need in changing the strategy and tactics of process planning. At that the issues of maintenance of equipment with simultaneous improvement of its efficiency and compatibility to domestically produced components are considering. In order to solve these problems, using the systems of computer-aided process planning for process design at all stages of power equipment life cycle is economically viable. Computer-aided process planning is developed for the purpose of improvement of process planning by using mathematical methods and optimisation of design and management processes on the basis of CALS technologies, which allows for simultaneous process design, process planning organisation and management based on mathematical and physical modelling of interrelated design objects and production system. An integration of computer-aided systems providing the interaction of informative and material processes at all stages of product life cycle is proposed as effective solution to the challenges in new equipment design and process planning.

  5. Efficiency improvement of flat plate solar collector using reflector

    Directory of Open Access Journals (Sweden)

    Himangshu Bhowmik

    2017-11-01

    Full Text Available Solar collectors are the main components of a solar heating system. The collectors collect the sun’s energy, transform this radiation into heat, and then transfer this heat into a fluid, water or air, which has many household or industrial applications. This paper introduces a new technology to improve the performance of the solar thermal collectors. The solar reflector used here with the solar collector to increase the reflectivity of the collector. Thus, the reflector concentrates both direct and diffuse radiation of the sun toward the collector. To maximize the intensity of incident radiation, the reflector was allowed to change its angle with daytime. The radiations coming from the sun’s energy were converted into heat, and then this heat was transferred to the collector fluid, water. A prototype of a solar water heating system was constructed and obtained the improvement of the collector efficiency around 10% by using the reflector. Thus, the present solar water heating systems having the best thermal performance compared to the available systems.

  6. Wound Care Center of Excellence: A Process for Continuous Monitoring and Improvement of Wound Care Quality.

    Science.gov (United States)

    Howell, Raelina S; Kohan, Lauren S; Woods, Jon S; Criscitelli, Theresa; Gillette, Brian M; Donovan, Virginia; Gorenstein, Scott

    2018-05-01

    To provide information about a study using a new process for continuous monitoring to improve chronic wound care quality.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After completing this continuing education activity, you should be better able to:1. Recognize problems associated with chronic wound care.2. Identify methods used in this project to improve care.3. Illustrate the findings from this and similar projects and implications for providing improved wound care.Patients with chronic wounds require complex care because of comorbidities that can affect healing. Therefore, the goal of this project was to develop a system of reviewing all hospitalized patients seen by the study authors' wound care service on a weekly basis to decrease readmissions, morbidity, and mortality. Weekly multidisciplinary conferences were conducted to evaluate patient data and systematically assess for adherence to wound care protocols, as well as to create and modify patient care plans. This review of pathology and the performance of root-cause analyses often led to improved patient care.

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

    Science.gov (United States)

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

    1997-01-01

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

  8. Agile, a guiding principle for health care improvement?

    Science.gov (United States)

    Tolf, Sara; Nyström, Monica E; Tishelman, Carol; Brommels, Mats; Hansson, Johan

    2015-01-01

    The purpose of this paper is to contribute to increased understanding of the concept agile and its potential for hospital managers to optimize design of organizational structures and processes to combine internal efficiency and external effectiveness. An integrative review was conducted using the reSEARCH database. Articles met the following criteria: first, a definition of agility; second, descriptions of enablers of becoming an agile organization; and finally, discussions of agile on multiple organizational levels. In total, 60 articles qualified for the final analysis. Organizational agility rests on the assumption that the environment is uncertain, ranging from frequently changing to highly unpredictable. Proactive, reactive or embracive coping strategies were described as possible ways to handle such uncertain environments. Five organizational capacities were derived as necessary for hospitals to use the strategies optimally: transparent and transient inter-organizational links; market sensitivity and customer focus; management by support for self-organizing employees; organic structures that are elastic and responsive; flexible human and resource capacity for timely delivery. Agile is portrayed as either the "new paradigm" following lean, the needed development on top of a lean base, or as complementary to lean in distinct hybrid strategies. Environmental uncertainty needs to be matched with coping strategies and organizational capacities to design processes responsive to real needs of health care. This implies that lean and agile can be combined to optimize the design of hospitals, to meet different variations in demand and create good patient management. While considerable value has been paid to strategies to improve the internal efficiency within hospitals, this review raise the attention to the value of strategies of external effectiveness.

  9. Interprofessional simulation to improve patient participation in transitional care.

    Science.gov (United States)

    Dyrstad, Dagrunn Nåden; Storm, Marianne

    2017-06-01

    Educating and training healthcare professionals is known to improve the quality of transitional care for older adults. Arranging interprofessional meetings for healthcare professionals might be useful to improve patient participation skills in transitional care. To describe the learning activities used in The Meeting Point programme, focusing on patient participation in transitional care, and assess whether they increase healthcare professionals' awareness of and competencies relating to patient participation in the transitional care of older patients. Data were collected as part of an educational intervention programme, The Meeting Point, including three seminars on 'Patient participation in the transitional care of older patients' and four follow-up meetings. Participants were nurses, care assistants, doctors, physiotherapists, patient coordinators and administrative personnel from hospital, nursing homes and home-based care services. The Meeting Point was organised around four pillars: introduction, teaching session, group work activity and plenary discussion. Qualitative data included log reports, summaries of meetings, notes from group work activities, and reports from participants and from follow-up meetings. Feedback from participants shows that they were satisfied with meeting healthcare professionals from other units of care. A film scenario was perceived relevant for group work activity and useful in focusing participants' attention to patient participation. Follow-up meetings show that some nursing home wards, the emergency department and one medical ward at the hospital continued with ongoing work to improve quality of care. Efforts included implementation of an observational waiting room with comfortable chairs, planning for discharge in hospital admission, a daily patient flow registration system and motivational interviewing during admission to nursing home. The description of the learning activities used at The Meeting Point seminars shows that they

  10. Improving the quality of depression and pain care in multiple sclerosis using collaborative care: The MS-care trial protocol.

    Science.gov (United States)

    Ehde, Dawn M; Alschuler, Kevin N; Sullivan, Mark D; Molton, Ivan P; Ciol, Marcia A; Bombardier, Charles H; Curran, Mary C; Gertz, Kevin J; Wundes, Annette; Fann, Jesse R

    2018-01-01

    Evidence-based pharmacological and behavioral interventions are often underutilized or inaccessible to persons with multiple sclerosis (MS) who have chronic pain and/or depression. Collaborative care is an evidence-based patient-centered, integrated, system-level approach to improving the quality and outcomes of depression care. We describe the development of and randomized controlled trial testing a novel intervention, MS Care, which uses a collaborative care model to improve the care of depression and chronic pain in a MS specialty care setting. We describe a 16-week randomized controlled trial comparing the MS Care collaborative care intervention to usual care in an outpatient MS specialty center. Eligible participants with chronic pain of at least moderate intensity (≥3/10) and/or major depressive disorder are randomly assigned to MS Care or usual care. MS Care utilizes a care manager to implement and coordinate guideline-based medical and behavioral treatments with the patient, clinic providers, and pain/depression treatment experts. We will compare outcomes at post-treatment and 6-month follow up. We hypothesize that participants randomly assigned to MS Care will demonstrate significantly greater control of both pain and depression at post-treatment (primary endpoint) relative to those assigned to usual care. Secondary analyses will examine quality of care, patient satisfaction, adherence to MS care, and quality of life. Study findings will aid patients, clinicians, healthcare system leaders, and policy makers in making decisions about effective care for pain and depression in MS healthcare systems. (PCORI- IH-1304-6379; clinicaltrials.gov: NCT02137044). This trial is registered at ClinicalTrials.gov, protocol NCT02137044. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Efficient rehabilitation care for joint replacement patients: skilled nursing facility or inpatient rehabilitation facility?

    Science.gov (United States)

    Tian, Wenqiang; DeJong, Gerben; Horn, Susan D; Putman, Koen; Hsieh, Ching-Hui; DaVanzo, Joan E

    2012-01-01

    There has been lengthy debate as to which setting, skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), is more efficient in treating joint replacement patients. This study aims to determine the efficiency of rehabilitation care provided by SNF and IRF to joint replacement patients with respect to both payment and length of stay (LOS). This study used a prospective multisite observational cohort design. Tobit models were used to examine the association between setting of care and efficiency. The study enrolled 948 knee replacement patients and 618 hip replacement patients from 11 IRFs and 7 SNFs between February 2006 and February 2007. Output was measured by motor functional independence measure (FIM) score at discharge. Efficiency was measured in 3 ways: payment efficiency, LOS efficiency, and stochastic frontier analysis efficiency. IRF patients incurred higher expenditures per case but also achieved larger motor FIM gains in shorter LOS than did SNF patients. Setting of care was not a strong predictor of overall efficiency of rehabilitation care. Great variation in characteristics existed within IRFs or SNFs and severity groups. Medium-volume facilities among both SNFs and IRFs were most efficient. Early rehabilitation was consistently predictive of efficient treatment. The advantage of either setting is not clear-cut. Definition of efficiency depends in part on preference between cost and time. SNFs are more payment efficient; IRFs are more LOS efficient. Variation within SNFs and IRFs blurred setting differences; a simple comparison between SNF and IRF may not be appropriate.

  12. Economic implications of neonatal intensive care unit collaborative quality improvement

    NARCIS (Netherlands)

    Rogowski, JA; Horbar, JD; Plsek, PE; Baker, LS; Deterding, J; Edwards, WH; Hocker, J; Kantak, AD; Lewallen, P; Lewis, W; Lewit, E; McCarroll, CJ; Mujsce, D; Payne, NR; Shiono, P; Soll, RF; Leahy, K

    Objective. To make measurable improvements in the quality and cost of neonatal intensive care using a multidisciplinary collaborative quality improvement model. Design. Interventional study. Data on treatment costs were collected for infants with birth weight 501 to 1500 g for the period of January

  13. 76 FR 61365 - Bundled Payments for Care Improvement Initiative

    Science.gov (United States)

    2011-10-04

    ...] Bundled Payments for Care Improvement Initiative AGENCY: Centers for Medicare & Medicaid Services (CMS...: Letter of Intent Submission Deadline: For Model 1 of this initiative, interested organizations must...-improvement.html . Application Submission Deadline: For Model 1 of this initiative, applications must be...

  14. Berkeley Lab Sheds Light on Improving Solar Cell Efficiency

    International Nuclear Information System (INIS)

    Lawrence Berkeley National Laboratory

    2007-01-01

    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

  15. Improving efficiency and reducing administrative burden through electronic communication.

    Science.gov (United States)

    Cook, Katlyn E; Ludens, Gail M; Ghosh, Amit K; Mundell, William C; Fleming, Kevin C; Majka, Andrew J

    2013-01-01

    The InBox messaging system is an internal, electronic program used at Mayo Clinic, Rochester, MN, to facilitate the sending, receiving, and answering of patient-specific messages and alerts. A standardized InBox was implemented in the Division of General Internal Medicine to decrease the time physicians, physician assistants, and nurse practitioners (clinicians) spend on administrative tasks and to increase efficiency. Clinicians completed surveys and a preintervention InBox pilot test to determine inefficiencies related to administrative burdens and defects (message entry errors). Results were analyzed using Pareto diagrams, value stream mapping, and root cause analysis to prioritize administrative-burden inefficiencies to develop a new, standardized InBox. Clinicians and allied health staff were the target of this intervention and received standardized InBox training followed by a postintervention pilot test for clinicians. Sixteen of 28 individuals (57%) completed the preintervention survey. Twenty-eight clinicians participated in 2 separate 8-day pilot tests (before and after intervention) for the standardized InBox. The number of InBox defects was substantially reduced from 37 (Pilot 1) to 7 (Pilot 2). Frequent InBox defects decreased from 25% to 10%. More than half of clinicians believed the standardized InBox positively affected their work, and 100% of clinicians reported no negative affect on their work. This project demonstrated the successful implementation of the standardized InBox messaging system. Initial assessments show substantial reduction of InBox entry defects and administrative tasks completed by clinicians. The findings of this project suggest increased clinician and allied health staff efficiency, satisfaction, improved clinician work-life balance, and decreased clinician burden caused by administrative tasks.

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

    International Nuclear Information System (INIS)

    D'Amato, Eduardo; Llacer, Carlos; Vicens, Hugo

    2001-01-01

    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. Streamlining cardiovascular clinical trials to improve efficiency and generalisability.

    Science.gov (United States)

    Zannad, Faiez; Pfeffer, Marc A; Bhatt, Deepak L; Bonds, Denise E; Borer, Jeffrey S; Calvo-Rojas, Gonzalo; Fiore, Louis; Lund, Lars H; Madigan, David; Maggioni, Aldo Pietro; Meyers, Catherine M; Rosenberg, Yves; Simon, Tabassome; Stough, Wendy Gattis; Zalewski, Andrew; Zariffa, Nevine; Temple, Robert

    2017-08-01

    Controlled trials provide the most valid determination of the efficacy and safety of an intervention, but large cardiovascular clinical trials have become extremely costly and complex, making it difficult to study many important clinical questions. A critical question, and the main objective of this review, is how trials might be simplified while maintaining randomisation to preserve scientific integrity and unbiased efficacy assessments. Experience with alternative approaches is accumulating, specifically with registry-based randomised controlled trials that make use of data already collected. This approach addresses bias concerns while still capitalising on the benefits and efficiencies of a registry. Several completed or ongoing trials illustrate the feasibility of using registry-based controlled trials to answer important questions relevant to daily clinical practice. Randomised trials within healthcare organisation databases may also represent streamlined solutions for some types of investigations, although data quality (endpoint assessment) is likely to be a greater concern in those settings. These approaches are not without challenges, and issues pertaining to informed consent, blinding, data quality and regulatory standards remain to be fully explored. Collaboration among stakeholders is necessary to achieve standards for data management and analysis, to validate large data sources for use in randomised trials, and to re-evaluate ethical standards to encourage research while also ensuring that patients are protected. The rapidly evolving efforts to streamline cardiovascular clinical trials have the potential to lead to major advances in promoting better care and outcomes for patients with cardiovascular disease. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Initial Steps for Quality Improvement of Obesity Care Across Divisions at a Tertiary Care Pediatric Hospital

    Directory of Open Access Journals (Sweden)

    Sheila Z. Chang

    2014-09-01

    Full Text Available Background: Pediatric subspecialists can participate in the care of obese children. Objective: To describe steps to help subspecialty providers initiate quality improvement efforts in obesity care. Methods: An anonymous patient data download, provider surveys and interviews assessed subspecialty providers’ identification and perspectives of childhood obesity and gathered information on perceived roles and care strategies. Participating divisions received summary analyses of quantitative and qualitative data and met with study leaders to develop visions for division/service-specific care improvement. Results: Among 13 divisions/services, subspecialists’ perceived role varied by specialty; many expressed the need for cross-collaboration. All survey informants agreed that identification was the first step, and expressed interest in obtaining additional resources to improve care. Conclusions: Subspecialists were interested in improving the quality and coordination of obesity care for patients across our tertiary care setting. Developing quality improvement projects to achieve greater pediatric obesity care goals starts with engagement of providers toward better identifying and managing childhood obesity.

  19. Improving the care of patients with cystic fibrosis (CF)

    Science.gov (United States)

    Khan, Ahsan Aftab; Nash, Edward F; Whitehouse, Joanna; Rashid, Rifat

    2017-01-01

    Background The West Midlands Adult Cystic Fibrosis (CF) Centre based at Birmingham Heartlands Hospital provides care for adults with CF in the West Midlands. People with CF are prone to pulmonary exacerbations, which often require inpatient admission for intravenous antibiotics. We observed that the admission process was efficient during working hours (9:00–17:00, Monday–Friday) when the CF team are routinely available, but out-of-working hours, there were delays in these patients being clerked and receiving their first antibiotic dose. We were concerned that this was resulting in quality and potential safety issues by causing delays in starting treatment and prolonging hospital inpatient stays. We therefore undertook a quality improvement project (QIP) aimed at addressing these issues. An initial survey showed median time to clerk of 5 hours, with 60% of patients missing their first dose of antibiotics and mean length of stay of 16 days. Methods We applied the Plan-Do-Study-Act (PDSA) cycle approach, with the first PDSA cycle involving raising awareness of the issue through education to doctors, nurses and patients. Results This led to a reduction of median time to clerk from 5 to 2 hours with 23% of patients missing their first antibiotic dose and mean length of stay reducing to 14 days. The second cycle involved introducing an admissions checklist and displaying education posters around the hospital, resulting in median time to clerk remaining at 2 hours but only 20% of patients missing their first antibiotic dose and the mean length of stay remaining at 14 days. Conclusion This QIP has improved the out-of-hours admissions process for adults with CF in our centre. We plan to review the longer term effects of the project including sustainability, effects on clinical outcomes and patient satisfaction. PMID:28959778

  20. 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.

  1. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

    Science.gov (United States)

    Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

    2016-01-01

    Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

  2. 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.

  3. Improving efficiency (optimization) of CIGS thin film solar cell using ...

    African Journals Online (AJOL)

    Jsc ,Voc , FF and Quantum efficiency (QE) decrease due to absorption of electrons of electrons to the surface of back connection and their participation in recomposition. Efficiency increases from 20.3399% to 21.3721% by increasing impurity density of absorbent layer and efficiency increases to 28.9266% and the quantum ...

  4. 75 FR 27341 - Increasing Market and Planning Efficiency Through Improved Software; Notice of Technical...

    Science.gov (United States)

    2010-05-14

    ..., ramp rates, and network topology), flexible dispatch, settlement calculations, transmission switching... Market and Planning Efficiency Through Improved Software; Notice of Technical Conference To Discuss Increasing Market and Planning Efficiency Through Improved Software May 7, 2010. Take notice that Commission...

  5. 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.

  6. Improving the efficiency of natural draft cooling towers

    Energy Technology Data Exchange (ETDEWEB)

    Smrekar, J. [Faculty of Mechanical Engineering, Askerceva 6, SI-1000 Ljubljana (Slovenia); Oman, J. [Faculty of Mechanical Engineering, Askerceva 6, SI-1000 Ljubljana (Slovenia)]. E-mail: janez.oman@fs.uni-lj.si; Sirok, B. [Faculty of Mechanical Engineering, Askerceva 6, SI-1000 Ljubljana (Slovenia)

    2006-06-15

    This study shows how the efficiency of a natural draft cooling tower can be improved by optimising the heat transfer along the cooling tower (CT) packing using a suitable water distribution across the plane area of the cooling tower. On the basis of cooling air measurements, it is possible to distribute the water in such a way that it approaches the optimal local water/air mass flow ratio and ensures the homogeneity of the heat transfer and a reduction of entropy generation, thus minimising the amount of exergy lost. The velocity and temperature fields of the air flow were measured with the aid of a remote control mobile robot unit that was developed to enable measurements at an arbitrary point above the spray zone over the entire plane area of the cooling tower. The topological structures of the moist air velocity profiles and the temperature profiles above the spray zone were used as input data for calculation of the local entropy generation in the tower. On the basis of the measured boundary conditions, a numerical analysis of the influence of the water distribution across the cooling tower's plane area on entropy generation and exergy destruction in the cooling tower was conducted.

  7. Improve the efficiency of PEMFC using neutron imaging

    International Nuclear Information System (INIS)

    Kim, Tae Joo; Shim, Chulmuu

    2010-01-01

    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 mm 2 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 10 6 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

  8. Improving the efficiency of natural draft cooling towers

    International Nuclear Information System (INIS)

    Smrekar, J.; Oman, J.; Sirok, B.

    2006-01-01

    This study shows how the efficiency of a natural draft cooling tower can be improved by optimising the heat transfer along the cooling tower (CT) packing using a suitable water distribution across the plane area of the cooling tower. On the basis of cooling air measurements, it is possible to distribute the water in such a way that it approaches the optimal local water/air mass flow ratio and ensures the homogeneity of the heat transfer and a reduction of entropy generation, thus minimising the amount of exergy lost. The velocity and temperature fields of the air flow were measured with the aid of a remote control mobile robot unit that was developed to enable measurements at an arbitrary point above the spray zone over the entire plane area of the cooling tower. The topological structures of the moist air velocity profiles and the temperature profiles above the spray zone were used as input data for calculation of the local entropy generation in the tower. On the basis of the measured boundary conditions, a numerical analysis of the influence of the water distribution across the cooling tower's plane area on entropy generation and exergy destruction in the cooling tower was conducted

  9. Retrofit of ammonia plant for improving energy efficiency

    International Nuclear Information System (INIS)

    Panjeshahi, M.H.; Ghasemian Langeroudi, E.; Tahouni, N.

    2008-01-01

    The aim of this work is to perform a retrofit study of an ammonia plant, in purpose of improving energy efficiency. As a common practice, one can divide an ammonia plant into two parts: the hot-end and the cold-end. In the hot section, two different options are investigated that both lead to a threshold condition and achieve maximum energy saving. The first option covers only process-to-process energy integration, while the second option considers some modification in the convection section of the primary reformer through a new arrangement of the heating coils. Thus, a considerable reduction in cooling water, HP steam and fuel gas consumption is achieved. In the cold section, retrofit study is dominated by reducing the amount of shaft work or power consumption in the refrigeration system. Application of the Combined Pinch and Exergy Analysis revealed that part of the shaft work, which was originally being used, was inefficient and could have been avoided in a well-integrated design. Therefore, by proposing optimum refrigeration levels, reasonable saving (15%) in power consumption was observed without the need for new investment

  10. CERAMIC MEMBRANE ENABLING TECHNOLOGY FOR IMPROVED IGCC EFFICIENCY

    International Nuclear Information System (INIS)

    Ravi Prasad

    2000-01-01

    The objective of this program is to conduct a technology development program to advance the state-of-the-art in ceramic Oxygen Transport Membranes (OTM) to the level required to produce step change improvements in process economics, efficiency, and environmental benefits for commercial IGCC systems and other applications. The IGCC program is focused on addressing key issues in materials, processing, manufacturing, engineering and system development that will make the OTM a commercial reality. The objective of the OTM materials development task is to identify a suitable material that can be formed into a thin film to produce the target oxygen flux. This requires that the material have an adequate permeation rate, and thermo-mechanical and thermo-chemical properties such that the material is able to be supported on the desired substrate and sufficient mechanical strength to survive the stresses involved in operation. The objective of the composite OTM development task is to develop the architecture and fabrication techniques necessary to construct stable, high performance, thin film OTMs supported on suitable porous, load bearing substrates. The objective of the process development task of this program to demonstrate the program objectives on a single OTM tube under test conditions simulating those of the optimum process cycle for the power plant

  11. 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.

  12. Palliative Care: Improving Nursing Knowledge, Attitudes, and Behaviors
.

    Science.gov (United States)

    Harden, Karen; Price, Deborah; Duffy, Elizabeth; Galunas, Laura; Rodgers, Cheryl

    2017-10-01

    Oncology nurses affect patient care at every point along the cancer journey. This creates the perfect opportunity to educate patients and caregivers about palliative care early and often throughout treatment. However, healthcare providers frequently do not have the knowledge and confidence to engage in meaningful conversations about palliative care.
. The specific aims were to improve oncology nurses' palliative care knowledge, attitudes, and behaviors by providing a palliative care nursing education program. An additional aim was to increase the number of conversations with patients and families about palliative care.
. This project had a pre-/post-test design to assess knowledge, attitudes, and behaviors at baseline and one month after implementation of an established education curriculum. The teaching strategy included one four-hour class for oncology RNs with topics about the definition of palliative care, pain and symptom management, and how to have palliative care conversations.
. Results showed a statistically significant difference after the educational intervention for knowledge, attitudes, and behaviors. The number of conversations with patients and caregivers about palliative and end-of-life care increased significantly.

  13. Improving children's access to health care: the role of decategorization.

    Science.gov (United States)

    Hughes, D C; Halfon, N; Brindis, C D; Newacheck, P W

    1996-01-01

    Far too many children in this country are unable to obtain the health care they need because of barriers that prohibit easy access. Among the most significant obstacles are financial barriers, including lack of adequate health insurance and inadequate funding of programs for low-income children and those with special health-care needs. Another set of "non-financial" barriers are related to the categorical nature of addressing children's health-care needs, which impedes access by increasing the complexity and burden of seeking care and discourages providers from providing care. Decategorization represents an appealing partial remedy to these problems because it can lead to fundamental and lasting changes in financing and delivering health services. The greatest appeal of decategorization is its potential to improve access to care with the expenditure of little or no new funds. Decategorization also holds considerable risk. Depending on how it is designed and implemented, decategorization may lead to diminished access to care by serving as a foil for budget cuts or by undermining essential standards of care. However, these risks do not negate the value of exploring decategorization as an approach that can be taken today to better organize services and ensure that existing resources adequately meet children's needs. In this report we examine the role of decategorization as a mechanism for removing the barriers to care that are created by categorical funding of health programs.

  14. Does Medical Malpractice Law Improve Health Care Quality?

    Science.gov (United States)

    Frakes, Michael; Jena, Anupam B.

    2016-01-01

    We assess the potential for medical liability forces to deter medical errors and improve health care treatment quality, identifying liability’s influence by drawing on variations in the manner by which states formulate the negligence standard facing physicians. Using hospital discharge records from the National Hospital Discharge Survey and clinically-validated quality metrics inspired by the Agency for Health Care Research and Quality, we find evidence suggesting that treatment quality may improve upon reforms that expect physicians to adhere to higher quality clinical standards. We do not find evidence, however, suggesting that treatment quality may deteriorate following reforms to liability standards that arguably condone the delivery of lower quality care. Similarly, we do not find evidence of deterioration in health care quality following remedy-focused liability reforms such as caps on non-economic damages awards. PMID:28479642

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    Kathryn Rost

    2011-01-01

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

  17. 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

  18. Parental care improves immunity in the seahorse (Hippocampus erectus).

    Science.gov (United States)

    Lin, Tingting; Zhang, Dong; Liu, Xin; Xiao, Dongxue

    2016-11-01

    In the present study, the sexual dimorphism in immune response in the seahorse Hippocampus erectus in which males compete for mates and invest heavily in parental care was assessed. Variability in immunocompetence in virginal seahorses with differing levels of sexual maturity (i.e., immaturity, early maturity and maturity) and with different mating statuses (i.e., virginal, experienced mating failure and experienced mating success) were analyzed by evaluating immune parameters in the plasma. Additionally, ultrastructural characteristics of the inner epithelium of the brood pouch were compared between males that had experienced mating failure and those that had succeeded. Generally, immunity in sexually mature virgin males was greater than in females, and mating competition significantly reduced males' immunity. However, parental care gave males stronger immune and metabolic abilities and resulted in their immunity significantly rebounding after a successful mating. The present study quantitatively clarifies, for the first time, how parental care and mating competition jointly affect immunity. Moreover, previous findings that females display more efficient immune defenses than males in conventional species (i.e., males are as competitor and females as care giver) and that males' immunity is higher than females' in the pipefish (i.e., females are as competitor and males as care giver) in combination with the present results indicate that parental care is a key factor for sexual dimorphism in immunity. The care-giving sex has strong immunity regardless of the sex in charge of mating competition or not. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Pulmonary Hypertension Care Center Network: Improving Care and Outcomes in Pulmonary Hypertension.

    Science.gov (United States)

    Sahay, Sandeep; Melendres-Groves, Lana; Pawar, Leena; Cajigas, Hector R

    2017-04-01

    Pulmonary hypertension (PH) is a chronic, progressive, life-threatening disease that requires expert multidisciplinary care. To facilitate this level of care, the Pulmonary Hypertension Association established across the United States a network of pulmonary hypertension care centers (PHCCs) with special expertise in PH, particularly pulmonary arterial hypertension, to raise the overall quality of care and outcomes for patients with this life-threatening disease. Since the inception of PHCCs in September 2014, to date 35 centers have been accredited in the United States. This model of care brings together physicians and specialists from other disciplines to provide care, facilitate basic and clinical research, and educate the next generation of providers. PHCCs also offer additional opportunities for improvements in PH care. The patient registry offered through the PHCCs is an organized system by which data are collected to evaluate the outcomes of patients with PH. This registry helps in detecting variations in outcomes across centers, thus identifying opportunities for improvement. Multiple tactics were undertaken to implement the strategic plan, training, and tools throughout the PHCC network. In addition, strategies to foster collaboration between care center staff and individuals with PH and their families are the cornerstone of the PHCCs. The Pulmonary Vascular Network of the American College of Chest Physicians believes this to be a positive step that will improve the quality of care delivered in the United States to patients with PH. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  20. EFFICIENT MEASURES FOR BURNOUT PREVENTION IN PALLIATIVE CARE

    Directory of Open Access Journals (Sweden)

    Cristina DOBRE

    2017-06-01

    Full Text Available The term burnout, meaning ”professional exhaustion”, was introduced by Herbert Freudenberger in 1974. On May 21, 2014 , the World Health Assembly, the decisional organ of the World Health Organization, voted the resolution for the integration and development of the capacity of palliative care services as a constituent part of the health systems. The resolution represents a major pace in the development of palliative care at world level, once the ministers responsible for the field took upon themselves - by means of information and training programs - the task of services’ development, mainly at community level, the support from the part of the next of kins, the elaboration of educational programs, of guides and clinical protocols for specialists, of instruments for the monitorization of the quality of services provided, an easier access of patients to medication, as well as partnerships with the civil society. Burnout is a state of emotional, mental and physical overfatigue caused by excessive and prolongued stress. It is installed mainly when the person affected with it feels care-worn and uncapable of fulfilling his/her usual duties. As the stress continues, he/she will come to lose the interest or motivation which made him/her assume a certain position in the organizational hierarchy. The burnout phenomenon includes three components: emotional exhaustion, depersonalization and lack of professional accomplishment. The main observations on the phenomenon indicate that, apparently, the burnout level in palliative care is not higher than in other services, such as intensive therapy or surgery. Nevertheless, mention should be made of a characteristic of the palliative care services which influences the burnout level, namely the emotional relation created between the patient and the medical team, as a result of the prolongued duration of the care services

  1. Study on the functional improvement of the CARE system

    International Nuclear Information System (INIS)

    Han, Seung Jae; Nam, K. W.; Kim, D. I.; Kim, D. S.; Kim, S. H.; Kang, W. S.; Kim, B. H.

    2003-12-01

    The CARE system was developed in order to protect the public during nuclear emergency in Korea by KINS staffs with cooperation of other concerned organizations. In this study, some improvements to be considered for effective operation of CARE system were drawn. In 2002, Emergency Technical Advisory Center was constructed. Following the function of this center, the CARE system should be enforced for effective analysis of the nuclear power plant operation and the severe accident as well as for another areas such as radiological accidents and physical protection. The modules in this system shall be expanded to analysis of broader radiological accidents by long-range consequences modelling and so on

  2. A Learning Collaborative Approach to Improve Primary Care STI Screening.

    Science.gov (United States)

    McKee, M Diane; Alderman, Elizabeth; York, Deborah V; Blank, Arthur E; Briggs, Rahil D; Hoidal, Kelsey E S; Kus, Christopher; Lechuga, Claudia; Mann, Marie; Meissner, Paul; Patel, Nisha; Racine, Andrew D

    2017-10-01

    The Bronx Ongoing Pediatric Screening (BOPS) project sought to improve screening for sexual activity and sexually transmitted infections (gonorrhea and chlamydia [GCC] and HIV) in a primary care network, employing a modified learning collaborative, real-time clinical data feedback to practices, improvement coaching, and a pay-for-quality monetary incentive. Outcomes are compared for 11 BOPS-participating sites and 10 non-participating sites. The quarterly median rate for documenting sexual activity status increased from 55% to 88% (BOPS sites) and from 13% to 74% (non-BOPS sites). GCC screening of sexually active youth increased at BOPS and non-BOPS sites. Screening at non-health care maintenance visits improved more at BOPS than non-BOPS sites. Data from nonparticipating sites suggests that introduction of an adolescent EMR template or other factors improved screening rates regardless of BOPS participation; BOPS activities appear to promote additional improvement of screening during non-health maintenance visits.

  3. Leading quality improvement in primary care: recommendations for success.

    Science.gov (United States)

    Van Hoof, Thomas J; Bisognano, Maureen; Reinertsen, James L; Meehan, Thomas P

    2012-09-01

    Leadership is increasingly recognized as a potential factor in the success of primary care quality improvement efforts, yet little is definitively known about which specific leadership behaviors are most important. Until more research is available, the authors suggest that primary care clinicians who are committed to developing their leadership skills should commit to a series of actions. These actions include embracing a theory of leadership, modeling the approach for others, focusing on the goal of improving patient outcomes, encouraging teamwork, utilizing available sources of power, and reflecting on one's approach in order to improve it. Primary care clinicians who commit themselves to such actions will be more effective leaders and will be more prepared as new research becomes available on this important factor. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Diabetic and Obese Patient Clinical Outcomes Improve During a Care Management Implementation in Primary Care.

    Science.gov (United States)

    Holtrop, Jodi Summers; Luo, Zhehui; Piatt, Gretchen; Green, Lee A; Chen, Qiaoling; Piette, John

    2017-10-01

    To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed. In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization. Targeted patients included diabetic patients with a hemoglobin A1c >9% and nondiabetic obese patients. Clinical values tracked were A1c, blood pressure, low-density lipoprotein, microalbumin, and weight. Clinically important improvements were demonstrated in the intervention versus comparison practices, with diabetic patients improving A1c control and obese patients experiencing weight loss. There was a 12% relative increase in the proportion of patients meeting the clinical target of A1c management practices lost 5% or more of their body weight as compared with 10% of comparison patients (adjusted relative improvement, 15%; CI, 2%-28%). These findings add to the growing evidence-base for the effectiveness of care management as an effective clinical practice with regard to improving diabetes- and obesity-related outcomes.

  5. Shared governance: a way to improve the care in an inpatient rehabilitation facility.

    Science.gov (United States)

    Torres, Audrey; Kunishige, Nalani; Morimoto, Denise; Hanzawa, Tracie; Ebesu, Mike; Fernandez, John; Nohara, Lynne; SanAgustin, Eliseo; Borg, Stephanie

    2015-01-01

    Rehabilitation care is specialized and individualized requiring effective and efficient communication to achieve optimal patient outcomes. To examine how effective implementation of shared governance could improve care delivery, promote patient-centered care, and improve patient outcomes. The shared governance approach included all members of the rehabilitation team (i.e., physical therapist, occupational therapist, speech therapist, registered nurse and nurse aide) and was implemented over 6 months. The major end products of this shared governance effort were improved staff communication, problem solving, patient outcomes, and staff satisfaction on our stroke and brain injury unit. When effectively implemented and sustained, shared governance between all rehabilitation team stakeholders can increase the effectiveness of communication along with more positive patient and staff outcomes. © 2014 Association of Rehabilitation Nurses.

  6. Improving care for patients whose recovery is uncertain. The AMBER care bundle: design and implementation.

    Science.gov (United States)

    Carey, Irene; Shouls, Susanna; Bristowe, Katherine; Morris, Michelle; Briant, Linda; Robinson, Carole; Caulkin, Ruth; Griffiths, Mathew; Clark, Kieron; Koffman, Jonathan; Hopper, Adrian

    2015-12-01

    Despite preferences to the contrary, 53% of deaths in England occur in hospital. Difficulties in managing clinical uncertainty can result in delayed recognition that a person may be approaching the end of life, and a failure to address his/her preferences. Planning and shared decision-making for hospital patients need to improve where an underlying condition responds poorly to acute medical treatment and there is a risk of dying in the next 1-2 months. This paper suggests an approach to improve this care. A care bundle (the AMBER care bundle) was designed by a multiprofessional development team, which included service users, utilising the model for improvement following an initial scoping exercise. The care bundle includes two identification questions, four subsequent time restricted actions and systematic daily follow-up. This paper describes the development and implementation of a care bundle. From August 2011 to July 2012, 638 patients received care supported by the AMBER care bundle. In total 42.8% died in hospital and a further 14.5% were readmitted as emergencies within 30 days of discharge. Clinical outcome measures are in development. It has been possible to develop a care bundle addressing a complex area of care which can be a lever for cultural change. The implementation of the AMBER care bundle has the potential to improve care of clinically uncertain hospital patients who may be approaching the end of life by supporting their recognition and prompting discussion of their preferences. Outcomes associated with its use are currently being formally evaluated. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Calibrating EASY-Care independence scale to improve accuracy

    Science.gov (United States)

    Jotheeswaran, A. T.; Dias, Amit; Philp, Ian; Patel, Vikram; Prince, Martin

    2016-01-01

    Background there is currently limited support for the reliability and validity of the EASY-Care independence scale, with little work carried out in low- or middle-income countries. Therefore, we assessed the internal construct validity and hierarchical and classical scaling properties among frail dependent older people in the community. Objective we assessed the internal construct validity and hierarchical and classical scaling properties among frail dependent older people in the community. Methods three primary care physicians administered EASY-Care comprehensive geriatric assessment for 150 frail and/or dependent older people in the primary care setting. A Mokken model was applied to investigate hierarchical scaling properties of EASY-Care independence scale, and internal consistency (Cronbach's alpha) of the scale was also examined. Results we found that EASY-Care independence scale is highly internally consistent and is a strong hierarchical scale, hence providing strong evidence for unidimensionality. However, two items in the scale (unable to use telephone and manage finances) had much lower item Loevinger H coefficients than others. Exclusion of these two items improved the overall internal consistency of the scale. Conclusions the strong performance of the EASY-Care independence scale among community-dwelling frail older people is encouraging. This study confirms that EASY-Care independence scale is highly internally consistent and a strong hierarchical scale. PMID:27496925

  8. SOEC efficiency and cost improvement Part 1 and 2

    International Nuclear Information System (INIS)

    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.

    2007-01-01

    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 0.8 Sr 0.2 MnO 3+d (LSM) show different initial performance and different electrochemical activation under SOEC conditions, a good mixed ionic electronic conductor La 0.8 Sr 0.2 CoO 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 material for solid oxide fuel

  9. 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

  10. 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.

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

    Science.gov (United States)

    Stelfox, Henry T; Niven, Daniel J; Clement, Fiona M; Bagshaw, Sean M; Cook, Deborah J; McKenzie, Emily; Potestio, Melissa L; Doig, Christopher J; O'Neill, Barbara; Zygun, David

    2015-01-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Lazarus, M.; Hill, D.; Cornland, D.W.; Heaps, C.; Hippel, D. von; Williams, R.

    1997-07-01

    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 (CO{sub 2}) 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 CO{sub 2} 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.

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

    International Nuclear Information System (INIS)

    Lazarus, M.; Hill, D.; Cornland, D.W.; Heaps, C.; Hippel, D. von; Williams, R.

    1997-01-01

    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 (CO 2 ) 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 CO 2 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

  14. Improving Care Teams' Functioning: Recommendations from Team Science.

    Science.gov (United States)

    Fiscella, Kevin; Mauksch, Larry; Bodenheimer, Thomas; Salas, Eduardo

    2017-07-01

    Team science has been applied to many sectors including health care. Yet there has been relatively little attention paid to the application of team science to developing and sustaining primary care teams. Application of team science to primary care requires adaptation of core team elements to different types of primary care teams. Six elements of teams are particularly relevant to primary care: practice conditions that support or hinder effective teamwork; team cognition, including shared understanding of team goals, roles, and how members will work together as a team; leadership and coaching, including mutual feedback among members that promotes teamwork and moves the team closer to achieving its goals; cooperation supported by an emotionally safe climate that supports expression and resolution of conflict and builds team trust and cohesion; coordination, including adoption of processes that optimize efficient performance of interdependent activities among team members; and communication, particularly regular, recursive team cycles involving planning, action, and debriefing. These six core elements are adapted to three prototypical primary care teams: teamlets, health coaching, and complex care coordination. Implementation of effective team-based models in primary care requires adaptation of core team science elements coupled with relevant, practical training and organizational support, including adequate time to train, plan, and debrief. Training should be based on assessment of needs and tasks and the use of simulations and feedback, and it should extend to live action. Teamlets represent a potential launch point for team development and diffusion of teamwork principles within primary care practices. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  15. [Improvement in the efficiency of a rehabilitation service using Lean Healthcare methodology].

    Science.gov (United States)

    Pineda Dávila, S; Tinoco González, J

    2015-01-01

    The aim of this study was to evaluate the reduction in costs and the increase in time devoted to the patient, by applying Lean Healthcare methodology. A multidisciplinary team was formed, setting up three potential areas for improvement by performing a diagnostic process, including the storage and standardization of materials, and professional tasks in the therapeutic areas, by implementing three Lean tools: kanban, 5S and 2P. Stored material costs decreased by 43%, the cost of consumables per patient treated by 19%, and time dedicated to patient treatment increased by 7%. The processes were standardized and "muda" (wastefulness) was eliminated, thus reducing costs and increasing the value to the patient. All this demonstrates that it is possible to apply tools of industrial origin to the health sector, with the aim of improving the quality of care and achieve maximum efficiency. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

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

    Science.gov (United States)

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

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  17. Interdependence in decision-making by medical consultants: implications for improving the efficiency of inpatient physician services.

    Science.gov (United States)

    Wilk, Adam S; Chen, Lena M

    2017-12-01

    Hospital administrators are seeking to improve efficiency in medical consultation services, yet whether consultants make decisions to provide more or less care is unknown. We examined how medical consultants account for prior consultants' care when determining whether to provide intensive consulting care or sign off in the treatment of complex surgical inpatients. We applied three distinct theoretical frameworks in the interpretation of our results. We performed a retrospective cohort study of consultants' care intensity, measured alternately using a dummy variable for providing two or more days consulting (versus one) and a continuous measure of total days consulting, with 100% Medicare claims data from 2007-2010. Our analytic samples included consults for beneficiaries undergoing coronary artery bypass grafting (n = 61,785) or colectomy (n = 33,460) in general acute care hospitals. We compared the care intensity of consultants who observed different patterns of consulting care before their initial consults using ordinary least squares regression models at the patient-physician dyad level, controlling for patient comorbidity and many other patient- and physician-level factors as well as hospital region and year fixed effects. Consultants were less likely to provide intensive consulting care with each additional prior consultant on the case (1.2-1.7 percent) or if a prior consultant rendered intensive consulting care (20.6-21.5 percent) but more likely when prior consults were more concentrated across consultants (2.9-3.1 percent). Effects on consultants' total days consulting were similar. On average, consultants appeared to calibrate their care intensity for individual patients to maximize their value to all patients. Interventions for improving consulting care efficiency should seek to facilitate (not constrain) consultants' decision-making processes.

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

    Science.gov (United States)

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

    2013-02-01

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

  19. Developing concepts for improved efficiency of robot work preparation

    NARCIS (Netherlands)

    Essers, M.S.; Vaneker, Thomas 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

  20. The Determinants of the Technical Efficiency of Acute Inpatient Care in Canada.

    Science.gov (United States)

    Wang, Li; Grignon, Michel; Perry, Sheril; Chen, Xi-Kuan; Ytsma, Alison; Allin, Sara; Gapanenko, Katerina

    2018-04-17

    To evaluate the technical efficiency of acute inpatient care at the pan-Canadian level and to explore the factors associated with inefficiency-why hospitals are not on their production frontier. Canadian Management Information System (MIS) database (CMDB) and Discharge Abstract Database (DAD) for the fiscal year of 2012-2013. We use a nonparametric approach (data envelopment analysis) applied to three peer groups (teaching, large, and medium hospitals, focusing on their acute inpatient care only). The double bootstrap procedure (Simar and Wilson 2007) is adopted in the regression. Information on inpatient episodes of care (number and quality of outcomes) was extracted from the DAD. The cost of the inpatient care was extracted from the CMDB. On average, acute hospitals in Canada are operating at about 75 percent efficiency, and this could thus potentially increase their level of outcomes (quantity and quality) by addressing inefficiencies. In some cases, such as for teaching hospitals, the factors significantly correlated with efficiency scores were not related to management but to the social composition of the caseload. In contrast, for large and medium nonteaching hospitals, efficiency related more to the ability to discharge patients to postacute care facilities. The efficiency of medium hospitals is also positively related to treating more clinically noncomplex patients. The main drivers of efficiency of acute inpatient care vary by hospital peer groups. Thus, the results provide different policy and managerial implications for teaching, large, and medium hospitals to achieve efficiency gains. © Health Research and Educational Trust.

  1. Improving Quality of Care in Patients with Liver Cirrhosis.

    Science.gov (United States)

    Saberifiroozi, Mehdi

    2017-10-01

    Liver cirrhosis is a major chronic disease in the field of digestive diseases. It causes more than one million deaths per year. Despite established evidence based guidelines, the adherence to standard of care or quality indicators are variable. Complete adherence to the recommendations of guidelines is less than 50%. To improve the quality of care in patients with cirrhosis, we need a more holistic view. Because of high rate of death due to cardiovascular disease and neoplasms, the care of comorbid conditions and risk factors such as smoking, hypertension, high blood sugar or cholesterol, would be important in addition to the management of primary liver disease. Despite a holistic multidisciplinary approach for this goal, the management of such patients should be patient centered and individualized. The diagnosis of underlying etiology and its appropriate treatment is the most important step. Definition and customizing the quality indicators for quality measure in patients are needed. Because most suggested quality indicators are designed for measuring the quality of care in decompensated liver cirrhosis, we need special quality indicators for compensated and milder forms of chronic liver disease as well. Training the patients for participation in their own management, design of special clinics with dedicated health professionals in a form of chronic disease model, is suggested for improvement of quality of care in this group of patients. Special day care centers by a dedicated gastroenterologist and a trained nurse may be a practical model for better management of such patients.

  2. Implementing Family Meetings Into a Respiratory Care Unit: A Care and Communication Quality Improvement Project.

    Science.gov (United States)

    Loeslie, Vicki; Abcejo, Ma Sunnimpha; Anderson, Claudia; Leibenguth, Emily; Mielke, Cathy; Rabatin, Jeffrey

    Substantial evidence in critical care literature identifies a lack of quality and quantity of communication between patients, families, and clinicians while in the intensive care unit. Barriers include time, multiple caregivers, communication skills, culture, language, stress, and optimal meeting space. For patients who are chronically critically ill, the need for a structured method of communication is paramount for discussion of goals of care. The objective of this quality improvement project was to identify barriers to communication, then develop, implement, and evaluate a process for semistructured family meetings in a 9-bed respiratory care unit. Using set dates and times, family meetings were offered to patients and families admitted to the respiratory care unit. Multiple avenues of communication were utilized to facilitate attendance. Utilizing evidence-based family meeting literature, a guide for family meetings was developed. Templates were developed for documentation of the family meeting in the electronic medical record. Multiple communication barriers were identified. Frequency of family meeting occurrence rose from 31% to 88%. Staff satisfaction with meeting frequency, meeting length, and discussion of congruent goals of care between patient/family and health care providers improved. Patient/family satisfaction with consistency of message between team members; understanding of medications, tests, and dismissal plan; and efficacy to address their concerns with the medical team improved. This quality improvement project was implemented to address the communication gap in the care of complex patients who require prolonged hospitalizations. By identifying this need, engaging stakeholders, and developing a family meeting plan to meet to address these needs, communication between all members of the patient's care team has improved.

  3. A model for ageing-home-care service process improvement

    OpenAIRE

    Yu, Shu-Yan; Shie, An-Jin

    2017-01-01

    The purpose of this study was to develop an integrated model to improve service processes in ageing-home-care. According to the literature, existing service processes have potential service failures that affect service quality and efficacy. However, most previous studies have only focused on conceptual model development using New Service Development (NSD) and fail to provide a systematic model to analyse potential service failures and facilitate managers developing solutions to improve the se...

  4. An efficient non hydrostatic dynamical care far high-resolution simulations down to the urban scale

    International Nuclear Information System (INIS)

    Bonaventura, L.; Cesari, D.

    2005-01-01

    Numerical simulations of idealized stratified flows aver obstacles at different spatial scales demonstrate the very general applicability and the parallel efficiency of a new non hydrostatic dynamical care far simulation of mesoscale flows aver complex terrain

  5. 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.

  6. The potential of crowdsourcing to improve patient-centered care.

    Science.gov (United States)

    Weiner, Michael

    2014-01-01

    Crowdsourcing (CS) is the outsourcing of a problem or task to a crowd. Although patient-centered care (PCC) may aim to be tailored to an individual's needs, the uses of CS for generating ideas, identifying values, solving problems, facilitating research, and educating an audience represent powerful roles that can shape both allocation of shared resources and delivery of personalized care and treatment. CS can often be conducted quickly and at relatively low cost. Pitfalls include bias, risks of research ethics, inadequate quality of data, inadequate metrics, and observer-expectancy effect. Health professionals and consumers in the US should increase their attention to CS for the benefit of PCC. Patients' participation in CS to shape health policy and decisions is one way to pursue PCC itself and may help to improve clinical outcomes through a better understanding of patients' perspectives. CS should especially be used to traverse the quality-cost curve, or decrease costs while preserving or improving quality of care.

  7. Choosing Wisely: Opportunities for Improving Value in Cancer Care Delivery?

    Science.gov (United States)

    Rocque, Gabrielle B; Williams, Courtney P; Jackson, Bradford E; Wallace, Audrey S; Halilova, Karina I; Kenzik, Kelly M; Partridge, Edward E; Pisu, Maria

    2017-01-01

    Patients, providers, and payers are striving to identify where value in cancer care can be increased. As part of the Choosing Wisely (CW) campaign, ASCO and the American Society for Therapeutic Radiology and Oncology have recommended against specific, yet commonly performed, treatments and procedures. We conducted a retrospective analysis of Medicare claims data to examine concordance with CW recommendations across 12 cancer centers in the southeastern United States. Variability for each measure was evaluated on the basis of patient characteristics and site of care. Hierarchical linear modeling was used to examine differences in average costs per patient by concordance status. Potential cost savings were estimated on the basis of a potential 95% adherence rate and average cost difference. The analysis included 37,686 patients with cancer with Fee-for-Service Medicare insurance. Concordance varied by CW recommendation from 39% to 94%. Patient characteristics were similar for patients receiving concordant and nonconcordant care. Significant variability was noted across centers for all recommendations, with as much as an 89% difference. Nonconcordance was associated with higher costs for every measure. If concordance were to increase to 95% for all measures, we would estimate a $19 million difference in total cost of care per quarter. These results demonstrate ample room for reduction of low-value care and corresponding costs associated with the CW recommendations. Because variability in concordance was driven primarily by site of care, rather than by patient factors, continued education about these low-value services is needed to improve the value of cancer care.

  8. EFFICIENCY IMPROVEMENT IN INDUSTRIAL BOILER BY FLUE GAS DUCT INSULATION

    OpenAIRE

    Sanjay H. Zala

    2017-01-01

    Now a days in industry major losses are find out so here we calculate these losses and find out efficiency of boiler. Boiler efficiency and energy losses from boiler are important parameter for any industry using boiler. In this work a detailed analysis was carried out for boiler at Anish Chemicals Bhavnagar. It is a combined water and fire tube boiler using biomass coal as fuel. Boiler efficiency calculated by direct method is in range of (78.5% to 81.6%). Major losses from boiler are heat ...

  9. Improving Family Meetings in Intensive Care Units: A Quality Improvement Curriculum.

    Science.gov (United States)

    Gruenewald, David A; Gabriel, Michelle; Rizzo, Dorothy; Luhrs, Carol A

    2017-07-01

    Family meetings in the intensive care unit are associated with beneficial outcomes for patients, their families, and health care systems, yet these meetings often do not occur in a timely, effective, reliable way. The Department of Veterans Affairs Comprehensive End-of-Life Care Implementation Center sponsored a national initiative to improve family meetings in Veterans Affairs intensive care units across the United States. Process measures of success for the initiative were identified, including development of a curriculum to support facility-based quality improvement projects to implement high-quality family meetings. Identified curriculum requirements included suitability for distance learning and applicability to many clinical intensive care units. Curriculum modules were cross-mapped to the "Plan-Do-Study-Act" model to aid in planning quality improvement projects. A questionnaire was e-mailed to users to evaluate the curriculum's effectiveness. Users rated the curriculum's effectiveness in supporting and achieving aims of the initiative as 3.6 on a scale of 0 (not effective) to 4 (very effective). Users adapted the curriculum to meet local needs. The number of users increased from 6 to 17 quality improvement teams in 2 years. All but 3 teams progressed to implementation of an action plan. Users were satisfied with the effectiveness and adaptability of a family-meeting quality improvement curriculum to support implementation of a quality improvement project in Veterans Affairs intensive care units. This tool may be useful in facilitating projects to improve the quality of family meetings in other intensive care units. ©2017 American Association of Critical-Care Nurses.

  10. 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.

  11. Improving end-of-life care: Recommendations from the IOM.

    Science.gov (United States)

    Dobbins, Elizabeth H

    2016-09-22

    A 2014 consensus report by the Institute of Medicine offers recommendations for healthcare providers to decrease unwanted care and improve the quality of life at the end of life. This article discusses the recommendations of interest to advanced practice registered nurses.

  12. Improving Quality of Care in Peptic Ulcer Bleeding

    DEFF Research Database (Denmark)

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

    2013-01-01

    OBJECTIVES:The treatment of peptic ulcer bleeding (PUB) is complex, and mortality remains high. We present results from a nationwide initiative to monitor and improve the quality of care (QOC) in PUB.METHODS:All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered...

  13. 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.

  14. Improving occupational health care for construction workers: a process evaluation

    NARCIS (Netherlands)

    Boschman, Julitta S.; van der Molen, Henk F.; Sluiter, Judith K.; Frings-Dresen, Monique H. W.

    2013-01-01

    To evaluate the process of a job-specific workers' health surveillance (WHS) in improving occupational health care for construction workers. From January to July 2012 were 899 bricklayers and supervisors invited for the job-specific WHS at three locations of one occupational health service

  15. Evidence-based care: an innovation to improve nursing practice ...

    African Journals Online (AJOL)

    Evidence-based care: an innovation to improve nursing practice globally. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... best available evidence from research findings, expert ideas from specialists in the various health ... need to be addressed to enhance utilization of the best available evidence in nursing practice.

  16. Strategies to Improve the Quality of Health Care - Learning from ...

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

    Improving access to primary health care and the quality of services in Latin American countries is urgently needed to address high health inequities in the region. ... International Water Resources Association, in close collaboration with IDRC, is holding a webinar titled “Climate change and adaptive water management: ...

  17. Quasi-Resonant Absorption for Quantum Efficiency Improvement in Detectors

    Data.gov (United States)

    National Aeronautics and Space Administration — Quasi-resonant absorption has been demonstrated to enhance the quantum efficiency of devices across the spectrum, but specifically it is a challenge in the UV...

  18. Combined cycle power plants: technological prospects for improving the efficiency

    International Nuclear Information System (INIS)

    Lauri, R.

    2009-01-01

    The combined cycle power plants characteristics are better than one course open to a closed loop presenting an electrical efficiency close to 60% do not reach for gas turbine engines for power plants and conventional steam engines. [it

  19. An Improved, Highly Efficient Method for the Synthesis of Bisphenols

    Directory of Open Access Journals (Sweden)

    L. S. Patil

    2011-01-01

    Full Text Available An efficient synthesis of bisphenols is described by condensation of substituted phenols with corresponding cyclic ketones in presence of cetyltrimethylammonium chloride and 3-mercaptopropionic acid as a catalyst in extremely high purity and yields.

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

    KAUST Repository

    Shono, Ahmad N.

    2014-01-01

    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

  1. Developing concepts for improved efficiency of robot work preparation

    OpenAIRE

    Essers, M.S.; Vaneker, Thomas 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 intelligent mobile robots that execute medium sized production runs. For a wide range of products, the machining tasks will be defined on an appropriate level, enabling control over the robots beha...

  2. Fertigation for improved water use efficiency and crop yield

    International Nuclear Information System (INIS)

    Al-Wabel, M.I.; Al-Jaloud, A.A.; Hussain, G.; Karimulla, S.

    2002-01-01

    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 ( 15 N) 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

  3. 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

  4. Improvement attributes in healthcare: implications for integrated care.

    Science.gov (United States)

    Harnett, Patrick John

    2018-04-16

    Purpose Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care. Design/methodology/approach This study is based on an integrative literature review on systemic improvement in healthcare. Findings A central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics. Practical implications Accommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process. Originality/value Shared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches.

  5. 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.

  6. Health care managers' views on and approaches to implementing models for improving care processes.

    Science.gov (United States)

    Andreasson, Jörgen; Eriksson, Andrea; Dellve, Lotta

    2016-03-01

    To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes. In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome. In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory. 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work. Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management. © 2015 John Wiley & Sons Ltd.

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

    Science.gov (United States)

    Mayer-Amberg, Norbert; Woltmann, Rainer; Walther, Stefanie

    2015-01-01

    The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various health-care 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 Integrated Care Initiative Schizophrenia has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialized nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient's departments, and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative) to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarized in a quality monitoring report. In addition, standardized patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre-post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented Integrated Care Initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia.

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

    Directory of Open Access Journals (Sweden)

    Norbert eMayer-Amberg

    2016-01-01

    Full Text Available 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 concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialised nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient’s departments and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarised in a quality monitoring report. In addition, standardised patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre-post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented integrated care initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia.

  9. Caring for LGBTQ patients: Methods for improving physician cultural competence.

    Science.gov (United States)

    Klein, Elizabeth W; Nakhai, Maliheh

    2016-05-01

    This article summarizes the components of a curriculum used to teach family medicine residents and faculty about LGBTQ patients' needs in a family medicine residency program in the Pacific Northwest region of the United States. This curriculum was developed to provide primary care physicians and physicians-in-training with skills to provide better health care for LGBTQ-identified patients. The curriculum covers topics that range from implicit and explicit bias and appropriate terminology to techniques for crafting patient-centered treatment plans. Additionally, focus is placed on improving the understanding of specific and unique barriers to competent health care encountered by LGBTQ patients. Through facilitated discussion, learners explore the health disparities that disproportionately affect LGBTQ individuals and develop skills that will improve their ability to care for LGBTQ patients. The goal of the curriculum is to teach family medicine faculty and physicians in training how to more effectively communicate with and treat LGBTQ patients in a safe, non-judgmental, and welcoming primary care environment. © The Author(s) 2016.

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

    Science.gov (United States)

    van Dam, P A; Verkinderen, L; Hauspy, J; Vermeulen, P; Dirix, L; Huizing, M; Altintas, S; Papadimitriou, K; 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 and breast cancer" and "benchmarking and breast cancer care", and we have added some data from personal experience. The current data clearly show that the use of QIs for breast cancer care, regular internal and external audit of performance of breast units, and benchmarking are effective to improve quality of care. Adherence to guidelines improves markedly (particularly regarding adjuvant treatment) and there are data emerging showing that this results in a better outcome. As quality assurance benefits patients, it will be a challenge for the medical and hospital community to develop affordable quality control systems, which are not leading to excessive workload.

  11. Improving the rate and quality of medicaid well child care exams in primary care practices.

    Science.gov (United States)

    Smith, Katy Duncan; Merchen, Eileen; Turner, Crystal D; Vaught, Cara; Fritz, Terrie; Mold, Jim

    2010-07-01

    Providing recommended well child care to children insured bythe Medicaid Program can be challenging. Members of the Department of Family and Preventive Medicine (DFPM) at the University of Oklahoma Health Sciences Center contracted to help practices improve the rates and quality of well child care visits within the Oklahoma Medicaid Program. Sixteen pediatric and family medicine practices in three Oklahoma counties chose to participate in this quality improvement initiative. The records of Sooner Care-insured children age 0-20 were reviewed for both rate and quality of well child care visits made during the previous twelve months. Performance feedback was provided. Practice guidelines, Sooner Care requirements, and tips from exemplary practices were provided. In two of the counties, a case manager helped practices with challenging patients. Practice Enhancement Assistants (PEAs) then helped practices implement a variety of strategies to increase visit rates and improve the quality of early and periodic screening, diagnosis, and treatment (EPSDT) visits. Information technology (IT) support was provided when needed. The average rates of visits, for all counties combined, increased. Visit rates increased more in the younger age groups (birth to two years). There was significant improvement in quality of visits. Rates and quality improved much more in some practices than in others. A combination of academic detailing, performance feedback, practice facilitation, case management, and IT support produced increases in the quality and rates of EPSDT exams.

  12. Improving nurse documentation and record keeping in stoma care.

    Science.gov (United States)

    Law, Lesley; Akroyd, Karen; Burke, Linda

    Evidence suggests that nurse documentation is often inconsistent and lacks a coherent and standardized approach. This article reports on research into the use of nurse documentation on a stoma care ward in a large London hospital, and explores the factors that may affect the process of record keeping by nursing staff. This study uses stoma care as a case study to explore the role of documentation on the ward, focusing on how this can be improved. It is based on quantitative and qualitative methods. The medical notes of 56 patients were analysed and in addition, focus groups with a number of nurses were undertaken. Quantitative findings indicate that although 80% of patients had a chart filed in their medical notes, only a small portion of the form was completed by nursing staff. Focus group findings indicate that this is because forms lacked standardization and because the language used was often ambiguous. Staff also felt that such documentation was not viewed by other nurses and so, was not effective in improving patient care. As a result of this study, significant improvements have been made to documentation used on the stoma care ward. This is an important exploration of record keeping within nursing in the context of the Nursing and Midwifery Council's emphasis on the importance of documentation in achieving effective patient outcomes.

  13. Improving regional variation using quality of care measures

    Directory of Open Access Journals (Sweden)

    Scott A Berkowitz

    2009-11-01

    Full Text Available Scott A Berkowitz1, Gary Gerstenblith1, Robert Herbert2, Gerard Anderson1,21Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Center for Hospital Finance and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAAbstract: There is significant regional variability in the quality of care provided in the United States. This article compares regional performance for three measures that focus on transitions in care, and the care of patients with multiple conditions. Admissions for people with ambulatory care-sensitive conditions, hospital readmissions within 30 days of discharge, and compliance with practice guidelines for people with three chronic conditions (congestive heart failure, chronic obstructive pulmonary disease, and diabetes were analyzed using data drawn from the Centers for Medicare & Medicaid Services’ Standard Analytic Files for 5% of a 2004 national sample of Medicare beneficiaries which was divided by hospital referral regions and regional performance. There were significant regional differences in performance which we hypothesize could be improved through better care coordination and system management.Keywords: performance, quality, chronic condition, ambulatory care, sensitive conditions, readmissions

  14. Benchmarking to improve the quality of cystic fibrosis care.

    Science.gov (United States)

    Schechter, Michael S

    2012-11-01

    Benchmarking involves the ascertainment of healthcare programs with most favorable outcomes as a means to identify and spread effective strategies for delivery of care. The recent interest in the development of patient registries for patients with cystic fibrosis (CF) has been fueled in part by an interest in using them to facilitate benchmarking. This review summarizes reports of how benchmarking has been operationalized in attempts to improve CF care. Although certain goals of benchmarking can be accomplished with an exclusive focus on registry data analysis, benchmarking programs in Germany and the United States have supplemented these data analyses with exploratory interactions and discussions to better understand successful approaches to care and encourage their spread throughout the care network. Benchmarking allows the discovery and facilitates the spread of effective approaches to care. It provides a pragmatic alternative to traditional research methods such as randomized controlled trials, providing insights into methods that optimize delivery of care and allowing judgments about the relative effectiveness of different therapeutic approaches.

  15. Development of a Medical Care Terminal for Efficient Monitoring of Bedridden Subjects

    OpenAIRE

    Pereira, Filipe; Carvalho, Vítor; Soares, Filomena; Machado, José; Bezerra, Karolina; Silva, Rui; Matos, Demétrio

    2016-01-01

    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 Lab VIE...

  16. Energy efficiency improvements in electric motors and drives

    Energy Technology Data Exchange (ETDEWEB)

    Bertoldi, P. [Commission of the European Communities, Brussels (Belgium). Directorate General for Energy; Ameida, A.T. de [Coimbra Univ. (Portugal). Dept. de Engenharia Electrotecnica; Falkner, H. [eds.] [AEA Technolgy, Harwell (United Kingdom). ETSU

    2000-07-01

    This book covers the state of the art of energy-efficient electric motor technologies, which can be used now and in the near future to achieve significant and cost-effective energy savings. Recent developments in advanced motor technologies by some of the largest manufacturers of motors and drives are also presented. Although energy-efficient motor technologies can save a huge amount of electricity, they still have not been widely adopted. The barriers which can hinder the adoption of those technologies are presented. Policies and programmes to promote the large scale penetration of energy-efficient technologies and the market transformation are featured in the book, describing the experiences carried out in different parts of the world. This extensive coverage includes contributions from relevant institutions in the European Union, North America, Latin America, Japan, Australia and New Zealand. (orig.)

  17. Improving nurse documentation and record keeping in stoma care

    OpenAIRE

    Law, Lesley; Akroyd, Karen; Burke, Linda

    2010-01-01

    Evidence suggests that nurse documentation is often inconsistent and lacks a coherent and standardized approach. This article reports on research into the use of nurse documentation on a stoma care ward in a large London hospital, and explores the factors that may affect the process of record keeping by nursing staff. This study uses stoma care as a case study to explore the role of documentation on the ward, focusing on how this can be improved. It is based on quantitative and qualitative me...

  18. Improving wound and pressure area care in a nursing home.

    Science.gov (United States)

    Sprakes, Kate; Tyrer, Julie

    Wound and pressure ulcer prevention are key quality indicators of nursing care. This article describes a collaborative project between a community skin care service and a nursing home. The aim of the project was to establish whether the implementation of a wound and pressure ulcer management competency framework within a nursing home would improve patient outcomes and reduce the severity and number of wounds and pressure ulcers. Following the project's implementation, there was a reduction in the number of wounds and pressure ulcers, hospital admissions and district nursing visits. Nursing home staff also reported an increase in their knowledge and skills.

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

    Directory of Open Access Journals (Sweden)

    Elizabeth H Bradley

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

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

    Science.gov (United States)

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

    2012-01-01

    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. 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. Effective health strengthening efforts may require intensive development of managerial problem solving skills, strong relationships with

  1. A Novel Design for Drug-Drug Interaction Alerts Improves Prescribing Efficiency.

    Science.gov (United States)

    Russ, Alissa L; Chen, Siying; Melton, Brittany L; Johnson, Elizabette G; Spina, Jeffrey R; Weiner, Michael; Zillich, Alan J

    2015-09-01

    Drug-drug interactions (DDIs) are common in clinical care and pose serious risks for patients. Electronic health records display DDI alerts that can influence prescribers, but the interface design of DDI alerts has largely been unstudied. In this study, the objective was to apply human factors engineering principles to alert design. It was hypothesized that redesigned DDI alerts would significantly improve prescribers' efficiency and reduce prescribing errors. In a counterbalanced, crossover study with prescribers, two DDI alert designs were evaluated. Department of Veterans Affairs (VA) prescribers were video recorded as they completed fictitious patient scenarios, which included DDI alerts of varying severity. Efficiency was measured from time-stamped recordings. Prescribing errors were evaluated against predefined criteria. Efficiency and prescribing errors were analyzed with the Wilcoxon signed-rank test. Other usability data were collected on the adequacy of alert content, prescribers' use of the DDI monograph, and alert navigation. Twenty prescribers completed patient scenarios for both designs. Prescribers resolved redesigned alerts in about half the time (redesign: 52 seconds versus original design: 97 seconds; p<.001). Prescribing errors were not significantly different between the two designs. Usability results indicate that DDI alerts might be enhanced by facilitating easier access to laboratory data and dosing information and by allowing prescribers to cancel either interacting medication directly from the alert. Results also suggest that neither design provided adequate information for decision making via the primary interface. Applying human factors principles to DDI alerts improved overall efficiency. Aspects of DDI alert design that could be further enhanced prior to implementation were also identified.

  2. Patient-centered medical homes improve care for adults with chronic conditions.

    Science.gov (United States)

    Pourat, Nadereh; Lavarreda, Shana Alex; Snyder, Sophie

    2013-05-01

    The success of health care reform implementation in 2014 partly depends on more efficient delivery of care to the millions of California residents eligible to gain insurance. Emerging evidence supports the effectiveness of the patient-centered medical home (PCMH) as a potential model of care delivery, which improves health outcomes and reduces costs. Among other principles, PCMH entails receipt of care from a personal doctor, who coordinates the patient's care and develops an individualized treatment plan for the patient. These principles are particularly essential in delivery of care to those with chronic conditions who require more intensive care management. Using the 2009 California Health Interview Survey (CHIS 2009), this policy brief indicates that patients who reported meeting these fundamental PCMH principles were more likely to have visited the doctor and to have received flu shots, and they also had better communication with providers than those who did not report meeting these PCMH principles. The data also showed that uninsured individuals, Medi-Cal beneficiaries, those at or below 133% of the federal poverty level, Latinos, and Asian-Americans were less likely to report meeting all three PCMH principles. These findings highlight the population groups that would most benefit from the PCMH care delivery model, particularly Medi-Cal beneficiaries and those eligible for Covered California, the California health benefits exchange.

  3. Regional hospital improves efficiency with co-generation retrofit.

    Science.gov (United States)

    Knutson, D; Anderson, L

    1999-11-01

    Feasibility analysis of the co-generation retrofit of the Red Deer Regional Hospital pointed to a reasonable payback of capital cost and increased efficiency in operation of the facility. Budget restrictions nearly stopped the project from proceeding. Innovative construction procedures proposed by the Facility Management Group, in particular, Mr Keith Metcalfe, Director of Maintenance, allowed a worthwhile project to reach successful completion. We feel that this model can perhaps be used by similar facilities in the future to achieve their energy efficiency goals.

  4. [Does public health insurance improve health care? The case of prenatal care for adolescents in Mexico].

    Science.gov (United States)

    Saavedra-Avendaño, Biani; Darney, Blair G; Reyes-Morales, Hortensia; Serván-Mori, Edson

    2016-01-01

    To test the association between public health insurance and adequate prenatal care among female adolescents in Mexico. Cross-sectional study, using the National Health and Nutrition Survey 2000, 2006, and 2012.We included 3 978 (N=4 522 296) adolescent (12-19) women who reported a live birth.We used logistic regression models to test the association of insurance and adequate (timeliness, frequency and content) prenatal care. The multivariable predicted probability of timely and frequent prenatal care improved over time, from 0.60 (IC95%:0.56;0.64) in 2000 to 0.71 (IC95%:0.66;0.76) in 2012. In 2012, the probability of adequate prenatal care was 0.54 (IC95%:0.49;0.58); women with Social Security had higher probability than women with Seguro Popular and without health insurance. Having Social Security is associated with receipt of adequate prenatal care among adolescents in Mexico.

  5. Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care

    Science.gov (United States)

    Lake, James; Turner, Mason Spain

    2017-01-01

    Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally. This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics. PMID:28898197

  6. A dementia care management intervention: which components improve quality?

    Science.gov (United States)

    Chodosh, Joshua; Pearson, Marjorie L; Connor, Karen I; Vassar, Stefanie D; Kaisey, Marwa; Lee, Martin L; Vickrey, Barbara G

    2012-02-01

    To analyze whether types of providers and frequency of encounters are associated with higher quality of care within a coordinated dementia care management (CM) program for patients and caregivers. Secondary analysis of intervention-arm data from a dementia CM cluster-randomized trial, where intervention participants interacted with healthcare organization care managers (HOCMs), community agency care managers (CACMs), and/ or healthcare organization primary care providers (HOPCPs) over 18 months. Encounters of 238 patient/caregivers (dyads) with HOCMs, CACMs, and HOPCPs were abstracted from care management electronic records. The quality domains of assessment, treatment, education/support, and safety were measured from medical record abstractions and caregiver surveys. Mean percentages of met quality indicators associated with exposures to each provider type and frequency were analyzed using multivariable regression, adjusting for participant characteristics and baseline quality. As anticipated, for all 4 domains, the mean percentage of met dementia quality indicators was 15.5 to 47.2 percentage points higher for dyads with HOCM--only exposure than for dyads with none (all P < .008); not anticipated were higher mean percentages with increasing combinations of provider-type exposure-up to 73.7 percentage points higher for safety (95% confidence interval 65.2%-82.1%) with exposure to all 3 provider types compared with no exposure. While greater frequency of HOCM-dyad encounters was associated with higher quality (P < .04), this was not so for other provider types. HOCMs' interactions with dyads was essential for dementia care quality improvement. Additional coordinated interactions with primary care and community agency staff yielded even higher quality.

  7. Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review.

    Science.gov (United States)

    Kruse, Florien M; Stadhouders, Niek W; Adang, Eddy M; Groenewoud, Stef; Jeurissen, Patrick P T

    2018-03-02

    European countries have enhanced the scope of private provision within their health care systems. Privatizing services have been suggested as a means to improve access, quality, and efficiency in health care. This raises questions about the relative performance of private hospitals compared with public hospitals. Most systematic reviews that scrutinize the performance of the private hospitals originate from the United States. A systematic overview for Europe is nonexisting. We fill this gap with a systematic realist review comparing the performance of public hospitals to private hospitals on efficiency, accessibility, and quality of care in the European Union. This review synthesizes evidence from Italy, Germany, the United Kingdom, France, Greece, Austria, Spain, and Portugal. Most evidence suggests that public hospitals are at least as efficient as or are more efficient than private hospitals. Accessibility to broader populations is often a matter of concern in private provision: Patients with higher social-economic backgrounds hold better access to private hospital provision, especially in private parallel systems such as the United Kingdom and Greece. The existing evidence on quality of care is often too diverse to make a conclusive statement. In conclusion, the growth in private hospital provision seems not related to improvements in performance in Europe. Our evidence further suggests that the private (for-profit) hospital sector seems to react more strongly to (financial) incentives than other provider types. In such cases, policymakers either should very carefully develop adequate incentive structures or be hesitant to accommodate the growth of the private hospital sector. Copyright © 2018 John Wiley & Sons, Ltd.

  8. Patients' expectations and solutions for improving primary diabetes care.

    Science.gov (United States)

    Vachon, Brigitte; Huynh, Ai-Thuy; Breton, Mylaine; Quesnel, Louise; Camirand, Michel; Leblanc, Jeannette; Tardif, Sylvie

    2017-07-10

    Purpose The purpose of this paper is to document health care needs expressed by people living with diabetes, describe the solutions they envisaged for improving the quality of primary care (PC) services and empower them to make better use of PC services. Design/methodology/approach A participatory research approach was used. Six workshops were organised to provide diabetes patients with knowledge on available services and to engage them in sharing their experience. Group discussions were recorded. Data were analysed using the thematic analysis method. Findings In total, 79 persons living with diabetes for a mean of 13 years participated. Needs expressed were grouped under seven themes: assurance of satisfactory follow-up by a family physician, continuous access to services adapted to evolving needs, motivation to adopt and maintain healthy behaviours, maintenance of knowledge about diabetes, psychological support, financial constraints, and collaboration with secondary-level services. Patients proposed solutions for improving services that were grouped under five themes: facilitating access to services, disseminating information about available services, centralising diabetes information on the internet, offering personalised services and improving interprofessional collaboration. Practical implications Needs expressed by diabetic patients concern different aspects of care such as accessibility, organisation, coordination, and better dissemination and visibility of services. The solutions proposed by patients focussed on better access to information and interprofessional services. Originality/value The workshop format used in this study offers an original and interesting approach and tool for actively engaging patients in quality improvement of services.

  9. Improving Farmers' Efficiency in Rice Production In Nigeria: The ...

    African Journals Online (AJOL)

    This paper assesses the effects of extension services on farmers' efficiency and productivity in rice production in Kano State, Nigeria. Data for the study were collected from 126 rice farmers selected using multi stage sampling technique. Stochastic production frontier function was estimated to ascertain the effects of ...

  10. Innovative financing for energy-efficiency improvements. Phase I report

    Energy Technology Data Exchange (ETDEWEB)

    Klepper, M.; Schwartz, H.K.; Feder, J.M.; Smith, D.C.; Green, R.H.; Williams, J.; Sherman, J.L.; Carroll, M.

    1982-01-01

    The use of utility-assisted financing, tax-exempt financing, bank financing, leasing, and joint venture financing to promote energy efficiency investments for each of three different categories of buildings (multifamily, commercial, and industrial) is discussed in separate chapters. (MCW)

  11. 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

    of the 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...

  12. Cambridge journals blog: Improving feed efficiency in dairy production

    Science.gov (United States)

    Because the cost of feeding animals is one of the greatest expenses in dairy production (40-60% of production costs), research focused on ways to identify and select for animals that are the most efficient at converting feed into milk has greatly expanded during the last decade. The animal Article o...

  13. 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.

  14. 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

  15. 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.

  16. Strategies for Improving siRNA-Induced Gene Silencing Efficiency.

    Science.gov (United States)

    Safari, Fatemeh; Rahmani Barouji, Solmaz; Tamaddon, Ali Mohammad

    2017-12-01

    Purpose: Human telomerase reverse transcriptase (hTERT) plays a crucial role in tumorigenesis and progression of cancers. Gene silencing of hTERT by short interfering RNA (siRNA) is considered as a promising strategy for cancer gene therapy. Various algorithms have been devised for designing a high efficient siRNA which is a significant issue in the clinical usage. Thereby, in the present study, the relation of siRNA designing criteria and the gene silencing efficiency was evaluated. Methods: The siRNA sequences were designed and characterized by using on line soft wares. Cationic co-polymer (polyethylene glycol-g-polyethylene imine (PEG-g-PEI)) was used for the construction of polyelectrolyte complexes (PECs) containing siRNAs. The cellular uptake of the PECs was evaluated. The gene silencing efficiency of different siRNA sequences was investigated and the effect of observing the rational designing on the functionality of siRNAs was assessed. Results: The size of PEG-g-PEI siRNA with N/P (Nitrogen/Phosphate) ratio of 2.5 was 114 ± 0.645 nm. The transfection efficiency of PECs was desirable (95.5% ± 2.4%.). The results of Real-Time PCR showed that main sequence (MS) reduced the hTERT expression up to 90% and control positive sequence (CPS) up to 63%. These findings demonstrated that the accessibility to the target site has priority than the other criteria such as sequence preferences and thermodynamic features. Conclusion: siRNA opens a hopeful window in cancer therapy which provides a convenient and tolerable therapeutic approach. Thereby, using the set of criteria and rational algorithms in the designing of siRNA remarkably affect the gene silencing efficiency.

  17. The impact of managed care penetration and hospital quality on efficiency in hospital staffing.

    Science.gov (United States)

    Mobley, Lee R; Magnussen, Jon

    2002-01-01

    The state of California has recently mandated minimum nurse-staffing ratios, raising concerns about possible affects on hospital efficiency. In this study, we examine how market factors and quality were related to staffing levels in California hospitals in 1995 (prior to implementation of the new law). We are particularly interested in the affect of managed care penetration on this aspect of hospital efficiency because the call to legislative action was predicated on fears that hospitals were reducing staffing below optimal levels in response to managed care pressures. We derive a unique measure of excess staffing in hospitals based on a data envelopment analysis (DEA) production function model, which explicitly includes ancillary care among the inputs and outputs. This careful specification of production is important because ancillary care use has risen relative to daily hospital services, with the spread of managed care and advances in medical technology. We find that market share (adjusted for size) and market concentration are the major determinants of excess staffing while managed care penetration is insignificant. We also find that poor quality (outcomes worse than expected) is associated with less efficient staffing. These findings suggest that the larger, more efficient urban hospitals will be penalized more heavily under binding staffing ratios than smaller, less-urban hospitals.

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

    Directory of Open Access Journals (Sweden)

    Meijboom Bert

    2010-09-01

    Full Text Available Abstract Background As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. Methods Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. Results Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. Conclusion The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to

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

    Science.gov (United States)

    2010-01-01

    Background As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. Methods Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. Results Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. Conclusion The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to elaborate on how to further

  20. Using a handbook to improve nurses' continence care.

    Science.gov (United States)

    Williams, K; Roe, B; Sindhu, F

    Nursing care should be based on sound research evidence with demonstrated clinical effectiveness. Dissemination of this research evidence is, therefore, of paramount importance. A study using focus groups was undertaken during 1993-1994 to evaluate the dissemination of a clinical handbook for continence care to qualified nurses, in relation to reported nursing practice in care of the elderly wards/units in one health authority. A total of 124 nurses participated in the study and 98 variables were included. Improvements were recorded in nurses' responses between the pre-test and post-test for 84 (86 per cent) variables in the experimental group and 58 (59 per cent) in the control group. This demonstrates the positive value of the clinical handbook as a method of disseminating research evidence.

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

    International Nuclear Information System (INIS)

    Velde Van de, A.; Burtak, F.

    2001-01-01

    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)

  2. Use of automated rendezvous trajectory planning to improve spacecraft operations efficiency

    Science.gov (United States)

    Mulder, Tom A.

    1991-01-01

    The current planning process for space shuttle rendezvous with a second Earth-orbiting vehicle is time consuming and costly. It is a labor-intensive, manual process performed pre-mission with the aid of specialized maneuver processing tools. Real-time execution of a rendezvous plan must closely follow a predicted trajectory, and targeted solutions leading up to the terminal phase are computed on the ground. Despite over 25 years of Gemini, Apollo, Skylab, and shuttle vehicle-to-vehicle rendezvous missions flown to date, rendezvous in Earth orbit still requires careful monitoring and cannot be taken for granted. For example, a significant trajectory offset was experienced during terminal phase rendezvous of the STS-32 Long Duration Exposure Facility retrieval mission. Several improvements can be introduced to the present rendezvous planning process to reduce costs, produce more fuel-efficient profiles, and increase the probability of mission success.

  3. Applying Toyota production system techniques for medication delivery: improving hospital safety and efficiency.

    Science.gov (United States)

    Newell, Terry L; Steinmetz-Malato, Laura L; Van Dyke, Deborah L

    2011-01-01

    The inpatient medication delivery system used at a large regional acute care hospital in the Midwest had become antiquated and inefficient. The existing 24-hr medication cart-fill exchange process with delivery to the patients' bedside did not always provide ordered medications to the nursing units when they were needed. In 2007 the principles of the Toyota Production System (TPS) were applied to the system. Project objectives were to improve medication safety and reduce the time needed for nurses to retrieve patient medications. A multidisciplinary team was formed that included representatives from nursing, pharmacy, informatics, quality, and various operational support departments. Team members were educated and trained in the tools and techniques of TPS, and then designed and implemented a new pull system benchmarking the TPS Ideal State model. The newly installed process, providing just-in-time medication availability, has measurably improved delivery processes as well as patient safety and satisfaction. Other positive outcomes have included improved nursing satisfaction, reduced nursing wait time for delivered medications, and improved efficiency in the pharmacy. After a successful pilot on two nursing units, the system is being extended to the rest of the hospital. © 2010 National Association for Healthcare Quality.

  4. The productivity and cost-efficiency of models for involving nurse practitioners in primary care: a perspective from queueing analysis.

    Science.gov (United States)

    Liu, Nan; D'Aunno, Thomas

    2012-04-01

    To develop simple stylized models for evaluating the productivity and cost-efficiencies of different practice models to involve nurse practitioners (NPs) in primary care, and in particular to generate insights on what affects the performance of these models and how. The productivity of a practice model is defined as the maximum number of patients that can be accounted for by the model under a given timeliness-to-care requirement; cost-efficiency is measured by the corresponding annual cost per patient in that model. Appropriate queueing analysis is conducted to generate formulas and values for these two performance measures. Model parameters for the analysis are extracted from the previous literature and survey reports. Sensitivity analysis is conducted to investigate the model performance under different scenarios and to verify the robustness of findings. Employing an NP, whose salary is usually lower than a primary care physician, may not be cost-efficient, in particular when the NP's capacity is underutilized. Besides provider service rates, workload allocation among providers is one of the most important determinants for the cost-efficiency of a practice model involving NPs. Capacity pooling among providers could be a helpful strategy to improve efficiency in care delivery. The productivity and cost-efficiency of a practice model depend heavily on how providers organize their work and a variety of other factors related to the practice environment. Queueing theory provides useful tools to take into account these factors in making strategic decisions on staffing and panel size selection for a practice model. © Health Research and Educational Trust.

  5. The improving efficiency frontier of religious not-for-profit hospitals.

    Science.gov (United States)

    Harrison, Jeffrey P; Sexton, Christopher

    2006-01-01

    By using data-envelopment analysis (DEA), this study evaluates the efficiency of religious not-for-profit hospitals. Hospital executives, healthcare policy makers, taxpayers, and other stakeholders benefit from studies that improve hospital efficiency. Results indicate that overall efficiency in religious hospitals improved from 72% in 1998 to 74% in 2001. What is more important is that the number of religious hospitals operating on the efficiency frontier increased from 40 in 1998 to 47 in 2001. This clearly documents that religious hospitals are becoming more efficient in the management of resources. From a policy perspective, this study highlights the economic importance of encouraging increased efficiency throughout the healthcare industry.

  6. Improving efficiencies of irrigation and nitrogen uptake in wheat

    International Nuclear Information System (INIS)

    Bazza, M.

    2000-01-01

    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)

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

    Science.gov (United States)

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

    2014-01-01

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

  8. Evaluation and Improvement of Lighting Efficiency in Working Spaces

    OpenAIRE

    Ana Castillo-Martinez; Jose-Amelio Medina-Merodio; Jose-Maria Gutierrez-Martinez; Juan Aguado-Delgado; Carmen de-Pablos-Heredero; Salvador Otón

    2018-01-01

    Lighting is an essential element for modern life, promoting a sense of wellbeing for users. However, bad illumination may produce health problems such as headaches and fatigue, among other vision problems. For that reason, this paper proposes the development of a smartphone-based application to help in lighting evaluation to guarantee the compliance of illumination regulations and to help increase illuminance efficiency, reducing its energy consumption. To perform this evaluation, the smartph...

  9. Alternative Practices to Improve Surface Fleet Fuel Efficiency

    Science.gov (United States)

    2014-09-01

    through changes in procedures and operational modifications. iENCON uses BBLs/hr (barrels per hour) to evaluate the change in fuel efficiency (Pehlivan...policies and procedures that can be changed to continue the Navy’s efforts in the reduction of fuel consumption. Chapter III addresses drift...and four main engines. In a “full power” lineup all four engines are online. In a “split plant” lineup two engines remain online, one per shaft

  10. 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.

  11. Efficiency of hydrogen peroxide in improving disinfection of ICU rooms.

    Science.gov (United States)

    Blazejewski, Caroline; Wallet, Frédéric; Rouzé, Anahita; Le Guern, Rémi; Ponthieux, Sylvie; Salleron, Julia; Nseir, Saad

    2015-02-02

    The primary objective of this study was to determine the efficiency of hydrogen peroxide (H₂O₂) techniques in disinfection of ICU rooms contaminated with multidrug-resistant organisms (MDRO) after patient discharge. Secondary objectives included comparison of the efficiency of a vaporizator (HPV, Bioquell) and an aerosolizer using H₂O₂, and peracetic acid (aHPP, Anios) in MDRO environmental disinfection, and assessment of toxicity of these techniques. This prospective cross-over study was conducted in five medical and surgical ICUs located in one University hospital, during a 12-week period. Routine terminal cleaning was followed by H₂O₂ disinfection. A total of 24 environmental bacteriological samplings were collected per room, from eight frequently touched surfaces, at three time-points: after patient discharge (T0), after terminal cleaning (T1) and after H₂O₂ disinfection (T2). In total 182 rooms were studied, including 89 (49%) disinfected with aHPP and 93 (51%) with HPV. At T0, 15/182 (8%) rooms were contaminated with at least 1 MDRO (extended spectrum β-lactamase-producing Gram-negative bacilli 50%, imipenem resistant Acinetobacter baumannii 29%, methicillin-resistant Staphylococcus aureus 17%, and Pseudomonas aeruginosa resistant to ceftazidime or imipenem 4%). Routine terminal cleaning reduced environmental bacterial load (P disinfection efficiency.

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

    International Nuclear Information System (INIS)

    Loovere, L.; Boyle, E.M.; Blatz, S.; Bowslaugh, M.; Kereliuk, M.; Paes, B.

    2008-01-01

    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)

  13. [Robotics and improvement of the quality of geriatric care].

    Science.gov (United States)

    Ettore, Éric; Wyckaert, Emeline; David, Renaud; Robert, Philippe; Guérin, Olivier; Prate, Frédéric

    2016-01-01

    New technologies offer innovations to improve the care of the elderly with Alzheimer's or and other forms of dementia. Robots, endowed with features such as monitoring of physiological parameters, cognitive training or occupational therapy, have appeared. They are not, however, intended to replace humans. Still underutilized, these robots are in development, much like the digital literacy of the elderly. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  14. A Multiorganization Approach to Improving Palliative Care in Honduras.

    Science.gov (United States)

    Kennedy Sheldon, Lisa; Dahlin, Constance; Maingi, Shail; Sanchez, Jose

    2017-01-01

    Since 2011, oncology nurses and physicians in the United States have been volunteering in Honduras with the International Cancer Corps (ICC), organized by the American Society of Clinical Oncology (ASCO), in partnership with Health Volunteers Overseas (HVO). In this article, the authors will summarize the work of the ASCO/HVO ICC teams that developed educational programs with local partners to improve cancer and palliative care in Honduras.

  15. Leveraging Interactive Patient Care Technology to Improve Pain Management Engagement.

    Science.gov (United States)

    Rao-Gupta, Suma; Kruger, David; Leak, Lonna D; Tieman, Lisa A; Manworren, Renee C B

    2017-12-15

    Most children experience pain in hospitals; and their parents report dissatisfaction with how well pain was managed. Engaging patients and families in the development and evaluation of pain treatment plans may improve perceptions of pain management and hospital experiences. The aim of this performance improvement project was to engage patients and families to address hospitalized pediatric patients' pain using interactive patient care technology. The goal was to stimulate conversations about pain management expectations and perceptions of treatment plan effectiveness among patients, parents, and health care teams. Plan-Do-Study-Act was used to design, develop, test, and pilot new workflows to integrate the interactive patient care technology system with the automated medication dispensing system and document actions from both systems into the electronic health record. The pediatric surgical unit and hematology/oncology unit of a free-standing, university-affiliated, urban children's hospital were selected to pilot this performance improvement project because of the high prevalence of pain from surgeries and hematologic and oncologic diseases, treatments, and invasive procedures. Documentation of pain assessments, nonpharmacologic interventions, and evaluation of treatment effectiveness increased. The proportion of positive family satisfaction responses for pain management significantly increased from fiscal year 2014 to fiscal year 2016 (p = .006). By leveraging interactive patient care technologies, patients and families were engaged to take an active role in pain treatment plans and evaluation of treatment outcomes. Improved active communication and partnership with patients and families can effectively change organizational culture to be more sensitive to patients' pain and patients' and families' hospital experiences. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  16. Nine-point plan to improve care of the injured patient: A case study from Kenya.

    Science.gov (United States)

    Bachani, Abdulgafoor M; Botchey, Isaac; Paruk, Fatima; Wako, Daniel; Saidi, Hassan; Aliwa, Bethuel; Kibias, Simon; Hyder, Adnan A

    2017-12-01

    Injury rates in low- and middle-income countries are among the greatest in the world, with >90% of unintentional injury occurring in low- or middle-income countries. The risk of death from injuries is 6 times more in low- and middle-income countries than in high-income countries. This increased rate of injury is partly due to the lack of availability and access to timely and appropriate medical care for injured individuals. Kenya, like most low- and middle-income countries, has seen a 5-fold increase in injury fatalities throughout the past 4 decades, in large part related to the absence of a coordinated, integrated system of trauma care. We aimed to assess the trauma-care system in Kenya and to develop and implement a plan to improve it. A trauma system profile was performed to understand the landscape for the care of the injured patient in Kenya. This process helped identify key gaps in care ranging from prehospital to hospital-based care. In response to this observation, a 9-point plan to improve trauma care in Kenya was developed and implemented in close collaboration with local stakeholders. The 9-point plan was centered on engagement of the stakeholders, generation of key data to guide and improve services, capacity development for prehospital and hospital care, and strengthening policy and legislation. There is an urgent need for coordinated strategies to provide appropriate and timely medical care to injured individuals in low- or middle-income countries to decrease the burden of injuries and related fatalities. Our work in Kenya shows that such an integrated system of trauma care could be achieved through a step-by-step integrated and multifaceted approach that emphasizes engagement of local stakeholders and evidence-based approaches to ensure effectiveness, efficiency, and sustainability of system-wide improvements. This plan and lessons learned in its development and implementation could be adaptable to other similar settings to improve the care of the

  17. The Critical Care Communication project: improving fellows' communication skills.

    Science.gov (United States)

    Arnold, Robert M; Back, Anthony L; Barnato, Amber E; Prendergast, Thomas J; Emlet, Lillian L; Karpov, Irina; White, Patrick H; Nelson, Judith E

    2015-04-01

    The aim of this study was to develop an evidence-based communication skills training workshop to improve the communication skills of critical care fellows. Pulmonary and critical care fellows (N = 38) participated in a 3-day communication skills workshop between 2008 and 2010 involving brief didactic talks, faculty demonstration of skills, and faculty-supervised small group skills practice sessions with simulated families. Skills included the following: giving bad news, achieving consensus on goals of therapy, and discussing the limitations of life-sustaining treatment. Participants rated their skill levels in a pre-post survey in 11 core communication tasks using a 5-point Likert scale. Of 38 fellows, 36 (95%) completed all 3 days of the workshop. We compared pre and post scores using the Wilcoxon signed rank test. Overall, self-rated skills increased for all 11 tasks. In analyses by participant, 95% reported improvement in at least 1 skill; with improvement in a median of 10 of 11 skills. Ninety-two percent rated the course as either very good/excellent, and 80% recommended that it be mandatory for future fellows. This 3-day communication skills training program increased critical care fellows' self-reported family meeting communication skills. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. 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"?

  19. Using standardized insulin orders to improve patient safety in a tertiary care centre.

    Science.gov (United States)

    Doyle, Mary-Anne; Brez, Sharon; Sicoli, Silvana; De Sousa, Filomena; Keely, Erin; Malcom, Janine C

    2014-04-01

    To standardize insulin prescribing practices for inpatients, improve management of hypoglycemia, reduce reliance on sliding scales, increase use of basal-bolus insulin and improve patient safety. Patients with diabetes were admitted to 2 pilot inpatient units followed by corporate spread to all insulin-treated patients on noncritical care units in a Canadian tertiary care multicampus teaching hospital. Standardized preprinted insulin and hypoglycemia management orders, decision support tools and multidisciplinary education strategies were developed, tested and implemented by way of the Model for Improvement and The Ottawa Model for Research Process. Clinical and balance measures were evaluated through statistical process control. Patient safety was improved through a reduction in hypoglycemia and decreased dependence on correctional scales. Utilization of the preprinted orders approached the target of 70% at the end of the test period and was sustained at 89% corporately 3 years post-implementation. The implementation of a standardized, preprinted insulin order set facilitates best practices for insulin therapy, improves patient safety and is highly supported by treating practitioners. The utilization of formal quality-improvement methodology promoted efficiency, enhanced sustainability, increased support among clinicians and senior administrators, and was effective in instituting sustained practice change in a complex care centre. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  20. Generic project definitions for improvement of health care delivery: a case-based approach.

    Science.gov (United States)

    Niemeijer, Gerard C; Does, Ronald J M M; de Mast, Jeroen; Trip, Albert; van den Heuvel, Jaap

    2011-01-01

    The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning approach to project definition. Data sources were project documentation and hospital-performance statistics of 271 Lean Six Sigma health care projects from 2002 to 2009 of general, teaching, and academic hospitals in the Netherlands and Belgium. Objectives and operational definitions of improvement projects in the sample, analyzed and structured in a uniform format and terminology. Extraction of reusable elements of earlier project definitions, presented in the form of 9 templates called generic project definitions. These templates function as exemplars for future process improvement projects, making the selection, definition, and operationalization of similar projects more efficient. Each template includes an explicated rationale, an operationalization in the form of metrics, and a prototypical example. Thus, a process of incremental and sustained learning based on case-based reasoning is facilitated. The quality of project definitions is a crucial success factor in pursuits to improve health care delivery. We offer 9 tried and tested improvement themes related to patient safety, patient satisfaction, and business-economic performance of hospitals.

  1. Expected Improvements in Work Truck Efficiency Through Connectivity and Automation

    Energy Technology Data Exchange (ETDEWEB)

    Walkowicz, Kevin A [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2018-03-12

    This presentation focuses on the potential impact of connected and automated technologies on commercial vehicle operations. It includes topics such as the U.S. Department of Energy's Energy Efficient Mobility Systems (EEMS) program and the Systems and Modeling for Accelerated Research in Transportation (SMART) Mobility Initiative. It also describes National Renewable Energy Laboratory (NREL) research findings pertaining to the potential energy impacts of connectivity and automation and stresses the need for integration and optimization to take advantage of the benefits offered by these transformative technologies while mitigating the potential negative consequences.

  2. Improving efficiency of polystyrene concrete production with composite binders

    Science.gov (United States)

    Lesovik, R. V.; Ageeva, M. S.; Lesovik, G. A.; Sopin, D. M.; Kazlitina, O. V.; Mitrokhina, A. A.

    2018-03-01

    According to leading marketing researchers, the construction market in Russia and CIS will continue growing at a rapid rate; this applies not only to a large-scale major construction, but to a construction of single-family houses and small-scale industrial facilities as well. Due to this, there are increased requirements for heat insulation of the building enclosures and a significant demand for efficient walling materials with high thermal performance. All these developments led to higher requirements imposed on the equipment that produces such materials.

  3. Diphosphonic acid complexants for improved separation efficiency of transuranic elements

    International Nuclear Information System (INIS)

    Nash, K.L.

    1994-01-01

    A study was made of the thermodynamics of protonation and complexation of Eu(III), Th(IV), and U(VI) by a series of simple diphosphonic acid chelating agents to assess the potential for application in actinide waste processing. It was found that the strongest complexes are formed with ligands having two phosphonate binding groups on the same C atom (1,1-diphosphonates) and that the water-soluble complexes are formed with protonated ligand species. More efficient separation/recovery processes could be designed using these ligands

  4. A scoping review of patient discharge from intensive care: opportunities and tools to improve care.

    Science.gov (United States)

    Stelfox, Henry T; Lane, Dan; Boyd, Jamie M; Taylor, Simon; Perrier, Laure; Straus, Sharon; Zygun, David; Zuege, Danny J

    2015-02-01

    We conducted a scoping review to systematically review the literature reporting patient discharge from ICUs, identify facilitators and barriers to high-quality care, and describe tools developed to improve care. We searched Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Data were extracted on the article type, study details for research articles, patient population, phase of care during discharge, and dimensions of health-care quality. From 8,154 unique publications we included 224 articles. Of these, 131 articles (58%) were original research, predominantly case series (23%) and cohort (16%) studies; 12% were narrative reviews; and 11% were guidelines/policies. Common themes included patient and family needs/experiences (29% of articles) and the importance of complete and accurate information (26%). Facilitators of high-quality care included provider-patient communication (30%), provider-provider communication (25%), and the use of guidelines/policies (29%). Patient and family anxiety (21%) and limited availability of ICU and ward resources (26%) were reported barriers to high-quality care. A total of 47 tools to facilitate patient discharge from the ICU were identified and focused on patient evaluation for discharge (29%), discharge planning and teaching (47%), and optimized discharge summaries (23%). Common themes, facilitators and barriers related to patient and family needs/experiences, communication, and the use of guidelines/policies to standardize patient discharge from ICU transcend the literature. Candidate tools to improve care are available; comparative evaluation is needed prior to broad implementation and could be tested through local quality-improvement programs.

  5. Efficiency improvement of variable speed electrical drives for HVAC applications

    Energy Technology Data Exchange (ETDEWEB)

    Abrahamsen, F.; Blaabjerg, F.; Pedersen, J.K. [Aalborg Univ., Inst. of Energy Technology, Aalborg East (Denmark)

    2000-07-01

    A large part of the produced electrical energy is consumed by ventilators, pumps and compressors, the so-called HVAC applications. A lot of this energy can be saved by speed control, but even with the large saving obtained alone by introduction of variable speed, it is still essential to optimise the control of the variable speed drive and to optimise the electrical machine with respect to efficiency. Experiments are made with energy optimal induction motor control on a 2.2 kW variable speed pump system. It is demonstrated that 10% of the consumed energy can typically be saved by energy optimal motor control compared with constant V/Hz control. In a comparison of induction motors and permanent magnet synchronous motors for a variable speed pump application it is shown that for 2.2 kW motors an investment in high-efficiency or PM motors are typically paid back within 2.5 years and 7 years respectively. For a 90 kW PM motor the pay-back time would be 24 years. It is today not profitable to use PM motors for variable speed HVAC applications above 2 kW rated motor power. A further study is required to determine this limit in power rating more precisely. (orig.)

  6. Nuclear turbine efficiency improvement by wet steam study

    International Nuclear Information System (INIS)

    Nishikawa, Tsuyoshi; Morson, A.; Markytan, R.

    2000-01-01

    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.)

  7. Layout design in order to improve efficiency in manufacturing

    Science.gov (United States)

    Siregar, I.; Tarigan, U.; Nasution, T. H.

    2018-02-01

    This research was conducted at the company that produces bobbins and ream type cigarette paper. Problems that found on the production process is the back and forth (back tracking) movement. Back and forth (back tracking) movement extending the total distance moved by the material and increase the total moment of transfer materials thus reducing the efficiency of the transfer of materials in the production process. The purpose of this study is to give design for the layout of production facilities in the company, so that the expected production produced by the company can reach the targets set by the management company. The method used in this research is the Graph-Based Construction and Travel Chart Method. The results of the analysis of the proposed layout with Graph-Based Construction was selected with a total value that is equal to the moment of transfer of 780 758 m / year. This result is better than the actual layout in the amount of 1,021,038.12 meters / year and the results of the method Travel Alternative Chart I of 826.236,60 meters/year, Alternative II of 1.004.433,56 meters / year, and Alternative III for 828,467.12 meters/year. The design layout of Graph-Based Construction material increases the transfer efficiency for 23.53%. With this layout proposal, expected production capacity will be increased along with the shortening of the distance of the displacement that must be passed by the material to be processed.

  8. Improvement of operational efficiency based on fast startup plant concepts

    Energy Technology Data Exchange (ETDEWEB)

    Kurz, Harald; Meinecke, Gero; Ohresser, Sylvia; Pickard, Andreas

    2010-09-15

    One of the major global challenges of the present time is the reduction of CO2 emissions. Provisions for integration of a CO2 capture plant are already required today in new power plant construction projects in order to enable current plants to also benefit from the possibilities of carbon capture systems to be developed in the future. These provisions for integration should account for the fact that the scrubbing processes are still in the optimization phase. Requisite process parameters may still change in the future. In the development of a plant interface, the paper describes a concept developed by Siemens which ensures maximum flexibility with simultaneous optimization of the plant for the capture process. Emphasis was placed on the following points in the development of this interface and the associated connection concepts: Maximum plant efficiency before and after modification; Maximum flexibility with regard to future process parameters; Optimization of customer investment cash flow; and, Applicability also to existing plants. According to the paper, Siemens can offer a concept which enables future conversion in accordance with the specified criteria. This concept requires no compromises with regard to plant efficiency in process optimization for either current power plant operation without carbon capture or for future operation with carbon capture. The concept also enables retrofitting of existing plants which are not yet capture-ready. However, retrofitting of power plants which are not prepared for operation with carbon capture is considerably more elaborate in most cases, as corridors must frequently still be cleared for the connecting piping.

  9. System solution to improve energy efficiency of HVAC systems

    Science.gov (United States)

    Chretien, L.; Becerra, R.; Salts, N. P.; Groll, E. A.

    2017-08-01

    According to recent surveys, heating and air conditioning systems account for over 45% of the total energy usage in US households. Three main types of HVAC systems are available to homeowners: (1) fixed-speed systems, where the compressor cycles on and off to match the cooling load; (2) multi-speed (typically, two-speed) systems, where the compressor can operate at multiple cooling capacities, leading to reduced cycling; and (3) variable-speed systems, where the compressor speed is adjusted to match the cooling load of the household, thereby providing higher efficiency and comfort levels through better temperature and humidity control. While energy consumption could reduce significantly by adopting variable-speed compressor systems, the market penetration has been limited to less than 10% of the total HVAC units and a vast majority of systems installed in new construction remains single speed. A few reasons may explain this phenomenon such as the complexity of the electronic circuitry required to vary compressor speed as well as the associated system cost. This paper outlines a system solution to boost the Seasonal Energy Efficiency Rating (SEER) of a traditional single-speed unit through using a low power electronic converter that allows the compressor to operate at multiple low capacity settings and is disabled at high compressor speeds.

  10. [Job satisfaction and improvement factors in primary care professionals].

    Science.gov (United States)

    Pérez-Ciordia, I; Guillén-Grima, F; Brugos, A; Aguinaga, I

    2013-09-06

    The quality of services in a health system is related to the level of satisfaction of its professionals. The aim of this article is to determine job satisfaction in primary care professionals and rank those factors capable of improving it. Descriptive study carried out in Navarre in 2010. A validated questionnaire was sent by post to the population of the study: primary care doctors, pediatricians and nurses. Variables on socio-demographic data were collected and job satisfaction was self-evaluated on a scale of 1 to 10. Respondents were asked to rank 10 factors that could improve the previously mentioned satisfaction. Averages were compared and bivariate analysis was carried out using the chi-square test, studying the association between variables through the Odds Ratio (OR). The adjusted analysis was realized through unconditional logistic regression. We collected 432 questionnaires (77.5%). Average satisfaction was 6.7 (scale of 1 to 10), higher in nursing. Women showed a higher average than men (6.90:6.34). The workers at urban health centers (OR: 1.71; CI: 1.10-2.65) showed a higher risk of dissatisfaction with respect to professionals at rural centers. The training activities of the professional is the most highly valued item, followed by economic questions and questions of care pressure, with no differences found by profession. Job satisfaction is a dimension of quality management in primary care and its study enables identification of problems or opportunities for improvement with an impact on the quality of the services offered.

  11. Gender and relative economic efficiency in improved cassava farms ...

    African Journals Online (AJOL)

    Educational level and extension contact were positive and significant at 5% for both gender farmer groups. Credit was negative but significant at 5% amongst female farmer groups. Gender participation in improved new cassava showed that those energy sapping operations were dominated by male folk while light operation ...

  12. Pathways to improving the N efficiency of grazing bovines

    NARCIS (Netherlands)

    Hoekstra, N.J.; Schulte, R.P.O.; Struik, P.C.; Lantinga, E.A.

    2007-01-01

    Livestock production has been identified as a major source of nitrogen (N) losses. Therefore, it is important to reduce N output through animal excretions by improving N utilisation by the animal. The objective of this paper is to identify pathways for producing grass-based diets that maximise

  13. Improving radiation use efficiency in greenhouse production systems

    NARCIS (Netherlands)

    Li, Tao

    2015-01-01

    SUMMARY

    A large increase in agricultural production is needed to feed the increasing world population with their increasing demand per capita. However, growing competition for arable land, water, energy, and the degradation of the environment impose challenges to improve

  14. Energy efficiency improvement target for SIC 34 - fabricated metal products

    Energy Technology Data Exchange (ETDEWEB)

    Byrer, T. G.; Billhardt, C. F.; Farkas, M. S.

    1977-03-15

    A March 15, 1977 revision of a February 15, 1977 document on the energy improvement target for the Fabricated Metal Products industry (SIC 34) is presented. A net energy savings in 1980 of 24% as compared with 1972 energy consumption in SIC 34 is considered a realistic goal. (ERA citation 04:045008)

  15. Improving Pain Care with Project ECHO in Community Health Centers.

    Science.gov (United States)

    Anderson, Daren; Zlateva, Ianita; Davis, Bennet; Bifulco, Lauren; Giannotti, Tierney; Coman, Emil; Spegman, Douglas

    2017-10-01

    Pain is an extremely common complaint in primary care, and patient outcomes are often suboptimal. This project evaluated the impact of Project ECHO Pain videoconference case-based learning sessions on knowledge and quality of pain care in two Federally Qualified Health Centers. Quasi-experimental, pre-post intervention, with comparison group. Two large, multisite federally qualified health centers in Connecticut and Arizona. Intervention (N = 10) and comparison (N = 10) primary care providers. Primary care providers attended 48 weekly Project ECHO Pain sessions between January and December 2013, led by a multidisciplinary pain specialty team. Surveys and focus groups assessed providers' pain-related knowledge and self-efficacy. Electronic health record data were analyzed to evaluate opioid prescribing and specialty referrals. Compared with control, primary care providers in the intervention had a significantly greater increase in pain-related knowledge and self-efficacy. Providers who attended ECHO were more likely to use formal assessment tools and opioid agreements and refer to behavioral health and physical therapy compared with control providers. Opioid prescribing decreased significantly more among providers in the intervention compared with those in the control group. Pain is an extremely common and challenging problem, particularly among vulnerable patients such as those cared for at the more than 1,200 Federally Qualified Health Centers in the United States. In this study, attendance at weekly Project ECHO Pain sessions not only improved knowledge and self-efficacy, but also altered prescribing and referral patterns, suggesting that knowledge acquired during ECHO sessions translated into practice changes. © 2017 American Academy of Pain Medicine.

  16. The reality of homeless mobility and implications for improving care.

    Science.gov (United States)

    Parker, R David; Dykema, Shana

    2013-08-01

    Homeless persons are perceived as a highly mobile population, and have high rates of co-morbid conditions, including mental health and substance use issues. This study sought to determine the characteristics of the mobility and reported health conditions of homeless persons. The sample for this cross sectional study (n = 674) accounted for 88 % of the homeless population in a medium sized southern city in the United States. Participants were recruited from a homeless shelter operating during the winter season. Homeless persons were less mobile than the general state population (46.11 % were born in-state vs. 40.7 % of the general population) and less transient than the general state population (78 % reported an in-state zip code for the last permanent residence). 31.9 % reported a disabling condition of a serious and long term nature. These findings challenge the concept that homeless persons are primarily a mobile population. Furthermore, homeless persons in this sample were more likely to remain in the state where they lived after becoming homeless. Thus, provider perceptions that homeless persons would not benefit from referral to a regular source of outpatient care may be misinformed. As homeless persons often seek care in emergency departments for conditions that could be addressed through outpatient care, if a medical care system implemented standard practices specifically for homeless patients, this could decrease recidivism. Such interventions represent significant opportunities to reduce costs, conserve resources, and improve care through policy modification that ensures a focus on a successful, active linkage to outpatient care and programs specific to the homeless population.

  17. [Evaluation of 12 pilot projects to improve outpatient palliative care].

    Science.gov (United States)

    Schmidt-Wolf, G; Elsner, F; Lindena, G; Hilgers, R-D; Heussen, N; Rolke, R; Ostgathe, C; Radbruch, L

    2013-12-01

    With a priority programme the German Cancer Aid supported the development of quality-assured outpatient palliative care to cover the whole country. The 12 regional pilot projects funded with the aim to improve outpatient palliative care in different models and different frameworks were concurrently monitored and evaluated. The supported projects, starting and ending individually, documented all patients who were cared for using HOPE (Hospice and palliative care evaluation) and MIDOS (Minimal documentation system for palliative patients). Total data were analyzed for 3239 patients decriptively. In addition to the quantitative data the experiences of the projects were recorded in a number of workshops (2008, 2009, 2010, and 2012). In particular, the experiences reported in the final meeting in July 2012 were considered for this article as well as the final reports for the German Cancer Aid. In the quantitative evaluation 85.6% of 3239 palliative care patients had a cancer diagnosis. In all model projects the goal of a network with close cooperation of primary providers, social support, and outpatient and inpatient specialist services has been achieved. For all projects, the initial financing of the German Cancer Aid was extremely important, because contracts with health insurance funds were negotiated slowly, and could then be built on the experiences with the projects. The participants of the project-completion meeting emphasized the need to carry out a market analysis before starting palliative care organizations considering the different regional structures and target groups of patients. Education, training and continuing education programs contribute significantly to the network. A reliably funded coordination center/case management across all institutions is extremely important. © Georg Thieme Verlag KG Stuttgart · New York.

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

    International Nuclear Information System (INIS)

    Hutchinson, Emma J.; Wilkinson, Paul; Hong, Sung H.; Oreszczyn, Tadj

    2006-01-01

    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 o C (when the outdoor temperature was 5 o C). 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 o C, 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

  19. An effective and efficient approach for manually improving geocoded data

    Directory of Open Access Journals (Sweden)

    Knoblock Craig A

    2008-11-01

    Full Text Available Abstract Background The process of geocoding produces output coordinates of varying degrees of quality. Previous studies have revealed that simply excluding records with low-quality geocodes from analysis can introduce significant bias, but depending on the number and severity of the inaccuracies, their inclusion may also lead to bias. Little quantitative research has been presented on the cost and/or effectiveness of correcting geocodes through manual interactive processes, so the most cost effective methods for improving geocoded data are unclear. The present work investigates the time and effort required to correct geocodes contained in five health-related datasets that represent examples of data commonly used in Health GIS. Results Geocode correction was attempted on five health-related datasets containing a total of 22,317 records. The complete processing of these data took 11.4 weeks (427 hours, averaging 69 seconds of processing time per record. Overall, the geocodes associated with 12,280 (55% of records were successfully improved, taking 95 seconds of processing time per corrected record on average across all five datasets. Geocode correction improved the overall match rate (the number of successful matches out of the total attempted from 79.3 to 95%. The spatial shift between the location of original successfully matched geocodes and their corrected improved counterparts averaged 9.9 km per corrected record. After geocode correction the number of city and USPS ZIP code accuracy geocodes were reduced from 10,959 and 1,031 to 6,284 and 200, respectively, while the number of building centroid accuracy geocodes increased from 0 to 2,261. Conclusion The results indicate that manual geocode correction using a web-based interactive approach is a feasible and cost effective method for improving the quality of geocoded data. The level of effort required varies depending on the type of data geocoded. These results can be used to choose between

  20. Improving IC process efficiency with critical materials management

    Science.gov (United States)

    Hanson, Kathy L.; Andrews, Robert E.

    2003-06-01

    The management of critical materials in a high technology manufacturing facility is crucial to obtaining consistently high production yield. This is especially true in an industry like semiconductors where the success of the product is so dependent on the integrity of the critical production materials. Bar code systems, the traditional management tools, are voluntary, defeatable, and do not continuously monitor materials when in use. The significant costs associated with mis-management of chemicals can be captured with a customized model resulting in highly favorable ROI"s for the NOWTrak RFID chemical management system. This system transmits reliable chemical data about each individual container and generates information that can be used to increase wafer production efficiency and yield. The future of the RFID system will expand beyond the benefits of chemical management and into dynamic IC process management

  1. Improving pain care through implementation of the Stepped Care Model at a multisite community health center

    Directory of Open Access Journals (Sweden)

    Anderson DR

    2016-11-01

    Full Text Available Daren R Anderson,1 Ianita Zlateva,1 Emil N Coman,2 Khushbu Khatri,1 Terrence Tian,1 Robert D Kerns3 1Weitzman Institute, Community Health Center, Inc., Middletown, 2UCONN Health Disparities Institute, University of Connecticut, Farmington, 3VA Connecticut Healthcare System, West Haven, CT, USA Purpose: Treating pain in primary care is challenging. Primary care providers (PCPs receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM at a large, multisite Federally Qualified Health Center. Methods: The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence. Results: Providers’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009. There was no

  2. Managing Quality in Health Care: Involving Patient Care Information Systems and Healthcare Professionals in Quality Monitoring and Improvement

    NARCIS (Netherlands)

    M. de Mul (Marleen)

    2009-01-01

    textabstractIt is no longer possible to ignore the issue of quality in health care. Care institutions strive to provide all patients with effective, efficient, safe, timely, patient-centered care. Increased attention for quality is also found in discussions regarding use of information

  3. A revolutionary concept to improve the efficiency of IC antennas

    Energy Technology Data Exchange (ETDEWEB)

    Milanesio, D.; Maggiora, R. [Politecnico di Torino, Dipartimento di Elettronica e Telecomunicazioni (DET), Torino (Italy)

    2014-02-12

    The successful design of an Ion Cyclotron (IC) antenna mainly relies on the capability of coupling high power to the plasma (MW), feature that is currently reached by allowing rather high voltages (tens of kV) on the unavoidable unmatched part of the feeding lines. This requirement is often responsible of arcs along the transmission lines and other unwanted phenomena that considerably limit the usage of IC launchers. In this work, we suggest and describe a revolutionary approach based on high impedance surfaces, which allows to increase the antenna radiation efficiency and, hence, to highly reduce the imposed voltages to couple the same level of power to the plasma. High-impedance surfaces are periodic metallic structures (patches) displaced usually on top of a dielectric substrate and grounded by means of vertical posts usually embedded inside a dielectric, in a mushroom-like shape. In terms of working properties, high impedance surfaces are electrically thin in-phase reflectors, i.e. they present a high impedance, within a given frequency band, such that the image currents are in-phase with the currents of the antenna itself, thus determining a significant efficiency increase. While the usual design of a high impedance surface requires the presence of a dielectric layer, some alternative solutions can be realized in vacuum, taking advantage of double layers ofmetallic patches. After an introductory part on the properties of high impedance surfaces, this work documents both their design by means of numerical codes and their implementation on a scaled mock-up.

  4. Application of gold nanoparticles for improved drug efficiency

    Science.gov (United States)

    Shittu, K. O.; Bankole, M. T.; Abdulkareem, A. S.; Abubakre, O. K.; Ubaka, A. U.

    2017-09-01

    Due to increasing resistance of microorganisms towards current antibiotics, there is a need for new or enhanced antibiotics. Nanotechnology is a technology that enhances the use of gold nanoparticles (AuNP) in area of medical applications, especially as a drug carrier for targeted drug delivery. In this research, AuNPs was synthesized using biological method via bioreduction of Piper guineense aqueous leaf extract on tetra gold chloride, characterized using UV-Vis spectrophometer, DLS, TEM/EDS and FTIR. The synthesized AuNPs was covalently functionalized with polyethylene glycol and encapsulated with Lincomycin and in vitro dissolution methods was used to evaluate the potential performance of the formulated nanodrug. The nanodrug has highest release efficiency at the 9th minutes (23.4 mg ml-1 for 40 °C) and (29.5 mg ml-1 for 60 °C) compared with the non-nanodrug. The antibacterial potential of the nanodrug was seen on the gram-positive bacteria of Staphylococcus aureus and Streptococcus pyogenes with highest inhibitions of 18 mm (at 40 °C) and 16 mm (at 60 °C) for S. aureus, and 16 mm for S. pyogenes (both at 40 °C and 60 °C). The bacteria growth inhibition continued and lasted for 15 min, while that of non-nanodrug lasted for 9 min with lesser growth inhibition compared to the formulated nanodrug. This work shows that the presence of the AuNPs increased the release efficiency of lincomycin even at a lower concentration and also bacteria growth inhibition thereby suggesting the effectiveness of the nanodrug formulation.

  5. Use of telemedicine to improve burn care in Ukraine.

    Science.gov (United States)

    Fuzaylov, Gennadiy; Knittel, Justin; Driscoll, Daniel N

    2013-01-01

    Global burn injuries have been described as the "forgotten public health crises" by the World Health Organization. Nearly 11 million people a year suffer burns severe enough to require medical attention; more people are burned each year than are infected with human immunodeficiency virus/acquired immunodeficiency syndrome and tuberculosis combined. Telemedicine has the potential to link experts in specialized fields, such as burn care, to regions of the world that have limited or no access to such specialized care. A multilevel telemedicine program was developed between Massachusetts General Hospital/Shriners Hospital in Boston, Massachusetts, and City Hospital #8 in Lviv, Ukraine. The program should lead to a sustainable improvement in the care of burn victims in Ukraine. The authors helped establish a Learning Center at City Hospital #8 in Lviv, Ukraine, through which they were able to consult from Shriners Hospital in Boston, on a total of 14 acute burn patients in Ukraine. This article discusses two case reports with the use of telemedicine and how it has allowed the authors to provide not only acute care consultation on an international scale, but also to arrange for direct expert examination and international transport to their specialized burn center in the United States. The authors have established a program through doctors from Massachusetts General Hospital/Shriner's Hospital in Boston, which works with a hospital in Ukraine and has provided acute consultation, as well as patient transportation to the United States for treatment and direct assessment.

  6. Significant Improvement of Catalytic Efficiencies in Ionic Liquids

    International Nuclear Information System (INIS)

    Song, Choong Eui; Yoon, Mi Young; Choi, Doo Seong

    2005-01-01

    The use of ionic liquids as reaction media can confer many advantages upon catalytic reactions over reactions in organic solvents. In ionic liquids, catalysts having polar or ionic character can easily be immobilized without additional structural modification and thus the ionic solutions containing the catalyst can easily be separated from the reagents and reaction products, and then, be reused. More interestingly, switching from an organic solvent to an ionic liquid often results in a significant improvement in catalytic performance (e.g., rate acceleration, (enantio)selectivity improvement and an increase in catalyst stability). In this review, some recent interesting results which can nicely demonstrate these positive 'ionic liquid effect' on catalysis are discussed

  7. Grinding efficiency improvement of hydraulic cylinders parts for mining equipment

    Directory of Open Access Journals (Sweden)

    Korotkov Aleksandr

    2017-01-01

    Full Text Available The aim of the article is to find out ways to improve parts treatment and components of mining equipment on the example of hydraulic cylinders parts, used as pillars for mine roof supports, and other actuator mechanisms. In the course of the research work methods of machine retaining devices design were used, the scientific approaches for the selection of progressive grinding schemes were applied; theoretical and practical experience in the design and production of new constructions of grinding tools was used. As a result of this work it became possible to create a progressive construction of a machine retaining device for grinding of large parts of hydraulic cylinders, to apply an effective scheme of rotary abrasive treatment, to create and implement new design of grinding tools by means of grains with controllable shape and orientation. Implementation of the results obtained in practice will improve the quality and performance of repairing and manufacturing of mining equipment.

  8. Staff Experience of Pain Management: An Improvement in Palliative Care

    Directory of Open Access Journals (Sweden)

    Anna Unné

    2013-09-01

    Full Text Available Palliative care involves helping patients to achieve best possible quality of life by alleviating symptoms and suffering. The aim of the study was to describe and analyze staff member’s experience of working with evidence-based guidelines for pain management in palliative care. The study comprised a total of eight group interviews and 93 narratives from 22 staff members, all of who worked in palliative care. Data was analyzed using manifest qualitative content analysis and deductive perspectives according to SOC (sense of coherence. Three categories, “Awareness of Pain Management”, “Participation in Pain Management”, and “Safety at Pain Management”, were identified. The result showed an increased awareness of the value of a deeper understanding of policy documents and local guidelines. A key factor in improvement work was that team members were given the opportunity to repeat and continuously reflect on their performed work together within the team in dialog form. Teamwork may contribute to a better knowledge and understanding of how to develop high quality in healthcare by learning from each other in everyday work and by using evidence-based practices. Consistency in the working group could improve healthcare by using the espoused theory and theory-in-use for develop procedures and guidelines at work.

  9. Improving the performance and energy-efficiency of virtual memory

    OpenAIRE

    Karakostas, Vasileios

    2016-01-01

    Virtual memory improves programmer productivity, enhances process security, and increases memory utilization. However, virtual memory requires an address translation from the virtual to the physical address space on every memory operation. Page-based implementations of virtual memory divide physical memory into fixed size pages, and use a per-process page table to map virtual pages to physical pages. The hardware key component for accelerating address translation is the Translation Lookasi...

  10. Improving the efficiency of plasma heat treatment of metals

    International Nuclear Information System (INIS)

    Gabdrakhmanov, Az T; Israphilov, I H; Galiakbarov, A T; Samigullin, A D; Gabdrakhmanov, Al T

    2016-01-01

    This paper proposes an effective way of the plasma hardening the surface layer at the expense combined influence of the plasma jet and a cold air flow. After that influence occurs a distinctive by plasma treatment microstructure with increased microhardness (an increase of 35%) and depth. There is proposed an improved design of the vortex tube for receiving the air flow with a temperature of 20 C to - 120C. (paper)

  11. Prior-knowledge-independent equalization to improve battery uniformity with energy efficiency and time efficiency for lithium-ion battery

    International Nuclear Information System (INIS)

    Zhang, Shumei; Qiang, Jiaxi; Yang, Lin; Zhao, Xiaowei

    2016-01-01

    To improve battery uniformity as well as energy efficiency and time efficiency, a SOC (state of charge)-based equalization by AGA (adaptive genetic algorithm) is proposed on basis of two-stage DC/DC converters. The simulation results indicate that compared with FLC (fuzzy logic controller) equalization, the standard deviation of final SOC is improved by 78.7% while energy efficiency is improved by 6.01% and equalization time is decreased by 20% for AGA equalization of extreme dispersion. Additionally, AGA improves the battery uniformity by 30.77% with shortening equalization time by 16.29% and saving energy loss by 1.51% compared with FLC for equalization of regular dispersion. For further validation, the equalization optimization is verified by experiment based on the data-driven parameter identification method which is used to enhance the real-time capability of AGA. For AGA equalization of extreme dispersion, the standard deviation of final SOC is just 0.41% while equalization time prolongs only 14 min and energy efficiency is decreased by 0.81% compared with simulation results. Moreover, not only the standard deviation of final SOC is just 0.28% but also the energy efficiency is decreased by 0.69% and equalization time prolongs by 10.4 min compared with the simulation results for equalization of regular dispersion. - Highlights: • Issues of over equalization, time consumption and energy loss are addressed. • A SOC-based equalization is proposed based on adaptive genetic algorithm. • The equalization aims to improve battery uniformity, efficiency of energy and time. • Data-driven parameter identification is used to enhance the real-time capability.

  12. Using data to improve medical practice by measuring processes and outcomes of care.

    Science.gov (United States)

    Nelson, E C; Splaine, M E; Godfrey, M M; Kahn, V; Hess, A; Batalden, P; Plume, S K

    2000-12-01

    The purpose of this article is to help clinicians expand their use of data to improve medical practice performance and to do improvement research. Clinical practices can be viewed as small, complex organizations (microsystems) that produce services for specific patient populations. These services can be greatly improved by embedding measurement into the flow of daily work in the practice. WHY DO IT?: Four good reasons to build measures into daily medical practice are to (1) diagnose strengths and weaknesses in practice performance; (2) improve and innovate in providing care and services using improvement research; (3) manage patients and the practice; and (4) evaluate changes in results over time. It is helpful to have a "physiological" model of a medical practice to analyze the practice, to manage it, and to improve it. One model views clinical practices as microsystems that are designed to generate desired health outcomes for specific subsets of patients and to use resources efficiently. This article provides case study examples to show what an office-based practice might look like if it were using front-line measurement to improve care and services most of the time and to conduct clinical improvement research some of the time. WHAT ARE THE PRINCIPLES FOR USING DATA TO IMPROVE PROCESSES AND OUTCOMES OF CARE?: Principles reflected in the case study examples--such as "Keep Measurement Simple. Think Big and Start Small" and "More Data Is Not Necessarily Better Data. Seek Usefulness, Not Perfection, in Your Measures"--may help guide the development of data to study and improve practice. HOW CAN A PRACTICE START TO USE DATA TO IMPROVE CARE AND CONDUCT IMPROVEMENT RESEARCH?: Practical challenges are involved in starting to use data for enhancing care and improvement research. To increase the odds for success, it would be wise to use a change management strategy to launch the startup plan. Other recommendations include "Establish a Sense of Urgency. (Survival Is Not

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

    NARCIS (Netherlands)

    Franx, G.C.; Meeuwissen, J.A.; Sinnema, H.; Spijker, J.; Huyser, J.; Wensing, M.J.P.; Lange, J.

    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

  14. 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.

  15. How improving practice relationships among clinicians and nonclinicians can improve quality in primary care.

    Science.gov (United States)

    Lanham, Holly J; McDaniel, Reuben R; Crabtree, Benjamin F; Miller, William L; Stange, Kurt C; Tallia, Alfred F; Nutting, Paula

    2009-09-01

    Understanding the role of relationships health care organizations (HCOs) offers opportunities for shaping health care delivery. When quality is treated as a property arising from the relationships within HCOs, then different contributors of quality can be investigated and more effective strategies for improvement can be developed. Data were drawn from four large National Institutes of Health (NIH)-funded studies, and an iterative analytic strategy and a grounded theory approach were used to understand the characteristics of relationships within primary care practices. This multimethod approach amassed rich and comparable data sets in all four studies, which were all aimed at primary care practice improvement. The broad range of data included direct observation of practices during work activities and of patient-clinician interactions, in-depth interviews with physicians and other key staff members, surveys, structured checklists of office environments, and chart reviews. Analyses focused on characteristics of relationships in practices that exhibited a range of success in achieving practice improvement. Complex adaptive systems theory informed these analyses. Trust, mindfulness, heedfulness, respectful interaction, diversity, social/task relatedness, and rich/lean communication were identified as important in practice improvement. A model of practice relationships was developed to describe how these characteristics work together and interact with reflection, sensemaking, and learning to influence practice-level quality outcomes. Although this model of practice relationships was developed from data collected in primary care practices, which differ from other HCOs in some important ways, the ideas that quality is emergent and that relationships influence quality of care are universally important for all HCOs and all medical specialties.

  16. Social efficiency of hospital care delivery: frontier analysis from the consumer's perspective.

    Science.gov (United States)

    Bernet, Patrick M; Moises, James; Valdmanis, Vivian Grace

    2011-02-01

    The efficiency of hospital services and patients' access to hospitals are both important health care policy issues. In the past, research has relied on studying these topics separately. In this article, we measure both efficiency and access at the same time using data envelopment analysis (DEA). By including both the technically efficient use of resources, as well as the patients' travel distances, we found increases in social efficiency when patients' travel distances were taken into account. When compared with patients with nonurgent conditions, we found that patients suffering from conditions requiring urgent attention were treated at closer hospitals, increasing the social efficiency. Insurance coverage and hospital ownership were also examined. Our findings corroborated past literature in the hospital and travel distance literature and set out a framework for future research. Perhaps most important, we demonstrate the techniques needed to incorporate broader measures of social costs into studies of hospital efficiency.

  17. 77 FR 19280 - Increasing Market and Planning Efficiency Through Improved Software; Notice of Technical...

    Science.gov (United States)

    2012-03-30

    ... concerns that current system data quality might not allow for an AC optimal power flow model to be properly... Market and Planning Efficiency Through Improved Software; Notice of Technical Conference: Increasing Real-Time and Day- Ahead Market Efficiency Through Improved Software Take notice that Commission staff will...

  18. Face-to-face handoff: improving transfer to the pediatric intensive care unit after cardiac surgery.

    Science.gov (United States)

    Vergales, Jeffrey; Addison, Nancy; Vendittelli, Analise; Nicholson, Evelyn; Carver, D Jeannean; Stemland, Christopher; Hoke, Tracey; Gangemi, James

    2015-01-01

    The goal was to develop and implement a comprehensive, primarily face-to-face handoff process that begins in the operating room and concludes at the bedside in the intensive care unit (ICU) for pediatric patients undergoing congenital heart surgery. Involving all stakeholders in the planning phase, the framework of the handoff system encompassed a combination of a formalized handoff tool, focused process steps that occurred prior to patient arrival in the ICU, and an emphasis on face-to-face communication at the conclusion of the handoff. The final process was evaluated by the use of observer checklists to examine quality metrics and timing for all patients admitted to the ICU following cardiac surgery. The process was found to improve how various providers view the efficiency of handoff, the ease of asking questions at each step, and the overall capability to improve patient care regardless of overall surgical complexity. © 2014 by the American College of Medical Quality.

  19. Standardizing Care and Improving Quality under a Bundled Payment Initiative for Total Joint Arthroplasty.

    Science.gov (United States)

    Froemke, Cecily C; Wang, Lian; DeHart, Matthew L; Williamson, Ronda K; Ko, Laura Matsen; Duwelius, Paul J

    2015-10-01

    Increasing demands for episodic bundled payments in total hip and knee arthroplasty are motivating providers to wring out inefficiencies and coordinate services. This study describes a care pathway and gainshare arrangement as the mechanism by which improvements in efficiency were realized under a bundled payment pilot. Analysis of cut-to-close time, LOS, discharge destination, implant cost, and total allowed claims between pre-pilot and pilot cohorts showed an 18% reduction in average LOS (70.8 to 58.2 hours) and a shift from home health and skilled nursing facility discharge to home self-care (54.1% to 63.7%). No significant differences were observed for cut-to-close time and implant cost. Improvements resulted in a 6% reduction in the average total allowed claims per case. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Improvement of operational efficiency based on fast startup plant concepts

    Energy Technology Data Exchange (ETDEWEB)

    Grumann, Ulrich; Kurz, Harald; Meinecke, Gero; Pickard, Andreas

    2010-09-15

    The power generation sector is currently confronted with new challenges relating to the conservation of dwindling fuel reserves. At the same time we must reduce CO2 emissions in order to counteract global warming. This paper shows that power plant operation, which employs shutdowns during periods of low load demand coupled with the optimization of startup procedures are a key to reducing CO2 emissions and to conserving resources. The startup technology developed by Siemens also offers grid support in the event of naturally occurring failures of renewable energy sources. Additionally, plant profitability is improved due to the resulting savings in fuel.

  1. Improvement of industrial efficiency by knowledge management in maintenance engineering

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Mariotoni

    2015-09-01

    Full Text Available This article shows research and studies dealing with the management of knowledge in industrial maintenance engineering, developed in the field of applied research in real industrial companies of Europe, which are the consequences of  having knowledge on islands, as well as measures improvements when there is an adequate knowledge management. The peculiarities which are given in the maintenance of the company departments, knowledge of operators and technicians operating in these areas, is heavily based on their experiences (strong tacit component, what is difficult to measure and articulate, and however, on numerous occasions, this break from the knowledge, can impose a high cost for the industry.

  2. Shifting Landscapes: The Impact of Centralized and Decentralized Nursing Station Models on the Efficiency of Care.

    Science.gov (United States)

    Fay, Lindsey; Carll-White, Allison; Schadler, Aric; Isaacs, Kathy B; Real, Kevin

    2017-10-01

    The focus of this research was to analyze the impact of decentralized and centralized hospital design layouts on the delivery of efficient care and the resultant level of caregiver satisfaction. An interdisciplinary team conducted a multiphased pre- and postoccupancy evaluation of a cardiovascular service line in an academic hospital that moved from a centralized to decentralized model. This study examined the impact of walkability, room usage, allocation of time, and visibility to better understand efficiency in the care environment. A mixed-methods data collection approach was utilized, which included pedometer measurements of staff walking distances, room usage data, time studies in patient rooms and nurses' stations, visibility counts, and staff questionnaires yielding qualitative and quantitative results. Overall, the data comparing the centralized and decentralized models yielded mixed results. This study's centralized design was rated significantly higher in its ability to support teamwork and efficient patient care with decreased staff walking distances. The decentralized unit design was found to positively influence proximity to patients in a larger design footprint and contribute to increased visits to and time spent in patient rooms. Among the factors contributing to caregiver efficiency and satisfaction are nursing station design, an integrated team approach, and the overall physical layout of the space on walkability, allocation of caregiver time, and visibility. However, unit design alone does not solely impact efficiency, suggesting that designers must consider the broader implications of a culture of care and processes.

  3. Ringing Artefact Reduction By An Efficient Likelihood Improvement Method

    Science.gov (United States)

    Fuderer, Miha

    1989-10-01

    In MR imaging, the extent of the acquired spatial frequencies of the object is necessarily finite. The resulting image shows artefacts caused by "truncation" of its Fourier components. These are known as Gibbs artefacts or ringing artefacts. These artefacts are particularly. visible when the time-saving reduced acquisition method is used, say, when scanning only the lowest 70% of the 256 data lines. Filtering the data results in loss of resolution. A method is described that estimates the high frequency data from the low-frequency data lines, with the likelihood of the image as criterion. It is a computationally very efficient method, since it requires practically only two extra Fourier transforms, in addition to the normal. reconstruction. The results of this method on MR images of human subjects are promising. Evaluations on a 70% acquisition image show about 20% decrease of the error energy after processing. "Error energy" is defined as the total power of the difference to a 256-data-lines reference image. The elimination of ringing artefacts then appears almost complete..

  4. Car Assembly Line Efficiency Improvement by Lean Principle

    Science.gov (United States)

    Sawassalung, Suwalee; Chutima, Parames

    2017-06-01

    This research aimed to increase the efficiency of actual working time to compare to design standard time ratio (DSTR) as per analysing process of Lean System of the assembly line in a car manufacturer in Thailand. Currently, the case study factory and its group of factories, which have many branches all over the world, have competed with each other on quality, delivered time and production cost. The production cost which can reduce without affecting quality and acceptable by clients is the manpower cost. The index of competition is DSTR. The factory now has DSTR of 6.13 and DSTR of the assembly department is 4.24 which is very high comparing to other departments. The low DSTR indicates that the factory has good quality. The ways to solve the problem are to apply the following tools, i.e. Lean principle, Value Stream Mapping (VSM), Waste Analysis and ECRS. After implementing the above tools, the results showed that DSTR decreased from 4.24 to 4.06 or 4.25%.

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

    Directory of Open Access Journals (Sweden)

    Azra Korjenic

    2015-06-01

    Full Text Available 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 explores alternative usage of sheep wool as a construction material beyond its traditional application in the textile industry. Another goal of this research was to study the feasibility of replacement of commonly used thermal insulations with natural and renewable materials which have better environmental and primary energy values. Building physics, energy and environmental characteristics were evaluated and compared based on hygrothermal simulation and ecological balance methods. The observations demonstrate that sheep wool, compared with mineral wool and calcium silicate, provides comparable thermal insulation characteristics, and in some applications even reveals better performance.

  6. A tale of two audits: statistical process control for improving diabetes care in primary care settings.

    Science.gov (United States)

    Al-Hussein, Fahad Abdullah

    2008-01-01

    Diabetes constitutes a major burden of disease globally. Both primary and secondary prevention need to improve in order to face this challenge. Improving management of diabetes in primary care is therefore of fundamental importance. The objective of these series of audits was to find means of improving diabetes management in chronic disease mini-clinics in primary health care. In the process, we were able to study the effect and practical usefulness of different audit designs - those measuring clinical outcomes, process of care, or both. King Saud City Family and Community Medicine Centre, Saudi National Guard Health Affairs in Riyadh city, Saudi Arabia. Simple random samples of 30 files were selected every two weeks from a sampling frame of file numbers for all diabetes clients seen over the period. Information was transferred to a form, entered on the computer and an automated response was generated regarding the appropriateness of management, a criterion mutually agreed upon by care providers. The results were plotted on statistical process control charts, p charts, displayed for all employees. Data extraction, archiving, entry, analysis, plotting and design and preparation of p charts were managed by nursing staff specially trained for the purpose by physicians with relevant previous experience. Audit series with mixed outcome and process measures failed to detect any changes in the proportion of non-conforming cases over a period of one year. The process measures series, on the other hand, showed improvement in care corresponding to a reduction in the proportion non-conforming by 10% within a period of 3 months. Non-conformities dropped from a mean of 5.0 to 1.4 over the year (P process audits and feedbacks. Frequent process audits in the context of statistical process control should be supplemented with concurrent outcome audits, once or twice a year.

  7. Leveraging Behavioral Economics to Improve Heart Failure Care and Outcomes.

    Science.gov (United States)

    Chang, Leslie L; DeVore, Adam D; Granger, Bradi B; Eapen, Zubin J; Ariely, Dan; Hernandez, Adrian F

    2017-08-22

    Behavioral challenges are often present in human illness, so behavioral economics is increasingly being applied in healthcare settings to better understand why patients choose healthy or unhealthy behaviors. The application of behavioral economics to healthcare settings parallels recent shifts in policy and reimbursement structures that hold providers accountable for outcomes that are dependent on patient behaviors. Numerous studies have examined the application of behavioral economics principles to policy making and health behaviors, but there are limited data on applying these concepts to the management of chronic conditions, such as heart failure (HF). Given its increasing prevalence and high associated cost of care, HF is a paradigm case for studying novel approaches to improve health care; therefore, if we can better understand why patients with HF make the choices they do, then we may be more poised to help them manage their medications, influence daily behaviors, and encourage healthy decision making. In this article, we will give a brief explanation of the core behavioral economics concepts that apply to patients with HF. We will also examine how to craft these concepts into tools such as financial incentives and social networks that may improve the management of patients with HF. We believe that behavioral economics can help us understand barriers to change, encourage positive behaviors, and offer additional approaches to improving the outcomes of patients with HF. © 2017 American Heart Association, Inc.

  8. Parental care improves offspring survival and growth in burying beetles

    Science.gov (United States)

    Eggert; Reinking; MULLER

    1998-01-01

    Burying beetles (genus Nicrophorus) provide elaborate parental care to their offspring. Parental beetles defend a small vertebrate carcass, which constitutes the sole food source for the larvae. They also manipulate the carcass in various ways and directly regurgitate pre-digested carrion to the young. The benefits of carcass manipulation and regurgitation have been the subject of a few small-scale studies that have yielded conflicting results. In this study, we investigated the benefits of these behaviours and tested for possible beneficial effects on larval survival rates and final body mass in N. vespilloides. In this species: (1) larval survival and mass were significantly higher in broods receiving parental care throughout larval development on the carcass than in broods developing in the absence of adults; (2) parental presence immediately subsequent to larval hatching greatly improved larval survival rates; (3) continued parental presence for several days further improved larval growth, leading to a greater final mass of individual larvae; (4) larval survival and growth were improved by parental preparation of carcasses and by an excision made in the integument of the carcass surface by the parents that allows the larvae ready access to their food; (5) positive effects of parental feeding on larval survival and growth were not mediated by the transfer of symbionts. Copyright 1998 The Association for the Study of Animal Behaviour.

  9. Global Lessons In Frugal Innovation To Improve Health Care Delivery In The United States.

    Science.gov (United States)

    Bhatti, Yasser; Taylor, Andrea; Harris, Matthew; Wadge, Hester; Escobar, Erin; Prime, Matt; Patel, Hannah; Carter, Alexander W; Parston, Greg; Darzi, Ara W; Udayakumar, Krishna

    2017-11-01

    In a 2015 global study of low-cost or frugal innovations, we identified five leading innovations that scaled successfully in their original contexts and that may provide insights for scaling such innovations in the United States. We describe common themes among these diverse innovations, critical factors for their translation to the United States to improve the efficiency and quality of health care, and lessons for the implementation and scaling of other innovations. We highlight promising trends in the United States that support adapting these innovations, including growing interest in moving care out of health care facilities and into community and home settings; the growth of alternative payment models and incentives to experiment with new approaches to population health and care delivery; and the increasing use of diverse health professionals, such as community health workers and advanced practice providers. Our findings should inspire policy makers and health care professionals and inform them about the potential for globally sourced frugal innovations to benefit US health care.

  10. Incentives and technologies for improving irrigation water use efficiency

    Science.gov (United States)

    Bruggeman, Adriana; Djuma, Hakan; Giannakis, Elias; Eliades, Marinos

    2014-05-01

    The European Water Framework Directive requires Member States to set water prices that provide adequate incentives for users to use water resources efficiently. These new water pricing policies need to consider cost recovery of water services, including financial, environmental and resource cost. Prices were supposed to have been set by 2010. So far the record has been mixed. The European Commission has sent reasoned opinions to a number of countries (Austria, Belgium, Denmark, Estonia, Finland, Germany, Hungary, Netherlands, Sweden) requesting them to adjust their national legislation to include all water services. Unbalanced water pricing may negatively affect the agricultural sector, especially in the southern EU countries, which are more dependent on irrigation water for production. The European Commission is funding several projects that aim to reduce the burden of increasing water prices on farmers by developing innovative technologies and decision support systems that will save water and increase productivity. The FP7 ENORASIS project (grant 282949) has developed a new integrated irrigation management decision support platform, which include high-resolution, ensemble weather forecasting, a GIS widget for the location of fields and sensors and a comprehensive decision support and database management software package to optimize irrigation water management. The field component includes wireless, solar-powered soil moisture sensors, small weather stations, and remotely controlled irrigation valves. A mobile App and a web-package are providing user-friendly interfaces for farmers, water companies and environmental consultants. In Cyprus, agricultural water prices have been set to achieve a cost recovery rate of 54% (2010). The pricing policy takes in consideration the social importance and financial viability of the agricultural sector, an important flexibility provided by the Water Framework Directive. The new price was set at 0.24 euro per m3 for water supply

  11. Accountability feedback assessments for improving efficiency of nuclear regulatory institutions

    International Nuclear Information System (INIS)

    Lavarenne, Jean; Shwageraus, Eugene; Weightman, Michael

    2016-01-01

    The Fukushima-Daiichi Accident demonstrated the need of assessing and strengthening institutions involved in nuclear safety, including the accountability of regulators. There are a few problems hindering the path towards a greater understanding of accountability systems, the ensemble of mechanisms holding to account the nuclear regulator on behalf of the public. There is no consensus on what it should deliver and no systematic assessment method exists. This article proposes a method of assessing institutions based on defence in depth concepts and inspired from risk-assessment techniques used for nuclear safety. As a first step in testing the proposal, it presents a simple Monte-Carlo simulation, illustrating some of the workings of the method of assessment and demonstrating the kind of results it will be able to supply. This on-going work will assist policy-makers take better informed decisions about the size, structure and organisation of a nuclear regulator and the cost-effective funding of its accountability system. It will assist in striking a balance between efficiency and resilience of regulatory decision-making processes. It will also promote the involvement of stakehold