Palliative Care Leadership Centers Are Key To The Diffusion Of Palliative Care Innovation.

Science.gov (United States)

Cassel, J Brian; Bowman, Brynn; Rogers, Maggie; Spragens, Lynn H; Meier, Diane E

2018-02-01

Between 2000 and 2015 the proportion of US hospitals with more than fifty beds that had palliative care programs tripled, from 25 percent to 75 percent. The rapid adoption of this high-value program, which is voluntary and runs counter to the dominant culture in US hospitals, was catalyzed by tens of millions of dollars in philanthropic support for innovation, dissemination, and professionalization in the palliative care field. We describe the dissemination strategies of the Center to Advance Palliative Care in the context of the principles of social entrepreneurship, and we provide an in-depth look at its hallmark training initiative, Palliative Care Leadership Centers. Over 1,240 hospital palliative care teams have trained at the Leadership Centers to date, with 80 percent of them instituting palliative care services within two years. We conclude with lessons learned about the role of purposeful technical assistance in promoting the rapid diffusion of high-value health care innovation.

DSCOVR Contamination Lessons Learned

Science.gov (United States)

Graziani, Larissa

2015-01-01

The Triana observatory was built at NASA GSFC in the late 1990's, then placed into storage. After approximately ten years it was removed from storage and repurposed as the Deep Space Climate Observatory (DSCOVR). This presentation outlines the contamination control program lessons learned during the integration, test and launch of DSCOVR.

Lessons from the Institute for New Heads (INH) Class of 2006: Ten Headships--134 Years of Hard-Earned Experience

Science.gov (United States)

Raphel, Annette; Huber, John; Chandler, Carolyn; Vorenberg, Amy; Jones-Wilkins, Andy; Devey, Mark A.; Holford, Josie; Craig, Ian; Elam, Julie

2016-01-01

Ten years ago in July 2006, 64 mostly starry-eyed men and women attended the NAIS Institute for New Heads (INH) in order to learn the ropes of headship. These newly minted heads were filled with enthusiasm, commitment, and passion, along with humility and a bit of healthy trepidation. One core group connected under the careful guidance of…

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

Science.gov (United States)

Kragh, John F; Dubick, Michael A

2016-01-01

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

Ideologies of aid, practices of power: lessons for Medicaid managed care.

Science.gov (United States)

Nelson, Nancy L

2005-03-01

The articles in this special issue teach valuable lessons based on what happened in New Mexico with the shift to Medicaid managed care. By reframing these lessons in broader historical and cultural terms with reference to aid programs, we have the opportunity to learn a great deal more about the relationship between poverty, public policy, and ideology. Medicaid as a state and federal aid program in the United States and economic development programs as foreign aid provide useful analogies specifically because they exhibit a variety of parallel patterns. The increasing concatenation of corporate interests with state and nongovernmental interests in aid programs is ultimately producing a less centralized system of power and responsibility. This process of decentralization, however, is not undermining the sources of power behind aid efforts, although it does make the connections between intent, planning, and outcome less direct. Ultimately, the devolution of power produces many unintended consequences for aid policy. But it also reinforces the perspective that aid and the need for it are nonpolitical issues.

Ten clinician-driven strategies for maximising value of Australian health care.

Science.gov (United States)

Scott, Ian

2014-05-01

To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low- or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia. What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of

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.

Implementing Indigenous community control in health care: lessons from Canada.

Science.gov (United States)

Lavoie, Josée G; Dwyer, Judith

2016-09-01

Objective Over past decades, Australian and Canadian Indigenous primary healthcare policies have focused on supporting community controlled Indigenous health organisations. After more than 20 years of sustained effort, over 89% of eligible communities in Canada are currently engaged in the planning, management and provision of community controlled health services. In Australia, policy commitment to community control has also been in place for more than 25 years, but implementation has been complicated by unrealistic timelines, underdeveloped change management processes, inflexible funding agreements and distrust. This paper discusses the lessons from the Canadian experience to inform the continuing efforts to achieve the implementation of community control in Australia. Methods We reviewed Canadian policy and evaluation grey literature documents, and assessed lessons and recommendations for relevance to the Australian context. Results Our analysis yielded three broad lessons. First, implementing community control takes time. It took Canada 20 years to achieve 89% implementation. To succeed, Australia will need to make a firm long term commitment to this objective. Second, implementing community control is complex. Communities require adequate resources to support change management. And third, accountability frameworks must be tailored to the Indigenous primary health care context to be meaningful. Conclusions We conclude that although the Canadian experience is based on a different context, the processes and tools created to implement community control in Canada can help inform the Australian context. What is known about the topic? Although Australia has promoted Indigenous control over primary healthcare (PHC) services, implementation remains incomplete. Enduring barriers to the transfer of PHC services to community control have not been addressed in the largely sporadic attention to this challenge to date, despite significant recent efforts in some jurisdictions

Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults.

Science.gov (United States)

Gibson, William; Wand, Benedict M; O'Connell, Neil E

2017-09-14

Neuropathic pain, which is due to nerve disease or damage, represents a significant burden on people and society. It can be particularly unpleasant and achieving adequate symptom control can be difficult. Non-pharmacological methods of treatment are often employed by people with neuropathic pain and may include transcutaneous electrical nerve stimulation (TENS). This review supersedes one Cochrane Review 'Transcutaneous electrical nerve stimulation (TENS) for chronic pain' (Nnoaham 2014) and one withdrawn protocol 'Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults' (Claydon 2014). This review replaces the original protocol for neuropathic pain that was withdrawn. To determine the analgesic effectiveness of TENS versus placebo (sham) TENS, TENS versus usual care, TENS versus no treatment and TENS in addition to usual care versus usual care alone in the management of neuropathic pain in adults. We searched CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, Web of Science, PEDro, LILACS (up to September 2016) and various clinical trials registries. We also searched bibliographies of included studies for further relevant studies. We included randomised controlled trials where TENS was evaluated in the treatment of central or peripheral neuropathic pain. We included studies if they investigated the following: TENS versus placebo (sham) TENS, TENS versus usual care, TENS versus no treatment and TENS in addition to usual care versus usual care alone in the management of neuropathic pain in adults. Two review authors independently screened all database search results and identified papers requiring full-text assessment. Subsequently, two review authors independently applied inclusion/exclusion criteria to these studies. The same review authors then independently extracted data, assessed for risk of bias using the Cochrane standard tool and rated the quality of evidence using GRADE. We included 15 studies with 724 participants. We found a

Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider.

Science.gov (United States)

Douglas, Heather E; Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

2017-04-10

There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients.

A Study in Critical Listening Using Eight to Ten Year Olds in an Analysis of Commercial Propaganda Emanating from Television.

Science.gov (United States)

Cook, Jimmie Ellis

Selected eight to ten year old Maryland children were used in this study measuring the effect of lessons in becoming aware of propaganda employed by commercial advertisers in television programs. Sixteen 45-minute lessons directed to the propaganda techniques of Band Wagon, Card Stacking, Glittering Generalities, Name Calling, Plain Folks,…

Lessons from the business sector for successful knowledge management in health care: a systematic review.

Science.gov (United States)

Kothari, Anita; Hovanec, Nina; Hastie, Robyn; Sibbald, Shannon

2011-07-25

The concept of knowledge management has been prevalent in the business sector for decades. Only recently has knowledge management been receiving attention by the health care sector, in part due to the ever growing amount of information that health care practitioners must handle. It has become essential to develop a way to manage the information coming in to and going out of a health care organization. The purpose of this paper was to summarize previous studies from the business literature that explored specific knowledge management tools, with the aim of extracting lessons that could be applied in the health domain. We searched seven databases using keywords such as "knowledge management", "organizational knowledge", and "business performance". We included articles published between 2000-2009; we excluded non-English articles. 83 articles were reviewed and data were extracted to: (1) uncover reasons for initiating knowledge management strategies, (2) identify potential knowledge management strategies/solutions, and (3) describe facilitators and barriers to knowledge management. KM strategies include such things as training sessions, communication technologies, process mapping and communities of practice. Common facilitators and barriers to implementing these strategies are discussed in the business literature, but rigorous studies about the effectiveness of such initiatives are lacking. The health care sector is at a pinnacle place, with incredible opportunities to design, implement (and evaluate) knowledge management systems. While more research needs to be done on how best to do this in healthcare, the lessons learned from the business sector can provide a foundation on which to build.

Social Networking Sites and Addiction: Ten Lessons Learned.

Science.gov (United States)

Kuss, Daria J; Griffiths, Mark D

2017-03-17

Online social networking sites (SNSs) have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning online social networking sites and addiction based on the insights derived from recent empirical research will be presented. These are: (i) social networking and social media use are not the same; (ii) social networking is eclectic; (iii) social networking is a way of being; (iv) individuals can become addicted to using social networking sites; (v) Facebook addiction is only one example of SNS addiction; (vi) fear of missing out (FOMO) may be part of SNS addiction; (vii) smartphone addiction may be part of SNS addiction; (viii) nomophobia may be part of SNS addiction; (ix) there are sociodemographic differences in SNS addiction; and (x) there are methodological problems with research to date. These are discussed in turn. Recommendations for research and clinical applications are provided.

Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care

DEFF Research Database (Denmark)

Nyqvist, Kerstin H; Häggkvist, Anna-Pia; Hansen, Mette N

2013-01-01

In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different...... provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother......'s own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability...

Students' response to disaster: a lesson for health care professional schools.

Science.gov (United States)

Reyes, Humberto

2010-11-16

The response of medical students, young physicians, and other health professionals to the February 2010 earthquake and tsunami in Chile provides important lessons about health care delivery during disasters and about the development of professionalism. Tertiary and secondary care of victims of these disasters was possible because local and national resources were available and field hospitals provided by Chile's armed forces and foreign countries replaced damaged hospitals. However, primary care of persons living on the outskirts of towns and in small villages and coves that were destroyed and isolated by the disaster required the involvement of volunteer groups that were largely composed of students and other young members of the health professions, all of whom were motivated by solidarity, compassion, and social commitment. This experience, similar to previous catastrophes in Chile and elsewhere, reinforces that medical and other health professional schools must instill in graduates an understanding that the privileges of being a health professional come with responsibilities to society. Beyond providing high-quality scientific and technological education, curricula in these schools should include training that enables graduates to meaningfully contribute in the setting of unexpected disasters and that nurtures a sense of responsibility to do so.

Through Their Eyes: Lessons Learned Using Participatory Methods in Health Care Quality Improvement Projects.

Science.gov (United States)

Balbale, Salva N; Locatelli, Sara M; LaVela, Sherri L

2016-08-01

In this methodological article, we examine participatory methods in depth to demonstrate how these methods can be adopted for quality improvement (QI) projects in health care. We draw on existing literature and our QI initiatives in the Department of Veterans Affairs to discuss the application of photovoice and guided tours in QI efforts. We highlight lessons learned and several benefits of using participatory methods in this area. Using participatory methods, evaluators can engage patients, providers, and other stakeholders as partners to enhance care. Participant involvement helps yield actionable data that can be translated into improved care practices. Use of these methods also helps generate key insights to inform improvements that truly resonate with stakeholders. Using participatory methods is a valuable strategy to harness participant engagement and drive improvements that address individual needs. In applying these innovative methodologies, evaluators can transcend traditional approaches to uniquely support evaluations and improvements in health care. © The Author(s) 2015.

[Dental care in pregnancy. Ten questions and answers].

Science.gov (United States)

Patcas, Raphael; Schmidlin, Patrick R; Zimmermann, Roland; Gnoinski, Wanda

2012-01-01

Dental care of pregnant patients is a demanding task. On one hand, clinicians are facing patients with an altered physiology that may cause a greater need for treatment. On the other hand, pregnancy in itself as well as the unborn child involves potential contraindications to dental interventions. It is therefore essential that dentists be knowledgeable of the ramifications pregnancy has on medical findings and therapy. Also, clinicians must be able to conduct their treatment based on well-grounded data to avoid any harm to the pregnant woman and her unborn child. This article focuses on facts specifically relevant to clinicians. Based on most current scientific data, we aim to answer the following ten questions: 1. What are the physiological changes during pregnancy? 2. What is the adequate lying position for a pregnant patient? 3. Is there a pregnancy-related gingivitis? 4. What is the association between periodontitis, pregnancy and preterm birth? 5. Are there oral manifestations of pregnancy-related therapies? 6. Are caries and erosions inevitable during pregnancy? 7. Should the intake of fluoride be advocated? 8. Is it permissible to x-ray pregnant patients? 9. Is orthodontics contraindicated during pregnancy and 10. Which medication should be administered with caution?

Social Networking Sites and Addiction: Ten Lessons Learned

Science.gov (United States)

Kuss, Daria J.; Griffiths, Mark D.

2017-01-01

Online social networking sites (SNSs) have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning online social networking sites and addiction based on the insights derived from recent empirical research will be presented. These are: (i) social networking and social media use are not the same; (ii) social networking is eclectic; (iii) social networking is a way of being; (iv) individuals can become addicted to using social networking sites; (v) Facebook addiction is only one example of SNS addiction; (vi) fear of missing out (FOMO) may be part of SNS addiction; (vii) smartphone addiction may be part of SNS addiction; (viii) nomophobia may be part of SNS addiction; (ix) there are sociodemographic differences in SNS addiction; and (x) there are methodological problems with research to date. These are discussed in turn. Recommendations for research and clinical applications are provided. PMID:28304359

Social Networking Sites and Addiction: Ten Lessons Learned

Directory of Open Access Journals (Sweden)

Daria J. Kuss

2017-03-01

Full Text Available Online social networking sites (SNSs have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning online social networking sites and addiction based on the insights derived from recent empirical research will be presented. These are: (i social networking and social media use are not the same; (ii social networking is eclectic; (iii social networking is a way of being; (iv individuals can become addicted to using social networking sites; (v Facebook addiction is only one example of SNS addiction; (vi fear of missing out (FOMO may be part of SNS addiction; (vii smartphone addiction may be part of SNS addiction; (viii nomophobia may be part of SNS addiction; (ix there are sociodemographic differences in SNS addiction; and (x there are methodological problems with research to date. These are discussed in turn. Recommendations for research and clinical applications are provided.

Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider

Directory of Open Access Journals (Sweden)

Heather E Douglas

2017-04-01

Full Text Available Introduction: There is limited evidence of the benefits of information and communication technology (ICT to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Methods: Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Results: Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. Conclusions: There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients.

Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider

Science.gov (United States)

Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

2017-01-01

Introduction: There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Methods: Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Results: Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. Conclusions: There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients. PMID:29042851

Amish-Initiated Burn Care Project: Case Report and Lessons Learned in Participatory Research.

Science.gov (United States)

Hess, Rosanna F

2017-03-01

This case report describes the phases of an Amish Burn Care Project and the lessons learned throughout the process. Data sources to construct the case report included participant observation, interviews, archival documents, and a focus group. The narrative is organized into five phases of a participatory research approach: engagement, formalization, mobilization, maintenance, and expansion. Community-initiated research led to legitimate change, working together for change took time, team members grew in mutual trust and respect for each other, cultural humility brought personal and professional growth, and capacity building took place through mutually supported efforts.

Thomas L Petty's lessons for the respiratory care clinician of today.

Science.gov (United States)

Pierson, David J

2014-08-01

Because of the importance of his original contributions and their practical relevance today, Thomas L Petty (1932-2009) was arguably the most important physician in the history of respiratory care. As much as any single individual, he was responsible for the concept of intensive and multidisciplinary respiratory care. In the 1960s and 1970s, he made key observations and introduced pioneering therapies in the ICU and in the home. He was the first to describe and name ARDS and to show how to use PEEP to treat life-threatening hypoxemia. He was one of the first anywhere to organize a pulmonary rehabilitation program and to show the beneficial effects of long-term oxygen therapy in COPD. Dr Petty emphasized the importance of practical, hands-on respiratory care education for both physicians and non-physicians using a collaborative team approach. He targeted educational activities and practical resources specifically to patients, and he showed how researchers and clinicians could interact responsibly with innovators in industry to the benefit of both. His life and career provide 6 important lessons for respiratory clinicians today and in the future: (1) whatever their roles, RTs and other clinicians in this field need to be experts in its core areas, such as mechanical ventilation, ARDS, and COPD; (2) respiratory care is a team activity: every member is important, and all the members need to communicate well and work together; (3) education needs to be targeted to those in the best position to benefit the patient, including primary care providers and family members; (4) everyone in the field needs to understand the important role of the respiratory care industry and to deal with it responsibly; (5) it must never be forgotten that it is all about the patient; and (6) respiratory care should be exciting and fun. Copyright © 2014 by Daedalus Enterprises.

Health Care for Older Adults in Uganda: Lessons for the Developing World.

Science.gov (United States)

Tam, Wai Jia; Yap, Philip

2017-06-01

Approximately two-thirds of the world's older adults live in developing nations. By 2050, as many as 80% of such older people will live in low- and middle-income countries. In sub-Saharan Africa alone, the number of individuals aged 60 and older is projected to reach 163 million. Despite this demographic wave, the majority of Africa has limited access to qualified geriatric health care. 3 Although foreign aid and capacity-building efforts can help to close this gap over time, it is likely that failure to understand the unique context of Africa's older adults, many of whom are marginalized, will lead to inadequacies in service delivery and poor health outcomes. 4 As the need for culturally competent care of older adults gains recognition in the developed world, research in geriatric care in developing countries should progress in tandem. 4 By examining the multidimensional challenges that an older woman with the human immunodeficiency virus (HIV) in rural Uganda faces, this article makes contextualized policy recommendations for older adults in Africa and provides lessons for the developing world. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Essentials for emergency care: Lessons from an inventory assessment of an emergency centre in Sub-Saharan Africa

Directory of Open Access Journals (Sweden)

Kofi Marfo Osei

2014-12-01

Conclusion: Beyond pointing out specific material resource deficiencies at the Surgical Medical Emergency (SME centre, our inventory assessment indicated a need to develop better implementation strategies for infection control policies, to collaborate with other departments on coordination of patient care, and to set a research agenda to develop emergency and acute care protocols that are both effective and sustainable in our setting. Equipment and supplies are essential elements of emergency preparedness that must be both available and ‘ready-to-hand’. Consequently, key factors in determining readiness to provide quality emergency care include supply-chain, healthcare financing, functionality of systems, and a coordinated institutional vision. Lessons learnt may be useful for others facing similar challenges to emergency medicine development.

Cancer Care Ontario and integrated cancer programs: portrait of a performance management system and lessons learned.

Science.gov (United States)

Cheng, Siu Mee; Thompson, Leslee J

2006-01-01

A performance management system has been implemented by Cancer Care Ontario (CCO). This system allows for the monitoring and management of 11 integrated cancer programs (ICPs) across the Province of Ontario. The system comprises of four elements: reporting frequency, reporting requirements, review meetings and accountability and continuous improvement activities. CCO and the ICPs have recently completed quarterly performance review exercises for the last two quarters of the fiscal year 2004-2005. The purpose of this paper is to address some of the key lessons learned. The paper provides an outline of the CCO performance management system. These lessons included: data must be valid and reliable; performance management requires commitments from both parties in the performance review exercises; streamlining performance reporting is beneficial; technology infrastructure which allows for cohesive management of data is vital for a sustainable performance management system; performance indicators need to stand up to scrutiny by both parties; and providing comparative data across the province is valuable. Critical success factors which would help to ensure a successful performance management system include: corporate engagement from various parts of an organization in the review exercises; desire to focus on performance improvement and avoidance of blaming; and strong data management systems. The performance management system is a practical and sustainable system that allows for performance improvement of cancer care services. It can be a vital tool to enhance accountability within the health care system. The paper demonstrates that the performance management system supports accountability in the cancer care system for Ontario, and reflects the principles of the provincial governments commitment to continuous improvement of healthcare.

Lessons Learned from the Crew Health Care System (CHeCS) Rack 1 Environmental Control and Life Support (ECLS) Design

Science.gov (United States)

Williams, David E.

2006-01-01

This paper will provide an overview of the International Space Station (ISS) Environmental Control and Life Support (ECLS) design of the Crew Health Care System (CHeCS) Rack 1 and it will document some of the lessons that have been learned to date for the ECLS equipment in this rack.

Organizing and delivering case management services: lessons from the National Long Term Care Channeling Demonstration.

Science.gov (United States)

Christianson, J B; Applebaum, R; Carcagno, G; Phillips, B

1988-01-01

This article discusses issues relating to the design and internal administration of a case-management agency for community based home care for the elderly. Included in the article are issues relating to screening procedures, assessment and case management activities, cost controls, automated management information systems, and personnel matters. The analysis is based on the experience of the National Long Term Care Demonstration ("Channeling") which established and evaluated ten case management projects nationwide under federal funding.

Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care

Directory of Open Access Journals (Sweden)

Sandra C Thompson

2016-11-01

Full Text Available Background: The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. Methods: The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. Results: Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. Conclusion: Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their

Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care.

Science.gov (United States)

Thompson, Sandra C; Haynes, Emma; Woods, John A; Bessarab, Dawn C; Dimer, Lynette A; Wood, Marianne M; Sanfilippo, Frank M; Hamilton, Sandra J; Katzenellenbogen, Judith M

2016-01-01

The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients and work at multiple levels both outside and

Deburring: technical capabilities and cost-effective approaches, Lessons 3 and 4

Energy Technology Data Exchange (ETDEWEB)

Gillespie, L.K.

1980-06-01

This ten lesson text on deburring is designed to provide engineers and production supervisors with an overall understanding of deburring economics and current capabilities. The material included describes economics, side effects, process selection techniques, product design influences, standards, plantwide approaches, burr formation, and prevention. Deburring methods described include barrel, centrifugal barrel, vibratory, spindle, manual, electrochemical, electropolish, brush, abrasive jet, abrasive flow, water jet, thermal energy, and mechanized mechanical. Lessons 3 and 4 describe product design influences and burr prevention and minimization respectively.

Development of a Web-Based Health Care Intervention for Patients With Heart Disease: Lessons Learned From a Participatory Design Study.

Science.gov (United States)

Noergaard, Birgitte; Sandvei, Marianne; Rottmann, Nina; Johannessen, Helle; Wiil, Uffe; Schmidt, Thomas; Pedersen, Susanne S

2017-05-17

The use of telemedicine technologies in health care has increased substantially, together with a growing interest in participatory design methods when developing telemedicine approaches. We present lessons learned from a case study involving patients with heart disease and health care professionals in the development of a personalized Web-based health care intervention. We used a participatory design approach inspired by the method for feasibility studies in software development. We collected qualitative data using multiple methods in 3 workshops and analyzed the data using thematic analysis. Participants were 7 patients with diagnosis of heart disease, 2 nurses, 1 physician, 2 systems architects, 3 moderators, and 3 observers. We present findings in 2 parts. (1) Outcomes of the participatory design process: users gave valuable feedback on ease of use of the platforms' tracking tools, platform design, terminology, and insights into patients' monitoring needs, information and communication technologies skills, and preferences for self-management tools. (2) Experiences from the participatory design process: patients and health care professionals contributed different perspectives, with the patients using an experience-based approach and the health care professionals using a more attitude-based approach. The essential lessons learned concern planning and organization of workshops, including the finding that patients engaged actively and willingly in a participatory design process, whereas it was more challenging to include and engage health care professionals. ©Birgitte Noergaard, Marianne Sandvei, Nina Rottmann, Helle Johannessen, Uffe Wiil, Thomas Schmidt, Susanne S Pedersen. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 17.05.2017.

Application of TQM to mental health: lessons from ten mental health centers.

Science.gov (United States)

Sluyter, G V

1996-01-01

The principles and techniques of total quality management (TQM) have only recently been applied to the field of mental health. This article reviews issues and offers some preliminary observations, based on the author's consultation and training work with ten state-operated mental health organizations in Missouri (Jul 1, 1994-Jun 30, 1995). Since many mental health organizations have operated in the public sector as part of large, hierarchical state agencies, the legacy of bureaucratic structures and a command and control leadership style may pose additional challenges. Two types of training have proven helpful in the Missouri project: general overview or awareness training for all staff and specialized training for team leaders and facilitators. To be successful with TQM, mental health organizations should clearly delineate their governing ideas, continuously reinforce them with all staff, and use the ideas as a measuring stick for progress. Some of the organizations in the Missouri project link their governing ideas and strategic planning efforts with critical success factors and the measurement methodology to track them. This dimension, which may include a quality council, a quality department, and quality improvement (QI) teams, also extends to the way in which facilities are organized and function. The structure evolving from a team-oriented, time-limited, data-based, and problem-solving approach can facilitate the functioning of the entire organization. The philosophy and techniques of TQM are as applicable to mental health as to health care in general--the question is one more of motivation than of fit.

A summary of lessons learned at the Shippingport Station Decommissioning Project (SSDP)

International Nuclear Information System (INIS)

Crimi, F.P.; Mullee, G.R.

1987-10-01

This paper describes the lessons learned from a management perspective during decommissioning. The lessons learned are presented in a chronological sequence during the life of the project up to the present time. The careful analysis of the lessons learned and the implementation of corresponding actions have contributed toward improving the effectiveness of decommissioning as time progresses. The lessons learned should be helpful in planning future decommissioning projects

Ten Demands of Improved Usability in eHealth and Some Progress - Co-Creation by Health and Social Care Professionals.

Science.gov (United States)

Scandurra, Isabella; Liljequist, David

2016-01-01

Current healthcare organizations often do not accomplish the intended effects of their eHealth systems due to inadequate usability. Commissioned by the Swedish Ministry of Health and Social Affairs, the usability of current eHealth systems in Swedish health and social care has been analysed from the perspective of their professionals. The objective of the study was to report on current problems, potential solutions as well as to relate these to research in relevant areas. Using a participatory approach, nine workshops were held where health informatics researchers guided staff from different care organizations, representatives of the national associations of health and social care professionals and the national eHealth system vendor organization. This paper presents ten demands that Swedish health and social care professionals find imperative to prioritize. The study emphasizes that development of eHealth systems must be integrated into the care practice improvement process and iteratively evaluated regarding usability.

'It ain't what you do it's the way that you do it': lessons for health care from decommissioning of older people's services.

Science.gov (United States)

Robinson, Suzanne; Glasby, Jon; Allen, Kerry

2013-11-01

Public sector organisations are facing one of the most difficult financial periods in history and local decision-makers are tasked with making tough rationing decisions. Withdrawing or limiting services is an emotive and complex task and something the National Health Service has always found difficult. Over time, local authorities have gained significant experience in the closure of care homes - an equally complex and controversial issue. Drawing on local knowledge and best practice examples, this article highlights lessons and themes identified by those decommissioning care home services. We believe that such lessons are relevant to those making disinvestment decisions across public sector services, including health-care. The study employed semi-structured interviews with 12 Directors of Adult Social Services who had been highlighted nationally as having extensive experience of home closures. Interviews were conducted over a 2-week period in March 2011. Results from the study found that having local policy guidance that is perceived as fair and reasonable was advocated by those involved in home closures. Many local policies had evolved over time and had often been developed following experiences of home closures (both good and bad). Decisions to close care home services require a combination of strong leadership, clear strategic goals, a fair decision-making process, strong evidence of the need for change and good communication, alongside wider stakeholder engagement and support. The current financial challenge means that public sector organisations need to make tough choices on investment and disinvestment decisions. Any such decisions need to be influenced by what we know constitutes best practice. Sharing lessons and experiences within and between sectors could well inform and develop decision-making practices. © 2013 John Wiley & Sons Ltd.

Developing children’s palliative care in Africa through beacon centres: lessons learnt

Science.gov (United States)

2013-01-01

Much progress has been made in the provision of palliative care across sub-Saharan Africa, however much still remains to be done, particularly in the area of children’s palliative care (CPC). The Beacon Centres programme was set up in 2009, aimed at improving access to CPC in South Africa, Uganda and Tanzania through more and better-trained health professionals and CPC clinical services of a high standard. Having identified sites in each country to develop into CPC Beacon Centres, Navigators were identified who would be the ‘champions’ for CPC in those sites and lead a programme of training, mentorship and support. Five navigators (2 in Uganda and Tanzania and 1 in South Africa) were trained between September and December 2009. Following this they undertook CPC needs assessments at the 3 centres and set up and delivered a six-month CPC training programme, providing mentorship and support to students to enable them to integrate CPC into their workplaces. To date, 188 participants have commenced the six-month course, with 80 having completed it. CPC has been integrated into the activities of the centres and a CPC virtual resource centre set up in South Africa. The achievements from the Beacon project have been great and the work of the navigators immense, but as in all projects it has not been without its challenges. Lessons learnt include issues around: the focus of the project; the length and nature of the training; assessment; accreditation; the choice of navigators; mentoring; administrative support; co-ordination; the choice of project sites; and the integration of CPC into services. The need for CPC is not going to go away and it is therefore important that models of scaling-up are found that are not only practical, feasible, affordable and sustainable, but that focus on the outcome of improved CPC for all those who need it. It is hoped that the lessons shared from the Beacon Project will help in developing and implementing such models. PMID:23419095

Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care.

Science.gov (United States)

Goyder, Clare R; Jones, Caroline H D; Heneghan, Carl J; Thompson, Matthew J

2015-12-01

Because of the difficulties inherent in diagnosis in primary care, it is inevitable that diagnostic errors will occur. However, despite the important consequences associated with diagnostic errors and their estimated high prevalence, teaching and research on diagnostic error is a neglected area. To ascertain the key learning points from GPs' experiences of diagnostic errors and approaches to clinical decision making associated with these. Secondary analysis of 36 qualitative interviews with GPs in Oxfordshire, UK. Two datasets of semi-structured interviews were combined. Questions focused on GPs' experiences of diagnosis and diagnostic errors (or near misses) in routine primary care and out of hours. Interviews were audiorecorded, transcribed verbatim, and analysed thematically. Learning points include GPs' reliance on 'pattern recognition' and the failure of this strategy to identify atypical presentations; the importance of considering all potentially serious conditions using a 'restricted rule out' approach; and identifying and acting on a sense of unease. Strategies to help manage uncertainty in primary care were also discussed. Learning from previous examples of diagnostic errors is essential if these events are to be reduced in the future and this should be incorporated into GP training. At a practice level, learning points from experiences of diagnostic errors should be discussed more frequently; and more should be done to integrate these lessons nationally to understand and characterise diagnostic errors. © British Journal of General Practice 2015.

Market competition in health care markets in the Netherlands: some lessons for England?

Science.gov (United States)

den Exter, André P; Guy, Mary J

2014-01-01

This article seeks to establish what lessons might be available to the English health care sector following enactment of the Health and Social Care Act 2012 from the Dutch experience of introducing market competition into health care via a mandatory health insurance scheme implemented by for-profit insurance companies. The existence of the Beveridge NHS model in England, and a Bismarckian insurance system in The Netherlands perhaps suggest that a comparison of the two countries is at best limited, and reinforced by the different Enthoven-inspired competitive models each has adopted. However, we contend that there are positive and negative issues arising from introducing competition into health care-, e.g. concerns about equity and benefits of efficiencies-which go beyond national boundaries and different systems and reflect the global paradigm shift towards the use of market forces in previously non-market areas such as health. The article examines the situation in England following the HSCA 2012 and The Netherlands following the 2006 reforms before analysing two areas of common ground: the focus in both countries on competition on quality (as opposed to price) and integrated care, which is assuming ever greater significance. We suggest that our combined insights (as a health lawyer and competition lawyer respectively) coupled with a comparative approach create a novel contribution to current calls for a wider public debate about the real role of markets in health care over and above simple characterisation as a force for good or bad. © The Author 2014. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

Enhancing and Adapting Treatment Foster Care: Lessons Learned in Trying to Change Practice.

Science.gov (United States)

Murray, Maureen M; Southerland, Dannia; Farmer, Elizabeth M; Ballentine, Kess

2010-01-01

Evidence-based practices to improve outcomes for children with severe behavioral and emotional problems have received a great deal of attention in children's mental health. Therapeutic Foster Care (TFC), a residential intervention for youth with emotional or behavioral problems, is one of the few community-based programs that is considered to be evidence-based. However, as for most treatment approaches, the vast majority of existing programs do not deliver the evidence-based version. In an attempt to fill this gap and improve practice across a wide range of TFC agencies, we developed an enhanced model of TFC based on input from both practice and research. It includes elements associated with improved outcomes for youth in "usual care" TFC agencies as well as key elements from Chamberlain's evidence-based model. The current manuscript describes this "hybrid" intervention - Together Facing the Challenge - and discusses key issues in implementation. We describe the sample and settings, highlight key implementation strategies, and provide "lessons learned" to help guide others who may wish to change practice in existing agencies.

Developing a pediatric palliative care service in a large urban hospital: challenges, lessons, and successes.

Science.gov (United States)

Edlynn, Emily S; Derrington, Sabrina; Morgan, Helene; Murray, Jennifer; Ornelas, Beatriz; Cucchiaro, Giovanni

2013-04-01

We report the process of creating a new palliative care service at a large, urban children's hospital. Our aim was to provide a detailed guide to developing an inpatient consultation service, along with reporting on the challenges, lessons, and evaluation. We examined the hiring process of personnel and marketing strategies, a clinical database facilitated ongoing quality review and identified trends, and a survey project assessed provider satisfaction and how referring physicians used the palliative care service. The pilot phase of service delivery laid the groundwork for a more effective service by creating documentation templates and identifying relevant data to track growth and outcomes. It also allowed time to establish a clear delineation of team members and distinction of roles. The survey of referring physicians proved a useful evaluation starting point, but conclusions could not be generalized because of the low response rate. It may be necessary to reconsider the survey technique and to expand the sample to include patients and families. Future research is needed to measure the financial benefits of a well-staffed inpatient pediatric palliative care service.

Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State

Directory of Open Access Journals (Sweden)

Reed Peter

2012-12-01

Full Text Available Abstract Background Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance. Methods We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus. Results Innovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation. Conclusions Patient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets

Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial.

Science.gov (United States)

MacPherson, Hugh; Tilbrook, Helen; Richmond, Stewart; Woodman, Julia; Ballard, Kathleen; Atkin, Karl; Bland, Martin; Eldred, Janet; Essex, Holly; Hewitt, Catherine; Hopton, Ann; Keding, Ada; Lansdown, Harriet; Parrott, Steve; Torgerson, David; Wenham, Aniela; Watt, Ian

2015-11-03

Management of chronic neck pain may benefit from additional active self-care-oriented approaches. To evaluate clinical effectiveness of Alexander Technique lessons or acupuncture versus usual care for persons with chronic, nonspecific neck pain. Three-group randomized, controlled trial. (Current Controlled Trials: ISRCTN15186354). U.K. primary care. Persons with neck pain lasting at least 3 months, a score of at least 28% on the Northwick Park Questionnaire (NPQ) for neck pain and associated disability, and no serious underlying pathology. 12 acupuncture sessions or 20 one-to-one Alexander lessons (both 600 minutes total) plus usual care versus usual care alone. NPQ score (primary outcome) at 0, 3, 6, and 12 months (primary end point) and Chronic Pain Self-Efficacy Scale score, quality of life, and adverse events (secondary outcomes). 517 patients were recruited, and the median duration of neck pain was 6 years. Mean attendance was 10 acupuncture sessions and 14 Alexander lessons. Between-group reductions in NPQ score at 12 months versus usual care were 3.92 percentage points for acupuncture (95% CI, 0.97 to 6.87 percentage points) (P = 0.009) and 3.79 percentage points for Alexander lessons (CI, 0.91 to 6.66 percentage points) (P = 0.010). The 12-month reductions in NPQ score from baseline were 32% for acupuncture and 31% for Alexander lessons. Participant self-efficacy improved for both interventions versus usual care at 6 months (P neck pain and associated disability compared with usual care at 12 months. Enhanced self-efficacy may partially explain why longer-term benefits were sustained. Arthritis Research UK.

Transitioning HIV-Positive Adolescents to Adult Care: Lessons Learned From Twelve Adolescent Medicine Clinics.

Science.gov (United States)

Tanner, Amanda E; Philbin, Morgan M; DuVal, Anna; Ellen, Jonathan; Kapogiannis, Bill; Fortenberry, J Dennis

2016-01-01

To maximize positive health outcomes for youth with HIV as they transition from youth to adult care, clinical staff need strategies and protocols to help youth maintain clinic engagement and medication adherence. Accordingly, this paper describe transition processes across twelve clinics within the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) to provide lessons learned and inform the development of transition protocols to improve health outcomes as youth shift from adolescent to adult HIV care. During a large multi-method Care Initiative program evaluation, three annual visits were completed at each site from 2010-2012 and conducted 174 semi-structured interviews with clinical and program staff (baseline n=64, year 1 n=56, year 2=54). The results underscore the value of adhering to recent American Academy of Pediatrics (AAP) transition recommendations, including: developing formal transition protocols, preparing youth for transition, facilitating youth's connection to the adult clinic, and identifying necessary strategies for transition evaluation. Transitioning youth with HIV involves targeting individual-, provider-, and system-level factors. Acknowledging and addressing key barriers is essential for developing streamlined, comprehensive, and context-specific transition protocols. Adolescent and adult clinic involvement in transition is essential to reduce service fragmentation, provide coordinated and continuous care, and support individual and community level health. Copyright © 2016 Elsevier Inc. All rights reserved.

Ten years of negotiating rights around maternal health in Uttar Pradesh, India.

Science.gov (United States)

Dasgupta, Jashodhara

2011-12-16

Preventable maternal mortality and morbidity have been globally recognized as human rights issues. Maternal mortality in India is among the highest in the world, and reflects inequity in access to healthcare: women from certain states as well as poorer women and less literate women appear to be significantly disadvantaged. The government of India has been attempting to improve maternal outcomes through a cash transfer within the National Rural Health Mission to encourage women to come to hospitals for childbirth. This paper reviews documents of the last ten years describing the experiences of a Non-Governmental Organisation, SAHAYOG, in working with a civil society platform, the Healthwatch Forum, to develop 'rights based' strategies around maternal health. The paper builds an analysis using recent frameworks on accountability and gendered rights claiming to examine these experiences and draw out lessons regarding rights claiming strategies for poor women. The examination of documents over the last ten years indicates defined phases of development in the evolution of SAHAYOG's understanding and of the shifts in strategy among SAHAYOG and its close allies, and responses by the state. The first three stages depict the deepening of SAHAYOG's understanding of the manner in which poor and marginalized women negotiate their access to health care; the fourth stage explores a health system intervention and the challenges of working from within civil society in alliance with poor and marginalized women. The findings from SAHAYOG's experiences with poor Dalit women in Uttar Pradesh reveal the elements of social exclusion within the health system that prevent poor and marginalized women from accessing effective lifesaving care. Creating a voice for the most marginalised and carving space for its articulation impacts upon the institutions and actors that have a duty to meet the claims being made. However, given the accountability deficit, the analysis indicates the importance

Ten design lessons from the literature on child development and children’s use of technology

CSIR Research Space (South Africa)

Gelderblom, H

2009-06-01

Full Text Available sampling, data collection and data analysis [15]. We used multiple case sampling [28] to establish a trustworthy profile of five to eight year old children and reputational case selection [28] to choose the relevant theories of development, research... here will confirm. For this paper we selected, from the complete framework, ten themes to focus on. We present the guidelines associated with these themes as ten ‘lessons’ grounded in respected theoretical or empirical research results...

The road to patient experience of care measurement: lessons from the United States.

Science.gov (United States)

Zimlichman, Eyal; Rozenblum, Ronen; Millenson, Michael L

2013-09-17

Patient-centered care has become an increasing priority in the United States and plays a prominent role in recent healthcare reforms. One way the country has managed to advance patient-centered care is through establishment of a family of national patient experience surveys (the Consumer Assessment of Healthcare Providers and Systems Plans (CAHPS). CAHPS is publicly reported for several types of providers and was recently tied to hospital reimbursement. This is part of a trend over the last two decades that has shifted provider-patient relationships from a traditional paternal approach to customer service and then to clinical partnership. The health care system in Israel, however, is still struggling to overcome barriers to change in this area. While community based biannual patient experience surveys are conducted by the Myers-JDC-Brookdale Institute, there is no comprehensive national approach to measuring the patient experience across a broad range of settings. Only recently did the Israeli Ministry of Health take its first steps to include patient experience as a dimension of health care quality.In its current position, Israel should learn from the U.S. experience with policies promoting patient-centered care, and specifically the impact on clinical services of measuring the patient experience. Looking at what has happened in the United States, we suggest three main lessons. First, there is a need for a set of national patient experience surveys that would be publicly reported and eventually tied to provider reimbursement. Secondly, the national survey tools should be customized to the unique characteristics of Israeli society and draw from recent research on patient-centeredness to include new and important domains such as patient activation and shared decision-making. Finally, newer technological approaches should be explored with the aim of increasing response rates and the timeliness and usefulness of the surveys.

Lessons for the new CMS innovation center from the Medicare health support program.

Science.gov (United States)

Barr, Michael S; Foote, Sandra M; Krakauer, Randall; Mattingly, Patrick H

2010-07-01

The Patient Protection and Affordable Care Act establishes a new Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services (CMS). The center is intended to enhance the CMS's role in promoting much-needed improvements in payment and service delivery. Lessons from the Medicare Health Support Program, a chronic care pilot program that ran between 2005 and 2008, illustrate the value of drawing on experience in planning for the center and future pilot programs. The lessons include the importance of strong leadership; collaboration and flexibility to foster innovation; receptivity of beneficiaries to care management; and the need for timely data on patients' status. The lessons also highlight pitfalls to be avoided in planning future pilot programs, such as flawed strategies for selecting populations to target when testing payment and service delivery reforms.

[Development and evolution of a balanced scorecard in primary health care: Lessons learned].

Science.gov (United States)

Bartolomé-Benito, E; Jiménez-Carramiñana, J; Sánchez-Perruca, L; Bartolomé-Casado, M S; Dominguez-Mandueño, A B; Marti-Argandoña, M; Hernández-Pascual, M; Miquel-Gómez, A

To describe the design, implementation, and monitoring of eSOAP (Primary Health Care Balanced Scorecard) and its role in the deployment of strategic objectives and clinical management, as well as to show the lessons learned during six years of follow-up. Descriptive study areas: methodology (conceptual framework, strategic matrix, strategic map, and processes map), technology and standardisation. As of December 2014, 9,046 (78%) professionals are registered in eSOAP. A total of 381 indicators were measured from 16 data sources, of which 36% were of results (EFQM model), 39.1% of clinical management, and 20% were included in the Program Centre Contract. The Balanced Scorecard has enabled to deploy all strategic lines of Primary Health Care, and has enabled the healthcare professionals to evaluate the evolution of results over time, and at patient level (e.g. 16% increase in control of diabetic patients). A total of 295,779 reports were generated and 13,080 professionals were evaluated by goals. There was an increased use of the eSOAP application by the professionals. The Balanced Scorecard was the key in deploying Primary Health Care strategies. It has helped clinical management and improved relevant indicators (health, patient experience, and costs), such as the management models that we used as references (EFQM Kaplan and Norton), and new emerging scenarios (Triple aim). Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Residential care for abandoned children and their integration into a family-based setting in Uganda: lessons for policy and programming.

Science.gov (United States)

Walakira, Eddy J; Ochen, Eric A; Bukuluki, Paul; Alllan, Sue

2014-01-01

This article describes a model of care for abandoned and neglected infants in need of urgent physical, social, and medical support as implemented by the Child's i Foundation, an international, nongovernmental organization operating in Uganda. The model discounts the need for long-term care of young children within institutions and challenges the basis for intercountry adoption. Underpinned by the essentials of care continuum provided under the Uganda National Alternative Care Framework (Ministry of Gender, Labour and Social Development, 2012), the model emphasizes the need to effect the reintegration of the separated child within the family of his or her birth, or locally organize foster care or adoption. Highlighting policy and programming lessons, the model showcases a holistic approach to the problem and puts emphasis on interventions that are protective, promotional, and transformational and the use of a community-oriented approach. The model offers guidance to both government and nongovernment actors in addressing the problems of child neglect and abandonment through the implementation of the alternative care framework. © 2014 Michigan Association for Infant Mental Health.

Ten principles of good interdisciplinary team work.

Science.gov (United States)

Nancarrow, Susan A; Booth, Andrew; Ariss, Steven; Smith, Tony; Enderby, Pam; Roots, Alison

2013-05-10

Interdisciplinary team work is increasingly prevalent, supported by policies and practices that bring care closer to the patient and challenge traditional professional boundaries. To date, there has been a great deal of emphasis on the processes of team work, and in some cases, outcomes. This study draws on two sources of knowledge to identify the attributes of a good interdisciplinary team; a published systematic review of the literature on interdisciplinary team work, and the perceptions of over 253 staff from 11 community rehabilitation and intermediate care teams in the UK. These data sources were merged using qualitative content analysis to arrive at a framework that identifies characteristics and proposes ten competencies that support effective interdisciplinary team work. Ten characteristics underpinning effective interdisciplinary team work were identified: positive leadership and management attributes; communication strategies and structures; personal rewards, training and development; appropriate resources and procedures; appropriate skill mix; supportive team climate; individual characteristics that support interdisciplinary team work; clarity of vision; quality and outcomes of care; and respecting and understanding roles. We propose competency statements that an effective interdisciplinary team functioning at a high level should demonstrate.

The Aethereal Network on Chip after Ten Years: Goals, Evolution, Lessons, and Future

NARCIS (Netherlands)

Goossens, Kees; Hansson, A.

2010-01-01

The goals for the Æthereal network on silicon, as it was then called, were set in 2000 and its concepts were defined early 2001. Ten years on, what has been achieved? Did we meet the goals, and what is left of the concepts? In this paper we answer those questions, and evaluate different

The aethereal network on chip after ten years: Goals, evolution, lessons and future

NARCIS (Netherlands)

Goossens, K.G.W.; Hansson, M.A.

2010-01-01

The goals for the Æthereal network on silicon, as it was then called, were set in 2000 and its concepts were defined early 2001. Ten years on, what has been achieved? Did we meet the goals, and what is left of the concepts? In this paper we answer those questions, and evaluate different

Lessons from abroad: Rebalancing accountability and pedagogy in the Irish social care sector through the use of effective leadership

Directory of Open Access Journals (Sweden)

Jones Cathy

2016-08-01

Full Text Available A concern is emerging in Ireland that social care managers and staff are moving too far away from the ‘care’ in social ‘care’ work. In this paper a discussion of the impact of the bureaucratic procedures and regulation within the social work and social care work sectors is presented along with an exploration of leadership approaches. It is argued that certain leadership approaches, in particular pedagogical leadership, could not only help social care managers to negotiate the complex issues they are facing but also facilitate putting the ‘care’ back into social ‘care’ work. Pedagogical leadership is globally supported across a variety of human service disciplines: it facilitates the creation of a learning culture within the workplace where social care managers facilitate conversations with their teams to encourage reflection, critical thinking and contributions to the professional wisdom required for quality service. The purpose of this article is to contribute to the dialogue within leadership practice for social care professionals. This discourse is necessary if lessons are to be learned from past experiences in this country and others about how to balance the need for care, learning and compassion with accountability.

Lessons from Fukushima: New Concerns for the Future

International Nuclear Information System (INIS)

Matsumura, Akio; Girard, Odile

2016-01-01

In this article, the author, former Japanese diplomat, expresses lessons he learned from the catastrophe. He outlines that several aspects of this crisis keep on affecting population's health and environmental safety. He outlines several aspects: experts as well as the public have been looking for technical solutions during the first two weeks, experts knew from the beginning that the crisis was largely beyond the current technical capacities. He states that, without the intervention of experts from different fields, important information would have remained in the government's and public operator's hands rather than been communicated to the public. According to him, the main lesson is that we are now living surrounded by new threats which have been actually present for ten years, and that Fukushima is a matter of new concerns about nuclear plants

Lessons-Learned from an Event during Overhaul

Energy Technology Data Exchange (ETDEWEB)

Kim, Jitae [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

2013-05-15

The event frequency, also including portion of human errors, has been decreasing compared to last ten years. However, events due to human errors during overhaul occur every year. From analyzed results for human-related events during overhaul, similar problems were identified. And organizational and safety cultural factors were also identified. On the other hand, another event during overhaul is analyzed and Lessons-Learned is drawn in an aspect of the operators' situation awareness. There was an event during overhaul and the analyzed results drawn Lessons-Learned in the aspect of the operators' situation awareness. From the analysis, several alarms and variation of plant parameters during overhaul can occur due to various maintenance works and tests. And in the aspect of the situation awareness, operators can miss, neglect, or not recognize the abnormal situation due to other maintenance activities occurring simultaneously. Therefore, countermeasures such as operator education or training, development of operator support systems, and further researches should be necessary to cope with these problems.

Lessons-Learned from an Event during Overhaul

International Nuclear Information System (INIS)

Kim, Jitae

2013-01-01

The event frequency, also including portion of human errors, has been decreasing compared to last ten years. However, events due to human errors during overhaul occur every year. From analyzed results for human-related events during overhaul, similar problems were identified. And organizational and safety cultural factors were also identified. On the other hand, another event during overhaul is analyzed and Lessons-Learned is drawn in an aspect of the operators' situation awareness. There was an event during overhaul and the analyzed results drawn Lessons-Learned in the aspect of the operators' situation awareness. From the analysis, several alarms and variation of plant parameters during overhaul can occur due to various maintenance works and tests. And in the aspect of the situation awareness, operators can miss, neglect, or not recognize the abnormal situation due to other maintenance activities occurring simultaneously. Therefore, countermeasures such as operator education or training, development of operator support systems, and further researches should be necessary to cope with these problems

Lecciones de Quechua. Primer Nivel, Segundo Nivel (Quechua Lessons. First Level, Second Level).

Science.gov (United States)

Herrero, Joaquin; And Others

The two volumes comprising this text represent the beginning and intermediate levels of a course in the Quechua language for speakers of Spanish. Based on the "Audio Lingual Materials" format, the ten lessons in the the first volume generally contain: (1) a short dialog and a supplementary vocabulary section or adapted dialog which…

Strategies to enhance price and quality competition in health care: lessons learned from tracking local markets.

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Lesser, Cara S; Ginsburg, Paul B

2006-06-01

Drawing on observations from tracking changes in local health care markets over the past ten years, this article critiques two Federal Trade Commission and Department of Justice recommendations to enhance price and quality competition. First, we take issue with the notion that consumers, acting independently, will drive greater competition in health care markets. Rather we suggest an important role remains for trusted agents who can analyze inherently complex price and quality information and negotiate on consumers' behalf. With aggregated information identifying providers who deliver cost-effective care, consumers would be better positioned to respond to financial incentives about where to seek care and thereby drive more meaningful competition among providers to reduce costs and improve quality. Second, we take issue with the FTC/DOJ recommendation to provide more direct subsidies to prevent distortions in competition. In the current political environment, it is not practical to provide direct subsidies for all of the unfunded care that exists in health care markets today; instead, some interference with competition may be necessary to protect cross subsidies. Barriers can be reduced, though, by revising pricing policies that have resulted in marked disparities in the relative profitability of different services.

Ten years of negotiating rights around maternal health in Uttar Pradesh, India

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Dasgupta Jashodhara

2011-12-01

Full Text Available Abstract Background Preventable maternal mortality and morbidity have been globally recognized as human rights issues. Maternal mortality in India is among the highest in the world, and reflects inequity in access to healthcare: women from certain states as well as poorer women and less literate women appear to be significantly disadvantaged. The government of India has been attempting to improve maternal outcomes through a cash transfer within the National Rural Health Mission to encourage women to come to hospitals for childbirth. Methods This paper reviews documents of the last ten years describing the experiences of a Non-Governmental Organisation, SAHAYOG, in working with a civil society platform, the Healthwatch Forum, to develop ‘rights based’ strategies around maternal health. The paper builds an analysis using recent frameworks on accountability and gendered rights claiming to examine these experiences and draw out lessons regarding rights claiming strategies for poor women. Results The examination of documents over the last ten years indicates defined phases of development in the evolution of SAHAYOG’s understanding and of the shifts in strategy among SAHAYOG and its close allies, and responses by the state. The first three stages depict the deepening of SAHAYOG’s understanding of the manner in which poor and marginalized women negotiate their access to health care; the fourth stage explores a health system intervention and the challenges of working from within civil society in alliance with poor and marginalized women. Conclusion The findings from SAHAYOG’s experiences with poor Dalit women in Uttar Pradesh reveal the elements of social exclusion within the health system that prevent poor and marginalized women from accessing effective lifesaving care. Creating a voice for the most marginalised and carving space for its articulation impacts upon the institutions and actors that have a duty to meet the claims being made

Southwest Airlines: lessons in loyalty.

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D'Aurizio, Patricia

2008-01-01

Southwest Airlines continues to garner accolades in the areas of customer service, workforce management, and profitability. Since both the health care and airlines industries deal with a service rather than a product, the customer experience depends on the people who deliver that experience. Employees' commitment or "loyalty" to their customers, their employer, and their work translates into millions of dollars of revenue. What employee wants to work for "the worst employer in town?" Nine loyalty lessons from Southwest can be carried over to the health care setting for the benefit of employees and patients.

An Economic Evaluation of TENS in Addition to Usual Primary Care Management for the Treatment of Tennis Elbow: Results from the TATE Randomized Controlled Trial.

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Martyn Lewis

Full Text Available The TATE trial was a multicentre pragmatic randomized controlled trial of supplementing primary care management (PCM-consisting of a GP consultation followed by information and advice on exercises-with transcutaneous electrical nerve stimulation (TENS, to reduce pain intensity in patients with tennis elbow. This paper reports the health economic evaluation.Adults with new diagnosis of tennis elbow were recruited from 38 general practices in the UK, and randomly allocated to PCM (n = 120 or PCM plus TENS (n = 121. Outcomes included reduction in pain intensity and quality-adjusted-life-years (QALYs based on the EQ5D and SF6D. Two economic perspectives were evaluated: (i healthcare-inclusive of NHS and private health costs for the tennis elbow; (ii societal-healthcare costs plus productivity losses through work absenteeism. Mean outcome and cost differences between the groups were evaluated using a multiple imputed dataset as the base case evaluation, with uncertainty represented in cost-effectiveness planes and through probabilistic cost-effectiveness acceptability curves. Incremental healthcare cost was £33 (95%CI -40, 106 and societal cost £65 (95%CI -307, 176 for PCM plus TENS. Mean differences in outcome were: 0.11 (95%CI -0.13, 0.35 for change in pain (0-10 pain scale; -0.015 (95%CI -0.058, 0.029 for QALYEQ5D; 0.007 (95%CI -0.022, 0.035 for QALYSF6D (higher score differences denote greater benefit for PCM plus TENS. The ICER (incremental cost effectiveness ratio for the main evaluation of mean difference in societal cost (£ relative to mean difference in pain outcome was -582 (95%CI -8666, 8113. However, incremental ICERs show differences in cost-effectiveness of additional TENS, according to the outcome being evaluated.Our findings do not provide evidence for or against the cost-effectiveness of TENS as an adjunct to primary care management of tennis elbow.

Health care in the Netherlands.

NARCIS (Netherlands)

Weel, C. van; Schers, H.J.; Timmermans, A.

2012-01-01

This article analyzes Dutch experiences of health care reform--in particular in primary care--with emphasis on lessons for current United States health care reforms. Recent major innovations were the introduction of private insurance based on the principles of primary care-led health care and

Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis.

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Wodchis, Walter P; Dixon, Anna; Anderson, Geoff M; Goodwin, Nick

2015-01-01

To address the challenges of caring for a growing number of older people with a mix of both health problems and functional impairment, programmes in different countries have different approaches to integrating health and social service supports. The goal of this analysis is to identify important lessons for policy makers and service providers to enable better design, implementation and spread of successful integrated care models. This paper provides a structured cross-case synthesis of seven integrated care programmes in Australia, Canada, the Netherlands, New Zealand, Sweden, the UK and the USA. All seven programmes involved bottom-up innovation driven by local needs and included: (1) a single point of entry, (2) holistic care assessments, (3) comprehensive care planning, (4) care co-ordination and (5) a well-connected provider network. The process of achieving successful integration involves collaboration and, although the specific types of collaboration varied considerably across the seven case studies, all involved a care coordinator or case manager. Most programmes were not systematically evaluated but the two with formal external evaluations showed benefit and have been expanded. Case managers or care coordinators who support patient-centred collaborative care are key to successful integration in all our cases as are policies that provide funds and support for local initiatives that allow for bottom-up innovation. However, more robust and systematic evaluation of these initiatives is needed to clarify the 'business case' for integrated health and social care and to ensure successful generalization of local successes.

Didactic Contracts in Realistic Mathematics Education Teaching Practice in Indonesia: A lesson on addition

DEFF Research Database (Denmark)

Putra, Zetra Hainul

combinations that make ten based on a Palembang traditional food, pempek, and tablets of medicine. The result shows that some features such as formulation and validation appear during the teaching and learning process. The students are able to produce combinations that make ten individually and collectively......This paper aims to investigate characterize features of didactic contracts in realistic mathematics education teaching practice in Indonesia in the case of a lesson on addition. We just focus on some episodes of 26 first grade students and a female teacher from SDN 197 Palembang learning...

Comparison of radiology residency programs in ten countries

International Nuclear Information System (INIS)

Willatt, J.M.G.; Mason, A.C.

2006-01-01

The purpose of our study was to compare various aspects of radiology training schemes in ten countries. A questionnaire was sent to senior residents in the UK, USA, Canada, Australia, New Zealand, Italy, Egypt, India, Malaysia and Greece. The questions concerned length of training, required pre-training experience, the organization of the training scheme, teaching, resources, stages at which residents can independently perform and report examinations, fellowships, and progression to jobs. A wide variety of training, ranging from highly scheduled programs with detailed aims and objectives, to self-learning occurs across the world. Examinations and assessments are also variable. There are lessons to be learned from varying practices; more exchanges of ideas should be encouraged. In view of the ''internationalization'' of radiology services and the variation in training styles an international qualification for quality assurance purposes may be desirable. (orig.)

Flying Lessons for Clinicians: Developing System 2 Practice.

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Gregoire, Jerome N; Alfes, Celeste M; Reimer, Andrew P; Terhaar, Mary F

There is a long history of adopting lessons learned from aviation to improve health care practice. Two of the major practices that have successfully transferred include using a checklist and simulation. Training and simulation technology is currently underdeveloped for nurses and health care providers entering critical care transport. This article describes a pedagogical approach adopted from aviation to develop a new simulation platform and program of research to develop the science of critical care transport nursing education. Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Building the Partners HealthCare Biobank at Partners Personalized Medicine: Informed Consent, Return of Research Results, Recruitment Lessons and Operational Considerations

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Elizabeth W. Karlson

2016-01-01

Full Text Available The Partners HealthCare Biobank is a Partners HealthCare enterprise-wide initiative whose goal is to provide a foundation for the next generation of translational research studies of genotype, environment, gene-environment interaction, biomarker and family history associations with disease phenotypes. The Biobank has leveraged in-person and electronic recruitment methods to enroll >30,000 subjects as of October 2015 at two academic medical centers in Partners HealthCare since launching in 2010. Through a close collaboration with the Partners Human Research Committee, the Biobank has developed a comprehensive informed consent process that addresses key patient concerns, including privacy and the return of research results. Lessons learned include the need for careful consideration of ethical issues, attention to the educational content of electronic media, the importance of patient authentication in electronic informed consent, the need for highly secure IT infrastructure and management of communications and the importance of flexible recruitment modalities and processes dependent on the clinical setting for recruitment.

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.

Science.gov (United States)

Little, Paul; Lewith, George; Webley, Fran; Evans, Maggie; Beattie, Angela; Middleton, Karen; Barnett, Jane; Ballard, Kathleen; Oxford, Frances; Smith, Peter; Yardley, Lucy; Hollinghurst, Sandra; Sharp, Debbie

2008-08-19

To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain. Factorial randomised trial. 64 general practices in England. 579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups were randomised to exercise prescription. Normal care (control), six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling. Roland Morris disability score (number of activities impaired by pain) and number of days in pain. Exercise and lessons in the Alexander technique, but not massage, remained effective at one year (compared with control Roland disability score 8.1: massage -0.58, 95% confidence interval -1.94 to 0.77, six lessons -1.40, -2.77 to -0.03, 24 lessons -3.4, -4.76 to -2.03, and exercise -1.29, -2.25 to -0.34). Exercise after six lessons achieved 72% of the effect of 24 lessons alone (Roland disability score -2.98 and -4.14, respectively). Number of days with back pain in the past four weeks was lower after lessons (compared with control median 21 days: 24 lessons -18, six lessons -10, massage -7) and quality of life improved significantly. No significant harms were reported. One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons. National Research Register N0028108728.

Promoting Local Ownership: Lessons Learned from Process of Transitioning Clinical Mentoring of HIV Care and Treatment in Ethiopia

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Getnet M. Kassie

2018-02-01

Full Text Available IntroductionFocus on improving access and quality of HIV care and treatment gained acceptance in Ethiopia through the work of the International Training and Education Center for Health. The initiative deployed mobile field-based teams and capacity building teams to mentor health care providers on clinical services and program delivery in three regions, namely Tigray, Amhara, and Afar. Transitioning of the clinical mentoring program (CMP began in 2012 through capacity building and transfer of skills and knowledge to local health care providers and management.ObjectiveThe initiative explored the process of transitioning a CMP on HIV care and treatment to local ownership and documented key lessons learned.MethodsA mixed qualitative design was used employing focus group discussions, individual in-depth interviews, and review of secondary data. The participants included regional focal persons, mentors, mentees, multidisciplinary team members, and International Training and Education Center for Health (I-TECH staff. Three facilities were selected in each region. Data were collected by trained research assistants using customized guides for interviews and with data extraction format. The interviews were recorded and fully transcribed. Open Code software was used for coding and categorizing the data.ResultsA total of 16 focus group discussions and 20 individual in-depth interviews were conducted. The critical processes for transitioning a project were: establishment of a mentoring transition task force, development of a roadmap to define steps and directions for implementing the transition, and signing of a memorandum of understanding (MOU between the respective regional health bureaus and I-TECH Ethiopia to formalize the transition. The elements of implementation included mentorship and capacity building, joint mentoring, supportive supervision, review meetings, and independent mentoring supported by facility-based mechanisms: multidisciplinary team

Reporting intellectual capital in health care organizations: specifics, lessons learned, and future research perspectives.

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Veltri, Stefania; Bronzetti, Giovanni; Sicoli, Graziella

2011-01-01

This article analyzes the concept of intellectual capital (IC) in the health sector sphere by studying the case of a major nonprofit research organization in this sector, which has for some time been publishing IC reports. In the last few years, health care organizations have been the object of great attention in the implementation and transfer of managerial models and tools; however, there is still a lack of attention paid to the strategic management of IC as a fundamental resource for supporting and enhancing performance improvement dynamics. The main aim of this article is to examine the IC reporting model used by the Center of Molecular Medicine (CMM), a Swedish health organization which is an outstanding benchmark in reporting its IC. We also consider the specifics of IC reporting for health organizations, the lessons learned by analyzing CMM's IC reporting, and future perspectives for research.

Ten Things Gay Men Should Discuss with Their Health Care Provider

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... Conference Newsroom Support GLMA Site Search Ten Things Gay Men Should discuss with Their Healthcare Provider ( Download . ... have identified as most commonly of concern for gay men. While not all of these items apply ...

Feasibility study of Transcutaneous Electrical Nerve Stimulation (TENS) for cancer bone pain.

Science.gov (United States)

Bennett, Michael I; Johnson, Mark I; Brown, Sarah R; Radford, Helen; Brown, Julia M; Searle, Robert D

2010-04-01

This multicenter study assessed the feasibility of conducting a phase III trial of transcutaneous electrical nerve stimulation (TENS) in patients with cancer bone pain recruited from palliative care services. Eligible patients received active and placebo TENS for 1 hour at site of pain in a randomized crossover design; median interval between applications 3 days. Responses assessed at 30 and 60 minutes included numerical and verbal ratings of pain at rest and on movement, and pain relief. Recruitment, tolerability, adverse events, and effectiveness of blinding were also evaluated. Twenty-four patients were randomised and 19 completed both applications. The intervention was well tolerated. Five patients withdrew: 3 due to deteriorating performance status, and 2 due to increased pain (1 each following active and placebo TENS). Confidence interval estimation around the differences in outcomes between active and placebo TENS suggests that TENS has the potential to decrease pain on movement more than pain on rest. Nine patients did not consider that a placebo was used; the remaining 10 correctly identified placebo TENS. Feasibility studies are important in palliative care prior to undertaking clinical trials. Our findings suggest that further work is required on recruitment strategies and refining the control arm before evaluating TENS in cancer bone pain. Cancer bone pain is common and severe, and partly mediated by hyperexcitability. Animal studies suggest that Transcutaneous Electrical Nerve Stimulation can reduce hyperalgesia. This study examined the feasibility of evaluating TENS in patients with cancer bone pain in order to optimize methods before a phase III trial. Copyright 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.

How can health care organisations make and justify decisions about risk reduction? Lessons from a cross-industry review and a health care stakeholder consensus development process

International Nuclear Information System (INIS)

Sujan, Mark A.; Habli, Ibrahim; Kelly, Tim P.; Gühnemann, Astrid; Pozzi, Simone; Johnson, Christopher W.

2017-01-01

Interventions to reduce risk often have an associated cost. In UK industries decisions about risk reduction are made and justified within a shared regulatory framework that requires that risk be reduced as low as reasonably practicable. In health care no such regulatory framework exists, and the practice of making decisions about risk reduction is varied and lacks transparency. Can health care organisations learn from relevant industry experiences about making and justifying risk reduction decisions? This paper presents lessons from a qualitative study undertaken with 21 participants from five industries about how such decisions are made and justified in UK industry. Recommendations were developed based on a consensus development exercise undertaken with 20 health care stakeholders. The paper argues that there is a need in health care to develop a regulatory framework and an agreed process for managing explicitly the trade-off between risk reduction and cost. The framework should include guidance about a health care specific notion of acceptable levels of risk, guidance about standardised risk reduction interventions, it should include regulatory incentives for health care organisations to reduce risk, and it should encourage the adoption of an approach for documenting explicitly an organisation's risk position. - Highlights: • Empirical description of industry perceptions on making risk reduction decisions. • Health care consensus development identified five recommendations. • Risk concept should be better integrated into safety management. • Education and awareness about risk concept are required. • Health systems need to start a dialogue about acceptable levels of risk.

Examining the need assessment process by identifying the need profiles of elderly care recipients in the Ten-year Long-Term Care Project (TLTCP) of Taiwan.

Science.gov (United States)

Liu, Li-Fan; Yao, Hui-Ping

2014-12-01

To deal with the increasing long-term care (LTC) needs of elderly people in Taiwan, the government launched the Ten-year Long-term Care Project (TLTCP) in 2007, and through the care management system, care plans for those in need were distributed and implemented by care managers according to the single assessment process. Based on the emphasis of linking the right need assessment to the care plan, this study aimed to explore the need profiles of LTC recipients with regard to their health indicators to serve as a validity check on the identified dependency levels and care plans in the current care management system. A model based on latent class analysis (LCA) was used for dealing with the issue of health heterogeneity. LCA provides an empirical method that examines the interrelationships among health indicators and characterizes the underlying set of mutually exclusive latent classes that account for the observed indicators. The analysis included a total of 2901 elderly care recipients in the LTC dataset from a southern city, 1 of the 5 major metropolitan areas in Taiwan. The identified dependency levels of the samples and their care plans in need assessment were compared and discussed. Four need profiles were explored in the LTC dataset. Apart from the low (LD) (32.95%) and moderate dependent groups (MD) (17.48%), there were 2 groups identified among the high-dependency levels, including the severe physical and psychological dependency (SPP) (26.37%) and the comorbidities and severe dependency (CSD) groups (23.20%), which in sum were approximately identified as high dependency (HD) by care managers in the LTC dataset. In addition, the CSD group currently costs more for their care plans on average in LTC services (NT. 277,081.15, approximately 9200 USD) than the SPP group (NT. 244,084.21) and the other groups. Need assessment is a key to success in care management in LTC. The results of this study showed the importance of focusing on multifacet indicators

Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations.

Science.gov (United States)

Nyqvist, Kerstin H; Häggkvist, Anna-Pia; Hansen, Mette N; Kylberg, Elisabeth; Frandsen, Annemi L; Maastrup, Ragnhild; Ezeonodo, Aino; Hannula, Leena; Haiek, Laura N

2013-08-01

In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up.

Ten years integrated care for mental disorders in the Netherlands

Directory of Open Access Journals (Sweden)

Christina M van der Feltz-Cornelis

2011-03-01

Full Text Available Background and problem statement: Integrated care for mental disorders aims to encompass forms of collaboration between different health care settings for the treatment of mental disorders. To this end, it requires integration at several levels, i.e. integration of psychiatry in medicine, of the psychiatric discourse in the medical discourse; of localization of mental health care and general health care facilities; and of reimbursement systems.   Description of policy practice: Steps have been taken in the last decade to meet these requirements, enabling psychiatry to move on towards integrated treatment of mental disorder as such, by development of a collaborative care model that includes structural psychiatric consultation that was found to be applicable and effective in several Dutch health care settings. This collaborative care model is a feasible and effective model for integrated care in several health care settings. The Bio Psycho Social System has been developed as a feasible instrument for assessment in integrated care as well. Discussion: The discipline of Psychiatry has moved from anti-psychiatry in the last century, towards an emancipated medical discipline. This enabled big advances towards integrated care for mental disorder, in collaboration with other medical disciplines, in the last decade. Conclusion: Now is the time to further expand this concept of care towards other mental disorders, and towards integrated care for medical and mental co-morbidity. Integrated care for mental disorder should be readily available to the patient, according to his/her preference, taking somatic co-morbidity into account, and with a focus on rehabilitation of the patient in his or her social roles.

Ten years integrated care for mental disorders in the Netherlands

Directory of Open Access Journals (Sweden)

Christina M van der Feltz-Cornelis

2011-03-01

Full Text Available Background and problem statement: Integrated care for mental disorders aims to encompass forms of collaboration between different health care settings for the treatment of mental disorders. To this end, it requires integration at several levels, i.e. integration of psychiatry in medicine, of the psychiatric discourse in the medical discourse; of localization of mental health care and general health care facilities; and of reimbursement systems.  Description of policy practice: Steps have been taken in the last decade to meet these requirements, enabling psychiatry to move on towards integrated treatment of mental disorder as such, by development of a collaborative care model that includes structural psychiatric consultation that was found to be applicable and effective in several Dutch health care settings. This collaborative care model is a feasible and effective model for integrated care in several health care settings. The Bio Psycho Social System has been developed as a feasible instrument for assessment in integrated care as well.Discussion: The discipline of Psychiatry has moved from anti-psychiatry in the last century, towards an emancipated medical discipline. This enabled big advances towards integrated care for mental disorder, in collaboration with other medical disciplines, in the last decade.Conclusion: Now is the time to further expand this concept of care towards other mental disorders, and towards integrated care for medical and mental co-morbidity. Integrated care for mental disorder should be readily available to the patient, according to his/her preference, taking somatic co-morbidity into account, and with a focus on rehabilitation of the patient in his or her social roles.

[Engineering aspects of seismic behavior of health-care facilities: lessons from California earthquakes].

Science.gov (United States)

Rutenberg, A

1995-03-15

The construction of health-care facilities is similar to that of other buildings. Yet the need to function immediately after an earthquake, the helplessness of the many patients and the high and continuous occupancy of these buildings, require that special attention be paid to their seismic performance. Here the lessons from the California experience are invaluable. In this paper the behavior of California hospitals during destructive earthquakes is briefly described. Adequate structural design and execution, and securing of nonstructural elements are required to ensure both safety of occupants, and practically uninterrupted functioning of equipment, mechanical and electrical services and other vital systems. Criteria for post-earthquake functioning are listed. In view of the hazards to Israeli hospitals, in particular those located along the Jordan Valley and the Arava, a program for the seismic evaluation of medical facilities should be initiated. This evaluation should consider the hazards from nonstructural elements, the safety of equipment and systems, and their ability to function after a severe earthquake. It should not merely concentrate on safety-related structural behavior.

Delivery of Type 2 diabetes care in low- and middle-income countries: lessons from Lima, Peru.

Science.gov (United States)

Cardenas, M K; Miranda, J J; Beran, D

2016-06-01

The health system's response is crucial to addressing the increasing burden of diabetes, particularly that affecting low- and middle-income countries. This study aims to assess the facilitators and barriers that help or hinder access to care for people with diabetes in Peru. We used a survey tool to design and collect qualitative and quantitative data from primary and secondary sources of information at different levels of the health system. We performed 111 interviews in Lima, the capital city of Peru, with patients with diabetes, healthcare providers and healthcare officials. We applied the six building blocks framework proposed by the World Health Organization in our analysis. We found low political commitment, as well as several barriers that directly affect access to medicines, regular laboratory check-ups and follow-up appointments for diabetes, especially at the primary healthcare level. Three major system-level barriers were identified: (1) the availability of information at different healthcare system levels that affects several processes in the healthcare provision; (2) insufficient financial resources; and (3) insufficient human resources trained in diabetes management. Despite an initial political commitment by the Peruvian government to improve the delivery of diabetes care, there exist several key limitations that affect access to adequate diabetes care, especially at the primary healthcare level. In a context in which various low- and middle-income countries are aiming to achieve universal health coverage, this study provides lessons for the implementation of strategies related to diabetes care delivery. © 2016 Diabetes UK.

Integrating Patient-Reported Outcomes into Spine Surgical Care through Visual Dashboards: Lessons Learned from Human-Centered Design

Science.gov (United States)

Hartzler, Andrea L.; Chaudhuri, Shomir; Fey, Brett C.; Flum, David R.; Lavallee, Danielle

2015-01-01

Introduction: The collection of patient-reported outcomes (PROs) draws attention to issues of importance to patients—physical function and quality of life. The integration of PRO data into clinical decisions and discussions with patients requires thoughtful design of user-friendly interfaces that consider user experience and present data in personalized ways to enhance patient care. Whereas most prior work on PROs focuses on capturing data from patients, little research details how to design effective user interfaces that facilitate use of this data in clinical practice. We share lessons learned from engaging health care professionals to inform design of visual dashboards, an emerging type of health information technology (HIT). Methods: We employed human-centered design (HCD) methods to create visual displays of PROs to support patient care and quality improvement. HCD aims to optimize the design of interactive systems through iterative input from representative users who are likely to use the system in the future. Through three major steps, we engaged health care professionals in targeted, iterative design activities to inform the development of a PRO Dashboard that visually displays patient-reported pain and disability outcomes following spine surgery. Findings: Design activities to engage health care administrators, providers, and staff guided our work from design concept to specifications for dashboard implementation. Stakeholder feedback from these health care professionals shaped user interface design features, including predefined overviews that illustrate at-a-glance trends and quarterly snapshots, granular data filters that enable users to dive into detailed PRO analytics, and user-defined views to share and reuse. Feedback also revealed important considerations for quality indicators and privacy-preserving sharing and use of PROs. Conclusion: Our work illustrates a range of engagement methods guided by human-centered principles and design

Integrating Patient-Reported Outcomes into Spine Surgical Care through Visual Dashboards: Lessons Learned from Human-Centered Design.

Science.gov (United States)

Hartzler, Andrea L; Chaudhuri, Shomir; Fey, Brett C; Flum, David R; Lavallee, Danielle

2015-01-01

The collection of patient-reported outcomes (PROs) draws attention to issues of importance to patients-physical function and quality of life. The integration of PRO data into clinical decisions and discussions with patients requires thoughtful design of user-friendly interfaces that consider user experience and present data in personalized ways to enhance patient care. Whereas most prior work on PROs focuses on capturing data from patients, little research details how to design effective user interfaces that facilitate use of this data in clinical practice. We share lessons learned from engaging health care professionals to inform design of visual dashboards, an emerging type of health information technology (HIT). We employed human-centered design (HCD) methods to create visual displays of PROs to support patient care and quality improvement. HCD aims to optimize the design of interactive systems through iterative input from representative users who are likely to use the system in the future. Through three major steps, we engaged health care professionals in targeted, iterative design activities to inform the development of a PRO Dashboard that visually displays patient-reported pain and disability outcomes following spine surgery. Design activities to engage health care administrators, providers, and staff guided our work from design concept to specifications for dashboard implementation. Stakeholder feedback from these health care professionals shaped user interface design features, including predefined overviews that illustrate at-a-glance trends and quarterly snapshots, granular data filters that enable users to dive into detailed PRO analytics, and user-defined views to share and reuse. Feedback also revealed important considerations for quality indicators and privacy-preserving sharing and use of PROs. Our work illustrates a range of engagement methods guided by human-centered principles and design recommendations for optimizing PRO Dashboards for patient

Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour.

Science.gov (United States)

Dowswell, Therese; Bedwell, Carol; Lavender, Tina; Neilson, James P

2009-04-15

Transcutaneous nerve stimulation (TENS) has been proposed as a means of reducing pain in labour. The TENS unit emits low-voltage electrical impulses which vary in frequency and intensity. During labour, TENS electrodes are generally placed on the lower back, although TENS may be used to stimulate acupuncture points or other parts of the body. The physiological mechanisms whereby TENS relieves pain are uncertain. The TENS unit is frequently operated by women, which may increase sense of control in labour. To assess the effects of TENS on pain in labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008). Randomised controlled trials comparing women receiving TENS for pain relief in labour versus routine care, alternative pharmacological methods of pain relief, or placebo devices. We included all types of TENS machines. Two review authors assessed for inclusion all trials identified by the search strategy, carried out data extraction and assessed risk of bias. We have recorded reasons for excluding studies. The search identified 25 studies; we excluded six and included 19 studies including 1671 women. Fifteen examined TENS applied to the back, two to acupuncture points and two to the cranium. Overall, there was little difference in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (risk ratio 0.41, 95% confidence interval 0.32 to 0.55). The majority of women using TENS said they would be willing to use it again in a future labour. Where TENS was used as an adjunct to epidural analgesia there was no evidence that it reduced pain. There was no consistent evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and babies. No adverse events were reported. There is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact (either positive or

Affirming Life in the Face of Death: Ricoeur's Living Up to Death as a modern ars moriendi and a lesson for palliative care.

Science.gov (United States)

de Lange, Ds Frits

2014-11-01

In his posthumously published Living Up to Death Paul Ricoeur left an impressive testimony on what it means to live at a high old age with death approaching. In this article I present him as a teacher who reminds us of valuable lessons taught by patients in palliative care and their caretakers who accompany them on their way to death, and also as a guide in our search for a modern ars moriendi, after--what many at least experience as--the breakdown of traditional religious belief in a personal afterlife. These lessons can be summarized in the following theses. 'Living up to death, one cannot experience one's own death. Therefore, never consider someone dying as moribund'. 'Though everybody is alone in dying, nobody should die alone.' 'The preparation for death is an affirmation of life'. 'Life experienced as a gift can be given up'. The plausibility of the last thesis, however, may go beyond the confines of austere philosophical thinking.

Lessons learned bulletin

International Nuclear Information System (INIS)

1994-05-01

During the past four years, the Department of Energy -- Savannah River Operations Office and the Westinghouse Savannah River Company (WSRC) Environmental Restoration (ER) Program completed various activities ranging from waste site investigations to closure and post closure projects. Critiques for lessons learned regarding project activities are performed at the completion of each project milestone, and this critique interval allows for frequent recognition of lessons learned. In addition to project related lessons learned, ER also performs lessons learned critiques. T'he Savannah River Site (SRS) also obtains lessons learned information from general industry, commercial nuclear industry, naval nuclear programs, and other DOE sites within the complex. Procedures are approved to administer the lessons learned program, and a database is available to catalog applicable lessons learned regarding environmental remediation, restoration, and administrative activities. ER will continue to use this database as a source of information available to SRS personnel

Primary care-based multifaceted, interdisciplinary medical educational intervention for patients with systolic heart failure: lessons learned from a cluster randomised controlled trial

Directory of Open Access Journals (Sweden)

Schellberg Dieter

2009-08-01

Full Text Available Abstract Background Chronic (systolic heart failure (CHF is a common and disabling condition. Adherence to evidence-based guidelines in primary care has been shown to improve health outcomes. The aim was to explore the impact of a multidisciplinary educational intervention for general practitioners (GPs (Train the trainer = TTT on patient and performance outcomes. Methods This paper presents the key findings from the trial and discusses the lessons learned during the implementation of the TTT trial. Primary care practices were randomly assigned to the TTT intervention or to the control group. 37 GPs (18 TTT, 19 control were randomised and 168 patients diagnosed with ascertained CHF (91 TTT, 77 control were enrolled. GPs in the intervention group attended four meetings addressing clinical practice guidelines and pharmacotherapy feedback. The primary outcome was patient self-reported quality of life at seven months, using the SF-36 Physical Functioning scale. Secondary outcomes included other SF-36 scales, the Kansas City Cardiomyopathy Questionnaire (KCCQ, total mortality, heart failure hospital admissions, prescribing, depressive disorders (PHQ-9, behavioural change (European Heart Failure Self-Care Behaviour Scale, patient-perceived quality of care (EUROPEP and improvement of heart failure using NT-proBNP-levels. Because recruitment targets were not achieved an exploratory analysis was conducted. Results There was high baseline achievement in both groups for many outcomes. At seven months, there were no significant mean difference between groups for the primary outcome measure (-3.3, 95%CI -9.7 to 3.1, p = 0.30. The only difference in secondary outcomes related to the prescribing of aldosterone antagonists by GPs in the intervention group, with significant between group differences at follow-up (42 vs. 24%, adjusted OR = 4.0, 95%CI 1.2–13; p = 0.02. Conclusion The intervention did not change the primary outcome or most secondary outcomes

Primary care-based multifaceted, interdisciplinary medical educational intervention for patients with systolic heart failure: lessons learned from a cluster randomised controlled trial.

Science.gov (United States)

Peters-Klimm, Frank; Campbell, Stephen; Müller-Tasch, Thomas; Schellberg, Dieter; Gelbrich, Goetz; Herzog, Wolfgang; Szecsenyi, Joachim

2009-08-13

Chronic (systolic) heart failure (CHF) is a common and disabling condition. Adherence to evidence-based guidelines in primary care has been shown to improve health outcomes. The aim was to explore the impact of a multidisciplinary educational intervention for general practitioners (GPs) (Train the trainer = TTT) on patient and performance outcomes. This paper presents the key findings from the trial and discusses the lessons learned during the implementation of the TTT trial. Primary care practices were randomly assigned to the TTT intervention or to the control group. 37 GPs (18 TTT, 19 control) were randomised and 168 patients diagnosed with ascertained CHF (91 TTT, 77 control) were enrolled. GPs in the intervention group attended four meetings addressing clinical practice guidelines and pharmacotherapy feedback. The primary outcome was patient self-reported quality of life at seven months, using the SF-36 Physical Functioning scale. Secondary outcomes included other SF-36 scales, the Kansas City Cardiomyopathy Questionnaire (KCCQ), total mortality, heart failure hospital admissions, prescribing, depressive disorders (PHQ-9), behavioural change (European Heart Failure Self-Care Behaviour Scale), patient-perceived quality of care (EUROPEP) and improvement of heart failure using NT-proBNP-levels. Because recruitment targets were not achieved an exploratory analysis was conducted. There was high baseline achievement in both groups for many outcomes. At seven months, there were no significant mean difference between groups for the primary outcome measure (-3.3, 95%CI -9.7 to 3.1, p = 0.30). The only difference in secondary outcomes related to the prescribing of aldosterone antagonists by GPs in the intervention group, with significant between group differences at follow-up (42 vs. 24%, adjusted OR = 4.0, 95%CI 1.2-13; p = 0.02). The intervention did not change the primary outcome or most secondary outcomes. Recruitment targets were not achieved and the under

Ten years of integrated care in Switzerland

Directory of Open Access Journals (Sweden)

Peter Berchtold

2011-03-01

Full Text Available In Switzerland, a growing part of primary care is provided by networks of physicians and health maintenance organizations (HMOs acting on the principles of gatekeeping. To date, an average of one out of eight insured person in Switzerland, and one out of three in the regions in north-eastern Switzerland, opted for the provision of care by general practitioners in one of the 86 physician networks or HMOs. About 50% of all general practitioners and more than 400 other specialists have joined a physician networks. Seventy-three of the 86 networks (84% have contracts with the healthcare insurance companies in which they agree to assume budgetary co-responsibility, i.e. to adhere to set cost targets for particular groups of patients. Within and outside the physician networks, at regional and/or cantonal levels, several initiatives targeting chronic diseases have been developed, such as clinical pathways for heart failure and breast cancer patients or chronic disease management programs for patients with diabetes. The relevance of these developments towards more integration of healthcare as well as their implications for the future are discussed.

[Psychosocial care following the firework disaster in Enschede; the lessons from the Bijlmer airline disaster].

Science.gov (United States)

Gersons, B P R; Huijsman-Rubingh, R R R; Olff, M

2004-07-17

When the psychosocial-care scheme for victims of the firework explosion in Enschede, the Netherlands (2000) was set up, lessons learned from the Bijlmer airline disaster (Amsterdam 1992) were put into practice. The aftermath of this incident showed that psychological and physical health problems can still occur many years later. The main failure of the aftercare of the Bijlmer disaster lay in the coordination of aid and the monitoring of health problems. In Enschede steps were taken to redress these problems. An information and advice centre (IAC) was set up to monitor the well-being of the victims, and to provide them with information and, where necessary, assistance. It is responsible for limiting the effects of the disaster. A total of 13,000 people have consulted the IAC. A residents' association was formed. This gave the victims a common voice during the process of attempting to restore normality in their lives. A specialized mental health-care unit was founded to treat disaster-related disorders using evidence-based treatments. So far approximately 1,300 people have consulted this body. A longitudinal study has been set up to map the consequences of the disaster and to advise aid organizations. This will also give information on the extent to which these methods have been able to limit the long-term consequences.

Transcutaneous electrical nerve stimulation (TENS) for pain management in labour

Science.gov (United States)

Dowswell, Therese; Bedwell, Carol; Lavender, Tina; Neilson, James P

2014-01-01

Background Transcutaneous nerve stimulation (TENS) has been proposed as a means of reducing pain in labour. The TENS unit emits low-voltage electrical impulses which vary in frequency and intensity. During labour, TENS electrodes are generally placed on the lower back, although TENS may be used to stimulate acupuncture points or other parts of the body. The physiological mechanisms whereby TENS relieves pain are uncertain. TENS machines are frequently operated by women, which may increase a sense of control in labour. Objectives To assess the effects of TENS on pain in labour. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 April 2011) and reference lists of retrieved papers. Selection criteria Randomised controlled trials comparing women receiving TENS for pain management in labour versus routine care, alternative non-pharmacological methods of pain relief, or placebo devices. We included all types of TENS machines. Data collection and analysis Two review authors assessed for inclusion all trials identified by the search strategy, carried out data extraction and assessed risk of bias. We have recorded reasons for excluding studies. Main results Seventeen trials with 1466 women contribute data to the review. Thirteen examined TENS applied to the back, two to acupuncture points, and two to the cranium. Overall, there was little difference in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (average risk ratio 0.41, 95% confidence interval 0.31 to 0.54; measured in two studies). The majority of women using TENS said they would be willing to use it again in a future labour. Where TENS was used as an adjunct to epidural analgesia there was no evidence that it reduced pain. There was no consistent evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and babies. No

Transformation of an academic medical center: lessons learned from restructuring and downsizing.

Science.gov (United States)

Woodard, B; Fottler, M D; Kilpatrick, A O

1999-01-01

This article reviews management literature on health care transformation and describes the processes, including restructuring, job redesign, and downsizing, involved in one academic medical center's experience. The article concludes with lessons learned at each of the stages of the transformation process: planning, implementation, and process continuation. Managerial implications for similar transformation efforts in other health care organizations are suggested.

Do Lessons in Nature Boost Subsequent Classroom Engagement? Refueling Students in Flight

Directory of Open Access Journals (Sweden)

Ming Kuo

2018-01-01

Full Text Available Teachers wishing to offer lessons in nature may hold back for fear of leaving students keyed up and unable to concentrate in subsequent, indoor lessons. This study tested the hypothesis that lessons in nature have positive—not negative—aftereffects on subsequent classroom engagement. Using carefully matched pairs of lessons (one in a relatively natural outdoor setting and one indoors, we observed subsequent classroom engagement during an indoor instructional period, replicating these comparisons over 10 different topics and weeks in the school year, in each of two third grade classrooms. Pairs were roughly balanced in how often the outdoor lesson preceded or followed the classroom lesson. Classroom engagement was significantly better after lessons in nature than after their matched counterparts for four of the five measures developed for this study: teacher ratings; third-party tallies of “redirects” (the number of times the teacher stopped instruction to direct student attention back onto the task at hand; independent, photo-based ratings made blind to condition; and a composite index each showed a nature advantage; student ratings did not. This nature advantage held across different teachers and held equally over the initial and final 5 weeks of lessons. And the magnitude of the advantage was large. In 48 out of 100 paired comparisons, the nature lesson was a full standard deviation better than its classroom counterpart; in 20 of the 48, the nature lesson was over two standard deviations better. The rate of “redirects” was cut almost in half after a lesson in nature, allowing teachers to teach for longer periods uninterrupted. Because the pairs of lessons were matched on teacher, class (students and classroom, topic, teaching style, week of the semester, and time of day, the advantage of the nature-based lessons could not be attributed to any of these factors. It appears that, far from leaving students too keyed up to concentrate

An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

Directory of Open Access Journals (Sweden)

Chan Brian T

2011-10-01

Full Text Available Abstract Background Globally, chronic diseases are responsible for an enormous burden of deaths, disability, and economic loss, yet little is known about the optimal health sector response to chronic diseases in poor, post-conflict countries. Liberia's experience in strengthening health systems and health financing overall, and addressing HIV/AIDS and mental health in particular, provides a relevant case study for international stakeholders and policymakers in other poor, post-conflict countries seeking to understand and prioritize the global response to chronic diseases. Methods We conducted a historical review of Liberia's post-conflict policies and their impact on general economic and health indicators, as well as on health systems strengthening and chronic disease care and treatment. Key sources included primary documents from Liberia's Ministry of Health and Social Welfare, published and gray literature, and personal communications from key stakeholders engaged in Liberia's Health Sector Reform. In this case study, we examine the early reconstruction of Liberia's health care system from the end of conflict in 2003 to the present time, highlight challenges and lessons learned from this initial experience, and describe future directions for health systems strengthening and chronic disease care and treatment in Liberia. Results Six key lessons emerge from this analysis: (i the 2007 National Health Policy's 'one size fits all' approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system; (ii the innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy; (iii a substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system; (iv effective strategies for HIV/AIDS care in other settings should be

Lessons Learned From the Development and Parameterization of a Computer Simulation Model to Evaluate Task Modification for Health Care Providers.

Science.gov (United States)

Kasaie, Parastu; David Kelton, W; Ancona, Rachel M; Ward, Michael J; Froehle, Craig M; Lyons, Michael S

2018-02-01

Computer simulation is a highly advantageous method for understanding and improving health care operations with a wide variety of possible applications. Most computer simulation studies in emergency medicine have sought to improve allocation of resources to meet demand or to assess the impact of hospital and other system policies on emergency department (ED) throughput. These models have enabled essential discoveries that can be used to improve the general structure and functioning of EDs. Theoretically, computer simulation could also be used to examine the impact of adding or modifying specific provider tasks. Doing so involves a number of unique considerations, particularly in the complex environment of acute care settings. In this paper, we describe conceptual advances and lessons learned during the design, parameterization, and validation of a computer simulation model constructed to evaluate changes in ED provider activity. We illustrate these concepts using examples from a study focused on the operational effects of HIV screening implementation in the ED. Presentation of our experience should emphasize the potential for application of computer simulation to study changes in health care provider activity and facilitate the progress of future investigators in this field. © 2017 by the Society for Academic Emergency Medicine.

Designing Effective Interactions for Concordance around End-of-Life Care Decisions: Lessons from Hospice Admission Nurses

Directory of Open Access Journals (Sweden)

Carey Candrian

2017-04-01

choice patients make to forego aggressive treatment measures when they enroll in hospice. In a literal sense, to enroll in hospice means to bring in support for end-of-life care. It means to identify the need for expertise around symptom management at end-of-life, and agree to having a care team come and manage someone’s physical, psychosocial, and/or spiritual needs. As with all care, hospice can be stopped if it is no longer considered appropriate. To uncover the communication tensions undergirding a hospice admission interaction, we use Street’s ecological theory of patient-centered communication to analyze a case exemplar of a hospice admission interaction. This analysis reveals diverse points of struggle within hospice decision-making processes around hospice care and the need for communication techniques that promote trust and acceptance of end-of-life care. Lessons learned from talking about hospice care can inform other quality initiatives around communication and informed decision-making in the context of advance care planning, palliative care, and end-of-life care.

Breathing Life into Engineering: A Lesson Study Life Science Lesson

Science.gov (United States)

Lawrence, Maria; Yang, Li-Ling; Briggs, May; Hession, Alicia; Koussa, Anita; Wagoner, Lisa

2016-01-01

A fifth grade life science lesson was implemented through a lesson study approach in two fifth grade classrooms. The research lesson was designed by a team of four elementary school teachers with the goal of emphasizing engineering practices consistent with the "Next Generation Science Standards" (NGSS) (Achieve Inc. 2013). The fifth…

Defining Health in the Era of Value-based Care: Lessons from England of Relevance to Other Health Systems.

Science.gov (United States)

Gentry, Sarah; Badrinath, Padmanabhan

2017-03-06

The demand for healthcare is rising due to aging populations, rising chronic disease prevalence, and technological innovations. There are currently more effective and cost-effective interventions available than can be afforded within limited budgets. A new way of thinking about the optimal use of resources is needed. Ensuring that available resources are used for interventions that provide outcomes that patient's most value, rather than a focus just on effectiveness and cost-effectiveness, may help to ensure that resources are used optimally. Value-based healthcare puts what patients value at the center of healthcare. It helps ensure that they receive the care that can provide them with outcomes they think are important and that limited resources are focused on high-value interventions. In order to do this, we need flexible definitions of 'health', personalized and tailored to patient values. We review the current status of value-based health care in England and identify lessons applicable to a variety of health systems. For this, we draw upon the work of the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS), Right Care Initiative, and our local experience in promoting value-based health care for specific conditions in our region. Combining the best available evidence with open and honest dialogue between patients, clinicians, and others, whilst requiring considerable time and resources are essential to building a consensus around the value that allows the best use of limited budgets. Values have been present in healthcare since its beginnings. Placing value and values at the center of healthcare could help to ensure available resources are used to provide the greatest possible benefit to patients.

The Knitting Lesson.

Science.gov (United States)

Smith, Pamela

1987-01-01

Based on Jean-Francois Millet's 1869 painting, "The Knitting Lesson," this lesson's goal is to introduce students in grades seven through nine to genre (everyday life) painting the nineteenth century. The lesson is also designed to show that some aspects of genre may be timeless. (BSR)

Dominating Duffer’s Domain: Lessons for the U.S. Marine corps Information Operations Practitioner

Science.gov (United States)

2017-01-01

has learned 26 hard -won lessons that readers may find useful for the future conduct and planning of IO. The principles espoused here were derived from...to be frank, it wasn’t that hard . I had done the ten-day Intermediate MAGTF (Marine Air Ground Task Force) Information Operations Practitioner...paragraph, with no phases. It was, however, beauti- fully formatted , and the task listing had everything: military deception, electronic warfare, OPSEC

What lessons can history teach us about the Charcot foot?

Science.gov (United States)

Sanders, Lee J

2008-01-01

Regrettably, physicians today receive very little instruction in the history of medicine. Most health care providers have a very limited, contemporary knowledge of the condition that we know of as the Charcot foot. Yet, historical concepts of the pathogenesis and natural history of this condition provide us with important lessons that enhance our understanding, recognition, and management of this rare but debilitating neurogenic arthropathy. It is my belief that knowledge of the history of medicine provides us with a better understanding of present-day issues and clearer vision as we look to the future. This article describes some of the important lessons learned from the history of the Charcot foot.

Lessons learned and advice from Vietnam war nurses: a qualitative study.

Science.gov (United States)

Scannell-Desch, Elizabeth A

2005-03-01

The aim of this paper is to describe guidance for nurses today from the lessons learned by nurses who served in the Vietnam War. There is little research focusing on nurses' experiences in the Vietnam War. Lessons learned and subsequent advice from nurses who served in Vietnam may be helpful to those serving in current and future wars. A Husserlian phenomenological approach was taken, using interviews with a purposive sample of Registered Nurses who were female, and had served in the United States of America armed forces in Vietnam during the war. Seven theme clusters described the lesson learned and guidance offered by the Vietnam War nurses: advice about journaling, training, caring for yourself, use of support systems, talking about your experiences, understanding the mission, and lack of preparation for war. Much can be learned from the lessons learned and advice given by Vietnam War nurses. These lessons stress that nurses need to take a pro-active role in preparing themselves for deployment to a war zone, and that institutional training for war needs to be intensive and realistic. The environmental, cultural, technological, clinical and psychosocial demands of war nursing need to be comprehensively addressed before nurses deploy to a war.

Lessons learnt from the introduction of the contraceptive implant in ...

African Journals Online (AJOL)

This article explores the complexities of introducing new contra ... framework[1,2] and other emerging literature, lessons are identified and key .... events and negative user experiences related to inadequate quality of care, which even if ..... completion; CM, JS, NLD: reviewed and assisted with the development of the initial ...

The history of a lesson

DEFF Research Database (Denmark)

Rasmussen, Mikkel Vedby

2003-01-01

and emphasises the need to study the history of lessons rather than the lessons of history. This approach shows that Munich is the end point of a constitutive history that begins in the failure of the Versailles treaty to create a durable European order following the First World War. The Munich lesson is thus......The article investigates the concept of lessons in IR. By means of a constructivist critique of the 'lessons literature', the article analyses one of the most important of IR lessons: that of Munich. Examining how the Munich lesson came about, the article shows the praxeological nature of lessons...... one element of the lesson of Versailles, which is a praxeology that defines how the West is to make peace, and against whom peace must be defended. The lesson of Versailles has been, at least in part, constitutive of the outbreak of the Cold War, and it continues to define the Western conception...

Lessons learned about ageing and gerontological nursing in South Africa

Directory of Open Access Journals (Sweden)

Staja Q. Booker

2015-07-01

Full Text Available Background: The unprecedented global growth in older adults merits high-quality gerontological nursing care. As gerontological nursing grows in visibility in developed and developing countries, nurses must possess a broader worldview of ageing with knowledge of physiological, psychosocial, and cultural issues. Purpose: The purpose of this article is to: (1 highlight lessons learned on differences and similarities in ageing and care of older adults in the United States of America (USA and South Africa (SA; and (2 provide recommendations on how to advance gerontological nursingeducation in SA. Methods: A two-week international service-learning project was undertaken by visiting SA and learning about their nursing system and care of older adults. Service-learning is an innovative teaching-learning-service method that provided reflective and hands-on experience of gerontological nursing. This article provides a personal reflection of lessons learned about ageing and gerontological nursing during the service-learning project. Findings: Care of older adults in SA is in many ways different from and similar to that in the USA. Consequently global nurses should recognise those differences and provide culturally appropriate care. This service-learning experience also demonstrated the need for gerontological nursing education in SA. Based on this, recommendations on how to infuse and advance gerontological nursing education in SA are provided. Conclusion: Caring for older adults in a global context requires knowledge and understanding of cultures and their values and practices. With a growing population of diverse older adults, there is a need for incorporation

Lesson Learning at JPL

Science.gov (United States)

Oberhettinger, David

2011-01-01

A lessons learned system is a hallmark of a mature engineering organization A formal lessons learned process can help assure that valuable lessons get written and published, that they are well-written, and that the essential information is "infused" into institutional practice. Requires high-level institutional commitment, and everyone's participation in gathering, disseminating, and using the lessons

Strengthening Multipayer Collaboration: Lessons From the Comprehensive Primary Care Initiative.

Science.gov (United States)

Anglin, Grace; Tu, H A; Liao, Kristie; Sessums, Laura; Taylor, Erin Fries

2017-09-01

Policy Points: Collaboration across payers to align financial incentives, quality measurement, and data feedback to support practice transformation is critical, but challenging due to competitive market dynamics and competing institutional priorities. The Centers for Medicare & Medicaid Services or other entities convening multipayer initiatives can build trust with other participants by clearly outlining each participant's role and the parameters of collaboration at the outset of the initiative. Multipayer collaboration can be improved if participating payers employ neutral, proactive meeting facilitators; develop formal decision-making processes; seek input on decisions from practice representatives; and champion the initiative within their organizations. With increasing frequency, public and private payers are joining forces to align goals and resources for primary care transformation. However, sustaining engagement and achieving coordination among payers can be challenging. The Comprehensive Primary Care (CPC) initiative is one of the largest multipayer initiatives ever tested. Drawing on the experience of the CPC initiative, this paper examines the factors that influence the effectiveness of multipayer collaboration. This paper draws largely on semistructured interviews with CPC-participating payers and payer conveners that facilitated CPC discussions and on observation of payer meetings. We coded and analyzed these qualitative data to describe collaborative dynamics and outcomes and assess the factors influencing them. We found that several factors appeared to increase the likelihood of successful payer collaboration: contracting with effective, neutral payer conveners; leveraging the support of payer champions, and seeking input on decisions from practice representatives. The presence of these factors helped some CPC regions overcome significant initial barriers to achieve common goals. We also found that leadership from the Centers for Medicare & Medicaid

Exploring the use of lesson study with six Canadian middle-school science teachers

Science.gov (United States)

Bridges, Terry James

This qualitative case study explores the use of lesson study over a ten-week period with six Ontario middle school science teachers. The research questions guiding this study were: (1) How does participation in science-based lesson study influence these teachers': (a) science subject matter knowledge (science SMK), (b) science pedagogical content knowledge (science PCK), and (c) confidence in teaching science?, and (2) What benefits and challenges do they associate with lesson study? Data sources for this study were: teacher questionnaires, surveys, reflections, pre- and post- interviews, and follow-up emails; researcher field notes and reflections; pre- and post- administration of the Science Teaching Efficacy Belief Instrument; and audio recordings of group meetings. The teachers demonstrated limited gains in science SMK. There was evidence for an overall improvement in teacher knowledge of forces and simple machines, and two teachers demonstrated improvement in over half of the five scenarios assessing teacher science SMK. Modest gains in teacher science PCK were found. One teacher expressed more accurate understanding of students' knowledge of forces and a better knowledge of effective science teaching strategies. The majority of teachers reported that they would be using three-part lessons and hands-on activities more in their science teaching. Gains in teacher pedagogical knowledge (PK) were found in four areas: greater emphasis on anticipation of student thinking and responses, recognition of the importance of observing students, more intentional teaching, and anticipated future use of student video data. Most teachers reported feeling more confident in teaching structures and mechanisms, and attributed this increase in confidence to collaboration and seeing evidence of student learning and engagement during the lesson teachings. Teacher benefits included: learning how to increase student engagement and collaboration, observing students, including video data

Regime destabilisation as the flipside of energy transitions: Lessons from the history of the British coal industry (1913–1997)

International Nuclear Information System (INIS)

Turnheim, Bruno; Geels, Frank W.

2012-01-01

This paper investigates a neglected aspect of the transitions literature: the destabilisation of existing regimes and industries. It presents an analytical perspective that integrates four existing views on destabilisation and conceptualizes the process as a multi-dimensional and enacted phenomenon involving technical, economic, political, and cultural processes. This perspective is illustrated with two historical cases of the British coal industry (1913–1967, 1967–1997). These cases are also used to articulate five lessons regarding the overall destabilisation process and five lessons regarding the economic and socio-political environments of industries. The conclusion section translates the historical lessons into insights with relevance for the contemporary challenge of climate change and transitions to low-carbon energy systems. - Highlights: ► We investigate the destabilisation of existing regimes and industries. ► We conceptualise destabilisation as a multi-dimensional and enacted phenomenon. ► We mobilise two historical cases of the British coal industry. ► We develop ten original lessons on destabilisation. ► We provide insights of relevance to transitions to low-carbon energy systems.

A Good Supervisor--Ten Facts of Caring Supervision

Science.gov (United States)

Määttä, Kaarina

2015-01-01

This article describes the elements of caring supervision of doctoral theses. The purpose was to describe the best practices as well as challenges of supervision especially from the supervisor's perspective. The analysis is based on the author's extensive experience as a supervisor and related data obtained for research and developmental purposes.…

in primary care

African Journals Online (AJOL)

Claire van Deventer

Keywords: child HIV, doctor involvement, primary health care, quality improvement ... expertise increased, PHC facilities are now expected to be able to .... organised patient documentation were revisited. .... Review: what can we learn from quality ... South Pacific: Review of evidence and lessons from an innovative.

Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial.

Science.gov (United States)

Santana, Licia Santos; Gallo, Rubneide Barreto Silva; Ferreira, Cristine Homsi Jorge; Duarte, Geraldo; Quintana, Silvana Maria; Marcolin, Alessandra Cristina

2016-01-01

In the active phase of the first stage of labour, does transcutaneous electrical nerve stimulation (TENS) relieve pain or change its location? Does TENS delay the request for neuraxial analgesia during labour? Does TENS produce any harmful effects in the mother or the foetus? Are women in labour satisfied with the care provided? Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. Forty-six low-risk, primigravida parturients with a gestational age > 37 weeks, cervical dilation of 4cm, and without the use of any medications from hospital admission until randomisation. The principal investigator applied TENS to the experimental group for 30minutes starting at the beginning of the active phase of labour. A second investigator assessed the outcomes in both the control and experimental groups. Both groups received routine perinatal care. The primary outcome was pain severity after the intervention period, which was assessed using the 100-mm visual analogue scale. Secondary outcomes included: pain location, duration of the active phase of labour, time to pharmacological labour analgesia, mode of birth, neonatal outcomes, and the participant's satisfaction with the care provided. After the intervention, a significant mean difference in change in pain of 15mm was observed favouring the experimental group (95% CI 2 to 27). The application of TENS did not alter the location or distribution of the pain. The mean time to pharmacological analgesia after the intervention was 5.0hours (95% CI 4.1 to 5.9) longer in the experimental group. The intervention did not significantly impact the other maternal and neonatal outcomes. Participants in both groups were satisfied with the care provided during labour. TENS produces a significant decrease in pain during labour and postpones the need for pharmacological analgesia for pain relief. NCT01600495. Copyright © 2015. Published by Elsevier B.V.

Lessons to be learned from an analysis of ammonium nitrate disasters in the last 100 years

Energy Technology Data Exchange (ETDEWEB)

Pittman, William; Han, Zhe; Harding, Brian; Rosas, Camilo; Jiang, Jiaojun; Pineda, Alba; Mannan, M. Sam, E-mail: mannan@tamu.edu

2014-09-15

Highlights: • Root causes and contributing factors from ammonium nitrate incidents are categorized into 10 lessons. • The lessons learned from the past 100 years of ammonium nitrate incidents can be used to improve design, operation, and maintenance procedures. • Improving organizational memory to help improve safety performance. • Combating and changing organizational cultures. - Abstract: Process safety, as well as the safe storage and transportation of hazardous or reactive chemicals, has been a topic of increasing interest in the last few decades. The increased interest in improving the safety of operations has been driven largely by a series of recent catastrophes that have occurred in the United States and the rest of the world. A continuous review of past incidents and disasters to look for common causes and lessons is an essential component to any process safety and loss prevention program. While analyzing the causes of an accident cannot prevent that accident from occurring, learning from it can help to prevent future incidents. The objective of this article is to review a selection of major incidents involving ammonium nitrate in the last century to identify common causes and lessons that can be gleaned from these incidents in the hopes of preventing future disasters. Ammonium nitrate has been involved in dozens of major incidents in the last century, so a subset of major incidents were chosen for discussion for the sake of brevity. Twelve incidents are reviewed and ten lessons from these incidents are discussed.

Lessons to be learned from an analysis of ammonium nitrate disasters in the last 100 years

International Nuclear Information System (INIS)

Pittman, William; Han, Zhe; Harding, Brian; Rosas, Camilo; Jiang, Jiaojun; Pineda, Alba; Mannan, M. Sam

2014-01-01

Highlights: • Root causes and contributing factors from ammonium nitrate incidents are categorized into 10 lessons. • The lessons learned from the past 100 years of ammonium nitrate incidents can be used to improve design, operation, and maintenance procedures. • Improving organizational memory to help improve safety performance. • Combating and changing organizational cultures. - Abstract: Process safety, as well as the safe storage and transportation of hazardous or reactive chemicals, has been a topic of increasing interest in the last few decades. The increased interest in improving the safety of operations has been driven largely by a series of recent catastrophes that have occurred in the United States and the rest of the world. A continuous review of past incidents and disasters to look for common causes and lessons is an essential component to any process safety and loss prevention program. While analyzing the causes of an accident cannot prevent that accident from occurring, learning from it can help to prevent future incidents. The objective of this article is to review a selection of major incidents involving ammonium nitrate in the last century to identify common causes and lessons that can be gleaned from these incidents in the hopes of preventing future disasters. Ammonium nitrate has been involved in dozens of major incidents in the last century, so a subset of major incidents were chosen for discussion for the sake of brevity. Twelve incidents are reviewed and ten lessons from these incidents are discussed

Transcutaneous Electrical Nerve Stimulation (TENS) for the Control of Pain during Rehabilitation Following Total Knee Arthroplasty (TKA): A Randomized, Blinded, Placebo-Controlled Trial

Science.gov (United States)

Rakel, Barbara; Zimmerman, M. Bridget; Geasland, Katharine; Embree, Jennie; Clark, Charles R; Noiseux, Nicolas O; Callaghan, John J; Herr, Keela; Walsh, Deirdre; Sluka, Kathleen A

2014-01-01

This study evaluated the efficacy of TENS in reducing pain and hyperalgesia and increasing function following total knee arthroplasty (TKA). We hypothesized participants using TENS during rehabilitation exercises would: 1) report significantly lower pain during range-of-motion (ROM) and fast walking but not at rest; 2) have less hyperalgesia; and, 3) have better function than participants receiving Placebo-TENS or Standard Care. We also hypothesized that change in ROM pain would differ based on psychological characteristics (trait anxiety, pain catastrophizing and depression) and treatment group. This prospective, randomized study used intent-to-treat analyses on 317 subjects after primary, unilateral TKA. Assessors, blinded to treatment allocation, measured pain, function (ROM and gait speed), and hyperalgesia (quantitative sensory tests) postoperatively and 6 weeks after surgery. Analgesic intake, anxiety, depression, and pain catastrophizing were also assessed. TENS participants used it 1–2 times/day at 42 mA (on average) and had less pain postoperatively during active knee extension (p=0.019) and fast walking (p=0.006) than Standard Care participants. TENS and Placebo-TENS were not significantly different. TENS participants who scored low on anxiety and pain catastrophizing had a greater reduction in ROM pain at 6 weeks than those scoring high on these factors (p=0.002 and 0.03). Both TENS and Placebo-TENS participants had less postoperative mechanical hyperalgesia (p=0.03 – 0.01) than Standard Care participants. Supplementing pharmacologic analgesia with TENS during rehabilitation exercises reduces movement pain postoperatively but a placebo influence exists and the effect is gone by 6 weeks. Patients with low anxiety and pain catastrophizing may benefit most from TENS. PMID:25270585

Clinical experience with TENS and TENS combined with nitrous oxide-oxygen. Report of 371 patients.

OpenAIRE

Quarnstrom, F. C.; Milgrom, P.

1989-01-01

Transcutaneous electrical nerve stimulation (TENS) alone or TENS combined with nitrous oxide-oxygen (N2O) was administered for restorative dentistry without local anesthesia to 371 adult patients. A total of 55% of TENS alone and 84% of TENS/N2O visits were rated successful. A total of 53% of TENS alone and 82% of TENS/N2O patients reported slight or no pain. In multivariable analyses, pain reports were related to the anesthesia technique and patient fear and unrelated to sex, race, age, toot...

Patient safety: lessons learned

International Nuclear Information System (INIS)

Bagian, James P.

2006-01-01

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

Coordinating health care: lessons from Norway

Directory of Open Access Journals (Sweden)

Trond Tjerbo

2005-11-01

Full Text Available Objective: What influences the coordination of care between general practitioners and hospitals? In this paper, general practitioner satisfaction with hospital—GP interaction is revealed, and related to several background variables. Method: A questionnaire was sent to all general practitioners in Norway (3388, asking their opinion on the interaction and coordination of health care in their district. A second questionnaire was sent to all the somatic hospitals in Norway (59 regarding formal routines and structures. The results were analysed using ordinary least squares regression. Results: General practitioners tend to be less satisfied with the coordination of care when their primary hospital is large and cost-effective with a high share of elderly patients. Together with the degree to which the general practitioner is involved in arenas where hospital physicians and general practitioners interact, these factors turned out to be good predictors of general practitioner satisfaction. Implication: To improve coordination between general practitioners and specialists, one should focus upon the structural traits within the hospitals in different regions as well as creating common arenas where the physicians can interact.

Base line definitions and methodological lessons from Zimbabwe

International Nuclear Information System (INIS)

Maya, R.S.

1995-01-01

The UNEP Greenhouse Gas Abatement Costing Studies carried out under the management of the UNEP Collaborating Centre On Energy and Environment at Risoe National Laboratories in Denmark has placed effort in generating methodological approaches to assessing the cost of abatement activities to reduce CO 2 emissions. These efforts have produced perhaps the most comprehensive set of methodological approaches to defining and assessing the cost of greenhouse gas abatement. Perhaps the most importance aspect of the UNEP study which involved teams of researchers from ten countries is the mix of countries in which the studies were conducted and hence the representation of views and concepts from researchers in these countries particularly those from developing countries namely, Zimbabwe, India, Venezuela, Brazil, Thailand and Senegal. Methodological lessons from Zimbabwe, therefore, would have benefited from the interactions with methodological experiences form the other participating countries. Methodological lessons from the Zimbabwean study can be placed in two categories. One relates to the modelling of tools to analyze economic trends and the various factors studied in order to determine the unit cost of CO 2 abatement. The other is the definition of factors influencing the levels of emissions reducible and those realised under specific economic trends. (au)

International experience in the implementation of the lessons learned from the Three Mile Island incident

International Nuclear Information System (INIS)

1983-08-01

This document consists of two parts and an Appendix. Part I provides a summary of worldwide experiences and subsequent recommendations regarding the implementation of the Three Mile Island-Unit 2 incident lessons learned. Part II gives in a summary fashion, specific responses and actions of the mentioned countries and international organizations as categorized into ten (10) subject areas. The Appendix, on the other hand, contains examples of the experiences of Brazil, Germany (F.R.), Hungary, and the Philippines, on the implementation of TMI lessons learned. This document should be useful to countries with nuclear power development programmes in that it provides a means for comparison of their actions with others. For countries which are embarking on their first nuclear power project, the document should provide a useful reference for specific TMI-related issues that need to be considered in their nuclear programmes

The strategy role of transitional care units to support Integrated Care and Personalised pathways for frail persons

OpenAIRE

Morando, Verdiana; Tozzi, Valeria D.

2017-01-01

The paper presents a comparative analysis of three models of transitional care units that have been set up in Italy in the last three years within the processes of Regional Healthcare Services and healthcare organisations’ reforms. The comparative analysis is worth of providing interesting insights and generalizable lessons learnt from integrated care in practice. The three cases of transitional care units belong to a similar background wherein greater needs for care coordination across the s...

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain: economic evaluation.

Science.gov (United States)

Hollinghurst, Sandra; Sharp, Debbie; Ballard, Kathleen; Barnett, Jane; Beattie, Angela; Evans, Maggie; Lewith, George; Middleton, Karen; Oxford, Frances; Webley, Fran; Little, Paul

2008-12-11

An economic evaluation of therapeutic massage, exercise, and lessons in the Alexander technique for treating persistent back pain. Cost consequences study and cost effectiveness analysis at 12 month follow-up of a factorial randomised controlled trial. 579 patients with chronic or recurrent low back pain recruited from primary care. Normal care (control), massage, and six or 24 lessons in the Alexander technique. Half of each group were randomised to a prescription for exercise from a doctor plus behavioural counselling from a nurse. Costs to the NHS and to participants. Comparison of costs with Roland-Morris disability score (number of activities impaired by pain), days in pain, and quality adjusted life years (QALYs). Comparison of NHS costs with QALY gain, using incremental cost effectiveness ratios and cost effectiveness acceptability curves. Intervention costs ranged from pound30 for exercise prescription to pound596 for 24 lessons in Alexander technique plus exercise. Cost of health services ranged from pound50 for 24 lessons in Alexander technique to pound124 for exercise. Incremental cost effectiveness analysis of single therapies showed that exercise offered best value ( pound61 per point on disability score, pound9 per additional pain-free day, pound2847 per QALY gain). For two-stage therapy, six lessons in Alexander technique combined with exercise was the best value (additional pound64 per point on disability score, pound43 per additional pain-free day, pound5332 per QALY gain). An exercise prescription and six lessons in Alexander technique alone were both more than 85% likely to be cost effective at values above pound20 000 per QALY, but the Alexander technique performed better than exercise on the full range of outcomes. A combination of six lessons in Alexander technique lessons followed by exercise was the most effective and cost effective option.

Risk and Uncertainties, Analysis and Evaluation: Lessons for Adaptation and Integration

International Nuclear Information System (INIS)

Yohe, G.; Dowlatabadi, H.

1999-01-01

This paper draws ten lessons from analyses of adaptation to climate change under conditions of risk and uncertainty: (1) Socio-economic systems will likely respond most to extreme realizations of climate change. (2) Systems have been responding to variations in climate for centuries. (3) Future change will effect future citizens and their institutions. (4) Human systems can be the sources of surprise. (5) Perceptions of risk depend upon welfare valuations that depend upon expectations. (6) Adaptive decisions will be made in response to climate change and climate change policy. (7) Analysis of adaptive decisions should recognize the second-best context of those decisions. (8) Climate change offers opportunity as well as risk. (9) All plausible futures should be explored. (10) Multiple methodological approaches should be accommodated. These lessons support two pieces of advice for the Third Assessment Report: (1) Work toward consensus, but not at the expense of thorough examination and reporting of the 'tails' of the distributions of the future. (2) Integrated assessment is only one unifying methodology; others that can better accommodate those tails should be encouraged and embraced. 12 refs

Electricity prices in Spain between 2000 and 2011: lessons to be learnt from a descent into Hell

International Nuclear Information System (INIS)

2011-01-01

This note aims at analysing the impact of public authorities' decisions on the Spanish electricity tariffing system since the year 2000: 1 - the Spanish electricity tariff out of touch; 2 - the strategic choice made by Spain; 3 - 2008 crisis and securitization; 4 - a desperate attempt to move backward; 5 - the last ten years balance sheet for the Spanish power system; 6 - the lessons to be learnt from the Spanish experience

Expansion of the ten steps to successful breastfeeding into neonatal intensive care

DEFF Research Database (Denmark)

Nyqvist, Kerstin Hedberg; Häggkvist, Anna-Pia; Hansen, Mette Ness

2012-01-01

The World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care (2009) identifies the need for expanding the guidelines originally developed for maternity units to include neonatal intensive care. For this purpose...... and infants: 1. The staff attitude to the mother must focus on the individual mother and her situation. 2. The facility must provide family-centered care, supported by the environment. 3. The health care system must ensure continuity of care, that is, continuity of pre-, peri-, and postnatal care and post......; and for external assessment to decide whether neonatal intensive/intermediate care units meet the conditions required to be designated as Baby-Friendly. The documents will be finalized after consultation with the World Health Organization/United Nations Children's Fund, and the goal is to offer these documents...

Lessons Learned for Decommissioning Planning

International Nuclear Information System (INIS)

Sohn, Wook; Kim, Young-gook; Kim, Hee-keun

2015-01-01

The purpose of this paper is to introduce the U.S. nuclear industrial's some key lessons learned especially for decommissioning planning based on which well informed decommissioning planning can be carried out. For a successful decommissioning, it is crucial to carry out a well-organized decommissioning planning before the decommissioning starts. This paper discussed four key factors which should be decided or considered carefully during the decommissioning planning period with introduction of related decommissioning lessons learned of U.S. nuclear industry. Those factors which have been discussed in this paper include the end state of a site, the overall decommissioning strategy, the management of the spent fuels, and the spent fuel pool island. Among them, the end state of a site should be decided first as it directs the whole decommissioning processes. Then, decisions on the overall decommissioning strategy (DECON vs. SAFSTOR) and the management of the spent fuels (wet vs. dry) should follow. Finally, the spent fuel pool island should be given due consideration because its implementation will result in much cost saving. Hopefully, the results of this paper would provide useful inputs to performing the decommissioning planing for the Kori unit 1

Lessons Learnt and Mitigation Measures for the CERN LHC Equipment with RF fingers

CERN Document Server

Métral, E; Assmann, R W; Baglin, V; Barnes, M J; Berrig, O E; Bertarelli, A; Bregliozzi, G; Calatroni, S; Carra, F; Caspers, F; Day, H A; Ferro-Luzzi, M; Gallilee, M A; Garion, C; Garlasche, M; Grudiev, A; Jimenez, J M; Jones, R; Kononenko, O; Losito, R; Nougaret, J L; Parma, V; Redaelli, S; Salvant, B; Strubin, P; Veness, R; Vollinger, C; Weterings, W

2013-01-01

Beam-induced RF heating has been observed in several LHC components when the bunch/beam intensity was increased and/or the bunch length reduced. In particular eight bellows, out of the ten double-bellow modules present in the machine in 2011, were found with the spring, which should keep the RF fingers in good electrical contact with the central insert, broken. Following these observations, the designs of all the components of the LHC equipped with RF fingers have been reviewed. The lessons learnt and mitigation measures are presented in this paper.

Musings on management. Ten ideas designed to rile everyone who cares about management.

Science.gov (United States)

Mintzberg, H

1996-01-01

Henry Mintzberg, a professor of management at McGill University in Canada and at INSEAD in France, takes aim at the hype surrounding management fads and gurus and dares to suggest that the emperor has no clothes. In order to rile all who care about management and get them thinking creatively, he presents ten contrarian observations on such topics as the meanness of leanness, the folly of CEOs who fancy themselves strategists, the disempowering that so-called empowerment creates, the myopia of purely financial measures, and the inadequacy of M.B.A. programs. Mintzberg maintains, for example, that it is time to delayer the delayerers. He argues that delayering has created more problems than it has solved be cause it is, in essence, a process by which people who barely know what's going on get rid of those who do--a process ensuring that the real database of the organization, the key to what was its future, lines up at the unemployment office. Too many managers, he says, dream of becoming the next turnaround doctor. They fail to understand that great organizations, once created, don't need great leaders: if a company can't function on its own, a hero won't help. A leader who draws out the knowledge embedded in all parts of an organization is a leader who can help a company function alone--without heroes. Such leaders often practice what Mintzberg calls the craft style of management (as opposed to the professional style or the boss style). It is about inspiring, not empowering. It is based on mutual respect rooted in common experience and offers hope for improving what is now wrong with management.

The Fernald Closure Project: Lessons Learned

International Nuclear Information System (INIS)

Murphy, Cornelius M.; Carr, Dennis

2008-01-01

For nearly 37 years, the U.S. Department of Energy site at Fernald - near Cincinnati, Ohio - produced 230,000 metric tons (250,000 short tons) of high-purity, low-enriched uranium for the U.S. Defense Program, generating more than 5.4 million metric tons (6 million short tons) of liquid and solid waste as it carried out its Cold War mission. The facility was shut down in 1989 and clean up began in 1992, when Fluor won the contract to clean up the site. Cleaning up Fernald and returning it to the people of Ohio was a $4.4 billion mega environmental-remediation project that was completed in October 2006. Project evolved through four phases: - Conducting remedial-investigation studies to determine the extent of damage to the environment and groundwater at, and adjacent to, the production facilities; - Selecting cleanup criteria - final end states that had to be met that protect human health and the environment; - Selecting and implementing the remedial actions to meet the cleanup goals; - Executing the work in a safe, compliant and cost-effective manner. In the early stages of the project, there were strained relationships - in fact total distrust - between the local community and the DOE as a result of aquifer contamination and potential health effects to the workers and local residents. To engage citizens and interested stakeholders groups in the decision-making process, the DOE and Fluor developed a public-participation strategy to open the channels of communication with the various parties: site leadership, technical staff and regulators. This approach proved invaluable to the success of the project, which has become a model for future environmental remediation projects. This paper will summarize the history and shares lessons learned: the completion of the uranium-production mission to the implementation of the Records of Decision defining the cleanup standards and the remedies achieved. Lessons learned fall into ten categories: - Regulatory approach with end

Primary health care lessons from the northeast of Brazil: the Agentes de Saúde Program.

Science.gov (United States)

Cufino Svitone, E; Garfield, R; Vasconcelos, M I; Araujo Craveiro, V

2000-05-01

Market-led economic reforms are usually viewed as being in conflict with government-stimulated socioeconomic development for disadvantaged groups. Nevertheless, Ceará, a poor state in the Northeast of Brazil, has since 1987 pursued both of those strategies simultaneously. One part of that approach has been a program of nurse-directed auxiliary health workers serving about 5 million people--almost all the persons outside the capital city and half of those in the capital. The system requires that the auxiliaries, called agentes de saúde, live in the local communities that they serve. The health agents visit each home once a month to carry out a small number of priority health activities. While health agent positions are in high demand, the minimum-wage salary that the agents receive makes up only a small portion of the state budget. A key aspect of the system is timely and comprehensive information, which is based on agent visits and is managed by trained nurses. Since the health agents system was launched, there has been a rapid decline in infant mortality, a rapid rise in immunization, identification of bottlenecks limiting the utilization of other medical resources, and timely interventions in times of crisis. The health agents system has combined administrative decentralization with financial centralization during a period of electoral democratization. The system has strengthened Ceará's commitment to primary care even as market-oriented changes have reduced the overall role of government. The Ceará program is being copied throughout the Northeast and other regions of Brazil. The key role that nurses play in the Ceará program in organizing and leading a system of basic primary care in poor neighborhoods and rural areas may provide useful lessons for other countries. In addition, Ceará does not have many of the favorable characteristics of other countries that have successfully invested in primary health care. Ceará thus represents a more achievable model

Preparing Science-Trained Professionals for the Biotechnology Industry: A Ten-Year Perspective on a Professional Science Master’s Program

Directory of Open Access Journals (Sweden)

Paul T. Hamilton

2012-02-01

Full Text Available The biotechnology industry has a need for business-savvy scientists; however, this is not the way scientists are traditionally trained at universities and colleges. To address this need, universities have developed Professional Science Master’s (PSM degree programs that offer advanced training in a technical field along with professional skills development through team-based projects and internships. Nearly ten years ago, the Department of Microbiology at NCSU started a PSM program in Microbial Biotechnology (MMB. This article provides an overview of the MMB program, and shares some of the lessons that we have learned.

Lessons from Queer Bioethics: A Response to Timothy F. Murphy.

Science.gov (United States)

Richie, Cristina

2016-06-01

'Bioethics still has important work to do in helping to secure status equality for LGBT people' writes Timothy F. Murphy in a recent Bioethics editorial. The focus of his piece, however, is much narrower than human rights, medical care for LGBT people, or ending the HIV/AIDS pandemic. Rather, he is primarily concerned with sexuality and gender identity, and the medical intersections thereof (i.e. DSM diagnosis; access to SrS or ARTs). It is the objective of this response to provide an alternate account of bioethics from a Queer perspective. I will situate Queer bioethics within Queer studies, and offer three 'lessons' that bioethics can derive from this perspective. These are not definitive rules for Queer bioethics, since it is a field which fundamentally opposes categorizations, favoring pastiche over principles. These lessons are exploratory examples, which both complement and contradict LGBT bioethics. My latter two lessons - on environmental bioethics and disability - overlap with some of Murphy's concerns, as well as other conceptions of LGBT bioethics. However, the first lesson takes an antithetical stance to Murphy's primary focus by resisting all forms of heteroconformity and disavowing reproduction as consonant with Queer objectives and theory. The first lesson, which doubles as a primer in Queer theory, does heavy philosophical lifting for the remainder of the essay. This response to Timothy F. Murphy, whose work is certainly a legacy in bioethics, reveals the multiplicity of discourses in LGBT/Queer studies, many of which are advantageous - even essential - to other disciplines like bioethics. © 2016 John Wiley & Sons Ltd.

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.

Transcutaneous electrical nerve stimulation (TENS reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial

Directory of Open Access Journals (Sweden)

Licia Santos Santana

2016-01-01

Full Text Available Questions: In the active phase of the first stage of labour, does transcutaneous electrical nerve stimulation (TENS relieve pain or change its location? Does TENS delay the request for neuraxial analgesia during labour? Does TENS produce any harmful effects in the mother or the foetus? Are women in labour satisfied with the care provided? Design: Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. Participants: Forty-six low-risk, primigravida parturients with a gestational age > 37 weeks, cervical dilation of 4 cm, and without the use of any medications from hospital admission until randomisation. Intervention: The principal investigator applied TENS to the experimental group for 30 minutes starting at the beginning of the active phase of labour. A second investigator assessed the outcomes in both the control and experimental groups. Both groups received routine perinatal care. Outcome measures: The primary outcome was pain severity after the intervention period, which was assessed using the 100-mm visual analogue scale. Secondary outcomes included: pain location, duration of the active phase of labour, time to pharmacological labour analgesia, mode of birth, neonatal outcomes, and the participant's satisfaction with the care provided. Results: After the intervention, a significant mean difference in change in pain of 15 mm was observed favouring the experimental group (95% CI 2 to 27. The application of TENS did not alter the location or distribution of the pain. The mean time to pharmacological analgesia after the intervention was 5.0 hours (95% CI 4.1 to 5.9 longer in the experimental group. The intervention did not significantly impact the other maternal and neonatal outcomes. Participants in both groups were satisfied with the care provided during labour. Conclusion: TENS produces a significant decrease in pain during labour and postpones the need for pharmacological

Lessons Learned from Developing a Patient Engagement Panel: An OCHIN Report.

Science.gov (United States)

Arkind, Jill; Likumahuwa-Ackman, Sonja; Warren, Nate; Dickerson, Kay; Robbins, Lynn; Norman, Kathy; DeVoe, Jennifer E

2015-01-01

There is renewed interest in patient engagement in clinical and research settings, creating a need for documenting and publishing lessons learned from efforts to meaningfully engage patients. This article describes early lessons learned from the development of OCHIN's Patient Engagement Panel (PEP). OCHIN supports a national network of more than 300 community health centers (CHCs) and other primary care settings that serve over 1.5 million patients annually across nearly 20 states. The PEP was conceived in 2009 to harness the CHC tradition of patient engagement in this new era of patient-centered outcomes research and to ensure that patients were engaged throughout the life cycle of our research projects, from conception to dissemination. Developed by clinicians and researchers within our practice-based research network, recruitment of patients to serve as PEP members began in early 2012. The PEP currently has a membership of 18 patients from 3 states. Over the past 24 months, the PEP has been involved with 12 projects. We describe developing the PEP and challenges and lessons learned (eg, recruitment, funding model, creating value for patient partners, compensation). These lessons learned are relevant not only for research but also for patient engagement in quality improvement efforts and other clinical initiatives. © Copyright 2015 by the American Board of Family Medicine.

HIPs at Ten

Science.gov (United States)

Kuh, George; O'Donnell, Ken; Schneider, Carol Geary

2017-01-01

2017 is the anniversary of the introduction of what are now commonly known as high-impact practices (HIPs). Many of the specific activities pursued under the HIPs acronym have been around in some form for decades, such as study abroad, internships, and student-faculty research. It was about ten years ago that, after conferring HIPs at Ten with…

Creating a winning team: lessons from football.

Science.gov (United States)

Simons, Sherri Lee

2005-01-01

There are tasks best done on an individual basis when caring for a neonate, but the ultimate outcome for infants and their families results from a team effort. Incorporating ten strategies drawn from football can help the NICU manager create and foster effective teamwork.

Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a Tertiary Care Hospital in Dammam, Saudi Arabia

Directory of Open Access Journals (Sweden)

Ayman A Al-Talib

2016-01-01

Full Text Available Objectives: To study the clinical presentation and treatment outcome of molar pregnancy at a Tertiary Care Hospital in Dammam, Saudi Arabia. Materials and Methods: Reviewed medical records of all molar pregnancy cases among all the deliveries at a tertiary care hospital in Dammam from 2005 to 2014, after approval by institutional ethical review committee. Data abstracted included patient′s age, parity, presenting symptoms, gestational age at diagnosis, uterine size, ultrasonographic findings, BhCG level at the time of diagnosis and at follow-up after evacuation, and blood loss during evacuation. Data was entered and analyzed using Excel; frequency distribution for categorical variables and descriptive statistics for continuous variables were computed. Results: Of a total of 25,000 deliveries in ten years, 22 cases of complete molar pregnancy were encountered: 0.9 cases of molar pregnancy per 1000 pregnancies. Majority of patients (63.7% were older than 35 years, and were nulliparous (45.5%. The commonest symptom was vaginal bleeding (86.4% followed by hyperemesis gravidarum (41.0%; Hyperthyroidism was seen in 1 patient (4.5%. Ovarian enlargement by theca-lutin cyst was seen in 3 patients (13.6%. The majority of patients (63.6% had normal BhCG within 9 weeks (63 days after suction curettage. The majority of the cases followed a benign course. Conclusion: Aged older than 35 years seems a risk factor and vaginal bleeding is the commonest presenting symptom. Early booking of pregnant women to antenatal care clinics and routine first trimester ultrasound made diagnosis easier and earlier before complications appear.

Contributions of COPD, asthma, and ten comorbid conditions to health care utilization and patient-centered outcomes among US adults with obstructive airway disease.

Science.gov (United States)

Murphy, Terrence E; McAvay, Gail J; Allore, Heather G; Stamm, Jason A; Simonelli, Paul F

2017-01-01

Among persons with obstructive airway disease, the relative contributions of chronic obstructive pulmonary disease (COPD), asthma, and common comorbid conditions to health care utilization and patient-centered outcomes (PCOs) have not been previously reported. We followed a total of 3,486 persons aged ≥40 years with COPD, asthma, or both at baseline, from the Medical Expenditure Panel Survey (MEPS) cohorts enrolled annually from 2008 through 2012 for 1 year. MEPS is a prospective observational study of US households recording self-reported COPD, asthma, and ten medical conditions: angina, arthritis, cancer, coronary heart disease, cognitive impairment, diabetes, hypertension, lung cancer, myocardial infarction, and stroke/transient ischemic attack. We studied the separate contributions of these conditions to health care utilization (all-cause and respiratory disease hospitalization, any emergency department [ED] visit, and six or more outpatient visits) and PCOs (seven or more days spent in bed due to illness, incident loss of mobility, and incident decline in self-perceived health). COPD made the largest contributions to all-cause and respiratory disease hospitalization and ED visits, while arthritis made the largest contribution to outpatient health care. Arthritis and COPD, respectively, made the greatest contributions to the PCOs. COPD made the largest and second largest contributions to health care utilization and PCOs among US adults with obstructive airway disease. The twelve medical conditions collectively accounted for between 52% and 61% of the health care utilization outcomes and between 53% and 68% of the PCOs. Cognitive impairment, diabetes, hypertension, and stroke also made significant contributions.

Ten years of health workforce planning in the Netherlands: a tentative evaluation of GP planning as an example.

NARCIS (Netherlands)

Greuningen, M. van; Batenburg, R.S.; Velden, L.F.J. van der

2012-01-01

INTRODUCTION: In many countries, health-care labour markets are constantly being challenged by an alternation of shortage and oversupply. Avoiding these cyclic variations is a major challenge. In the Netherlands, a workforce planning model has been used in health care for ten years. Case description

Experience and lessons learned in the assessment of safety justifications for experiments mounted in research reactors

International Nuclear Information System (INIS)

Cox, R.F.

1990-01-01

Some experiments in research reactors are arguably a risky undertaking due to their uncertain outcome. The justifications for such experiments require careful assessment to validate their undertaking. The public, the operators and the installation itself must be safeguarded. Assessment of the potential risk is an acquired skill but in doing so the route can be eased by learning from the lessons experience can teach. This paper, essentially for the usage of safety managers, sets out some of the issues relating to the assessment process gained from our experience over a few tens of years in the assessment of experiments. Many of the conclusions reached may appear all too obvious viewed in retrospect, but they were not necessarily clear at the time. Those organizations setting up assessment teams may find some of the conclusions of value such that their proposed management system can embrace methodologies for assessment that can avoid or lessen the impact of some of the pitfalls we have tried to identify. Failure to recognise some of these points may run the risk of delayed clearances, dilated timescales and cost overruns. It is in the hope of reducing all these penalties that we offer our experiences

Competence of health care providers on care of newborns at birth in ...

African Journals Online (AJOL)

Introduction: This is an observational study which was carried out at a level one health facility in Yaoundé from June to July 2009. The aim was to evaluate the competence of health care providers towards newborns' care at birth. Methods: Ten health care providers took care of three hundred and thirty-five pregnant women ...

Lessons learned from an installation perspective for chemical demilitarization plant start-up at four operating incineration sites.

Energy Technology Data Exchange (ETDEWEB)

Motz, L.; Decision and Information Sciences

2011-02-21

This study presents the lessons learned by chemical storage installations as they prepared for the start of chemical demilitarization plant operations at the four current chemical incinerator sites in Alabama, Arkansas, Oregon, and Utah. The study included interviews with persons associated with the process and collection of available documents prepared at each site. The goal was to provide useful information for the chemical weapons storage sites in Colorado and Kentucky that will be going through plant start-up in the next few years. The study is not a compendium of what to do and what not to do. The information has been categorized into ten lessons learned; each is discussed individually. Documents that may be useful to the Colorado and Kentucky sites are included in the appendices. This study should be used as a basis for planning and training.

A Lesson about the Circular Flow. Active Learning Lessons. Economics International.

Science.gov (United States)

Landfried, Janet

This lesson plan was developed through "Economics International," an international program to help build economic education infrastructures in the emerging market economies. It provides a lesson description; appropriate grade level; economic concepts; content standards and benchmarks; related subjects; instructional objectives; time…

A data infrastructure for the assessment of health care performance: lessons from the BRIDGE-health project.

Science.gov (United States)

Bernal-Delgado, Enrique; Estupiñán-Romero, Francisco

2018-01-01

The integration of different administrative data sources from a number of European countries has been shown useful in the assessment of unwarranted variations in health care performance. This essay describes the procedures used to set up a data infrastructure (e.g., data access and exchange, definition of the minimum common wealth of data required, and the development of the relational logic data model) and, the methods to produce trustworthy healthcare performance measurements (e.g., ontologies standardisation and quality assurance analysis). The paper ends providing some hints on how to use these lessons in an eventual European infrastructure on public health research and monitoring. Although the relational data infrastructure developed has been proven accurate, effective to compare health system performance across different countries, and efficient enough to deal with hundred of millions of episodes, the logic data model might not be responsive if the European infrastructure aims at including electronic health records and carrying out multi-cohort multi-intervention comparative effectiveness research. The deployment of a distributed infrastructure based on semantic interoperability, where individual data remain in-country and open-access scripts for data management and analysis travel around the hubs composing the infrastructure, might be a sensible way forward.

Classroom Management and Lesson Planning(4)

Institute of Scientific and Technical Information of China (English)

2006-01-01

Lesson PlanningTask 1As teachers,we all need to plan our lessons before we teach.Make a list of things that you think need tobe included in a lesson plan.Then compare and discuss your list with another teacher.Also think about reasonswhy we need to plan our lessons.

Constellation Program Lessons Learned. Volume 2; Detailed Lessons Learned

Science.gov (United States)

Rhatigan, Jennifer; Neubek, Deborah J.; Thomas, L. Dale

2011-01-01

These lessons learned are part of a suite of hardware, software, test results, designs, knowledge base, and documentation that comprises the legacy of the Constellation Program. The context, summary information, and lessons learned are presented in a factual format, as known and described at the time. While our opinions might be discernable in the context, we have avoided all but factually sustainable statements. Statements should not be viewed as being either positive or negative; their value lies in what we did and what we learned that is worthy of passing on. The lessons include both "dos" and "don ts." In many cases, one person s "do" can be viewed as another person s "don t"; therefore, we have attempted to capture both perspectives when applicable and useful. While Volume I summarizes the views of those who managed the program, this Volume II encompasses the views at the working level, describing how the program challenges manifested in day-to-day activities. Here we see themes that were perhaps hinted at, but not completely addressed, in Volume I: unintended consequences of policies that worked well at higher levels but lacked proper implementation at the working level; long-term effects of the "generation gap" in human space flight development, the need to demonstrate early successes at the expense of thorough planning, and the consequences of problems and challenges not yet addressed because other problems and challenges were more immediate or manifest. Not all lessons learned have the benefit of being operationally vetted, since the program was cancelled shortly after Preliminary Design Review. We avoid making statements about operational consequences (with the exception of testing and test flights that did occur), but we do attempt to provide insight into how operational thinking influenced design and testing. The lessons have been formatted with a description, along with supporting information, a succinct statement of the lesson learned, and

Space reactor safety, 1985--1995 lessons learned

International Nuclear Information System (INIS)

Marshall, A.C.

1995-01-01

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

Space reactor safety, 1985--1995 lessons learned

Energy Technology Data Exchange (ETDEWEB)

Marshall, A.C.

1995-12-31

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

Classroom Management and Lesson Planning(4)

Institute of Scientific and Technical Information of China (English)

2006-01-01

@@ Lesson Planning Task 1 As teachers,we all need to plan our lessons before we teach.Make a list of things that you think need to be included in a lesson plan.Then compare and discuss your list with another teacher.Also think about reasons why we need to plan our lessons.

Lessons from school: what nurse leaders can learn from education.

Science.gov (United States)

Davies, Nigel

2015-07-01

The drive to improve quality in the education sector is similar to that in health care, and lessons from the schools system are relevant to nursing leadership. This article discusses these shared traits, and details how school improvement was achieved in London and how a model of learning-centred leadership helped to transform pupil attainment in schools that had been performing poorly. Parallels are drawn between the education inspection system undertaken by Ofsted and the hospital inspections undertaken by the Care Quality Commission, and between the practice discipline-based managerial roles of nurse directors and head teachers. The article suggests that a learning-centred approach to improving the quality of patient care is needed, with a focus on the education and continuing professional development of staff.

Lesson Planning the Kodaly Way.

Science.gov (United States)

Boshkoff, Ruth

1991-01-01

Discusses the contribution of Zoltan Kodaly to music lesson planning. Emphasizes preparation, presentation, and practice as the three important strategies in teaching concepts and skills to be included in a lesson plan. Includes a sample lesson plan covering a semester and advice on choosing song material. (DK)

Granulocyte colony-stimulating factor in toxic epidermal necrolysis (TEN) and Chelsea & Westminster TEN management protocol [corrected].

Science.gov (United States)

de Sica-Chapman, A; Williams, G; Soni, N; Bunker, C B

2010-04-01

Toxic epidermal necrolysis (TEN) is a rare but life-threatening, allergic drug reaction. Skin blistering with epidermal and mucosal necrolysis with subsequent detachment from an inflamed underlying dermis is a hallmark of the condition. The pathogenesis of TEN is not well understood, accounting for controversies about its management and significant delay in initiating potentially beneficial therapy. There are no management protocols based on a robust evidence base. Prompt recognition of the diagnosis and consensus on early management initiatives are necessary in order to improve outcomes and survival in TEN. To date, TEN management has been directed at arresting the allergic reaction and treating the complications. We have identified a need for specific medical interventions to accelerate wound regeneration. This approach has not previously been adopted in the management of TEN. We observed that in two cases of severe TEN, dramatic re-epithelialization and recovery coincided with the introduction of granulocyte colony-stimulating factor (G-CSF) for neutropenia. We explain how addition of the G-CSF promotes recovery from TEN by enhanced bioregeneration of the damaged tissues through accelerated re-epithelialization. G-CSF has been used for severe neutropenia in TEN, but we recommend and explain why, as in our Chelsea and Westminster protocol, G-CSF should be considered in treating severe TEN irrespective of the severity of neutropenia.

Analysing the integration of engineering in science lessons with the Engineering-Infused Lesson Rubric

Science.gov (United States)

Peterman, Karen; Daugherty, Jenny L.; Custer, Rodney L.; Ross, Julia M.

2017-09-01

Science teachers are being called on to incorporate engineering practices into their classrooms. This study explores whether the Engineering-Infused Lesson Rubric, a new rubric designed to target best practices in engineering education, could be used to evaluate the extent to which engineering is infused into online science lessons. Eighty lessons were selected at random from three online repositories, and coded with the rubric. Overall results documented the strengths of existing lessons, as well as many components that teachers might strengthen. In addition, a subset of characteristics was found to distinguish lessons with the highest level of engineering infusion. Findings are discussed in relation to the potential of the rubric to help teachers use research evidence-informed practice generally, and in relation to the new content demands of the U.S. Next Generation Science Standards, in particular.

With Interest It Comes To...Unconscionable Clauses in Sales Contracts. A Student's Lesson Plan [and] A Teacher's Lesson Plan [and] A Lawyer's Lesson Plan.

Science.gov (United States)

Howard, Estelle; And Others

One of a series of secondary level teaching units presenting case studies with pro and con analysis of particular legal problems, the document presents a student's lesson plan, a teacher's lesson plan, and a lawyer's lesson plan on unconscionable clauses in sales contracts. The unit acquaints students with the operation of sales contracts and…

Lessons Learned in Pilot Testing Specialty Consultations to Benefit Individuals with Lower Limb Loss

Directory of Open Access Journals (Sweden)

Christine Elnitsky

2012-12-01

Full Text Available Telerehabilitation technologies enable the delivery of rehabilitation services from providers to people with disabilities as well as specialty care consultations. This article discusses the barriers experienced when planning and pilot testing a telerehabilitation multi-site specialty consultation for specialists in their medical centers, and the lessons learned. The barriers included integration and participation, coordination across organizational units, and privacy and information security. Lessons learned included the need for collaboration across multiple departments, telerehabilitation equipment back-ups, and anonymous and private communication protocols. Despite delays resulting from coordination at multiple levels of a national organization, we developed a program plan and successfully implemented a pilot test of the southeast region program.  Specialty consultation using telerehabilitation delivery methods requires identifying provider preferences for technological features. Lessons learned could inform development of outpatient telerehabilitation for patients with amputations and studies of patients and providers involved in telerehabilitation.

Funding models in palliative care: Lessons from international experience

Science.gov (United States)

Groeneveld, E Iris; Cassel, J Brian; Bausewein, Claudia; Csikós, Ágnes; Krajnik, Malgorzata; Ryan, Karen; Haugen, Dagny Faksvåg; Eychmueller, Steffen; Gudat Keller, Heike; Allan, Simon; Hasselaar, Jeroen; García-Baquero Merino, Teresa; Swetenham, Kate; Piper, Kym; Fürst, Carl Johan; Murtagh, Fliss EM

2017-01-01

Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest. PMID:28156188

Funding models in palliative care: Lessons from international experience.

Science.gov (United States)

Groeneveld, E Iris; Cassel, J Brian; Bausewein, Claudia; Csikós, Ágnes; Krajnik, Malgorzata; Ryan, Karen; Haugen, Dagny Faksvåg; Eychmueller, Steffen; Gudat Keller, Heike; Allan, Simon; Hasselaar, Jeroen; García-Baquero Merino, Teresa; Swetenham, Kate; Piper, Kym; Fürst, Carl Johan; Murtagh, Fliss Em

2017-04-01

Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. To assess national models and methods for financing and reimbursing palliative care. Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest.

Transitional Care and Patient Experience Workshop

OpenAIRE

Espaulella, Joan; Escarrabill, Joan; Martí, Tino; Wynne-Jones, Kathryn

2016-01-01

Upon the Integrated Care Exchange program initiated between Oldham CCG and Catalan healthcare providers (Hospital Clinic, CHV, CAPSE and CASAP) and co-organised by AQuA and IFIC in 2014-2015, we do aim to continue the learning exchange around a central topic: Transitional Care.We propose a double session. The first one will address different interventions in Transitional Care to be compared following a similar presentation pattern that will allow to identify the lessons learns in three key as...

Fun on the Farm: Evaluation of a Lesson to Teach Students about the Spread of Infection on School Farm Visits

Science.gov (United States)

Hawking, Meredith K. D.; Lecky, Donna M.; Verlander, Neville Q.; McNulty, Cliodna A. M.

2013-01-01

Background School visits to farms are a positive educational experience but pose risks due to the spread of zoonotic infections. A lesson plan to raise awareness about microbes on the farm and preventative behaviours was developed in response to the Griffin Investigation into the E. coli outbreak associated with Godstone Farm in 2009. This study evaluated the effectiveness of the delivery of the lesson plan in increasing knowledge about the spread of infection on the farm, amongst school students. Methods Two hundred and twenty-five 9–11 year old students from seven junior schools in England participated. Two hundred and ten students filled in identical questionnaires covering microbes, hand hygiene, and farm hygiene before and after the lesson. Statistical analysis assessed knowledge change using difference in percentage correct answers. Results Significant knowledge improvement was observed for all sections. In the ‘Farm Hygiene’ section, girls and boys demonstrated 18% (plesson plan was successful at increasing awareness of microbes on the farm and infection prevention measures and should be used by teachers in preparation for a farm visit. PMID:24146765

Lessons learned related to packaging and transportation

International Nuclear Information System (INIS)

Wallen, C.

1995-01-01

The use of lessons learned as a tool for learning from past experiences is well established, especially by many organizations within the nuclear industry. Every person has, at some time, used the principles of lessons learned to adopt good work practices based on their own experiences or the experiences of others. Lessons learned can also help to avoid the recurrence of adverse practices, which is often an area that most lessons-learned programs tend to focus on. This paper will discuss how lessons learned relate to packaging and transportation issues and events experienced at Department of Energy (DOE) facilities. It will also discuss the role performed by the Office of Nuclear and Facility Safety's Office of Operating Experience Analysis and Feedback in disseminating lessons learned and operating experience feedback to the DOE complex. The central concept of lessons learned is that any organization should be able to learn from its own experiences and events. In addition, organizations should implement methodologies to scan external environments for lessons learned, to analyze and determine the relevance of lessons learned, and to bring about the necessary changes learned from these experiences. With increased concerns toward facility safety, the importance of utilizing the lessons-learned principles and the establishment of lessons-learned programs can not be overstated

Deep geologic disposal. Lessons learnt from recent performance assessment studies

International Nuclear Information System (INIS)

Pescatore, C.; Andersson, J.

1998-01-01

Performance assessment (PA) studies are part of the decision basis for the siting, operation, and closure of deep repositories of long-lived nuclear wastes. In 1995 the NEA set up the Working Group on Integrated Performance Assessments of Deep Repositories (IPAG) with the goals to analyse existing PA studies, learn about what has been produced to date, and shed light on what could be done in future studies. Ten organisations submitted their most recent PA study for analysis and discussion, including written answers to over 70 questions. Waste management programmes, disposal concepts, geologies, and different types and amounts of waste offered a unique opportunity for exchanging information, assessing progress in PA since 1990, and identifying recent trends. A report was completed whose main lessons are overviewed. (author)

Maternity Nurses' Perceptions of Implementation of the Ten Steps to Successful Breastfeeding.

Science.gov (United States)

Cunningham, Emilie M; Doyle, Eva I; Bowden, Rodney G

The purpose of this study was to determine maternity nurses' perceptions of implementing the Ten Steps to Successful Breastfeeding. An online survey and a focus group were used to evaluate perceptions of maternity nurses of implementing the Ten Steps to Successful Breastfeeding in an urban Texas hospital at the onset of the project initiation. Responses were transcribed and coded using Nvivo software. Thematic analysis was conducted and consensus was reached among the research team to validate themes. Twenty-eight maternity nurses participated. Nurses perceived a number of barriers to implementing the Ten Steps to Successful Breastfeeding including nurse staffing shortages, variations in practice among nurses, different levels of nurse education and knowledge about breastfeeding, lack of parental awareness and knowledge about breastfeeding, culture, and postpartum issues such as maternal fatigue, visitors, and routine required procedures during recovery care that interfered with skin-to-skin positioning. Maternity nurses desired more education about breastfeeding; specifically, a hands-on approach, rather than formal classroom instruction, to be able to promote successful implementation of the Ten Steps. More education on breastfeeding for new mothers, their families, and healthcare providers was recommended. Nurse staffing should be adequate to support nurses in their efforts to promote breastfeeding. Skin-to-skin positioning should be integrated into the recovery period. Hospital leadership support for full implementation and policy adherence is essential. Challenges in implementing the Ten Steps were identified along with potential solutions.

Lessons for Teaching Art Criticism.

Science.gov (United States)

Barrett, Terry, Ed.; Clark, Gilbert, Ed.

This collection of lessons is meant to be a practical guide to help teachers engage children in art criticism. The lessons generally follow a similar format. Most suggest an age group but may be modified for use with younger or older students. Several authors suggest variations and extensions for lessons that include studio activities. A broad…

"Frankenstein." [Lesson Plan].

Science.gov (United States)

Simon, Melanie

Based on Mary Shelley's novel "Frankenstein," this lesson plan presents activities designed to help students understand that active readers interpret a novel (its characters, plot, setting, and theme) in different ways; and the great literature can be and has been adapted in many ways over time. The main activity of the lesson involves students…

Phagocytosis: history's lessons.

Science.gov (United States)

Garg, Manish; Chandawarkar, Rajiv Y

2013-01-01

The assimilation of lessons from the past is an essential component of education for scientists of tomorrow. These lessons are not easy to find. History books on science are few and usually highly dramatized and biographies of scientists tend to exaggerate the pomp of scientific discovery. Both underplay the hard and laborious work that is integral to any scientific pursuit. Here we illustrate one such example. A century ago, the Nobel Prize in Medicine was awarded to two scientists: Ilya Metchnikoff, a Russian zoologist, for the discovery ofphagocytosis-a cell-mediated ingestion ofmicrobes; and Paul Ehrlich, a distinguished physician-scientist, for discovering a highly antigen-specific serum-derived antibody-based immune defense. These two diametrically opposing views of the host-pathogen interaction set the stage for a strife that led to seminal advancements in immunology. Mirrored in this journey are important lessons for scientists today--ubiquitously as applicable to modern scientific life as they were a century ago. This commentaryhighlights these lessons--a fitting centenary to a well-deserved recognition.

Long-term care financing: lessons from France.

Science.gov (United States)

Doty, Pamela; Nadash, Pamela; Racco, Nathalie

2015-06-01

POLICY POINTS: France's model of third-party coverage for long-term services and supports (LTSS) combines a steeply income-adjusted universal public program for people 60 or older with voluntary supplemental private insurance. French and US policies differ: the former pay cash; premiums are lower; and take-up rates are higher, in part because employer sponsorship, with and without subsidization, is more common-but also because coverage targets higher levels of need and pays a smaller proportion of costs. Such inexpensive, bare-bones private coverage, especially if marketed as a supplement to a limited public benefit, would be more affordable to those Americans currently most at risk of "spending down" to Medicaid. An aging population leads to a growing demand for long-term services and supports (LTSS). In 2002, France introduced universal, income-adjusted, public long-term care coverage for adults 60 and older, whereas the United States funds means-tested benefits only. Both countries have private long-term care insurance (LTCI) markets: American policies create alternatives to out-of-pocket spending and protect purchasers from relying on Medicaid. Sales, however, have stagnated, and the market's viability is uncertain. In France, private LTCI supplements public coverage, and sales are growing, although its potential to alleviate the long-term care financing problem is unclear. We explore whether France's very different approach to structuring public and private financing for long-term care could inform the United States' long-term care financing reform efforts. We consulted insurance experts and conducted a detailed review of public reports, academic studies, and other documents to understand the public and private LTCI systems in France, their advantages and disadvantages, and the factors affecting their development. France provides universal public coverage for paid assistance with functional dependency for people 60 and older. Benefits are steeply income

The Construction and Pilot Application of a Scoring Rubric for Creative Drama Lesson Planning

Science.gov (United States)

Korkut, Perihan

2018-01-01

Instructional planning is an important part of successful teaching. Therefore, quality lesson planning is accepted as an important indicator of teacher knowledge and ability. This is no different for creative drama. Although drama is strongly rooted in the participating group's creativity and spontaneity, its success depends on a careful and…

Community-based interventions for obesity prevention: lessons learned by Australian policy-makers

Directory of Open Access Journals (Sweden)

Haby Michelle M

2012-01-01

Full Text Available Abstract Background Interest in community-based interventions (CBIs for health promotion is increasing, with a lot of recent activity in the field. This paper aims, from a state government perspective, to examine the experience of funding and managing six obesity prevention CBIs, to identify lessons learned and to consider the implications for future investment. Specifically, we focus on the planning, government support, evaluation, research and workforce development required. Methods The lessons presented in this paper come from analysis of key project documents, the experience of the authors in managing the projects and from feedback obtained from key program stakeholders. Results CBIs require careful management, including sufficient planning time and clear governance structures. Selection of interventions should be based on evidence and tailored to local needs to ensure adequate penetration in the community. Workforce and community capacity must be assessed and addressed when selecting communities. Supporting the health promotion workforce to become adequately skilled and experienced in evaluation and research is also necessary before implementation. Comprehensive evaluation of future projects is challenging on both technical and affordability grounds. Greater emphasis may be needed on process evaluation complemented by organisation-level measures of impact and monitoring of nutrition and physical activity behaviours. Conclusions CBIs offer potential as one of a mix of approaches to obesity prevention. If successful approaches are to be expanded, care must be taken to incorporate lessons from existing and past projects. To do this, government must show strong leadership and work in partnership with the research community and local practitioners.

Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review.

Science.gov (United States)

Woodman, J P; Moore, N R

2012-01-01

Complementary medicine and alternative approaches to chronic and intractable health conditions are increasingly being used, and require critical evaluation. The aim of this review was to systematically evaluate available evidence for the effectiveness and safety of instruction in the Alexander Technique in health-related conditions. PUBMED, EMBASE, PSYCHINFO, ISI Web-of-Knowledge, AMED, CINHAL-plus, Cochrane library and Evidence-based Medicine Reviews were searched to July 2011. Inclusion criteria were prospective studies evaluating Alexander Technique instruction (individual lessons or group delivery) as an intervention for any medical indication/health-related condition. Studies were categorised and data extracted on study population, randomisation method, nature of intervention and control, practitioner characteristics, validity and reliability of outcome measures, completeness of follow-up and statistical analyses.   Of 271 publications identified, 18 were selected: three randomised, controlled trials (RCTs), two controlled non-randomised studies, eight non-controlled studies, four qualitative analyses and one health economic analysis. One well-designed, well-conducted RCT demonstrated that, compared with usual GP care, Alexander Technique lessons led to significant long-term reductions in back pain and incapacity caused by chronic back pain. The results were broadly supported by a smaller, earlier RCT in chronic back pain. The third RCT, a small, well-designed, well-conducted study in individuals with Parkinson's disease, showed a sustained increased ability to carry out everyday activities following Alexander lessons, compared with usual care. The 15 non-RCT studies are also reviewed. Strong evidence exists for the effectiveness of Alexander Technique lessons for chronic back pain and moderate evidence in Parkinson's-associated disability. Preliminary evidence suggests that Alexander Technique lessons may lead to improvements in balance skills in the

Elliot Lake uranium mine reclamation, the first ten years

International Nuclear Information System (INIS)

Payne, R.A.

2000-01-01

In 1989, Rio Algom Limited finalized its plans for the closure and subsequent decommissioning of two of its then three operating mines in Elliot Lake as a result of market conditions. These two mines closed in August 1990. These mine closures had significant impacts. The principal mining operations of Rio Algom at that time were still in Elliot Lake and had been the very foundation of the company for about 40 years. The business impact on the Corporation was regarded as possibly severe. The resultant layoff of over 1,500 long-term, highly qualified, skilled and well-paid employees, a devastating blow to the affected employees and their families, would have a significant financial impact on the municipal economy, particularly as this announcement was seen as the first step in the early closure of all four operating mines in the region. At that time there was little precedence for such a high profile mine closure program and consequently the many unknowns relating to the mine decommissioning process, legislative requirements and society's expectations resulted in a perception of a significant yet ill-defined liability. In this atmosphere of understandable company, stakeholder and public concern, Rio Algom Limited embarked on what has turned out to be a long, rigorous, challenging yet ultimately reasonable and rewarding process of progressive reclamation of all its Elliot Lake mines, some ten in total (nine uranium, one copper). Over the past ten years, reclamation of all ten mines has been successfully completed, some $70 m plus has been expended in direct site reclamation works and the workforce has been reduced from over 2,500 to just 4. After ten years, the focus of attention is now on the long-term care, maintenance, monitoring and reporting required for the decommissioned mine sites, and the accomplishment of this in the best interests of all the stakeholders. (author)

Contributions of COPD, asthma, and ten comorbid conditions to health care utilization and patient-centered outcomes among US adults with obstructive airway disease

Directory of Open Access Journals (Sweden)

Murphy TE

2017-08-01

Full Text Available Terrence E Murphy,1 Gail J McAvay,1 Heather G Allore,1 Jason A Stamm,2 Paul F Simonelli2 1Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA; 2Department of Internal Medicine, Section of Thoracic Medicine, Geisinger Medical Center, Danville, PA, USA Background: Among persons with obstructive airway disease, the relative contributions of chronic obstructive pulmonary disease (COPD, asthma, and common comorbid conditions to health care utilization and patient-centered outcomes (PCOs have not been previously reported.Methods: We followed a total of 3,486 persons aged ≥40 years with COPD, asthma, or both at baseline, from the Medical Expenditure Panel Survey (MEPS cohorts enrolled annually from 2008 through 2012 for 1 year. MEPS is a prospective observational study of US households recording self-reported COPD, asthma, and ten medical conditions: angina, arthritis, cancer, coronary heart disease, cognitive impairment, diabetes, hypertension, lung cancer, myocardial infarction, and stroke/transient ischemic attack. We studied the separate contributions of these conditions to health care utilization (all-cause and respiratory disease hospitalization, any emergency department [ED] visit, and six or more outpatient visits and PCOs (seven or more days spent in bed due to illness, incident loss of mobility, and incident decline in self-perceived health.Results: COPD made the largest contributions to all-cause and respiratory disease hospitalization and ED visits, while arthritis made the largest contribution to outpatient health care. Arthritis and COPD, respectively, made the greatest contributions to the PCOs.Conclusion: COPD made the largest and second largest contributions to health care utilization and PCOs among US adults with obstructive airway disease. The twelve medical conditions collectively accounted for between 52% and 61% of the health care utilization outcomes and between 53

Customer care in the NHS.

Science.gov (United States)

Ruddick, Fred

2015-01-20

Viewing individuals in need of NHS care as customers has the potential to refocus the way their care is delivered. This article highlights some of the benefits of reframing the nurse-patient relationship in terms of customer care, and draws parallels between good customer care and the provision of high quality patient care in the NHS. It explores lessons to be learned from those who have studied the customer experience, which can be adapted to enhance the customer care experience within the health service. Developing professional expertise in the knowledge and skills that underpin good-quality interpersonal encounters is essential to improve the customer experience in health care and should be prioritised alongside the development of more technical skills. Creating a culture where emotional intelligence, caring and compassion are essential requirements for all nursing staff will improve patient satisfaction.

Ten Frequently Asked Questions About Veterans’ Transitions: Results of a Decade of RAND Work on Veteran Life

Science.gov (United States)

2016-01-01

no prior civilian work experi- ence and those with injuries or disabilities. As part of their duty to care for the men and women who have served...personal, and cultural fac- tors. Many service members expressed concern that using men - tal health services will negatively affect their military...lesson learned from previous research is how inaccurate many stereotypes about veterans are. For example, the research takes issue with the

Breastfeeding Practices and Barriers to Implementing the Ten Steps to Successful Breastfeeding in Mississippi Hospitals.

Science.gov (United States)

Alakaam, Amir; Lemacks, Jennifer; Yadrick, Kathleen; Connell, Carol; Choi, Hwanseok Winston; Newman, Ray G

2018-05-01

Mississippi has the lowest rates of breastfeeding in the United States at 6 and 12 months. There is growing evidence that the rates and duration of infant breastfeeding improve after hospitals implement the Ten Steps to Successful Breastfeeding; moreover, the Ten Steps approach is considered the standard model for evaluation of breastfeeding practices in birthplaces. Research aim: This study aimed to examine the implementation level of the Ten Steps and identify barriers to implementing the Ten Steps in Mississippi hospitals. A cross-sectional self-report survey was used to answer the research aim. Nurse managers of the birthing and maternity units of all 43 Mississippi hospitals that provided birthing and maternity care were recruited. A response rate of 72% ( N = 31) was obtained. Implementation of the Ten Steps in these hospitals was categorized as low, partial, moderate, or high. The researcher classified implementation in 29% of hospitals as moderate and in 71% as partial. The hospital level of implementation was significantly positively associated with the hospital delivery rate along with the hospital cesarean section rate per year. The main barriers for the implementation process of the Ten Steps reported were resistance to new policies, limited financial and human resources, and lack of support from national and state governments. Breastfeeding practices in Mississippi hospitals need to be improved. New policies need to be established in Mississippi to encourage hospitals to adopt the Ten Steps policies and practice in the maternity and birthing units.

Continuing Care

Science.gov (United States)

... Can’t Grandma Remember My Name? Artwork for Purchase Support Articles Ten Signs of Caregiver Stress Therapeutic ... loved one with Alzheimer’s may be a difficult decision. It is best to make decisions about care ...

Adapting the Quebecois method for assessing implementation to the French National Alzheimer Plan 2008–2012: lessons for gerontological services integration

Directory of Open Access Journals (Sweden)

Dominique Somme

2014-06-01

Full Text Available Introduction: Many countries face ageing-related demographic and epidemiological challenges, notably neurodegenerative disorders, due to the multiple care services they require, thereby pleading for a more integrated system of care. The integrated Quebecois method issued from the Programme of Research to Integrate Services for the Maintenance of Autonomy inspired a French pilot experiment and the National Alzheimer Plan 2008–2012. Programme of Research to Integrate Services for the Maintenance of Autonomy method implementation was rated with an evaluation grid adapted to assess its successive degrees of completion.Discussion: The approaching end of the president's term led to the method's institutionalization (2011–2012, before the implementation study ended. When the government changed, the study was interrupted. The results extracted from that ‘lost’ study (presented herein have, nonetheless, ‘found’ some key lessons.Key lessons/conclusion: It was possible to implement a Quebecois integrated-care method in France. We describe the lessons and pitfalls encountered in adapting this evaluation tool. This process is necessarily multidisciplinary and requires a test phase. A simple tool for quantitative assessment of integration was obtained. The first assessment of the tool was unsatisfactory but requires further studies. In the meantime, we recommend using mixed methodologies to assess the services integration level.

Adapting the Quebecois method for assessing implementation to the French National Alzheimer Plan 2008–2012: lessons for gerontological services integration

Directory of Open Access Journals (Sweden)

Dominique Somme

2014-06-01

Full Text Available Introduction: Many countries face ageing-related demographic and epidemiological challenges, notably neurodegenerative disorders, due to the multiple care services they require, thereby pleading for a more integrated system of care. The integrated Quebecois method issued from the Programme of Research to Integrate Services for the Maintenance of Autonomy inspired a French pilot experiment and the National Alzheimer Plan 2008–2012. Programme of Research to Integrate Services for the Maintenance of Autonomy method implementation was rated with an evaluation grid adapted to assess its successive degrees of completion. Discussion: The approaching end of the president's term led to the method's institutionalization (2011–2012, before the implementation study ended. When the government changed, the study was interrupted. The results extracted from that ‘lost’ study (presented herein have, nonetheless, ‘found’ some key lessons. Key lessons/conclusion: It was possible to implement a Quebecois integrated-care method in France. We describe the lessons and pitfalls encountered in adapting this evaluation tool. This process is necessarily multidisciplinary and requires a test phase. A simple tool for quantitative assessment of integration was obtained. The first assessment of the tool was unsatisfactory but requires further studies. In the meantime, we recommend using mixed methodologies to assess the services integration level.

Fun on the farm: evaluation of a lesson to teach students about the spread of infection on school farm visits.

Directory of Open Access Journals (Sweden)

Meredith K D Hawking

Full Text Available BACKGROUND: School visits to farms are a positive educational experience but pose risks due to the spread of zoonotic infections. A lesson plan to raise awareness about microbes on the farm and preventative behaviours was developed in response to the Griffin Investigation into the E. coli outbreak associated with Godstone Farm in 2009. This study evaluated the effectiveness of the delivery of the lesson plan in increasing knowledge about the spread of infection on the farm, amongst school students. METHODS: Two hundred and twenty-five 9-11 year old students from seven junior schools in England participated. Two hundred and ten students filled in identical questionnaires covering microbes, hand hygiene, and farm hygiene before and after the lesson. Statistical analysis assessed knowledge change using difference in percentage correct answers. RESULTS: Significant knowledge improvement was observed for all sections. In the 'Farm Hygiene' section, girls and boys demonstrated 18% (p<0.001 and 11% (p<0.001 improvement, respectively (girls vs. boys p<0.004. As girls had lower baseline knowledge the greater percentage improvement resulted in similar post intervention knowledge scores between genders (girls 80%, boys 83%. CONCLUSIONS: The lesson plan was successful at increasing awareness of microbes on the farm and infection prevention measures and should be used by teachers in preparation for a farm visit.

Advantages and Disadvantages of the Patient-Centered Medical Home: A Critical Analysis and Lessons Learned.

Science.gov (United States)

Budgen, Jacqueline; Cantiello, John

This article provides a detailed examination of the pros and cons associated with patient-centered medical homes (PCMHs). Opinions and findings from those who have studied PCMHs and those who have been directly involved with this type of health care model are outlined. Key lessons from providers are detailed, and critical success factors are highlighted. This synthesized analysis serves to lend evidence to health care managers and providers who are considering implementation of the PCMH model.

Lesson study in prospective mathematics teacher education: didactic and paradidactic technology in the post-lesson reflection

DEFF Research Database (Denmark)

Rasmussen, Klaus

2016-01-01

This paper presents a detailed analysis of the post-lesson reflection, carried out in the context of eight cases of lesson study conducted by teams of Danish, lower secondaryprospective teachers and their supervisors. The participants, representing different institutions, were all new to the less...... and concern to the whole profession of mathematics teachers and the analysis adds to our insight into the potential of lesson study in prospective education as a meeting place where pertinent actors contribute to the expansion and dissemination of shared professional knowledge......This paper presents a detailed analysis of the post-lesson reflection, carried out in the context of eight cases of lesson study conducted by teams of Danish, lower secondaryprospective teachers and their supervisors. The participants, representing different institutions, were all new to the lesson...... study format. Nevertheless, it is demonstrated how their interaction shape the development of discourse about mathematical learning. The anthropological theory of the didactic is employed as the theoretical approach to analyse the mathematical and primarily didactical praxeologies developed...

Quality of care in reproductive health programmes: monitoring and evaluation of quality improvement.

Science.gov (United States)

Kwast, B E

1998-12-01

As 200 million women become pregnant every year, at least 30 million will develop life-threatening complications requiring emergency treatment at any level of society where they live. But it is a basic human right that pregnancy be made safe for all women as complications are mostly unpredictable. This requires reproductive health programmes which are responsive to women's and their families' needs and expectations on the one hand and enhancement of community participation, high quality obstetric services, and both provider collaboration and satisfaction on the other. Monitoring and evaluation of these facets need to be an integral part of any safe motherhood programme, not only to assess progress, but also to use this information for subsequent planning and implementation cycles of national programmes. Lessons learned from ten years' implementation of Safe Motherhood programmes indicate that process and outcome indicators are more feasible for short-term evaluation purposes than impact indicators, such as maternal mortality reduction. The former are described in this paper with relevant country examples. This is the third, and last, article in a series on quality of care in reproductive health programmes. The first (Kwast 1998a) contains an overview of concepts, assessments, barriers and improvements of quality of care. The second (Kwast 1998b) addresses education issues for quality improvement.

Implementation fidelity of self-administered transcutaneous electrical nerve stimulation (TENS) in patients with chronic back pain: an observational study.

Science.gov (United States)

Pallett, Edward J; Rentowl, Patricia; Johnson, Mark I; Watson, Paul J

2014-03-01

The efficacy of transcutaneous electrical nerve stimulation (TENS) for pain relief has not been reliably established. Inconclusive findings could be due to inadequate TENS delivery and inappropriate outcome assessment. Electronic monitoring devices were used to determine patient compliance with a TENS intervention and outcome assessment protocol, to record pain scores before, during, and after TENS, and measure electrical output settings. Patients with chronic back pain consented to use TENS daily for 2 weeks and to report pain scores before, during, and after 1-hour treatments. A ≥ 30% reduction in pain scores was used to classify participants as TENS responders. Electronic monitoring devices "TLOG" and "TSCORE" recorded time and duration of TENS use, electrical settings, and pain scores. Forty-two patients consented to participate. One of 35 (3%) patients adhered completely to the TENS use and pain score reporting protocol. Fourteen of 33 (42%) were TENS responders according to electronic pain score data. Analgesia onset occurred within 30 to 60 minutes for 13/14 (93%) responders. It was not possible to correlate TENS amplitude, frequency, or pulse width measurements with therapeutic response. Findings from TENS research studies depend on the timing of outcome assessment; pain should be recorded during stimulation. TENS device sophistication might be an issue and parameter restriction should be considered. Careful protocol design is required to improve adherence and monitoring is necessary to evaluate the validity of findings. This observational study provides objective evidence to support concerns about poor implementation fidelity in TENS research.

Effect of burst TENS and conventional TENS combined with cryotherapy on pressure pain threshold: randomised, controlled, clinical trial.

Science.gov (United States)

Macedo, L B; Josué, A M; Maia, P H B; Câmara, A E; Brasileiro, J S

2015-06-01

To assess the immediate effect of conventional and burst transcutaneous electrical nerve stimulation (TENS) in combination with cryotherapy on pain threshold and tolerance in healthy individuals. Randomised, controlled trial. University laboratory. One hundred and twelve healthy women. Volunteers were allocated at random to seven groups (n=16): (1) control, (2) placebo TENS, (3) conventional TENS, (4) burst TENS, (5) cryotherapy, (6) cryotherapy in combination with burst TENS, and (7) cryotherapy in combination with conventional TENS. Pain threshold and tolerance were measured by applying a pressure algometer at the lateral epicondyle of the humerus, before and after each intervention. The primary outcome measure was pressure pain threshold. A significant increase in pain threshold and tolerance at the 5% level of significance was recorded as follows: burst TENS {pain threshold: mean difference 1.3 [95% confidence interval (CI) 1.4 to 1.2]; pain tolerance: mean difference 3.8 (95% CI 3.9 to 3.7)}, cryotherapy [pain threshold: mean difference 1.3 (95% CI 1.4 to 1.2); pain tolerance: mean difference 1.9 (95% CI 1.8 to 2.0)] and cryotherapy in combination with burst TENS [pain threshold: mean difference 2.6 (95% CI 2.4 to 2.8); pain tolerance: mean difference 4.9 (95% CI 5.0 to 4.8)]. Cryotherapy in combination with burst TENS provided greater analgesia compared with the other groups (Pcryotherapy in combination with burst TENS to reduce induced pain, and suggest a potentiating effect when these techniques are combined. No such association was found between cryotherapy and conventional TENS. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

The lessons of SARS in Hong Kong.

Science.gov (United States)

Lai, Thomas Sik To; Yu, Wai Cho

2010-02-01

Severe acute respiratory syndrome (SARS) is a novel coronavirus infection which broke out in Hong Kong in March 2003. Princess Margaret Hospital was designated to manage this new, mysterious and serious disease. Healthcare workers had to work under extremely stressful and often risky conditions to care for patients. Despite manpower and equipment reinforcements, staff infection occurred as a result of bodily exhaustion, working in an unfamiliar environment and lapses in infection control. Patients suffered even more, not only due to physical discomfort, but also because of the fear of isolation and death away from family and friends. Health authorities learnt their lessons in the outbreak and formulated emergency plans for future infectious disease epidemics. The healthcare infrastructure has been examined and upgraded with regard to intensive care capacity, infection control measures, professional training, manpower deployment, staff facilities, and stockpiling of drugs and personal protective equipment.

Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults.

Science.gov (United States)

Hurlow, Adam; Bennett, Michael I; Robb, Karen A; Johnson, Mark I; Simpson, Karen H; Oxberry, Stephen G

2012-03-14

cancer population. The initial review identified two RCTs (64 participants) therefore this review now includes a total of three RCTs (88 participants). These studies were heterogenous with respect to study population, sample size, study design, methodological quality, mode of TENS, treatment duration, method of administration and outcome measures used. In one RCT, there were no significant differences between TENS and placebo in women with chronic pain secondary to breast cancer treatment. In the other RCT, there were no significant differences between acupuncture-type TENS and sham in palliative care patients; this study was underpowered. Despite the one additional RCT, the results of this updated systematic review remain inconclusive due to a lack of suitable RCTs. Large multi-centre RCTs are required to assess the value of TENS in the management of cancer-related pain in adults.

TENS (transcutaneous electrical nerve stimulation) for labour pain.

Science.gov (United States)

Francis, Richard

2012-05-01

Because TENS is applied inconsistently and not always in line with optimal TENS application theory, this may explain why TENS for labour pain appears to be effective in some individuals and not in others. This article reviews TENS theory, advises upon optimal TENS application for labour pain and discusses some of the limitations of TENS research on labour pain. TENS application for labour pain may include TENS applied to either side of the lower spine, set to 200 mus pulse duration and 100 pulses per second. As pain increases, TENS intensity should be increased and as pain decreases, TENS intensity should be reduced to maintain a strong but pain free intensity of stimulation. This application may particularly reduce back pain during labour.

Regulatory analysis and lessons learned from the LLRW [low-level radioactive waste] disposal area at West Valley, New York: Final report

International Nuclear Information System (INIS)

1986-12-01

The New York State Energy Research and Development Authority has sponsored a project to develop an integrated set of site management plans for the West Valley low-level radioactive waste (LLRW) disposal area. The plans were directed to upgrade the disposal area so that passive custodial care and monitoring activities would be sufficient to protect public health and safety and the environment. Tasks 5 and 6, Regulatory Analysis and Lessons Learned, are the subject of this report. The regulatory analysis identified areas of inconsistencies between the historic site operations and the current state and federal LLRW disposal regulations and guidelines. The lessons learned task identified the causes of the disposal problems at West Valley, discussed the lessons learned, and described the responses developed by the NRC and industry to the lessons learned. 85 refs., 6 figs., 19 tabs

Lessons learned from completed evaluation reviews (1983 to mid-1993). Special evaluation review

International Nuclear Information System (INIS)

1993-01-01

With this in mind, the Agency in 1983 set up in the Department of Technical Co-operation an Evaluation Unit (upgraded to Section rank in 1986), to assist already existing self-evaluation efforts through a more systematic and independent approach and thus provide senior management with the information required for more efficient and effective programme planning and implementation. A first analysis of the lessons learned through technical co-operation evaluation was carried out after five years, in mid-1988. It included both lessons learned with regard to the procedures and components of the programme, in general, as well as the findings specific to individual projects or groups of projects, and reported on the resulting administrative changes introduced by the Agency with a view to improving the programme. The current review, covering the second five-year period, from mid-1988 to mid-1993, continued along the same lines, while also illustrating the changing pattern in the work of the Evaluation Section itself. In order to present a full picture of the activities and results of ten years of TC evaluation, this report combines the results of both reviews

Trends in Baby-Friendly® Care in the United States: Historical Influences on Contemporary Care.

Science.gov (United States)

Salera-Vieira, Jean; Zembo, Cynthia T

2016-01-01

The protection that breast-feeding affords both mother and infant against acute and chronic illness is well documented. The grassroots, public health, and governmental supports for breast-feeding have influenced changes in maternal and newborn care. History indicates that the additional influence has come in the form of governmental workshops and initiatives, professional organizations, as well as The Joint Commission. This includes the influence that the Baby-Friendly® Hospital Initiative and the Ten Steps to Successful Breastfeeding have had on infant care throughout the years. The requirements that hospitals must follow to implement all, or some, of the Ten Steps lead to change in care that not only increases breast-feeding rates but also leads to health improvements. This article reviews how an upward trend in the adoption of Baby-Friendly practices to support breast-feeding impacts infant care.

Leading in crisis: lessons for safety leaders.

Science.gov (United States)

George, William W; Denham, Charles R; Burgess, L Hayley; Angood, Peter B; Keohane, Carol

2010-03-01

The National Quality Forum (NQF) Safe Practices are a group of 34 evidence-based Safe Practices that should be universally used to reduce the risk of harm to patients. Four of these practices specifically address leadership. A recently published book, 7 Lessons for Leading in Crisis, offers practical advice on how to lead in crisis. An analysis of how concepts from the 7 lessons could be applied to the Safe Practices was presented nationally by webinar to assess the audience's reaction to the information. The objective of this article was to present the information and the audience's reaction to it. Recommendations for direct actions that health care leaders can take to accelerate adoption of NQF Safe Practices were presented to health care leaders, followed by an immediate direct survey that used Reichheld's "Net Promoter Score" to assess whether the concepts presented were considered applicable and valuable to the audience. In a separate presentation, the challenges and crises facing nursing leaders were addressed by nursing leaders. Six hundred seventy-four hospitals, with an average of 4.5 participants per hospital, participated in the webinar. A total of 272 safety leaders responded to a survey immediately after the webinar. A Net Promoter Score assessment revealed that 58% of those surveyed rated the value of the information at 10, and 91% scored the value of the webinar to be between 8 and 10, where 10 is considered a strong recommendation that those voting would recommend this program to others. The overwhelmingly high score indicated that the principles presented were important and valuable to this national audience of health care leadership. The 2010 environment of uncertainty and shrinking financial resources poses significant risk to patients and new challenges for leaders at all levels. A values-grounded focus on personal accountability for leading in crisis situations strongly resonates with those interested in or leading patient safety initiatives.

Lesson "Balance in Nature

Science.gov (United States)

Chapanova, V.

2012-04-01

Lesson "Balance in Nature" This simulation game-lesson (Balance in Nature) gives an opportunity for the students to show creativity, work independently, and to create models and ideas. It creates future-oriented thought connected to their experience, allowing them to propose solutions for global problems and personal responsibility for their activities. The class is divided in two teams. Each team chooses questions. 1. Question: Pollution in the environment. 2. Question: Care for nature and climate. The teams work on the chosen tasks. They make drafts, notes and formulate their solutions on small pieces of paper, explaining the impact on nature and society. They express their points of view using many different opinions. This generates alternative thoughts and results in creative solutions. With the new knowledge and positive behaviour defined, everybody realizes that they can do something positive towards nature and climate problems and the importance of individuals for solving global problems is evident. Our main goal is to recover the ecological balance, and everybody explains his or her own well-grounded opinions. In this work process the students obtain knowledge, skills and more responsible behaviour. This process, based on his or her own experience, dialogue and teamwork, helps the participant's self-development. Making the model "human↔ nature" expresses how human activities impact the natural Earth and how these impacts in turn affect society. Taking personal responsibility, we can reduce global warming and help the Earth. By helping nature we help ourselves. Teacher: Veselina Boycheva-Chapanova " Saint Patriarch Evtimii" Scholl Str. "Ivan Vazov"-19 Plovdiv Bulgaria

Alberta's systems approach to chronic disease management and prevention utilizing the expanded chronic care model.

Science.gov (United States)

Delon, Sandra; Mackinnon, Blair

2009-01-01

Alberta's integrated approach to chronic disease management programming embraces client-centred care, supports self-management and facilitates care across the continuum. This paper presents strategies implemented through collaboration with primary care to improve care of individuals with chronic conditions, evaluation evidence supporting success and lessons learned from the Alberta perspective.

Case-mix payment for nursing home care: lessons from Maryland.

Science.gov (United States)

Feder, J; Scanlon, W

1989-01-01

Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients. This paper evaluates one such system, adopted by the state of Maryland in 1983 as part of an overall reimbursement reform. Using data on nursing home patient characteristics, costs, and staffing, as well as interviews with officials and various providers of care, the article shows that Maryland's system was successful in shifting nursing home service away from light-care and toward heavy-care patients. Furthermore, the shift occurred without inducing readily measurable declines in quality of care and with little additional administrative cost (partly because the state built its case-mix system on preexisting patient review activities). Although states could learn from and improve upon Maryland's experience--most notably in offering incentives to improve quality of care and in targeting community care on the light-care patients that nursing homes become less willing to serve--Maryland demonstrates that case-mix payment can change nursing home behavior in desired directions without substantial negative consequences.

Powers of ten

CERN Document Server

1979-01-01

Powers of Ten is a 1977 short documentary film written and directed by Charles Eames and his wife, Ray. The film depicts the relative scale of the Universe in factors of ten (see also logarithmic scale and order of magnitude). The idea for the film appears to have come from the 1957 book Cosmic View by Kees Boeke. The film begins with an aerial image of a man reclining on a blanket; the view is that of one meter across. The viewpoint, accompanied by expository voiceover, then slowly zooms out to a view ten meters across ( or 101 m in standard form), revealing that the man is picnicking in a park with a female companion. The zoom-out continues, to a view of 100 meters (102 m), then 1 kilometer (103 m), and so on, increasing the perspective—the picnic is revealed to be taking place near Soldier Field on Chicago's waterfront—and continuing to zoom out to a field of view of 1024 meters, or the size of the observable universe. The camera then zooms back in to the picnic, and then to views of negative pow...

Compromises in orchestra pit design: A ten-year trench war in The Royal Theatre, Copenhagen

DEFF Research Database (Denmark)

Gade, Anders Christian; Mortensen, Bo

1998-01-01

of opera finally opened the way for a new renovation of the pit, which solved most of the problems. The paper describes the many lessons learned during the ten-year period in which the authors were involved with the case as acoustic consultants. Questions of how pit configuration influences mutual hearing......The ``old stage'' of The Royal Theatre in Copenhagen-a classical horseshoe theatre with an almost flat audience floor and four balcony levels—is the primary opera and ballet theatre in Denmark. In the early 1980s the orchestra pit was enlarged and its size made flexible. However, in the following...... years this new flexibility caused a formal battle between the orchestra, the singers, and management, because each group had different interests as to how the pit should be configured for each new production. In the 1990s, increased concern about the musicians' hearing and the increase in the popularity...

The individual teacher in lesson study collaboration

DEFF Research Database (Denmark)

Skott, Charlotte Krog; Møller, Hanne

2017-01-01

used in lesson study research. Design/methodology/approach The authors use collective case studies. By being participant observers the authors provide detailed descriptions of two selected teachers’ lived experiences of lesson study collaboration. In addition to gain first-hand insights, the authors...... in the participation of each of the two teachers during a two-year lesson study project. By comparing these shifts the authors identify significant conditions for their individual learning. Research limitations/implications Although the study is small scale, both the insights into the different ways in which teachers...... participated and the theoretical insights might be valuable for other lesson study research approaches. Practical implications This paper provides valuable insights into conditions that might influence teachers’ participation in lesson study activities, especially in cultures with little experience of lesson...

What Happens at the Lesson Start?

Science.gov (United States)

Saloviita, Timo

2016-01-01

Transitional periods, such as lesson starts, are necessary steps from one activity to another, but they also compete with time for actual learning. The aim of the present study was to replicate a previous pilot study on lesson starts and explore possible disturbances. In total, 130 lesson starts in Finnish basic education in grades 1-9 were…

Associations of Household Wealth and Individual Literacy with Prenatal Care in Ten West African Countries.

Science.gov (United States)

Taylor, Yhenneko J; Laditka, Sarah B; Laditka, James N; Huber, Larissa R Brunner; Racine, Elizabeth F

2016-11-01

Objective To examine associations of household wealth and individual literacy with prenatal care in West Africa. Methods Data on women with recent births in Benin, Burkina Faso, Ghana, Guinea, Liberia, Mali, Nigeria, Niger, Senegal and Sierra Leone were obtained from 2006 to 2010 Demographic and Health Surveys (n = 58,512). Separate logistic regressions estimated associations of literacy and wealth quintiles with prenatal care, controlling for age, parity, marital status, rural/urban residence, religion, multiple births, pregnancy wantedness, and the woman's involvement in decision-making at home. Any prenatal care was defined by ≥1 prenatal care visit. Adequate prenatal care was defined as at least four prenatal care visits beginning in the first trimester, at least one with a skilled provider. Results Seventy-eight percent of women had any prenatal care; 23 % had adequate care. Women who were not literate had lower odds of having any prenatal care (odds ratio, OR 0.29; 95 % confidence interval, CI 0.26-0.33) and lower odds of adequate care (OR 0.73, CI 0.68-0.78). Women in the poorest wealth quintile were substantially less likely to have any prenatal care than women in the wealthiest quintile (OR 0.24, CI 0.11-0.18), and less likely to have adequate care (OR 0.31, CI 0.27-0.35). Conclusions for Practice A substantial percentage of women in West Africa have no prenatal care. Few have adequate care. Illiteracy and poverty are important risk factors for having little or no prenatal care. Increasing education for girls, promoting culturally appropriate messages about prenatal care, and building trust in providers may increase prenatal care.

Lesson study i Danmark?

DEFF Research Database (Denmark)

Mogensen, Arne

2009-01-01

Der beskrives et japansk lesson study forløb, og det diskuteres i hvilket omfang, de gode japanske erfaringer kan overføres til dansk matematikundervisning.......Der beskrives et japansk lesson study forløb, og det diskuteres i hvilket omfang, de gode japanske erfaringer kan overføres til dansk matematikundervisning....

The Council of Academic Hospitals of Ontario (CAHO) Adopting Research to Improve Care (ARTIC) Program: Reach, Sustainability, Spread and Lessons Learned from an Implementation Funding Model.

Science.gov (United States)

Moore, Julia E; Grouchy, Michelle; Graham, Ian D; Shandling, Maureen; Doyle, Winnie; Straus, Sharon E

2016-05-01

Despite evidence on what works in healthcare, there is a significant gap in the time it takes to bring research into practice. The Council of Academic Hospitals of Ontario's Adopting Research to Improve Care program addresses this research-to-practice gap by incorporating the following components into its funding program: strategic selection of evidence for implementation, education and training for implementation, implementation supports, executive champions and governance, and evaluation. Funded projects have been sustained (76% reported full sustainability) and spread to over 200 new sites. Lessons learned include the following: assess readiness, develop tailored implementation materials, consider characteristics of implementation supports, protect champion time and consider evaluation feasibility. Copyright © 2016 Longwoods Publishing.

Module Ten: Transformers; Basic Electricity and Electronics Individualized Learning System.

Science.gov (United States)

Bureau of Naval Personnel, Washington, DC.

The module introduces a very important electrical device, the transformer. The module is divided into six lessons: transformer construction, transformer theory and operation, turns and voltage ratios, power and current, transformer efficiency, and semiconductor rectifiers. Each lesson consists of an overview, a list of study resources, lesson…

Clinical review: International comparisons in critical care - lessons learned.

Science.gov (United States)

Murthy, Srinivas; Wunsch, Hannah

2012-12-12

Critical care medicine is a global specialty and epidemiologic research among countries provides important data on availability of critical care resources, best practices, and alternative options for delivery of care. Understanding the diversity across healthcare systems allows us to explore that rich variability and understand better the nature of delivery systems and their impact on outcomes. However, because the delivery of ICU services is complex (for example, interplay of bed availability, cultural norms and population case-mix), the diversity among countries also creates challenges when interpreting and applying data. This complexity has profound influences on reported outcomes, often obscuring true differences. Future research should emphasize determination of resource data worldwide in order to understand current practices in different countries; this will permit rational pandemic and disaster planning, allow comparisons of in-ICU processes of care, and facilitate addition of pre- and post-ICU patient data to better interpret outcomes.

Prospects for regulated competition in the health care system: what can China learn from Russia's experience?

Science.gov (United States)

Xu, Weiwei; Sheiman, Igor; van de Ven, Wynand P M M; Zhang, Wei

2011-05-01

As China explores new directions to reform its health care system, regulated competition among both insurers and providers of care might be one potential model. The Russian Federation in 1993 implemented legislation intended to stimulate such regulated competition in the health care sector. The subsequent progress and lessons learned over these 17 years can shed light on and inform the future evolution of the Chinese system. In this paper, we list the necessary pre-conditions for reaping the benefits of regulated competition in the health care sector. We indicate to what extent these conditions are being fulfilled in the post-reform Russian and current Chinese health care systems. We draw lessons from the Russian experience for the Chinese health care system, which shares a similar economic and political background with the pre-reform Russian health care system in terms of the starting point of the reform, and analyse the prospects for regulated competition in China.

Spent Fuel Storage Operation - Lessons Learned

International Nuclear Information System (INIS)

2013-12-01

Experience gained in planning, constructing, licensing, operating, managing and modifying spent fuel storage facilities in some Member States now exceeds 50 years. Continual improvement is only achieved through post-project review and ongoing evaluation of operations and processes. This publication is aimed at collating and sharing lessons learned. Hopefully, the information provided will assist Member States that already have a developed storage capability and also those considering development of a spent nuclear fuel storage capability in making informed decisions when managing their spent nuclear fuel. This publication is expected to complement the ongoing Coordinated Research Project on Spent Fuel Performance Assessment and Research (SPAR-III); the scope of which prioritizes facility operational practices in lieu of fuel and structural components behaviour over extended durations. The origins of the current publication stem from a consultants meeting held on 10-12 December 2007 in Vienna, with three participants from the IAEA, Slovenia and USA, where an initial questionnaire on spent fuel storage was formulated (Annex I). The resultant questionnaire was circulated to participants of a technical meeting, Spent Fuel Storage Operations - Lessons Learned. The technical meeting was held in Vienna on 13-16 October 2008, and sixteen participants from ten countries attended. A consultants meeting took place on 18-20 May 2009 in Vienna, with five participants from the IAEA, Slovenia, UK and USA. The participants reviewed the completed questionnaires and produced an initial draft of this publication. A third consultants meeting took place on 9-11 March 2010, which six participants from Canada, Hungary, IAEA, Slovenia and the USA attended. The meeting formulated a second questionnaire (Annex II) as a mechanism for gaining further input for this publication. A final consultants meeting was arranged on 20-22 June 2011 in Vienna. Six participants from Hungary, IAEA, Japan

St. Louis FUSRAP Lessons Learned

International Nuclear Information System (INIS)

Eberlin, J.; Williams, D.; Mueller, D.

2003-01-01

The purpose of this paper is to present lessons learned from fours years' experience conducting Remedial Investigation and Remedial Action activities at the St. Louis Downtown Site (SLDS) under the Formerly Utilized Sites Remedial Action Program (FUSRAP). Many FUSRAP sites are experiencing challenges conducting Remedial Actions within forecasted volume and budget estimates. The St. Louis FUSRAP lessons learned provide insight to options for cost effective remediation at FUSRAP sites. The lessons learned are focused on project planning (budget and schedule), investigation, design, and construction

A Relevant Lesson: Hitler Goes to the Mall

Science.gov (United States)

Gerwin, David

2003-01-01

A "Motivation" eliciting the "Aim" of each lesson initiates each lesson in the orthodox "developmental lesson-plan" that has dominated classroom instruction in NYC public schools for at least the past half-century. An action-research study of 38 lesson-plans (over 5 each from 5 teachers) drawn from student-teaching…

No hospital left behind? Education policy lessons for value-based payment in healthcare.

Science.gov (United States)

Maurer, Kristin A; Ryan, Andrew M

2016-01-01

Value-based payment systems have been widely implemented in healthcare in an effort to improve the quality of care. However, these programs have not broadly improved quality, and some evidence suggests that they may increase inequities in care. No Child Left Behind is a parallel effort in education to address uneven achievement and inequalities. Yet, by penalizing the lowest performers, No Child Left Behind's approach to accountability has led to a number of unintended consequences. This article draws lessons from education policy, arguing that financial incentives should be designed to support the lowest performers to improve quality. © 2015 Society of Hospital Medicine.

Driving improvement in patient care: lessons from Toyota.

Science.gov (United States)

Thompson, Debra N; Wolf, Gail A; Spear, Steven J

2003-11-01

Nurses today are attempting to do more with less while grappling with faulty error-prone systems that do not focus on patients at the point of care. This struggle occurs against a backdrop of rising national concern over the incidence of medical errors in healthcare. In an effort to create greater value with scarce resources and fix broken systems that compromise quality care, UPMC Health System is beginning to master and implement the Toyota Production System (TPS)--a method of managing people engaged in work that emphasizes frequent rapid problem solving and work redesign that has become the global archetype for productivity and performance. The authors discuss the rationale for applying TPS to healthcare and implementation of the system through the development of "learning unit" model lines and initial outcomes, such as dramatic reductions in the number of missing medications and thousands of hours and dollars saved as a result of TPS-driven changes. Tracking data further suggest that TPS, with sufficient staff preparation and involvement, has the potential for continuous, lasting, and accelerated improvement in patient care.

Beautiful Beads: A Lesson in Making Beads with Friendly Clay. AMACO[R] Lesson.

Science.gov (United States)

Gamble, Harriet; Gamble, David

This lesson resource includes a brief summary of the history of bead making and historic fascination with beads as adornment. A focus on design elements, color theory, craftsmanship, and technical skill in bead making is encouraged. The plan includes lesson goals and objectives; background preparation; a glossary of terms; a list of supplies; and…

Ten PM Note of Organophosphae Poisoning- Successful outcome of a Medical Audit with complete seven steps

Directory of Open Access Journals (Sweden)

M D Bhattarai

2010-03-01

Full Text Available Medical audit in general consists of seven steps like choosing topic, setting criterion and standard, collecting first data, comparing data with standard, introducing change, collecting second data and reflecting. Its three basic premise are improvement of patient care by using existing knowledge, team work with ongoing educational process and change management and promotion of blame-free culture maintaining confidentiality. Audit mostly relates to a particular practice and is therefore not generalisable. An audit of residents' late evening routine notes of organophosphate poisoning patients is reported here, as the change introduced appears relevant to the situation of developing countries. Organophosphate poisoning patients should be managed in intensive care unit with close monitoring, as inadvertent stoppage or slowing of atropine infusion may occur, particularly at night, leading to reappearance of poisoning manifestations, which may cause respiratory failure and death. If they are managed in wards, residents-on-duty can check the clinical and intravenous drip status in the late evening and communicate with nurses and relatives to be particularly vigilant. In the audit done, such regular ten pm notes of organophosphate poisoning about the clinical and drip status and communication by residents were increased from 15.5% in the first to 81.7% in the second data collection (p < 0.01 after the introduction of the change. The ten pm note is being continued for about two years now. Implementation of ten pm note of organophosphate poisoning patients admitted in medical wards is feasible and appears useful to improve the quality of health care delivery and learning of residents. Keywords: atrophine, audit, audit steps, organophosphate mortality, organophosphate poisoning.

Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms.

Science.gov (United States)

Thoumi, Andrea; Udayakumar, Krishna; Drobnick, Elizabeth; Taylor, Andrea; McClellan, Mark

2015-09-01

The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease prevention, diagnosis, and treatment. Although evidence on the effectiveness of innovative care models is emerging, scaling up or extending these models beyond their original setting has been difficult. We developed a framework to highlight policy barriers-institutional, regulatory, and financial-to the diffusion of transformative innovations in diabetes care. The framework builds on accountable care principles that support higher-value care, or better patient-level outcomes at lower cost. We applied this framework to three case studies from the United States, Mexico, and India to describe how innovators and policy leaders have addressed barriers, with a focus on important financing barriers to provider and consumer payment. The lessons have implications for policy reform to promote innovation through new funding approaches, institutional reforms, and performance measures with the goal of addressing the growing burdens of diabetes and other chronic diseases. Project HOPE—The People-to-People Health Foundation, Inc.

Group Health's participation in a shared decision-making demonstration yielded lessons, such as role of culture change.

Science.gov (United States)

King, Jaime; Moulton, Benjamin

2013-02-01

In 2007 Washington State became the first state to enact legislation encouraging the use of shared decision making and decision aids to address deficiencies in the informed-consent process. Group Health volunteered to fulfill a legislated mandate to study the costs and benefits of integrating these shared decision-making processes into clinical practice across a range of conditions for which multiple treatment options are available. The Group Health Demonstration Project, conducted during 2009-11, yielded five key lessons for successful implementation, including the synergy between efforts to reduce practice variation and increase shared decision making; the need to support modifications in practice with changes in physician training and culture; and the value of identifying best implementation methods through constant evaluation and iterative improvement. These lessons, and the legislated provisions that supported successful implementation, can guide other states and health care institutions moving toward informed patient choice as the standard of care for medical decision making.

Nursing Reference Center: a point-of-care resource.

Science.gov (United States)

Vardell, Emily; Paulaitis, Gediminas Geddy

2012-01-01

Nursing Reference Center is a point-of-care resource designed for the practicing nurse, as well as nursing administrators, nursing faculty, and librarians. Users can search across multiple resources, including topical Quick Lessons, evidence-based care sheets, patient education materials, practice guidelines, and more. Additional features include continuing education modules, e-books, and a new iPhone application. A sample search and comparison with similar databases were conducted.

Metabonomics and Intensive Care

OpenAIRE

Antcliffe, D; Gordon, AC

2016-01-01

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at http://www.biomedcentral.com/collections/annualupdate2016. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

Ten good reasons why everybody can and should perform cardiac ultrasound in the ICU.

Science.gov (United States)

Charron, Cyril; Repessé, Xavier; Bodson, Laurent; Au, Siu-Ming; Vieillard-Baron, Antoine

2014-01-01

Critical care ultrasonography (CCUS) has been defined as an ultrasound evaluation of the heart, abdomen, pleura and lungs at the bedside by the intensivist, 24/7. Within CCUS, critical care echocardiography (CCE) is used to assess cardiac function and more generally haemodynamics. Experts in haemodynamics have published a 'consensus of 16' regarding an update on haemodynamic monitoring. They reported the ten key properties of an 'ideal' haemodynamic monitoring system, which perfectly match the ten good reasons we describe here for performing CCE in critically ill patients. Even though unfortunately no evidence-based medicine study is available to support this review, especially regarding CCE-related improvement of outcome, many clinical studies have demonstrated that CCE provides measurements of relevant, accurate, reproducible and interpretable variables, is easy to use, readily available, has a rapid response time, causes no harm, and is cost-effective. Whether it is operator-independent is obviously more debatable and is discussed in this review. All these characteristics are arguments for the extensive use of CCE by intensivists. This is why experts in the field have recommended that a basic level of CCE should be included in the training of all intensivists.

PIMA Point of Care CD4+ Cell Count Machines in Remote MNCH Settings: Lessons Learned from Seven Districts in Zimbabwe

Science.gov (United States)

Mtapuri-Zinyowera, Sekesai; Chiyaka, Edward T.; Mushayi, Wellington; Musuka, Godfrey; Naluyinda-Kitabire, Florence; Mushavi, Angella; Chikwasha, Vasco

2013-01-01

An evaluation was commissioned to generate evidence on the impact of PIMA point-of-care CD4+ count machines in maternal and new-born child health settings in Zimbabwe; document best practices, lessons learned, challenges, and recommendations related to scale up of this new technology. A mixed methodology approach that included 31 in-depth interviews with stakeholders involved in procurement, distribution, and use of the POC machines was employed. Additionally, data was also abstracted from 207 patient records from 35 sites with the PIMA POC CD4+ count machines and 10 other comparative sites without the machine. A clearer training strategy was found to be necessary. The average time taken to initiate clients on antiretroviral treatment (ART) was substantially less, 15 days (IQR-1-149) for sites with a PIMA POC machine as compared to 32.7 days (IQR-1-192) at sites with no PIMA POC machine. There was general satisfaction because of the presence of the PIMA POC CD4+ count machine at sites that also initiated ART. PMID:24847177

Lessons from the evolution of 401(k) retirement plans for increased consumerism in health care: an application of behavioral research.

Science.gov (United States)

DiCenzo, Jodi; Fronstin, Paul

2008-08-01

Employment-based health and retirement benefit programs have followed a similar path of evolution. The relative decision-making roles of the employer and the worker have shifted from the employer to the worker, and workers are more responsible than perhaps they ever have been for their well being--both in terms of their health in general and their financial security during retirement. This shift has been supported, in part, by legislation--namely ERISA, the HMO Act of 1973, the Revenue Act of 1978, and most recently, the Pension Protection Act. This Issue Brief does not pass judgment on this development or address who should bear the responsibilities of preparing workers for retirement or of rationing health care services. The current trend in health care design is toward increased "consumerism." Consumer-driven health is based on the assumption that the combination of greater cost sharing (by workers) and better information about the cost and quality of health care will engage workers to become better health care decision makers. It is hoped that workers will seek important, necessary, high-quality, cost-effective care and services, and become less likely to engage providers and services that are unnecessary and ineffective from either a quality or cost perspective. As employers look ahead toward continually improved plan design, there may be benefits in considering the lessons learned from studying worker behaviors. Specifically, there is evidence about the effects of choice, financial incentives, and information on worker decision making. As a result of research in this area, many retirement plan sponsors have moved toward plan designs and programs that recognize the benefits of well-designed defaults, simplified choices, required active decision making, framing, and commitment to future improvements. With respect to choice, it is now known that more is not always better and may even be worse in some cases. Just as fewer shoppers actually bought a jar of jelly

Formation of community-based hypertension practice networks: success, obstacles, and lessons learned.

Science.gov (United States)

Dart, Richard A; Egan, Brent M

2014-06-01

Community-based practice networks for research and improving the quality of care are growing in size and number but have variable success rates. In this paper, the authors review recent efforts to initiate a community-based hypertension network modeled after the successful Outpatient Quality Improvement Network (O'QUIN) project, located at the Medical University of South Carolina. Key lessons learned and new directions to be explored are highlighted. ©2014 Wiley Periodicals, Inc.

Analysing the Integration of Engineering in Science Lessons with the Engineering-Infused Lesson Rubric

Science.gov (United States)

Peterman, Karen; Daugherty, Jenny L.; Custer, Rodney L.; Ross, Julia M.

2017-01-01

Science teachers are being called on to incorporate engineering practices into their classrooms. This study explores whether the Engineering-Infused Lesson Rubric, a new rubric designed to target best practices in engineering education, could be used to evaluate the extent to which engineering is infused into online science lessons. Eighty lessons…

Historical Lessons for Our Time : Italy’s Response to the Challenge of Terrorism

OpenAIRE

Drake, Richard

2016-01-01

During the so-called years of lead, Italy had the highest rate of terrorist violence in the industrialized world. Terrorist groups, descending ideologically from the country’s Marxist-Leninist and neo-fascist traditions, sought to destroy its democratic institutions. They failed. The success of the Italian government in ending this scourge merits careful study, for the lessons that might be gained in learning how we might cope with terrorism today.

Risky business: human factors in critical care.

Science.gov (United States)

Laussen, Peter C; Allan, Catherine K; Larovere, Joan M

2011-07-01

Remarkable achievements have occurred in pediatric cardiac critical care over the past two decades. The specialty has become well defined and extremely resource intense. A great deal of focus has been centered on optimizing patient outcomes, particularly mortality and early morbidity, and this has been achieved through a focused and multidisciplinary approach to management. Delivering high-quality and safe care is our goal, and during the Risky Business symposium and simulation sessions at the Eighth International Conference of the Pediatric Cardiac Intensive Care Society in Miami, December 2010, human factors, systems analysis, team training, and lessons learned from malpractice claims were presented.

The use of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour: a review of the evidence.

Science.gov (United States)

Bedwell, Carol; Dowswell, Therese; Neilson, James P; Lavender, Tina

2011-10-01

to assess the effects of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. studies were identified from a search of the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008). randomised controlled trials comparing women receiving TENS for pain relief in labour vs routine care or placebo devices. All types of TENS machines were included. two review authors assessed all trials identified by the search strategy, carried out data extraction and assessed risk of bias. 14 studies including 1256 women were included: 11 examined TENS applied to the back, two to acupuncture points and one to the cranium. Overall, there was little difference in satisfaction with pain relief or in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (risk ratio 0.41, 95% confidence interval 0.32-0.55). The majority of women using TENS would use it again in a future labour. There was no evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and infants. No adverse events were reported. there is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact on other outcomes for mothers or infants. The use of TENS at home in early labour has not been evaluated. Although the guidelines of the National Institute for Health and Clinical Excellence recommend that TENS should not be offered to women in labour, women appear to be choosing it and midwives are supporting them in their choice. Given the absence of adverse effects and the limited evidence base, it seems unreasonable to deny women that choice. More robust studies of effectiveness are needed. Copyright © 2009 Elsevier Ltd. All rights reserved.

Ballistic trauma: lessons learned from iraq and afghanistan.

Science.gov (United States)

Shin, Emily H; Sabino, Jennifer M; Nanos, George P; Valerio, Ian L

2015-02-01

Management of upper extremity injuries secondary to ballistic and blast trauma can lead to challenging problems for the reconstructive surgeon. Given the recent conflicts in Iraq and Afghanistan, advancements in combat-casualty care, combined with a high-volume experience in the treatment of ballistic injuries, has led to continued advancements in the treatment of the severely injured upper extremity. There are several lessons learned that are translatable to civilian trauma centers and future conflicts. In this article, the authors provide an overview of the physics of ballistic injuries and principles in the management of such injuries through experience gained from military involvement in Iraq and Afghanistan.

"Who Cares for the Children?" Lessons from a Global Perspective of Child Care Policy

Science.gov (United States)

Lokteff, Maegan; Piercy, Kathleen W.

2012-01-01

We present the argument that the meaning of child care and the policies that address it are explicitly linked with national ideologies, work force participation, economic success, and child outcomes. The relationship between family and child care policies is cyclical in nature, with a nation's ideology and vision of family often driving child care…

Lessons Learned from the On-Site Disposal Facility at Fernald Closure Project

International Nuclear Information System (INIS)

Kumthekar, U.A.; Chiou, J.D.

2006-01-01

The On-Site Disposal Facility (OSDF) at the U.S. Department of Energy's (DOE) Fernald Closure Project near Cincinnati, Ohio is an engineered above-grade waste disposal facility being constructed to permanently store low level radioactive waste (LLRW) and treated mixed LLRW generated during Decommissioning and Demolition (D and D) and soil remediation performed in order to achieve the final land use goal at the site. The OSDF is engineered to store 2.93 million cubic yards of waste derived from the remediation activities. The OSDF is intended to isolate its LLRW from the environment for at least 200 years and for up to 1,000 years to the extent practicable and achievable. Construction of the OSDF started in 1997 and waste placement activities will complete by the middle of April 2006 with the final cover (cap) placement over the last open cell by the end of Spring 2006. An on-site disposal alternative is considered critical to the success of many large-scale DOE remediation projects throughout the United States. However, for various reasons this cost effective alternative is not readily available in many cases. Over the last ten years Fluor Fernald Inc. has cumulated many valuable lessons learned through the complex engineering, construction, operation, and closure processes of the OSDF. Also in the last several years representatives from other DOE sites, State agencies, as well as foreign government agencies have visited the Fernald site to look for proven experiences and practices, which may be adapted for their sites. This paper present a summary of the major issues and lessons leaned at the Fernald site related to engineering, construction, operation, and closure processes for the disposal of remediation waste. The purpose of this paper is to share lessons learned and to benefit other projects considering or operating similar on-site disposal facilities from our successful experiences. (authors)

Medical Logistics Lessons Observed During Operations Enduring Freedom and Iraqi Freedom.

Science.gov (United States)

Dole, Mark J; Kissane, Jonathan M

2016-01-01

Medical Logistics (MEDLOG) is a function of the Army's integrated System for Health that provides the medical products and specialized logistics services required to deliver health protection and care under all operational conditions. In unified land operations, MEDLOG is an inherent function of Health Service Support (HSS), which also includes casualty care and medical evacuation. This paper focuses on a few key lessons observed during Operations Enduring Freedom and Iraqi Freedom with direct implications for the support of HSS in future operations as envisioned in the Army Operating Concept and the Joint Concept for Health Services. It also examines a few key enablers that helped mitigate these challenges that are not yet fully acknowledged in Army Medical Department doctrine, policy, and planning.

An Analysis of Secondary Integrated STEM Lesson Plans: Common Characteristics, Learning Expectations and the Impact from the Teacher's Definition of I-STEM

Science.gov (United States)

Hayward, Jacob B.

This qualitative study investigated teachers' understanding of their definition of I-STEM (Integrated STEM education), how those understandings manifested into lessons and associated lesson artifacts, how they assessed students in such lessons, and what factors or rationales supported their ability to conduct or not conduct I-STEM lessons. A survey was sent to the members of four professional organizations representing I-STEM disciplines to solicit their participation in this project. Ten teachers ranging from grades 9-12 participated in this study. Of those who responded, six teachers identified with National Science Teachers Association (NSTA), three teachers selected International Technology and Engineering Education Association (ITEEA), and one teacher claimed International STEM Education Association (ISEA). No teachers identified with National Council of Teachers of Mathematics. In addition to surveys, data were collected using interviews, email responses, and a review of lesson artifacts. Three distinct factors emerged from this study. First, there was a lack of consistency among I-STEM disciplines, then, assessments of students was predominately focused on soft-skills, and finally, several participants shared three characteristics that seemed to define experiences for conducting what they believed were I-STEM lessons. Additionally teachers emphasized factors effecting implementation of I-STEM describing rationales enabling participants' to implement I-STEM lessons. Responses provided insight and revealed how teachers understood I-STEM definition, how they interpreted integration of the disciplines, and "why" they conducted I-STEM lessons. The majority of participants implemented I-STEM in the absence of an official school/district definition. Assessments provided interesting results in this study. The majority of participants identified expected outcomes or products based on their I-STEM definition and in their responses. However, the rubrics submitted

Lessons learned from application of the Swedish regulations for decommissioning of nuclear facilities - The regulator's perspective

International Nuclear Information System (INIS)

Efraimsson, Henrik; Amft, Martin; Leisvik, Mathias

2016-01-01

The paper presents an overview of the Swedish regulations for decommissioning of nuclear facilities. It describes some of the experiences that the Swedish Radiation Safety Authority has gained from the application of these regulations. The focus of the present paper lies on administrative aspects of the care and maintenance operation and on the safety related documentation that has to be prepared before dismantling commences. Lessons learned during recent years will be considered when revising the regulations for decommissioning. Also these lessons learned will help to streamline the administration of the large NPP decommissioning projects that are anticipated to commence in Sweden in the near future. (authors)

Collaborative project to co-ordinate care for patients with dementia.

Science.gov (United States)

Kennerley, Dorothy; Bolas, Robert; Bourne, Jennifer; Branson, Kathy; Cavenagh, Penny; Chappell, Pam; Collins, Gwen; Coveney, Nick; Day, Nicole; Hardman, Mary; Hayter, Sue; Fenner, Pam; Jones, Jennifer; Jordan, Siobhan; Noble, Brendon; Osbourne, Sarah; Smith, Carol; Wigens, Lynn

2011-05-01

Health leaders from across Suffolk joined together in a collaborative action-learning project to identify ways of offering more productive and personalised care for patients with dementia and their carers. The project revealed a range of factors necessary for success, notably professional collaboration and effective facilitation. The outcome was a range of evidenced-based recommendations to improve care and efficiency, as well as ensuring that the quality, innovation, productivity and prevention (QIPP) agenda was met. The lessons can be applied not just in dementia care, but to other long-term and complex care situations.

Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned.

Science.gov (United States)

Slusher, Tina M; Kiragu, Andrew W; Day, Louise T; Bjorklund, Ashley R; Shirk, Arianna; Johannsen, Colleen; Hagen, Scott A

2018-01-01

Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

Pediatric Critical Care in Resource-Limited Settings—Overview and Lessons Learned

Directory of Open Access Journals (Sweden)

Tina M. Slusher

2018-03-01

Full Text Available Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

Simple and Practical Efficiency Lessons

Science.gov (United States)

Kolpin, Van

2018-01-01

The derivation of conditions necessary for Pareto efficient production and exchange is a lesson frequently showcased in microeconomic theory textbooks. Traditional delivery of this lesson is, however, limited in its scope of application and can be unnecessarily convoluted. The author shows that the universe of application is greatly expanded and a…

The next ten years in neonatology: new directions in research

Directory of Open Access Journals (Sweden)

Vassilios Fanos

2014-06-01

Full Text Available This paper is a prelude to proceedings of the 10th International Workshop on Neonatology to be held in Cagliari, Italy from October 21st to 25th, 2014. These proceedings will be a significant milestone, highlighting the new frontiers of perinatal and neonatal research. Over the five days of this meeting, we aim to (1 examine the roots of the new directions in perinatal and neonatal research; (2 predict the trajectories of advancement in medical technologies, research, clinical care and teaching that will be the future of perinatology and neonatology. The discussion will be in four sections:back to the future: the placenta and perinatal programming;paradigm shift: the revolution of metabolomics in perinatalogy and neonatology;brave new world: the microbiome and microbiomics from perinatal to adult life;new inhabitants on the planet earth: adults who were born with extremely low birth weight. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

Planning geometry lessons with learning platforms

DEFF Research Database (Denmark)

Tamborg, Andreas Lindenskov

mathematics teachers’ joint planning of a lesson in geometry with a learning platform called Meebook is analyzed using the instrumental approach. It is concluded that the interface in Meebook orients the teachers work toward what the students should do rather than what they should learn, although the latter......This paper investigates how mathematics teachers plan lessons with a recently implemented Danish learning platform designed to support teachers in planning lessons in line with a recent objective-oriented curriculum. Drawing on data from observations of and interviews with teachers, three...... is a key intention behind the implementation of the platform. It is also concluded that when the teachers succeed in using learning objectives actively in their planning, the objectives support the teachers in designing lessons that correspond with their intentions. The paper concludes with a discussion...

Nuclear Instrumentation and Control Cyber Testbed Considerations – Lessons Learned

Energy Technology Data Exchange (ETDEWEB)

Jonathan Gray; Robert Anderson; Julio G. Rodriguez; Cheol-Kwon Lee

2014-08-01

Abstract: Identifying and understanding digital instrumentation and control (I&C) cyber vulnerabilities within nuclear power plants and other nuclear facilities, is critical if nation states desire to operate nuclear facilities safely, reliably, and securely. In order to demonstrate objective evidence that cyber vulnerabilities have been adequately identified and mitigated, a testbed representing a facility’s critical nuclear equipment must be replicated. Idaho National Laboratory (INL) has built and operated similar testbeds for common critical infrastructure I&C for over ten years. This experience developing, operating, and maintaining an I&C testbed in support of research identifying cyber vulnerabilities has led the Korean Atomic Energy Research Institute of the Republic of Korea to solicit the experiences of INL to help mitigate problems early in the design, development, operation, and maintenance of a similar testbed. The following information will discuss I&C testbed lessons learned and the impact of these experiences to KAERI.

Implementing Business Process Redesign: early lessons from the Australian experience

Directory of Open Access Journals (Sweden)

Marianne Broadbent

1995-05-01

Full Text Available Business Process Redesign (BPR is a change management approach aimed at achieving quantum improvements in business performance. Industry interest levels in BPR are high as a direct result of current difficulties in the global economic climate and tight business conditions. Integral to BPR is the availability of new stable technologies which both stimulate and enable process changes. This paper highlights the experiences of a number of Australian firms which have implemented BPR. A ten step framework for BPR is presented together with a series of caveats. BPR is a difficult, messy and often non-linear activity which challenges many of the ways organisations operate. Information Technology plays a pivotal role in BPR as both an enabler and disenabler for change. Lessons emerging from early Australian experiences with BPR focus on the role of executive sponsorship, consultants, measurements, education and training, technology and people involved in the change process.

Prehospital Trauma Care in Singapore.

Science.gov (United States)

Ho, Andrew Fu Wah; Chew, David; Wong, Ting Hway; Ng, Yih Yng; Pek, Pin Pin; Lim, Swee Han; Anantharaman, Venkataraman; Hock Ong, Marcus Eng

2015-01-01

Prehospital emergency care in Singapore has taken shape over almost a century. What began as a hospital-based ambulance service intended to ferry medical cases was later complemented by an ambulance service under the Singapore Fire Brigade to transport trauma cases. The two ambulance services would later combine and come under the Singapore Civil Defence Force. The development of prehospital care systems in island city-state Singapore faces unique challenges as a result of its land area and population density. This article defines aspects of prehospital trauma care in Singapore. It outlines key historical milestones and current initiatives in service, training, and research. It makes propositions for the future direction of trauma care in Singapore. The progress Singapore has made given her circumstances may serve as lessons for the future development of prehospital trauma systems in similar environments. Key words: Singapore; trauma; prehospital emergency care; emergency medical services.

Masterwork Art Lesson: Kandinsky Watercolors.

Science.gov (United States)

LiPira, Michael

2003-01-01

Presents an art lesson used with sixth-grade students which also can be used with other grade levels. Explains that the artwork of Wassily Kandinsky served as inspiration for this lesson. Explains that the students learned about abstract art and used watercolors to create their own paintings in the style of Kandinsky. (CMK)

Bead Game Simulation. Lesson Plan.

Science.gov (United States)

Ripp, Ken

This lesson plan offers students the opportunity to participate in the three basic economic systems (market, command, and tradition). By working in each of the systems, students will internalize the fundamental values present in each system and will gain insights into the basic advantages and disadvantages of each system. The lesson plan provides…

Implementing US Department of Energy lessons learned programs. Volume 2

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-08-01

The DOE Lessons Learned Handbook is a two-volume publication developed to supplement the DOE Lessons Learned Standard (DOE-STD-7501-95) with information that will organizations in developing or improving their lessons learned programs. Volume 1 includes greater detail than the Standard in areas such as identification and documentation of lessons learned; it also contains sections on specific processes such as training and performance measurement. Volume 2 (this document) contains examples of program documents developed by existing lessons learned programs as well as communications material, functional categories, transmittal documents, sources of professional and industry lessons learned, and frequently asked questions about the Lessons Learned List Service.

The Supersymmetric Top-Ten Lists

OpenAIRE

Haber, Howard E.

1993-01-01

Ten reasons are given why supersymmetry is the leading candidate for physics beyond the Standard Model. Ultimately, the experimental discovery of supersymmetric particles at future colliders will determine whether supersymmetry is relevant for TeV scale physics. The grand hope of supersymmetry enthusiasts is to connect TeV scale supersymmetry with Planck scale physics. The ten most pressing theoretical problems standing in the way of this goal are briefly described.

Health care consumerism: incentives, behavior change and uncertainties.

Science.gov (United States)

Domaszewicz, Sander; Havlin, Linda; Connolly, Susan

2010-01-01

Employers affected by the recession's 2009 peak must press for cost containment in 2010, especially in health care benefits. Encouraging employee consumerism--through consumer-directed health plans and other strategies--can be enhanced by incentives, but federal efforts at health care reform add some element of uncertainty to the consumer-directed solution. This article provides some lessons to guide the course of action for employers considering implementing a consumerist approach to improve employee health and control the cost trend.

Physically active academic lessons in elementary children.

Science.gov (United States)

Bartholomew, John B; Jowers, Esbelle M

2011-06-01

Although schools are an ideal location to conduct interventions that target children, the emphasis on standardized testing makes it difficult to implement interventions that do not directly support academic instruction. In response, physically active academic lessons have been developed as a strategy to increase physical activity while also addressing core educational goals. Texas I-CAN! is one incarnation of this approach. We will review the on-going research on the impact of these active lessons on: teacher implementation, child step count, child attention control, and academic performance. The collected studies support the impact of physically active academic lessons on each area of interest. If these data can be replicated, it suggests that teachers might find these lessons of benefit to their primary role as educators, which should ease dissemination of these and other physically active lessons in elementary schools. Copyright © 2011 Elsevier Inc. All rights reserved.

Epidemiologic methods lessons learned from environmental public health disasters: Chernobyl, the World Trade Center, Bhopal, and Graniteville, South Carolina.

Science.gov (United States)

Svendsen, Erik R; Runkle, Jennifer R; Dhara, Venkata Ramana; Lin, Shao; Naboka, Marina; Mousseau, Timothy A; Bennett, Charles

2012-08-01

Environmental public health disasters involving hazardous contaminants may have devastating effects. While much is known about their immediate devastation, far less is known about long-term impacts of these disasters. Extensive latent and chronic long-term public health effects may occur. Careful evaluation of contaminant exposures and long-term health outcomes within the constraints imposed by limited financial resources is essential. Here, we review epidemiologic methods lessons learned from conducting long-term evaluations of four environmental public health disasters involving hazardous contaminants at Chernobyl, the World Trade Center, Bhopal, and Graniteville (South Carolina, USA). We found several lessons learned which have direct implications for the on-going disaster recovery work following the Fukushima radiation disaster or for future disasters. These lessons should prove useful in understanding and mitigating latent health effects that may result from the nuclear reactor accident in Japan or future environmental public health disasters.

10 lessons learned by a misguided physician.

Science.gov (United States)

Levin, Barry E

2017-07-01

It was a great and humbling honor to receive the 2016 Distinguished Career Award from my SSIB colleagues. This paper summarizes the major points of my DCA talk at the 2016 annual meeting. It is a reflection on my 50year medical and research career and 10 lessons I have learned over those years which might be of help to young investigators near the beginning of their own research careers. These lessons include: the value of being receptive to the opportunities provided you; how clinician-scientists can serve as critical role models for young investigators like me and a history of how my career developed as a result of their influence; the importance of carefully examining your own data, particularly when it doesn't agree with your preconceived ideas; the critical role that students, postdocs and PhD (and even veterinarian) colleagues can play in developing one's career; the likelihood that your career path will have many interesting twists and turns determined by changes in your own scientific interests and how rewarding various areas of research focus are to you; the importance of building a close-knit laboratory staff family; the fact that science and romance can mix. Finally, I offer 3 somewhat self-evident free pieces of advice for building and maintaining a rewarding career. Copyright © 2016 Elsevier Inc. All rights reserved.

Blended learning: strengths, challenges, and lessons learned in an interprofessional training program.

Science.gov (United States)

Lotrecchiano, G R; McDonald, P L; Lyons, L; Long, T; Zajicek-Farber, M

2013-11-01

This field report outlines the goals of providing a blended learning model for an interdisciplinary training program for healthcare professionals who care for children with disabilities. The curriculum blended traditional face-to-face or on-site learning with integrated online interactive instruction. Credit earning and audited graduate level online coursework, community engagement experiences, and on-site training with maternal and child health community engagement opportunities were blended into a cohesive program. The training approach emphasized adult learning principles in different environmental contexts integrating multiple components of the Leadership Education in Neurodevelopmental and Related Disabilities Program. This paper describes the key principles adopted for this blended approach and the accomplishments, challenges, and lessons learned. The discussion offers examples from training content, material gathered through yearly program evaluation, as well as university course evaluations. The lessons learned consider the process and the implications for the role of blended learning in this type of training program with suggestions for future development and adoption by other programs.

Goiania, ten years later. Proceedings of an international conference

International Nuclear Information System (INIS)

1998-12-01

Following the radiological accident that happened in Goiania, Brazil, in late 1987, the Brazilian National Nuclear Energy Commission (CNEN) was able to turn to the international community for assistance under the terms of the 1986 IAEA sponsored Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency; this marked the first time the convention was invoked. Additionally, to prevent the loss of useful information, CNEN and the IAEA designated a panel of international experts to investigate the causes and consequences of the accident and draw up a comprehensive report, 'The Radiological Accident in Goiania', which the IAEA published in 1988. Under its nuclear safety programme, it is the IAEA's intention to follow up serious radiological accidents with review and analysis, to document the causes and circumstances and to disseminate conclusions, lessons to be learned and recommendations from which all States may benefit. A decade after the Goiania accident, the CNEN convened the international conference 'Goiania, Ten Years Later' in co-operation with the IAEA. The purpose of this conference was to share with the local population and the international community the knowledge gained during this tragic event and in the following years. The conference attracted some 400 participants from 17 countries (Argentina, Austria, Brazil, Canada, Cuba, El Salvador, Estonia, Germany, Israel, Italy, Mexico, Peru, Russian Federation, Spain, Uruguay, United States of America and Venezuela). The present IAEA proceedings contain some 50 papers selected for publication by the editorial committee of the conference

Lesson Study and History Education

Science.gov (United States)

Halvorsen, Anne-Lise; Kesler Lund, Alisa

2013-01-01

This article examines the experiences of a group of fifth-grade teachers who used lesson study, a teacher-driven form of professional development, to teach history in a project supported by a Teaching American History Grant. The project addressed the following questions: What does a lesson study cycle for history education look like? What…

Value pricing pilot program : lessons learned

Science.gov (United States)

2008-08-01

This "Lessons Learned Report" provides a summary of projects sponsored by the Federal Highway Administration's (FHWA's) Congestion and Value Pricing Pilot Programs from 1991 through 2006 and draws lessons from a sample of projects with the richest an...

ALGORITHMS FOR TETRAHEDRAL NETWORK (TEN) GENERATION

Institute of Scientific and Technical Information of China (English)

无

2000-01-01

The Tetrahedral Network(TEN) is a powerful 3-D vector structure in GIS, which has a lot of advantages such as simple structure, fast topological relation processing and rapid visualization. The difficulty of TEN application is automatic creating data structure. Al though a raster algorithm has been introduced by some authors, the problems in accuracy, memory requirement, speed and integrity are still existent. In this paper, the raster algorithm is completed and a vector algorithm is presented after a 3-D data model and structure of TEN have been introducted. Finally, experiment, conclusion and future work are discussed.

Students’ motivation in a disc golf-lesson and a soccer-lesson: An experimental study in the Physical Education setting

Directory of Open Access Journals (Sweden)

Kristian Vernegaard

2017-09-01

Full Text Available One of the purposes of physical education (PE in both Norway and Denmark is that PE should inspire to a lifelong active lifestyle. Based on the self-determination theory, the aim of the present study was to compare students’ intrinsic motivation, extrinsic motivation, and perceived competence in a lifestyle sport inspired PE-lesson (disc golf to a traditional PE-lesson (soccer and general PE. In addition, we aimed to investigate whether differences in motivation and perceived competence were conditional of the students’ relative attitude toward PE. The result of the study revealed that perceived competence was higher in the disc golf-lesson compared to the soccer-lesson and general PE. No overall differences in intrinsic motivation were found. However, when investigating differences in intrinsic motivation according to the students’ relative attitude toward PE, the results indicated that the students with a negative attitude toward PE was significantly more intrinsically motivated in disc golf-lesson compared to soccer-lesson and general PE. The findings may be seen as further recommendations to physical educators to vary the activity choices in physical education classes.

The five times ten things everyone should have had in their hands before they are ten and two years old.

Science.gov (United States)

Hut, R.; Poot, A.

2017-12-01

To train the young ones to become people that make stuff, I present the five times ten things we use a lot that everyone should have used before they are ten and two years old. I will bring at least two times ten of these things and show them live to you! And: I will bring a large paper for you to bring home with those five times ten things on it to put in the hands of your kids!

Critical care in resource-poor settings: lessons learned and future directions.

Science.gov (United States)

Riviello, Elisabeth D; Letchford, Stephen; Achieng, Loice; Newton, Mark W

2011-04-01

Critical care faces the same challenges as other aspects of healthcare in the developing world. However, critical care faces an additional challenge in that it has often been deemed too costly or complicated for resource-poor settings. This lack of prioritization is not justified. Hospital care for the sickest patients affects overall mortality, and public health interventions depend on community confidence in healthcare to ensure participation and adherence. Some of the most effective critical care interventions, including rapid fluid resuscitation, early antibiotics, and patient monitoring, are relatively inexpensive. Although cost-effectiveness studies on critical care in resource-poor settings have not been done, evidence from the surgical literature suggests that even resource-intensive interventions can be cost effective in comparison to immunizations and human immunodeficiency virus care. In the developing world, where many critically ill patients are younger and have fewer comorbidities, critical care presents a remarkable opportunity to provide significant incremental benefit, arguably much more so than in the developed world. Key areas of consideration in developing critical care in resource-poor settings include: Personnel and training, equipment and support services, ethics, and research. Strategies for training and retaining skilled labor include tying education to service commitment and developing protocols for even complex processes. Equipment and support services need to focus on technologies that are affordable and sustainable. Ethical decision making must be based on data when possible and on transparent articulated policies always. Research should be performed in resource-poor settings and focus on needs assessment, prognostication, and cost effectiveness. The development of critical care in resource-poor settings will rely on the stepwise introduction of service improvements, leveraging human resources through training, a focus on sustainable

Leading Integrated Health and Social Care Systems: Perspectives from Research and Practice.

Science.gov (United States)

Evans, Jenna M; Daub, Stacey; Goldhar, Jodeme; Wojtak, Anne; Purbhoo, Dipti

2016-01-01

As the research evidence on integrated care has evolved over the past two decades, so too has the critical role leaders have for the implementation, effectiveness and sustainability of integrated care. This paper explores what it means to be an effective leader of integrated care initiatives by drawing from the experiences of a leadership team in implementing an award-winning integrated care program in Toronto, Canada. Lessons learned are described and assessed against existing theory and research to identify which skills and behaviours facilitate effective leadership of integrated care initiatives.

Prehospital trauma care reduces mortality. Ten-year results from a time-cohort and trauma audit study in Iraq

Directory of Open Access Journals (Sweden)

Murad Mudhafar K

2012-02-01

Full Text Available Abstract Background Blunt implementation of Western trauma system models is not feasible in low-resource communities with long prehospital transit times. The aims of the study were to evaluate to which extent a low-cost prehospital trauma system reduces trauma deaths where prehospital transit times are long, and to identify specific life support interventions that contributed to survival. Methods In the study period from 1997 to 2006, 2,788 patients injured by land mines, war, and traffic accidents were managed by a chain-of-survival trauma system where non-graduate paramedics were the key care providers. The study was conducted with a time-period cohort design. Results 37% of the study patients had serious injuries with Injury Severity Score ≥ 9. The mean prehospital transport time was 2.5 hours (95% CI 1.9 - 3.2. During the ten-year study period trauma mortality was reduced from 17% (95% CI 15 -19 to 4% (95% CI 3.5 - 5, survival especially improving in major trauma victims. In most patients with airway problems, in chest injured, and in patients with external hemorrhage, simple life support measures were sufficient to improve physiological severity indicators. Conclusion In case of long prehospital transit times simple life support measures by paramedics and lay first responders reduce trauma mortality in major injuries. Delegating life-saving skills to paramedics and lay people is a key factor for efficient prehospital trauma systems in low-resource communities.

Learning to observe mathematical learning in lesson studies

DEFF Research Database (Denmark)

Rasmussen, Klaus; Østergaard, Camilla Hellsten; Foss, Kristian Kildemoes

2016-01-01

This poster deals with lesson study (LS) in pre-service teacher education. In particular how to prepare for, carry out, and reflect upon, observations of pupil learning. Observation is of crucial importance to the lesson study process, and here we present a study of observation features which ena...... enable or hinder fruitful lesson study. While substantial research has been carried out in the general field of bserving pupils’ learning processes and teachers’ pedagogical practice, little is known about this in the particular setting of lesson study....

Smoking cessation counseling for Asian immigrants with serious mental illness: using RE-AIM to understand challenges and lessons learned in primary care-behavioral health integration.

Science.gov (United States)

Saw, Anne; Kim, Jin; Lim, Joyce; Powell, Catherine; Tong, Elisa K

2013-09-01

Engagement in modifiable risk behaviors, such as tobacco use, substantially contributes to early mortality rates in individuals with serious mental illness (SMI). There is an alarmingly high prevalence of tobacco use among subgroups of Asian Americans, such as immigrants and individuals with SMI, yet there are no empirically supported effective smoking cessation interventions that have been tailored to meet the unique cultural, cognitive, and psychological needs of Asian immigrants with SMI. In this article, we share the experiences of clinicians in the delivery of smoking cessation counseling to Asian American immigrants with SMI, in the context of an Asian-focused integrated primary care and behavioral health setting. Through a qualitative analysis of clinician perspectives organized with the RE-AIM framework, we outline challenges, lessons learned, and promising directions for delivering smoking cessation counseling to Asian American immigrant clients with SMI.

Early Childhood Care and Education (ECCE) in Ethiopia ...

African Journals Online (AJOL)

Early childhood care and education has been for many years in Ethiopia. However, these experiences were not systematized, reflected up on and, hence, efforts were not made to extract lessons and delineate future directions. This paper has made a modest attempt to bring to light developments registered, gaps noted and ...

Tens bij bevallingen

NARCIS (Netherlands)

Tuin-Nuis, F.D.F.

2000-01-01

TENS (Transcutane Electrische Neuro Stimulatie) is een pijnverlichtingsmethode die berust op de Gate Control Theory van Melzack en Wall. Door middel van electrische pulsen via de huid zou de geleiding van nociceptieve signalen (pijnprikkels) worden beïnvloed en zou het lichaam endorfinen aanmaken:

Caring for our youngest: public attitudes in the United States.

Science.gov (United States)

Sylvester, K

2001-01-01

Families make choices about employment and care for their children in a context that is shaped by public policies and colored by public opinion. Debates over whether the government should increase funding for child care or do more to help parents stay home with their children reflect tensions among strongly held ideas about family life, work, and the role of government. This article summarizes the results of public opinion polls that probe attitudes about parent and government roles and responsibilities with respect to children's care. The polling findings yield three main lessons: The American public believes that parents should be the primary influence in their children's lives and that it is best if mothers can be home to care for the very young. The public also values family self-sufficiency and understands that low-income families may need child care assistance to balance child rearing and employment responsibilities. However, skepticism about the appropriateness of government involvement in family life limits public support for proposals that the government act directly to provide or improve child care. From these lessons, the author draws several conclusions for policymakers: Policies focused on caregiving should respect the rights of parents to raise their children by ensuring that an array of options is available. Public programs should help families who are struggling economically to balance their obligations to work and family. Rather than directly providing child care services, government should fund community-based child care programs, and provide flexible assistance to help families secure the services they need and want.

Toward Integrated Resource Management: Lessons About the EcosystemApproach from the Laurentian Great Lakes

Science.gov (United States)

MACKENZIE

1997-03-01

/ The ecosystem approach is an innovative tool for integratedresource management. Its goal is to restore, enhance, and protect ecosystemintegrity through a holistic and integrated mode of planning. Under thisapproach, the ecosystem itself becomes the unit of analysis and organizingprinciple for environmental management. Utilizing the ecosystem approachchallenges the prevailing structure and function of contemporary resourcemanagement agencies. This paper explores a number of important policy andmanagement issues in the context of a ten-year initiative to remediate theLaurentian Great Lakes using the ecosystem approach. The lessons gleaned fromthe Great Lakes experience are relevant to other areas in North America andabroad where resource management responsibilities are held by multiple andsometimes overlapping jurisdictions.KEY WORDS: Integrated resource management; Ecosystem approach; Watershedmanagement; Great Lakes

Integrated complex care model: lessons learned from inter-organizational partnership.

Science.gov (United States)

Cohen, Eyal; Bruce-Barrett, Cindy; Kingsnorth, Shauna; Keilty, Krista; Cooper, Anna; Daub, Stacey

2011-01-01

Providing integrated care for children with medical complexity in Canada is challenging as these children are, by definition, in need of coordinated care from disparate providers, organizations and funders across the continuum in order to optimize health outcomes. We describe the development of an inter-organizational team constructed as a unique tripartite partnership of an acute care hospital, a children's rehabilitation hospital and a home/community health organization focused on children who frequently use services across these three organizations. Model building and operationalization within the Canadian healthcare system is emphasized. Key challenges identified to date include communication and policy barriers as well as optimizing interactions with families; critical enablers have been alignment with policy trends in healthcare and inter-organizational commitment to integrate at the point of care. Considerations for policy developments supporting full integration across service sectors are raised. Early indicators of success include the enrolment of 34 clients and patients and the securing of funds to evaluate and expand the model to serve more children.

Keiko, Killer Whale. [Lesson Plan].

Science.gov (United States)

Discovery Communications, Inc., Bethesda, MD.

This lesson plan presents activities designed to help students understand that Keiko, the killer whale, lived for a long time in an aquarium and had to be taught to live independently; and that computer users can get updates on how Keiko is doing. The main activity of the lesson involves middle school students working in small groups to produce a…

Mini-Lessons on Language (The Round Table).

Science.gov (United States)

English Journal, 1993

1993-01-01

Describes several successful lessons that provide students with new awareness of the English language. Includes lessons focusing on language change, onomatopoeia, slang, word origin, dialect, and language functions. (MM)

Epidemiologic Methods Lessons Learned from Environmental Public Health Disasters: Chernobyl, the World Trade Center, Bhopal, and Graniteville, South Carolina

Directory of Open Access Journals (Sweden)

Timothy A. Mousseau

2012-08-01

Full Text Available Background: Environmental public health disasters involving hazardous contaminants may have devastating effects. While much is known about their immediate devastation, far less is known about long-term impacts of these disasters. Extensive latent and chronic long-term public health effects may occur. Careful evaluation of contaminant exposures and long-term health outcomes within the constraints imposed by limited financial resources is essential. Methods: Here, we review epidemiologic methods lessons learned from conducting long-term evaluations of four environmental public health disasters involving hazardous contaminants at Chernobyl, the World Trade Center, Bhopal, and Graniteville (South Carolina, USA. Findings: We found several lessons learned which have direct implications for the on-going disaster recovery work following the Fukushima radiation disaster or for future disasters. Interpretation: These lessons should prove useful in understanding and mitigating latent health effects that may result from the nuclear reactor accident in Japan or future environmental public health disasters.

Scaling up HIV viral load - lessons from the large-scale implementation of HIV early infant diagnosis and CD4 testing.

Science.gov (United States)

Peter, Trevor; Zeh, Clement; Katz, Zachary; Elbireer, Ali; Alemayehu, Bereket; Vojnov, Lara; Costa, Alex; Doi, Naoko; Jani, Ilesh

2017-11-01

The scale-up of effective HIV viral load (VL) testing is an urgent public health priority. Implementation of testing is supported by the availability of accurate, nucleic acid based laboratory and point-of-care (POC) VL technologies and strong WHO guidance recommending routine testing to identify treatment failure. However, test implementation faces challenges related to the developing health systems in many low-resource countries. The purpose of this commentary is to review the challenges and solutions from the large-scale implementation of other diagnostic tests, namely nucleic-acid based early infant HIV diagnosis (EID) and CD4 testing, and identify key lessons to inform the scale-up of VL. Experience with EID and CD4 testing provides many key lessons to inform VL implementation and may enable more effective and rapid scale-up. The primary lessons from earlier implementation efforts are to strengthen linkage to clinical care after testing, and to improve the efficiency of testing. Opportunities to improve linkage include data systems to support the follow-up of patients through the cascade of care and test delivery, rapid sample referral networks, and POC tests. Opportunities to increase testing efficiency include improvements to procurement and supply chain practices, well connected tiered laboratory networks with rational deployment of test capacity across different levels of health services, routine resource mapping and mobilization to ensure adequate resources for testing programs, and improved operational and quality management of testing services. If applied to VL testing programs, these approaches could help improve the impact of VL on ART failure management and patient outcomes, reduce overall costs and help ensure the sustainable access to reduced pricing for test commodities, as well as improve supportive health systems such as efficient, and more rigorous quality assurance. These lessons draw from traditional laboratory practices as well as fields

Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial.

Science.gov (United States)

Mira, Ticiana A A; Giraldo, Paulo C; Yela, Daniela A; Benetti-Pinto, Cristina L

2015-11-01

Evaluate TENS effectiveness as a complementary treatment of chronic pelvic pain and deep dyspareunia in women with deep endometriosis. This randomized controlled trial was performed in a tertiary health care center, including twenty-two women with deep endometriosis undergoing hormone therapy with persistent pelvic pain and/or deep dyspareunia. This study was registered in the Brazilian Record of Clinical Trials (ReBEC), under n RBR-3rndh6. TENS application for 8 weeks followed a randomized allocation into two groups: Group 1 - acupuncture-like TENS (Frequency: 8Hz, pulse duration: 250μs) - VIF (n=11) and Group 2 - self-applied TENS (Frequency: 85Hz, pulse duration: 75μs) (n=11). The intensity applied was "strong, but comfortable". We evaluated patients before and after treatment by the use of the Visual Analogue Scale, Deep Dyspareunia Scale and Endometriosis Quality of Life Questionnaire. We used the Wilcoxon and Mann-Whitney tests to compare before and after treatment conditions. Despite the use of hormone therapy for 1.65±2.08 years, the 22 women with deep endometriosis sustained pelvic pain complaints (VAS=5.95±2.13 and 2.45±2.42, pTENS. Both application types of TENS were effective for improving the evaluated types of pain. Both resources (acupuncture-like TENS and self-applied TENS) demonstrated effectiveness as a complementary treatment of pelvic pain and deep dyspareunia, improving quality of life in women with deep endometriosis regardless of the device used for treatment. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Motivation and/or warm up games for third grade children Physical Education lesson

Directory of Open Access Journals (Sweden)

Margelia Bárbara Ramírez Blanco

2017-07-01

Full Text Available The Physical Education is an important element for the child’s multilateral and harmonic formation, its appropriate implementation is paramount for the development of the individual's physical performance capacity, the health preservation and for the moral and social values formation. The game is an important task for the children to  appropriate and correct physical, psychological and social development, they have as rights to enjoy fully the games and the recreation, which will be guided toward educational aims, their importance in the individual's integral development is universally recognized, they are also an effective aid in the Physical Education. Supported on theoretical and empiric research methods we could carry out our work offering motivational and warm up games like effective tool to be used by the professor in the Physical Education initial part lesson to work with the third grader boys and girls of “Camilo Cienfuegos” elementary school in Pinar del Rio municipality. The designed proposal is composed of ten games, which have the appropriate characteristics of the motivation and/or warm up games, that´s to say, games to increase the students´ motivation; easy to comprehend, of short duration, and to prepare the body to be worked with in the main part of the lesson, what implies the correct relationship whit the objective of it.

Improving Mathematics Teaching as Deliberate Practice through Chinese Lesson Study

Science.gov (United States)

Huang, Rongjin; Prince, Kyle M.; Barlow, Angela T.

2017-01-01

This study examined how a ninth grade teacher improved an Algebra I lesson through a lesson study approach. We used multiple data sources to investigate the improvement of the lesson towards student-centered mathematics instruction, perceived benefits of the teacher, and factors associated with the improvement of teaching. The lesson group…

Craft Lessons: Teaching Writing K-8. Second Edition

Science.gov (United States)

Fletcher, Ralph; Portalupi, JoAnn

2007-01-01

Since its publication in 1998 Craft Lessons has become a mainstay of writing teachers, both new and experienced. Practical lessons--each printed on one page--and the instructional language geared to three grade-level groupings: K-2, 3-4, and 5-8 are contained in this book. In the decade since Craft Lessons' publication the world has changed in…

Increasing intensity of TENS prevents analgesic tolerance in rats

Science.gov (United States)

Sato, Karina L.; Sanada, Luciana S.; Rakel, Barbara A.; Sluka, Kathleen A.

2012-01-01

Transcutaneous electrical nerve stimulation (TENS) reduces hyperalgesia and pain. Both low frequency (LF) and high frequency (HF) TENS, delivered at the same intensity (90% motor threshold (MT)) daily, result in analgesic tolerance with repeated use by the 5th day of treatment. Thecurrentstudytestedif 1) increasingintensityby 10% per daypreventsthedevelopmentoftolerance to repeated TENS, and 2) iflowerintensity TENS (50 % MT) produces an equivalentreduction in hyperalgesia when compared to 90% MT TENS. Sprague-Dawley rats with unilateral knee joint inflammation (3% carrageenan) were separated according to the intensity of TENS used: Sham, 50% LF, 50% HF, 90% LF, 90% HF, and increased intensity by 10% per day (LF and HF). The reduced mechanical withdrawal threshold following the induction of inflammation was reversed by application of TENS applied at 90% MT and increasing intensity for the first 4 days. On the 5th day, the groups that received 90% MT intensity showed tolerance. Nevertheless, the group that received an increased intensity on each day still showed a reversal of the mechanical withdrawal threshold with TENS. These results show that the development of tolerance can be delayed by increasing intensity of TENS. PMID:22858165

Anticipating students' reasoning and planning prompts in structured problem-solving lessons

Science.gov (United States)

Vale, Colleen; Widjaja, Wanty; Doig, Brian; Groves, Susie

2018-02-01

Structured problem-solving lessons are used to explore mathematical concepts such as pattern and relationships in early algebra, and regularly used in Japanese Lesson Study research lessons. However, enactment of structured problem-solving lessons which involves detailed planning, anticipation of student solutions and orchestration of whole-class discussion of solutions is an ongoing challenge for many teachers. Moreover, primary teachers have limited experience in teaching early algebra or mathematical reasoning actions such as generalising. In this study, the critical factors of enacting the structured problem-solving lessons used in Japanese Lesson Study to elicit and develop primary students' capacity to generalise are explored. Teachers from three primary schools participated in two Japanese Lesson Study teams for this study. The lesson plans and video recordings of teaching and post-lesson discussion of the two research lessons along with students' responses and learning are compared to identify critical factors. The anticipation of students' reasoning together with preparation of supporting and challenging prompts was critical for scaffolding students' capacity to grasp and communicate generality.

[Educational practices in accordance with the "Ten steps to successful breastfeeding" in a Human Milk Bank].

Science.gov (United States)

Silva, Cristianny Miranda E; Pellegrinelli, Ana Luiza Rodrigues; Pereira, Simone Cardoso Lisboa; Passos, Ieda Ribeiro; Santos, Luana Caroline Dos

2017-05-01

This article sought to evaluate educational practices in line with the "Ten Steps to Successful Breastfeeding" in a Human Milk Bank. It involved a retrospective study using sociodemographic data about the pregnancy and the baby, obtained from a nursing mothers care protocol (2009-2012). These data were associated to steps related to educational practices from the "Ten Steps." Descriptive analysis, chi-square test and Poisson regression were performed. 12,283 mothers, with a median of 29 (12-54) years old, were evaluated. The guidelines about breastfeeding received during prenatal care (step 3) prevailed among mothers aged 30-39 years and the skin to skin contact (step 4) prevailed among oriented mothers. Breastfeeding training (step 5) predominated among those who breastfed exclusively. Higher prevalence of exclusive breastfeeding (step 6), breastfeeding on demand (step 8) and use of artificial nipples (step 9) were noted among infants whose mothers were oriented. These findings indicate the important role of health professionals on mother/child training about breastfeeding, on encouragement of the skin/skin contact, exclusive breastfeeding and breastfeeding on demand. The guidelines indicated the need to improve in order to reduce the use of artificial nipples and enhance exclusive breastfeeding.

Professor's Page: Do Demonstration Lessons Work?

Science.gov (United States)

Clarke, Doug

2011-01-01

As part of a large research and professional development project funded by the Catholic Education Office Melbourne (CEOM), called "Contemporary Teaching and Learning of Mathematics," the ACU team has been leading demonstration lessons. There is certainly not universal agreement on the worth of demonstration lessons in the mathematics…

Perspectives of an Interdisciplinaryg Research Team to Engage Practice: Lessons from a Knowledge Exchange Trainee Experience

Science.gov (United States)

Urquhart, Robin L.; Johnston, Grace M.; McVorran, Shauna M.; Burge, Fred I.

2010-01-01

End-of-life (EOL) care is an area of health services that will ultimately affect us all. To share the knowledge emerging from EOL research and to address inequities in the quality of EOL care in Nova Scotia, a knowledge exchange (KE) trainee was hired to translate research and surveillance into a Surveillance Report. The purpose of this paper is to reflect upon this initiative and share the research team's perspectives on their KE experiences. We describe four key competencies of the KE trainee selected, and discuss lessons learned from this KE trainee experience, to expand our understanding of KE. PMID:21532769

Primary care and addiction treatment: lessons learned from building bridges across traditions.

Science.gov (United States)

Stanley, A H

1999-01-01

A primary care unit combined with residential addiction treatment allows patients with addictive disease and chronic medical or psychiatric problems to successfully complete the treatment. These are patients who would otherwise fail treatment or fail to be considered candidates for treatment. Health care providers should have a background in primary care and have the potential to respond professionally to clinical problems in behavioral medicine. Ongoing professional training and statistical quality management principles can maintain morale and productivity. Health education is an integral part of primary care. The costs of such concurrent care when viewed in the context of the high societal and economic costs of untreated addictive disease and untreated chronic medical problems are low. The principles used to develop this primary care unit can be used to develop health care units for other underserved populations. These principles include identification of specific health care priorities and continuity of rapport with the target population and with addiction treatment staff.

Recruitment of family child care homes for an obesity prevention intervention study

Directory of Open Access Journals (Sweden)

Dianne S. Ward

2016-08-01

Conclusion: Results of these enhanced recruitment strategies demonstrate the many lessons learned about successful recruitment of a difficult-to-reach population, family child care homes; specifically, the importance of building relationships, communicating clearly, and identifying key motivators.

Defense Language Institute Russian Basic Course. Volumes XXVIII, Lessons 131-140. Volume XXX, Lessons 151-159.

Science.gov (United States)

Defense Language Inst., Washington, DC.

The 19 lessons in these two volumes are intended for the advanced phase of a 159-lesson intensive audiolingual basic Russian course developed recently by the Defense Language Institute to train native speakers of English to a Level 3 second language proficiency. These third and fifth volumes contain such features as (1) texts on the Russian Civil…

Kangaroo Care: Experiences and Needs of Parents in Neonatal Intensive Care: A Systematic Review ‘Parents’ Experience of Kangaroo Care’

NARCIS (Netherlands)

Gabriels, karlijn; Brouwer, AJ; maat, Jessica; van den Hoogen, Agnes

2015-01-01

Abstract This review is focusing on the experiences and needs of parents with infants within NICU regarding Kangaroo Care. Ten studies with qualitative designs were included. Kangaroo Care was overall experienced as positive; giving parents the opportunity to get to know their babies and (re-)

Children's Satisfaction with Private Music Lessons.

Science.gov (United States)

Rife, Nora A.; Shnek, Zachary M.; Lauby, Jennifer L.; Lapidus, Leah Blumberg

2001-01-01

Determines the language children use to express their feelings of satisfaction with private music lessons. Offers a list of statements from children about private music lessons to be used to assess those feelings. Discusses the effects of age, gender, and musical instruments on satisfaction for music educators. Includes references. (DAJ)

Human Spaceflight Conjunction Assessment: Lessons Learned

Science.gov (United States)

Smith, Jason T.

2011-01-01

This viewgraph presentation reviews the process of a human space flight conjunction assessment and lessons learned from the more than twelve years of International Space Station (ISS) operations. Also, the application of these lessons learned to a recent ISS conjunction assessment with object 84180 on July 16, 2009 is also presented.

Integrating UNESCO ICT-Based Instructional Materials in Chemistry Lessons

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CHARLIE P. NACARIO

2014-08-01

Full Text Available This study determined the effectiveness of the lessons in Chemistry integrating UNESCO ICT-based instructional material on the achievement of Chemistry students at Central Bicol State University of Agriculture. It aimed to identify lessons that may be developed integrating UNESCO ICT-based instructional materials, determine the effect of the developed lessons using the material on: conceptual understanding; science process skills; and attitude towards chemistry and gather insights from the experiences of the students and teacher. The study used the single group pretest and posttest experimental design. Descriptive, quantitative and qualitative techniques were also utilized. Quantitative data were taken from the pretest-posttest results on the Test on Conceptual Understanding, Science Process Skills and Chemistry Attitudinaire. Qualitative data were drawn from the experts’ assessment of the developed lessons and research instruments, and the insights of students and teacher. The developed lessons integrating UNESCO ICT-based instructional materials were Atomic Model and Structure, Periodic Table of Elements, Chemical Bonding, and Balancing Chemical Equation. These lessons increased the conceptual understanding of the students by topic and skill from very low mastery to average mastery level. The students have slightly improved along the different science process skills. After teaching the lessons, the students’ attitude also improved. The students became more motivated and interested in Chemistry and the lessons were student centered and entailed teacher’s competence and flexibility in computer use.

Changing the focus of care: from curative to palliative care

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Silvia Soffritti

2014-06-01

Full Text Available The improvements in the obstetrical and neonatal diagnosis and therapies have resulted into an increase in the survival rate of infants previously considered as non-viable. Debate is focusing on professionals’ behaviour about withdrawal or withholding of life sustaining treatment (LST and administration of palliative care for newborns whose conditions are incompatible with a prolonged life. Decisions about treatment should be made jointly by the professionals’ team and the family, placing the interest of the baby at the very heart of the decision process. It is very important that the environment in which the family has to make the decision is characterized by openness, dialogue and frankness. A proper and effective communication with parents is always necessary and can resolve any conflict caused by disagreement. Furthermore, parents need time in the decision making process. Other supports, which could help the family in the final decision are the possibility to ask for a specialist’s second opinion and the involvement of religious leaders and of an indipendent clinical ethics committee. Withholding or withdrawal of LST does not mean cessation of care for the baby, it means to change the focus of care from curative to palliative care. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou 

COMMUNITY HEALTH & PRIMARY HEALTH CARE

African Journals Online (AJOL)

2Primary Health Care Department, Ikpoba Okha Local Government Area, Benin City, ... selected from each of the ten wards in the LGA using multistage sampling technique. ..... Knowledge of HIV/AIDS Insurance Companies in Lagos State.

Free Trade and Tariffs: Level III, Unit 2, Lesson 1; Capitalism, Communism, Socialism: Lesson 2; Nationalism vs. Internationalism: Lesson 3. Advanced General Education Program. A High School Self-Study Program.

Science.gov (United States)

Manpower Administration (DOL), Washington, DC. Job Corps.

This self-study program for high-school level contains lessons on: Free Trade and Tariffs; Capitalism, Communism, Socialism; and Nationalism vs. Internationalism. Each of the lessons concludes with a Mastery Test to be completed by the student. (DB)

The Role of a Commander in Military Lessons Learned Systems

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Zenon Waliński

2015-06-01

Full Text Available The aim of the paper is to investigate the role of a commander in military Lessons Learned systems. In order to achieve the aim, the paper presents (1 the architecture of the Lessons Learned capabilities in the U.S. Army, NATO and the Polish Armed Forces, (2 the commander’s role in the Lessons Learned process (3 the commander’s role in fostering Lessons Learned organisation culture. The paper is based on multiple case study analysis including Lessons Learned systems in NATO, the U.S. Army and the Polish Armed Forces.

Intensive Care in a Patient with Toxic Epidermal Necrolysis

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J. Wallenborn

2017-01-01

Full Text Available Toxic epidermal necrolysis (TEN is a serious adverse drug reaction with high lethality, which usually requires intensive-medical care. A 44-year-old man developed generalized exanthema with increasing exfoliation and mucosal involvement after taking allopurinol, ibuprofen, and etoricoxib. The clinical diagnosis of TEN was histologically confirmed. Prednisolone therapy with 3 mg/kg body weight (BW was not able to prevent further progress to finally 80% of the body surface, and infliximab 5 mg/kg BW was given as a single dose. This prevented further progression of the TEN. Despite marked improvement in skin findings, the ICU stay was prolonged by a complex analgosedation, transient kidney failure, volume management, positioning therapy, and vegetatively impeded weaning. Moreover, there was colonization with multiresistant bacteria (MRSA and VRE. Nonetheless, the patient could be restored to health and was released after four weeks. Infliximab seems to be effective in the treatment of TEN, especially in cases of rapid progression. Moreover, patients with TEN are difficult to handle in intensive-medical care, whereby attention should especially be paid to sufficient pain therapy, and the positioning of the patient is a particular challenge.

Complexity in practice: understanding primary care as a complex adaptive system

Directory of Open Access Journals (Sweden)

Beverley Ellis

2010-06-01

Conclusions The results are real-world exemplars of the emergent properties of complex adaptive systems. Improving clinical governance in primary care requires both complex social interactions and underpinning informatics. The socio-technical lessons learned from this research should inform future management approaches.

Lessons learned from the development of health applications in a tertiary hospital.

Science.gov (United States)

Park, Joong-Yeol; Lee, Guna; Shin, Soo-Yong; Kim, Jeong Hun; Han, Hye-Won; Kwon, Tae-Wan; Kim, Woo Sung; Lee, Jae Ho

2014-03-01

Adoption of smart devices for hospital use has been increasing with the development of health applications (apps) for patient point-of-care and hospital management. To promote the use of health apps, we describe the lessons learned from developing 12 health apps in the largest tertiary hospital in Korea. We reviewed and analyzed 12 routinely used apps in three categories-Smart Clinic, Smart Patient, and Smart Hospital-based on target users and functions. The log data for each app were collected from the date of release up until December 2012. Medical personnel accessed a mobile electronic medical record app classified as Smart Clinic an average of 452 times per day. Smart Hospital apps are actively used to communicate with each other. Patients logged on to a mobile personal health record app categorized as Smart Patient an average of 222 times per day. As the mobile trend, the choice of supporting operating system (OS) is more difficult. By developing these apps, a monitoring system is needed for evaluation. We described the lessons learned regarding OS support, device choice, and developmental strategy. The OS can be chosen according to market share or hospital strategic plan. Smartphones were favored compared with tablets. Alliance with an information technology company can be the best way to develop apps. Health apps designed for smart devices can be used to improve healthcare. However, to develop health apps, hospitals must define their future goals and carefully consider all the aspects.

Bruce A restart (execution and lessons-learned)

International Nuclear Information System (INIS)

Soini, J.

2011-01-01

Lessons learned with the Bruce Units 3 and 4 restart have been incorporated into the current refurbishment of Units 1 and 2. In addition, lessons learned on the lead unit (U2) are aggressively applied on the lagging unit (U1) to maximize efficiency and productivity. There will be a discussion on how this internal OPEX, along with external lessons learned, are used to continuously improve all aspects of the Bruce A Restart project management cycle, from scope selection, through planning and scheduling, to execution.

Integrated care: achieving better coordination of care for the chronically ill. Lessons from The Netherlands bundled-payment initiative.

NARCIS (Netherlands)

Dijk, C. van; Raams, J.; Schut, E.; Baan, C.; Struijs, J.; Vrijhoef, B.; Wildt, J.E. de; Bakker, D. de

2013-01-01

Background: In 2010, a bundled payment system for diabetes care, COPD care and vascular risk management was introduced nationwide in The Netherlands. In the bundled payment system, are for thesepatients is organised by a care group that provides general and more specialised care for the specific

The physical education lesson in Turkish primary schools: Affective ...

African Journals Online (AJOL)

In the study students' affective entry characteristics related to Physical Education lessons were examined based on three dimensions: interest towards the lesson, level of motivation in the lesson and educational gains. The study further aimed to investigate how these three dimensions were affected by the gender factor.

Inductive & Deductive Science Thinking: A Model for Lesson Development

Science.gov (United States)

Bilica, Kim; Flores, Margaret

2009-01-01

Middle school students make great learning gains when they participate in lessons that invite them to practice their developing scientific reasoning skills; however, designing developmentally appropriate, clear, and structured lessons about scientific thinking and reasoning can be difficult. This challenge can be met through lessons that teach…

Goiania, ten years later. Proceedings of an international conference

Energy Technology Data Exchange (ETDEWEB)

NONE

1998-12-01

Following the radiological accident that happened in Goiania, Brazil, in late 1987, the Brazilian National Nuclear Energy Commission (CNEN) was able to turn to the international community for assistance under the terms of the 1986 IAEA sponsored Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency; this marked the first time the convention was invoked. Additionally, to prevent the loss of useful information, CNEN and the IAEA designated a panel of international experts to investigate the causes and consequences of the accident and draw up a comprehensive report, `The Radiological Accident in Goiania`, which the IAEA published in 1988. Under its nuclear safety programme, it is the IAEA`s intention to follow up serious radiological accidents with review and analysis, to document the causes and circumstances and to disseminate conclusions, lessons to be learned and recommendations from which all States may benefit. A decade after the Goiania accident, the CNEN convened the international conference `Goiania, Ten Years Later` in co-operation with the IAEA. The purpose of this conference was to share with the local population and the international community the knowledge gained during this tragic event and in the following years. The conference attracted some 400 participants from 17 countries (Argentina, Austria, Brazil, Canada, Cuba, El Salvador, Estonia, Germany, Israel, Italy, Mexico, Peru, Russian Federation, Spain, Uruguay, United States of America and Venezuela). The present IAEA proceedings contain some 50 papers selected for publication by the editorial committee of the conference Refs, figs, tabs

Lessons from psychiatry and psychiatric education for medical learners and teachers.

Science.gov (United States)

Hilty, Donald M; Srinivasan, Malathi; Xiong, Glen L; Ferranti, Jessica; Li, Su-Ting T

2013-06-01

Medical learners, teachers, and institutions face significant challenges in health care delivery and in training the next generation of clinicians. We propose that psychiatry offers lessons which may help improve how we take care of patients and how we teach others to care for patients. Our objective is to discuss what learners and teachers can learn from psychiatry, organized around (1) how we make decisions, (2) how we learn, and (3) how we reflect on our practice. Information from clinical care, education, neuroscience and other aspects of life (e.g. business, creativity, and research) help us on these processes. We make 'good' decisions in concert with patients and learners, by listening to their experiences, asking questions and exploring subjective and objective information. Our learning has a neurobiological basis, and is effectively furthered by personalization, reinforcement, acquisition of critical thinking skills, and assessment of our limitations and errors. Our ability to reflect is determined by attitude, skill, tolerating ambiguity or dissonance, and planning for the unexpected. These processes - in addition to knowledge and other skills - will help physicians be successful in practice, learning and teaching, research and leadership.

"How much will I get charged for this?" Patient charges for top ten diagnoses in the emergency department.

Directory of Open Access Journals (Sweden)

Nolan Caldwell

Full Text Available We examined the charges, their variability, and respective payer group for diagnosis and treatment of the ten most common outpatient conditions presenting to the Emergency department (ED.We conducted a cross-sectional study of the 2006-2008 Medical Expenditure Panel Survey. Analysis was limited to outpatient visits with non-elderly, adult (years 18-64 patients with a single discharge diagnosis.We studied 8,303 ED encounters, representing 76.6 million visits. Median charges ranged from $740 (95% CI $651-$817 for an upper respiratory infection to $3437 (95% CI $2917-$3877 for a kidney stone. The median charge for all ten outpatient conditions in the ED was $1233 (95% CI $1199- $1268, with a high degree of charge variability. All diagnoses had an interquartile range (IQR greater than $800 with 60% of IQRs greater than $1550.Emergency department charges for common conditions are expensive with high charge variability. Greater acute care charge transparency will at least allow patients and providers to be aware of the emergency department charges patients may face in the current health care system.

A Qualitative Study on Primary School Mathematics Lesson Evaluation

Science.gov (United States)

Zhao, Dongchen; Ma, Yunpeng

2009-01-01

Through the qualitative interviews of five implementers of primary school mathematics curriculum, this study addresses the ways in which mathematics lessons are evaluated. Results show that each evaluator recognizes different aspects of a "good lesson," however, among all criteria, the design of the lesson plan, realization of the lesson…

"Elements of Astronomy": A Television Course of 30 Lessons

Science.gov (United States)

Perez, J. P. D.; Del Pozo, E. P. G.; Rodriguez, R. R. T.; Mendez, A. M. B.; Rodriguez, E. R. F.; Gamez, R. G. D.

2006-08-01

It was broadcasted to all Cuba from March to December 2005, one lesson per week, transmitting three times each lesson, this means 90 hours of broadcasting. It was one of the courses of the Program "University for All", that Educative Channel produced. The Thematic: Sky Coordinates and Constellations; Astronomical Instruments; Solar System; Planets and their Moons; Comets, Asteroids and Meteoroids; Sun; Cosmic Environment and Space Weather; Stars; Galaxy and Quasars; Observable Universe; Life, Intelligent Life and Civilizations in the Universe; and History of Astronomy in Cuba. The professor staff was a group of 5 researchers of the Astronomy Department. They did an effort that each lesson had the best information level with a minimum of mathematical expressions. And were used more than 60 slides and various astronomical films fragments per lesson. To make one lesson was analyzed several astronomical films, selected a group of fragments and pre-edited into various blocks with the TV specialists, later a power point presentation was conformed using all available information on-line and bibliography. Then the lesson was recorded by the TV specialist at the Educative Channel and latter reviewed and improved by one AVID edition. The Course groundwork began in April 2003, with the first list of 12 lessons, later in June was increased to18 lessons, and started the work of "Tabloide" making; it is a journal-type book of 32 pages, equivalent to about 120 normal pages including 64 illustrations. At December 2004 the Course was increased to 30 lessons and the "Tabloide" was send to editor, later 200,000 exemplars was published. Many people followed Course and "Tabloide" was shopped in some months.

Implementasi Metode Sokratik Melalui Lesson Study Untuk Meningkatkan Keterampilan Berpikir Kritis Mahasiswa

Directory of Open Access Journals (Sweden)

Ketut Susiani

2017-01-01

Full Text Available This article reports the experience of implementing the action research to apply the Socratic dialogue method through lesson study in the lecture of Educational Profession to improve critical thinking skills of the university students. The subject of this action research is 36 students (22 women and 14 men in grade VI class B, Department Guidance and Counseling (BK, Faculty of Education, Universitas Pendidikan Ganesha (Undiksha on academic years 2016/2017. This action research conducted in cycles (reported in three cycles which is integrated into the activities of lesson study. In every cycle consisted of a plan, action, observation/evaluation and reflection phase. Critical thinking skills are assessed through observation activities in group discussion activities and classes, as well as through student response in solving essay test (on cases analysis, which assessed by a rubric assessment of students critical thinking skills at each end of the course. The results showed that the mean of the critical thinking skills of students at the end of the first cycle is 50 (low, then at the end of the second cycle increased to 65 (average and at the end of the third cycle increased again to 89 (high. Research also shows that the lesson learned were founded through collaborating and careful observation of the course observer with researchers in identifying strengths and constraints and to produce efforts to improve the implementation of the course to improve the quality of learning.

Lessons learned from accidents investigations

Energy Technology Data Exchange (ETDEWEB)

Zuniga-Bello, P. [Consejo Nacional de Ciencia y Tecnologia (CONACYT), Mexico City (Mexico); Croft, J. [National Radiological Protection Board (United Kingdom); Glenn, J

1997-12-31

Accidents from three main practices: medical applications, industrial radiography and industrial irradiators are used to illustrate some common causes of accidents and the main lessons to be learned. A brief description of some of these accidents is given. Lessons learned from the described accidents are approached by subjects covering: safety culture, quality assurance, human factors, good engineering practice, defence in depth, security of sources, safety assessment and monitoring and verification compliance. (author)

Lessons learned from accident investigations

International Nuclear Information System (INIS)

Zuniga-Bello, P.; Croft, J.R.; Glenn, J.

1998-01-01

Accidents in three main practices - medical applications, industrial radiography and industrial irradiators - are used to illustrate some common causes of accidents and the main lessons to be learned from them. A brief description of some of these accidents is given. Lessons learned from the accidents described are approached bearing in mind: safety culture, quality assurance, human factors, good engineering practice, defence in depth, security of sources, safety assessment and monitoring and verification compliance. (author)

Accrediting the MD Programme in Sultan Qaboos University: Process, Earned Benefits, and Lessons Learned

Directory of Open Access Journals (Sweden)

Sulayma Albarwani

2015-12-01

Full Text Available The MD Programme of the College of Medicine and Health Sciences, Sultan Qaboos University, has been accredited recently. The College has been preparing for this event for more than ten years and wishes to share its experience with other regional medical colleges. The process of accreditation per se took less than three years to complete and most of the time was spent to prepare for the process; to build-up capacity in addition to implementing curricular reforms and other requirements that were needed to comply with accreditation standards. In the end of this exercise, the College has earned many benefits as well as learned some lessons. This article describes the most notable activities and events and discusses how the College responded to the challenges posed.

Supporting teachers' technology integration in lesson plans

NARCIS (Netherlands)

Janssen, Noortje

2017-01-01

Lesson planning offers rich opportunities for teachers to consider and implement technology in the classroom. This dissertation investigated the design and effectiveness of supplementary information to assist pre-service teachers during the lesson planning process. Based on the Technological,

Pet Care Teaching Unit: 1st-3rd Grades.

Science.gov (United States)

Peninsula Humane Society, San Mateo, CA.

Activities in this unit are designed to familiarize primary grade students with the responsibilities involved in pet ownership. Teaching plans are provided for a total of 12 lessons involving social studies, language arts, math, and health sciences. Activities adaptable for readers and non-readers focus on pet overpopulation, care of pets when…

Lessons Learned in Software Testing A Context-Driven Approach

CERN Document Server

Kaner, Cem; Pettichord, Bret

2008-01-01

Decades of software testing experience condensed into the most important lessons learned.The world's leading software testing experts lend you their wisdom and years of experience to help you avoid the most common mistakes in testing software. Each lesson is an assertion related to software testing, followed by an explanation or example that shows you the how, when, and why of the testing lesson. More than just tips, tricks, and pitfalls to avoid, Lessons Learned in Software Testing speeds you through the critical testing phase of the software development project without the extensive trial an

Lesson Planning with the Common Core

Science.gov (United States)

Estes, Linda A.; McDuffie, Amy Roth; Tate, Cathie

2014-01-01

Planning a lesson can be similar to planning a road trip--a metaphor the authors use to describe how they applied research and theory to their lesson planning process. A map and mode of transportation, the Common Core State Standards for Mathematics (CCSSM) and textbooks as resources, can lead to desired destinations, such as students engaging in…

So you want to be a CEO: lessons from the field.

Science.gov (United States)

Rothberg, E D

2001-01-01

This article discusses graduate educational options for those seeking to become chief executive officers and examines the subject areas that are important on a practical level. It then discusses six areas that are essential to a successful manager: problem solving, critical thinking, and organizational behavior; breadth of knowledge; financial management; corporate culture; for profit and not for profit, and--politics--internal and external. Each area includes a lesson drawn from experience as a president and CEO. Readers should gain a level of understanding of the scope of responsibilities and skills necessary to succeed in today's health care environment.

The Role of Humoral Alloreactivity in Liver Transplantation: Lessons Learned and New Perspectives

Directory of Open Access Journals (Sweden)

Elaine Y. Cheng

2017-01-01

Full Text Available More than ten years after the initial description of the humoral theory of transplantation by Dr. Paul I. Terasaki, the significance of humoral alloimmunity in liver transplantation has yet to be clearly defined. The liver allograft has an inherent tolerogenic capacity which confers its resistance to cell-mediated as well as antibody-mediated rejection. Nevertheless, the protection against alloimmunity is not complete, and antibody-mediated tissue injury can occur in the liver graft under specific circumstances. In this article the evidence on the clinicopathologic effects of donor-specific alloantibodies in liver transplantation will be examined and interpreted in parallel with lessons learned from renal transplantation. The unique anatomic and immunologic features of the liver will be reviewed to gain new insights into the complex interactions between humoral immune system and the liver allograft.

[Economics] Introductory Lesson (Begin Day One). Lesson Plan.

Science.gov (United States)

Lewin, Roland

This introductory lesson on teaching economics concepts contains sections on the following: purpose; objectives; time; materials needed; and step-by-step classroom procedures. The focus is on the economic problem of scarcity and opportunity costs. Attached is an original skit, "There's no such thing as a free lunch," and a chart that…

English language-in-education: A lesson planning model for subject ...

African Journals Online (AJOL)

English language-in-education: A lesson planning model for subject teachers. ... lack of critical academic language skills in English as the Language of Learning and ... process of lesson design and the 'forward' process of lesson presentation.

Ten major trends now emerging in the United States

Energy Technology Data Exchange (ETDEWEB)

Naisbitt, J.

1978-01-01

Using a special analytical procedure for tracking and assessing events reported in the nation's newspapers, the Center for Policy Process has identified ten emerging trends in the United States that are having a major impact on all our lives and on all businesses and industries--and especially on the electric utility industry. Although the trends may move in contradictory directions and have different degrees of significance, all have been carefully monitored for a considerable length of time. All are firmly established--and are not to be viewed as the momentary interests of certain radical elements of the population. The ten trends are: the fast-emerging clash between nuclear fuel and coal as an environmental health issue; displacement of racism and sexism by ''ageism'' as society's most prominent anti-discrimination preoccupation, and the complete elimination soon of mandatory retirement; in government and technology, the phenomenon of ''appropriate scale'' replacing economies of scale, emergence of single-issue political organizations; coming-of-age of the recycling ethic; emergence of ''access to capital'' as the new equity issue--the new rights issue; continuing shift from centralization to decentralization; movement of society in the dual directions of high technology/high touch; business' increasing involvement with the well-established accountability trend; and shift from a representative democracy to a participatory democracy--this profound change in American democracy actually began about a decade or so ago.

The TEN-T core network and the Fehmarnbelt region

DEFF Research Database (Denmark)

Guasco, Clement Nicolas

This note is a snapshot picture, taken in early 2014, that places the Green STRING corridor project within the context of the TEN-T strategy and gives a summarized overview on the impact of this strategy in the region. Chapter 1 contains a summary of the TEN-T strategy today, chapter 2 presents...... the sources used for this note, chapter 3 presents all the relevant EU regulations with direct impact on the development of TEN-T corridors, chapter 4 gives practical examples of the challenges for the development of TEN-T corridors, chapter 5 pre-sents the national initiatives related to the TEN-T corridor...

Keynote on lessons from major radiation accidents

International Nuclear Information System (INIS)

Ortiz, P.; Oresegun, M.; Wheatley, J.

2000-01-01

Generic lessons have been learned from a relatively large number of accidents in the most relevant practices (a set of analysis have been made on about 90 radiotherapy events, 43 industrial radiography and nine from industrial irradiations); more specific lessons have been drawn from in-depth investigations of individual accidents. The body of knowledge is grouped as follows: a) radiotherapy is very unique in that humans (patients) are purposely given very high radiation doses (20-75 Gy) by placing them in the radiation beam or by placing radioactive sources in contact with tissues. Intended deterministic effects are the essence of the normal radiotherapy practice and relatively small deviation from the intended doses, i.e,, slightly higher or lower than intended may cause increased rate of severe complication or reduce probability of cure. Consequences of major accidents have been devastating, affecting tens, even hundreds of patients and causing death (directly or indirectly) to a large number of them; b) accidents involving industrial radiography are the most frequent cause of overexposure to workers (radiographers); c) accidents with industrial irradiators have lower probability of occurrence, however, they are deemed to be fatal, especially when whole body exposure to panoramic gamma irradiators occur; partial body irradiation from industrial or research accelerator beams has led to amputation of hands and legs; d) when control of sources was relinquished ('orphan' sources) this has resulted in severe injuries, in some cases death and widespread contamination of the environment. A tool for further dissemination of lessons will be an international reporting system of unusual radiation events (RADEV), being introduced world-wide. Accidents were rarely due to a single human error or isolated equipment failure. In most cases there was a combination of elements such as: a) unawareness of the potential for an accident, b) poor education, which usually did not

Ten Simple Rules for the Care and Feeding of Scientific Data

OpenAIRE

Goodman, A.; Pepe, A.; Blocker, A.W.; Borgman, C.L.; Cranmer, K.; Crosas, M.; Di Stefano, R.; Gil, Y; Groth, P.T.; Hedstrom, M.; Hogg, D.W.; Kashyap, V.; Mahabal, A.; Siemiginowska, A.; Slavkovic, A.

2014-01-01

In the early 1600s, Galileo Galilei turned a telescope toward Jupiter. In his log book each night, he drew to-scale schematic diagrams of Jupiter and some oddly moving points of light near it. Galileo labeled each drawing with the date. Eventually he used his observations to conclude that the Earth orbits the Sun, just as the four Galilean moons orbit Jupiter. History shows Galileo to be much more than an astronomical hero, though. His clear and careful record keeping and publication style no...

Feedback of safety - related operational experience: Lessons learned

Energy Technology Data Exchange (ETDEWEB)

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

1997-09-01

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

Feedback of safety - related operational experience: Lessons learned

International Nuclear Information System (INIS)

Elias, D.

1997-01-01

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

Lessons from the recent rise in use of female sterilization in Malawi.

Science.gov (United States)

Jacobstein, Roy

2013-03-01

Although female sterilization is the most widely used modern contraceptive method in the world, most family planning programs in Africa have had difficulty providing it. Malawi, however, despite daunting constraints, has made female sterilization widely and equitably accessible, thereby increasing method choice and helping its citizens better meet their reproductive intentions. Ten percent of currently married Malawian women of reproductive age rely on female sterilization for contraceptive protection, compared with less than 2 percent across Africa, and demand to limit births now exceeds demand to space births. Malawi's female sterilization prevalence surpasses that of some high-resource countries. Key service-delivery factors enabling this achievement include supportive policies, strong public-private partnerships, and mobile services delivered at no cost by dedicated providers. Challenges remain, but Malawi's achievement offers lessons for other countries with low availability of female sterilization and similar resource constraints. © 2013 The Population Council, Inc.

Lessons from past experiences: the critical path - a third party perspective

International Nuclear Information System (INIS)

Vincenti, J.R.

1986-01-01

When most people are confronted with the question, ''What do you think about the low-level radioactive waste disposal issue facing your state,'' the first reaction is one of concern and fear for public health and environmental safety. This reaction, though very common, is but a small part of a complex scenario of social and technical issues that face those who generate and those who are responsible for the disposal of hazardous and toxic waste in America. This paper discusses: 1) ten lessons that the PIER (Public Involvement and Education on Radiation) Program at Penn State has experienced since its inception back in November of 1983; 2) the role of a university as a third party in controversial issues; 3) understanding the public and influential people - what they think and their differences; 4) the importance of interacting with the news media; and 5) the bottom line summary of the important parts of continuing education programs to the public

Results and lessons from the GMOS survey of transiting exoplanet atmospheres

Science.gov (United States)

Todorov, Kamen; Desert, Jean-Michel; Huitson, Catherine; Bean, Jacob; Fortney, Jonathan; Bergmann, Marcel; Stevenson, Kevin

2018-01-01

We present results from the first comprehensive survey program dedicated to probing transiting exoplanet atmospheres using transmission spectroscopy with a multi-object spectrograph (MOS). Our four-years survey focussed on ten close-in giant planets for which the wavelength dependent transit depths in the visible were measured with Gemini/GMOS. We present the complete analysis of all the targets observed (50 transits, 300 hours), and the challenges to overcome to achieve the best spectrophotometric precision (200-500 ppm / 10 nm). We also present the main results and conclusions from this survey. We show that the precision achieved by this survey permits to distinguish hazy atmospheres from cloud-free ones. We discuss the challenges faced by such an experiment, and the lessons learnt for future MOS survey. We lay out the challenges facing future ground based MOS transit surveys aiming for the atmospheric characterization of habitable worlds, and utilizing the next generation of multi-object spectrographs mounted on extremely large ground based telescopes (ELT, TMT).

Newborn cord care practices amongst mothers in Port Harcourt ...

African Journals Online (AJOL)

Information obtained included biodata, age and sex of last baby, social class, place of antenatal care and delivery, and cord care practices. Data were analysed using SPSS version 16.0. Results: Two hundred and ten mothers participated in the study. 71.9% were of high social class. Over 80% received antenatal care in ...

A doctor in the house: rationale for providing on-site urological consultation to geriatric patients in nursing health care facilities.

Science.gov (United States)

Watson, Richard A; Suchak, Nihirika; Steel, Knight

2010-08-01

To establish a rationale for providing on-site urological care on a regular basis in the nursing health care center setting and to share "lessons learned," which we have garnered in providing that care over a 5-year experience. We have reviewed and assessed our experiences in providing urological outreach to nursing health care center patients. Our outreach program has been well received both by patients and by health care center personnel. Over this time, we have capitalized on many advantages that this initiative offers, and we have gained, through this experience, several "lessons learned," not only regarding what to do, but also what to avoid. Advantages to on-site urological care include: (1) timely, targeted clinical intervention; (2) significant disease prevention; (3) expedition of treatment; (4) health care provider education; and (5) rich opportunities for clinical investigation. In addition, the on-site urologist can provide the health care center with helpful advice and validation in meeting federal and state health care requirements. Unfortunately, to date, remuneration for such programs has been discouraging. Federal and state regulations continue to impede innovative change. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Driver. D530.2 – Tools for the Lessons Learned Framework

NARCIS (Netherlands)

Schaik, M.G. van; et al

2016-01-01

In this deliverable D530.2 “Tools for the Lessons Learned Framework” the overall lessons learned framework will be clarified based on the delivery D53.1 “Lessons Learned Framework Concept” and aligned with the deliverable D52.1 “Harmonized competence framework”. The Tools for the Lessons Learned

UNLEARNED LESSONS OF CONTEMPORARY HISTORY

Directory of Open Access Journals (Sweden)

А Н Данилов

2017-12-01

Full Text Available The article considers the complex geopolitical situation in the global world at the end of the second decade of the 21st century as determined by the consequences of the collapse of the Soviet Union and by the new world order. The author seeks to answer the questions who will define the current geopolitical situation, whose aims it will reflect, what will become the basis of new geopolitical realities, the basis of moral solidarity of humankind, and the spiritual basis of future civilizations. The new challenges give rise to a desperate struggle for different scenarios for building a happy life. Moreover, it is not clear which ideal of the future world will be widely supported as a development guideline. The recognition as such of the standard of living and development of the strongest ones becomes a real threat to the new civilization for it leads to the loss of national interests of sovereign states, and to the loss of an independent future. Today, there is an active search for new theories and concepts that will adequately explain con-temporary global processes. In this thematic context, the author identifies main lessons not learned by the world political elites. The first lesson: new states are not born in an empty place, their common history is a great advantage ensuring prospects for the further development of interstate cooperation. The second lesson: the widespread falsification of history has a negative impact on national, cultural and social-group identity in transforming societies. The third lesson: after the collapse of the Soviet Union, the post-war balance of power was destroyed together with the system of checks and balances in world politics (a bipolar model of the world. The fourth lesson: under radical social transformations, the moral system of the population devaluates with numerous crisis consequences.

The Recovery-Oriented Care Collaborative: A Practice-Based Research Network to Improve Care for People With Serious Mental Illnesses.

Science.gov (United States)

Kelly, Erin L; Kiger, Holly; Gaba, Rebecca; Pancake, Laura; Pilon, David; Murch, Lezlie; Knox, Lyndee; Meyer, Mathew; Brekke, John S

2015-11-01

Practice-based research networks (PBRNs) create continuous collaborations among academic researchers and practitioners. Most PBRNs have operated in primary care, and less than 5% of federally registered PBRNs include mental health practitioners. In 2012 the first PBRN in the nation focused on individuals with serious mental illnesses-the Recovery-Oriented Care Collaborative-was established in Los Angeles. This column describes the development of this innovative PBRN through four phases: building an infrastructure, developing a research study, executing the study, and consolidating the PBRN. Key lessons learned are also described, such as the importance of actively engaging direct service providers and clients.

The Cambia Sojourns Scholars Leadership Program: Conversations with Emerging Leaders in Palliative Care.

Science.gov (United States)

Cruz-Oliver, Dulce M; Bernacki, Rachelle; Cooper, Zara; Grudzen, Corita; Izumi, Seiko; Lafond, Deborah; Lam, Daniel; LeBlanc, Thomas W; Tjia, Jennifer; Walter, Jennifer

2017-08-01

There is a pressing workforce shortage and leadership scarcity in palliative care to adequately meet the demands of individuals with serious illness and their families. To address this gap, the Cambia Health Foundation launched its Sojourns Scholars Leadership Program in 2014, an initiative designed to identify, cultivate, and advance the next generation of palliative care leaders. This report intends to summarize the second cohort of Sojourns Scholars' projects and their reflection on their leadership needs. This report summarizes the second cohort of sojourns scholars' project and their reflection on leadership needs. After providing a written reflection on their own projects, the second cohort participated in a group interview (fireside chat) to elicit their perspectives on barriers and facilitators in providing palliative care, issues facing leadership in palliative care in the United States, and lessons from personal and professional growth as leaders in palliative care. They analyzed the transcript of the group interview using qualitative content analysis methodology. Three themes emerged from descriptions of the scholars' project experience: challenges in palliative care practice, leadership strategies in palliative care, and three lessons learned to be a leader were identified. Challenges included perceptions of palliative care, payment and policy, and workforce development. Educating and collaborating with other clinicians and influencing policy change are important strategies used to advance palliative care. Time management, leading team effort, and inspiring others are important skills that promote effectiveness as a leader. Emerging leaders have a unique view of conceptualizing contemporary palliative care and shaping the future. Providing comprehensive, coordinated care that is high quality, patient and family centered, and readily available depends on strong leadership in palliative care. The Cambia Scholars Program represents a unique opportunity.

The implementation of school-based lesson study at elementary school

Directory of Open Access Journals (Sweden)

Purnomo Purnomo

2017-07-01

Full Text Available This study aims to describe and interpret the implementation of school-based lesson study in SDN I Kretek. This study uses the qualitative research. The data were collected through in-depth interviews, participant observation, field notes, and documentation. The data validity was determined through sources and techniques triangulation. The data were analyzed using the Interactive Analysis Model from Miles and Huberman. The results show: (1 the planning of school-based lesson study program at SDN 1 Kretek has been implemented from the beginning of the school year 2014/2015 by establishing school-based lesson study team. This team is responsible for planning, managing, and evaluating school-based lesson study program at SDN 1 Kretek, (2 school-based lesson study at SDN 1 Kretek is implemented in three phases, namely planning, implementation, and reflection, and (3 The evaluation of lesson study is conducted by each teacher who has conducted the open class and conducted thoroughly with a meeting by a team of school-based lesson study SDN 1 Kretek at the end of the school year.

From theory to application: using performance measures for contraceptive care in the Title X family planning program.

Science.gov (United States)

Loyola Briceno, Ana Carolina; Kawatu, Jennifer; Saul, Katie; DeAngelis, Katie; Frederiksen, Brittni; Moskosky, Susan B; Gavin, Lorrie

2017-09-01

The objective was to describe a Performance Measure Learning Collaborative (PMLC) designed to help Title X family planning grantees use new clinical performance measures for contraceptive care. Twelve Title X grantee-service site teams participated in an 8-month PMLC from November 2015 to June 2016; baseline was assessed in October 2015. Each team documented their selected best practices and strategies to improve performance, and calculated the contraceptive care performance measures at baseline and for each of the subsequent 8 months. PMLC sites implemented a mix of best practices: (a) ensuring access to a broad range of methods (n=7 sites), (b) supporting women through client-centered counseling and reproductive life planning (n=8 sites), (c) developing systems for same-day provision of all methods (n=10 sites) and (d) utilizing diverse payment options to reduce cost as a barrier (n=4 sites). Ten sites (83%) observed an increase in the clinical performance measures focused on most and moderately effective methods (MME), with a median percent change of 6% for MME (from a median of 73% at baseline to 77% post-PMLC). Evidence suggests that the PMLC model is an approach that can be used to improve the quality of contraceptive care offered to clients in some settings. Further replication of the PMLC among other groups and beyond the Title X network will help strengthen the current model through lessons learned. Using the performance measures in the context of a learning collaborative may be a useful strategy for other programs (e.g., Federally Qualified Health Centers, Medicaid, private health plans) that provide contraceptive care. Expanded use of the measures may help increase access to contraceptive care to achieve national goals for family planning. Published by Elsevier Inc.

Plant Identification Characteristics for Deciduous Trees & Shrubs. Lesson Plans.

Science.gov (United States)

Burkholder, Kathy

This manual contains a group of lesson plans designed for use with a slide series (not included here). Its purpose is to introduce students to the basic concepts and terminology used in the identification of deciduous trees and shrubs. The manual is composed of 12 lesson plans. The first lesson is an introduction to plant identification. The…

Transcutaneous electric nerve stimulation (TENS) in dentistry- A review.

Science.gov (United States)

Kasat, Vikrant; Gupta, Aditi; Ladda, Ruchi; Kathariya, Mitesh; Saluja, Harish; Farooqui, Anjum-Ara

2014-12-01

Transcutaneous electric nerve stimulation (TENS) is a non-pharmacological method which is widely used by medical and paramedical professionals for the management of acute and chronic pain in a variety of conditions. Similarly, it can be utilized for the management of pain during various dental procedures as well as pain due to various conditions affecting maxillofacial region. This review aims to provide an insight into clinical research evidence available for the analgesic and non analgesic uses of TENS in pediatric as well as adult patients related to the field of dentistry. Also, an attempt is made to briefly discuss history of therapeutic electricity, mechanism of action of TENS, components of TENs equipment, types, techniques of administration, advantages and contradictions of TENS. With this we hope to raise awareness among dental fraternity regarding its dental applications thereby increasing its use in dentistry. Key words:Dentistry, pain, TENS.

Considerations for implementing an organizational lessons learned process.

Energy Technology Data Exchange (ETDEWEB)

Fosshage, Erik D

2013-05-01

This report examines the lessons learned process by a review of the literature in a variety of disciplines, and is intended as a guidepost for organizations that are considering the implementation of their own closed-loop learning process. Lessons learned definitions are provided within the broader context of knowledge management and the framework of a learning organization. Shortcomings of existing practices are summarized in an attempt to identify common pitfalls that can be avoided by organizations with fledgling experiences of their own. Lessons learned are then examined through a dual construct of both process and mechanism, with emphasis on integrating into organizational processes and promoting lesson reuse through data attributes that contribute toward changed behaviors. The report concludes with recommended steps for follow-on efforts.

Towards a lessons learned system for critical software

International Nuclear Information System (INIS)

Andrade, J.; Ares, J.; Garcia, R.; Pazos, J.; Rodriguez, S.; Rodriguez-Paton, A.; Silva, A.

2007-01-01

Failure can be a major driver for the advance of any engineering discipline and Software Engineering is no exception. But failures are useful only if lessons are learned from them. In this article we aim to make a strong defence of, and set the requirements for, lessons learned systems for safety-critical software. We also present a prototype lessons learned system that includes many of the features discussed here. We emphasize that, apart from individual organizations, lessons learned systems should target industrial sectors and even the Software Engineering community. We would like to encourage the Software Engineering community to use this kind of systems as another tool in the toolbox, which complements or enhances other approaches like, for example, standards and checklists

Towards a lessons learned system for critical software

Energy Technology Data Exchange (ETDEWEB)

Andrade, J. [University of A Coruna. Campus de Elvina, s/n. 15071, A Coruna (Spain)]. E-mail: jag@udc.es; Ares, J. [University of A Coruna. Campus de Elvina, s/n. 15071, A Coruna (Spain)]. E-mail: juanar@udc.es; Garcia, R. [University of A Coruna. Campus de Elvina, s/n. 15071, A Coruna (Spain)]. E-mail: rafael@udc.es; Pazos, J. [Technical University of Madrid. Campus de Montegancedo, s/n. 28660, Boadilla del Monte, Madrid (Spain)]. E-mail: jpazos@fi.upm.es; Rodriguez, S. [University of A Coruna. Campus de Elvina, s/n. 15071, A Coruna (Spain)]. E-mail: santi@udc.es; Rodriguez-Paton, A. [Technical University of Madrid. Campus de Montegancedo, s/n. 28660, Boadilla del Monte, Madrid (Spain)]. E-mail: arpaton@fi.upm.es; Silva, A. [Technical University of Madrid. Campus de Montegancedo, s/n. 28660, Boadilla del Monte, Madrid (Spain)]. E-mail: asilva@fi.upm.es

2007-07-15

Failure can be a major driver for the advance of any engineering discipline and Software Engineering is no exception. But failures are useful only if lessons are learned from them. In this article we aim to make a strong defence of, and set the requirements for, lessons learned systems for safety-critical software. We also present a prototype lessons learned system that includes many of the features discussed here. We emphasize that, apart from individual organizations, lessons learned systems should target industrial sectors and even the Software Engineering community. We would like to encourage the Software Engineering community to use this kind of systems as another tool in the toolbox, which complements or enhances other approaches like, for example, standards and checklists.

Non-infant adoption from care: lessons for safeguarding children.

Science.gov (United States)

Rees, C A; Selwyn, J

2009-07-01

To explore use of adoption in remedying abuse and neglect, to inform child protection practice and to identify professional responsibilities to adoptive families. A cohort of 130 children was identified for whom adoption was recommended in 1991-1996 at a mean age of 5.7 years (range 3-11). All were in local authority care for child protection reasons. information was gathered from social work records. The children were traced between 6 and 11 years later and their adopters interviewed. The Strengths and Difficulties Questionnaire and the Parent-Child Communication Scale were completed. All but three birth parents had traumatic childhoods involving abuse, neglect and/or time in care. Eighty-six per cent had violent adult relationships. Mental illness, learning difficulties and substance abuse were prominent. Sixty-seven per cent of families were known to social services when children were born, but 98% experienced abuse or neglect. Most adopters found the first year challenging, though rewarding. Depression, anxiety and marital problems were common. Children's learning difficulties, conduct problems, emotional 'phoniness' and rejection affected closeness. At follow-up 28% described rewarding, happy placements, and 62% described continuing difficulties tempered by rewards. However, 10% reported no rewards. Hyperactivity and inattention frequently persisted despite stable adoption and were associated with conduct and attachment difficulties. Use of professional services was substantial. Thirty-eight per cent of children failed to achieve stable adoption. Later entry to care correlated with poorer outcome. This study highlights the importance in safeguarding children of considering the implications of parental childhood experiences, and indicates the risk of delay. The high prevalence of domestic violence in birth families indicates the need for better resources for managing emotional dysregulation. Adoption is a valuable therapeutic tool, but professional

Engaging stakeholders: lessons from the use of participatory tools for improving maternal and child care health services.

Science.gov (United States)

Ekirapa-Kiracho, Elizabeth; Ghosh, Upasona; Brahmachari, Rittika; Paina, Ligia

2017-12-28

Effective stakeholder engagement in research and implementation is important for improving the development and implementation of policies and programmes. A varied number of tools have been employed for stakeholder engagement. In this paper, we discuss two participatory methods for engaging with stakeholders - participatory social network analysis (PSNA) and participatory impact pathways analysis (PIPA). Based on our experience, we derive lessons about when and how to apply these tools. This paper was informed by a review of project reports and documents in addition to reflection meetings with the researchers who applied the tools. These reports were synthesised and used to make thick descriptions of the applications of the methods while highlighting key lessons. PSNA and PIPA both allowed a deep understanding of how the system actors are interconnected and how they influence maternal health and maternal healthcare services. The findings from the PSNA provided guidance on how stakeholders of a health system are interconnected and how they can stimulate more positive interaction between the stakeholders by exposing existing gaps. The PIPA meeting enabled the participants to envision how they could expand their networks and resources by mentally thinking about the contributions that they could make to the project. The processes that were considered critical for successful application of the tools and achievement of outcomes included training of facilitators, language used during the facilitation, the number of times the tool is applied, length of the tools, pretesting of the tools, and use of quantitative and qualitative methods. Whereas both tools allowed the identification of stakeholders and provided a deeper understanding of the type of networks and dynamics within the network, PIPA had a higher potential for promoting collaboration between stakeholders, likely due to allowing interaction between them. Additionally, it was implemented within a participatory action

Refining MARGINS Mini-Lessons Using Classroom Observations

Science.gov (United States)

Iverson, E. A.; Manduca, C. A.; McDaris, J. R.; Lee, S.

2009-12-01

One of the challenges that we face in developing teaching materials or activities from research findings is testing the materials to determine that they work as intended. Traditionally faculty develop material for their own class, notice what worked and didn’t, and improve them the next year. However, as we move to a community process of creating and sharing teaching materials, a community-based process for testing materials is appropriate. The MARGINS project has piloted such a process for testing teaching materials and activities developed as part of its mini-lesson project (http://serc.carleton.edu/margins/index.html). Building on prior work developing mechanisms for community review of teaching resources (e.g. Kastens, 2002; Hancock and Manduca, 2005; Mayhew and Hall, 2007), the MARGINS evaluation team developed a structured classroom observation protocol. The goals of field testing are to a) gather structured, consistent feedback for the lesson authors based on classroom use; b) guide reviewers of these lessons to reflect on research-based educational practice as a framework for their comments; c) collect information on the data and observations that the reviewer used to underpin their review; d) determine which mini-lessons are ready to be made widely available on the website. The protocol guides faculty observations on why they used the activity, the effectiveness of the activity in their classroom, the success of the activity in leading to the desired learning, and what other faculty need to successfully use the activity. Available online (http://serc.carleton.edu/margins/protocol.html), the protocol can be downloaded and completed during instruction with the activity. In order to encourage review of mini-lessons using the protocol, a workshop focused on review and revision of activities was held in May 2009. In preparation for the workshop, 13 of the 28 participants chose to field test a mini-lesson prior to the workshop and reported that they found this

When things go wrong: how health care organizations deal with major failures.

Science.gov (United States)

Walshe, Kieran; Shortell, Stephen M

2004-01-01

Concern about patient safety, caused in part by high-profile major failures in which many patients have been harmed, is rising worldwide. This paper draws on examples of such failures from several countries to analyze how these events are dealt with and to identify lessons and recommendations for policy. Better systems are needed for reporting and investigating failures and for implementing the lessons learned. The culture of secrecy, professional protectionism, defensiveness, and deference to authority is central to such major failures, and preventing future failures depends on cultural as much as structural change in health care systems and organizations.

Lessons from Early Medicaid Expansions Under Health Reform..

Data.gov (United States)

U.S. Department of Health & Human Services — Lessons from Early Medicaid Expansions Under Health Reform, Interviews with Medicaid Officials In a new study entitled Lessons from Early Medicaid Expansions Under...

Lessons in Integrating Shared Decision-Making Into Cancer Care

DEFF Research Database (Denmark)

Steffensen, Karina Dahl; Vinter, Mette; Crüger, Dorthe

2018-01-01

The benefits of shared decision-making (SDM) in health care delivery are well documented, but implementing SDM at the institutional level is challenging, particularly when patients have complex illnesses and care needs, as in cancer. Denmark's Lillebaelt Hospital, in creating The Patient's Cancer...... championed. It organized multiple demonstration projects focused on use of decision aids, patient-reported outcome measures, and better communication tools and practices. It designed programs to train clinicians in the art of doctor-patient communication. It used research evidence to inform development...... of the decision aids that its clinicians use with their patients. And it rigorously measured SDM performance in an ongoing fashion so that progress could be tracked and refined to ensure continuous improvement. Initial data on the institution's SDM initiatives from the Danish national annual survey of patients...

Safety and Mission Assurance for In-House Design Lessons Learned from Ares I Upper Stage

Science.gov (United States)

Anderson, Joel M.

2011-01-01

This viewgraph presentation identifies lessons learned in the course of the Ares I Upper Stage design and in-house development effort. The contents include: 1) Constellation Organization; 2) Upper Stage Organization; 3) Presentation Structure; 4) Lesson-Importance of Systems Engineering/Integration; 5) Lesson-Importance of Early S&MA Involvement; 6) Lesson-Importance of Appropriate Staffing Levels; 7) Lesson-Importance S&MA Team Deployment; 8) Lesson-Understanding of S&MA In-Line Engineering versus Assurance; 9) Lesson-Importance of Close Coordination between Supportability and Reliability/Maintainability; 10) Lesson-Importance of Engineering Data Systems; 11) Lesson-Importance of Early Development of Supporting Databases; 12) Lesson-Importance of Coordination with Safety Assessment/Review Panels; 13) Lesson-Implementation of Software Reliability; 14) Lesson-Implementation of S&MA Technical Authority/Chief S&MA Officer; 15) Lesson-Importance of S&MA Evaluation of Project Risks; 16) Lesson-Implementation of Critical Items List and Government Mandatory Inspections; 17) Lesson-Implementation of Critical Items List Mandatory Inspections; 18) Lesson-Implementation of Test Article Safety Analysis; and 19) Lesson-Importance of Procurement Quality.

Reducing health care hazards: lessons from the commercial aviation safety team.

Science.gov (United States)

Pronovost, Peter J; Goeschel, Christine A; Olsen, Kyle L; Pham, Julius C; Miller, Marlene R; Berenholtz, Sean M; Sexton, J Bryan; Marsteller, Jill A; Morlock, Laura L; Wu, Albert W; Loeb, Jerod M; Clancy, Carolyn M

2009-01-01

The movement to improve quality of care and patient safety has grown, but examples of measurable and sustained progress are rare. The slow progress made in health care contrasts with the success of aviation safety. After a tragic 1995 plane crash, the aviation industry and government created the Commercial Aviation Safety Team to reduce fatal accidents. This public-private partnership of safety officials and technical experts is responsible for the decreased average rate of fatal aviation accidents. We propose a similar partnership in the health care community to coordinate national efforts and move patient safety and quality forward.

Ten steps to successful software process improvement

Science.gov (United States)

Kandt, R. K.

2003-01-01

This paper identifies ten steps for managing change that address organizational and cultural issues. Four of these steps are critical, that if not done, will almost guarantee failure. This ten-step program emphasizes the alignment of business goals, change process goals, and the work performed by the employees of an organization.

Lessons from Goiania

International Nuclear Information System (INIS)

Nazari Alves, R.

2000-01-01

The lessons learned from the radiological accident of Goiania in 1987 derived from the observations from the Regulatory Agency which was in charge of the decontamination tasks may be consolidated into four classes: Preventive Actions, characterised as those that aim to minimise the probability of occurrence of a radiological accident; Minimisation of time between the moment of the accident occurrence and the beginning of intervention, in case a radiological accident does occur, despite all preventive measures; Intervention, which is correlated to the type of installation, its geographical location, the social classes involved and their contamination vectors; and Follow up, for which well established rules to allow continuing monitoring of the victims and rebuilding of homes are necessary. The greatest lesson of all was the need for integration of the professionals involved, from all organizations. (author)

Lessons learned on digital systems safety

International Nuclear Information System (INIS)

Sivertsen, Terje

2005-06-01

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

Finnish Students’ Engagement in Science Lessons

Directory of Open Access Journals (Sweden)

Janna Linnansaari

2015-05-01

Full Text Available The decreasing number of students who are engaged in science learning has been recognised as a problem. The pre-conditions of engagement and actual engagement were examined using a novel research method to obtain detailed information on Finnish students’ engagement in different situations and to gain a better understanding of this phenomenon. The study’s participants consisted of 68 students (31 girls, 37 boys from 9th grade and 67 students (46 girls, 21 boys from 1st grade in upper secondary school. The research aimed to answer the following question: How does Finnish students’ engagement occur in exact and life science lessons? Participants received smartphones equipped with a smartphone application that included an experience sampling method questionnaire. The smartphones were programmed to emit a signal during every science lesson and otherwise randomly during the day (from 8 am to 8 pm. The results reveal that situation and grade had significant effects on students’ pre-conditions of engagement and actual engagement. Our results also show that girls had the highest interest in life science lessons and boys in exact science lessons.

Lesson Study-Building Communities of Learning Among Pre-Service Science Teachers

Science.gov (United States)

Hamzeh, Fouada

Lesson Study is a widely used pedagogical approach that has been used for decades in its country of origin, Japan. It is a teacher-led form of professional development that involves the collaborative efforts of teachers in co-planning and observing the teaching of a lesson within a unit for evidence that the teaching practices used help the learning process (Lewis, 2002a). The purpose of this research was to investigate if Lesson Study enables pre-service teachers to improve their own teaching in the area of science inquiry-based approaches. Also explored are the self-efficacy beliefs of one group of science pre-service teachers related to their experiences in Lesson Study. The research investigated four questions: 1) Does Lesson Study influence teacher preparation for inquiry-based instruction? 2) Does Lesson Study improve teacher efficacy? 3) Does Lesson Study impact teachers' aspiration to collaborate with colleagues? 4) What are the attitudes and perceptions of pre-service teachers to the Lesson Study idea in Science? The 12 participants completed two pre- and post-study surveys: STEBI- B, Science Teaching Efficacy Belief Instrument (Enochs & Riggs, 1990) and ASTQ, Attitude towards Science Teaching. Data sources included student teaching lesson observations, lesson debriefing notes and focus group interviews. Results from the STEBI-B show that all participants measured an increase in efficacy throughout the study. This study added to the body of research on teaching learning communities, professional development programs and teacher empowerment.

Lessons of nuclear robot history

International Nuclear Information System (INIS)

Oomichi, Takeo

2014-01-01

Severe accidents occurred at Fukushima Daiichi Nuclear Power Station stirred up people's great expectation of nuclear robot's deployment. However unexpected nuclear disaster, especially rupture of reactor building caused by core meltdown and hydrogen explosion, made it quite difficult to introduce nuclear robot under high radiation environment to cease accidents and dispose damaged reactor. Robotics Society of Japan (RSJ) set up committee to look back upon lessons learned from 50 year's past experience of nuclear robot development and summarized 'Lessons of nuclear robot history', which was shown on the home page website of RSJ. This article outlined it with personal comment. History of nuclear robot developed for inspection and maintenance at normal operation and for specific required response at nuclear accidents was reviewed with many examples at home and abroad for TMI, Chernobyl and JCO accidents. Present state of Fukushima accident response robot's introduction and development was also described with some comments on nuclear robot development from academia based on lessons. (T. Tanaka)

PENERAPAN LESSON STUDY UNTUK MENINGKATAN KEMAMPUAN MENGAJAR MAHASISWA CALON GURU FISIKA

Directory of Open Access Journals (Sweden)

Rif’ati Dina Handayani

2015-02-01

ABSTRAK Lesson study merupakan suatu model pengembangan kemampuan mengajar melalui pengkajian pembelajaran secara kolaboratif dan berkelanjutan. Lesson study dilaksanakan dalam tiga tahapan, yaitu plan, do, see yang dilaksanakan secara terstruktur, bersiklus dan berkelanjutan. Dalam penelitian ini subjek dari pelaksanaan lesson study adalah empat orang  mahasiswa calon guru fisika yang sedang melaksanakan PPL di salah satu SMP Negeri di Bondowoso. Hasil penelitian menunjukkan bahwa penerapan lesson study dapat meningkatkan kemampuan mengajar mahasiswa calon guru fisika dari kriteria kurang baik menjadi kriteria sangat baik. Kata kunci: Calon guru fisika, Lesson Study, Kemampuan Mengajar

Provider-Sponsored Health Plans: Lessons Learned over Three Decades.

Science.gov (United States)

Breon, Richard C

2016-01-01

Healthcare's movement to value-based care is causing health systems across the country to consider whether owning or partnering with a health plan could benefit their organizations. Although organizations have different reasons for wanting to enter the insurance business, potential benefits include improving care quality, lowering costs, managing population health, expanding geographic reach, and diversifying the organization's revenue stream. However, the challenges and risks of owning a health plan are formidable: Assuming 100 percent financial risk for a patient population requires considerable financial resources, as well as competencies that are wholly different from those needed to run a hospital or physician group. For Spectrum Health, an integrated, not-for-profit health system based in Grand Rapids, Michigan, owning a health plan has been vital to fulfilling its mission of improving the health of the communities it serves, as well as its value proposition of providing highquality care at lower costs. This article weighs the pros and cons of operating a health plan; explores key business factors and required competencies that organizations need to consider when deciding whether to buy, build, or partner; examines the current environment for provider-sponsored health plans; and shares some of the lessons Spectrum Health has learned over three decades of running its health plan, Priority Health.

Constellation Program: Lessons Learned. Volume 1; Executive Summary

Science.gov (United States)

Rhatigan, Jennifer L. (Editor)

2011-01-01

This document (Volume I) provides an executive summary of the lessons learned from the Constellation Program. A companion Volume II provides more detailed analyses for those seeking further insight and information. In this volume, Section 1.0 introduces the approach in preparing and organizing the content to enable rapid assimilation of the lessons. Section 2.0 describes the contextual framework in which the Constellation Program was formulated and functioned that is necessary to understand most of the lessons. Context of a former program may seem irrelevant in the heady days of new program formulation. However, readers should take some time to understand the context. Many of the lessons would be different in a different context, so the reader should reflect on the similarities and differences in his or her current circumstances. Section 3.0 summarizes key findings developed from the significant lessons learned at the program level that appear in Section 4.0. Readers can use the key findings in Section 3.0 to peruse for particular topics, and will find more supporting detail and analyses in Section 4.0 in a topical format. Appendix A contains a white paper describing the Constellation Program formulation that may be of use to readers wanting more context or background information. The reader will no doubt recognize some very similar themes from previous lessons learned, blue-ribbon committee reviews, National Academy reviews, and advisory panel reviews for this and other large-scale human spaceflight programs; including Apollo, Space Shuttle, Shuttle/Mir, and the ISS. This could represent an inability to learn lessons from previous generations; however, it is more likely that similar challenges persist in the Agency structure and approach to program formulation, budget advocacy, and management. Perhaps the greatest value of these Constellation lessons learned can be found in viewing them in context with these previous efforts to guide and advise the Agency and its

Development of short Indonesian lesson plan to improve teacher performance

Science.gov (United States)

Yulianto, B.; Kamidjan; Ahmadi, A.; Asteria, P. V.

2018-01-01

The developmental research was motivated by the results of preliminary study through interviews, which revealed almost all of the teachers did not create lesson plan themselves. As a result of this load, the performance of the real learning in the classroom becomes inadequate. Moreover, when lesson plan was not made by teachers themselves, the learning process becomes ineffective. Therefore, this study designed to develop a prototype of the short lesson plan, in particular, Indonesian language teaching, and to investigate its effectiveness. The participants in the study were teachers who were trained through lesson study group to design short model’s lesson plan. Questionnaires and open-ended questions were used, and the quantitative and qualitative data obtained were analyzed accordingly. The analysis of the quantitative data, aided with SPSS, were frequency, percentage, and means, whereas the qualitative data were analyzed descriptively. The results showed that the teachers liked the model, and they were willing to design their own lesson plan. The observation data revealed that the classroom learning process became more interactive, and classroom atmosphere was more engaging and natural because the teachers did not stick to the lesson plan made by other teachers.

Equity in mobility : learning from health care, education and especially housing

NARCIS (Netherlands)

Jeekel, J.F.; Martens, K.

2016-01-01

The objective of the paper is, first, to identify the principles of justice that guide the policy domains of health care, education and housing, and, second, to explore what lessons could be drawn for the domain of transportation. Like policies in the three other domains, interventions in the

Lessons Learned from L'Aquila Trial for Scientists' Communication

Science.gov (United States)

Koketsu, K.; Cerase, A.; Amato, A.; Oki, S.

2017-12-01

The Appeal and Supreme Courts of Italy concluded that there was no bad communication by defendants except for the "glass of wine interview" which was made by a government official before the scientists' meeting. This meeting was held 6 days before the 2009 L'Aquila earthquake to discuss the outlook for the seismic activity in the L'Aquila area. However, at least two TV stations and a newspaper reported the content of the "glass of wine interview" in the next morning as it was announced by the defendant scientists. The reports triggered a domino effect of misinterpretations, which may be well acknowledged in the light of the social amplification of risk framework. These TV stations and newspaper should be also considered responsible for the bad communication. This point was missing in the sentence documents by the Appeal and Supreme Courts. Therefore, for scientists, a lesson of communication, especially during a seismic hazard crisis, is that they must carefully craft their messages and the way they circulate, both in broadcast and digital media, and follow reports released by the media on their activities. As another lesson, scientists must be aware that key concepts of safety such as "no danger" and "favorable situation", which were used in the "glass of wine interview", and the idea of probability can have different meanings for scientists, media, and citizens.

Process and impact evaluation of the Romp & Chomp obesity prevention intervention in early childhood settings: lessons learned from implementation in preschools and long day care settings.

Science.gov (United States)

de Silva-Sanigorski, Andrea M; Bell, Andrew C; Kremer, Peter; Park, Janet; Demajo, Lisa; Smith, Michael; Sharp, Sharon; Nichols, Melanie; Carpenter, Lauren; Boak, Rachel; Swinburn, Boyd

2012-06-01

The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children's dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention. Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups. The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs. These results provide confidence that obesity prevention interventions in children's settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health

Pacemaker Primary Curriculum; Lesson Book Level B.

Science.gov (United States)

Ross, Dorothea M.; Ross, Sheila A.

This lesson book, which is the second in a four-level program for young children with learning difficulties, describes the purpose of and equipment and procedures for teaching lessons in the following subjects areas on the primary grade level: arithmetic, reading, vocabulary, listening, planning, problem solving, social behavior, art, music, and…

Pacemaker Primary Curriculum; Lesson Book Level A.

Science.gov (United States)

Ross, Dorothea M.; Ross, Sheila A.

This lesson book, which is the first in a four-level program for young children with learning difficulties, describes the purpose of and equipment and procedures for teaching lessons in the following subject areas on the kindergarten level: arithmetic concepts, number concepts, reading readiness, vocabulary, language, listening, social behavior,…

Pacemaker Primary Curriculum; Lesson Book Level C.

Science.gov (United States)

Ross, Dorothea M.; Ross, Sheila A.

This lesson book, which is the third in a four-level program for young children with learning difficulties, describes the purpose of and equipment and procedures for teaching lessons in the following subject areas on the primary grade level: arithmetic, reading, vocabulary, spelling, printing, listening, planning, problem solving, social behavior,…

Pacemaker Primary Curriculum; Lesson Book Level D.

Science.gov (United States)

Ross, Dorothea M.; Ross, Sheila A.

This lesson book, which is the last in a four-level program for young children with learning difficulties, describes the purpose of and equipment and procedures for teaching lessons in the following subject areas on the primary level: arithmetic, reading, vocabulary, spelling, printing, listening, planning and problem solving, social behavior,…

Examining approaches to renewables consultation. Lessons from Awel Aman Tawe community wind farm project

Energy Technology Data Exchange (ETDEWEB)

Hinshelwood, E; McCallum, D

2001-07-01

The overall aim was to develop and test a range of methods for a Participatory Assessment Process (PAP) in a large community on the subject of a Renewable Energy project in the area. Furthermore, to extract lessons regarding the methods and approaches undertaken. The specific objectives were: 1. To identify and shape appropriate tools, methods and approaches for undertaking a fair community assessment process regarding a Renewable Energy project in the locality. 2. To conduct an in-depth (ten month) community consultation and assessment process for a proposed wind farm. 3. To assess the methods and approaches used in the community consultation and assessment process for their efficiency and value to other developers and community groups. 4. To write up and disseminate the findings regarding the most valuable, efficient and appropriate methods and approaches undertaken. (Author)

Lessons learned from first generation nuclear plant probabalistic risk assessments

International Nuclear Information System (INIS)

Garrick, B.J.

1984-01-01

The paper by Garrick summarizes the state-of-the-art in what are perhaps the most archetypical probabilistic risk assessments (PRAs). Because of its unique regulatory environment and because of the high levels of perceived (not necessarily actual) risk, the nuclear industry more than any other has been concerned with quantitative risk analysis. Garrick's paper summarizes the lessons learned from ten PRA's conducted in the nuclear industry, including six that can be characterized as full-scope risk studies. Most of the quantitative data, though, came from two especially thorough studies done for the Zion and Indian Point power plants, operated by Commonwealth Edison and Consolidated Edison respectively. The principal conclusions of the Garrick survey are that the public risk (from radiation release) is now known to be very small for commercial nuclear power plants, but that the risk to utilities (from core damage) is somewhat larger. Significant radiation releases require both core meltdown -- an event occurring only about once every 10,000 reactor-years -- and containment failure, occurring only about once in every hundred meltdowns

A Worldwide Production Grid Service Built on EGEE and OSG Infrastructures Lessons Learnt and Long-term Requirements

International Nuclear Information System (INIS)

Shiers, J.; Dimou, M.; Mendez Lorenzo, P.

2007-01-01

Using the Grid Infrastructures provided by EGEE, OSG and others, a worldwide production service has been built that provides the computing and storage needs for the 4 main physics collaborations at CERN's Large Hadron Collider (LHC). The large number of users, their geographical distribution and the very high service availability requirements make this experience of Grid usage worth studying for the sake of a solid and scalable future operation. This service must cater for the needs of thousands of physicists in hundreds of institutes in tens of countries. A 24x7 service with availability of up to 99% is required with major service responsibilities at each of some ten T ier1 a nd of the order of one hundred T ier2 s ites. Such a service - which has been operating for some 2 years and will be required for at least an additional decade - has required significant manpower and resource investments from all concerned and is considered a major achievement in the field of Grid computing. We describe the main lessons learned in offering a production service across heterogeneous Grids as well as the requirements for long-term operation and sustainability. (Author)

Medical support to Sri Lanka in the wake of tsunamis: planning considerations and lessons learned.

Science.gov (United States)

Lane, David A

2006-10-01

When massive tsunamis affected the coast of Sri Lanka and other Indian Ocean littorals, elements of the Third Force Service Support Group and assigned Navy, Air Force, Army, and Coast Guard units from the U.S. Pacific Command were "task organized" to form Combined Support Group-Sri Lanka (CSG-SL), charged to conduct humanitarian assistance/disaster relief (HA/DR) operations. The specific mission was to provide immediate relief to the affected population of Sri Lanka and the Maldives, to minimize loss of life, and to mitigate human suffering. A 30-person health care team deployed to the northern province of Jaffna and provided medical assistance to that chronically underserved and acutely overstressed region. For a 12-day period, the team served as the principal medical staff of an under-resourced government hospital and conducted mobile primary care clinics at nearby welfare camps housing > 7,000 internally displaced persons made homeless by the tsunamis. By every measurable standard, CSG-SL accomplished its assigned HA/DR task in Sri Lanka, including the medical mission. In doing so, the medical team learned many important lessons, including five of particular value to planners of similar relief operations in the future. This article discusses the context in which CSG-SL planned and executed the medical aspects of its HA/DR operations in Sri Lanka, and it describes the most significant medical lessons learned.

Knowledge and Cognitive Process Dimensions of Technology Teachers' Lesson Objectives

Science.gov (United States)

Mathumbu, David; Rauscher, Willem; Braun, Max

2014-01-01

A clearly stated lesson objective is considered an essential component of a well-planned lesson. Many teachers of Technology, a relatively new subject in South African schools, teach Technology with rather limited training both in content and methodological approaches. This study sought to investigate and classify lesson objectives framed or…

Connecting polar research to NGSS STEM classroom lessons

Science.gov (United States)

Brinker, R.; Kast, D.

2016-12-01

Next Generation Science Standards (NGSS) are designed to bring consistent, rigorous science teaching across the United States. Topics are categorized as Performance Expectations (PE), Disciplinary Core Ideas (DCI), Cross-Cutting Concepts (CCC), and Science and Engineering Practices (SEP). NGSS includes a focus on environmental science and climate change across grade levels. Earth and planetary sciences are required at the high school level. Integrating polar science lessons into NGSS classrooms brings relevant, rigorous climate change curriculum across grade levels. Polar science provides opportunities for students to use current data during lessons, conduct their own field work, and collaborate with scientists. Polar science provides a framework of learning that is novel to most students. Inquiry and engagement are high with polar science lessons. Phenomenon related to polar science provide an excellent tool for science teachers to use to engage students in a lesson, stimulate inquiry, and promote critical thinking. When taught effectively, students see the connections between their community, polar regions and climate change, regardless of where on the planet students live. This presentation describes examples of how to effectively implement NGSS lessons by incorporating polar science lessons and field research. Examples of introductory phenomenon and aligned PEs, CCCs, DCIs, and SEPs are given. Suggested student activities, assessments, examples of student work, student research, labs, and PolarTREC fieldwork, use of current science data, and connections to scientists in the field are provided. The goals of the presentation are to give teachers a blueprint to follow when implementing NGSS lessons, and give scientists an understanding of the basics of NGSS so they may be better able to relate their work to U.S. science education and be more effective communicators of their science findings.

Effective Lesson Planning: Field Trips in the Science Curriculum

Science.gov (United States)

Rieger, C. R.

2010-10-01

Science field trips can positively impact and motivate students. However, if a field trip is not executed properly, with appropriate preparation and follow-up reinforcement, it can result in a loss of valuable educational time and promote misconceptions in the students. This study was undertaken to determine if a classroom lesson before an out-of-the-classroom activity would affect learner gain more or less than a lesson after the activity. The study was based on the immersive theater movie ``Earth's Wild Ride'' coupled with a teacher-led Power Point lesson. The participants in the study were students in a sixth grade physical science class. The order of lessons showed no detectable effect on final learner outcomes. Based on pre- and post-testing, improvement in mean learning gain came from the teacher-led lesson independent of the movie. The visit to the immersive theater, however, had significant positive effects that did not show up in the quantitative results of the testing.

The origin of the future ten questions for the next ten years

CERN Document Server

Gribbin, John

2006-01-01

How did the universe begin? Where do galaxies come from? How do stars and planets form? Where do the material particles we are made of come from? How did life begin? Today we have only provisional answers to such questions. But scientific progress will improve these answers dramatically over the next ten years, predicts John Gribbin in this riveting book. He focuses on what we know—or think we know—about ten controversial, unanswered issues in the physical sciences and explains how current cutting-edge research may yield solutions in the very near future. With his trademark facility for engaging readers with or without a scientific background, the author explores ideas concerning the creation of the universe, the possibility of other forms of life, and the fate of the expanding cosmos. He examines “theories of everything,” including grand unified theories and string theory, and he discusses the Big Bang theory, the origin of structure and patterns of matter in the galaxies, and dark mass and dark ene...

Field building: lessons from the Robert Wood Johnson Foundation's anthology series.

Science.gov (United States)

Isaacs, Stephen L; Knickman, James R

2005-01-01

As editors of the Robert Wood Johnson Foundation's (RWJF's) anthology series, we have examined the entire range of the foundation's grant making since 1972. We found that the RWJF has enjoyed considerable success in building fields--from nurse practitioners to tobacco control to end-of-life care. The RWJF has done this by shaping fields as they were emerging, by adopting a wide-ranging "bear hug" approach, and by staying the course. The lessons from the RWJF's field-building efforts are relevant for both large and small foundations: Small funders can develop strategic plans aimed at building fields in their home state or locality.

Noncombatant Evacuation Operations: Department of State’s Lessons Learned Program

Science.gov (United States)

2016-06-10

means for utilizing the lessons learned, in some form of rehearsal or exercise, will 4 make the lessons learned meaningful. A lesson should only...required by DOS policy. The Department agreed with the recommendations to establish certain procedures to address the need to constantly 44 update...doctrine.31 Futch also explained that CALL is constantly seeking to expand training and educational efforts about the lessons learned process and

Integrated community-based dementia care: the Geriant model

Directory of Open Access Journals (Sweden)

Ludo Glimmerveen

2015-09-01

Full Text Available This article gives an in-depth description of the service delivery model of Geriant, a Dutch organization providing community-based care services for people suffering from dementia. Core to its model is the provision of clinical case management, embedded in multidisciplinary dementia care teams. As Geriant's client group includes people from the first presumption of dementia until they can no longer live at home, its care model provides valuable lessons about how different mechanisms of integration are flexibly put to use if the complexity of clients” care needs increases. It showcases how the integration of services for a specific sub-population is combined with alignment of these services with generalist network partners. After a detailed description of the programme and its results, this article builds on the work of Walter Leutz for a conceptual discussion of Geriant's approach to care integration. 

Leadership in American Indian Communities: Winter Lessons

Science.gov (United States)

Metoyer, Cheryl A.

2010-01-01

Winter lessons, or stories told in the winter, were one of the ways in which tribal elders instructed and directed young men and women in the proper ways to assume leadership responsibilities. Winter lessons stressed the appropriate relationship between the leader and the community. The intent was to remember the power and purpose of that…

Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain.

Science.gov (United States)

Milne, S; Welch, V; Brosseau, L; Saginur, M; Shea, B; Tugwell, P; Wells, G

2001-01-01

Low back pain (LBP) affects a large proportion of the population. Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as an alternative therapy to pharmacological treatments for chronic pain. However, despite its widespread use, the effectiveness of TENS is still controversial. The aim of this systematic review was to determine the efficacy of TENS in the treatment of chronic LBP. We searched MEDLINE, EMBASE, PEDro and the Cochrane Controlled Trials Register up to June 1, 2000. Only randomized controlled clinical trials of TENS for the treatment of patients with a clinical diagnosis of chronic LBP were included. Abstracts were excluded unless further data could be obtained from the authors. Two reviewers independently selected trials and extracted data using predetermined forms. Heterogeneity was tested with Cochran's Q test. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results are presented as weighted mean differences (WMD) with 95% confidence intervals (95% CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences (SMD) were calculated by dividing the difference between the treated and control by the baseline variance. SMD were used when different scales were used to measure the same concept. Dichotomous outcomes were analyzed with odds ratios. Five trials were included, with 170 subjects randomized to the placebo group receiving sham-TENS and 251 subjects receiving active TENS (153 for conventional mode, 98 for acupuncture-like TENS). The schedule of treatments varied greatly between studies ranging from one treatment/day for two consecutive days, to three treatments/day for four weeks. There were no statistically significant differences between the active TENS group when compared to the placebo TENS group for any outcome measures

Mathematics teachers’ reflective practice within the context of adapted lesson study

Directory of Open Access Journals (Sweden)

Barbara Posthuma

2012-11-01

Full Text Available There seems to be paucity of research in South Africa on mathematics teachers’ reflective practice. In order to study this phenomenon, the context of lesson study (in an adapted form was introduced to five mathematics teachers in a rural school in the Free State. The purpose was to investigate their reflective practice whilst they collaboratively planned mathematics lessons and reflected on the teaching of the lessons. Data were obtained through interviews, video-recorded lesson observations, field notes taken during the lesson study group meetings and document analyses (lesson plans and reflective writings. The adapted lesson study context provided a safe space for teachers to reflect on their teaching and they reported an increase in self-knowledge and finding new ways of teaching mathematics to learners. This finding has some potential value for planning professional learning programmes in which teachers are encouraged to talk about their classroom experiences, share their joys and challenges with one another and strive to build a community of reflective practitioners to enhance their learners’ understanding of mathematics.

A Worldwide Production Grid Service Built on EGEE and OSG Infrastructures – Lessons Learnt and Long-term Requirements

CERN Document Server

Shiers, J; Dimou, M; CERN. Geneva. IT Department

2007-01-01

Using the Grid Infrastructures provided by EGEE, OSG and others, a worldwide production service has been built that provides the computing and storage needs for the 4 main physics collaborations at CERN's Large Hadron Collider (LHC). The large number of users, their geographical distribution and the very high service availability requirements make this experience of Grid usage worth studying for the sake of a solid and scalable future operation. This service must cater for the needs of thousands of physicists in hundreds of institutes in tens of countries. A 24x7 service with availability of up to 99% is required with major service responsibilities at each of some ten "Tier1" and of the order of one hundred "Tier2" sites. Such a service - which has been operating for some 2 years and will be required for at least an additional decade - has required significant manpower and resource investments from all concerned and is considered a major achievement in the field of Grid computing. We describe the main lessons...

Confronting the fear factor: the coverage/access disparity in universal health care.

Science.gov (United States)

Litow, Mark E

2007-01-01

Since their introduction following World War II, single-payer health care systems and universally mandated health care systems have stumbled, but in their pratfalls are many lessons that apply to the universal health care proposals currently on the table in the United States. The critical and often-over-looked point is that universal coverage does not guarantee that individuals will receive needed care--In many cases guaranteed access to care is a false promise or available only on a delayed timetable. A more feasible alternative lies in providing a safety net for citizens who truly need care and financial support with an appropriate system of checks and balances--without disrupting the economic and actuarial fundamental principles of supply and demand and risk classification.

Summary of Planned Implementation for the HTGR Lessons Learned Applicable to the NGNP

International Nuclear Information System (INIS)

Mckirdy, Ian

2011-01-01

This document presents a reconciliation of the lessons learned during a 2010 comprehensive evaluation of pertinent lessons learned from past and present high temperature gas-cooled reactors that apply to the Next Generation Nuclear Plant Project along with current and planned activities. The data used are from the latest Idaho National Laboratory research and development plans, the conceptual design report from General Atomics, and the pebble bed reactor technology readiness study from AREVA. Only those lessons related to the structures, systems, and components of the Next Generation Nuclear Plant (NGNP), as documented in the recently updated lessons learned report are addressed. These reconciliations are ordered according to plant area, followed by the affected system, subsystem, or component; lesson learned; and finally an NGNP implementation statement. This report (1) provides cross references to the original lessons learned document, (2) describes the lesson learned, (3) provides the current NGNP implementation status with design data needs associated with the lesson learned, (4) identifies the research and development being performed related to the lesson learned, and (5) summarizes with a status of how the lesson learned has been addressed by the NGNP Project.

The Implementation of Lesson Study to Strengthen Students: Understanding Participation and Application Capabilities in History Education Research Method on Topic Research and Development

Science.gov (United States)

Towaf, Siti Malikhah

2016-01-01

Learning can be observed from three-dimensions called: effectiveness, efficiency, and attractiveness of learning. Careful study carried out by analyzing the learning elements of the system are: input, process, and output. Lesson study is an activity designed and implemented as an effort to improve learning in a variety of dimensions. "Lesson…

Gross Domestic Pizza. Active Learning Lessons. Economics International.

Science.gov (United States)

Zaleskiene, Irena; Venger, Anatoly; MacDonald, Rich; Davis, Debbie

This lesson plan was developed through "Economics International," an international program to help build economic education infrastructures in the emerging market economies. It provides a lesson description; appropriate age level; economic concepts; content standards and benchmarks; related subject areas; instructional objectives; time…

Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems.

Science.gov (United States)

Mueller, Keith J; Potter, Andrew J; MacKinney, A Clinton; Ward, Marcia M

2014-02-01

Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion.

A Ten-Year Reflection

Science.gov (United States)

Phillip, Cyndi

2016-01-01

Five initiatives launched during Cyndi Phillip's term as American Association of School Librarians (AASL) President (2006-2007) continue to have an impact on school librarians ten years later. They include the rewriting of AASL's learning standards, introduction of the SKILLS Act, the presentation of the Crystal Apple Award to Scholastic Library…

Diabetes self-care: lessons from research on the family and broader contexts.

Science.gov (United States)

Anderson, Barbara J

2003-04-01

The foundation of diabetes management is the self-care behavior of the patient. All of the systems within which the person with diabetes interacts, as well as the media and broader social and cultural values, affect this self-care behavior. In this article I focus on recent research that has examined the link between relationships in the patient's intimate network (i.e., family and close friends) and in the patient's exchange network (i.e., patient-provider relationship, Internet support). The goal of this review is to identify relational targets associated with self-care behaviors that are potentially modifiable within the diabetes medical care setting. Evidence-based suggestions are made for points of intervention entry, and areas for future research are explored.

NIDCAP and developmental care

Directory of Open Access Journals (Sweden)

Dominique Haumont

2014-06-01

Full Text Available Perinatal mortality in very low birth weight infants has dramatically decreased during the last decades. However, 15-25% of these infants will show neurodevelopmental impairment later on. The aim of implementing early developmental care (EDC, emerged as a new field in neonatology, is to create an intervention program designed to provide support for optimal neurobehavioral development during this highly vulnerable period of brain growth. The theoretical framework, which underlies the approach, is supported by research in different scientific fields, including neuroscience, psychology, medicine and nursing. EDC utilizes a range of medical and nursing interventions that aim to decrease the stress of preterm neonates in neonatal intensive care units (NICUs. The Neonatal Individualized Developmental Care Assessment Program (NIDCAP is an integrated and holistic form of family-centered developmental care. Changing the traditional NICU towards an EDC-NICU includes training nursing and medical staff, investing in their quality and most importantly keeping parents in proximity to the infants. The new challenge of modern neonatology is to restore the mother-infant dyad applying “couplet care” starting at birth until discharge. Most of the European NICUs apply some elements of EDC, but it is more consistent in northern Europe. The development of NIDCAP training centers in Europe demonstrates the evolution of care. It is likely that future research and intervention programs will optimize our practices. Developmental care could prove to be an important recent step in improving outcome in extremely preterm neonates. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

Medical faculty members' attitude on lesson planning Semnan University of Medical Sciences

Directory of Open Access Journals (Sweden)

Masomeh Saberian

2003-01-01

Full Text Available Background: Lesson planning has a distinct role in enhancing education quality, as well as maintaining the friendly and dynamic atmosphere of the academic environment and increasing student's initiatives for achieving better educational attainments. Lesson planning is a process for defining the goals, understanding the needs, and specifying available tools and possible limitations. Lesson planning is a written description of this process, which shows the materials, the route, the time, and the place of instructions, as well as a method for evaluating students. Purpose: to identify the attitudes of Semnan University of Medical Sciences (SUMS on lesson planning. Methods: Fifty-three faculty members of the SUMS participated in this study. A questionnaire was used, which contained 8 demographic questions, and 24 r questions for identification the faculty members' attitude. Questionnaires were distributed among the faculty members in sealed envelopes, without denoting their names. The questionnaires were gathered after being completed. Results were analyzed by calculating the mean, standard deviation, absolute and relative frequencies, and using Chi-square and Fischer exact test at the level of 5%. Results: II was shown that 88% of faculty members favoured lesson planning before the beginning of the semester. But they found lesson planning a difficult task, because of their heavy workload. Of the faculty members, 60.4% organized their teaching classes according to a designed lesson plan, and believed that it did affect the quality of their teaching, but 49.1% disagreed with distributing the designed lesson plan among the students. Discussion: Although professor favoured lesson planning and find it necessary to work according to such a plan, workload and lack of knowledge are defined as two main obstacles in doing so. It is believed that by decreasing the professor's workload and provision of lesson planning workshops, these problems could be solved

Lessons learned from AU PSO-missions in Africa

DEFF Research Database (Denmark)

Mandrup, Thomas

The paper deals with the lessons learned from AU's PSO since 2002, and what that entails for the design of future PSO.......The paper deals with the lessons learned from AU's PSO since 2002, and what that entails for the design of future PSO....

Lessons learned from case studies of inhalation exposures of workers to radioactive aerosols

Energy Technology Data Exchange (ETDEWEB)

Hoover, M.D.; Fencl, A.F.; Newton, G.J. [and others

1995-12-01

Various Department of Energy requirements, rules, and orders mandate that lessons learned be identified, evaluated, shared, and incorporated into current practices. The recently issued, nonmandatory DOE standard for Development of DOE Lessons Learned Program states that a DOE-wide lessons learned program will {open_quotes}help to prevent recurrences of negative experiences, highlight best practices, and spotlight innovative ways to solve problems or perform work more safely, efficiently, and cost effectively.{close_quotes} Additional information about the lessons learned program is contained in the recently issued DOE handbook on Implementing U.S. Department of Energy Lessons Learned Programs and in October 1995 DOE SAfety Notice on Lessons Learned Programs. This report summarizes work in progress at ITRI to identify lessons learned for worker exposures to radioactive aerosols, and describes how this work will be incorporated into the DOE lessons learned program, including a new technical guide for measuring, modeling, and mitigating airborne radioactive particles. Follow-on work is focusing on preparation of {open_quotes}lessons learned{close_quotes} training materials for facility designers, managers, health protection professionals, line supervisors, and workers.

Lessons learned from case studies of inhalation exposures of workers to radioactive aerosols

International Nuclear Information System (INIS)

Hoover, M.D.; Fencl, A.F.; Newton, G.J.

1995-01-01

Various Department of Energy requirements, rules, and orders mandate that lessons learned be identified, evaluated, shared, and incorporated into current practices. The recently issued, nonmandatory DOE standard for Development of DOE Lessons Learned Program states that a DOE-wide lessons learned program will open-quotes help to prevent recurrences of negative experiences, highlight best practices, and spotlight innovative ways to solve problems or perform work more safely, efficiently, and cost effectively.close quotes Additional information about the lessons learned program is contained in the recently issued DOE handbook on Implementing U.S. Department of Energy Lessons Learned Programs and in October 1995 DOE SAfety Notice on Lessons Learned Programs. This report summarizes work in progress at ITRI to identify lessons learned for worker exposures to radioactive aerosols, and describes how this work will be incorporated into the DOE lessons learned program, including a new technical guide for measuring, modeling, and mitigating airborne radioactive particles. Follow-on work is focusing on preparation of open-quotes lessons learnedclose quotes training materials for facility designers, managers, health protection professionals, line supervisors, and workers

Head and neck trauma in Iraq and Afghanistan: different war, different surgery, lessons learned.

Science.gov (United States)

Brennan, Joseph

2013-10-01

The objectives are to compare and contrast the head and neck trauma experience in Iraq and Afghanistan and to identify trauma lessons learned that are applicable to civilian practice. A retrospective review of one head and neck surgeon's operative experience in Iraq and Afghanistan was performed using operative logs and medical records. The surgeon's daily operative log book with patient demographic data and operative reports was reviewed. Also, patient medical records were examined to identify the preoperative and postoperative course of care. The head and neck trauma experiences in Iraq and Afghanistan were very different, with a higher percentage of emergent cases performed in Iraq. In Iraq, only 10% of patients were pretreated at a facility with surgical capabilities. In Afghanistan, 93% of patients were pretreated at such facilities. Emergent neck exploration for penetrating neck trauma and emergent airway surgery were more common in Iraq, which most likely accounted for the increased perioperative mortality also seen in Iraq (5.3% in Iraq vs. 1.3% in Afghanistan). Valuable lessons regarding soft tissue trauma repair, midface fracture repair, and mandible fracture repair were learned. The head and neck trauma experiences in Iraq and Afghanistan were very different, and the future training for mass casualty trauma events should reflect these differences. Furthermore, valuable head and neck trauma lessons learned in both war zones are applicable to the civilian practice of trauma. Level 4. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Biotech Business Lessons for Defense Acquisition

Science.gov (United States)

2016-01-01

repudiates what func- tional personnel hold dear—that their hurdles are vital to some moral or ethical responsibility to protect or safeguard...94 Strategic Studies Quarterly ♦ Summer 2016 Biotech Business Lessons for Defense Acquisition Col David L. Peeler Jr., USAF Abstract The desire to...examples and lessons from private business sectors would serve DOD interests well. ✵ ✵ ✵ ✵ ✵ Acquisition reform! No other two words so stress or trouble

Improving the primary school science learning unit about force and motion through lesson study

Science.gov (United States)

Phaikhumnam, Wuttichai; Yuenyong, Chokchai

2018-01-01

The study aimed to develop primary school science lesson plan based on inquiry cycle (5Es) through lesson study. The study focused on the development of 4 primary school science lesson plans of force and motion for Grade 3 students in KKU Demonstration Primary School (Suksasart), first semester of 2015 academic year. The methodology is mixed method. The Inthaprasitha (2010) lesson study cycle was implemented in group of KKU Demonstration Primary School. Instruments of reflection of lesson plan developing included participant observation, meeting and reflection report, lesson plan and other document. The instruments of examining students' learning include classroom observation and achievement test. Data was categorized from these instruments to find the issues of changing and improving the good lesson plan of Thai primary school science learning. The findings revealed that teachers could develop the lesson plans through lesson study. The issues of changing and improving were disused by considering on engaging students related to societal issues, students' prior knowledge, scientific concepts for primary school students, and what they learned from their changing. It indicated that the Lesson Study allowed primary school science teachers to share ideas and develop ideas to improve the lesson. The study may have implications for Thai science teacher education through Lesson Study.

ELPSA AS A LESSON DESIGN FRAMEWORK

Directory of Open Access Journals (Sweden)

Tom Lowrie

2015-07-01

Full Text Available This paper offers a framework for mathematics lesson design that is consistent with the way we learn about, and discover, most things in life. In addition, the framework provides a structure for identifying how mathematical concepts and understanding are acquired and developed. This framework is called ELPSA and represents five learning components, namely: Experience, Language, Pictorial, Symbolic and Applications. This framework has been used in developing lessons and teacher professional programs in Indonesia since 2012 in cooperation with the World Bank. This paper describes the theory that underlines the framework in general and in relation to each inter-connected component. Two explicit learning sequences for classroom practice are described, associated with Pythagoras theorem and probability. This paper then concludes with recommendations for using ELPSA in various institutional contexts.Keywords: ELPSA, lesson design framework, Pythagoras theorem, probability DOI: dx.doi.org/10.22342/jme.62.77

Five-year forward view: lessons from emergency care at the extremes of age.

Science.gov (United States)

Minhas, J S; Minhas, D; Coats, T; Banerjee, J; Roland, D

2018-03-01

Objective The progressive rise in demand on NHS emergency care resources is partly attributable to increases in attendances of children and older people. A quality gap exists in the care provision for the old and the young. The Five Year Forward View suggested new models of care but that the "answer is not one-size-fits-all". This article discusses the urgent need for person-centred outcome measures to bridge the gap that exists between demand and provision. Design This review is based on evidence gathered from literature searching across several platforms using a variety of search terms to account for the obvious heterogeneity, drawing on key 'think-tank' evidence. Settings Qualitative and quantitative studies examining approaches to caring for individuals at the extremes of age. Participants Individuals at the extremes of age (infants and older people). Main Outcome Measures Understanding similarities and disparities in the care of individuals at the extremes of age in an emergency and non-emergency context. Results There exists several similarities and disparities in the care of individuals at the extremes of age. The increasing burden of health disease on the economy must acknowledge the challenges that exist in managing patients in emergency settings at the extremes of age and build systems to acknowledge the traits these individuals exhibit. Conclusion Commissioners of services must optimise the models of care delivery by appreciating the similarities and differences between care requirements in these two large groups seeking emergency care.

Targeting health visitor care: lessons from Starting Well.

Science.gov (United States)

Wright, C M; Jeffrey, S K; Ross, M K; Wallis, L; Wood, R

2009-01-01

UK child health promotion guidelines expect health visitors to assess family needs before new babies are aged 4 months and offer targeted care on that basis thereafter. Data from an intensive family support programme were used to assess how accurately family needs can be predicted at this stage. A population based cohort of 1202 families with new babies receiving an intensive health visiting programme. Analysis of routinely recorded data. Starting Well project, Glasgow, UK. Health visitor rating of family needs. Families receiving high visiting rates or referred to social work services. Of 302 families rated high need, only 143 (47%) were identified by age 4 months. Visiting rates in the first year for those initially rated high need were nearly double those for the remainder, but around two thirds of those with high contact rates/referred to social work were not initially rated high need. Six family characteristics (no income, baby born preterm, multiple pregnancy, South Asian, prior social work/criminal justice involvement, either parent in care as a child) were identified as the commonest/strongest predictors of contact rates; 1003 (83%) families had one such characteristics and/or lived in a highly deprived area, including 228 (93%) of those with high contact rates and 157 (96%) of those referred to social work. Most families at risk will not be identified on an individual basis in the early weeks. Most families in deprived areas need continued input if the most vulnerable families are to be reliably identified.

Supersymmetric gauged scale covariance in ten and lower dimensions

International Nuclear Information System (INIS)

Nishino, Hitoshi; Rajpoot, Subhash

2004-01-01

We present globally supersymmetric models of gauged scale covariance in ten, six, and four dimensions. This is an application of a recent similar gauging in three dimensions for a massive self-dual vector multiplet. In ten dimensions, we couple a single vector multiplet to another vector multiplet, where the latter gauges the scale covariance of the former. Due to scale covariance, the system does not have a Lagrangian formulation, but has only a set of field equations, like Type IIB supergravity in ten dimensions. As by-products, we construct similar models in six dimensions with N=(2,0) supersymmetry, and four dimensions with N=1 supersymmetry. We finally get a similar model with N=4 supersymmetry in four dimensions with consistent interactions that have never been known before. We expect a series of descendant theories in dimensions lower than ten by dimensional reductions. This result also indicates that similar mechanisms will work for other vector and scalar multiplets in space-time lower than ten dimensions

Chinese Lessons from Other Peoples’ Wars

Science.gov (United States)

2011-11-01

as the lessons “not learned” or not adopted, the so-called “ dogs that do not bark.” While it may be difficult to parse real lessons learned from...under the barrel of the Type 95 5.8mm assault rifle. There is no muzzle brake or flash suppressor fitted and it is fed from a box magazine that

Speed, Acceleration, and Velocity: Level II, Unit 9, Lesson 1; Force, Mass, and Distance: Lesson 2; Types of Motion and Rest: Lesson 3; Electricity and Magnetism: Lesson 4; Electrical, Magnetic, and Gravitational Fields: Lesson 5; The Conservation and Conversion of Matter and Energy: Lesson 6; Simple Machines and Work: Lesson 7; Gas Laws: Lesson 8; Principles of Heat Engines: Lesson 9; Sound and Sound Waves: Lesson 10; Light Waves and Particles: Lesson 11; Program. A High.....

Science.gov (United States)

Manpower Administration (DOL), Washington, DC. Job Corps.

This self-study program for high-school level contains lessons on: Speed, Acceleration, and Velocity; Force, Mass, and Distance; Types of Motion and Rest; Electricity and Magnetism; Electrical, Magnetic, and Gravitational Fields; The Conservation and Conversion of Matter and Energy; Simple Machines and Work; Gas Laws; Principles of Heat Engines;…

Strategic Purchasing in Practice: Comparing Ten European Countries.

Science.gov (United States)

Klasa, Katarzyna; Greer, Scott L; van Ginneken, Ewout

2018-02-05

Strategic purchasing of health care services is widely recommended as a policy instrument. We conducted a review of literature of material drawn from the European Observatory on Health Systems and Policies Health Systems in Transition series, other European Observatory databases, and selected country-specific literature to augment the comparative analysis by providing the most recent healthcare trends in ten selected countries. There is little evidence of purchasing being strategic according to any of the established definitions. There is little or no literature suggesting that existing purchasing mechanisms in Europe deliver improved population health, citizen empowerment, stronger governance and stewardship, or develop purchaser organization and capacity. Strategic purchasing has not generally been implemented. Policymakers considering adopting strategic purchasing policies should be aware of this systemic implementation problem. Policymakers in systems with strategic purchasing built into policy should not assume that a purchasing system is strategic or that it is delivering any expected objectives. However, there are individual components of strategic purchasing that are worth pursuing and can provide benefits to health systems. Copyright © 2018. Published by Elsevier B.V.

Affordances: Ten Years On

Science.gov (United States)

Brown, Jill P.; Stillman, Gloria

2014-01-01

Ten years ago the construct, affordance, was rising in prominence in scholarly literature. A proliferation of different uses and meanings was evident. Beginning with its origin in the work of Gibson, we traced its development and use in various scholarly fields. This paper revisits our original question with respect to its utility in mathematics…

Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity.

Science.gov (United States)

Moran, Fidelma; Leonard, Tracey; Hawthorne, Stephanie; Hughes, Ciara M; McCrum-Gardner, Evie; Johnson, Mark I; Rakel, Barbara A; Sluka, Kathleen A; Walsh, Deirdre M

2011-08-01

Transcutaneous electrical nerve stimulation (TENS) is an electrophysical modality used for pain management. This study investigated the dose response of different TENS intensities on experimentally induced pressure pain. One hundred and thirty TENS naïve healthy individuals (18-64 years old; 65 males, 65 females) were randomly allocated to 5 groups (n = 26 per group): Strong Non Painful TENS; Sensory Threshold TENS; Below Sensory Threshold TENS; No Current Placebo TENS; and Transient Placebo TENS. Active TENS (80 Hz) was applied to the forearm for 30 minutes. Transient Placebo TENS was applied for 42 seconds after which the current amplitude automatically reset to 0 mA. Pressure pain thresholds (PPT) were recorded from 2 points on the hand and forearm before and after TENS to measure hypoalgesia. There were significant differences between groups at both the hand and forearm (ANOVA; P = .005 and .002). At 30 minutes, there was a significant hypoalgesic effect in the Strong Non Painful TENS group compared to: Below Sensory Threshold TENS, No Current Placebo TENS and Transient Placebo TENS groups (P TENS and No Current Placebo TENS groups at the hand (P = .001). There was no significant difference between Strong Non Painful TENS and Sensory Threshold TENS groups. The area under the curve for the changes in PPT significantly correlated with the current amplitude (r(2) = .33, P = .003). These data therefore show that there is a dose-response effect of TENS with the largest effect occurring with the highest current amplitudes. This study shows a dose response for the intensity of TENS for pain relief with the strongest intensities showing the greatest effect; thus, we suggest that TENS intensity should be titrated to achieve the strongest possible intensity to achieve maximum pain relief. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

From papyrus to the electronic tablet: a brief history of the clinical medical record with lessons for the digital age.

Science.gov (United States)

Gillum, Richard F

2013-10-01

A major transition is underway in documentation of patient-related data in clinical settings with rapidly accelerating adoption of the electronic health record and electronic medical record. This article examines the history of the development of medical records in the West in order to suggest lessons applicable to the current transition. The first documented major transition in the evolution of the clinical medical record occurred in antiquity, with the development of written case history reports for didactic purposes. Benefiting from Classical and Hellenistic models earlier than physicians in the West, medieval Islamic physicians continued the development of case histories for didactic use. A forerunner of modern medical records first appeared in Paris and Berlin by the early 19th century. Development of the clinical record in America was pioneered in the 19th century in major teaching hospitals. However, a clinical medical record useful for direct patient care in hospital and ambulatory settings was not developed until the 20th century. Several lessons are drawn from the 4000-year history of the medical record that may help physicians improve patient care in the digital age. Copyright © 2013 Elsevier Inc. All rights reserved.

Lessons from the other side: what can we learn from the private sector?

Science.gov (United States)

Clarke, D

1999-01-01

Business has reacted in an impressive manner to increasing globalisation, short-term stock market pressure for performance, emerging industries and new technologies. While the private sector has become increasingly competitive, the public sector has not adopted this commercial rigour. Funding pressures on health services will continue, as will increasing consumer and staff demands and the blurring of public and private health care provision. As a result, there are lessons and techniques the public and private health sectors should learn from each other. I have drawn the issues that follow from my experience in the steel and food industries.

Ten Things Every Professor Should Know about Assessment

Science.gov (United States)

Wolf, Kenneth; Dunlap, Joanna; Stevens, Ellen

2012-01-01

This article describes ten key assessment practices for advancing student learning that all professors should be familiar with and strategically incorporate in their classrooms and programs. Each practice or concept is explained with examples and guidance for putting it into practice. The ten are: learning outcomes, performance assessments,…

A Model of Microteaching Lesson Study Implementation in the Prospective History Teacher Education

Science.gov (United States)

Utami, Indah Wahyu Puji; Mashuri; Nafi'ah, Ulfatun

2016-01-01

Microteaching lesson study is a model to improve prospective teacher quality by incorporating several element of microteaching and lesson study. This study concern on the implementation of microteaching lesson study in prospective history teacher education. Microteaching lesson study model implemented in this study consist of three stages: plan,…

Health lessons learned from the recent earthquakes and Tsunami in Asia.

Science.gov (United States)

de Ville de Goyet, Claudele

2007-01-01

The evaluations following the Tsunami that affected 12 countries (December 2004) and the earthquakes in Bam, Iran (2003), and in Pakistan (2005) offered valuable lessons for public health preparedness against all types of risks (natural, complex, or technological) in all countries (regardless their level of development). The lessons learned, needs assessments, effectiveness of external life-saving assistance, disease surveillance and control, as well as donations management, were reviewed. Although hundreds of surveys or studies were conducted, the needs assessments were partial and uncoordinated. The findings often were not shared by individual agencies. The evaluations in each of the three disasters point to some additional issues: 1. Foreign mobile hospitals rarely arrived in time for immediate trauma care. Existing international guidelines for the use of field hospitals often were ignored and must be updated and promoted. Local and neighboring facilities are best at providing immediate, life-saving care; 2. Occassionally, the risk of epidemics was grossly overestimated by the agencies and the mass media. Surveillance and improved routine control programs work without resorting to costly, improvised immunization campaigns of doubtless value. Improving or re-establishing water and sanitation must be the first priority; 3. Health donations were not always appropriate, nor did they follow the World Health Organization guidelines. The costly destruction of inappropriate donations was a recurrent problem; and 4. Medical volunteers from within the affected country were abounding, but did not benefit from the external logistical and material support. The international community should provide logistical and material support before sending expatriate teams that are unfamiliar with the area and its alth problems. Investing in the preparedness of the national health services and communities should become a priority for disaster-prone countries and those assisting them in

Do Students Really Understand Topology in the Lesson? A Case Study

Science.gov (United States)

Narli, Serkan

2010-01-01

This study aims to specify to what extent students understand topology during the lesson and to determine possible misconceptions. 14 teacher trainees registered at Secondary School Mathematics education department were observed in the topology lessons throughout a semester and data collected at the first topology lesson is presented here.…

The Level and Quality of Accountability Talk in the Science Lessons

Science.gov (United States)

Motlhabane, Abraham

2016-01-01

Teachers are actively encouraged to plan their lessons such that there is maximum classroom talk, namely accountability talk. However, many lessons do not display sufficient accountability talk. This study attempted to better understand the level and quality of accountability talk in six science lessons. The study aimed to provide teachers with…

Lessons from Our Kissing Cousins: Third Culture Kids and Gifted Children

Science.gov (United States)

Sheard, Wenda

2008-01-01

This article describes characteristics shared by "third culture kids" (TCKs) and gifted children and summarizes lessons to be learned from the two communities. Some of the lessons are from TCKs themselves; the article includes quotes from students the author has taught in recent years. Pedagogical lessons for raising the global awareness…

The key factors affecting students' individual interest in school science lessons

Science.gov (United States)

Cheung, Derek

2018-01-01

Individual interest in school science lessons can be defined as a relatively stable and enduring personal emotion comprising affective and behavioural reactions to events in the regular science lessons at school. Little research has compared the importance of different factors affecting students' individual interest in school science lessons. The present study aimed to address this gap, using a mixed methods design. Qualitative interview data were collected from 60 Hong Kong junior secondary school students, who were asked to describe the nature of their interest in science lessons and the factors to which they attribute this. Teacher interviews, parent interviews, and classroom observations were conducted to triangulate student interview data. Five factors affecting students' individual interest in school science lessons were identified: situational influences in science lessons, individual interest in science, science self-concept, grade level, and gender. Quantitative data were then collected from 591 students using a questionnaire. Structural equation modelling was applied to test a hypothesised model, which provided an acceptable fit to the student data. The strongest factor affecting students' individual interest in school science lessons was science self-concept, followed by individual interest in science and situational influences in science lessons. Grade level and gender were found to be nonsignificant factors. These findings suggest that teachers should pay special attention to the association between academic self-concept and interest if they want to motivate students to learn science at school.

TRANSCUTANEOUS ELECTRICAL NERVE-STIMULATION (TENS) IN RAYNAUDS-PHENOMENON

NARCIS (Netherlands)

MULDER, P; DOMPELING, EC; VANSLOCHTERENVANDERBOOR, JC; KUIPERS, WD; SMIT, AJ

Transcutaneous nerve stimulation (TENS) has been described as resulting in vasodilatation. The effect of 2 Hz TENS of the right hand during forty-five minutes on skin temperature and plethysmography of the third digit of both hands and feet and on transcutaneous oxygen tension (TcpO2) of the right

The application of micro-lesson in optics teaching

Science.gov (United States)

Yuan, Suzhen; Mao, Xuefeng; Lu, Yongle; Wang, Yan; Luo, Yuan

2017-08-01

In order to improve students' ability on self-study, this paper discusses the application of micro-lesson as a supplementary way in the course of optics teaching. Both geometric optics and wave optics require a lot of demos, fortunately, micro-lesson just meets this requirement. Nowadays, college education focuses on quality education, so the new nurture scheme of most universities shortened the class hours. However, the development of students and the social needs also require students to have a solid foundation. The effective way to solve this contradiction is to improve the efficiency of classroom teaching and provide the repeatable learning form, micro-lesson.

Brentwood Lessons Learned Project Report

Energy Technology Data Exchange (ETDEWEB)

Rivkin, Carl H. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Caton, Melanie C. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Ainscough, Christopher D. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Marcinkoski, Jason [Dept. of Energy (DOE), Washington DC (United States)

2017-09-26

The purpose of this report is to document lessons learned in the installation of the hydrogen fueling station at the National Park Service Brentwood site in Washington, D.C., to help further the deployment of hydrogen infrastructure required to support hydrogen and other fuel cell technologies. Hydrogen fueling is the most difficult infrastructure component to build and permit. Hydrogen fueling can include augmenting hydrogen fueling capability to existing conventional fuel fueling stations as well as building brand new hydrogen fueling stations. This report was produced as part of the Brentwood Lessons Learned project. The project consisted of transplanting an existing modular hydrogen fueling station from Connecticut to the National Park Service Brentwood site. This relocation required design and construction at the Brentwood site to accommodate the existing station design as well as installation and validation of the updated station. One of the most important lessons learned was that simply moving an existing modular station to an operating site was not necessarily straight-forward - performing the relocation required significant effort and cost. The station has to function at the selected operating site and this functionality requires a power supply, building supports connecting to an existing alarm system, electrical grounding and lighting, providing nitrogen for purging, and providing deionized water if an electrolyzer is part of the station package. Most importantly, the station has to fit into the existing site both spatially and operationally and not disrupt existing operations at the site. All of this coordination and integration requires logistical planning and project management. The idea that a hydrogen fueling station can be simply dropped onto a site and made immediately operational is generally not realistic. Other important lessons learned include that delineating the boundaries of the multiple jurisdictions that have authority over a project for

Moroccan Arabic Technical Lessons for Rehab./Special Ed.

Science.gov (United States)

Chtatou, Mohamed, Ed.

The instructional materials in Moroccan Arabic are designed to meet the language needs of Peace Corps volunteers working in rehabilitation and special education in Morocco. The lessons are almost entirely in Arabic, and include vocabulary lists with both technical and everyday language pertaining to disabilities. Lesson topics include singing, the…

"The magic is in the mix": lessons from research capacity building in the Canadian tobacco control community, 2000-2010.

Science.gov (United States)

Riley, Barbara L; Viehbeck, Sarah M; Cohen, Joanna E; Chia, Marie C

2013-02-25

Global public health issues, including tobacco use, will be addressed most effectively if informed by relevant evidence. Additional capacity is needed to undertake and sustain relevant and rigorous research that will inform and enable learning from interventions. Despite the undisputed importance of research capacity building (RCB), there is little evidence about how to create relevant capacities. RCB for tobacco control in Canada from 2000-2010 offers a rich experience from which to learn. Lessons were derived using structured data collection from seven capacity-building initiatives and an invitational workshop, at which reflections on major contributions and lessons learned were discussed by initiative leads. Ten years of RCB for tobacco control in Canada revealed the importance of a) taking an organic approach to RCB, b) targeting and sustaining investments in a mix of RCB activities, c) vision and collaborative leadership at organizational and initiative levels, d) a focus on building community, and e) studying capacity building. The experience also provided tangible examples of RCB initiatives and how independent investments can be linked to create a coherent approach. Looking ahead, promising directions may include positioning RCB within a broader context of "field building", focusing on practical approaches to sustainability, and enhancing research on RCB.

Benefits of Lessons Expected by Parents : Results of a Survey on Parents Enrolling Their Children in Piano Lessons

OpenAIRE

末永,雅子

2013-01-01

With the declining birth rate, parents are becoming increasingly interested in childhood education. While the objective of cram schools and English lessons, which are targeted at advancement to higher education, is enhancement of academic ability, the expected benefits of lessons in activities such as piano and sports are not the acquisition of special knowledge or skills, but rather the development of physical fitness, concentration, and other abilities that are useful in dail...

ABACC ten years applying safeguards

International Nuclear Information System (INIS)

Palacios, Elias

2001-01-01

The Argentinian-Brazilian Agency for Accounting and Control of nuclear special materials has been in operations for ten years. The rational behind the creation and the work performed by the Agency during the last decade is described. (author)

How to Analyze Routines in Teachers' Thinking Processes during Lesson Planning.

Science.gov (United States)

Bromme, Rainer

A justification for the study of teachers' routines, as they affect the preparation of lesson plans, prefaces this paper on teachers' thought processes during lesson planning. In focusing on the importance of research into teachers' routines, it is pointed out that lesson preparation and classroom routines permit teachers to direct attention to…

The Implementation of Lesson Study in English Language Learning: A Case Study

Directory of Open Access Journals (Sweden)

Wakhid Nashruddin

2016-12-01

Full Text Available Lesson Study as a growing interest in the education world has attracted educators, experts, and professionals in the area to make use of it in improving the lessons—it also happens in Indonesia. Originally applied in the teaching of mathematics in Japan, now it turns to be used in other fields, and English is one of them. This paper highlights the guideline on Lesson Study and pictures its application in a private senior high school in Malang, East Java, Indonesia. The adaptation of Lesson Study is interesting since Japan and Indonesia have different cultural background. How Lesson Study is usually implemented in Japan and the US and how it is applied in Indonesia will be seen here. As this is a case study, it will only focus on a school and the result should not be used to generalize Lesson Study applications in Indonesia. Interview and observation were instruments used in this study. The interview was used to gain information on how Lesson Study was normally conducted and observation (and the researchers’ involvements was used to see the real implementation of Lesson Study. What happened during the implementation of Lesson Study and during the teaching and learning process become a great attention here.

EEG Correlates of Ten Positive Emotions.

Science.gov (United States)

Hu, Xin; Yu, Jianwen; Song, Mengdi; Yu, Chun; Wang, Fei; Sun, Pei; Wang, Daifa; Zhang, Dan

2017-01-01

Compared with the well documented neurophysiological findings on negative emotions, much less is known about positive emotions. In the present study, we explored the EEG correlates of ten different positive emotions (joy, gratitude, serenity, interest, hope, pride, amusement, inspiration, awe, and love). A group of 20 participants were invited to watch 30 short film clips with their EEGs simultaneously recorded. Distinct topographical patterns for different positive emotions were found for the correlation coefficients between the subjective ratings on the ten positive emotions per film clip and the corresponding EEG spectral powers in different frequency bands. Based on the similarities of the participants' ratings on the ten positive emotions, these emotions were further clustered into three representative clusters, as 'encouragement' for awe, gratitude, hope, inspiration, pride, 'playfulness' for amusement, joy, interest, and 'harmony' for love, serenity. Using the EEG spectral powers as features, both the binary classification on the higher and lower ratings on these positive emotions and the binary classification between the three positive emotion clusters, achieved accuracies of approximately 80% and above. To our knowledge, our study provides the first piece of evidence on the EEG correlates of different positive emotions.

[Ten years of early complex geriatric rehabilitation therapy in the DRG system].

Science.gov (United States)

Kolb, G; Breuninger, K; Gronemeyer, S; van den Heuvel, D; Lübke, N; Lüttje, D; Wittrich, A; Wolff, J

2014-01-01

Geriatric medicine, as a specialized form of treatment for the elderly, is gaining in importance due to demographic changes. Especially important for geriatric medicine is combining acute care with the need to maintain functionality and participation. This includes prevention of dependency on structured care or chronic disability and handicap by means of rehabilitation. Ten years ago, the German DRG system tried to incorporate procedures (e.g., "early rehabilitation in geriatric medicine") in the hospital reimbursement system. OPS 8-550.x, defined by structural quality, days of treatment, and number of therapeutic interventions, triggers 17 different geriatric DRGs, covering most of the fields of medicine. OPS 8-550.x had been revised continuously to give a clear structure to quality aspects of geriatric procedures. However, OPS 8-550.x is based on proven need of in-hospital treatment. In the last 10 years, no such definition has been produced taking aspects of the German hospital system into account as well as aspects of transparency and benefit in everyday work. The German DRG system covers just basic reimbursement aspects of geriatric medicine quite well; however, a practicable and patient-oriented definition of "hospital necessity" is still lacking, but is absolutely essential for proper compensation. A further problem concerning geriatric medicine reimbursement in the DRG system is due to the different structures of providing geriatric in-hospital care throughout Germany.

Ten years of integrated care: backwards and forwards. The case of the province of Québec, Canada

Directory of Open Access Journals (Sweden)

Isabelle Vedel

2011-02-01

Full Text Available Introduction: Québec's rapidly growing elderly and chronically ill population represents a major challenge to its healthcare delivery system, attributable in part to the system's focus on acute care and fragmented delivery. Description of policy practice: Over the past few years, reforms have been implemented at the provincial policy level to integrate hospital-based, nursing home, homecare and social services in 95 catchment areas. Recent organizational changes in primary care have also resulted in the implementation of family medicine groups and network clinics. Several localized initiatives were also developed to improve integration of care for older persons or persons with chronic diseases. Conclusion and discussion: Québec has a history of integration of health and social services at the structural level. Recent evaluations of the current reform show that the care provided by various institutions in the healthcare system is becoming better integrated. The Québec health care system nevertheless continues to face three important challenges in its management of chronic diseases: implementing the reorganization of primary care, successfully integrating primary and secondary care at the clinical level, and developing effective governance and change management. Efforts should focus on strengthening primary care by implementing nurse practitioners, developing a shared information system, and achieving better collaboration between primary and secondary care.

Ten years of integrated care: backwards and forwards. The case of the province of Québec, Canada

Directory of Open Access Journals (Sweden)

Isabelle Vedel

2011-02-01

Full Text Available Introduction: Québec's rapidly growing elderly and chronically ill population represents a major challenge to its healthcare delivery system, attributable in part to the system's focus on acute care and fragmented delivery. Description of policy practice: Over the past few years, reforms have been implemented at the provincial policy level to integrate hospital-based, nursing home, homecare and social services in 95 catchment areas. Recent organizational changes in primary care have also resulted in the implementation of family medicine groups and network clinics. Several localized initiatives were also developed to improve integration of care for older persons or persons with chronic diseases.Conclusion and discussion: Québec has a history of integration of health and social services at the structural level. Recent evaluations of the current reform show that the care provided by various institutions in the healthcare system is becoming better integrated. The Québec health care system nevertheless continues to face three important challenges in its management of chronic diseases: implementing the reorganization of primary care, successfully integrating primary and secondary care at the clinical level, and developing effective governance and change management.Efforts should focus on strengthening primary care by implementing nurse practitioners, developing a shared information system, and achieving better collaboration between primary and secondary care.

Using TENS for pain control: the state of the evidence

Science.gov (United States)

Vance, Carol GT; Dailey, Dana L; Rakel, Barbara A; Sluka, Kathleen A

2014-01-01

Summary Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological intervention that activates a complex neuronal network to reduce pain by activating descending inhibitory systems in the central nervous system to reduce hyperalgesia. The evidence for TENS efficacy is conflicting and requires not only description but also critique. Population-specific systemic reviews and meta-analyses are emerging, indicating both HF and LF TENS being shown to provide analgesia, specifically when applied at a strong, nonpainful intensity. The purpose of this article is to provide a critical review of the latest basic science and clinical evidence for TENS. Additional research is necessary to determine if TENS has effects specific to mechanical stimuli and/or beyond reduction of pain and will improve activity levels, function and quality of life. PMID:24953072

Plants and Photosynthesis: Level III, Unit 3, Lesson 1; The Human Digestive System: Lesson 2; Functions of the Blood: Lesson 3; Human Circulation and Respiration: Lesson 4; Reproduction of a Single Cell: Lesson 5; Reproduction by Male and Female Cells: Lesson 6; The Human Reproductive System: Lesson 7; Genetics and Heredity: Lesson 8; The Nervous System: Lesson 9; The Glandular System: Lesson 10. Advanced General Education Program. A High School Self-Study Program.

Science.gov (United States)

Manpower Administration (DOL), Washington, DC. Job Corps.

This self-study program for the high-school level contains lessons in the following subjects: Plants and Photosynthesis; The Human Digestive System; Functions of the Blood; Human Circulation and Respiration; Reproduction of a Single Cell; Reproduction by Male and Female Cells; The Human Reproductive System; Genetics and Heredity; The Nervous…

"Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

LENUS (Irish Health Repository)

Walsh, E K

2012-02-01

Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction.

"Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

LENUS (Irish Health Repository)

Walsh, E K

2010-09-01

Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction.

Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC/Advancing Quality Alliance integrated care fellowship experience

Directory of Open Access Journals (Sweden)

Michael Gregory

2015-05-01

Full Text Available The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world.In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care.I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre.

Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC)/Advancing Quality Alliance integrated care fellowship experience.

Science.gov (United States)

Gregory, Michael

2015-01-01

The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world. In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care. I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre.

Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC/Advancing Quality Alliance integrated care fellowship experience

Directory of Open Access Journals (Sweden)

Michael Gregory

2015-05-01

Full Text Available The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world. In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care. I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre.

Advances in Health Care in Taiwan: Lessons for Developing Countries

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John R. Watt

2008-11-01

Full Text Available Taiwan's health services, now among the best in the world, were largely developed after 1947 under conditions of epidemiological and political crisis. Its medical, nursing, and public health leaders knew the importance of focusing on preventive health strategies, and its central government leaders knew how important health care was to the achievement of economic goals. Although there were from time to time setbacks and difficulties, the leadership learned from their mistakes and made effective use of international advice and resources. Taiwan's record makes the case that modernization of health care contributes to economic development and should not be viewed solely as a budgetary cost. Its record provides a mine of information for countries seeking to develop health services compatible with sustained economic and social development.

Integrating self-regulated learning and discovery learning into English lesson plan

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Sayukti Ni Kadek Heny

2018-01-01

Full Text Available The notion of learner-centeredness has been embedded in the National Curriculum of Indonesia, 2013 Curriculum. However, most of the teachers seem to be hardly acquainted with the concept of Self-Regulated Learning (SRL and discovery learning in the lesson planning. Considering the phenomenon, this study intends to explore the concept of Self-Regulated Learning in the lesson plan of English subject for a tenth-grade level by employing a qualitative design with data obtained from a teacher-made lesson plan and a semi-structured interview. The researcher used content analysis to analyze the lesson plan. Meanwhile, the qualitative data from interview result were preceded through a coding sheet and transcribed modified figure. The findings revealed an integration of SRL cyclical phase and discovery learning in the teacher-made lesson plan. Based on the discussion, the results need to be applied in a considerably large context, in order to see thoroughly dynamic integration between Self-Regulated Learning model, lesson planning and the concept of learner autonomy.

Early interventions and lessons from Harvard Business Review.

Science.gov (United States)

Chong, Siow-Ann

2007-11-01

To describe the establishment and development of an Early Psychosis Intervention Programme in Singapore that is based on a business model and with concepts drawn from the corporate world. The author who directed this programme describes the circumstances that led to this initiative, the ideas borrowed and adapted from the corporate world, and the lessons learnt in setting up this intervention programme. The modus operandi of the programme is based on the Balanced Scorecard - a model which stresses four equally important components: customers, internal processes, financial health and learning and innovation. Other complementary actions like creating a sense of urgency, forging a vision with a core ideology, empowerment of team members, creating short-term wins, anchoring the changes and finding meaning in the work are vital for the programme to thrive. This model also emphasizes the importance of accountability through the measurability of indicators. These indicators included a significant reduction in the duration of untreated psychosis, a positive change in the referral patterns with better engagement of the primary health-care sector and an improvement in the quality of care for the patients. Much can be learnt from the business world in building and maintaining a public mental health programme. Effective change also requires effective leadership, and the successful implementation of certain strategic steps.

How to help depressed older people living in residential care: a multifaceted shared-care intervention for late-life depression.

Science.gov (United States)

Llewellyn-Jones, R H; Baikie, K A; Castell, S; Andrews, C L; Baikie, A; Pond, C D; Willcock, S M; Snowdon, J; Tennant, C C

2001-12-01

To describe a population-based, multifaceted shared-care intervention for late-life depression in residential care as a new model of geriatric practice, to outline its development and implementation, and to describe the lessons learned during the implementation process. A large continuing-care retirement community in Sydney, Australia, providing three levels of care (independent living units, assisted-living complexes, and nursing homes). The intervention was implemented for the entire non-nursing home population (residents in independent and assisted living: N = 1,466) of the facility and their health care providers. Of the 1,036 residents whowere eligible and agreed to be interviewed, 281 (27.1%) were classified as depressed according to the Geriatric Depression Scale. INTERVENTION DESCRIPTION: The intervention included: (a) multidisciplinary collaboration between primary care physicians, facility health care providers, and the local psychogeriatric service; (b) training for primary care physicians and other facility health care providers about detecting and managing depression; and (c) depression-related health education/promotion programs for residents. The intervention was widely accepted by residents and their health care providers, and was sustained and enhanced by the facility after the completion of the study. It is possible to implement and sustain a multifaceted shared-care intervention for late-life depression in a residential care facility where local psychogeriatric services are scarce, staff-to-resident ratios are low, and the needs of depressed residents are substantial.

Using American sign language interpreters to facilitate research among deaf adults: lessons learned.

Science.gov (United States)

Sheppard, Kate

2011-04-01

Health care providers commonly discuss depressive symptoms with clients, enabling earlier intervention. Such discussions rarely occur between providers and Deaf clients. Most culturally Deaf adults experience early-onset hearing loss, self-identify as part of a unique culture, and communicate in the visual language of American Sign Language (ASL). Communication barriers abound, and depression screening instruments may be unreliable. To train and use ASL interpreters for a qualitative study describing depressive symptoms among Deaf adults. Training included research versus community interpreting. During data collection, interpreters translated to and from voiced English and ASL. Training eliminated potential problems during data collection. Unexpected issues included participants asking for "my interpreter" and worrying about confidentiality or friendship in a small community. Lessons learned included the value of careful training of interpreters prior to initiating data collection, including resolution of possible role conflicts and ensuring conceptual equivalence in real-time interpreting.

The Finishing Touch: Anatomy of Expert Lesson Closures

Science.gov (United States)

Webster, Collin A.; Connolly, Graeme; Schempp, Paul G.

2009-01-01

Background: Based on the idea that students remember best what is presented last, the lesson closure is commonly identified as an important component of effective teaching and has recently surfaced as a routine practice of expert teachers in sport. Despite its link to both effective and expert instruction, the lesson closure has seen scarce…

Ten Tips for Parents to Help Their Children Avoid Teen Pregnancy

Science.gov (United States)

... we do » Resource library » Ten tips for parents Ten Tips for Parents to Help Their Children Avoid Teen Pregnancy Publication Created with Sketch. Ten Tips for Parents to Help Their Children Avoid ...

PENGEMBANGAN MODEL PEMBINAAN KOMPETENSI CALON GURU MATEMATIKA MELALUI LESSON STUDY

Directory of Open Access Journals (Sweden)

Rahmad Bustanul Anwar

2014-06-01

Full Text Available Education has a very important role in improving the quality of human resources. Therefore, education is expected to be one of the ways to prepare generations of qualified human resources and has the ability to deal with the progress of time and technology development . In order to enhance the quality of student mastery of competencies in the development of prospective teachers in this study will be applied to the activities in the process of lesson study in lecture . Lesson study is a model of coaching to people who work as both teacher educators and lecturers through collaborative learning and assessment in building sustainable learning communities. The purpose of this research is to improve the competence of prospective mathematics teachers through lesson study . More specifically , this study aims to describe the efforts made to improve the pedagogical, professional competence , social competence and personal competence prospective mathematics teachers through lesson study . Subjects in this study were students who took the micro teaching courses totaling 15 students , divided into 3 group . This type of research is a qualitative descriptive study is to develop the competence of prospective mathematics teachers through lesson study . Lesson study conducted collaborated with Action Research activities ( Action Reseach. The results of this research activity is the implementation of lesson study to greater competence to prospective teachers teaching mathematics through the micro subjects namely: pedagogical competence categories were 80 % and 20 % lower, professional competence categories were 46.7 % and 53.3 % lower, personal competence 100 % category being and social competence categories were 86.7 % and 13.3 % lower .

Multidisciplinary practice experience of nursing faculty and their collaborators for primary health care in Korea.

Science.gov (United States)

Kim, Mi Ja; Chung, Hyang-In Cho; Ahn, Yang Heui

2008-03-01

This study aimed to describe the range of participation of nursing faculty members and their collaborators in multidisciplinary primary health care in Korea and to analyze facilitators, benefits, barriers, and learned lessons. An exploratory descriptive research design was utilized. A total of 13 nursing faculty members and 13 multidisciplinary collaborators were interviewed face to face using a brief questionnaire and semi-structured interview guide. Descriptive statistics, comparative analysis, and content analysis were used for data analysis. About 43% of the nursing faculty had multidisciplinary primary health care experience. Facilitators included a government-funded research/demonstration project, personal belief and expertise in primary health care, and well-delineated role boundaries. Benefits included improved quality of life, more convenient community life, meeting multifaceted needs of community residents, and enhanced research activities. Barriers were lack of teamwork; territoriality and self-protective behaviors; lack of insight into primary health care among stakeholders; nurses undervaluing their work; and the rigid bureaucratic system of public health centers. Learned lessons were the importance of teamwork and its synergistic benefits, the importance of conducting clinically relevant research, having the government's support in the improvement of public health, developing health policies through multidisciplinary primary health care (M-D PHC) work, and respecting each other's territory and expertise. Teamwork should be included in all health professions' curricula, and nursing clinical practicums should include primary health care in all specialty areas. More faculties should engage in multidisciplinary primary health care. The benefits of a multidisciplinary approach to primary health care outweigh the difficulties experienced by multidisciplinary team members. The findings of this study may be useful for future multidisciplinary primary health

PROMOTING ENGLISH TEACHERS’ PROFESSIONAL DEVELOPMENT (TPD THROUGH THE PRACTICE OF LESSON STUDY

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Yanuarti Apsari

2017-12-01

Full Text Available This paper sheds some lights on the practice of lesson study conducted in higher education level in relations to teacher professional development. This study employed an explorative research design which involved a team of three English teachers of STKIP Siliwangi and one class of English Department. The team was involved in jointly designing, teaching, researching, refining a research lesson. The research was conducted in three cycles, in which each cycle was evaluated. The data were collected through two instruments: classroom observation and teachers’ reflective notes. The result revealed that the practice of lesson study can create multiple pathways for teaching improvement, especially in terms of collaborative activities done by teachers involved in the lesson study team. The result also revealed that the practice of lesson study the practice of lesson study can improve not only students’ academic skills, but also students’ social skills.

Not the Color Purple: Black Feminist Lessons for Educational Caring.

Science.gov (United States)

Thompson, Audrey

1998-01-01

Asserts that theories of caring in education have avoided issues of racial imbalance. Reinterprets these themes from a black feminist perspective: moral relevance, primacy of survival, significance of one's standpoint, and the moral power of narrative. (SK)

Solid-State Lighting: Early Lessons Learned on the Way to Market

Energy Technology Data Exchange (ETDEWEB)

Sandahl, Linda J.; Cort, Katherine A.; Gordon, Kelly L.

2013-12-31

The purpose of this report is to document early challenges and lessons learned in the solid-state lighting (SSL) market development as part of the DOE’s SSL Program efforts to continually evaluate market progress in this area. This report summarizes early actions taken by DOE and others to avoid potential problems anticipated based on lessons learned from the market introduction of compact fluorescent lamps and identifies issues, challenges, and new lessons that have been learned in the early stages of the SSL market introduction. This study identifies and characterizes12 key lessons that have been distilled from DOE SSL program results.

What Works In Chronic Care Management : The Case Of Heart Failure

NARCIS (Netherlands)

Sochalski, Julie; Jaarsma, Tiny; Krumholz, Harlan M.; Laramee, Ann; McMurray, John J. V.; Naylor, Mary D.; Rich, Michael W.; Riegel, Barbara; Stewart, Simon

2009-01-01

The evidence base of what works in chronic care management programs is underdeveloped. To fill the gap, we pooled and reanalyzed data from ten randomized clinical trials of heart failure care management programs to discern how program delivery methods contribute to patient outcomes. We found that

Satellite-instrument system engineering best practices and lessons

Science.gov (United States)

Schueler, Carl F.

2009-08-01

This paper focuses on system engineering development issues driving satellite remote sensing instrumentation cost and schedule. A key best practice is early assessment of mission and instrumentation requirements priorities driving performance trades among major instrumentation measurements: Radiometry, spatial field of view and image quality, and spectral performance. Key lessons include attention to technology availability and applicability to prioritized requirements, care in applying heritage, approaching fixed-price and cost-plus contracts with appropriate attention to risk, and assessing design options with attention to customer preference as well as design performance, and development cost and schedule. A key element of success either in contract competition or execution is team experience. Perhaps the most crucial aspect of success, however, is thorough requirements analysis and flowdown to specifications driving design performance with sufficient parameter margin to allow for mistakes or oversights - the province of system engineering from design inception to development, test and delivery.

Local environment but not genetic differentiation influences biparental care in ten plover populations.

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Orsolya Vincze

Full Text Available Social behaviours are highly variable between species, populations and individuals. However, it is contentious whether behavioural variations are primarily moulded by the environment, caused by genetic differences, or a combination of both. Here we establish that biparental care, a complex social behaviour that involves rearing of young by both parents, differs between closely related populations, and then test two potential sources of variation in parental behaviour between populations: ambient environment and genetic differentiation. We use 2904 hours behavioural data from 10 geographically distinct Kentish (Charadrius alexandrinus and snowy plover (C. nivosus populations in America, Europe, the Middle East and North Africa to test these two sources of behavioural variation. We show that local ambient temperature has a significant influence on parental care: with extreme heat (above 40 °C total incubation (i.e. % of time the male or female incubated the nest increased, and female share (% female share of incubation decreased. By contrast, neither genetic differences between populations, nor geographic distances predicted total incubation or female's share of incubation. These results suggest that the local environment has a stronger influence on a social behaviour than genetic differentiation, at least between populations of closely related species.

World Hunger: Famine in Africa. Sample Lessons, Secondary.

Science.gov (United States)

Neeson, Eileen; And Others

This model social studies lesson includes a simulated interview with a relief worker describing the famine conditions in Ethiopia. A map of Africa and pictures of famine victims are included. The objectives of the lesson are to have students describe the situation in Ethiopia, analyze the causes, and evaluate solutions to the famine. In the model…

Western impressions of the Hong Kong health care system.

Science.gov (United States)

Bennett, C L; Pei, G K; Ultmann, J E

1996-01-01

Hong Kong, Taiwan, Singapore, and Malaysia are initiating health care reform to meet the changing demands of populations with improved socioeconomic status and access to modern technologies and who are living longer than in previous generations. Hong Kong, in particular, is facing a unique set of circumstances as its people prepare for the transition in 1997 from a British colony to a Special Administrative Region of China. While spending only 4% of its gross domestic product on health care, it has a large and regulated public hospital system for most inpatient medical care and a separate, loosely regulated private health care system for most outpatient medical care. In 1993 the Secretary for Health and Welfare of Hong Kong initiated a year-long process to debate the pros and cons of 5 fundamental programs for health care reform. After a year of open consultation, options were chosen. We describe the Hong Kong health care system, the fundamental changes that have been adopted, and lessons for reformers in the United States.

Integrated care services: lessons learned from the deployment of the NEXES project

Directory of Open Access Journals (Sweden)

Carme Hernandez

2015-03-01

Full Text Available Objectives: To identify barriers to deployment of four articulated Integrated Care Services supported by Information Technologies in three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus. Setting: One health care sector in Spain (Barcelona (n = 11.382; six municipalities in Norway (Trondheim (n = 450; and one hospital in Greece (Athens (n = 388. Method: The four services were: (i Home-based long-term maintenance of rehabilitation effects (n = 337; (ii Enhanced Care for frail patients, n = 1340; (iii Home Hospitalization and Early Discharge (n = 2404; and Support for remote diagnosis (forced spirometry testing in primary care (Support (n = 8139. Both randomized controlled trials and pragmatic study designs were combined. Two technological approaches were compared. The Model for Assessment of Telemedicine applications was adopted. Results: The project demonstrated: (i Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (p < 0.01; (ii Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05; (iii Reduced in-hospital days for all types of patients (p < 0.001 in Home Hospitalization/Early Discharge; and (iv Increased quality of testing (p < 0.01 for patients with respiratory symptoms in Support, with marked differences among sites. Conclusions: The four integrated care services showed high potential to enhance health outcomes with cost-containment. Change management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations.

Integrated care services: lessons learned from the deployment of the NEXES project

Directory of Open Access Journals (Sweden)

Carme Hernandez

2015-03-01

Full Text Available Objectives: To identify barriers to deployment of four articulated Integrated Care Services supported by Information Technologies in three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus.Setting: One health care sector in Spain (Barcelona (n = 11.382; six municipalities in Norway (Trondheim (n = 450; and one hospital in Greece (Athens (n = 388.Method: The four services were: (i Home-based long-term maintenance of rehabilitation effects (n = 337; (ii Enhanced Care for frail patients, n = 1340; (iii Home Hospitalization and Early Discharge (n = 2404; and Support for remote diagnosis (forced spirometry testing in primary care (Support (n = 8139. Both randomized controlled trials and pragmatic study designs were combined. Two technological approaches were compared. The Model for Assessment of Telemedicine applications was adopted.Results: The project demonstrated: (i Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (p < 0.01; (ii Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05; (iii Reduced in-hospital days for all types of patients (p < 0.001 in Home Hospitalization/Early Discharge; and (iv Increased quality of testing (p < 0.01 for patients with respiratory symptoms in Support, with marked differences among sites.Conclusions: The four integrated care services showed high potential to enhance health outcomes with cost-containment. Change management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations.

Recycling Lesson Plan

Science.gov (United States)

Okaz, Abeer Ali

2013-01-01

This lesson plan designed for grade 2 students has the goal of teaching students about the environmental practice of recycling. Children will learn language words related to recycling such as: "we can recycle"/"we can't recycle" and how to avoid littering with such words as: "recycle paper" and/or "don't throw…

Chernobyl ten years after

International Nuclear Information System (INIS)

1996-01-01

The accident in the fourth reactor plant in Chernobyl in Ukraine occurred ten years years ago, caused the death of 31 people while the health consequences have turned out to be difficult to assess. This review describes the accident, its consequences and effects to health, studies carried out at the present state as well as the comparison with the other accidents and disaster. (author)

ANALGETSKI UCINAK TRANSAKUTNE ELEKTRICNE NERVNE STIMULACIJE (TENS)

OpenAIRE

ĆURKOVIĆ, B.

1984-01-01

Transkutana električna nervna stimulacija. (TENS) danas je široko prihvaćen terapijski postupak za suzbijanje boli. Način njezina djelovanja nije još jasno definiran, premda se većina autora priklanja centralnom mehranizmu smanjenja boli. Rezultati, u literaturi, variraju od nesignifikantno boljeg učinka od placeba do 95°/o dobrog analgetskog djelovanja. U Zavodu za reumatske bolesti i rehabilitaciju Kliničkog bolničkog centra, Zagreb, evaluiran je učinak TENS-a u bolesnika s križ...