Impact of leaf motion constraints on IMAT plan quality, deliver accuracy, and efficiency

International Nuclear Information System (INIS)

Chen Fan; Rao Min; Ye Jinsong; Shepard, David M.; Cao Daliang

2011-01-01

Purpose: Intensity modulated arc therapy (IMAT) is a radiation therapy delivery technique that combines the efficiency of arc based delivery with the dose painting capabilities of intensity modulated radiation therapy (IMRT). A key challenge in developing robust inverse planning solutions for IMAT is the need to account for the connectivity of the beam shapes as the gantry rotates from one beam angle to the next. To overcome this challenge, inverse planning solutions typically impose a leaf motion constraint that defines the maximum distance a multileaf collimator (MLC) leaf can travel between adjacent control points. The leaf motion constraint ensures the deliverability of the optimized plan, but it also impacts the plan quality, the delivery accuracy, and the delivery efficiency. In this work, the authors have studied leaf motion constraints in detail and have developed recommendations for optimizing the balance between plan quality and delivery efficiency. Methods: Two steps were used to generate optimized IMAT treatment plans. The first was the direct machine parameter optimization (DMPO) inverse planning module in the Pinnacle 3 planning system. Then, a home-grown arc sequencer was applied to convert the optimized intensity maps into deliverable IMAT arcs. IMAT leaf motion constraints were imposed using limits of between 1 and 30 mm/deg. Dose distributions were calculated using the convolution/superposition algorithm in the Pinnacle 3 planning system. The IMAT plan dose calculation accuracy was examined using a finer sampling calculation and the quality assurance verification. All plans were delivered on an Elekta Synergy with an 80-leaf MLC and were verified using an IBA MatriXX 2D ion chamber array inserted in a MultiCube solid water phantom. Results: The use of a more restrictive leaf motion constraint (less than 1-2 mm/deg) results in inferior plan quality. A less restrictive leaf motion constraint (greater than 5 mm/deg) results in improved plan quality

Effect of patient size, anatomical location and modulation strength on dose delivered and image-quality on CT examination

International Nuclear Information System (INIS)

Greffier, Joel; Larbi, Ahmed; Macri, Francesco; Beregi, Jean-Paul; Pereira, Fabricio

2017-01-01

To study the effect of patient size, anatomical location and modulation strength (MS) on image-quality and delivered dose of CT scans acquired with automatic-exposure control system (AEC). Four anthropomorphic phantoms (three paediatric and one thin adult) were studied, and normal and obese adults were simulated by placing bolus plates around the adult phantom. Thorax and abdomen pelvis CT were performed using an AEC system equipped with five possible MS. Modulated tube current (mAs mod ) was compared to Reference mAs and image-noise was assessed. Effective-mAs were lower than Reference-mAs for all but the obese phantom. However, reversal points were estimated for an effective diameter of 27.8 cm in thorax and 26.9 cm in abdomen pelvis scans, beyond which the patterns of MS were inverted. mAs mod were dependent on attenuation differences among distinct anatomical location. Finally, dose delivered was associated to the mAs mod and patient s size, with both affecting image-quality. (authors)

Use of spaced education to deliver a curriculum in quality, safety and value for postgraduate medical trainees: trainee satisfaction and knowledge.

Science.gov (United States)

Bruckel, Jeffrey; Carballo, Victoria; Kalibatas, Orinta; Soule, Michael; Wynne, Kathryn E; Ryan, Megan P; Shaw, Tim; Co, John Patrick T

2016-03-01

Quality, patient safety and value are important topics for graduate medical education (GME). Spaced education delivers case-based content in a structured longitudinal experience. Use of spaced education to deliver quality and safety education in GME at an institutional level has not been previously evaluated. To implement a spaced education course in quality, safety and value; to assess learner satisfaction; and to describe trainee knowledge in these areas. We developed a case-based spaced education course addressing learning objectives related to quality, safety and value. This course was offered to residents and fellows about two-thirds into the academic year (March 2014) and new trainees during orientation (June 2014). We assessed learner satisfaction by reviewing the course completion rate and a postcourse survey, and trainee knowledge by the per cent of correct responses. The course was offered to 1950 trainees. A total of 305 (15.6%) enrolled in the course; 265/305 (86.9%) answered at least one question, and 106/305 (34.8%) completed the course. Fewer participants completed the March programme compared with the orientation programme (42/177 (23.7%) vs 64/128 (50.0%), peducation can help deliver and assess learners' understanding of quality, safety and value principles. Offering a voluntary course may result in low completion. Learners were satisfied with their experience and were introduced to new concepts. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Assessing the quality of proton PBS treatment delivery using machine log files: comprehensive analysis of clinical treatments delivered at PSI Gantry 2

International Nuclear Information System (INIS)

Scandurra, D; Albertini, F; Van der Meer, R; Meier, G; Weber, D C; Bolsi, A; Lomax, A

2016-01-01

Pencil beam scanning (PBS) proton therapy requires the delivery of many thousand proton beams, each modulated for position, energy and monitor units, to provide a highly conformal patient treatment. The quality of the treatment is dependent on the delivery accuracy of each beam and at each fraction. In this work we describe the use of treatment log files, which are a record of the machine parameters for a given field delivery on a given fraction, to investigate the integrity of treatment delivery compared to the nominal planned dose. The dosimetry-relevant log file parameters are used to reconstruct the 3D dose distribution on the patient anatomy, using a TPS-independent dose calculation system. The analysis was performed for patients treated at Paul Scherrer Institute on Gantry 2, both for individual fields and per series (or plan), and delivery quality was assessed by determining the percentage of voxels in the log file dose distribution within  +/−  1% of the nominal dose. It was seen that, for all series delivered, the mean pass rate is 96.4%. Furthermore, this work establishes a correlation between the delivery quality of a field and the beam position accuracy. This correlation is evident for all delivered fields regardless of individual patient or plan characteristics. We have also detailed further usefulness of log file analysis within our clinical workflow. In summary, we have highlighted that the integrity of PBS treatment delivery is dependent on daily machine performance and is specifically highly correlated with the accuracy of beam position. We believe this information will be useful for driving machine performance improvements in the PBS field. (paper)

49 CFR 192.197 - Control of the pressure of gas delivered from high-pressure distribution systems.

Science.gov (United States)

2010-10-01

... 49 Transportation 3 2010-10-01 2010-10-01 false Control of the pressure of gas delivered from high-pressure distribution systems. 192.197 Section 192.197 Transportation Other Regulations Relating to... STANDARDS Design of Pipeline Components § 192.197 Control of the pressure of gas delivered from high...

Quality and Quantity of Rehabilitation Exercises Delivered By A 3-D Motion Controlled Camera: A Pilot Study.

Science.gov (United States)

Komatireddy, Ravi; Chokshi, Anang; Basnett, Jeanna; Casale, Michael; Goble, Daniel; Shubert, Tiffany

2014-08-01

Tele-rehabiliation technologies that track human motion could enable physical therapy in the home. To be effective, these systems need to collect critical metrics without PT supervision both in real time and in a store and forward capacity. The first step of this process is to determine if PTs (PTs) are able to accurately assess the quality and quantity of an exercise repetition captured by a tele-rehabilitation platform. The purpose of this pilot project was to determine the level of agreement of quality and quantity of an exercise delivered and assessed by the Virtual Exercise Rehabilitation Assistant (VERA), and seven PTs. Ten healthy subjects were instructed by a PT in how to perform four lower extremity exercises. Subjects then performed each exercises delivered by VERA which counted repetitions and quality. Seven PTs independently reviewed video of each subject's session and assessed repetitions quality. The percent difference in total repetitions and analysis of the distribution of rating repetition quality was assessed between the VERA and PTs. The VERA counted 426 repetitions across 10 subjects performing the four different exercises while the mean repetition count from the PT panel was 426.7 (SD = 0.8). The VERA underestimated the total repetitions performed by 0.16% (SD = 0.03%, 95% CI 0.12 - 0. 22). Chi square analysis across raters was χ 2 = 63.17 (df = 6, p<.001), suggesting significant variance in at least one rater. The VERA count of repetitions was accurate in comparison to a seven member panel of PTs. For exercise quality the VERA was able to rate 426 exercise repetitions across 10 patients and four different exercises in a manner consistent with five out of seven experienced PTs.

Computer and telephone delivered interventions to support caregivers of people with dementia: a systematic review of research output and quality

Directory of Open Access Journals (Sweden)

Amy Waller

2017-11-01

Full Text Available Abstract Background To assess the scope, volume and quality of research on the acceptability, utilisation and effectiveness of telephone- and computer-delivered interventions for caregivers of people living with dementia. Methods Medline, EMBASE, CINAHL and Cochrane databases were searched (Jan 1990 – Dec 2016. Eligible papers were classified as data-based descriptive, measurement or intervention studies. Intervention studies were first categorised according to mode of delivery (e.g. telephone, computer; then assessed against the Effective Practice and Organisation of Care (EPOC methodological criteria for research design. Impact on health-related outcomes; and the acceptability, feasibility and utilisation of interventions were also assessed. Results The number of publications increased by 13% each year (p < 0.001. Half were descriptive studies (n = 92, 50% describing caregiver views on acceptability, access or utilization of technology. The remainder (n = 89, 48% reported on interventions designed to improve caregiver outcomes. Only 34 met EPOC design criteria. Interventions were delivered via computer (n = 10, multiple modalities (n = 9 or telephone (n = 15. Interventions that incorporated various elements of psycho-education, peer support, skills training and health assessments led to improvements in caregiver wellbeing. While largely acceptable, utilisation of computer-based interventions was variable, with use often decreasing over time. Conclusion Interventions delivered via telephone and computer have the potential to augment existing dementia care. High-quality trials are required to make clear recommendations about the types of interventions that are most effective. Those that provide caregivers with: access to practical strategies to manage care of the person with dementia and their own wellbeing, advice and support from peers and/or clinicians; and that target the dyad should be explored.

Delivering high-quality family planning services in crisis-affected settings I: program implementation.

Science.gov (United States)

Curry, Dora Ward; Rattan, Jesse; Nzau, Jean Jose; Giri, Kamlesh

2015-02-04

In 2012, about 43 million women of reproductive age experienced the effects of conflict. Provision of basic sexual and reproductive health services, including family planning, is a recognized right and need of refugees and internally displaced people, but funding and services for family planning have been inadequate. This article describes lessons learned during the first 2.5 years of implementing the ongoing Supporting Access to Family Planning and Post-Abortion Care in Emergencies (SAFPAC) initiative, led by CARE, which supports government health systems to deliver family planning services in 5 crisis-affected settings (Chad, Democratic Republic of the Congo, Djibouti, Mali, and Pakistan). SAFPAC's strategy focuses on 4 broad interventions drawn from public health best practices in more stable settings: competency-based training for providers, improved supply chain management, regular supervision, and community mobilization to influence attitudes and norms related to family planning. Between July 2011 and December 2013, the initiative reached 52,616 new users of modern contraceptive methods across the 5 countries (catchment population of 698,053 women of reproductive age), 61% of whom chose long-acting methods of implants or intrauterine devices. Prudent use of data to inform decision making has been an underpinning to the project's approach. A key approach to ensuring sustained ability to train and supervise new providers has been to build capacity in clinical skills training and supervision by establishing in-country training centers. In addition, monthly supervision using simple checklists has improved program and service quality, particularly with infection prevention procedures and stock management. We have generally instituted a "pull" system to manage commodities and other supplies, whereby health facilities place resupply orders as needed based on actual consumption patterns and stock-alert thresholds. Finally, reaching the community with mobilization

The ELIXIR-EXCELERATE Train-the-Trainer pilot programme: empower researchers to deliver high-quality training [version 1; referees: 2 approved

Directory of Open Access Journals (Sweden)

Sarah L Morgan

2017-08-01

Full Text Available One of the main goals of the ELIXIR-EXCELERATE project from the European Union’s Horizon 2020 programme is to support a pan-European training programme to increase bioinformatics capacity and competency across ELIXIR Nodes. To this end, a Train-the-Trainer (TtT programme has been developed by the TtT subtask of EXCELERATE’s Training Platform, to try to expose bioinformatics instructors to aspects of pedagogy and evidence-based learning principles, to help them better design, develop and deliver high-quality training in future. As a first step towards such a programme, an ELIXIR-EXCELERATE TtT (EE-TtT pilot was developed, drawing on existing ‘instructor training’ models, using input both from experienced instructors and from experts in bioinformatics, the cognitive sciences and educational psychology. This manuscript describes the process of defining the pilot programme, illustrates its goals, structure and contents, and discusses its outcomes. From Jan 2016 to Jan 2017, we carried out seven pilot EE-TtT courses (training more than sixty new instructors, collaboratively drafted the training materials, and started establishing a network of trainers and instructors within the ELIXIR community. The EE-TtT pilot represents an essential step towards the development of a sustainable and scalable ELIXIR TtT programme. Indeed, the lessons learned from the pilot, the experience gained, the materials developed, and the analysis of the feedback collected throughout the seven pilot courses have both positioned us to consolidate the programme in the coming years, and contributed to the development of an enthusiastic and expanding ELIXIR community of instructors and trainers.

Assessment of the Quality of Delivered Care for Iranian patients with Rheumatoid Arthritis by Using Comprehensive Quality Measurement Model in Health Care (CQMH

Directory of Open Access Journals (Sweden)

Saeed Karimi

2015-12-01

Full Text Available Introduction: Quality of care has become increasingly critical in the evaluation of healthcare and healthcare services. The aim of this study was to assess quality of delivered care among patients with rheumatoid arthritis using a model of Comprehensive Quality Measurement in Health Care (CQMH. Methods: This cross-sectional study was conducted on 172 patients with rheumatoid arthritis (RA who were received care from private clinics of Isfahan University of medical sciences in 2013. CQMH questionnaires were used for assessing the quality of care. Data were analyzed using SPSS for Windows. Results: The mean scores of Quality Index, Service Quality (SQ, Technical Quality (TQ, and Costumer Quality (CQ were 72.70, 79.09, 68.54 and 70.25 out of 100, respectively. For CQ only 19.8% of participations staying the course of action even under stress and financial constraints, there is a significant gap between what RA care they received with what was recommended in the guideline for TQ. Scores of service quality was low in majority of aspects especially in "availability of support group" section. Conclusion: Study shows paradoxical findings and expresses that quality scores of service delivery for patients with arthritis rheumatoid from patient's perspective is relatively low. Therefore, for fixing this paradoxical problem, improving the participation of patients and their family and empowering them for self-management and decision should be regarded by health systems.

Impact of peer delivered wellness coaching.

Science.gov (United States)

Swarbrick, Margaret; Gill, Kenneth J; Pratt, Carlos W

2016-09-01

People receiving publicly funded behavioral health services for severe mental disorders have shorter lifespans and significantly impaired health-related quality of life compared to the general population. The aim of this article was to explore how peer wellness coaching (PWC), a manualized approach to pursue specific physical wellness goals, impacted goal attainment and overall health related quality of life. Deidentified archival program evaluation data were examined to explore whether peer delivered wellness coaching had an impact on 33 service recipients with regard to goal attainment and health-related quality of life. Participants were served by 1 of 12 wellness coach trainees from a transformation transfer initiative grant who had been trained in the manualized approach. Coaching participants and their coaches reported significant progress toward the attainment of individually chosen goals, 2 to 4 weeks after establishing their goals. After 8 to 10 weeks of peer delivered wellness coaching, improvements were evident in the self-report of physical health, general health, and perceived health. These improvements were sustained 90 days later. PWC is potentially a promising practice for helping people choose and pursue individual goals and facilitating positive health and wellness changes. Rigorous controlled research with larger samples is needed to evaluate the benefits of peer delivered wellness coaching. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Impact of caregivers' unmet needs for supportive care on quality of terminal cancer care delivered and caregiver's workforce performance.

Science.gov (United States)

Park, Sang Min; Kim, Young Jin; Kim, Samyong; Choi, Jong Soo; Lim, Ho-Yeong; Choi, Youn Seon; Hong, Young Seon; Kim, Si-Young; Heo, Dae Seog; Kang, Ki Moon; Jeong, Hyun Sik; Lee, Chang Geol; Moon, Do Ho; Choi, Jin-Young; Kong, In Sik; Yun, Young Ho

2010-06-01

Family caregivers play an important role in caring for cancer patients, but the impact of caregivers' unmet needs on the quality of end-of-life (EOL) care they deliver and on their workplace performance are less understood. We identified 1,662 family caregivers of cancer patients who had died at any of 17 hospitals in Korea during 2004. The caregivers answered a telephone questionnaire about needs that were not met when they delivered terminal cancer care and how those unmet their needs affected their workplace performance; they also answered the Quality Care Questionnaire-End of Life (QCQ-EOL). Compared with caregivers who did not have unmet needs, caregivers who had unmet needs for symptom management, financial support, or community support showed poorer QCQ-EOL scores (P < 0.01). Caregivers who had unmet needs for financial support (adjusted odds ratio (aOR) = 7.55; 95% confidential interval (CI) 3.80-15.00), psychosocial support (aOR = 6.24; 95% CI 2.95-13.05), symptom management (aOR = 3.21; 95% CI 2.26-4.54), community support (aOR = 3.82; 95% CI 2.38-6.11), or religious support (aOR = 4.55; 95% CI 1.84-11.26) were more likely to experience work limitations. Caregivers of patients receiving conventional hospital care were more likely to have unmet needs for symptom management (aOR = 1.21; 95% CI 1.00-1.47), psychosocial support (aOR = 1.99; 95% CI 1.37-2.88), and religious support (aOR = 1.73; 95% CI 1.08-2.78) than those of patients receiving palliative hospice care. Caregivers' unmet needs negatively affected both the quality of EOL care they delivered and their workplace performance. More investment in caregiver support and public policies that meet caregiver needs are needed, and hospice use should be encouraged.

High frequency of sub-optimal semen quality in an unselected population of young men

DEFF Research Database (Denmark)

Andersen, A G; Jensen, T K; Carlsen, E

2000-01-01

for military service, this provided a unique opportunity to study the reproductive function in an unbiased population. Altogether 891 young men delivered a blood sample in which reproductive hormones were measured. From 708 of these men data were also obtained on semen quality and testis size. The median sperm...... immotile spermatozoa and follicle stimulating hormone. Possible causes for this high frequency of young men with suboptimal semen quality are obscure and need to be explored. Whether these findings apply for young male populations of comparable countries remains to be seen....

Systems analysis of clinical incidents as a basis for improvement the quality of medical care delivered to patients with arterial hypertension

OpenAIRE

Posnenkova O.M.; Kiselev A.R.; Popova Y.V.; Volkova E.N.; Gridnev V.I.

2014-01-01

Background — Systems analysis of clinical incidents – is a relatively novel approach to medical care quality improvement. Its basis is studying of healthcare system with use of modeling. The purpose of the present work was to compare the potential value of different modeling methods, which implemented in systems analysis of clinical incidents, and form the basis for improvement the quality of medical care delivered to patients with arterial hypertension (AH). Material and Methods — Thre...

Afterschool Quality

Science.gov (United States)

Smith, Charles; Akiva, Tom; McGovern, Gina; Peck, Stephen C.

2014-01-01

This chapter discusses efforts to define and improve the quality of afterschool services, highlighting areas of agreement and identifying leading-edge issues. We conclude that the afterschool field is especially well positioned to deliver high-quality services and demonstrate effectiveness at scale because a strong foundation has been built for…

Quality assurance of the dose delivered by small radiation segments

International Nuclear Information System (INIS)

Hansen, Vebeke N.; Evans, Philip M.; Budgell, Geoffrey J.; Mott, Judith H.L.; Williams, Peter C.; Brugmans, Marco J.P.; Wittkaemper, Frits W.; Mijnheer, Ben J.; Brown, Kevin

1998-01-01

The use of intensity modulation with multiple static fields has been suggested by many authors as a way to achieve highly conformal fields in radiotherapy. However, quality assurance of linear accelerators is generally done only for beam segments of 100 MU or higher, and by measuring beam profiles once the beam has stabilized. We propose a set of measurements to check the stability of dose delivery in small segments, and present measured data from three radiotherapy centres. The dose delivered per monitor unit, MU, was measured for various numbers of MU segments. The field flatness and symmetry were measured using either photographic films that are subsequently scanned by a densitometer, or by using a diode array. We performed the set of measurements at the three radiotherapy centres on a set of five different Philips SL accelerators with energies of 6 MV, 8 MV, 10 MV and 18 MV. The dose per monitor unit over the range of 1 to 100 MU was found to be accurate to within ±5% of the nominal dose per monitor unit as defined for the delivery of 100 MU for all the energies. For four out of the five accelerators the dose per monitor unit over the same range was even found to be accurate to within ±2%. The flatness and symmetry were in some cases found to be larger for small segments by a maximum of 9% of the flatness/symmetry for large segments. The result of this study provides the dosimetric evidence that the delivery of small segment doses as top-up fields for beam intensity modulation is feasible. However, it should be stressed that linear accelerators have different characteristics for the delivery of small segments, hence this type of measurement should be performed for each machine before the delivery of small dose segments is approved. In some cases it may be advisable to use a low pulse repetition frequency (PRF) to obtain more accurate dose delivery of small segments. (author)

Transmission of laser pulses with high output beam quality using step-index fibers having large cladding

Science.gov (United States)

Yalin, Azer P; Joshi, Sachin

2014-06-03

An apparatus and method for transmission of laser pulses with high output beam quality using large core step-index silica optical fibers having thick cladding, are described. The thick cladding suppresses diffusion of modal power to higher order modes at the core-cladding interface, thereby enabling higher beam quality, M.sup.2, than are observed for large core, thin cladding optical fibers. For a given NA and core size, the thicker the cladding, the better the output beam quality. Mode coupling coefficients, D, has been found to scale approximately as the inverse square of the cladding dimension and the inverse square root of the wavelength. Output from a 2 m long silica optical fiber having a 100 .mu.m core and a 660 .mu.m cladding was found to be close to single mode, with an M.sup.2=1.6. Another thick cladding fiber (400 .mu.m core and 720 .mu.m clad) was used to transmit 1064 nm pulses of nanosecond duration with high beam quality to form gas sparks at the focused output (focused intensity of >100 GW/cm.sup.2), wherein the energy in the core was laser pulses was about 6 ns. Extending the pulse duration provided the ability to increase the delivered pulse energy (>20 mJ delivered for 50 ns pulses) without damaging the silica fiber.

The impact of employees' Motivation and Empowerment on Delivering Service Quality to Enhance Customer Satisfaction: Case Company X

OpenAIRE

Maria Amaanda, Nepwanga

2011-01-01

The main objective of this thesis is to assess the impact of employee motivation and empowerment on delivering quality service towards the enhancement of customer satisfaction for Company X of Namibia. The main purpose is to assist the management of Company X in finding the various measures that can be adopted to motivate and empower the employees. To analyse the current situation prevailing within the organization under review a qualitative research approach was used in this study. The r...

Game Sense as a Model for Delivering Quality Teaching in Physical Education

Science.gov (United States)

Light, Richard; Curry, Christina; Mooney, Amanda

2014-01-01

As a well-developed indicator of high-quality teaching in any subject area we use the New South Wales (NSW) Quality Teaching Framework (QTF) in this article to identify what might constitute quality teaching in physical education and to suggest the extent to which Game Sense pedagogy can be seen to meet the expectations of the NSW QTF. We identify…

Overcoming job demands to deliver high quality care in a hospital setting across Europe: The role of teamwork and positivity

OpenAIRE

Montgomery Anthony; Panagopoulou Efharis; Costa Patricia

2014-01-01

Health care professionals deal on a daily basis with several job demands – emotional, cognitive, organizational and physical. They must also ensure high quality care to their patients. The aim of this study is to analyse the impact of job demands on quality of care and to investigate team (backup behaviors) and individual (positivity ratio) processes that help to shield that impact. Data was collected from 2,890 doctors and nurses in 9 European countries by means of questionnaires. Job demand...

Twin pregnancy possibly associated with high semen quality

DEFF Research Database (Denmark)

Asklund, Camilla; Jensen, Tina Kold; Jørgensen, Niels

2007-01-01

BACKGROUND: Recent studies found an association between a long waiting time to pregnancy (TTP) and reduced probability of twinning and a reduced dizygotic (DZ) twinning rate in subfertile men. However, it remains unsolved whether semen quality is associated with twin offspring. We therefore studied...... the semen quality in a group of fathers of naturally conceived twins. METHODS: In this study, 37 fathers of DZ twins and 15 fathers of monozygotic (MZ) twins participated, and 349 normal fertile men served as a reference group. All men delivered a semen sample, underwent a physical examination and completed...... points higher than the reference group (P semen quality than the reference group, which supports...

Do mobile clinics provide high-quality antenatal care? A comparison of care delivery, knowledge outcomes and perception of quality of care between fixed and mobile clinics in central Haiti.

Science.gov (United States)

Phillips, Erica; Stoltzfus, Rebecca J; Michaud, Lesly; Pierre, Gracia Lionel Fils; Vermeylen, Francoise; Pelletier, David

2017-10-16

Antenatal care (ANC) is an important health service for women in developing countries, with numerous proven benefits. Global coverage of ANC has steadily increased over the past 30 years, in part due to increased community-based outreach. However, commensurate improvements in health outcomes such as reductions in the prevalence of maternal anemia and infants born small-for-gestational age have not been achieved, even with increased coverage, indicating that quality of care may be inadequate. Mobile clinics are one community-based strategy used to further improve coverage of ANC, but their quality of care delivery has rarely been evaluated. To determine the quality of care of ANC in central Haiti, we compared adherence to national guidelines between fixed and mobile clinics by performing direct observations of antenatal care consultations and exit interviews with recipients of care using a multi-stage random sampling procedure. Outcome variables were eight components of care, and women's knowledge and perception of care quality. There were significant differences in the predicted proportion or probability of recommended services for four of eight care components, including intake, laboratory examinations, infection control, and supplies, iron folic acid supplements and Tetanus Toxoid vaccine provided to women. These care components were more likely performed in fixed clinics, except for distribution of supplies, iron-folic acid supplements, and Tetanus Toxoid vaccine, more likely provided in mobile clinics. There were no differences between clinic type for the proportion of total physical exam procedures performed, health and communication messages delivered, provider communication or documentation. Women's knowledge about educational topics was poor, but women perceived extremely high quality of care in both clinic models. Although adherence to guidelines differed by clinic type for half of the care components, both clinics had a low percentage of overall services

Implementation of a Quality Improvement Process Aimed to Deliver Higher-Value Physical Therapy for Patients With Low Back Pain: Case Report.

Science.gov (United States)

Karlen, Emily; McCathie, Becky

2015-12-01

The current state of health care demands higher-value care. Due to many barriers, clinicians routinely do not implement evidence-based care even though it is known to improve quality and reduce cost of care. The purpose of this case report is to describe a theory-based, multitactic implementation of a quality improvement process aimed to deliver higher-value physical therapy for patients with low back pain. Patients were treated from January 2010 through December 2014 in 1 of 32 outpatient physical therapy clinics within an academic health care system. Data were examined from 47,755 patients (mean age=50.3 years) entering outpatient physical therapy for management of nonspecific low back pain, with or without radicular pain. Development and implementation tactics were constructed from adult learning and change management theory to enhance adherence to best practice care among 130 physical therapists. A quality improvement team implemented 4 tactics: establish care delivery expectations, facilitate peer-led clinical and operational teams, foster a learning environment focused on meeting a population's needs, and continuously collect and analyze outcomes data. Physical therapy utilization and change in functional disability were measured to assess relative cost and quality of care. Secondarily, charge data assessed change in physical therapists' application of evidence-based care. Implementation of a quality improvement process was measured by year-over-year improved clinical outcomes, decreased utilization, and increased adherence to evidence-based physical therapy, which was associated with higher-value care. When adult learning and change management theory are combined in quality improvement efforts, common barriers to implementing evidence-based care can be overcome, creating an environment supportive of delivering higher-value physical therapy for patients with low back pain. © 2015 American Physical Therapy Association.

Moving up the Ladder: How Do States Deliver Quality Improvement Supports within Their Quality Rating and Improvement Systems? Brief

Science.gov (United States)

Holod, Aleksandra; Faria, Ann-Marie; Weinberg, Emily; Howard, Eboni

2015-01-01

As national attention has increasingly focused on the potential for high-quality early childhood education (ECE) to improve children's school readiness, states have developed quality rating and improvement systems (QRISs) to document the quality of ECE programs, support systematic quality improvement, and provide clear information to families…

Providing high-quality care in primary care settings: how to make trade-offs.

Science.gov (United States)

Beaulieu, Marie-Dominique; Geneau, Robert; Del Grande, Claudio; Denis, Jean-Louis; Hudon, Eveline; Haggerty, Jeannie L; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William

2014-05-01

To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Three regions of Quebec. Health care professionals and staff of 5 PC practices. Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Irrespective of their models, PC practices' pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. Copyright© the College of Family Physicians of Canada.

Versatile, High Quality and Scalable Continuous Flow Production of Metal-Organic Frameworks

Science.gov (United States)

Rubio-Martinez, Marta; Batten, Michael P.; Polyzos, Anastasios; Carey, Keri-Constanti; Mardel, James I.; Lim, Kok-Seng; Hill, Matthew R.

2014-01-01

Further deployment of Metal-Organic Frameworks in applied settings requires their ready preparation at scale. Expansion of typical batch processes can lead to unsuccessful or low quality synthesis for some systems. Here we report how continuous flow chemistry can be adapted as a versatile route to a range of MOFs, by emulating conditions of lab-scale batch synthesis. This delivers ready synthesis of three different MOFs, with surface areas that closely match theoretical maxima, with production rates of 60 g/h at extremely high space-time yields. PMID:24962145

Delivering advanced therapies: the big pharma approach.

Science.gov (United States)

Tarnowski, J; Krishna, D; Jespers, L; Ketkar, A; Haddock, R; Imrie, J; Kili, S

2017-09-01

After two decades of focused development and some recent clinical successes, cell and gene therapy (CGT) is emerging as a promising approach to personalized medicines. Genetically engineered cells as a medical modality are poised to stand alongside or in combination with small molecule and biopharmaceutical approaches to bring new therapies to patients globally. Big pharma can have a vital role in industrializing CGT by focusing on diseases with high unmet medical need and compelling genetic evidence. Pharma should invest in manufacturing and supply chain solutions that deliver reproducible, high-quality therapies at a commercially viable cost. Owing to the fast pace of innovation in this field proactive engagement with regulators is critical. It is also vital to understand the needs of patients all along the patient care pathway and to establish product pricing that is accepted by prescribers, payers and patients.

Inefficient charging for delivered gas by local gas distributors

Directory of Open Access Journals (Sweden)

Siniša Bikić

2005-10-01

Full Text Available In this region, especially in Serbia, common belief is that local distributors of gas used by households don’t charge for gas properly. It is suspected that there are two sources for improper ways of gas charging. Local distributors charge for delivered gas only, according to flow rat but not according to gas quality. It is usual that local distributors deliver gas of different quality than one signed in contract. In this work will be considered only one of aspects inefficient charging for delivered gas by local gas distributors, which is connected to variable atmospheric pressure. There is doubt, that local distributors make mistakes during accounting for delivered gas to costumers in regard atmospheric pressure. At the beginning of every investigation, problem has to be located and recognized. Authors are going to collect as much as possible available data, to elaborate and analyze data by scientific methods and to represent conclusions. So, the aim of this work is to diagnose current state and to approve or disapprove above mentioned suspicions. In our region this theme is very interesting, both because of energy efficiency and air pollution control. In this way both consumer and distributor will know, how mush energy they have really spent.

Implementing a Coach-Delivered Dating Violence Prevention Program with High School Athletes.

Science.gov (United States)

Jaime, Maria Catrina D; McCauley, Heather L; Tancredi, Daniel J; Decker, Michele R; Silverman, Jay G; O'Connor, Brian; Miller, Elizabeth

2018-05-10

Teen dating violence and sexual violence are severe public health problems. Abusive behaviors within the context of dating or romantic relationships are associated with adverse health outcomes. Promoting positive bystander intervention and increasing knowledge of abusive behaviors are promising strategies for preventing dating and sexual violence. Coaching Boys Into Men (CBIM) is an evidence-based, athletic coach-delivered dating violence prevention program that has been shown to increase positive bystander behaviors and reduce abuse perpetration among high school male athletes. Identifying specific barriers and facilitators based on the coaches' experiences with program delivery combined with the coaches' and athletes' program perceptions may help optimize future CBIM implementation and sustainability. Semi-structured interviews with coaches (n = 36) explored the implementers' perspectives on strategies that worked well and potential barriers to program implementation. Ten focus groups with male athletes (n = 39) assessed their experiences with CBIM and the suitability of having their coaches deliver this program. Coaches described using the CBIM training cards and integrating program delivery during practice. Athletes reported coaches routinely delivering the CBIM program and adding their own personal stories or examples to the discussions. Key facilitators to program implementation include support from the violence prevention advocate, the ease of integrating CBIM into the sports season, and using the program materials. Barriers to implementation included finding sufficient time for the program, dynamics of delivering sensitive program content, and participant constraints. Coaches and athletes alike found the program feasible and acceptable to implement within the sports setting. Both coaches and athletes offered insights on the implementation and the feasibility and acceptability of CBIM within school-based athletic programs. These experiences by

Future of Food : Shaping the Food System to Deliver Jobs

OpenAIRE

Townsend, Robert; Benfica, Rui Manuel; Prasann, Ashesh; Lee, Maria

2017-01-01

Shaping the Food System to Deliver Jobs is the fourth paper in a series on The Future of Food. This paper focuses on how the food system can deliver jobs. It provides a framework for understanding the factors determining the number and quality of jobs in the food system, including inclusion of women and youth. It highlights a set of actions that countries can adopt, adapt, and apply to the...

Delivering Formal Outdoor Learning in Protected Areas: A Case Study of Scottish Natural Heritage National Nature Reserves

Science.gov (United States)

Black, Rosemary

2013-01-01

In most countries, protected area management agencies provide formal outdoor learning opportunities for a wide range of educational groups. For high-quality formal outdoor learning programmes that provide a range of experiences to be effectively delivered, specific resources and infrastructure are needed. Using the case study of Scottish Natural…

The knowledge and skills gap of medical practitioners delivering ...

African Journals Online (AJOL)

The knowledge and skills gap of medical practitioners delivering district hospital ... and quality health services, and also for guiding appropriate undergraduate, ... The uneven skill and knowledge base in aspects of HIV/AIDS management ...

High-power diode-end-pumped Tm:YLF slab laser delivering 189 W at 1890 nm

CSIR Research Space (South Africa)

Koen, W

2010-09-01

Full Text Available Laser Delivering 189 W at 1890 nm W. Koen, H.J. Strauss, C. Bollig and M.J.D. Esser CSIR National Laser Centre, Meiring Naude Road, Brummeria, Pretoria, 0001 wkoen@csir.co.za Abstract: We present a high-power Tm:YLF slab laser double...

Manufacturing of High Quality Teachers for Chemistry Education at Higher Secondary Level in Current Era

OpenAIRE

R. Azmat

2013-01-01

Education is the most influential tool whose efficient use requires the power of determination, devoted work and sacrifice. As teachers are major handler of this tool therefore, they must possess qualities of high education and competency for deliver. Education extends attractive way of life, talent and manners which make an individual a fine civilian. Primary and secondary education is one of the foundation stone of development of children and country. It acts as a vital part in placing the ...

Moderator/collimator for a proton/deuteron linac to produce a high-intensity, high-quality thermal neutron beam for neutron radiography

International Nuclear Information System (INIS)

Singleterry, R.C. Jr.; Imel, G.R.; McMichael, G.E.

1995-01-01

Reactor based high resolution neutron radiography facilities are able to deliver a well-collimated (L/D ≥100) thermal flux of 10 6 n/cm 2 ·sec to an image plane. This is well in excess of that achievable with the present accelerator based systems such as sealed tube D-T sources, Van der Graaff's, small cyclotrons, or low duty factor linacs. However, continuous wave linacs can accelerate tens of milliamperes of protons to 2.5 to 4 MeV. The MCNP code has been used to analyze target/moderator configurations that could be used with Argonne's Continuous Wave Linac (ACWL). These analyses have shown that ACWL could be modified to generate a neutron beam that has a high intensity and is of high quality

COST QUALITY MANAGEMENT

Directory of Open Access Journals (Sweden)

Vitanova Gordana

2009-05-01

Full Text Available Within the contemporary economic conditions, enterprises might achieve a competitive advantage if only they sell goods and services with high quality and lower prices. Customers, usually, prefer quality goods with acceptable prices, while such goods create reputation with the particular brand. The perfect control system is necessary to achieve a high quality product, which the cost quality management is considered to be an indispensable part in. The cost quality is nevertheless created to ensure that customers’ requirements are being appropriately attained. The most important objective of quality costs controlling is to assist the management in enhancing the product’s value permanently. The superior cost quality control system helps the management to achieve other strategic objectives, such as: producing goods with acceptable costs and deliver the products to their customers in time.

High repetition rate, high energy, actively Q-switched all-in-fiber laser

Science.gov (United States)

Lecourt, J. B.; Bertrand, A.; Guillemet, S.; Hernandez, Y.; Giannone, D.

2010-05-01

We report an actively Q-switched Ytterbium-doped all-in-fibre laser delivering 10ns pulses with high repetition rate (from 100kHz to 1MHz). The laser operation has been validated at three different wavelengths (1040, 1050 and 1064nm). The laser can deliver up to 20Watts average power with an high beam quality (M2 = 1).

Brazil's PROFORMAÇÃO Project: A Case Study of an Integrated Virtual System for Delivering In-Service Teacher Education

Science.gov (United States)

Moore, Michael G.

2016-01-01

A systems methodology was employed to design and deliver a highly successful demonstration of the effectiveness of distance education as a means of providing high quality training to tens of thousands of teachers in the most remote areas of Brazil. Key elements in the success of the program were significant funding, top political buy-in, and…

Technical Quality of Delivered Care for Patients with Inflammatory Bowel Disease in Tabriz Care Centers

Directory of Open Access Journals (Sweden)

Mohammad Hosein Somi

2015-08-01

Full Text Available ​Background and objectives : Inflammatory Bowel Disease (IBD is a chronic disease and requires complex treatment. Due to the various treatment options and gradual understanding of specialists about the risks and benefits of different treatments of IBD, delivering care according to the treatment protocols and guidelines is essential. This study was conducted to assess delivered care from the perspective of patients with inflammatory bowel disease. Material and Methods : This cross-sectional study was conducted with 94 participants with IBD selected randomly in Emam Reza hospital and Golgasht clinic in Tabriz. Data were collected by an approved researcher-made questionnaire via interviewing patients. Chi-Squared Test was used to evaluate the relationship between demographic variables and accordance of delivered care with standards. SPSS17 was used for data analysis. Results : The results indicated that "visit by specialist" and "providing dietary recommendation by nutritionist" aspects had highest and lowest degree of accordance with standards, respectively. Furthermore, the aspects of “delivered care in exacerbation status of disease” and “delivered care by other specialists” had only 20 percent compliance with standards. Also, there was a significant relationship between age, job, education status, smoking and compliance with related standards in some care aspects (p Conclusion : The study results indicated that there is a deep gap between delivered cares for patients with inflammatory bowel disease and related standards. These deficiencies showed the parts that need improvement and require healthcare managers and policy makers’ attention.

Cone Beam CT vs. Fan Beam CT: A Comparison of Image Quality and Dose Delivered Between Two Differing CT Imaging Modalities.

Science.gov (United States)

Lechuga, Lawrence; Weidlich, Georg A

2016-09-12

A comparison of image quality and dose delivered between two differing computed tomography (CT) imaging modalities-fan beam and cone beam-was performed. A literature review of quantitative analyses for various image quality aspects such as uniformity, signal-to-noise ratio, artifact presence, spatial resolution, modulation transfer function (MTF), and low contrast resolution was generated. With these aspects quantified, cone beam computed tomography (CBCT) shows a superior spatial resolution to that of fan beam, while fan beam shows a greater ability to produce clear and anatomically correct images with better soft tissue differentiation. The results indicate that fan beam CT produces superior images to that of on-board imaging (OBI) cone beam CT systems, while providing a considerably less dose to the patient.

A Robust Optimization Approach for Improving Service Quality

OpenAIRE

Andreas C. Soteriou; Richard B. Chase

2000-01-01

Delivering high quality service during the service encounter is central to competitive advantage in service organizations. However, achieving such high quality while controlling for costs is a major challenge for service managers. The purpose of this paper is to present an approach for addressing this challenge. The approach entails developing a model linking service process operational variables to service quality metrics to provide guidelines for service resource allocation. The approach en...

International VLBI Service for Geodesy and Astrometry. Delivering high-quality products and embarking on observations of the next generation

Science.gov (United States)

Nothnagel, A.; Artz, T.; Behrend, D.; Malkin, Z.

2017-07-01

The International VLBI Service for Geodesy and Astrometry (IVS) regularly produces high-quality Earth orientation parameters from observing sessions employing extensive networks or individual baselines. The master schedule is designed according to the telescope days committed by the stations and by the need for dense sampling of the Earth orientation parameters (EOP). In the pre-2011 era, the network constellations with their number of telescopes participating were limited by the playback and baseline capabilities of the hardware (Mark4) correlators. This limitation was overcome by the advent of software correlators, which can now accommodate many more playback units in a flexible configuration. In this paper, we describe the current operations of the IVS with special emphasis on the quality of the polar motion results since these are the only EOP components which can be validated against independent benchmarks. The polar motion results provided by the IVS have improved continuously over the years, now providing an agreement with IGS results at the level of 20-25 μas in a WRMS sense. At the end of the paper, an outlook is given for the realization of the VLBI Global Observing System.

Training the Next Generation of School Psychologists to Deliver Evidence Based Mental Health Practices: Current Challenges and Future Directions

Science.gov (United States)

Shernoff, Elisa S.; Bearman, Sarah Kate; Kratochwill, Thomas R.

2017-01-01

School psychologists are uniquely positioned to support the delivery of evidence-based mental health practices (EBMHPs) to address the overwhelming mental health needs of children and youth. Graduate training programs can promote EBMHPs in schools by ensuring school psychologists enter the workplace prepared to deliver and support high-quality,…

Manager traits and quality-of-care performance in hospitals.

Science.gov (United States)

Aij, Kjeld Harald; Aernoudts, René L M C; Joosten, Gepke

2015-07-06

This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Four traits were found to be significantly different (alpha management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management.

The experiences of high intensity therapists delivering cognitive behavioural therapy to people with intellectual disabilities.

Science.gov (United States)

Marwood, Hayley; Chinn, Deborah; Gannon, Kenneth; Scior, Katrina

2018-01-01

People with intellectual disabilities (ID) should be able to access the Improving Access to Psychological Therapies (IAPT) programme, currently a main provider of mainstream mental health services in England. IAPT offer cognitive behavioural therapy (CBT) to individuals experiencing mental health problems, although its effectiveness for people with ID, when delivered within IAPT, is unclear. Ten high-intensity therapists took part in semi-structured interviews, analysed using thematic analysis, regarding their experiences of delivering CBT to people with ID in IAPT. The rigidity of the IAPT model appears to offer a poor fit with the needs of people with ID. Therapists appeared uncertain about how to modify CBT and highlighted training and service development needs. Findings suggest barriers to accessing IAPT largely remain unaddressed where people with ID are concerned. Services may need to reconsider what constitutes appropriate reasonable adjustments to ensure equitable access. © 2017 John Wiley & Sons Ltd.

Zerodur polishing process for high surface quality and high efficiency

International Nuclear Information System (INIS)

Tesar, A.; Fuchs, B.

1992-08-01

Zerodur is a glass-ceramic composite importance in applications where temperature instabilities influence optical and mechanical performance, such as in earthbound and spaceborne telescope mirror substrates. Polished Zerodur surfaces of high quality have been required for laser gyro mirrors. Polished surface quality of substrates affects performance of high reflection coatings. Thus, the interest in improving Zerodur polished surface quality has become more general. Beyond eliminating subsurface damage, high quality surfaces are produced by reducing the amount of hydrated material redeposited on the surface during polishing. With the proper control of polishing parameters, such surfaces exhibit roughnesses of < l Angstrom rms. Zerodur polishing was studied to recommend a high surface quality polishing process which could be easily adapted to standard planetary continuous polishing machines and spindles. This summary contains information on a polishing process developed at LLNL which reproducibly provides high quality polished Zerodur surfaces at very high polishing efficiencies

[Quality management is associated with high quality services in health care].

Science.gov (United States)

Nielsen, Tenna Hassert; Riis, Allan; Mainz, Jan; Jensen, Anne-Louise Degn

2013-12-09

In these years, quality management has been the focus in order to meet high quality services for the patients in Danish health care. This article provides information on quality management and quality improvement and it evaluates its effectiveness in achieving better organizational structures, processes and results in Danish health-care organizations. Our findings generally support that quality management is associated with high quality services in health care.

Supporting Quality Timely PhD Completions: Delivering Research Outcomes

Science.gov (United States)

Gasson, Susan

2015-01-01

The case study used a three-phase organising process to explain how design and implementation of an accessible and interactive electronic thesis submission form streamlined quality assurance of theses and their timely dissemination via an online thesis repository. The quality of the theses submitted is assured by key academics in their final sign…

Automated high speed volume computed tomography for inline quality control

International Nuclear Information System (INIS)

Hanke, R.; Kugel, A.; Troup, P.

2004-01-01

Increasing complexity of innovative products as well as growing requirements on quality and reliability call for more detailed knowledge about internal structures of manufactured components rather by 100 % inspection than just by sampling test. A first-step solution, like radioscopic inline inspection machines, equipped with automated data evaluation software, have become state of the art in the production floor during the last years. However, these machines provide just ordinary two-dimensional information and deliver no volume data e.g. to evaluate exact position or shape of detected defects. One way to solve this problem is the application of X-ray computed tomography (CT). Compared to the performance of the first generation medical scanners (scanning times of many hours), today, modern Volume CT machines for industrial applications need about 5 minutes for a full object scan depending on the object size. Of course, this is still too long to introduce this powerful method into the inline production quality control. In order to gain acceptance, the scanning time including subsequent data evaluation must be decreased significantly and adapted to the manufacturing cycle times. This presentation demonstrates the new technical set up, reconstruction results and the methods for high-speed volume data evaluation of a new fully automated high-speed CT scanner with cycle times below one minute for an object size of less than 15 cm. This will directly create new opportunities in design and construction of more complex objects. (author)

Defining High-Quality Palliative Care in Oncology Practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement.

Science.gov (United States)

Bickel, Kathleen E; McNiff, Kristen; Buss, Mary K; Kamal, Arif; Lupu, Dale; Abernethy, Amy P; Broder, Michael S; Shapiro, Charles L; Acheson, Anupama Kurup; Malin, Jennifer; Evans, Tracey; Krzyzanowska, Monika K

2016-09-01

Integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to specialist palliative medicine. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. An expert steering committee outlined 966 palliative care service items, in nine domains, each describing a candidate element of primary palliative care delivery for patients with advanced cancer or high symptom burden. Using modified Delphi methodology, 31 multidisciplinary panelists rated each service item on three constructs: importance, feasibility, and scope within medical oncology practice. Panelists endorsed the highest proportion of palliative care service items in the domains of End-of-Life Care (81%); Communication and Shared Decision Making (79%); and Advance Care Planning (78%). The lowest proportions were in Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level, with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea, and pain. Within the Appropriate Palliative Care and Hospice Referral domain, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients appropriately. This statement describes the elements comprising high-quality primary palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find this information useful to inform operational changes and quality improvement efforts. Copyright © 2016 by American Society of Clinical Oncology.

Quality Indicators for Family Support Services and Their Relationship to Organizational Social Context

Science.gov (United States)

Olin, S. Serene; Williams, Nate; Pollock, Michele; Armusewicz, Kelsey; Kutash, Krista; Glisson, Charles; Hoagwood, Kimberly E.

2013-01-01

Quality measurement is an important component of healthcare reform. The relationship of quality indicators (QIs) for parent-delivered family support services to organizational social contexts known to improve quality is unexamined. This study employs data collected from 21 child mental health programs that deliver team-based family support services. Performance on two levels of QIs —those targeting the program and staff -- were significantly associated with organizational social context profiles and dimensions. High quality program policies are associated with positive organizational cultures and engaging climates. Inappropriate staff practices are associated with resistant cultures. Implications for organizational strategies to improve service quality are discussed. PMID:23709286

Quality of delivered care for people with type 2 diabetes: a new patient-centred model.

Science.gov (United States)

Tabrizi, Jafar S

2009-12-28

The quality of care from the perspective of people with Type 2 diabetes using a new model (CQMH) including three dimensions of quality in health care (Technical, Service and Customer Quality) was assessed. A cross-sectional survey with a sample of 577 people with Type 2 diabetes was conducted. Measures were self-reported adherence to national guidelines for technical quality, the Netherlands Institute for Health Services Research questionnaire for service quality and the short form of the Patient Activation Measure for Customer Quality. There was a significant gap in technical quality between what diabetes care the patients reported receiving and what was recommended in the guideline, particularly for management and lifestyle aspects. For service quality, the lowest scores were for choice of care provider and accessibility of care. The mean Customer Quality score was 64.5 (meaning higher score indicating better quality). A positive relationship was demonstrated between higher technical, service and customer quality scores, and better diabetes control status as well as maintaining continuity of care. The average Quality Index was 70.0 of a 0-100 scale. Customer Quality appears to be a useful third dimension in conceptualising quality in health care, particularly in the context of chronic disease, where good self-management can improve the outcomes of care. A high proportion of Queensland adults with Type 2 diabetes reported receiving suboptimal care in the majority aspects of provided care services as reflected in the overall Quality Index score indicating substantial room for quality improvement.

Delivering Diagnostic Quality Video over Mobile Wireless Networks for Telemedicine

Directory of Open Access Journals (Sweden)

Sira P. Rao

2009-01-01

Full Text Available In real-time remote diagnosis of emergency medical events, mobility can be enabled by wireless video communications. However, clinical use of this potential advance will depend on definitive and compelling demonstrations of the reliability of diagnostic quality video. Because the medical domain has its own fidelity criteria, it is important to incorporate diagnostic video quality criteria into any video compression system design. To this end, we used flexible algorithms for region-of-interest (ROI video compression and obtained feedback from medical experts to develop criteria for diagnostically lossless (DL quality. The design of the system occurred in three steps-measurement of bit rate at which DL quality is achieved through evaluation of videos by medical experts, incorporation of that information into a flexible video encoder through the notion of encoder states, and an encoder state update option based on a built-in quality criterion. Medical experts then evaluated our system for the diagnostic quality of the video, allowing us to verify that it is possible to realize DL quality in the ROI at practical communication data transfer rates, enabling mobile medical assessment over bit-rate limited wireless channels. This work lays the scientific foundation for additional validation through prototyped technology, field testing, and clinical trials.

Delivered Pricing, FOB Pricing, and Collusion in Spatial Markets

OpenAIRE

Maria Paz Espinosa

1992-01-01

This article examines price discrimination and collusion in spatial markets. The problem is analyzed in the context of a repeated duopoly game. I conclude that the prevailing pricing systems depend on the structural elements of the market. Delivered pricing systems emerge in equilibrium in highly monopolistic and highly competitive industries, while FOB is used in intermediate market structures. The fact driving this result is that delivered pricing policies allow spatial price discrimination...

Delivering quality of care while managing the interests of all stakeholders.

Science.gov (United States)

Stopper, Andrea; Raddatz, Agnieszka; Grassmann, Aileen; Stuard, Stefano; Menzer, Marcus; Possnien, Gernot; Scatizzi, Laura; Marcelli, Daniele

2011-01-01

National healthcare systems worldwide face growing challenges to reconcile interests of patients for high-quality medical care and of payers for sustainable and affordable funding. Advances in the provision of renal replacement therapy can only be made by developing and implementing appropriate sophisticated and state-of-the-art business models that include reimbursement schemes for comprehensive care packages. Such business models must succeed in integrating and reconciling the interests of all stakeholders. NephroCare as dialysis provider has adopted and tailored recognized management techniques, i.e. Balanced Scorecard and Kaizen, to achieve these goals. Success of the complete business model package is tangible - strategies initiated to improve treatment quality even at the cost of providers have been translated into win-win scenarios for the complete stakeholder community. Room for improvement exists: the possibility to extend the portfolio of service offerings within the comprehensive care frame, as well as the challenge for achieving a balance between the stability of targets while keeping these up to date concerning new insights. Copyright © 2011 S. Karger AG, Basel.

Linkages between forest soils and water quality and quantity

Science.gov (United States)

Daniel G. Neary; George G. Ice; C. Rhett Jackson

2009-01-01

The most sustainable and best quality fresh water sources in the world originate in forest ecosystems. The biological, chemical, and physical characteristics of forest soils are particularly well suited to delivering high quality water to streams, moderating stream hydrology, and providing diverse aquatic habitat. Forest soils feature litter layers and...

Delivering IT and eBusiness value

CERN Document Server

Willcocks, Leslie

2001-01-01

Delivering Business Value from IT' is focused on the evaluation issue in IT and how IT evaluation can proceed across the life-cycle of any IT investment and be linked positively to improving business performance. .Chapters 1,2 and 3 detail an approach to IT evaluation whilst chapters 4 and 5 build on these by showing two distinctive approaches to linking IT to business performance. The remaining three chapters deal with a range of evaluation issues emerging as important - specifically Internet evaluation, Y2K and beyond, EMU, quality outsourcing, infrastructure, role of benchmarking, and cost

Caregivers' quality of life and quality of services for children with cancer: a review from iran.

Science.gov (United States)

Sajjadi, Homeira; Vameghi, Meroe; Ghazinour, Mehdi; Khodaeiardekani, Mohammadreza

2013-03-04

Caregivers of cancer patients are exposed to different types of psychosocial stress which influence their quality of life. The purposes of this study were to assess quality of life in caregivers of children with cancer and to investigate the relationship between the caregivers' quality of life and quality of services in the social work section. 125 caregivers were recruited. Quality of life was measured by the Iranian version of the WHOQOL-BREF questionnaire and data concerning service quality were obtained from the Iranian version of the SERVQUAL questionnaire. Scores in physical health, psychological status and environmental conditions for caregivers of children with cancer were significantly lower than the general population. There was a negative correlation between the tangible domain of SERVQUAL and the psychological status and environmental conditions of quality of life. The tangible dimension was the only aspect of service quality to predict caregivers' quality of life regarding psychological status and environmental conditions. Caregivers of children with a disease are care consumers and, like all consumers, they expect good service. Delivering high quality services consistently is difficult but profitable for a service organization. In other words, trying to deliver more appropriate services than patients expect to receive from their social work care is one of the most reliable ways to promote caregivers' satisfaction and quality of life.

Caregivers’ Quality of Life and Quality of Services for Children with Cancer: A Review from Iran

Science.gov (United States)

Sajjadi, Homeira; Vameghi, Meroe; Ghazinour, Mehdi; KhodaeiArdakani, Mohammadreza

2013-01-01

Objective: Caregivers of cancer patients are exposed to different types of psychosocial stress which influence their quality of life. The purposes of this study were to assess quality of life in caregivers of children with cancer and to investigate the relationship between the caregivers’ quality of life and quality of services in the social work section. Method: 125 caregivers were recruited. Quality of life was measured by the Iranian version of the WHOQOL-BREF questionnaire and data concerning service quality were obtained from the Iranian version of the SERVQUAL questionnaire. Findings: Scores in physical health, psychological status and environmental conditions for caregivers of children with cancer were significantly lower than the general population. There was a negative correlation between the tangible domain of SERVQUAL and the psychological status and environmental conditions of quality of life. The tangible dimension was the only aspect of service quality to predict caregivers’ quality of life regarding psychological status and environmental conditions. Conclusion: Caregivers of children with a disease are care consumers and, like all consumers, they expect good service. Delivering high quality services consistently is difficult but profitable for a service organization. In other words, trying to deliver more appropriate services than patients expect to receive from their social work care is one of the most reliable ways to promote caregivers’ satisfaction and quality of life. PMID:23618487

Developing an effective toxicology/quality assurance partnership. Improving quality, compliance, and cooperation.

Science.gov (United States)

Usher, R W

1995-12-01

Toxicology and Quality Assurance (QA) at Eli Lilly and Company are well integrated, yet still independent organizations that are aligned with the same overall business objective: to efficiently deliver a high-quality product to the customer. One of the keys to success has been the implementation of a monitoring/metric and trend analysis program of key work processes that are central to the delivery of final product. Our metrics program indicates that the multiple changes that we have made have resulted in a higher quality product. This paper will discuss the practical changes we have made as a part of our Total Quality journey. This article is based solely on the authors' experiences while at Eli Lilly and Company.

Randomized Controlled Trial of Telephone-Delivered Cognitive Behavioral Therapy for Chronic Insomnia

Science.gov (United States)

Arnedt, J. Todd; Cuddihy, Leisha; Swanson, Leslie M.; Pickett, Scott; Aikens, James; Chervin, Ronald D.

2013-01-01

Study Objectives: To compare the efficacy of telephone-delivered cognitive-behavioral therapy for insomnia to an information pamphlet control on sleep and daytime functioning at pretreatment, posttreatment, and 12-wk follow-up. Design: Randomized controlled parallel trial. Setting: N/A. Participants: Thirty individuals with chronic insomnia (27 women, age 39.1 ± 14.4 years, insomnia duration 8.7 ± 10.7 years). Interventions: Cognitive behavioral therapy for insomnia (CBTI) delivered in up to eight weekly telephone sessions (CBTI-Phone, n = 15) versus an information pamphlet control (IPC, n = 15). Measurements and Results: Sleep/wake diary, sleep-related questionnaires (Insomnia Severity Index, Pittsburgh Sleep Quality Index, 16-item Dysfunctional Beliefs and Attitudes about Sleep), and daytime symptom assessments (fatigue, depression, anxiety, and quality of life) were completed at pretreatment, posttreatment, and 12-wk follow-up. Linear mixed models indicated that sleep/wake diary sleep efficiency and total sleep time improved significantly at posttreatment in both groups and remained stable at 12-wk follow-up. More CBTI-Phone than IPC patients showed posttreatment improvements in unhelpful sleep-related cognitions (P insomnia at follow-up (P insomnia. Future larger-scale studies with more diverse samples are warranted. Some individuals with insomnia may also benefit from pamphlet-delivered CBTI with brief telephone support. Citation: Arnedt JT; Cuddihy L; Swanson LM; Pickett S; Aikens J; Chervin RD. Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia. SLEEP 2013;36(3):353-362. PMID:23450712

Controlling torque and cutting costs: steerable drill bits deliver in Latin America

Energy Technology Data Exchange (ETDEWEB)

Barton, Steve; Garcia, Alexis; Amorim, Dalmo [ReedHycalog, Stonehouse (United Kingdom); Iramina, Wilson [University of Sao Paulo (USP), SP (Brazil); Herrera, Gabriel

2008-07-01

Tool face Control is widely regarded as one of the greatest directional drilling challenges with a Fixed Cutter (FC) drill bit on a Steerable Motor assembly. Tool face offset is proportional to the torque generated by the bit, and by nature, FC bits are capable of generating high levels of torque. If large changes in downhole torque are produced while drilling, this will cause rotation of the drill string, and loss of tool face orientation. This results in inefficient drilling and increases risk of bit and downhole tool damage. This paper examines the effect of various FC drill bit components to determine the key design requirements to deliver a smooth torque response and an improved directional performance. Included is a review of the results from comprehensive laboratory testing to determine the effectiveness of a number of different configurations of removable Torque Controlling Components (TCC). These, in combination with specific cutting structure layouts, combine to provide predictable torque response while optimized for high rates of penetration. In addition, unique gauge geometry is disclosed that was engineered to reduce drag and deliver improved borehole quality. This gauge design produces less torque when sliding and beneficial gauge pad interaction with the borehole when in rotating mode. Field performance studies from within Latin America clearly demonstrate that matching TCC, an optimized cutting structure, and gauge geometry to a steerable assembly delivers smooth torque response and improved directional control. Benefits with regard to improved stability are also discussed. Successful application has resulted in significant time and cost savings for the operator, demonstrating that Stability and Steerability improvements can be achieved with an increase in penetration rate. (author)

Adoption of high technology medical imaging and hospital quality and efficiency: Towards a conceptual framework.

Science.gov (United States)

Sandoval, Guillermo A; Brown, Adalsteinn D; Wodchis, Walter P; Anderson, Geoffrey M

2018-05-17

Measuring the value of medical imaging is challenging, in part, due to the lack of conceptual frameworks underlying potential mechanisms where value may be assessed. To address this gap, this article proposes a framework that builds on the large body of literature on quality of hospital care and the classic structure-process-outcome paradigm. The framework was also informed by the literature on adoption of technological innovations and introduces 2 distinct though related aspects of imaging technology not previously addressed specifically in the literature on quality of hospital care: adoption (a structural hospital characteristic) and use (an attribute of the process of care). The framework hypothesizes a 2-part causality where adoption is proposed to be a central, linking factor between hospital structural characteristics, market factors, and hospital outcomes (ie, quality and efficiency). The first part indicates that hospital structural characteristics and market factors influence or facilitate the adoption of high technology medical imaging within an institution. The presence of this technology, in turn, is hypothesized to improve the ability of the hospital to deliver high quality and efficient care. The second part describes this ability throughout 3 main mechanisms pointing to the importance of imaging use on patients, to the presence of staff and qualified care providers, and to some elements of organizational capacity capturing an enhanced clinical environment. The framework has the potential to assist empirical investigations of the value of adoption and use of medical imaging, and to advance understanding of the mechanisms that produce quality and efficiency in hospitals. Copyright © 2018 John Wiley & Sons, Ltd.

Delivering stable high-quality video: an SDN architecture with DASH assisting network elements

NARCIS (Netherlands)

J.W.M. Kleinrouweler (Jan Willem); S. Cabrero Barros (Sergio); P.S. Cesar Garcia (Pablo Santiago)

2016-01-01

textabstractDynamic adaptive streaming over HTTP (DASH) is a simple, but effective, technology for video streaming over the Internet. It provides adaptive streaming while being highly scalable at the side of the content providers. However, the mismatch between TCP and the adaptive bursty nature of

High-quality compressive ghost imaging

Science.gov (United States)

Huang, Heyan; Zhou, Cheng; Tian, Tian; Liu, Dongqi; Song, Lijun

2018-04-01

We propose a high-quality compressive ghost imaging method based on projected Landweber regularization and guided filter, which effectively reduce the undersampling noise and improve the resolution. In our scheme, the original object is reconstructed by decomposing of regularization and denoising steps instead of solving a minimization problem in compressive reconstruction process. The simulation and experimental results show that our method can obtain high ghost imaging quality in terms of PSNR and visual observation.

Photonic crystal fiber technology for compact fiber-delivered high-power ultrafast fiber lasers

Science.gov (United States)

Triches, Marco; Michieletto, Mattia; Johansen, Mette M.; Jakobsen, Christian; Olesen, Anders S.; Papior, Sidsel R.; Kristensen, Torben; Bondue, Magalie; Weirich, Johannes; Alkeskjold, Thomas T.

2018-02-01

Photonic crystal fiber (PCF) technology has radically impacted the scientific and industrial ultrafast laser market. Reducing platform dimensions are important to decrease cost and footprint while maintaining high optical efficiency. We present our recent work on short 85 μm core ROD-type fiber amplifiers that maintain single-mode performance and excellent beam quality. Robust long-term performance at 100 W average power and 250 kW peak power in 20 ps pulses at 1030 nm wavelength is presented, exceeding 500 h with stable performance in terms of both polarization and power. In addition, we present our recent results on hollow-core ultrafast fiber delivery maintaining high beam quality and polarization purity.

Formulation of dark chocolate as a carrier to deliver eicosapentaenoic and docosahexaenoic acids: Effects on product quality.

Science.gov (United States)

Toker, Omer Said; Konar, Nevzat; Palabiyik, Ibrahim; Rasouli Pirouzian, Haniyeh; Oba, Sirin; Polat, Derya Genc; Poyrazoglu, Ender Sinan; Sagdic, Osman

2018-07-15

In this study, dark chocolate enriched with EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) was developed using various forms and origins. Quality characteristics such as physical, thermo-gravimetric, rheological, textural and sensory properties of chocolates were investigated. The highest EPA/DHA stability was determined in samples prepared by free-flowing powder and microencapsulated forms of omega-3 fatty acids (FA). The L ∗ and C ∗ values varied from 32.16-33.37 and 7.45-8.09, respectively for the all samples. Hardness values ranged between 6422 and 8367 N and the use of EPA/DHA in the triglyceride form caused softer chocolate whereas control sample was the hardest sample. Melting and rheological properties were not significantly affected by the studied EPA/DHA sources (P chocolate was the most preferred source whereas sample with algae oil showed the lowest acceptability. According to the results, dark chocolate can be used for delivering omega-3 FA by considering their origin and physical form. Copyright © 2018 Elsevier Ltd. All rights reserved.

Fabrication of high-quality brazed joints

International Nuclear Information System (INIS)

Orlov, A.V.

1980-01-01

Problem of ensuring of joint high-quality when brazing different parts in power engineering is considered. To obtain high-quality joints it is necessary to correctly design brazed joint and to choose a gap width, overlap length and fillet radius; to clean up carefully the surfaces to be brazed and fix them properly one relative to another; to apply a solder so as to provide its flowing into the gap and sticking in it; to exactly regulate thermal conditions of brazing. High quality and reliability of brazed joints are ensured by the application of solders based on noble metals, and cheap solders based on nickel, manganese and copper. Joints brazed with nickel base solders may operate at temperatures as high as 888 deg C

Gluten characteristics imparting bread quality in wheats differing for high molecular weight glutenin subunits at Glu D1 locus.

Science.gov (United States)

Mohan, Devinder; Gupta, Raj Kumar

2015-07-01

High yielding genotypes differing for high molecular weight glutenin subunits at Glu D1 locus in national wheat programme of India were examined for bread loaf volume, gluten and protein contents, gluten strength, gluten index and protein-gluten ratio. Number of superior bread quality genotypes in four agro-climatically diverse zones of Indian plains was comparable in both categories of wheat i.e., 5 + 10 and 2 + 12. There wasn't any difference in average bread loaf volume and grain protein content either. 5 + 10 wheats showed better gluten strength and their gluten quality was also superior in the zones where protein content was high. 2 + 10 wheats exerted more gluten due to better protein-gluten ratio. Good bread making in 5 + 10 was derived by better gluten strength and also gluten quality in certain regions but bread quality in 2 + 12 wheats was channelized through higher gluten content as they were more efficient in extracting gluten from per unit protein. Difference in route to bread quality was apparent as gluten content and gluten strength were the key gluten attributes in 5 + 10 whereas protein content and gluten index were prominent in 2 + 12 types. Unlike 2 + 12, there was a ceiling in gluten harvest of 5 + 10 wheats as higher protein failed to deliver more gluten after some limit.

A Process Framework for Managing Interactions between Sotware Quality Charateristics

OpenAIRE

García Mireles, Gabriel Alberto

2016-01-01

Software quality is dominated by the manufacturing view in which the conformance to software process models is considered to be the best approach by which to deliver high quality software products. Product quality is measured by using surrogates as the number of defects found in software products and/or rework costs. This view, although useful for structuring practices that a software organization deploys, lacks the appropriate support needed to directly focus on the quality needs of differe...

Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand

Science.gov (United States)

Bhutta, Zulfiqar A; Darmstadt, Gary L; Haws, Rachel A; Yakoob, Mohammad Yawar; Lawn, Joy E

2009-01-01

impact of the wide-scale implementation of these strategies on stillbirth rates. Strategies to improve quality of care by upgrading the skills of community cadres have shown demonstrable impact on perinatal mortality, particularly in conjunction with health systems strengthening and facilitation of referrals. Neonatal resuscitation training for physicians and other health workers shows potential to prevent many neonatal deaths currently misclassified as stillbirths. Perinatal audit systems, which aim to improve quality of care by identifying deficiencies in care, are a quality improvement measure that shows some evidence of benefit for changes in clinical practice that prevent stillbirths, and are strongly recommended wherever practical, whether as hospital case review or as confidential enquiry at district or national level. Conclusion Delivering interventions to reduce the global burden of stillbirths requires action at all levels of the health system. Packages of interventions should be tailored to local conditions, including local levels and causes of stillbirth, accessibility of care and health system resources and provider skill. Antenatal care can potentially serve as a platform to deliver interventions to improve maternal nutrition, promote behaviour change to reduce harmful exposures and risk of infections, screen for and treat risk factors, and encourage skilled attendance at birth. Following the example of high-income countries, improving intrapartum monitoring for fetal distress and access to Caesarean section in low-/middle-income countries appears to be key to reducing intrapartum stillbirth. In remote or low-resource settings, families and communities can be galvanised to demand and seek quality care through financial incentives and health promotion efforts of local cadres of health workers, though these interventions often require simultaneous health systems strengthening. Perinatal audit can aid in the development of better standards of care, improving

Availability of high quality weather data measurements

DEFF Research Database (Denmark)

Andersen, Elsa; Johansen, Jakob Berg; Furbo, Simon

In the period 2016-2017 the project “Availability of high quality weather data measurements” is carried out at Department of Civil Engineering at the Technical University of Denmark. The aim of the project is to establish measured high quality weather data which will be easily available...... for the building energy branch and the solar energy branch in their efforts to achieve energy savings and for researchers and students carrying out projects where measured high quality weather data are needed....

A randomized trial of Internet-delivered treatment for social anxiety disorder in high school students.

Science.gov (United States)

Tillfors, Maria; Andersson, Gerhard; Ekselius, Lisa; Furmark, Tomas; Lewenhaupt, Susanne; Karlsson, Anders; Carlbring, Per

2011-01-01

Internet-based cognitive behavior therapy (CBT) has been shown effective for university students with social anxiety disorder (SAD) and public speaking fears. The aim of this study was to investigate whether the promising results can be transferred to high school students suffering from this condition. A total of 19 speech-anxious high school students with SAD were randomized either into 9 weeks of Internet-delivered CBT or to a wait-list control group. Significant improvements were found on measures of social anxiety, general anxiety, and depression. Effects were maintained at 1-year follow-up. The average within- and between-group effect sizes (Cohen's d) for the primary social anxiety scales at posttest were 0.98 and 1.38, respectively. However, the average number of completed modules in the CBT program was low. Although compliance can be improved, the results suggest that Internet-based guided self-help is effective in the treatment of high school students with SAD.

Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness.

Directory of Open Access Journals (Sweden)

Filip K Arnberg

Full Text Available Greater access to evidence-based psychological treatments is needed. This review aimed to evaluate whether internet-delivered psychological treatments for mood and anxiety disorders are efficacious, noninferior to established treatments, safe, and cost-effective for children, adolescents and adults.We searched the literature for studies published until March 2013. Randomized controlled trials (RCTs were considered for the assessment of short-term efficacy and safety and were pooled in meta-analyses. Other designs were also considered for long-term effect and cost-effectiveness. Comparisons against established treatments were evaluated for noninferiority. Two reviewers independently assessed the relevant studies for risk of bias. The quality of the evidence was graded using an international grading system.A total of 52 relevant RCTs were identified whereof 12 were excluded due to high risk of bias. Five cost-effectiveness studies were identified and three were excluded due to high risk of bias. The included trials mainly evaluated internet-delivered cognitive behavioral therapy (I-CBT against a waiting list in adult volunteers and 88% were conducted in Sweden or Australia. One trial involved children. For adults, the quality of evidence was graded as moderate for the short-term efficacy of I-CBT vs. waiting list for mild/moderate depression (d = 0.83; 95% CI 0.59, 1.07 and social phobia (d = 0.85; 95% CI 0.66, 1.05, and moderate for no efficacy of internet-delivered attention bias modification vs. sham treatment for social phobia (d =  -0.04; 95% CI -0.24, 0.35. The quality of evidence was graded as low/very low for other disorders, interventions, children/adolescents, noninferiority, adverse events, and cost-effectiveness.I-CBT is a viable treatment option for adults with depression and some anxiety disorders who request this treatment modality. Important questions remain before broad implementation can be supported. Future research would

Healthcare reform from the inside: A neurosurgical clinical quality program

OpenAIRE

Afsar-Manesh, Nasim; Martin, Neil A.

2012-01-01

During the past decade, the U.S. health care system has faced increasing challenges in delivering high quality of care, ensuring patient safety, providing access to care, and maintaining manageable costs. While reform progresses at a national level, health care providers have a responsibility and obligation to advance quality and safety. In 2009, the authors implemented a department-wide Clinical Quality Program. This Program comprised of an inter-disciplinary group of providers and staff wor...

Highly qualified does not equal high quality: A study of urban stakeholders' perceptions of quality in science teaching

Science.gov (United States)

Miranda, Rommel Joseph

By employing qualitative methods, this study sought to determine the perceptions that urban stakeholders hold about what characteristics should distinguish a high school science teacher whom they would consider to demonstrate high quality in science teaching. A maximum variation sample of six science teachers, three school administrators, six parents and six students from a large urban public school district were interviewed using semi-structured, in-depth interview techniques. From these data, a list of observable characteristics which urban stakeholders hold as evidence of high quality in science teaching was generated. Observational techniques were utilized to determine the extent to which six urban high school science teachers, who meet the NCLB Act criteria for being "highly qualified", actually possessed the characteristics which these stakeholders hold as evidence of high quality in science teaching. Constant comparative analysis was used to analyze the data set. The findings suggest that urban stakeholders perceive that a high school science teacher who demonstrates high quality in science teaching should be knowledgeable about their subject matter, their student population, and should be resourceful; should possess an academic background in science and professional experience in science teaching; should exhibit professionalism, a passion for science and teaching, and a dedication to teaching and student learning; should be skillful in planning and preparing science lessons and in organizing the classroom, in presenting the subject matter to students, in conducting a variety of hands-on activities, and in managing a classroom; and should assess whether students complete class goals and objectives, and provide feedback about grades for students promptly. The findings further reveal that some of the urban high school science teachers who were deemed to be "highly qualified", as defined by the NCLB Act, engaged in practices that threatened quality in science

How Well Does Your IEP Measure Up?: Quality Indicators for Effective Service Delivery.

Science.gov (United States)

Twachtman-Cullen, Diane; Twachtman-Reilly, Jennifer

This book is intended to offer guidance in writing individualized education programs (IEPs) that deliver high-quality, need-based educational programming for students with autism spectrum disorders. Following an introductory historical overview of special education law, the remaining chapters in part 1 address the quality indicators for each of…

Fast High-Quality Noise

DEFF Research Database (Denmark)

Frisvad, Jeppe Revall; Wyvill, Geoff

2007-01-01

At the moment the noise functions available in a graphics programmer's toolbox are either slow to compute or they involve grid-line artifacts making them of lower quality. In this paper we present a real-time noise computation with no grid-line artifacts or other regularity problems. In other words......, we put a new tool in the box that computes fast high-quality noise. In addition to being free of artifacts, the noise we present does not rely on tabulated data (everything is computed on the fly) and it is easy to adjust quality vs. quantity for the noise. The noise is based on point rendering (like...... spot noise), but it extends to more than two dimensions. The fact that it is based on point rendering makes art direction of the noise much easier....

Alginate-Based Edible Films Delivering Probiotic Bacteria to Sliced Ham Pretreated with High Pressure Processing

Directory of Open Access Journals (Sweden)

Foteini Pavli

2017-08-01

Full Text Available The aim of the present work was to evaluate the efficacy of Na-alginate edible films as vehicles for delivering probiotic bacteria to sliced ham with or without pretreatment using high pressure processing (HPP. Three strains of probiotic bacteria were incorporated in Na-alginate forming solution. Ham slices (with or without pretreatment using HPP at 500 MPa for 2 min were packed under vacuum in contact with the films and then stored at 4, 8 and 12 °C for 66, 47 and 40 days, respectively. Microbiological analysis was performed in parallel with pH and color measurements. Sensory characteristics were assessed, while the presence and the relative abundance of each probiotic strain during storage was evaluated using pulsed field gel electrophoresis. In ham slices without HPP treatment, probiotic bacteria were enumerated above 106 CFU/g during storage at all temperatures. Same results were obtained in cases of HPP treated samples, but pH measurements showed differences with the latter ones exhibiting higher values. Sensory evaluation revealed that probiotic samples had a more acidic taste and odor than the control ones, however these characteristics were markedly compromised in samples treated with HPP. Overall, the results of the study are promising since probiotic bacteria were successfully delivered in the products by edible films regardless of the HPP treatment.

Alginate-Based Edible Films Delivering Probiotic Bacteria to Sliced Ham Pretreated with High Pressure Processing.

Science.gov (United States)

Pavli, Foteini; Kovaiou, Ioanna; Apostolakopoulou, Georgia; Kapetanakou, Anastasia; Skandamis, Panagiotis; Nychas, George-John E; Tassou, Chrysoula; Chorianopoulos, Nikos

2017-08-29

The aim of the present work was to evaluate the efficacy of Na-alginate edible films as vehicles for delivering probiotic bacteria to sliced ham with or without pretreatment using high pressure processing (HPP). Three strains of probiotic bacteria were incorporated in Na-alginate forming solution. Ham slices (with or without pretreatment using HPP at 500 MPa for 2 min) were packed under vacuum in contact with the films and then stored at 4, 8 and 12 °C for 66, 47 and 40 days, respectively. Microbiological analysis was performed in parallel with pH and color measurements. Sensory characteristics were assessed, while the presence and the relative abundance of each probiotic strain during storage was evaluated using pulsed field gel electrophoresis. In ham slices without HPP treatment, probiotic bacteria were enumerated above 10⁶ CFU/g during storage at all temperatures. Same results were obtained in cases of HPP treated samples, but pH measurements showed differences with the latter ones exhibiting higher values. Sensory evaluation revealed that probiotic samples had a more acidic taste and odor than the control ones, however these characteristics were markedly compromised in samples treated with HPP. Overall, the results of the study are promising since probiotic bacteria were successfully delivered in the products by edible films regardless of the HPP treatment.

Assuring quality in high-consequence engineering

Energy Technology Data Exchange (ETDEWEB)

Hoover, Marcey L.; Kolb, Rachel R.

2014-03-01

In high-consequence engineering organizations, such as Sandia, quality assurance may be heavily dependent on staff competency. Competency-dependent quality assurance models are at risk when the environment changes, as it has with increasing attrition rates, budget and schedule cuts, and competing program priorities. Risks in Sandia's competency-dependent culture can be mitigated through changes to hiring, training, and customer engagement approaches to manage people, partners, and products. Sandia's technical quality engineering organization has been able to mitigate corporate-level risks by driving changes that benefit all departments, and in doing so has assured Sandia's commitment to excellence in high-consequence engineering and national service.

Training radiographers to deliver an intervention to promote early presentation of breast cancer

International Nuclear Information System (INIS)

Burgess, Caroline; Teasdale, Emma; Omar, Lynne; Tucker, Lorraine; Ramirez, Amanda-Jane

2012-01-01

Aim: To evaluate the feasibility of training sufficient radiographers to deliver an intervention to promote early presentation of breast cancer to all older women attending for their final routine mammogram within the NHS Breast Screening Programme. If the Promoting Early Presentation (PEP) intervention is demonstrated to be cost-effective, it may be implemented across the NHS requiring at least four radiographers per screening service to deliver the intervention. Methods: A pilot study in a single breast screening service was conducted to assess the feasibility of training sufficient radiographers to meet this objective. Quantitative and qualitative methods were used to evaluate the impact of training on participating radiographers and the screening service. Competency to deliver the intervention was assessed at key points during training according to quality criteria based on delivery of the key messages and style of delivery. Confidence to deliver the intervention was assessed using a self-report measure before and after training. Radiographers' experiences of training were elicited in face-to-face qualitative interviews. Results: Seven of eight radiographers who were released to undertake the training achieved the required level of competency to deliver the intervention within four months. All improved over time in their confidence to deliver the key messages of the intervention. The qualitative analysis revealed the benefits and challenges of training from the perspective of the radiographers. Conclusion: It was feasible and acceptable to train sufficient radiographers to deliver the PEP Intervention. The training package will be streamlined to improve efficiency for large implementation trials and clinical practice across the NHS.

Determination of the delivered hemodialysis dose using standard methods and on-line clearance monitoring

Directory of Open Access Journals (Sweden)

Vlatković Vlastimir

2006-01-01

Full Text Available Background/aim: Delivered dialysis dose has a cumulative effect and significant influence upon the adequacy of dialysis, quality of life and development of co-morbidity at patients on dialysis. Thus, a great attention is given to the optimization of dialysis treatment. On-line Clearance Monitoring (OCM allows a precise and continuous measurement of the delivered dialysis dose. Kt/V index (K = dialyzer clearance of urea; t = dialysis time; V = patient's total body water, measured in real time is used as a unit for expressing the dialysis dose. The aim of this research was to perform a comparative assessment of the delivered dialysis dose by the application of the standard measurement methods and a module for continuous clearance monitoring. Methods. The study encompassed 105 patients who had been on the chronic hemodialysis program for more than three months, three times a week. By random choice, one treatment per each controlled patient was taken. All the treatments understood bicarbonate dialysis. The delivered dialysis dose was determined by the calculation of mathematical models: Urea Reduction Ratio (URR singlepool index Kt/V (spKt/V and by the application of OCM. Results. Urea Reduction Ratio was the most sensitive parameter for the assessment and, at the same time, it was in the strongest correlation with the other two, spKt/V indexes and OCM. The values pointed out an adequate dialysis dose. The URR values were significantly higher in women than in men, p < 0.05. The other applied model for the delivered dialysis dose measurement was Kt/V index. The obtained values showed that the dialysis dose was adequate, and that, according to this parameter, the women had significantly better dialysis, then the men p < 0.05. According to the OCM, the average value was slightly lower than the adequate one. The women had a satisfactory dialysis according to this index as well, while the delivered dialysis dose was insufficient in men. The difference

SIFT: A method to verify the IMRT fluence delivered during patient treatment using an electronic portal imaging device

International Nuclear Information System (INIS)

Vieira, Sandra C.; Dirkx, Maarten L.P.; Heijmen, Ben J.M.; Boer, Hans C.J. de

2004-01-01

Purpose: Radiotherapy patients are increasingly treated with intensity-modulated radiotherapy (IMRT) and high tumor doses. As part of our quality control program to ensure accurate dose delivery, a new method was investigated that enables the verification of the IMRT fluence delivered during patient treatment using an electronic portal imaging device (EPID), irrespective of changes in patient geometry. Methods and materials: Each IMRT treatment field is split into a static field and a modulated field, which are delivered in sequence. Images are acquired for both fields using an EPID. The portal dose image obtained for the static field is used to determine changes in patient geometry between the planning CT scan and the time of treatment delivery. With knowledge of these changes, the delivered IMRT fluence can be verified using the portal dose image of the modulated field. This method, called split IMRT field technique (SIFT), was validated first for several phantom geometries, followed by clinical implementation for a number of patients treated with IMRT. Results: The split IMRT field technique allows for an accurate verification of the delivered IMRT fluence (generally within 1% [standard deviation]), even if large interfraction changes in patient geometry occur. For interfraction radiological path length changes of 10 cm, deliberately introduced errors in the delivered fluence could still be detected to within 1% accuracy. Application of SIFT requires only a minor increase in treatment time relative to the standard IMRT delivery. Conclusions: A new technique to verify the delivered IMRT fluence from EPID images, which is independent of changes in the patient geometry, has been developed. SIFT has been clinically implemented for daily verification of IMRT treatment delivery

A high throughput DNA extraction method with high yield and quality

Directory of Open Access Journals (Sweden)

Xin Zhanguo

2012-07-01

Full Text Available Abstract Background Preparation of large quantity and high quality genomic DNA from a large number of plant samples is a major bottleneck for most genetic and genomic analyses, such as, genetic mapping, TILLING (Targeting Induced Local Lesion IN Genome, and next-generation sequencing directly from sheared genomic DNA. A variety of DNA preparation methods and commercial kits are available. However, they are either low throughput, low yield, or costly. Here, we describe a method for high throughput genomic DNA isolation from sorghum [Sorghum bicolor (L. Moench] leaves and dry seeds with high yield, high quality, and affordable cost. Results We developed a high throughput DNA isolation method by combining a high yield CTAB extraction method with an improved cleanup procedure based on MagAttract kit. The method yielded large quantity and high quality DNA from both lyophilized sorghum leaves and dry seeds. The DNA yield was improved by nearly 30 fold with 4 times less consumption of MagAttract beads. The method can also be used in other plant species, including cotton leaves and pine needles. Conclusion A high throughput system for DNA extraction from sorghum leaves and seeds was developed and validated. The main advantages of the method are low cost, high yield, high quality, and high throughput. One person can process two 96-well plates in a working day at a cost of $0.10 per sample of magnetic beads plus other consumables that other methods will also need.

Internet-Delivered Exposure Therapy for Fibromyalgia: A Randomized Controlled Trial.

Science.gov (United States)

Hedman-Lagerlöf, Maria; Hedman-Lagerlöf, Erik; Axelsson, Erland; Ljótsson, Brjánn; Engelbrektsson, Johanna; Hultkrantz, Sofia; Lundbäck, Karolina; Björkander, Daniel; Wicksell, Rikard K; Flink, Ida; Andersson, Erik

2018-06-01

Fibromyalgia (FM) is a common and disabling chronic pain disorder, for which existing pharmacological and psychological treatments have yet yielded insufficient effects. Previous literature has shown that exposure therapy may be an effective treatment for chronic pain. This study constitutes the first randomized controlled trial evaluating exposure therapy for FM. A total of 140 participants with diagnosed FM were randomized to a 10-week Internet-delivered exposure treatment (iExp; n=70) or a waitlist control condition (WLC; n=70). Primary outcome measure were FM symptoms and impact, and secondary outcome measures were fatigue, disability, quality of life, pain-related distress and avoidance behaviors, insomnia, depression, and anxiety. Data retention was high (100% data completion at posttreatment for primary outcome, 96% at 6-month follow-up and 94% at 12-month follow-up). Results showed that participants in the iExp group made large and superior improvements compared with WLC on FM symptoms and impact (B, -1.93; z, -10.14; P<0.001, between-group Cohen d=0.90), as well as all secondary outcomes (between-group Cohen d ranging from 0.44 to 1.38) with sustained results. We conclude that iExp seems to be an efficacious treatment for FM compared with no treatment, and the results also highlight the potential increase of accessibility by using the Internet format to deliver psychological treatments for these patients. Future trials with active control conditions are warranted.

Concrete Waste Recycling Process for High Quality Aggregate

International Nuclear Information System (INIS)

Ishikura, Takeshi; Fujii, Shin-ichi

2008-01-01

Large amount of concrete waste generates during nuclear power plant (NPP) dismantling. Non-contaminated concrete waste is assumed to be disposed in a landfill site, but that will not be the solution especially in the future, because of decreasing tendency of the site availability and natural resources. Concerning concrete recycling, demand for roadbeds and backfill tends to be less than the amount of dismantled concrete generated in a single rural site, and conventional recycled aggregate is limited of its use to non-structural concrete, because of its inferior quality to ordinary natural aggregate. Therefore, it is vital to develop high quality recycled aggregate for general uses of dismantled concrete. If recycled aggregate is available for high structural concrete, the dismantling concrete is recyclable as aggregate for industry including nuclear field. Authors developed techniques on high quality aggregate reclamation for large amount of concrete generated during NPP decommissioning. Concrete of NPP buildings has good features for recycling aggregate; large quantity of high quality aggregate from same origin, record keeping of the aggregate origin, and little impurities in dismantled concrete such as wood and plastics. The target of recycled aggregate in this development is to meet the quality criteria for NPP concrete as prescribed in JASS 5N 'Specification for Nuclear Power Facility Reinforced Concrete' and JASS 5 'Specification for Reinforced Concrete Work'. The target of recycled aggregate concrete is to be comparable performance with ordinary aggregate concrete. The high quality recycled aggregate production techniques are assumed to apply for recycling for large amount of non-contaminated concrete. These techniques can also be applied for slightly contaminated concrete dismantled from radiological control area (RCA), together with free release survey. In conclusion: a technology on dismantled concrete recycling for high quality aggregate was developed

Views of Freshmen Students on Foreign Language Courses Delivered via E-Learning

Science.gov (United States)

Ozudogru, Fatma; Hismanoglu, Murat

2016-01-01

With the increasing number of foreign language courses via e-learning in higher education institutions, it is important to investigate whether the quality of e-learning is up to the standard. This study aimed at finding out the views of freshmen students on foreign language courses delivered via e-learning and revealing whether there were any…

Development and Feasibility of a COPD Self-Management Intervention Delivered with Motivational Interviewing Strategies

Science.gov (United States)

Benzo, Roberto; Vickers, Kristin; Ernst, Denise; Tucker, Sharon; McEvoy, Charlene; Lorig, Kate

2013-01-01

BACKGROUND Self-management (SM) is proposed as the standard of care in chronic obstructive pulmonary disease (COPD) but details of the process and training required to deliver effective SM are not widely available. In addition, recent data suggest that patient engagement and motivation are critical ingredients for effective self-management. This manuscript carefully describes a self-management intervention using Motivational Interviewing skills, aimed to increase engagement and commitment in severe COPD patients. METHODS The intervention was developed and pilot tested for fidelity to protocol, for patient and interventionist feedback (qualitative) and effect on quality of life. Engagement between patient and interventionists was measured by the Working Alliance Inventory. The intervention was refined based in the results of the pilot study and delivered in the active arm of a prospective randomized study. RESULTS The pilot study suggested improvements in quality of life, fidelity to theory and patient acceptability. The refined self-management intervention was delivered 540 times in the active arm of a randomized study. We observed a retention rate of 86% (patients missing or not available for only 14% the scheduled encounters). CONCLUSIONS A self-management intervention, that includes motivational interviewing as the way if guiding patient into behavior change, is feasible in severe COPD and may increase patient engagement and commitment to self-management. This provides a very detailed description of the SM process for (the specifics of training and delivering the intervention) that facilitates replicability in other settings and could be translated to cardiac rehabilitation. PMID:23434613

Effect of forage quality in faeces from different ruminant species fed high and low quality forage

DEFF Research Database (Denmark)

Jalali, A R; Nørgaard, P; Nielsen, M O

2010-01-01

Effect of forage quality in faeces from different ruminant species fed high and low quality forage......Effect of forage quality in faeces from different ruminant species fed high and low quality forage...

Improving Hospital Quality and Patient Safety an Examination of Organizational Culture and Information Systems

Science.gov (United States)

Gardner, John Wallace

2012-01-01

This dissertation examines the effects of safety culture, including operational climate and practices, as well as the adoption and use of information systems for delivering high quality healthcare and improved patient experience. Chapter 2 studies the influence of both general and outcome-specific hospital climate and quality practices on process…

Variable dose rate single-arc IMAT delivered with a constant dose rate and variable angular spacing

International Nuclear Information System (INIS)

Tang, Grace; Earl, Matthew A; Yu, Cedric X

2009-01-01

delivered with a different dose rate, extra mode-up time (xMOT) was needed between the transitions of the successive sectors during delivery. On average, the delivery times of the CDR plans were approximately less than 1 min longer than the treatment times of the VDR plans, with an average of about 0.33 min of xMOT per sector transition. The results have shown that VDR may not be necessary for single-arc IMAT. Using variable angular spacing, VDR RapidArc plans can be implemented into the clinics that are not equipped with the new VDR-enabled machines without compromising the plan quality or treatment efficiency. With a prospective optimization approach using variable angular spacing, CDR delivery times can be further minimized while maintaining the high delivery efficiency of single-arc IMAT treatment.

TOTAL QUALITY MANAGEMENT IN HIGH EDUCATION

Directory of Open Access Journals (Sweden)

Hasan SERİN, Alper AYTEKİN

2009-01-01

Full Text Available The approach of Total Quality Management (TQM has been even more common and most recently its use in high education has been discussed. Likewise the enterprises producing various products, universities have also inputs, processes, and outputs. Due to conditions of competition, universities have to improve the qualities of these inputs, processes, and outputs, according to satisfaction, demands, and expectations of internal and external customers. If the TQM has been implemented in the universities with a manner that aims for customer satisfaction (students, lecturers, public and private establishments, and families, supports constant development, ensures participatory approach, and encourages working in groups, it will provide universities with effectiveness, efficiency, dynamics, and economics. In this study, common problems of universities, definitions of quality and TQM in high education, customer concept at universities, and factors affecting the quality of education have been explained. Besides, in order TQM approach to be successfully implemented in the universities, various suggestions have been presented.

Experimental forest watershed studies contribution to the effect of disturbances on water quality

Science.gov (United States)

Daniel G. Neary

2012-01-01

The most sustainable and best quality fresh water sources in the world originate in forested watersheds (Dissmeyer 2000, Brooks et al. 2003, Barten and Ernst 2004). The biological, chemical, and physical characteristics of forest soils are particularly well suited to delivering high quality water to streams, and moderating the climatic extremes which affect stream...

Comparison of radiation delivered by current diagnostic procedures for herniated disc

International Nuclear Information System (INIS)

Gasquet, C.; Drouineau, J.; Goubault, F.; Hurmic, A.; Lavigne, B.; Vandermarcq, P.

1983-01-01

Three methods are currently employed for the diagnosis of sciatica due to disc lesions: radiculography, spinal phlebography, and computed tomography. Though their indications vary according to the author, it seemed worthwhile to compare radiation delivered by each of them, because of the often young age of the patients. Dosimetric studies using a Rando Phantom enabled calculation of doses to the skin, spinal cord, and gonads. Results indicated that low doses were delivered by the scanner, relatively high doses by spinal phlebography, and intermediate doses by radiculography. These findings suggest that the initial examination preoperatively in cases of simple sciatica due to herniated disc should be a CT scan whenever possible. Phlebography, on the contrary, and particularly in young women, should be used only exceptionally, as a result of the high doses delivered to the ovaries even during technically simple explorations [fr

Analysis of high-quality modes in open chaotic microcavities

International Nuclear Information System (INIS)

Fang, W.; Yamilov, A.; Cao, H.

2005-01-01

We present a numerical study of the high-quality modes in two-dimensional dielectric stadium microcavities. Although the classical ray mechanics is fully chaotic in a stadium billiard, all of the high-quality modes show a 'strong scar' around unstable periodic orbits. When the deformation (ratio of the length of the straight segments over the diameter of the half circles) is small, the high-quality modes correspond to whispering-gallery-type trajectories and their quality factors decrease monotonically with increasing deformation. At large deformation, each high-quality mode is associated with multiple unstable periodic orbits. Its quality factor changes nonmonotonically with the deformation, and there exists an optimal deformation for each mode at which its quality factor reaches a local maximum. This unusual behavior is attributed to the interference of waves propagating along different constituent orbits that could minimize light leakage out of the cavity

The 5x1 DAFNE study protocol: a cluster randomised trial comparing a standard 5 day DAFNE course delivered over 1 week against DAFNE training delivered over 1 day a week for 5 consecutive weeks

Directory of Open Access Journals (Sweden)

Elliott Jackie

2012-11-01

Full Text Available Abstract Background Structured education programmes are now established as an essential component to assist effective self-management of diabetes. In the case of Type 1 diabetes, the Dose Adjustment For Normal Eating (DAFNE programme improves both glycaemic control and quality of life. Traditionally delivered over five consecutive days, this format has been cited as a barrier to participation by some patients, such as those who work full-time. Some centres in the UK have organised structured education programmes to be delivered one day a week over several consecutive weeks. This type of format may add benefit by allowing more time in which to practice skills between sessions, but may suffer as a result of weaker peer support being generated compared to that formed over five consecutive days. Methods/design We aim to compare DAFNE delivered over five consecutive days (1 week course with DAFNE delivered one day a week over five weeks (5 week course in a randomised controlled trial. A total of 213 patients were randomised to attend either a 1 week or a 5 week course delivered in seven participating centres. Study outcomes (measured at baseline, 6 and 12 months post-course include HbA1c, weight, self-reported rates of severe hypoglycaemia, psychosocial measures of quality of life, and cost-effectiveness. Generalisability was optimised by recruiting patients from DAFNE waiting lists at each centre, and by mailing eligible patients from hospital clinic lists. The inclusion and exclusion criteria were identical to those used to recruit to a standard DAFNE course (e.g., HbA1c Discussion This trial has been designed to test the hypothesis that the benefits of delivering a structured education programme over 5 weeks are comparable to those observed after a 1 week course. The results of the trial and the qualitative sub-study will both inform the design and delivery of future DAFNE courses, and the development of structured education programmes in other

SU-E-J-21: Advantages of Ultra Fast Radiation Dose Delivering

International Nuclear Information System (INIS)

Feng, Y

2014-01-01

Purpose: For delivering conformed dose to a moving tumor and sparing normal tissue, we presented an innovation that was combined a linear accelerator and a storage ring to generate ultra high dose rate. This innovation allows delivering prescribed dose to a moving target in such a short time period, for an example 0.1 second, during which the displacement of the target could be ignored. Methods: The advantages of this approach were evaluated based on normal tissue sparing, feasibility, accuracy, and time saving in clinical treatment. The target volume reduction with this innovation approach was demonstrated by analyzing the values of GTVs, ITVs, and PTVs obtained from 15 patients who had been diagnosed with malignant neoplasm of lung and treated with SBRT. The processes of SBRT treatment were investigated and advantages of this innovation in improving SBRT lung treatment were evaluated. Results: With the ultra-high dose rate, the target volumes could be reduced by ∼30% to 50%. The innovation combining with IGRT technique could deliver prescribed dose to moving target accurately with simpler procedures than that of adaptive approach. This new approach could reduce the time of guiding treatment by many times. The new technique make a new strategy became feasible that was to deliver the dose to a target when it moved to a desirable location, such as away from critical organs. Conclusion: Combining with IGRT technique, this innovation could significantly improve the accuracy to deliver dose to moving targets with a shorter time than conventional techniques. The innovation opens a door for new strategies to deliver dose to moving targets

High quality-factor optical resonators

International Nuclear Information System (INIS)

Henriet, Rémi; Salzenstein, Patrice; Coillet, Aurélien; Saleh, Khaldoun; Chembo, Yanne K; Ristic, Davor; Ferrari, Maurizio; Mortier, Michel; Rasoloniaina, Alphonse; Dumeige, Yannick; Féron, Patrice; Cibiel, Gilles; Llopis, Olivier

2014-01-01

Various resonators are investigated for microwave photonic applications. Micro-sphere, disk and fiber ring resonators were designed, realized and characterized. Obtained quality factors are as high as Q = 10 10 . (paper)

Nuevo Amanecer: results of a randomized controlled trial of a community-based, peer-delivered stress management intervention to improve quality of life in Latinas with breast cancer.

Science.gov (United States)

Nápoles, Anna María; Ortíz, Carmen; Santoyo-Olsson, Jasmine; Stewart, Anita L; Gregorich, Steven; Lee, Howard E; Durón, Ysabel; McGuire, Peggy; Luce, Judith

2015-07-01

We evaluated a community-based, translational stress management program to improve health-related quality of life in Spanish-speaking Latinas with breast cancer. We adapted a cognitive-behavioral stress management program integrating evidence-based and community best practices to address the needs of Latinas with breast cancer. Spanish-speaking Latinas with breast cancer were randomly assigned to an intervention or usual-care control group. Trained peers delivered the 8-week intervention between February 2011 and February 2014. Primary outcomes were breast cancer-specific quality of life and distress, and general symptoms of distress. Of 151 participants, 95% were retained at 6 months (between May 2011 and May 2014). Improvements in quality of life from baseline to 6 months were greater for the intervention than the control group on physical well-being, emotional well-being, breast cancer concerns, and overall quality of life. Decreases from baseline to 6 months were greater for the intervention group on depression and somatization. Results suggest that translation of evidence-based programs can reduce psychosocial health disparities in Latinas with breast cancer. Integration of this program into community-based organizations enhances its dissemination potential.

Quality control as a way to find out doses as low as reasonably practicable in mammography systems

International Nuclear Information System (INIS)

Hwang, S.F.; Nogueira, M.S.; Peixoto, J.E.; Paraguay, Y.V.

2008-01-01

The breast cancer is the most common neoplasm amongst women. Mammography is an essential tool for diagnosis and early detection of this disease. In order to guarantee the effectiveness of the diagnosis taking into account the patient radiation safety, it is mandatory to perform the quality control tests of the mammographic equipment. The main objective of this work has been to evaluate the relationship between the image quality and the total performance of the medical equipment. Primary data were collected from several radiological facilities during the quality control inspections performed by the local regulatory authorities of the Brazilian health, the National Commission of Nuclear Energy and the Brazilian College of Radiology. The main important functioning parameters were evaluated as well as the image quality using the simulator 'phantom mama'. In spite of the fact that high quality images could suggest delivering large radiation doses to patients it has been demonstrated that it is possible to acquire images with a good quality for clinical diagnosis without delivering high doses if the system is working properly. It has been concluded that following an optimized quality control program could avoid the complex dosimetric studies to guarantee good images quality. (author)

High-quality cardiopulmonary resuscitation: current and future directions.

Science.gov (United States)

Abella, Benjamin S

2016-06-01

Cardiopulmonary resuscitation (CPR) represents the cornerstone of cardiac arrest resuscitation care. Prompt delivery of high-quality CPR can dramatically improve survival outcomes; however, the definitions of optimal CPR have evolved over several decades. The present review will discuss the metrics of CPR delivery, and the evidence supporting the importance of CPR quality to improve clinical outcomes. The introduction of new technologies to quantify metrics of CPR delivery has yielded important insights into CPR quality. Investigations using CPR recording devices have allowed the assessment of specific CPR performance parameters and their relative importance regarding return of spontaneous circulation and survival to hospital discharge. Additional work has suggested new opportunities to measure physiologic markers during CPR and potentially tailor CPR delivery to patient requirements. Through recent laboratory and clinical investigations, a more evidence-based definition of high-quality CPR continues to emerge. Exciting opportunities now exist to study quantitative metrics of CPR and potentially guide resuscitation care in a goal-directed fashion. Concepts of high-quality CPR have also informed new approaches to training and quality improvement efforts for cardiac arrest care.

Quality management manual for production of high quality cassava flour

DEFF Research Database (Denmark)

Dziedzoave, Nanam Tay; Abass, Adebayo Busura; Amoa-Awua, Wisdom K.

The high quality cassava flour (HQCF) industry has just started to evolve in Africa and elsewhere. The sustainability of the growing industry, the profitability of small- and medium-scale enterprises (SMEs) that are active in the industry and good-health of consumers can best be guaranteed through...... the adoption of proper quality and food safety procedures. Cassava processing enterprises involved in the productionof HQCF must therefore be commited to the quality and food safety of the HQCF. They must have the right technology, appropriate processing machhinery, standard testing instruments...... and the necessary technical expertise. This quality manual was therefore developed to guide small- to medium-scale cassava in the design and implematation of Hazard Analysis Critical Control Point (HACCP) system and Good manufacturing Practices (GMP) plans for HQCF production. It describes the HQCF production...

PhysioDirect: Supporting physiotherapists to deliver telephone assessment and advice services within the context of a randomised trial

Science.gov (United States)

Bishop, Annette; Gamlin, Jill; Hall, Jeanette; Hopper, Cherida; Foster, Nadine E.

2013-01-01

Physiotherapy-led telephone assessment and advice services for patients with musculoskeletal problems have been developed in many services in the UK, but high quality trial data on clinical and cost effectiveness has been lacking. In order to address this ‘The PhysioDirect trial’ (ISRCTN55666618), was a pragmatic randomised trial of a PhysioDirect telephone assessment and advice service. This paper describes the PhysioDirect system used in the trial and how physiotherapists were trained and supported to use the system and deliver the PhysioDirect service. The PhysioDirect system used in the trial was developed in Huntingdon and now serves a population of 350,000 people. When initiating or providing physiotherapy-led telephone assessment and advice services training and support for physiotherapists delivering care in this way is essential. An enhanced skill set is required for telephone assessment and advice particularly in listening and communication skills. In addition to an initial training programme, even experienced physiotherapists benefit from a period of skill consolidation to become proficient and confident in assessing patients and delivering care using the telephone. A computer-based system assists the delivery of a physiotherapy-led musculoskeletal assessment and advice service. Clinical Trials Registration Number (ISRCTN55666618). PMID:23219629

original article assessment of quality of care delivered for infectious

African Journals Online (AJOL)

Abrham

ABSTRACT. BACK GROUND: Providing quality of care for infectious pulmonary tuberculosis patients is crucial in ... Although a cure for tuberculosis was developed more than 50 .... 1(5.0%) Junior clinical nurse and 1(5.0%) health assistants.

Delivering tertiary centre specialty care to ALS patients via telemedicine: a retrospective cohort analysis.

Science.gov (United States)

Selkirk, Stephen M; Washington, Monique O; McClellan, Frances; Flynn, Broderick; Seton, Jacinta M; Strozewski, Richard

2017-08-01

This study was undertaken to determine if ALS patients evaluated via telemedicine received the same quality of care as patients evaluated by traditional face-to-face encounters. A retrospective cohort study design was used. Participants were patients diagnosed with ALS that received multidisciplinary care at the tertiary Cleveland VA ALS Centre between 1 March 2008- and 31 anuary 2015. Participants were not randomised, but chose telemedicine based on preference, disability level or distance from the clinic. Telemedicine in this study consisted of a video conferencing platform enabling remote rather than face-to-face encounters with participants. There was no significant association between receiving quality ALS care and the mode of care. There was a trend for telemedicine patients to utilise home health care less often than those that received clinic care (AOR 0.50; 95% CI 0.16-1.59). There was no significant difference in survival time between the two groups (log-rank test χ 2  = 3.62, df = 1, p = 0.05). Patients receiving telemedicine had a higher probability of remaining stable or having telemedicine (HR = 0.39, 95% CI = 0.16-0.93). Patients managed by telemedicine received the same quality of care and had similar outcomes to those patients seen via traditional face-to-face encounters. Telemedicine is an effective platform for delivering high quality tertiary ALS care.

Dosimetric quality assurance interpreted for ISO 17025 in public health England's personal dosimetry service

International Nuclear Information System (INIS)

Gilvin, P.J.; Gibbens, N.J.; Baker, S.T.

2016-01-01

Many individual monitoring services (IMSs) have long experience in delivering high-quality dosimetry, and many follow rigorous quality assurance (QA) procedures. Typically, these procedures have been developed through experience and are highly effective in maintaining high-quality dose measurements. However, it is not always clear how the range of QA procedures normally followed by IMSs maps on to the various requirements of ISO 17025. The Personal Dosimetry Service of Public Health England has interpreted its QA procedures both in operating existing services and in developing a new one. (authors)

Development of an Exergame to Deliver a Sustained Dose of High-Intensity Training: Formative Pilot Randomized Trial.

Science.gov (United States)

McBain, Thomas; Weston, Matthew; Crawshaw, Paul; Haighton, Catherine; Spears, Iain

2018-03-27

Sport science can play a critical role in reducing health inequalities. The inverse relationship between life expectancy, cardiorespiratory fitness, and socioeconomic status could be addressed by performing high-intensity training (HIT), delivered in a class salient and accessible approach. Commercially available exergames have shown encouraging compliance rates but are primarily designed for entertainment purposes rather than focusing on health-related outcomes. A serious game tailored toward delivering an exercise stimulus, while reducing the aversive protocols associated with HIT, could be beneficial to engage and improve health outcomes in socially deprived males. The aims of this study were to develop an exergame capable of delivering HIT and evaluate the effect on selected health outcomes in men recruited in regions of socioeconomic deprivation. We conducted an exploratory trial in our target population, and participants were allocated to intervention (n=14) or control groups (n=10) by third-party minimization. The intervention was a 6-week training program consisting of three sessions of exergaming per week. The sessions involved a structured warm-up, then brief intermittent repetitions in the form of boxing rounds (10 s, 20 s, and 30 s) against their peers with a work/rest ratio of 0.25. Retention to the intervention was 87.5% (21/24). Over the duration of the intervention, session attendance was 67.5% (170/252); repetition mean and peak heart rates (% of maximal) and session ratings of perceived exertion (AU, arbitrary units) were 86.3 (5.4%), 89.9 (6.1%), and 7.5 (2.2 AU), respectively. The effect of the intervention, when compared with the control, was a likely small beneficial improvement in predicted maximum oxygen consumption (VO 2 max, 3.0; 90% confidence limits ±2.6%). Effects on body mass, waist circumference, and blood pressure were either trivial or unclear. Over the 6-week intervention, the exergame delivered a consistent and sustained dose of

Simply delivered meals: a tale of collaboration.

Science.gov (United States)

Martin, Sarah L; Connelly, Nancy; Parsons, Cassandra; Blackstone, Katlyn

2018-06-01

Western medicine is undergoing a transition toward transparency of quality and costs, and healthcare systems are striving to achieve the Triple Aim, a framework for improving the patient experience of care, improving the health of populations, and reducing the per capita cost of healthcare. Meanwhile, there is growing recognition of the impact of social determinants of health and a new federal requirement for nonprofit hospitals to implement prevention strategies. A specialized meal delivery program called Simply Delivered for ME (SDM) was formed in an effort to improve care and reduce 30-day hospital readmission rates.The Maine Medical Center (MMC) partnered with the Southern Maine Agency on Aging to offer SDM on a voluntary basis to high-risk Medicare patients already enrolled in the Community-based Care Transition Program (CCTP) at MMC. We report the results of the 2-year intervention in terms of 30-day hospital readmission rates and cost measures (ie, return on investment and cost savings).Of the 622 MMC patients who received SDM during the 24 months, the 30-day readmission rate was 10.3% (compared with the 16.6% 30-day rate of hospital readmission at baseline [ie, before the adoption of CCTP]) for all-cause readmissions. The cost savings for reduced readmissions were $212,160. The return on investment was 387%, or a benefit-cost ratio of $3.87 for every $1.00 spent on meals. Programs such as SDM may reduce the rate of hospital readmission among high-risk older adults and, thereby, yield lower healthcare costs.

Quality Assurance Strategy for Existing Homes: Final Quality Management Primer for High Performing Homes

Energy Technology Data Exchange (ETDEWEB)

Del Bianco, M.; Taggart, J.; Sikora, J.; Wood, A.

2012-12-01

This guide is designed to help Building America (BA) Teams understand quality management and its role in transitioning from conventional to high performance home building and remodeling. It explains what quality means, the value of quality management systems, the unique need for QMS when building high performing homes, and the first steps to a implementing a comprehensive QMS. This document provides a framework and context for BA teams when they encounter builders and remodelers.

Quality Assurance Strategy for Existing Homes. Final Quality Management Primer for High Performing Homes

Energy Technology Data Exchange (ETDEWEB)

Del Bianco, M. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Taggart, J. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Sikora, J. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Wood, A. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States)

2012-12-01

This guide is designed to help Building America (BA) teams understand quality management and its role in transitioning from conventional to high performance home building and remodeling. It explains what quality means, the value of quality management systems, the unique need for QMS when building high performing homes, and the first steps to a implementing a comprehensive QMS. This document provides a framework and context for BA teams when they encounter builders and remodelers.

Next level of board accountability in health care quality.

Science.gov (United States)

Pronovost, Peter J; Armstrong, C Michael; Demski, Renee; Peterson, Ronald R; Rothman, Paul B

2018-03-19

Purpose The purpose of this paper is to offer six principles that health system leaders can apply to establish a governance and management system for the quality of care and patient safety. Design/methodology/approach Leaders of a large academic health system set a goal of high reliability and formed a quality board committee in 2011 to oversee quality and patient safety everywhere care was delivered. Leaders of the health system and every entity, including inpatient hospitals, home care companies, and ambulatory services staff the committee. The committee works with the management for each entity to set and achieve quality goals. Through this work, the six principles emerged to address management structures and processes. Findings The principles are: ensure there is oversight for quality everywhere care is delivered under the health system; create a framework to organize and report the work; identify care areas where quality is ambiguous or underdeveloped (i.e. islands of quality) and work to ensure there is reporting and accountability for quality measures; create a consolidated quality statement similar to a financial statement; ensure the integrity of the data used to measure and report quality and safety performance; and transparently report performance and create an explicit accountability model. Originality/value This governance and management system for quality and safety functions similar to a finance system, with quality performance documented and reported, data integrity monitored, and accountability for performance from board to bedside. To the authors' knowledge, this is the first description of how a board has taken this type of systematic approach to oversee the quality of care.

Evolution of a nursing education program delivered to baccalaureate-prepared Haitian nurses.

Science.gov (United States)

Lev, Elise L; Lindgren, Teri G; Pearson, Gayle A; Alcindor, Hilda

2013-01-01

Haiti has high morbidity and mortality rates, a large proportion of people living in poverty, and a shortage of nurses and nursing faculty members. A partnership program between a US and Haitian university was formed to deliver a certificate program in nursing education. The authors describe their experiences developing, delivering, and evaluating the blended on-site and online program and their future goals.

High engagement, high quality: A guiding framework for developing empirically informed asynchronous e-learning programs for health professional educators.

Science.gov (United States)

Sinclair, Peter M; Levett-Jones, Tracey; Morris, Amanda; Carter, Ben; Bennett, Paul N; Kable, Ashley

2017-03-01

E-learning involves the transfer of skills and knowledge via technology so that learners can access meaningful and authentic educational materials. While learner engagement is important, in the context of healthcare education, pedagogy must not be sacrificed for edu-tainment style instructional design. Consequently, health professional educators need to be competent in the use of current web-based educational technologies so that learners are able to access relevant and engaging e-learning materials without restriction. The increasing popularity of asynchronous e-learning programs developed for use outside of formal education institutions has made this need more relevant. In these contexts, educators must balance design and functionality to deliver relevant, cost-effective, sustainable, and accessible programs that overcome scheduling and geographic barriers for learners. This paper presents 10 guiding design principles and their application in the development of an e-learning program for general practice nurses focused on behavior change. Consideration of these principles will assist educators to develop high quality, pedagogically sound, engaging, and interactive e-learning resources. © 2017 John Wiley & Sons Australia, Ltd.

Inequality in Preschool Quality? Community-Level Disparities in Access to High-Quality Learning Environments

Science.gov (United States)

Bassok, Daphna; Galdo, Eva

2016-01-01

In recent years, unequal access to high-quality preschool has emerged as a growing public policy concern. Because of data limitations, it is notoriously difficult to measure disparities in access to early learning opportunities across communities and particularly challenging to quantify gaps in access to "high-quality" programs. Research…

Low-quality birds do not display high-quality signals: The cysteine-pheomelanin mechanism of honesty

Science.gov (United States)

Galván, Ismael; Wakamatsu, Kazumasa; Camarero, Pablo R; Mateo, Rafael; Alonso-Alvarez, Carlos

2015-01-01

The mechanisms that make that the costs of producing high-quality signals are unaffordable to low-quality signalers are a current issue in animal communication. The size of the melanin-based bib of male house sparrows Passer domesticus honestly signals quality. We induced the development of new bibs while treating males with buthionine-sulfoximine (BSO), a substance that depletes the levels of the antioxidant glutathione (GSH) and the amino acid cysteine, two elements that switch melanogenesis from eumelanin to pheomelanin. Final bib size is negatively related to pheomelanin levels in the bib feathers. BSO reduced cysteine and GSH levels in all birds, but improved phenotypes (bibs larger than controls) were only expressed by high-quality birds (BSO birds with largest bibs initially). Negative associations between final bib size and cysteine levels in erythrocytes, and between pheomelanin and cysteine levels, were observed in high-quality birds only. These findings suggest that a mechanism uncoupling pheomelanin and cysteine levels may have evolved in low-quality birds to avoid producing bibs of size not corresponding to their quality and greater relative costs. Indeed, greater oxidative stress in cells was not observed in low-quality birds. This may represent the first mechanism maintaining signal honesty without producing greater relative costs on low-quality signalers. PMID:25330349

Delivering effective science communication: advice from a professional science communicator.

Science.gov (United States)

Illingworth, Sam

2017-10-01

Science communication is becoming ever more prevalent, with more and more scientists expected to not only communicate their research to a wider public, but to do so in an innovative and engaging manner. Given the other commitments that researchers and academics are required to fulfil as part of their workload models, it is unfair to be expect them to also instantly produce effective science communication events and activities. However, by thinking carefully about what it is that needs to be communicated, and why this is being done, it is possible to develop high-quality activities that are of benefit to both the audience and the communicator(s). In this paper, I present some practical advice for developing, delivering and evaluating effective science communication initiatives, based on over a decade of experience as being a professional science communicator. I provide advice regarding event logistics, suggestions on how to successfully market and advertise your science communication initiatives, and recommendations for establishing effective branding and legacy. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

High-Capacity Cathode Material with High Voltage for Li-Ion Batteries.

Science.gov (United States)

Shi, Ji-Lei; Xiao, Dong-Dong; Ge, Mingyuan; Yu, Xiqian; Chu, Yong; Huang, Xiaojing; Zhang, Xu-Dong; Yin, Ya-Xia; Yang, Xiao-Qing; Guo, Yu-Guo; Gu, Lin; Wan, Li-Jun

2018-03-01

Electrochemical energy storage devices with a high energy density are an important technology in modern society, especially for electric vehicles. The most effective approach to improve the energy density of batteries is to search for high-capacity electrode materials. According to the concept of energy quality, a high-voltage battery delivers a highly useful energy, thus providing a new insight to improve energy density. Based on this concept, a novel and successful strategy to increase the energy density and energy quality by increasing the discharge voltage of cathode materials and preserving high capacity is proposed. The proposal is realized in high-capacity Li-rich cathode materials. The average discharge voltage is increased from 3.5 to 3.8 V by increasing the nickel content and applying a simple after-treatment, and the specific energy is improved from 912 to 1033 Wh kg -1 . The current work provides an insightful universal principle for developing, designing, and screening electrode materials for high energy density and energy quality. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Emblems of Quality in Higher Education. Developing and Sustaining High-Quality Programs.

Science.gov (United States)

Haworth, Jennifer Grant; Conrad, Clifton F.

This book proposes an "engagement" theory of program quality to evaluate and improve higher education programs at all degree levels. Based on interviews with 781 participants in a national study of Masters degree programs, it focuses on the interactive roles of students, faculty, and administrators in developing high-quality programs…

Delivering environmental benefit from the use of Environmental Quality Standards: why we need to focus on implementation.

Science.gov (United States)

Merrington, Graham; Peters, Adam; Whitehouse, Paul; Clarke, Robin; Merckel, Dan

2018-02-01

The UK has adopted a broader approach to the introduction of Environmental Quality Standard (EQS) for the aquatic environment than many other jurisdictions around the world, with a greater focus on the implementation of scientifically derived standards. This follows the publication of a report by the Royal Commission on Environmental Pollution in 1998 which drew attention to the need to recognise that whilst an EQS is often just viewed as a numerical value, it also has other important characteristics that need to be recognised if it is to be a practical and effective regulatory tool. One of the aspects that has not always been recognised was that of implementation assessment, i.e. the steps needed to ensure that a standard actually delivers environmental benefit or improvements. In many jurisdictions, there is considerable technical and sometimes political emphasis on the numerical value of the EQS (e.g. the critical concentration in an environmental matrix like water), including the method of derivation, the scrutiny of the reliability and relevance of the ecotoxicity test data and extensive deliberations of unquantified uncertainties in relation to the choice of assessment factor. The regulatory value of an EQS only comes through a comparison against a measured environmental concentration, yet only relatively limited regulatory effort has historically been expended on this component of the classic environmental risk assessment paradigm. For example, there needs to be an acceptable (i.e. small) uncertainty in the EQS, an appropriate analytical method and detection limit in the correct matrix, a method to deliver a comparison with the EQS and a robust statistical method to draw unbiased conclusions about environmental risk. In addition, we argue that there is a case for checking the consequences of introducing a standard against field data, wherever possible. This validation of the EQS rarely happens currently. We explain what implementation assessment is and why

Where do the rural poor deliver when high coverage of health facility delivery is achieved? Findings from a community and hospital survey in Tanzania.

Directory of Open Access Journals (Sweden)

Manuela Straneo

Full Text Available As part of maternal mortality reducing strategies, coverage of delivery care among sub-Saharan African rural poor will improve, with a range of facilities providing services. Whether high coverage will benefit all socio-economic groups is unknown. Iringa rural District, Southern Tanzania, with high facility delivery coverage, offers a paradigm to address this question. Delivery services are available in first-line facilities (dispensaries, health centres and one hospital. We assessed whether all socio-economic groups access the only comprehensive emergency obstetric care facility equally, and surveyed existing delivery services.District population characteristics were obtained from a household community survey (n = 463. A Hospital survey collected data on women who delivered in this facility (n = 1072. Principal component analysis on household assets was used to assess socio-economic status. Hospital population socio-demographic characteristics were compared to District population using multivariable logistic regression. Deliveries' distribution in District facilities and staffing were analysed using routine data.Women from the hospital compared to the District population were more likely to be wealthier. Adjusted odds ratio of hospital delivery increased progressively across socio-economic groups, from 1.73 for the poorer (p = 0.0031 to 4.53 (p<0.0001 for the richest. Remarkable dispersion of deliveries and poor staffing were found. In 2012, 5505/7645 (72% institutional deliveries took place in 68 first-line facilities, the remaining in the hospital. 56/68 (67.6% first-line facilities reported ≤100 deliveries/year, attending 33% of deliveries. Insufficient numbers of skilled birth attendants were found in 42.9% of facilities.Poorer women remain disadvantaged in high coverage, as they access lower level facilities and are under-represented where life-saving transfusions and caesarean sections are available. Tackling the challenges

Long quantum channels for high-quality entanglement transfer

International Nuclear Information System (INIS)

Banchi, L; Apollaro, T J G; Cuccoli, A; Verrucchi, P; Vaia, R

2011-01-01

High-quality quantum-state and entanglement transfer can be achieved in an unmodulated spin bus operating in the ballistic regime, which occurs when the endpoint qubits A and B are nonperturbatively coupled to the chain by a suitable exchange interaction j 0 . Indeed, the transition amplitude characterizing the transfer quality exhibits a maximum for a finite optimal value j opt 0 (N), where N is the channel length. We show that j opt 0 (N) scales as N -1/6 for large N and that it ensures a high-quality entanglement transfer even in the limit of arbitrarily long channels, almost independently of the channel initialization. For instance, for any chain length the average quantum-state transmission fidelity exceeds 90% and decreases very little in a broad neighbourhood of j opt 0 (N). We emphasize that, taking the reverse point of view, should j 0 be experimentally constrained, high-quality transfer can still be obtained by adjusting the channel length to its optimal value. (paper)

Identifying suitable substrates for high-quality graphene-based heterostructures

Science.gov (United States)

Banszerus, L.; Janssen, H.; Otto, M.; Epping, A.; Taniguchi, T.; Watanabe, K.; Beschoten, B.; Neumaier, D.; Stampfer, C.

2017-06-01

We report on a scanning confocal Raman spectroscopy study investigating the strain-uniformity and the overall strain and doping of high-quality chemical vapour deposited (CVD) graphene-based heterostuctures on a large number of different substrate materials, including hexagonal boron nitride (hBN), transition metal dichalcogenides, silicon, different oxides and nitrides, as well as polymers. By applying a hBN-assisted, contamination free, dry transfer process for CVD graphene, high-quality heterostructures with low doping densities and low strain variations are assembled. The Raman spectra of these pristine heterostructures are sensitive to substrate-induced doping and strain variations and are thus used to probe the suitability of the substrate material for potential high-quality graphene devices. We find that the flatness of the substrate material is a key figure for gaining, or preserving high-quality graphene.

Delivering a quality-assured fracture liaison service in a UK teaching hospital-is it achievable?

Science.gov (United States)

Shipman, K E; Stammers, J; Doyle, A; Gittoes, N

2016-10-01

To determine whether new national guidance on the specifications of a fracture liaison service are realistically deliverable, 1 year of data on the performance of such a service were audited. Audit targets were mostly met. This audit demonstrates that these standards are deliverable in a real world setting. UK service specifications for a fracture liaison service (FLS) have been produced (National Osteoporosis Society, NOS) to promote effective commissioning and delivery of the highest quality care to patients with fragility fractures. How deliverable these standards are has not as yet been methodically reported. Our FLS was modelled on the ten NOS standards; performance was audited after 1 year to determine whether these standards could be delivered and to describe the lessons learnt. Performance was audited against the NOS FLS Service Standards, with management based on the Fracture Risk Assessment Tool (FRAX®), the four-item Falls Risk Assessment Tool (FRAT), National Institute for Health and Care Excellence (NICE) and the National Osteoporosis Guideline Groups (NOGG) guidance. Data were recorded prospectively on a database. The FLS commenced in May 2014, was fully operational in August 2014 and data were captured from 1 September 2014 to 1 September 2015. The FLS detected 1773 patients and standards were largely achieved. Most, 94 %, patients were seen within 6 weeks, 533 DXA requests were generated, 804 outpatient FRAT assessments were recorded (134 required falls intervention) and 773 patients had bone treatments started. On follow-up at 3 months, between 78-79 % were still taking medication. Preliminary evaluation of a FLS implemented according to UK NOS standards demonstrates that the model is practical to apply to a large teaching hospital population. Collection and review of outcome and cost effectiveness data is required to determine the performance of this model in comparison with existing models.

Quantification of the effects of quality investment on the Cost of Poor Quality: A quasi-experimental study

Science.gov (United States)

Tamimi, Abdallah Ibrahim

Quality management is a fundamental challenge facing businesses. This research attempted to quantify the effect of quality investment on the Cost of Poor Quality (COPQ) in an aerospace company utilizing 3 years of quality data at United Launch Alliance, a Boeing -- Lockheed Martin Joint Venture Company. Statistical analysis tools, like multiple regressions, were used to quantify the relationship between quality investments and COPQ. Strong correlations were evident by the high correlation coefficient R2 and very small p-values in multiple regression analysis. The models in the study helped produce an Excel macro that based on preset constraints, optimized the level of quality spending to minimize COPQ. The study confirmed that as quality investments were increased, the COPQ decreased steadily until a point of diminishing return was reached. The findings may be used to develop an approach to reduce the COPQ and enhance product performance. Achieving superior quality in rocket launching enhances the accuracy, reliability, and mission success of delivering satellites to their precise orbits in pursuit of knowledge, peace, and freedom while assuring safety for the end user.

Quality assurance protocol for linear accelerators used in radiotherapy

International Nuclear Information System (INIS)

Petkovska, Sonja

2012-01-01

Radiotherapy is a modality of choice for treatment of malignant diseases. Linear accelerators are the most common devices for implementing external radiation therapy. Taking into account the fact during the treatment, healthy tissue will inevitably be exposed to ionizing radiation, predicted dose in each radiotherapy case should be delivered with the greatest possible accuracy. Medical requirement for quality treatment achieving means as mach as possible dose into volume of interest and the greatest possible healthy tissue protection. From radiation protection point of view, occupational exposure of the staff involved in radiotherapy process should be minimized. To be able to reach it, consistent adherence to the Quality Assurance Programme is necessary. It should be in accordance with higher national and international protocols, because they give guidelines on the necessary standards, procedures, processes, resources and responsibilities that should be defined in structuring the overall radiotherapy quality management. As a part of this Master thesis, quality management as well as Quality Assurance Programme that is necessary to be applied in each radiotherapy center have been prepared. Mandatory dosimetry measurements included in the internal recommendations are also emphasized. Measurement results and external audit by IAEA indicated high accuracy and quality radiotherapy dose delivering in Macedonia. Based on the measurements and analysis, the aim of this Master thesis is offering a Quality Assurance Protocol for external beam radiotherapy that can be used on the national level in Republic of Macedonia. (Author)

Evidence, Quality, and Waste: Solving the Value Equation in Neonatology.

Science.gov (United States)

Dukhovny, Dmitry; Pursley, DeWayne M; Kirpalani, Haresh M; Horbar, Jeffrey H; Zupancic, John A F

2016-03-01

Rising health care costs challenge governments, payers, and providers in delivering health care services. Tremendous pressures result to deliver better quality care while simultaneously reducing costs. This has led to a wholesale re-examination of current practice methods, including explicit consideration of efficiency and waste. Traditionally, reductions in the costs of care have been considered as independent, and sometimes even antithetical, to the practice of high-quality, intensive medicine. However, it is evident that provision of evidence-based, locally relevant care can result in improved outcomes, lower resource utilization, and opportunities to reallocate resources. This is particularly relevant to the practice of neonatology. In the United States, 12% of the annual birth cohort is affected by preterm birth, and 3% is affected by congenital anomalies. Both of these conditions are associated with costly health care during, and often long after, the NICU admission. We will discuss how 3 drivers of clinical practice in neonatal care (evidence-based medicine, evidence-based economics, and quality improvement) can together optimize clinical and fiscal outcomes. Copyright © 2016 by the American Academy of Pediatrics.

The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients

NARCIS (Netherlands)

J.M. Hartgerink (Jacqueline); J.M. Cramm (Jane); T.J.E.M. Bakker (Ton); A.M. van Eijsden (A.); J.P. Mackenbach (Johan); A.P. Nieboer (Anna)

2013-01-01

textabstractAim: To identify predictors of relational coordination among professionals delivering care to older patients. Background: Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design: This cross-sectional

Delivery of completed irradiation vehicles and the quality assurance document to the High Flux Isotope Reactor for irradiation

Energy Technology Data Exchange (ETDEWEB)

Petrie, Christian M. [Oak Ridge National Laboratory (ORNL), Oak Ridge, TN (United States); McDuffee, Joel Lee [Oak Ridge National Laboratory (ORNL), Oak Ridge, TN (United States); Katoh, Yutai [Oak Ridge National Laboratory (ORNL), Oak Ridge, TN (United States); Terrani, Kurt A. [Oak Ridge National Laboratory (ORNL), Oak Ridge, TN (United States)

2015-10-01

This report details the initial fabrication and delivery of two Fuel Cycle Research and Development (FCRD) irradiation capsules (ATFSC01 and ATFSC02), with associated quality assurance documentation, to the High Flux Isotope Reactor (HFIR). The capsules and documentation were delivered by September 30, 2015, thus meeting the deadline for milestone M3FT-15OR0202268. These irradiation experiments are testing silicon carbide composite tubes in order to obtain experimental validation of thermo-mechanical models of stress states in SiC cladding irradiated under a prototypic high heat flux. This document contains a copy of the completed capsule fabrication request sheets, which detail all constituent components, pertinent drawings, etc., along with a detailed summary of the capsule assembly process performed by the Thermal Hydraulics and Irradiation Engineering Group (THIEG) in the Reactor and Nuclear Systems Division (RNSD). A complete fabrication package record is maintained by the THIEG and is available upon request.

Delivering Online Examinations: A Case Study

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John MESSING

2004-07-01

Full Text Available Delivering Online Examinations: A Case Study Jason HOWARTH John MESSING Irfan ALTAS Charles Sturt University Wagga Wagga-AUSTRALIA ABSTRACT This paper represents a brief case study of delivering online examinations to a worldwide audience. These examinations are delivered in partnership with a commercial online testing company as part of the Industry Master’s degree at Charles Sturt University (CSU. The Industry Master’s degree is an academic program for students currently employed in the IT industry. Using Internet Based Testing (IBT, these students are examined in test centres throughout the world. This offers many benefits. For example, students have the freedom of sitting exams at any time during a designated interval. Computer-based testing also provides instructors with valuable feedback through test statistics and student comments. In this paper, we document CSU’s use of the IBT system, including how tests are built and delivered, and how both human and statistical feedback is used to evaluate and enhance the testing process.

Total Quality Management: A Selected Bibliography

Science.gov (United States)

1993-03-01

1991) Zeithaml, Valarie A.; Parasuraman, A.; and Berry, Leonard L. DELIV- ERING QUALITY SERVICE: BALANCING CUSTOMER PERCEPTIONS AND EXPECTA- TIONS...August 1992, pp. 24-27. Danjin, Dick. "Will TQM Go the Way of QWL (Quality of Worklife )?" JOURNAL FOR QUALITY AND PARTICIPATION, Vol. 15, July-August

Transdiagnostic internet-delivered cognitive-behaviour therapy (CBT) for adults with functional gastrointestinal disorders (FGID): A feasibility open trial.

Science.gov (United States)

Dear, B F; Fogliati, V J; Fogliati, R; Gandy, M; McDonald, S; Talley, N; Holtmann, G; Titov, N; Jones, M

2018-05-01

Many people with functional gastrointestinal disorders (FGIDs) face significant barriers in accessing psychological treatments that are known to reduce symptoms and their psychological sequelae. This study examined the feasibility and initial outcomes of a transdiagnostic and internet-delivered cognitive behaviour therapy (iCBT) intervention, the Chronic Conditions Course, for adults with functional gastrointestinal disorders (FGIDs). A single-group feasibility open trial design was employed and administered to twenty seven participants. The course ran for 8 weeks and was provided with weekly contact from a Clinical Psychologist. Seventy percent of participants completed the course within the 8 weeks and 81.5% provided data at post-treatment. High levels of satisfaction were observed and relatively little clinician time (M = 42.70 min per participant; SD = 46.25 min) was required. Evidence of clinical improvements in FGID symptoms (ds ≥ 0.46; avg. improvement ≥21%), anxiety symptoms (ds ≥ 0.99; avg. improvement ≥42%), and depression symptoms (ds ≥ 0.75; avg. improvement ≥35%) were observed, which either maintained or continued to improve to 3-month follow-up. Evidence of improvement was also observed in pain catastrophising and mental-health related quality of life, but not physical-health related quality of life. These findings highlight the potential value of transdiagnostic internet-delivered programs for adults with FGIDs and support for the conduct of larger-scale controlled studies. Copyright © 2018 Elsevier Inc. All rights reserved.

Challenges and Ideas from a Research Program on High Quality, Evidence-Based Practice in School Mental Health

Science.gov (United States)

Weist, Mark D.; Youngstrom, Eric A.; Stephan, Sharon; Lever, Nancy; Fowler, Johnathan; Taylor, Leslie; McDaniel, Heather; Chappelle, Lori; Paggeot, Samantha; Hoagwood, Kimberly

2013-01-01

Objective Reviews the progression of a research program designed to develop, implement and study the implementation of “achievable” evidence-based practices (EBPs) in schools. Reviews challenges encountered and ideas to overcome them to enhance this avenue of research. Method Presents two federally funded randomized controlled trials involving comparison of a four-component targeted intervention (Quality Assessment and Improvement, Family Engagement and Empowerment, Modular Evidence-Based Practice, Implementation Support) versus a comparison intervention focused on Personal Wellness. In both studies primary aims focused on changes in clinician attitudes and behavior, including the delivery of high quality, evidence-based practices and secondary aims focused on student level impacts. Results A number of challenges, many not reported in the literature are reviewed, and ideas for overcoming them are presented. Conclusions Given the reality that the majority of youth mental health services are delivered in schools and the potential of school mental health (SMH) services to provide a continuum of mental health care from promotion to intervention, it is critical that the field consider and address the logistical and methodological challenges associated with implementing and studying EBP implementation by clinicians. PMID:24063310

Challenges and ideas from a research program on high-quality, evidence-based practice in school mental health.

Science.gov (United States)

Weist, Mark D; Youngstrom, Eric A; Stephan, Sharon; Lever, Nancy; Fowler, Johnathan; Taylor, Leslie; McDaniel, Heather; Chappelle, Lori; Paggeot, Samantha; Hoagwood, Kimberly

2014-01-01

This article reviews the progression of a research program designed to develop, implement, and study the implementation of "achievable" evidence-based practices (EBPs) in schools. We review challenges encountered and ideas to overcome them to enhance this avenue of research. The article presents two federally funded randomized controlled trials involving comparison of a four-component targeted intervention (Quality Assessment and Improvement, Family Engagement and Empowerment, Modular Evidence-Based Practice, Implementation Support) versus a comparison intervention focused on personal wellness. In both studies, primary aims focused on changes in clinician attitudes and behavior, including the delivery of high-quality EBPs and secondary aims focused on student-level impacts. A number of challenges, many not reported in the literature, are reviewed, and ideas for overcoming them are presented. Given the reality that the majority of youth mental health services are delivered in schools and the potential of school mental health services to provide a continuum of mental health care from promotion to intervention, it is critical that the field consider and address the logistical and methodological challenges associated with implementing and studying EBP implementation by clinicians.

Internet-delivered cognitive therapy for PTSD: a development pilot series

Directory of Open Access Journals (Sweden)

Jennifer Wild

2016-11-01

Full Text Available Background: Randomised controlled trials have established that face-to-face cognitive therapy for posttraumatic stress disorder (CT-PTSD based on Ehlers and Clark's cognitive model of PTSD is highly effective and feasible with low rates of dropout. Access to evidence-based psychological treatments for PTSD is insufficient. Several studies have shown that therapist-assisted treatment delivery over the Internet is a promising way of improving access to cognitive behavioural therapy interventions. Objective: To develop an Internet version of CT-PTSD that significantly reduces therapist contact time without compromising treatment integrity or retention rates. Methods: We describe the development of an Internet version of CT-PTSD. It implements all the key procedures of face-to-face CT-PTSD, including techniques that focus on the trauma memory, such as memory updating, stimulus discrimination and revisiting the trauma site, as well as restructuring individually relevant appraisals relating to overgeneralisation of danger, guilt, shame or anger, behavioural experiments and planning activities to reclaim quality of life. A cohort of 10 patients meeting DSM-IV criteria for PTSD worked through the programme, with remote guidance from a therapist, and they were assessed at pre- and post-treatment on PTSD outcome, mood, work and social adjustment and process measures. Results: No patients dropped out. Therapists facilitated the treatment with 192 min of contact time per patient, plus 57 min for reviewing the patient's progress and messages. Internet-delivered CT-PTSD was associated with very large improvements on all outcome and process measures, with 80% of patients achieving clinically significant change and remission from PTSD. Conclusions: Internet-delivered cognitive therapy for PTSD (iCT-PTSD appears to be an acceptable and efficacious treatment. Therapist time was reduced to less than 25% of time in face-to-face CT-PTSD. Randomised controlled trials

High quality data: An evaluation of AIM data quality and data quality procedures

Science.gov (United States)

The goal of every monitoring program is to collect high-quality data which can then be used to provide information to decision makers. The Bureau of Land Management (BLM) Assessment, Inventory, and Monitoring (AIM) program is one such data set which provides rangeland status, condition, and trend in...

Health-related quality of life in children with high-functioning autism.

Science.gov (United States)

Potvin, Marie-Christine; Snider, Laurie; Prelock, Patricia A; Wood-Dauphinee, Sharon; Kehayia, Eva

2015-01-01

The health-related quality of life of school-aged children with high-functioning autism is poorly understood. The objectives of this study were to compare the health-related quality of life of children with high-functioning autism to that of typically developing peers and to compare child-self and parent-proxy reports of health-related quality of life of children. A cross-sectional study of children with high-functioning autism (n = 30) and peers (n = 31) was conducted using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales. Children with high-functioning autism had significantly poorer health-related quality of life than peers whether reported by themselves (p children and parental scores suggested variance in points of view. This study specifically investigated health-related quality of life in children with high-functioning autism as compared to a sample of peers, from the child's perspective. It strengthens earlier findings that children with high-functioning autism experience poorer health-related quality of life than those without this disorder and points to the importance of clinicians working with families to identify areas in a child's life that promote or hinder their sense of well-being. © The Author(s) 2013.

Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis

Science.gov (United States)

Seyffert, Michael; Lagisetty, Pooja; Landgraf, Jessica; Chopra, Vineet; Pfeiffer, Paul N.; Conte, Marisa L.; Rogers, Mary A. M.

2016-01-01

Background Insomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia. Objectives The primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings. Data Sources We searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials. Methods Studies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis. Results We found 15 trials, all utilizing a pretest-posttest randomized control group design. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3%; pinternet-delivered cognitive behavioral therapy versus control. Internet-delivered cognitive behavioral therapy resulted in a decrease in the insomnia severity index by 4.3 points (95% CI: -7.1, -1.5; p = 0.017) compared to control. Total sleep time averaged 5.7 hours at baseline and increased by 20 minutes with internet-delivered therapy versus control (95% CI: 9, 31; p = 0.004). The severity of depression decreased by 2.3 points (95% CI: -2.9, -1.7; p = 0.013) in individuals who received internet-delivered cognitive behavioral therapy compared to control. Improvements in sleep efficiency, the insomnia severity index and depression scores with internet-delivered cognitive behavioral therapy were maintained from 4 to

Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis.

Directory of Open Access Journals (Sweden)

Michael Seyffert

Full Text Available Insomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia.The primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings.We searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials.Studies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis.We found 15 trials, all utilizing a pretest-posttest randomized control group design. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3%; p<0.001 with internet-delivered cognitive behavioral therapy versus control. Internet-delivered cognitive behavioral therapy resulted in a decrease in the insomnia severity index by 4.3 points (95% CI: -7.1, -1.5; p = 0.017 compared to control. Total sleep time averaged 5.7 hours at baseline and increased by 20 minutes with internet-delivered therapy versus control (95% CI: 9, 31; p = 0.004. The severity of depression decreased by 2.3 points (95% CI: -2.9, -1.7; p = 0.013 in individuals who received internet-delivered cognitive behavioral therapy compared to control. Improvements in sleep efficiency, the insomnia severity index and depression scores with internet-delivered cognitive behavioral therapy were maintained from 4 to 48 weeks after post

Developing and Delivering a Geoscience MOOC -- What's Involved, and What Works (Invited)

Science.gov (United States)

Marshak, S.; Tomkin, J. H.

2013-12-01

Efforts to develop free Massive Open Online Courses (MOOCs) have exploded in the last year, and geoscience education is part of this boom. Developing and delivering a MOOC is a major undertaking, and the proliferation of MOOCs can potentially be disruptive to more traditional forms of education, so it's worth asking: What role can/should/will MOOCs play in future geoscience education? Our experience in developing and delivering two MOOCs--Introduction to Sustainability (the first geoscience-related MOOC ever delivered), and Planet Earth . . . and You--provide insight into the impact that a MOOC can have, and into approaches that can work to yield a pedagogically sound experience. Both of these courses cover content similar to that of lower-division college classes, but MOOCs have very different participants than do equivalent, for-credit (i.e., for-fee) university courses. Examination of statistics that characterize student performance, along with interpretations of exit surveys, indicate that MOOC participants are older, are more likely to be working, are not enrolled in a college, and have different educational backgrounds than do traditional students. Significantly, MOOC participants are international (more than100 different nationalities were represented in our MOOCs) and come from both western and non-western traditions. This situation not only leads to ESL challenges, but also enables cross-cultural discussions and global ("crowd sourcing") data collection, beyond what is possible in traditional classes. Peak participant performance is very high (better than the performance of students in campus courses), but drop-out rates are also very high (typically, less than 20% of participants complete all assignments). Active MOOC participants perform as well in online assessments as do either traditional on-campus or traditional (small class, for-credit) online students. MOOC development can improve on-campus instruction, partly through technology transfer and partly

Image Quality in High-resolution and High-cadence Solar Imaging

Science.gov (United States)

Denker, C.; Dineva, E.; Balthasar, H.; Verma, M.; Kuckein, C.; Diercke, A.; González Manrique, S. J.

2018-03-01

Broad-band imaging and even imaging with a moderate bandpass (about 1 nm) provides a photon-rich environment, where frame selection (lucky imaging) becomes a helpful tool in image restoration, allowing us to perform a cost-benefit analysis on how to design observing sequences for imaging with high spatial resolution in combination with real-time correction provided by an adaptive optics (AO) system. This study presents high-cadence (160 Hz) G-band and blue continuum image sequences obtained with the High-resolution Fast Imager (HiFI) at the 1.5-meter GREGOR solar telescope, where the speckle-masking technique is used to restore images with nearly diffraction-limited resolution. The HiFI employs two synchronized large-format and high-cadence sCMOS detectors. The median filter gradient similarity (MFGS) image-quality metric is applied, among others, to AO-corrected image sequences of a pore and a small sunspot observed on 2017 June 4 and 5. A small region of interest, which was selected for fast-imaging performance, covered these contrast-rich features and their neighborhood, which were part of Active Region NOAA 12661. Modifications of the MFGS algorithm uncover the field- and structure-dependency of this image-quality metric. However, MFGS still remains a good choice for determining image quality without a priori knowledge, which is an important characteristic when classifying the huge number of high-resolution images contained in data archives. In addition, this investigation demonstrates that a fast cadence and millisecond exposure times are still insufficient to reach the coherence time of daytime seeing. Nonetheless, the analysis shows that data acquisition rates exceeding 50 Hz are required to capture a substantial fraction of the best seeing moments, significantly boosting the performance of post-facto image restoration.

Trends and quality of care in outpatient visits to generalist and specialist physicians delivering primary care in the United States, 1997-2010.

Science.gov (United States)

Edwards, Samuel T; Mafi, John N; Landon, Bruce E

2014-06-01

Although many specialists serve as primary care physicians (PCPs), the type of patients they serve, the range of services they provide, and the quality of care they deliver is uncertain. To describe trends in patient, physician, and visit characteristics, and compare visit-based quality for visits to generalists and specialists self-identified as PCPs. Cross-sectional study and time trend analysis. Nationally representative sample of visits to office-based physicians from the National Ambulatory Medical Care Survey, 1997-2010. Proportions of primary care visits to generalist and specialists, patient characteristics, principal diagnoses, and quality. Among 84,041 visits to self-identified PCPs representing an estimated 4.0 billion visits, 91.5 % were to generalists, 5.9 % were to medical specialists and 2.6 % were to obstetrician/gynecologists. The proportion of PCP visits to generalists increased from 88.4 % in 1997 to 92.4 % in 2010, but decreased for medical specialists from 8.0 % to 4.8 %, p = 0.04). The proportion of medical specialist visits in which the physician self-identified as the patient's PCP decreased from 30.6 % in 1997 to 9.8 % in 2010 (p specialist PCPs take care of older patients (mean age 61 years), and dedicate most of their visits to chronic disease management (51.0 %), while generalist PCPs see younger patients (mean age 55.4 years) most commonly for new problems (40.5 %). Obstetrician/gynecologists self-identified as PCPs see younger patients (mean age 38.3 p specialists. Medical specialists are less frequently serving as PCPs for their patients over time. Generalist, medical specialist, and obstetrician/gynecologist PCPs serve different primary care roles for different populations. Delivery redesign efforts must account for the evolving role of generalist and specialist PCPs in the delivery of primary care.

The Customer Quality of Delivered Care to Patients with Inflammatory Bowel Disease in Tabriz City, Iran, 2012

Directory of Open Access Journals (Sweden)

Jafar Sadegh Tabrizi

2015-08-01

Full Text Available Abstract Background and purpose: Customer quality (CQ refers to knowledge, attitude, and skills of service-user in treatment process and this study aims to assess it in delivered care to patients with inflammatory bowel disease (IBD in Tabriz city, Iran, 2012. Materials and Methods: This is a cross-sectional investigation in which the target population includes 94 patients with IBD, who had medical care files in Imam Reza Hospital and Tabriz Golgasht Specialized Clinic. A 19-question inventory is the tool for data collection that its validity was approve by 10 experts and its reliability was examined and verified by conducting a pilot study and with calculation of internal consistency (α = 0.78. SPSS software was employed to analyze data. Results: The mean score of the variable of CQ was derived (70.63 ± 9.67 in patients with IBD disease. All participants had acquired the scores of self-management at the first phase. However, at last 11.7% of them had reported the highest scores in variable of CQ and they could continue their own medical care trend under variable conditions like stress and financial problems. Similarly, there was a significant relationship among CQ with an educational degree in the participants (P = 0.050 so that as the educational level was higher, the score of CQ was also increased. Conclusion: The acquired results signify that CQ is relatively acceptable in the studied population but major problems are visible in some areas, and this may imply the necessity for consideration by healthcare directors.

A service model for delivering care closer to home.

Science.gov (United States)

Dodd, Joanna; Taylor, Charlotte Elizabeth; Bunyan, Paul; White, Philippa Mary; Thomas, Siân Myra; Upton, Dominic

2011-04-01

Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient.This is a practical example of early implementation of the principles underlying the Department of Health's (DH) recent Best Practice Guidance, 'Delivering Care Closer to Home' (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the 'Customer Care' award by 'Management in Practice'. The Surgery was also awarded the 'Practice of the Year' award for this and a number of other customer-focussed projects.

Health-Related Quality of Life of Rural Clients Seeking Telepsychology Services

Directory of Open Access Journals (Sweden)

Kevin R. Tarlow

2014-01-01

Full Text Available Sixty million US residents live in rural areas, but health policies and interventions developed from an urban mindset often fail to address the significant barriers to health experienced by these local communities. Telepsychology, or psychological services delivered by distance via technology, is an emerging treatment modality with special implications for underserved rural areas. This study found that a sample of rural residents seeking telepsychology services (n=94 had low health-related quality of life (HRQOL, often due to cooccurring physical and mental health diagnoses including high rates of depression. However, a brief telepsychology treatment delivered to rural clients (n=40 was associated with an improvement in mental health-related quality of life (d = 0.70,  P<.001. These results indicate that despite the complex health needs of these underserved communities, telepsychology interventions may help offset the disparities in health service access in rural areas.

Inactivated poliovirus type 2 vaccine delivered to rat skin via high density microprojection array elicits potent neutralising antibody responses.

Science.gov (United States)

Muller, David A; Pearson, Frances E; Fernando, Germain J P; Agyei-Yeboah, Christiana; Owens, Nick S; Corrie, Simon R; Crichton, Michael L; Wei, Jonathan C J; Weldon, William C; Oberste, M Steven; Young, Paul R; Kendall, Mark A F

2016-02-25

Polio eradication is progressing rapidly, and the live attenuated Sabin strains in the oral poliovirus vaccine (OPV) are being removed sequentially, starting with type 2 in April 2016. For risk mitigation, countries are introducing inactivated poliovirus vaccine (IPV) into routine vaccination programs. After April 2016, monovalent type 2 OPV will be available for type 2 outbreak control. Because the current IPV is not suitable for house-to-house vaccination campaigns (the intramuscular injections require health professionals), we developed a high-density microprojection array, the Nanopatch, delivered monovalent type 2 IPV (IPV2) vaccine to the skin. To assess the immunogenicity of the Nanopatch, we performed a dose-matched study in rats, comparing the immunogenicity of IPV2 delivered by intramuscular injection or Nanopatch immunisation. A single dose of 0.2 D-antigen units of IPV2 elicited protective levels of poliovirus antibodies in 100% of animals. However, animals receiving IPV2 by IM required at least 3 immunisations to reach the same neutralising antibody titres. This level of dose reduction (1/40th of a full dose) is unprecedented for poliovirus vaccine delivery. The ease of administration coupled with the dose reduction observed in this study points to the Nanopatch as a potential tool for facilitating inexpensive IPV for mass vaccination campaigns.

Interest of pelvimetry by multi detectors computed tomography (M.D.C.T.) 40 pins, reduction of the delivered dose

International Nuclear Information System (INIS)

Thibaut, C.; Marie-Anne, O.; Douws, C.; Grenier, N.; Chateil, J.F.

2006-01-01

This new procedure has allowed to improve the quality of measurement accuracy, annuls the difficulties of realizations of the conventional pictures and reduces in a considerable way the dose delivered to the patient and to the baby. (N.C.)

Delivering care to oncology patients in the community: an innovative integrated approach.

LENUS (Irish Health Repository)

Hanan, Terry

2014-08-01

A community oncology nursing programme was developed in Ireland between the hospital and community health services for patients receiving systemic cancer therapy, in response to a service need. A robust evaluation of the pilot programme was undertaken, which found that defined clinical procedures traditionally undertaken in hospitals were safely undertaken in the patient\\'s home with no adverse effects. There was a dramatic decrease in hospital attendances for these defined clinical procedures, and hospital capacity was consequently freed up. Patients valued having aspects of their care delivered at home and reported that it improved their quality of life, including reduced hospital visits and travel time. Community nurses expanded their scope of practice and became partners with oncology day-ward nurses in caring for these patients. Community nurses developed the competence and confidence to safely deliver cancer care in the community. This initiative shows that defined elements of acute cancer care can be safely delivered in the community so long as the training and support are provided. The findings and recommendations of the evaluation resulted in university accreditation and approval for national roll-out of the programme. Integration of services between primary and secondary care is a key priority. This innovative programme is a good example of shared integrated care that benefits both patients and health-care providers.

Quality-oriented efforts in IPD, - a framework

DEFF Research Database (Denmark)

Andreasen, Mogens Myrup

1998-01-01

It is generally expected that modern quality efforts like TQM and ISO9000 should deliver a sufficient framework for quality efforts in industrial companies. Our findings in Danish industry shows a fragmented picture of islands of efforts and a weak understanding of basic quality concepts between...... designers. The paper propose a framework for quality efforts, illustrated by simple metaphors....

Methodology of clinical measures of healthcare quality delivered to patients with cardiovascular diseases

Directory of Open Access Journals (Sweden)

Posnenkova O.M.

2014-03-01

Full Text Available The results of implementation the methodology proposed by American Colleague of Cardiology and American Heart Association (ACC/AHA for development of Russian clinical quality measures for patients with arterial hypertension, coronary heart disease and chronic heart failure. Created quality measures cover the key elements of medical care influencing directly on clinical outcomes of treatment.

Real-World Solutions for Developing High-Quality PHP Frameworks and Applications

CERN Document Server

Bergmann, Sebastian

2011-01-01

Learn to develop high-quality applications and frameworks in PHP Packed with in-depth information and step-by-step guidance, this book escorts you through the process of creating, maintaining and extending sustainable software of high quality with PHP. World-renowned PHP experts present real-world case studies for developing high-quality applications and frameworks in PHP that can easily be adapted to changing business requirements. . They offer different approaches to solving  typical development and quality assurance problems that every developer needs to know and master.Details the process

Effectiveness of psychological interventions delivered by non-psychologists on low back pain and disability: a qualitative systematic review.

Science.gov (United States)

Bostick, Geoff P

2017-11-01

Psychological treatments delivered by non-psychologists have been proposed as a way to increase access to care to address important psychological barriers to recovery in people with low back pain (LBP). This review aimed to synthesize randomized controlled trials (RCTs) that assess the effectiveness of psychological interventions delivered by non-psychologists in reducing pain intensity and disability in adults with LBP, compared with usual care. A systematic review without meta-analysis was carried out. Randomized controlled trials including adult patients with all types of musculoskeletal LBP were eligible. Interventions included those based on psychological principles and delivered by non-psychologists. The primary outcomes of interest were self-reported pain intensity and disability. Information sources included Medline, EMBASE, and the Cochrane Central Registrar for Controlled Trials. The Cochrane Collaboration's tool for assessing risk of bias was used for the evaluation of internal validity. There were 1,101 records identified, 159 were assessed for eligibility, 16 were critically appraised, and 11 studies were included. Mild to moderate risk of bias was present in the included studies, with personnel and patient blinding, treatment fidelity, and attrition being the most common sources of bias. Considerable heterogeneity existed for patient population, intervention components, and comparison groups. Although most studies demonstrated statistical and clinical improvements in pain and disability, few were statistically superior to the comparison group. Consistent with the broader psychological literature, psychological interventions delivered by non-psychologists have modest effects on low back pain and disability. Additional high quality research is needed to understand what patients are likely to respond to psychological interventions, the appropriate dose to achieve the desired outcome, the amount of training required to implement psychological

Quality Control and Quality Assurance of Radiation Oncology

International Nuclear Information System (INIS)

Abaza, A.

2016-01-01

Radiotherapy (RT) has played important roles in cancer treatment for more than one century. The development of RT techniques allows high-dose irradiation to tumors while reducing the radiation doses delivered to surrounding normal tissues. However, RT is a complex process and involves understanding of the principles of medical physics, radiobiology, radiation safety, dosimetry, radiation treatment planning, simulation and interaction of radiation with other treatment modalities. Each step in the integrated process of RT needs quality control and quality assurance (QA) to prevent errors and to ensure that patients will receive the prescribed treatment correctly. The aim of this study is to help the radio therapists in identifying a system for QA that balances patient safety and quality with available resources. Recent advances in RT focus on the need for a systematic RT QA program that balances patient safety and quality with available resources. It is necessary to develop more formal error mitigation and process analysis methods, such as failure mode and effect analysis (FMEA), to focus available QA resources optimally on the process components. External audit programs are also effective. Additionally, Clinical trial QA has a significant role in enhancing the quality of care. The International Atomic Energy Agency (IAEA) has operated both an on-site and off-site postal dosimetry audit to improve practice and to assure the dose from RT equipment. Both postal dosimetry audit and clinical trial RTQA, especially for advanced technologies, in collaboration with global networks, will serve to enhance patient safety and quality of care

The History and State of Neonatal Nursing Quality Improvement Practice and Education.

Science.gov (United States)

Kukla, Aniko; Dowling, Donna A; Dolansky, Mary A

2018-03-01

Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver.

Phase Transition Control for High-Performance Blade-Coated Perovskite Solar Cells

KAUST Repository

Li, Jianbo; Munir, Rahim; Fan, Yuanyuan; Niu, Tianqi; Liu, Yucheng; Zhong, Yufei; Yang, Zhou; Tian, Yuansi; Liu, Bo; Sun, Jie; Smilgies, Detlef-M.; Thoroddsen, Sigurdur T; Amassian, Aram; Zhao, Kui; Liu, Shengzhong (Frank)

2018-01-01

with high crystal quality and photophysical properties can be obtained only via direct crystallization for both spin-coating and blade-coating processes. As a result, the blade-coated MAPbI3 films deliver excellent charge-collection efficiency at both short

Measuring Beam Quality of Hollow Core Photonic Crystal Fibers

DEFF Research Database (Denmark)

Shephard, J.D.; Roberts, John; Jones, J.D.C.

2006-01-01

In this paper, the authors measure the quality of the delivered beam from hollow core photonic crystal fibers (HC-PCFs). The$M^2$parameter is determined, and the near- to far-field transition is examined. The influence on these properties due to the presence of a core surround mode is evaluated.......17 for the same output beam. This highlights the need for careful consideration when measuring and describing the beam quality delivered by these novel photonic fibers....

Quality of service in the Netherlands

Energy Technology Data Exchange (ETDEWEB)

Knijp, J.; Zwart, T. de; Frenken, R.M.L. [KEMA (Netherlands)

1997-12-31

Growing competition between utilities, changing legislation and increased usage of sensitive and disturbing end-user equipment, are some reasons for growing attention for the customers` view towards the product electricity and its related services. This growing interest certainly does not mean that the technical quality level always has to be increased. This depends mainly on the requirements and expectations of the customers. Achieving a reliable power supply at high quality level requires enormous investments. For electric utilities, it is important to know how the customers value the delivered products and services in order to determine if the investments are proportionally. Utilities need new tools and techniques to search for an optimal quality level for each customer. Product differentiation and additional services can be developed if the right information is available. In 1994 KEMA has started a project called: Quality of service. During the project different methods and techniques have been developed. In this paper three tools will be presented. The ``customer simulator``, the Dutch power quality monitoring programme and the ``PSQ-indicator``. (Author)

Materials Delivered by Member States

International Nuclear Information System (INIS)

1966-01-01

The information given in this document is divided into two parts. In part I the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials delivered by Members up to 31 December 1965 in compliance with requests the Agency had made under Article IX. D. Part III contains information about materials which had not been delivered by 31 December but which had been allocated, in accordance with Article XI. F. 1 of the Statute, to approved Agency projects for which project arrangements were in force on that date

Materials Delivered by Member States

International Nuclear Information System (INIS)

1965-01-01

The information given in this document is divided into two parts. In part I the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials delivered by Members up to 31 December 1964 in compliance with requests the Agency had made under Article IX. D. Part II contains information about materials which had not been delivered by 31 December but which had been allocated, in accordance with Article XI. F. 1 of the Statute, to approved Agency projects for which project arrangements were in force on that date

Materials Delivered by Member States

International Nuclear Information System (INIS)

1968-01-01

The information given in this document is divided into two parts. In part I the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials delivered by Members up to 30 June 1968 in compliance with requests the Agency had made under Article IX,D. Part II contains information about materials which had not been delivered by 30 June 1968 but which had been allocated, in accordance with Article XI.F.I of the Statute, to approved Agency projects for which project arrangements were in force on that date

Mentoring Professors: A Model for Developing Quality Online Instructors and Courses in Higher Education

Science.gov (United States)

Barczyk, Casimir; Buckenmeyer, Janet; Feldman, Lori

2010-01-01

This article presents a four-stage model for mentoring faculty in higher education to deliver high quality online instruction. It provides a timeline that shows the stages of program implementation. Known as the Distance Education Mentoring Program, its major outcomes include certified instructors, student achievement, and the attainment of a…

Blueprint for action: steps toward a high-quality, high-value maternity care system.

Science.gov (United States)

Angood, Peter B; Armstrong, Elizabeth Mitchell; Ashton, Diane; Burstin, Helen; Corry, Maureen P; Delbanco, Suzanne F; Fildes, Barbara; Fox, Daniel M; Gluck, Paul A; Gullo, Sue Leavitt; Howes, Joanne; Jolivet, R Rima; Laube, Douglas W; Lynne, Donna; Main, Elliott; Markus, Anne Rossier; Mayberry, Linda; Mitchell, Lynn V; Ness, Debra L; Nuzum, Rachel; Quinlan, Jeffrey D; Sakala, Carol; Salganicoff, Alina

2010-01-01

Childbirth Connection hosted a 90th Anniversary national policy symposium, Transforming Maternity Care: A High Value Proposition, on April 3, 2009, in Washington, DC. Over 100 leaders from across the range of stakeholder perspectives were actively engaged in the symposium work to improve the quality and value of U.S. maternity care through broad system improvement. A multi-disciplinary symposium steering committee guided the strategy from its inception and contributed to every phase of the project. The "Blueprint for Action: Steps Toward a High Quality, High Value Maternity Care System", issued by the Transforming Maternity Care Symposium Steering Committee, answers the fundamental question, "Who needs to do what, to, for, and with whom to improve the quality of maternity care over the next five years?" Five stakeholder workgroups collaborated to propose actionable strategies in 11 critical focus areas for moving expeditiously toward the realization of the long term "2020 Vision for a High Quality, High Value Maternity Care System", also published in this issue. Following the symposium these workgroup reports and recommendations were synthesized into the current blueprint. For each critical focus area, the "Blueprint for Action" presents a brief problem statement, a set of system goals for improvement in that area, and major recommendations with proposed action steps to achieve them. This process created a clear sightline to action that if enacted could improve the structure, process, experiences of care, and outcomes of the maternity care system in ways that when anchored in the culture can indeed transform maternity care. Copyright 2010 Jacobs Institute of Women

Quality audit for dose determination in the field of radiotherapy using TLD

International Nuclear Information System (INIS)

Kharita, M. H.; Anjak, O.

2010-08-01

Quality audit is one of the important procedures in radiotherapy centers in order to verify the accuracy of the delivered radiation doses. The aim of this work is to establish a procedure for dose audit using TL dosimeters and to apply this procedure in radiotherapy centers. TL Dosimeters were distributed to several radiotherapy centers in Syria and Lebanon (4 with Co-60 and 14 with high energy photon beam radiotherapy units). They were exposed to 2 Gy in order to make an intercomparison study of the absorbed dose in water determined under reference conditions. The results show that only two beams were outside the accepted range, which is ±3.5%. and the were within the accepted range. External Quality audit is one of the important procedures in field of radiotherapy dosimeter in order to verify the accuracy of the radiation doses delivered to patients. (Author)

Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Seyffert, Michael; Lagisetty, Pooja; Landgraf, Jessica; Chopra, Vineet; Pfeiffer, Paul N; Conte, Marisa L; Rogers, Mary A M

2016-01-01

Insomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia. The primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings. We searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials. Studies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis. We found 15 trials, all utilizing a pretest-posttest randomized control group design. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3%; pcognitive behavioral therapy versus control. Internet-delivered cognitive behavioral therapy resulted in a decrease in the insomnia severity index by 4.3 points (95% CI: -7.1, -1.5; p = 0.017) compared to control. Total sleep time averaged 5.7 hours at baseline and increased by 20 minutes with internet-delivered therapy versus control (95% CI: 9, 31; p = 0.004). The severity of depression decreased by 2.3 points (95% CI: -2.9, -1.7; p = 0.013) in individuals who received internet-delivered cognitive behavioral therapy compared to control. Improvements in sleep efficiency, the insomnia severity index and depression scores with internet-delivered cognitive behavioral therapy were maintained from 4 to 48 weeks after post-treatment assessment. There were no statistically

High quality single atomic layer deposition of hexagonal boron nitride on single crystalline Rh(111) four-inch wafers

Energy Technology Data Exchange (ETDEWEB)

Hemmi, A.; Bernard, C.; Cun, H.; Roth, S.; Klöckner, M.; Kälin, T.; Osterwalder, J.; Greber, T., E-mail: greber@physik.uzh.ch [Physik-Institut, Universität Zürich, CH-8057 Zürich (Switzerland); Weinl, M.; Gsell, S.; Schreck, M. [Institut für Physik, Universität Augsburg, D-86135 Augsburg (Germany)

2014-03-15

The setup of an apparatus for chemical vapor deposition (CVD) of hexagonal boron nitride (h-BN) and its characterization on four-inch wafers in ultra high vacuum (UHV) environment is reported. It provides well-controlled preparation conditions, such as oxygen and argon plasma assisted cleaning and high temperature annealing. In situ characterization of a wafer is accomplished with target current spectroscopy. A piezo motor driven x-y stage allows measurements with a step size of 1 nm on the complete wafer. To benchmark the system performance, we investigated the growth of single layer h-BN on epitaxial Rh(111) thin films. A thorough analysis of the wafer was performed after cutting in atmosphere by low energy electron diffraction, scanning tunneling microscopy, and ultraviolet and X-ray photoelectron spectroscopies. The apparatus is located in a clean room environment and delivers high quality single layers of h-BN and thus grants access to large area UHV processed surfaces, which had been hitherto restricted to expensive, small area single crystal substrates. The facility is versatile enough for customization to other UHV-CVD processes, e.g., graphene on four-inch wafers.

Caffeine intake and semen quality in a population of 2,554 young Danish men

DEFF Research Database (Denmark)

Jensen, Tina Kold; Swan, Shanna H; Skakkebaek, Niels E

2010-01-01

The authors examined the association between semen quality and caffeine intake among 2,554 young Danish men recruited when they were examined to determine their fitness for military service in 2001-2005. The men delivered a semen sample and answered a questionnaire including information about...... caffeine intake from various sources, from which total caffeine intake was calculated. Moderate caffeine and cola intakes (101-800 mg/day and semen quality. High cola (>14 0.5-L bottles...

Alternative Fuels Data Center: Seattle Bakery Delivers With Biodiesel

Science.gov (United States)

Trucks Seattle Bakery Delivers With Biodiesel Trucks to someone by E-mail Share Alternative Fuels Data Center: Seattle Bakery Delivers With Biodiesel Trucks on Facebook Tweet about Alternative Fuels Data Center: Seattle Bakery Delivers With Biodiesel Trucks on Twitter Bookmark Alternative Fuels

Quality and safety in radiotherapy

CERN Document Server

Pawlicki, Todd

2010-01-01

The first text to focus solely on quality and safety in radiotherapy, this work encompasses not only traditional, more technically oriented, quality assurance activities, but also general approaches of quality and safety. It includes contributions from experts both inside and outside the field to present a global view. The task of assuring quality is no longer viewed solely as a technical, equipment-dependent endeavor. Instead, it is now recognized as depending on both the processes and the people delivering the service. Divided into seven broad categories, the text covers: Quality Management

Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden.

Science.gov (United States)

Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas

2017-07-14

Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier

Adoption and impact of high quality bambara flour (HQBF ...

African Journals Online (AJOL)

Adoption and impact of high quality bambara flour (HQBF) technology in the ... consumer acceptability/quality of products, credit, availability of raw materials, and ... as a result of 12.5 per cent increase in demand for bambara-based products.

Development of a high-quality cut-off wall using electrophoresis

International Nuclear Information System (INIS)

Kawachi, T.; Murahashi, H.

1991-01-01

Techniques to build a high-quality cut-off wall have been developed for storage facilities of low-level radioactive waste (LLW) as an emergency measures to prevent leakages. The cut-off wall is highly impermeable, nucleid-adsorptive and have long-term durability. Electrophoresis is used to form impermeable membrane of bentonite as main features of the cut-off wall. First of all, laboratory tests have been conducted to study ways of building barriers on site and to collect data on the barriers properties. Afterwards, on-site construction tests of a high-quality cut-off wall have been carried out. In this paper, we describe the process and results on the studies of the high-quality cut-off wall using electrophoresis

Timing of high-quality child care and cognitive, language, and preacademic development.

Science.gov (United States)

Li, Weilin; Farkas, George; Duncan, Greg J; Burchinal, Margaret R; Vandell, Deborah Lowe

2013-08-01

The effects of high- versus low-quality child care during 2 developmental periods (infant-toddlerhood and preschool) were examined using data from the National Institute of Child Health and Human Development Study of Early Child Care. Propensity score matching was used to account for differences in families who used different combinations of child care quality during the 2 developmental periods. Findings indicated that cognitive, language, and preacademic skills prior to school entry were highest among children who experienced high-quality care in both the infant-toddler and preschool periods, somewhat lower among children who experienced high-quality child care during only 1 of these periods, and lowest among children who experienced low-quality care during both periods. Irrespective of the care received during infancy-toddlerhood, high-quality preschool care was related to better language and preacademic outcomes at the end of the preschool period; high-quality infant-toddler care, irrespective of preschool care, was related to better memory skills at the end of the preschool period. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Health-Related Quality of Life in Children with High-Functioning Autism

Science.gov (United States)

Potvin, Marie-Christine; Snider, Laurie; Prelock, Patricia A.; Wood-Dauphinee, Sharon; Kehayia, Eva

2015-01-01

The health-related quality of life of school-aged children with high-functioning autism is poorly understood. The objectives of this study were to compare the health-related quality of life of children with high-functioning autism to that of typically developing peers and to compare child-self and parent-proxy reports of health-related quality of…

High quality digital holographic reconstruction on analog film

Science.gov (United States)

Nelsen, B.; Hartmann, P.

2017-05-01

High quality real-time digital holographic reconstruction, i.e. at 30 Hz frame rates, has been at the forefront of research and has been hailed as the holy grail of display systems. While these efforts have produced a fascinating array of computer algorithms and technology, many applications of reconstructing high quality digital holograms do not require such high frame rates. In fact, applications such as 3D holographic lithography even require a stationary mask. Typical devices used for digital hologram reconstruction are based on spatial-light-modulator technology and this technology is great for reconstructing arbitrary holograms on the fly; however, it lacks the high spatial resolution achievable by its analog counterpart, holographic film. Analog holographic film is therefore the method of choice for reconstructing highquality static holograms. The challenge lies in taking a static, high-quality digitally calculated hologram and effectively writing it to holographic film. We have developed a theoretical system based on a tunable phase plate, an intensity adjustable high-coherence laser and a slip-stick based piezo rotation stage to effectively produce a digitally calculated hologram on analog film. The configuration reproduces the individual components, both the amplitude and phase, of the hologram in the Fourier domain. These Fourier components are then individually written on the holographic film after interfering with a reference beam. The system is analogous to writing angularly multiplexed plane waves with individual component phase control.

UK key performance indicators and quality assurance standards for colonoscopy.

Science.gov (United States)

Rees, Colin J; Thomas Gibson, Siwan; Rutter, Matt D; Baragwanath, Phil; Pullan, Rupert; Feeney, Mark; Haslam, Neil

2016-12-01

Colonoscopy should be delivered by endoscopists performing high quality procedures. The British Society of Gastroenterology, the UK Joint Advisory Group on GI Endoscopy, and the Association of Coloproctology of Great Britain and Ireland have developed quality assurance measures and key performance indicators for the delivery of colonoscopy within the UK. This document sets minimal standards for delivery of procedures along with aspirational targets that all endoscopists should aim for. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Delivering Left-Skewed Portfolio Payoff Distributions in the Presence of Transaction Costs

Directory of Open Access Journals (Sweden)

Jacek B Krawczyk

2015-08-01

Full Text Available For pension-savers, a low payoff is a financial disaster. Such investors will most likely prefer left-skewed payoff distributions over right-skewed payoff distributions. We explore how such distributions can be delivered. Cautious-relaxed utility measures are cautious in ensuring that payoffs don’t fall much below a reference value, but relaxed about exceeding it. We find that the payoff distribution delivered by a cautious-relaxed utility measure has appealing features which payoff distributions delivered by traditional utility functions don’t. In particular, cautious-relaxed distributions can have the mass concentrated on the left, hence be left-skewed. However, cautious-relaxed strategies prescribe frequent portfolio adjustments which may be expensive if transaction costs are charged. In contrast, more traditional strategies can be time-invariant. Thus we investigate the impact of transaction costs on the appeal of cautious-relaxed strategies. We find that relatively high transaction fees are required for the cautious-relaxed strategy to lose its appeal. This paper contributes to the literature which compares utility measures by the payoff distributions they produce and finds that a cautious-relaxed utility measure will deliver payoffs that many investors will prefer.

Delivering the right dose

International Nuclear Information System (INIS)

Shaw, A

2004-01-01

For treatment with high intensity focused ultrasound (HIFU), delivering the correct amount of energy to the patient is critical. This paper describes a novel design of sensor based on the pyroelectric principle for monitoring the output power from HIFU transducers of the type used for tissue ablation. The sensor is intended to be minimally perturbing to the ultrasound field, so that it can remain in the ultrasound field throughout treatment and provide a constant monitor of ultrasound power. The main advantages of the technique are: power can be measured or monitored without dismantling the HIFU system, thus reducing equipment downtime; power can be measured immediately before or during every patient treatment, thus ensuring accurate dosimetry; power can be measured at the output levels used for treatment (whereas a radiation force balance may be damaged by overheating); the method uses components which are robust and simple to use compared to radiation force balances or hydrophone scanning systems

Final Scientific and Technical Report - Practical Fiber Delivered Laser Ignition Systems for Vehicles

Energy Technology Data Exchange (ETDEWEB)

Yalin, Azer [Seaforth, LLC

2014-03-30

Research has characterized advanced kagome fiber optics for their use in laser ignition systems. In comparison to past fibers used in laser ignition, these fibers have the important advantage of being relatively bend-insensitivity, so that they can be bent and coiled without degradation of output energy or beam quality. The results are very promising for practical systems. For pulse durations of ~12 ns, the fibers could deliver >~10 mJ pulses before damage onset. A study of pulse duration showed that by using longer pulse duration (~20 – 30 ns), it is possible to carry even higher pulse energy (by factor of ~2-3) which also provides future opportunities to implement longer duration sources. Beam quality measurements showed nearly single-mode output from the kagome fibers (i.e. M2 close to 1) which is the optimum possible value and, combined with their high pulse energy, shows the suitability of the fibers for laser ignition. Research has also demonstrated laser ignition of an engine including reliable (100%) ignition of a single-cylinder gasoline engine using the laser ignition system with bent and coiled kagome fiber. The COV of IMEP was <2% which is favorable for stable engine operation. These research results, along with the continued reduction in cost of laser sources, support our commercial development of practical laser ignition systems.

Internet-delivered interpersonal psychotherapy versus internet-delivered cognitive behavioral therapy for adults with depressive symptoms: randomized controlled noninferiority trial.

Science.gov (United States)

Donker, Tara; Bennett, Kylie; Bennett, Anthony; Mackinnon, Andrew; van Straten, Annemieke; Cuijpers, Pim; Christensen, Helen; Griffiths, Kathleen M

2013-05-13

Face-to-face cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are both effective treatments for depressive disorders, but access is limited. Online CBT interventions have demonstrated efficacy in decreasing depressive symptoms and can facilitate the dissemination of therapies among the public. However, the efficacy of Internet-delivered IPT is as yet unknown. This study examines whether IPT is effective, noninferior to, and as feasible as CBT when delivered online to spontaneous visitors of an online therapy website. An automated, 3-arm, fully self-guided, online noninferiority trial compared 2 new treatments (IPT: n=620; CBT: n=610) to an active control treatment (MoodGYM: n=613) over a 4-week period in the general population. Outcomes were assessed using online self-report questionnaires, the Center for Epidemiological Studies Depression scale (CES-D) and the Client Satisfaction Questionnaire (CSQ-8) completed immediately following treatment (posttest) and at 6-month follow-up. Completers analyses showed a significant reduction in depressive symptoms at posttest and follow-up for both CBT and IPT, and were noninferior to MoodGYM. Within-group effect sizes were medium to large for all groups. There were no differences in clinical significant change between the programs. Reliable change was shown at posttest and follow-up for all programs, with consistently higher rates for CBT. Participants allocated to IPT showed significantly lower treatment satisfaction compared to CBT and MoodGYM. There was a dropout rate of 1294/1843 (70%) at posttest, highest for MoodGYM. Intention-to-treat analyses confirmed these findings. Despite a high dropout rate and lower satisfaction scores, this study suggests that Internet-delivered self-guided IPT is effective in reducing depressive symptoms, and may be noninferior to MoodGYM. The completion rates of IPT and CBT were higher than MoodGYM, indicating some progress in refining Internet-based self

Patient's perceptions about the service quality of public hospitals located at District Kohat.

Science.gov (United States)

Aman, Bakhtiar; Abbas, Faisal

2016-01-01

To determine patients' perception regarding service and quality of healthcare at public-sector institutions. The descriptive quantitative study was conducted in Kohat district, Pakistan, between July and December 2014, and focussed on 30 variables to assess the participants' perceptions of the actual healthcare service quality delivered. SERVQUAL instrument was used to measure the reliability and cronbach alpha was calculated to measure the reliability and validity of the instrument. A total of 200 questionnaires were distributed and 157(78.5%) were received back fully filled. Of them, 105(67%) were men and 52(33%) were women.The mean value of Assurance parameter was 3.05±0.88, indicating trust in public hospitals was high as they had experienced and capable doctors. On the other hand, the lowest mean value of 2.61±0.84 was for Empathy, highlighting the fact that public hospitals lacked the ability to handle patients' problem properly, services were not offered in time and they were short of staff. Public hospitals were largely seen as failing to deliver quality service.

Patients' Evaluation of the Quality of Diabetes Care (PEQD)

DEFF Research Database (Denmark)

Pouwer, F; Snoek, Frank J

2002-01-01

aspects of the quality of diabetes care as delivered by the specialist in internal medicine (internist) and the diabetes nurse specialist (DNS). Two principal components analyses (internist/DNS) both yielded one 14 item factor with a high internal consistency. Satisfaction with diabetes care, fewer......OBJECTIVES: To develop a brief measure of patients' evaluation of the quality of diabetes care and to study predictors of consumers' rating of the quality of diabetes care. DESIGN: A prospective design. SUBJECTS: 176 adults with type 1 (39%) or type 2 (61%) diabetes. MAIN MEASURES: Demographic...... variables, HbA1c, number of diabetes complications, satisfaction with diabetes care, diabetes related distress, and fear of hypoglycaemia were assessed by self-report. In addition, satisfaction with diabetes care and evaluations about quality of the care were measured at 16 month follow up. Statistical...

Prediction of bread-making quality using size exclusion high ...

African Journals Online (AJOL)

Variation in the distribution of protein molecular weight in wheat (Triticum aestivum), influences breadmaking quality of wheat cultivars, resulting in either poor or good bread. The objective of this study was to predict breadmaking quality of wheat cultivars using size exclusion high performance liquid chromatography.

Exome sequencing generates high quality data in non-target regions

Directory of Open Access Journals (Sweden)

Guo Yan

2012-05-01

Full Text Available Abstract Background Exome sequencing using next-generation sequencing technologies is a cost efficient approach to selectively sequencing coding regions of human genome for detection of disease variants. A significant amount of DNA fragments from the capture process fall outside target regions, and sequence data for positions outside target regions have been mostly ignored after alignment. Result We performed whole exome sequencing on 22 subjects using Agilent SureSelect capture reagent and 6 subjects using Illumina TrueSeq capture reagent. We also downloaded sequencing data for 6 subjects from the 1000 Genomes Project Pilot 3 study. Using these data, we examined the quality of SNPs detected outside target regions by computing consistency rate with genotypes obtained from SNP chips or the Hapmap database, transition-transversion (Ti/Tv ratio, and percentage of SNPs inside dbSNP. For all three platforms, we obtained high-quality SNPs outside target regions, and some far from target regions. In our Agilent SureSelect data, we obtained 84,049 high-quality SNPs outside target regions compared to 65,231 SNPs inside target regions (a 129% increase. For our Illumina TrueSeq data, we obtained 222,171 high-quality SNPs outside target regions compared to 95,818 SNPs inside target regions (a 232% increase. For the data from the 1000 Genomes Project, we obtained 7,139 high-quality SNPs outside target regions compared to 1,548 SNPs inside target regions (a 461% increase. Conclusions These results demonstrate that a significant amount of high quality genotypes outside target regions can be obtained from exome sequencing data. These data should not be ignored in genetic epidemiology studies.

A better way to deliver bad news.

Science.gov (United States)

Manzoni, Jean-François

2002-09-01

In an ideal world, a subordinate would accept critical feedback from a manager with an open mind. He or she would ask a few clarifying questions, promise to work on certain performance areas, and show signs of improvement over time. But things don't always turn out that way. Such conversations can be unpleasant. Emotions can run high; tempers can flare. Fearing that the employee will become angry and defensive, the boss all too often inadvertently sabotages the meeting by preparing for it in a way that stifles honest discussion. This unintentional--indeed, unconscious--stress-induced habit makes it difficult to deliver corrective feedback effectively. Insead professor Jean-François Manzoni says that by changing the mind-set with which they develop and deliver negative feedback, managers can increase their odds of having productive conversations without damaging relationships. Manzoni describes two behavioral phenomena that color the feedback process--the fundamental attribution error and the false consensus effect--and uses real-world examples to demonstrate how bosses' critiques can go astray. Managers tend to frame difficult situations and decisions in a way that is narrow (alternatives aren't considered) and binary (there are only two possible outcomes--win or lose). And during the feedback discussion, managers' framing of the issues often remains frozen, regardless of the direction the conversation takes. Manzoni advises managers not to just settle on the first acceptable explanation for a behavior or situation they've witnessed. Bosses also need to consider an employee's circumstances rather than just attributing weak performance to a person's disposition. In short, delivering more effective feedback requires an open-minded approach, one that will convince employees that the process is fair and that the boss is ready for an honest conversation.

Power quality measurement service in the support of large customers

Energy Technology Data Exchange (ETDEWEB)

Levesque, F. [Hydro-Quebec, Montreal, PQ (Canada)

2006-07-01

Power quality and how it is measured among Hydro Quebec's major customers were the focus of this conference presentation. Background information on Hydro Quebec and its customers was provided with reference to information on clients, employees and how the organization is organized. The presentation also included a discussion of power quality and how it is delivered at Hydro Quebec. For example, characteristics and target values of the voltage supplied by Hydro Quebec for high, medium and low voltages were examined. Personnel responsible for the grid have created a system to document each event submitted by customers. Documenting the actual power quality at the point of common coupling allows benchmarking of real data against announced characteristics and target values. This approach quantifies disturbances and helps to find and focus on disturbances that really influence large customers, mainly industrials. Portable and permanent installations issues were discussed followed by a discussion of a new service offering power quality metering on a regular basis. This metering service includes a complete analysis and technical support with dedicated expertise since customers are rarely fully experienced in power quality. The metering service is presented from the perspective of preventive maintenance with continuous quantification of a large number of indicators to assess the quality of the delivered power. Essential tools that customers can benefit from with this new service include real time electronic mail notification, weekly reporting and ad hoc technical support. This combination of various levels of services allows Hydro-Quebec to address the needs of these large customers in a flexible way. figs.

Water Quality and Quantity in Intermittent and Continuous Piped Water Supplies in Hubli-Dharwad, India

OpenAIRE

Kumpel, Emily Katherine

2013-01-01

In at least 45 low- and middle-income countries, piped water systems deliver water for limited durations. Few data are available of the impact of intermittent water supply (IWS) on the water quality and quantity delivered to households. This thesis examines the impact of intermittently supplied piped water on the quality and quantity of water delivered to residential taps in Hubli-Dharwad, India, when compared to continuous piped water supply. A framework for understanding the pathways throug...

Maintaining High Quality Network Performance at the GSN: Sensor Installation Methods, New VBB Borehole Sensors and Data Quality Assessment from MUSTANG

Science.gov (United States)

Hafner, Katrin

2017-04-01

Data Management Center, which not only maintains the data archive, but also provides easy, rapid, and open access to data recorded from seconds to decades ago. All data flow to the IRIS DMC through the UCSD or ASL Data Collection Centers (DCCs). The DCCs focus on delivering data to the DMC, maintaining correct metadata for GSN stations, reviewing data quality from the stations that ASL and UCSD operate, and addressing circumstances that require special data handling, such as back filling following telemetry outages. Key to the high quality of the GSN data is the direct feedback on data quality problems identified by the DCC analysts to the network operations staff and field engineers. Aging of GSN equipment and station infrastructure has resulted in renewed emphasis on using data quality control tools such as MUSTANG. These tools allow the network operators to routinely monitor and analyze waveform data to detect and track problems and develop short and longer term action plans for improving network data quality. We will present summary data quality metrics for the GSN as obtained via these quality assurance tools.

Energy Saving Recommended: Delivering improved product standards, market presence and quality

Energy Technology Data Exchange (ETDEWEB)

Lock, Tom; Galvanoni, Frances [Energy Saving Trust (United Kingdom)

2007-07-01

CO{sub 2} emissions from the home equate to 27 % of UK total emissions. In order for consumers to use less energy, and reduce their environmental impact, the Energy Saving Recommended (ESR) voluntary product labelling scheme for domestic energy saving products was established to direct the consumer to choose better products and make smarter choices. With over 2000 certified products, ESR is present across 5 sectors and covers 24 product categories; 9 sets of standards were reviewed and revised in 2005/6 and a further 13 were delivered in 2006/7. ESR is now implementing existing and developing new standards in consumer electronics - from integrated digital televisions and recorders, to intelligent mains sockets and set-top-boxes, as well as assessing the feasibility of endorsing domestic ICT equipment. The Energy Saving Trust, through its marketing activities, acts as an enabler to make energy saving action simpler, easier and cheaper for the consumer to undertake. Using a variety of communication strategies the trade is engaged through the provision of value added member benefits; a holistic approach is taken with key partners to integrate energy efficiency throughout their businesses. Merchandising support helps product standards to be implemented in the market place; evaluation and research work demonstrates that markets can be changed and shows a 1 in 3 label recognition rate. The credibility and integrity of the label are reinforced through compliance testing, in-store and online label monitoring and legal enforcement, frequent data checks and the integration of ISO best practice standards through the certification system.

Adaption to High Altitude: An Evaluation of the Storage Quality of Suspended Red Blood Cells Prepared from the Whole Blood of Tibetan Plateau Migrants.

Science.gov (United States)

Zhong, Rui; Liu, Hua; Wang, Hong; Li, Xiaojuan; He, Zeng; Gangla, Meiduo; Zhang, Jingdan; Han, Dingding; Liu, Jiaxin

2015-01-01

Hypoxia has been reported to cause the significant enhancement of hemoglobin (Hb) and hematocrit (Hct), which stabilizes at relatively high levels after an individual ascends to a high altitude. However, the quality of the suspended red blood cells (SRBCs) obtained from individuals at high altitudes such as Tibetan plateau migrants after storage has not been studied. In this study, we compared the storage quality of SRBCs prepared from Tibetan plateau and Deyang lowland populations by adding a normal volume of mannitol-adenine-phosphate (MAP), which is a common additive solution used in blood storage in Asian countries. The storage cell characteristics were examined on days 1, 7, 14 and 35.We found higher Hct and Hb levels and viscosity in the high altitude samples. The metabolic rates, including those for electrolytes and lactate, were higher in plateau SRBCs than in lowland SRBCs; these findings were consistent with the higher osmotic fragility and hemolysis of plateau SRBCs throughout the entire storage period. In addition, the reduction rates of 2,3-diphosphoglycerate (2,3-DPG) and oxygen tension to attain 50% oxygen saturation of Hb (P50) in plateau SRBCs were higher than those in lowland SRBCs, and the oxygen delivering capacity in plateau SRBCs was weaker than that in lowland SRBCs. We concluded that the storage quality of plateau SRBCs was inferior to that of lowland SRBCs when using the same concentration of MAP. We suggested that the optimal formula, including the MAP concentration or even a new additive solution, to store the plateau SRBCs must be assessed and regulated.

Adaption to High Altitude: An Evaluation of the Storage Quality of Suspended Red Blood Cells Prepared from the Whole Blood of Tibetan Plateau Migrants

Science.gov (United States)

Wang, Hong; Li, Xiaojuan; He, Zeng; Gangla, Meiduo; Zhang, Jingdan; Han, Dingding; Liu, Jiaxin

2015-01-01

Hypoxia has been reported to cause the significant enhancement of hemoglobin (Hb) and hematocrit (Hct), which stabilizes at relatively high levels after an individual ascends to a high altitude. However, the quality of the suspended red blood cells (SRBCs) obtained from individuals at high altitudes such as Tibetan plateau migrants after storage has not been studied. In this study, we compared the storage quality of SRBCs prepared from Tibetan plateau and Deyang lowland populations by adding a normal volume of mannitol-adenine-phosphate (MAP), which is a common additive solution used in blood storage in Asian countries. The storage cell characteristics were examined on days1, 7, 14 and 35.We found higher Hct and Hb levels and viscosity in the high altitude samples. The metabolic rates, including those for electrolytes and lactate, were higher in plateau SRBCs than in lowland SRBCs; these findings were consistent with the higher osmotic fragility and hemolysis of plateau SRBCs throughout the entire storage period. In addition, the reduction rates of 2,3-diphosphoglycerate (2,3-DPG) and oxygen tension to attain 50% oxygen saturation of Hb (P50) in plateau SRBCs were higher than those in lowland SRBCs, and the oxygen delivering capacity in plateau SRBCs was weaker than that in lowland SRBCs. We concluded that the storage quality of plateau SRBCs was inferior to that of lowland SRBCs when using the same concentration of MAP. We suggested that the optimal formula, including the MAP concentration or even a new additive solution, to store the plateau SRBCs must be assessed and regulated. PMID:26637115

Adaption to High Altitude: An Evaluation of the Storage Quality of Suspended Red Blood Cells Prepared from the Whole Blood of Tibetan Plateau Migrants.

Directory of Open Access Journals (Sweden)

Rui Zhong

Full Text Available Hypoxia has been reported to cause the significant enhancement of hemoglobin (Hb and hematocrit (Hct, which stabilizes at relatively high levels after an individual ascends to a high altitude. However, the quality of the suspended red blood cells (SRBCs obtained from individuals at high altitudes such as Tibetan plateau migrants after storage has not been studied. In this study, we compared the storage quality of SRBCs prepared from Tibetan plateau and Deyang lowland populations by adding a normal volume of mannitol-adenine-phosphate (MAP, which is a common additive solution used in blood storage in Asian countries. The storage cell characteristics were examined on days 1, 7, 14 and 35.We found higher Hct and Hb levels and viscosity in the high altitude samples. The metabolic rates, including those for electrolytes and lactate, were higher in plateau SRBCs than in lowland SRBCs; these findings were consistent with the higher osmotic fragility and hemolysis of plateau SRBCs throughout the entire storage period. In addition, the reduction rates of 2,3-diphosphoglycerate (2,3-DPG and oxygen tension to attain 50% oxygen saturation of Hb (P50 in plateau SRBCs were higher than those in lowland SRBCs, and the oxygen delivering capacity in plateau SRBCs was weaker than that in lowland SRBCs. We concluded that the storage quality of plateau SRBCs was inferior to that of lowland SRBCs when using the same concentration of MAP. We suggested that the optimal formula, including the MAP concentration or even a new additive solution, to store the plateau SRBCs must be assessed and regulated.

Improving physical functional and quality of life in older adults with multiple sclerosis via a DVD-delivered exercise intervention: a study protocol.

Science.gov (United States)

Wójcicki, Thomas R; Roberts, Sarah A; Learmonth, Yvonne C; Hubbard, Elizabeth A; Kinnett-Hopkins, Dominque; Motl, Robert W; McAuley, Edward

2014-12-01

There is a need to identify innovative, low-cost and broad-reaching strategies for promoting exercise and improving physical function in older adults with multiple sclerosis (MS). This randomised controlled pilot trial will test the efficacy of a 6-month, DVD-delivered exercise intervention to improve functional performance and quality of life in older adults with MS. Participants will be randomised either into a DVD-delivered exercise condition or an attentional control condition. This novel approach to programme delivery provides participants with detailed exercise instructions which are presented in a progressive manner and includes a variety of modifications to better meet varying levels of physical abilities. The targeted exercises focus on three critical elements of functional fitness: flexibility, strength and balance. It is hypothesised that participants who are randomised to the exercise DVD condition will demonstrate improvements in physical function compared with participants assigned to the attentional control condition. Data analysis will include a 2 (condition)×2 (time) mixed factor analysis of variance (ANOVA) that follows intent-to-treat principles, as well as an examination of effect sizes. Participants will take part in qualitative interviews about perspectives on physical activity and programme participation. The study protocol was approved by a university institutional review board and registered with a federal database. Participants will be asked to read and sign a detailed informed consent document and will be required to provide a physician's approval to participate in the study. The exercise DVDs include an overview of safety-related concerns and recommendations relative to exercise participation, as well as detailed instructions highlighting the proper execution of each exercise presented on screen. Following completion of this trial, data will be immediately analysed and results will be presented at scientific meetings and published in

Sleep quality and its relationship with quality of life among high-risk pregnant women (gestational diabetes and hypertension).

Science.gov (United States)

Saadati, Fatemeh; Sehhatiei Shafaei, Fahimeh; Mirghafourvand, Mozhgan

2018-01-01

Sleep is one of the most basic human requirements. This research aims at determining the status of sleep quality and its relationship with quality of life among high-risk pregnant women in Tabriz, Iran, in 2015. This research was a sectional study done on 364 qualified women in 28-36 weeks of pregnancy suffering from mild preeclampsia and gestational diabetes. The sampling was done as convenience. Personal-social-midwifery questionnaire, Pittsburg sleep quality, and quality of life in pregnancy (QOL-ORAV) were used for gathering data. Multivariate linear regression model was used for determining the relationship between sleep quality and its subsets with quality of life and controlling confounders. In the current study, the prevalence of sleep disturbance was 96.4%. Mean (SD) of the total score of sleep quality was 10.1 (4.1) and the total score of quality of life was 61.7 (17.3). According to Pearson's correlation test, there was statistically significant relationship between quality of life and sleep quality and all its subsets except sleep duration and use of sleep medication (p quality of life. The findings of current research show that sleep quality is low among high-risk pregnant women and quality of life is medium. So, it is necessary that required training is given by health cares for improving sleep quality and quality of life to mothers.

Next Generation High Quality Videoconferencing Service for the LHC

CERN Multimedia

CERN. Geneva

2012-01-01

In recent times, we have witnessed an explosion of video initiatives in the industry worldwide. Several advancements in video technology are currently improving the way we interact and collaborate. These advancements are forcing tendencies and overall experiences: any device in any network can be used to collaborate, in most cases with an overall high quality. To cope with this technology progresses, CERN IT Department has taken the leading role to establish strategies and directions to improve the user experience in remote dispersed meetings and remote collaboration at large in the worldwide LHC communities. Due to the high rate of dispersion in the LHC user communities, these are critically dependent of videoconferencing technology, with a need of robustness and high quality for the best possible user experience. We will present an analysis of the factors that influenced the technical and strategic choices to improve the reliability, efficiency and overall quality of the LHC remote sessions. In particular, ...

An Investigation of the Application of Servqual in the Enhancement of Service Quality Among International Post- Graduate Students: Comparing Indonesia with Malaysia

OpenAIRE

Sunanto, Sandra; Satyarini, Ria; Taufiqurrahman, Taufiqurrahman; Amran, Amran; Shekarchizadeh, Ahmadreza

2010-01-01

Universities strive to deliver high-quality service throughout its educational curriculum and its administrative process. In order to do so, universities must view students as their primary clients and seek to maximize their satisfaction with the level of university offered.Using SERVQUAL model, this research has an objective to investigate the performance of services delivered by universities to the International post-graduate students Indonesia. As part of joint research commitment with Mal...

Optimization of nitridation conditions for high quality inter-polysilicon dielectric layers

NARCIS (Netherlands)

Klootwijk, J.H.; Bergveld, H.J.; van Kranenburg, H.; Woerlee, P.H.; Wallinga, Hans

1996-01-01

Nitridation of deposited high temperature oxides (HTO) was studied to form high quality inter-polysilicon dielectric layers for embedded non volatile memories. Good quality dielectric layers were obtained earlier by using an optimized deposition of polysilicon and by performing a post-dielectric

Nominal effective radiation doses delivered during clinical trials of boron neutron capture therapy

International Nuclear Information System (INIS)

Capala, J.; Diaz, A.Z.; Chanana, A.D.

1997-01-01

Boron neutron capture therapy (BNCT) is a binary system that, in theory, should selectively deliver lethal, high linear energy transfer (LET) radiation to tumor cells dispersed within normal tissues. It is based on the nuclear reaction 10-B(n, α)7-Li, which occurs when the stable nucleus of boron-10 captures a thermal neutron. Due to the relatively high cross-section of the 10-B nucleus for thermal neutron capture and short ranges of the products of this reaction, tumor cells in the volume exposed to thermal neutrons and containing sufficiently high concentration of 10-B would receive a much higher radiation dose than the normal cells contained within the exposed volume. Nevertheless, radiation dose deposited in normal tissue by gamma and fast neutron contamination of the neutron beam, as well as neutron capture in nitrogen, 14-N(n,p)14-C, hydrogen, 1-H(n,γ)2-H, and in boron present in blood and normal cells, limits the dose that can be delivered to tumor cells. It is, therefore, imperative for the success of the BNCT the dosed delivered to normal tissues be accurately determined in order to optimize the irradiation geometry and to limit the volume of normal tissue exposed to thermal neutrons. These are the major objectives of BNCT treatment planning

The six critical attributes of the next generation of quality management software systems.

Science.gov (United States)

Clark, Kathleen

2011-07-01

Driven by both the need to meet regulatory requirements and a genuine desire to drive improved quality, quality management systems encompassing standard operating procedure, corrective and preventative actions and related processes have existed for many years, both in paper and electronic form. The impact of quality management systems on 'actual' quality, however, is often reported as far less than desired. A quality management software system that moves beyond formal forms-driven processes to include a true closed loop design, manage disparate processes across the enterprise, provide support for collaborative processes and deliver insight into the overall state of control has the potential to close the gap between simply accomplishing regulatory compliance and delivering measurable improvements in quality and efficiency.

A Brief Study of Variation Theory in Quality Management

Directory of Open Access Journals (Sweden)

Mostafa Farah Bakhsh

2016-06-01

Full Text Available Variation is part of everyday life and exists all the time. Variation is the product of differences. Difference in nature of processes results in different products during the time. Proper diagnosis of variation patterns in minimizing the loss is necessary. Continuous quality improvement is regarded as successive reduction of performance variation for delivering high quality products to the customers. In Deming viewpoint, quality deviation is classified to two groups of common and special causes. Variation is not a new word, but understanding and concerns about it are modern. First step in performance variation management is acceptance and belief of variation. For proper management of variations, appropriate tools should be used for detection and display of them. Control are useful tools in recognition, analysis and removing process performance variations.

Influence of organizational culture on quality healthcare delivery.

Science.gov (United States)

Carney, Marie

2011-01-01

The purpose of this paper is to identify if aspects of organizational culture may indicate a new terrain in the cultural influences-quality healthcare relationship. This research stems from the author's belief that viewing the role of head of department or directorate as pivotal to health care management is critical to health care planning and quality healthcare delivery. Interviews were undertaken among 50 professional clinician and non-clinician managers working in the role of head of department, in acute care hospitals in Ireland. The sample was drawn from the total population of 850 managers, utilized in a previous survey study. Organizational culture is more complex than was previously thought. Several cultural influences such as excellence in care delivery, ethical values, involvement, professionalism, value-for-money, cost of care, commitment to quality and strategic thinking were found to be key cultural determinants in quality care delivery. Health care managers perceive that in order to deliver quality focused care they need to act in a professional, committed manner and to place excellence at the forefront of care delivery, whilst at the same time being capable of managing the tensions that exist between cost effectiveness and quality of care. These tensions require further research in order to determine if quality of care is affected in a negative manner by those tensions. Originality relates to the new cultural terrain presented in this paper that recognizes the potential of health service managers to influence the organizations' culture and through this influence to take a greater part in ensuring that quality health care is delivered to their patients. It also seems to be important that value-for-money is viewed as an ethical means of delivering healthcare, and not as a conflict between quality and cost.

Producing high-quality slash pine seeds

Science.gov (United States)

James Barnett; Sue Varela

2003-01-01

Slash pine is a desirable species. It serves many purposes and is well adapted to poorly drained flatwoods and seasonally flooded areas along the lower Coastal Plain of the Southeastern US. The use of high-quality seeds has been shown to produce uniform seedlings for outplanting, which is key to silvicultural success along the Coastal Plain and elsewhere. We present...

Materials Delivered by Member States

International Nuclear Information System (INIS)

1962-01-01

The information given in this document is divided into two parts. In part I the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials delivered up to 30 September 1962 by Member States in compliance with requests the Agency has made under Article IX. D. Part II contains information about materials which have not yet been delivered but which have been allocated, in accordance with Article XI. F. 1 of the Statute, to approved Agency projects for which project agreements were in force on 30 September 1962. Reports on subsequent deliveries of materials and revised information about allocated but undelivered materials will be issued from time to time

85 μm core rod fiber amplifier delivering 350 W/m

DEFF Research Database (Denmark)

Johansen, Mette Marie; Michieletto, Mattia; Kristensen, Torben

2016-01-01

An improved version of the distributed modal filtering (DMF) rod fiber is tested in a high power setup delivering 350 W/m of extracted signal average power limited by the available pump power. The rod fiber is thoroughly tested to record the transverse modal instability (TMI) behavior and also me...

Quality system for Medical laboratories

Directory of Open Access Journals (Sweden)

Shiva Raj K.C.

2015-03-01

Full Text Available According to William Edwards Deming “Good quality does not necessarily mean high quality. Instead it means a predicable degree of uniformity and dependability at low cost with a quality suited to the market.” Whereas according to famous engineer and management consultant Joseph M. Juran quality is “fitness for purpose”. It should meet the customers’ expectations and requirements, should be cost effective.ISO began in 1926 as the International Federation of the National Standardizing Associations (ISA. The name, "ISO" was derived from the Greek word "isos" meaning "equal". (The relation to standards is that if two objects meet the same standard, they should be equal. This name eliminates any confusion that could result from the translation of "International Organization for Standardization" into different languages which would lead to different acronyms.In health sector, quality plays pivotal role, as it is directly related to patient’s care. Earlier time, health service was simple, quite safe but ineffective. Now health care system is an organizational system with more complex processes to deliver care. Medical laboratory service is an integral part in patient’s management system. So, for everyone involved in the treatment of the patient, the accuracy, reliability and safety of those services must be the primary concerns. Accreditation is a significant enabler of quality, thereby delivering confidence to healthcare providers, clinicians, the medical laboratories and the patients themselves.ISO announced meeting in Philadelphia to form a technical committee to develop a new standard for medical laboratory quality. It took 7 years for the creation of a new Quality standard for medical laboratories. It was named as “ISO 15189” and was first published in 2003. The ISO has released three versions of the standard. The first two were released in 2003 and 2007. In 2012, a revised and updated version of the standard, ISO 15189

Breeding and maintaining high-quality insects

DEFF Research Database (Denmark)

Jensen, Kim; Kristensen, Torsten Nygård; Heckmann, Lars-Henrik

2017-01-01

Insects have a large potential for sustainably enhancing global food and feed production, and commercial insect production is a rising industry of high economic value. Insects suitable for production typically have fast growth, short generation time, efficient nutrient utilization, high...... reproductive potential, and thrive at high density. Insects may cost-efficiently convert agricultural and industrial food by-products into valuable protein once the technology is finetuned. However, since insect mass production is a new industry, the technology needed to efficiently farm these animals is still...... in a starting phase. Here, we discuss the challenges and precautions that need to be considered when breeding and maintaining high-quality insect populations for food and feed. This involves techniques typically used in domestic animal breeding programs including maintaining genetically healthy populations...

Effective pile-up density as a measure of the experimental data quality for High-Luminosity LHC operational scenarios.

CERN Document Server

Medina Medrano, Luis Eduardo; Arduini, Gianluigi; Napsuciale, Mauro

2018-01-01

The High-Luminosity LHC (HL-LHC) experiments will operate at unprecedented level of event pile-up from proton-proton collisions at 14TeV center-of-mass energy. In this paper we study the performance of the baseline and a series of alternative scenarios in terms of the delivered integrated luminosity and its quality (pile-up density). A new figure-of-merit is introduced, the effective pile-up density, a concept that reflects the expected detector efficiency in the reconstruction of event vertices for a given operational scenario, acting as a link between the machine and experimental slides. Alternative scenarios have been proposed either to improve the baseline performance, or tot provide operational schemes in the case of particular limitations. Simulations of the evolution of optimum fills with the latest set of parameters of the HL-LHC are performed with β* - levelling, and results are discussed in terms of both the integrated luminosity and the effective pile-up density. The crab kissing scheme, a propose...

Collaborative Engagement Approaches For Delivering Sustainable Infrastructure Projects In The AEC Sector

Directory of Open Access Journals (Sweden)

Adetola, Alaba

2011-12-01

Full Text Available The public sector has traditionally financed and operated infrastructure projects using resources from taxes and various levies (e.g. fuel taxes, road user charges. However, the rapid increase in human population growth coupled with extended globalisation complexities and associated social/political/economic challenges have placed new demands on the purveyors and operators of infrastructure projects. The importance of delivering quality infrastructure has been underlined by the United Nations declaration of the Millennium Development Goals; as has the provision of ‘adequate’ basic structures and facilities necessary for the well-being of urban populations in developing countries. Thus, in an effort to finance developing countries’ infrastructure needs, most countries have adopted some form of public-private collaboration strategy. This paper critically reviews these collaborative engagement approaches, identifies and highlights 10 critical themes that need to be appropriately captured and aligned to existing business models in order to successfully deliver sustainable infrastructure projects. Research findings show that infrastructure services can be delivered in many ways, and through various routes. For example, a purely public approach can cause problems such as slow and ineffective decision-making, inefficient organisational and institutional augmentation, and lack of competition and inefficiency (collectively known as government failure. On the other hand, adopting a purely private approach can cause problems such as inequalities in the distribution of infrastructure services (known as market failure. Thus, to overcome both government and market failures, a collaborative approach is advocated which incorporates the strengths of both of these polarised positions.

High Quality Virtual Reality for Architectural Exhibitions

DEFF Research Database (Denmark)

Kreutzberg, Anette

2016-01-01

This paper will summarise the findings from creating and implementing a visually high quality Virtual Reality (VR) experiment as part of an international architecture exhibition. It was the aim to represent the architectural spatial qualities as well as the atmosphere created from combining natural...... and artificial lighting in a prominent not yet built project. The outcome is twofold: Findings concerning the integration of VR in an exhibition space and findings concerning the experience of the virtual space itself. In the exhibition, an important aspect was the unmanned exhibition space, requiring the VR...... experience to be self-explanatory. Observations of different visitor reactions to the unmanned VR experience compared with visitor reactions at guided tours with personal instructions are evaluated. Data on perception of realism, spatial quality and light in the VR model were collected with qualitative...

Can learning health systems help organisations deliver personalised care?

Science.gov (United States)

Nwaru, Bright I; Friedman, Charles; Halamka, John; Sheikh, Aziz

2017-10-02

There is increasing international policy and clinical interest in developing learning health systems and delivering precision medicine, which it is hoped will help reduce variation in the quality and safety of care, improve efficiency, and lead to increasing the personalisation of healthcare. Although reliant on similar policies, informatics tools, and data science and implementation research capabilities, these two major initiatives have thus far largely progressed in parallel. In this opinion piece, we argue that they should be considered as complementary, synergistic initiatives whereby the creation of learning health systems infrastructure can support and catalyse the delivery of precision medicine that maximises the benefits and minimises the risks associated with treatments for individual patients. We illustrate this synergy by considering the example of treatments for asthma, which is now recognised as an umbrella term for a heterogeneous group of related conditions.

Increasing capacity to deliver diabetes self-management education

DEFF Research Database (Denmark)

Carey, M. E.; Mandalia, P. K.; Daly, H.

2014-01-01

Aim: To develop and test a format of delivery of diabetes self-management education by paired professional and lay educators. Methods: We conducted an equivalence trial with non-randomized participant allocation to a Diabetes Education and Self Management for Ongoing and Newly Diagnosed Type 2 di...... educator role can provide equivalent patient benefits. This could provide a method that increases capacity, maintains quality and is cost-effective, while increasing access to self-management education.......Aim: To develop and test a format of delivery of diabetes self-management education by paired professional and lay educators. Methods: We conducted an equivalence trial with non-randomized participant allocation to a Diabetes Education and Self Management for Ongoing and Newly Diagnosed Type 2...... diabetes (DESMOND) course, delivered in the standard format by two trained healthcare professional educators (to the control group) or by one trained lay educator and one professional educator (to the intervention group). A total of 260 people with Type 2 diabetes diagnosed within the previous 12 months...

Predictors and moderators of response to internet-delivered Interpersonal Psychotherapy and Cognitive Behavior Therapy for depression.

Science.gov (United States)

Donker, T; Batterham, P J; Warmerdam, L; Bennett, K; Bennett, A; Cuijpers, P; Griffiths, K M; Christensen, H

2013-10-01

By identifying which predictors and moderators lead to beneficial outcomes, accurate selection of the best initial treatment will have significant benefits for depressed individuals. An automated, fully self-guided randomized controlled internet-delivered noninferiority trial was conducted comparing two new interventions (Interpersonal Psychotherapy [IPT; n=620] and Cognitive Behavioral Therapy [CBT; n=610]) to an active control intervention (MoodGYM; n=613) over a period of 4 weeks to spontaneous visitors of an internet-delivered therapy website (e-couch). A range of putative predictors and moderators (socio-demographic characteristics [age, gender, marital status, education level], clinical characteristics [depression/anxiety symptoms, disability, quality of life, medication use], skills [mastery and dysfunctional attitudes] and treatment preference) were assessed using internet-delivered self-report measures at baseline and immediately following treatment and at six months follow-up. Analyses were conducted using Mixed Model Repeated Measures (MMRM). Female gender, lower mastery and lower dysfunctional attitudes predicted better outcome at post-test and/or follow-up regardless of intervention. No overall differential effects for condition on depression as a function of outcome were found. However, based on time-specific estimates, a significant interaction effect of age was found. For younger people, internet-delivered IPT may be the preferred treatment choice, whereas older participants derive more benefits from internet-delivered CBT programs. Although the sample of participants was large, power to detect moderator effects was still lacking. Different e-mental health programs may be more beneficial for specific age groups. The findings raise important possibilities for increasing depression treatment effectiveness and improving clinical practice guidelines for depression treatment of different age groups. © 2013 Elsevier B.V. All rights reserved.

Estimations and remedies for quality of experience in multimedia streaming

NARCIS (Netherlands)

Menkovski, V.; Exarchakos, G.; Liotta, A.; Cuadra Sánchez, A.

2010-01-01

Managing multimedia network services in a User-centric manner provides for more delivered quality to the users, whilst maintaining a limited footprint on the network resources. For efficient User-centric management it is imperative to have a precise metric for perceived quality. Quality of

Internet-delivered cognitive-behavioral treatment for adolescents with chronic pain and their parents: a randomized controlled multicenter trial.

Science.gov (United States)

Palermo, Tonya M; Law, Emily F; Fales, Jessica; Bromberg, Maggie H; Jessen-Fiddick, Tricia; Tai, Gabrielle

2016-01-01

Internet-delivered interventions are emerging as a strategy to address barriers to care for individuals with chronic pain. This is the first large multicenter randomized controlled trial of Internet-delivered cognitive-behavioral therapy (CBT) for pediatric chronic pain. Participants included were 273 adolescents (205 females and 68 males), aged 11 to 17 years with mixed chronic pain conditions and their parents, who were randomly assigned in a parallel-group design to Internet-delivered CBT (n = 138) or Internet-delivered Education (n = 135). Assessments were completed before treatment, immediately after treatment, and at 6-month follow-up. All data collection and procedures took place online. The primary analysis used linear growth models. Results demonstrated significantly greater reduction on the primary outcome of activity limitations from baseline to 6-month follow-up for Internet CBT compared with Internet education (b = -1.13, P = 0.03). On secondary outcomes, significant beneficial effects of Internet CBT were found on sleep quality (b = 0.14, P = 0.04), on reducing parent miscarried helping (b = -2.66, P = 0.007) and protective behaviors (b = -0.19, P = 0.001), and on treatment satisfaction (P values parent-perceived impact (ie, reductions in depression, anxiety, self-blame about their adolescent's pain, and improvement in parent behavioral responses to pain). In conclusion, our Internet-delivered CBT intervention produced a number of beneficial effects on adolescent and parent outcomes, and could ultimately lead to wide dissemination of evidence-based psychological pain treatment for youth and their families.

A Designed Framework for Delivering Systems Thinking Skills to Small Business Managers

Directory of Open Access Journals (Sweden)

Daowei Sun

2014-06-01

Full Text Available Many small businesses suffer from inadequate management skills which can lead to poor business performance and unsustainable businesses. Research to date has focused on traditional skills such as communication, time management and people skills, yet critically many business managers have no systems thinking skills. This paper presents a framework targeted at delivering systems thinking skills to managers of small businesses utilizing some key characteristic of small business managers. The design is also based on a systems analysis and guided by both adult learning theory and teaching theory. The quality of a training framework depends on the quality of the content design and the right training delivery methods. The systems thinking skills training framework structured systems thinking knowledge into three modules in order to meet the needs of different levels of managers. The framework advocates blended training delivery methods and it also presents possible pitfalls based on training experiences. Additionally, the framework incorporates a continuous improvement process for ongoing systemic improvement.

Integration study of high quality teaching resources in universities

Directory of Open Access Journals (Sweden)

Honglu Liu

2012-12-01

Full Text Available Purpose: The development level and quality of education depend on the merits and efficiency in the use of teaching resources, especially in the case of obvious contradiction between the demand and supply of teaching resources. So to integrate teaching resources, improve the efficiency in the use of high quality teaching resources, and take the road of content development to enhance the competitiveness of education has become very important and urgent.Design/methodology/approach: On the basis of analysis on the teaching resources of universities and the problems they faced, this paper introduced the basic concepts of cloud storage, and built the integration architecture of high quality teaching resources in universities based on the cloud storage.Findings and Originality/value: The HDFS-based cloud storage proposed in this paper is a dynamically adjustable and Internet-based storage solution, and the users can access storage targets using the network through a common and easy-to-use protocol and application programming interfaces. This new technology is useful for end users benefits. With the continuous development and improvement of cloud storage, it will necessarily result in more and more applications in the institutions of higher learning and education network.Originality/value: This paper introduced the cloud storage into the integration of high quality teaching resources in universities first and as a new form of service, it can be a good solution.

Serving two masters: quality teaching and learning versus economic rationalism.

Science.gov (United States)

Kenny, A J; Kendall, S

2001-11-01

Nurse educators face the challenge of competing pressures. Programmes must be developed that more adequately prepare students to meet the demands of a changing and complex health care system. These programmes must reflect excellence in teaching and learning and this needs to be achieved within the constraints of economic rationalism. The design of a model based on principles of self directed learning assisted one university to deliver a high quality clinical skills programme. Copyright 2001 Harcourt Publishers Ltd.

Perceived justice and recovery satisfaction: the moderating role of customer-perceived quality

Directory of Open Access Journals (Sweden)

Jha Subhash

2015-09-01

Full Text Available Recovery strategies are critical to service providers in their efforts to maintain satisfied and loyal customers. While the existing research shows that recovery satisfaction is a function of customer perception of distributive, procedural and interactional justice, the present study considers an important contextual factor - customer-perceived quality of the service provider in the evaluation of justice dimensions and satisfaction. To test the hypotheses proposed, a survey was carried out in the mobile services context. The findings reveal that customer-perceived quality affects the evaluation of justice dimensions and its outcomes. The findings reveal that while distributive justice enhances recovery satisfaction for low perceived quality services, the procedural justice resulted in greater satisfaction in high perceived quality services. Thus, by understanding the role of customer-perceived quality, service managers can deliver effective recovery strategies thereby enhancing satisfaction and loyalty.

A framework for business oriented software quality approaches

NARCIS (Netherlands)

Trienekens, J.J.M.; Veenendaal, van E.P.W.M.; McMullan, J.

1997-01-01

The importance of software for business systems continues to grow. Software products play an increasingly important role in industry and society. The need f~r delivering "quality products" and "quality services" has become as relevant for companies in the field qf sqfiware development as for any

SERVICE QUALITY IN THE PUBLIC SERVICE

OpenAIRE

Prabha Ramseook-Munhurrun; Soolakshna D. Lukea-Bhiwajee; Perunjodi Naidoo

2010-01-01

The purpose of this paper is to obtain a better understanding of the extent to which service quality is delivered within the Mauritian public service by drawing on front-line employees (FLE) and customer perceptions of service quality. The paper investigates how closely customer expectations of service and FLE perceptions of customer expectations match. SERVQUAL is used to measure service quality amongst FLE and customers in a major public sector department in Mauritius. The survey captures c...

Measurement of Quality of Educational Hospital Services by the SERVQUAL Model: The Iranian Patients' Perspective.

Science.gov (United States)

Rezaei, Satar; Matin, Behzad Karami; Moradi, Khalil; Bijan, Behroz; Fallahi, Masoud; Shokati, Behnam; Saeidi, Hamid

2016-03-01

The main mission of hospitals in any health system is to deliver high quality healthcare for patients and meet their needs and expectations. The aim of the current study was to assess the quality of the service of educational hospitals affiliated with Kermanshah University of Medical Sciences in 2015, from the perspective of patients. In this cross-sectional study, the perspectives of 400 patients were assessed about the quality of the services provided by educational hospitals in Kermanshah (western Iran) in 2015. The quality was assessed by the SERVQUAL questionnaire with five dimensions, i.e., tangibility, reliability, responsiveness, assurance, and empathy. In addition, the Wilcoxon test and the Kruskal-Wallis test were used to explore any association between the dependent variable and explanatory variables. The data were analyzed using Stata V.12 software. There were negative gaps in all five dimensions. The highest and lowest gaps in the mean score were found in the assurance (-0.88) and responsiveness (-0.56) dimensions. The patients ranked responsiveness as the most important dimension of the quality of healthcare. There were gaps between the patients' perceptions and their expectation about the five dimensions that were studied based on the SERVQUAL model. Also, it is recommended that improving the quality of healthcare is possible by various policies, such as good responsiveness, access to health workers, and delivering healthcare in less time.

Oral microflora in infants delivered vaginally and by caesarean section

DEFF Research Database (Denmark)

Nelun Barfod, Mette; Magnusson, Kerstin; Lexner, Michala Oron

2011-01-01

International Journal of Paediatric Dentistry 2011 Background. Early in life, vaginally delivered infants exhibit a different composition of the gut flora compared with infants delivered by caesarean section (C-section); however, it is unclear whether this also applies to the oral cavity. Aim....... To investigate and compare the oral microbial profile between infants delivered vaginally and by C-section. Design. This is a cross-sectional case-control study. Eighty-four infants delivered either vaginally (n = 42) or by C-section (n = 42) were randomly selected from the 2009 birth cohort at the County...

From volume to value? Can a value-based approach help deliver the ambitious aims of the NHS cardiovascular disease outcomes strategy?

Science.gov (United States)

Dunbar-Rees, Rupert; Panch, Trishan; Dancy, Mark

2014-06-01

The last year has seen the publication of two papers which will radically shape the future organisation of healthcare in general, and cardiovascular disease in particular: Cardiovascular Outcomes Strategy (Department of Health) and The Strategy That Will Fix Healthcare (Harvard Business Review). Both publications set out a health delivery mechanism based around improvement of outcomes for groups of patients with similar needs. Instead of organising care around disease categories, it is proposed that the cardiovascular diseases are treated as a single family of diseases. We are reaching the limits of what an activity-based system organised around existing provider structures can sustainably deliver. Unless we find delivery systems which reduce costs while at the same time improving outcomes that are meaningful to patients, then we will be faced with a future of healthcare rationing. The increasing burden of chronic disease and ongoing quality concerns in delivery systems has created a 'burning platform', which must be addressed if we are to maintain a system which offers high-quality care free at the point of delivery. This paper explores what an outcomes and value-based system could look like when applied to cardiovascular disease. It explores what it means for providers and patients if we start to think about outcomes by patients with similar needs, rather than by intervention, or by clinical specialty. As a specific example, the paper explores the features of an Integrated Circulation Service, what the challenges and implications might be, and whether there is any evidence that this would deliver improved outcomes, at a lower cost to the system.

High relative humidity in-package of fresh-cut fruits and vegetables: advantage or disadvantage considering microbiological problems and antimicrobial delivering systems?

Science.gov (United States)

Ayala-Zavala, J F; Del-Toro-Sánchez, L; Alvarez-Parrilla, E; González-Aguilar, G A

2008-05-01

This hypothesis article states that the high relative humidity (RH) of packaged fresh-cut fruits or vegetables that is associated with spoilage can be used as an advantageous way to deliver antimicrobial compounds using cyclodextrins (CDs) as carriers. CDs can function as antimicrobial delivery systems as they can release antioxidant and antimicrobial compounds (guest molecules) as the humidity levels increase in the headspace. Hydrophobic antimicrobial guests can be complexed with CDs due to the amphiphatic nature of the host. Then, at high RH values, due to the water-CDs interaction, host-guest interactions are weakened; consequently, the antimicrobial molecule is released and should protect the product against the microbial growth. Potential antimicrobial compounds capable of forming complexes with CDs are discussed, as well as possible applications to preserve fresh-cut produce and future research in this area.

[Evaluation of tidal volume delivered by ventilators during volume-controlled ventilation].

Science.gov (United States)

Zhou, Juan; Yan, Yong; Cao, Desen

2014-12-01

To study the ways which ensure the delivery of enough tidal volume to patients under various conditions close to the demand of the physician. The volume control ventilation model was chosen, and the simulation lung type was active servo lung ASL 5000 or Michigan lung 1601. The air resistance, air compliance and lung type in simulation lungs were set. The tidal volume was obtained from flow analyzer PF 300. At the same tidal volume, the displaying values of tidal volume of E5, Servo i, Evital 4, and Evital XL ventilators with different lung types of patient, compliance of gas piping, leakage, gas types, etc. were evaluated. With the same setting tidal volume of a same ventilator, the tidal volume delivered to patients was different with different lung types of patient, compliance of gas piping, leakage, gas types, etc. Reducing compliance and increasing resistance of the patient lungs caused high peak airway pressure, the tidal volume was lost in gas piping, and the tidal volume be delivered to the patient lungs was decreased. If the ventilator did not compensate to leakage, the tidal volume delivered to the patient lungs was decreased. When the setting gas type of ventilator did not coincide with that applying to the patient, the tidal volume be delivered to the patient lungs might be different with the setting tidal volume of ventilator. To ensure the delivery of enough tidal volume to patients close to the demand of the physician, containable factors such as the compliance of gas piping, leakage, and gas types should be controlled.

Delivering phonological and phonics training within whole-class teaching.

Science.gov (United States)

Shapiro, Laura R; Solity, Jonathan

2008-12-01

Early, intensive phonological awareness and phonics training is widely held to be beneficial for children with poor phonological awareness. However, most studies have delivered this training separately from children's normal whole-class reading lessons. We examined whether integrating this training into whole class, mixed-ability reading lessons could impact on children with poor phonological awareness, whilst also benefiting normally developing readers. Teachers delivered the training within a broad reading programme to whole classes of children from Reception to the end of Year 1 (N=251). A comparison group of children received standard teaching methods (N=213). Children's literacy was assessed at the beginning of Reception, and then at the end of each year until 1 year post-intervention. The strategy significantly impacted on reading performance for normally developing readers and those with poor phonological awareness, vastly reducing the incidence of reading difficulties from 20% in comparison schools to 5% in intervention schools. Phonological and phonics training is highly effective for children with poor phonological awareness, even when incorporated into whole-class teaching.

Delivering colonoscopy screening for low-income populations in Suffolk County: strategies, outcomes, and benchmarks.

Science.gov (United States)

Lane, Dorothy S; Messina, Catherine R; Cavanagh, Mary F; Anderson, Joseph C

2013-08-01

Current and pending legislation provides colorectal cancer screening reimbursement for previously uninsured populations. Colonoscopy is currently the screening method most frequently recommended by physicians for insured patients. The experience of the SCOPE (Suffolk County Preventive Endoscopy) demonstration project (Project SCOPE) at Stony Brook University Medical Center provides a model for delivering colonoscopy screening to low-income populations to meet anticipated increasing demands. Project SCOPE, based in the Department of Preventive Medicine, featured internal collaboration with the academic medical center's large gastroenterology practice and external collaboration with the Suffolk County Department of Health Services' network of community health centers. Colonoscopies were performed by faculty gastroenterologists or supervised fellows. Measures of colonoscopy performance were compared with quality indicators and differences between faculty and supervised fellows were identified. During a 40-month screening period, 800 initial colonoscopies were performed. Approximately 21% of women screened were found to have adenomatous polyps compared with 36% of men. Five cancers were detected. The majority of the population screened (70%) were members of minority populations. African American individuals had a higher percentage of proximally located adenomas (78%) compared with white individuals (65%) and Hispanics (49%), based on the location of the most advanced lesion. Hispanic individuals had a 36% lower risk of adenomas compared with white individuals. Performance measures including the percentage of procedures with adequate bowel preparation, cecum reached, scope withdrawal time, and adenoma detection rate met quality benchmarks when performed by either faculty or supervised fellows. Project SCOPE's operational strategies demonstrated a feasible method for an academic medical center to provide high-quality screening colonoscopy for low-income populations. �

EXPERT-ANALITICAL MONITORING OF LEARNING PROCESS QUALITY IN HIGH SCHOOL

Directory of Open Access Journals (Sweden)

T. M. Korotun

2010-10-01

Full Text Available The technological model is proposed for monitoring process of learning process quality in high school compliant with current European and home standards. The mathematical methods are elaborated for diverse activities as to learning process objects quality determination unified support. They self-consistently combine: automatic expert evaluation with Bayesian net and Value tree models; Delphi technique enhancement; best practices for education quality assessment. Quality estimates’ consistency index is introduced for their choice and acceptability analysis. Its permanent increasing over monitoring stages is guaranteed. The tools for these stages’ automatic support are described.

Combined microfluidization and ultrasonication: a synergistic protocol for high-efficient processing of SWCNT dispersions with high quality

Energy Technology Data Exchange (ETDEWEB)

Luo, Sida, E-mail: s.luo@buaa.edu.cn [Beihang University, School of Mechanical Engineering and Automation (China); Liu, Tao, E-mail: tliu@fsu.edu [Florida State University, High-Performance Materials Institute (United States); Wang, Yong; Li, Liuhe [Beihang University, School of Mechanical Engineering and Automation (China); Wang, Guantao; Luo, Yun [China University of Geosciences, Center of Safety Research, School of Engineering and Technology (China)

2016-08-15

High-efficient and large-scale production of high-quality CNT dispersions is necessary for meeting the future needs to develop various CNT-based electronic devices. Herein, we have designed novel processing protocols by combining conventional ultrasonication process with a new microfluidization technique to produce high-quality SWCNT dispersions with improved processing efficiency. To judge the quality of SWCNT dispersions, one critical factor is the degree of exfoliation, which could be quantified by both geometrical dimension of the exfoliated nanotubes and percentage of individual tubes in a given dispersion. In this paper, the synergistic effect of the combined protocols was systematically investigated through evaluating SWCNT dispersions with newly developed characterization techniques, namely preparative ultracentrifuge method (PUM) and simultaneous Raman scattering and photoluminescence spectroscopy (SRSPL). The results of both techniques draw similar conclusions that as compared with either of the processes operated separately, a low-pass microfluidization followed by a reasonable duration of ultrasonication could substantially improve the processing efficiency to produce high-quality SWCNT dispersions with averaged particle length and diameter as small as ~600 and ~2 nm, respectively.Graphical abstract.

High Power Diode Lasers with External Feedback: Overview and Prospects

DEFF Research Database (Denmark)

Chi, Mingjun; Petersen, Paul Michael

2012-01-01

In summary, different external-cavity feedback techniques to improve the spatial beam quality and narrow the linewidth of the output beam from both BALs and TDLs are presented. Broad-area diode laser system with external-cavity feedback around 800 nm can produce several Watts of output power...... with a good beam quality. Tapered diode laser systems with external-cavity feedback around 800 and 1060 nm can deliver more than 2 W output power with diffraction-limited beam quality and can be operated in single-longitudinal mode. These high-brightness, narrow linewidth, and tunable external-cavity diode...... lasers emerge as the next generation of compact lasers that have the potential of replacing conventional high power laser systems in many existing applications....

Optimising value and quality in general practice within the primary health care sector through relationship marketing: a conceptual framework.

Science.gov (United States)

Bansal, Manjit K

2004-01-01

Discusses the rationale of applying relationship marketing and service quality concepts within the primary health care sector. The use of relational strategies in general practice, by modelling the relationships between practitioners and patients from a marketing perspective, could potentially lead to sustained high quality service being provided, and to more efficient use of resources. This essentially conceptually focused paper addresses an area that has not yet been researched in detail, and furthers understanding of the relationships that facilitate exchange within general practice and service delivery in non-profit, resource-constrained conditions. Deeper understanding of the needs and expectations of patients and the way these can be delivered by general practice can only lead to improvements for all parties involved. The relationship marketing paradigm presents itself as a potentially exciting way of addressing issues associated with ensuring that the highest level of quality is delivered in this area of the UK National Health Service.

Clinical Performance Measures and Quality Improvement System Considerations for Dental Education.

Science.gov (United States)

Parkinson, Joseph W; Zeller, Gregory G

2017-03-01

Quality improvement and quality assurance programs are an integral part of providing excellence in health care delivery. The Dental Quality Alliance and the Commission on Dental Accreditation recognize this and have created standards and recommendations to advise health care providers and health care delivery systems, including dental schools, on measuring the quality of the care delivered to patients. Overall health care expenditures have increased, and the Affordable Care Act has made health care, including dentistry, available to more people in the United States. These increases in cost and in the number of patients accessing care contribute to a heightened interest in measurable quality improvement outcomes that reflect efficiency, effectiveness, and overall value. Practitioners and administrators, both in academia and in the "real world," need an understanding of various quality improvement methodologies available in order to select approaches that support effective monitoring of the quality of care delivered. This article compares and contrasts various quality improvement approaches, programs, and systems currently in use in order to assist dental providers and administrators in choosing quality improvement methodologies pertinent to their practice or institution.

Demystifying process mapping: a key step in neurosurgical quality improvement initiatives.

Science.gov (United States)

McLaughlin, Nancy; Rodstein, Jennifer; Burke, Michael A; Martin, Neil A

2014-08-01

Reliable delivery of optimal care can be challenging for care providers. Health care leaders have integrated various business tools to assist them and their teams in ensuring consistent delivery of safe and top-quality care. The cornerstone to all quality improvement strategies is the detailed understanding of the current state of a process, captured by process mapping. Process mapping empowers caregivers to audit how they are currently delivering care to subsequently strategically plan improvement initiatives. As a community, neurosurgery has clearly shown dedication to enhancing patient safety and delivering quality care. A care redesign strategy named NERVS (Neurosurgery Enhanced Recovery after surgery, Value, and Safety) is currently being developed and piloted within our department. Through this initiative, a multidisciplinary team led by a clinician neurosurgeon has process mapped the way care is currently being delivered throughout the entire episode of care. Neurosurgeons are becoming leaders in quality programs, and their education on the quality improvement strategies and tools is essential. The authors present a comprehensive review of process mapping, demystifying its planning, its building, and its analysis. The particularities of using process maps, initially a business tool, in the health care arena are discussed, and their specific use in an academic neurosurgical department is presented.

SU-E-T-29: A Web Application for GPU-Based Monte Carlo IMRT/VMAT QA with Delivered Dose Verification

International Nuclear Information System (INIS)

Folkerts, M; Graves, Y; Tian, Z; Gu, X; Jia, X; Jiang, S

2014-01-01

Purpose: To enable an existing web application for GPU-based Monte Carlo (MC) 3D dosimetry quality assurance (QA) to compute “delivered dose” from linac logfile data. Methods: We added significant features to an IMRT/VMAT QA web application which is based on existing technologies (HTML5, Python, and Django). This tool interfaces with python, c-code libraries, and command line-based GPU applications to perform a MC-based IMRT/VMAT QA. The web app automates many complicated aspects of interfacing clinical DICOM and logfile data with cutting-edge GPU software to run a MC dose calculation. The resultant web app is powerful, easy to use, and is able to re-compute both plan dose (from DICOM data) and delivered dose (from logfile data). Both dynalog and trajectorylog file formats are supported. Users upload zipped DICOM RP, CT, and RD data and set the expected statistic uncertainty for the MC dose calculation. A 3D gamma index map, 3D dose distribution, gamma histogram, dosimetric statistics, and DVH curves are displayed to the user. Additional the user may upload the delivery logfile data from the linac to compute a 'delivered dose' calculation and corresponding gamma tests. A comprehensive PDF QA report summarizing the results can also be downloaded. Results: We successfully improved a web app for a GPU-based QA tool that consists of logfile parcing, fluence map generation, CT image processing, GPU based MC dose calculation, gamma index calculation, and DVH calculation. The result is an IMRT and VMAT QA tool that conducts an independent dose calculation for a given treatment plan and delivery log file. The system takes both DICOM data and logfile data to compute plan dose and delivered dose respectively. Conclusion: We sucessfully improved a GPU-based MC QA tool to allow for logfile dose calculation. The high efficiency and accessibility will greatly facilitate IMRT and VMAT QA

SU-E-T-29: A Web Application for GPU-Based Monte Carlo IMRT/VMAT QA with Delivered Dose Verification

Energy Technology Data Exchange (ETDEWEB)

Folkerts, M [The University of Texas Southwestern Medical Ctr, Dallas, TX (United States); University of California, San Diego, La Jolla, CA (United States); Graves, Y [University of California, San Diego, La Jolla, CA (United States); Tian, Z; Gu, X; Jia, X; Jiang, S [The University of Texas Southwestern Medical Ctr, Dallas, TX (United States)

2014-06-01

Purpose: To enable an existing web application for GPU-based Monte Carlo (MC) 3D dosimetry quality assurance (QA) to compute “delivered dose” from linac logfile data. Methods: We added significant features to an IMRT/VMAT QA web application which is based on existing technologies (HTML5, Python, and Django). This tool interfaces with python, c-code libraries, and command line-based GPU applications to perform a MC-based IMRT/VMAT QA. The web app automates many complicated aspects of interfacing clinical DICOM and logfile data with cutting-edge GPU software to run a MC dose calculation. The resultant web app is powerful, easy to use, and is able to re-compute both plan dose (from DICOM data) and delivered dose (from logfile data). Both dynalog and trajectorylog file formats are supported. Users upload zipped DICOM RP, CT, and RD data and set the expected statistic uncertainty for the MC dose calculation. A 3D gamma index map, 3D dose distribution, gamma histogram, dosimetric statistics, and DVH curves are displayed to the user. Additional the user may upload the delivery logfile data from the linac to compute a 'delivered dose' calculation and corresponding gamma tests. A comprehensive PDF QA report summarizing the results can also be downloaded. Results: We successfully improved a web app for a GPU-based QA tool that consists of logfile parcing, fluence map generation, CT image processing, GPU based MC dose calculation, gamma index calculation, and DVH calculation. The result is an IMRT and VMAT QA tool that conducts an independent dose calculation for a given treatment plan and delivery log file. The system takes both DICOM data and logfile data to compute plan dose and delivered dose respectively. Conclusion: We sucessfully improved a GPU-based MC QA tool to allow for logfile dose calculation. The high efficiency and accessibility will greatly facilitate IMRT and VMAT QA.

Partner-delivered reflexology: effects on cancer pain and anxiety.

Science.gov (United States)

Stephenson, Nancy L N; Swanson, Melvin; Dalton, Joann; Keefe, Frances J; Engelke, Martha

2007-01-01

To compare the effects of partner-delivered foot reflexology and usual care plus attention on patients' perceived pain and anxiety. The experimental pretest/post-test design included patient-partner dyads randomly assigned to an experimental or control group. Four hospitals in the southeastern United States. 42 experimental and 44 control subjects comprised 86 dyads of patients with metastatic cancer and their partners, representing 16 different types of cancer; 23% of patients had lung cancer, followed by breast, colorectal, and head and neck cancer and lymphoma. The subjects had a mean age of 58.3 years, 51% were female, 66% had a high school education or less, and 58% were Caucasian, 40% were African American, and 1% were Filipino. The intervention included a 15- to 30-minute teaching session on foot reflexology to the partner by a certified reflexologist, an optional 15- to 30-minute foot reflexology session for the partner, and a 30-minute, partner-delivered foot reflexology intervention for the patient. The control group received a 30-minute reading session from their partners. Pain and anxiety. Following the initial partner-delivered foot reflexology, patients experienced a significant decrease in pain intensity and anxiety. A nurse reflexologist taught partners how to perform reflexology on patients with metastatic cancer pain in the hospital, resulting in an immediate decrease in pain intensity and anxiety; minimal changes were seen in the control group, who received usual care plus attention. Hospitals could have qualified professionals offer reflexology as a complementary therapy and teach interested partners the modality.

Examination of Operation Quality for High-frequent Railway Operation

DEFF Research Database (Denmark)

Landex, Alex; Kaas, Anders H.

2009-01-01

take the first train in their direction. The article examines four different approaches to examine operation quality for high-frequent operation that are based on the experiences of the passengers. These approaches are the service frequency of the operation, travel time extension, a combination......The examination of operation quality for high-frequent operation requires other approaches than the typical evaluation of punctuality (trains on time) and reliability (operated trains). This is because passengers in high-frequent railway systems do not necessarily notice train delays as they just...... of the service frequency and travel time approaches, and passenger delays. The service frequency and travel time approaches are simple measurements with low complexity and complement each other. Therefore, the article recommends combining the service frequency and travel time approaches to get a more accurate...

Empowering Lay-Counsellors with Technology: Masivukeni, a Standardized Multimedia Counselling Support Tool to Deliver ART Counselling.

Science.gov (United States)

Gouse, H; Robbins, R N; Mellins, C A; Kingon, A; Rowe, J; Henry, M; Remien, R H; Pearson, A; Victor, F; Joska, J A

2018-05-19

Lay-counsellors in resource-limited settings convey critical HIV- and ART-information, and face challenges including limited training and variable application of counselling. This study explored lay-counsellors and Department of Health (DoH) perspectives on the utility of a multimedia adherence counselling program. Masivukeni, an mHealth application that provides scaffolding for delivering standardized ART counselling was used in a 3-year randomized control trail at two primary health care clinics in Cape Town, South Africa. In this programmatic and descriptive narrative report, we describe the application; lay-counsellors' response to open-ended questions regarding their experience with using Masivukeni; and perspectives of the City of Cape Town and Western Cape Government DoH, obtained through ongoing engagements and feedback sessions. Counsellors reported Masivukeni empowered them to provide high quality counselling. DoH indicated strong support for a future implementation study assessing feasibility for larger scale roll-out. Masivukeni has potential as a counselling tool in resource-limited settings.

Delivered volumes of enteral nutrition exceed prescribed volumes.

Science.gov (United States)

Walker, Renee Nichole; Utech, Anne; Velez, Maria Eugenia; Schwartz, Katie

2014-10-01

Enteral nutrition (EN) provisions are typically calculated based on a 24-hour infusion period. However, feedings are often interrupted for daily activities, procedures, or gastrointestinal intolerance. The study's objective was to determine the delivered EN quantities provided to stable hospitalized patients, using cellular time and measured volumes to verify our EN calculation adjustment. A supply of consecutively numbered ready-to-hang (RTH) EN product was delivered to the bedside of 26 inpatients with established EN tolerance at goal rates on various types of nursing units. The dietitian weighed the volume remaining in the infusing product and recorded the measurement time. On the following days, the dietitian continued to weigh the infusing RTH product and the empty RTH bottles saved by nursing. The primary outcome was the difference between the prescribed and delivered EN provisions, which was calculated with a paired t test. Patients received significantly more calories in the delivered enteral feeding (mean [SD], 1678 [385] kcal) than prescribed calories in the EN order (1489 [246 kcal]; t = 3.736, P = .001), adjusting for observed time. No significant differences were found between nursing units, product, and rate. EN delivered may actually exceed ordered amounts by 5%–21% (mean, 12%) with feeding pump inaccuracy as the primary contributing factor. This differs from what others have found. Our findings support using a volume-based ordering system vs a rate-based ordering system for more accurate EN delivery.

Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.

Science.gov (United States)

Alyeshmerni, Daniel; Froehlich, James B; Lewin, Jack; Eagle, Kim A

2014-07-01

Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan

Directory of Open Access Journals (Sweden)

Daniel Alyeshmerni

2014-07-01

Full Text Available Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA, and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

Medical nutrition therapy: use of sourdough lactic acid bacteria as a cell factory for delivering functional biomolecules and food ingredients in gluten free bread

LENUS (Irish Health Repository)

2011-08-30

Abstract Celiac disease (CD) is an immune-mediated disease, triggered in genetically susceptible individuals by ingesting gluten from wheat, rye, barley, and other closely related cereal grains. Currently, the estimated prevalence of CD is around 1 % of the population in the western world and medical nutritional therapy (MNT) is the only accepted treatment for celiac disease. To date, the replacement of gluten in bread presents a significant technological challenge for the cereal scientist due to the low baking performance of gluten free products (GF). The increasing demand by the consumer for high quality gluten-free (GF) bread, clean labels and natural products is rising. Sourdough has been used since ancient times for the production of rye and wheat bread, its universal usage can be attributed to the improved quality, nutritional properties and shelf life of sourdough based breads. Consequently, the exploitation of sourdough for the production of GF breads appears tempting. This review will highlight how sourdough LAB can be an efficient cell factory for delivering functional biomolecules and food ingredients to enhance the quality of gluten free bread.

Endorectal high dose rate brachytherapy quality assurance

International Nuclear Information System (INIS)

Devic, S.; Vuong, T.; Evans, M.; Podgorsak, E.

2008-01-01

We describe our quality assurance method for preoperative high dose rate (HDR) brachytherapy of endorectal tumours. Reproduction of the treatment planning dose distribution on a daily basis is crucial for treatment success. Due to the cylindrical symmetry, two types of adjustments are necessary: applicator rotation and dose distribution shift along the applicator axis. (author)

Delivering energy efficiency and carbon reduction schemes in England: Lessons from Green Deal Pioneer Places

International Nuclear Information System (INIS)

Marchand, Robert D.; Koh, S.C. Lenny; Morris, Jonathan C.

2015-01-01

Against a background of growing international and national carbon reduction legislation, the UK government introduced the “Green Deal” to deliver a significant increase in housing energy efficiency and reduction in carbon emissions. This paper reflects on one English local authority's experience delivering a programme intended to foster local interest in the Green Deal. Drawing on social surveys and pre and post Green Deal intervention interviews with five demonstrator homes (households that applied to receive a Green Deal package fully funded by the scheme, providing a test bed for the Green Deal recruitment and installation process), this paper shows that awareness and understanding of the Green Deal scheme is low. There is opposition to the cost of finance offered but a strong interest in improving household warmth and for funding improvements through payments added to the electricity bill. Demonstrator home residents perceived Green Deals had improved the warmth and quality of their home, but saving money was the primary motivator for their involvement, not increasing warmth. Whilst Green Deal has not delivered the level of success that was hoped, much can be learned from the scheme to improve future energy efficiency schemes that will be necessary to deliver emission reduction commitments. -- Highlights: •Resident awareness and understanding of the Green Deal is low. •Green Deal assessment costs and loan interest rates are biggest barriers to uptake. •Funding energy improvements via a charge on electricity bill welcomed by residents. •Saving money rather than increasing warmth main motivator for scheme involvement. •Insights from this work should be used to inform future emission reduction schemes

Evaluation of primary care midwifery in The Netherlands: design and rationale of a dynamic cohort study (DELIVER).

Science.gov (United States)

Manniën, Judith; Klomp, Trudy; Wiegers, Therese; Pereboom, Monique; Brug, Johannes; de Jonge, Ank; van der Meijde, Margreeth; Hutton, Eileen; Schellevis, Francois; Spelten, Evelien

2012-03-20

In the Netherlands, midwives are autonomous medical practitioners and 78% of pregnant women start their maternity care with a primary care midwife. Scientific research to support evidence-based practice in primary care midwifery in the Netherlands has been sparse. This paper describes the research design and methodology of the multicenter multidisciplinary prospective DELIVER study which is the first large-scale study evaluating the quality and provision of primary midwifery care. Between September 2009 and April 2011, data were collected from clients and their partners, midwives and other healthcare professionals across the Netherlands. Clients from twenty midwifery practices received up to three questionnaires to assess the expectations and experiences of clients (e.g. quality of care, prenatal screening, emotions, health, and lifestyle). These client data were linked to data from the Netherlands Perinatal Register and electronic client records kept by midwives. Midwives and practice assistants from the twenty participating practices recorded work-related activities in a diary for one week, to assess workload. Besides, the midwives were asked to complete a questionnaire, to gain insight into collaboration of midwives with other care providers, their tasks and attitude towards their job, and the quality of the care they provide. Another questionnaire was sent to all Dutch midwifery practices which reveals information regarding the organisation of midwifery practices, provision of preconception care, collaboration with other care providers, and provision of care to ethnic minorities. Data at client, midwife and practice level can be linked. Additionally, partners of pregnant women and other care providers were asked about their expectations and experiences regarding the care delivered by midwives and in six practices client consults were videotaped to objectively assess daily practice. In total, 7685 clients completed at least one questionnaire, 136 midwives and

Evaluation of primary care midwifery in the Netherlands: design and rationale of a dynamic cohort study (DELIVER

Directory of Open Access Journals (Sweden)

Manniën Judith

2012-03-01

Full Text Available Abstract Background In the Netherlands, midwives are autonomous medical practitioners and 78% of pregnant women start their maternity care with a primary care midwife. Scientific research to support evidence-based practice in primary care midwifery in the Netherlands has been sparse. This paper describes the research design and methodology of the multicenter multidisciplinary prospective DELIVER study which is the first large-scale study evaluating the quality and provision of primary midwifery care. Methods/Design Between September 2009 and April 2011, data were collected from clients and their partners, midwives and other healthcare professionals across the Netherlands. Clients from twenty midwifery practices received up to three questionnaires to assess the expectations and experiences of clients (e.g. quality of care, prenatal screening, emotions, health, and lifestyle. These client data were linked to data from the Netherlands Perinatal Register and electronic client records kept by midwives. Midwives and practice assistants from the twenty participating practices recorded work-related activities in a diary for one week, to assess workload. Besides, the midwives were asked to complete a questionnaire, to gain insight into collaboration of midwives with other care providers, their tasks and attitude towards their job, and the quality of the care they provide. Another questionnaire was sent to all Dutch midwifery practices which reveals information regarding the organisation of midwifery practices, provision of preconception care, collaboration with other care providers, and provision of care to ethnic minorities. Data at client, midwife and practice level can be linked. Additionally, partners of pregnant women and other care providers were asked about their expectations and experiences regarding the care delivered by midwives and in six practices client consults were videotaped to objectively assess daily practice. Discussion In total, 7685

INTRODUCING NOVEL GENERATION OF HIGH ACCURACY CAMERA OPTICAL-TESTING AND CALIBRATION TEST-STANDS FEASIBLE FOR SERIES PRODUCTION OF CAMERAS

Directory of Open Access Journals (Sweden)

M. Nekouei Shahraki

2015-12-01

Full Text Available The recent advances in the field of computer-vision have opened the doors of many opportunities for taking advantage of these techniques and technologies in many fields and applications. Having a high demand for these systems in today and future vehicles implies a high production volume of video cameras. The above criterions imply that it is critical to design test systems which deliver fast and accurate calibration and optical-testing capabilities. In this paper we introduce new generation of test-stands delivering high calibration quality in single-shot calibration of fisheye surround-view cameras. This incorporates important geometric features from bundle-block calibration, delivers very high (sub-pixel calibration accuracy, makes possible a very fast calibration procedure (few seconds, and realizes autonomous calibration via machines. We have used the geometrical shape of a Spherical Helix (Type: 3D Spherical Spiral with special geometrical characteristics, having a uniform radius which corresponds to the uniform motion. This geometrical feature was mechanically realized using three dimensional truncated icosahedrons which practically allow the implementation of a spherical helix on multiple surfaces. Furthermore the test-stand enables us to perform many other important optical tests such as stray-light testing, enabling us to evaluate the certain qualities of the camera optical module.

Process Analytical Technology and On-Line Spectroscopic Measurements of Chemical Meat Quality

DEFF Research Database (Denmark)

Sørensen, Klavs Martin

This thesis deals with process analytical technology and how it can be implemented in the meat industry through on-line grading of chemical meat quality. The focus will be on two applications, namely the rapid quality control of fat quality and the development of a method for on-line detection...... of nano-molar quantification in few seconds, in addition to an accelerated extraction-free GC-MS method that through automation can deliver results much faster than other similar methods. The implementation of these high tech methods will provide the meat industry with a leading edge not only with product...... of boar taint. The chemical makeup of fat has a large effect on meat cut quality. Fat quality has traditionally been determined by methylation of a tissue sample followed by chromatography on a GC-MS system, elucidating the composition of the individual fatty acids. As this procedure typically takes far...

Implementation of quality assurance and quality control in the Nuclear Analytical Laboratory of the Estonian Radiation Protection Centre

International Nuclear Information System (INIS)

Koeoep, T.; Jakobson, E.

2002-01-01

The Analytical Laboratory of the Estonian Radiation Protection Centre is in the process of implementing the system of Quality Assurance (QA) and Quality Control (QC) in the framework of the IAEA TC Project RER/2/004/ 'QA/QC of Nuclear Analytical Techniques'. The draft Quality Manual with annexes has been prepared accordingly to the ISO 17025 Guide, documents and other printed material delivered on the seminars of the project. The laboratory supply has been supplemented with necessary equipment for guaranteeing of quality. Proficiency testing included in the project has been performed successfully. (author)

Materials Delivered by Member States

International Nuclear Information System (INIS)

1969-01-01

In this document the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials delivered by Members up to 30 June 1969 in compliance with requests the Agency had made under Article IX. D

Computational inference and control of quality in multimedia services

NARCIS (Netherlands)

Menkovski, V.

2013-01-01

Quality is the degree of excellence we expect of a service or a product. It is also one of the key factors that determine its value. For multimedia services, understanding the experienced quality means understanding how the delivered delity, precision and reliability correspond to the users'

The Barriers to High-Quality Inpatient Pain Management: A Qualitative Study.

Science.gov (United States)

Lin, Richard J; Reid, M Carrington; Liu, Lydia L; Chused, Amy E; Evans, Arthur T

2015-09-01

The current literature suggests deficiencies in the quality of acute pain management among general medical inpatients. The aim of this qualitative study is to identify potential barriers to high-quality acute pain management among general medical inpatients at an urban academic medical center during a 2-year period. Data are collected using retrospective chart reviews, survey questionnaires, and semistructured, open-ended interviews of 40 general medical inpatients who have experienced pain during their hospitalization. Our results confirm high prevalence and disabling impacts of pain and significant patient- and provider-related barriers to high-quality acute pain management. We also identify unique system-related barriers such as time delay and pain management culture. Efforts to improve the pain management experience of general medical inpatients will need to address all these barriers. © The Author(s) 2014.

Contractor firm strategies in delivering green project: A review

Science.gov (United States)

Powmya, Ayisha; Abidin, Nazirah Zainul; Azizi, Nurul Sakina Mokhtar

2017-10-01

Building green requires effort from various parties, from those who plan, design, manage and construct the building. Contractors are responsible for converting the design on paper into a real building and their role at the construction site support environmental sustainability by implementing responsible construction practices. Inefficient or inexperienced contractor in green construction project may find that delivering this type of project is not an easy task due to added requirement in design, stringent practices at site and the use of green technology and materials. Adopting suitable strategies at firm level will assist in preparatory process and readiness of delivering the green project. This paper reviews the strategies at firm level to deliver green construction project. From extensive literature review, it was discovered that there are six strategies to be adopted by the contractor. Understanding these strategies is expected to promote more contractors to be proactive in delivering green projects.

Feedstock quality : an important consideration in forest biomass supply

Energy Technology Data Exchange (ETDEWEB)

Ryans, M. [FP Innovations, Vancouver, BC (Canada). FERIC

2009-07-01

The move to forest-based sources of biomass requires an emphasis on the quality of forest residues. Customers set the feedstock requirements, and demand homogeneous and predictable quality. The top quality factors are appropriate moisture content, consistent particle size, chlorine content, and clean material. The seasonal variability of the resource means that suppliers must determine how to deliver a year-round supply with appropriate moisture content. Methods such as pre-piling and covering with a tarp are being tested. Although mills tailored for biomass deliveries have modernized boilers capable of burning a variety of biomass feedstocks at varying moisture contents, a 10 per cent reduction in moisture content can offer a good return on investment because suppliers could transports more energy content and less water per tonne of biomass. This presentation also discussed the range of equipment choices available for delivering the right-sized biomass, and outlined the right and wrong practices that influence biomass quality along the supply chain. figs.

Temperature of gas delivered from ventilators.

Science.gov (United States)

Chikata, Yusuke; Onodera, Mutsuo; Imanaka, Hideaki; Nishimura, Masaji

2013-01-01

Although heated humidifiers (HHs) are the most efficient humidifying device for mechanical ventilation, some HHs do not provide sufficient humidification when the inlet temperature to the water chamber is high. Because portable and home-care ventilators use turbines, blowers, pistons, or compressors to inhale in ambient air, they may have higher gas temperature than ventilators with piping systems. We carried out a bench study to investigate the temperature of gas delivered from portable and home-care ventilators, including the effects of distance from ventilator outlet, fraction of inspiratory oxygen (FIO2), and minute volume (MV). We evaluated five ventilators equipped with turbine, blower, piston, or compressor system. Ambient air temperature was adjusted to 24°C ± 0.5°C, and ventilation was set at FIO2 0.21, 0.6, and 1.0, at MV 5 and 10 L/min. We analyzed gas temperature at 0, 40, 80, and 120 cm from ventilator outlet and altered ventilator settings. While temperature varied according to ventilators, the outlet gas temperature of ventilators became stable after, at the most, 5 h. Gas temperature was 34.3°C ± 3.9°C at the ventilator outlet, 29.5°C ± 2.2°C after 40 cm, 25.4°C ± 1.2°C after 80 cm and 25.1°C ± 1.2°C after 120 cm (P < 0.01). FIO2 and MV did not affect gas temperature. Gas delivered from portable and home-care ventilator was not too hot to induce heated humidifier malfunctioning. Gas soon declined when passing through the limb.

When high-volume PCI operators in high-volume hospitals move to lower volume hospitals-Do they still maintain high volume and quality of outcomes?

Science.gov (United States)

Lu, Tsung-Hsueh; Li, Sheng-Tun; Liang, Fu-Wen; Lee, Jo-Chi; Yin, Wei-Hsian

2017-10-31

The aim of this quasi-experimental study was to examine whether high-volume percutaneous coronary intervention (PCI) operators still maintain high volume and quality of outcomes when they moved to lower volume hospitals. Systematic reviews have indicated that high-volume PCI operators and hospitals have higher quality outcomes. However, little is known on whether high PCI volume and high quality outcomes are mainly due to operator characteristics (i.e., skill and experience) and is portable across organizations or whether it is due to hospital characteristics (i.e., equipment, team, and management system) and is less portable. We used Taiwan National Health Insurance claims data 2000-2012 to identify 98 high-volume PCI operators, 10 of whom moved from one hospital to another during the study period. We compared the PCI volume, risk-adjusted mortality ratio, and major adverse cardiovascular event (MACE) ratio before and after moving. Of the 10 high-volume operators who moved, 6 moved from high- to moderate- or low-volume hospitals, with median annual PCI volumes (interquartile range) of 130 (117-165) in prior hospitals and 54 (46-84) in subsequent hospitals (the hospital the operator moved to), and the remaining 4 moved from high to high-volume hospitals, with median annual PCI volumes (interquartile range) of 151 (133-162) in prior hospitals and 193 (178-239) in subsequent hospitals. No significant differences were observed in the risk-adjusted mortality ratios and MACE ratios between high-volume operators and matched controls before and after moving. High-volume operators cannot maintain high volume when they moved from high to moderate or low-volume hospitals; however, the quality of care is maintained. High PCI volume and high-quality outcomes are less portable and more hospital bound. © 2017 Wiley Periodicals, Inc.

Materials Delivered by Member States

International Nuclear Information System (INIS)

1975-01-01

In this document the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials which Members had delivered up to 30 June 1975, in compliance with requests the Agency had made under Article IX. D

Materials Delivered by Member States

International Nuclear Information System (INIS)

1974-01-01

In this document the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials which Members had delivered up to 31 March 1974, in compliance with requests the Agency had made under Article IX. D

Materials Delivered by Member States

International Nuclear Information System (INIS)

1971-01-01

In this document the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials which Members had delivered up to the end of 1970, in compliance with requests the Agency had made under Article IX. D

Materials Delivered by Member States

International Nuclear Information System (INIS)

1973-01-01

In this document the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials which Members had delivered up to the end of 1972, in compliance with requests the Agency had made under Article IX. D

Materials Delivered by Member States

International Nuclear Information System (INIS)

1972-01-01

In this document the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials which Members had delivered up to the end of 1971, in compliance with requests the Agency had made under Article IX. D

Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis.

Science.gov (United States)

Park, Claire Su-Yeon

2017-08-01

To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care. Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost. Theory synthesis. Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015). Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theorem in Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care. A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed. © 2017 The Author. Journal of Advanced Nursing © John Wiley & Sons Ltd.

Characteristics of primary care practices associated with high quality of care.

Science.gov (United States)

Beaulieu, Marie-Dominique; Haggerty, Jeannie; Tousignant, Pierre; Barnsley, Janet; Hogg, William; Geneau, Robert; Hudon, Éveline; Duplain, Réjean; Denis, Jean-Louis; Bonin, Lucie; Del Grande, Claudio; Dragieva, Natalyia

2013-09-03

No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling. The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0-35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8-14.4), presence of allied health professionals (15.3; 95% CI 5.4-25.2) and/or specialist physicians (19.6; 95% CI 8.3-30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0-12.4) and average organizational access to the practice (4.9; 95% CI 2.6-7.2). The number of physicians (1.2; 95% CI 0.6-1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1-2.5) were modestly associated with high-quality care. We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.

DESIGNS MATTER: Delivering Information Sources for Tourism

Directory of Open Access Journals (Sweden)

Margie A. Nolasco

2016-11-01

Full Text Available Tourism has benefits not just for travelers, but also to the local economy. Since, Bicol Region has natural and cultural attractions; it is a potential travel destination in the country. Technology in delivering information sources played vital role for the success of the tourism industry in the Region. This allows travel enthusiasts to get more information about various tourist attractions. This paper analyzes the effectiveness of delivering information sources such as web advertisement and desktop publishing for tourist promotion in the Bicol Region. Specifically, it determined the status of tourism, and identified common forms of promotions for tourism development. The study adopted mixed method of research. This method was utilized to confirm and validate findings. Interviews and focus group discussions were used to gather data from the respondents of the selected Local Government Units, Department of Tourism, Travel Agencies and Hotel Agents in the Region. Based on the findings, of the total foreign visitors in the country, only 9.14% visited Bicol Region in 2014. That is why, domestic tourist showed high percentage against foreign visitors with 25.7%. Brochures with EZ maps as most commonly used desktop publishing materials and websites and social media for web advertisement. Thus, there is a need to reevaluate promotional activities by the DOT and other agencies. Adoption suggestive features for creative desktop publishing materials and web services should be considered to increase tourist visitors in the Region.

Alternative Fuels Data Center: Golden Eagle Delivers Beer With Natural Gas

Science.gov (United States)

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A systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings

Directory of Open Access Journals (Sweden)

Howel Denise

2006-03-01

Full Text Available Abstract Background Socio-economic variations in health, including variations in health according to wealth and income, have been widely reported. A potential method of improving the health of the most deprived groups is to increase their income. State funded welfare programmes of financial benefits and benefits in kind are common in developed countries. However, there is evidence of widespread under claiming of welfare benefits by those eligible for them. One method of exploring the health effects of income supplementation is, therefore, to measure the health effects of welfare benefit maximisation programmes. We conducted a systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings. Methods Published and unpublished literature was accessed through searches of electronic databases, websites and an internet search engine; hand searches of journals; suggestions from experts; and reference lists of relevant publications. Data on the intervention delivered, evaluation performed, and outcome data on health, social and economic measures were abstracted and assessed by pairs of independent reviewers. Results are reported in narrative form. Results 55 studies were included in the review. Only seven studies included a comparison or control group. There was evidence that welfare rights advice delivered in healthcare settings results in financial benefits. There was little evidence that the advice resulted in measurable health or social benefits. This is primarily due to lack of good quality evidence, rather than evidence of an absence of effect. Conclusion There are good theoretical reasons why income supplementation should improve health, but currently little evidence of adequate robustness and quality to indicate that the impact goes beyond increasing income.

Isolation of high quality RNA from pistachio (Pistacia vera L.) and other woody plants high in secondary metabolites.

Science.gov (United States)

Moazzam Jazi, Maryam; Rajaei, Saideh; Seyedi, Seyed Mahdi

2015-10-01

The quality and quantity of RNA are critical for successful downstream transcriptome-based studies such as microarrays and RNA sequencing (RNA-Seq). RNA isolation from woody plants, such as Pistacia vera, with very high amounts of polyphenols and polysaccharides is an enormous challenge. Here, we describe a highly efficient protocol that overcomes the limitations posed by poor quality and low yield of isolated RNA from pistachio and various recalcitrant woody plants. The key factors that resulted in a yield of 150 μg of high quality RNA per 200 mg of plant tissue include the elimination of phenol from the extraction buffer, raising the concentration of β-mercaptoethanol, long time incubation at 65 °C, and nucleic acid precipitation with optimized volume of NaCl and isopropyl alcohol. Also, the A260/A280 and A260/A230 of extracted RNA were about 1.9-2.1and 2.2-2.3, respectively, revealing the high purity. Since the isolated RNA passed highly stringent quality control standards for sensitive reactions, including RNA sequencing and real-time PCR, it can be considered as a reliable and cost-effective method for RNA extraction from woody plants.

Quack: A quality assurance tool for high throughput sequence data.

Science.gov (United States)

Thrash, Adam; Arick, Mark; Peterson, Daniel G

2018-05-01

The quality of data generated by high-throughput DNA sequencing tools must be rapidly assessed in order to determine how useful the data may be in making biological discoveries; higher quality data leads to more confident results and conclusions. Due to the ever-increasing size of data sets and the importance of rapid quality assessment, tools that analyze sequencing data should quickly produce easily interpretable graphics. Quack addresses these issues by generating information-dense visualizations from FASTQ files at a speed far surpassing other publicly available quality assurance tools in a manner independent of sequencing technology. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients

OpenAIRE

Hartgerink, Jacqueline; Cramm, Jane; Bakker, Ton; Eijsden, A.; Mackenbach, Johan; Nieboer, Anna

2013-01-01

textabstractAim: To identify predictors of relational coordination among professionals delivering care to older patients. Background: Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design: This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. Methods: This study was performed in sp...

The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients

OpenAIRE

J.M. Hartgerink; J.M. Cramm; T.J.E.M. Bakker; A.M. van Eijsden; J.P. Mackenbach; A.P. Nieboer

2013-01-01

Aim To identify predictors of relational coordination among professionals delivering care to older patients. Background Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. Methods This study was performed in spring 2010 among ...

Measurement of Quality of Educational Hospital Services by the SERVQUAL Model: The Iranian Patients’ Perspective

Science.gov (United States)

Rezaei, Satar; Matin, Behzad Karami; Moradi, Khalil; Bijan, Behroz; Fallahi, Masoud; Shokati, Behnam; Saeidi, Hamid

2016-01-01

Introduction The main mission of hospitals in any health system is to deliver high quality healthcare for patients and meet their needs and expectations. The aim of the current study was to assess the quality of the service of educational hospitals affiliated with Kermanshah University of Medical Sciences in 2015, from the perspective of patients. Methods In this cross-sectional study, the perspectives of 400 patients were assessed about the quality of the services provided by educational hospitals in Kermanshah (western Iran) in 2015. The quality was assessed by the SERVQUAL questionnaire with five dimensions, i.e., tangibility, reliability, responsiveness, assurance, and empathy. In addition, the Wilcoxon test and the Kruskal-Wallis test were used to explore any association between the dependent variable and explanatory variables. The data were analyzed using Stata V.12 software. Results There were negative gaps in all five dimensions. The highest and lowest gaps in the mean score were found in the assurance (−0.88) and responsiveness (−0.56) dimensions. The patients ranked responsiveness as the most important dimension of the quality of healthcare. Conclusion There were gaps between the patients’ perceptions and their expectation about the five dimensions that were studied based on the SERVQUAL model. Also, it is recommended that improving the quality of healthcare is possible by various policies, such as good responsiveness, access to health workers, and delivering healthcare in less time. PMID:27123218

WE-AB-207B-09: Margin Reduction for Planning Target Volume (PTV) in Patients with Localized Prostate Cancer: Impact On Delivered Dose and Quality of Life

Energy Technology Data Exchange (ETDEWEB)

Kumarasiri, A; Liu, C; Brown, S; Glide-Hurst, C; Elshaikh, M; Chetty, I; Movsas, B [Henry Ford Health System, Detroit, MI (United States)

2016-06-15

Purpose: To estimate the delivered (cumulative) dose to targets and organs at risk for localized prostate cancer patients treated with reduced PTV margins and to evaluate preliminary patient reported quality-of-life (QOL). Methods: Under an IRB-approved protocol, 20 prostate cancer patients (including 11 control patients) were treated with reduced planning margins (5 mm uniform with 4 mm at prostate/rectum interface). Control patients had standard margin (10/6 mm)-based treatments. A parameter-optimized Elastix algorithm along with energy-mass mapping was used to deform and resample dose of the day onto the planning CT for each fraction to estimate the delivered dose over all fractions. QOL data were collected via Expanded Prostate cancer Index Composite (EPIC-26) questionnaires at time points pre-treatment, post-treatment, and at 2, 6, 12, 18 month follow-ups. Standardized QOL scores [range: 0–100] were determined and baseline-corrected by subtracting pre-treatment QOL data. Mean QOL differences between the margin reduced group and control group (QOLmr-QOLcontrol) were calculated for first 18 months. Results: The difference between the cumulative mean dose (Dmean) and the planned mean dose (±SD) for PTV, prostate, bladder, and rectum were −2.2±1.0, 0.3±0.5, −0.7±2.6, and −2.1±1.3 Gy respectively for the margin-reduced group, and −0.8±2.0, 0.9±1.4, - 0.7±3.1 and −1.0±2.4 Gy for the control group. Difference between the two groups was statistically insignificant (p=0.1). Standardized and baseline corrected QOLmr-QOLcontrol for EPIC domains categorized as “Urinary Incontinence”, “Urinary Irritative/Obstructive”, “Bowel”, “Sexual”, and “Hormonal” were 0.6, 12.1, 9.1, 13.3, and −0.9 for the 18 months following radiation therapy (higher values better). Delivered dose to rectum showed a weak correlation to “Bowel” domain (Pearson’s coefficient −0.24, p<0.001), while bladder dose did not correlate to Urinary Incontinence

WE-AB-207B-09: Margin Reduction for Planning Target Volume (PTV) in Patients with Localized Prostate Cancer: Impact On Delivered Dose and Quality of Life

International Nuclear Information System (INIS)

Kumarasiri, A; Liu, C; Brown, S; Glide-Hurst, C; Elshaikh, M; Chetty, I; Movsas, B

2016-01-01

Purpose: To estimate the delivered (cumulative) dose to targets and organs at risk for localized prostate cancer patients treated with reduced PTV margins and to evaluate preliminary patient reported quality-of-life (QOL). Methods: Under an IRB-approved protocol, 20 prostate cancer patients (including 11 control patients) were treated with reduced planning margins (5 mm uniform with 4 mm at prostate/rectum interface). Control patients had standard margin (10/6 mm)-based treatments. A parameter-optimized Elastix algorithm along with energy-mass mapping was used to deform and resample dose of the day onto the planning CT for each fraction to estimate the delivered dose over all fractions. QOL data were collected via Expanded Prostate cancer Index Composite (EPIC-26) questionnaires at time points pre-treatment, post-treatment, and at 2, 6, 12, 18 month follow-ups. Standardized QOL scores [range: 0–100] were determined and baseline-corrected by subtracting pre-treatment QOL data. Mean QOL differences between the margin reduced group and control group (QOLmr-QOLcontrol) were calculated for first 18 months. Results: The difference between the cumulative mean dose (Dmean) and the planned mean dose (±SD) for PTV, prostate, bladder, and rectum were −2.2±1.0, 0.3±0.5, −0.7±2.6, and −2.1±1.3 Gy respectively for the margin-reduced group, and −0.8±2.0, 0.9±1.4, - 0.7±3.1 and −1.0±2.4 Gy for the control group. Difference between the two groups was statistically insignificant (p=0.1). Standardized and baseline corrected QOLmr-QOLcontrol for EPIC domains categorized as “Urinary Incontinence”, “Urinary Irritative/Obstructive”, “Bowel”, “Sexual”, and “Hormonal” were 0.6, 12.1, 9.1, 13.3, and −0.9 for the 18 months following radiation therapy (higher values better). Delivered dose to rectum showed a weak correlation to “Bowel” domain (Pearson’s coefficient −0.24, p<0.001), while bladder dose did not correlate to Urinary Incontinence

Delivering Training for Highly Demanding Information Systems

Science.gov (United States)

Norton, Andrew Lawrence; Coulson-Thomas, Yvette May; Coulson-Thomas, Colin Joseph; Ashurst, Colin

2012-01-01

Purpose: There is a lack of research covering the training requirements of organisations implementing highly demanding information systems (HDISs). The aim of this paper is to help in the understanding of appropriate training requirements for such systems. Design/methodology/approach: This research investigates the training delivery within a…

[Quality of sleep and academic performance in high school students].

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Bugueño, Maithe; Curihual, Carolina; Olivares, Paulina; Wallace, Josefa; López-AlegrÍa, Fanny; Rivera-López, Gonzalo; Oyanedel, Juan Carlos

2017-09-01

Sleeping and studying are the day-to-day activities of a teenager attending school. To determine the quality of sleep and its relationship to the academic performance among students attending morning and afternoon shifts in a public high school. Students of the first and second year of high school answered an interview about socio-demographic background, academic performance, student activities and subjective sleep quality; they were evaluated using the Pittsburgh Sleep Quality Index (PSQI). The interview was answered by 322 first year students aged 15 ± 5 years attending the morning shift and 364 second year students, aged 16 ± 0.5 years, attending the afternoon shift. The components: sleep latency, habitual sleep efficiency, sleep disturbance, drug use and daytime dysfunction were similar and classified as good in both school shifts. The components subjective sleep quality and duration of sleep had higher scores among students of the morning shift. The mean grades during the first semester of the students attending morning and afternoon shifts were 5.9 and 5.8, respectively (of a scale from 1 to 7). Among students of both shifts, the PSQI scale was associated inversely and significantly with academic performance. A bad sleep quality influences academic performance in these students.

extraction of high quality dna from polysaccharides-secreting ...

African Journals Online (AJOL)

cistvr

A DNA extraction method using CTAB was used for the isolation of genomic DNA from ten. Xanthomonas campestris pathovars, ten isolates of Xanthomonas albilineans and one isolate of. Pseudomonas rubrisubalbicans. High quality DNA was obtained that was ideal for molecular analy- ses. Extracellular polysaccharides ...

Service quality in contracted facilities.

Science.gov (United States)

Rabbani, Fauziah; Pradhan, Nousheen Akber; Zaidi, Shehla; Azam, Syed Iqbal; Yousuf, Farheen

2015-01-01

The purpose of this paper is to explore the readiness of contracted and non-contracted first-level healthcare facilities in Pakistan to deliver quality maternal and neonatal health (MNH) care. A balanced scorecard (BSC) was used as the assessment framework. Using a cross-sectional study design, two rural health centers (RHCs) contracted out to Aga Khan Health Service, Pakistan were compared with four government managed RHCs. A BSC was designed to assess RHC readiness to deliver good quality MNH care. In total 20 indicators were developed, representing five BSC domains: health facility functionality, service provision, staff capacity, staff and patient satisfaction. Validated data collection tools were used to collect information. Pearson χ2, Fisher's Exact and the Mann-Whitney tests were applied as appropriate to detect significant service quality differences among the two facilities. Contracted facilities were generally found to be better than non-contracted facilities in all five BSC domains. Patients' inclination for facility-based delivery at contracted facilities was, however, significantly higher than non-contracted facilities (80 percent contracted vs 43 percent non-contracted, p=0.006). The study shows that contracting out initiatives have the potential to improve MNH care. This is the first study to compare MNH service delivery quality across contracted and non-contracted facilities using BSC as the assessment framework.

Managing quality inside a high-technology project organization

OpenAIRE

Jokinen, T. (Tauno)

2004-01-01

Abstract This action research addresses the deployment of Total Quality Management (TQM) principles in a high-technology new product development organisation. During the period of study, the organisation grew fast. High-technology product development and hypergrowth provided a unique combination of extreme conditions for the study. The existing concepts of TQM are presented as an organised map enabling strategic analysis for an implementation plan. The history of TQM dates back to the ...

A systematic review of randomised control trials of sexual health interventions delivered by mobile technologies.

Science.gov (United States)

Burns, Kara; Keating, Patrick; Free, Caroline

2016-08-12

use. Finally, one trial showed that collection of sexual health information using mobile technology was acceptable. The findings suggest interventions delivered by SMS interventions can increase uptake of sexual health services and STI testing. High quality trials of interventions using standardised objective measures and employing a wider range of behavioural change techniques are needed to assess if interventions delivered by mobile phone can alter safer sex behaviours carried out between couples and reduce STIs.

Power conversion and quality of the Santa Clara 2 MW direct carbonate fuel cell demonstration plant

Energy Technology Data Exchange (ETDEWEB)

Skok, A.J. [Fuel Cell Engineering Corp., Danbury, CT (United States); Abueg, R.Z. [Basic Measuring Instruments, Santa Clara, CA (United States); Schwartz, P. [Fluor Daniel, Inc., Irvine, CA (United States)] [and others

1996-12-31

The Santa Clara Demonstration Project (SCDP) is the first application of a commercial-scale carbonate fuel cell power plant on a US electric utility system. It is also the largest fuel cell power plant ever operated in the United States. The 2MW plant, located in Santa Clara, California, utilizes carbonate fuel cell technology developed by Energy Research Corporation (ERC) of Danbury, Connecticut. The ultimate goal of a fuel cell power plant is to deliver usable power into an electrical distribution system. The power conversion sub-system does this for the Santa Clara Demonstration Plant. A description of this sub-system and its capabilities follows. The sub-system has demonstrated the capability to deliver real power, reactive power and to absorb reactive power on a utility grid. The sub-system can be operated in the same manner as a conventional rotating generator except with enhanced capabilities for reactive power. Measurements demonstrated the power quality from the plant in various operating modes was high quality utility grade power.

Quality improvement teaching at medical school: a student perspective

OpenAIRE

Nair, Pooja; Barai, Ishani; Prasad, Sunila; Gadhvi, Karishma

2016-01-01

Pooja Nair, Ishani Barai, Sunila Prasad, Karishma Gadhvi Department of Medicine, Imperial College School of Medicine, Imperial College London, London, UK Abstract: Guidelines in the UK require all doctors to actively take part in quality improvement. To ease future doctors into the process, formal quality improvement teaching can be delivered during medical school. Keywords: quality improvement, medical school, patient safety, patient satisfaction, medical student, clinical audit

High quality transportation fuels from renewable feedstock

Energy Technology Data Exchange (ETDEWEB)

Lindfors, Lars Peter

2010-09-15

Hydrotreating of vegetable oils is novel process for producing high quality renewable diesel. Hydrotreated vegetable oils (HVO) are paraffinic hydrocarbons. They are free of aromatics, have high cetane numbers and reduce emissions. HVO can be used as component or as such. HVO processes can also be modified to produce jet fuel. GHG savings by HVO use are significant compared to fossil fuels. HVO is already in commercial production. Neste Oil is producing its NExBTL diesel in two plants. Production of renewable fuels will be limited by availability of sustainable feedstock. Therefore R and D efforts are made to expand feedstock base further.

Improving high quality, equitable maternal health services in Malawi ...

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

Improving high quality, equitable maternal health services in Malawi (IMCHA) ... In response, the Ministry of Health implemented a Standards-Based Management and Recognition for Reproductive Health initiative to improve ... Total funding.

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England.

Science.gov (United States)

Osaro, Erhabor; Chima, Njemanze

2014-06-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the "engine room" of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

High throughput electrospinning of high-quality nanofibers via an aluminum disk spinneret

Science.gov (United States)

Zheng, Guokuo

In this work, a simple and efficient needleless high throughput electrospinning process using an aluminum disk spinneret with 24 holes is described. Electrospun mats produced by this setup consisted of fine fibers (nano-sized) of the highest quality while the productivity (yield) was many times that obtained from conventional single-needle electrospinning. The goal was to produce scaled-up amounts of the same or better quality nanofibers under variable concentration, voltage, and the working distance than those produced with the single needle lab setting. The fiber mats produced were either polymer or ceramic (such as molybdenum trioxide nanofibers). Through experimentation the optimum process conditions were defined to be: 24 kilovolt, a distance to collector of 15cm. More diluted solutions resulted in smaller diameter fibers. Comparing the morphologies of the nanofibers of MoO3 produced by both the traditional and the high throughput set up it was found that they were very similar. Moreover, the nanofibers production rate is nearly 10 times than that of traditional needle electrospinning. Thus, the high throughput process has the potential to become an industrial nanomanufacturing process and the materials processed by it may be used as filtration devices, in tissue engineering, and as sensors.

Mechanisms affecting water quality in an intermittent piped water supply.

Science.gov (United States)

Kumpel, Emily; Nelson, Kara L

2014-01-01

Drinking water distribution systems throughout the world supply water intermittently, leaving pipes without pressure between supply cycles. Understanding the multiple mechanisms that affect contamination in these intermittent water supplies (IWS) can be used to develop strategies to improve water quality. To study these effects, we tested water quality in an IWS system with infrequent and short water delivery periods in Hubli-Dharwad, India. We continuously measured pressure and physicochemical parameters and periodically collected grab samples to test for total coliform and E. coli throughout supply cycles at 11 sites. When the supply was first turned on, water with elevated turbidity and high concentrations of indicator bacteria was flushed out of pipes. At low pressures (water was delivered with a chlorine residual and at pressures >17 psi.

Coupling of high-quality-factor optical resonators

International Nuclear Information System (INIS)

Salzenstein, Patrice; Henriet, Rémi; Coillet, Aurélien; Chembo, Yanne K; Mortier, Michel; Sérier-Brault, Hélène; Rasoloniaina, Alphonse; Dumeige, Yannick; Féron, Patrice

2013-01-01

We improve theoretically and experimentally the problem of the coupling between a high Q-factor resonator and its external coupler. We have observed oscillations of ringing induced by the sweeping of the excitation frequency of an active microsphere. Thanks to this approach, the quality factor of an optical resonator was measured and we obtained Q = 5.8 × 10 8 . (paper)

High-picture quality industrial CT scanner

International Nuclear Information System (INIS)

Shoji, Takao; Nishide, Akihiko; Fujii, Masashi.

1989-01-01

Industrial X-ray-CT-scanners, which provide cross-sectional images of a tested sample without destroying it, are attracting attention as a new nondestructive inspection device. In 1982, Toshiba commenced the development of industrial CT scanners, and introduced the 'TOSCANER' -3000 and-4000 series. Now, the state of the art 'TOSCANER'-20000 series of CT systems has been developed incorporating the latest computer tomography and image processing technology, such as the T9506 image processor. One of the advantages of this system is its applicability to a wide range of X-ray energy . The 'TOSCANER'-20000 series can be utilized for inspecting castings and other materials with relatively low-transparency to X-rays, as well as ceramics, composite materials and other materials with high X-ray transparency. A further feature of the new system is its high-picture quality, with a high-spatial resolution resulting from a pixel size of 0.2x0.2(mm). (author)

Computer-aided control of high-quality cast iron

Directory of Open Access Journals (Sweden)

S. Pietrowski

2008-04-01

Full Text Available The study discusses the possibility of control of the high-quality grey cast iron and ductile iron using the author’s genuine computer programs. The programs have been developed with the help of algorithms based on statistical relationships that are said to exist between the characteristic parameters of DTA curves and properties, like Rp0,2, Rm, A5 and HB. It has been proved that the spheroidisation and inoculation treatment of cast iron changes in an important way the characteristic parameters of DTA curves, thus enabling a control of these operations as regards their correctness and effectiveness, along with the related changes in microstructure and mechanical properties of cast iron. Moreover, some examples of statistical relationships existing between the typical properties of ductile iron and its control process were given for cases of the melts consistent and inconsistent with the adopted technology.A test stand for control of the high-quality cast iron and respective melts has been schematically depicted.

Effect of high hydrostatic pressure on overall quality parameters of watermelon juice.

Science.gov (United States)

Liu, Y; Zhao, X Y; Zou, L; Hu, X S

2013-06-01

High hydrostatic pressure as a kind of non-thermal processing might maintain the quality of thermo-sensitive watermelon juice. So, the effect of high hydrostatic pressure treatment on enzymes and quality of watermelon juice was investigated. After high hydrostatic pressure treatment, the activities of polyphenol oxidase, peroxidase, and pectin methylesterase of juice decreased significantly with the pressure (P  0.05). No significant difference was observed in lycopene and total phenolics after high hydrostatic pressure treatment when compared to the control (P > 0.05). Cloudiness and viscosity increased with pressure (P  0.05). a*- and b*-value both unchanged after high hydrostatic pressure treatment (P > 0.05) while L*-value increased but the values had no significant difference among treated juices. Browning degree after high hydrostatic pressure treatment decreased with increase in pressure and treatment time (P hydrostatic pressure had little effect on color of juice. The results of this study demonstrated the efficacy of high hydrostatic pressure in inactivating enzymes and maintaining the quality of watermelon juice.

High quality ceramic coatings sprayed by high efficiency hypersonic plasma spraying gun

International Nuclear Information System (INIS)

Zhu Sheng; Xu Binshi; Yao JiuKun

2005-01-01

This paper introduced the structure of the high efficiency hypersonic plasma spraying gun and the effects of hypersonic plasma jet on the sprayed particles. The optimised spraying process parameters for several ceramic powders such as Al 2 O 3 , Cr 2 O 3 , ZrO 2 , Cr 3 C 2 and Co-WC were listed. The properties and microstructure of the sprayed ceramic coatings were investigated. Nano Al 2 O 3 -TiO 2 ceramic coating sprayed by using the high efficiency hypersonic plasma spraying was also studied. Compared with the conventional air plasma spraying, high efficiency hypersonic plasma spraying improves greatly the ceramic coatings quality but at low cost. (orig.)

High quality electron beams from a laser wakefield accelerator

Energy Technology Data Exchange (ETDEWEB)

Wiggins, S M; Issac, R C; Welsh, G H; Brunetti, E; Shanks, R P; Anania, M P; Cipiccia, S; Manahan, G G; Aniculaesei, C; Ersfeld, B; Islam, M R; Burgess, R T L; Vieux, G; Jaroszynski, D A [SUPA, Department of Physics, University of Strathclyde, Glasgow (United Kingdom); Gillespie, W A [SUPA, Division of Electronic Engineering and Physics, University of Dundee, Dundee (United Kingdom); MacLeod, A M [School of Computing and Creative Technologies, University of Abertay Dundee, Dundee (United Kingdom); Van der Geer, S B; De Loos, M J, E-mail: m.wiggins@phys.strath.ac.u [Pulsar Physics, Burghstraat 47, 5614 BC Eindhoven (Netherlands)

2010-12-15

High quality electron beams have been produced in a laser-plasma accelerator driven by femtosecond laser pulses with a peak power of 26 TW. Electrons are produced with an energy up to 150 MeV from the 2 mm gas jet accelerator and the measured rms relative energy spread is less than 1%. Shot-to-shot stability in the central energy is 3%. Pepper-pot measurements have shown that the normalized transverse emittance is {approx}1{pi} mm mrad while the beam charge is in the range 2-10 pC. The generation of high quality electron beams is understood from simulations accounting for beam loading of the wakefield accelerating structure. Experiments and self-consistent simulations indicate that the beam peak current is several kiloamperes. Efficient transportation of the beam through an undulator is simulated and progress is being made towards the realization of a compact, high peak brilliance free-electron laser operating in the vacuum ultraviolet and soft x-ray wavelength ranges.

Isolation of high-quality total RNA from leaves of Myrciaria dubia "CAMU CAMU".

Science.gov (United States)

Gómez, Juan Carlos Castro; Reátegui, Alina Del Carmen Egoavil; Flores, Julián Torres; Saavedra, Roberson Ramírez; Ruiz, Marianela Cobos; Correa, Sixto Alfredo Imán

2013-01-01

Myrciaria dubia is a main source of vitamin C for people in the Amazon region. Molecular studies of M. dubia require high-quality total RNA from different tissues. So far, no protocols have been reported for total RNA isolation from leaves of this species. The objective of this research was to develop protocols for extracting high-quality total RNA from leaves of M. dubia. Total RNA was purified following two modified protocols developed for leaves of other species (by Zeng and Yang, and by Reid et al.) and one modified protocol developed for fruits of the studied species (by Silva). Quantity and quality of purified total RNA were assessed by spectrophotometric and electrophoretic analysis. Additionally, quality of total RNA was evaluated with reverse-transcription polymerase chain reaction (RT-PCR). With these three modified protocols we were able to isolate high-quality RNA (A260nm/A280nm >1.9 and A260nm/A230nm >2.0). Highest yield was produced with the Zeng and Yang modified protocol (384±46µg ARN/g fresh weight). Furthermore, electrophoretic analysis showed the integrity of isolated RNA and the absence of DNA. Another proof of the high quality of our purified RNA was the successful cDNA synthesis and amplification of a segment of the M. dubia actin 1 gene. We report three modified protocols for isolation total RNA from leaves of M. dubia. The modified protocols are easy, rapid, low in cost, and effective for high-quality and quantity total RNA isolation suitable for cDNA synthesis and polymerase chain reaction.

Negative Binomial charts for monitoring high-quality processes

NARCIS (Netherlands)

Albers, Willem/Wim

Good control charts for high quality processes are often based on the number of successes between failures. Geometric charts are simplest in this respect, but slow in recognizing moderately increased failure rates p. Improvement can be achieved by waiting until r > 1 failures have occurred, i.e. by

High quality mask storage in an advanced Logic-Fab

Science.gov (United States)

Jähnert, Carmen; Fritsche, Silvio

2012-02-01

High efficient mask logistics as well as safe and high quality mask storage are essential requirements within an advanced lithography area of a modern logic waferfab. Fast operational availability of the required masks at the exposure tool with excellent mask condition requires a safe mask handling, safeguarding of high mask quality over the whole mask usage time without any quality degradation and an intelligent mask logistics. One big challenge is the prevention of haze on high advanced phase shift masks used in a high volume production line for some thousands of 248nm or 193nm exposures. In 2008 Infineon Dresden qualified a customer specific developed semi-bare mask storage system from DMSDynamic Micro Systems in combination with a high advanced mask handling and an interconnected complex logistic system. This high-capacity mask storage system DMS M1900.22 for more than 3000 masks with fully automated mask and box handling as well as full-blown XCDA purge has been developed and adapted to the Infineon Lithotoollandscape using Nikon and SMIF reticle cases. Advanced features for ESD safety and mask security, mask tracking via RFID and interactions with the exposure tools were developed and implemented. The stocker is remote controlled by the iCADA-RSM system, ordering of the requested mask directly from the affected exposure tool allows fast access. This paper discusses the advantages and challenges for this approach as well as the practical experience gained during the implementation of the new system which improves the fab performance with respect to mask quality, security and throughput. Especially the realization of an extremely low and stable humidity level in addition with a well controlled air flow at each mask surface, preventing masks from haze degradation and particle contamination, turns out to be a notable technical achievement. The longterm stability of haze critical masks has been improved significantly. Relevant environmental parameters like

Simultaneously improving the mechanical and electrical properties of poly(vinyl alcohol) composites by high-quality graphitic nanoribbons.

Science.gov (United States)

Yang, Ming; Weng, Lin; Zhu, Hanxing; Zhang, Fan; Fan, Tongxiang; Zhang, Di

2017-12-07

Although carbon nanotubes (CNTs) have shown great potential for enhancing the performance of polymer matrices, their reinforcement role still needs to be further improved. Here we implement a structural modification of multi-walled CNTs (MWCNTs) to fully utilize their fascinating mechanical and electrical properties via longitudinal splitting of MWCNTs into graphitic nanoribbons (GNRs). This nanofiller design strategy is advantageous for surface functionalization, strong interface adhesion as well as boosting the interfacial contact area without losing the intrinsic graphitic structure. The obtained GNRs have planar geometry, quasi-1D structure and high-quality crystallinity, which outperforms their tubular counterparts, delivering a superior load-bearing efficiency and conductive network for realizing a synchronous improvement of the mechanical and electrical properties of a PVA-based composite. Compared to PVA/CNTs, the tensile strength, Young's modulus and electrical conductivity of the PVA/GNR composite at a filling concentration of 3.6 vol.% approach 119.1 MPa, 5.3 GPa and 2.4 × 10 -4 S m -1 , with increases of 17%, 32.5% and 5.9 folds, respectively. The correlated mechanics is further rationalized by finite element analysis, the generalized shear-lag theory and the fracture mechanisms.

How to design and deliver a local teaching program

OpenAIRE

Limb, Christopher; Whitehurst, Katharine; Gundogan, Buket; Koshy, Kiron; Agha, Riaz

2017-01-01

Teaching is an invaluable aspect of any medical or surgical career. Many trainees will find themselves delivering teaching at several stages in their career and in this “How to” article we explain how to design, set up, and deliver a successful teaching program, as well as how to evidence this in your portfolio.

IMPACT OF RESILIENCE, ICT SUPPORT AND QUALITY OF STUDENT'S LIFE ON QUALITY OF HIGH EDUCATION PROCESS

Directory of Open Access Journals (Sweden)

Zorica Lazic

2016-12-01

Full Text Available Answers to the questions of how and in what way the quality of life of students, resilience and ICT support affects the quality of high education we will get through this work where main objective is to define a network of processes and process management ensuring more quality and more innovative managing and service provision, therefore satisfying the needs of service users - in this case the students of the university. To collect the relevant data in the thematic analysis of this paper, the method of interviewing by questionnaires was applied. The sample survey was conducted among undergraduate students, teachers and staff of the Teacher Training Faculty in Uzice.

Learning to trust your data : how data quality profiling saves money

Energy Technology Data Exchange (ETDEWEB)

Gregory, P.; King, I. [Intervera Data Solutions, Calgary, AB (Canada)

2006-07-01

Exploration and production companies (EPs) require new solutions on using and manipulating data from a range of sources due to data variability and newer technologies. Data capture methods and data accuracy levels collected over the operating history of a well's life cycle also pose challenges in terms of data integrity. Data quality is the basis and prerequisite for standardization and integration of varying data repositories into value added knowledge management systems. A roadmap for improving business performance was presented by providing examples of EP companies who have encountered data quality issues and successfully measured the business impact associated with poor data quality, and developed solutions that delivered benefits throughout their organizations. The paper discussed how to overcome the data quality challenge and provided reasons to enhance data quality. Several case studies were profiled that examined operational risk mitigation, regulatory compliance risk, contractual and liability risk, and corporate and financial risk. Second generation data profiling, cleansing and migration tools are introduced with an emphasis on how these automated tools helped EPs define, and deliver business benefits with data quality. 1 fig.

Cloud Computing Quality

Directory of Open Access Journals (Sweden)

Anamaria Şiclovan

2013-02-01

Full Text Available Cloud computing was and it will be a new way of providing Internet services and computers. This calculation approach is based on many existing services, such as the Internet, grid computing, Web services. Cloud computing as a system aims to provide on demand services more acceptable as price and infrastructure. It is exactly the transition from computer to a service offered to the consumers as a product delivered online. This paper is meant to describe the quality of cloud computing services, analyzing the advantages and characteristics offered by it. It is a theoretical paper.Keywords: Cloud computing, QoS, quality of cloud computing

Internet-delivered cognitive behavioural therapy for adults with mild to moderate depression and high cardiovascular disease risks: a randomised attention-controlled trial.

Directory of Open Access Journals (Sweden)

Nicholas Glozier

Full Text Available BACKGROUND AND AIM: Mild to moderate depression is common in those with cardiovascular disease and undertreated. We aimed to evaluate the effectiveness of internet-delivered Cognitive Behaviour Therapy (iCBT on depressive symptom severity and adherence to medical advice and lifestyle interventions in adults with mild to moderate depression and high cardiovascular disease (CVD risks. METHODS: Randomised double-blind, 12 week attention-controlled trial comparing an iCBT programme (E-couch with an internet-delivered attention control health information package (HealthWatch, n = 282. The primary outcome was depression symptom level on the nine-item Patient Health Questionnaire (PHQ-9 (trial registration: ACTRN12610000085077. RESULTS: 487/562 (88% participants completed the endpoint assessment. 383/562 (70% were currently treated for cardiovascular disease and 314/562 (56% had at least one other comorbid condition. In ITT analysis of 562 participants iCBT produced a greater decline in the mean PHQ-9 score compared to the attention control of 1.06 (95% CI: 0.23-1.89 points, with differences between the two arms increasing over the intervention period (time by treatment effect interaction p = .012. There were also larger improvements in adherence (2.16 points; 95% CI: 0.33-3.99, reductions in anxiety (0.96 points; 95% CI: 0.19-1.73, and a greater proportion engaging in beneficial physical activity (Odds Ratio 1.91, 95%CI: 1.01-3.61 in the iCBT participants but no effect upon disability, or walking time/day. There were no withdrawals due to study related adverse events. CONCLUSIONS: In people with mild to moderate depression and high levels of CVD risk factors, a freely accessible iCBT programme (http://www.ecouch.anu.edu.au produced a small, but robust, improvement in depressive symptoms, adherence and some health behaviours. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12610000085077.

Particle tracker system delivered to CERN

CERN Multimedia

Pitcher, Graham

2006-01-01

"The CCLRC Rutherford Appleton Laboratory (RAL) has delivered a system to CERN that will help to process the vast amounts of data generated by the silicon tracking detector within the Compact Muon Solenoid experiment." (1/2 page)

High Power Spark Delivery System Using Hollow Core Kagome Lattice Fibers

Directory of Open Access Journals (Sweden)

Ciprian Dumitrache

2014-08-01

Full Text Available This study examines the use of the recently developed hollow core kagome lattice fibers for delivery of high power laser pulses. Compared to other photonic crystal fibers (PCFs, the hollow core kagome fibers have larger core diameter (~50 µm, which allows for higher energy coupling in the fiber while also maintaining high beam quality at the output (M2 = 1.25. We have conducted a study of the maximum deliverable energy versus laser pulse duration using a Nd:YAG laser at 1064 nm. Pulse energies as high as 30 mJ were transmitted for 30 ns pulse durations. This represents, to our knowledge; the highest laser pulse energy delivered using PCFs. Two fiber damage mechanisms were identified as damage at the fiber input and damage within the bulk of the fiber. Finally, we have demonstrated fiber delivered laser ignition on a single-cylinder gasoline direct injection engine.

Quality improvement teaching at medical school: a student perspective

Directory of Open Access Journals (Sweden)

Nair P

2016-03-01

Full Text Available Pooja Nair, Ishani Barai, Sunila Prasad, Karishma Gadhvi Department of Medicine, Imperial College School of Medicine, Imperial College London, London, UK Abstract: Guidelines in the UK require all doctors to actively take part in quality improvement. To ease future doctors into the process, formal quality improvement teaching can be delivered during medical school. Keywords: quality improvement, medical school, patient safety, patient satisfaction, medical student, clinical audit

Learning Disabilities and Achieving High-Quality Education Standards

Science.gov (United States)

Gartland, Debi; Strosnider, Roberta

2017-01-01

This is an official document of the National Joint Committee on Learning Disabilities (NJCLD), of which Council for Learning Disabilities is a long-standing, active member. With this position paper, NJCLD advocates for the implementation of high-quality education standards (HQES) for students with learning disabilities (LD) and outlines the…

CCD Astrophotography High-Quality Imaging from the Suburbs

CERN Document Server

Stuart, Adam

2006-01-01

This is a reference book for amateur astronomers who have become interested in CCD imaging. Those glorious astronomical images found in astronomy magazines might seem out of reach to newcomers to CCD imaging, but this is not the case. Great pictures are attainable with modest equipment. Adam Stuart’s many beautiful images, reproduced in this book, attest to the quality of – initially – a beginner’s efforts. Chilled-chip astronomical CCD-cameras and software are also wonderful tools for cutting through seemingly impenetrable light-pollution. CCD Astrophotography from the Suburbs describes one man’s successful approach to the problem of getting high-quality astronomical images under some of the most light-polluted conditions. Here is a complete and thoroughly tested program that will help every CCD-beginner to work towards digital imaging of the highest quality. It is equally useful to astronomers who have perfect observing conditions, as to those who have to observe from light-polluted city skies.

Distributed mode filtering rod fiber amplifier delivering 292W with improved mode stability

DEFF Research Database (Denmark)

Laurila, Marko; Jørgensen, Mette Marie; Hansen, Kristian Rymann

2012-01-01

We demonstrate a high power fiber (85μm core) amplifier delivering up to 292Watts of average output power using a mode-locked 30ps source at 1032nm. Utilizing a single mode distributed mode filter bandgap rod fiber, we demonstrate 44% power improvement before the threshold-like onset of mode inst...

The influence of knowledge management implementation toward the quality of high schools

Directory of Open Access Journals (Sweden)

Hilda Ainissyifa

2012-09-01

Full Text Available The purpose of this study is to analyze the influence of knowledge management implementation toward the quality of high schools. This study was conducted among five high schools under an education foundation. The analysis models used in the study were correlation analysis and t-test. The respondents were used as the profession references are 86 teachers. The result of the study shows that knowledge management implementation has a positive and significant influence toward the quality of high schools.

Boiling curve in high quality flow boiling

International Nuclear Information System (INIS)

Shiralkar, B.S.; Hein, R.A.; Yadigaroglu, G.

1980-01-01

The post dry-out heat transfer regime of the flow boiling curve was investigated experimentally for high pressure water at high qualities. The test section was a short round tube located downstream of a hot patch created by a temperature controlled segment of tubing. Results from the experiment showed that the distance from the dryout point has a significant effect on the downstream temperatures and there was no unique boiling curve. The heat transfer coefficients measured sufficiently downstream of the dryout point could be correlated using the Heineman correlation for superheated steam, indicating that the droplet deposition effects could be neglected in this region

SU-F-T-511: Feasibility Study of Using Flattening-Filter-Free Photon Beams to Deliver Conventional Flat Beam

International Nuclear Information System (INIS)

Potter, N; Lebron, S; Yan, G; Li, J; Liu, C; Lu, B

2016-01-01

Purpose: Various dosimetric benefits such as increased dose rate, and reduced leakage and out of field dose has led to the growth of FFF technology in the clinic. In this study, we concentrate on investigating the feasibility of using flattening-filter-free (FFF) beams to deliver conventional flat beams (CFB), since completely getting rid of the flattening-filter module from the gantry head can not only simplify the gantry design but also decrease the workload on machine maintain and quality assurance. Methods: The sliding window based IMRT technique was utilized to generate the CFB from the FFF beam for various beam configurations on the Elekta Versa HD. The flat beam reproducibility and MU efficiency were compared for each beam configuration among FFF planning, delivery and CFB planning. Results: Compared to the CFB plan, the 3%3mm passing rates of the FFF beams from both measurement and plan are 100% and 95%(or better) for 15×15 cm 2 or smaller field size and for any field size greater than 15×15 cm 2 at 10 cm depth, respectively. The largest discrepancy is about 5% and typically appears at the field shoulder area. The MU increase average was 80% for FFF compared to CFB, however has a minimal impact on treatment delivery time. Conclusion: The ability to deliver conventional flat treatments is not absent when operating in FFF mode. With proper TPS manipulation and beam modulation, FFF mode can achieve reasonable flat profiles and comparable dose coverage as CFB does for various conventional treatment techniques, such as four field box, or long spine treatment techniques. The ability to deliver most clinical treatments from the same treatment unit, will allow for less quality assurance as well as maintenance, and completely eliminate the need for the flattening filter on modern linacs.

SU-F-T-511: Feasibility Study of Using Flattening-Filter-Free Photon Beams to Deliver Conventional Flat Beam

Energy Technology Data Exchange (ETDEWEB)

Potter, N; Lebron, S; Yan, G; Li, J; Liu, C; Lu, B [University Florida, Gainesville, FL (United States)

2016-06-15

Purpose: Various dosimetric benefits such as increased dose rate, and reduced leakage and out of field dose has led to the growth of FFF technology in the clinic. In this study, we concentrate on investigating the feasibility of using flattening-filter-free (FFF) beams to deliver conventional flat beams (CFB), since completely getting rid of the flattening-filter module from the gantry head can not only simplify the gantry design but also decrease the workload on machine maintain and quality assurance. Methods: The sliding window based IMRT technique was utilized to generate the CFB from the FFF beam for various beam configurations on the Elekta Versa HD. The flat beam reproducibility and MU efficiency were compared for each beam configuration among FFF planning, delivery and CFB planning. Results: Compared to the CFB plan, the 3%3mm passing rates of the FFF beams from both measurement and plan are 100% and 95%(or better) for 15×15 cm{sup 2} or smaller field size and for any field size greater than 15×15 cm{sup 2}at 10 cm depth, respectively. The largest discrepancy is about 5% and typically appears at the field shoulder area. The MU increase average was 80% for FFF compared to CFB, however has a minimal impact on treatment delivery time. Conclusion: The ability to deliver conventional flat treatments is not absent when operating in FFF mode. With proper TPS manipulation and beam modulation, FFF mode can achieve reasonable flat profiles and comparable dose coverage as CFB does for various conventional treatment techniques, such as four field box, or long spine treatment techniques. The ability to deliver most clinical treatments from the same treatment unit, will allow for less quality assurance as well as maintenance, and completely eliminate the need for the flattening filter on modern linacs.

A dynamic allocation mechanism of delivering capacity in coupled networks

International Nuclear Information System (INIS)

Du, Wen-Bo; Zhou, Xing-Lian; Zhu, Yan-Bo; Zheng, Zheng

2015-01-01

Traffic process is ubiquitous in many critical infrastructures. In this paper, we introduce a mechanism to dynamically allocate the delivering capacity into the data-packet traffic model on the coupled Internet autonomous-system-level network of South Korea and Japan, and focus on its effect on the transport efficiency. In this mechanism, the total delivering capacity is constant and the lowest-load node will give one unit delivering capacity to the highest-load node at each time step. It is found that the delivering capacity of busy nodes and non-busy nodes can be well balanced and the effective betweenness of busy nodes with interconnections is significantly reduced. Consequently, the transport efficiency such as average traveling time and packet arrival rate is remarkably improved. Our work may shed some light on the traffic dynamics in coupled networks.

CBE growth of high-quality ZnO epitaxial layers

Energy Technology Data Exchange (ETDEWEB)

El-Shaer, A.; Bakin, A.; Mofor, A.C.; Kreye, M.; Waag, A. [Institute of Semiconductor Technology, Technical University Braunschweig, Hans-Sommer-Strasse 66, 38106 Braunschweig (Germany); Blaesing, J.; Krost, A. [Institute of Experimental Physics, Otto-von-Guericke-University Magdeburg (Germany); Stoimenos, J. [Physics Department, Aristotele University, Univ. Campus, 54006 Thessaloniki (Greece); Pecz, B. [Research Institute for Technical Physics and Materials Science, Hungarian Academy of Sciences, P.O. Box 49, 1525 Budapest (Hungary); Heuken, M. [Aixtron AG, Kackertstr. 15-17, 52072 Aachen (Germany)

2006-03-15

Further improvements on the recently reported novel approach to zinc oxide Chemical Beam Epitaxy (CBE) are presented. Hydrogen peroxide is employed as a very efficient novel oxidant. ZnO layers with a thickness from 100 nm to 600 nm were grown on c-sapphire using a MgO buffer. PL-mapping as well as conductivity mapping shows a good uniformity across the 2 inch ZnO-on-sapphire epiwafers. The measured surface roughness for the best layers is as low as 0.26 nm. HRXRD measurements of the obtained ZnO layers show excellent quality of the single crystalline ZnO. The FWHM of the HRXRD (0002) rocking curves measured for the 2 inch ZnO-on-sapphire wafers is as low as 27 arcsec with a very high lateral homogeneity across the whole wafer. Plane view HRTEM observations reveal the very good quality of the ZnO films. The results indicate that CBE is a suitable technique to fabricate ZnO of very high structural quality, which can eventually be used as an alternative to bulk ZnO substrates. (copyright 2006 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim) (orig.)

High quality factor GaAs microcavity with buried bullseye defects

DEFF Research Database (Denmark)

Winkler, K.; Gregersen, Niels; Hayrynen, T.

2018-01-01

The development of high quality factor solid-state microcavities with low mode volumes has paved the way towards on-chip cavity quantum electrodynamics experiments and the development of high-performance nanophotonic devices. Here, we report on the implementation of a new kind of solid...

Low-cost high-quality crystalline germanium based flexible devices

KAUST Repository

Nassar, Joanna M.

2014-06-16

High performance flexible electronics promise innovative future technology for various interactive applications for the pursuit of low-cost, light-weight, and multi-functional devices. Thus, here we show a complementary metal oxide semiconductor (CMOS) compatible fabrication of flexible metal-oxide-semiconductor capacitors (MOSCAPs) with high-κ/metal gate stack, using a physical vapor deposition (PVD) cost-effective technique to obtain a high-quality Ge channel. We report outstanding bending radius ~1.25 mm and semi-transparency of 30%.

Low-cost high-quality crystalline germanium based flexible devices

KAUST Repository

Nassar, Joanna M.; Hussain, Aftab M.; Rojas, Jhonathan Prieto; Hussain, Muhammad Mustafa

2014-01-01

High performance flexible electronics promise innovative future technology for various interactive applications for the pursuit of low-cost, light-weight, and multi-functional devices. Thus, here we show a complementary metal oxide semiconductor (CMOS) compatible fabrication of flexible metal-oxide-semiconductor capacitors (MOSCAPs) with high-κ/metal gate stack, using a physical vapor deposition (PVD) cost-effective technique to obtain a high-quality Ge channel. We report outstanding bending radius ~1.25 mm and semi-transparency of 30%.

High-quality GaN epitaxially grown on Si substrate with serpentine channels

Science.gov (United States)

Wei, Tiantian; Zong, Hua; Jiang, Shengxiang; Yang, Yue; Liao, Hui; Xie, Yahong; Wang, Wenjie; Li, Junze; Tang, Jun; Hu, Xiaodong

2018-06-01

A novel serpentine-channeled mask was introduced to Si substrate for low-dislocation GaN epitaxial growth and the fully coalesced GaN film on the masked Si substrate was achieved for the first time. Compared with the epitaxial lateral overgrowth (ELOG) growth method, this innovative mask only requires one-step epitaxial growth of GaN which has only one high-dislocation region per mask opening. This new growth method can effectively reduce dislocation density, thus improving the quality of GaN significantly. High-quality GaN with low dislocation density ∼2.4 × 107 cm-2 was obtained, which accounted for about eighty percent of the GaN film in area. This innovative technique is promising for the growth of high-quality GaN templates and the subsequent fabrication of high-performance GaN-based devices like transistors, laser diodes (LDs), and light-emitting diodes (LEDs) on Si substrate.

The Principals and Practice of Distributed High Throughput Computing

CERN Multimedia

CERN. Geneva

2016-01-01

The potential of Distributed Processing Systems to deliver computing capabilities with qualities ranging from high availability and reliability to easy expansion in functionality and capacity were recognized and formalized in the 1970’s. For more three decade these principals Distributed Computing guided the development of the HTCondor resource and job management system. The widely adopted suite of software tools offered by HTCondor are based on novel distributed computing technologies and are driven by the evolving needs of High Throughput scientific applications. We will review the principals that underpin our work, the distributed computing frameworks and technologies we developed and the lessons we learned from delivering effective and dependable software tools in an ever changing landscape computing technologies and needs that range today from a desktop computer to tens of thousands of cores offered by commercial clouds. About the speaker Miron Livny received a B.Sc. degree in Physics and Mat...

Delivering migrant workers' remittances

OpenAIRE

Ballard, Roger

2004-01-01

As globalization has led to ever higher levels of labour mobility, so the volume of funds remitted to their families by workers employed in countries far distant from their homes has increased by leaps and bounds. The total volume of such transfers currently amounts to over $100 billion per annum, the greater part of which flows from economically advanced regions in the West and North to developing countries in the East and South. Delivering those funds swiftly, reliably and cheaply to relati...

Study on quality assurance for high-level radioactive waste disposal project

International Nuclear Information System (INIS)

Takada, Susumu

2005-01-01

The U.S. Department of Energy (DOE) has developed comparatively detailed quality assurance requirements for the high-level radioactive waste disposal systems. Quality assurance is recognized as a key issue for confidence building and smooth implementation of the HLW program in Japan, and Japan is at an initial phase of repository development. Then the quality assurance requirements at site research and site selection, site characterization, and site suitability analysis used in the Yucca Mountain project were examined in detail and comprehensive descriptions were developed using flow charts. Additionally, the applicability to the Japan high-level radioactive waste disposal project was studied. The examination and study were performed for the following QA requirements: The requirements that have the relative importance at site research and site selection, site characterization, and site suitability analysis (such as planning and performing scientific investigations, sample control, data control, model development and use, technical report review, software control, and control of the electric management of data). The requirements that have the relative importance at the whole repository phases (such as quality assurance program, document control, and control of quality assurance records). (author)

Evaluating predictive models of software quality

International Nuclear Information System (INIS)

Ciaschini, V; Canaparo, M; Ronchieri, E; Salomoni, D

2014-01-01

Applications from High Energy Physics scientific community are constantly growing and implemented by a large number of developers. This implies a strong churn on the code and an associated risk of faults, which is unavoidable as long as the software undergoes active evolution. However, the necessities of production systems run counter to this. Stability and predictability are of paramount importance; in addition, a short turn-around time for the defect discovery-correction-deployment cycle is required. A way to reconcile these opposite foci is to use a software quality model to obtain an approximation of the risk before releasing a program to only deliver software with a risk lower than an agreed threshold. In this article we evaluated two quality predictive models to identify the operational risk and the quality of some software products. We applied these models to the development history of several EMI packages with intent to discover the risk factor of each product and compare it with its real history. We attempted to determine if the models reasonably maps reality for the applications under evaluation, and finally we concluded suggesting directions for further studies.

Evaluating Predictive Models of Software Quality

Science.gov (United States)

Ciaschini, V.; Canaparo, M.; Ronchieri, E.; Salomoni, D.

2014-06-01

Applications from High Energy Physics scientific community are constantly growing and implemented by a large number of developers. This implies a strong churn on the code and an associated risk of faults, which is unavoidable as long as the software undergoes active evolution. However, the necessities of production systems run counter to this. Stability and predictability are of paramount importance; in addition, a short turn-around time for the defect discovery-correction-deployment cycle is required. A way to reconcile these opposite foci is to use a software quality model to obtain an approximation of the risk before releasing a program to only deliver software with a risk lower than an agreed threshold. In this article we evaluated two quality predictive models to identify the operational risk and the quality of some software products. We applied these models to the development history of several EMI packages with intent to discover the risk factor of each product and compare it with its real history. We attempted to determine if the models reasonably maps reality for the applications under evaluation, and finally we concluded suggesting directions for further studies.

Effect of high-oxygen and high-carbon-dioxide atmospheres on strawberry flavor and other quality traits.

Science.gov (United States)

Pérez, A G; Sanz, C

2001-05-01

The effect of high-oxygen atmospheres on strawberry flavor was studied. Strawberry fruits (Fragariax ananassa Duch. cv. Camarosa) were stored at 8 degrees C in four different atmospheres: air, 5% O(2)/20% CO(2), 80% O(2)/20% CO(2), and 90% O(2)/10% CO(2). Changes in several quality parameters were evaluated. Atmospheres combining high O(2) and high CO(2) were the most effective in preventing fungal growth and enhancing strawberry firmness. Other quality parameters such as color, titrable acidity, sugars and organic acids distribution, off-flavor development, and aroma were only mildly affected by superatmospheric O(2) levels. After one week of storage, unexpected high contents of off-flavor related compounds were found in the 80% O(2)/20% CO(2) and 90% O(2)/10% CO(2) atmospheres. Evidence of an altered ester biosynthesis was also found in fruits stored under these high-O(2) atmospheres. Data obtained suggest that stress induced by high CO(2) and stress induced by high O(2) have an additive effect on strawberry flavor alteration.

IMRT delivers lower radiation doses to dental structures than 3DRT in head and neck cancer patients

International Nuclear Information System (INIS)

Fregnani, Eduardo Rodrigues; Parahyba, Cláudia Joffily; Morais-Faria, Karina; Fonseca, Felipe Paiva; Ramos, Pedro Augusto Mendes; Moraes, Fábio Yone de; Conceição Vasconcelos, Karina Gondim Moutinho da; Menegussi, Gisela; Santos-Silva, Alan Roger; Brandão, Thais B.

2016-01-01

Radiotherapy (RT) is frequently used in the treatment of head and neck cancer, but different side-effects are frequently reported, including a higher frequency of radiation-related caries, what may be consequence of direct radiation to dental tissue. The intensity-modulated radiotherapy (IMRT) was developed to improve tumor control and decrease patient’s morbidity by delivering radiation beams only to tumor shapes and sparing normal tissue. However, teeth are usually not included in IMRT plannings and the real efficacy of IMRT in the dental context has not been addressed. Therefore, the aim of this study is to assess whether IMRT delivers lower radiation doses to dental structures than conformal 3D radiotherapy (3DRT). Radiation dose delivery to dental structures of 80 patients treated for head and neck cancers (oral cavity, tongue, nasopharynx and oropharynx) with IMRT (40 patients) and 3DRT (40 patients) were assessed by individually contouring tooth crowns on patients’ treatment plans. Clinicopathological data were retrieved from patients’ medical files. The average dose of radiation to teeth delivered by IMRT was significantly lower than with 3DRT (p = 0.007); however, only patients affected by nasopharynx and oral cavity cancers demonstrated significantly lower doses with IMRT (p = 0.012 and p = 0.011, respectively). Molars received more radiation with both 3DRT and IMRT, but the latter delivered significantly lower radiation in this group of teeth (p < 0.001), whereas no significant difference was found for the other dental groups. Maxillary teeth received lower doses than mandibular teeth, but only IMRT delivered significantly lower doses (p = 0.011 and p = 0.003). Ipsilateral teeth received higher doses than contralateral teeth with both techniques and IMRT delivered significantly lower radiation than 3DRT for contralateral dental structures (p < 0.001). IMRT delivered lower radiation doses to teeth than 3DRT, but only for some groups of patients and

Delivering "Just-In-Time" Smoking Cessation Support Via Mobile Phones: Current Knowledge and Future Directions.

Science.gov (United States)

Naughton, Felix

2016-05-28

Smoking lapses early on during a quit attempt are highly predictive of failing to quit. A large proportion of these lapses are driven by cravings brought about by situational and environmental cues. Use of cognitive-behavioral lapse prevention strategies to combat cue-induced cravings is associated with a reduced risk of lapse, but evidence is lacking in how these strategies can be effectively promoted. Unlike most traditional methods of delivering behavioral support, mobile phones can in principle deliver automated support, including lapse prevention strategy recommendations, Just-In-Time (JIT) for when a smoker is most vulnerable, and prevent early lapse. JIT support can be activated by smokers themselves (user-triggered), by prespecified rules (server-triggered) or through sensors that dynamically monitor a smoker's context and trigger support when a high risk environment is sensed (context-triggered), also known as a Just-In-Time Adaptive Intervention (JITAI). However, research suggests that user-triggered JIT cessation support is seldom used and existing server-triggered JIT support is likely to lack sufficient accuracy to effectively target high-risk situations in real time. Evaluations of mobile phone cessation interventions that include user and/or server-triggered JIT support have yet to adequately assess whether this improves management of high risk situations. While context-triggered systems have the greatest potential to deliver JIT support, there are, as yet, no impact evaluations of such systems. Although it may soon be feasible to learn about and monitor a smoker's context unobtrusively using their smartphone without burdensome data entry, there are several potential advantages to involving the smoker in data collection. This commentary describes the current knowledge on the potential for mobile phones to deliver automated support to help smokers manage or cope with high risk environments or situations for smoking, known as JIT support. The article

The effect of an outdoor activities' intervention delivered by older volunteers on the quality of life of older people with severe mobility limitations: a randomized controlled trial.

Science.gov (United States)

Rantanen, Taina; Äyräväinen, Irma; Eronen, Johanna; Lyyra, Tiinamari; Törmäkangas, Timo; Vaarama, Marja; Rantakokko, Merja

2015-04-01

Older community-living disabled people often have unmet activity needs and participation restrictions potentially reducing their quality of life (QoL). We examined the effects of an individualized out-of-home activity intervention delivered by volunteers on QoL among community-living older people, who have difficulty accessing the outdoors independently. Volunteering, Access to Outdoor Activities and Wellbeing in Older People (VOW; ISRCTN56847832) was a two-arm randomized single-blinded, controlled effectiveness trial (RCT) in Jyväskylä, Finland. The inclusion criteria were: age 65 or over, severe mobility limitation, able to communicate, and agree to participate in a RCT. Each intervention group member was assigned a trained volunteer with whom out-of-home activities were done once a week for 3 months (e.g., running errands or recreational activities). The primary outcome was the environmental subscore of QoL assessed with WHOQOL-BREF. Secondary outcomes were the overall QoL, physical capacity, psychological well-being, and social relationships assessed with WHOQOL_BREF and lower-extremity performance assessed with Short Physical Performance Battery (SPPB). 121 people aged 67-92 years (mean age 81.9 years, SD 5.9, 90 % women) were randomized. No treatment effect on the environmental QoL subscore was observed, but for physical capacity subscore a significant treatment effect was observed (General Linear Model, Group by Time p = 0.001). No effects were observed for the other QoL subscores or for SPPB score. This study suggests that individualized out-of-home activity intervention delivered by volunteers may influence the QoL of old severely mobility-limited community-living people in a positive way. Further studies are needed to better understand how to improve QoL of older disabled community-living people and potentially buffer them against more severe care needs and institutionalization.

A safe inexpensive method to isolate high quality plant and fungal ...

African Journals Online (AJOL)

STORAGESEVER

2008-08-18

Aug 18, 2008 ... quality DNA from plant and fungal species. This method uses potassium acetate to remove proteins and polysaccharides in an SDS extraction buffer. Further DNA purification is achieved using a low salt. CTAB treatment. This SDS/CTAB protocol was used to isolate high quality genomic DNA subject to.

Computer-delivered and web-based interventions to improve depression, anxiety, and psychological well-being of university students: a systematic review and meta-analysis.

Science.gov (United States)

Davies, E Bethan; Morriss, Richard; Glazebrook, Cris

2014-05-16

Depression and anxiety are common mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used to improve students' mental health. The effectiveness of these intervention types requires investigation to identify whether these are viable prevention strategies for university students. The intent of the study was to systematically review and analyze trials of Web-based and computer-delivered interventions to improve depression, anxiety, psychological distress, and stress in university students. Several databases were searched using keywords relating to higher education students, mental health, and eHealth interventions. The eligibility criteria for studies included in the review were: (1) the study aimed to improve symptoms relating to depression, anxiety, psychological distress, and stress, (2) the study involved computer-delivered or Web-based interventions accessed via computer, laptop, or tablet, (3) the study was a randomized controlled trial, and (4) the study was trialed on higher education students. Trials were reviewed and outcome data analyzed through random effects meta-analyses for each outcome and each type of trial arm comparison. Cochrane Collaboration risk of bias tool was used to assess study quality. A total of 17 trials were identified, in which seven were the same three interventions on separate samples; 14 reported sufficient information for meta-analysis. The majority (n=13) were website-delivered and nine interventions were based on cognitive behavioral therapy (CBT). A total of 1795 participants were randomized and 1480 analyzed. Risk of bias was considered moderate, as many publications did not sufficiently report their methods and seven explicitly conducted completers' analyses. In comparison to the inactive

Internet-delivered cognitive behavior therapy for adolescents with functional gastrointestinal disorders — An open trial

Directory of Open Access Journals (Sweden)

Marianne Bonnert

2014-07-01

Full Text Available Functional gastrointestinal disorders (FGID, including irritable bowel syndrome, functional dyspepsia and functional abdominal pain, are common in adolescents and are associated with substantially decreased quality of life. Cognitive behavior therapy for children and adolescents with FGID is one of few treatments that have shown effect, but treatment access is limited. In adults with irritable bowel syndrome, exposure-based internet-delivered CBT (ICBT leads to reduced symptoms and increased quality of life, but studies in children are lacking. This open pilot aimed to evaluate feasibility and the potential efficacy of an exposure-based ICBT-program for adolescents with pain-predominant FGID. Twenty-nine adolescents (age 13–17, with FGID were included. The ICBT-program lasted for 8 weeks with weekly online therapist support. The protocol for adolescents included exposure to abdominal symptoms, while the protocol for parents aimed at increasing parents' attention to adolescent healthy behaviors. Assessment points were baseline, post-treatment and 6-month follow-up. The primary outcome was the Gastrointestinal Symptoms Rating Scale-IBS (GSRS-IBS. Effect sizes were calculated using Cohen's d in an intent to treat analysis. GSRS-IBS improved significantly from baseline to post-treatment (mean difference 6.48; 95% CI [2.37–10.58] and to follow-up (mean difference 7.82; 95% CI [3.43–12.21], corresponding to moderate effect sizes (within-group Cohen's d = 0.50; 95% CI [0.16–0.84] and d = 0.63; 95% CI [0.24–1.02], respectively. Treatment adherence was high with 22 of 29 (76% adolescents completing the entire treatment period. High adherence indicates acceptability of format and content, while symptomatic improvement suggests potential efficacy for this ICBT intervention in adolescents with FGID.

Effectiveness of mobile technologies delivering Ecological Momentary Interventions for stress and anxiety: a systematic review.

Science.gov (United States)

Loo Gee, Brendan; Griffiths, Kathleen M; Gulliver, Amelia

2016-01-01

Mobile technologies may be suitable for delivering Ecological Momentary Interventions (EMI) to treat anxiety in real-time. This review aims to synthesize evidence on the effectiveness of EMI for treating anxiety conditions. Four databases and the reference lists of previous studies were searched. A total of 1949 abstracts were double screened for inclusion. Sufficient studies were available to undertake a quantitative meta-analysis on EMIs on generalized anxiety symptoms. The 15 randomized trials and randomized controlled trials examined anxiety (n = 7), stress (n = 3), anxiety and stress (n = 2), panic disorder (n = 2), and social phobia (n = 1). Eight EMIs comprised self-monitoring integrated with therapy modules, seven comprised multimedia content, and three comprised self-monitoring only. The quality of studies presented high risk of biases. Meta-analysis (n = 7) demonstrated that EMIs reduced generalized anxiety compared to control and/or comparison groups (Effect Size (ES) = 0.32, 95% CI, 0.12-0.53). Most EMIs targeting stress were reported effective relative to control as were the two EMIs targeting panic disorders. The EMI targeting social phobia was not effective. EMIs have potential in treating both anxiety and stress. However, few high-quality trials have been conducted for specific anxiety disorders. Further trials are needed to assess the value of EMI technologies for anxiety in enhancing existing treatments. This study found a small significant effect of EMI studies on reducing generalized anxiety. Studies on stress demonstrated EMI was effective compared to control, with the small number of studies on panic and social phobia demonstrating mixed results. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Wellbeing Understanding in High Quality Healthcare Informatics and Telepractice.

Science.gov (United States)

Fiorini, Rodolfo A; De Giacomo, Piero; L'Abate, Luciano

2016-01-01

The proper use of healthcare informatics technology and multidimensional conceptual clarity are fundamental to create and boost outstanding clinical and telepractice results. Avoiding even terminology ambiguities is mandatory for high quality of care service. For instance, well-being or wellbeing is a different way to write the same concept only, or there is a good deal of ambiguity around the meanings of these terms the way they are written. In personal health, healthcare and healthcare informatics, this kind of ambiguity and lack of conceptual clarity has been called out repeatedly over the past 50 years. It is time to get the right, terse scenario. We present a brief review to develop and achieve ultimate wellbeing understanding for practical high quality healthcare informatics and telepractice application. This article presents an innovative point of view on deeper wellbeing understanding towards its increased clinical effective application.

Construction of High-Quality Camel Immune Antibody Libraries.

Science.gov (United States)

Romão, Ema; Poignavent, Vianney; Vincke, Cécile; Ritzenthaler, Christophe; Muyldermans, Serge; Monsion, Baptiste

2018-01-01

Single-domain antibodies libraries of heavy-chain only immunoglobulins from camelids or shark are enriched for high-affinity antigen-specific binders by a short in vivo immunization. Thus, potent binders are readily retrieved from relatively small-sized libraries of 10 7 -10 8 individual transformants, mostly after phage display and panning on a purified target. However, the remaining drawback of this strategy arises from the need to generate a dedicated library, for nearly every envisaged target. Therefore, all the procedures that shorten and facilitate the construction of an immune library of best possible quality are definitely a step forward. In this chapter, we provide the protocol to generate a high-quality immune VHH library using the Golden Gate Cloning strategy employing an adapted phage display vector where a lethal ccdB gene has to be substituted by the VHH gene. With this procedure, the construction of the library can be shortened to less than a week starting from bleeding the animal. Our libraries exceed 10 8 individual transformants and close to 100% of the clones harbor a phage display vector having an insert with the length of a VHH gene. These libraries are also more economic to make than previous standard approaches using classical restriction enzymes and ligations. The quality of the Nanobodies that are retrieved from immune libraries obtained by Golden Gate Cloning is identical to those from immune libraries made according to the classical procedure.

Interventional radiology delivers high-value health care and is an Imaging 3.0 vanguard.

Science.gov (United States)

Charalel, Resmi A; McGinty, Geraldine; Brant-Zawadzki, Michael; Goodwin, Scott C; Khilnani, Neil M; Matsumoto, Alan H; Min, Robert J; Soares, Gregory M; Cook, Philip S

2015-05-01

Given the changing climate of health care and the imperative to add value, radiologists must join forces with the rest of medicine to deliver better patient care in a more cost-effective, evidence-based manner. For several decades, interventional radiology has added value to the health care system through innovation and the provision of alternative and effective minimally invasive treatments, which have decreased morbidity, mortality, and overall cost. The clinical practice of interventional radiology embodies many of the features of Imaging 3.0, the program recently launched by the ACR. We provide a review of some of the major contributions made by interventional radiology and offer general principles from that experience, which are applicable to all radiologists. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Air Quality Standards for Particulate Matter (PM) at high altitude cities

International Nuclear Information System (INIS)

Bravo Alvarez, H.; Sosa Echeverria, R.; Sanchez Alvarez, P.; Krupa, S.

2013-01-01

The Air Quality Standards for Particulate Matter (PM) at high altitude urban areas in different countries, must consider the pressure and temperature due to the effect that these parameters have on the breath volume. This paper shows the importance to correct Air Quality Standards for PM considering pressure and temperature at different altitudes. Specific factors were suggested to convert the information concerning PM, from local to standard conditions, and adjust the Air Quality Standards for different high altitudes cities. The correction factors ranged from: 1.03 for Santiago de Chile to 1.47 for El Alto Bolivia. Other cities in this study include: Mexico City, México; La Paz, Bolivia; Bogota, Cali and Medellin, Colombia; Quito, Ecuador and Cuzco, Peru. If these corrections are not considered, the atmospheric concentrations will be underestimated. - Highlights: ► AQS for particulate matter concentrations adjusted by pressure and temperature. ► Particulate matter concentrations can be underestimated in high altitude Cities. ► Particulate matter concentrations must be compared under the same conditions. - In order to compare high altitude atmospheric PM concentrations with AQS, one must consider T and P of the sampling site.

Long-term corporate climate change targets: What could they deliver?

International Nuclear Information System (INIS)

Gouldson, Andy; Sullivan, Rory

2013-01-01

Highlights: ► Increasingly, companies are setting long-term greenhouse gas emission reduction targets. ► Many of these corporate targets appear to exceed those being set by national governments. ► Achieving these corporate targets relies on energy prices remaining high. ► Weaknesses in corporate reporting make it difficult to tell whether targets are being achieved. -- Abstract: Driven by the rising cost of energy, stakeholder pressure and the expectation that governments will continue to implement policy measures directed at reducing greenhouse gas emissions, an increasing number of companies have set targets to reduce their greenhouse gas emissions. These commitments raise two important questions. The first is whether they can be considered – individually or collectively – to be an appropriate response to the threat presented by climate change. The second is whether they are dependable; that is, can policy makers and other stakeholders can rely on companies to deliver on the commitments that they have made? This article examines these two questions using the case of the UK supermarket sector to illustrate and explain the issues at stake and, more generally, to examine the contribution that these types of voluntary commitments can make to wider public policy goals on climate change. The reasons for focusing on the UK supermarket sector are that the companies in this sector are some of the largest retailers in the world, they are significant emitters (their direct emissions account for 0.9% of UK carbon emissions, and some indications suggest that their indirect emissions account for ten times as much), and they are less heavily regulated that other sectors with comparable carbon footprints. The article concludes that the targets being set voluntarily by companies in this sector align with, or may even exceed, the climate change policy goals being set by national governments. Moreover, the article concludes that the companies targets are plausible and

Stainless steel fabrication for high quality requirements in the nuclear industry

International Nuclear Information System (INIS)

Wareing, A.J.

1990-01-01

In this paper the author explains the welding procedures and practices adopted within the nuclear industry to achieve the high quality and standards of welds required. The changeover to mechanised welding, orbital TIG welding and synergic MIG welding, has resulted in consistent achievement of high quality standards as well as optimising the productivity. However, the use of mechanised welding machines does require the welder operating them to be fully trained and qualified. The formally organised training courses are described and the cost savings and production rates achieved by utilising the mechanised method are discussed. (author)

How natural capital delivers ecosystem services

NARCIS (Netherlands)

Smith, A.C.; Harrison, P.A.; Pérez Soba, M.; Archaux, F.; Blicharska, M.; Egoh, B.N.; Erős, T.; Fabrega Domenech, N.; György, I.; Haines-Young, R.; Li, S.; Lommelen, E.; Meiresonne, L.; Miguel Ayala, L.; Mononen, L.; Simpson, G.; Stange, E.; Turkelboom, F.; Uiterwijk, M.; Veerkamp, C.J.; Wyllie de Echeverria, V.

2017-01-01

There is no unified evidence base to help decision-makers understand how the multiple components of natural capital interact to deliver ecosystem services. We systematically reviewed 780 papers, recording how natural capital attributes (29 biotic attributes and 11 abiotic factors) affect the

Application of stochastic programming to reduce uncertainty in quality-based supply planning of slaughterhouses

NARCIS (Netherlands)

Rijpkema, W.A.; Hendrix, E.M.T.; Rossi, R.; Vorst, van der J.G.A.J.

2016-01-01

To match products of different quality with end market preferences under supply uncertainty, it is crucial to integrate product quality information in logistics decision making. We present a case of this integration in a meat processing company that faces uncertainty in delivered livestock quality.

IMRT delivers lower radiation doses to dental structures than 3DRT in head and neck cancer patients.

Science.gov (United States)

Fregnani, Eduardo Rodrigues; Parahyba, Cláudia Joffily; Morais-Faria, Karina; Fonseca, Felipe Paiva; Ramos, Pedro Augusto Mendes; de Moraes, Fábio Yone; da Conceição Vasconcelos, Karina Gondim Moutinho; Menegussi, Gisela; Santos-Silva, Alan Roger; Brandão, Thais B

2016-09-07

Radiotherapy (RT) is frequently used in the treatment of head and neck cancer, but different side-effects are frequently reported, including a higher frequency of radiation-related caries, what may be consequence of direct radiation to dental tissue. The intensity-modulated radiotherapy (IMRT) was developed to improve tumor control and decrease patient's morbidity by delivering radiation beams only to tumor shapes and sparing normal tissue. However, teeth are usually not included in IMRT plannings and the real efficacy of IMRT in the dental context has not been addressed. Therefore, the aim of this study is to assess whether IMRT delivers lower radiation doses to dental structures than conformal 3D radiotherapy (3DRT). Radiation dose delivery to dental structures of 80 patients treated for head and neck cancers (oral cavity, tongue, nasopharynx and oropharynx) with IMRT (40 patients) and 3DRT (40 patients) were assessed by individually contouring tooth crowns on patients' treatment plans. Clinicopathological data were retrieved from patients' medical files. The average dose of radiation to teeth delivered by IMRT was significantly lower than with 3DRT (p = 0.007); however, only patients affected by nasopharynx and oral cavity cancers demonstrated significantly lower doses with IMRT (p = 0.012 and p = 0.011, respectively). Molars received more radiation with both 3DRT and IMRT, but the latter delivered significantly lower radiation in this group of teeth (p dental groups. Maxillary teeth received lower doses than mandibular teeth, but only IMRT delivered significantly lower doses (p = 0.011 and p = 0.003). Ipsilateral teeth received higher doses than contralateral teeth with both techniques and IMRT delivered significantly lower radiation than 3DRT for contralateral dental structures (p radiation doses to teeth than 3DRT, but only for some groups of patients and teeth, suggesting that this decrease was more likely due to the protection of

Z-Source Inverter Based Power Quality Compensator with Enhanced Ride-Through Capability

DEFF Research Database (Denmark)

Gajanayake, C.J.; Vilathgamuwa, D.M.; Loh, P.C.

2007-01-01

Distributed generation has been gaining acceptance over the years and it has the potential to provide reliable power to sensitive loads. However, distributed networks are prone to unbalanced faults conditions. This makes single inverter DG systems unsuitable as UPS systems. This paper proposes...... a Zsource inverter based power quality compensator and a control structure that supplies high quality voltage to the connected sensitive load in the presence of other non linear loads. The proposed topology consists of combination of shunt and series inverters connected to a common Z-source impedance...... network. The shunt inverter is controlled to maintain a quality voltage waveform at the load bus. Whereas the series inverter enhances the ride-through capability during grid faults, protects the shunt inverter by limiting the current and also controls the power delivered to the grid. The performance...

SWEET CubeSat - Water detection and water quality monitoring for the 21st century

Science.gov (United States)

Antonini, Kelly; Langer, Martin; Farid, Ahmed; Walter, Ulrich

2017-11-01

Water scarcity and contamination of clean water have been identified as major challenges of the 21st century, in particular for developing countries. According to the International Water Management Institute, about 30% of the world's population does not have reliable access to clean water. Consequently, contaminated water contributes to the death of about 3 million people every year, mostly children. Access to potable water has been proven to boost education, equality and health, reduce hunger, as well as help the economy of the developing world. Currently used in-situ water monitoring techniques are sparse, and often difficult to execute. Space-based instruments will help to overcome these challenges by providing means for water level and water quality monitoring of medium-to-large sweet (fresh) water reservoirs. Data from hyperspectral imaging instruments on past and present governmental missions, such as Envisat and Aqua, has been used for this purpose. However, the high cost of large multi-purpose space vessels, and the lack of dedicated missions limits the continuous monitoring of inland and coastal water quality. The proposed CubeSat mission SWEET (Sweet Water Earth Education Technologies) will try to fill this gap. The SWEET concept is a joint effort between the Technical University of Munich, the German Space Operations Center and the African Steering Committee of the IAF. By using a novel Fabry-Perot interferometer-based hyperspectral imager, the mission will deliver critical data directly to national water resource centers in Africa with an unmatched cost per pixel ratio and high temporal resolution. Additionally, SWEET will incorporate education of students in CubeSat design and water management. Although the aim of the mission is to deliver local water quality and water level data to African countries, further coverage could be achieved with subsequent satellites. Finally, a constellation of SWEET-like CubeSats would extend the coverage to the whole

Quality factors for monoenergetic neutrons

International Nuclear Information System (INIS)

Cross, W.G.; Ing, H.

1984-01-01

Mean quality factors anti Q(E/sub n/), for the dose resulting from first interactons of monoenergetic neutrons in tissue, have been calculated at energies from thermal to 14.7 MeV. Knowledge of these values, along with kerma factors, allows the calculation of the heavy-particle dose equivalent for any known neutron spectrum in tissue. The partial quality factors for the dose delivered by C, N, and O elastic and inelastic recoils are found to be virtually independent of the scattering angular distributions and are given by simple expressions

Service quality of cloud-based applications

CERN Document Server

Bauer, Eric

2014-01-01

This book explains why applications running on cloud might not deliver the same service reliability, availability, latency and overall quality to end users as they do when the applications are running on traditional (non-virtualized, non-cloud) configurations, and explains what can be done to mitigate that risk.

Assessing Quality Outcome Measures in Children with Coeliac Disease—Experience from Two UK Centres

Science.gov (United States)

Ross, Alexander; Shelley, Helen; Novell, Kim; Ingham, Elizabeth; Callan, Julia; Heuschkel, Robert; Morris, Mary-Anne; Zilbauer, Matthias

2013-01-01

Improved diagnosis of coeliac disease has increased incidence and therefore burden on the health care system. There are no quality outcome measures (QOM) in use nationally to assess hospital management of this condition. This study applied QOM devised by the East of England paediatric gastroenterology network to 99 patients reviewed at two tertiary hospitals in the Network, to assess the quality of care provided by nurse led and doctor led care models. The average performance across all QOM was 96.2% at Addenbrooke’s Hospital (AH), and 98.7% at Norfolk and Norwich Hospital (NNUH), whilst 95% (n = 18) of QOM were met. Patient satisfaction was high at both sites (uptake of questionnaire 53 of 99 patients in the study). The study showed a comparably high level of care delivered by both a nurse and doctor led service. Our quality assessment tools could be applied in the future by other centres to measure standards of care. PMID:24284612

Assessing Quality Outcome Measures in Children with Coeliac Disease—Experience from Two UK Centres

Directory of Open Access Journals (Sweden)

Alexander Ross

2013-11-01

Full Text Available Improved diagnosis of coeliac disease has increased incidence and therefore burden on the health care system. There are no quality outcome measures (QOM in use nationally to assess hospital management of this condition. This study applied QOM devised by the East of England paediatric gastroenterology network to 99 patients reviewed at two tertiary hospitals in the Network, to assess the quality of care provided by nurse led and doctor led care models. The average performance across all QOM was 96.2% at Addenbrooke’s Hospital (AH, and 98.7% at Norfolk and Norwich Hospital (NNUH, whilst 95% (n = 18 of QOM were met. Patient satisfaction was high at both sites (uptake of questionnaire 53 of 99 patients in the study. The study showed a comparably high level of care delivered by both a nurse and doctor led service. Our quality assessment tools could be applied in the future by other centres to measure standards of care.

A randomized trial of videoconference-delivered cognitive behavioral therapy for survivors of breast cancer with self-reported cognitive dysfunction.

Science.gov (United States)

Ferguson, Robert J; Sigmon, Sandra T; Pritchard, Andrew J; LaBrie, Sharon L; Goetze, Rachel E; Fink, Christine M; Garrett, A Merrill

2016-06-01

Long-term chemotherapy-related cognitive dysfunction (CRCD) affects a large number of cancer survivors. To the authors' knowledge, to date there is no established treatment for this survivorship problem. The authors herein report results of a small randomized controlled trial of a cognitive behavioral therapy (CBT), Memory and Attention Adaptation Training (MAAT), compared with an attention control condition. Both treatments were delivered over a videoconference device. A total of 47 survivors of female breast cancer who reported CRCD were randomized to MAAT or supportive therapy and were assessed at baseline, after treatment, and at 2 months of follow-up. Participants completed self-report measures of cognitive symptoms and quality of life and a brief telephone-based neuropsychological assessment. MAAT participants made gains in perceived (self-reported) cognitive impairments (P = .02), and neuropsychological processing speed (P = .03) compared with supportive therapy controls. A large MAAT effect size was observed at the 2-month follow-up with regard to anxiety concerning cognitive problems (Cohen's d for standard differences in effect sizes, 0.90) with medium effects noted in general function, fatigue, and anxiety. Survivors rated MAAT and videoconference delivery with high satisfaction. MAAT may be an efficacious psychological treatment of CRCD that can be delivered through videoconference technology. This research is important because it helps to identify a treatment option for survivors that also may improve access to survivorship services. Cancer 2016;122:1782-91. © 2016 American Cancer Society. © 2016 American Cancer Society.

Ensuring suitable quality of clinical measurements through design.

Science.gov (United States)

Orzechowski, Anthony; Petrides, Victoria; Scopp, Richard

2018-04-17

To design and deliver high quality, safe and effective products, manufacturers of in vitro diagnostic (IVD) products follow a structured, traceable process for controlling the uncertainty of results reported from their measurement systems. This process and its results however, are not often shared in detail with those outside of the manufacturing company. The objective of this paper is to facilitate discussion by describing some of the best practices used during the IVD design and development process, highlighting some design challenges manufacturers face, and to offer ideas for how IVD manufacturers and laboratories could work together to drive further improvement to public health. Copyright © 2018. Published by Elsevier Inc.

Tracking the Quality of Care for Sick Children Using Lot Quality Assurance Sampling: Targeting Improvements of Health Services in Jigawa, Nigeria

OpenAIRE

Oladele, Edward Adekola; Ormond, Louise; Adeyemi, Olusegun; Patrick, David; Okoh, Festus; Oresanya, Olusola Bukola; Valadez, Joseph J.

2012-01-01

BACKGROUND\\ud \\ud In Nigeria, 30% of child deaths are due to malaria. The National Malaria Control Program of Nigeria (NMCP) during 2009 initiated a program to improve the quality of paediatric malaria services delivered in health facilities (HF). This study reports a rapid approach used to assess the existing quality of services in Jigawa state at decentralised levels of the health system.\\ud \\ud METHODS\\ud \\ud NMCP selected Lot Quality Assurance Sampling (LQAS) to identify the variation in ...

Developments in Technology-Delivered Psychological Interventions / Desarrollos en Intervenciones Psicológicas utilizando la Tecnología

Directory of Open Access Journals (Sweden)

Derek Richards

2013-06-01

Full Text Available The worldwide penetration of the Internet and its related technologies, the rapid developments of new technologies and the pervasive use of technology in people’s lives, are indicators that we live in a technological age. New technologies and their potential for use in psychological interventions and mental health services have not gone unnoticed. The last 15 years or so have witnessed the employment of new technologies in developing and delivering a variety of psychological interventions, these include information WebPages, internet-based computer programs that are addressed to treatment of specific problems, the use of mobile phones and games to help psychological practice, among others. However, while a broad range of technology-delivered psychological interventions have demonstrated success in high-income countries, little is known of their potential for countries such as Colombia. The paper begins with a brief history, followed by an overview of the field of technology-delivered psychological interventions. Lastly, the paper seeks to present a justification for the potential use of technology delivered psychological interventions in Colombia.

Video quality measure for mobile IPTV service

Science.gov (United States)

Kim, Wonjun; Kim, Changick

2008-08-01

Mobile IPTV is a multimedia service based on wireless networks with interactivity and mobility. Under mobile IPTV scenarios, people can watch various contents whenever they want and even deliver their request to service providers through the network. However, the frequent change of the wireless channel bandwidth may hinder the quality of service. In this paper, we propose an objective video quality measure (VQM) for mobile IPTV services, which is focused on the jitter measurement. Jitter is the result of frame repetition during the delay and one of the most severe impairments in the video transmission via mobile channels. We first employ YUV color space to compute the duration and occurrences of jitter and the motion activity. Then the VQM is modeled by the combination of these three factors and the result of subjective assessment. Since the proposed VQM is based on no-reference (NR) model, it can be applied for real-time applications. Experimental results show that the proposed VQM highly correlates to subjective evaluation.

CSRNet: Dilated Convolutional Neural Networks for Understanding the Highly Congested Scenes

OpenAIRE

Li, Yuhong; Zhang, Xiaofan; Chen, Deming

2018-01-01

We propose a network for Congested Scene Recognition called CSRNet to provide a data-driven and deep learning method that can understand highly congested scenes and perform accurate count estimation as well as present high-quality density maps. The proposed CSRNet is composed of two major components: a convolutional neural network (CNN) as the front-end for 2D feature extraction and a dilated CNN for the back-end, which uses dilated kernels to deliver larger reception fields and to replace po...

Research article – A comparison of Sinogram Affirmed Iterative Reconstruction and filtered back projection on image quality and dose reduction in paediatric head CT: a phantom study

NARCIS (Netherlands)

Bakker, Astrid; de Lange, René; Ahmed, Abdulfatah; Garcia, André; Tomkinson, David; Salamin, Julie; Buyvidovich, Sergey A.; Sohrabi, Tina; Dominguez, Alexandre; Campeanu, Cosmin

2015-01-01

Background: Computed tomography (CT) is one of the most used modalities for diagnostics in paediatric populations, which is a concern as it also delivers a high patient dose. Research has focused on developing computer algorithms that provide better image quality at lower dose. The iterative

76 FR 45397 - Export Inspection and Weighing Waiver for High Quality Specialty Grain Transported in Containers

Science.gov (United States)

2011-07-29

...-AB18 Export Inspection and Weighing Waiver for High Quality Specialty Grain Transported in Containers... permanent a waiver due to expire on July 31, 2012, for high quality specialty grain exported in containers... of high quality specialty grain exported in containers are small entities that up until recently...

Quality of life of people living with HIV/AIDS and on highly active ...

African Journals Online (AJOL)

Quality of life of people living with HIV/AIDS and on highly active ... the Short Form-36 Health Survey (SF-36) was used to measure quality of life among patients on ... instrument for use in Ethiopia to assess the quality of life of people living with ...

An Agrobacterium-delivered CRISPR/Cas9 system for high-frequency targeted mutagenesis in maize.

Science.gov (United States)

Char, Si Nian; Neelakandan, Anjanasree K; Nahampun, Hartinio; Frame, Bronwyn; Main, Marcy; Spalding, Martin H; Becraft, Philip W; Meyers, Blake C; Walbot, Virginia; Wang, Kan; Yang, Bing

2017-02-01

CRISPR/Cas9 is a powerful genome editing tool in many organisms, including a number of monocots and dicots. Although the design and application of CRISPR/Cas9 is simpler compared to other nuclease-based genome editing tools, optimization requires the consideration of the DNA delivery and tissue regeneration methods for a particular species to achieve accuracy and efficiency. Here, we describe a public sector system, ISU Maize CRISPR, utilizing Agrobacterium-delivered CRISPR/Cas9 for high-frequency targeted mutagenesis in maize. This system consists of an Escherichia coli cloning vector and an Agrobacterium binary vector. It can be used to clone up to four guide RNAs for single or multiplex gene targeting. We evaluated this system for its mutagenesis frequency and heritability using four maize genes in two duplicated pairs: Argonaute 18 (ZmAgo18a and ZmAgo18b) and dihydroflavonol 4-reductase or anthocyaninless genes (a1 and a4). T 0 transgenic events carrying mono- or diallelic mutations of one locus and various combinations of allelic mutations of two loci occurred at rates over 70% mutants per transgenic events in both Hi-II and B104 genotypes. Through genetic segregation, null segregants carrying only the desired mutant alleles without the CRISPR transgene could be generated in T 1 progeny. Inheritance of an active CRISPR/Cas9 transgene leads to additional target-specific mutations in subsequent generations. Duplex infection of immature embryos by mixing two individual Agrobacterium strains harbouring different Cas9/gRNA modules can be performed for improved cost efficiency. Together, the findings demonstrate that the ISU Maize CRISPR platform is an effective and robust tool to targeted mutagenesis in maize. © 2016 The Authors. Plant Biotechnology Journal published by Society for Experimental Biology and The Association of Applied Biologists and John Wiley & Sons Ltd.

A Systematic Process for Developing High Quality SaaS Cloud Services

Science.gov (United States)

La, Hyun Jung; Kim, Soo Dong

Software-as-a-Service (SaaS) is a type of cloud service which provides software functionality through Internet. Its benefits are well received in academia and industry. To fully utilize the benefits, there should be effective methodologies to support the development of SaaS services which provide high reusability and applicability. Conventional approaches such as object-oriented methods do not effectively support SaaS-specific engineering activities such as modeling common features, variability, and designing quality services. In this paper, we present a systematic process for developing high quality SaaS and highlight the essentiality of commonality and variability (C&V) modeling to maximize the reusability. We first define criteria for designing the process model and provide a theoretical foundation for SaaS; its meta-model and C&V model. We clarify the notion of commonality and variability in SaaS, and propose a SaaS development process which is accompanied with engineering instructions. Using the proposed process, SaaS services with high quality can be effectively developed.

The quality of high-energy X-ray beams

International Nuclear Information System (INIS)

LaRiviere, P.D.

1989-01-01

Supplement 17 of the British Journal of Radiology is a survey of central-axis depth doses for radiotherapy machines, patterned largely on BJR Supplement 11 (1972). Inspection of high-energy X-ray depth doses for a 10 x 10 cm field at an SSD of 100 cm disclosed large differences between the two sets of data, especially for qualities above 8 MV, e.g. a depth dose of 80% at 10 cm is rated at about 19 MV according to BJR Supplement 11, and 23 MV according to BJR Supplement 17. It was found that Supplement 17 depth-dose data above 8 MV were erratic, but Supplement 11 data could be represented by an analytical expression, providing a unique means of assigning MV quality. It was also found that dose-weighted average energy of the filtered beam plotted smoothly against depth dose. For dosimetric purposes, it is suggested that this parameter be used as a true measure of beam quality, removing discrepancies introduced by the use of nominal MV for this purpose. (author)

Using mobile phones and short message service to deliver self-management interventions for chronic conditions: a meta-review.

Science.gov (United States)

Jones, Katherine R; Lekhak, Nirmala; Kaewluang, Napatsawan

2014-04-01

The worldwide burden of chronic disease is widespread and growing. This shift from acute to chronic care requires rethinking how resources are invested in managing these conditions. One response has been to create programs and interventions that have the goal of helping patients better manage their own conditions. Over time, these self-management interventions and strategies have increasingly relied on various technologies for their implementation, with the newest technology being mobile phones and short message service (SMS). The objective of this meta-review was to evaluate the current evidence on the use of mobile phones and SMS to deliver self-management interventions for chronic conditions. A meta-review was conducted of the 11 systematic reviews (SRs) that were identified and retrieved after an extensive search of electronic databases covering the years 2000-2012. Relevant information was abstracted from each systematic review and a quality assessment carried out using the AMSTAR ("A Measurement Tool to Assess Systematic Reviews") criteria. The number and types of included studies and total number of subjects varied significantly across the systematic reviews. Mobile phone text messaging was reported to significantly improve adherence to appointments and antiretroviral therapy, short-term smoking quit rates, and selected clinical and behavioral outcomes. AMSTAR scores ranged from 11 to 3, reflecting substantial variation in SR quality. Mobile phones and SMS show promise as a technology to deliver self-management interventions to improve outcomes of chronic care management. However, the quality of future studies and systematic reviews needs to be improved. There also are unresolved issues about the technology itself. © 2014 Sigma Theta Tau International.

High quality flux control system for electron gun evaporation

International Nuclear Information System (INIS)

Appelbloom, A.M.; Hadley, P.; van der Marel, D.; Mooij, J.E.

1991-01-01

This paper reports on a high quality flux control system for electron gun evaporation developed and tested for the MBE growth of high temperature superconductors. The system can be applied to any electron gun without altering the electron gun itself. Essential elements of the system are a high bandwidth mass spectrometer, control electronics and a high voltage modulator to sweep the electron beam over the melt at high frequencies. the sweep amplitude of the electron beam is used to control the evaporation flux at high frequencies. The feedback loop of the system has a bandwidth of over 100 Hz, which makes it possible to grow superlattices and layered structures in a fast and precisely controlled manner

High quality factor GaAs microcavity with buried bullseye defects

Science.gov (United States)

Winkler, K.; Gregersen, N.; Häyrynen, T.; Bradel, B.; Schade, A.; Emmerling, M.; Kamp, M.; Höfling, S.; Schneider, C.

2018-05-01

The development of high quality factor solid-state microcavities with low mode volumes has paved the way towards on-chip cavity quantum electrodynamics experiments and the development of high-performance nanophotonic devices. Here, we report on the implementation of a new kind of solid-state vertical microcavity, which allows for confinement of the electromagnetic field in the lateral direction without deep etching. The confinement originates from a local elongation of the cavity layer imprinted in a shallow etch and epitaxial overgrowth technique. We show that it is possible to improve the quality factor of such microcavities by a specific in-plane bullseye geometry consisting of a set of concentric rings with subwavelength dimensions. This design results in a smooth effective lateral photonic potential and therefore in a reduction of lateral scattering losses, which makes it highly appealing for experiments in the framework of exciton-polariton physics demanding tight spatial confinement.

Delivering an evidence-based outdoor journey intervention to people with stroke: Barriers and enablers experienced by community rehabilitation teams

Directory of Open Access Journals (Sweden)

Middleton Sandy

2010-01-01

Full Text Available Abstract Background Transferring knowledge from research into practice can be challenging, partly because the process involves a change in attitudes, roles and behaviour by individuals and teams. Helping teams to identify then target potential barriers may aid the knowledge transfer process. The aim of this study was to identify barriers and enablers, as perceived by allied health professionals, to delivering an evidence-based (Level 1 outdoor journey intervention for people with stroke. Methods A qualitative design and semi-structured interviews were used. Allied health professionals (n = 13 from two community rehabilitation teams were interviewed, before and after receiving feedback from a medical record audit and attending a training workshop. Interviews allowed participants to identify potential and actual barriers, as well as enablers to delivering the intervention. Qualitative data were analysed using theoretical domains described by Michie and colleagues. Results Two barriers to delivery of the intervention were the social influence of people with stroke and their family, and professionals' beliefs about their capabilities. Other barriers included professionals' knowledge and skills, their role identity, availability of resources, whether professionals remembered to provide the intervention, and how they felt about delivering the intervention. Enablers to delivering the intervention included a belief that they could deliver the intervention, a willingness to expand and share professional roles, procedures that reminded them what to do, and feeling good about helping people with stroke to participate. Conclusions This study represents one step in the quality improvement process. The interviews encouraged reflection by staff. We obtained valuable data which have been used to plan behaviour change interventions addressing identified barriers. Our methods may assist other researchers who need to design similar behaviour change interventions.

Methodology and Supporting Toolset Advancing Embedded Systems Quality

DEFF Research Database (Denmark)

Berger, Michael Stübert; Soler, José; Brewka, Lukasz Jerzy

2013-01-01

Software quality is of primary importance in the development of embedded systems that are often used in safety-critical applications. Moreover, as the life cycle of embedded products becomes increasingly tighter, productivity and quality are simultaneously required and closely interrelated towards...... delivering competitive products. In this context, the MODUS (Methodology and supporting toolset advancing embedded systems quality) project aims to provide a pragmatic and viable solution that will allow SMEs to substantially improve their positioning in the embedded-systems development market. This paper...... will describe the MODUS project with focus on the technical methodologies that will be developed advancing embedded system quality....

SU-F-J-105: Towards a Novel Treatment Planning Pipeline Delivering Pareto- Optimal Plans While Enabling Inter- and Intrafraction Plan Adaptation

Energy Technology Data Exchange (ETDEWEB)

Kontaxis, C; Bol, G; Lagendijk, J; Raaymakers, B [University Medical Center Utrecht, Utrecht (Netherlands); Breedveld, S; Sharfo, A; Heijmen, B [Erasmus University Medical Center Rotterdam, Rotterdam (Netherlands)

2016-06-15

Purpose: To develop a new IMRT treatment planning methodology suitable for the new generation of MR-linear accelerator machines. The pipeline is able to deliver Pareto-optimal plans and can be utilized for conventional treatments as well as for inter- and intrafraction plan adaptation based on real-time MR-data. Methods: A Pareto-optimal plan is generated using the automated multicriterial optimization approach Erasmus-iCycle. The resulting dose distribution is used as input to the second part of the pipeline, an iterative process which generates deliverable segments that target the latest anatomical state and gradually converges to the prescribed dose. This process continues until a certain percentage of the dose has been delivered. Under a conventional treatment, a Segment Weight Optimization (SWO) is then performed to ensure convergence to the prescribed dose. In the case of inter- and intrafraction adaptation, post-processing steps like SWO cannot be employed due to the changing anatomy. This is instead addressed by transferring the missing/excess dose to the input of the subsequent fraction. In this work, the resulting plans were delivered on a Delta4 phantom as a final Quality Assurance test. Results: A conventional static SWO IMRT plan was generated for two prostate cases. The sequencer faithfully reproduced the input dose for all volumes of interest. For the two cases the mean relative dose difference of the PTV between the ideal input and sequenced dose was 0.1% and −0.02% respectively. Both plans were delivered on a Delta4 phantom and passed the clinical Quality Assurance procedures by achieving 100% pass rate at a 3%/3mm gamma analysis. Conclusion: We have developed a new sequencing methodology capable of online plan adaptation. In this work, we extended the pipeline to support Pareto-optimal input and clinically validated that it can accurately achieve these ideal distributions, while its flexible design enables inter- and intrafraction plan

SU-F-J-105: Towards a Novel Treatment Planning Pipeline Delivering Pareto- Optimal Plans While Enabling Inter- and Intrafraction Plan Adaptation

International Nuclear Information System (INIS)

Kontaxis, C; Bol, G; Lagendijk, J; Raaymakers, B; Breedveld, S; Sharfo, A; Heijmen, B

2016-01-01

Purpose: To develop a new IMRT treatment planning methodology suitable for the new generation of MR-linear accelerator machines. The pipeline is able to deliver Pareto-optimal plans and can be utilized for conventional treatments as well as for inter- and intrafraction plan adaptation based on real-time MR-data. Methods: A Pareto-optimal plan is generated using the automated multicriterial optimization approach Erasmus-iCycle. The resulting dose distribution is used as input to the second part of the pipeline, an iterative process which generates deliverable segments that target the latest anatomical state and gradually converges to the prescribed dose. This process continues until a certain percentage of the dose has been delivered. Under a conventional treatment, a Segment Weight Optimization (SWO) is then performed to ensure convergence to the prescribed dose. In the case of inter- and intrafraction adaptation, post-processing steps like SWO cannot be employed due to the changing anatomy. This is instead addressed by transferring the missing/excess dose to the input of the subsequent fraction. In this work, the resulting plans were delivered on a Delta4 phantom as a final Quality Assurance test. Results: A conventional static SWO IMRT plan was generated for two prostate cases. The sequencer faithfully reproduced the input dose for all volumes of interest. For the two cases the mean relative dose difference of the PTV between the ideal input and sequenced dose was 0.1% and −0.02% respectively. Both plans were delivered on a Delta4 phantom and passed the clinical Quality Assurance procedures by achieving 100% pass rate at a 3%/3mm gamma analysis. Conclusion: We have developed a new sequencing methodology capable of online plan adaptation. In this work, we extended the pipeline to support Pareto-optimal input and clinically validated that it can accurately achieve these ideal distributions, while its flexible design enables inter- and intrafraction plan

A design technique of low cost but high quality peak stretcher

Energy Technology Data Exchange (ETDEWEB)

Lo, H Y; Su, C S; Hsu, J Y; Wang, L

1981-03-01

This paper presents the design of low cost but high quality pulse peak stretcher incorporated with a LSI of 12 bit ADC and SKD-85 microcomputer. The conflict between the capacitor high charging speed and longer holding time for realizing a high quality stretcher is discussed and solved. For a lager number of channels available in a dual ramp Wilkinson-type ADC, two-stage stretchers connected in series are designed. The first stage is a fast-discharge to keep the output stretched pulse follow-up the input quickly and the second-stage (main stretcher) is a slow-discharge to keep the transient of the circuit minimum. Both of these two peak stretchers are described and the experiment results are photographically recorded.

High dose-rate brachytherapy source position quality assurance using radiochromic film

International Nuclear Information System (INIS)

Evans, M.D.C.; Devic, S.; Podgorsak, E.B.

2007-01-01

Traditionally, radiographic film has been used to verify high-dose-rate brachytherapy source position accuracy by co-registering autoradiographic and diagnostic images of the associated applicator. Filmless PACS-based clinics that do not have access to radiographic film and wet developers may have trouble performing this quality assurance test in a simple and practical manner. We describe an alternative method for quality assurance using radiochromic-type film. In addition to being easy and practical to use, radiochromic film has some advantages in comparison with traditional radiographic film when used for HDR brachytherapy quality assurance

The efficacy of internet-delivered treatment for generalized anxiety disorder: A systematic review and meta-analysis

Directory of Open Access Journals (Sweden)

Derek Richards

2015-09-01

Full Text Available Generalized Anxiety Disorder (GAD is typically considered a chronic condition characterized by excessive worry. Lifetime prevalence is 4.3–5.9%, yet only a small percentage seeks treatment. GAD is treatable and in recent years internet-delivered treatment interventions have shown promise. This paper aims to systematically search for literature on internet-delivered psychological interventions for the treatment of GAD and conduct a meta-analysis to examine their efficacy. The purpose of the paper is to inform the community of researchers, program developers and practitioners in internet delivered interventions of the current state-of-the-art and research gaps that require attention. A systematic search of the literature was conducted to find all studies of internet-delivered treatments for GAD (N = 20. Using Review Manager 5 all Randomized Controlled Trials (RCTs; n = 11 that met our established eligibility criteria were included into a meta-analysis that calculated effect sizes via the standardized mean difference. Compared to the waiting-list controls, the results demonstrate positive outcomes for GAD symptoms (d = −0.91 and its central construct of pathological worry (d = −0.74. The meta-analysis supports the efficacy of internet-delivered treatments for GAD including the use of disorder-specific (4 studies and transdiagnostic treatment protocols (7 studies. Caution is advised regarding the results as the data is limited and highly heterogeneous, but revealing of what future research might be needed.

Evaluation of a quality improvement intervention for obstetric and neonatal care in selected public health facilities across six states of India.

Science.gov (United States)

Sarin, Enisha; Kole, Subir K; Patel, Rachana; Sooden, Ankur; Kharwal, Sanchit; Singh, Rashmi; Rahimzai, Mirwais; Livesley, Nigel

2017-05-02

While increase in the number of women delivering in health facilities has been rapid, the quality of obstetric and neonatal care continues to be poor in India, contributing to high maternal and neonatal mortality. The USAID ASSIST Project supported health workers in 125 public health facilities (delivering approximately 180,000 babies per year) across six states to use quality improvement (QI) approaches to provide better care to women and babies before, during and immediately after delivery. As part of this intervention, each month, health workers recorded data related to nine elements of routine care alongside data on perinatal mortality. We aggregated facility level data and conducted segmented regression to analyse the effect of the intervention over time. Care improved to 90-99% significantly (p improving provision of routine care, yet these approaches are underused in the Indian health system. We discuss the implications of this for policy makers.

Comparison of C-reactive protein levels with delivered dose of Kt/V in patients with end-stage renal disease on maintenance hemodialysis

Directory of Open Access Journals (Sweden)

Humayun Rashid

2015-01-01

Full Text Available The objective of our study is to compare the C-reactive protein (CRP levels with the delivered dose of dialysis in terms of Kt/V in patients undergoing maintenance hemodialysis (HD. This is a comparative, cross-sectional survey. The study was conducted at the HD unit of the Shaikh Zayed Hospital, Lahore, Pakistan. Patients who fulfilled the inclusion and exclusion criteria were enrolled in this study. The delivered dose of HD (Kt/V was assessed by an online clearance module (OCM in Fresenius machines at the end of every dialysis session and the weekly Kt/V was determined by adding all three Kt/V values. The serum CRP sample was taken after each session of HD and the mean CRP was calculated and considered elevated if it was >6 mg/dL. Both weekly Kt/V and CRP values were entered in a pre-designed proforma. Data were analyzed by using statistical software SPSS and P-value £0.05 was considered significant. Of 100 patients on maintenance HD, high serum CRP level (>6 mg/dL was found in 38 patients. When the Kt/V was compared with the CRP level, there was a negative correlation between the two parameters (r = 0.212, P = 0.032. Low Kt/V means dialysis inadequacy, which is associated with chronic inflammatory state, resulting in high CRP levels. We suggest that the quality of life of dialysis patients can be improved by offering an adequate dose of HD reflected by Kt/V ≥3.6/week.

High Quality Education and Learning for All through Open Education

NARCIS (Netherlands)

Stracke, Christian M.

2016-01-01

Keynote at the International Lensky Education Forum 2016, Yakutsk, Republic of Sakha, Russian Federation, by Stracke, C. M. (2016, 16 August): "High Quality Education and Learning for All through Open Education"

Delivering a medical school elective with massive open online course (MOOC) technology.

Science.gov (United States)

Robinson, Robert

2016-01-01

The educational technology of massive open online courses (MOOCs) has been successfully applied in a wide variety of disciplines and are an intense focus of educational research at this time. Educators are now looking to MOOC technology as a means to improve professional medical education, but very little is known about how medical MOOCs compare with traditional content delivery. A retrospective analysis of the course evaluations for the Medicine as a Business elective by fourth-year medical students at Southern Illinois University School of Medicine (SIU-SOM) for the 2012-2015 academic years was conducted. This course was delivered by small group flipped classroom discussions for 2012-2014 and delivered via MOOC technology in 2015. Learner ratings were compared between the two course delivery methods using routinely collected course evaluations. Course enrollment has ranged from 6-19 students per year in the 2012-2015 academic years. Student evaluations of the course are favorable in the areas of effective teaching, accurate course objectives, meeting personal learning objectives, recommending the course to other students, and overall when rated on a 5-point Likert scale. The majority of all student ratings (76-95%) of this elective course are for the highest possible choice (Strongly agree or Excellent) for any criteria, regardless if the course was delivered via a traditional or MOOC format. Statistical analysis of these ratings suggests that the Effective Teacher and Overall Evaluations did not statistically differ between the two delivery formats. Student ratings of this elective course were highly similar when delivered in a flipped classroom format or by using MOOC technology. The primary advantage of this new course format is flexibility of time and place for learners, allowing them to complete the course objectives when convenient for them. The course evaluations suggest this is a change that is acceptable to the target audience. This study suggests that

Safety and quality management at the high flux reactor Petten

International Nuclear Information System (INIS)

Zurita, A.; Ahlf, J.

1995-01-01

The High Flux Reactor (HFR) is one high power multi-purpose materials testing research reactor of the tank-in-pool type, cooled and moderated by light-water. It is operated at 45 MW at a prescribed schedule of 11 cycles per year, each comprising 25 operation days and three shut-down days. Since the licence for the operation of HFR was granted in 1962, a total of 14 amendments to the original licence have been made following different modifications in the installations. In the meantime, international nuclear standards were developed, especially in the framework of the NUSS programme of the IAEA, which were adopted by the Dutch Licensing Authorities. In order to implement the new standards, the situation at the HFR was comprehensively reviewed in the course of an audit performed by the Dutch Licensing Authorities in 1988. This also resulted in formulating the task of setting-up an 'HFR - Integral Quality Assurance Handbook' (HFR-IQAD) involving both organizations JRCIAM and ECN, which had the unique framework and basic guideline to assure the safe and efficient operation and exploitation of the HFR and to promote safety and quality in all aspects of HFR related activities. The assurance of safe and efficient operation and exploitation of the HFR is condensed together under the concepts of safety and quality of services and is achieved through the safety and quality management. (orig.)

Is Beauty in the Eyes of the Beholder? Aesthetic Quality versus Technical Skill in Movement Evaluation of Tai Chi.

Science.gov (United States)

Zamparo, Paola; Zorzi, Elena; Marcantoni, Sara; Cesari, Paola

2015-01-01

The aim of this study was to compare experts to naïve practitioners in rating the beauty and the technical quality of a Tai Chi sequence observed in video-clips (of high and middle level performances). Our hypothesis are: i) movement evaluation will correlate with the level of skill expressed in the kinematics of the observed action but ii) only experts will be able to unravel the technical component from the aesthetic component of the observed action. The judgments delivered indicate that both expert and non-expert observers are able to discern a good from a mediocre performance; however, as expected, only experts discriminate the technical from the aesthetic component of the action evaluated and do this independently of the level of skill shown by the model (high or middle level performances). Furthermore, the judgments delivered were strongly related to the kinematic variables measured in the observed model, indicating that observers rely on specific movement kinematics (e.g. movement amplitude, jerk and duration) for action evaluation. These results provide evidence of the complementary functional role of visual and motor action representation in movement evaluation and underline the role of expertise in judging the aesthetic quality of movements.

Positron annihilation spectroscopy using high-energy photons

International Nuclear Information System (INIS)

Butterling, Maik; Jungmann, Marco; Krause-Rehberg, Reinhard; Krille, Arnold; Anwand, Wolfgang; Brauer, Gerhard; Cowan, Thomas E.; Hartmann, Andreas; Kosev, Krasimir; Schwengner, Ronald; Wagner, Andreas

2010-01-01

The superconducting electron accelerator ELBE (Electron Linac with high Brilliance and low Emittance) at the Research Centre Dresden-Rossendorf (Germany) serves as a high-intensity bremsstrahlung photon-source delivering a pulsed beam (26 MHz) with very short bunches (<5 ps). The photons are being converted into positrons by means of pair production inside the target material thus forming an intense positron source. The accelerator machine pulse is used as time reference allowing positron lifetime spectroscopy. We performed positron annihilation spectroscopy by pair production in different sample materials and used coincidence techniques to reduce the background due to scattered photons significantly in order resulting in spectra of extraordinary high quality. (Abstract Copyright [2010], Wiley Periodicals, Inc.)

Measurement and Management of the Level of Quality Control Process in SoC (System on Chip Embedded Software Development

Directory of Open Access Journals (Sweden)

Ki-Won Song

2012-04-01

Full Text Available This paper presents the process of measuring the level of quality control process to ensure the quality of delivered software package during the development cycle. The success of the project requires three pre-requisites and they constrain one another. Quality is the most important factor for successful project completion. In other words, quality should not be sacrificed for the sake of meeting cost budget or delivering within schedule. Also, cost caused by any quality issues such as defect resolution increases exponentially once the product is out of the door. Having said that, we also have to consider the schedule side of constraints for the successful project. In other words, we have no time to do a quality job and we have to compete with other competitors to ship the product to the market earlier than them. So, the quality measurement and management concept is introduced to meet the agile software development environment in conjunction with performance strategies to execute within organization. Obviously, there are many key performance indexes derivable from the actual data associated with quality control activities and it is desirable to create a quality process to integrally represent overall level of quality control activities performed while developing the software deliverables. With the quality process, it is possible to evaluate whether enough quality control activities are performed for the project officially and secure the quality of the software deliverables before it is delivered to the customers.

Reconfiguring grid-interfacing converters for power quality improvement

NARCIS (Netherlands)

Wang, F.; Duarte, J.L.; Hendrix, M.A.M.; Encica, L.; Gysen, B.L.J.; Jansen, J.W.; Krop, D.C.J.

2008-01-01

In this paper reconfiguration of grid-interfacing converters is proposed for power quality improvement. In addition to the traditional function of delivering energy between distributed sources and the utility grid, more flexible ancillary functions can be integrated into the control of

Real-time video quality monitoring

Science.gov (United States)

Liu, Tao; Narvekar, Niranjan; Wang, Beibei; Ding, Ran; Zou, Dekun; Cash, Glenn; Bhagavathy, Sitaram; Bloom, Jeffrey

2011-12-01

The ITU-T Recommendation G.1070 is a standardized opinion model for video telephony applications that uses video bitrate, frame rate, and packet-loss rate to measure the video quality. However, this model was original designed as an offline quality planning tool. It cannot be directly used for quality monitoring since the above three input parameters are not readily available within a network or at the decoder. And there is a great room for the performance improvement of this quality metric. In this article, we present a real-time video quality monitoring solution based on this Recommendation. We first propose a scheme to efficiently estimate the three parameters from video bitstreams, so that it can be used as a real-time video quality monitoring tool. Furthermore, an enhanced algorithm based on the G.1070 model that provides more accurate quality prediction is proposed. Finally, to use this metric in real-world applications, we present an example emerging application of real-time quality measurement to the management of transmitted videos, especially those delivered to mobile devices.

Mechanical design and fabrication of the VHF-gun, the Berkeley normal-conducting continuous-wave high-brightness electron source

Science.gov (United States)

Wells, R. P.; Ghiorso, W.; Staples, J.; Huang, T. M.; Sannibale, F.; Kramasz, T. D.

2016-02-01

A high repetition rate, MHz-class, high-brightness electron source is a key element in future high-repetition-rate x-ray free electron laser-based light sources. The VHF-gun, a novel low frequency radio-frequency gun, is the Lawrence Berkeley National Laboratory (LBNL) response to that need. The gun design is based on a normal conducting, single cell cavity resonating at 186 MHz in the VHF band and capable of continuous wave operation while still delivering the high accelerating fields at the cathode required for the high brightness performance. The VHF-gun was fabricated and successfully commissioned in the framework of the Advanced Photo-injector EXperiment, an injector built at LBNL to demonstrate the capability of the gun to deliver the required beam quality. The basis for the selection of the VHF-gun technology, novel design features, and fabrication techniques are described.

Quality and efficiency in high dimensional Nearest neighbor search

KAUST Repository

Tao, Yufei; Yi, Ke; Sheng, Cheng; Kalnis, Panos

2009-01-01

Nearest neighbor (NN) search in high dimensional space is an important problem in many applications. Ideally, a practical solution (i) should be implementable in a relational database, and (ii) its query cost should grow sub-linearly with the dataset size, regardless of the data and query distributions. Despite the bulk of NN literature, no solution fulfills both requirements, except locality sensitive hashing (LSH). The existing LSH implementations are either rigorous or adhoc. Rigorous-LSH ensures good quality of query results, but requires expensive space and query cost. Although adhoc-LSH is more efficient, it abandons quality control, i.e., the neighbor it outputs can be arbitrarily bad. As a result, currently no method is able to ensure both quality and efficiency simultaneously in practice. Motivated by this, we propose a new access method called the locality sensitive B-tree (LSB-tree) that enables fast highdimensional NN search with excellent quality. The combination of several LSB-trees leads to a structure called the LSB-forest that ensures the same result quality as rigorous-LSH, but reduces its space and query cost dramatically. The LSB-forest also outperforms adhoc-LSH, even though the latter has no quality guarantee. Besides its appealing theoretical properties, the LSB-tree itself also serves as an effective index that consumes linear space, and supports efficient updates. Our extensive experiments confirm that the LSB-tree is faster than (i) the state of the art of exact NN search by two orders of magnitude, and (ii) the best (linear-space) method of approximate retrieval by an order of magnitude, and at the same time, returns neighbors with much better quality. © 2009 ACM.

IT service management - key to the quality of IT service delivering

International Nuclear Information System (INIS)

Recky, M.

2004-01-01

Objective of the contribution is to introduce IT service management (ITSM) as an approach to services quality improvement provided by IT departments of enterprises. As a result of massive application of information technologies in the past, the enterprises have become increasingly dependent on processes within IT of which many are critical for the business operations. Therefore it appears to be inevitable for IT organizations to become customer-oriented. ITSM's objective is to implement standardized and measurable IT services in every enterprise, to enable accurate service cost allocation and increase accuracy of planning of IT budget and investments. This method is based on processes definition, necessary technologies implementation and restructuralisation of human resources in IT organisations. It requires a change of attitude towards IT users who become IT department customers as well as cost-balanced utilization of in-sourcing and out-sourcing etc. Hewlett-Packard is a global leader offering its consulting and integration services in the area of IT service management together with an extensive portfolio of related technologies based on HP OpenView software platform. (author)

Safe and High Quality Food Production using Low Quality Waters and Improved Irrigation Systems and Management, EU Project

DEFF Research Database (Denmark)

Plauborg, Finn; Jensen, Christian Richardt; Dalsgaard, Anders

2009-01-01

: the safety and quality of food products, and the increasing competition for clean freshwater. SAFIR is funded for the period 2005-2009 under the Food Quality and Safety thematic area of the EU 6th Framework Research Programme. The challenge for the next years will be to produce safe and high quality foods...... a multi-disciplinary team, with food safety and quality experts, engineers, agronomists and economists from17 research institutes and private companies in Europe, Israel and China working together. The project assesses potential risks to farmers. Coupled with farm management and economic models, a new...... intelligent tool for efficient and safe use and re-use of low-quality water are being developed. Already published results indicate water saving in the order of 25-30% in agricultural crops as potatoes and tomatoes are possible without yield reduction. Slightly treated waste water can be used safely when...

Bullying as a risk for poor sleep quality among high school students in China.

Directory of Open Access Journals (Sweden)

Ying Zhou

Full Text Available To determine whether involvement in bullying as a bully, victim, or bully-victim was associated with a higher risk of poor sleep quality among high school students in China.A cross-sectional study was conducted. A total of 23,877 high school students were surveyed in six cities in Guangdong Province. All students were asked to complete the adolescent health status questionnaire, which included the Chinese version of the Pittsburgh Sleep Quality Index (PSQI and bullying involvement. Descriptive statistics were used to evaluate sleep quality and the prevalence of school bullying. Multi-level logistic regression analyses were conducted to examine the association between being victimized and bullying others with sleep quality.Among the 23,877 students, 6,127 (25.66% reported having poor sleep quality, and 10.89% reported being involved in bullying behaviors. Of the respondents, 1,410 (5.91% were pure victims of bullying, 401 (1.68% were bullies and 784 (3.28% were bully-victims. Frequently being involved in bullying behaviors (being bullied or bullying others was related to increased risks of poor sleep quality compared with adolescents who were not involved in bullying behaviors. After adjusting for age, sex, and other confounding factors, the students who were being bullied (OR=2.05, 95%CI=1.81-2.32, bullied others (OR=2.30, 95%CI=1.85-2.86 or both (OR=2.58, 95%CI=2.20-3.03 were at a higher risk for poor sleep quality.Poor sleep quality among high school students is highly prevalent, and school bullying is prevalent among adolescents in China. The present results suggested that being involved in school bullying might be a risk factor for poor sleep quality among adolescents.

Bullying as a risk for poor sleep quality among high school students in China.

Science.gov (United States)

Zhou, Ying; Guo, Lan; Lu, Ci-yong; Deng, Jian-xiong; He, Yuan; Huang, Jing-hui; Huang, Guo-liang; Deng, Xue-qing; Gao, Xue

2015-01-01

To determine whether involvement in bullying as a bully, victim, or bully-victim was associated with a higher risk of poor sleep quality among high school students in China. A cross-sectional study was conducted. A total of 23,877 high school students were surveyed in six cities in Guangdong Province. All students were asked to complete the adolescent health status questionnaire, which included the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) and bullying involvement. Descriptive statistics were used to evaluate sleep quality and the prevalence of school bullying. Multi-level logistic regression analyses were conducted to examine the association between being victimized and bullying others with sleep quality. Among the 23,877 students, 6,127 (25.66%) reported having poor sleep quality, and 10.89% reported being involved in bullying behaviors. Of the respondents, 1,410 (5.91%) were pure victims of bullying, 401 (1.68%) were bullies and 784 (3.28%) were bully-victims. Frequently being involved in bullying behaviors (being bullied or bullying others) was related to increased risks of poor sleep quality compared with adolescents who were not involved in bullying behaviors. After adjusting for age, sex, and other confounding factors, the students who were being bullied (OR=2.05, 95%CI=1.81-2.32), bullied others (OR=2.30, 95%CI=1.85-2.86) or both (OR=2.58, 95%CI=2.20-3.03) were at a higher risk for poor sleep quality. Poor sleep quality among high school students is highly prevalent, and school bullying is prevalent among adolescents in China. The present results suggested that being involved in school bullying might be a risk factor for poor sleep quality among adolescents.

Medical Assistant-based care management for high risk patients in small primary care practices

DEFF Research Database (Denmark)

Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.

2016-01-01

Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2......, and monitoring delivered by medical assistants with usual care. Measurements: All-cause hospitalizations at 12 months (primary outcome) and quality of life scores (Short Form 12 Health Questionnaire [SF-12] and the Euroqol instrument [EQ-5D]). Results: Included patients had, on average, four co-occurring chronic...

The Role of Dosimetry in High-Quality EMI Risk Assessment

National Research Council Canada - National Science Library

2006-01-01

The Final Proceedings for The role of EMF dosimetry in high quality risk assessment 13 September 2006 - 15 September 2006 In the last three decades the use of devices that emit electromagnetic fields (EMF...

The development of NEdSERV: quantitative instrumentation to measure service quality in nurse education.

Science.gov (United States)

Roberts, P

1999-07-01

The political climate of health care provision and education for health care in the latter years of the 20th century is evolving from the uncertainty of newly created markets to a more clearly focused culture of collaboration, dissemination of good practice, with an increased emphasis on quality provision and its measurement. The need for provider units to prove and improve efficiency and effectiveness through evidence-based quality strategies in order to stay firmly in the market place has never been more necessary. The measurement of customer expectations and perceptions of delivered service quality is widely utilized as a basis for customer retention and business growth in both commercial and non-profit organizations. This paper describes the methodological development of NEdSERV--quantitative instrumentation designed to measure and respond to ongoing stakeholder expectations and perceptions of delivered service quality within nurse education.

A Narrative Review of High-Quality Literature on the Effects of Resident Duty Hours Reforms.

Science.gov (United States)

Lin, Henry; Lin, Emery; Auditore, Stephanie; Fanning, Jon

2016-01-01

To summarize current high-quality studies evaluating the effect and efficacy of resident duty hours reforms (DHRs) on patient safety and resident education and well-being. The authors searched PubMed and Medline in August 2012 and again in May 2013 for literature (1987-2013) about the effects of DHRs. They assessed the quality of articles using the Medical Education Research Study Quality Instrument (MERSQI) scoring system. They considered randomized controlled trials (RCTs), partial RCTs, and all studies with a MERSQI score ≥ 14 to be "high-quality" methodology studies. A total of 72 high-quality studies met inclusion criteria. Most studies showed no change or slight improvement in mortality and complication rates after DHRs. Resident well-being was generally improved, but there was a perceived negative impact on education (knowledge acquisition, skills, and cognitive performance) following DHRs. Eleven high-quality studies assessed the impact of DHR interventions; all reported a neutral to positive impact. Seven high-quality studies assessed costs associated with DHRs and demonstrated an increase in hospital costs. The results of most studies that allow enough time for DHR interventions to take effect suggest a benefit to patient safety and resident well-being, but the effect on the quality of training remains unknown. Additional methodologically sound studies on the impact of DHRs are necessary. Priorities for future research include approaches to optimizing education and clinical proficiency and studies on the effect of intervention strategies on both education and patient safety. Such studies will provide additional information to help improve duty hours policies.

Are rehabilitation and/or care co-ordination interventions delivered in the community effective in reducing depression, facilitating participation and improving quality of life after stroke?

Science.gov (United States)

Graven, Christine; Brock, Kim; Hill, Keith; Joubert, Lynette

2011-01-01

To conduct a systematic review to explore the effectiveness of community-based rehabilitation interventions delivered by allied health professionals and/or nursing staff in reducing depression, facilitating participation and improving health-related quality of life (HRQoL) post-inpatient stroke rehabilitation. A search was conducted in the databases of MEDLINE, PEDro, CINAHL and the Cochrane Library. Publications were classified into categories based on the type of the interventions. Best evidence synthesis and meta-analysis were utilised to determine the level of evidence. Fifty-four studies were included in the review, and divided into nine broad intervention categories. Meta-analysis demonstrated significant reduction in depression with exercise interventions (n = 137; effect estimate SMD: -2.03, 95%CI: -3.22, -0.85). Community-based interventions targeting participation and leisure domains showed moderate evidence for improvement in global participation measures and HRQoL. Comprehensive rehabilitation demonstrated limited evidence for depression and participation, and strong evidence for HRQoL. There is limited to moderate evidence supporting some rehabilitation interventions in affecting the outcomes of depression, participation and HRQoL post-stroke. Heterogeneity of the studies made evidence synthesis difficult. Further consideration needs to be given to the type and timing of outcome measures selected to represent the domains of participation and HRQoL.

Assessing the irradiance delivered from light-curing units in private dental offices in Jordan.

Science.gov (United States)

Maghaireh, Ghada A; Alzraikat, Hanan; Taha, Nessrin A

2013-08-01

The authors conducted a study to examine the irradiance from light-curing units (LCUs) used in dental offices in Jordan. Two of the authors visited 295 private dental offices (15 percent) in Jordan and collected the following information about the LCUs: age, type (quartz-tungsten-halogen or light-emitting diode), date of last maintenance, type of maintenance, last date of use, number of times used during the day, availability of a radiometer, exposure time for each resin-based composite increment, size of light-curing tips and presence of resin-based composite on the tips. The authors used a radiometer to measure the irradiance from the LCUs. They used linear regression with stepwise correlation for the statistical analysis. The authors set the minimum acceptable irradiance at 300 milliwatts/square centimeter. The mean irradiance of the 295 LCUs examined was 361 mW/cm(2), and 136 LCUs (46.1 percent) delivered an irradiance of less than 300 mW/cm(2). The unit's age, type and presence of resin-based composite on the light-curing tips had a significant effect on the irradiance (P ≤ .001). Only 37 of the 141 quartz-tungsten-halogen units (26.2 percent) and 122 of the 154 light-emitting diode units (79.2 percent) delivered at least 300 mW/cm(2). Resin contamination on the light-curing tips had a significant effect on the irradiance delivered. The irradiance from the LCUs decreased with use. Practical Implications. The irradiance from many of the units in this study was less than 300 mW/cm(2), which may affect the quality of resin-based composite restorations. Dentists should monitor the performance of the LCUs in their offices weekly.

Current situation of doses delivered to the patients in the field of dental radiology

International Nuclear Information System (INIS)

Baechler, S.; Monnin, P.; Aroua, A.; Valley, J.F.; Verdun, F.R.; Perrier, M.

2006-01-01

The purpose of this paper is to present an overview of the doses delivered to the patients in the field of dental radiology. The technology progress in medical imaging will be discussed from a dose perspective. In this work, patient dosimetry has been performed for intra-oral, panoramic and CT dental examinations. Doses were estimated using appropriate dosimetric indicators such as the entrance surface kerma (ESK) and the kerma area product (KAP). These indicators are easily measurable and enable to estimate the effective dose for a standard patient. KAP values were measured for two intra-oral systems using D and E/F speed dental films, as well as a digital system based on the CCD technology. In addition, the KAP was measured on three ortho-pan-tomograms (OPGs) of various generations. Finally, in order to assess the dose delivered during dental implants planning, the kerma length product (KLP) and the computed tomography dose index (CTDI W ) were determined for a CT scanner using the Dentascan protocol and a new DVT (Digital Volume Tomography) dedicated system. Using E/F speed instead of D speed films allowed to educe the KAP by a factor of 2 without significant loss of image quality. A further dose reduction by a factor of 6 was possible with digital systems but with an important degradation of the spatial resolution (variation of the MTF at 50% from 13 mm -1 to 5 mm -1 ). KAP measurements on OPGs showed that old systems delivered doses three times higher than a more recent devices. The new dedicated tomographic system enabled a reduction of the patient dose by a factor of 18 when compared with the Dentascan CT system. (author)

Quality Assurance/Quality Control Issues for Intraoperative Planning and Adaptive Repeat Planning of Image-Guided Prostate Implants

International Nuclear Information System (INIS)

Zaider, Marco; Cohen, Gilad; Meli, Jerome; Rosenfeld, Anatoly B.

2008-01-01

The quality assurance/quality control purpose is this. We design a treatment plan, and we wish to be as certain as reasonably possible that the treatment is delivered as planned. In the case of conventionally planned prostate brachytherapy, implementing to the letter the implantation plan is rarely attainable and therefore can require adaptive replanning (a quality control issue). The reasons for this state of affairs include changes in the prostate shape and volume during implantation and treatment delivery (e.g., edema resolution) and unavoidable inaccuracy in the placement of the seeds in the prostate. As a result, quality-control activities (e.g., the need to monitor-ideally, on the fly-the target and urethral and rectal dosage) must be also addressed

High cardiac vagal control is related to better subjective and objective sleep quality.

Science.gov (United States)

Werner, Gabriela G; Ford, Brett Q; Mauss, Iris B; Schabus, Manuel; Blechert, Jens; Wilhelm, Frank H

2015-03-01

Cardiac vagal control (CVC) has been linked to both physical and mental health. One critical aspect of health, that has not received much attention, is sleep. We hypothesized that adults with higher CVC--operationalized by high-frequency heart rate variability (HF-HRV)--will exhibit better sleep quality assessed both subjectively (i.e., with Pittsburgh Sleep Quality Index) and objectively (i.e., with polysomnography). HF-HRV was measured in 29 healthy young women during an extended neutral film clip. Participants then underwent full polysomnography to obtain objective measures of sleep quality and HF-HRV during a night of sleep. As expected, higher resting HF-HRV was associated with higher subjective and objective sleep quality (i.e., shorter sleep latency and fewer arousals). HF-HRV during sleep (overall or separated by sleep phases) showed less consistent relationships with sleep quality. These findings indicate that high waking CVC may be a key predictor of healthy sleep. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Prevalence of HBsAg and anti-HBs among delivering women.

Science.gov (United States)

Sabău, M; Căpîlnă; Kiss, E

1979-01-01

A survey of 2,500 delivering women revealed a 7.6% incidence of past infection with hepatitis B virus (HBV) (HBsAg or anti-HBs). Only 5.9% of the anti-HBs-positive mothers had a possible history of parenteral exposure to hepatitis B and none of the 55 HBsAg carriers had such a history. The findings suggest that HBV is endemic and that it is probably spread in part by nonparenteral means. The high rates of HBsAg and anti-HBs point to the possible preventive value of routine screenings for this system among pregnant women.

Automated quality control in a file-based broadcasting workflow

Science.gov (United States)

Zhang, Lina

2014-04-01

Benefit from the development of information and internet technologies, television broadcasting is transforming from inefficient tape-based production and distribution to integrated file-based workflows. However, no matter how many changes have took place, successful broadcasting still depends on the ability to deliver a consistent high quality signal to the audiences. After the transition from tape to file, traditional methods of manual quality control (QC) become inadequate, subjective, and inefficient. Based on China Central Television's full file-based workflow in the new site, this paper introduces an automated quality control test system for accurate detection of hidden troubles in media contents. It discusses the system framework and workflow control when the automated QC is added. It puts forward a QC criterion and brings forth a QC software followed this criterion. It also does some experiments on QC speed by adopting parallel processing and distributed computing. The performance of the test system shows that the adoption of automated QC can make the production effective and efficient, and help the station to achieve a competitive advantage in the media market.

Certification of production-quality gLite Job Management components

International Nuclear Information System (INIS)

Andreetto, P; Bertocco, S; Dorigo, A; Frizziero, E; Gianelle, A; Sgaravatto, M; Zangrando, L; Capannini, F; Cecchi, M; Giacomini, F; Mezzadri, M; Molinari, E; Prelz, F; Rebatto, D; Monforte, S

2011-01-01

With the advent of the recent European Union (EU) funded projects aimed at achieving an open, coordinated and proactive collaboration among the European communities that provide distributed computing services, more strict requirements and quality standards will be asked to middleware providers. Such a highly competitive and dynamic environment, organized to comply a business-oriented model, has already started pursuing quality criteria, thus requiring to formally define rigorous procedures, interfaces and roles for each step of the software life-cycle. This will ensure quality-certified releases and updates of the Grid middleware. In the European Middleware Initiative (EMI), the release management for one or more components will be organized into Product Team (PT) units, fully responsible for delivering production ready, quality-certified software and for coordinating each other to contribute to the EMI release as a whole. This paper presents the certification process, with respect to integration, installation, configuration and testing, adopted at INFN by the Product Team responsible for the gLite Web-Service based Computing Element (CREAM CE) and for the Workload Management System (WMS). The used resources, the testbeds layout, the integration and deployment methods, the certification steps to provide feedback to developers and to grant quality results are described.

Certification of production-quality gLite Job Management components

Science.gov (United States)

Andreetto, P.; Bertocco, S.; Capannini, F.; Cecchi, M.; Dorigo, A.; Frizziero, E.; Giacomini, F.; Gianelle, A.; Mezzadri, M.; Molinari, E.; Monforte, S.; Prelz, F.; Rebatto, D.; Sgaravatto, M.; Zangrando, L.

2011-12-01

With the advent of the recent European Union (EU) funded projects aimed at achieving an open, coordinated and proactive collaboration among the European communities that provide distributed computing services, more strict requirements and quality standards will be asked to middleware providers. Such a highly competitive and dynamic environment, organized to comply a business-oriented model, has already started pursuing quality criteria, thus requiring to formally define rigorous procedures, interfaces and roles for each step of the software life-cycle. This will ensure quality-certified releases and updates of the Grid middleware. In the European Middleware Initiative (EMI), the release management for one or more components will be organized into Product Team (PT) units, fully responsible for delivering production ready, quality-certified software and for coordinating each other to contribute to the EMI release as a whole. This paper presents the certification process, with respect to integration, installation, configuration and testing, adopted at INFN by the Product Team responsible for the gLite Web-Service based Computing Element (CREAM CE) and for the Workload Management System (WMS). The used resources, the testbeds layout, the integration and deployment methods, the certification steps to provide feedback to developers and to grant quality results are described.

Healthy Body Image Intervention Delivered to Young Women via Facebook Groups: Formative Study of Engagement and Acceptability.

Science.gov (United States)

Stapleton, Jerod L; Manne, Sharon L; Day, Ashley K; Levonyan-Radloff, Kristine; Pagoto, Sherry L

2018-02-20

There is increasing interest in using social media sites such as Facebook to deliver health interventions so as to expose people to content while they are engaging in their usual social media habit. This formative intervention development study is novel in describing a preliminary test of using the secret group feature of Facebook to deliver a behavioral intervention targeting users of indoor tanning beds to reduce their risk of skin cancer. Intervention content was designed to challenge body image-related constructs associated with indoor tanning through the use of dissonance-inducing content. To evaluate engagement with and acceptability of using a secret Facebook group to deliver a healthy body image intervention to young women engaged in indoor tanning. Seventeen young women completed a baseline survey and joined a secret Facebook group with intervention content delivered via daily posts for 4 weeks. Engagement data was extracted and acceptability was measured via a follow-up survey. The study had a high retention rate (94%, [16/17]). On average, posts were viewed by 91% of participants, liked by 35%, and commented on by 26%. The average comment rate was highest (65%) for posts that elicited comments by directly posing questions or discussion topics to the group. Average intervention acceptability ratings were highly positive and participants reported feeling connected to the group and its topic. Average rates of past 1-month indoor tanning reported following the intervention were lower than the baseline rate (P=.08, Cohen d=0.47). This study is novel in demonstrating participant engagement with and acceptability of using Facebook secret groups to deliver a dissonance-inducing intervention approach that utilizes group-based discussions related to body image. The study is also unique within the field of skin cancer prevention by demonstrating the potential value of delivering an indoor tanning intervention within an interactive social media format. The findings

Healthy Body Image Intervention Delivered to Young Women via Facebook Groups: Formative Study of Engagement and Acceptability

Science.gov (United States)

Manne, Sharon L; Day, Ashley K; Levonyan-Radloff, Kristine; Pagoto, Sherry L

2018-01-01

Background There is increasing interest in using social media sites such as Facebook to deliver health interventions so as to expose people to content while they are engaging in their usual social media habit. This formative intervention development study is novel in describing a preliminary test of using the secret group feature of Facebook to deliver a behavioral intervention targeting users of indoor tanning beds to reduce their risk of skin cancer. Intervention content was designed to challenge body image-related constructs associated with indoor tanning through the use of dissonance-inducing content. Objective To evaluate engagement with and acceptability of using a secret Facebook group to deliver a healthy body image intervention to young women engaged in indoor tanning. Methods Seventeen young women completed a baseline survey and joined a secret Facebook group with intervention content delivered via daily posts for 4 weeks. Engagement data was extracted and acceptability was measured via a follow-up survey. Results The study had a high retention rate (94%, [16/17]). On average, posts were viewed by 91% of participants, liked by 35%, and commented on by 26%. The average comment rate was highest (65%) for posts that elicited comments by directly posing questions or discussion topics to the group. Average intervention acceptability ratings were highly positive and participants reported feeling connected to the group and its topic. Average rates of past 1-month indoor tanning reported following the intervention were lower than the baseline rate (P=.08, Cohen d=0.47). Conclusions This study is novel in demonstrating participant engagement with and acceptability of using Facebook secret groups to deliver a dissonance-inducing intervention approach that utilizes group-based discussions related to body image. The study is also unique within the field of skin cancer prevention by demonstrating the potential value of delivering an indoor tanning intervention within

Selection of process parameters for producing high quality defatted sesame flour at pilot scale.

Science.gov (United States)

Manikantan, M R; Sharma, Rajiv; Yadav, D N; Gupta, R K

2015-03-01

The present work was undertaken to study the effect of pearling duration, soaking time, steaming duration and drying temperature on the quality of sesame seeds and mechanically extracted partially defatted sesame cake. On the basis of quality attributes i.e. high protein, low crude fibre, low residual oil and low oxalic acid, the optimum process parameters were selected. The combination of 20 min of pearling duration, 15 min of soaking, 15 min of steaming at 100 kPa pressure and drying at 50 °C yielded high quality partially defatted protein rich sesame flour as compared to untreated defatted sesame flour. The developed high quality partially defatted protein rich sesame flour may be used in various food applications as a vital ingredient to increase the nutritional significance of the prepared foodstuffs.

Synthesis of high-quality mesoporous silicon particles for enhanced lithium storage performance

Energy Technology Data Exchange (ETDEWEB)

Wang, Chundong, E-mail: apcdwang@hust.edu.cn [School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan 430074 (China); Center of Super-Diamond and Advanced Films (COSDAF), Department of Physics and Materials Science, City University of Hong Kong, Kowloon, Hong Kong SAR (China); Ren, Jianguo [Center of Super-Diamond and Advanced Films (COSDAF), Department of Physics and Materials Science, City University of Hong Kong, Kowloon, Hong Kong SAR (China); Chen, Hao [Department of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou (China); Zhang, Yi [School of Chemical Engineering and Pharmacy, Wuhan Institute of Technology, Wuhan, 430073 (China); Ostrikov, Kostya [School of Chemistry, Physics, and Mechanical Engineering, Queensland University of Technology, Brisbane 4000, QLD (Australia); Manufacturing Flagship, CSIRO, P. O. Box 218, Lindfield, NSW 2070 (Australia); Zhang, Wenjun [Center of Super-Diamond and Advanced Films (COSDAF), Department of Physics and Materials Science, City University of Hong Kong, Kowloon, Hong Kong SAR (China); Li, Yi, E-mail: liyi@suda.edu.cn [Department of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou (China); Center of Super-Diamond and Advanced Films (COSDAF), Department of Physics and Materials Science, City University of Hong Kong, Kowloon, Hong Kong SAR (China)

2016-04-15

Silicon has been considered as one of the most promising anode materials for high-capacity lithium-ion batteries (LIBs) due to its ultrahigh theoretical capacity, abundance, and environmentally benign nature. Nonetheless, the severe break during the prolonged cycling results in poor electrochemical performance, which hinders its practical application. Herein, we report the synthesis of novel mesoporous silicon particles with a facile template method by using a magnesiothermic reduction for LIBs. The obtained silicon nanoparticles are highly porous with densely porous cavities (20–40 nm) on the wall, of which it presents good crystallization. Electrochemical measurements showed that the mesoporous silicon nanoparticles delivered a high reversible specific capacity of 910 mA h g{sup −1} at a high current density of 1200 mA g{sup −1} over 50 cycles. The specific capacity at such high current density is still over twofold than that of commercial graphite anode, suggesting that the nanoporous Si architectures is suitable for high-performance Si-based anodes for lithium ion batteries in terms of capacity, cycle life, and rate capacity. - Highlights: • Silica nanotubes were prepared with a facile template method. • Novel mesoporous silicon particles were obtained by magnesiothermic reduction. • High-Performance LIBs were achieved by using mesoporous Si particle Electrodes.

IoT-Based Image Recognition System for Smart Home-Delivered Meal Services

Directory of Open Access Journals (Sweden)

Hsiao-Ting Tseng

2017-07-01

Full Text Available Population ageing is an important global issue. The Taiwanese government has used various Internet of Things (IoT applications in the “10-year long-term care program 2.0”. It is expected that the efficiency and effectiveness of long-term care services will be improved through IoT support. Home-delivered meal services for the elderly are important for home-based long-term care services. To ensure that the right meals are delivered to the right recipient at the right time, the runners need to take a picture of the meal recipient when the meal is delivered. This study uses the IoT-based image recognition system to design an integrated service to improve the management of image recognition. The core technology of this IoT-based image recognition system is statistical histogram-based k-means clustering for image segmentation. However, this method is time-consuming. Therefore, we proposed using the statistical histogram to obtain a probability density function of pixels of a figure and segmenting these with weighting for the same intensity. This aims to increase the computational performance and achieve the same results as k-means clustering. We combined histogram and k-means clustering in order to overcome the high computational cost for k-means clustering. The results indicate that the proposed method is significantly faster than k-means clustering by more than 10 times.

Quality Management in Tourism and Hospitality: an Exploratory Study among Tourism Stakeholders

OpenAIRE

Soultana Kapiki

2012-01-01

Quality in the tourism and hospitality industry involves consistent delivery of products and guest services according to expected standards. Delivering quality service is one of the major challenges the hospitality managers will be facing in the following years as it is an essential condition for success in the emerging, keenly competitive, global hospitality markets. There are various tools that measure and improve quality service, as well as mechanisms for quality recognition in the tourism...

Quality of after-hours primary care in The Netherlands: adherence to national guidelines

NARCIS (Netherlands)

Willekens, M.; Giesen, P.H.J.; Plat, E.; Mokkink, H.G.A.; Burgers, J.S.; Grol, R.P.T.M.

2011-01-01

OBJECTIVE: To assess the quality of after-hours clinical care as delivered by general practitioner (GP) cooperatives in The Netherlands. METHODS: A cross-sectional analysis was undertaken of patient health records of five GP cooperatives during 1 year. We used quality indicators derived from

An improved multi-exposure approach for high quality holographic femtosecond laser patterning

International Nuclear Information System (INIS)

Zhang, Chenchu; Hu, Yanlei; Li, Jiawen; Lao, Zhaoxin; Ni, Jincheng; Chu, Jiaru; Huang, Wenhao; Wu, Dong

2014-01-01

High efficiency two photon polymerization through single exposure via spatial light modulator (SLM) has been used to decrease the fabrication time and rapidly realize various micro/nanostructures, but the surface quality remains a big problem due to the speckle noise of optical intensity distribution at the defocused plane. Here, a multi-exposure approach which used tens of computer generate holograms successively loaded on SLM is presented to significantly improve the optical uniformity without losing efficiency. By applying multi-exposure, we found that the uniformity at the defocused plane was increased from ∼0.02 to ∼0.6 according to our simulation. The fabricated two series of letters “HELLO” and “USTC” under single-and multi-exposure in our experiment also verified that the surface quality was greatly improved. Moreover, by this method, several kinds of beam splitters with high quality, e.g., 2 × 2, 5 × 5 Daman, and complex nonseperate 5 × 5, gratings were fabricated with both of high quality and short time (<1 min, 95% time-saving). This multi-exposure SLM-two-photon polymerization method showed the promising prospect in rapidly fabricating and integrating various binary optical devices and their systems

An improved multi-exposure approach for high quality holographic femtosecond laser patterning

Energy Technology Data Exchange (ETDEWEB)

Zhang, Chenchu; Hu, Yanlei, E-mail: huyl@ustc.edu.cn, E-mail: jwl@ustc.edu.cn; Li, Jiawen, E-mail: huyl@ustc.edu.cn, E-mail: jwl@ustc.edu.cn; Lao, Zhaoxin; Ni, Jincheng; Chu, Jiaru; Huang, Wenhao; Wu, Dong [Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026 (China)

2014-12-01

High efficiency two photon polymerization through single exposure via spatial light modulator (SLM) has been used to decrease the fabrication time and rapidly realize various micro/nanostructures, but the surface quality remains a big problem due to the speckle noise of optical intensity distribution at the defocused plane. Here, a multi-exposure approach which used tens of computer generate holograms successively loaded on SLM is presented to significantly improve the optical uniformity without losing efficiency. By applying multi-exposure, we found that the uniformity at the defocused plane was increased from ∼0.02 to ∼0.6 according to our simulation. The fabricated two series of letters “HELLO” and “USTC” under single-and multi-exposure in our experiment also verified that the surface quality was greatly improved. Moreover, by this method, several kinds of beam splitters with high quality, e.g., 2 × 2, 5 × 5 Daman, and complex nonseperate 5 × 5, gratings were fabricated with both of high quality and short time (<1 min, 95% time-saving). This multi-exposure SLM-two-photon polymerization method showed the promising prospect in rapidly fabricating and integrating various binary optical devices and their systems.

Methods and systems for fabricating high quality superconducting tapes

Science.gov (United States)

Majkic, Goran; Selvamanickam, Venkat

2018-02-13

An MOCVD system fabricates high quality superconductor tapes with variable thicknesses. The MOCVD system can include a gas flow chamber between two parallel channels in a housing. A substrate tape is heated and then passed through the MOCVD housing such that the gas flow is perpendicular to the tape's surface. Precursors are injected into the gas flow for deposition on the substrate tape. In this way, superconductor tapes can be fabricated with variable thicknesses, uniform precursor deposition, and high critical current densities.

The use of citation indicators to identify and support high-quality research in Poland.

Science.gov (United States)

Pilc, Andrzej

2008-01-01

In large, mostly English-speaking countries, where the "critical mass" of scientists working in different subfields of science is achieved, the peer review system may be sufficient to assess the quality of scientific research. However, in smaller countries, outside the Anglo-American circle, it is important to introduce different systems to identify research of high quality. In Poland, a parametric system for assessing the quality of research has been introduced. It was largely based on the impact factor of scientific journals. While the use of this indicator to assess research quality is highly questionable, the implementation of the system in the Polish reality is even worse. Therefore it is important to change and improve the system currently used by the Ministry of Science and Higher Education to both evaluate and, more importantly, finance science in Poland. Here, a system based on three factors, i.e. the impact factor, the institutional h-index, and the institutional number of citations, is proposed. The scientific quality of institutions in Division VI: Medical Sciences of the Polish Academy of Sciences were evaluated and the results were compared with the existing system. Moreover, a method to identify high-quality researchers and institutions at the national level based on the quantity of highly cited papers is shown. Additionally, an attempt to identify the highest quality Polish research on an international level is proposed. This is based on the number of individual citations, the individual h-index, the number of publications, and the priority of the discovery.

Delivering construction projects using innovative building technologies

CSIR Research Space (South Africa)

Ampofo-Anti, Naalamkai

2017-07-01

Full Text Available . Figure 1: IBT delivery flowchart Proceedings 11th Built Environment Conference 6 th August – 8 th August 2017 Delivering construction projects using innovative building technologies Durban, South Africa 5. REFERENCES Ampofo-Anti, N...

Who delivers where? The effect of obstetric risk on facility delivery in East Africa.

Science.gov (United States)

Virgo, Sandra; Gon, Giorgia; Cavallaro, Francesca L; Graham, Wendy; Woodd, Susannah

2017-09-01

Skilled attendance at birth is key for the survival of pregnant women. This study investigates whether women at increased risk of maternal and newborn complications in four East African countries are more likely to deliver in a health facility than those at lower risk. Demographic and Health Survey data for Kenya 2014, Rwanda 2014-15, Tanzania 2015-16 and Uganda 2011 were used to study women with a live birth in the three years preceding the survey. A three-level obstetric risk index was created using known risk factors. Generalised linear Poisson regression was used to investigate the association between obstetric risk and facility delivery. We analysed data from 13 119 women across the four countries of whom 42-45% were considered at medium risk and 12-17% at high risk, and the remainder were at low risk. In Rwanda, 93% of all women delivered in facilities but this was lower (59-66%) in the other three countries. There was no association between a woman's obstetric risk level and her place of delivery in any country; greater wealth and more education were, however, independently strongly associated with facility delivery. In four East African countries, women at higher obstetric risk were not more likely to deliver in a facility than those with lower risk. This calls for a renewed focus on antenatal risk screening and improved communication on birth planning to ensure women with an increased chance of maternal and newborn complications are supported to deliver in facilities with skilled care. © 2017 John Wiley & Sons Ltd.

Innovative and high quality education through Open Education and OER

OpenAIRE

Stracke, Christian M.

2017-01-01

Online presentation and webinar by Stracke, C. M. (2017, 18 December) on "Innovative and high quality education through Open Education and OER" for the Belt and Road Open Education Learning Week by the Beijing Normal University, China.

Teaching Surgical Procedures with Movies: Tips for High-quality Video Clips

OpenAIRE

Jacquemart, Mathieu; Bouletreau, Pierre; Breton, Pierre; Mojallal, Ali; Sigaux, Nicolas

2016-01-01

Summary: Video must now be considered as a precious tool for learning surgery. However, the medium does present production challenges, and currently, quality movies are not always accessible. We developed a series of 7 surgical videos and made them available on a publicly accessible internet website. Our videos have been viewed by thousands of people worldwide. High-quality educational movies must respect strategic and technical points to be reliable.

Teaching Surgical Procedures with Movies: Tips for High-quality Video Clips.

Science.gov (United States)

Jacquemart, Mathieu; Bouletreau, Pierre; Breton, Pierre; Mojallal, Ali; Sigaux, Nicolas

2016-09-01

Video must now be considered as a precious tool for learning surgery. However, the medium does present production challenges, and currently, quality movies are not always accessible. We developed a series of 7 surgical videos and made them available on a publicly accessible internet website. Our videos have been viewed by thousands of people worldwide. High-quality educational movies must respect strategic and technical points to be reliable.

Evaluation of publicly financed and privately delivered model of emergency referral services for maternal and child health care in India.

Directory of Open Access Journals (Sweden)

Shankar Prinja

Full Text Available BACKGROUND: Emergency referral services (ERS are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost. METHODS: Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective. RESULTS: On an average, an ambulance transported 3-4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7 per patient transported or INR 21 (USD 0.35 per km travelled. CONCLUSION: Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system.

Study on the quality assurance of diagnostic X-ray machines and assessment of the absorbed dose to patients

Science.gov (United States)

Hassan, G. M.; Rabie, N.; Mustafa, K. A.; Abdel-Khalik, S. S.

2012-09-01

Radiation exposure and image quality in X-ray diagnostic radiology provide a clear understanding of the relationship between the radiation dose delivered to a patient and image quality in optimizing medical diagnostic radiology. Because a certain amount of radiation is unavoidably delivered to patients, this should be as low as reasonably achievable. Several X-ray diagnostic machines were used at different medical diagnostic centers in Egypt for studying the beam quality and the dose delivered to the patient. This article studies the factors affecting the beam quality, such as the kilo-volt peak (kVp), exposure time (mSc), tube current (mAs) and the absorbed dose in (μGy) for different examinations. The maximum absorbed dose measured per mAs was 594±239 and 12.5±3.7 μGy for the abdomen and the chest, respectively, while the absorbed dose at the elbow was 18±6 μGy, which was the minimum dose recorded. The compound and expanded uncertainties accompanying these measurements were 4±0.35% and 8±0.7%, respectively. The measurements were done through quality control tests as acceptance procedures.

Figure and finish characterization of high performance metal mirrors

International Nuclear Information System (INIS)

Takacs, P.Z.; Church, E.L.

1991-10-01

Most metal mirrors currently used in synchrotron radiation (SR) beam lines to reflect soft x-rays are made of electroless nickel plate on an aluminum substrate. This material combination has allowed optical designers to incorporate exotic cylindrical aspheres into grazing incidence x-ray beam-handling systems by taking advantage of single-point diamond machining techniques. But the promise of high-quality electroless nickel surfaces has generally exceeded the performance. We will examine the evolution of electroless nickel surfaces through a study of the quality of mirrors delivered for use at the National Synchrotron Light Source over the past seven years. We have developed techniques to assess surface quality based on the measurement of surface roughness and figure errors with optical profiling instruments. It is instructive to see how the quality of the surface is related to the complexity of the machine operations required to produce it

Benefits of a good quality assurance program to an electric utility

Energy Technology Data Exchange (ETDEWEB)

Mahoney, W.J. (Detroit Edison, Detroit, MI (United States))

1994-10-01

A good quality assurance program at a coal mine or power plant should be timely and consistent. The quality analysis is accurate due to a complete sampling of the coal stream loaded into the unit train. The sample analysis is accurate because standardized testing procedures are applied. A good coal quality assurance program includes: coal quality analysis of the delivered coal; bias testing of mechanical coal samplers; dust control during coal handling; and freeze conditioning during the winter. 2 figs., 2 plates

Bridging existing governance gaps: five evidence-based actions that boards can take to pursue high quality care.

Science.gov (United States)

Leggat, Sandra G; Balding, Cathy

2017-11-13

Objective To explore the impact of the organisational quality systems on quality of care in Victorian health services. Methods During 2015 a total of 55 focus groups were conducted with more than 350 managers, clinical staff and board members in eight Victorian health services to explore the effectiveness of health service quality systems. A review of the quality and safety goals and strategies outlined in the strategic and operating plans of the participating health services was also undertaken. Results This paper focuses on the data related to the leadership role of health service boards in ensuring safe, high-quality care. The findings suggest that health service boards are not fully meeting their governance accountability to ensure consistently high-quality care. The data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety and the implementation of these expectations at point of care. These gaps were further compounded by quality system confusion, over-reliance on compliance, and inadequate staff engagement. Conclusion Based on the existing evidence we propose five specific actions boards can take to close the gaps, thereby supporting improved care for all consumers. What is known about this topic? Effective governance is essential for high-quality healthcare delivery. Boards are required to play an active role in their organisation's pursuit of high quality care. What does this paper add? Recent government reports suggest that Australian health service boards are not fully meeting their governance requirements for high quality, safe care delivery, and our research pinpoints key governance gaps. What are the implications for practitioners? Based on our research findings we outline five evidence-based actions for boards to improve their governance of quality care delivery. These actions focus on an organisational strategy for high-quality care, with the chief executive officer held accountable for

Ballistic quality assurance

International Nuclear Information System (INIS)

Cassol, E.; Bonnet, J.; Porcheron, D.; Mazeron, J.J.; Peiffert, D.; Alapetite, C.

2012-01-01

This review describes the ballistic quality assurance for stereotactic intracranial irradiation treatments delivered with Gamma Knife R either dedicated or adapted medical linear accelerators. Specific and periodic controls should be performed in order to check the mechanical stability for both irradiation and collimation systems. If this step remains under the responsibility of the medical physicist, it should be done in agreement with the manufacturer's technical support. At this time, there are no recent published guidelines. With technological developments, both frequency and accuracy should be assessed in each institution according to the treatment mode: single versus hypo-fractionated dose, circular collimator versus micro-multi-leaf collimators. In addition, 'end-to-end' techniques are mandatory to find the origin of potential discrepancies and to estimate the global ballistic accuracy of the delivered treatment. Indeed, they include frames, non-invasive immobilization devices, localizers, multimodal imaging for delineation and in-room positioning imaging systems. The final precision that could be reasonably achieved is more or less 1 mm. (authors)

Key factors for a high-quality peritoneal dialysis program--the role of the PD team and continuous quality improvement.

Science.gov (United States)

Fang, Wei; Ni, Zhaohui; Qian, Jiaqi

2014-06-01

The proportion of end-stage renal disease (ESRD) patients on peritoneal dialysis (PD) has increased very fast in China over the last decade. Renji Hospital, affiliated with Shanghai Jiaotong University School of Medicine, is a recognized high-quality PD unit with a high PD utilization rate, excellent patient and technique survival (1-year and 5-year patient survival rate of 93% and 71%, and 1-year and 5-year technique survival of 96% and 82%, respectively), low peritonitis rate and a well-documented good quality of life of the treated patients. We believe that a dedicated and experienced PD team, a structured patient training program, continuous patient support, establishing and utilizing standardized protocols, starting PD with low dialysis dose, monitoring key performance indicators (KPIs), and continuous quality improvement (CQI) are the key factors underlying this successful PD program. Copyright © 2014 International Society for Peritoneal Dialysis.

Integrated Pathology Informatics Enables High-Quality Personalized and Precision Medicine: Digital Pathology and Beyond.

Science.gov (United States)

Volynskaya, Zoya; Chow, Hung; Evans, Andrew; Wolff, Alan; Lagmay-Traya, Cecilia; Asa, Sylvia L

2018-03-01

- The critical role of pathology in diagnosis, prognosis, and prediction demands high-quality subspecialty diagnostics that integrates information from multiple laboratories. - To identify key requirements and to establish a systematic approach to providing high-quality pathology in a health care system that is responsible for services across a large geographic area. - This report focuses on the development of a multisite pathology informatics platform to support high-quality surgical pathology and hematopathology using a sophisticated laboratory information system and whole slide imaging for histology and immunohistochemistry, integrated with ancillary tools, including electron microscopy, flow cytometry, cytogenetics, and molecular diagnostics. - These tools enable patients in numerous geographic locations access to a model of subspecialty pathology that allows reporting of every specimen by the right pathologist at the right time. The use of whole slide imaging for multidisciplinary case conferences enables better communication among members of patient care teams. The system encourages data collection using a discrete data synoptic reporting module, has implemented documentation of quality assurance activities, and allows workload measurement, providing examples of additional benefits that can be gained by this electronic approach to pathology. - This approach builds the foundation for accurate big data collection and high-quality personalized and precision medicine.

High frequency of sub-optimal semen quality in an unselected population of young men

DEFF Research Database (Denmark)

Andersen, A G; Jensen, Tina Kold; Carlsen, E

2000-01-01

concentration was 41 x 10(6)/ml (mean 57.4 x 10(6)/ml). Men with ejaculation abstinence above 48 h had slightly higher sperm concentrations (median 45 x10(6)/ml, mean 63.2 x 10(6)/ml), but even in this subgroup, 21 and 43% respectively had sperm counts below 20 x 10(6)/ml and 40 x 10(6)/ml. Among men...... with no history of reproductive diseases and a period of abstinence above 48 h, as many as 18 and 40% respectively had concentrations below 20 and 40 x 10(6)/ml. Sperm counts were positively correlated with testis size, percentage normal spermatozoa and inhibin B, and negatively correlated with percentage...... for military service, this provided a unique opportunity to study the reproductive function in an unbiased population. Altogether 891 young men delivered a blood sample in which reproductive hormones were measured. From 708 of these men data were also obtained on semen quality and testis size. The median sperm...

Utah Delivers Opportunities for Career Exploration

Science.gov (United States)

Dobson, Kristine; Fischio, Shannon

2006-01-01

Providing information and resources to support career exploration is key to the mission of career and technical education (CTE) in Utah. Utah CTE has responded in a variety of ways to meet the career exploration needs of students of all ages. This article discusses how the career and technical education in Utah delivers opportunities for career…

Recent developments in high-quality drying of vegetables, fruits, and aquatic products.

Science.gov (United States)

Zhang, Min; Chen, Huizhi; Mujumdar, Arun S; Tang, Juming; Miao, Song; Wang, Yuchuan

2017-04-13

Fresh foods like vegetables, fruits, and aquatic products have high water activity and they are highly heat-sensitive and easily degradable. Dehydration is one of the most common methods used to improve food shelf-life. However, drying methods used for food dehydration must not only be efficient and economic but also yield high-quality products based on flavor, nutrients, color, rehydration, uniformity, appearance, and texture. This paper reviews some new drying technologies developed for dehydration of vegetables, fruits, and aquatic products. These include: infrared drying, microwave drying, radio frequency drying, electrohydrodynamic drying, etc., as well as hybrid drying methods combining two or more different drying techniques. A comprehensive review of recent developments in high-quality drying of vegetables, fruits and aquatic products is presented and recommendations are made for future research.

High-quality ZnO growth, doping, and polarization effect

Science.gov (United States)

Kun, Tang; Shulin, Gu; Jiandong, Ye; Shunming, Zhu; Rong, Zhang; Youdou, Zheng

2016-03-01

The authors have reported their recent progress in the research field of ZnO materials as well as the corresponding global advance. Recent results regarding (1) the development of high-quality epitaxy techniques, (2) the defect physics and the Te/N co-doping mechanism for p-type conduction, and (3) the design, realization, and properties of the ZnMgO/ZnO hetero-structures have been shown and discussed. A complete technology of the growth of high-quality ZnO epi-films and nano-crystals has been developed. The co-doping of N plus an iso-valent element to oxygen has been found to be the most hopeful path to overcome the notorious p-type hurdle. High mobility electrons have been observed in low-dimensional structures utilizing the polarization of ZnMgO and ZnO. Very different properties as well as new physics of the electrons in 2DEG and 3DES have been found as compared to the electrons in the bulk. Project supported by the National Natural Science Foundation of China (Nos. 61025020, 61274058, 61322403, 61504057, 61574075), the Natural Science Foundation of Jiangsu Province (Nos. BK2011437, BK20130013, BK20150585), the Priority Academic Program Development of Jiangsu Higher Education Institutions, and the Fundamental Research Funds for the Central Universities.

Medical radio-physics. Quality assurance. Transparency

International Nuclear Information System (INIS)

Krembel, D.

2009-07-01

This short presentation, given by the national safety authority (ASN) at the meeting of July 1, 2009 of the high committee for the nuclear safety transparency and information (HCTISN), recalls, first, the missions of the ASN in the medical domain (radiation protection, control and inspections). Then it presents the reactions of the ASN in response to the increase of the number of radiological accidents since 2005: regulation reminder, circular letters, guidebooks, communication to the public and to the mass media. Finally, it defines the main priorities of the ASN with respect to radiotherapy: increase of human resources (radio-physicists shortage), declaration of incidents/accidents, quality assurance for the control of radiation doses delivered to patients, inspection of radiotherapy centres, expertise of new devices, improvement of softwares safety and ergonomics. (J.S.)

Documentation of pain care processes does not accurately reflect pain management delivered in primary care.

Science.gov (United States)

Krebs, Erin E; Bair, Matthew J; Carey, Timothy S; Weinberger, Morris

2010-03-01

Researchers and quality improvement advocates sometimes use review of chart-documented pain care processes to assess the quality of pain management. Studies have found that primary care providers frequently fail to document pain assessment and management. To assess documentation of pain care processes in an academic primary care clinic and evaluate the validity of this documentation as a measure of pain care delivered. Prospective observational study. 237 adult patients at a university-affiliated internal medicine clinic who reported any pain in the last week. Immediately after a visit, we asked patients to report the pain treatment they received. Patients completed the Brief Pain Inventory (BPI) to assess pain severity at baseline and 1 month later. We extracted documentation of pain care processes from the medical record and used kappa statistics to assess agreement between documentation and patient report of pain treatment. Using multivariable linear regression, we modeled whether documented or patient-reported pain care predicted change in pain at 1 month. Participants' mean age was 53.7 years, 66% were female, and 74% had chronic pain. Physicians documented pain assessment for 83% of visits. Patients reported receiving pain treatment more often (67%) than was documented by physicians (54%). Agreement between documentation and patient report was moderate for receiving a new pain medication (k = 0.50) and slight for receiving pain management advice (k = 0.13). In multivariable models, documentation of new pain treatment was not associated with change in pain (p = 0.134). In contrast, patient-reported receipt of new pain treatment predicted pain improvement (p = 0.005). Chart documentation underestimated pain care delivered, compared with patient report. Documented pain care processes had no relationship with pain outcomes at 1 month, but patient report of receiving care predicted clinically significant improvement. Chart review measures may not accurately

Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials.

Science.gov (United States)

Păsărelu, Costina Ruxandra; Andersson, Gerhard; Bergman Nordgren, Lise; Dobrean, Anca

2017-01-01

Anxiety and depressive disorders are often comorbid. Transdiagnostic and tailored treatments seem to be promising approaches in dealing with comorbidity. Although several primary studies have examined the effects of Internet-delivered cognitive behavior therapy (iCBT) for anxiety and depression, no meta-analysis including different types of iCBT that address comorbidity has been conducted so far. We conducted systematic searches in databases up to 1 July 2016. Only randomized trials comparing transdiagnostic/tailored iCBT for adult anxiety and/or depression with control groups were included. Nineteen randomized trials with a total of 2952 participants that met inclusion criteria were analyzed. The quality of the studies was high, however the blinding criteria were not fulfilled. The uncontrolled effect size (Hedges' g) of transdiagnostic/tailored iCBT on anxiety and depression outcomes was large and medium for quality of life. The controlled effect size for iCBT on anxiety and depression outcomes was medium to large (anxiety: g = .82, 95% CI: .58-1.05, depression: g = .79, 95% CI: .59-1.00) and medium on quality of life (g = .56, 95% CI: .37-.73). Heterogeneity was small (quality of life) to moderate (anxiety, depression). There was a large effect on generic outcome measures and a moderate effect on comorbidities. When compared to disorder-specific treatments there were no differences on anxiety and quality of life outcomes, however there were differences in depression outcomes. Transdiagnostic and tailored iCBT are effective interventions for anxiety disorders and depression. Future studies should investigate mechanisms of change and develop outcome measures for these interventions.

Methods and systems for fabricating high quality superconducting tapes

Energy Technology Data Exchange (ETDEWEB)

Majkic, Goran; Selvamanickam, Venkat

2018-02-13

An MOCVD system fabricates high quality superconductor tapes with variable thicknesses. The MOCVD system can include a gas flow chamber between two parallel channels in a housing. A substrate tape is heated and then passed through the MOCVD housing such that the gas flow is perpendicular to the tape's surface. Precursors are injected into the gas flow for deposition on the substrate tape. In this way, superconductor tapes can be fabricated with variable thicknesses, uniform precursor deposition, and high critical current densities.

High Efficiency, Illumination Quality OLEDs for Lighting

Energy Technology Data Exchange (ETDEWEB)

Joseph Shiang; James Cella; Kelly Chichak; Anil Duggal; Kevin Janora; Chris Heller; Gautam Parthasarathy; Jeffery Youmans; Joseph Shiang

2008-03-31

The goal of the program was to demonstrate a 45 lumen per watt white light device based upon the use of multiple emission colors through the use of solution processing. This performance level is a dramatic extension of the team's previous 15 LPW large area illumination device. The fundamental material system was based upon commercial polymer materials. The team was largely able to achieve these goals, and was able to deliver to DOE a 90 lumen illumination source that had an average performance of 34 LPW a 1000 cd/m{sup 2} with peak performances near 40LPW. The average color temperature is 3200K and the calculated CRI 85. The device operated at a brightness of approximately 1000cd/m{sup 2}. The use of multiple emission colors particularly red and blue, provided additional degrees of design flexibility in achieving white light, but also required the use of a multilayered structure to separate the different recombination zones and prevent interconversion of blue emission to red emission. The use of commercial materials had the advantage that improvements by the chemical manufacturers in charge transport efficiency, operating life and material purity could be rapidly incorporated without the expenditure of additional effort. The program was designed to take maximum advantage of the known characteristics of these material and proceeded in seven steps. (1) Identify the most promising materials, (2) assemble them into multi-layer structures to control excitation and transport within the OLED, (3) identify materials development needs that would optimize performance within multilayer structures, (4) build a prototype that demonstrates the potential entitlement of the novel multilayer OLED architecture (5) integrate all of the developments to find the single best materials set to implement the novel multilayer architecture, (6) further optimize the best materials set, (7) make a large area high illumination quality white OLED. A photo of the final deliverable is shown

Production of high quality water for oil sands application

Energy Technology Data Exchange (ETDEWEB)

Beaudette-Hodsman, C.; Macleod, B. [Pall Corp., Mississauga, ON (Canada); Venkatadri, R. [Pall Corp., East Hills, NY (United States)

2008-10-15

This paper described a pressurized microfiltration membrane system installed at an oil sands extraction site in Alberta. The system was designed to complement a reverse osmosis (RO) system installed at the site to produce the high quality feed water required by the system's boilers. Groundwater in the region exhibited moderate total suspended solids and high alkalinity and hardness levels, and the RO system required feed water with a silt density index of 3 or less. The conventional pretreatment system used at the site was slowing down production due to the severe fouling of the RO membranes. The new microfiltration system contained an automated PVDF hollow fiber microfiltration membrane system contained in a trailer. Suspended particles and bacteria were captured within the filter, and permeate was sent to the RO unit. Within 6 hours of being installed, the unit was producing water with SDI values in the range of 1.0 to 2.5. It was concluded that the microfiltration system performed reliably regardless of wide variations in feed water quality and flow rates. 3 refs., 1 tab., 8 figs.

Progressing quality control in environmental impact assessment beyond legislative compliance: An evaluation of the IEMA EIA Quality Mark certification scheme

International Nuclear Information System (INIS)

Bond, Alan; Fischer, Thomas B; Fothergill, Josh

2017-01-01

The effectiveness of Environmental Impact Assessment (EIA) systems is contingent on a number of control mechanisms: procedural; judicial; evaluative; public and government agency; professional; and development aid agency. If we assume that procedural and judicial controls are guaranteed in developed EIA systems, then progressing effectiveness towards an acceptable level depends on improving the performance of other control mechanisms over time. These other control mechanisms are either absent, or are typically centrally controlled, requiring public finances; this we argue is an unpopular model in times of greater Government austerity. Here we evaluate a market-based mechanism for improving the performance of evaluative and professional control mechanisms, the UK Institute of Environmental Management and Assessments' EIA Quality Mark. We do this by defining dimensions of effectiveness for the purposes of our evaluation, and by identifying international examples of the approaches taken to delivering the other control measures to validate the approach taken in the EIA Quality Mark. We then evaluate the EIA Quality Mark, when used in combination with legal procedures and an active judiciary, against the effectiveness dimensions and use time-series analysis of registrant data to examine its ability to progress practice. We conclude that the EIA Quality Mark has merit as a model for a market-based mechanism, and may prove a more financially palatable approach for delivering effective EIA in mature systems in countries that lack centralised agency oversight. It may, therefore, be of particular interest to some Member States of the European Union for ensuring forthcoming certification requirements stemming from recent amendments to the EIA Directive. - Highlights: • Quality control mechanisms in EIA are identified. • Effectiveness of EIA is conceptualised for evaluation purposes. • The UK IEMA EIA Quality Mark is introduced as a market-based mechanism. • The

Progressing quality control in environmental impact assessment beyond legislative compliance: An evaluation of the IEMA EIA Quality Mark certification scheme

Energy Technology Data Exchange (ETDEWEB)

Bond, Alan, E-mail: alan.bond@uea.ac.uk [School of Environmental Sciences, University of East Anglia (United Kingdom); Research Unit for Environmental Sciences and Management, North-West University (South Africa); Fischer, Thomas B, E-mail: fischer@liverpool.ac.uk [School of Environmental Sciences, University of Liverpool (United Kingdom); Fothergill, Josh, E-mail: j.fothergill@iema.net [Institute of Environmental Management and Assessment, Lincoln (United Kingdom)

2017-03-15

The effectiveness of Environmental Impact Assessment (EIA) systems is contingent on a number of control mechanisms: procedural; judicial; evaluative; public and government agency; professional; and development aid agency. If we assume that procedural and judicial controls are guaranteed in developed EIA systems, then progressing effectiveness towards an acceptable level depends on improving the performance of other control mechanisms over time. These other control mechanisms are either absent, or are typically centrally controlled, requiring public finances; this we argue is an unpopular model in times of greater Government austerity. Here we evaluate a market-based mechanism for improving the performance of evaluative and professional control mechanisms, the UK Institute of Environmental Management and Assessments' EIA Quality Mark. We do this by defining dimensions of effectiveness for the purposes of our evaluation, and by identifying international examples of the approaches taken to delivering the other control measures to validate the approach taken in the EIA Quality Mark. We then evaluate the EIA Quality Mark, when used in combination with legal procedures and an active judiciary, against the effectiveness dimensions and use time-series analysis of registrant data to examine its ability to progress practice. We conclude that the EIA Quality Mark has merit as a model for a market-based mechanism, and may prove a more financially palatable approach for delivering effective EIA in mature systems in countries that lack centralised agency oversight. It may, therefore, be of particular interest to some Member States of the European Union for ensuring forthcoming certification requirements stemming from recent amendments to the EIA Directive. - Highlights: • Quality control mechanisms in EIA are identified. • Effectiveness of EIA is conceptualised for evaluation purposes. • The UK IEMA EIA Quality Mark is introduced as a market-based mechanism. • The

Made in U.S.A.: a renaissance in quality.

Science.gov (United States)

Juran, J M

1993-01-01

In the opinion of some journalists and business leaders, Japan's preeminence in product quality is a direct consequence of lectures delivered 40 years ago in Tokyo by two Americans--W. Edwards Deming and Joseph M. Juran. According to Dr. Juran, this view is pure chauvinist nonsense. Despite the shoddiness of Japanese consumer goods before the war, the Japanese did have a quality tradition in the superb workmanship of certain ancient crafts and in the design and manufacture of their military hardware, which, at the outset of the war, was highly competitive with our own. It was just that the Japanese had never devoted engineering expertise, capital, or management attention to the quality of exportable consumer goods. The shock of losing the war changed that mind-set. When Dr. Juran first lectured in Japan in 1954, his audience consisted of 140 CEOs. He had given the very same lectures dozens of times in the United States, but never to top management. American CEOs concentrated their attention on financial reports. Quality was a discipline that they delegated to engineers and special quality departments. In Japan, senior executives took personal charge of managing for quality; trained their managers, engineers, and employees in quality methods; developed quality measurements; pursued quality change at a revolutionary pace; and kept at it year after year until, by the mid-1970s, Japan had passed the United States in quality manufacturing. The unsung heroes of the Japanese quality revolution were Japanese managers, not American experts. Now Dr. Juran sees the beginnings of a quality revolution in the United States as global competition drives managers to focus on their nondelegable responsibilities in quality management.

An Examination of Peer-Delivered Parenting Skills Programs Across New York State.

Science.gov (United States)

Acri, Mary C; Craig, Nancy; Adler, Josh

2018-03-24

Peers are an important adjunct to the public mental health service system, and are being increasingly utilized across the country as a cost-effective solution to workforce shortages. Despite the tremendous growth of peer-delivered support over the past two decades, it has only been within the past few years that peer programs have been the subject of empirical inquiry. The purpose of this study was to examine the prevalence and characteristics of peer-delivered parenting programs across the New York State public mental health service system. We surveyed 46 family peer organizations across New York State regarding their delivery of structured peer-delivered parenting programs. Thirty-four (76%) completed the questionnaire, and of them, 18 (53%) delivered a parenting program. Subsequent interviews with seven of the 18 organizations revealed peer organizations had been delivering eight unique parenting programs for upwards of two decades. Additionally, organizations offered multiple supports to families to participate. Training, supervision, and issues around fidelity are discussed, as well as the implications of this study for states utilizing a peer workforce.

Delivering Bad News: Attitudes, Feelings, and Practice Characteristics Among Speech-Language Pathologists.

Science.gov (United States)

Gold, Rinat; Gold, Azgad

2018-02-06

The purpose of this study was to examine the attitudes, feelings, and practice characteristics of speech-language pathologists (SLPs) in Israel regarding the subject of delivering bad news. One hundred and seventy-three Israeli SLPs answered an online survey. Respondents represented SLPs in Israel in all stages of vocational experience, with varying academic degrees, from a variety of employment settings. The survey addressed emotions involved in the process of delivering bad news, training on this subject, and background information of the respondents. Frequency distributions of the responses of the participants were determined, and Pearson correlations were computed to determine the relation between years of occupational experience and the following variables: frequency of delivering bad news, opinions regarding training, and emotions experienced during the process of bad news delivery. Our survey showed that bad news delivery is a task that most participants are confronted with from the very beginning of their careers. Participants regarded training in the subject of delivering bad news as important but, at the same time, reported receiving relatively little training on this subject. In addition, our survey showed that negative emotions are involved in the process of delivering bad news. Training SLPs on specific techniques is required for successfully delivering bad news. The emotional burden associated with breaking bad news in the field of speech-language pathology should be noticed and addressed.

How Do Management Students Perceive the Quality of Education in Public Institutions?

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Narang, Ritu

2012-01-01

Purpose: Keeping in mind the urgent need to deliver quality education in higher education institutes, the current paper seeks to measure the quality perception of management students in India. Design/methodology/approach: Based on an exploratory study a modified version of SERVQUAL was employed as the research instrument. Data were collected from…

Quality circles: the nurse executive as mentor.

Science.gov (United States)