Early diagnosis and Early Start Denver Model intervention in autism spectrum disorders delivered in an Italian Public Health System service.

Science.gov (United States)

Devescovi, Raffaella; Monasta, Lorenzo; Mancini, Alice; Bin, Maura; Vellante, Valerio; Carrozzi, Marco; Colombi, Costanza

2016-01-01

Early diagnosis combined with an early intervention program, such as the Early Start Denver Model (ESDM), can positively influence the early natural history of autism spectrum disorders. This study evaluated the effectiveness of an early ESDM-inspired intervention, in a small group of toddlers, delivered at low intensity by the Italian Public Health System. Twenty-one toddlers at risk for autism spectrum disorders, aged 20-36 months, received 3 hours/wk of one-to-one ESDM-inspired intervention by trained therapists, combined with parents' and teachers' active engagement in ecological implementation of treatment. The mean duration of treatment was 15 months. Cognitive and communication skills, as well as severity of autism symptoms, were assessed by using standardized measures at pre-intervention (Time 0 [T0]; mean age =27 months) and post-intervention (Time 1 [T1]; mean age =42 months). Children made statistically significant improvements in the language and cognitive domains, as demonstrated by a series of nonparametric Wilcoxon tests for paired data. Regarding severity of autism symptoms, younger age at diagnosis was positively associated with greater improvement at post-assessment. Our results are consistent with the literature that underlines the importance of early diagnosis and early intervention, since prompt diagnosis can reduce the severity of autism symptoms and improve cognitive and language skills in younger children. Particularly in toddlers, it seems that an intervention model based on the ESDM principles, involving the active engagement of parents and nursery school teachers, may be effective even when the individual treatment is delivered at low intensity. Furthermore, our study supports the adaptation and the positive impact of the ESDM entirely sustained by the Italian Public Health System.

Improved Speech Following Parent-Delivered Qigong Massage in Young Children with Down Syndrome: A Pilot Randomised Controlled Trial

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Silva, Louisa M. T.; Schalock, Mark; Williams, Mary

2013-01-01

Qigong massage is an eastern form of massage that can be delivered by western parents to their children with appropriate training and support. It has been shown to improve developmental measures in young children with autism when given daily for five months. A recent trial evaluating its effect on motor development in young children with Down…

Systematic review of integrated models of health care delivered at the primary-secondary interface: how effective is it and what determines effectiveness?

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Mitchell, Geoffrey K; Burridge, Letitia; Zhang, Jianzhen; Donald, Maria; Scott, Ian A; Dart, Jared; Jackson, Claire L

2015-01-01

Integrated multidisciplinary care is difficult to achieve between specialist clinical services and primary care practitioners, but should improve outcomes for patients with chronic and/or complex chronic physical diseases. This systematic review identifies outcomes of different models that integrate specialist and primary care practitioners, and characteristics of models that delivered favourable clinical outcomes. For quality appraisal, the Cochrane Risk of Bias tool was used. Data are presented as a narrative synthesis due to marked heterogeneity in study outcomes. Ten studies were included. Publication bias cannot be ruled out. Despite few improvements in clinical outcomes, significant improvements were reported in process outcomes regarding disease control and service delivery. No study reported negative effects compared with usual care. Economic outcomes showed modest increases in costs of integrated primary-secondary care. Six elements were identified that were common to these models of integrated primary-secondary care: (1) interdisciplinary teamwork; (2) communication/information exchange; (3) shared care guidelines or pathways; (4) training and education; (5) access and acceptability for patients; and (6) a viable funding model. Compared with usual care, integrated primary-secondary care can improve elements of disease control and service delivery at a modestly increased cost, although the impact on clinical outcomes is limited. Future trials of integrated care should incorporate design elements likely to maximise effectiveness.

Analyzing Supply Chain Uncertainty to Deliver Sustainable Operational Performance: Symmetrical and Asymmetrical Modeling Approaches

Directory of Open Access Journals (Sweden)

Mohammad Asif Salam

2017-11-01

Full Text Available The purpose of this study is to analyze different types of supply chain uncertainties and suggest strategies to deal with unexpected contingencies to deliver superior operational performance (OP using symmetrical and asymmetrical modeling approaches. The data were collected through a survey given to 146 supply chain managers within the fast moving consumer goods industry in Thailand. Symmetrical modeling is applied via partial least squares structural equation modeling (PLS-SEM in order to assess the theoretical relationships among the latent variables, while asymmetrical modeling is applied via fuzzy set qualitative comparative analysis (fsQCA to emphasize their combinatory causal relation. The empirical results support the theory by highlighting the mediating effect of supply chain strategy (SCS in the relation between supply chain uncertainty (SCU and firms’ OP and, hence, deliver business sustainability for the firms, demonstrating that the choice of SCS should not be an “either-or” decision. This research contributes by providing an illustration of a PLS-SEM and fsQCA based estimation for the rapidly emerging field of sustainable supply chain management. This study provides empirical support for resource dependence theory (RDT in explaining the relation between SCU and SCS, which leads to sustainable OP. From a methodological standpoint, this study also illustrates predictive validation testing of models using holdout samples and testing for causal asymmetry.

Operator models for delivering municipal solid waste management services in developing countries. Part A: The evidence base.

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Wilson, David C; Kanjogera, Jennifer Bangirana; Soós, Reka; Briciu, Cosmin; Smith, Stephen R; Whiteman, Andrew D; Spies, Sandra; Oelz, Barbara

2017-08-01

This article presents the evidence base for 'operator models' - that is, how to deliver a sustainable service through the interaction of the 'client', 'revenue collector' and 'operator' functions - for municipal solid waste management in emerging and developing countries. The companion article addresses a selection of locally appropriate operator models. The evidence shows that no 'standard' operator model is effective in all developing countries and circumstances. Each city uses a mix of different operator models; 134 cases showed on average 2.5 models per city, each applying to different elements of municipal solid waste management - that is, street sweeping, primary collection, secondary collection, transfer, recycling, resource recovery and disposal or a combination. Operator models were analysed in detail for 28 case studies; the article summarises evidence across all elements and in more detail for waste collection. Operators fall into three main groups: The public sector, formal private sector, and micro-service providers including micro-, community-based and informal enterprises. Micro-service providers emerge as a common group; they are effective in expanding primary collection service coverage into poor- or peri-urban neighbourhoods and in delivering recycling. Both public and private sector operators can deliver effective services in the appropriate situation; what matters more is a strong client organisation responsible for municipal solid waste management within the municipality, with stable political and financial backing and capacity to manage service delivery. Revenue collection is also integral to operator models: Generally the municipality pays the operator from direct charges and/or indirect taxes, rather than the operator collecting fees directly from the service user.

Video Modeling Training Effects on Types of Attention Delivered by Educational Care-Providers.

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Taber, Traci A; Lambright, Nathan; Luiselli, James K

2017-06-01

We evaluated the effects of abbreviated (i.e., one-session) video modeling on delivery of student-preferred attention by educational care-providers. The video depicted a novel care-provider interacting with and delivering attention to the student. Within a concurrent multiple baseline design, video modeling increased delivery of the targeted attention for all participants as well as their delivery of another type of attention that was not trained although these effects were variable within and between care-providers. We discuss the clinical and training implications from these findings.

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

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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

Feasibility of motivational interviewing delivered by a glaucoma educator to improve medication adherence.

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Cook, Paul F; Bremer, Robert W; Ayala, A J; Kahook, Malik Y

2010-10-05

Adherence to glaucoma treatment is poor, potentially reducing therapeutic effects. A glaucoma educator was trained to use motivational interviewing (MI), a patient-centered counseling style, to improve adherence. This study was designed to evaluate whether MI was feasible in a busy ophthalmology practice. Feasibility was assessed using five criteria from the National Institutes of Health Behavior Change consortium: fidelity of intervention components to MI theory; success of the training process; delivery of MI-consistent interventions by the glaucoma educator; patient receipt of the intervention based on enrollment, attrition, and satisfaction; and patient enactment of changes in motivation and adherence over the course of the intervention. A treatment manual was designed by a multidisciplinary team with expertise in health psychology, public health, and ophthalmology. The glaucoma educator received 6 hours of training including role-play exercises, self-study, and individual supervision. His MI-related knowledge and skills increased following training, and he delivered exclusively MI-consistent interventions in 66% of patient encounters. 86% (12/14) of eligible patients agreed to be randomized into glaucoma educator support or a control condition. All 8 patients assigned to the glaucoma educator completed at least 2 of 6 planned contacts, and 50% (4/8) completed all 6 contacts. Patients assigned to the glaucoma educator improved over time in both motivation and adherence. The introduction of a glaucoma educator was feasible in a busy ophthalmology practice. Patients improved their adherence while participating in the glaucoma educator program, although this study was not designed to show a causal effect. The use of a glaucoma educator to improve glaucoma patients' medication adherence may be feasible at other ophthalmology clinics, and can be implemented with a standardized training approach. Pilot data show the intervention can be implemented with fidelity, is

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

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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

Optimizing a Drone Network to Deliver Automated External Defibrillators.

Science.gov (United States)

Boutilier, Justin J; Brooks, Steven C; Janmohamed, Alyf; Byers, Adam; Buick, Jason E; Zhan, Cathy; Schoellig, Angela P; Cheskes, Sheldon; Morrison, Laurie J; Chan, Timothy C Y

2017-06-20

Public access defibrillation programs can improve survival after out-of-hospital cardiac arrest, but automated external defibrillators (AEDs) are rarely available for bystander use at the scene. Drones are an emerging technology that can deliver an AED to the scene of an out-of-hospital cardiac arrest for bystander use. We hypothesize that a drone network designed with the aid of a mathematical model combining both optimization and queuing can reduce the time to AED arrival. We applied our model to 53 702 out-of-hospital cardiac arrests that occurred in the 8 regions of the Toronto Regional RescuNET between January 1, 2006, and December 31, 2014. Our primary analysis quantified the drone network size required to deliver an AED 1, 2, or 3 minutes faster than historical median 911 response times for each region independently. A secondary analysis quantified the reduction in drone resources required if RescuNET was treated as a large coordinated region. The region-specific analysis determined that 81 bases and 100 drones would be required to deliver an AED ahead of median 911 response times by 3 minutes. In the most urban region, the 90th percentile of the AED arrival time was reduced by 6 minutes and 43 seconds relative to historical 911 response times in the region. In the most rural region, the 90th percentile was reduced by 10 minutes and 34 seconds. A single coordinated drone network across all regions required 39.5% fewer bases and 30.0% fewer drones to achieve similar AED delivery times. An optimized drone network designed with the aid of a novel mathematical model can substantially reduce the AED delivery time to an out-of-hospital cardiac arrest event. © 2017 American Heart Association, Inc.

Where to deliver baits for deworming urban red foxes for Echinococcus multilocularis control: new protocol for micro-habitat modeling of fox denning requirements.

Science.gov (United States)

Ikeda, Takako; Yoshimura, Masashi; Onoyama, Keiichi; Oku, Yuzaburo; Nonaka, Nariaki; Katakura, Ken

2014-08-06

Deworming wild foxes by baiting with the anthelmintic praziquantel is being established as a preventive technique against environmental contamination with Echinococcus multilocularis eggs. Improvement of the cost-benefit performance of baiting treatment is required urgently to raise and maintain the efficacy of deworming. We established a spatial model of den site selection by urban red foxes, the definitive host, to specify the optimal micro-habitats for delivering baits in a new modeling approach modified for urban fox populations. The model was established for two cities (Obihiro and Sapporo) in Hokkaido, Japan, in which a sylvatic cycle of E. multilocularis is maintained. The two cities have different degrees of urbanization. The modeling process was designed to detect the best combination of key environmental factors and spatial scale that foxes pay attention to most (here named 'heeding range') when they select den sites. All possible models were generated using logistic regression analysis, with "presence" or "absence" of fox den as the objective variable, and nine landscape categories customized for urban environments as predictor variables to detect the best subset of predictors. This procedure was conducted for each of ten sizes of concentric circles from dens and control points to detect the best circle size. Out of all models generated, the most parsimonious model was selected using Akaike's Information Criterion (AIC) inspection. Our models suggest that fox dens in Obihiro are located at the center of a circle with 500 m radius including low percentages of wide roads, narrow roads, and occupied buildings, but high percentages of green covered areas; the dens in Sapporo within 300 m radius with low percentages of wide roads, occupied buildings, but high percentages of riverbeds and green covered areas. The variation of the models suggests the necessity of accumulating models for various types of cities in order to reveal the patterns of the model. Our

A national-scale model of linear features improves predictions of farmland biodiversity.

Science.gov (United States)

Sullivan, Martin J P; Pearce-Higgins, James W; Newson, Stuart E; Scholefield, Paul; Brereton, Tom; Oliver, Tom H

2017-12-01

Modelling species distribution and abundance is important for many conservation applications, but it is typically performed using relatively coarse-scale environmental variables such as the area of broad land-cover types. Fine-scale environmental data capturing the most biologically relevant variables have the potential to improve these models. For example, field studies have demonstrated the importance of linear features, such as hedgerows, for multiple taxa, but the absence of large-scale datasets of their extent prevents their inclusion in large-scale modelling studies.We assessed whether a novel spatial dataset mapping linear and woody-linear features across the UK improves the performance of abundance models of 18 bird and 24 butterfly species across 3723 and 1547 UK monitoring sites, respectively.Although improvements in explanatory power were small, the inclusion of linear features data significantly improved model predictive performance for many species. For some species, the importance of linear features depended on landscape context, with greater importance in agricultural areas. Synthesis and applications . This study demonstrates that a national-scale model of the extent and distribution of linear features improves predictions of farmland biodiversity. The ability to model spatial variability in the role of linear features such as hedgerows will be important in targeting agri-environment schemes to maximally deliver biodiversity benefits. Although this study focuses on farmland, data on the extent of different linear features are likely to improve species distribution and abundance models in a wide range of systems and also can potentially be used to assess habitat connectivity.

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).

Improved sonothrombolysis from a modified diagnostic transducer delivering impulses containing a longer pulse duration.

Science.gov (United States)

Wu, Juefei; Xie, Feng; Kumar, Tanmay; Liu, Jinjin; Lof, John; Shi, William; Everbach, E Carr; Porter, Thomas R

2014-07-01

Although guided high-mechanical-index (MI) impulses from a diagnostic ultrasound transducer have been used in preclinical studies to dissolve coronary arterial and microvascular thrombi in the presence of intravenously infused microbubbles, it is possible that pulse durations (PDs) longer than that used for diagnostic imaging may further improve the effectiveness of this approach. By use of an established in vitro model flow system, a total of 90 occlusive porcine arterial thrombi (thrombus age: 3-4 h) within a vascular mimicking system were randomized to 10-min treatments with two different PDs (5 and 20 μs) using a Philips S5-1 transducer (1.6-MHz center frequency) at a range of MIs (from 0.2 to 1.4). All impulses were delivered in an intermittent fashion to permit microbubble replenishment within the thrombosed vessel. Diluted lipid-encapsulated microbubbles (0.5% Definity) were infused during the entire treatment period. A tissue-mimicking phantom 5 cm thick was placed between the transducer and thrombosed vessel to mimic transthoracic attenuation. Two 20-MHz passive cavitation detection systems were placed confocal to the insonified vessel to assess for inertial cavitational activity. Percentage thrombus dissolution was calculated by weighing the thrombi before and after each treatment. Percentage thrombus dissolution was significantly higher with a 20-μs PD already at the 0.2 and 0.4 MI therapeutic impulses (54 ± 12% vs. 33 ± 17% and 54 ± 22% vs. 34 ± 17%, p cavitation detection systems detected only low intensities of inertial cavitation. At higher MI settings and 20-μs PDs, percentage thrombus dissolution decreased most likely from high-intensity cavitation shielding of the thrombus. Slightly prolonging the PD on a diagnostic transducer improves the degree of sonothrombolysis that can be achieved without fibrinolytic agents at a lower mechanical index. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc

Software-as-a-Service Vendors: Are They Ready to Successfully Deliver?

Science.gov (United States)

Heart, Tsipi; Tsur, Noa Shamir; Pliskin, Nava

Software as a service (SaaS) is a software sourcing option that allows organizations to remotely access enterprise applications, without having to install the application in-house. In this work we study vendors' readiness to deliver SaaS, a topic scarcely studied before. The innovation classification (evolutionary vs. revolutionary) and a new, Seven Fundamental Organizational Capabilities (FOCs) Model, are used as the theoretical frameworks. The Seven FOCs model suggests generic yet comprehensive set of capabilities that are required for organizational success: 1) sensing the stakeholders, 2) sensing the business environment, 3) sensing the knowledge environment, 4) process control, 5) process improvement, 6) new process development, and 7) appropriate resolution.

Nursing leaders can deliver a new model of care.

Science.gov (United States)

Shalala, Donna E

2014-01-01

Millions more insured Americans. Increasing numbers of older patients. Higher rates of chronic illness. Fewer providers. How can our healthcare system not only manage these challenges but also improve performance and access to care while containing costs? The answer lies with our nurses. In some parts of the United States, nurses provide the full spectrum of primary and preventive care. They have successfully improved access and quality in rural areas. In other parts, nurses' hands are tied by antiquated laws and regulations that limit their ability to expand access to care. Our system cannot increase access when we have providers who are not allowed to perform to the top of their education, training, and capability. It is time to rethink how we deliver primary and preventive care and redefine the roles of doctors and nurses. This article examines the history of the Institute of Medicine's (IOM) Future of Nursing report (chaired by the author) and the resulting Future of Nursing Campaign for Action, which is working to institute the report's recommendations in all 50 states. The IOM report's recommendations are simple: 1. Remove outdated restrictions on nursing practice. 2. Promote nurse leadership on hospital boards and in all healthcare sectors. 3. Strengthen nurse education and training, and increase the number of nurses with advanced degrees. 4. Increase diversity in the nursing workforce to better reflect the patient population. 5. Improve data reporting and compilation to predict workforce needs. New York, Kentucky, and Minnesota are three recent states to remove barriers pre venting advanced practice registered nurses from practicing at the top of their license. Similar efforts in California, Florida, and Indiana failed initially but are expected to make progress in the near future. The article makes clear how and why the Center to Champion Nursing in America (an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation) is working to

Early diagnosis and Early Start Denver Model intervention in autism spectrum disorders delivered in an Italian Public Health System service

Directory of Open Access Journals (Sweden)

Devescovi R

2016-06-01

Full Text Available Raffaella Devescovi,1 Lorenzo Monasta,2 Alice Mancini,3 Maura Bin,1 Valerio Vellante,1 Marco Carrozzi,1 Costanza Colombi4 1Division of Child Neurology and Psychiatry, 2Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, 3Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 4Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA Background: Early diagnosis combined with an early intervention program, such as the Early Start Denver Model (ESDM, can positively influence the early natural history of autism spectrum disorders. This study evaluated the effectiveness of an early ESDM-inspired intervention, in a small group of toddlers, delivered at low intensity by the Italian Public Health System.Methods: Twenty-one toddlers at risk for autism spectrum disorders, aged 20–36 months, received 3 hours/wk of one-to-one ESDM-inspired intervention by trained therapists, combined with parents’ and teachers’ active engagement in ecological implementation of treatment. The mean duration of treatment was 15 months. Cognitive and communication skills, as well as severity of autism symptoms, were assessed by using standardized measures at pre-intervention (Time 0 [T0]; mean age =27 months and post-intervention (Time 1 [T1]; mean age =42 months.Results: Children made statistically significant improvements in the language and cognitive domains, as demonstrated by a series of nonparametric Wilcoxon tests for paired data. Regarding severity of autism symptoms, younger age at diagnosis was positively associated with greater improvement at post-assessment.Conclusion: Our results are consistent with the literature that underlines the importance of early diagnosis and early intervention, since prompt diagnosis can reduce the severity of autism symptoms and improve cognitive and language skills in younger children

Brief Report: Predictors of Outcomes in the Early Start Denver Model Delivered in a Group Setting

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Vivanti, Giacomo; Dissanayake, Cheryl; Zierhut, Cynthia; Rogers, Sally J.

2013-01-01

There is a paucity of studies that have looked at factors associated with responsiveness to interventions in preschoolers with autism spectrum disorder (ASD). We investigated learning profiles associated with response to the Early Start Denver Model delivered in a group setting. Our preliminary results from 21 preschool children with an ASD aged…

Qualitative assessment of adolescents' views about improving exposure to internet-delivered interventions

NARCIS (Netherlands)

Crutzen, R.; de Nooijer, J.; Brouwer, W.; Oenema, A.; Brug, J.

2008-01-01

Purpose - The purpose of this paper is to gain first insight into factors which might be associated with exposure to internet-delivered interventions. Design/methodology/approach - Semi-structured focus group interviews were conducted with five groups of Dutch adolescents (n=54), aged 12-17 years.

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.

School Nurse-Delivered Adolescent Relationship Abuse Prevention

Science.gov (United States)

Raible, Claire A.; Dick, Rebecca; Gilkerson, Fern; Mattern, Cheryl S.; James, Lisa; Miller, Elizabeth

2017-01-01

Background: Project Connect is a national program to build partnerships among public health agencies and domestic violence services to improve the health care sector response to partner and sexual violence. Pennsylvania piloted the first school nurse-delivered adolescent relationship abuse intervention in the certified school nurses' office…

Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes

Science.gov (United States)

Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

2015-01-01

While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. PMID:26178332

Collaborative Practice Model: Improving the Delivery of Bad News.

Science.gov (United States)

Bowman, Pamela N; Slusser, Kim; Allen, Deborah

2018-02-01

Ideal bad news delivery requires skilled communication and team support. The literature has primarily focused on patient preferences, impact on care decisions, healthcare roles, and communication styles, without addressing systematic implementation. This article describes how an interdisciplinary team, led by advanced practice nurses, developed and implemented a collaborative practice model to deliver bad news on a unit that had struggled with inconsistencies. Using evidence-based practices, the authors explored current processes, role perceptions and expectations, and perceived barriers to developing the model, which is now the standard of care and an example of interprofessional team collaboration across the healthcare system. This model for delivering bad news can be easily adapted to meet the needs of other clinical units.
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Evidence supporting a promotora-delivered entertainment education intervention for improving mothers' dietary intake: the Entre Familia: Reflejos de Salud Study.

Science.gov (United States)

Ayala, Guadalupe X; Ibarra, Leticia; Horton, Lucy; Arredondo, Elva M; Slymen, Donald J; Engelberg, Moshe; Rock, Cheryl L; Hernandez, Erika; Parada, Humberto; Elder, John P

2015-01-01

Entertainment education and the promotora model are 2 evidence-based health communication strategies. This study examined their combined effect on promoting healthy eating among mothers in a family-based intervention. Participants were 361 Mexican-origin families living in Imperial County, California, who were randomly assigned to an intervention or delayed treatment condition. The intervention involved promotoras (community health workers) who delivered 11 home visits and 4 telephone calls. Home visits included a 12-minute episode of a 9-part situation comedy depicting a family struggling with making healthy eating choices; an accompanying family workbook was reviewed to build skills and left with the family. Baseline and immediate postintervention data were collected from the mothers, including the primary outcome of daily servings of fruits and vegetables. Other dietary and psychosocial factors related to healthy eating were examined. At postintervention, mothers in the intervention reported increases in daily vegetable servings (p ≤ .05); however, no changes were observed in fruit consumption. Improvements were observed in behavioral strategies to increase fiber (p ≤ .001) and to decrease fat intake (p ≤ .001), unhealthy eating behaviors (p ≤ .001), and individual (p ≤ .05) and family-related (p ≤ .01) perceived barriers to healthy eating. Entertainment education and promotoras engaged families and improved mothers' diets. Further research should examine the dose needed for greater changes.

Improved stoves in India: A study of sustainable business models

International Nuclear Information System (INIS)

Shrimali, Gireesh; Slaski, Xander; Thurber, Mark C.; Zerriffi, Hisham

2011-01-01

Burning of biomass for cooking is associated with health problems and climate change impacts. Many previous efforts to disseminate improved stoves – primarily by governments and NGOs – have not been successful. Based on interviews with 12 organizations selling improved biomass stoves, we assess the results to date and future prospects of commercial stove operations in India. Specifically, we consider how the ability of these businesses to achieve scale and become self-sustaining has been influenced by six elements of their respective business models: design, customers targeted, financing, marketing, channel strategy, and organizational characteristics. The two companies with the most stoves in the field shared in common generous enterprise financing, a sophisticated approach to developing a sales channel, and many person-years of management experience in marketing and operations. And yet the financial sustainability of improved stove sales to households remains far from assured. The only company in our sample with demonstrated profitability is a family-owned business selling to commercial rather than household customers. The stove sales leader is itself now turning to the commercial segment to maintain flagging cash flow, casting doubt on the likelihood of large positive impacts on health from sales to households in the near term. - Highlights: ► Business models to sell improved stoves can be viable in India. ► Commercial stove efforts may not be able to deliver all the benefits hoped for. ► The government could play a useful role if policies are targeted and well thought-out. ► Develops models for that hard-to-define entity mixing business and charity.

The Alpha Stem Cell Clinic: a model for evaluating and delivering stem cell-based therapies.

Science.gov (United States)

Trounson, Alan; DeWitt, Natalie D; Feigal, Ellen G

2012-01-01

Cellular therapies require the careful preparation, expansion, characterization, and delivery of cells in a clinical environment. There are major challenges associated with the delivery of cell therapies and high costs that will limit the companies available to fully evaluate their merit in clinical trials, and will handicap their application at the present financial environment. Cells will be manufactured in good manufacturing practice or near-equivalent facilities with prerequisite safety practices in place, and cell delivery systems will be specialized and require well-trained medical and nursing staff, technicians or nurses trained to handle cells once delivered, patient counselors, as well as statisticians and database managers who will oversee the monitoring of patients in relatively long-term follow-up studies. The model proposed for Alpha Stem Cell Clinics will initially use the capacities and infrastructure that exist in the most advanced tertiary medical clinics for delivery of established bone marrow stem cell therapies. As the research evolves, they will incorporate improved procedures and cell preparations. This model enables commercialization of medical devices, reagents, and other products required for cell therapies. A carefully constructed cell therapy clinical infrastructure with the requisite scientific, technical, and medical expertise and operational efficiencies will have the capabilities to address three fundamental and critical functions: 1) fostering clinical trials; 2) evaluating and establishing safe and effective therapies, and 3) developing and maintaining the delivery of therapies approved by the Food and Drug Administration, or other regulatory agencies.

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

Development of a Health System-Based Nurse-Delivered Aromatherapy Program.

Science.gov (United States)

Joswiak, Denise; Kinney, Mary Ellen; Johnson, Jill R; Kolste, Alison K; Griffin, Kristen H; Rivard, Rachael L; Dusek, Jeffery A

2016-04-01

Healthcare systems are increasingly looking to integrate aromatherapy (essential oils) as a safe, low-cost, and nonpharmacologic option for patient care to reduce pain, nausea, and anxiety and to improve sleep. This article describes the development and implementation of a healthcare system-wide program of nurse-delivered essential oil therapeutic interventions to inpatients throughout an acute care setting. In addition, we provide lessons learned for nursing administrators interested in developing similar nurse-delivered aromatherapy programs.

A Multilevel Approach to Breastfeeding Promotion: Using Healthy Start to Deliver Individual Support and Drive Collective Impact.

Science.gov (United States)

Leruth, Chelsey; Goodman, Jacqueline; Bragg, Brian; Gray, Dara

2017-12-01

Purpose Breastfeeding has been linked to a host of positive health effects for women and children. However, disparities in breastfeeding initiation and duration prevent many low-income and African-American women from realizing these benefits. Existing breastfeeding promotion efforts often do not reach women who need support the most. In response, the Westside Healthy Start program (WHS), located in Chicago, Illinois, developed an ongoing multilevel approach to breastfeeding promotion. Description Key elements of our WHS breastfeeding model include individual education and counseling from pregnancy to 6 months postpartum and partnership with a local safety-net hospital to implement the Baby-Friendly Hospital Initiative and provide lactation support to delivering patients. Assessment In the year our model was implemented, 44.6% (49/110) of prenatal WHS participants reported that they planned to breastfeed, and 67.0% (183/273) of delivered participants initiated. Among participants reaching 6 months postpartum, 10.5% (9/86) were breastfeeding. WHS also had 2667 encounters with women delivering at our partner hospital during breastfeeding rounds, with 65.1% of contacts initiating. Community data was not available to assess the efficacy of our model at the local level. However, WHS participants fared better than all delivering patients at our partner hospital, where 65.0% initiated in 2015. Conclusion Healthy Start programs are a promising vehicle to improve breastfeeding initiation at the individual and community level. Additional evaluation is necessary to understand barriers to duration and services needed for this population.

Clinical performance improvement series. Classic CQI integrated with comprehensive disease management as a model for performance improvement.

Science.gov (United States)

Joshi, M S; Bernard, D B

1999-08-01

In recent years, health and disease management has emerged as an effective means of delivering, integrating, and improving care through a population-based approach. Since 1997 the University of Pennsylvania Health System (UPHS) has utilized the key principles and components of continuous quality improvement (CQI) and disease management to form a model for health care improvement that focuses on designing best practices, using best practices to influence clinical decision making, changing processes and systems to deploy and deliver best practices, and measuring outcomes to improve the process. Experience with 28 programs and more than 14,000 patients indicates significant improvement in outcomes, including high physician satisfaction, increased patient satisfaction, reduced costs, and improved clinical process and outcome measures across multiple diseases. DIABETES DISEASE MANAGEMENT: In three months a UPHS multidisciplinary diabetes disease management team developed a best practice approach for the treatment of all patients with diabetes in the UPHS. After the program was pilot tested in three primary care physician sites, it was then introduced progressively to additional practice sites throughout the health system. The establishment of the role of the diabetes nurse care managers (certified diabetes educators) was central to successful program deployment. Office-based coordinators ensure incorporation of the best practice protocols into routine flow processes. A disease management intranet disseminates programs electronically. Outcomes of the UPHS health and disease management programs so far demonstrate success across multiple dimensions of performance-service, clinical quality, access, and value. The task of health care leadership today is to remove barriers and enable effective implementation of key strategies, such as health and disease management. Substantial effort and resources must be dedicated to gain physician buy-in and achieve compliance. The

Using Workflow Modeling to Identify Areas to Improve Genetic Test Processes in the University of Maryland Translational Pharmacogenomics Project.

Science.gov (United States)

Cutting, Elizabeth M; Overby, Casey L; Banchero, Meghan; Pollin, Toni; Kelemen, Mark; Shuldiner, Alan R; Beitelshees, Amber L

Delivering genetic test results to clinicians is a complex process. It involves many actors and multiple steps, requiring all of these to work together in order to create an optimal course of treatment for the patient. We used information gained from focus groups in order to illustrate the current process of delivering genetic test results to clinicians. We propose a business process model and notation (BPMN) representation of this process for a Translational Pharmacogenomics Project being implemented at the University of Maryland Medical Center, so that personalized medicine program implementers can identify areas to improve genetic testing processes. We found that the current process could be improved to reduce input errors, better inform and notify clinicians about the implications of certain genetic tests, and make results more easily understood. We demonstrate our use of BPMN to improve this important clinical process for CYP2C19 genetic testing in patients undergoing invasive treatment of coronary heart disease.

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

Improved animal models for testing gene therapy for atherosclerosis.

Science.gov (United States)

Du, Liang; Zhang, Jingwan; De Meyer, Guido R Y; Flynn, Rowan; Dichek, David A

2014-04-01

Gene therapy delivered to the blood vessel wall could augment current therapies for atherosclerosis, including systemic drug therapy and stenting. However, identification of clinically useful vectors and effective therapeutic transgenes remains at the preclinical stage. Identification of effective vectors and transgenes would be accelerated by availability of animal models that allow practical and expeditious testing of vessel-wall-directed gene therapy. Such models would include humanlike lesions that develop rapidly in vessels that are amenable to efficient gene delivery. Moreover, because human atherosclerosis develops in normal vessels, gene therapy that prevents atherosclerosis is most logically tested in relatively normal arteries. Similarly, gene therapy that causes atherosclerosis regression requires gene delivery to an existing lesion. Here we report development of three new rabbit models for testing vessel-wall-directed gene therapy that either prevents or reverses atherosclerosis. Carotid artery intimal lesions in these new models develop within 2-7 months after initiation of a high-fat diet and are 20-80 times larger than lesions in a model we described previously. Individual models allow generation of lesions that are relatively rich in either macrophages or smooth muscle cells, permitting testing of gene therapy strategies targeted at either cell type. Two of the models include gene delivery to essentially normal arteries and will be useful for identifying strategies that prevent lesion development. The third model generates lesions rapidly in vector-naïve animals and can be used for testing gene therapy that promotes lesion regression. These models are optimized for testing helper-dependent adenovirus (HDAd)-mediated gene therapy; however, they could be easily adapted for testing of other vectors or of different types of molecular therapies, delivered directly to the blood vessel wall. Our data also supports the promise of HDAd to deliver long

A Sentiment Delivering Estimate Scheme Based on Trust Chain in Mobile Social Network

Directory of Open Access Journals (Sweden)

Meizi Li

2015-01-01

Full Text Available User sentiment analysis has become a flourishing frontier in data mining mobile social network platform since the mobile social network plays a significant role in users’ daily communication and sentiment interaction. This study studies the scheme of sentiment estimate by using the users’ trustworthy relationships for evaluating sentiment delivering. First, we address an overview of sentiment delivering estimate scheme and propose its related definitions, that is, trust chain among users, sentiment semantics, and sentiment ontology. Second, this study proposes the trust chain model and its evaluation method, which is composed of evaluation of atomic, serial, parallel, and combined trust chains. Then, we propose sentiment modeling method by presenting its modeling rules. Further, we propose the sentiment delivering estimate scheme from two aspects: explicit and implicit sentiment delivering estimate schemes, based on trust chain and sentiment modeling method. Finally, examinations and results are given to further explain effectiveness and feasibility of our scheme.

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

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

Improved malignant melanoma prognosis at a consultant-delivered multidisciplinary pigmented lesion clinic in Cork.

LENUS (Irish Health Repository)

Field, S

2012-02-01

Early detection and excision is the only effective treatment for malignant melanoma. To assess the effect of a consultant-delivered, rapid-access pigmented lesion clinic (PLC) established at the South Infirmary-Victoria University Hospital (SIVUH), we analyzed melanoma tumour-stage prior to (1998-2002) and after (2003-2007) the advent of the PLC. Patients attending SIVUH had a greater proportion of early-stage tumours (65.3%) compared to the rest of Cork (51.2%), County Cork as a whole (56.7%) and all of Ireland (57.4%). The proportion of SIVUH males with early-stage tumours was statistically significantly higher than the rest of County Cork (chi2 = 11.23, P < 0.05). The proportion of patients > 50y with early-stage tumours was also statistically significantly higher than the rest of County Cork (chi2 = 18.88, P < 0.05), the whole of County Cork (chi2 = 7.84, P < 0.05) and all of Ireland (chi2 = 9.67, P < 0.05). We believe that the early detection and improved prognosis of Cork melanoma patients is at least partly due to the PLC.

Improved malignant melanoma prognosis at a consultant-delivered multidisciplinary pigmented lesion clinic in Cork.

LENUS (Irish Health Repository)

Field, S

2010-02-01

Early detection and excision is the only effective treatment for malignant melanoma. To assess the effect of a consultant-delivered, rapid-access pigmented lesion clinic (PLC) established at the South Infirmary-Victoria University Hospital (SIVUH), we analyzed melanoma tumour-stage prior to (1998-2002) and after (2003-2007) the advent of the PLC. Patients attending SIVUH had a greater proportion of early-stage tumours (65.3%) compared to the rest of Cork (51.2%), County Cork as a whole (56.7%) and all of Ireland (57.4%). The proportion of SIVUH males with early-stage tumours was statistically significantly higher than the rest of County Cork (chi2 = 11.23, P < 0.05). The proportion of patients > 50y with early-stage tumours was also statistically significantly higher than the rest of County Cork (chi2 = 18.88, P < 0.05), the whole of County Cork (chi2 = 7.84, P < 0.05) and all of Ireland (chi2 = 9.67, P < 0.05). We believe that the early detection and improved prognosis of Cork melanoma patients is at least partly due to the PLC.

Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment.

Directory of Open Access Journals (Sweden)

Giorgia Gon

Full Text Available Hygiene during childbirth is essential to the health of mothers and newborns, irrespective of where birth takes place. This paper investigates the status of water and sanitation in both the home and facility childbirth environments, and for whom and where this is a more significant problem.We used three datasets: a global dataset, with information on the home environment from 58 countries, and two datasets for each of four countries in Eastern Africa: a healthcare facility dataset, and a dataset that incorporated information on facilities and the home environment to create a comprehensive description of birth environments in those countries. We constructed indices of improved water, and improved water and sanitation combined (WATSAN, for the home and healthcare facilities. The Joint Monitoring Program was used to construct indices for household; we tailored them to the facility context-household and facility indices include different components. We described what proportion of women delivered in an environment with improved WATSAN. For those women who delivered at home, we calculated what proportion had improved WATSAN by socio-economic status, education and rural-urban status.Among women delivering at home (58 countries, coverage of improved WATSAN by region varied from 9% to 53%. Fewer than 15% of women who delivered at home in Sub-Saharan Africa, had access to water and sanitation infrastructure (range 0.1% to 37%. This was worse among the poorest, the less educated and those living in rural areas. In Eastern Africa, where we looked at both the home and facility childbirth environment, a third of women delivered in an environment with improved water in Uganda and Rwanda; whereas, 18% of women in Kenya and 7% in Tanzania delivered with improved water and sanitation. Across the four countries, less than half of the facility deliveries had improved water, or improved water and sanitation in the childbirth environment.Access to water and

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.

Internet delivered diabetes self-management education: a review.

Science.gov (United States)

Pereira, Katherine; Phillips, Beth; Johnson, Constance; Vorderstrasse, Allison

2015-01-01

Diabetes self-management education is a cornerstone of successful diabetes management. Various methods have been used to reach the increasing numbers of patients with diabetes, including Internet-based education. The purpose of this article is to review various delivery methods of Internet diabetes education that have been evaluated, as well as their effectiveness in improving diabetes-related outcomes. Literature was identified in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Medline, EBSCO, the Cochrane Library, and the Web of Science databases through searches using the following terms: "type 2 diabetes AND internet/web based AND education" and "type 2 diabetes AND diabetes self-management education (DSME) AND web-based/internet OR technology assisted education." The search was limited to English language articles published in the last 10 years. The search yielded 111 articles; of these, 14 met criteria for inclusion in this review. Nine studies were randomized controlled trials, and study lengths varied from 2 weeks to 24 months, for a total of 2,802 participants. DSME delivered via the Internet is effective at improving measures of glycemic control and diabetes knowledge compared with usual care. In addition, results demonstrate that improved eating habits and increased attendance at clinic appointments occur after the online DSME, although engagement and usage of Internet materials waned over time. Interventions that included an element of interaction with healthcare providers were seen as attractive to participants. Internet-delivered diabetes education has the added benefit of easier access for many individuals, and patients can self-pace themselves through materials. More research on the cost-benefits of Internet diabetes education and best methods to maintain patient engagement are needed, along with more studies assessing the long-term impact of Internet-delivered DSME.

Virally delivered, constitutively active NFκB improves survival of injured retinal ganglion cells.

Science.gov (United States)

Dvoriantchikova, Galina; Pappas, Steve; Luo, Xueting; Ribeiro, Marcio; Danek, Dagmara; Pelaez, Daniel; Park, Kevin K; Ivanov, Dmitry

2016-12-01

As axon damage and retinal ganglion cell (RGC) loss lead to blindness, therapies that increase RGC survival and axon regrowth have direct clinical relevance. Given that NFκB signaling is critical for neuronal survival and may regulate neurite growth, we investigated the therapeutic potential of NFκB signaling in RGC survival and axon regeneration. Although both NFκB subunits (p65 and p50) are present in RGCs, p65 exists in an inactive (unphosphorylated) state when RGCs are subjected to neurotoxic conditions. In this study, we used a phosphomimetic approach to generate DNA coding for an activated (phosphorylated) p65 (p65mut), then employed an adeno-associated virus serotype 2 (AAV2) to deliver the DNA into RGCs. We tested whether constitutive p65mut expression prevents death and facilitates neurite outgrowth in RGCs subjected to transient retinal ischemia or optic nerve crush (ONC), two models of neurotoxicity. Our data indicate that RGCs treated with AAV2-p65mut displayed a significant increase in survival compared to controls in ONC model (77 ± 7% vs. 25 ± 3%, P-value = 0.0001). We also found protective effect of modified p65 in RGCs of ischemic retinas (55 ± 12% vs. 35 ± 6%), but not to a statistically significant degree (P-value = 0.14). We did not detect a difference in axon regeneration between experimental and control animals after ONC. These findings suggest that increased NFκB signaling in RGCs attenuates retinal damage in animal models of neurodegeneration, but insignificantly impacts axon regeneration. © 2016 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Ensuring implementation success: how should coach injury prevention education be improved if we want coaches to deliver safety programmes during training sessions?

Science.gov (United States)

White, Peta E; Otago, Leonie; Saunders, Natalie; Romiti, Maria; Donaldson, Alex; Ullah, Shahid; Finch, Caroline F

2014-03-01

Coaches play a major role in encouraging and ensuring that participants of their teams adopt appropriate safety practices. However, the extent to which the coaches undertake this role will depend upon their attitudes about injury prevention, their perceptions of what the other coaches usually do and their own beliefs about how much control they have in delivering such programmes. Fifty-one junior netball coaches were surveyed about incorporating the teaching of correct (safe) landing technique during their delivery of training sessions to junior players. Overall, >94% of coaches had strongly positive attitudes towards teaching correct landing technique and >80% had strongly positive perceptions of their own control over delivering such programmes. Coaches' ratings of social norms relating to what others think about teaching safe landing were more positive (>94%) than those relating to what others actually do (63-74%). In conclusion, the junior coaches were generally receptive towards delivering safe landing training programmes in the training sessions they led. Future coach education could include role modelling by prominent coaches so that more community-level coaches are aware that this is a behaviour that many coaches can, and do, engage in.

The effect of support on Internet-delivered treatment for insomnia: Does baseline depression severity matter?

NARCIS (Netherlands)

Lancee, J.; Sorbi, M.J.; Eisma, M.C.; van Straten, A.; van den Bout, J.

2014-01-01

Internet-delivered cognitive-behavioral treatment is effective for insomnia. However, little is known about the beneficial effects of support. Recently we demonstrated that motivational support moderately improved the effects of Internet-delivered treatment for insomnia. In the present study, we

Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes.

Science.gov (United States)

Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

2015-10-01

While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Improved immunogenicity of individual influenza vaccine components delivered with a novel dissolving microneedle patch stable at room temperature

Science.gov (United States)

Vassilieva, Elena V.; Kalluri, Haripriya; McAllister, Devin; Taherbhai, Misha T.; Esser, E. Stein; Pewin, Winston P.; Pulit-Penaloza, Joanna A.; Prausnitz, Mark R.; Compans, Richard W.; Skountzou, Ioanna

2015-01-01

Prevention of seasonal influenza epidemics and pandemics relies on widespread vaccination coverage to induce protective immunity. In addition to a good antigenic match with the circulating viruses, the effectiveness of individual strains represented in the trivalent vaccines depends on their immunogenicity. In this study we evaluated the immunogenicity of H1N1, H3N2 and B seasonal influenza virus vaccine strains delivered individually with a novel dissolving microneedle patch and the stability of this formulation during storage at 25°C. Our data demonstrate that all strains retained their antigenic activity after incorporation in the dissolving patches as measured by SRID assay and immune responses to vaccination in BALB/c mice. After a single immunization all three antigens delivered with microneedle patches induced superior neutralizing antibody titers compared to intramuscular immunization. Cutaneous antigen delivery was especially beneficial for the less immunogenic B strain. Mice immunized with dissolving microneedle patches encapsulating influenza A/Brisbane/59/07 (H1N1) vaccine were fully protected against lethal challenge by homologous mouse-adapted influenza virus. All vaccine components retained activity during storage at room temperature for at least three months as measured in vitro by SRID assay and in vivo by mouse immunization studies. Our data demonstrate that dissolving microneedle patches are a promising advance for influenza cutaneous vaccination due to improved immune responses using less immunogenic influenza antigens and enhanced stability. PMID:25895053

Fetal uptake of intra-amniotically delivered dendrimers in a mouse model of intrauterine inflammation and preterm birth.

Science.gov (United States)

Burd, Irina; Zhang, Fan; Dada, Tahani; Mishra, Manoj K; Borbiev, Talaibek; Lesniak, Wojciech G; Baghlaf, Haitham; Kannan, Sujatha; Kannan, Rangaramanujam M

2014-08-01

Intrauterine inflammation is associated with preterm birth and can lead to fetal neuroinflammation and neurobehavioral disorders in newborns. Dendrimers can intrinsically target and deliver drugs for the treatment of neuroinflammation. We explore whether hydroxyl polyamidoamine (PAMAM) dendrimer (G4-OH)-based nanomedicines can be delivered to the fetus by intra-amniotic administration, in a mouse model of intrauterine inflammation. The time-dependent accumulation of G4-OH-fluorophore conjugate was quantified by fluorescence. These studies suggest that, after intra-amniotic administration, there is significant accumulation of dendrimer in the fetus gut and brain. In addition, there is some fetal-maternal transport of the dendrimer. Confocal microscopy confirmed the presence of G4-OH in the fetal brain, with a large accumulation in the brain blood vessels and the brain parenchyma, and some microglial uptake. We believe that intra-amniotic administration of G4-OH-drug nanomedicines may enable the treatment of diseases related to intrauterine inflammation and fetal neuroinflammation. Using a mouse model of intrauterin inflammation leading to neuroinflammation in the fetus, these investigators demonstrate that intra-amniotic delivery of hydroxyl polyamidoamine (PAMAM) dendrimer (G4-OH)-based nanomedicines may provide an effective method in preventing this complication. Copyright © 2014 Elsevier Inc. All rights reserved.

Effects of Mother-Delivered Social Stories and Video Modeling in Teaching Social Skills to Children with Autism Spectrum Disorders

Science.gov (United States)

Acar, Cimen; Tekin-Iftar, Elif; Yikmis, Ahmet

2017-01-01

An adapted alternating treatments design was used to compare mother-developed and delivered social stories and video modeling in teaching social skills to children with autism spectrum disorder (ASD). Mothers' opinions about the social validity of the study were also examined. Three mother-child dyads participated in the study. Results showed that…

A small business worksite wellness model for improving health behaviors.

Science.gov (United States)

Merrill, Ray M

2013-08-01

To evaluate the effectiveness of a wellness program delivered by WellSteps, LLC, aimed at improving employee health behaviors in small companies that lack the resources to independently develop and manage a wellness program. Analyses are based on 618 employees from five diverse companies that completed an initial personal health assessment. Exercise and dietary behaviors significantly improved across the five companies. Significant improvements in health perception and life satisfaction also resulted and were associated with improvements in health behaviors. Three of the five companies, each with fewer than 50 employees, were most effective in influencing positive health behaviors, health perceptions, and life satisfaction. The worksite wellness program effectively improved health behaviors, health perceptions, and life satisfaction.

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.

A novel vascular-targeting peptide for gastric cancer delivers low-dose TNFα to normalize the blood vessels and improve the anti-cancer efficiency of 5-fluorouracil.

Science.gov (United States)

Lu, Lan; Li, Zhi Jie; Li, Long Fei; Shen, Jing; Zhang, Lin; Li, Ming Xing; Xiao, Zhan Gang; Wang, Jian Hao; Cho, Chi Hin

2017-11-01

Various vascular-targeted agents fused with tumor necrosis factor α (TNFα) have been shown to improve drug absorption into tumor tissues and enhance tumor vascular function. TCP-1 is a peptide selected through in vivo phage library biopanning against a mouse orthotopic colorectal cancer model and is a promising agent for drug delivery. This study further investigated the targeting ability of TCP-1 phage and peptide to blood vessels in an orthotopic gastric cancer model in mice and assessed the synergistic anti-cancer effect of 5-fluorouracil (5-FU) with subnanogram TNFα targeted delivered by TCP-1 peptide. In vivo phage targeting assay and in vivo colocalization analysis were carried out to test the targeting ability of TCP-1 phage/peptide. A targeted therapy for improvement of the therapeutic efficacy of 5-FU and vascular function was performed through administration of TCP-1/TNFα fusion protein in this model. TCP-1 phage exhibited strong homing ability to the orthotopic gastric cancer after phage injection. Immunohistochemical staining suggested that and TCP-1 phage/TCP-1 peptide could colocalize with tumor vascular endothelial cells. TCP-1/TNFα combined with 5-FU was found to synergistically inhibit tumor growth, induce apoptosis and reduce cell proliferation without evident toxicity. Simultaneously, subnanogram TCP-1/TNFα treatment normalized tumor blood vessels. Targeted delivery of low-dose TNFα by TCP-1 peptide can potentially modulate the vascular function of gastric cancer and increase the drug delivery of chemotherapeutic drugs. Copyright © 2017. Published by Elsevier Inc.

Improving uptake and engagement with child body image interventions delivered to mothers: Understanding mother and daughter preferences for intervention content.

Science.gov (United States)

Garbett, Kirsty M; Diedrichs, Phillippa C

2016-12-01

Mothers are a key influence on adolescent girls' body image. This study aimed to improve understanding of mothers' and daughters' preferences for content in body image interventions designed to assist mothers to promote positive body image among their daughters. British mother-daughter dyads (N=190) viewed descriptions of five evidence-based influences on body image (family, friends, and relationships; appearance-based teasing; media and celebrities; appearance conversations; body acceptance and care). Mothers and daughters each selected the two most important influences to learn about in these interventions. Overall, both mothers and daughters most frequently opted for family, friends, and relationships and body acceptance and care, whereas media and celebrities was their least preferred topic. While the overall sample of mothers and daughters agreed on preferences, Fisher's exact tests showed that within-dyad agreement was low. Recommendations for improving parent and child engagement with, and effectiveness of, child body image interventions delivered to parents are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Motivational support provided via email improves the effectiveness of internet-delivered self-help treatment for insomnia: A randomized trial.

NARCIS (Netherlands)

Lancee, J.; van den Bout, J.; Sorbi, M.J.; van Straten, A.

2013-01-01

Internet-delivered treatment is effective for insomnia, but little is known about the beneficial effects of support. The aim of the current study was to investigate the additional effects of low-intensity support to an internet-delivered treatment for insomnia. Two hundred and sixty-two participants

Motivational support provided via email improves the effectiveness of internet-delivered self-help treatment for insomnia: A randomized trial

NARCIS (Netherlands)

Lancee, J.; van den Bout, J.; Sorbi, M.J.; van Straten, A.

2013-01-01

Internet-delivered treatment is effective for insomnia, but little is known about the beneficial effects of support. The aim of the current study was to investigate the additional effects of low-intensity support to an internet-delivered treatment for insomnia. Two hundred and sixty-two participants

Thermal Modeling Method Improvements for SAGE III on ISS

Science.gov (United States)

Liles, Kaitlin; Amundsen, Ruth; Davis, Warren; McLeod, Shawn

2015-01-01

The Stratospheric Aerosol and Gas Experiment III (SAGE III) instrument is the fifth in a series of instruments developed for monitoring aerosols and gaseous constituents in the stratosphere and troposphere. SAGE III will be delivered to the International Space Station (ISS) via the SpaceX Dragon vehicle. A detailed thermal model of the SAGE III payload, which consists of multiple subsystems, has been developed in Thermal Desktop (TD). Many innovative analysis methods have been used in developing this model; these will be described in the paper. This paper builds on a paper presented at TFAWS 2013, which described some of the initial developments of efficient methods for SAGE III. The current paper describes additional improvements that have been made since that time. To expedite the correlation of the model to thermal vacuum (TVAC) testing, the chambers and GSE for both TVAC chambers at Langley used to test the payload were incorporated within the thermal model. This allowed the runs of TVAC predictions and correlations to be run within the flight model, thus eliminating the need for separate models for TVAC. In one TVAC test, radiant lamps were used which necessitated shooting rays from the lamps, and running in both solar and IR wavebands. A new Dragon model was incorporated which entailed a change in orientation; that change was made using an assembly, so that any potential additional new Dragon orbits could be added in the future without modification of the model. The Earth orbit parameters such as albedo and Earth infrared flux were incorporated as time-varying values that change over the course of the orbit; despite being required in one of the ISS documents, this had not been done before by any previous payload. All parameters such as initial temperature, heater voltage, and location of the payload are defined based on the case definition. For one component, testing was performed in both air and vacuum; incorporating the air convection in a submodel that was

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)

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

Automated Student Model Improvement

Science.gov (United States)

Koedinger, Kenneth R.; McLaughlin, Elizabeth A.; Stamper, John C.

2012-01-01

Student modeling plays a critical role in developing and improving instruction and instructional technologies. We present a technique for automated improvement of student models that leverages the DataShop repository, crowd sourcing, and a version of the Learning Factors Analysis algorithm. We demonstrate this method on eleven educational…

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

Do accountable care organizations (ACOs) help or hinder primary care physicians' ability to deliver high-quality care?

Science.gov (United States)

Berenson, Robert A; Burton, Rachel A; McGrath, Megan

2016-09-01

Many view advanced primary care models such as the patient-centered medical home as foundational for accountable care organizations (ACOs), but it remains unclear how these two delivery reforms are complementary and how they may produce conflict. The objective of this study was to identify how joining an ACO could help or hinder a primary care practice's efforts to deliver high-quality care. This qualitative study involved interviews with a purposive sample of 32 early adopters of advanced primary care and/or ACO models, drawn from across the U.S. and conducted in mid-2014. Interview notes were coded using qualitative data analysis software, permitting topic-specific queries which were then summarized. Respondents perceived many potential benefits of joining an ACO, including care coordination staff, data analytics, and improved communication with other providers. However, respondents were also concerned about added "bureaucratic" requirements, referral restrictions, and a potential inability to recoup investments in practice improvements. Interviewees generally thought joining an ACO could complement a practice's efforts to deliver high-quality care, yet noted some concerns that could undermine these synergies. Both the advantages and disadvantages of joining an ACO seemed exacerbated for small practices, since they are most likely to benefit from additional resources yet are most likely to chafe under added bureaucratic requirements. Our identification of the potential pros and cons of joining an ACO may help providers identify areas to examine when weighing whether to enter into such an arrangement, and may help ACOs identify potential areas for improvement. Copyright © 2016 Elsevier Inc. All rights reserved.

Improving student success using predictive models and data visualisations

Directory of Open Access Journals (Sweden)

Hanan Ayad

2012-08-01

Full Text Available The need to educate a competitive workforce is a global problem. In the US, for example, despite billions of dollars spent to improve the educational system, approximately 35% of students never finish high school. The drop rate among some demographic groups is as high as 50–60%. At the college level in the US only 30% of students graduate from 2-year colleges in 3 years or less and approximately 50% graduate from 4-year colleges in 5 years or less. A basic challenge in delivering global education, therefore, is improving student success. By student success we mean improving retention, completion and graduation rates. In this paper we describe a Student Success System (S3 that provides a holistic, analytical view of student academic progress.1 The core of S3 is a flexible predictive modelling engine that uses machine intelligence and statistical techniques to identify at-risk students pre-emptively. S3 also provides a set of advanced data visualisations for reaching diagnostic insights and a case management tool for managing interventions. S3's open modular architecture will also allow integration and plug-ins with both open and proprietary software. Powered by learning analytics, S3 is intended as an end-to-end solution for identifying at-risk students, understanding why they are at risk, designing interventions to mitigate that risk and finally closing the feedback look by tracking the efficacy of the applied intervention.

Model-based software process improvement

Science.gov (United States)

Zettervall, Brenda T.

1994-01-01

The activities of a field test site for the Software Engineering Institute's software process definition project are discussed. Products tested included the improvement model itself, descriptive modeling techniques, the CMM level 2 framework document, and the use of process definition guidelines and templates. The software process improvement model represents a five stage cyclic approach for organizational process improvement. The cycles consist of the initiating, diagnosing, establishing, acting, and leveraging phases.

Treating anxiety and depression in young adults: A randomised controlled trial comparing clinician-guided versus self-guided Internet-delivered cognitive behavioural therapy.

Science.gov (United States)

Dear, Blake F; Fogliati, Vincent J; Fogliati, Rhiannon; Johnson, Bareena; Boyle, Olivia; Karin, Eyal; Gandy, Milena; Kayrouz, Rony; Staples, Lauren G; Titov, Nickolai

2017-10-01

Internet-delivered cognitive behaviour therapy may increase access by young adults to evidence-based treatments for anxiety and depression. The aim of this study was to compare the efficacy of an Internet-delivered cognitive behaviour therapy intervention designed for adults aged 18-24 years, when delivered in clinician-guided versus self-guided formats. The intervention, the Mood Mechanic Course, is a transdiagnostic treatment that simultaneously targets symptoms of anxiety and depression using cognitive and behavioural skills. The brief intervention comprised four lessons, delivered over 5 weeks. Following a brief telephone interview, young adults ( n = 191) with symptoms of anxiety and depression were randomly allocated to either (1) clinician-guided treatment ( n = 96) or (2) self-guided treatment ( n = 95). At post treatment, large reductions (average improvement; clinician guided vs self-guided) were observed in symptoms of anxiety (44% vs 35%) and depression (40% vs 31%) in both groups. Significant improvements were also observed in general psychological distress (33% vs 29%), satisfaction with life (18% vs 15%) and disability (36% vs 29%). No marked or consistent differences in clinical outcomes emerged between conditions at post-treatment, at 3-month or 12-month follow-up. Satisfaction was high with both treatment formats, but slightly higher for clinician-guided treatment. These results indicate the potential of carefully developed Internet-delivered cognitive behaviour therapy interventions for young adults with anxiety and depression provided in either self or therapist-guided format. Further large-scale research is required to determine the short- and long-term advantages and disadvantages of different models of support.

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

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.

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

Experiences of non-adherence to Internet-delivered cognitive behavior therapy: A qualitative study

Directory of Open Access Journals (Sweden)

Olof Johansson

2015-05-01

Full Text Available Many trials on Internet-delivered psychological treatments have had problems with nonadherence, but not much is known about the subjective reasons for non-adhering. The aim of this study was to explore participants' experiences of non-adherence to Internet-delivered psychological treatment. Grounded theory was used to analyze data from seven in-depth interviews with persons who had non-adhered to a study on Internet-delivered cognitive behavioral therapy for generalized anxiety disorder. The process of non-adherence is described as an interaction between patient factors and treatment factors. A working model theory was generated to illustrate the experience of nonadherence. The model describes a process where treatment features such as workload, text-content complexity and treatment process don't match personal prerequisites regarding daily routines, perceived language skills and treatment expectations respectively, resulting in the decision to nonadhere. Negative effects were also stated as a reason for non-adherence. Several common strategies used for increasing adherence to Internet-delivered therapy in general are by these non-completers regarded as factors directly related to their reason for non-adherence.

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.

Sequence-specific antimicrobials using efficiently delivered RNA-guided nucleases.

Science.gov (United States)

Citorik, Robert J; Mimee, Mark; Lu, Timothy K

2014-11-01

Current antibiotics tend to be broad spectrum, leading to indiscriminate killing of commensal bacteria and accelerated evolution of drug resistance. Here, we use CRISPR-Cas technology to create antimicrobials whose spectrum of activity is chosen by design. RNA-guided nucleases (RGNs) targeting specific DNA sequences are delivered efficiently to microbial populations using bacteriophage or bacteria carrying plasmids transmissible by conjugation. The DNA targets of RGNs can be undesirable genes or polymorphisms, including antibiotic resistance and virulence determinants in carbapenem-resistant Enterobacteriaceae and enterohemorrhagic Escherichia coli. Delivery of RGNs significantly improves survival in a Galleria mellonella infection model. We also show that RGNs enable modulation of complex bacterial populations by selective knockdown of targeted strains based on genetic signatures. RGNs constitute a class of highly discriminatory, customizable antimicrobials that enact selective pressure at the DNA level to reduce the prevalence of undesired genes, minimize off-target effects and enable programmable remodeling of microbiota.

Health service planning and sustainable development: considering what, where and how care is delivered through a pro-environmental lens.

Science.gov (United States)

Desmond, Sharon

2017-03-02

The aim of the present paper was to review the opportunities currently available to health service planners to advance sustainable development in their future-facing roles within health service organisation. Critical challenges and enablers to facilitate health services planners in adopting a pro-environmental lens are discussed. What is known about the topic? Despite its harmful effect on the environment, health has been slower than other industries to embrace the sustainable development agenda. The attitudes and knowledge base of health service planners with regard to environmental sustainability has not been widely studied. For health service planners, embracing pro-environmental considerations in sustainable model of care development is a powerful opportunity to review care paradigms and prepare for the implementation of meaningful, improved health and system efficiency. What does this paper add? This paper advances the case for health service planners to embrace a pro-environmental stance and guides health service leaders in the preparation and implementation of sustainable and improved health and system efficiency. What are the implications for practitioners? Health service planers are in an ideal position to champion the sustainable development agenda as they explore what care is delivered, how care is delivered and where care is delivered. External policy, health service leadership and carbon literacy are advanced as critical contextual factors to facilitate the key role that health service planners can play in building sustainable healthcare organisations.

Treatment of child anxiety disorders via guided parent-delivered cognitive-behavioural therapy: randomised controlled trial.

Science.gov (United States)

Thirlwall, Kerstin; Cooper, Peter J; Karalus, Jessica; Voysey, Merryn; Willetts, Lucy; Creswell, Cathy

2013-12-01

Promising evidence has emerged of clinical gains using guided self-help cognitive-behavioural therapy (CBT) for child anxiety and by involving parents in treatment; however, the efficacy of guided parent-delivered CBT has not been systematically evaluated in UK primary and secondary settings. To evaluate the efficacy of low-intensity guided parent-delivered CBT treatments for children with anxiety disorders. A total of 194 children presenting with a current anxiety disorder, whose primary carer did not meet criteria for a current anxiety disorder, were randomly allocated to full guided parent-delivered CBT (four face-to-face and four telephone sessions) or brief guided parent-delivered CBT (two face-to-face and two telephone sessions), or a wait-list control group (trial registration: ISRCTN92977593). Presence and severity of child primary anxiety disorder (Anxiety Disorders Interview Schedule for DSM-IV, child/parent versions), improvement in child presentation of anxiety (Clinical Global Impression - Improvement scale), and change in child anxiety symptoms (Spence Children's Anxiety Scale, child/parent version and Child Anxiety Impact scale, parent version) were assessed at post-treatment and for those in the two active treatment groups, 6 months post-treatment. Full guided parent-delivered CBT produced superior diagnostic outcomes compared with wait-list at post-treatment, whereas brief guided parent-delivered CBT did not: at post-treatment, 25 (50%) of those in the full guided CBT group had recovered from their primary diagnosis, compared with 16 (25%) of those on the wait-list (relative risk (RR) 1.85, 95% CI 1.14-2.99); and in the brief guided CBT group, 18 participants (39%) had recovered from their primary diagnosis post-treatment (RR = 1.56, 95% CI 0.89-2.74). Level of therapist training and experience was unrelated to child outcome. Full guided parent-delivered CBT is an effective and inexpensive first-line treatment for child anxiety.

Feasibility and preliminary efficacy of remotely delivering cognitive training to people with schizophrenia using tablets

Directory of Open Access Journals (Sweden)

Bruno Biagianti

2017-12-01

Conclusion: Although underpowered and not randomized, this study demonstrates that delivering CT remotely to people with SZ using tablets is feasible and results in retention rates, adherence, and cognitive and functional outcome improvements that are comparable to those observed when CT is delivered in the laboratory. This has important implications in terms of scalability and dissemination of CT. These results require confirmation in larger samples.

Improving Earth/Prediction Models to Improve Network Processing

Science.gov (United States)

Wagner, G. S.

2017-12-01

The United States Atomic Energy Detection System (USAEDS) primaryseismic network consists of a relatively small number of arrays andthree-component stations. The relatively small number of stationsin the USAEDS primary network make it both necessary and feasibleto optimize both station and network processing.Station processing improvements include detector tuning effortsthat use Receiver Operator Characteristic (ROC) curves to helpjudiciously set acceptable Type 1 (false) vs. Type 2 (miss) errorrates. Other station processing improvements include the use ofempirical/historical observations and continuous background noisemeasurements to compute time-varying, maximum likelihood probabilityof detection thresholds.The USAEDS network processing software makes extensive use of theazimuth and slowness information provided by frequency-wavenumberanalysis at array sites, and polarization analysis at three-componentsites. Most of the improvements in USAEDS network processing aredue to improvements in the models used to predict azimuth, slowness,and probability of detection. Kriged travel-time, azimuth andslowness corrections-and associated uncertainties-are computedusing a ground truth database. Improvements in station processingand the use of improved models for azimuth, slowness, and probabilityof detection have led to significant improvements in USADES networkprocessing.

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

Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians.

Science.gov (United States)

Durey, Angela; Wynaden, Dianne; Thompson, Sandra C; Davidson, Patricia M; Bessarab, Dawn; Katzenellenbogen, Judith M

2012-06-01

Well-documented health disparities between Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) and non-Aboriginal Australians are underpinned by complex historical and social factors. The effects of colonisation including racism continue to impact negatively on Aboriginal health outcomes, despite being under-recognised and under-reported. Many Aboriginal people find hospitals unwelcoming and are reluctant to attend for diagnosis and treatment, particularly with few Aboriginal health professionals employed on these facilities. In this paper, scientific literature and reports on Aboriginal health-care, methodology and cross-cultural education are reviewed to inform a collaborative model of hospital-based organisational change. The paper proposes a collaborative model of care to improve health service delivery by building capacity in Aboriginal and non-Aboriginal personnel by recruiting more Aboriginal health professionals, increasing knowledge and skills to establish good relationships between non-Aboriginal care providers and Aboriginal patients and their families, delivering quality care that is respectful of culture and improving Aboriginal health outcomes. A key element of model design, implementation and evaluation is critical reflection on barriers and facilitators to providing respectful and culturally safe quality care at systemic, interpersonal and patient/family-centred levels. Nurses are central to addressing the current state of inequity and are pivotal change agents within the proposed model. © 2011 Blackwell Publishing Ltd.

Improving Employee Well-Being and Effectiveness: Systematic Review and Meta-Analysis of Web-Based Psychological Interventions Delivered in the Workplace.

Science.gov (United States)

Carolan, Stephany; Harris, Peter R; Cavanagh, Kate

2017-07-26

Stress, depression, and anxiety among working populations can result in reduced work performance and increased absenteeism. Although there is evidence that these common mental health problems are preventable and treatable in the workplace, uptake of psychological treatments among the working population is low. One way to address this may be the delivery of occupational digital mental health interventions. While there is convincing evidence for delivering digital psychological interventions within a health and community context, there is no systematic review or meta-analysis of these interventions in an occupational setting. The aim of this study was to identify the effectiveness of occupational digital mental health interventions in enhancing employee psychological well-being and increasing work effectiveness and to identify intervention features associated with the highest rates of engagement and adherence. A systematic review of the literature was conducted using Cochrane guidelines. Papers published from January 2000 to May 2016 were searched in the PsychINFO, MEDLINE, PubMed, Science Direct, and the Cochrane databases, as well as the databases of the researchers and relevant websites. Unpublished data was sought using the Conference Proceedings Citation Index and the Clinical Trials and International Standard Randomized Controlled Trial Number (ISRCTN) research registers. A meta-analysis was conducted by applying a random-effects model to assess the pooled effect size for psychological well-being and the work effectiveness outcomes. A positive deviance approach was used to identify those intervention features associated with the highest rates of engagement and adherence. In total, 21 randomized controlled trials (RCTs) met the search criteria. Occupational digital mental health interventions had a statistically significant effect post intervention on both psychological well-being (g=0.37, 95% CI 0.23-0.50) and work effectiveness (g=0.25, 95% CI 0

Absorption mechanism of whey-protein-delivered curcumin using Caco-2 cell monolayers.

Science.gov (United States)

Li, Ming; Cui, Jie; Ngadi, Michael O; Ma, Ying

2015-08-01

Curcumin (CCM) is a bioactive polyphenolic compound that suffers a low bioavailability because of its low water solubility. In this work β-lactoglobulin (β-Lg) and nanoemulsion were used as carriers to deliver curcumin. The pH stability of β-Lg-CCM was investigated. The digestion of β-Lg-CCM and the nanoemulsion was studied using an in vitro gastrointestinal model. The effect of different carriers on the permeability of curcumin was assessed using the Caco-2 cell monolayer model. The results revealed that the water solubility and the pH stability of curcumin significantly increased by binding with β-Lg. In SDS-PAGE experiments the β-Lg-CCM complex and nanoemulsion were found to be resistant to pepsin digestion but sensitive to trypsin. In the permeability experiment it was shown that the digested nanoemulsion and β-Lg-CCM improved significantly the permeation rate of curcumin. Copyright © 2015 Elsevier Ltd. All rights reserved.

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...

Mapping a product-service-system delivering defence avionics availability

OpenAIRE

Settanni, E.; Thenent, N.; Newnes, L.; Parry, G.; Goh, Y. M.

2017-01-01

Long-term support agreements such as availability-based contracts are often associated with the servitization of business models in such sectors as defence aerospace. In practice, there is no unambiguous way of linking availability and service outcomes from an operational perspective; rather, the focus tends to be placed almost exclusively on product-related metrics. To address this gap, this paper outlines a conceptual model of how advanced service outcomes should be delivered under an avail...

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.

Non-Dam Alternatives for Delivering Water Services at Least Cost and Risk

Directory of Open Access Journals (Sweden)

Michael P. Totten

2010-06-01

We present evidence that a value-adding and risk-minimising water planning process can be achieved by shifting from the conventional focus on supply expansion to one that concentrates on efficiently delivering services at and near the point of use. The State of California has two decades of experience with this approach, demonstrating that market-based policy and regulatory innovations can unleash efficiency gains resulting in more utility water services and energy services delivered with less supply expansion at lower costs, while minimising climate-change risk, pollution and the social cost that accompany large infrastructural projects. Efficiency in delivered water services could be accomplished with investments in the range of US$10-25 billion annually, while obviating the need for spending hundreds of billions of dollars on more expensive hydropower and related infrastructural expansion projects. The shift to a regulatory system that encompasses cost-effective end-use efficiency improvements in delivering water and energy services could eliminate the need for an estimated half of all proposed dams globally, thus allowing for the maintenance of other ecosystem service benefits and offer the best hopes of meeting basic human needs for water at a more achievable level of investment.

Improved models of dense anharmonic lattices

Energy Technology Data Exchange (ETDEWEB)

Rosenau, P., E-mail: rosenau@post.tau.ac.il; Zilburg, A.

2017-01-15

We present two improved quasi-continuous models of dense, strictly anharmonic chains. The direct expansion which includes the leading effect due to lattice dispersion, results in a Boussinesq-type PDE with a compacton as its basic solitary mode. Without increasing its complexity we improve the model by including additional terms in the expanded interparticle potential with the resulting compacton having a milder singularity at its edges. A particular care is applied to the Hertz potential due to its non-analyticity. Since, however, the PDEs of both the basic and the improved model are ill posed, they are unsuitable for a study of chains dynamics. Using the bond length as a state variable we manipulate its dispersion and derive a well posed fourth order PDE. - Highlights: • An improved PDE model of a Newtonian lattice renders compacton solutions. • Compactons are classical solutions of the improved model and hence amenable to standard analysis. • An alternative well posed model enables to study head on interactions of lattices' solitary waves. • Well posed modeling of Hertz potential.

Improving access and equity in reducing cardiovascular risk: the Queensland Health model.

Science.gov (United States)

Ski, Chantal F; Vale, Margarite J; Bennett, Gary R; Chalmers, Victoria L; McFarlane, Kim; Jelinek, V Michael; Scott, Ian A; Thompson, David R

2015-02-16

To measure changes in cardiovascular risk factors among patients with coronary heart disease (CHD) and/or type 2 diabetes enrolled in a centralised statewide coaching program delivered by telephone and mail-out in the public health sector in Queensland. A population-based audit of cardiovascular risk factor data collected prospectively as part of The COACH (Coaching Patients On Achieving Cardiovascular Health) Program (TCP) delivered through Queensland Health's Health Contact Centre. 1962 patients with CHD and 707 patients with type 2 diabetes who completed TCP from 20 February 2009 to 20 June 2013, of whom 145 were Indigenous Australians. Changes in fasting lipids, fasting glucose, glycosylated haemoglobin levels, blood pressure, body weight, body mass index, smoking, alcohol consumption and physical activity, as measured at entry to and completion of the program. Statistically significant improvements in cardiovascular risk factor status, from entry to completion of the program, were found across all biomedical and lifestyle factors in patients with CHD and/or type 2 diabetes. For both diseases, improvements in serum lipids, blood glucose, smoking habit and alcohol consumption combined with increases in physical activity were the most notable findings. Similar differences were found in mean change scores in cardiovascular risk factors between Indigenous and non-Indigenous Queenslanders. A centralised statewide coaching program delivered by telephone and mail-out overcomes obstacles of distance and limited access to health services and facilitates a guideline-concordant decrease in cardiovascular risk.

Improved steamflood analytical model

Energy Technology Data Exchange (ETDEWEB)

Chandra, S.; Mamora, D.D. [Society of Petroleum Engineers, Richardson, TX (United States)]|[Texas A and M Univ., TX (United States)

2005-11-01

Predicting the performance of steam flooding can help in the proper execution of enhanced oil recovery (EOR) processes. The Jones model is often used for analytical steam flooding performance prediction, but it does not accurately predict oil production peaks. In this study, an improved steam flood model was developed by modifying 2 of the 3 components of the capture factor in the Jones model. The modifications were based on simulation results from a Society of Petroleum Engineers (SPE) comparative project case model. The production performance of a 5-spot steamflood pattern unit was simulated and compared with results obtained from the Jones model. Three reservoir types were simulated through the use of 3-D Cartesian black oil models. In order to correlate the simulation and the Jones analytical model results for the start and height of the production peak, the dimensionless steam zone size was modified to account for a decrease in oil viscosity during steam flooding and its dependence on the steam injection rate. In addition, the dimensionless volume of displaced oil produced was modified from its square-root format to an exponential form. The modified model improved results for production performance by up to 20 years of simulated steam flooding, compared to the Jones model. Results agreed with simulation results for 13 different cases, including 3 different sets of reservoir and fluid properties. Reservoir engineers will benefit from the improved accuracy of the model. Oil displacement calculations were based on methods proposed in earlier research, in which the oil displacement rate is a function of cumulative oil steam ratio. The cumulative oil steam ratio is a function of overall thermal efficiency. Capture factor component formulae were presented, as well as charts of oil production rates and cumulative oil-steam ratios for various reservoirs. 13 refs., 4 tabs., 29 figs.

Delivering Results for Peace and Development

International Nuclear Information System (INIS)

Pattison, Hazel

2013-01-01

The IAEA’s technical cooperation programme is the primary mechanism for delivering the IAEA’s capacity-building services to its Member States. The programme supports the safe and secure application of nuclear technology for sustainable socioeconomic development in Member States. The overall strategic framework of the TC programme is determined by pertinent provisions laid down in key documents of the IAEA. Strategic direction for the multi-annual TC programme is provided by the Agency’s Members States and, more specifically, by relevant advisory and governance entities. The programme concentrates on: improving human health; supporting agriculture, rural development and food security; advancing water resource management; addressing environmental challenges; helping sustainable energy development, including the use of nuclear power for electricity; and promoting safety and security

Delivering Online Examinations: A Case Study

Directory of Open Access Journals (Sweden)

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.

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.

Centers for medicare and medicaid services: using an episode-based payment model to improve oncology care.

Science.gov (United States)

Kline, Ronald M; Bazell, Carol; Smith, Erin; Schumacher, Heidi; Rajkumar, Rahul; Conway, Patrick H

2015-03-01

Cancer is a medically complex and expensive disease with costs projected to rise further as new treatment options increase and the United States population ages. Studies showing significant regional variation in oncology quality and costs and model tests demonstrating cost savings without adverse outcomes suggest there are opportunities to create a system of oncology care in the US that delivers higher quality care at lower cost. The Centers for Medicare and Medicaid Services (CMS) have designed an episode-based payment model centered around 6 month periods of chemotherapy treatment. Monthly per-patient care management payments will be made to practices to support practice transformation, including additional patient services and specific infrastructure enhancements. Quarterly reporting of quality metrics will drive continuous quality improvement and the adoption of best practices among participants. Practices achieving cost savings will also be eligible for performance-based payments. Savings are expected through improved care coordination and appropriately aligned payment incentives, resulting in decreased avoidable emergency department visits and hospitalizations and more efficient and evidence-based use of imaging, laboratory tests, and therapeutic agents, as well as improved end of life care. New therapies and better supportive care have significantly improved cancer survival in recent decades. This has come at a high cost, with cancer therapy consuming $124 billion in 2010. CMS has designed an episode-based model of oncology care that incorporates elements from several successful model tests. By providing care management and performance based payments in conjunction with quality metrics and a rapid learning environment, it is hoped that this model will demonstrate how oncology care in the US can transform into a high value, high quality system. Copyright © 2015 by American Society of Clinical Oncology.

A System Dynamics Model to Improve Water Resources Allocation in the Conchos River

Science.gov (United States)

Gastelum, J. R.; Valdes, J. B.; Stewart, S.

2005-12-01

The Conchos river located in Chihuahua state on a semiarid region is the most important Mexican river contributing water deliveries to USA as established by the Water treaty of 1944 signed between Mexico and USA. Historically, Mexico has delivered to UNITED STATES 550 Hm3 (445,549.5 ACF) per year of water since the treaty was established, which is 25% above the yearly water volume Mexico is required to deliver. The Conchos river has contributed with 54% of the historic Mexican water treaty deliveries to the UNITED STATES, which represents the highest percentage of the 6 Mexican rivers considered on the water treaty. However, during drought situations the basin has proven to be vulnerable, for instance, because of the severe drought of the 90's, several cities in 1992 on Chihuahua state where declared disaster areas, and from 1992 to 2001 Mexico had accumulated a water treaty deficit of 2111.6 Hm3 (1,710,586 ACF). This has conduced to economic, social, and political difficulties in both countries. Because of the cited problematic and considering the poor understanding of the relationship between water supply and demand factors on the basin, a decision support system (DSS) has been developed aimed to improve the decision making process related with the water resources allocation process. This DSS has been created using System Dynamics (SD). It is a semi-distributed model and is running on monthly time step basis. For both the short and long term, three important water resources management strategies have been evaluated: several water allocation policies from reservoirs to water users; bulk water rights transfers inside and outside Irrigation Districts; and improvement of water distribution efficiencies. The model results have provided very useful regard to gain more quantitative understanding of the different strategies being implemented. They have also indicated that the different water resources alternatives change its degree of importance according to the

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.

Modeling of scroll compressors - Improvements

Energy Technology Data Exchange (ETDEWEB)

Duprez, Marie-Eve; Dumont, Eric; Frere, Marc [Thermodynamics Department, Universite de Mons - Faculte Polytechnique, 31 bd Dolez, 7000 Mons (Belgium)

2010-06-15

This paper presents an improvement of the scroll compressors model previously published by. This improved model allows the calculation of refrigerant mass flow rate, power consumption and heat flow rate that would be released at the condenser of a heat pump equipped with the compressor, from the knowledge of operating conditions and parameters. Both basic and improved models have been tested on scroll compressors using different refrigerants. This study has been limited to compressors with a maximum electrical power of 14 kW and for evaporation temperatures ranging from -40 to 15 C and condensation temperatures from 10 to 75 C. The average discrepancies on mass flow rate, power consumption and heat flow rate are respectively 0.50%, 0.93% and 3.49%. Using a global parameter determination (based on several refrigerants data), this model can predict the behavior of a compressor with another fluid for which no manufacturer data are available. (author)

Increasing Customer Service Behaviors Using Manager-Delivered Task Clarification and Social Praise

Science.gov (United States)

Rice, Anna; Austin, John; Gravina, Nicole

2009-01-01

This project assessed an intervention to improve employee customer service behaviors (correct greetings and closing behaviors). A combination of task clarification and manager-delivered social praise resulted in increased correct greeting from 11.5% to 66% and correct closing from 8% to 70%. The effect was maintained at a 48-week follow-up for…

Using the Cascade Model to Improve Antenatal Screening for the Hemoglobin Disorders

Science.gov (United States)

Gould, Dinah; Papadopoulos, Irena; Kelly, Daniel

2012-01-01

Introduction: The inherited hemoglobin disorders constitute a major public health problem. Facilitators (experienced hemoglobin counselors) were trained to deliver knowledge and skills to "frontline" practitioners to enable them to support parents during antenatal screening via a cascade (train-the-trainer) model. Objectives of…

Effectiveness of online word of mouth on exposure to an Internet-delivered intervention.

Science.gov (United States)

Crutzen, Rik; de Nooijer, Jascha; Brouwer, Wendy; Oenema, Anke; Brug, Johannes; de Vries, Nanne

2009-07-01

The use of online word of mouth (WOM) seems a promising strategy to motivate young people to visit Internet-delivered interventions. An Internet-delivered intervention aimed at changing implicit attitudes related to alcohol was used in two experiments to test effectiveness of e-mail invitations on a first visit to the intervention. The results of the first experiment (N = 196) showed that an invitation by e-mail from a friend was more effective to attract young adults (aged 18-24 years) to the intervention website than an invitation from an institution. A 2 x 2 design was used in the second experiment (N = 236) to test manipulations of argument strength and the use of peripheral cues in invitations. Results showed that weak arguments were more effective to attract young adults to the intervention website when an incentive was withheld. These results need to be taken into account when using online WOM as a strategy to improve exposure to Internet-delivered interventions.

Process evaluation determines the pathway of success for a health center-delivered, nutrition education intervention for infants in Trujillo, Peru.

Science.gov (United States)

Robert, Rebecca C; Gittelsohn, Joel; Creed-Kanashiro, Hilary M; Penny, Mary E; Caulfield, Laura E; Narro, M Rocio; Black, Robert E

2006-03-01

Process evaluation was used to explain the success of a randomized, controlled trial of an educational intervention to improve the feeding behaviors of caregivers and the nutritional status of infants in Trujillo, Peru. Health personnel delivered a multicomponent intervention within the environment of usual care at government health centers. We created a model of the expected intervention pathway to successful outcomes. Process data were then collected on health center implementation of the intervention and caregiver reception to it. Using multivariate models, we found that variables of health center implementation, caregiver exposure, and caregiver message recall were all significant determinants in the pathway leading to improved feeding behaviors. These outcomes were consistent with our original intervention model. Further support for our model arose from the differences in caregiver reception between intervention and control centers. Process data allowed us to characterize the pathway through which an effective nutrition intervention operated. This study underscores the importance of including process evaluation, which will lead to the development and implementation of more effective nutrition interventions.

A Pilot Investigation of Speech Sound Disorder Intervention Delivered by Telehealth to School-Age Children

Directory of Open Access Journals (Sweden)

Sue Grogan-Johnson

2011-05-01

Full Text Available This article describes a school-based telehealth service delivery model and reports outcomes made by school-age students with speech sound disorders in a rural Ohio school district. Speech therapy using computer-based speech sound intervention materials was provided either by live interactive videoconferencing (telehealth, or conventional side-by-side intervention.  Progress was measured using pre- and post-intervention scores on the Goldman Fristoe Test of Articulation-2 (Goldman & Fristoe, 2002. Students in both service delivery models made significant improvements in speech sound production, with students in the telehealth condition demonstrating greater mastery of their Individual Education Plan (IEP goals. Live interactive videoconferencing thus appears to be a viable method for delivering intervention for speech sound disorders to children in a rural, public school setting. Keywords:  Telehealth, telerehabilitation, videoconferencing, speech sound disorder, speech therapy, speech-language pathology; E-Helper

Delivering high performance BWR fuel reliably

International Nuclear Information System (INIS)

Schardt, J.F.

1998-01-01

Utilities are under intense pressure to reduce their production costs in order to compete in the increasingly deregulated marketplace. They need fuel, which can deliver high performance to meet demanding operating strategies. GE's latest BWR fuel design, GE14, provides that high performance capability. GE's product introduction process assures that this performance will be delivered reliably, with little risk to the utility. (author)

Physiologic effects of alveolar recruitment and inspiratory pauses during moderately-high-frequency ventilation delivered by a conventional ventilator in a severe lung injury model.

Directory of Open Access Journals (Sweden)

Ricardo Luiz Cordioli

Full Text Available To investigate whether performing alveolar recruitment or adding inspiratory pauses could promote physiologic benefits (VT during moderately-high-frequency positive pressure ventilation (MHFPPV delivered by a conventional ventilator in a porcine model of severe acute respiratory distress syndrome (ARDS.Prospective experimental laboratory study with eight pigs. Induction of acute lung injury with sequential pulmonary lavages and injurious ventilation was initially performed. Then, animals were ventilated on a conventional mechanical ventilator with a respiratory rate (RR = 60 breaths/minute and PEEP titrated according to ARDS Network table. The first two steps consisted of a randomized order of inspiratory pauses of 10 and 30% of inspiratory time. In final step, we removed the inspiratory pause and titrated PEEP, after lung recruitment, with the aid of electrical impedance tomography. At each step, PaCO2 was allowed to stabilize between 57-63 mmHg for 30 minutes.The step with RR of 60 after lung recruitment had the highest PEEP when compared with all other steps (17 [16,19] vs 14 [10, 17]cmH2O, but had lower driving pressures (13 [13,11] vs 16 [14, 17]cmH2O, higher P/F ratios (212 [191,243] vs 141 [105, 184] mmHg, lower shunt (23 [20, 23] vs 32 [27, 49]%, lower dead space ventilation (10 [0, 15] vs 30 [20, 37]%, and a more homogeneous alveolar ventilation distribution. There were no detrimental effects in terms of lung mechanics, hemodynamics, or gas exchange. Neither the addition of inspiratory pauses or the alveolar recruitment maneuver followed by decremental PEEP titration resulted in further reductions in VT.During MHFPPV set with RR of 60 bpm delivered by a conventional ventilator in severe ARDS swine model, neither the inspiratory pauses or PEEP titration after recruitment maneuver allowed reduction of VT significantly, however the last strategy decreased driving pressures and improved both shunt and dead space.

Models for Delivering Written Business Communication Skills: Improving the Process

Science.gov (United States)

Penrod, Catherine B.; Tucker, Mary; Hartman, Katherine B.

2017-01-01

Employers, higher education faculty, and accrediting bodies value communication as an important entry-level job skill. Unfortunately, research indicates that college graduates have inadequate communication skills and, in particular, lack strong business writing acumen. The ways business communication is taught, integrated, and assessed varies by…

THE SELLER'S OBLIGATION TO DELIVER THE GOODS ACCORDING TO CISG

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Dan VELICU

2017-05-01

Full Text Available This article aims to analyze the seller's obligations under the Convention on International Sale of Goods (CISG and in particular the obligation to deliver the goods showing the main issues that arise in an international sale. We also wish to point the major innovations or improvements brought by the CISG in comparison to the European civil codes regulation and to conclude if the CSIG managed to revolutionize the tradition view on this issue.

Linking ecological science to decision-making: delivering environmental monitoring information as societal feedback.

Science.gov (United States)

Vaughan, Hague; Whitelaw, Graham; Craig, Brian; Stewart, Craig

2003-01-01

The paper describes the Ecological Monitoring and Assessment Network's (EMAN) operational and program response to certain challenges of environmental monitoring in Canada, in particular, efforts to improve the ability of the network to deliver relevant information to decision makers. In addition to its familiar roles, environmental monitoring should deliver feedback to society on environmental changes associated with development patterns, trends, processes and interventions. In order for such feedback to be effective, it must be relevant, timely, useful and accessible: all characteristics that are defined by the user, not the provider. Demand driven environmental monitoring is explored through EMAN's experiences with Canada's Biosphere Reserves, the NatureWatch Program and the Canadian Community Monitoring Network.

Network governance and capacity of local governments to deliver LED in Uganda

Directory of Open Access Journals (Sweden)

Rose B Namara

2016-02-01

Full Text Available This paper discusses network governance and its contribution to the capacity of local governments (LGs to deliver local economic development (LED in Uganda. Although a formal LED policy was only established in Uganda in February 2014, there have been LED-inspired practices in the past decade. Various scholars and practitioners have observed that the autonomy and capacity of LGs to deliver LED is limited, but have been hopeful that new governance strategies like network governance would increase the capacities of LGs. However, neither network governance arrangements among LGs, nor their potential to improve governance capacity, have been documented. In a case study of Kyenjojo District, this paper finds that existing network governance arrangements have been fundamental in improving financial autonomy at this LG, delivering some income to invest in LED activities, although no evidence was found of reduced transaction costs in transforming local economies. The study further reveals that network governance arrangements have not led to the development of specialised skills in regulation or law enforcement, and capacity gaps are evident amongst staff and members in understanding the private sector and how it works. On a positive note, there is clear evidence of attempts by the LG to be innovative. Based on these findings, this study recommends that LGs need to consider a multi-pronged or multi-network governance approach to LED, which in turn will require a refocusing of governance mechanisms to become more dynamic and responsive, and offer incentives to the various actors in the development sector.

Can shared care deliver better outcomes for patients undergoing total hip replacement?

NARCIS (Netherlands)

Rosendal, H.; Beekum, W.T. van; Nijhof, P.; Witte, L.P. de; Schrijvers, A.J.P.

2000-01-01

Objectives: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. Design: Prospective, observational cohort study. Setting: Two regions in the Netherlands where different organisational health care models have been

Delivering high performance BWR fuel reliably

Energy Technology Data Exchange (ETDEWEB)

Schardt, J.F. [GE Nuclear Energy, Wilmington, NC (United States)

1998-07-01

Utilities are under intense pressure to reduce their production costs in order to compete in the increasingly deregulated marketplace. They need fuel, which can deliver high performance to meet demanding operating strategies. GE's latest BWR fuel design, GE14, provides that high performance capability. GE's product introduction process assures that this performance will be delivered reliably, with little risk to the utility. (author)

Evaluation and management of the impact of land use change on the nitrogen and phosphorus load delivered to surface waters: the export coefficient modelling approach

Science.gov (United States)

Johnes, P. J.

1996-09-01

A manageable, relatively inexpensive model was constructed to predict the loss of nitrogen and phosphorus from a complex catchment to its drainage system. The model used an export coefficient approach, calculating the total nitrogen (N) and total phosphorus (P) load delivered annually to a water body as the sum of the individual loads exported from each nutrient source in its catchment. The export coefficient modelling approach permits scaling up from plot-scale experiments to the catchment scale, allowing application of findings from field experimental studies at a suitable scale for catchment management. The catchment of the River Windrush, a tributary of the River Thames, UK, was selected as the initial study site. The Windrush model predicted nitrogen and phosphorus loading within 2% of observed total nitrogen load and 0.5% of observed total phosphorus load in 1989. The export coefficient modelling approach was then validated by application in a second research basin, the catchment of Slapton Ley, south Devon, which has markedly different catchment hydrology and land use. The Slapton model was calibrated within 2% of observed total nitrogen load and 2.5% of observed total phosphorus load in 1986. Both models proved sensitive to the impact of temporal changes in land use and management on water quality in both catchments, and were therefore used to evaluate the potential impact of proposed pollution control strategies on the nutrient loading delivered to the River Windrush and Slapton Ley.

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

Improved TOPSIS decision model for NPP emergencies

International Nuclear Information System (INIS)

Zhang Jin; Liu Feng; Huang Lian

2011-01-01

In this paper,an improved decision model is developed for its use as a tool to respond to emergencies at nuclear power plants. Given the complexity of multi-attribute emergency decision-making on nuclear accident, the improved TOPSIS method is used to build a decision-making model that integrates subjective weight and objective weight of each evaluation index. A comparison between the results of this new model and two traditional methods of fuzzy hierarchy analysis method and weighted analysis method demonstrates that the improved TOPSIS model has a better evaluation effect. (authors)

Examining the cost of delivering routine immunization in Honduras.

Science.gov (United States)

Janusz, Cara Bess; Castañeda-Orjuela, Carlos; Molina Aguilera, Ida Berenice; Felix Garcia, Ana Gabriela; Mendoza, Lourdes; Díaz, Iris Yolanda; Resch, Stephen C

2015-05-07

Many countries have introduced new vaccines and expanded their immunization programs to protect additional risk groups, thus raising the cost of routine immunization delivery. Honduras recently adopted two new vaccines, and the country continues to broaden the reach of its program to adolescents and adults. In this article, we estimate and examine the economic cost of the Honduran routine immunization program for the year 2011. The data were gathered from a probability sample of 71 health facilities delivering routine immunization, as well as 8 regional and 1 central office of the national immunization program. Data were collected on vaccinations delivered, staff time dedicated to the program, cold chain equipment and upkeep, vehicle use, infrastructure, and other recurrent and capital costs at each health facility and administrative office. Annualized economic costs were estimated from a modified societal perspective and reported in 2011 US dollars. With the addition of rotavirus and pneumococcal conjugate vaccines, the total cost for routine immunization delivery in Honduras for 2011 was US$ 32.5 million. Vaccines and related supplies accounted for 23% of the costs. Labor, cold chain, and vehicles represented 54%, 4%, and 1%, respectively. At the facility level, the non-vaccine system costs per dose ranged widely, from US$ 25.55 in facilities delivering fewer than 500 doses per year to US$ 2.84 in facilities with volume exceeding 10,000 doses per year. Cost per dose was higher in rural facilities despite somewhat lower wage rates for health workers in these settings; this appears to be driven by lower demand for services per health worker in sparsely populated areas, rather than increased cost of outreach. These more-precise estimates of the operational costs to deliver routine immunizations provide program managers with important information for mobilizing resources to help sustain the program and for improving annual planning and budgeting as well as longer

Assessing the performance of commercial Agisoft PhotoScan software to deliver reliable data for accurate3D modelling

Directory of Open Access Journals (Sweden)

Jebur Ahmed

2018-01-01

Full Text Available 3D models delivered from digital photogrammetric techniques have massively increased and developed to meet the requirements of many applications. The reliability of these models is basically dependent on the data processing cycle and the adopted tool solution in addition to data quality. Agisoft PhotoScan is a professional image-based 3D modelling software, which seeks to create orderly, precise n 3D content from fixed images. It works with arbitrary images those qualified in both controlled and uncontrolled conditions. Following the recommendations of many users all around the globe, Agisoft PhotoScan, has become an important source to generate precise 3D data for different applications. How reliable is this data for accurate 3D modelling applications is the current question that needs an answer. Therefore; in this paper, the performance of the Agisoft PhotoScan software was assessed and analyzed to show the potential of the software for accurate 3D modelling applications. To investigate this, a study was carried out in the University of Baghdad / Al-Jaderia campus using data collected from airborne metric camera with 457m flying height. The Agisoft results show potential according to the research objective and the dataset quality following statistical and validation shape analysis.

Compressor-less Hydrogen Transmission Pipelines Deliver Large-scale Stranded Renewable Energy at Competitive Cost

International Nuclear Information System (INIS)

W Leighty; J Holloway; R Merer; B Somerday; C San Marchi; G Keith; D White

2006-01-01

We assume a transmission-constrained world, where large new wind plants and other renewable energies must pay all transmission costs for delivering their energy to distant markets. We modeled a 1,000 MW (1 GW) (name plate) wind plant in the large wind resource of the North America Great Plains, delivering exclusively hydrogen fuel, via a new gaseous hydrogen (GH2) pipeline, to an urban market at least 300 km distant. All renewable electric energy output would be converted, at the source, to hydrogen, via 100 bar output electrolyzers, directly feeding the GH2 transmission pipeline without costly compressor stations at inlet or at midline. The new GH2 pipeline is an alternative to new electric transmission lines. We investigate whether the pipeline would provide valuable energy storage. We present a simple model by which we estimate the cost of wind-source hydrogen fuel delivered to the distant city gate in year 2010, at GW scale. Ammonia, synthetic hydrocarbons, and other substances may also be attractive renewable-source energy carriers, storage media, and fuels; they are not considered in this paper. (authors)

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.

An improved interfacial bonding model for material interface modeling

Science.gov (United States)

Lin, Liqiang; Wang, Xiaodu; Zeng, Xiaowei

2016-01-01

An improved interfacial bonding model was proposed from potential function point of view to investigate interfacial interactions in polycrystalline materials. It characterizes both attractive and repulsive interfacial interactions and can be applied to model different material interfaces. The path dependence of work-of-separation study indicates that the transformation of separation work is smooth in normal and tangential direction and the proposed model guarantees the consistency of the cohesive constitutive model. The improved interfacial bonding model was verified through a simple compression test in a standard hexagonal structure. The error between analytical solutions and numerical results from the proposed model is reasonable in linear elastic region. Ultimately, we investigated the mechanical behavior of extrafibrillar matrix in bone and the simulation results agreed well with experimental observations of bone fracture. PMID:28584343

Gravity model improvement investigation. [improved gravity model for determination of ocean geoid

Science.gov (United States)

Siry, J. W.; Kahn, W. D.; Bryan, J. W.; Vonbun, F. F.

1973-01-01

This investigation was undertaken to improve the gravity model and hence the ocean geoid. A specific objective is the determination of the gravity field and geoid with a space resolution of approximately 5 deg and a height resolution of the order of five meters. The concept of the investigation is to utilize both GEOS-C altimeter and satellite-to-satellite tracking data to achieve the gravity model improvement. It is also planned to determine the geoid in selected regions with a space resolution of about a degree and a height resolution of the order of a meter or two. The short term objectives include the study of the gravity field in the GEOS-C calibration area outlined by Goddard, Bermuda, Antigua, and Cape Kennedy, and also in the eastern Pacific area which is viewed by ATS-F.

Comparison of the efficacy of intensity modulated radiotherapy delivered by competing technologies

International Nuclear Information System (INIS)

Seco, Joao Carlos

2003-01-01

The project involved the study and comparison of the various intensity-modulated radiation therapy (IMRT) delivery techniques. IMRT can be delivered via (i) the NOMOS MIMiC tomotherapy device, (ii) the dynamic multileaf collimator (DMLC), and (iii) the technique of multiple-static fields (MSF) using a multileaf collimator (MLC). To evaluate the relative benefits and limitations of the different methods of delivering IMRT an inverse-planning simulation code was developed. The simulation uses two distinct beam models: (a) the PEACOCK pencil-beam model based on the double Gaussian convolution for the MIMiC, and (b) the macropencil beam model (with the extended source model included to correct for the output factor) which is used for the DMLC and MSF-MLC delivery techniques. The process of delivering an IMRT treatment may involve various beam-modifying techniques such as multileaf collimators, the NOMOS MIMiC, blocks, wedges, etc. The constraints associated with the IMRT delivery technique are usually neglected in the process of obtaining the 'optimal' inverse treatment plan. Consequently, dose optimization may be significantly reduced when the 'optimal' beam profiles are converted to leaf/diaphragm positions via a leaf-sequencing interpreter. The work developed assessed the effects on the optimum treatment plan of the following leaf-sequencing algorithms: MSF-MLC, DMLC, and NOMOS MIMiC. An increase of 2.5%, 3.7% and 5.7% was observed for the PTV dose, when delivering a fluence profile with the DMLC, MSF, and NOMOS MIMiC techniques, respectively. An intensity-modulated beam optimization algorithm was developed to incorporate the delivery constraints into the optimization cycle. The optimization algorithm was based on the quasi-Newton method of iteratively solving minimization problems. The developed algorithm iteratively corrects the incident, pencil-beam-like fluence to incorporate the delivery constraints. In the case of the DMLC and MSF the optimization converged

The Potential of Zebrafish as a Model Organism for Improving the Translation of Genetic Anticancer Nanomedicines

Directory of Open Access Journals (Sweden)

C Gutiérrez-Lovera

2017-11-01

Full Text Available In the last few decades, the field of nanomedicine applied to cancer has revolutionized cancer treatment: several nanoformulations have already reached the market and are routinely being used in the clinical practice. In the case of genetic nanomedicines, i.e., designed to deliver gene therapies to cancer cells for therapeutic purposes, advances have been less impressive. This is because of the many barriers that limit the access of the therapeutic nucleic acids to their target site, and the lack of models that would allow for an improvement in the understanding of how nanocarriers can be tailored to overcome them. Zebrafish has important advantages as a model species for the study of anticancer therapies, and have a lot to offer regarding the rational development of efficient delivery of genetic nanomedicines, and hence increasing the chances of their successful translation. This review aims to provide an overview of the recent advances in the development of genetic anticancer nanomedicines, and of the zebrafish models that stand as promising tools to shed light on their mechanisms of action and overall potential in oncology.

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

Live Cell Characterization of DNA Aggregation Delivered through Lipofection.

Science.gov (United States)

Mieruszynski, Stephen; Briggs, Candida; Digman, Michelle A; Gratton, Enrico; Jones, Mark R

2015-05-27

DNA trafficking phenomena, such as information on where and to what extent DNA aggregation occurs, have yet to be fully characterised in the live cell. Here we characterise the aggregation of DNA when delivered through lipofection by applying the Number and Brightness (N&B) approach. The N&B analysis demonstrates extensive aggregation throughout the live cell with DNA clusters in the extremity of the cell and peri-nuclear areas. Once within the nucleus aggregation had decreased 3-fold. In addition, we show that increasing serum concentration of cell media results in greater cytoplasmic aggregation. Further, the effects of the DNA fragment size on aggregation was explored, where larger DNA constructs exhibited less aggregation. This study demonstrates the first quantification of DNA aggregation when delivered through lipofection in live cells. In addition, this study has presents a model for alternative uses of this imaging approach, which was originally developed to study protein oligomerization and aggregation.

An eighteen-month follow-up of a pilot parent-delivered play-based intervention to improve the social play skills of children with attention deficit hyperactivity disorder and their playmates.

Science.gov (United States)

Cantrill, Alycia; Wilkes-Gillan, Sarah; Bundy, Anita; Cordier, Reinie; Wilson, Nathan J

2015-06-01

Children with attention deficit hyperactivity disorder (ADHD) experience significant ongoing social difficulties which occur in multiple contexts. Interventions designed to improve these social difficulties have demonstrated minimal effectiveness. Thus, there is a clear need to establish interventions that are effective in addressing the social difficulties of children with ADHD across contexts and in the long term. To examine the long-term effectiveness and appropriateness of a pilot parent-delivered intervention designed to improve the social play skills of children with ADHD and their playmates. Participants included five children with ADHD who had completed the intervention 18-months prior, their typically developing playmates and mothers of children with ADHD. Blinded ratings from the Test of Playfulness were used to measure children's social play: post-intervention and 18-months following the intervention in the home and clinic. Wilcoxon signed-ranks and Cohen's-d calculations were used to measure effectiveness. Parents' perspectives of the appropriateness of the intervention were explored through semi-structured interviews and data were analysed thematically. The social play skills of children with ADHD and their playmates were maintained following the intervention in the home and clinic. Thematic analysis revealed four core-themes against an intervention appropriateness framework: new parenting tools, a social shift, adapting strategies over time and the next developmental challenge. The parent-delivered intervention demonstrated long-term effectiveness and appropriateness for improving children's social play skills. These preliminary results are promising as maintaining treatment effects and achieving generalisation across contexts has remained an unachieved goal for most psycho-social interventions. © 2015 Occupational Therapy Australia.

Randomized Controlled Trial of Nurse-Delivered Cognitive Behavioral Therapy Versus Supportive Psychotherapy Telehealth Interventions for Chronic Back Pain.

Science.gov (United States)

Rutledge, Thomas; Atkinson, J Hampton; Holloway, Rachael; Chircop-Rollick, Tatiana; D'Andrea, John; Garfin, Steven R; Patel, Shetal; Penzien, Donald B; Wallace, Mark; Weickgenant, Anne L; Slater, Mark

2018-04-16

This study evaluated a nurse-delivered, telehealth intervention of cognitive behavioral therapy versus supportive psychotherapy for chronic back pain. Participants (N=61) had chronic back pain (pain "daily" ≥ 6 months at an intensity ≥4/10 scale) and were randomized to an 8-week, 12-session, Cognitive Behavioral Therapy (CBT) or to Supportive Care (SC) matched for frequency, format, and time, with each treatment delivered by a primary care nurse. The primary outcome was the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes included the Numerical Rating Scale (NRS) and the Patient Global Impressions Scale (CGI). CBT participants (n=30) showed significant improvements on the RMDQ (means=11.4[5.9] vs. 9.4[6.1] at baseline and post-treatment, respectively, p.10). The results suggest that telehealth, nurse-delivered CBT and SC treatments for chronic back pain can offer significant and relatively comparable benefits. ClinicalTrials.gov: NCT00608530. This article describes the benefits of training primary care nurses to deliver evidence-based behavioral therapies for low back pain. Due to the high prevalence of chronic pain and the growing emphasis on non-opioid therapies, training nurses to provide behavior therapies could be a cost-effective way to improve pain management. Copyright © 2018. Published by Elsevier Inc.

Business Model Innovation: A Blueprint for Higher Education

Science.gov (United States)

Flanagan, Christine

2012-01-01

Business model innovation is one of the most challenging components of 21st-century leadership. Making incremental improvements to a business model--creating new efficiencies, expanding into adjacent markets--is hard enough. Developing and experimenting with new business models that truly transform how an institution delivers value (while…

Application of Improved Radiation Modeling to General Circulation Models

Energy Technology Data Exchange (ETDEWEB)

Michael J Iacono

2011-04-07

This research has accomplished its primary objectives of developing accurate and efficient radiation codes, validating them with measurements and higher resolution models, and providing these advancements to the global modeling community to enhance the treatment of cloud and radiative processes in weather and climate prediction models. A critical component of this research has been the development of the longwave and shortwave broadband radiative transfer code for general circulation model (GCM) applications, RRTMG, which is based on the single-column reference code, RRTM, also developed at AER. RRTMG is a rigorously tested radiation model that retains a considerable level of accuracy relative to higher resolution models and measurements despite the performance enhancements that have made it possible to apply this radiation code successfully to global dynamical models. This model includes the radiative effects of all significant atmospheric gases, and it treats the absorption and scattering from liquid and ice clouds and aerosols. RRTMG also includes a statistical technique for representing small-scale cloud variability, such as cloud fraction and the vertical overlap of clouds, which has been shown to improve cloud radiative forcing in global models. This development approach has provided a direct link from observations to the enhanced radiative transfer provided by RRTMG for application to GCMs. Recent comparison of existing climate model radiation codes with high resolution models has documented the improved radiative forcing capability provided by RRTMG, especially at the surface, relative to other GCM radiation models. Due to its high accuracy, its connection to observations, and its computational efficiency, RRTMG has been implemented operationally in many national and international dynamical models to provide validated radiative transfer for improving weather forecasts and enhancing the prediction of global climate change.

Oscillating Square Wave Transcranial Direct Current Stimulation (tDCS) Delivered During Slow Wave Sleep Does Not Improve Declarative Memory More Than Sham: A Randomized Sham Controlled Crossover Study.

Science.gov (United States)

Sahlem, Gregory L; Badran, Bashar W; Halford, Jonathan J; Williams, Nolan R; Korte, Jeffrey E; Leslie, Kimberly; Strachan, Martha; Breedlove, Jesse L; Runion, Jennifer; Bachman, David L; Uhde, Thomas W; Borckardt, Jeffery J; George, Mark S

2015-01-01

A 2006 trial in healthy medical students found that anodal slow oscillating tDCS delivered bi-frontally during slow wave sleep had an enhancing effect in declarative, but not procedural memory. Although there have been supporting animal studies, and similar findings in pathological groups, this study has not been replicated, or refuted, in the intervening years. We therefore tested these earlier results for replication using similar methods with the exception of current waveform (square in our study, nearly sinusoidal in the original). Our objective was to test the findings of a 2006 trial suggesting bi-frontal anodal tDCS during slow wave sleep enhances declarative memory. Twelve students (mean age 25, 9 women) free of medical problems underwent two testing conditions (active, sham) in a randomized counterbalanced fashion. Active stimulation consisted of oscillating square wave tDCS delivered during early Non-Rapid Eye Movement (NREM) sleep. The sham condition consisted of setting-up the tDCS device and electrodes, but not turning it on during sleep. tDCS was delivered bi-frontally with anodes placed at F3/F4, and cathodes placed at mastoids. Current density was 0.517 mA/cm(2), and oscillated between zero and maximal current at a frequency of 0.75 Hz. Stimulation occurred during five-five minute blocks with 1-min inter-block intervals (25 min total stimulation). The primary outcomes were both declarative memory consolidation measured by a paired word association test (PWA), and non-declarative memory, measured by a non-dominant finger-tapping test (FTT). We also recorded and analyzed sleep EEG. There was no difference in the number of paired word associations remembered before compared to after sleep [(active = 3.1 ± 3.0 SD more associations) (sham = 3.8 ± 3.1 SD more associations)]. Finger tapping improved, (non-significantly) following active stimulation [(3.6 ± 2.7 SD correctly typed sequences) compared to sham stimulation (2.3 ± 2.2 SD correctly typed

Effects of Home-Delivered Cognitive Behavioral Therapy (CBT) for Depression on Anxiety Symptoms among Rural, Ethnically Diverse Older Adults.

Science.gov (United States)

DiNapoli, Elizabeth A; Pierpaoli, Christina M; Shah, Avani; Yang, Xin; Scogin, Forrest

2017-01-01

We examined the effects of home-delivered cognitive-behavioral therapy (CBT) for depression on anxiety symptoms in an ethnically diverse, low resource, and medically frail sample of rural, older adults. This was a secondary analysis of a randomized clincial trial with 134 rural-dwelling adults 65 years and older with decreased quality of life and elevated psychological symptomatology. Anxiety symptoms were assessed with the anxiety and phobic anxiety subscales of the Symptom Checklist-90-Revised (SCL-90-R). Compared to a minimal support control condition, CBT for depression resulted in significantly greater improvements in symptoms of anxiety and phobic anxiety from pre-treatment to post-treatment. Home-delivered CBT for depression can be an effective treatment for anxiety in a hard-to-reach older populations. Additional research should explore integrated anxiety and depression protocols and other treatment modalities, including bibliotherapy or telehealth models of CBT, to reduce costs associated with its in home delivery. Flexibility in administration and adaptations to the CBT protocol may be necessary for use with vulnerable, rural older adults.

An improved gravity model for Mars: Goddard Mars Model 1

Science.gov (United States)

Smith, D. E.; Lerch, F. J.; Nerem, R. S.; Zuber, M. T.; Patel, G. B.; Fricke, S. K.; Lemoine, F. G.

1993-01-01

Doppler tracking data of three orbiting spacecraft have been reanalyzed to develop a new gravitational field model for the planet Mars, Goddard Mars Model 1 (GMM-1). This model employs nearly all available data, consisting of approximately 1100 days of S band tracking data collected by NASA's Deep Space Network from the Mariner 9 and Viking 1 and Viking 2 spacecraft, in seven different orbits, between 1971 and 1979. GMM-1 is complete to spherical harmonic degree and order 50, which corresponds to a half-wavelength spatial resolution of 200-300 km where the data permit. GMM-1 represents satellite orbits with considerably better accuracy than previous Mars gravity models and shows greater resolution of identifiable geological structures. The notable improvement in GMM-1 over previous models is a consequence of several factors: improved computational capabilities, the use of otpimum weighting and least squares collocation solution techniques which stabilized the behavior of the solution at high degree and order, and the use of longer satellite arcs than employed in previous solutions that were made possible by improved force and measurement models. The inclusion of X band tracking data from the 379-km altitude, nnear-polar orbiting Mars Observer spacecraft should provide a significant improvement over GMM-1, particularly at high latitudes where current data poorly resolve the gravitational signature of the planet.

[Modern information and communication technology in medical rehabilitation. Enhanced sustainability through Internet-delivered aftercare].

Science.gov (United States)

Kordy, H; Theis, F; Wolf, M

2011-04-01

Internet and mobile phones open new avenues for the optimization of health services in medical rehabilitation. Various models of Internet-delivered aftercare after psychosomatic inpatient treatment have shown promising results. The focus of this report is on the experience in translating one of the promising models, the Internet-Bridge ("Internet-Brücke"), to every day health care. Effectiveness was estimated through comparison of 254 patients who were treated in a hospital specialized in psychosomatic medicine and who participated in the Internet-Bridge as well as in the 1-year follow-up in the frame of standard quality assurance between 2003-2010 with 364 patients of the same hospital who also participated in the 1-year follow-up, but did not utilize the aftercare. Sustainable, reliable, and clinically significant improvements were more frequent in participants of the Internet-Bridge, especially with regard to psychological well-being, social problems, and psychosocial competence-at small additional costs. Results are understood as encouragement to start translation to routine care accompanied by research.

A Preliminary Investigation of a Specialized Music Therapy Model for Children with Disabilities Delivered in a Classroom Setting

Directory of Open Access Journals (Sweden)

Jenna Mendelson

2016-01-01

Full Text Available Music therapy is gaining popularity as an intervention strategy for children with developmental disabilities, including autism spectrum disorder (ASD. This study was a pilot investigation of a classroom-based music-based intervention, Voices Together®, for improving communication skills in children with ASD and children with intellectual disabilities. Four local public elementary school special education classrooms, serving 5 children with a classification of autistic disorder and 32 children with intellectual disability without autism, were randomly selected to receive one of two levels of exposure to Voices Together music therapy: “long-term” (15 weeks beginning in January 2015 (Time 1, n=14 or “short-term” (7 weeks beginning 7 weeks later in February (Time 2, n=17. Using observational ratings, investigators reliably scored participants live in terms of their level of verbal responsiveness to prompts during three songs featured each week of the program. Both groups demonstrated increases in verbal responses over time; however, only the long-term group demonstrated significant within-group increases. Preliminary findings suggest that music therapy delivered in a classroom in 45-minute weekly sessions for 15 weeks can promote improvements in verbal responsiveness among individuals with autism and other developmental disabilities. Findings warrant further investigation into the efficacy of classroom-based music therapy programs.

A Preliminary Investigation of a Specialized Music Therapy Model for Children with Disabilities Delivered in a Classroom Setting.

Science.gov (United States)

Mendelson, Jenna; White, Yasmine; Hans, Laura; Adebari, Richard; Schmid, Lorrie; Riggsbee, Jan; Goldsmith, Ali; Ozler, Burcu; Buehne, Kristen; Jones, Sarah; Shapleton, Jennifer; Dawson, Geraldine

2016-01-01

Music therapy is gaining popularity as an intervention strategy for children with developmental disabilities, including autism spectrum disorder (ASD). This study was a pilot investigation of a classroom-based music-based intervention, Voices Together® , for improving communication skills in children with ASD and children with intellectual disabilities. Four local public elementary school special education classrooms, serving 5 children with a classification of autistic disorder and 32 children with intellectual disability without autism, were randomly selected to receive one of two levels of exposure to Voices Together music therapy: "long-term" (15 weeks beginning in January 2015 (Time 1), n = 14) or "short-term" (7 weeks beginning 7 weeks later in February (Time 2), n = 17). Using observational ratings, investigators reliably scored participants live in terms of their level of verbal responsiveness to prompts during three songs featured each week of the program. Both groups demonstrated increases in verbal responses over time; however, only the long-term group demonstrated significant within-group increases. Preliminary findings suggest that music therapy delivered in a classroom in 45-minute weekly sessions for 15 weeks can promote improvements in verbal responsiveness among individuals with autism and other developmental disabilities. Findings warrant further investigation into the efficacy of classroom-based music therapy programs.

Improvement of MARS code reflood model

International Nuclear Information System (INIS)

Hwang, Moonkyu; Chung, Bub-Dong

2011-01-01

A specifically designed heat transfer model for the reflood process which normally occurs at low flow and low pressure was originally incorporated in the MARS code. The model is essentially identical to that of the RELAP5/MOD3.3 code. The model, however, is known to have under-estimated the peak cladding temperature (PCT) with earlier turn-over. In this study, the original MARS code reflood model is improved. Based on the extensive sensitivity studies for both hydraulic and wall heat transfer models, it is found that the dispersed flow film boiling (DFFB) wall heat transfer is the most influential process determining the PCT, whereas the interfacial drag model most affects the quenching time through the liquid carryover phenomenon. The model proposed by Bajorek and Young is incorporated for the DFFB wall heat transfer. Both space grid and droplet enhancement models are incorporated. Inverted annular film boiling (IAFB) is modeled by using the original PSI model of the code. The flow transition between the DFFB and IABF, is modeled using the TRACE code interpolation. A gas velocity threshold is also added to limit the top-down quenching effect. Assessment calculations are performed for the original and modified MARS codes for the Flecht-Seaset test and RBHT test. Improvements are observed in terms of the PCT and quenching time predictions in the Flecht-Seaset assessment. In case of the RBHT assessment, the improvement over the original MARS code is found marginal. A space grid effect, however, is clearly seen from the modified version of the MARS code. (author)

Longitudinal change in parent and child functioning after internet-delivered cognitive-behavioral therapy for chronic pain.

Science.gov (United States)

Law, Emily F; Fisher, Emma; Howard, Waylon J; Levy, Rona; Ritterband, Lee; Palermo, Tonya M

2017-10-01

Theoretical models of pediatric chronic pain propose longitudinal associations between children's pain experiences and parent and family factors. A large body of cross-sectional research supports these models, demonstrating that greater parent distress and maladaptive parenting behaviors are associated with greater child disability. Family-based cognitive-behavioral therapy interventions have been developed for youth with chronic pain which aim to improve child disability and reduce maladaptive parenting behaviors. However, little is known about temporal, longitudinal associations between parent and child functioning in this population. In the present study, we conducted a secondary analysis of data from 138 families of youth with chronic pain aged 11 to 17 years old who received family-based cognitive-behavioral therapy delivered through the Internet as part of a randomized controlled trial. Measures of child disability, parent protective behavior, and parent distress were obtained at pretreatment, immediate posttreatment, 6-month follow-up, and 12-month follow-up. Latent growth modeling indicated that child disability, parent protective behavior, and parent distress improved with treatment over the 12-month study period. Latent growth modeling for parallel processes indicated that higher parent distress at pretreatment predicted less improvement in child disability over 12 months. No other predictive paths between parent and child functioning were significant. These findings indicate that parent distress may increase the risk of poor response to psychological pain treatment among youth with chronic pain. At present, parent distress is not routinely targeted in psychological interventions for pediatric chronic pain. Research is needed to determine optimal strategies for targeting parent and family factors in the treatment of pediatric chronic pain.

Development of fiber-delivered laser peening system to prevent stress corrosion cracking of reactor components

International Nuclear Information System (INIS)

Sano, Y.; Kimura, M.; Yoda, M.; Mukai, N.; Sato, K.; Uehara, T.; Ito, T.; Shimamura, M.; Sudo, A.; Suezono, N.

2001-01-01

The authors have developed a system to deliver water-penetrable intense laser pulses of frequency-doubled Nd:YAG laser through optical fiber. The system is capable of improving a residual stress on water immersed metal material remotely, which is effective to prevent the initiation of stress corrosion cracking (SCC) of reactor components. Experimental results showed that a compressive residual stress with enough amplitude and depth was built in the surface layer of type 304 stainless steel (SUS304) by irradiating laser pulses through optical fiber with diameter of 1 mm. A prototype peening head with miniaturized dimensions of 88 mm x 46 mm x 25 mm was assembled to con-firm the accessibility to the heat affected zone (HAZ) along weld lines of a reactor core shroud. The accessibility was significantly improved owing to the flexible optical fiber and the miniaturized peening head. The fiber delivered system opens up the possibility of new applications of laser peening. (author)

'Working with the team': an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care.

Science.gov (United States)

Hepworth, Julie; Askew, Deborah; Jackson, Claire; Russell, Anthony

2013-01-01

This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants' responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.

Afraid of Delivering at the Hospital or Afraid of Delivering at Home: A Qualitative Study of Thai Hmong Families' Decision-Making About Maternity Services.

Science.gov (United States)

Culhane-Pera, Kathleen A; Sriphetcharawut, Sarinya; Thawsirichuchai, Rasamee; Yangyuenkun, Wirachon; Kunstadter, Peter

2015-11-01

Thailand has high rates of maternity services; both antenatal care (ANC) and hospital delivery are widely used by its citizens. A recent Northern Thailand survey showed that Hmong women used maternity services at lower rates. Our objectives were to identify Hmong families' socio-cultural reasons for using and not using maternity services, and suggest ways to improve Hmong women's use of maternity services. In one Hmong village, we classified all 98 pregnancies in the previous 5 years into four categories: no ANC/home birth, ANC/home, no ANC/hospital, ANC/hospital. We conducted life-history case studies of 4 women from each category plus their 12 husbands, and 17 elders. We used grounded theory to guide qualitative analysis. Families not using maternity services considered pregnancy a normal process that only needed traditional home support. In addition, they disliked institutional processes that interfered with cultural birth practices, distrusted discriminatory personnel, and detested invasive, involuntary hospital procedures. Families using services perceived physical needs or potential delivery risks that could benefit from obstetrical assistance not available at home. While they disliked aspects of hospital births, they tolerated these conditions for access to obstetrical care they might need. Families also considered cost, travel distance, and time as structural issues. The families ultimately balanced their fear of delivering at home with their fear of delivering at the hospital. Providing health education about pregnancy risks, and changing healthcare practices to accommodate Hmong people's desires for culturally-appropriate family-centered care, which are consistent with evidence-based obstetrics, might improve Hmong women's use of maternity services.

Modeling soil water content for vegetation modeling improvement

Science.gov (United States)

Cianfrani, Carmen; Buri, Aline; Zingg, Barbara; Vittoz, Pascal; Verrecchia, Eric; Guisan, Antoine

2016-04-01

Soil water content (SWC) is known to be important for plants as it affects the physiological processes regulating plant growth. Therefore, SWC controls plant distribution over the Earth surface, ranging from deserts and grassland to rain forests. Unfortunately, only a few data on SWC are available as its measurement is very time consuming and costly and needs specific laboratory tools. The scarcity of SWC measurements in geographic space makes it difficult to model and spatially project SWC over larger areas. In particular, it prevents its inclusion in plant species distribution model (SDMs) as predictor. The aims of this study were, first, to test a new methodology allowing problems of the scarcity of SWC measurements to be overpassed and second, to model and spatially project SWC in order to improve plant SDMs with the inclusion of SWC parameter. The study was developed in four steps. First, SWC was modeled by measuring it at 10 different pressures (expressed in pF and ranging from pF=0 to pF=4.2). The different pF represent different degrees of soil water availability for plants. An ensemble of bivariate models was built to overpass the problem of having only a few SWC measurements (n = 24) but several predictors to include in the model. Soil texture (clay, silt, sand), organic matter (OM), topographic variables (elevation, aspect, convexity), climatic variables (precipitation) and hydrological variables (river distance, NDWI) were used as predictors. Weighted ensemble models were built using only bivariate models with adjusted-R2 > 0.5 for each SWC at different pF. The second step consisted in running plant SDMs including modeled SWC jointly with the conventional topo-climatic variable used for plant SDMs. Third, SDMs were only run using the conventional topo-climatic variables. Finally, comparing the models obtained in the second and third steps allowed assessing the additional predictive power of SWC in plant SDMs. SWC ensemble models remained very good, with

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.

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

A systematic review evaluating the role of nurses and processes for delivering early mobility interventions in the intensive care unit.

Science.gov (United States)

Krupp, Anna; Steege, Linsey; King, Barbara

2018-04-19

To investigate processes for delivering early mobility interventions in adult intensive care unit patients used in research and quality improvement studies and the role of nurses in early mobility interventions. A systematic review was conducted. Electronic databases PubMED, CINAHL, PEDro, and Cochrane were searched for studies published from 2000 to June 2017 that implemented an early mobility intervention in adult intensive care units. Included studies involved progression to ambulation as a component of the intervention, included the role of the nurse in preparing for or delivering the intervention, and reported at least one patient or organisational outcome measure. The System Engineering Initiative for Patient Safety (SEIPS) model, a framework for understanding structure, processes, and healthcare outcomes, was used to evaluate studies. 25 studies were included in the final review. Studies consisted of randomised control trials, prospective, retrospective, or mixed designs. A range of processes to support the delivery of early mobility were found. These processes include forming interdisciplinary teams, increasing mobility staff, mobility protocols, interdisciplinary education, champions, communication, and feedback. Variation exists in the process of delivering early mobility in the intensive care unit. In particular, further rigorous studies are needed to better understand the role of nurses in implementing early mobility to maintain a patient's functional status. Copyright © 2018 Elsevier Ltd. All rights reserved.

[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.

Mental health workshops delivered by medical students in Cambridge secondary schools: an evaluation of learning.

Science.gov (United States)

Bentham, Chloe; Daunt, Anna; Taylor, Stephanie; Simmons, Meinou

2013-09-01

For a group of medical students to design and deliver a mental health workshop in Cambridge secondary schools. Subsequently, to evaluate any improvements in pupils' knowledge of mental health issues, including knowledge of common mental illnesses, stigma and where to access help with mental health problems. A group of three medical students undertook a five week Student Selected Component to develop a mental health workshop in Spring 2013. The workshop was designed to include interactive components, such as role play, models and video. It was delivered to eight classes of 12-13 year old pupils across two local secondary schools, a total of 230 students. Questionnaires were completed before and after each workshop to test knowledge acquisition of mental health issues, stigma and where pupils could get help with mental health problems. Comparisons between data from the pre- and post-workshop questionnaires were made to assess learning. The responses from the questionnaires showed a global improvement in knowledge of mental health. This is highlighted by the increase in awareness of the prevalence of mental health problems amongst young people from 47.0% before the workshops to 97.8% after the workshops. The ability to identify symptoms of anxiety rose from 21.7% to 44.8% and the ability to identify depression rose from 29.0% to 53.5% respectively. Whilst only 15.2% pupils disagreed with a stigmatising statement about mental illness before the workshops, 61.3% pupils disagreed afterwards. The students were also better informed about how to access help and identified areas that they found useful to learn about. Comparison of the pre- and post-workshop questionnaires indicate that medical student-led workshops are an effective method for improving knowledge of mental health topics amongst 12-13 year old school pupils, as well as encouraging positive attitudes towards mental health. The project highlights a demand for mental health education in schools and brings to

Improvements of evaporation drag model

International Nuclear Information System (INIS)

Li Xiaoyan; Yang Yanhua; Xu Jijun

2004-01-01

A special observable experiment facility has been established, and a series of experiments have been carried out on this facility by pouring one or several high-temperature particles into a water pool. The experiment has verified the evaporation drag model, which believe the non-symmetric profile of the local evaporation rate and the local density of the vapor would bring about a resultant force on the hot particle so as to resist its motion. However, in Yang's evaporation drag model, radiation heat transfer is taken as the only way to transfer heat from hot particle to the vapor-liquid interface and all of the radiation energy is deposited on the vapor-liquid interface, thus contributing to the vaporization rate and mass balance of the vapor film. So, the heat conduction and the heat convection are taken into account in improved model. At the same time, the improved model given by this paper presented calculations of the effect of hot particles temperature on the radiation absorption behavior of water

Low Intensity Extracorporeal Shock Wave Therapy Improves Erectile Function in a Model of Type II Diabetes Independently of NO/cGMP Pathway.

Science.gov (United States)

Assaly-Kaddoum, Rana; Giuliano, François; Laurin, Miguel; Gorny, Diane; Kergoat, Micheline; Bernabé, Jacques; Vardi, Yoram; Alexandre, Laurent; Behr-Roussel, Delphine

2016-09-01

Erectile dysfunction is highly prevalent in type II diabetes mellitus. Low intensity extracorporeal shock wave therapy improves erectile function in patients with erectile dysfunction of vasculogenic origin, including diabetes. However, its mode of action remains unknown. We investigated the effects of low intensity extracorporeal shock wave therapy compared to or combined with sildenafil on erectile dysfunction in a type II diabetes mellitus model. Our purpose was to test our hypothesis of a mode of action targeting the cavernous nitric oxide/cyclic guanosine monophosphate pathway. GK rats, a validated model of type II diabetes mellitus, and age matched Wistar rats were treated with low intensity extracorporeal shock wave therapy twice weekly for 3 weeks. Treatment was repeated after a 3-week no-treatment interval. The penis was stretched and dipped in a specifically designed water-filled cage. Shock waves were delivered by a calibrated probe yielding a controlled energy flux density (0.09 mJ/mm(2)). The probe was attached to an electrohydraulic unit with a focused shock wave source, allowing for accurate extrapolation to humans. Following a 4-week washout period erectile function was assessed as well as endothelium dependent and independent, and nitrergic relaxations of the corpus cavernosum of GK rats. Low intensity extracorporeal shock wave therapy significantly improved erectile function in GK rats to the same extent as sildenafil. Treatment effects were potentiated when combined with sildenafil. Shock wave effects were not associated with improved cavernous endothelium dependent or independent, or nitrergic reactivity. Low intensity extracorporeal shock wave therapy improved erectile function in GK rats. Unexpectedly, this was not mediated by a nitric oxide/cyclic guanosine monophosphate dependent mechanism. Sildenafil increased shock wave efficacy. This preclinical paradigm to deliver low intensity extracorporeal shock wave therapy to the rat penis should

QUALITY IMPROVEMENT MODEL AT THE MANUFACTURING PROCESS PREPARATION LEVEL

Directory of Open Access Journals (Sweden)

Dusko Pavletic

2009-12-01

Full Text Available The paper expresses base for an operational quality improvement model at the manufacturing process preparation level. A numerous appropriate related quality assurance and improvement methods and tools are identified. Main manufacturing process principles are investigated in order to scrutinize one general model of manufacturing process and to define a manufacturing process preparation level. Development and introduction of the operational quality improvement model is based on a research conducted and results of methods and tools application possibilities in real manufacturing processes shipbuilding and automotive industry. Basic model structure is described and presented by appropriate general algorithm. Operational quality improvement model developed lays down main guidelines for practical and systematic application of quality improvements methods and tools.

Model improvements to simulate charging in SEM

Science.gov (United States)

Arat, K. T.; Klimpel, T.; Hagen, C. W.

2018-03-01

Charging of insulators is a complex phenomenon to simulate since the accuracy of the simulations is very sensitive to the interaction of electrons with matter and electric fields. In this study, we report model improvements for a previously developed Monte-Carlo simulator to more accurately simulate samples that charge. The improvements include both modelling of low energy electron scattering and charging of insulators. The new first-principle scattering models provide a more realistic charge distribution cloud in the material, and a better match between non-charging simulations and experimental results. Improvements on charging models mainly focus on redistribution of the charge carriers in the material with an induced conductivity (EBIC) and a breakdown model, leading to a smoother distribution of the charges. Combined with a more accurate tracing of low energy electrons in the electric field, we managed to reproduce the dynamically changing charging contrast due to an induced positive surface potential.

Improved malignant melanoma prognosis at a consultant-delivered multidisciplinary pigmented lesion clinic in Cork.

Science.gov (United States)

Field, S; Deady, S; Fitzgibbon, J; Murphy, M; Comber, H

2010-02-01

Early detection and excision is the only effective treatment for malignant melanoma. To assess the effect of a consultant-delivered, rapid-access pigmented lesion clinic (PLC) established at the South Infirmary-Victoria University Hospital (SIVUH), we analyzed melanoma tumour-stage prior to (1998-2002) and after (2003-2007) the advent of the PLC. Patients attending SIVUH had a greater proportion of early-stage tumours (65.3%) compared to the rest of Cork (51.2%), County Cork as a whole (56.7%) and all of Ireland (57.4%). The proportion of SIVUH males with early-stage tumours was statistically significantly higher than the rest of County Cork (chi2 = 11.23, P 50y with early-stage tumours was also statistically significantly higher than the rest of County Cork (chi2 = 18.88, P Cork (chi2 = 7.84, P Cork melanoma patients is at least partly due to the PLC.

Process correlation analysis model for process improvement identification.

Science.gov (United States)

Choi, Su-jin; Kim, Dae-Kyoo; Park, Sooyong

2014-01-01

Software process improvement aims at improving the development process of software systems. It is initiated by process assessment identifying strengths and weaknesses and based on the findings, improvement plans are developed. In general, a process reference model (e.g., CMMI) is used throughout the process of software process improvement as the base. CMMI defines a set of process areas involved in software development and what to be carried out in process areas in terms of goals and practices. Process areas and their elements (goals and practices) are often correlated due to the iterative nature of software development process. However, in the current practice, correlations of process elements are often overlooked in the development of an improvement plan, which diminishes the efficiency of the plan. This is mainly attributed to significant efforts and the lack of required expertise. In this paper, we present a process correlation analysis model that helps identify correlations of process elements from the results of process assessment. This model is defined based on CMMI and empirical data of improvement practices. We evaluate the model using industrial data.

Soil hydraulic properties near saturation, an improved conductivity model

DEFF Research Database (Denmark)

Børgesen, Christen Duus; Jacobsen, Ole Hørbye; Hansen, Søren

2006-01-01

of commonly used hydraulic conductivity models and give suggestions for improved models. Water retention and near saturated and saturated hydraulic conductivity were measured for a variety of 81 top and subsoils. The hydraulic conductivity models by van Genuchten [van Genuchten, 1980. A closed-form equation...... for predicting the hydraulic conductivity of unsaturated soils. Soil Sci. Soc. Am. J. 44, 892–898.] (vGM) and Brooks and Corey, modified by Jarvis [Jarvis, 1991. MACRO—A Model of Water Movement and Solute Transport in Macroporous Soils. Swedish University of Agricultural Sciences. Department of Soil Sciences....... Optimising a matching factor (k0) improved the fit considerably whereas optimising the l-parameter in the vGM model improved the fit only slightly. The vGM was improved with an empirical scaling function to account for the rapid increase in conductivity near saturation. Using the improved models...

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.

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...

Thiolated chitosan nanoparticles enhance anti-inflammatory effects of intranasally delivered theophylline.

Science.gov (United States)

Lee, Dong-Won; Shirley, Shawna A; Lockey, Richard F; Mohapatra, Shyam S

2006-08-24

Chitosan, a polymer derived from chitin, has been used for nasal drug delivery because of its biocompatibility, biodegradability and bioadhesiveness. Theophylline is a drug that reduces the inflammatory effects of allergic asthma but is difficult to administer at an appropriate dosage without causing adverse side effects. It was hypothesized that adsorption of theophylline to chitosan nanoparticles modified by the addition of thiol groups would improve theophylline absorption by the bronchial epithelium and enhance its anti-inflammatory effects. We sought to develop an improved drug-delivery matrix for theophylline based on thiolated chitosan, and to investigate whether thiolated chitosan nanoparticles (TCNs) can enhance theophylline's capacity to alleviate allergic asthma. A mouse model of allergic asthma was used to test the effects of theophylline in vivo. BALB/c mice were sensitized to ovalbumin (OVA) and OVA-challenged to produce an inflammatory allergic condition. They were then treated intranasally with theophylline alone, chitosan nanoparticles alone or theophylline adsorbed to TCNs. The effects of theophylline on cellular infiltration in bronchoalveolar lavage (BAL) fluid, histopathology of lung sections, and apoptosis of lung cells were investigated to determine the effectiveness of TCNs as a drug-delivery vehicle for theophylline. Theophylline alone exerts a moderate anti-inflammatory effect, as evidenced by the decrease in eosinophils in BAL fluid, the reduction of bronchial damage, inhibition of mucus hypersecretion and increased apoptosis of lung cells. The effects of theophylline were significantly enhanced when the drug was delivered by TCNs. Intranasal delivery of theophylline complexed with TCNs augmented the anti-inflammatory effects of the drug compared to theophylline administered alone in a mouse model of allergic asthma. The beneficial effects of theophylline in treating asthma may be enhanced through the use of this novel drug delivery

Thiolated chitosan nanoparticles enhance anti-inflammatory effects of intranasally delivered theophylline

Directory of Open Access Journals (Sweden)

Mohapatra Shyam S

2006-08-01

Full Text Available Abstract Background Chitosan, a polymer derived from chitin, has been used for nasal drug delivery because of its biocompatibility, biodegradability and bioadhesiveness. Theophylline is a drug that reduces the inflammatory effects of allergic asthma but is difficult to administer at an appropriate dosage without causing adverse side effects. It was hypothesized that adsorption of theophylline to chitosan nanoparticles modified by the addition of thiol groups would improve theophylline absorption by the bronchial epithelium and enhance its anti-inflammatory effects. Objectives We sought to develop an improved drug-delivery matrix for theophylline based on thiolated chitosan, and to investigate whether thiolated chitosan nanoparticles (TCNs can enhance theophylline's capacity to alleviate allergic asthma. Methods A mouse model of allergic asthma was used to test the effects of theophylline in vivo. BALB/c mice were sensitized to ovalbumin (OVA and OVA-challenged to produce an inflammatory allergic condition. They were then treated intranasally with theophylline alone, chitosan nanoparticles alone or theophylline adsorbed to TCNs. The effects of theophylline on cellular infiltration in bronchoalveolar lavage (BAL fluid, histopathology of lung sections, and apoptosis of lung cells were investigated to determine the effectiveness of TCNs as a drug-delivery vehicle for theophylline. Results Theophylline alone exerts a moderate anti-inflammatory effect, as evidenced by the decrease in eosinophils in BAL fluid, the reduction of bronchial damage, inhibition of mucus hypersecretion and increased apoptosis of lung cells. The effects of theophylline were significantly enhanced when the drug was delivered by TCNs. Conclusion Intranasal delivery of theophylline complexed with TCNs augmented the anti-inflammatory effects of the drug compared to theophylline administered alone in a mouse model of allergic asthma. The beneficial effects of theophylline in

Study on Software Quality Improvement based on Rayleigh Model and PDCA Model

OpenAIRE

Ning Jingfeng; Hu Ming

2013-01-01

As the software industry gradually becomes mature, software quality is regarded as the life of a software enterprise. This article discusses how to improve the quality of software, applies Rayleigh model and PDCA model to the software quality management, combines with the defect removal effectiveness index, exerts PDCA model to solve the problem of quality management objectives when using the Rayleigh model in bidirectional quality improvement strategies of software quality management, a...

Photochemical internalization enhanced macrophage delivered chemotherapy.

Science.gov (United States)

Shin, Diane; Christie, Catherine; Ju, David; Nair, Rohit Kumar; Molina, Stephanie; Berg, Kristian; Krasieva, Tatiana B; Madsen, Steen J; Hirschberg, Henry

2018-03-01

Macrophage (Ma) vectorization of chemotherapeutic drugs has the advantage for cancer therapy in that it can actively target and maintain an elevated concentration of drugs at the tumor site, preventing their spread into healthy tissue. A potential drawback is the inability to deliver a sufficient number of drug-loaded Ma into the tumor, thus limiting the amount of active drug delivered. This study examined the ability of photochemical internalization (PCI) to enhance the efficacy of released drug by Ma transport. Tumor spheroids consisting of either F98 rat glioma cells or F98 cells combined with a subpopulation of empty or doxorubicin (DOX)-loaded mouse Ma (RAW264.7) were used as in vitro tumor models. PCI was performed with the photosensitizer AlPcS 2a and laser irradiation at 670 nm. RAW264.7 Ma pulsed with DOX released the majority of the incorporated DOX within two hours of incubation. PCI significantly increased the toxicity of DOX either as pure drug or derived from monolayers of DOX-loaded Ma. Significant growth inhibition of hybrid spheroids was also observed with PCI even at subpopulations of DOX-loaded Ma as low as 11% of the total initial hybrid spheroid cell number. Results show that RAW264.7 Ma, pulsed with DOX, could effectively incorporate and release DOX. PCI significantly increased the ability of both free and Ma-released DOX to inhibit the growth of tumor spheroids in vitro. The growth of F98 + DOX loaded Ma hybrid spheroids were synergistically reduced by PCI, compared to either photodynamic therapy or released DOX acting alone. Copyright © 2017 Elsevier B.V. All rights reserved.

Principles for designing and delivering psychosocial and mental healthcare.

Science.gov (United States)

Williams, Richard; Kemp, V

2018-03-08

The development of the UK's military policy includes the potential for military organisations to deploy in support of humanitarian aid operations. This paper offers an overview of the risks to people's mental health of their exposure to emergencies, major incidents, disasters, terrorism, displacement, postconflict environments in which humanitarian aid is delivered, and deployments to conflict zones. It summarises the psychosocial approach recommended by many contemporary researchers and practitioners. It differentiates the extremely common experience of distress from the mental disorders that people who are affected may develop and introduces the construct of psychosocial resilience. The authors recognise the importance of trajectories of response in separating people who are distressed and require psychosocial care from those who require mental healthcare. Finally, this paper summarises a strategic approach to designing, planning and providing psychosocial and mental healthcare, provides a model of care and outlines the principles for early psychosocial interventions that do not require training in mental healthcare to deliver them. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effectiveness of Group-Delivered Cognitive Therapy and Treatment Length in Women Veterans with PTSD

Directory of Open Access Journals (Sweden)

Diane T. Castillo

2014-01-01

Full Text Available The effectiveness and length of group-delivered cognitive treatment for Posttraumatic Stress Disorder (PTSD was examined in a sample of women veterans. The sample included 271 primarily non-Hispanic white (61% and Hispanic (25% women veterans treated in 8-, 10-, or 12-group length sessions with manualized cognitive therapy for PTSD. Outcome was measured with the PTSD Symptom Checklist (PCL in an intention-to-treat analysis (N = 271, in completer subjects (n = 172, and with group as the unit of analysis (n = 47 groups. Significant decreases in PTSD were found in the full sample (effect size [ES] range = 0.27 to 0.38, completers (ES range = 0.37 to 0.54, and group as the unit of analysis (ES range = 0.71 to 0.92, suggesting effectiveness of cognitive group treatment for PTSD. PCL scores significantly improved in the 8, 10, and 12 group lengths, with no differences between each. Clinical improvement showed a third decreasing 10 or more PCL points and 22% no longer meeting PTSD diagnostic criteria, with the best results in the 10-session group. The results suggest group-delivered cognitive therapy is an effective, efficient, time-limited treatment for PTSD.

Conformal intensity-modulated radiotherapy (IMRT) delivered by robotic linac - testing IMRT to the limit?

International Nuclear Information System (INIS)

Webb, S.

1999-01-01

In this paper it is proposed that intensity-modulated radiotherapy (IMRT) could be delivered optimally by a short-length linac mounted on a robotic arm. The robot would allow the linac to 'plant' narrow pencils of photon radiation with any orientation (excluding zones within which the linac and couch might collide) relative to the planning target volume (PTV). The treatment is specified by the trajectory of the robot and by the number of monitor units (MUs) delivered at each robotic orientation. An inverse-planning method to determine the optimum robotic trajectory is presented. It is shown that for complex PTVs, specifically those with concavities in their outline, the conformality of the treatment is improved by the use of a complex trajectory in comparison with a less complex constrained trajectory and this improvement is quantified. It is concluded that robotic linac delivery would lead to a great flexibility in those IMRT treatments requiring very complicated dose distributions with complex 3D shapes. However, even using very fast computers, the goal of determining whether robotic linac delivery is the ultimate IMRT cannot be conclusively reached at present. (author)

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.

Pelvic Radiotherapy for Cancer of the Cervix: Is What You Plan Actually What You Deliver?

International Nuclear Information System (INIS)

Lim, Karen; Kelly, Valerie; Stewart, James; Xie, Jason; Cho, Young-Bin; Moseley, Joanne B.; Brock, Kristy; Fyles, Anthony; Lundin, Anna; Rehbinder, Henrik; Milosevic, Michael

2009-01-01

Purpose: Whole pelvic intensity-modulated radiotherapy (IMRT) is increasingly being used to treat cervix cancer and other gynecologic tumors. However, tumor and normal organ movement during treatment can substantially detract from the benefits of this approach. This study explored the effect of internal anatomic changes on the dose delivered to the tumor and organs at risk using a strategy integrating deformable soft-tissue modeling with simulated dose accumulation. Methods and Materials: Twenty patients with cervix cancer underwent baseline and weekly pelvic magnetic resonance imaging during treatment. Interfraction organ motion and delivered (accumulated) dose was modeled for three treatment scenarios: four-field box, large-margin whole pelvic IMRT (20-mm planning target volume, but 10 mm inferiorly) and small-margin IMRT (5-mm planning target volume). Results: Individually, the planned dose was not the same as the simulated delivered dose; however, when taken as a group, this was not statistically significant for the four-field box and large-margin IMRT plans. The small-margin IMRT plans yielded adequate target coverage in most patients; however, significant target underdosing occurred in 1 patient who displayed excessive, unpredictable internal target movement. The delivered doses to the organs at risk were significantly reduced with the small-margin plan, although substantial variability was present among the patients. Conclusion: Simulated dose accumulation might provide a more accurate depiction of the target and organ at risk coverage during fractionated whole pelvic IMRT for cervical cancer. The adequacy of primary tumor coverage using 5-mm planning target volume margins is contingent on the use of daily image-guided setup.

Selection of productivity improvement techniques via mathematical modeling

Directory of Open Access Journals (Sweden)

Mahassan M. Khater

2011-07-01

Full Text Available This paper presents a new mathematical model to select an optimal combination of productivity improvement techniques. The proposed model of this paper considers four-stage cycle productivity and the productivity is assumed to be a linear function of fifty four improvement techniques. The proposed model of this paper is implemented for a real-world case study of manufacturing plant. The resulted problem is formulated as a mixed integer programming which can be solved for optimality using traditional methods. The preliminary results of the implementation of the proposed model of this paper indicate that the productivity can be improved through a change on equipments and it can be easily applied for both manufacturing and service industries.

Evaluating the effectiveness of a peer-led education intervention to improve the patient safety attitudes of junior pharmacy students: a cross-sectional study using a latent growth curve modelling approach.

Science.gov (United States)

Walpola, Ramesh L; Fois, Romano A; McLachlan, Andrew J; Chen, Timothy F

2015-12-08

Despite the recognition that educating healthcare students in patient safety is essential, changing already full curricula can be challenging. Furthermore, institutions may lack the capacity and capability to deliver patient safety education, particularly from the start of professional practice studies. Using senior students as peer educators to deliver practice-based education can potentially overcome some of the contextual barriers in training junior students. Therefore, this study aimed to evaluate the effectiveness of a peer-led patient safety education programme for junior pharmacy students. A repeat cross-sectional design utilising a previously validated patient safety attitudinal survey was used to evaluate attitudes prior to, immediately after and 1 month after the delivery of a patient safety education programme. Latent growth curve (LGC) modelling was used to evaluate the change in attitudes of first-year students using second-year students as a comparator group. Undergraduate university students in Sydney, Australia. 175 first-year and 140 second-year students enrolled in the Bachelor of Pharmacy programme at the University of Sydney. An introductory patient safety programme was implemented into the first-year Bachelor of Pharmacy curriculum at the University of Sydney. The programme covered introductory patient safety topics including teamwork, communication skills, systems thinking and open disclosure. The programme consisted of 2 lectures, delivered by a senior academic, and a workshop delivered by trained final-year pharmacy students. A full LGC model was constructed including the intervention as a non-time-dependent predictor of change (χ(2) (51)=164.070, root mean square error of approximation=0.084, comparative fit index=0.913, standardised root mean square=0.056). First-year students' attitudes significantly improved as a result of the intervention, particularly in relation to internalising errors (p=0.010), questioning behaviours (pmethod that

Feasibility of a clearing house for improved cooperation between telemedicine networks delivering humanitarian services: acceptability to network coordinators

Directory of Open Access Journals (Sweden)

Richard Wootton

2012-10-01

Full Text Available Background: Telemedicine networks, which deliver humanitarian services, sometimes need to share expertise to find particular experts in other networks. It has been suggested that a mechanism for sharing expertise between networks (a ‘clearing house’ might be useful. Objective: To propose a mechanism for implementing the clearing house concept for sharing expertise, and to confirm its feasibility in terms of acceptability to the relevant networks. Design: We conducted a needs analysis among eight telemedicine networks delivering humanitarian services. A small proportion of consultations (5–10% suggested that networks may experience difficulties in finding the right specialists from within their own resources. With the assistance of key stakeholders, many of whom were network coordinators, various methods of implementing a clearing house were considered. One simple solution is to establish a central database holding information about consultants who have agreed to provide help to other networks; this database could be made available to network coordinators who need a specialist when none was available in their own network. Results: The proposed solution was examined in a desktop simulation exercise, which confirmed its feasibility and probable value. Conclusions: This analysis informs full-scale implementation of a clearing house, and an associated examination of its costs and benefits.

A technician-delivered 'virtual clinic' for triaging low-risk glaucoma referrals.

Science.gov (United States)

Kotecha, A; Brookes, J; Foster, P J

2017-06-01

PurposeThe purpose of this study is to describe the outcomes of a technician-delivered glaucoma referral triaging service with 'virtual review' of resultant data by a consultant ophthalmologist.Patients and methodsThe Glaucoma Screening Clinic reviewed new optometrist or GP-initiated glaucoma suspect referrals into a specialist ophthalmic hospital. Patients underwent testing by three ophthalmic technicians in a dedicated clinical facility. Data were reviewed at a different time and date by a consultant glaucoma ophthalmologist. Approximately 10% of discharged patients were reviewed in a face-to-face consultant-led clinic to examine the false-negative rate of the service.ResultsBetween 1 March 2014 and 31 March 2016, 1380 patients were seen in the clinic. The number of patients discharged following consultant virtual review was 855 (62%). The positive predictive value of onward referrals was 84%. Three of the 82 patients brought back for face-to-face review were deemed to require treatment, equating to negative predictive value of 96%.ConclusionsOur technician-delivered glaucoma referral triaging clinic incorporates consultant 'virtual review' to provide a service model that significantly reduces the number of onward referrals into the glaucoma outpatient department. This model may be an alternative to departments where there are difficulties in implementing optometrist-led community-based referral refinement schemes.

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

A Continuous Improvement Capital Funding Model.

Science.gov (United States)

Adams, Matt

2001-01-01

Describes a capital funding model that helps assess facility renewal needs in a way that minimizes resources while maximizing results. The article explains the sub-components of a continuous improvement capital funding model, including budgeting processes for finish renewal, building performance renewal, and critical outcome. (GR)

Achievable peak electrode voltage reduction by neurostimulators using descending staircase currents to deliver charge.

Science.gov (United States)

Halpern, Mark

2011-01-01

This paper considers the achievable reduction in peak voltage across two driving terminals of an RC circuit when delivering charge using a stepped current waveform, comprising a chosen number of steps of equal duration, compared with using a constant current over the total duration. This work has application to the design of neurostimulators giving reduced peak electrode voltage when delivering a given electric charge over a given time duration. Exact solutions for the greatest possible peak voltage reduction using two and three steps are given. Furthermore, it is shown that the achievable peak voltage reduction, for any given number of steps is identical for simple series RC circuits and parallel RC circuits, for appropriate different values of RC. It is conjectured that the maximum peak voltage reduction cannot be improved using a more complicated RC circuit.

Evaluating the Effect of Flow and Interface Type on Pressures Delivered With Bubble CPAP in a Simulated Model.

Science.gov (United States)

Bailes, Stephanie A; Firestone, Kimberly S; Dunn, Diane K; McNinch, Neil L; Brown, Miraides F; Volsko, Teresa A

2016-03-01

Bubble CPAP, used for spontaneously breathing infants to avoid intubation or postextubation support, can be delivered with different interface types. This study compared the effect that interfaces had on CPAP delivery. We hypothesized that there would be no difference between set and measured levels between interface types. A validated preterm infant nasal airway model was attached to the ASL 5000 breathing simulator. The simulator was programmed to deliver active breathing of a surfactant-deficient premature infant with breathing frequency at 70 breaths/min inspiratory time of 0.30 s, resistance of 150 cm H2O/L/s, compliance of 0.5 mL/cm H2O, tidal volume of 5 mL, and esophageal pressure of -10 cm H2O. Nasal CPAP prongs, size 4030, newborn and infant RAM cannulas were connected to a nasal airway model and a bubble CPAP system. CPAP levels were set at 4, 5, 6, 7, 8, and 9 cm H2O with flows of 6, 8, and 10 L/min each. Measurements were recorded after 1 min of stabilization. The analysis was performed using SAS 9.4. The Kolmogorov-Smirnov test assessed normality of the data. The Friedman test was used to compare non-normally distributed repeated measures. The Wilcoxon signed-rank test was used to conduct post hoc analysis. All tests were 2-sided, and P values of CPAP levels, 4-6 cm H2O, measured CPAP dropped precipitously with the nasal prongs with the highest flow setting. At higher CPAP levels, 7-9 cm H2O measured CPAP concomitantly increased as the flow setting increased. Statistically significant differences in set and measured CPAP occurred for all devices across all CPAP levels, with the measured CPAP less than set for all conditions, P CPAP. The concomitant drop in measured pressure with high and low flows could be attributed to increased resistance to spontaneous breathing or insufficient flow to meet inspiratory demand. Clinicians should be aware of the effect that the interface and flow have on CPAP delivery. Copyright © 2016 by Daedalus Enterprises.

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

Improving Healthcare in Pediatric Oncology: Development and Testing of Multiple Indicators to Evaluate a Hub-And-Spoke Model.

Science.gov (United States)

Zucchetti, Giulia; Bertorello, Nicoletta; Angelastro, Angela; Gianino, Paola; Bona, Gianni; Barbara, Affif; Besenzon, Luigi; Brach Del Prever, Adalberto; Pesce, Fernando; Nangeroni, Marco; Fagioli, Franca

2017-06-01

Purpose The hub-and-spoke is a new innovation model in healthcare that has been adopted in some countries to manage rare pathologies. We developed a set of indicators to assess current quality practices of the hub-and-spoke model adopted in the Interregional Pediatric Oncology Network in Northwest Italy and to promote patient, family, and professional healthcare empowerment. Methods Literature and evidence-based clinical guidelines were reviewed and multiprofessional team workshops were carried out to highlight some important issues on healthcare in pediatric oncology and to translate them into a set of multiple indicators. For each indicator, specific questions were formulated and tested through a series of questionnaires completed by 80 healthcare professionals and 50 pediatric patients and their parents. Results The results highlighted a positive perception of healthcare delivered by the hub-and-spoke model (M HP = 156, M Pat = 93, M Par = 104). Based on the participants' suggestions, some quality improvements have been implemented. Conclusions This study represents the first attempt to examine this new model of pediatric oncology care through the active involvement of patients, families, and healthcare professionals. Suggestions for adopting a hub-and-spoke model in pediatric oncology in other regions and countries are also highlighted.

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.

Feasibility of Training Physical Therapists to Deliver the Theory-Based Self-Management of Osteoarthritis and Low Back Pain Through Activity and Skills (SOLAS) Intervention Within a Trial.

Science.gov (United States)

Keogh, Alison; Matthews, James; Segurado, Ricardo; Hurley, Deirdre A

2018-02-01

Provider training programs are frequently underevaluated, leading to ambiguity surrounding effective intervention components. The purpose of this study was to assess the effectiveness of a training program in guiding physical therapists to deliver the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) group education and exercise intervention (ISRCTN49875385), using a communication style underpinned by self-determination theory (SDT). This was an assessment of the intervention arm training program using quantitative methods. Thirteen physical therapists were trained using mixed methods to deliver the SOLAS intervention. Training was evaluated using the Kirkpatrick model: (1) Reaction-physical therapists' satisfaction with training, (2) Learning-therapists' confidence in and knowledge of the SDT-based communication strategies and intervention content and their skills in applying the strategies during training, and (3) Behavior-8 therapists were audio-recorded delivering all 6 SOLAS intervention classes (n = 48), and 2 raters independently coded 50% of recordings (n = 24) using the Health Care Climate Questionnaire (HCCQ), the Controlling Coach Behavior Scale (CCBS), and an intervention-specific measure. Reaction: Physical therapists reacted well to training (median [IRQ]; min-max = 4.7; [0.5]; 3.7-5.0). Learning: Physical therapists' confidence in the SDT-based communication strategies and knowledge of some intervention content components significantly improved. Behavior: Therapists delivered the intervention in a needs-supportive manner (median HCCQ = 5.3 [1.4]; 3.9-6.0; median CCBS = 6.6 ([0.5]; 6.1-6.8; median intervention specific measure = 4.0 [1.2]; 3.2-4.9). However, "goal setting" was delivered below acceptable levels by all therapists (median 2.9 [0.9]; 2.0-4.0). The intervention group only was assessed as part of the process evaluation of the feasibility trial. Training effectively guided physical therapists to be needs

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.

Effects of local application of methylprednisolone delivered by the C/GP-hydrogel on the recovery of facial nerves.

Science.gov (United States)

Chao, Xiuhua; Fan, Zhaomin; Han, Yuechen; Wang, Yan; Li, Jianfeng; Chai, Renjie; Xu, Lei; Wang, Haibo

2015-01-01

Local administration of MP delivered by the C/GP-MP-hydrogel can improve the recovery of facial nerve following crush injury. The findings suggested that locally injected MP delivered by C/GP-hydrogel might be a promising treatment for facial nerve damage. In this study, the aim is to assess the effectiveness of locally administrating methylprednisolone(MP) loaded by chitosan-β-glycerophosphate hydrogel (C/GP-hydrogel) on the regeneration of facial nerve crush injury. After the crush of left facial nerves, Wistar rats were randomly divided into four different groups. Then, four different therapies were used to treat the damaged facial nerves. At the 1(st), 2(nd), 3(rd), and 4(th) week after injury, the functional recovery of facial nerves and the morphological changes of facial nerves were assessed. The expression of growth associated protein-43 (GAP-43) protein in the facial nucleus were also evaluated. Locally injected MP delivered by C/GP-hydrogel effectively accelerated the facial functional recovery. In addition, the regenerated facial nerves in the C/GP-MP group were more mature than those in the other groups. The expression of GAP-43 protein was also improved by the MP, especially in the C/GP-MP group.

Adapting a computer-delivered brief alcohol intervention for veterans with Hepatitis C.

Science.gov (United States)

Cucciare, Michael A; Jamison, Andrea L; Combs, Ann S; Joshi, Gauri; Cheung, Ramsey C; Rongey, Catherine; Huggins, Joe; Humphreys, Keith

2017-12-01

This study adapted an existing computer-delivered brief alcohol intervention (cBAI) for use in Veterans with the hepatitis C virus (HCV) and examined its acceptability and feasibility in this patient population. A four-stage model consisting of initial pilot testing, qualitative interviews with key stakeholders, development of a beta version of the cBAI, and usability testing was used to achieve the study objectives. In-depth interviews gathered feedback for modifying the cBAI, including adding HCV-related content such as the health effects of alcohol on liver functioning, immune system functioning, and management of HCV, a preference for concepts to be displayed through "newer looking" graphics, and limiting the use of text to convey key concepts. Results from usability testing indicated that the modified cBAI was acceptable and feasible for use in this patient population. The development model used in this study is effective for gathering actionable feedback that can inform the development of a cBAI and can result in the development of an acceptable and feasible intervention for use in this population. Findings also have implications for developing computer-delivered interventions targeting behavior change more broadly.

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

Pricing, subsidies, and the poor : demand for improved water services in Central America

OpenAIRE

Walker, Ian; Ordonez, Fidel; Serrano, Pedro; Halpern, Jonathan

2000-01-01

Reformulating tariff and subsidy policies is central to improving water and sanitation services in developing countries. The traditional model of state enterprise service provision, coupled with residential tariffs set well below the cost of service, has generally delivered unsatisfactory results. Low internal generation of funds has impeded expansion of networks into poor communities and ...

Applications of process improvement techniques to improve workflow in abdominal imaging.

Science.gov (United States)

Tamm, Eric Peter

2016-03-01

Major changes in the management and funding of healthcare are underway that will markedly change the way radiology studies will be reimbursed. The result will be the need to deliver radiology services in a highly efficient manner while maintaining quality. The science of process improvement provides a practical approach to improve the processes utilized in radiology. This article will address in a step-by-step manner how to implement process improvement techniques to improve workflow in abdominal imaging.

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

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Trucks Golden Eagle Delivers Beer With Natural Gas Trucks to someone by E-mail Share Alternative Fuels Data Center: Golden Eagle Delivers Beer With Natural Gas Trucks on Facebook Tweet about Alternative Fuels Data Center: Golden Eagle Delivers Beer With Natural Gas Trucks on Twitter Bookmark

An optimization model for improving highway safety

Directory of Open Access Journals (Sweden)

Promothes Saha

2016-12-01

Full Text Available This paper developed a traffic safety management system (TSMS for improving safety on county paved roads in Wyoming. TSMS is a strategic and systematic process to improve safety of roadway network. When funding is limited, it is important to identify the best combination of safety improvement projects to provide the most benefits to society in terms of crash reduction. The factors included in the proposed optimization model are annual safety budget, roadway inventory, roadway functional classification, historical crashes, safety improvement countermeasures, cost and crash reduction factors (CRFs associated with safety improvement countermeasures, and average daily traffics (ADTs. This paper demonstrated how the proposed model can identify the best combination of safety improvement projects to maximize the safety benefits in terms of reducing overall crash frequency. Although the proposed methodology was implemented on the county paved road network of Wyoming, it could be easily modified for potential implementation on the Wyoming state highway system. Other states can also benefit by implementing a similar program within their jurisdictions.

Can better modelling improve tokamak control?

International Nuclear Information System (INIS)

Lister, J.B.; Vyas, P.; Ward, D.J.; Albanese, R.; Ambrosino, G.; Ariola, M.; Villone, F.; Coutlis, A.; Limebeer, D.J.N.; Wainwright, J.P.

1997-01-01

The control of present day tokamaks usually relies upon primitive modelling and TCV is used to illustrate this. A counter example is provided by the successful implementation of high order SISO controllers on COMPASS-D. Suitable models of tokamaks are required to exploit the potential of modern control techniques. A physics based MIMO model of TCV is presented and validated with experimental closed loop responses. A system identified open loop model is also presented. An enhanced controller based on these models is designed and the performance improvements discussed. (author) 5 figs., 9 refs

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.

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

Development and Implementation of Efficiency-Improving Analysis Methods for the SAGE III on ISS Thermal Model Originating

Science.gov (United States)

Liles, Kaitlin; Amundsen, Ruth; Davis, Warren; Scola, Salvatore; Tobin, Steven; McLeod, Shawn; Mannu, Sergio; Guglielmo, Corrado; Moeller, Timothy

2013-01-01

The Stratospheric Aerosol and Gas Experiment III (SAGE III) instrument is the fifth in a series of instruments developed for monitoring aerosols and gaseous constituents in the stratosphere and troposphere. SAGE III will be delivered to the International Space Station (ISS) via the SpaceX Dragon vehicle in 2015. A detailed thermal model of the SAGE III payload has been developed in Thermal Desktop (TD). Several novel methods have been implemented to facilitate efficient payload-level thermal analysis, including the use of a design of experiments (DOE) methodology to determine the worst-case orbits for SAGE III while on ISS, use of TD assemblies to move payloads from the Dragon trunk to the Enhanced Operational Transfer Platform (EOTP) to its final home on the Expedite the Processing of Experiments to Space Station (ExPRESS) Logistics Carrier (ELC)-4, incorporation of older models in varying unit sets, ability to change units easily (including hardcoded logic blocks), case-based logic to facilitate activating heaters and active elements for varying scenarios within a single model, incorporation of several coordinate frames to easily map to structural models with differing geometries and locations, and streamlined results processing using an Excel-based text file plotter developed in-house at LaRC. This document presents an overview of the SAGE III thermal model and describes the development and implementation of these efficiency-improving analysis methods.

Predictors in Internet-delivered cognitive behavior therapy and behavioral stress management for severe health anxiety.

Science.gov (United States)

Hedman, Erik; Andersson, Erik; Lekander, Mats; Ljótsson, Brjánn

2015-01-01

Severe health anxiety can be effectively treated with exposure-based Internet-delivered cognitive behavior therapy (ICBT), but information about which factors that predict outcome is scarce. Using data from a recently conducted RCT comparing ICBT (n = 79) with Internet-delivered behavioral stress management (IBSM) (n = 79) the presented study investigated predictors of treatment outcome. Analyses were conducted using a two-step linear regression approach and the dependent variable was operationalized both as end state health anxiety at post-treatment and as baseline-to post-treatment improvement. A hypothesis driven approach was used where predictors expected to influence outcome were based on a previous predictor study by our research group. As hypothesized, the results showed that baseline health anxiety and treatment adherence predicted both end state health anxiety and improvement. In addition, anxiety sensitivity, treatment credibility, and working alliance were significant predictors of health anxiety improvement. Demographic variables, i.e. age, gender, marital status, computer skills, educational level, and having children, had no significant predictive value. We conclude that it is possible to predict a substantial proportion of the outcome variance in ICBT and IBSM for severe health anxiety. The findings of the present study can be of high clinical value as they provide information about factors of importance for outcome in the treatment of severe health anxiety. Copyright © 2014 Elsevier Ltd. All rights reserved.

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.

An improved gravity model for Mars: Goddard Mars Model-1 (GMM-1)

Science.gov (United States)

Smith, D. E.; Lerch, F. J.; Nerem, R. S.; Zuber, M. T.; Patel, G. B.; Fricke, S. K.; Lemoine, F. G.

1993-01-01

Doppler tracking data of three orbiting spacecraft have been reanalyzed to develop a new gravitational field model for the planet Mars, GMM-1 (Goddard Mars Model-1). This model employs nearly all available data, consisting of approximately 1100 days of S-bank tracking data collected by NASA's Deep Space Network from the Mariner 9, and Viking 1 and Viking 2 spacecraft, in seven different orbits, between 1971 and 1979. GMM-1 is complete to spherical harmonic degree and order 50, which corresponds to a half-wavelength spatial resolution of 200-300 km where the data permit. GMM-1 represents satellite orbits with considerably better accuracy than previous Mars gravity models and shows greater resolution of identifiable geological structures. The notable improvement in GMM-1 over previous models is a consequence of several factors: improved computational capabilities, the use of optimum weighting and least-squares collocation solution techniques which stabilized the behavior of the solution at high degree and order, and the use of longer satellite arcs than employed in previous solutions that were made possible by improved force and measurement models. The inclusion of X-band tracking data from the 379-km altitude, near-polar orbiting Mars Observer spacecraft should provide a significant improvement over GMM-1, particularly at high latitudes where current data poorly resolves the gravitational signature of the planet.

Enhancing Foreign Language Learning through Listening Strategies Delivered in L1: An Experimental Study

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Hitendra Pillay

2013-01-01

Full Text Available Listening used in language teaching refers to a complex process that allows us to understand spoken language. The current study, conducted in Iran with an experimental design, investigated the effectiveness of teaching listening strategies delivered in L1 (Persian and its effect on listening comprehension in L2. Five listening strategies: Guessing, making inferences, identifying topics, repetition, and note-taking were taught over 14 weeks during a semester. Sixty lower intermediate female participants came from two EFL classrooms in an English language institute. The experimental class (n = 30 who listened to their classroom activities performed better (t value = 10.083 than the control class using a methodology that led learners through five listening strategies in Persian. The same teacher taught the students in the control class (n = 30, who listened to the same classroom listening activities without any of the above listening strategies. A pre and post listening test made by a group of experts in the language institute assessed the effect of teaching listening strategies delivered in L1. Results gathered on the post intervention listening test revealed that listening strategies delivered in L1 led to a statistically significant improvement in their discrete listening scores compared with the control group.

Costs of delivering human papillomavirus vaccination to schoolgirls in Mwanza Region, Tanzania

Science.gov (United States)

2012-01-01

Background Cervical cancer is the leading cause of female cancer-related deaths in Tanzania. Vaccination against human papillomavirus (HPV) offers a new opportunity to control this disease. This study aimed to estimate the costs of a school-based HPV vaccination project in three districts in Mwanza Region (NCT ID: NCT01173900), Tanzania and to model incremental scaled-up costs of a regional vaccination program. Methods We first conducted a top-down cost analysis of the vaccination project, comparing observed costs of age-based (girls born in 1998) and class-based (class 6) vaccine delivery in a total of 134 primary schools. Based on the observed project costs, we then modeled incremental costs of a scaled-up vaccination program for Mwanza Region from the perspective of the Tanzanian government, assuming that HPV vaccines would be delivered through the Expanded Programme on Immunization (EPI). Results Total economic project costs for delivering 3 doses of HPV vaccine to 4,211 girls were estimated at about US$349,400 (including a vaccine price of US$5 per dose). Costs per fully-immunized girl were lower for class-based delivery than for age-based delivery. Incremental economic scaled-up costs for class-based vaccination of 50,290 girls in Mwanza Region were estimated at US$1.3 million. Economic scaled-up costs per fully-immunized girl were US$26.41, including HPV vaccine at US$5 per dose. Excluding vaccine costs, vaccine could be delivered at an incremental economic cost of US$3.09 per dose and US$9.76 per fully-immunized girl. Financial scaled-up costs, excluding costs of the vaccine and salaries of existing staff were estimated at US$1.73 per dose. Conclusions Project costs of class-based vaccination were found to be below those of age-based vaccination because of more eligible girls being identified and higher vaccine uptake. We estimate that vaccine can be delivered at costs that would make HPV vaccination a very cost-effective intervention. Potentially

Improving Agent Based Modeling of Critical Incidents

Directory of Open Access Journals (Sweden)

Robert Till

2010-04-01

Full Text Available Agent Based Modeling (ABM is a powerful method that has been used to simulate potential critical incidents in the infrastructure and built environments. This paper will discuss the modeling of some critical incidents currently simulated using ABM and how they may be expanded and improved by using better physiological modeling, psychological modeling, modeling the actions of interveners, introducing Geographic Information Systems (GIS and open source models.

INTEGRATED COST MODEL FOR IMPROVING THE PRODUCTION IN COMPANIES

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Zuzana Hajduova

2014-12-01

Full Text Available Purpose: All processes in the company play important role in ensuring functional integrated management system. We point out the importance of need for a systematic approach to the use of quantitative, but especially statistical methods for modelling the cost of the improvement activities that are part of an integrated management system. Development of integrated management systems worldwide leads towards building of systematic procedures of implementation maintenance and improvement of all systems according to the requirements of all the sides involved.Methodology: Statistical evaluation of the economic indicators of improvement costs and the need for a systematic approach to their management in terms of integrated management systems have become a key role also in the management of processes in the company Cu Drôt, a.s. The aim of this publication is to highlight the importance of proper implementation of statistical methods in the process of improvement costs management in the integrated management system of current market conditions and document the legitimacy of a systematic approach in the area of monitoring and analysing indicators of improvement with the aim of the efficient process management of company. We provide specific example of the implementation of appropriate statistical methods in the production of copper wire in a company Cu Drôt, a.s. This publication also aims to create a model for the estimation of integrated improvement costs, which through the use of statistical methods in the company Cu Drôt, a.s. is used to support decision-making on improving efficiency.Findings: In the present publication, a method for modelling the improvement process, by an integrated manner, is proposed. It is a method in which the basic attributes of the improvement in quality, safety and environment are considered and synergistically combined in the same improvement project. The work examines the use of sophisticated quantitative, especially

Process Improvement Essentials

CERN Document Server

Persse, James R

2006-01-01

Process Improvement Essentials combines the foundation needed to understand process improvement theory with the best practices to help individuals implement process improvement initiatives in their organization. The three leading programs: ISO 9001:2000, CMMI, and Six Sigma--amidst the buzz and hype--tend to get lumped together under a common label. This book delivers a combined guide to all three programs, compares their applicability, and then sets the foundation for further exploration.

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

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.

Public Private Partnership Benefits in Delivering Public Facilities in Malaysia

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Sapri M.

2016-01-01

Full Text Available The development of infrastructure in developing country such as Malaysia was increasingly founded by the Public–Private Partnership (PPP scheme. Collaboration with private sector has become popular as a means to improve the delivery of public facilities. Yet, empirical evidence on how PPP initiative has benefits the delivery of public facilities within Malaysia context is lagging. The purpose of this paper is to identify and assess the perception of stakeholders on the benefits of adopting PPP in delivering public facilities in Malaysia. Literature review was carried out to identify PPP benefits, which were then incorporated into the questionnaire. The mean score and mean score ranking was conducted to assess the agreement level of stakeholders towards the PPP benefits. The overall findings show that the implementation of PPP has benefitted the delivery of public facilities in both financial and non-financial aspects. From the analysis, improvement in service quality is perceived as the top advantage followed by innovation in design and transfer of risk. The findings provide more informed basis on the rationale of PPP implementation and its potential in improving the delivery of public facilities within Malaysia context.

Evaluation of Orally Delivered ST-246 as Postexposure Prophylactic and Antiviral Therapeutic in an Aerosolized Rabbitpox Rabbit Model

National Research Council Canada - National Science Library

Nalca, Aysegul; Hatkin, Josh M; Garza, Nicole L; Nichols, Donald K; Norris, Sarah W; Hruby, Dennis E; Jordan, Robert

2008-01-01

Orthopoxviruses, such as variola and monkeypox viruses, can cause severe disease in humans when delivered by the aerosol route, and thus represent significant threats to both military and civilian populations...

Delivering breast cancer care in urban India: Heterotopia, hospital ethnography and voluntarism.

Science.gov (United States)

Macdonald, Alison

2016-05-01

Despite substantial strides to improve cancer control in India, challenges to deliver oncology services persist. One major challenge is the provision and accessibility of adequate infrastructure. This paper offers ethnographic insight on the conceptual and material conditions that are currently shaping the delivery of oncology in Mumbai, focusing specifically on the way India's socio-economic context necessitates non-biomedical acts of voluntarism or 'seva' (selfless service). Developing the premise that hospitals are not identical clones of a biomedical model, detailed attention is paid to the way 'care' emerges through 'praxis of place' (Casey, 2003) within the cancer hospital as a multi-scalar 'heterotopic' (Street and Coleman, 2012) site. Such a perspective enables global/local tensions to come into view, together with the heterogeneous confluence of juxtaposing materialities, imaginations, social practices and values that both propels and constrains the everyday delivery of care. The paper reflects on the theoretical implications of hospital seva in Mumbai in light of social science studies of hospital ethnography and health activism and contributes important ethnographic insight into the current global health debates regarding effective implementation of cancer services in India. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.)

Depression Care Management: Can Employers Purchase Improved Outcomes?

Directory of Open Access Journals (Sweden)

Kathryn Rost

2011-01-01

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

Initial Progress Toward Development of a Voice-Based Computer-Delivered Motivational Intervention for Heavy Drinking College Students: An Experimental Study

Science.gov (United States)

Lechner, William J; MacGlashan, James; Wray, Tyler B; Littman, Michael L

2017-01-01

perceived importance of changing drinking behaviors. In comparison to the text-based computer-delivered intervention condition, those assigned to voice-based computer-delivered intervention reported significantly fewer alcohol-related problems at the 1-month follow-up (incident rate ratio 0.60, 95% CI 0.44-0.83, P=.002). The conditions did not differ significantly on perceived importance of changing drinking or on measures of drinking quantity and frequency of heavy drinking. Conclusions Results indicate that it is feasible to construct a series of open-ended questions and a bank of responses and follow-up prompts that can be used in a future fully automated voice-based computer-delivered intervention that may mirror more closely human-delivered motivational interventions to reduce drinking. Such efforts will require using advanced speech recognition capabilities and machine-learning approaches to train a program to mirror the decisions made by human controllers in the voice-based computer-delivered intervention used in this study. In addition, future studies should examine enhancements that can increase the perceived warmth and empathy of voice-based computer-delivered intervention, possibly through greater personalization, improvements in the speech generation software, and embodying the computer-delivered intervention in a physical form. PMID:28659259

Modelling simple helically delivered dose distributions

International Nuclear Information System (INIS)

Fenwick, John D; Tome, Wolfgang A; Kissick, Michael W; Mackie, T Rock

2005-01-01

In a previous paper, we described quality assurance procedures for Hi-Art helical tomotherapy machines. Here, we develop further some ideas discussed briefly in that paper. Simple helically generated dose distributions are modelled, and relationships between these dose distributions and underlying characteristics of Hi-Art treatment systems are elucidated. In particular, we describe the dependence of dose levels along the central axis of a cylinder aligned coaxially with a Hi-Art machine on fan beam width, couch velocity and helical delivery lengths. The impact on these dose levels of angular variations in gantry speed or output per linear accelerator pulse is also explored

Crop Model Improvement Reduces the Uncertainty of the Response to Temperature of Multi-Model Ensembles

Science.gov (United States)

Maiorano, Andrea; Martre, Pierre; Asseng, Senthold; Ewert, Frank; Mueller, Christoph; Roetter, Reimund P.; Ruane, Alex C.; Semenov, Mikhail A.; Wallach, Daniel; Wang, Enli

2016-01-01

To improve climate change impact estimates and to quantify their uncertainty, multi-model ensembles (MMEs) have been suggested. Model improvements can improve the accuracy of simulations and reduce the uncertainty of climate change impact assessments. Furthermore, they can reduce the number of models needed in a MME. Herein, 15 wheat growth models of a larger MME were improved through re-parameterization and/or incorporating or modifying heat stress effects on phenology, leaf growth and senescence, biomass growth, and grain number and size using detailed field experimental data from the USDA Hot Serial Cereal experiment (calibration data set). Simulation results from before and after model improvement were then evaluated with independent field experiments from a CIMMYT worldwide field trial network (evaluation data set). Model improvements decreased the variation (10th to 90th model ensemble percentile range) of grain yields simulated by the MME on average by 39% in the calibration data set and by 26% in the independent evaluation data set for crops grown in mean seasonal temperatures greater than 24 C. MME mean squared error in simulating grain yield decreased by 37%. A reduction in MME uncertainty range by 27% increased MME prediction skills by 47%. Results suggest that the mean level of variation observed in field experiments and used as a benchmark can be reached with half the number of models in the MME. Improving crop models is therefore important to increase the certainty of model-based impact assessments and allow more practical, i.e. smaller MMEs to be used effectively.

School Climate Improvement Action Guide for Community Partners. School Climate Improvement Resource Package

Science.gov (United States)

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines how community partners can support school climate improvements. Organizations and individuals can partner with schools in many different ways--from delivering or coordinating direct services to students and families inside or…

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.

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.

Implants delivering bisphosphonate locally increase periprosthetic bone density in an osteoporotic sheep model. A pilot study

Directory of Open Access Journals (Sweden)

GVA Stadelmann

2008-07-01

Full Text Available It is a clinical challenge to obtain a sufficient orthopaedic implant fixation in weak osteoporotic bone. When the primary implant fixation is poor, micromotions occur at the bone-implant interface, activating osteoclasts, which leads to implant loosening. Bisphosphonate can be used to prevent the osteoclastic response, but when administered systemically its bioavailability is low and the time it takes for the drug to reach the periprosthetic bone may be a limiting factor. Recent data has shown that delivering bisphosphonate locally from the implant surface could be an interesting solution. Local bisphosphonate delivery increased periprosthetic bone density, which leads to a stronger implant fixation, as demonstrated in rats by the increased implant pullout force. The aim of the present study was to verify the positive effect on periprosthetic bone remodelling of local bisphosphonate delivery in an osteoporotic sheep model. Four implants coated with zoledronate and two control implants were inserted in the femoral condyle of ovariectomized sheep for 4 weeks. The bone at the implant surface was 50% higher in the zoledronate-group compared to control group. This effect was significant up to a distance of 400µm from the implant surface. The presented results are similar to what was observed in the osteoporotic rat model, which suggest that the concept of releasing zoledronate locally from the implant to increase the implant fixation is not species specific. The results of this trial study support the claim that local zoledronate could increase the fixation of an implant in weak bone.

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…

ProvenCare perinatal: a model for delivering evidence/ guideline-based care for perinatal populations.

Science.gov (United States)

Berry, Scott A; Laam, Leslie A; Wary, Andrea A; Mateer, Harry O; Cassagnol, Hans P; McKinley, Karen E; Nolan, Ruth A

2011-05-01

Geisinger Health System (GHS) has applied its ProvenCare model to demonstrate that a large integrated health care delivery system, enabled by an electronic health record (EHR), could reengineer a complicated clinical process, reduce unwarranted variation, and provide evidence-based care for patients with a specified clinical condition. In 2007 GHS began to apply the model to a more complicated, longer-term condition of "wellness"--perinatal care. ADAPTING PROVENCARE TO PERINATAL CARE: The ProvenCare Perinatal initiative was more complex than the five previous ProvenCare endeavors in terms of breadth, scope, and duration. Each of the 22 sites created a process flow map to depict the current, real-time process at each location. The local practice site providers-physicians and mid-level practitioners-reached consensus on 103 unique best practice measures (BPMs), which would be tracked for every patient. These maps were then used to create a single standardized pathway that included the BPMs but also preserved some unique care offerings that reflected the needs of the local context. A nine-phase methodology, expanded from the previous six-phase model, was implemented on schedule. Pre- to postimplementation improvement occurred for all seven BPMs or BPM bundles that were considered the most clinically relevant, with five statistically significant. In addition, the rate of primary cesarean sections decreased by 32%, and birth trauma remained unchanged as the number of vaginal births increased. Preliminary experience suggests that integrating evidence/guideline-based best practices into work flows in inpatient and outpatient settings can achieve improvements in daily patient care processes and outcomes.

Improved SPICE electrical model of silicon photomultipliers

Energy Technology Data Exchange (ETDEWEB)

Marano, D., E-mail: davide.marano@oact.inaf.it [INAF, Osservatorio Astrofisico di Catania, Via S. Sofia 78, I-95123 Catania (Italy); Bonanno, G.; Belluso, M.; Billotta, S.; Grillo, A.; Garozzo, S.; Romeo, G. [INAF, Osservatorio Astrofisico di Catania, Via S. Sofia 78, I-95123 Catania (Italy); Catalano, O.; La Rosa, G.; Sottile, G.; Impiombato, D.; Giarrusso, S. [INAF, Istituto di Astrofisica Spaziale e Fisica Cosmica di Palermo, Via U. La Malfa 153, I-90146 Palermo (Italy)

2013-10-21

The present work introduces an improved SPICE equivalent electrical model of silicon photomultiplier (SiPM) detectors, in order to simulate and predict their transient response to avalanche triggering events. In particular, the developed circuit model provides a careful investigation of the magnitude and timing of the read-out signals and can therefore be exploited to perform reliable circuit-level simulations. The adopted modeling approach is strictly related to the physics of each basic microcell constituting the SiPM device, and allows the avalanche timing as well as the photodiode current and voltage to be accurately simulated. Predictive capabilities of the proposed model are demonstrated by means of experimental measurements on a real SiPM detector. Simulated and measured pulses are found to be in good agreement with the expected results. -- Highlights: • An improved SPICE electrical model of silicon photomultipliers is proposed. • The developed model provides a truthful representation of the physics of the device. • An accurate charge collection as a function of the overvoltage is achieved. • The adopted electrical model allows reliable circuit-level simulations to be performed. • Predictive capabilities of the adopted model are experimentally demonstrated.

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)

Improvements in ECN Wake Model

Energy Technology Data Exchange (ETDEWEB)

Versteeg, M.C. [University of Twente, Enschede (Netherlands); Ozdemir, H.; Brand, A.J. [ECN Wind Energy, Petten (Netherlands)

2013-08-15

Wind turbines extract energy from the flow field so that the flow in the wake of a wind turbine contains less energy and more turbulence than the undisturbed flow, leading to less energy extraction for the downstream turbines. In large wind farms, most turbines are located in the wake of one or more turbines causing the flow characteristics felt by these turbines differ considerably from the free stream flow conditions. The most important wake effect is generally considered to be the lower wind speed behind the turbine(s) since this decreases the energy production and as such the economical performance of a wind farm. The overall loss of a wind farm is very much dependent on the conditions and the lay-out of the farm but it can be in the order of 5-10%. Apart from the loss in energy production an additional wake effect is formed by the increase in turbulence intensity, which leads to higher fatigue loads. In this sense it becomes important to understand the details of wake behavior to improve and/or optimize a wind farm layout. Within this study improvements are presented for the existing ECN wake model which constructs the fundamental basis of ECN's FarmFlow wind farm wake simulation tool. The outline of this paper is as follows: first, the governing equations of the ECN wake farm model are presented. Then the near wake modeling is discussed and the results compared with the original near wake modeling and EWTW (ECN Wind Turbine Test Site Wieringermeer) data as well as the results obtained for various near wake implementation cases are shown. The details of the atmospheric stability model are given and the comparison with the solution obtained for the original surface layer model and with the available data obtained by EWTW measurements are presented. Finally the conclusions are summarized.

Improving Catastrophe Modeling for Business Interruption Insurance Needs.

Science.gov (United States)

Rose, Adam; Huyck, Charles K

2016-10-01

While catastrophe (CAT) modeling of property damage is well developed, modeling of business interruption (BI) lags far behind. One reason is the crude nature of functional relationships in CAT models that translate property damage into BI. Another is that estimating BI losses is more complicated because it depends greatly on public and private decisions during recovery with respect to resilience tactics that dampen losses by using remaining resources more efficiently to maintain business function and to recover more quickly. This article proposes a framework for improving hazard loss estimation for BI insurance needs. Improved data collection that allows for analysis at the level of individual facilities within a company can improve matching the facilities with the effectiveness of individual forms of resilience, such as accessing inventories, relocating operations, and accelerating repair, and can therefore improve estimation accuracy. We then illustrate the difference this can make in a case study example of losses from a hurricane. © 2016 Society for Risk Analysis.

Improved hydrogen combustion model for multi-compartment analysis

International Nuclear Information System (INIS)

Ogino, Masao; Hashimoto, Takashi

2000-01-01

NUPEC has been improving a hydrogen combustion model in MELCOR code for severe accident analysis. In the proposed combustion model, the flame velocity in a node was predicted using six different flame front shapes of fireball, prism, bubble, spherical jet, plane jet, and parallelepiped. A verification study of the proposed model was carried out using the NUPEC large-scale combustion test results following the previous work in which the GRS/Battelle multi-compartment combustion test results had been used. The selected test cases for the study were the premixed test and the scenario-oriented test which simulated the severe accident sequences of an actual plant. The improved MELCOR code replaced by the proposed model could predict sufficiently both results of the premixed test and the scenario-oriented test of NUPEC large-scale test. The improved MELCOR code was confirmed to simulate the combustion behavior in the multi-compartment containment vessel during a severe accident with acceptable degree of accuracy. Application of the new model to the LWR severe accident analysis will be continued. (author)

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...

Improvement of In Vivo Expression of Genes Delivered by Self-Amplifying RNA Using Vaccinia Virus Immune Evasion Proteins

Science.gov (United States)

Beissert, Tim; Koste, Lars; Perkovic, Mario; Walzer, Kerstin C.; Erbar, Stephanie; Selmi, Abderraouf; Diken, Mustafa; Kreiter, Sebastian; Türeci, Özlem; Sahin, Ugur

2017-01-01

Among nucleic acid–based delivery platforms, self-amplifying RNA (saRNA) vectors are of increasing interest for applications such as transient expression of recombinant proteins and vaccination. saRNA is safe and, due to its capability to amplify intracellularly, high protein levels can be produced from even minute amounts of transfected templates. However, it is an obstacle to full exploitation of this platform that saRNA induces a strong innate host immune response. In transfected cells, pattern recognition receptors sense double-stranded RNA intermediates and via activation of protein kinase R (PKR) and interferon signaling initiate host defense measures including a translational shutdown. To reduce pattern recognition receptor stimulation and unleash suppressed saRNA translation, this study co-delivered non-replicating mRNA encoding vaccinia virus immune evasion proteins E3, K3, and B18. It was shown that E3 is far superior to K3 or B18 as a highly potent blocker of PKR activation and of interferon (IFN)-β upregulation. B18, in contrast, is superior in controlling OAS1, a key IFN-inducible gene involved in viral RNA degradation. By combining all three vaccinia proteins, the study achieved significant suppression of PKR and IFN pathway activation in vitro and enhanced expression of saRNA-encoded genes of interest both in vitro and in vivo. This approach promises to overcome key hurdles of saRNA gene delivery. Its application may improve the bioavailability of the encoded protein, and reduce the effective dose and correspondingly the cost of goods of manufacture in the various fields where saRNA utilization is envisioned. PMID:28877647

Individualized, home-based interactive training of cerebral palsy children delivered through the Internet

DEFF Research Database (Denmark)

Bilde, Peder E; Kliim-Due, Mette; Rasmussen, Betina

2011-01-01

The available health resources limit the amount of therapy that may be offered to children with cerebral palsy and the amount of training in each session may be insufficient to drive the neuroplastic changes, which are necessary for functional improvements to take place. The aim of this pilot study...... was to provide proof of concept that individualized and supervised interactive home-based training delivered through the internet may provide an efficient way of maintaining intensive training of children with cerebral palsy over prolonged periods....

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.

Improvements on Semi-Classical Distorted-Wave model

Energy Technology Data Exchange (ETDEWEB)

Sun Weili; Watanabe, Y.; Kuwata, R. [Kyushu Univ., Fukuoka (Japan); Kohno, M.; Ogata, K.; Kawai, M.

1998-03-01

A method of improving the Semi-Classical Distorted Wave (SCDW) model in terms of the Wigner transform of the one-body density matrix is presented. Finite size effect of atomic nuclei can be taken into account by using the single particle wave functions for harmonic oscillator or Wood-Saxon potential, instead of those based on the local Fermi-gas model which were incorporated into previous SCDW model. We carried out a preliminary SCDW calculation of 160 MeV (p,p`x) reaction on {sup 90}Zr with the Wigner transform of harmonic oscillator wave functions. It is shown that the present calculation of angular distributions increase remarkably at backward angles than the previous ones and the agreement with the experimental data is improved. (author)

Initial Progress Toward Development of a Voice-Based Computer-Delivered Motivational Intervention for Heavy Drinking College Students: An Experimental Study.

Science.gov (United States)

Kahler, Christopher W; Lechner, William J; MacGlashan, James; Wray, Tyler B; Littman, Michael L

2017-06-28

behaviors. In comparison to the text-based computer-delivered intervention condition, those assigned to voice-based computer-delivered intervention reported significantly fewer alcohol-related problems at the 1-month follow-up (incident rate ratio 0.60, 95% CI 0.44-0.83, P=.002). The conditions did not differ significantly on perceived importance of changing drinking or on measures of drinking quantity and frequency of heavy drinking. Results indicate that it is feasible to construct a series of open-ended questions and a bank of responses and follow-up prompts that can be used in a future fully automated voice-based computer-delivered intervention that may mirror more closely human-delivered motivational interventions to reduce drinking. Such efforts will require using advanced speech recognition capabilities and machine-learning approaches to train a program to mirror the decisions made by human controllers in the voice-based computer-delivered intervention used in this study. In addition, future studies should examine enhancements that can increase the perceived warmth and empathy of voice-based computer-delivered intervention, possibly through greater personalization, improvements in the speech generation software, and embodying the computer-delivered intervention in a physical form. ©Christopher W Kahler, William J Lechner, James MacGlashan, Tyler B Wray, Michael L Littman. Originally published in JMIR Mental Health (http://mental.jmir.org), 28.06.2017.

Evaluation of a co-delivered training package for community mental health professionals on service user- and carer-involved care planning.

Science.gov (United States)

Grundy, A C; Walker, L; Meade, O; Fraser, C; Cree, L; Bee, P; Lovell, K; Callaghan, P

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: There is consistent evidence that service users and carers feel marginalized in the process of mental health care planning. Mental health professionals have identified ongoing training needs in relation to involving service users and carers in care planning. There is limited research on the acceptability of training packages for mental health professionals which involve service users and carers as co-facilitators. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: A co-produced and co-delivered training package on service user- and carer-involved care planning was acceptable to mental health professionals. Aspects of the training that were particularly valued were the co-production model, small group discussion and the opportunity for reflective practice. The organizational context of care planning may need more consideration in future training models. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses using co-production models of delivering training to other mental health professionals can be confident that such initiatives will be warmly welcomed, acceptable and engaging. On the basis of the results reported here, we encourage mental health nurses to use co-production approaches more often. Further research will show how clinically effective this training is in improving outcomes for service users and carers. Background There is limited evidence for the acceptability of training for mental health professionals on service user- and carer-involved care planning. Aim To investigate the acceptability of a co-delivered, two-day training intervention on service user- and carer-involved care planning. Methods Community mental health professionals were invited to complete the Training Acceptability Rating Scale post-training. Responses to the quantitative items were summarized using descriptive statistics (Miles, ), and qualitative responses were coded using content analysis (Weber, ). Results Of 350 trainees, 310 completed the

Improved double Q2 rescaling model

International Nuclear Information System (INIS)

Gao Yonghua

2001-01-01

The authors present an improved double Q 2 rescaling model. Based on this condition of the nuclear momentum conservation, the authors have found a Q 2 rescaling parameters' formula of the model, where authors have established the connection between the Q 2 rescaling parameter ζ i (i = v, s, g) and the mean binding energy in nucleus. By using this model, the authors coned explain the experimental data of the EMC effect in the whole x region, the nuclear Drell-Yan process and J/Ψ photoproduction process

Does patient-delivered partner treatment improve disclosure for treatable sexually transmitted diseases?

Science.gov (United States)

Mohammed, Hamish; Leichliter, Jami S; Schmidt, Norine; Farley, Thomas A; Kissinger, Patricia

2010-03-01

The objective of this research was to determine the factors associated with disclosure of three treatable sexually transmitted diseases (STDs). Data were obtained from two intervention trials to determine the ideal means of partner referral. Men diagnosed with urethritis and women diagnosed with trichomoniasis at public clinics in New Orleans, Louisiana were randomly assigned to partner referral (PR), booklet-enhanced partner referral (BEPR), or patient-delivered partner treatment (PDPT). Participants were asked about sex partners at baseline, then whether they disclosed to them at follow-up. The male trial was conducted from December 2001 to March 2004 and the female trial from December 2001 to August 2004. Data on men and women were analyzed separately. Nine hundred seventy-seven men and 463 women-reporting information on 1991 and 521 sex partners-were respectively enrolled in each trial. Disclosure occurred to 57.8% and 87.3% of their partners, respectively. Most men (68.3%) reported having two or more partners and disclosure was more likely to occur in: those who reported only one sex partner (adjusted odds ratio [aOR] 95% confidence interval [CI]: 1.54 [1.10, 2.16]); those in steady relationships (OR [95% CI]: 1.37 [1.08,1.74]); and those assigned PDPT [OR [95% CI]: 2.71 [1.93,3.82]). Most women reported having only one partner (86.8%) and disclosure was more likely to occur in steady relationships (OR [95% CI]: 2.65 [1.24,5.66]), and when sex was reinitiated with partners during the follow-up period (OR [95% CI]: 3.30 [1.54,7.09]). The provision of PDPT was associated with increased STD disclosure among men but not among women. Both men and women were less likely to disclose to casual partners. Women had high rates of disclosure irrespective of intervention arm.

Connecting Biochemical Photosynthesis Models with Crop Models to Support Crop Improvement.

Science.gov (United States)

Wu, Alex; Song, Youhong; van Oosterom, Erik J; Hammer, Graeme L

2016-01-01

The next advance in field crop productivity will likely need to come from improving crop use efficiency of resources (e.g., light, water, and nitrogen), aspects of which are closely linked with overall crop photosynthetic efficiency. Progress in genetic manipulation of photosynthesis is confounded by uncertainties of consequences at crop level because of difficulties connecting across scales. Crop growth and development simulation models that integrate across biological levels of organization and use a gene-to-phenotype modeling approach may present a way forward. There has been a long history of development of crop models capable of simulating dynamics of crop physiological attributes. Many crop models incorporate canopy photosynthesis (source) as a key driver for crop growth, while others derive crop growth from the balance between source- and sink-limitations. Modeling leaf photosynthesis has progressed from empirical modeling via light response curves to a more mechanistic basis, having clearer links to the underlying biochemical processes of photosynthesis. Cross-scale modeling that connects models at the biochemical and crop levels and utilizes developments in upscaling leaf-level models to canopy models has the potential to bridge the gap between photosynthetic manipulation at the biochemical level and its consequences on crop productivity. Here we review approaches to this emerging cross-scale modeling framework and reinforce the need for connections across levels of modeling. Further, we propose strategies for connecting biochemical models of photosynthesis into the cross-scale modeling framework to support crop improvement through photosynthetic manipulation.

Connecting Biochemical Photosynthesis Models with Crop Models to Support Crop Improvement

Science.gov (United States)

Wu, Alex; Song, Youhong; van Oosterom, Erik J.; Hammer, Graeme L.

2016-01-01

The next advance in field crop productivity will likely need to come from improving crop use efficiency of resources (e.g., light, water, and nitrogen), aspects of which are closely linked with overall crop photosynthetic efficiency. Progress in genetic manipulation of photosynthesis is confounded by uncertainties of consequences at crop level because of difficulties connecting across scales. Crop growth and development simulation models that integrate across biological levels of organization and use a gene-to-phenotype modeling approach may present a way forward. There has been a long history of development of crop models capable of simulating dynamics of crop physiological attributes. Many crop models incorporate canopy photosynthesis (source) as a key driver for crop growth, while others derive crop growth from the balance between source- and sink-limitations. Modeling leaf photosynthesis has progressed from empirical modeling via light response curves to a more mechanistic basis, having clearer links to the underlying biochemical processes of photosynthesis. Cross-scale modeling that connects models at the biochemical and crop levels and utilizes developments in upscaling leaf-level models to canopy models has the potential to bridge the gap between photosynthetic manipulation at the biochemical level and its consequences on crop productivity. Here we review approaches to this emerging cross-scale modeling framework and reinforce the need for connections across levels of modeling. Further, we propose strategies for connecting biochemical models of photosynthesis into the cross-scale modeling framework to support crop improvement through photosynthetic manipulation. PMID:27790232

Models for Delivering School-Based Dental Care.

Science.gov (United States)

Albert, David A.; McManus, Joseph M.; Mitchell, Dennis A.

2005-01-01

School-based health centers (SBHCs) often are located in high-need schools and communities. Dental service is frequently an addition to existing comprehensive services, functioning in a variety of models, configurations, and locations. SBHCs are indicated when parents have limited financial resources or inadequate health insurance, limiting…

Nanomolar Cellular Antisense Activity of Peptide Nucleic Acid (PNA) Cholic Acid ("Umbrella") and Cholesterol Conjugates Delivered by Cationic Lipids

DEFF Research Database (Denmark)

Shiraishi, Takehiko; Nielsen, Peter E

2012-01-01

of cholesterol and cholic acid ("umbrella") derivatives of splice correction antisense PNA oligomers. While the conjugates alone were practically inactive up to 1 µM, their activity was dramatically improved when delivered by a cationic lipid transfection agent (LipofectAMINE2000). In particular, PNAs...

Primary care resident perceived preparedness to deliver cross-cultural care: an examination of training and specialty differences.

Science.gov (United States)

Greer, Joseph A; Park, Elyse R; Green, Alexander R; Betancourt, Joseph R; Weissman, Joel S

2007-08-01

Previous research has shown that resident physicians report differences in training across primary care specialties, although limited data exist on education in delivering cross-cultural care. The goals of this study were to identify factors that relate to primary care residents' perceived preparedness to provide cross-cultural care and to explore the extent to which these perceptions vary across primary care specialties. Cross-sectional, national mail survey of resident physicians in their last year of training. Eleven hundred fifty primary care residents specializing in family medicine (27%), internal medicine (23%), pediatrics (26%), and obstetrics/gynecology (OB/GYN) (24%). Male residents as well as those who reported having graduated from U.S. medical schools, access to role models, and a greater cross-cultural case mix during residency felt more prepared to deliver cross-cultural care. Adjusting for these demographic and clinical factors, family practice residents were significantly more likely to feel prepared to deliver cross-cultural care compared to internal medicine, pediatric, and OB/GYN residents. Yet, when the quantity of instruction residents reported receiving to deliver cross-cultural care was added as a predictor, specialty differences became nonsignificant, suggesting that training opportunities better account for the variability in perceived preparedness than specialty. Across primary care specialties, residents reported different perceptions of preparedness to deliver cross-cultural care. However, this variation was more strongly related to training factors, such as the amount of instruction physicians received to deliver such care, rather than specialty affiliation. These findings underscore the importance of formal education to enhance residents' preparedness to provide cross-cultural care.

Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement.

Science.gov (United States)

Doyle, Cathal; Howe, Cathy; Woodcock, Thomas; Myron, Rowan; Phekoo, Karen; McNicholas, Chris; Saffer, Jessica; Bell, Derek

2013-10-26

The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). Data from project teams' responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as 'engaged,' 'partially engaged' and 'non-engaged.' Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a 'diversity of opinion' measure was derived to assess response variance over time. Of the 19 teams, six were categorized as 'engaged,' six 'partially engaged,' and seven as 'non-engaged.' Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness. The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This

Improvement and Validation of Weld Residual Stress Modelling Procedure

International Nuclear Information System (INIS)

Zang, Weilin; Gunnars, Jens; Dong, Pingsha; Hong, Jeong K.

2009-06-01

The objective of this work is to identify and evaluate improvements for the residual stress modelling procedure currently used in Sweden. There is a growing demand to eliminate any unnecessary conservatism involved in residual stress assumptions. The study was focused on the development and validation of an improved weld residual stress modelling procedure, by taking advantage of the recent advances in residual stress modelling and stress measurement techniques. The major changes applied in the new weld residual stress modelling procedure are: - Improved procedure for heat source calibration based on use of analytical solutions. - Use of an isotropic hardening model where mixed hardening data is not available. - Use of an annealing model for improved simulation of strain relaxation in re-heated material. The new modelling procedure is demonstrated to capture the main characteristics of the through thickness stress distributions by validation to experimental measurements. Three austenitic stainless steel butt-welds cases are analysed, covering a large range of pipe geometries. From the cases it is evident that there can be large differences between the residual stresses predicted using the new procedure, and the earlier procedure or handbook recommendations. Previously recommended profiles could give misleading fracture assessment results. The stress profiles according to the new procedure agree well with the measured data. If data is available then a mixed hardening model should be used

Improvement and Validation of Weld Residual Stress Modelling Procedure

Energy Technology Data Exchange (ETDEWEB)

Zang, Weilin; Gunnars, Jens (Inspecta Technology AB, Stockholm (Sweden)); Dong, Pingsha; Hong, Jeong K. (Center for Welded Structures Research, Battelle, Columbus, OH (United States))

2009-06-15

The objective of this work is to identify and evaluate improvements for the residual stress modelling procedure currently used in Sweden. There is a growing demand to eliminate any unnecessary conservatism involved in residual stress assumptions. The study was focused on the development and validation of an improved weld residual stress modelling procedure, by taking advantage of the recent advances in residual stress modelling and stress measurement techniques. The major changes applied in the new weld residual stress modelling procedure are: - Improved procedure for heat source calibration based on use of analytical solutions. - Use of an isotropic hardening model where mixed hardening data is not available. - Use of an annealing model for improved simulation of strain relaxation in re-heated material. The new modelling procedure is demonstrated to capture the main characteristics of the through thickness stress distributions by validation to experimental measurements. Three austenitic stainless steel butt-welds cases are analysed, covering a large range of pipe geometries. From the cases it is evident that there can be large differences between the residual stresses predicted using the new procedure, and the earlier procedure or handbook recommendations. Previously recommended profiles could give misleading fracture assessment results. The stress profiles according to the new procedure agree well with the measured data. If data is available then a mixed hardening model should be used

Improving practical atmospheric dispersion models

International Nuclear Information System (INIS)

Hunt, J.C.R.; Hudson, B.; Thomson, D.J.

1992-01-01

The new generation of practical atmospheric dispersion model (for short range ≤ 30 km) are based on dispersion science and boundary layer meteorology which have widespread international acceptance. In addition, recent improvements in computer skills and the widespread availability of small powerful computers make it possible to have new regulatory models which are more complex than the previous generation which were based on charts and simple formulae. This paper describes the basis of these models and how they have developed. Such models are needed to satisfy the urgent public demand for sound, justifiable and consistent environmental decisions. For example, it is preferable that the same models are used to simulate dispersion in different industries; in many countries at present different models are used for emissions from nuclear and fossil fuel power stations. The models should not be so simple as to be suspect but neither should they be too complex for widespread use; for example, at public inquiries in Germany, where simple models are mandatory, it is becoming usual to cite the results from highly complex computational models because the simple models are not credible. This paper is written in a schematic style with an emphasis on tables and diagrams. (au) (22 refs.)

An Improved Model for FE Modeling and Simulation of Closed Cell Al-Alloy Foams

OpenAIRE

Hasan, MD. Anwarul

2010-01-01

Cell wall material properties of Al-alloy foams have been derived by a combination of nanoindentation experiment and numerical simulation. Using the derived material properties in FE (finite element) modeling of foams, the existing constitutive models of closed-cell Al-alloy foams have been evaluated against experimental results. An improved representative model has been proposed for FE analysis of closed-cell Al-alloy foams. The improved model consists of a combination of spherical and cruci...

Understanding catchment behaviour through model concept improvement

NARCIS (Netherlands)

Fenicia, F.

2008-01-01

This thesis describes an approach to model development based on the concept of iterative model improvement, which is a process where by trial and error different hypotheses of catchment behaviour are progressively tested, and the understanding of the system proceeds through a combined process of

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

Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: cluster randomized controlled trial.

Science.gov (United States)

Attanasio, Orazio P; Fernández, Camila; Fitzsimons, Emla O A; Grantham-McGregor, Sally M; Meghir, Costas; Rubio-Codina, Marta

2014-09-29

To assess the effectiveness of an integrated early child development intervention, combining stimulation and micronutrient supplementation and delivered on a large scale in Colombia, for children's development, growth, and hemoglobin levels. Cluster randomized controlled trial, using a 2 × 2 factorial design, with municipalities assigned to one of four groups: psychosocial stimulation, micronutrient supplementation, combined intervention, or control. 96 municipalities in Colombia, located across eight of its 32 departments. 1420 children aged 12-24 months and their primary carers. Psychosocial stimulation (weekly home visits with play demonstrations), micronutrient sprinkles given daily, and both combined. All delivered by female community leaders for 18 months. Cognitive, receptive and expressive language, and fine and gross motor scores on the Bayley scales of infant development-III; height, weight, and hemoglobin levels measured at the baseline and end of intervention. Stimulation improved cognitive scores (adjusted for age, sex, testers, and baseline levels of outcomes) by 0.26 of a standard deviation (P=0.002). Stimulation also increased receptive language by 0.22 of a standard deviation (P=0.032). Micronutrient supplementation had no significant effect on any outcome and there was no interaction between the interventions. No intervention affected height, weight, or hemoglobin levels. Using the infrastructure of a national welfare program we implemented the integrated early child development intervention on a large scale and showed its potential for improving children's cognitive development. We found no effect of supplementation on developmental or health outcomes. Moreover, supplementation did not interact with stimulation. The implementation model for delivering stimulation suggests that it may serve as a promising blueprint for future policy on early childhood development.Trial registration Current Controlled trials ISRCTN18991160. © Attanasio et al 2014.

Increasing self-regulatory energy using an Internet-based training application delivered by smartphone technology.

Science.gov (United States)

Cranwell, Jo; Benford, Steve; Houghton, Robert J; Golembewski, Michael; Golembewksi, Michael; Fischer, Joel E; Hagger, Martin S

2014-03-01

Self-control resources can be defined in terms of "energy." Repeated attempts to override desires and impulses can result in a state of reduced self-control energy termed "ego depletion" leading to a reduced capacity to regulate future self-control behaviors effectively. Regular practice or "training" on self-control tasks may improve an individual's capacity to overcome ego depletion effectively. The current research tested the effectiveness of training using a novel Internet-based smartphone application to improve self-control and reduce ego depletion. In two experiments, participants were randomly assigned to either an experimental group, which received a daily program of self-control training using a modified Stroop-task Internet-based application delivered via smartphone to participants over a 4-week period, or a no-training control group. Participants assigned to the experimental group performed significantly better on post-training laboratory self-control tasks relative to participants in the control group. Findings support the hypothesized training effect on self-control and highlight the effectiveness of a novel Internet-based application delivered by smartphone as a practical means to administer and monitor a self-control training program. The smartphone training application has considerable advantages over other means to train self-control adopted in previous studies in that it has increased ecological validity and enables effective monitoring of compliance with the training program.

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.

Improved Mathematical Models for Particle-Size Distribution Data

African Journals Online (AJOL)

BirukEdimon

School of Civil & Environmental Engineering, Addis Ababa Institute of Technology,. 3. Murray Rix ... two improved mathematical models to describe ... demand further improvement to handle the PSD ... statistics and the range of the optimized.

Improving the Ni I atomic model for solar and stellar atmospheric models

International Nuclear Information System (INIS)

Vieytes, M. C.; Fontenla, J. M.

2013-01-01

Neutral nickel (Ni I) is abundant in the solar atmosphere and is one of the important elements that contribute to the emission and absorption of radiation in the spectral range between 1900 and 3900 Å. Previously, the Solar Radiation Physical Modeling (SRPM) models of the solar atmosphere only considered a few levels of this species. Here, we improve the Ni I atomic model by taking into account 61 levels and 490 spectral lines. We compute the populations of these levels in full NLTE using the SRPM code and compare the resulting emerging spectrum with observations. The present atomic model significantly improves the calculation of the solar spectral irradiance at near-UV wavelengths, which is important for Earth atmospheric studies, and particularly for ozone chemistry.

Improving the Ni I atomic model for solar and stellar atmospheric models

Energy Technology Data Exchange (ETDEWEB)

Vieytes, M. C. [Instituto de de Astronomía y Física del Espacio, CONICET and UNTREF, Buenos Aires (Argentina); Fontenla, J. M., E-mail: mariela@iafe.uba.ar, E-mail: johnf@digidyna.com [North West Research Associates, 3380 Mitchell Lane, Boulder, CO 80301 (United States)

2013-06-01

Neutral nickel (Ni I) is abundant in the solar atmosphere and is one of the important elements that contribute to the emission and absorption of radiation in the spectral range between 1900 and 3900 Å. Previously, the Solar Radiation Physical Modeling (SRPM) models of the solar atmosphere only considered a few levels of this species. Here, we improve the Ni I atomic model by taking into account 61 levels and 490 spectral lines. We compute the populations of these levels in full NLTE using the SRPM code and compare the resulting emerging spectrum with observations. The present atomic model significantly improves the calculation of the solar spectral irradiance at near-UV wavelengths, which is important for Earth atmospheric studies, and particularly for ozone chemistry.

Microparticles generated during chronic cerebral ischemia deliver proapoptotic signals to cultured endothelial cells

International Nuclear Information System (INIS)

Schock, Sarah C.; Edrissi, Hamidreza; Burger, Dylan; Cadonic, Robert; Hakim, Antoine; Thompson, Charlie

2014-01-01

Highlights: • Microparticles are elevated in the plasma in a rodent model of chronic cerebral ischemia. • These microparticles initiate apoptosis in cultured cells. • Microparticles contain caspase 3 and they activate receptors for TNF-α and TRAIL. - Abstract: Circulating microparticles (MPs) are involved in many physiological processes and numbers are increased in a variety of cardiovascular disorders. The present aims were to characterize levels of MPs in a rodent model of chronic cerebral hypoperfusion (CCH) and to determine their signaling properties. MPs were isolated from the plasma of rats exposed to CCH and quantified by flow cytometry. When MPs were added to cultured endothelial cells or normal rat kidney cells they induced cell death in a time and dose dependent manner. Analysis of pellets by electron microscopy indicates that cell death signals are carried by particles in the range of 400 nm in diameter or less. Cell death involved the activation of caspase 3 and was not a consequence of oxidative stress. Inhibition of the Fas/FasL signaling pathway also did not improve cell survival. MPs were found to contain caspase 3 and treating the MPs with a caspase 3 inhibitor significantly reduced cell death. A TNF-α receptor blocker and a TRAIL neutralizing antibody also significantly reduced cell death. Levels of circulating MPs are elevated in a rodent model of chronic cerebral ischemia. MPs with a diameter of 400 nm or less activate the TNF-α and TRAIL signaling pathways and may deliver caspase 3 to cultured cells

Microparticles generated during chronic cerebral ischemia deliver proapoptotic signals to cultured endothelial cells

Energy Technology Data Exchange (ETDEWEB)

Schock, Sarah C. [Ottawa Hospital Research Institute, Neuroscience, 451 Smyth Road, Ottawa, ON K1H 8M5 (Canada); Edrissi, Hamidreza [University of Ottawa, Neuroscience Graduate Program, 451 Smyth Road, Ottawa, ON K1H 8M5 (Canada); Burger, Dylan [Ottawa Hospital Research Institute, Kidney Centre, 451 Smyth Road, Ottawa, ON K1H 8M5 (Canada); Cadonic, Robert; Hakim, Antoine [Ottawa Hospital Research Institute, Neuroscience, 451 Smyth Road, Ottawa, ON K1H 8M5 (Canada); Thompson, Charlie, E-mail: charliet@uottawa.ca [Ottawa Hospital Research Institute, Neuroscience, 451 Smyth Road, Ottawa, ON K1H 8M5 (Canada)

2014-07-18

Highlights: • Microparticles are elevated in the plasma in a rodent model of chronic cerebral ischemia. • These microparticles initiate apoptosis in cultured cells. • Microparticles contain caspase 3 and they activate receptors for TNF-α and TRAIL. - Abstract: Circulating microparticles (MPs) are involved in many physiological processes and numbers are increased in a variety of cardiovascular disorders. The present aims were to characterize levels of MPs in a rodent model of chronic cerebral hypoperfusion (CCH) and to determine their signaling properties. MPs were isolated from the plasma of rats exposed to CCH and quantified by flow cytometry. When MPs were added to cultured endothelial cells or normal rat kidney cells they induced cell death in a time and dose dependent manner. Analysis of pellets by electron microscopy indicates that cell death signals are carried by particles in the range of 400 nm in diameter or less. Cell death involved the activation of caspase 3 and was not a consequence of oxidative stress. Inhibition of the Fas/FasL signaling pathway also did not improve cell survival. MPs were found to contain caspase 3 and treating the MPs with a caspase 3 inhibitor significantly reduced cell death. A TNF-α receptor blocker and a TRAIL neutralizing antibody also significantly reduced cell death. Levels of circulating MPs are elevated in a rodent model of chronic cerebral ischemia. MPs with a diameter of 400 nm or less activate the TNF-α and TRAIL signaling pathways and may deliver caspase 3 to cultured cells.

Utilization of the Behavior Change Wheel framework to develop a model to improve cardiometabolic screening for people with severe mental illness.

Science.gov (United States)

Mangurian, Christina; Niu, Grace C; Schillinger, Dean; Newcomer, John W; Dilley, James; Handley, Margaret A

2017-11-14

Individuals with severe mental illness (e.g., schizophrenia, bipolar disorder) die 10-25 years earlier than the general population, primarily from premature cardiovascular disease (CVD). Contributing factors are complex, but include systemic-related factors of poorly integrated primary care and mental health services. Although evidence-based models exist for integrating mental health care into primary care settings, the evidence base for integrating medical care into specialty mental health settings is limited. Such models are referred to as "reverse" integration. In this paper, we describe the application of an implementation science framework in designing a model to improve CVD outcomes for individuals with severe mental illness (SMI) who receive services in a community mental health setting. Using principles from the theory of planned behavior, focus groups were conducted to understand stakeholder perspectives of barriers to CVD risk factor screening and treatment identify potential target behaviors. We then applied results to the overarching Behavior Change Wheel framework, a systematic and theory-driven approach that incorporates the COM-B model (capability, opportunity, motivation, and behavior), to build an intervention to improve CVD risk factor screening and treatment for people with SMI. Following a stepped approach from the Behavior Change Wheel framework, a model to deliver primary preventive care for people that use community mental health settings as their de facto health home was developed. The CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness) model focuses on engaging community psychiatrists to expand their scope of practice to become responsible for CVD risk, with significant clinical decision support. The CRANIUM model was designed by integrating behavioral change theory and implementation theory. CRANIUM is feasible to implement, is highly acceptable to, and

Improved ionic model of liquid uranium dioxide

NARCIS (Netherlands)

Gryaznov, [No Value; Iosilevski, [No Value; Yakub, E; Fortov, [No Value; Hyland, GJ; Ronchi, C

The paper presents a model for liquid uranium dioxide, obtained by improving a simplified ionic model, previously adopted to describe the equation of state of this substance [1]. A "chemical picture" is used for liquid UO2 of stoichiometric and non-stoichiometric composition. Several ionic species

Improved gap conductance model for the TRAC code

International Nuclear Information System (INIS)

Hatch, S.W.; Mandell, D.A.

1980-01-01

The purpose of the present work, as indicated earlier, is to improve the present constant fuel clad spacing in TRAC-P1A without significantly increasing the computer costs. It is realized that the simple model proposed may not be accurate enough for some cases, but for the initial calculations made the DELTAR model improves the predictions over the constant Δr results of TRAC-P1A and the additional computing costs are negligible

The role of Aboriginal family workers in delivering a child safety focused home visiting program for Aboriginal families in an urban region of NSW.

Science.gov (United States)

Clapham, Kathleen; Bennett-Brook, Keziah; Hunter, Kate

2018-05-09

Aboriginal Australian children experience higher rates of injury than other Australian children. However few culturally acceptable programs have been developed or evaluated. The Illawarra Aboriginal Medical Service (IAMS) developed the Safe Homes Safe Kids program as an injury prevention program targeting disadvantaged Aboriginal families with children aged 0-5 in an urban region of NSW. Delivered by Aboriginal Family Workers the program aims to reduce childhood injury by raising awareness of safety in the home. A program evaluation was conducted to determine the effectiveness of the home visiting model as an injury prevention program. This paper reports on the qualitative interviews which explored the ways in which clients, IAMS staff, and external service providers experienced the program and assessed its delivery by the Aboriginal Family Workers. A qualitative program evaluation was conducted between January 2014 and June 2015. We report here on the semi-structured interviews undertaken with 34 individuals. The results show increased client engagement in the program; improved child safety knowledge and skills; increased access to services; improved attitudes to home and community safety; and changes in the home safety environment. Safe Homes Safe Kids provides a culturally appropriate child safety program delivered by Aboriginal Family Workers to vulnerable families. Clients, IAMS staff, and external service were satisfied with the family workers' delivery of the program and the holistic model of service provision. SO WHAT?: This promising program could be replicated in other Aboriginal health services to address unintentional injury to vulnerable Aboriginal children. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

A model for ageing-home-care service process improvement

OpenAIRE

Yu, Shu-Yan; Shie, An-Jin

2017-01-01

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

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.

Improved Modeling and Prediction of Surface Wave Amplitudes

Science.gov (United States)

2017-05-31

AFRL-RV-PS- AFRL-RV-PS- TR-2017-0162 TR-2017-0162 IMPROVED MODELING AND PREDICTION OF SURFACE WAVE AMPLITUDES Jeffry L. Stevens, et al. Leidos...data does not license the holder or any other person or corporation; or convey any rights or permission to manufacture, use, or sell any patented...SUBTITLE Improved Modeling and Prediction of Surface Wave Amplitudes 5a. CONTRACT NUMBER FA9453-14-C-0225 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER

Can community care workers deliver a falls prevention exercise program? A feasibility study

Directory of Open Access Journals (Sweden)

Burton E

2018-03-01

Full Text Available Elissa Burton,1 Gill Lewin,2 Hilary O’Connell,3 Mark Petrich,4,5 Eileen Boyle,1 Keith D Hill1 1School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; 2School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; 3Independent Living Centre Western Australia, Perth, Western Australia, Australia; 4Western Australian Department of Health, Perth, Western Australia, Australia; 5School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia Background: Almost half of older people receiving community care fall each year and this rate has not improved in the last decade. Falls prevention programs targeted at this group are uncommon, and expensively delivered by university trained allied health professionals. Purpose: To investigate the feasibility of community care workers delivering a falls prevention exercise program to older clients, at low or medium risk of falling, as part of an existing service provision. Patients and methods: Community care workers from 10 community care organizations participated in the training for, and delivery to their clients of, an 8-week evidence-based falls prevention exercise program. Community care workers included assessment staff (responsible for identifying the need for community care services through completing an assessment and support workers (responsible for providing support in the home. Clients were surveyed anonymously at the completion of the intervention and workers participated in a semi-structured interview. Results: Twenty-five community care workers participated in the study. The falls prevention program was delivered to 29 clients, with an average age of 82.7 (SD: 8.72 years and consisting of 65.5% female. The intervention was delivered safely with no adverse events recorded, and the eligibility and assessment tools

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.

Predictors of hepatitis B cure using gene therapy to deliver DNA cleavage enzymes: a mathematical modeling approach.

Directory of Open Access Journals (Sweden)

Joshua T Schiffer

Full Text Available Most chronic viral infections are managed with small molecule therapies that inhibit replication but are not curative because non-replicating viral forms can persist despite decades of suppressive treatment. There are therefore numerous strategies in development to eradicate all non-replicating viruses from the body. We are currently engineering DNA cleavage enzymes that specifically target hepatitis B virus covalently closed circular DNA (HBV cccDNA, the episomal form of the virus that persists despite potent antiviral therapies. DNA cleavage enzymes, including homing endonucleases or meganucleases, zinc-finger nucleases (ZFNs, TAL effector nucleases (TALENs, and CRISPR-associated system 9 (Cas9 proteins, can disrupt specific regions of viral DNA. Because DNA repair is error prone, the virus can be neutralized after repeated cleavage events when a target sequence becomes mutated. DNA cleavage enzymes will be delivered as genes within viral vectors that enter hepatocytes. Here we develop mathematical models that describe the delivery and intracellular activity of DNA cleavage enzymes. Model simulations predict that high vector to target cell ratio, limited removal of delivery vectors by humoral immunity, and avid binding between enzyme and its DNA target will promote the highest level of cccDNA disruption. Development of de novo resistance to cleavage enzymes may occur if DNA cleavage and error prone repair does not render the viral episome replication incompetent: our model predicts that concurrent delivery of multiple enzymes which target different vital cccDNA regions, or sequential delivery of different enzymes, are both potentially useful strategies for avoiding multi-enzyme resistance. The underlying dynamics of cccDNA persistence are unlikely to impact the probability of cure provided that antiviral therapy is given concurrently during eradication trials. We conclude by describing experiments that can be used to validate the model, which

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.

Primary Care Resident Perceived Preparedness to Deliver Cross-cultural Care: An Examination of Training and Specialty Differences

Science.gov (United States)

Park, Elyse R.; Green, Alexander R.; Betancourt, Joseph R.; Weissman, Joel S.

2007-01-01

Objective Previous research has shown that resident physicians report differences in training across primary care specialties, although limited data exist on education in delivering cross-cultural care. The goals of this study were to identify factors that relate to primary care residents’ perceived preparedness to provide cross-cultural care and to explore the extent to which these perceptions vary across primary care specialties. Design Cross-sectional, national mail survey of resident physicians in their last year of training. Participants Eleven hundred fifty primary care residents specializing in family medicine (27%), internal medicine (23%), pediatrics (26%), and obstetrics/gynecology (OB/GYN) (24%). Results Male residents as well as those who reported having graduated from U.S. medical schools, access to role models, and a greater cross-cultural case mix during residency felt more prepared to deliver cross-cultural care. Adjusting for these demographic and clinical factors, family practice residents were significantly more likely to feel prepared to deliver cross-cultural care compared to internal medicine, pediatric, and OB/GYN residents. Yet, when the quantity of instruction residents reported receiving to deliver cross-cultural care was added as a predictor, specialty differences became nonsignificant, suggesting that training opportunities better account for the variability in perceived preparedness than specialty. Conclusions Across primary care specialties, residents reported different perceptions of preparedness to deliver cross-cultural care. However, this variation was more strongly related to training factors, such as the amount of instruction physicians received to deliver such care, rather than specialty affiliation. These findings underscore the importance of formal education to enhance residents’ preparedness to provide cross-cultural care. PMID:17516107

MOSFET assessment of radiation dose delivered to mice using the Small Animal Radiation Research Platform (SARRP).

Science.gov (United States)

Ngwa, Wilfred; Korideck, Houari; Chin, Lee M; Makrigiorgos, G Mike; Berbeco, Ross I

2011-12-01

The Small Animal Radiation Research Platform (SARRP) is a novel isocentric irradiation system that enables state-of-the-art image-guided radiotherapy research to be performed with animal models. This paper reports the results obtained from investigations assessing the radiation dose delivered by the SARRP to different anatomical target volumes in mice. Surgically implanted metal oxide semiconductor field effect transistors (MOSFET) dosimeters were employed for the dose assessment. The results reveal differences between the calculated and measured dose of -3.5 to 0.5%, -5.2 to -0.7%, -3.9 to 0.5%, -5.9 to 2.5%, -5.5 to 0.5%, and -4.3 to 0% for the left kidney, liver, pancreas, prostate, left lung, and brain, respectively. Overall, the findings show less than 6% difference between the delivered and calculated dose, without tissue heterogeneity corrections. These results provide a useful assessment of the need for tissue heterogeneity corrections in SARRP dose calculations for clinically relevant tumor model sites.

A Unified Framework for Systematic Model Improvement

DEFF Research Database (Denmark)

Kristensen, Niels Rode; Madsen, Henrik; Jørgensen, Sten Bay

2003-01-01

A unified framework for improving the quality of continuous time models of dynamic systems based on experimental data is presented. The framework is based on an interplay between stochastic differential equation (SDE) modelling, statistical tests and multivariate nonparametric regression. This co......-batch bioreactor, where it is illustrated how an incorrectly modelled biomass growth rate can be pinpointed and an estimate provided of the functional relation needed to properly describe it....

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

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...

Motivation to Improve Work through Learning: A Conceptual Model

Directory of Open Access Journals (Sweden)

Kueh Hua Ng

2014-12-01

Full Text Available This study aims to enhance our current understanding of the transfer of training by proposing a conceptual model that supports the mediating role of motivation to improve work through learning about the relationship between social support and the transfer of training. The examination of motivation to improve work through motivation to improve work through a learning construct offers a holistic view pertaining to a learner's profile in a workplace setting, which emphasizes learning for the improvement of work performance. The proposed conceptual model is expected to benefit human resource development theory building, as well as field practitioners by emphasizing the motivational aspects crucial for successful transfer of training.

Improved transition models for cepstral trajectories

CSIR Research Space (South Africa)

Badenhorst, J

2012-11-01

Full Text Available We improve on a piece-wise linear model of the trajectories of Mel Frequency Cepstral Coefficients, which are commonly used as features in Automatic Speech Recognition. For this purpose, we have created a very clean single-speaker corpus, which...

An improved large signal model of InP HEMTs

Science.gov (United States)

Li, Tianhao; Li, Wenjun; Liu, Jun

2018-05-01

An improved large signal model for InP HEMTs is proposed in this paper. The channel current and charge model equations are constructed based on the Angelov model equations. Both the equations for channel current and gate charge models were all continuous and high order drivable, and the proposed gate charge model satisfied the charge conservation. For the strong leakage induced barrier reduction effect of InP HEMTs, the Angelov current model equations are improved. The channel current model could fit DC performance of devices. A 2 × 25 μm × 70 nm InP HEMT device is used to demonstrate the extraction and validation of the model, in which the model has predicted the DC I–V, C–V and bias related S parameters accurately. Project supported by the National Natural Science Foundation of China (No. 61331006).

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

Improvement of the design model for SMART fuel assembly

International Nuclear Information System (INIS)

Zee, Sung Kyun; Yim, Jeong Sik

2001-04-01

A Study on the design improvement of the TEP, BEP and Hoddown spring of a fuel assembly for SMART was performed. Cut boundary Interpolation Method was applied to get more accurate results of stress and strain distribution from the results of the coarse model calculation. The improved results were compared with that of a coarse one. The finer model predicted slightly higher stress and strain distribution than the coarse model, which meant the results of the coarse model was not converged. Considering that the test results always showed much less stress than the FEM and the location of the peak stress of the refined model, the pressure stress on the loading point seemed to contribute significantly to the stresses. Judging from the fact that the peak stress appeared only at the local area, the results of the refined model were considered enough to be a conservative prediction of the stress levels. The slot of the guide thimble screw was ignored to get how much thickness of the flow plate can be reduced in case of optimization of the thickness and also cut off the screw dent hole was included for the actual geometry. For the BEP, the leg and web were also included in the model and the results with and without the leg alignment support were compared. Finally, the holddown spring which is important during the in-reactor behavior of the FA was modeled more realistic and improved to include the effects of the friction between the leaves and the loading surface. Using this improved model, it was possible that the spring characteristics were predicted more accurate to the test results. From the analysis of the spring characteristics, the local plastic area controled the characteristics of the spring dominantly which implied that it was necessary for the design of the leaf to be optimized for the improvement of the plastic behavior of the leaf spring

Highly Adoptable Improvement: A Practical Model and Toolkit to Address Adoptability and Sustainability of Quality Improvement Initiatives.

Science.gov (United States)

Hayes, Christopher William; Goldmann, Don

2018-03-01

Failure to consider the impact of change on health care providers is a barrier to success. Initiatives that increase workload and have low perceived value are less likely to be adopted. A practical model and supporting tools were developed on the basis of existing theories to help quality improvement (QI) programs design more adoptable approaches. Models and theories from the diffusion of innovation and work stress literature were reviewed, and key-informant interviews and site visits were conducted to develop a draft Highly Adoptable Improvement (HAI) Model. A list of candidate factors considered for inclusion in the draft model was presented to an expert panel. A modified Delphi process was used to narrow the list of factors into main themes and refine the model. The resulting model and supporting tools were pilot tested by 16 improvement advisors for face validity and usability. The HAI Model depicts how workload and perceived value influence adoptability of QI initiatives. The supporting tools include an assessment guide and suggested actions that QI programs can use to help design interventions that are likely to be adopted. Improvement advisors reported good face validity and usability and found that the model and the supporting tools helped address key issues related to adoption and reported that they would continue to use them. The HAI Model addresses important issues regarding workload and perceived value of improvement initiatives. Pilot testing suggests that the model and supporting tools are helpful and practical in guiding design and implementation of adoptable and sustainable QI interventions. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Dual-Functional Nanoparticles Targeting CXCR4 and Delivering Antiangiogenic siRNA Ameliorate Liver Fibrosis.

Science.gov (United States)

Liu, Chun-Hung; Chan, Kun-Ming; Chiang, Tsaiyu; Liu, Jia-Yu; Chern, Guann-Gen; Hsu, Fu-Fei; Wu, Yu-Hsuan; Liu, Ya-Chi; Chen, Yunching

2016-07-05

The progression of liver fibrosis, an intrinsic response to chronic liver injury, is associated with hepatic hypoxia, angiogenesis, abnormal inflammation, and significant matrix deposition, leading to the development of cirrhosis and hepatocellular carcinoma (HCC). Due to the complex pathogenesis of liver fibrosis, antifibrotic drug development has faced the challenge of efficiently and specifically targeting multiple pathogenic mechanisms. Therefore, CXCR4-targeted nanoparticles (NPs) were formulated to deliver siRNAs against vascular endothelial growth factor (VEGF) into fibrotic livers to block angiogenesis during the progression of liver fibrosis. AMD3100, a CXCR4 antagonist that was incorporated into the NPs, served dual functions: it acted as a targeting moiety and suppressed the progression of fibrosis by inhibiting the proliferation and activation of hepatic stellate cells (HSCs). We demonstrated that CXCR4-targeted NPs could deliver VEGF siRNAs to fibrotic livers, decrease VEGF expression, suppress angiogenesis and normalize the distorted vessels in the fibrotic livers in the carbon tetrachloride (CCl4) induced mouse model. Moreover, blocking SDF-1α/CXCR4 by CXCR4-targeted NPs in combination with VEGF siRNA significantly prevented the progression of liver fibrosis in CCl4-treated mice. In conclusion, the multifunctional CXCR4-targeted NPs delivering VEGF siRNAs provide an effective antifibrotic therapeutic strategy.

Improvement of a combustion model in MELCOR code

International Nuclear Information System (INIS)

Ogino, Masao; Hashimoto, Takashi

1999-01-01

NUPEC has been improving a hydrogen combustion model in MELCOR code for severe accident analysis. In the proposed combustion model, the flame velocity in a node was predicted using five different flame front shapes of fireball, prism, bubble, spherical jet, and plane jet. For validation of the proposed model, the results of the Battelle multi-compartment hydrogen combustion test were used. The selected test cases for the study were Hx-6, 13, 14, 20 and Ix-2 which had two, three or four compartments under homogeneous hydrogen concentration of 5 to 10 vol%. The proposed model could predict well the combustion behavior in multi-compartment containment geometry on the whole. MELCOR code, incorporating the present combustion model, can simulate combustion behavior during severe accident with acceptable computing time and some degree of accuracy. The applicability study of the improved MELCOR code to the actual reactor plants will be further continued. (author)

Reflections on delivering a cross-discipline, cross-cultural, international, masters-level collaborative course using e-Learning technologies

NARCIS (Netherlands)

Leung, W.S.; Coulter, D.A.; Moes, C.C.M.; Horvath, I.

2012-01-01

This paper presents a case study on the experience of delivering an Internet-based international collaborative semester course at intermediate postgraduate level and attempts to distill a model for exploring the success factors involved when presenting such courses. The pedagogic and practical

Quality improvement in healthcare delivery utilizing the patient-centered medical home model.

Science.gov (United States)

Akinci, Fevzi; Patel, Poonam M

2014-01-01

Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.

Predicting the effects of organ motion on the dose delivered by dynamic intensity modulation

International Nuclear Information System (INIS)

Yu, C.X.; Jaffray, David; Martinez, A.A.; Wong, J.W.

1997-01-01

Purpose: Computer-optimized treatment plans, aimed to enhance tumor control and reduce normal tissue complication, generally require non-uniform beam intensities. One of the techniques for delivering intensity-modulated beams is the use of dynamic multileaf collimation, where the beam aperture and field shape change during irradiation. When intensity-modulated beams are delivered with dynamic collimation, intra-treatment organ motion may not only cause geometric misses at the field boundaries but also create hot and cold spots in the target. The mechanism for producing such effects has not been well understood. This study analyzes the dosimetric effects of intra-treatment organ motion on dynamic intensity modulation. A numerical method is developed for predicting the intensity distributions in a moving target before dose is delivered with dynamic intensity modulation. Material and Methods: In the numerical algorithm, the change in position and shape of the beam aperture with time were modeled as a three-dimensional 'tunnel', with the shape of the field aperture described in the x-y plane and its temporal position shown in the z-dimension. A point in the target had to be in the tunnel in order to receive irradiation and the dose to the point was proportional to the amount of time that this point stayed in the tunnel. Since each point in the target were analyzed separately, non-rigid body variations could easily be handled. The dependency of the dose variations on all parameters involved, including the speed of collimator motion, the frequency and amplitude of the target motion, and the size of the field segments, was analyzed. The algorithm was verified by irradiating moving phantoms with beams of dynamically modulated intensities. Predictions were also made for a treatment of a thoracic tumor using a dynamic wedge. The changes of target position with time were based on the MRI images of the chest region acquired using fast MRI scans in a cine fashion for a duration

Improved Solar-Radiation-Pressure Models for GPS Satellites

Science.gov (United States)

Bar-Sever, Yoaz; Kuang, Da

2006-01-01

A report describes a series of computational models conceived as an improvement over prior models for determining effects of solar-radiation pressure on orbits of Global Positioning System (GPS) satellites. These models are based on fitting coefficients of Fourier functions of Sun-spacecraft- Earth angles to observed spacecraft orbital motions.

Development of an equipment management model to improve effectiveness of processes

International Nuclear Information System (INIS)

Chang, H. S.; Ju, T. Y.; Song, T. Y.

2012-01-01

The nuclear industries have developed and are trying to create a performance model to improve effectiveness of the processes implemented at nuclear plants in order to enhance performance. Most high performing nuclear stations seek to continually improve the quality of their operations by identifying and closing important performance gaps. Thus, many utilities have implemented performance models adjusted to their plant's configuration and have instituted policies for such models. KHNP is developing a standard performance model to integrate the engineering processes and to improve the inter-relation among processes. The model, called the Standard Equipment Management Model (SEMM), is under development first by focusing on engineering processes and performance improvement processes related to plant equipment used at the site. This model includes performance indicators for each process that can allow evaluating and comparing the process performance among 21 operating units. The model will later be expanded to incorporate cost and management processes. (authors)

Using Unified Modelling Language (UML) as a process-modelling technique for clinical-research process improvement.

Science.gov (United States)

Kumarapeli, P; De Lusignan, S; Ellis, T; Jones, B

2007-03-01

The Primary Care Data Quality programme (PCDQ) is a quality-improvement programme which processes routinely collected general practice computer data. Patient data collected from a wide range of different brands of clinical computer systems are aggregated, processed, and fed back to practices in an educational context to improve the quality of care. Process modelling is a well-established approach used to gain understanding and systematic appraisal, and identify areas of improvement of a business process. Unified modelling language (UML) is a general purpose modelling technique used for this purpose. We used UML to appraise the PCDQ process to see if the efficiency and predictability of the process could be improved. Activity analysis and thinking-aloud sessions were used to collect data to generate UML diagrams. The UML model highlighted the sequential nature of the current process as a barrier for efficiency gains. It also identified the uneven distribution of process controls, lack of symmetric communication channels, critical dependencies among processing stages, and failure to implement all the lessons learned in the piloting phase. It also suggested that improved structured reporting at each stage - especially from the pilot phase, parallel processing of data and correctly positioned process controls - should improve the efficiency and predictability of research projects. Process modelling provided a rational basis for the critical appraisal of a clinical data processing system; its potential maybe underutilized within health care.

Pittsburgh Regional Healthcare Initiative puts new spin on improving healthcare quality.

Science.gov (United States)

2002-11-01

For nearly 4 years, the Pittsburgh Regional Healthcare Initiative (PRHI) has been working to improve the way healthcare is delivered in southwestern Pennsylvania by combining the voices and resources of hospitals, providers, the business community, insurers, health plans, and federal agencies. As one example of borrowing from business, the PRHI has created a new learning and management system, called Perfecting Patient Care, which is based on the Toyota Production System model and is now being used successfully in hospitals.

Confocal fluorescence microscopy in a murine model of microdissection testicular sperm extraction to improve sperm retrieval.

Science.gov (United States)

Smith, Ryan P; Lowe, Greg J; Kavoussi, Parviz K; Steers, William D; Costabile, Raymond A; Herr, John C; Shetty, Jagathpala; Lysiak, Jeffrey J

2012-05-01

Microdissection testicular sperm extraction markedly improves the sperm retrieval rates in men with nonobstructive azoospermia. However, localizing sperm foci can be time-consuming and it is not always successful. Fiberoptic confocal fluorescent microscopy offers the advantage of rapid in vivo detection of fluorescently labeled sperm in the seminiferous tubules. After establishing the feasibility of fiberoptic confocal fluorescent microscopy to identify antibody labeled sperm in vivo C57/B6 mice underwent intraperitoneal injection of busulfan to induce azoospermia. During spermatogenesis reestablishment at approximately 16 weeks the mice were anesthetized and the testes were delivered through a low midline incision. Fluorescein isothiocyanate labeled antibody to intra-acrosomal protein Hs-14 was injected retrograde into a single murine rete testis. The testes were imaged in vivo with fiberoptic confocal fluorescent microscopy and sperm foci were detected. The respective seminiferous tubules were excised and squash prepared for immunofluorescence microscopy. Sperm foci were identified in the testis injected with fluorescently tagged antibody by in vivo fiberoptic confocal fluorescence microscopy. The contralateral control testis of each mouse showed no specific signal. Immunofluorescence microscopy of the excised tubules provided morphological confirmation of the presence of labeled sperm with an absence in controls. Findings were consistent in the feasibility portion of the study and in the busulfan model of nonobstructive azoospermia. Fiberoptic confocal fluorescent microscopy was feasible during microdissection testicular sperm extraction in an azoospermic mouse model to identify fluorescently labeled sperm in vivo. Translation to the clinical setting could decrease operative time and improve the sperm harvest rate. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Improving Representational Competence with Concrete Models

Science.gov (United States)

Stieff, Mike; Scopelitis, Stephanie; Lira, Matthew E.; DeSutter, Dane

2016-01-01

Representational competence is a primary contributor to student learning in science, technology, engineering, and math (STEM) disciplines and an optimal target for instruction at all educational levels. We describe the design and implementation of a learning activity that uses concrete models to improve students' representational competence and…

A Case Study on Hydrodynamic Modeling and Design Improvement Evaluation to Manage Debris and Sediment Interference at a Water Intake Structure

Science.gov (United States)

Crissman, B. J.; Cunderlik, J. M.; Wong, R. P. L.; Pinero, A.

2017-12-01

Waterford 3 nuclear plant, located in Killona, Louisiana, provides approximately 10% of the state's electricity need. Located along the south bank of the Mississippi River, two miles upstream of the Bonnet Carre Spillway, the plant's single pass through cooling system continuously draws up to 1,000,000 gpm water from the river. On behalf of Entergy Louisiana, the project team evaluated options to improve the aging water intake structure with chronic debris and sediment entrainment issues. The highly complex and dynamic environment in the river coupled with regulatory constraints limited available improvement options: varying river stages allow debris to overflow the intake structure, but the maximum new wall height is restricted to minimize aesthetic intrusion and alteration to levee tie-back; bow waves push debris into the downstream intake wall, but the wall needs to maintain an opening to flush debris out from the intake structure; the river delivers significant sediment load, but any proposed intake structure cannot significantly alter existing bathymetry; EPA Clean Water Act Section 316(b) limited maximum velocity at the intake structure to 0.5 fps for entrainment prevention. To expedite alternative evaluation while providing sufficient data to inform management decision, instead of developing physical models, the project team developed a two-tier approach utilizing the TELEMAC hydrodynamic program to prepare screening analysis in 2D modeling and final evaluation in 3D modeling. The model was built upon the USACE ERDC ADH model, calibrated with river gauge data and peer reviewed by ERDC. TELEMAC, developed by EDF, provides novel features for modeling improvement options, including the recommended design concept, which is a hydraulically optimized intake geometry configured to maintain uniform intake flow while streamlining river flowline for debris and sediment deflection. The design includes submerged inlets with upstream and downstream walls to block

Telephone delivered interventions for reducing morbidity and mortality in people with HIV infection.

Science.gov (United States)

Gentry, Sarah; van-Velthoven, Michelle H M M T; Tudor Car, Lorainne; Car, Josip

2013-05-31

This is one of three Cochrane reviews examining the role of the telephone in HIV/AIDS services. Telephone interventions, delivered either by landline or mobile phone, may be useful in the management of people living with HIV (PLHIV) in many situations. Telephone delivered interventions have the potential to reduce costs, save time and facilitate more support for PLHIV. To assess the effectiveness of voice landline and mobile telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. We searched The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE, PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied Health, World Health Organisation's The Global Health Library and Current Controlled Trials from 1980 to June 2011. We searched the following grey literature sources: Dissertation Abstracts International, Centre for Agriculture Bioscience International Direct Global Health database, The System for Information on Grey Literature Europe, The Healthcare Management Information Consortium database, Google Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS Society, AIDS Educational Global Information System and reference lists of articles. Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series studies comparing the effectiveness of telephone delivered interventions for reducing morbidity and mortality in persons with HIV infection versus in-person interventions or usual care, regardless of demographic characteristics and in all settings. Both mobile and landline telephone interventions were included, but mobile phone messaging interventions were excluded. Two reviewers independently searched, screened, assessed study quality and extracted data. Primary outcomes were change in behaviour, healthcare uptake or clinical outcomes. Secondary outcomes were appropriateness of the

An Improved Walk Model for Train Movement on Railway Network

International Nuclear Information System (INIS)

Li Keping; Mao Bohua; Gao Ziyou

2009-01-01

In this paper, we propose an improved walk model for simulating the train movement on railway network. In the proposed method, walkers represent trains. The improved walk model is a kind of the network-based simulation analysis model. Using some management rules for walker movement, walker can dynamically determine its departure and arrival times at stations. In order to test the proposed method, we simulate the train movement on a part of railway network. The numerical simulation and analytical results demonstrate that the improved model is an effective tool for simulating the train movement on railway network. Moreover, it can well capture the characteristic behaviors of train scheduling in railway traffic. (general)

Efficient Adoption and Assessment of Multiple Process Improvement Reference Models

Directory of Open Access Journals (Sweden)

Simona Jeners

2013-06-01

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

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.

SOLVING THE STUDENTS’ SPEAKING PROBLEM IN DELIVERING ENGLISH PRESENTATION THROUGH 3-P TECHNIQUE

Directory of Open Access Journals (Sweden)

Nadif Ulfia

2017-01-01

Full Text Available Abstract: Solving the Students’ Speaking Problem in Delivering English Presentation Through 3-P Technique. The aims of this study were to (1 identify whether and to what extent 3-P Technique can improve the students’ speaking competence in delivering presentation;(2 describe the teaching and learning when 3-P technique is implemented in English class. This research was conducted at the eleventh grades of MAN 1 Bojonegoro. The subjects of the research were the teacher and the students in the academic year 2016/2017. This study applied 3 cycle action research. In collecting the data, the researcher used observations through field notes, video recording, questionnaire and interview. To analyze the quantitative data, the researcher applied descriptive statistics. Besides, to analyze qualitative data, the researcher applied constant comparative method as suggested by Garner. The findings shows that: (1 3-P Technique can improve students’ speaking competence in delivering presentation in terms of students achievement, fluency, pronunciation, ability to express their opinions, arguments, and ideas using appropriate vocabulary and grammatical form, using appropriate body language, voice control, gesture, and eye contact; and (2 3-P technique can improve classroom situation in terms of increasing students’ motivation and participation, creating live teaching atmosphere, and increasing teacher motivation. Key words: Speaking, 3 P technique, Action research Abstrak: Memecahkan Masalah Keterampilan Berbicara Siswa dalam Menyampaikan Presentasi Berbahasa Inggris Melalui Teknik 3-P. Tujuan dari penelitian ini adalah untuk (1 mengidentifikasi dan mengetahui sejauh mana teknik 3-P dapat meningkatkan kemampuan berbicara para siswa dalam menyampaikan sebuah presentasi; (2 mendeskripsikan kegiatan pembelajaran dalam penerapan teknik 3-P dalam pembelajaran Bahasa Inggris. Penelitian ini dilakukan pada kelas sebelas MAN 1 Bojonegoro. Subyek  penelitian ini

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...

Model-driven approach to data collection and reporting for quality improvement.

Science.gov (United States)

Curcin, Vasa; Woodcock, Thomas; Poots, Alan J; Majeed, Azeem; Bell, Derek

2014-12-01

Continuous data collection and analysis have been shown essential to achieving improvement in healthcare. However, the data required for local improvement initiatives are often not readily available from hospital Electronic Health Record (EHR) systems or not routinely collected. Furthermore, improvement teams are often restricted in time and funding thus requiring inexpensive and rapid tools to support their work. Hence, the informatics challenge in healthcare local improvement initiatives consists of providing a mechanism for rapid modelling of the local domain by non-informatics experts, including performance metric definitions, and grounded in established improvement techniques. We investigate the feasibility of a model-driven software approach to address this challenge, whereby an improvement model designed by a team is used to automatically generate required electronic data collection instruments and reporting tools. To that goal, we have designed a generic Improvement Data Model (IDM) to capture the data items and quality measures relevant to the project, and constructed Web Improvement Support in Healthcare (WISH), a prototype tool that takes user-generated IDM models and creates a data schema, data collection web interfaces, and a set of live reports, based on Statistical Process Control (SPC) for use by improvement teams. The software has been successfully used in over 50 improvement projects, with more than 700 users. We present in detail the experiences of one of those initiatives, Chronic Obstructive Pulmonary Disease project in Northwest London hospitals. The specific challenges of improvement in healthcare are analysed and the benefits and limitations of the approach are discussed. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Improving hand hygiene in a paediatric hospital: a multimodal quality improvement approach.

Science.gov (United States)

Jamal, Ahmed; O'Grady, G; Harnett, E; Dalton, D; Andresen, D

2012-02-01

Effective hand hygiene has long been recognised as an important way to reduce the transmission of bacterial and viral pathogens in healthcare settings. However, many studies have shown that adherence to hand hygiene remains low, and improvement efforts have often not delivered sustainable results. The Children's Hospital at Westmead is the largest tertiary paediatric hospital in Sydney, Australia. The hospital participated in a state-wide 'Clean hands save lives' campaign which was initiated in 2006. Strong leadership, good stakeholder engagement, readily accessible alcohol-based hand rub at the point of patient care, a multifaceted education programme, monitoring of staff, adherence to recommended hand hygiene practices and contemporaneous feedback of performance data have significantly improved and maintained compliance with hand hygiene. Hand hygiene compliance has increased from 23% in 2006 to 87% in 2011 (phand hygiene has been evident in the last 4 years. A decline in a set of hospital-acquired infections (including rotavirus, multiresistant organism transmission, and nosocomial bacteraemia) has also been noted as hand hygiene rates have improved. Monthly usage of alcohol-based hand rub has increased from 16 litres/1000 bed days to 51 litres/1000 bed days during this same period. This project has delivered sustained improvement in hand hygiene compliance by establishing a framework of multimodal evidence-based strategies.

Models for Evaluating and Improving Architecture Competence

National Research Council Canada - National Science Library

Bass, Len; Clements, Paul; Kazman, Rick; Klein, Mark

2008-01-01

... producing high-quality architectures. This report lays out the basic concepts of software architecture competence and describes four models for explaining, measuring, and improving the architecture competence of an individual...

Improvement of Reynolds-Stress and Triple-Product Lag Models

Science.gov (United States)

Olsen, Michael E.; Lillard, Randolph P.

2017-01-01

The Reynolds-stress and triple product Lag models were created with a normal stress distribution which was denied by a 4:3:2 distribution of streamwise, spanwise and wall normal stresses, and a ratio of r(sub w) = 0.3k in the log layer region of high Reynolds number flat plate flow, which implies R11(+)= [4/(9/2)*.3] approximately 2.96. More recent measurements show a more complex picture of the log layer region at high Reynolds numbers. The first cut at improving these models along with the direction for future refinements is described. Comparison with recent high Reynolds number data shows areas where further work is needed, but also shows inclusion of the modeled turbulent transport terms improve the prediction where they influence the solution. Additional work is needed to make the model better match experiment, but there is significant improvement in many of the details of the log layer behavior.

A process improvement model for software verification and validation

Science.gov (United States)

Callahan, John; Sabolish, George

1994-01-01

We describe ongoing work at the NASA Independent Verification and Validation (IV&V) Facility to establish a process improvement model for software verification and validation (V&V) organizations. This model, similar to those used by some software development organizations, uses measurement-based techniques to identify problem areas and introduce incremental improvements. We seek to replicate this model for organizations involved in V&V on large-scale software development projects such as EOS and space station. At the IV&V Facility, a university research group and V&V contractors are working together to collect metrics across projects in order to determine the effectiveness of V&V and improve its application. Since V&V processes are intimately tied to development processes, this paper also examines the repercussions for development organizations in large-scale efforts.

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.

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…

An Improved Valuation Model for Technology Companies

Directory of Open Access Journals (Sweden)

Ako Doffou

2015-06-01

Full Text Available This paper estimates some of the parameters of the Schwartz and Moon (2001 model using cross-sectional data. Stochastic costs, future financing, capital expenditures and depreciation are taken into account. Some special conditions are also set: the speed of adjustment parameters are equal; the implied half-life of the sales growth process is linked to analyst forecasts; and the risk-adjustment parameter is inferred from the company’s observed stock price beta. The model is illustrated in the valuation of Google, Amazon, eBay, Facebook and Yahoo. The improved model is far superior to the Schwartz and Moon (2001 model.

Improving PSA quality of KSNP PSA model

International Nuclear Information System (INIS)

Yang, Joon Eon; Ha, Jae Joo

2004-01-01

In the RIR (Risk-informed Regulation), PSA (Probabilistic Safety Assessment) plays a major role because it provides overall risk insights for the regulatory body and utility. Therefore, the scope, the level of details and the technical adequacy of PSA, i.e. the quality of PSA is to be ensured for the successful RIR. To improve the quality of Korean PSA, we evaluate the quality of the KSNP (Korean Standard Nuclear Power Plant) internal full-power PSA model based on the 'ASME PRA Standard' and the 'NEI PRA Peer Review Process Guidance.' As a working group, PSA experts of the regulatory body and industry also participated in the evaluation process. It is finally judged that the overall quality of the KSNP PSA is between the ASME Standard Capability Category I and II. We also derive some items to be improved for upgrading the quality of the PSA up to the ASME Standard Capability Category II. In this paper, we show the result of quality evaluation, and the activities to improve the quality of the KSNP PSA model

Quality of Diabetes Care in Germany Improved from 2000 to 2007 to 2014, but Improvements Diminished since 2007. Evidence from the Population-Based KORA Studies.

Directory of Open Access Journals (Sweden)

Michael Laxy

Full Text Available Little is known about the development of the quality of diabetes care in Germany. The aim of this study is to analyze time trends in patient self-management, physician-delivered care, medication, risk factor control, complications and quality of life from 2000 to 2014.Analyses are based on data from individuals with type 2 diabetes of the population-based KORA S4 (1999-2001, n = 150, F4 (2006-2008, n = 203, FF4 (2013/14, n = 212 cohort study. Information on patient self-management, physician-delivered care, medication, risk factor control and quality of life were assessed in standardized questionnaires and examinations. The 10-year coronary heart disease (CHD risk was calculated using the UKPDS risk engine. Time trends were analyzed using multivariable linear and logistic regression models adjusted for age, sex, education, diabetes duration, and history of cardiovascular disease.From 2000 to 2014 the proportion of participants with type 2 diabetes receiving oral antidiabetic/cardio-protective medication and of those reaching treatment goals for glycemic control (HbA1c<7%, 60% to 71%, p = 0.09, blood pressure (<140/80 mmHg, 25% to 69%, p<0.001 and LDL cholesterol (<2.6 mmol/l, 13% to 27%, p<0.001 increased significantly. However, improvements were generally smaller from 2007 to 2014 than from 2000 to 2007. Modeled 10-year CHD risk decreased from 30% in 2000 to 24% in 2007 to 19% in 2014 (p<0.01. From 2007 to 2014, the prevalence of microvascular complications decreased and quality of life increased, but no improvements were observed for the majority of indicators of self-management.Despite improvements, medication and risk factor control has remained suboptimal. The flattening of improvements and deteriorations in quality of (self- care since 2007 indicate that more effort is needed to improve quality of care and patient self-management. Due to selection or lead time bias an overestimation of quality of care improvements cannot be ruled out.

Change for the better: an innovative model of care delivering positive patient and workforce outcomes.

Science.gov (United States)

Cann, Tina; Gardner, Anne

2012-01-01

To evaluate patient and workforce outcomes following the implementation of the Practice Partnership Model of Care. Pre-test-post-test design. A 29-bed surgical ward at a tertiary-level regional hospital. Summary de-identified data from all patients and ward nursing staff in the study period. The Practice Partnership Model of Care has four main components: working in partnership; clinical handover at the bedside; comfort rounds; and environmental modifications. These reflect patient-centered and quality focused initiatives and use a total quality improvement framework that aims to transform care at the bedside. Patient outcomes: changes in patient safety (measured by numbers of medication errors and patient falls); satisfaction with care (use of the call bell system, number of complaints and compliments). Workforce outcomes: changes in staff satisfaction (measured through staff sick leave). A statistically significant reduction in use of nurse call bells (p=<0.001) post-implementation. Medication errors and patient falls reduced, with an overall reduction of 4% in staff sick leave. The Practice Partnership Model of Care positively affected patient and workforce outcomes, suggesting further exploration of this model in other hospital contexts is warranted.

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.

Improving Arctic Sea Ice Observations and Data Access to Support Advances in Sea Ice Forecasting

Science.gov (United States)

Farrell, S. L.

2017-12-01

The economic and strategic importance of the Arctic region is becoming apparent. One of the most striking and widely publicized changes underway is the declining sea ice cover. Since sea ice is a key component of the climate system, its ongoing loss has serious, and wide-ranging, socio-economic implications. Increasing year-to-year variability in the geographic location, concentration, and thickness of the Arctic ice cover will pose both challenges and opportunities. The sea ice research community must be engaged in sustained Arctic Observing Network (AON) initiatives so as to deliver fit-for-purpose remote sensing data products to a variety of stakeholders including Arctic communities, the weather forecasting and climate modeling communities, industry, local, regional and national governments, and policy makers. An example of engagement is the work currently underway to improve research collaborations between scientists engaged in obtaining and assessing sea ice observational data and those conducting numerical modeling studies and forecasting ice conditions. As part of the US AON, in collaboration with the Interagency Arctic Research Policy Committee (IARPC), we are developing a strategic framework within which observers and modelers can work towards the common goal of improved sea ice forecasting. Here, we focus on sea ice thickness, a key varaible of the Arctic ice cover. We describe multi-sensor, and blended, sea ice thickness data products under development that can be leveraged to improve model initialization and validation, as well as support data assimilation exercises. We will also present the new PolarWatch initiative (polarwatch.noaa.gov) and discuss efforts to advance access to remote sensing satellite observations and improve communication with Arctic stakeholders, so as to deliver data products that best address societal needs.

The Art and Skill of Delivering Culturally Responsive TF-CBT in Tanzania and Kenya

Science.gov (United States)

Kava, Christine M.; Akiba, Christopher F.; Lucid, Leah; Dorsey, Shannon

2016-01-01

Objective This study explored the facilitators, barriers, and strategies used to deliver a child mental health evidence-based treatment (EBT), trauma-focused cognitive behavioral therapy (TF-CBT), in a culturally responsive manner. In low- and middle-income countries most individuals with mental health problems do not receive treatment due to a shortage of mental health professionals. One approach to addressing this problem is task-sharing, in which lay counselors are trained to deliver mental health treatment. Combining this approach with a focus on EBT provides a strategy for bridging the mental health treatment gap. However, little is known how about western-developed EBTs are delivered in a culturally responsive manner. Method Semistructured qualitative interviews were conducted with 12 TF-CBT lay counselors involved in a large randomized controlled trial of TF-CBT in Kenya and Tanzania. An inductive approach was used to analyze the data. Results Lay counselors described the importance of being responsive to TF-CBT participants’ customs, beliefs, and socioeconomic conditions and highlighted the value of TF-CBT for their community. They also discussed the importance of partnering with other organizations to address unmet socioeconomic needs. Conclusion The findings from this study provide support for the acceptability and appropriateness of TF-CBT as a treatment approach for improving child mental health. Having a better understanding of the strategies used by lay counselors to ensure that treatment is relevant to the cultural and socioeconomic context of participants can help to inform the implementation of future EBTs. PMID:27414470

A Peer-Led, Social Media-Delivered, Safer Sex Intervention for Chinese College Students: Randomized Controlled Trial.

Science.gov (United States)

Sun, Wai Han; Wong, Carlos King Ho; Wong, William Chi Wai

2017-08-09

The peer-led, social media-delivered intervention is an emerging method in sexual health promotion. However, no research has yet investigated its effectiveness as compared with other online channels or in an Asian population. The objective of this study is to compare a peer-led, social media-delivered, safer sex intervention with a sexual health website. Both conditions target Chinese college students in Hong Kong. A randomized controlled trial was conducted with a peer-led, safer sex Facebook group as the intervention and an existing online sexual health website as the control. The intervention materials were developed with peer input and followed the information-motivation-behavioral skills model; the intervention was moderated by peer educators. The participants filled out the online questionnaires before and after the 6-week intervention period. Outcome evaluations included safer sex attitudes, behavioral skills, and behaviors, while process evaluation focused on online experience, online-visiting frequency, and online engagement. The effect of online-visiting frequency and online engagement on outcome variables was investigated. Of 196 eligible participants-100 in the control group and 96 in the intervention group-who joined the study, 2 (1.0%) control participants joined the Facebook group and 24 of the remaining 194 participants (12.4%) were lost to follow-up. For the process evaluation, participants in the intervention group reported more satisfying online experiences (Psocial media-delivered, safer sex intervention was found to be feasible and effective in improving attitudes toward condom use and behavioral skills, but was not significantly more effective than a website. Future research may focus on the long-term effectiveness and cost-effectiveness of this popular method, as well as the potential cultural differences of using social media between different countries. Chinese Clinical Trial Registry (ChiCTR): ChiCTR-IOR-16009495; http

An evaluation of the effect of an educational intervention for Australian social workers on competence in delivering brief cognitive behavioural strategies: a randomised controlled trial.

Science.gov (United States)

Armstrong, G; Blashki, G; Joubert, L; Bland, R; Moulding, R; Gunn, J; Naccarella, L

2010-11-05

Broad community access to high quality evidence-based primary mental health care is an ongoing challenge around the world. In Australia one approach has been to broaden access to care by funding psychologists and other allied health care professionals to deliver brief psychological treatments to general practitioners' patients. To date, there has been a scarcity of studies assessing the efficacy of social worker delivered psychological strategies. This study aims to build the evidence base by evaluating the impact of a brief educational intervention on social workers' competence in delivering cognitive behavioural strategies (strategies derived from cognitive behavioural therapy). A randomised controlled trial design was undertaken with baseline and one-week follow-up measurement of both objective and self-perceived competence. Simulated consultations with standardised depressed patients were recorded on videotape and objective competence was assessed by blinded reviewers using the Cognitive Therapy Scale. Questionnaires completed by participants were used to measure self-perceived competence. The training intervention was a 15 hour face-to-face course involving presentations, video example consultations, written materials and rehearsal of skills in pairs. 40 Melbourne-based (Australia) social workers enrolled and were randomised and 9 of these withdrew from the study before the pre training simulated consultation. 30 of the remaining 31 social workers (97%) completed all phases of the intervention and evaluation protocol (16 from intervention and 14 from control group). The intervention group showed significantly greater improvements than the control group in objective competence (mean improvement of 14.2 (7.38-21.02) on the 66 point Cognitive Therapy Scale) and in subjective confidence (mean improvement of 1.28 (0.84-1.72) on a 5 point Likert scale). On average, the intervention group improved from below to above the base competency threshold on the Cognitive

An evaluation of the effect of an educational intervention for Australian social workers on competence in delivering brief cognitive behavioural strategies: A randomised controlled trial

Directory of Open Access Journals (Sweden)

Moulding R

2010-11-01

Full Text Available Abstract Background Broad community access to high quality evidence-based primary mental health care is an ongoing challenge around the world. In Australia one approach has been to broaden access to care by funding psychologists and other allied health care professionals to deliver brief psychological treatments to general practitioners' patients. To date, there has been a scarcity of studies assessing the efficacy of social worker delivered psychological strategies. This study aims to build the evidence base by evaluating the impact of a brief educational intervention on social workers' competence in delivering cognitive behavioural strategies (strategies derived from cognitive behavioural therapy. Methods A randomised controlled trial design was undertaken with baseline and one-week follow-up measurement of both objective and self-perceived competence. Simulated consultations with standardised depressed patients were recorded on videotape and objective competence was assessed by blinded reviewers using the Cognitive Therapy Scale. Questionnaires completed by participants were used to measure self-perceived competence. The training intervention was a 15 hour face-to-face course involving presentations, video example consultations, written materials and rehearsal of skills in pairs. Results 40 Melbourne-based (Australia social workers enrolled and were randomised and 9 of these withdrew from the study before the pre training simulated consultation. 30 of the remaining 31 social workers (97% completed all phases of the intervention and evaluation protocol (16 from intervention and 14 from control group. The intervention group showed significantly greater improvements than the control group in objective competence (mean improvement of 14.2 (7.38-21.02 on the 66 point Cognitive Therapy Scale and in subjective confidence (mean improvement of 1.28 (0.84-1.72 on a 5 point Likert scale. On average, the intervention group improved from below to above

An evaluation of the effect of an educational intervention for Australian social workers on competence in delivering brief cognitive behavioural strategies: A randomised controlled trial

Science.gov (United States)

2010-01-01

Background Broad community access to high quality evidence-based primary mental health care is an ongoing challenge around the world. In Australia one approach has been to broaden access to care by funding psychologists and other allied health care professionals to deliver brief psychological treatments to general practitioners' patients. To date, there has been a scarcity of studies assessing the efficacy of social worker delivered psychological strategies. This study aims to build the evidence base by evaluating the impact of a brief educational intervention on social workers' competence in delivering cognitive behavioural strategies (strategies derived from cognitive behavioural therapy). Methods A randomised controlled trial design was undertaken with baseline and one-week follow-up measurement of both objective and self-perceived competence. Simulated consultations with standardised depressed patients were recorded on videotape and objective competence was assessed by blinded reviewers using the Cognitive Therapy Scale. Questionnaires completed by participants were used to measure self-perceived competence. The training intervention was a 15 hour face-to-face course involving presentations, video example consultations, written materials and rehearsal of skills in pairs. Results 40 Melbourne-based (Australia) social workers enrolled and were randomised and 9 of these withdrew from the study before the pre training simulated consultation. 30 of the remaining 31 social workers (97%) completed all phases of the intervention and evaluation protocol (16 from intervention and 14 from control group). The intervention group showed significantly greater improvements than the control group in objective competence (mean improvement of 14.2 (7.38-21.02) on the 66 point Cognitive Therapy Scale) and in subjective confidence (mean improvement of 1.28 (0.84-1.72) on a 5 point Likert scale). On average, the intervention group improved from below to above the base competency

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.

An Improved QTM Subdivision Model with Approximate Equal-area

Directory of Open Access Journals (Sweden)

ZHAO Xuesheng

2016-01-01

Full Text Available To overcome the defect of large area deformation in the traditional QTM subdivision model, an improved subdivision model is proposed which based on the “parallel method” and the thought of the equal area subdivision with changed-longitude-latitude. By adjusting the position of the parallel, this model ensures that the grid area between two adjacent parallels combined with no variation, so as to control area variation and variation accumulation of the QTM grid. The experimental results show that this improved model not only remains some advantages of the traditional QTM model(such as the simple calculation and the clear corresponding relationship with longitude/latitude grid, etc, but also has the following advantages: ①this improved model has a better convergence than the traditional one. The ratio of area_max/min finally converges to 1.38, far less than 1.73 of the “parallel method”; ②the grid units in middle and low latitude regions have small area variations and successive distributions; meanwhile, with the increase of subdivision level, the grid units with large variations gradually concentrate to the poles; ③the area variation of grid unit will not cumulate with the increasing of subdivision level.

Plant water potential improves prediction of empirical stomatal models.

Directory of Open Access Journals (Sweden)

William R L Anderegg

Full Text Available Climate change is expected to lead to increases in drought frequency and severity, with deleterious effects on many ecosystems. Stomatal responses to changing environmental conditions form the backbone of all ecosystem models, but are based on empirical relationships and are not well-tested during drought conditions. Here, we use a dataset of 34 woody plant species spanning global forest biomes to examine the effect of leaf water potential on stomatal conductance and test the predictive accuracy of three major stomatal models and a recently proposed model. We find that current leaf-level empirical models have consistent biases of over-prediction of stomatal conductance during dry conditions, particularly at low soil water potentials. Furthermore, the recently proposed stomatal conductance model yields increases in predictive capability compared to current models, and with particular improvement during drought conditions. Our results reveal that including stomatal sensitivity to declining water potential and consequent impairment of plant water transport will improve predictions during drought conditions and show that many biomes contain a diversity of plant stomatal strategies that range from risky to conservative stomatal regulation during water stress. Such improvements in stomatal simulation are greatly needed to help unravel and predict the response of ecosystems to future climate extremes.

Dust Rains Deliver Diverse Assemblages of Microorganisms to the Eastern Mediterranean

Science.gov (United States)

Itani, Ghida Nouhad; Smith, Colin Andrew

2016-03-01

Dust rains may be particularly effective at delivering microorganisms, yet their biodiversities have been seldom examined. During 2011 and 2012 in Beirut, Lebanon, 16 of 21 collected rainfalls appeared dusty. Trajectory modelling of air mass origins was consistent with North African sources and at least one Southwest Asian source. As much as ~4 g particulate matter, ~20 μg DNA, and 50 million colony forming units were found deposited per square meter during rainfalls each lasting less than one day. Sequencing of 93 bacteria and 25 fungi cultured from rain samples revealed diverse bacterial phyla, both Gram positive and negative, and Ascomycota fungi. Denaturing Gradient Gel Electrophoresis of amplified 16S rDNA of 13 rains revealed distinct and diverse assemblages of bacteria. Dust rain 16S libraries yielded 131 sequences matching, in decreasing order of abundance, Betaproteobacteria, Alphaproteobacteria, Firmicutes, Actinobacteria, Bacteroidetes, Cyanobacteria, Epsilonproteobacteria, Gammaproteobacteria, and Deltaproteobacteria. Clean rain 16S libraries yielded 33 sequences matching only Betaproteobacteria family Oxalobacteraceae. Microbial composition varied between dust rains, and more diverse and different microbes were found in dust rains than clean rains. These results show that dust rains deliver diverse communities of microorganisms that may be complex products of revived desert soil species and fertilized cloud species.

Using program logic model analysis to evaluate and better deliver what works

International Nuclear Information System (INIS)

Megdal, Lori; Engle, Victoria; Pakenas, Larry; Albert, Scott; Peters, Jane; Jordan, Gretchen

2005-01-01

There is a rich history in using program theories and logic models (PT/LM) for evaluation, monitoring, and program refinement in a variety of fields, such as health care, social and education programs. The use of these tools to evaluate and improve energy efficiency programs has been growing over the last 5-7 years. This paper provides an overview of the state-of-the-art methods of logic model development, with analysis that significantly contributed to: Assessing the logic behind how the program expects to be able to meets its ultimate goals, including the 'who', the 'how', and through what mechanism. In doing so, gaps and questions that still need to be addressed can be identified. Identifying and prioritize the indicators that should be measured to evaluate the program and program theory. Determining key researchable questions that need to be answered by evaluation/research, to assess whether the mechanism assumed to cause the changes in actions, attitudes, behaviours, and business practices is workable and efficient. Also will assess the validity in the program logic and the likelihood that the program can accomplish its ultimate goals. Incorporating analysis of prior like programs and social science theories in a framework to identify opportunities for potential program refinements. The paper provides an overview of the tools, techniques and references, and uses as example the energy efficiency program analysis conducted for the New York State Energy Research and Development Authority's (NYSERDA) New York ENERGY $MART SM programs

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 service adaptation with 3G technology

NARCIS (Netherlands)

Liotta, A.; Yew, A.; Bohoris, C.; Pavlou, G.; Feridun, M.; Kropf, P.G.; Babin, G.

2002-01-01

Now that 3G technologies have reached their maturity, newly advanced services can be delivered to the mobile user. These include context- aware services, adaptable services and Virtual Home Environment (VHE)-like services. Important research issues relate, however, to managing such services through

Utilization of the Behavior Change Wheel framework to develop a model to improve cardiometabolic screening for people with severe mental illness

Directory of Open Access Journals (Sweden)

Christina Mangurian

2017-11-01

Full Text Available Abstract Background Individuals with severe mental illness (e.g., schizophrenia, bipolar disorder die 10–25 years earlier than the general population, primarily from premature cardiovascular disease (CVD. Contributing factors are complex, but include systemic-related factors of poorly integrated primary care and mental health services. Although evidence-based models exist for integrating mental health care into primary care settings, the evidence base for integrating medical care into specialty mental health settings is limited. Such models are referred to as “reverse” integration. In this paper, we describe the application of an implementation science framework in designing a model to improve CVD outcomes for individuals with severe mental illness (SMI who receive services in a community mental health setting. Methods Using principles from the theory of planned behavior, focus groups were conducted to understand stakeholder perspectives of barriers to CVD risk factor screening and treatment identify potential target behaviors. We then applied results to the overarching Behavior Change Wheel framework, a systematic and theory-driven approach that incorporates the COM-B model (capability, opportunity, motivation, and behavior, to build an intervention to improve CVD risk factor screening and treatment for people with SMI. Results Following a stepped approach from the Behavior Change Wheel framework, a model to deliver primary preventive care for people that use community mental health settings as their de facto health home was developed. The CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness model focuses on engaging community psychiatrists to expand their scope of practice to become responsible for CVD risk, with significant clinical decision support. Conclusion The CRANIUM model was designed by integrating behavioral change theory and implementation

Effects of healthcare professional delivered early feeding interventions on feeding practices and dietary intake: A systematic review.

Science.gov (United States)

Matvienko-Sikar, Karen; Toomey, Elaine; Delaney, Lisa; Harrington, Janas; Byrne, Molly; Kearney, Patricia M

2018-04-01

Childhood obesity is a global public health challenge. Parental feeding practices, such as responsive feeding, are implicated in the etiology of childhood obesity. This systematic review aimed to examine of effects of healthcare professional-delivered early feeding interventions, on parental feeding practices, dietary intake, and weight outcomes for children up to 2 years. The role of responsive feeding interventions was also specifically examined. Databases searched included: CINAHL, the Cochrane Library, EMBASE, Medline, PubMed, PsycINFO, and Maternity and Infant Care. participants are parents of children ≤2 years; intervention includes focus on early child feeding to prevent overweight and obesity; intervention delivered by healthcare professionals. Sixteen papers, representing 10 trials, met inclusion criteria for review. Six interventions included responsive feeding components. Interventions demonstrated inconsistent effects on feeding practices, dietary intake, and weight outcomes. Findings suggest some reductions in pressure to eat and infant consumption of non-core beverages. Responsive feeding based interventions demonstrate greater improvements in feeding approaches, and weight outcomes. The findings of this review highlight the importance of incorporating responsive feeding in healthcare professional delivered early feeding interventions to prevent childhood obesity. Observed inconsistencies across trials may be explained by methodological limitations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improving the physiological realism of experimental models.

Science.gov (United States)

Vinnakota, Kalyan C; Cha, Chae Y; Rorsman, Patrik; Balaban, Robert S; La Gerche, Andre; Wade-Martins, Richard; Beard, Daniel A; Jeneson, Jeroen A L

2016-04-06

The Virtual Physiological Human (VPH) project aims to develop integrative, explanatory and predictive computational models (C-Models) as numerical investigational tools to study disease, identify and design effective therapies and provide an in silico platform for drug screening. Ultimately, these models rely on the analysis and integration of experimental data. As such, the success of VPH depends on the availability of physiologically realistic experimental models (E-Models) of human organ function that can be parametrized to test the numerical models. Here, the current state of suitable E-models, ranging from in vitro non-human cell organelles to in vivo human organ systems, is discussed. Specifically, challenges and recent progress in improving the physiological realism of E-models that may benefit the VPH project are highlighted and discussed using examples from the field of research on cardiovascular disease, musculoskeletal disorders, diabetes and Parkinson's disease.

Can model weighting improve probabilistic projections of climate change?

Energy Technology Data Exchange (ETDEWEB)

Raeisaenen, Jouni; Ylhaeisi, Jussi S. [Department of Physics, P.O. Box 48, University of Helsinki (Finland)

2012-10-15

Recently, Raeisaenen and co-authors proposed a weighting scheme in which the relationship between observable climate and climate change within a multi-model ensemble determines to what extent agreement with observations affects model weights in climate change projection. Within the Third Coupled Model Intercomparison Project (CMIP3) dataset, this scheme slightly improved the cross-validated accuracy of deterministic projections of temperature change. Here the same scheme is applied to probabilistic temperature change projection, under the strong limiting assumption that the CMIP3 ensemble spans the actual modeling uncertainty. Cross-validation suggests that probabilistic temperature change projections may also be improved by this weighting scheme. However, the improvement relative to uniform weighting is smaller in the tail-sensitive logarithmic score than in the continuous ranked probability score. The impact of the weighting on projection of real-world twenty-first century temperature change is modest in most parts of the world. However, in some areas mainly over the high-latitude oceans, the mean of the distribution is substantially changed and/or the distribution is considerably narrowed. The weights of individual models vary strongly with location, so that a model that receives nearly zero weight in some area may still get a large weight elsewhere. Although the details of this variation are method-specific, it suggests that the relative strengths of different models may be difficult to harness by weighting schemes that use spatially uniform model weights. (orig.)

Rapid-fire improvement with short-cycle kaizen.

Science.gov (United States)

Heard, E

1999-05-01

Continuous improvement is an attractive idea, but it is typically more myth than reality. SCK is no myth. It delivers dramatic improvements in traditional measures quickly. SCK accomplishes this via kaizens: rapid, repeated, time-compressed changes for the better in bite-sized chunks of the business.

Group interventions to improve health outcomes: a framework for their design and delivery

Directory of Open Access Journals (Sweden)

Avenell Alison

2010-12-01

Full Text Available Abstract Background Delivering an intervention to a group of patients to improve health outcomes is increasingly popular in public health and primary care, yet "group" is an umbrella term which encompasses a complex range of aims, theories, implementation processes and evaluation methods. We propose a framework for the design and process evaluation of health improvement interventions occurring in a group setting, which will assist practitioners, researchers and policy makers. Methods We reviewed the wider literature on health improvement interventions delivered to patient groups and identified a gap in the literature for designing, evaluating and reporting these interventions. We drew on our experiences conducting systematic reviews, intervention, mixed method and ethnographic studies of groups for breastfeeding and weight management. A framework for health improvement group design and delivery evolved through an iterative process of primary research, reference to the literature and research team discussion. Results Although there is an extensive literature on group processes in education, work, politics and psychological therapies, far less is known about groups where the aim is health improvement. Theories of behaviour change which are validated for individual use are often assumed to be generalisable to group settings, without being rigorously tested. Health improvement or behaviour change interventions delivered in a group setting are complex adaptive social processes with interactions between the group leader, participants, and the wider community and environment. Ecological models of health improvement, which embrace the complex relationship between behaviour, systems and the environment may be more relevant than an individual approach to behaviour change. Conclusion The evidence for effectiveness and cost-effectiveness of group compared with one-to-one interventions for many areas of health improvement in public health and primary care is

Improving Language Models in Speech-Based Human-Machine Interaction

Directory of Open Access Journals (Sweden)

Raquel Justo

2013-02-01

Full Text Available This work focuses on speech-based human-machine interaction. Specifically, a Spoken Dialogue System (SDS that could be integrated into a robot is considered. Since Automatic Speech Recognition is one of the most sensitive tasks that must be confronted in such systems, the goal of this work is to improve the results obtained by this specific module. In order to do so, a hierarchical Language Model (LM is considered. Different series of experiments were carried out using the proposed models over different corpora and tasks. The results obtained show that these models provide greater accuracy in the recognition task. Additionally, the influence of the Acoustic Modelling (AM in the improvement percentage of the Language Models has also been explored. Finally the use of hierarchical Language Models in a language understanding task has been successfully employed, as shown in an additional series of experiments.

An exploratory trial of the effectiveness of an enhanced consultative approach to delivering speech and language intervention in schools.

Science.gov (United States)

Mecrow, Carol; Beckwith, Jennie; Klee, Thomas

2010-01-01

, although improvements in raw scores were observed. Questionnaires completed before and after intervention showed some significant differences relating to how much the child's speech and language difficulties affected him/her at home and at school. This exploratory study demonstrates the benefit of an intensive therapy delivered by specialist teaching assistants for remediating speech and language difficulties experienced by young children in mainstream schools. The service delivery model was perceived by professionals as offering an inclusive and effective practice and provides empirical support for using both direct and indirect intervention in the school setting.

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

20 CFR 669.330 - How are services delivered to the customer?

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false How are services delivered to the customer... Farmworker Jobs Program Customers and Available Program Services § 669.330 How are services delivered to the customer? To ensure that all services are focused on the customer's needs, services are provided through a...

Effect of parent-delivered action observation therapy on upper limb function in unilateral cerebral palsy: a randomized controlled trial.

Science.gov (United States)

Kirkpatrick, Emma; Pearse, Janice; James, Peter; Basu, Anna

2016-10-01

To determine whether home-based, parent-delivered therapy comprising action observation (AO) and repeated practice (RP) improves upper limb function more than RP alone in children with unilateral cerebral palsy (UCP). single-blinded parallel-group randomized controlled trial with 1:1 allocation comparing AO+RP (intervention) with RP alone (control). computer-generated, with allocation concealment by opaque sequentially-numbered envelopes. northern England, August 2011 to September 2013. 70 children with UCP; mean age 5.6 years (SD 2.1), 31 female. home-based activities were provided, tailored to interests and abilities. 15 minutes/day, 5 days/week for 3 months. Assisting Hand Assessment (AHA; primary outcome measure), Melbourne Assessment 2 (MA2), and ABILHAND-Kids at baseline, 3 months, and 6 months. Outcome data was available at 3 months for 28 children in the AO+RP group and 31 controls, and at 6 months for 26 and 28 children respectively. There were no between-group differences in AHA, MA2, or ABILHAND-Kids at 3 or 6 months versus baseline (all p>0.05). Combined-group improvements (pMA2 at 3 months, were maintained at 6 months. ABILHAND-Kids also showed improvement at 3 months (p=0.003), maintained at 6 months. Parent-delivered RP (with or without AO) improves upper limb function and could supplement therapist input. © 2016 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.

Using Data From Ontario's Episode-Based Funding Model to Assess Quality of Chemotherapy.

Science.gov (United States)

Kaizer, Leonard; Simanovski, Vicky; Lalonde, Carlin; Tariq, Huma; Blais, Irene; Evans, William K

2016-10-01

A new episode-based funding model for ambulatory systemic therapy was implemented in Ontario, Canada on April 1, 2014, after a comprehensive knowledge transfer and exchange strategy with providers and administrators. An analysis of the data from the first year of the new funding model provided an opportunity to assess the quality of chemotherapy, which was not possible under the old funding model. Options for chemotherapy regimens given with adjuvant/curative intent or palliative intent were informed by input from disease site groups. Bundles were developed and priced to enable evidence-informed best practice. Analysis of systemic therapy utilization after model implementation was performed to assess the concordance rate of the treatments chosen with recommended practice. The actual number of cycles of treatment delivered was also compared with expert recommendations. Significant improvement compared with baseline was seen in the proportion of adjuvant/curative regimens that aligned with disease site group-recommended options (98% v 90%). Similar improvement was seen for palliative regimens (94% v 89%). However, overall, the number of cycles of adjuvant/curative therapy delivered was lower than recommended best practice in 57.5% of patients. There was significant variation by disease site and between facilities. Linking funding to quality, supported by knowledge transfer and exchange, resulted in a rapid improvement in the quality of systemic treatment in Ontario. This analysis has also identified further opportunities for improvement and the need for model refinement.

On improving the communication between models and data.

Science.gov (United States)

Dietze, Michael C; Lebauer, David S; Kooper, Rob

2013-09-01

The potential for model-data synthesis is growing in importance as we enter an era of 'big data', greater connectivity and faster computation. Realizing this potential requires that the research community broaden its perspective about how and why they interact with models. Models can be viewed as scaffolds that allow data at different scales to inform each other through our understanding of underlying processes. Perceptions of relevance, accessibility and informatics are presented as the primary barriers to broader adoption of models by the community, while an inability to fully utilize the breadth of expertise and data from the community is a primary barrier to model improvement. Overall, we promote a community-based paradigm to model-data synthesis and highlight some of the tools and techniques that facilitate this approach. Scientific workflows address critical informatics issues in transparency, repeatability and automation, while intuitive, flexible web-based interfaces make running and visualizing models more accessible. Bayesian statistics provides powerful tools for assimilating a diversity of data types and for the analysis of uncertainty. Uncertainty analyses enable new measurements to target those processes most limiting our predictive ability. Moving forward, tools for information management and data assimilation need to be improved and made more accessible. © 2013 John Wiley & Sons Ltd.

Bayesian Data Assimilation for Improved Modeling of Road Traffic

NARCIS (Netherlands)

Van Hinsbergen, C.P.Y.

2010-01-01

This thesis deals with the optimal use of existing models that predict certain phenomena of the road traffic system. Such models are extensively used in Advanced Traffic Information Systems (ATIS), Dynamic Traffic Management (DTM) or Model Predictive Control (MPC) approaches in order to improve the

An evaluation of a collaborative bibliotherapy scheme delivered via a library service.

Science.gov (United States)

Macdonald, J; Vallance, D; McGrath, M

2013-12-01

This paper reports on the evaluation of a bibliotherapy scheme delivered via a local library service, in conjunction with General Practice (GP) practices, local social welfare agencies and through self-referral. The Read Yourself Well (RYW) scheme was based on principles established from other similar schemes and as a way of delivering support for adults experiencing mild to moderate mental health problems for whom clinical treatments are not appropriate. The intervention consisted of initial referral and evaluation by the scheme bibliotherapist, a one-hour session at the beginning and end of the intervention where a purpose-designed questionnaire and two mental health assessments were carried out (the General Health Questionnaire and the Clinical Outcomes in Routine Evaluation questionnaire). Contact and support from the bibliotherapist was provided during the intervention period. One hundred and fifty-seven participants were recruited to the evaluation of whom 114 provided full data. Statistical analyses of the mental health scores showed significant improvements post treatment, for, both male and female participants, for all three referral routes, and for participants who were previously library users, and those who joined the library service to participate in the RYW scheme. The results of this large sample evaluation support the proposal that library-based bibliotherapy can be effective in the treatment of mental health problems. © 2012 John Wiley & Sons Ltd.

Racial differences in the effect of a telephone-delivered hypertension disease management program.

Science.gov (United States)

Jackson, George L; Oddone, Eugene Z; Olsen, Maren K; Powers, Benjamin J; Grubber, Janet M; McCant, Felicia; Bosworth, Hayden B

2012-12-01

African Americans are significantly more likely than whites to have uncontrolled hypertension, contributing to significant disparities in cardiovascular disease and events. The goal of this study was to examine whether there were differences in change in blood pressure (BP) for African American and non-Hispanic white patients in response to a medication management and tailored nurse-delivered telephone behavioral program. Five hundred and seventy-three patients (284 African American and 289 non-Hispanic white) primary care patients who participated in the Hypertension Intervention Nurse Telemedicine Study (HINTS) clinical trial. Study arms included: 1) nurse-administered, physician-directed medication management intervention, utilizing a validated clinical decision support system; 2) nurse-administered, behavioral management intervention; 3) combined behavioral management and medication management intervention; and 4) usual care. All interventions were activated based on poorly controlled home BP values. Post-hoc analysis of change in systolic and diastolic blood pressure. General linear models (PROC MIXED in SAS, version 9.2) were used to estimate predicted means at 6-month, 12-month, and 18-month time points, by intervention arm and race subgroups (separate models for systolic and diastolic blood pressure). Improvement in mean systolic blood pressure post-baseline was greater for African American patients in the combined intervention, compared to African American patients in usual care, at 12 months (6.6 mmHg; 95 % CI: -12.5, -0.7; p=0.03) and at 18 months (9.7 mmHg; -16.0, -3.4; p=0.003). At 18 months, mean diastolic BP was 4.8 mmHg lower (95 % CI: -8.5, -1.0; p=0.01) among African American patients in the combined intervention arm, compared to African American patients in usual care. There were no analogous differences for non-Hispanic white patients. The combination of home BP monitoring, remote medication management, and telephone tailored behavioral self

Short-term electricity price forecast based on the improved hybrid model

International Nuclear Information System (INIS)

Dong Yao; Wang Jianzhou; Jiang He; Wu Jie

2011-01-01

Highlights: → The proposed models can detach high volatility and daily seasonality of electricity price. → The improved hybrid forecast models can make full use of the advantages of individual models. → The proposed models create commendable improvements that are relatively satisfactorily for current research. → The proposed models do not require making complicated decisions about the explicit form. - Abstract: Half-hourly electricity price in power system are volatile, electricity price forecast is significant information which can help market managers and participants involved in electricity market to prepare their corresponding bidding strategies to maximize their benefits and utilities. However, the fluctuation of electricity price depends on the common effect of many factors and there is a very complicated random in its evolution process. Therefore, it is difficult to forecast half-hourly prices with traditional only one model for different behaviors of half-hourly prices. This paper proposes the improved forecasting model that detaches high volatility and daily seasonality for electricity price of New South Wales in Australia based on Empirical Mode Decomposition, Seasonal Adjustment and Autoregressive Integrated Moving Average. The prediction errors are analyzed and compared with the ones obtained from the traditional Seasonal Autoregressive Integrated Moving Average model. The comparisons demonstrate that the proposed model can improve the prediction accuracy noticeably.

Short-term electricity price forecast based on the improved hybrid model

Energy Technology Data Exchange (ETDEWEB)

Dong Yao, E-mail: dongyao20051987@yahoo.cn [School of Mathematics and Statistics, Lanzhou University, Lanzhou 730000 (China); Wang Jianzhou, E-mail: wjz@lzu.edu.cn [School of Mathematics and Statistics, Lanzhou University, Lanzhou 730000 (China); Jiang He; Wu Jie [School of Mathematics and Statistics, Lanzhou University, Lanzhou 730000 (China)

2011-08-15

Highlights: {yields} The proposed models can detach high volatility and daily seasonality of electricity price. {yields} The improved hybrid forecast models can make full use of the advantages of individual models. {yields} The proposed models create commendable improvements that are relatively satisfactorily for current research. {yields} The proposed models do not require making complicated decisions about the explicit form. - Abstract: Half-hourly electricity price in power system are volatile, electricity price forecast is significant information which can help market managers and participants involved in electricity market to prepare their corresponding bidding strategies to maximize their benefits and utilities. However, the fluctuation of electricity price depends on the common effect of many factors and there is a very complicated random in its evolution process. Therefore, it is difficult to forecast half-hourly prices with traditional only one model for different behaviors of half-hourly prices. This paper proposes the improved forecasting model that detaches high volatility and daily seasonality for electricity price of New South Wales in Australia based on Empirical Mode Decomposition, Seasonal Adjustment and Autoregressive Integrated Moving Average. The prediction errors are analyzed and compared with the ones obtained from the traditional Seasonal Autoregressive Integrated Moving Average model. The comparisons demonstrate that the proposed model can improve the prediction accuracy noticeably.

A model for continuous improvement at a South African minerals benefication plant

Directory of Open Access Journals (Sweden)

Ras, Eugene Ras

2015-05-01

Full Text Available South Africa has a variety of mineral resources, and several minerals beneficiation plants are currently in operation. These plants must be operated effectively to ensure that the end-users of its products remain internationally competitive. To achieve this objective, plants need a sustainable continuous improvement programme. Several frameworks for continuous improvement are used, with variable success rates, in beneficiation plants around the world. However, none of these models specifically addresses continuous improvement from a minerals-processing point of view. The objective of this research study was to determine which factors are important for a continuous improvement model at a minerals beneficiation plant, and to propose a new model using lean manufacturing, six sigma, and the theory of constraints. A survey indicated that managers in the industry prefer a model that combines various continuous improvement models.

Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom

Science.gov (United States)

Devlin, Alison M; McGee-Lennon, Marilyn; O’Donnell, Catherine A; Bouamrane, Matt-Mouley; Agbakoba, Ruth; O’Connor, Siobhan; Grieve, Eleanor; Finch, Tracy; Wyke, Sally; Watson, Nicholas; Browne, Susan

2016-01-01

Objective To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program—a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being. Materials and Methods Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit–led interviews at baseline/mid-point (n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings. Results Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant. Conclusions The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care. PMID:26254480

Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom.

Science.gov (United States)

Devlin, Alison M; McGee-Lennon, Marilyn; O'Donnell, Catherine A; Bouamrane, Matt-Mouley; Agbakoba, Ruth; O'Connor, Siobhan; Grieve, Eleanor; Finch, Tracy; Wyke, Sally; Watson, Nicholas; Browne, Susan; Mair, Frances S

2016-01-01

To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program-a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being. Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit-led interviews at baseline/mid-point (n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings. Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant. The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care. © The Author 2015. Published by Oxford University Press on behalf of

1000th magnet delivered!

CERN Multimedia

2006-01-01

On Monday 20 February members of the AT Department marked the delivery of the 1000th superconducting dipole magnet to CERN. Only 232 more of the dipole magnets are needed for the LHC. The 35 tonne-dipoles are 15 meters long and are being manufactured by three companies: Babcock Noell Nuclear in Germany (which finished its contract in November 2005), Ansaldo Superconduttori in Italy and Alstom-Jeumont in France. "The production is proceeding well and we expect to be complete in October as previously foreseen," said Lucio Rossi, Head of the Magnets and Superconductors Group (AT-MAS). In total, 1650 main magnets are needed for the LHC, of which 1300 have been delivered.

1000th magnet delivered!

CERN Multimedia

2006-01-01

On Monday 20 February members of the AT Department marked the delivery of the 1000th superconducting dipole magnet to CERN. Only 232 more of the dipole magnets are needed for the LHC. The 35-tonne-dipoles are 15 meters long and are being manufactured by three companies: Babcock Noell Nuclear in Germany (which completed its contract in November 2005), Ansaldo Superconduttori in Italy and Alstom-Jeumont in France. 'The production is proceeding well and we expect to be complete in October as foreseen,' said Lucio Rossi, Head of the Magnets and Superconductors Group (AT-MAS). In total, 1650 main magnets are needed for the LHC, of which 1300 have already been delivered.

BEING DELIVERED: SPIRITUALITY IN SURVIVORS OF SEXUAL VIOLENCE

Science.gov (United States)

Knapik, Gregory P.; Martsolf, Donna S.; Draucker, Claire B.

2011-01-01

A theoretical framework explaining how survivors of sexual violence use spirituality to respond to or recover from sexual violence is presented. Data were drawn from open-ended interviews of 27 women and 23 men who participated in a larger, ongoing study of women’s and men’s responses to sexual violence. Grounded theory methodology was used to develop the core category of Being Delivered, reflecting the participants’ experiences of being rescued, saved, or set free from the effects of sexual violence by a spiritual being or power. The theoretical framework describing Being Delivered is composed of three dimensions: Spiritual Connection, Spiritual Journey, and Spiritual Transformation. The framework can be used by clinicians to guide discussions of spirituality and healing with survivors of sexual violence. PMID:18382913

Evaluation of delivered dose for a clinical daily adaptive plan selection strategy for bladder cancer radiotherapy

International Nuclear Information System (INIS)

Lutkenhaus, Lotte J.; Visser, Jorrit; Jong, Rianne de; Hulshof, Maarten C.C.M.; Bel, Arjan

2015-01-01

Purpose: To account for variable bladder size during bladder cancer radiotherapy, a daily plan selection strategy was implemented. The aim of this study was to calculate the actually delivered dose using an adaptive strategy, compared to a non-adaptive approach. Material and methods: Ten patients were treated to the bladder and lymph nodes with an adaptive full bladder strategy. Interpolated delineations of bladder and tumor on a full and empty bladder CT scan resulted in five PTVs for which VMAT plans were created. Daily cone beam CT (CBCT) scans were used for plan selection. Bowel, rectum and target volumes were delineated on these CBCTs, and delivered dose for these was calculated using both the adaptive plan, and a non-adaptive plan. Results: Target coverage for lymph nodes improved using an adaptive strategy. The full bladder strategy spared the healthy part of the bladder from a high dose. Average bowel cavity V30Gy and V40Gy significantly reduced with 60 and 69 ml, respectively (p < 0.01). Other parameters for bowel and rectum remained unchanged. Conclusions: Daily plan selection compared to a non-adaptive strategy yielded similar bladder coverage and improved coverage for lymph nodes, with a significant reduction in bowel cavity V30Gy and V40Gy only, while other sparing was limited

Improvement of blow down model for LEAP code

International Nuclear Information System (INIS)

Itooka, Satoshi; Fujimata, Kazuhiro

2003-03-01

In Japan Nuclear Cycle Development Institute, the improvement of analysis method for overheating tube rapture was studied for the accident of sodium-water reactions in the steam generator of a fast breeder reactor and the evaluation of heat transfer condition in the tube were carried out based on study of critical heat flux (CHF) and post-CHF heat transfer equation in Light Water Reactors. In this study, the improvement of blow down model for the LEAP code was carried out taking into consideration the above-mentioned evaluation of heat transfer condition. Improvements of the LEAP code were following items. Calculations and verification were performed with the improved LEAP code in order to confirm the code functions. The addition of critical heat flux (CHF) by the formula of Katto and the formula of Tong. The addition of post-CHF heat transfer equation by the formula of Condie-BengstonIV and the formula of Groeneveld 5.9. The physical properties of the water and steam are expanded to the critical conditions of the water. The expansion of the total number of section and the improvement of the input form. The addition of the function to control the valve setting by the PID control model. (author)

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.

Using Self-Guided Treatment Software (ePST to Teach Clinicians How to Deliver Problem-Solving Treatment for Depression

Directory of Open Access Journals (Sweden)

James A. Cartreine

2012-01-01

Full Text Available Problem-solving treatment (PST offers a promising approach to the depression care; however, few PST training opportunities exist. A computer-guided, interactive media program has been developed to deliver PST electronically (ePST, directly to patients. The program is a six-session, weekly intervention modeled on an evidence-based PST protocol. Users are guided through each session by a clinician who is presented via hundreds of branching audio and video clips. Because expert clinician behaviors are modeled in the program, not only does the ePST program have the potential to deliver PST to patients but it may also serve as a training tool to teach clinicians how to deliver PST. Thirteen social workers and trainees used ePST self-instructionally and subsequently attended a day-long workshop on PST. Participants’ PST knowledge level increased significantly from baseline to post-ePST (P=.001 and did not increase significantly further after attending the subsequent workshop. Additionally, attending the workshop did not significantly increase the participants' skill at performing PST beyond the use of the ePST program. Using the ePST program appears to train novices to a sufficient level of competence to begin practicing PST under supervision. This self-instructional training method could enable PST for depression to be widely disseminated, although follow-up supervision is still required.

Nosocomial infections of ocular conjunctiva in newborns delivered by cesarian section.

Science.gov (United States)

Bezirtzoglou, E; Romond, C

1991-01-01

Colonization of the ocular conjunctiva in newborns delivered by cesarian section occurs usually within the first day of life. We have studied the flora of the ocular conjunctiva at birth, from 19 newborns delivered by cesarian section, coming from two different maternity hospitals. Ocular conjunctiva cultures yielded the main predominant flora in both maternity hospitals considered. The most common genus of this flora are: Staphylococcus, Corynebacterium and Propionibacterium acnes. Peptostreptococcus productus, Neisseria, Eubacterium and Clostridium perfringens are isolated occasionally. In newborns delivered by cesarian section, this flora principally acquired may be the consequence of the presence of bacteria in the ambient air, as well as differences in care provided by the nosocomial personnel.

Non-physician delivered intravitreal injection service is feasible and safe - a systematic review.

Science.gov (United States)

Rasul, Asrin; Subhi, Yousif; Sørensen, Torben Lykke; Munch, Inger Christine

2016-05-01

Non-physicians such as nurses are trained to give injections into the vitreous body of the eye to meet the increasing demand for intravitreal therapy with vascular endothelial growth factor inhibitors against common eye diseases, e.g. age-related macular degeneration and diabetic retinopathy. We systematically reviewed the existing literature to provide an overview of the experiences in this transformational process. We searched for literature on 22 September 2015 using PubMed, Embase, the Cochrane Library, CINAHL and the Web of Science. Eligible studies had to address any outcome based on non-physician delivered intravitreal therapy regardless of the study design. Being non-physician was defined as the injecting personnel not being a physician, but no further restrictions were made. Five studies were included with a total of 31,303 injections having been performed by 16 nurses. The studies found that having nurses perform the intravitreal injections produced to a short-term capacity improvement and liberated physicians for other clinical work. Training was provided through courses and direct supervision. The rates of endophthalmitis were 0-0.40‰, which is comparable to reported rates when the intravitreal therapy is given by physicians. Non-physician delivered intravitreal therapy seems feasible and safe.

Australian mental health consumers contributions to the evaluation and improvement of recovery-oriented service provision.

Science.gov (United States)

Marshal, Sarah L; Oades, Lindsay G; Growe, Trevor P

2010-01-01

One key component of recovery-oriented mental health services, typically overlooked, involves genuine collaboration between researchers and consumers to evaluate and improve services delivered within a recovery framework. Eighteen mental health consumers working with staff who had received training in the Collaborative Recovery Model (CRM) took part in in-depth focus group meetings, of approximately 2.5 hours each, to generate feedback to guide improvement of the CRM and its use in mental health services. Consumers identified clear avenues for improvement for the CRM both specific to the model and broadly applicable to recovery-oriented service provision. Findings suggest consumers want to be more engaged and empowered in the use of the CRM from the outset. Improved sampling procedures may have led to the identification of additional dissatisfied consumers. Collaboration with mental health consumers in the evaluation and improvement of recovery-oriented practice is crucial with an emphasis on rebuilding mental health services that are genuinely oriented to support recovery.

Improved heat transfer modeling of the eye for electromagnetic wave exposures.

Science.gov (United States)

Hirata, Akimasa

2007-05-01

This study proposed an improved heat transfer model of the eye for exposure to electromagnetic (EM) waves. Particular attention was paid to the difference from the simplified heat transfer model commonly used in this field. From our computational results, the temperature elevation in the eye calculated with the simplified heat transfer model was largely influenced by the EM absorption outside the eyeball, but not when we used our improved model.

Improved dust representation in the Community Atmosphere Model

Science.gov (United States)

Albani, S.; Mahowald, N. M.; Perry, A. T.; Scanza, R. A.; Zender, C. S.; Heavens, N. G.; Maggi, V.; Kok, J. F.; Otto-Bliesner, B. L.

2014-09-01

Aerosol-climate interactions constitute one of the major sources of uncertainty in assessing changes in aerosol forcing in the anthropocene as well as understanding glacial-interglacial cycles. Here we focus on improving the representation of mineral dust in the Community Atmosphere Model and assessing the impacts of the improvements in terms of direct effects on the radiative balance of the atmosphere. We simulated the dust cycle using different parameterization sets for dust emission, size distribution, and optical properties. Comparing the results of these simulations with observations of concentration, deposition, and aerosol optical depth allows us to refine the representation of the dust cycle and its climate impacts. We propose a tuning method for dust parameterizations to allow the dust module to work across the wide variety of parameter settings which can be used within the Community Atmosphere Model. Our results include a better representation of the dust cycle, most notably for the improved size distribution. The estimated net top of atmosphere direct dust radiative forcing is -0.23 ± 0.14 W/m2 for present day and -0.32 ± 0.20 W/m2 at the Last Glacial Maximum. From our study and sensitivity tests, we also derive some general relevant findings, supporting the concept that the magnitude of the modeled dust cycle is sensitive to the observational data sets and size distribution chosen to constrain the model as well as the meteorological forcing data, even within the same modeling framework, and that the direct radiative forcing of dust is strongly sensitive to the optical properties and size distribution used.

Titan I propulsion system modeling and possible performance improvements

Science.gov (United States)

Giusti, Oreste

This thesis features the Titan I propulsion systems and offers data-supported suggestions for improvements to increase performance. The original propulsion systems were modeled both graphically in CAD and via equations. Due to the limited availability of published information, it was necessary to create a more detailed, secondary set of models. Various engineering equations---pertinent to rocket engine design---were implemented in order to generate the desired extra detail. This study describes how these new models were then imported into the ESI CFD Suite. Various parameters are applied to these imported models as inputs that include, for example, bi-propellant combinations, pressure, temperatures, and mass flow rates. The results were then processed with ESI VIEW, which is visualization software. The output files were analyzed for forces in the nozzle, and various results were generated, including sea level thrust and ISP. Experimental data are provided to compare the original engine configuration models to the derivative suggested improvement models.

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.

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

Science.gov (United States)

Penney, Christine; Henry, Effie

2008-01-01

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

Progranulin Gene Therapy Improves Lysosomal Dysfunction and Microglial Pathology Associated with Frontotemporal Dementia and Neuronal Ceroid Lipofuscinosis.

Science.gov (United States)

Arrant, Andrew E; Onyilo, Vincent C; Unger, Daniel E; Roberson, Erik D

2018-02-28

Loss-of-function mutations in progranulin, a lysosomal glycoprotein, cause neurodegenerative disease. Progranulin haploinsufficiency causes frontotemporal dementia (FTD) and complete progranulin deficiency causes CLN11 neuronal ceroid lipofuscinosis (NCL). Progranulin replacement is a rational therapeutic strategy for these disorders, but there are critical unresolved mechanistic questions about a progranulin gene therapy approach, including its potential to reverse existing pathology. Here, we address these issues using an AAV vector (AAV- Grn ) to deliver progranulin in Grn -/- mice (both male and female), which model aspects of NCL and FTD pathology, developing lysosomal dysfunction, lipofuscinosis, and microgliosis. We first tested whether AAV- Grn could improve preexisting pathology. Even with treatment after onset of pathology, AAV- Grn reduced lipofuscinosis in several brain regions of Grn -/- mice. AAV- Grn also reduced microgliosis in brain regions distant from the injection site. AAV-expressed progranulin was only detected in neurons, not in microglia, indicating that the microglial activation in progranulin deficiency can be improved by targeting neurons and thus may be driven at least in part by neuronal dysfunction. Even areas with sparse transduction and almost undetectable progranulin showed improvement, indicating that low-level replacement may be sufficiently effective. The beneficial effects of AAV- Grn did not require progranulin binding to sortilin. Finally, we tested whether AAV- Grn improved lysosomal function. AAV-derived progranulin was delivered to the lysosome, ameliorated the accumulation of LAMP-1 in Grn -/- mice, and corrected abnormal cathepsin D activity. These data shed light on progranulin biology and support progranulin-boosting therapies for NCL and FTD due to GRN mutations. SIGNIFICANCE STATEMENT Heterozygous loss-of-function progranulin ( GRN ) mutations cause frontotemporal dementia (FTD) and homozygous mutations cause neuronal

Parotid Glands Dose–Effect Relationships Based on Their Actually Delivered Doses: Implications for Adaptive Replanning in Radiation Therapy of Head-and-Neck Cancer

Energy Technology Data Exchange (ETDEWEB)

Hunter, Klaudia U. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Fernandes, Laura L. [Department of Biostatistics, University of Michigan, Ann Arbor, Michigan (United States); Vineberg, Karen A.; McShan, Daniel; Antonuk, Alan E. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Cornwall, Craig [Department of Hospital Dentistry, University of Michigan, Ann Arbor, Michigan (United States); Feng, Mary [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Schipper, Mathew J. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Department of Biostatistics, University of Michigan, Ann Arbor, Michigan (United States); Balter, James M. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Eisbruch, Avraham, E-mail: eisbruch@umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)

2013-11-15

Purpose: Doses actually delivered to the parotid glands during radiation therapy often exceed planned doses. We hypothesized that the delivered doses correlate better with parotid salivary output than the planned doses, used in all previous studies, and that determining these correlations will help make decisions regarding adaptive radiation therapy (ART) aimed at reducing the delivered doses. Methods and Materials: In this prospective study, oropharyngeal cancer patients treated definitively with chemoirradiation underwent daily cone-beam computed tomography (CBCT) with clinical setup alignment based on the C2 posterior edge. Parotid glands in the CBCTs were aligned by deformable registration to calculate cumulative delivered doses. Stimulated salivary flow rates were measured separately from each parotid gland pretherapy and periodically posttherapy. Results: Thirty-six parotid glands of 18 patients were analyzed. Average mean planned doses was 32 Gy, and differences from planned to delivered mean gland doses were −4.9 to +8.4 Gy, median difference +2.2 Gy in glands in which delivered doses increased relative to planned. Both planned and delivered mean doses were significantly correlated with posttreatment salivary outputs at almost all posttherapy time points, without statistically significant differences in the correlations. Large dispersions (on average, SD 3.6 Gy) characterized the dose–effect relationships for both. The differences between the cumulative delivered doses and planned doses were evident at first fraction (r=.92, P<.0001) because of complex setup deviations (eg, rotations and neck articulations), uncorrected by the translational clinical alignments. Conclusions: After daily translational setup corrections, differences between planned and delivered doses in most glands were small relative to the SDs of the dose–saliva data, suggesting that ART is not likely to gain measurable salivary output improvement in most cases. These differences were

Is International Accounting Education Delivering Pedagogical Value?

Science.gov (United States)

Patel, Chris; Millanta, Brian; Tweedie, Dale

2016-01-01

This paper examines whether universities are delivering pedagogical value to international accounting students commensurate with the costs of studying abroad. The paper uses survey and interview methods to explore the extent to which Chinese Learners (CLs) in an Australian postgraduate accounting subject have distinct learning needs. The paper…

Improving activity transport models for water-cooled nuclear power reactors

Energy Technology Data Exchange (ETDEWEB)

Burrill, K.A

2001-08-01

Eight current models for describing radioactivity transport and radiation field growth around water-cooled nuclear power reactors have been reviewed and assessed. A frequent failing of the models is the arbitrary nature of the determination of the important processes. Nearly all modelers agree that the kinetics of deposition and release of both dissolved and particulate material must be described. Plant data must be used to guide the selection and development of suitable improved models, with a minimum of empirically-based rate constraints being used. Limiting case modelling based on experimental data is suggested as a way to simplify current models and remove their subjectivity. Improved models must consider the recent change to 'coordinated water chemistry' that appears to produce normal solubility behaviour for dissolved iron throughout the fuel cycle in PWRs, but retrograde solubility remains for dissolved nickel. Profiles are suggested for dissolved iron and nickel concentrations around the heat transport system in CANDU reactors, which operate nominally at constant chemistry, i.e., pH{sub T} constant with time, and which use carbon steel isothermal piping. These diagrams are modified for a CANDU reactor with stainless steel piping, in order to show the changes expected. The significance of these profiles for transport in PWRs is discussed for further model improvement. (author)

Forecasting China’s Annual Biofuel Production Using an Improved Grey Model

Directory of Open Access Journals (Sweden)

Nana Geng

2015-10-01

Full Text Available Biofuel production in China suffers from many uncertainties due to concerns about the government’s support policy and supply of biofuel raw material. Predicting biofuel production is critical to the development of this energy industry. Depending on the biofuel’s characteristics, we improve the prediction precision of the conventional prediction method by creating a dynamic fuzzy grey–Markov prediction model. Our model divides random time series decomposition into a change trend sequence and a fluctuation sequence. It comprises two improvements. We overcome the problem of considering the status of future time from a static angle in the traditional grey model by using the grey equal dimension new information and equal dimension increasing models to create a dynamic grey prediction model. To resolve the influence of random fluctuation data and weak anti-interference ability in the Markov chain model, we improve the traditional grey–Markov model with classification of states using the fuzzy set theory. Finally, we use real data to test the dynamic fuzzy prediction model. The results prove that the model can effectively improve the accuracy of forecast data and can be applied to predict biofuel production. However, there are still some defects in our model. The modeling approach used here predicts biofuel production levels based upon past production levels dictated by economics, governmental policies, and technological developments but none of which can be forecast accurately based upon past events.

Delivering stepped care: an analysis of implementation in routine practice

Directory of Open Access Journals (Sweden)

Richards David A

2012-01-01

Full Text Available Abstract Background In the United Kingdom, clinical guidelines recommend that services for depression and anxiety should be structured around a stepped care model, where patients receive treatment at different 'steps,' with the intensity of treatment (i.e., the amount and type increasing at each step if they fail to benefit at previous steps. There are very limited data available on the implementation of this model, particularly on the intensity of psychological treatment at each step. Our objective was to describe patient pathways through stepped care services and the impact of this on patient flow and management. Methods We recorded service design features of four National Health Service sites implementing stepped care (e.g., the types of treatments available and their links with other treatments, together with the actual treatments received by individual patients and their transitions between different treatment steps. We computed the proportions of patients accessing, receiving, and transiting between the various steps and mapped these proportions visually to illustrate patient movement. Results We collected throughput data on 7,698 patients referred. Patient pathways were highly complex and very variable within and between sites. The ratio of low (e.g., self-help to high-intensity (e.g., cognitive behaviour therapy treatments delivered varied between sites from 22:1, through 2.1:1, 1.4:1 to 0.5:1. The numbers of patients allocated directly to high-intensity treatment varied from 3% to 45%. Rates of stepping up from low-intensity treatment to high-intensity treatment were less than 10%. Conclusions When services attempt to implement the recommendation for stepped care in the National Institute for Health and Clinical Excellence guidelines, there were significant differences in implementation and consequent high levels of variation in patient pathways. Evaluations driven by the principles of implementation science (such as targeted planning

Experiences of non-adherence to Internet-delivered cognitive behavior therapy: A qualitative study

OpenAIRE

Johansson, Olof; Michel, Teresa; Andersson, Gerhard; Paxling, Björn

2015-01-01

Many trials on Internet-delivered psychological treatments have had problems with nonadherence, but not much is known about the subjective reasons for non-adhering. The aim of this study was to explore participants' experiences of non-adherence to Internet-delivered psychological treatment. Grounded theory was used to analyze data from seven in-depth interviews with persons who had non-adhered to a study on Internet-delivered cognitive behavioral therapy for generalized anxiety disorder. The ...

An improved model for the Earth's gravity field

Science.gov (United States)

Tapley, B. D.; Shum, C. K.; Yuan, D. N.; Ries, J. C.; Schutz, B. E.

1989-01-01

An improved model for the Earth's gravity field, TEG-1, was determined using data sets from fourteen satellites, spanning the inclination ranges from 15 to 115 deg, and global surface gravity anomaly data. The satellite measurements include laser ranging data, Doppler range-rate data, and satellite-to-ocean radar altimeter data measurements, which include the direct height measurement and the differenced measurements at ground track crossings (crossover measurements). Also determined was another gravity field model, TEG-1S, which included all the data sets in TEG-1 with the exception of direct altimeter data. The effort has included an intense scrutiny of the gravity field solution methodology. The estimated parameters included geopotential coefficients complete to degree and order 50 with selected higher order coefficients, ocean and solid Earth tide parameters, Doppler tracking station coordinates and the quasi-stationary sea surface topography. Extensive error analysis and calibration of the formal covariance matrix indicate that the gravity field model is a significant improvement over previous models and can be used for general applications in geodesy.

Pilot Randomized Controlled Trial of Internet-Delivered Cognitive-Behavioral Treatment for Pediatric Headache.

Science.gov (United States)

Law, Emily F; Beals-Erickson, Sarah E; Noel, Melanie; Claar, Robyn; Palermo, Tonya M

2015-01-01

To evaluate the feasibility and preliminary effectiveness of an Internet-delivered cognitive-behavioral therapy (CBT) intervention for adolescents with chronic headache. Headache is among the most common pain complaints of childhood. Cognitive-behavioral interventions are efficacious for improving pain among youth with headache. However, many youth do not receive psychological treatment for headache due to poor access, which has led to consideration of alternative delivery modalities such as the Internet. We used a parallel arm randomized controlled trial design to evaluate the feasibility and preliminary effectiveness of an Internet-delivered family-based CBT intervention, Web-based management of adolescent pain. Adolescents were eligible for the trial if they were a new patient being evaluated in a specialized headache clinic, between 11 and 17 years of age, and had recurrent headache for 3 months or more as diagnosed by a pediatric neurologist. Eighty-three youths were enrolled in the trial. An online random number generator was used to randomly assign participants to receive Internet CBT adjunctive to specialized headache treatment (n = 44) or specialized headache treatment alone (n = 39). The primary treatment outcome was headache days. Youth and parents in the Internet CBT group demonstrated high levels of engagement with the web program and reported satisfaction with the intervention. Multilevel modelling (MLM) was used to conduct hypothesis testing for continuous outcomes. For our primary treatment outcome of headache days, adolescents reported a statistically significant reduction in headache days from baseline to post-treatment and baseline to 3-month follow-up in both treatment conditions (main effect for time F(2, 136) = 19.70, P headache treatment group at post-treatment or follow-up (group × time interaction F(2, 134) = 0.94, P = .395). For our secondary treatment outcomes, findings from MLM showed that adolescents in both

Improved dual sided doped memristor: modelling and applications

Directory of Open Access Journals (Sweden)

Anup Shrivastava

2014-05-01

Full Text Available Memristor as a novel and emerging electronic device having vast range of applications suffer from poor frequency response and saturation length. In this paper, the authors present a novel and an innovative device structure for the memristor with two active layers and its non-linear ionic drift model for an improved frequency response and saturation length. The authors investigated and compared the I–V characteristics for the proposed model with the conventional memristors and found better results in each case (different window functions for the proposed dual sided doped memristor. For circuit level simulation, they developed a SPICE model of the proposed memristor and designed some logic gates based on hybrid complementary metal oxide semiconductor memristive logic (memristor ratioed logic. The proposed memristor yields improved results in terms of noise margin, delay time and dynamic hazards than that of the conventional memristors (single active layer memristors.

The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India

OpenAIRE

Balaji, Madhumitha; Chatterjee, Sudipto; Koschorke, Mirja; Rangaswamy, Thara; Chavan, Animish; Dabholkar, Hamid; Dakshin, Lilly; Kumar, Pratheesh; John, Sujit; Thornicroft, Graham; Patel, Vikram

2012-01-01

Abstract Background Care for schizophrenia in low and middle income countries is predominantly facility based and led by specialists, with limited use of non-pharmacological treatments. Although community based psychosocial interventions are emphasised, there is little evidence about their acceptability and feasibility. Furthermore, the shortage of skilled manpower is a major barrier to improving access to these interventions. Our study aimed to develop a lay health worker delivered community...

Process-Improvement Cost Model for the Emergency Department.

Science.gov (United States)

Dyas, Sheila R; Greenfield, Eric; Messimer, Sherri; Thotakura, Swati; Gholston, Sampson; Doughty, Tracy; Hays, Mary; Ivey, Richard; Spalding, Joseph; Phillips, Robin

2015-01-01

The objective of this report is to present a simplified, activity-based costing approach for hospital emergency departments (EDs) to use with Lean Six Sigma cost-benefit analyses. The cost model complexity is reduced by removing diagnostic and condition-specific costs, thereby revealing the underlying process activities' cost inefficiencies. Examples are provided for evaluating the cost savings from reducing discharge delays and the cost impact of keeping patients in the ED (boarding) after the decision to admit has been made. The process-improvement cost model provides a needed tool in selecting, prioritizing, and validating Lean process-improvement projects in the ED and other areas of patient care that involve multiple dissimilar diagnoses.

Bone marrow stem cells delivered into the subarachnoid space via cisterna magna improve repair of injured rat spinal cord white matter

Science.gov (United States)

Marcol, Wiesław; Slusarczyk, Wojciech; Sieroń, Aleksander L; Koryciak-Komarska, Halina; Lewin-Kowalik, Joanna

2015-01-01

The influence of bone marrow stem cells on regeneration of spinal cord in rats was investigated. Young adult male Wistar rats were used (n=22). Focal injury of spinal cord white matter at Th10 level was produced using our original non-laminectomy method by means of high-pressured air stream. Cells from tibial and femoral bone marrow of 1-month old rats (n=3) were cultured, labeled with BrdU/Hoechst and injected into cisterna magna (experimental group) three times: immediately after spinal cord injury and 3 as well as 7 days later. Neurons in brain stem and motor cortex were labeled with FluoroGold (FG) delivered caudally from the injury site a week before the end of experiment. Functional outcome and morphological features of regeneration were analyzed during 12-week follow-up. The lesions were characterized by means of MRI. Maximal distance of expansion of implanted cells in the spinal cord was measured and the number of FG-positive neurons in the brain was counted. Rats treated with stem cells presented significant improvement of locomotor performance and spinal cord morphology when compared to the control group. Distance covered by stem cells was 7 mm from the epicenter of the injury. Number of brain stem and motor cortex FG-positive neurons in experimental group was significantly higher than in control. Obtained data showed that bone marrow stem cells are able to induce the repair of injured spinal cord white matter. The route of cells application via cisterna magna appeared to be useful for their delivery in spinal cord injury therapy. PMID:26628950

A participatory model for improving occupational health and safety: improving informal sector working conditions in Thailand.

Science.gov (United States)

Manothum, Aniruth; Rukijkanpanich, Jittra; Thawesaengskulthai, Damrong; Thampitakkul, Boonwa; Chaikittiporn, Chalermchai; Arphorn, Sara

2009-01-01

The purpose of this study was to evaluate the implementation of an Occupational Health and Safety Management Model for informal sector workers in Thailand. The studied model was characterized by participatory approaches to preliminary assessment, observation of informal business practices, group discussion and participation, and the use of environmental measurements and samples. This model consisted of four processes: capacity building, risk analysis, problem solving, and monitoring and control. The participants consisted of four local labor groups from different regions, including wood carving, hand-weaving, artificial flower making, and batik processing workers. The results demonstrated that, as a result of applying the model, the working conditions of the informal sector workers had improved to meet necessary standards. This model encouraged the use of local networks, which led to cooperation within the groups to create appropriate technologies to solve their problems. The authors suggest that this model could effectively be applied elsewhere to improve informal sector working conditions on a broader scale.

Establishing an Improved Kane Dynamic Model for the 7-DOF Reconfigurable Modular Robot

Directory of Open Access Journals (Sweden)

Xiao Li

2017-01-01

Full Text Available We propose an improved Kane dynamic model theory for the 7-DOF modular robot in this paper, and the model precision is improved by the improved function T′it. We designed three types of progressive modular joints for reconfigurable modular robot that can be used in industrial robot, space robot, and special robot. The Kane dynamic model and the solid dynamic model are established, respectively, for the 7-DOF modular robot. After that, the experimental results are obtained from the simulation experiment of typical task in the established dynamic models. By the analysis model of error, the equation of the improved torque T′it is derived and proposed. And the improved Kane dynamic model is established for the modular robot that used T′it. Based on the experimental data, the undetermined coefficient matrix is five-order linear that was proved in 7-DOF modular robot. And the explicit formulation is solved of the Kane dynamic model and can be used in control system.

Improved Model for Depth Bias Correction in Airborne LiDAR Bathymetry Systems

Directory of Open Access Journals (Sweden)

Jianhu Zhao

2017-07-01

Full Text Available Airborne LiDAR bathymetry (ALB is efficient and cost effective in obtaining shallow water topography, but often produces a low-accuracy sounding solution due to the effects of ALB measurements and ocean hydrological parameters. In bathymetry estimates, peak shifting of the green bottom return caused by pulse stretching induces depth bias, which is the largest error source in ALB depth measurements. The traditional depth bias model is often applied to reduce the depth bias, but it is insufficient when used with various ALB system parameters and ocean environments. Therefore, an accurate model that considers all of the influencing factors must be established. In this study, an improved depth bias model is developed through stepwise regression in consideration of the water depth, laser beam scanning angle, sensor height, and suspended sediment concentration. The proposed improved model and a traditional one are used in an experiment. The results show that the systematic deviation of depth bias corrected by the traditional and improved models is reduced significantly. Standard deviations of 0.086 and 0.055 m are obtained with the traditional and improved models, respectively. The accuracy of the ALB-derived depth corrected by the improved model is better than that corrected by the traditional model.

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

International Nuclear Information System (INIS)

Gouldson, Andy; Sullivan, Rory

2013-01-01

have a reasonably high likelihood of being delivered if energy prices remain high and if the companies can sustain recent rates of improvement. However, the article also cautions against relying on these types of voluntary commitments, noting that their scope is limited (i.e. most targets relate to companies’ direct rather than indirect emissions), and that the inconsistencies and opacities in company reporting on performance and outcomes make it extremely difficult for stakeholders to have confidence that the targets set have actually been delivered

Long-term Clinical Outcomes of Whole-Breast Irradiation Delivered in the Prone Position

International Nuclear Information System (INIS)

Stegman, Lauren D.; Beal, Katherine P.; Hunt, Margie A.; Fornier, Monica N.; McCormick, Beryl

2007-01-01

Purpose: The aim of this study was to evaluate retrospectively the effectiveness and toxicity of post-lumpectomy whole-breast radiation therapy delivered with prone positioning. Methods and Materials: Between September 1992 and August 2004, 245 women with 248 early-stage invasive or in situ breast cancers were treated using a prone breast board. Photon fields treated the whole breast to 46 to 50.4 Gy with standard fractionation. The target volume was clinically palpable breast tissue; no attempt was made to irradiate chest wall lymphatics. Tumor bed boosts were delivered in 85% of cases. Adjuvant chemotherapy and hormonal therapy were administered to 42% and 62% of patients, respectively. Results: After a median follow-up of 4.9 years, the 5 year actuarial true local and elsewhere ipsilateral breast tumor recurrence rates were 4.8% and 1.3%, respectively. The 5-year actuarial rates of regional nodal recurrence and distant metastases were 1.6% and 7.4%. Actuarial disease-free, disease-specific, and overall survival rates at 5 years were 89.4%, 97.3%, and 93%, respectively. Treatment breaks were required by 2.4% of patients. Grade 3 acute dermatitis and edema were each limited to 2% of patients. Only 4.9% of patients complained of acute chest wall discomfort. Chronic Grade 2 to 3 skin and subcutaneous tissue toxicities were reported in 4.4% and 13.7% of patients, respectively. Conclusions: Prone position breast radiation results in similar long-term disease control with a favorable toxicity profile compared with standard supine tangents. The anatomic advantages of prone positioning may contribute to improving the therapeutic ratio of post-lumpectomy radiation by improving dose homogeneity and minimizing incidental cardiac and lung dose

Basic study of the plant maintenance model considering plant improvement/modification

International Nuclear Information System (INIS)

Tsumaya, Akira; Inoue, Kazuya; Mochizuki, Masahito; Wakamatsu, Hidefumi; Arai, Eiji

2007-01-01

This paper proposes a maintenance activity model that considers not only routine maintenance activity but also functional maintenance including improvement/modification. Required maintenance types are categorized, and limitation of Activity Domain Integration Diagram (ADID) proposed by ISO18435 are discussed based on framework for life cycle maintenance management of manufacturing assets. Then, we proposed extension ADID model for plant maintenance activity model considering functional improvement/modification. (author)

Improved model for solar heating of buildings

OpenAIRE

Lie, Bernt

2015-01-01

A considerable future increase in the global energy use is expected, and the effects of energy conversion on the climate are already observed. Future energy conversion should thus be based on resources that have negligible climate effects; solar energy is perhaps the most important of such resources. The presented work builds on a previous complete model for solar heating of a house; here the aim to introduce ventilation heat recovery and improve on the hot water storage model. Ventilation he...

A Case Study Using Modeling and Simulation to Predict Logistics Supply Chain Issues

Science.gov (United States)

Tucker, David A.

2007-01-01

Optimization of critical supply chains to deliver thousands of parts, materials, sub-assemblies, and vehicle structures as needed is vital to the success of the Constellation Program. Thorough analysis needs to be performed on the integrated supply chain processes to plan, source, make, deliver, and return critical items efficiently. Process modeling provides simulation technology-based, predictive solutions for supply chain problems which enable decision makers to reduce costs, accelerate cycle time and improve business performance. For example, United Space Alliance, LLC utilized this approach in late 2006 to build simulation models that recreated shuttle orbiter thruster failures and predicted the potential impact of thruster removals on logistics spare assets. The main objective was the early identification of possible problems in providing thruster spares for the remainder of the Shuttle Flight Manifest. After extensive analysis the model results were used to quantify potential problems and led to improvement actions in the supply chain. Similarly the proper modeling and analysis of Constellation parts, materials, operations, and information flows will help ensure the efficiency of the critical logistics supply chains and the overall success of the program.

76 FR 24339 - Streamlining Service Delivery and Improving Customer Service

Science.gov (United States)

2011-05-02

... accessed by the Internet or mobile phone and improved processes that deliver services faster and more... ``Conversations with America'' to Further Improve Customer Service). However, with advances in technology and... major initiative (signature initiative) that will use technology to improve the customer experience; (b...

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.

Process improvement : the creation and evaluation of process alternatives

NARCIS (Netherlands)

Netjes, M.

2010-01-01

Companies continuously strive to improve their processes to increase productivity and delivered quality against lower costs. With Business Process Redesign (BPR) projects such improvement goals can be achieved. BPR involves the restructuring of business processes, stimulated by the application of

Development of an intervention delivered by mobile phone aimed at decreasing unintended pregnancy among young people in three lower middle income countries.

Science.gov (United States)

McCarthy, Ona L; Wazwaz, Ola; Osorio Calderon, Veronica; Jado, Iman; Saibov, Salokhiddin; Stavridis, Amina; López Gallardo, Jhonny; Tokhirov, Ravshan; Adada, Samia; Huaynoca, Silvia; Makleff, Shelly; Vandewiele, Marieka; Standaert, Sarah; Free, Caroline

2018-05-02

Unintended pregnancies can result in poorer health outcomes for women, children and families. Young people in low and middle income countries are at particular risk of unintended pregnancies and could benefit from innovative contraceptive interventions. There is growing evidence that interventions delivered by mobile phone can be effective in improving a range of health behaviours. This paper describes the development of a contraceptive behavioural intervention delivered by mobile phone for young people in Tajikistan, Bolivia and Palestine, where unmet need for contraception is high among this group. Guided by Intervention Mapping, the following steps contributed to the development of the interventions: (1) needs assessment; (2) specifying behavioural change to result from the intervention; (3) selecting behaviour change methods to include in the intervention; (4) producing and refining the intervention content. The results of the needs assessment produced similar interventions across the countries. The interventions consist of short daily messages delivered over 4 months (delivered by text messaging in Palestine and mobile phone application instant messages in Bolivia and Tajikistan). The messages provide information about contraception, target attitudes that are barriers to contraceptive uptake and support young people in feeling that they can influence their reproductive health. The interventions each contain the same ten behaviour change methods, adapted for delivery by mobile phone. The development resulted in a well-specified, theory-based intervention, tailored to each country. It is feasible to develop an intervention delivered by mobile phone for young people in resource-limited settings.

Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes.

Science.gov (United States)

Cunningham, Shayna D; Lewis, Jessica B; Thomas, Jordan L; Grilo, Stephanie A; Ickovics, Jeannette R

2017-05-18

Despite biomedical advances and intervention efforts, rates of preterm birth and other adverse outcomes in the United States have remained relatively intransigent. Evidence suggests that group prenatal care can reduce these risks, with implications for maternal and child health as well as substantial cost savings. However, widespread dissemination presents challenges, in part because training and health systems have not been designed to deliver care in a group setting. This manuscript describes the design and evaluation of Expect With Me, an innovative model of group prenatal care with a strong integrated information technology (IT) platform designed to be scalable nationally. Expect With Me follows clinical guidelines from the American Congress of Obstetricians and Gynecologists. Expect With Me incorporates the best evidence-based features of existing models of group care with a novel integrated IT platform designed to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. A multisite prospective longitudinal cohort study is being conducted to examine the impact of Expect With Me on perinatal and postpartum outcomes, and to identify and address barriers to national scalability. Process and outcome evaluation will include quantitative and qualitative data collection at patient, provider, and organizational levels. Mixed-method data collection includes patient surveys, medical record reviews, patient focus groups; provider surveys, session evaluations, provider focus groups and in-depth interviews; an online tracking system; and clinical site visits. A two-to-one matched cohort of women receiving individual care from each site will provide a comparison group (n = 1,000 Expect With Me patients; n = 2,000 individual care patients) for outcome and cost analyses. By bundling prevention and care services into a high-touch, high-tech group prenatal care model

New calibration method for I-scan sensors to enable the precise measurement of pressures delivered by 'pressure garments'.

Science.gov (United States)

Macintyre, Lisa

2011-11-01

Accurate measurement of the pressure delivered by medical compression products is highly desirable both in monitoring treatment and in developing new pressure inducing garments or products. There are several complications in measuring pressure at the garment/body interface and at present no ideal pressure measurement tool exists for this purpose. This paper summarises a thorough evaluation of the accuracy and reproducibility of measurements taken following both of Tekscan Inc.'s recommended calibration procedures for I-scan sensors; and presents an improved method for calibrating and using I-scan pressure sensors. The proposed calibration method enables accurate (±2.1 mmHg) measurement of pressures delivered by pressure garments to body parts with a circumference ≥30 cm. This method is too cumbersome for routine clinical use but is very useful, accurate and reproducible for product development or clinical evaluation purposes. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

School Improvement Model to Foster Student Learning

Science.gov (United States)

Rulloda, Rudolfo Barcena

2011-01-01

Many classroom teachers are still using the traditional teaching methods. The traditional teaching methods are one-way learning process, where teachers would introduce subject contents such as language arts, English, mathematics, science, and reading separately. However, the school improvement model takes into account that all students have…

Tinnitus therapy using tailor-made notched music delivered via a smartphone application and Ginko combined treatment: A pilot study.

Science.gov (United States)

Kim, So Young; Chang, Mun Young; Hong, Min; Yoo, Sun-Gil; Oh, Dongik; Park, Moo Kyun

2017-10-01

Notched music therapy has been suggested to be effective for relieving tinnitus. We have developed a smartphone application using tailor-made notched music for tinnitus patients. This study aimed to evaluate the effect of this smartphone application on reducing tinnitus. In addition, we investigated the predictive factors for tinnitus treatment outcome using this smartphone application. A total of 26 patients who were chronically distressed by tinnitus with a ≥18 Tinnitus Handicap Inventory (THI) score were recruited from March 2013 to March 2015 (National Clinical Trial (NCT) Identifier Number 01663467). Patients were instructed to listen to tailor-made notched music through our smartphone application for 30-60min per day and were prescribed Ginkgo biloba for 3 months. Treatment outcome was evaluated using the THI, a visual analogue scale that measures the effects of tinnitus in terms of loudness, noticeable time, annoyance, and disruption of daily life. Demographic data, including age, sex, duration of tinnitus, and pre-treatment scores on questionnaires such as the Beck Depression Inventory (BDI), State Trait Anxiety Inventory (TAI), and Pittsburgh Sleep Quality Index (PSQI) scores were compared between the effective and non-effective groups according to the differences between their pre- and post-treatment THI scores. Smartphone application-delivered notched music therapy and Ginko combined treatment improved the THI score from 33.9±18.9 to 23.1±15.2; the effect was particularly marked for the emotional score of the THI. Improvement in the THI score was positively correlated with the initial THI score (P=0.001, adjusted estimated value=0.49, 95% confidence interval=0.25-0.73). Chronic tinnitus patients who underwent smartphone application-delivered notched music therapy and Ginko combined treatment showed improved THI scores, particularly the emotional score of the THI. A smartphone application-delivered therapy and Ginko combined treatment may be more

An improved Corten-Dolan's model based on damage and stress state effects

International Nuclear Information System (INIS)

Gao, Huiying; Huang, Hong Zhong; Lv, Zhiqiang; Zuo, Fang Jun; Wang, Hai Kun

2015-01-01

The value of exponent d in Corten-Dolan's model is generally considered to be a constant. Nonetheless, the results predicted on the basis of this statement deviate significantly from the real values. In consideration of the effects of damage and stress state on fatigue life prediction, Corten-Dolan's model is improved by redefining the exponent d used in the traditional model. The improved model performs better than the traditional one with respect to the demonstration of a fatigue failure mechanism. Predictions of fatigue life on the basis of investigations into three metallic specimens indicate that the errors caused by the improved model are significantly smaller than those induced by the traditional model. Meanwhile, predictions derived according to the improved model fall into a narrower dispersion zone than those made as per Miner's rule and the traditional model. This finding suggests that the proposed model improves the life prediction accuracy of the other two models. The predictions obtained using the improved Corten-Dolan's model differ slightly from those derived according to a model proposed in previous literature; a few life predictions obtained on the basis of the former are more accurate than those derived according to the latter. Therefore, the improved model proposed in this paper is proven to be rational and reliable given the proven validity of the existing model. Therefore, the improved model can be feasibly and credibly applied to damage accumulation and fatigue life prediction to some extent.

An improved Corten-Dolan's model based on damage and stress state effects

Energy Technology Data Exchange (ETDEWEB)

Gao, Huiying; Huang, Hong Zhong; Lv, Zhiqiang; Zuo, Fang Jun; Wang, Hai Kun [University of Electronic Science and Technology of China, Chengdu (China)

2015-08-15

The value of exponent d in Corten-Dolan's model is generally considered to be a constant. Nonetheless, the results predicted on the basis of this statement deviate significantly from the real values. In consideration of the effects of damage and stress state on fatigue life prediction, Corten-Dolan's model is improved by redefining the exponent d used in the traditional model. The improved model performs better than the traditional one with respect to the demonstration of a fatigue failure mechanism. Predictions of fatigue life on the basis of investigations into three metallic specimens indicate that the errors caused by the improved model are significantly smaller than those induced by the traditional model. Meanwhile, predictions derived according to the improved model fall into a narrower dispersion zone than those made as per Miner's rule and the traditional model. This finding suggests that the proposed model improves the life prediction accuracy of the other two models. The predictions obtained using the improved Corten-Dolan's model differ slightly from those derived according to a model proposed in previous literature; a few life predictions obtained on the basis of the former are more accurate than those derived according to the latter. Therefore, the improved model proposed in this paper is proven to be rational and reliable given the proven validity of the existing model. Therefore, the improved model can be feasibly and credibly applied to damage accumulation and fatigue life prediction to some extent.

Changes in nurse education: delivering the curriculum.

Science.gov (United States)

Carr, Graham

2008-01-01

The aim of this study is to examine changes in pre-registration nursing education through the personal accounts of nurse teachers. This paper is based on 37 in-depth interviews within a central London Healthcare Faculty. Each interview was subjected to a process of content analysis described by Miles and Huberman. The interviews took place between August 2003 and March 2004 and totalled 34.4 hours or 305,736 words. There were thirty female and seven male participants, who shared 1015 years of nursing experience, averaging at 27.4 years (min 7-max 42). These were supplemented by 552 years of teaching practice, the average being 15 years (min 0.5-max 29). This paper--delivering the nursing curriculum--identifies that the nature of nursing has changed as it has both expanded and contracted. Participants identified three major changes; the nature of nursing, selection of future nurses and the current impact that large cohorts have on our traditional model of person-centred education. The practice placements remain central to nursing education and it is the nursing role that should define the curriculum and the values of higher education should be supportive of this identity.

Targeted decorin gene therapy delivered with adeno-associated virus effectively retards corneal neovascularization in vivo.

Directory of Open Access Journals (Sweden)

Rajiv R Mohan

Full Text Available Decorin, small leucine-rich proteoglycan, has been shown to modulate angiogenesis in nonocular tissues. This study tested a hypothesis that tissue-selective targeted decorin gene therapy delivered to the rabbit stroma with adeno-associated virus serotype 5 (AAV5 impedes corneal neovascularization (CNV in vivo without significant side effects. An established rabbit CNV model was used. Targeted decorin gene therapy in the rabbit stroma was delivered with a single topical AAV5 titer (100 µl; 5×10(12 vg/ml application onto the stroma for two minutes after removing corneal epithelium. The levels of CNV were examined with stereomicroscopy, H&E staining, lectin, collagen type IV, CD31 immunocytochemistry and CD31 immunoblotting. Real-time PCR quantified mRNA expression of pro- and anti-angiogenic genes. Corneal health in live animals was monitored with clinical, slit-lamp and optical coherence tomography biomicroscopic examinations. Selective decorin delivery into stroma showed significant 52% (p<0.05, 66% (p<0.001, and 63% (p<0.01 reduction at early (day 5, mid (day 10, and late (day 14 stages of CNV in decorin-delivered rabbit corneas compared to control (no decorin delivered corneas in morphometric analysis. The H&E staining, lectin, collagen type IV, CD31 immunostaining (57-65, p<0.5, and CD31 immunoblotting (62-67%, p<0.05 supported morphometric findings. Quantitative PCR studies demonstrated decorin gene therapy down-regulated expression of VEGF, MCP1 and angiopoietin (pro-angiogenic and up-regulated PEDF (anti-angiogenic genes. The clinical, biomicroscopy and transmission electron microscopy studies revealed that AAV5-mediated decorin gene therapy is safe for the cornea. Tissue-targeted AAV5-mediated decorin gene therapy decreases CNV with no major side effects, and could potentially be used for treating patients.

An improved bipolar junction transistor model for electrical and radiation effects

International Nuclear Information System (INIS)

Kleiner, C.T.; Messenger, G.C.

1982-01-01

The use of bipolar technology in hardened electronic design requires an in-depth understanding of how the Bipolar Junction Transistor (BJT) behaves under normal electrical and radiation environments. Significant improvements in BJT process technology have been reported, and the successful use of sophisticated Computer Aided Design (CAD) tools has aided implementation with respect to specific families of hardened devices. The most advanced BJT model used to date is the Improved Gummel-Poon (IGP) model which is used in CAA programs such as the SPICE II and SLICE programs. The earlier Ebers-Moll model (ref 1 and 2) has also been updated to compare with the older Gummel-Poon model. This paper describes an adaptation of an existing computer model which incorporates the best features of both models into a new, more accurate model called the Improved Bipolar Junction Transistor model. This paper also describes a unique approach to data reduction for the B(I /SUB c/) and V /SUB BE/(ACT) vs I /SUB c/characterizations which has been successfully programmed in Basic using a Commodore PET computer. This model is described in the following sections

Air quality management: challenges and solutions in delivering air quality action plans

Energy Technology Data Exchange (ETDEWEB)

Beattie, C.I.; Longhurst, J.W.S.; Woodfield, N.K.

2000-07-01

The Air Quality Strategy for England, Scotland, Wales and Northern Ireland (DETR, 2001) has the aim of showing how improved local air quality in the UK may be delivered. Through a process of reviewing and assessing local air quality in both urban and rural localities, a clear picture is emerging of areas of the UK where air quality objectives are not likely to be met. The next challenge will be the identification of the required actions and new ways of working to achieve specific air quality objectives. The declaration of air quality management areas, where objectives are not predicted to be met by their target years, involves co-ordinated local action and collaborative working, which can only be effective with support across local authority departments and external stake holders. This paper provides a background to the relevant legislation underpinning, local air quality management and summarises the review and assessment process. It then comments on future directions in relation to the designation of Air Quality Management Areas and considers the requirements of action plans to deliver the goal of cleaner air in the UK. It is concluded that the UK has developed a highly sophisticated system of air quality management over a relatively short period of time, and with it has brought a new way of local authority working. The challenge of the next stage of the process is likely to be in implementing cost effective and proportional solutions to identified problems at the local level. (Author)

An improved multi-value cellular automata model for heterogeneous bicycle traffic flow

Energy Technology Data Exchange (ETDEWEB)

Jin, Sheng [College of Civil Engineering and Architecture, Zhejiang University, Hangzhou, 310058 China (China); Qu, Xiaobo [Griffith School of Engineering, Griffith University, Gold Coast, 4222 Australia (Australia); Xu, Cheng [Department of Transportation Management Engineering, Zhejiang Police College, Hangzhou, 310053 China (China); College of Transportation, Jilin University, Changchun, 130022 China (China); Ma, Dongfang, E-mail: mdf2004@zju.edu.cn [Ocean College, Zhejiang University, Hangzhou, 310058 China (China); Wang, Dianhai [College of Civil Engineering and Architecture, Zhejiang University, Hangzhou, 310058 China (China)

2015-10-16

This letter develops an improved multi-value cellular automata model for heterogeneous bicycle traffic flow taking the higher maximum speed of electric bicycles into consideration. The update rules of both regular and electric bicycles are improved, with maximum speeds of two and three cells per second respectively. Numerical simulation results for deterministic and stochastic cases are obtained. The fundamental diagrams and multiple states effects under different model parameters are analyzed and discussed. Field observations were made to calibrate the slowdown probabilities. The results imply that the improved extended Burgers cellular automata (IEBCA) model is more consistent with the field observations than previous models and greatly enhances the realism of the bicycle traffic model. - Highlights: • We proposed an improved multi-value CA model with higher maximum speed. • Update rules are introduced for heterogeneous bicycle traffic with maximum speed 2 and 3 cells/s. • Simulation results of the proposed model are consistent with field bicycle data. • Slowdown probabilities of both regular and electric bicycles are calibrated.

An improved multi-value cellular automata model for heterogeneous bicycle traffic flow

International Nuclear Information System (INIS)

Jin, Sheng; Qu, Xiaobo; Xu, Cheng; Ma, Dongfang; Wang, Dianhai

2015-01-01

This letter develops an improved multi-value cellular automata model for heterogeneous bicycle traffic flow taking the higher maximum speed of electric bicycles into consideration. The update rules of both regular and electric bicycles are improved, with maximum speeds of two and three cells per second respectively. Numerical simulation results for deterministic and stochastic cases are obtained. The fundamental diagrams and multiple states effects under different model parameters are analyzed and discussed. Field observations were made to calibrate the slowdown probabilities. The results imply that the improved extended Burgers cellular automata (IEBCA) model is more consistent with the field observations than previous models and greatly enhances the realism of the bicycle traffic model. - Highlights: • We proposed an improved multi-value CA model with higher maximum speed. • Update rules are introduced for heterogeneous bicycle traffic with maximum speed 2 and 3 cells/s. • Simulation results of the proposed model are consistent with field bicycle data. • Slowdown probabilities of both regular and electric bicycles are calibrated

Supportive supervision for volunteers to deliver reproductive health education: a cluster randomized trial.

Science.gov (United States)

Singh, Debra; Negin, Joel; Orach, Christopher Garimoi; Cumming, Robert

2016-10-03

Community Health Volunteers (CHVs) can be effective in improving pregnancy and newborn outcomes through community education. Inadequate supervision of CHVs, whether due to poor planning, irregular visits, or ineffective supervisory methods, is, however, recognized as a weakness in many programs. There has been little research on best practice supervisory or accompaniment models. From March 2014 to February 2015 a proof of concept study was conducted to compare training alone versus training and supportive supervision by paid CHWs (n = 4) on the effectiveness of CHVs (n = 82) to deliver education about pregnancy, newborn care, family planning and hygiene. The pair-matched cluster randomized trial was conducted in eight villages (four intervention and four control) in Budondo sub-county in Jinja, Uganda. Increases in desired behaviors were seen in both the intervention and control arms over the study period. Both arms showed high retention rates of CHVs (95 %). At 1 year follow-up there was a significantly higher prevalence of installed and functioning tippy taps for hand washing (p services. Supportive supervision involves creating a non-threatening, empowering environment in which both the CHV and the supervising CHW learn together and overcome obstacles that might otherwise demotivate the CHV. While the results seem promising for added value with supportive supervision for CHVs undertaking reproductive health activities, further research on a larger scale will be needed to substantiate the effect.

Efficacy of an education course delivered to community health workers in diabetes control: A randomized clinical trial.

Science.gov (United States)

de Souza, Camila Furtado; Dalzochio, Mériane Boeira; Zucatti, Alessandra Teixeira Netto; De Nale, Rosana; de Almeida, Marília Tavares; Gross, Jorge Luiz; Leitão, Cristiane Bauermann

2017-08-01

Community health workers are community members who provide education and care for patients for a broad range of health issues, including diabetes mellitus. However, few community health workers are trained for diabetes education and little is known about the effectiveness of their interventions. The aim of this study is to evaluate the effect of a diabetes education program delivered to community health workers in improving the metabolic control of patients with type 2 diabetes mellitus. Eight community health workers, providing care for 118 patients, were randomized in two groups to receive a 1-month diabetes education program (intervention, patients n = 62) or an education course in other health issues (control, patients n = 56). Each community health worker was responsible for transmitting the acquired knowledge to patients. Primary outcome was changed in HbA1C 3 months after the intervention. PARTICIPANTS: Mean age was 61 ± 11 years, 35% were men and 62% were whites. HbA1c levels reduced in both groups (intervention: 9.1 ± 2.2 vs. 7.9 ± 1.9%; control: 9.1 ± 2.1 vs. 8.4 ± 2.5%, p patients' follow-up, but it was similar in intervention and control groups. The diabetes mellitus education course delivered to community health workers was able to improve patients' lipid profile.

Resource allocation decision modeling for a Louisiana Public Benefit Fund program

International Nuclear Information System (INIS)

Kaiser, Mark J.; Pulsipher, Allan G.

2003-01-01

A simulation model is developed to value energy efficiency improvement programs in Louisiana proposed to be delivered through a Public Benefits Fund. A uniform 1 mill/kW h non-bypassable surcharge on the electric rates of all electricity users is proposed to be distributed for low-income bill assistance, low-income weatherization, and energy efficiency programs across the residential and commercial sector of Louisiana. The economic and environmental impact of the energy improvement programs is coupled to a stochastic linear program to specify the resource allocation subject to policy and system constraints. The model is illustrated through a realistic policy scenario. (Author)

Delivering the Goods: Scaling out Results of Natural Resource Management Research

Directory of Open Access Journals (Sweden)

Larry Harrington

2002-01-01

Full Text Available To help integrated natural resource management (INRM research "deliver the goods" for many of the world's poor over a large area and in a timely manner, the authors suggest a problem-solving approach that facilitates the scaling out of relevant agricultural practices. They propose seven ways to foster scaling out: (1 develop more attractive practices and technologies through participatory research (2 balance supply-driven approaches with resource user demands, (3 use feedback to redefine the research agenda, (4 encourage support groups and networks for information sharing, (5 facilitate negotiation among stakeholders, (6 inform policy change and institutional development, and (7 make sensible use of information management tools, including models and geographic information systems (GIS. They also draw on experiences in Mesoamerica, South Asia, and southern Africa to describe useful information management tools, including site similarity analyses, the linking of simulation models with GIS, and the use of farmer and land type categories.

Potential of discrete Gaussian edge feathering method for improving abutment dosimetry in eMLC-delivered segmented-field electron conformal therapy

Energy Technology Data Exchange (ETDEWEB)

Eley, John G.; Hogstrom, Kenneth R.; Matthews, Kenneth L.; Parker, Brent C.; Price, Michael J. [Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, 202 Nicholson Hall, Tower Drive, Baton Rouge, Louisiana 70803-4001 (United States); Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, 202 Nicholson Hall, Tower Drive, Baton Rouge, Louisiana 70803-4001 (United States) and Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, Louisiana 70809-3482 (United States); Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, 202 Nicholson Hall, Tower Drive, Baton Rouge, Louisiana 70803-4001 (United States); Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, 202 Nicholson Hall, Tower Drive, Baton Rouge, Louisiana 70803-4001 (United States) and Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, Louisiana 70809-3482 (United States)

2011-12-15

Purpose: The purpose of this work was to investigate the potential of discrete Gaussian edge feathering of the higher energy electron fields for improving abutment dosimetry in the planning volume when using an electron multileaf collimator (eMLC) to deliver segmented-field electron conformal therapy (ECT). Methods: A discrete (five-step) Gaussian edge spread function was used to match dose penumbras of differing beam energies (6-20 MeV) at a specified depth in a water phantom. Software was developed to define the leaf eMLC positions of an eMLC that most closely fit each electron field shape. The effect of 1D edge feathering of the higher energy field on dose homogeneity was computed and measured for segmented-field ECT treatment plans for three 2D PTVs in a water phantom, i.e., depth from the water surface to the distal PTV surface varied as a function of the x-axis (parallel to leaf motion) and remained constant along the y-axis (perpendicular to leaf motion). Additionally, the effect of 2D edge feathering was computed and measured for one radially symmetric, 3D PTV in a water phantom, i.e., depth from the water surface to the distal PTV surface varied as a function of both axes. For the 3D PTV, the feathering scheme was evaluated for 0.1-1.0-cm leaf widths. Dose calculations were performed using the pencil beam dose algorithm in the Pinnacle{sup 3} treatment planning system. Dose verification measurements were made using a prototype eMLC (1-cm leaf width). Results: 1D discrete Gaussian edge feathering reduced the standard deviation of dose in the 2D PTVs by 34, 34, and 39%. In the 3D PTV, the broad leaf width (1 cm) of the eMLC hindered the 2D application of the feathering solution to the 3D PTV, and the standard deviation of dose increased by 10%. However, 2D discrete Gaussian edge feathering with simulated eMLC leaf widths of 0.1-0.5 cm reduced the standard deviation of dose in the 3D PTV by 33-28%, respectively. Conclusions: A five-step discrete Gaussian edge

Mentoring approach improves evaluation capacity of ICTD ...

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

2016-06-09

Jun 9, 2016 ... ... initiative is improving evaluation capacities of researchers studying Information and ... Capacity in ICTD (DECI) provides researchers from five IDRC-funded projects in ... Using technology to deliver quality education in Asia.

Improving quality of care in inflammatory bowel disease: what changes can be made today?

Science.gov (United States)

Panés, Julián; O'Connor, Marian; Peyrin-Biroulet, Laurent; Irving, Peter; Petersson, Joel; Colombel, Jean-Frédéric

2014-09-01

There are a number of gaps in our current quality of care for patients with inflammatory bowel diseases. This review proposes changes that could be made now to improve inflammatory bowel disease care. Evidence from the literature and clinical experience are presented that illustrate best practice for improving current quality of care of patients with inflammatory bowel diseases. Best care for inflammatory bowel disease patients will involve services provided by a multidisciplinary team, ideally delivered at a centre of excellence and founded on current guidelines. Dedicated telephone support lines, virtual clinics and networking may also provide models through which to deliver high-quality, expert integrated patient care. Improved physician-patient collaboration may improve treatment adherence, producing tangible improvements in disease outcomes, and may also allow patients to better understand the benefits and risks of a disease management plan. Coaching programmes and tools that improve patient self-management and empowerment are likely to be supported by payers if these can be shown to reduce long-term disability. Halting disease progression before there is widespread bowel damage and disability are ideal goals of inflammatory bowel disease management. Improving patient-physician communication and supporting patients in their understanding of the evidence base are vital for ensuring patient commitment and involvement in the long-term management of their condition. Furthermore, there is a need to create more centres of excellence and to develop inflammatory bowel disease networks to ensure a consistent level of care across different settings. Copyright © 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Improved Inference of Heteroscedastic Fixed Effects Models

Directory of Open Access Journals (Sweden)

Afshan Saeed

2016-12-01

Full Text Available Heteroscedasticity is a stern problem that distorts estimation and testing of panel data model (PDM. Arellano (1987 proposed the White (1980 estimator for PDM with heteroscedastic errors but it provides erroneous inference for the data sets including high leverage points. In this paper, our attempt is to improve heteroscedastic consistent covariance matrix estimator (HCCME for panel dataset with high leverage points. To draw robust inference for the PDM, our focus is to improve kernel bootstrap estimators, proposed by Racine and MacKinnon (2007. The Monte Carlo scheme is used for assertion of the results.

Improved Kinetic Models for High-Speed Combustion Simulation

National Research Council Canada - National Science Library

Montgomery, C. J; Tang, Q; Sarofim, A. F; Bockelie, M. J; Gritton, J. K; Bozzelli, J. W; Gouldin, F. C; Fisher, E. M; Chakravarthy, S

2008-01-01

Report developed under an STTR contract. The overall goal of this STTR project has been to improve the realism of chemical kinetics in computational fluid dynamics modeling of hydrocarbon-fueled scramjet combustors...

Improvement of Axial Reflector Cross Section Generation Model for PWR Core Analysis

Energy Technology Data Exchange (ETDEWEB)

Shim, Cheon Bo; Lee, Kyung Hoon; Cho, Jin Young [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2016-10-15

This paper covers the study for improvement of axial reflector XS generation model. In the next section, the improved 1D core model is represented in detail. Reflector XS generated by the improved model is compared to that of the conventional model in the third section. Nuclear design parameters generated by these two XS sets are also covered in that section. Significant of this study is discussed in the last section. Two-step procedure has been regarded as the most practical approach for reactor core designs because it offers core design parameters quite rapidly within acceptable range. Thus this approach is adopted for SMART (System-integrated Modular Advanced Reac- Tor) core design in KAERI with the DeCART2D1.1/ MASTER4.0 (hereafter noted as DeCART2D/ MASTER) code system. Within the framework of the two-step procedure based SMART core design, various researches have been studied to improve the core design reliability and efficiency. One of them is improvement of reflector cross section (XS) generation models. While the conventional FA/reflector two-node model used for most core designs to generate reflector XS cannot consider the actual configuration of fuel rods that intersect at right angles to axial reflectors, the revised model reflects the axial fuel configuration by introducing the radially simplified core model. The significance of the model revision is evaluated by observing HGC generated by DeCART2D, reflector XS, and core design parameters generated by adopting the two models. And it is verified that about 30 ppm CBC error can be reduced and maximum Fq error decreases from about 6 % to 2.5 % by applying the revised model. Error of AO and axial power shapes are also reduced significantly. Therefore it can be concluded that the simplified 1D core model improves the accuracy of the axial reflector XS and leads to the two-step procedure reliability enhancement. Since it is hard for core designs to be free from the two-step approach, it is necessary to find

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

Improving the diagnosis and treatment of osteoporosis using a senior-friendly peer-led community education and mentoring model: a randomized controlled trial.

Science.gov (United States)

Kloseck, Marita; Fitzsimmons, Deborah A; Speechley, Mark; Savundranayagam, Marie Y; Crilly, Richard G

2017-01-01

This randomized controlled trial (RCT) evaluated a 6-month peer-led community education and mentorship program to improve the diagnosis and management of osteoporosis. Ten seniors (74-90 years of age) were trained to become peer educators and mentors and deliver the intervention. In the subsequent RCT, 105 seniors (mean age =80.5±6.9; 89% female) were randomly assigned to the peer-led education and mentorship program (n=53) or control group (n=52). Knowledge was assessed at baseline and 6 months. Success was defined as discussing osteoporosis risk with their family physician, obtaining a bone mineral density assessment, and returning to review their risk profile and receive advice and/or treatment. Knowledge of osteoporosis did not change significantly. There was no difference in knowledge change between the two groups (mean difference =1.3, 95% confidence interval [CI] of difference -0.76 to 3.36). More participants in the intervention group achieved a successful outcome (odds ratio 0.16, 95% CI 0.06-0.42, P seniors. This model was effective for improving osteoporosis risk assessment, diagnosis, and treatment in a community setting.

How to Deliver Open Sustainable Innovation: An Integrated Approach for a Sustainable Marketable Product

Directory of Open Access Journals (Sweden)

Francesco Cappa

2016-12-01

Full Text Available The adoption of open innovation and peer production, powered by 3D printing technology, is transforming traditional manufacturing methods towards a “third industrial revolution”. The purpose of this research is to provide empirical evidence for an integrated approach, based on collaborative product development and peer production, combined with 3D printing, to deliver more sustainable, yet competitive, marketable products. In particular, this experimental study is conducted in the context of mobile forensics, an emerging market where limited expensive products exist and alternative solutions are needed. The technical viability and economic feasibility of the prototype developed in this research validate the proposed integrated approach, which could be a game-changer in the field of mobile forensics, as well as in other sectors. The sustainability improvements with this approach are a reduction of the total cost, thereby making it affordable for lower income users, and a decrease in energy consumption and pollutant emissions. The validated integrated approach offers start-up opportunities to develop and deliver more sustainable, marketable products, towards the paradigm of Open Sustainable Innovation. While the device developed and tested in this research has similar features to existing products, the methodology, implementation, and motivation are original.

In vitro magnetic stimulation: a simple stimulation device to deliver defined low intensity electromagnetic fields

Directory of Open Access Journals (Sweden)

Stephanie Grehl

2016-11-01

Full Text Available Non-invasive electromagnetic field brain stimulation (NIBS appears to benefit human neurological and psychiatric conditions, although the optimal stimulation parameters and underlying mechanisms remain unclear. Although in vitro studies have begun to elucidate cellular mechanisms, stimulation is delivered by a range of coils (from commercially available human stimulation coils to laboratory-built circuits so that the electromagnetic fields induced within the tissue to produce the reported effects are ill-defined.Here we develop a simple in vitro stimulation device with plug-and-play features that allow delivery of a range of stimulation parameters. We chose to test low intensity repetitive magnetic stimulation (LI-rMS delivered at 3 frequencies to hindbrain explant cultures containing the olivocerebellar pathway. We used computational modelling to define the parameters of a stimulation circuit and coil that deliver a unidirectional homogeneous magnetic field of known intensity and direction, and therefore a predictable electric field, to the target. We built the coil to be compatible with culture requirements: stimulation within an incubator; a flat surface allowing consistent position and magnetic field direction; location outside the culture plate to maintain sterility and no heating or vibration. Measurements at the explant confirmed the induced magnetic field was homogenous and matched the simulation results. To validate our system we investigated biological effects following LI-rMS at 1 Hz, 10 Hz and biomimetic high frequency (BHFS, which we have previously shown induces neural circuit reorganisation. We found that gene expression was modified by LI-rMS in a frequency-related manner. Four hours after a single 10-minute stimulation session, the number of c-fos positive cells increased, indicating that our stimulation activated the tissue. Also, after 14 days of LI-rMS, the expression of genes normally present in the tissue was differentially

Internet-delivered eye movement desensitization and reprocessing (iEMDR: an open trial [v2; ref status: indexed, http://f1000r.es/zr

Directory of Open Access Journals (Sweden)

Jay Spence

2013-05-01

Full Text Available Recent research indicates internet-delivered cognitive behavioural therapy (iCBT can reduce symptoms of post traumatic stress disorder (PTSD. This study examined the efficacy of an internet-delivered treatment protocol that combined iCBT and internet-delivered eye movement desensitization and reprocessing (iEMDR, in an uncontrolled trial. Eleven of the 15 participants completed post-treatment questionnaires. Large effect sizes were found from pre-treatment to 3-month follow-up (d = 1.03 – 1.61 on clinician-assessed and self-reported measures of PTSD, anxiety and distress, with moderate effect sizes (d = 0.59 – 0.70 found on measures of depression and disability. At post-treatment, 55% of the participants no longer met criteria for PTSD and this was sustained at follow-up. Symptom worsening occurred in 3 of 15 (20% of the sample from pre- to post-treatment; however, these participants reported overall symptom improvement by follow-up. Future research directions for iEMDR are discussed.

On Improving 4-km Mesoscale Model Simulations

Science.gov (United States)

Deng, Aijun; Stauffer, David R.

2006-03-01

A previous study showed that use of analysis-nudging four-dimensional data assimilation (FDDA) and improved physics in the fifth-generation Pennsylvania State University National Center for Atmospheric Research Mesoscale Model (MM5) produced the best overall performance on a 12-km-domain simulation, based on the 18 19 September 1983 Cross-Appalachian Tracer Experiment (CAPTEX) case. However, reducing the simulated grid length to 4 km had detrimental effects. The primary cause was likely the explicit representation of convection accompanying a cold-frontal system. Because no convective parameterization scheme (CPS) was used, the convective updrafts were forced on coarser-than-realistic scales, and the rainfall and the atmospheric response to the convection were too strong. The evaporative cooling and downdrafts were too vigorous, causing widespread disruption of the low-level winds and spurious advection of the simulated tracer. In this study, a series of experiments was designed to address this general problem involving 4-km model precipitation and gridpoint storms and associated model sensitivities to the use of FDDA, planetary boundary layer (PBL) turbulence physics, grid-explicit microphysics, a CPS, and enhanced horizontal diffusion. Some of the conclusions include the following: 1) Enhanced parameterized vertical mixing in the turbulent kinetic energy (TKE) turbulence scheme has shown marked improvements in the simulated fields. 2) Use of a CPS on the 4-km grid improved the precipitation and low-level wind results. 3) Use of the Hong and Pan Medium-Range Forecast PBL scheme showed larger model errors within the PBL and a clear tendency to predict much deeper PBL heights than the TKE scheme. 4) Combining observation-nudging FDDA with a CPS produced the best overall simulations. 5) Finer horizontal resolution does not always produce better simulations, especially in convectively unstable environments, and a new CPS suitable for 4-km resolution is needed. 6

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

Development of a culturally appropriate computer-delivered tailored Internet-based health literacy intervention for Spanish-dominant Hispanics living with HIV.

Science.gov (United States)

Jacobs, Robin J; Caballero, Joshua; Ownby, Raymond L; Kane, Michael N

2014-11-30

Low health literacy is associated with poor medication adherence in persons with human immunodeficiency virus (HIV), which can lead to poor health outcomes. As linguistic minorities, Spanish-dominant Hispanics (SDH) face challenges such as difficulties in obtaining and understanding accurate information about HIV and its treatment. Traditional health educational methods (e.g., pamphlets, talking) may not be as effective as delivering through alternate venues. Technology-based health information interventions have the potential for being readily available on desktop computers or over the Internet. The purpose of this research was to adapt a theoretically-based computer application (initially developed for English-speaking HIV-positive persons) that will provide linguistically and culturally appropriate tailored health education to Spanish-dominant Hispanics with HIV (HIV + SDH). A mixed methods approach using quantitative and qualitative interviews with 25 HIV + SDH and 5 key informants guided by the Information-Motivation-Behavioral (IMB) Skills model was used to investigate cultural factors influencing medication adherence in HIV + SDH. We used a triangulation approach to identify major themes within cultural contexts relevant to understanding factors related to motivation to adhere to treatment. From this data we adapted an automated computer-based health literacy intervention to be delivered in Spanish. Culture-specific motivational factors for treatment adherence in HIV + SDH persons that emerged from the data were stigma, familismo (family), mood, and social support. Using this data, we developed a culturally and linguistically adapted a tailored intervention that provides information about HIV infection, treatment, and medication related problem solving skills (proven effective in English-speaking populations) that can be delivered using touch-screen computers, tablets, and smartphones to be tested in a future study. Using a theoretically

Externally Delivered Focused Ultrasound for Renal Denervation.

Science.gov (United States)

Neuzil, Petr; Ormiston, John; Brinton, Todd J; Starek, Zdenek; Esler, Murray; Dawood, Omar; Anderson, Thomas L; Gertner, Michael; Whitbourne, Rob; Schmieder, Roland E

2016-06-27

The aim of this study was to assess clinical safety and efficacy outcomes of renal denervation executed by an externally delivered, completely noninvasive focused therapeutic ultrasound device. Renal denervation has emerged as a potential treatment approach for resistant hypertension. Sixty-nine subjects received renal denervation with externally delivered focused ultrasound via the Kona Medical Surround Sound System. This approach was investigated across 3 consecutive studies to optimize targeting, tracking, and dosing. In the third study, treatments were performed in a completely noninvasive way using duplex ultrasound image guidance to target the therapy. Short- and long-term safety and efficacy were evaluated through use of clinical assessments, magnetic resonance imaging scans prior to and 3 and 24 weeks after renal denervation, and, in cases in which a targeting catheter was used to facilitate targeting, fluoroscopic angiography with contrast. All patients tolerated renal denervation using externally delivered focused ultrasound. Office blood pressure (BP) decreased by 24.6 ± 27.6/9.0 ± 15.0 mm Hg (from baseline BP of 180.0 ± 18.5/97.7 ± 13.7 mm Hg) in 69 patients after 6 months and 23.8 ± 24.1/10.3 ± 13.1 mm Hg in 64 patients with complete 1-year follow-up. The response rate (BP decrease >10 mm Hg) was 75% after 6 months and 77% after 1 year. The most common adverse event was post-treatment back pain, which was reported in 32 of 69 patients and resolved within 72 h in most cases. No intervention-related adverse events involving motor or sensory deficits were reported. Renal function was not altered, and vascular safety was established by magnetic resonance imaging (all patients), fluoroscopic angiography (n = 48), and optical coherence tomography (n = 5). Using externally delivered focused ultrasound and noninvasive duplex ultrasound, image-guided targeting was associated with substantial BP reduction without any major safety signals. Further

Evaluation of a Telephone-Delivered, Community-Based Collaborative Care Management Program for Caregivers of Older Adults with Dementia.

Science.gov (United States)

Mavandadi, Shahrzad; Wray, Laura O; DiFilippo, Suzanne; Streim, Joel; Oslin, David

2017-09-01

To evaluate whether a community-based, telephone-delivered, brief patient/caregiver-centered collaborative dementia care management intervention is associated with improved caregiver and care recipient (CR) outcomes. Longitudinal program evaluation of a clinical intervention; assessments at baseline and 3- and 6-month follow-up. General community. Caregivers (N = 440) of older, community-dwelling, low-income CRs prescribed a psychotropic medication by a primary care provider who met criteria for dementia and were enrolled in the SUpporting Seniors Receiving Treatment And INtervention (SUSTAIN) program for older adults. Dementia care management versus clinical evaluation only. Perceived caregiving burden and caregiver general health (primary outcomes); CR neuropsychiatric symptoms and caregiver distress in response to CRs' challenging dementia-related behaviors (secondary outcomes). Caregivers were, on average, 64.0 (SD: 11.8) years old and 62.6% provided care for the CR for 20 or more hours per week. The majority of the sample was female (73.2%), non-Hispanic White (90.2%), and spousal caregivers (72.5%). Adjusted longitudinal models of baseline and 3- and 6-month data suggest that compared with caregivers receiving clinical evaluation only, caregivers receiving care management reported greater reductions in burden over time. Subgroup analyses also showed statistically significant reductions in caregiver-reported frequency of CR dementia-related behaviors and caregiver distress in response to those symptoms at 3-month follow-up. A community-based, telephone-delivered care management program for caregivers of individuals with dementia is associated with favorable caregiver and CR-related outcomes. Findings support replication and further research in the impact of tailored, collaborative dementia care management programs that address barriers to access and engagement. Published by Elsevier Inc.

Maximizing the biological effect of proton dose delivered with scanned beams via inhomogeneous daily dose distributions

Energy Technology Data Exchange (ETDEWEB)

Zeng Chuan; Giantsoudi, Drosoula; Grassberger, Clemens; Goldberg, Saveli; Niemierko, Andrzej; Paganetti, Harald; Efstathiou, Jason A.; Trofimov, Alexei [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114 (United States)

2013-05-15

control probability (TCP) and normal tissue complication probability (NTCP). To assess potential local RBE variations, LET distributions were calculated with Monte Carlo, and compared for different plans. The results were assessed in terms of their sensitivity to uncertainties in model parameters and delivery. Results: IFD courses included equal number of fractions boosting either hemisphere, thus, the combined physical dose was close to uniform throughout the prostate. However, for the entire course, the prostate EUD in IFD was higher than in conventional FTP by up to 14%, corresponding to the estimated increase in TCP to 96% from 88%. The extent of gain depended on the mixing factor, i.e., relative weights used to combine FTP and STP spot weights. Increased weighting of STP typically yielded a higher target EUD, but also led to increased sensitivity of dose to variations in the proton's range. Rectal and bladder EUD were same or lower (per normalization), and the NTCP for both remained below 1%. The LET distributions in IFD also depended strongly on the mixing weights: plans using higher weight of STP spots yielded higher LET, indicating a potentially higher local RBE. Conclusions: In proton therapy delivered by pencil beam scanning, improved therapeutic outcome can potentially be expected with delivery of IFD distributions, while administering the prescribed quasi-uniform dose to the target over the entire course. The biological effectiveness of IFD may be further enhanced by optimizing the LET distributions. IFD distributions are characterized by a dose gradient located in proximity of the prostate's midplane, thus, the fidelity of delivery would depend crucially on the precision with which the proton range could be controlled.

Maximizing the biological effect of proton dose delivered with scanned beams via inhomogeneous daily dose distributions

International Nuclear Information System (INIS)

Zeng Chuan; Giantsoudi, Drosoula; Grassberger, Clemens; Goldberg, Saveli; Niemierko, Andrzej; Paganetti, Harald; Efstathiou, Jason A.; Trofimov, Alexei

2013-01-01

control probability (TCP) and normal tissue complication probability (NTCP). To assess potential local RBE variations, LET distributions were calculated with Monte Carlo, and compared for different plans. The results were assessed in terms of their sensitivity to uncertainties in model parameters and delivery. Results: IFD courses included equal number of fractions boosting either hemisphere, thus, the combined physical dose was close to uniform throughout the prostate. However, for the entire course, the prostate EUD in IFD was higher than in conventional FTP by up to 14%, corresponding to the estimated increase in TCP to 96% from 88%. The extent of gain depended on the mixing factor, i.e., relative weights used to combine FTP and STP spot weights. Increased weighting of STP typically yielded a higher target EUD, but also led to increased sensitivity of dose to variations in the proton's range. Rectal and bladder EUD were same or lower (per normalization), and the NTCP for both remained below 1%. The LET distributions in IFD also depended strongly on the mixing weights: plans using higher weight of STP spots yielded higher LET, indicating a potentially higher local RBE. Conclusions: In proton therapy delivered by pencil beam scanning, improved therapeutic outcome can potentially be expected with delivery of IFD distributions, while administering the prescribed quasi-uniform dose to the target over the entire course. The biological effectiveness of IFD may be further enhanced by optimizing the LET distributions. IFD distributions are characterized by a dose gradient located in proximity of the prostate's midplane, thus, the fidelity of delivery would depend crucially on the precision with which the proton range could be controlled.

Maximizing the biological effect of proton dose delivered with scanned beams via inhomogeneous daily dose distributions.

Science.gov (United States)

Zeng, Chuan; Giantsoudi, Drosoula; Grassberger, Clemens; Goldberg, Saveli; Niemierko, Andrzej; Paganetti, Harald; Efstathiou, Jason A; Trofimov, Alexei

2013-05-01

(TCP) and normal tissue complication probability (NTCP). To assess potential local RBE variations, LET distributions were calculated with Monte Carlo, and compared for different plans. The results were assessed in terms of their sensitivity to uncertainties in model parameters and delivery. IFD courses included equal number of fractions boosting either hemisphere, thus, the combined physical dose was close to uniform throughout the prostate. However, for the entire course, the prostate EUD in IFD was higher than in conventional FTP by up to 14%, corresponding to the estimated increase in TCP to 96% from 88%. The extent of gain depended on the mixing factor, i.e., relative weights used to combine FTP and STP spot weights. Increased weighting of STP typically yielded a higher target EUD, but also led to increased sensitivity of dose to variations in the proton's range. Rectal and bladder EUD were same or lower (per normalization), and the NTCP for both remained below 1%. The LET distributions in IFD also depended strongly on the mixing weights: plans using higher weight of STP spots yielded higher LET, indicating a potentially higher local RBE. In proton therapy delivered by pencil beam scanning, improved therapeutic outcome can potentially be expected with delivery of IFD distributions, while administering the prescribed quasi-uniform dose to the target over the entire course. The biological effectiveness of IFD may be further enhanced by optimizing the LET distributions. IFD distributions are characterized by a dose gradient located in proximity of the prostate's midplane, thus, the fidelity of delivery would depend crucially on the precision with which the proton range could be controlled.

Ciclesonide improves measures of small airway involvement in asthma

NARCIS (Netherlands)

Cohen, J.; Douma, W. R.; ten Hacken, N. H. T.; Vonk, J. M.; Oudkerk, M.; Postma, D. S.

Ciclesonide is delivered as a small-particle inhaled corticosteroid and improves lung function and airway hyperresponsiveness. The objective of the present study was to assess whether ciclesonide can specifically improve small airway function in asthma. A total of 16 mild-to-moderate asthma patients

Towards improved modeling of steel-concrete composite wall elements

International Nuclear Information System (INIS)

Vecchio, Frank J.; McQuade, Ian

2011-01-01

Highlights: → Improved analysis of double skinned steel concrete composite containment walls. → Smeared rotating crack concept applied in formulation of new analytical model. → Model implemented into finite element program; numerically stable and robust. → Models behavior of shear-critical elements with greater ease and improved accuracy. → Accurate assessments of strength, deformation and failure mode of test specimens. - Abstract: The Disturbed Stress Field Model, a smeared rotating crack model for reinforced concrete based on the Modified Compression Field Theory, is adapted to the analysis of double-skin steel-concrete wall elements. The computational model is then incorporated into a two-dimensional nonlinear finite element analysis algorithm. Verification studies are undertaken by modeling various test specimens, including panel elements subject to uniaxial compression, panel elements subjected to in-plane shear, and wall specimens subjected to reversed cyclic lateral displacements. In all cases, the analysis model is found to provide accurate calculations of structural load capacities, pre- and post-peak displacement responses, post-peak ductility, chronology of damage, and ultimate failure mode. Minor deficiencies are found in regards to the accurate portrayal of faceplate buckling and the effects of interfacial slip between the faceplates and the concrete. Other aspects of the modeling procedure that are in need of further research and development are also identified and discussed.

Engineering a plant community to deliver multiple ecosystem services.

Science.gov (United States)

Storkey, Jonathan; Döring, Thomas; Baddeley, John; Collins, Rosemary; Roderick, Stephen; Jones, Hannah; Watson, Christine

2015-06-01

The sustainable delivery of multiple ecosystem services requires the management of functionally diverse biological communities. In an agricultural context, an emphasis on food production has often led to a loss of biodiversity to the detriment of other ecosystem services such as the maintenance of soil health and pest regulation. In scenarios where multiple species can be grown together, it may be possible to better balance environmental and agronomic services through the targeted selection of companion species. We used the case study of legume-based cover crops to engineer a plant community that delivered the optimal balance of six ecosystem services: early productivity, regrowth following mowing, weed suppression, support of invertebrates, soil fertility building (measured as yield of following crop), and conservation of nutrients in the soil. An experimental species pool of 12 cultivated legume species was screened for a range of functional traits and ecosystem services at five sites across a geographical gradient in the United Kingdom. All possible species combinations were then analyzed, using a process-based model of plant competition, to identify the community that delivered the best balance of services at each site. In our system, low to intermediate levels of species richness (one to four species) that exploited functional contrasts in growth habit and phenology were identified as being optimal. The optimal solution was determined largely by the number of species and functional diversity represented by the starting species pool, emphasizing the importance of the initial selection of species for the screening experiments. The approach of using relationships between functional traits and ecosystem services to design multifunctional biological communities has the potential to inform the design of agricultural systems that better balance agronomic and environmental services and meet the current objective of European agricultural policy to maintain viable food

Power Delivered to Mechanical Systems by Random Vibrations

Directory of Open Access Journals (Sweden)

Timothy S. Edwards

2009-01-01

Full Text Available This paper develops deformational response power descriptions of multiple degree-of-freedom systems due to stationary random vibration excitation. Two new concepts are developed. The deformational response power density (DRPD can be computed when a structure's natural frequencies and modal masses are available. The DRPD shows the spectral content of the deformational power delivered to a specific structure by the stationary, random excitation. This function can be found through a weighted windowing of the power spectrum of the input acceleration excitation. Deformational response input power spectra (DRIPS, similar to the input energy spectrum and shock response spectrum, give the power delivered to single-degree-of-freedom systems as a function of natural frequency. It is shown that the DRIPS is simply a smoothed version of the power spectrum of the input acceleration excitation. The DRIPS gives rise to a useful power-based data smoothing operation.

Infants delivered in maternity homes run by traditional birth attendants in urban Nigeria: a community-based study.

Science.gov (United States)

Olusanya, Bolajoko O; Inem, Victor A; Abosede, Olayinka A

2011-06-01

We explored factors associated with traditional maternity/herbal homes (TMHs) run by traditional birth attendants (TBAs) compared with hospital or home delivery in Lagos, Nigeria, and found that infants delivered at TMHs were less likely to have severe hyperbilirubinemia compared with infants delivered in hospitals or residential homes. These infants were also less likely to be preterm compared with those delivered in hospitals or undernourished compared with infants delivered in residential homes. We concluded that infants delivered at TMHs who survive are unlikely to be at greater risks of some adverse perinatal outcomes than those delivered in hospitals or family homes.

Does model performance improve with complexity? A case study with three hydrological models

Science.gov (United States)

Orth, Rene; Staudinger, Maria; Seneviratne, Sonia I.; Seibert, Jan; Zappa, Massimiliano

2015-04-01

In recent decades considerable progress has been made in climate model development. Following the massive increase in computational power, models became more sophisticated. At the same time also simple conceptual models have advanced. In this study we validate and compare three hydrological models of different complexity to investigate whether their performance varies accordingly. For this purpose we use runoff and also soil moisture measurements, which allow a truly independent validation, from several sites across Switzerland. The models are calibrated in similar ways with the same runoff data. Our results show that the more complex models HBV and PREVAH outperform the simple water balance model (SWBM) in case of runoff but not for soil moisture. Furthermore the most sophisticated PREVAH model shows an added value compared to the HBV model only in case of soil moisture. Focusing on extreme events we find generally improved performance of the SWBM during drought conditions and degraded agreement with observations during wet extremes. For the more complex models we find the opposite behavior, probably because they were primarily developed for prediction of runoff extremes. As expected given their complexity, HBV and PREVAH have more problems with over-fitting. All models show a tendency towards better performance in lower altitudes as opposed to (pre-) alpine sites. The results vary considerably across the investigated sites. In contrast, the different metrics we consider to estimate the agreement between models and observations lead to similar conclusions, indicating that the performance of the considered models is similar at different time scales as well as for anomalies and long-term means. We conclude that added complexity does not necessarily lead to improved performance of hydrological models, and that performance can vary greatly depending on the considered hydrological variable (e.g. runoff vs. soil moisture) or hydrological conditions (floods vs. droughts).

Can radiographers be trained to deliver an intervention to raise breast cancer awareness, and thereby promote early presentation of breast cancer, in older women?

International Nuclear Information System (INIS)

Omar, L.; Burgess, C.C.; Tucker, L.D.; Whelehan, P.; Ramirez, A.J.

2010-01-01

Aims: To assess the feasibility of training radiographers to deliver a one-to-one intervention to raise breast cancer awareness among older women. The ultimate aim is to increase the likelihood of early presentation of breast cancer by older women and improve survival from the disease. Method: Four radiographers were trained to deliver a 10-min scripted one-to-one intervention. Key elements of training included rehearsal of the intervention using role-play with actors and colleagues and practice interviews with women attending NHS breast screening clinics. All practice interventions were videotaped to facilitate positive, constructive feedback on performance. Competence to deliver the intervention was assessed on delivery of the key messages and the style of delivery. Radiographers' experiences of training and intervention delivery were collated from reflective diaries. Results: Three radiographers were assessed as competent after training and all four increased in confidence to deliver the intervention. Reported benefits to radiographers included increased awareness of communication skills and enhanced interaction with women attending breast screening. Radiographers reported challenges relating to mastering the prescriptive nature of the intervention and to delivering complex health messages within time constraints. Discussion: It was feasible but challenging for radiographers to be trained to deliver a one-to-one intervention designed to raise breast cancer awareness and thereby to promote early presentation of breast cancer. If the intervention is found to be cost-effective it may be implemented across the NHS Breast Screening Programme with diagnostic radiographers playing a key role in promoting early presentation of breast cancer.

Factors affecting the intention of providers to deliver more effective continuing medical education to general practitioners: a pilot study

Directory of Open Access Journals (Sweden)

Higginbotham Nick

2003-12-01

Full Text Available Abstract Background Despite the importance of continuing medical education (CME for GPs, there has been little research into how providers decide what types of CME to deliver to GPs. This study aimed to identify factors affecting the intention of providers to provide more effective types of CME; and to design a survey instrument which can be used to test the applicability of Triandis' model of social behaviour to the provision of CME to general practitioners. Methods This was a cross-sectional study on a convenience sample of 11 Australian providers of CME for interviews and a random sample of 25 providers for the pilot test. Open-ended interviews structured on Triandis' theory were performed with key informants who provide CME to GPs. These were used to develop a pilot survey instrument to measure the factors affecting intention, resulting in a revised instrument for use in further research. Results There was a broad range of factors affecting providers' intention to deliver more effective forms of CME identified, and these were classifiable in a manner which was consistent with Triandis' model. Key factors affecting providers' intention were the attitude toward CME within organisations and the time and extra work involved. Conclusions We identified a range of potential factors influencing the intention of providers to provide more effective forms of CME, in all categories of Triandis model. Those interested in increasing the choice of more effective CME activities available to GPs may need to broaden the methods used in working with providers to influence them to use more effective CME techniques. The interview material and questionnaire analysis of the pilot survey support the use of Triandis model. Further research is needed to validate Triandis'model for the intention to deliver more effective forms of CME. Such research will inform future strategies aimed at increasing the amount and choice of effective CME activities available for GPs.

Improving deep convolutional neural networks with mixed maxout units.

Directory of Open Access Journals (Sweden)

Hui-Zhen Zhao

Full Text Available Motivated by insights from the maxout-units-based deep Convolutional Neural Network (CNN that "non-maximal features are unable to deliver" and "feature mapping subspace pooling is insufficient," we present a novel mixed variant of the recently introduced maxout unit called a mixout unit. Specifically, we do so by calculating the exponential probabilities of feature mappings gained by applying different convolutional transformations over the same input and then calculating the expected values according to their exponential probabilities. Moreover, we introduce the Bernoulli distribution to balance the maximum values with the expected values of the feature mappings subspace. Finally, we design a simple model to verify the pooling ability of mixout units and a Mixout-units-based Network-in-Network (NiN model to analyze the feature learning ability of the mixout models. We argue that our proposed units improve the pooling ability and that mixout models can achieve better feature learning and classification performance.

An Improved Inventory Control Model for the Brazilian Navy Supply System

Science.gov (United States)

2001-12-01

Portuguese Centro de Controle de Inventario da Marinha, the Brazilian Navy Inventory Control Point (ICP) developed an empirical model called SPAADA...NAVAL POSTGRADUATE SCHOOL Monterey, California THESIS Approved for public release; distribution is unlimited AN IMPROVED INVENTORY CONTROL ...AN IMPROVED INVENTORY CONTROL MODEL FOR THE BRAZILIAN NAVY SUPPLY SYSTEM Contract Number Grant Number Program Element Number Author(s) Moreira

How can model comparison help improving species distribution models?

Directory of Open Access Journals (Sweden)

Emmanuel Stephan Gritti

Full Text Available Today, more than ever, robust projections of potential species range shifts are needed to anticipate and mitigate the impacts of climate change on biodiversity and ecosystem services. Such projections are so far provided almost exclusively by correlative species distribution models (correlative SDMs. However, concerns regarding the reliability of their predictive power are growing and several authors call for the development of process-based SDMs. Still, each of these methods presents strengths and weakness which have to be estimated if they are to be reliably used by decision makers. In this study we compare projections of three different SDMs (STASH, LPJ and PHENOFIT that lie in the continuum between correlative models and process-based models for the current distribution of three major European tree species, Fagussylvatica L., Quercusrobur L. and Pinussylvestris L. We compare the consistency of the model simulations using an innovative comparison map profile method, integrating local and multi-scale comparisons. The three models simulate relatively accurately the current distribution of the three species. The process-based model performs almost as well as the correlative model, although parameters of the former are not fitted to the observed species distributions. According to our simulations, species range limits are triggered, at the European scale, by establishment and survival through processes primarily related to phenology and resistance to abiotic stress rather than to growth efficiency. The accuracy of projections of the hybrid and process-based model could however be improved by integrating a more realistic representation of the species resistance to water stress for instance, advocating for pursuing efforts to understand and formulate explicitly the impact of climatic conditions and variations on these processes.

An improved active contour model for glacial lake extraction

Science.gov (United States)

Zhao, H.; Chen, F.; Zhang, M.

2017-12-01

Active contour model is a widely used method in visual tracking and image segmentation. Under the driven of objective function, the initial curve defined in active contour model will evolve to a stable condition - a desired result in given image. As a typical region-based active contour model, C-V model has a good effect on weak boundaries detection and anti noise ability which shows great potential in glacial lake extraction. Glacial lake is a sensitive indicator for reflecting global climate change, therefore accurate delineate glacial lake boundaries is essential to evaluate hydrologic environment and living environment. However, the current method in glacial lake extraction mainly contains water index method and recognition classification method are diffcult to directly applied in large scale glacial lake extraction due to the diversity of glacial lakes and masses impacted factors in the image, such as image noise, shadows, snow and ice, etc. Regarding the abovementioned advantanges of C-V model and diffcults in glacial lake extraction, we introduce the signed pressure force function to improve the C-V model for adapting to processing of glacial lake extraction. To inspect the effect of glacial lake extraction results, three typical glacial lake development sites were selected, include Altai mountains, Centre Himalayas, South-eastern Tibet, and Landsat8 OLI imagery was conducted as experiment data source, Google earth imagery as reference data for varifying the results. The experiment consequence suggests that improved active contour model we proposed can effectively discriminate the glacial lakes from complex backgound with a higher Kappa Coefficient - 0.895, especially in some small glacial lakes which belongs to weak information in the image. Our finding provide a new approach to improved accuracy under the condition of large proportion of small glacial lakes and the possibility for automated glacial lake mapping in large-scale area.

Improving Baseline Model Assumptions: Evaluating the Impacts of Typical Methodological Approaches in Watershed Models

Science.gov (United States)

Muenich, R. L.; Kalcic, M. M.; Teshager, A. D.; Long, C. M.; Wang, Y. C.; Scavia, D.

2017-12-01

Thanks to the availability of open-source software, online tutorials, and advanced software capabilities, watershed modeling has expanded its user-base and applications significantly in the past thirty years. Even complicated models like the Soil and Water Assessment Tool (SWAT) are being used and documented in hundreds of peer-reviewed publications each year, and likely more applied in practice. These models can help improve our understanding of present, past, and future conditions, or analyze important "what-if" management scenarios. However, baseline data and methods are often adopted and applied without rigorous testing. In multiple collaborative projects, we have evaluated the influence of some of these common approaches on model results. Specifically, we examined impacts of baseline data and assumptions involved in manure application, combined sewer overflows, and climate data incorporation across multiple watersheds in the Western Lake Erie Basin. In these efforts, we seek to understand the impact of using typical modeling data and assumptions, versus using improved data and enhanced assumptions on model outcomes and thus ultimately, study conclusions. We provide guidance for modelers as they adopt and apply data and models for their specific study region. While it is difficult to quantitatively assess the full uncertainty surrounding model input data and assumptions, recognizing the impacts of model input choices is important when considering actions at the both the field and watershed scales.